Manufacturing process for making t cells expressing chimeric antigen receptors

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application No. 62/934,991, filed Nov. 13, 2019, which is hereby incorporated by reference in its entirety.

[0002] The application contains a Sequence Listing that has been filed electronically in the form of a text file, created Nov. 13, 2020, and named “095136-0145-002US1_SEQ.TXT” (80,786 bytes), the contents of which are incorporated by reference herein in their entirety.

[0003] Chimeric antigen receptor (CAR) T-cell therapy has shown promising therapeutic effects in treating hematologic cancer. Typically, CAR-T cells are generated by genetic engineering of either patient immune cells (autologous) or immune cells from unrelated human donors (allogenic). Production of high-quality, clinical grade CAR-T cells is a prerequisite for the wide application of this technology. It is therefore of great interest to develop efficient manufacturing processes for large-scale production of CAR-T cells.

[0004] The present disclosure is based, at least in part, on the development of methods for manufacturing genetically engineered T cells expressing a chimeric antigen receptor (CAR) that provide several improvements over conventional manufacturing methods. Such improvements include, but are not limited to, improvements in consistency and efficiency of genetic modifications described herein, which allows production of a robust supply of clinically useful CAR T-cell therapies.

[0005] Accordingly, one aspect of the present disclosure provides a method for manufacturing genetically engineered T cells, the method comprising: (i) providing a first population of T cells; (ii) incubating the first population of T cells in the presence of a T cell activating agent in a cell culture vessel to produce a second population of T cells, wherein the second population of T cells comprises activated T cells; (iii) introducing into the activated T cells a first ribonucleoprotein (RNP) complex comprising a first Cas9 enzyme and a first guide RNA (gRNA) targeting a T cell receptor alpha chain constant region (TRAC) gene, and a second RNP complex comprising a second Cas9 enzyme and a second gRNA targeting a β2M gene to produce a third population of T cells, wherein the third population of T cells comprises T cells having the TRAC gene disrupted and the β2M gene disrupted; (iv) incubating the third population of T cells with an adeno-associated viral (AAV) vector to produce a fourth population of T cells, wherein the fourth population of T cells comprises T cells expressing a chimeric antigen receptor (CAR), wherein the AAV vector comprises a nucleic acid sequence encoding the CAR, and wherein the CAR-encoding nucleic acid sequence is flanked by homologous sequences to the TRAC gene locus targeted by the first gRNA; (v) expanding the fourth population of T cells; (vi) removing TCRαβ⁺ T cells from the expanded T cells to produce a population of genetically engineered T cells, wherein the population of genetically engineered T cells comprises T cells expressing the CAR and having the TRAC gene and the β2M gene disrupted; and (vii) harvesting the population of genetically engineered T cells.

[0006] In some embodiments, the first population of T cells is derived from cryopreserved T cells enriched from human blood cells. In some embodiments, the first population of T cells is prepared by a process comprising: (a) obtaining blood cells from a human donor; and (b) enriching CD4⁺ T cells and CD8⁺ T cells. In some embodiments, (b) is performed using magnetic beads conjugated with anti-CD4 and/or anti-CD8 antibodies. In some embodiments, the first population of T cells has a cell viability of at least 80% and/or a purity of at least 80% of CD4⁺ and CD8⁺ T cells. In some embodiments, methods further comprise (c) cryopreserving the enriched CD4⁺ T cells and CD8⁺ T cells produced in step (b).

[0007] In some embodiments, the T cell activating agent comprises a CD3 agonist and a CD28 agonist attached to a nanomatrix particle. In some embodiments, step (ii) is performed by mixing the first population of T cells with the T cell activating agent in the cell culture vessel at a cell seeding density of about 2×10⁶/cm² and a cell concentration of about 2×10⁶ cells/mL; and incubating the mixture thus formed for about 48 hours. In some embodiments, the ratio of the T cell activating agent to medium in the mixture is about 1:12.5 (v/v).

[0008] In some embodiments, a method disclosed herein may further comprise diluting the T cell activating agent in the second population of T cells after step (ii) to reduce activation and to allow cells to recover before step (iii).

[0009] In some embodiments, step (iii) is performed by electroporation. In some embodiments, step (iii) involves one electroporation event. In some embodiments, the first RNP complex and the second RNP complex are introduced into the activated T cells in the one electroporation event. In some embodiments, the amount of the first Cas9 enzyme in the first RNP complex is the same as the amount of the second Cas9 enzyme in the second RNA complex. In some embodiments, the concentration of the first Cas9 enzyme is about 0.15 mg/mL, the concentration of the second Cas9 enzyme is about 0.15 mg/mL, the concentration of the first gRNA targeting the TRAC gene is about 0.08 mg/mL, and the concentration of the second gRNA targeting the β2M gene is about 0.2 mg/mL. In some embodiments, the cell concentration in step (iii) is about 100×10⁶ cells/mL to about 400×10⁶ cells/mL. In some embodiments, the cell concentration in step (iii) is about 300×10⁶ cells/mL. In other embodiments, the total cell number in each vessel used in step (iii) (e.g., electroporation) can be about 5×10⁸ to about 1×10⁹ cells, for example, about 7×10⁸ cells. In some examples, multiple vessels may be used in step (iii) (e.g., electroporation), for example, about 5-10 vessels. In specific examples, as many as 7 vessels may be used in step (iii), which may contain about 1.5×10⁹ to about 3×10⁹ cells (e.g., about 2.1×10⁹ cells or about 2.7×10⁹ cells), e.g., for electroporation.

[0010] In some embodiments, the AAV vector has a multiplicity of infection (MOI) value of about 10,000 to about 80,000. In some embodiments, the MOI of the AAV vector is about 20,000. In some embodiments, the AAV vector is AAV serotype 6 (AAV6) vector.

[0011] In some embodiments, step (v) is performed by seeding the fourth population of T cells in a cell culture vessel at a seeding density of about 2×10⁵ cells/cm² to about 7×10⁵ cells/cm², and culturing the cells for about 6 days to about 12 days. In some embodiments, the fourth population of T cells may be seeded in a cell culture vessel at a seeding density of about 150,000 cells/cm² to about 600,000 cells/cm². In some embodiments, step (v) is performed by culturing the fourth population of T cells in a cell culture vessel at a seeding density of about 2×10⁵ cells/cm² to about 5×10⁵ cells/cm² for about 7 days to about 9 days. In some embodiments, step (v) is performed by seeding the fourth population of T cells in a cell culture vessel at a seeding density of about 3×10⁵ cells/cm² to about 5×10⁵ cells/cm². In some embodiments, the cell culture vessel is a static cell culture vessel (also referred interchangeably herein as a static culture vessel) allowing for cell expansion for about 10 days to about 12 days without medium change. In some embodiments, the cell culture vessel is a static cell culture vessel allowing for cell expansion for about 7 days to about 9 days without medium change. In some embodiments, step (vi) is performed by contacting the expanded cells to beads on which anti-TCRαβ antibodies are immobilized, and collecting unbound cells.

[0012] In some embodiments, the first Cas9 enzyme, the second Cas9 enzyme, or both are Streptococcus pyogenes Cas9 nuclease (spCas9). In some embodiments, the first Cas9 enzyme and the second Cas9 enzyme are the same. In some embodiments, the first Cas9 enzyme comprises the amino acid sequence of SEQ ID NO: 1, and/or wherein the second Cas9 enzyme comprises the amino acid sequence of SEQ ID NO: 1. In some embodiments, the first gRNA targeting the TRAC gene comprises a spacer sequence of SEQ ID NO: 4. In some embodiments, the first gRNA targeting the TRAC gene comprises the nucleotide sequence of SEQ ID NO: 2. In some embodiments, the second gRNA targeting the β2M gene comprises a spacer sequence of SEQ ID NO: 8. In some embodiments, the second gRNA targeting the β2M gene comprises the nucleotide sequence of SEQ ID NO: 6. In some embodiments, the first gRNA, the second gRNA, or both comprise one or more 2′-O-methyl phosphorothioate modification.

[0013] In some embodiments, the CAR comprises an extracellular domain targeting a cancer antigen, a transmembrane domain, a co-stimulatory domain, and a CD3z cytoplasmic signaling domain. In some embodiments, the extracellular domain comprises a single-chain variable fragment (scFv), the transmembrane domain is derived from CD8a, and/or the co-stimulatory domain is derived from CD28 and/or 4-1BB. In some embodiments, the CAR binds CD19. In some embodiments, the CAR comprises the amino acid sequence of SEQ ID NO: 37. In some embodiments, the CAR binds BCMA. In some embodiments, the CAR comprises the amino acid sequence of SEQ ID NO: 61.

[0014] Aspects of the present disclosure provide a genetically engineered T cell population, which is produced by a method described herein.

[0015] The details of one or more embodiments of the invention are set forth in the description below. Other features or advantages of the present invention will be apparent from the following drawings and detailed description of several embodiments, and also from the appended claims.

[0042] The present disclosure is based, at least in part, on the development of improved manufacturing processes for producing CAR-T cells, particularly allogenic CAR-T cells, including improved conditions for one or more steps of the manufacturing processes. The improved manufacturing processes disclosed herein led to at least the following advantageous outcomes:

• • [0043] (a) Improved T cell purity and improved T cell viability resulting from the improved T cell enrichment conditions provided herein.
  • [0044] (b) Improved consistency and improved efficiency for producing CAR-expressing T cells resulting from the improved T cell transduction conditions provided herein.
  • [0045] (c) Improved consistency and improved efficiency of TRAC gene and β2M gene disruptions in T cells resulting from the improved CRISPR-Cas9-mediated gene editing conditions provided herein.
  • [0046] (d) Increased supply of CAR T-cell therapy resulting from decreased production times and decreased production costs provided by the improved manufacturing processes described herein.
  • [0047] (e) Reduced variability of manufactured drug product resulting from production of uniform and high quality CAR T-therapies using the improved manufacturing processes described herein.
  • [0048] (f) Simplified AAV transduction condition while maintaining high CAR expression level in T cells.

[0049] Accordingly, provided herein are methods for manufacturing genetically engineered T cells expressing a CAR construct, such as a CAR construct targeting a cancer antigen, for example, CD19 or BCMA, and having TRAC and β2M gene knocked-out. The genetically engineered T cell populations produced by methods described herein, and therapeutic uses thereof are also within the scope of the present disclosure.

I. Manufacturing Genetically Engineered T Cells

[0050] Aspects of the present disclosure provide methods for manufacturing genetically engineered T cells comprising a disrupted beta-2-microglobulin (β2M) gene, and a disrupted T cell receptor alpha chain constant region (TRAC) gene, and an inserted nucleic acid encoding a chimeric antigen receptor (CAR).

[0051] Disruption of the β2M gene and the TRAC gene renders the genetically engineered T cell non-alloreactive and suitable for allogeneic transplantation. Insertion of a nucleic acid encoding a CAR enables the genetically engineered T cell to express the CAR on its surface where it targets the genetically engineered T cell to cancer cells.

[0052] Accordingly, methods for manufacturing genetically engineered T cells disclosed herein, in some embodiments, involve the use of CRISPR-Cas9 gene editing to disrupt expression of TRAC and β2M, and the use of adeno-associated virus (AAV) transduction to insert a nucleic acid encoding a CAR.

[0053] In general, the method for manufacturing CAR-T cells disclosed herein may comprise: (i) enriching CD4⁺/CD8⁺ T cells from a suitable human immune cell source, (ii) activating the enriched CD4⁺/CD8⁺ T cells, and (iii) genetically engineering the activated T cells to produce CAR-T cells having disrupted TRAC and B2M genes; and harvesting the genetically engineered T cells for therapeutic uses. When needed, the enriched CD4⁺/CD8⁺ T cells may be stored via cryopreservation for future use. Alternatively or in addition, the genetically engineered T cells may be expanded in vitro prior to harvesting. TCRαβ⁺ T cells may be depleted from the CAR-T cell population thus produced.

(i) T Cell Enrichment

[0054] Any of the manufacturing methods disclosed herein may use human blood cells as the starting material. For example, T cells can be obtained from a unit of blood collected from a subject using techniques known to a skilled person, such as sedimentation, e.g., FICOLL™ separation. Alternatively, the T cells for use in making the genetically engineered T cells may be derived from stem cells (e.g., HSCs or iPSCs) via in vitro differentiation. In some embodiments, blood cells can be obtained from an individual human donor. In other embodiments, blood cells can be obtained from multiple human donors (e.g., 2, 3, 4, or 5 human donors).

[0055] In some examples, leukopak samples from a suitable human donor may be used. As known in the art, a leukopak sample is an enriched leukapheresis product collected from peripheral blood. It typically contains a variety of blood cells including monocytes, lymphocytes, platelets, plasma, and red cells. The human donor preferably is a healthy human donor. For example, a human donor candidate may be subject to screening for HBV, HCV, HIV, HTLV, WNV, Trypanosoma cruzi, and/or CMV. A human subject showing negative results in the screening may be used as a donor for blood cells.

[0056] The sources of T-cells that find use in the present methods is not particularly limited. In some embodiments, T cells from a T cell bank can be used as the starting material in any of the manufacturing methods disclosed herein. A T cell bank may comprise T cells with genetic editing of certain genes (e.g., genes involved in cell self renewal, apoptosis, and/or T cell exhaustion or replicative senescence) to improve T cell persistence in cell culture. A T cell bank may be produced from bonafide T cells, for example, non-transformed T cells, terminally differentiated T cells, T cells having stable genome, and/or T cells that depend on cytokines and growth factors for proliferation and expansion. Alternatively, such a T cell bank may be produced from precursor cells such as hematopoietic stem cells (e.g., iPSCs), e.g., in vitro culture. In some examples, the T cells in the T cell bank may comprise genetic editing of one or more genes involved in cell self-renewal, one or more genes involved in apoptosis, and/or one or more genes involved in T cell exhaustion, so as to disrupt or reduce expression of such genes, leading to improved persistence in culture. Examples of the edited genes in a T cell bank include, but are not limited to, Tet2, Fas, CD70, Regnase-1, or a combination thereof. Compared with the non-edited T counterpart, T cells in a T cell bank may have enhanced expansion capacity in culture, enhanced proliferation capacity, greater T cell activation, and/or reduced apoptosis levels.

[0057] Suitable T cells can be enriched from human blood cells using conventional methods or methods disclosed herein. T cells for use in making the genetically engineered T cells may express one or more of the T cell markers, including, but not limited to a CD4⁺, CD8⁺, or a combination thereof. In some embodiments, CD4⁺ T cells can be enriched from human blood cells. In other embodiments, CD8⁺ T cells can be enriched. In specific examples, both CD4⁺ and CD8⁺ T cells are purified from human blood cells.

[0058] CD4⁺ T cells and/or CD8⁺ T cells can be isolated from a suitable blood cell source, such as those described herein, using any method known in the art or those disclosed herein, for example, using antibodies capable of binding to specific cell-surface biomarkers for the target T cells, e.g., antibodies specific to CD4 and/or antibodies specific to CD8. In some embodiments, enriching CD4⁺ T cells and CD8⁺ T cells can be performed using anti-CD4 and anti-CD8 antibodies conjugated to magnetic beads. A cell population comprising CD4⁺ and CD8⁺ T cells can be incubated with such magnetic beads under suitable conditions for a suitable period allowing for binding of the target T cells to the magnetic beads via the antibodies conjugated to the beads. Non-bound cells can be washed and CD4⁺ and CD8⁺ T cells bound to the beads can be collected using routine methods.

[0059] The enriched T cells (e.g., CD4⁺ T cells and CD8⁺ T cells) may be evaluated for features such as cell viability and/or purity of the target T cells following routine practice. In some embodiments, the T cell population from the enrichment step disclosed here may have a cell viability of at least about 80% (e.g., at least about 85%, at least about 90%, at least about 95%, or above). Alternatively or in addition to, the enriched T cell population may have a purity of at least about 80% of the target T cells (e.g., CD4⁺ and/or CD8⁺ T cells), for example, at least about 85%, at least about 90%, at least about 95%, at least about 97%, about 98% or higher. Alternatively or in addition to, the enriched T cell population may have a purity of at least about 70% of the target T cells (e.g., CD4⁺ and/or CD8⁺ T cells), for example, at least about 75%, at least about 80%, at least about 85%, at least about 90%, at least about 95%, at least about 97%, about 98% or higher.

[0060] The term “about” or “approximately” means within an acceptable error range for the particular value as determined by one of ordinary skill in the art, which will depend in part on how the value is measured or determined, i.e., the limitations of the measurement system. For example, “about” can mean within an acceptable standard deviation, per the practice in the art. Alternatively, “about” can mean a range of up to ±20%, preferably up to ±10%, more preferably up to ±5%, and more preferably still up to ±1% of a given value. Alternatively, particularly with respect to biological systems or processes, the term can mean within an order of magnitude, preferably within 2-fold, of a value. Where particular values are described in the application and claims, unless otherwise stated, the term “about” is implicit and in this context means within an acceptable error range for the particular value.

[0061] The enriched T cell population (which is also within the scope of the present disclosure) may be used immediately for further processing as disclosed herein. Alternatively, the enriched T cell population may be stored under suitable conditions for future use, for example, via cryopreservation. Prior to further processing, cryopreserved T cells can be thawed following routine procedures. Cell viability of the thawed cells can be assessed to determine whether the thawed cells are suitable for further processing.

(ii) T Cell Activation

[0062] The enriched T cells may be subject to T cell activation to allow for proliferation and expansion of the enriched CD4⁺/CD8⁺ T cells. The T cell activation step used in any of the methods disclosed herein may involve T cell activation conditions disclosed herein that provide high T cell activation efficiency. Further, the activated T cells obtained therefrom would exhibit high gene editing efficiencies and great rates of T cell expansion post editing. See Examples below.

[0063] In some embodiments, T cell activation can be achieved using a T cell activating agent or agents, for example, agents that stimulates a CD3/TCR-mediated signaling pathway and/or a co-stimulatory molecule (e.g., CD28) mediated signaling pathway. For example, a T cell activating agent may be a CD3 agonist (e.g., an agonistic anti-CD3 antibody) and activates the CD3/TCR-mediated cell signaling pathway. Alternatively or in addition, a T cell activating agent may be a CD28 agonist (e.g., an anti-CD28 antibody) and activate the co-stimulatory signaling pathway mediated by CD28. Any of the T cell activating agents for use in the method disclosed herein may be conjugated to a support member, such as a nanomatrix particle. In specific examples, the T cell activating agent for use in the method disclosed herein may comprise an anti-CD3 antibody and an anti-CD28 antibody, which may be conjugated to nanomatrix particles. In some embodiments, the T cell activating agent comprises a CD3 agonist and a CD28 agonist attached to a nanomatrix particle. In some embodiments, the CD3 agonist and a CD28 agonist are attached to the same nanomatrix particle. In some embodiments, the CD3 agonist and a CD28 agonist are attached to different nanomatrix particles.

[0064] To achieve T cell activation, the enriched T cells as disclosed herein (e.g., CD4⁺/CD8⁺ T cells) may be placed in a cell culture vessel at a suitable cell seeding density and a suitable cell concentration and incubated in the presence of any of the T cell activating agents disclosed herein for a suitable period to induce T cell activation.

[0065] In some instances, ratios of the T cell activating agent to the cell culture medium in the cell culture vessel may range from about 1:10 (v/v) to about 1:15 (v/v). In some examples, the ratio of the T cell activating agent to the cell culture medium in the cell culture vessel may be about 1:10 (v/v), about 1:10.5 (v/v), about 1:11 (v/v), about 1:11.5 (v/v), about 1:12 (v/v), about 1:12.5 (v/v), about 1:13 (v/v), about 1:13.5 (v/v), about 1:14 (v/v), about 1:14.5 (v/v), or about 1:15 (v/v). In specific examples, the ratio of the T cell activating agent to the culture medium in the cell culture vessel is about 1:12.5 (v/v).

[0066] Alternatively or in addition, a suitable cell seeding density may be about 1.5×10⁶ to 2.5×10⁶ (e.g., 2×10⁶/cm²) and a suitable cell concentration may be about 1.5×10⁶ to 2.5×10⁶ (e.g., 2×10⁶/ml). The cells may be incubated with the T cell activating agent for about 42-54 hours, for example, about 48 hours.

[0067] In some embodiments, the cell culture vessel may be a static culture vessel, which would allow for relatively large-scale production of the genetically engineered T cells as disclosed herein. Compared to conventional cell culture flasks, static cell culture vessels allow T cells to reside on a highly gas permeable membrane submerged under medium that supplies oxygen and nutrients to the T cells without mixing or shaking. Static culture vessels allow T cell manufacturing without medium change. Accordingly, in some embodiments, the T cell activation process in any of the methods disclosed herein may involve no medium change.

[0068] When needed, the activating agent may be removed from the cell culture vessel or diluted prior to the follow-on gene editing events to minimize any potential impact that the activating agent may confer during gene editing. In some embodiments, the activating agent can be removed from the cell culture vessel using routine methods, e.g., centrifugation. Alternatively, the activating agent may be diluted in the cell culture vessel prior to gene editing, e.g., diluted by addition of media to the cell culture vessel.

[0069] In some embodiments, the activated T cells derived from any of the T cell activation processes disclosed herein may be cultured overnight (e.g., about 16 hours) to allow T cells to recover prior to gene editing. In some instances, the activated T cell culture may still contain the T activating agent. In other instances, the activated T cells may have little or no presence of the T cell activating agent.

(iii) CRISPR-CAS9-Mediated Gene Editing of Activated T Cells

[0070] The activated T cells prepared by any of the procedures disclosed herein may subject to gene editing to knock out host response related genes, for example, the TRAC gene and/or the β2M gene, via, for example, CRISPR-Cas9 gene editing technology.

[0071] The TRAC gene encodes a component of the TCR complex. Disruption of the TRAC gene leads to loss of function of the TCR and renders the engineered T cell non-alloreactive and suitable for allogeneic transplantation, minimizing the risk of graft versus host disease. The β2M gene encodes a common (invariant) component of the major histocompatibility complex (MHC) I complexes. Disrupting the β2M gene can prevent host versus therapeutic allogeneic T cells responses. Knocking out both the TRAC gene and the β2M gene would result in production of allogeneic T cells for use in cell therapy.

CRISPR-Cas9-Mediated Gene Editing System

[0072] The CRISPR-Cas9 system is a naturally-occurring defense mechanism in prokaryotes that has been repurposed as an RNA-guided DNA-targeting platform used for gene editing. It relies on the DNA nuclease Cas9, and two noncoding RNAs, crisprRNA (crRNA) and trans-activating RNA (tracrRNA), to target the cleavage of DNA. CRISPR is an acronym for Clustered Regularly Interspaced Short Palindromic Repeats, a family of DNA sequences found in the genomes of bacteria and archaea that contain fragments of DNA (spacer DNA) with similarity to foreign DNA previously exposed to the cell, for example, by viruses that have infected or attacked the prokaryote. These fragments of DNA are used by the prokaryote to detect and destroy similar foreign DNA upon re-introduction, for example, from similar viruses during subsequent attacks. Transcription of the CRISPR locus results in the formation of an RNA molecule comprising the spacer sequence, which associates with and targets Cas (CRISPR-associated) proteins able to recognize and cut the foreign, exogenous DNA. Numerous types and classes of CRISPR/Cas systems have been described (see, e.g., Koonin et al., (2017) Curr Opin Microbiol 37:67-78).

[0073] crRNA drives sequence recognition and specificity of the CRISPR-Cas9 complex through Watson-Crick base pairing typically with a 20 nucleotide (nt) sequence in the target DNA. Changing the sequence of the 5′ 20 nt in the crRNA allows targeting of the CRISPR-Cas9 complex to specific loci. The CRISPR-Cas9 complex only binds DNA sequences that contain a sequence match to the first 20 nt of the crRNA, if the target sequence is followed by a specific short DNA motif (with the sequence NGG) referred to as a protospacer adjacent motif (PAM).

[0074] TracrRNA hybridizes with the 3′ end of crRNA to form an RNA-duplex structure that is bound by the Cas9 endonuclease to form the catalytically active CRISPR-Cas9 complex, which can then cleave the target DNA.

[0075] Once the CRISPR-Cas9 complex is bound to DNA at a target site, two independent nuclease domains within the Cas9 enzyme each cleave one of the DNA strands upstream of the PAM site, leaving a double-strand break (DSB) where both strands of the DNA terminate in a base pair (a blunt end).

[0076] After binding of CRISPR-Cas9 complex to DNA at a specific target site and formation of the site-specific DSB, the next key step is repair of the DSB. Cells use two main DNA repair pathways to repair the DSB: non-homologous end joining (NHEJ) and homology-directed repair (HDR).

[0077] NHEJ is a robust repair mechanism that appears highly active in the majority of cell types, including non-dividing cells. NHEJ is error-prone and can often result in the removal or addition of between one and several hundred nucleotides at the site of the DSB, though such modifications are typically <20 nt. The resulting insertions and deletions (indels) can disrupt coding or noncoding regions of genes. Alternatively, HDR uses a long stretch of homologous donor DNA, provided endogenously or exogenously, to repair the DSB with high fidelity. HDR is active only in dividing cells, and occurs at a relatively low frequency in most cell types. In many embodiments of the present disclosure, NHEJ is utilized as the repair operant.

(i) Cas9

[0078] In some embodiments, the Cas9 (CRISPR associated protein 9) endonuclease is used in a CRISPR method for making the genetically engineered T cells as disclosed herein. The Cas9 enzyme may be one from Streptococcus pyogenes, although other Cas9 homologs may also be used. It should be understood that wild-type Cas9 may be used or modified versions of Cas9 may be used (e.g., evolved versions of Cas9, or Cas9 orthologues or variants), as provided herein. In some embodiments, Cas9 comprises a Streptococcus pyogenes-derived Cas9 nuclease protein that has been engineered to include C- and N-terminal SV40 large T antigen nuclear localization sequences (NLS). The resulting Cas9 nuclease (sNLS-spCas9-sNLS) is a 162 kDa protein that is produced by recombinant E. coli fermentation and purified by chromatography. The spCas9 amino acid sequence can be found as UniProt Accession No. Q99ZW2, which is provided herein as SEQ ID NO: 1.

(ii) Guide RNAs (gRNAs)

[0079] CRISPR-Cas9-mediated gene editing as described herein includes the use of a guide RNA or a gRNA. As used herein, a “gRNA” refers to a genome-targeting nucleic acid that can direct the Cas9 to a specific target sequence within a TRAC gene or a β2M gene for gene editing at the specific target sequence. A guide RNA comprises at least a spacer sequence that hybridizes to a target nucleic acid sequence within a target gene for editing, and a CRISPR repeat sequence.

[0080] An exemplary gRNA targeting a TRAC gene is provided in SEQ ID NO: 2. See also International Application No. PCT/IB2018/001619, filed May 11, 2018, which published as WO 2019/097305A2, the relevant disclosures of which are incorporated by reference herein for the subject matter and purpose referenced herein. Other gRNA sequences may be designed using the TRAC gene sequence located on chromosome 14 (GRCh38: chromosome 14: 22,547,506-22,552,154; Ensembl; ENSG00000277734). In some embodiments, gRNAs targeting the TRAC genomic region and Cas9 create breaks in the TRAC genomic region resulting Indels in the TRAC gene disrupting expression of the mRNA or protein.

[0081] In some embodiments, gRNAs targeting the TRAC genomic region create Indels in the TRAC gene comprising at least one nucleotide sequence selected from the sequences in Table 9. In some embodiments, gRNA (SEQ ID NO: 2) targeting the TRAC genomic region create Indels in the TRAC gene comprising at least one nucleotide sequence selected from the sequences in Table 9.

[0082] An exemplary gRNA targeting a β2M gene is provided in SEQ ID NO: 6. See also International Application No. PCT/IB2018/001619, filed May 11, 2018, which published as WO 2019/097305A2, the relevant disclosures of which are incorporated by reference herein for the subject matter and purpose referenced herein. Other gRNA sequences may be designed using the β2M gene sequence located on Chromosome 15 (GRCh38 coordinates: Chromosome 15: 44,711,477-44,718,877; Ensembl: ENSG00000166710). In some embodiments, gRNAs targeting the β2M genomic region and RNA-guided nuclease create breaks in the β2M genomic region resulting in Indels in the β2M gene disrupting expression of the mRNA or protein.

[0083] In some embodiments, gRNAs targeting the β2M genomic region create Indels in the β2M gene comprising at least one nucleotide sequence selected from the sequences in Table 10. In some embodiments, gRNA (SEQ ID NO: 6) targeting the β2M genomic region create Indels in the β2M gene comprising at least one nucleotide sequence selected from the sequences in Table 10.

[0084] In Type II systems, the gRNA also comprises a second RNA called the tracrRNA sequence. In the Type II gRNA, the CRISPR repeat sequence and tracrRNA sequence hybridize to each other to form a duplex. In the Type V gRNA, the crRNA forms a duplex. In both systems, the duplex binds a site-directed polypeptide, such that the guide RNA and site-direct polypeptide form a complex. In some embodiments, the genome-targeting nucleic acid provides target specificity to the complex by virtue of its association with the site-directed polypeptide. The genome-targeting nucleic acid thus directs the activity of the site-directed polypeptide.

[0085] As is understood by the person of ordinary skill in the art, each guide RNA is designed to include a spacer sequence complementary to its genomic target sequence. See Jinek et al., Science, 337, 816-821 (2012) and Deltcheva et al., Nature, 471, 602-607 (2011).

[0086] In some embodiments, the genome-targeting nucleic acid (e.g., gRNA) is a double-molecule guide RNA. In some embodiments, the genome-targeting nucleic acid (e.g., gRNA) is a single-molecule guide RNA.

[0087] A double-molecule guide RNA comprises two strands of RNA molecules. The first strand comprises in the 5′ to 3′ direction, an optional spacer extension sequence, a spacer sequence and a minimum CRISPR repeat sequence. The second strand comprises a minimum tracrRNA sequence (complementary to the minimum CRISPR repeat sequence), a 3′ tracrRNA sequence and an optional tracrRNA extension sequence.

[0088] A single-molecule guide RNA (referred to as a “sgRNA”) in a Type II system comprises, in the 5′ to 3′ direction, an optional spacer extension sequence, a spacer sequence, a minimum CRISPR repeat sequence, a single-molecule guide linker, a minimum tracrRNA sequence, a 3′ tracrRNA sequence and an optional tracrRNA extension sequence. The optional tracrRNA extension may comprise elements that contribute additional functionality (e.g., stability) to the guide RNA. The single-molecule guide linker links the minimum CRISPR repeat and the minimum tracrRNA sequence to form a hairpin structure. The optional tracrRNA extension comprises one or more hairpins. A single-molecule guide RNA in a Type V system comprises, in the 5′ to 3′ direction, a minimum CRISPR repeat sequence and a spacer sequence.

[0089] The “target sequence” is in a target gene that is adjacent to a PAM sequence and is the sequence to be modified by Cas9. The “target sequence” is on the so-called PAM-strand in a “target nucleic acid,” which is a double-stranded molecule containing the PAM-strand and a complementary non-PAM strand. One of skill in the art recognizes that the gRNA spacer sequence hybridizes to the complementary sequence located in the non-PAM strand of the target nucleic acid of interest. Thus, the gRNA spacer sequence is the RNA equivalent of the target sequence.

[0090] For example, if the TRAC target sequence is 5′-AGAGCAACAGTGCTGTGGCC-3′ (SEQ ID NO: 11), then the gRNA spacer sequence is 5′-AGAGCAACAGUGCUGUGGCC-3′ (SEQ ID NO: 5). In another example, if the β2M target sequence is 5′-GCTACTCTCTCTTTCTGGCC-3′ (SEQ ID NO: 13), then the gRNA spacer sequence is 5′-GCUACUCUCUCUUUCUGGCC-3′ (SEQ ID NO: 9). The spacer of a gRNA interacts with a target nucleic acid of interest in a sequence-specific manner via hybridization (i.e., base pairing). The nucleotide sequence of the spacer thus varies depending on the target sequence of the target nucleic acid of interest.

[0091] In a CRISPR/Cas system herein, the spacer sequence is designed to hybridize to a region of the target nucleic acid that is located 5′ of a PAM recognizable by a Cas9 enzyme used in the system. The spacer may perfectly match the target sequence or may have mismatches. Each Cas9 enzyme has a particular PAM sequence that it recognizes in a target DNA. For example, S. pyogenes recognizes in a target nucleic acid a PAM that comprises the sequence 5′-NRG-3′, where R comprises either A or G, where N is any nucleotide and N is immediately 3′ of the target nucleic acid sequence targeted by the spacer sequence.

[0092] In some embodiments, the target nucleic acid sequence has 20 nucleotides in length. In some embodiments, the target nucleic acid has less than 20 nucleotides in length. In some embodiments, the target nucleic acid has more than 20 nucleotides in length. In some embodiments, the target nucleic acid has at least: 5, 10, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 30 or more nucleotides in length. In some embodiments, the target nucleic acid has at most: 5, 10, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 30 or more nucleotides in length. In some embodiments, the target nucleic acid sequence has 20 bases immediately 5′ of the first nucleotide of the PAM. For example, in a sequence comprising 5′-NNNNNNNNNNNNNNNNNNNNNRG-3′, the target nucleic acid can be the sequence that corresponds to the Ns, wherein N can be any nucleotide, and the underlined NRG sequence is the S. pyogenes PAM.

[0093] A spacer sequence in a gRNA is a sequence (e.g., a 20 nucleotide sequence) that defines the target sequence (e.g., a DNA target sequences, such as a genomic target sequence) of a target gene of interest. An exemplary spacer sequence of a gRNA targeting a TRAC gene is provided in SEQ ID NO: 4. An exemplary spacer sequence of a gRNA targeting a β2M gene is provided in SEQ ID NO:8.

[0094] The guide RNA disclosed herein may target any sequence of interest via the spacer sequence in the crRNA. In some embodiments, the degree of complementarity between the spacer sequence of the guide RNA and the target sequence in the target gene can be about 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 97%, 98%, 99%, or 100%. In some embodiments, the spacer sequence of the guide RNA and the target sequence in the target gene is 100% complementary. In other embodiments, the spacer sequence of the guide RNA and the target sequence in the target gene may contain up to 10 mismatches, e.g., up to 9, up to 8, up to 7, up to 6, up to 5, up to 4, up to 3, up to 2, or up to 1 mismatch.

[0095] Non-limiting examples of gRNAs that may be used as provided herein are provided in International Application No. PCT/IB2018/001619, filed May 11, 2018, which published as WO 2019/097305A2, and International Application No. PCT/IB2019/000500, filed May 10, 2019, which published as WO/2019/215500. the relevant disclosures of each of the prior applications are herein incorporated by reference for the purposes and subject matter referenced herein. For any of the gRNA sequences provided herein, those that do not explicitly indicate modifications are meant to encompass both unmodified sequences and sequences having any suitable modifications.

[0096] The length of the spacer sequence in any of the gRNAs disclosed herein may depend on the CRISPR/Cas9 system and components used for editing any of the target genes also disclosed herein. For example, different Cas9 proteins from different bacterial species have varying optimal spacer sequence lengths. Accordingly, the spacer sequence may have 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, or more than 50 nucleotides in length. In some embodiments, the spacer sequence may have 18-24 nucleotides in length. In some embodiments, the targeting sequence may have 19-21 nucleotides in length. In some embodiments, the spacer sequence may comprise 20 nucleotides in length.

[0097] In some embodiments, the gRNA can be a sgRNA, which may comprise a 20 nucleotide spacer sequence at the 5′ end of the sgRNA sequence. In some embodiments, the sgRNA may comprise a less than 20 nucleotide spacer sequence at the 5′ end of the sgRNA sequence. In some embodiments, the sgRNA may comprise a more than 20 nucleotide spacer sequence at the 5′ end of the sgRNA sequence. In some embodiments, the sgRNA comprises a variable length spacer sequence with 17-30 nucleotides at the 5′ end of the sgRNA sequence. Examples are provided in Table 8 in Example 7.

[0098] In some embodiments, the sgRNA comprises no uracil at the 3′ end of the sgRNA sequence. In other embodiments, the sgRNA may comprise one or more uracil at the 3′ end of the sgRNA sequence. For example, the sgRNA can comprise 1-8 uracil residues, at the 3′ end of the sgRNA sequence, e.g., 1, 2, 3, 4, 5, 6, 7, or 8 uracil residues at the 3′ end of the sgRNA sequence.

[0099] Any of the gRNAs disclosed herein, including any of the sgRNAs, may be unmodified. Alternatively, it may contain one or more modified nucleotides and/or modified backbones. For example, a modified gRNA such as an sgRNA can comprise one or more 2′-O-methyl phosphorothioate nucleotides, which may be located at either the 5′ end, the 3′ end, or both.

[0100] In certain embodiments, more than one guide RNAs can be used with a CRISPR/Cas nuclease system. Each guide RNA may contain a different targeting sequence, such that the CRISPR/Cas system cleaves more than one target nucleic acid. In some embodiments, one or more guide RNAs may have the same or differing properties such as activity or stability within the Cas9 RNP complex. Where more than one guide RNA is used, each guide RNA can be encoded on the same or on different vectors. The promoters used to drive expression of the more than one guide RNA is the same or different.

[0101] It should be understood that more than one suitable Cas9 and more than one suitable gRNA can be used in methods described herein, for example, those known in the art or disclosed herein. In some embodiments, methods comprise a Cas9 enzyme and/or a gRNA known in the art. Examples can be found in, e.g., International Application No. PCT/IB2018/001619, filed May 11, 2018, which published as WO 2019/097305A2, and International Application No. PCT/IB2019/000500, filed May 10, 2019, which published as WO/2019/215500, the relevant disclosures of each of the prior applications are herein incorporated by reference for the purposes and subject matter referenced herein.

CRISPR-Cas9-Mediated Gene Editing of TRAC and B2M Genes

[0102] In some embodiments, the activated T cells as disclosed herein may subject to gene editing of both the TRAC gene and β2M gene via CRISPR-Cas9-mediated gene editing under conditions disclosed herein, which would result in higher and more consistent gene editing efficiencies compared to those provided by conventional conditions. Further, the TRAC⁻/β2M⁻ T cells obtained from the gene editing process disclosed herein showed high expression level of a chimeric antigen receptor (CAR) when a viral vector coding for the CAR construct is delivered into the TRAC⁻/β2M⁻ T cells.

[0103] The Cas9 enzyme and the gRNAs targeting the TRAC gene and β2M gene may form one or more ribonucleoprotein (RNP) complexes, which can be delivered into the activated T cells as disclosed herein. RNPs are useful for gene editing, at least because they minimize the risk of promiscuous interactions in a nucleic acid-rich cellular environment and protect the RNA from degradation. Methods for forming RNPs are known in the art.

[0104] The CRISPR-Cas9-mediated gene editing process may involve two ribonucleoprotein complexes. The first RNP complex comprises a first Cas9 enzyme and a guide RNA (gRNA) targeting a TRAC gene. The second RNP complex comprises a second Cas9 enzyme and a gRNA targeting a β2M gene. In some examples, the two RNP complexes may comprise different Cas9 enzymes. In other examples, the two RNP complexes comprise the same Cas9 enzyme. In specific examples, the Cas9 enzyme of SEQ ID NO:1 can be used in both the first and second RNPs.

[0105] In some embodiments, the two RNP complexes may contain the same amount of the Cas9 enzyme. For example, both RNP complexes may comprise about 0.1-0.3 mg/ml (e.g., about 0.1-0.2 mg/ml) of the Cas9 enzyme (e.g., the Cas9 enzyme of SEQ ID NO:1). In some examples, each of the RNP complexes may comprise about 0.15 mg/ml of the Cas9 enzyme, which may be the Cas9 enzyme of SEQ ID NO:1.

[0106] In other embodiments, the two RNP complexes may contain different amounts of the Cas9 enzyme. In some examples, the RNP complex targeting the TRAC gene may comprise a higher amount of the Cas9 enzyme relative to the RNP complex targeting the β2M gene. Alternatively, the RNP complex targeting the β2M gene may comprise a higher amount of the Cas9 enzyme relative to the RNP complex targeting the TRAC gene.

[0107] The two RNP complexes may comprise the same amount of the gRNAs (one targeting TRAC and the other targeting β2M). Alternatively, the two RNP complexes may comprise different amounts of the gRNAs. For example, the amount of the gRNA targeting the TRAC gene may range from about 0.035 mg/ml to about 0.8 mg/ml, for example, about 50 μg/ml to about 80 μg/ml. In specific examples, the amount of the gRNA targeting the TRAC gene is about 0.08 mg/ml. Alternatively or in addition, the amount of the gRNA targeting the β2M gene may range from about 0.075 mg/ml to about 0.3 mg/ml, for example, about 0.1 mg/ml to about 0.3 mg/ml. In specific examples, the amount of the gRNA targeting the β2M gene is about 0.2 mg/ml.

[0108] In specific examples, the RNP complex targeting the TRAC gene may comprise about 0.15 mg/ml Cas9 (e.g., the Cas9 of SEQ ID NO:1) and about 0.08 mg/ml of a gRNA targeting the TRAC gene (e.g., the gRNA of TA-1). Alternatively or in addition, the RNP complex targeting the β2M gene may comprise about 0.15 mg/ml Cas9 (e.g., the Cas9 of SEQ ID NO:1) and about 0.2 mg/ml of a gRNA targeting the β2M gene (e.g., the gRNA of B2M-1).

[0109] In some embodiments, the two RNPs may be introduced into the activated T cell via electroporation sequentially, i.e., via two electroporation event. Alternatively, the two RNPs may be introduced into the activated T cells simultaneously, i.e., via one electroporation event. In this case, the two RNPs may be combined to form a mixture prior to the electroporation event.

[0110] Any of the RNPs disclosed herein may be introduced into the activated T cells by mixing the RNP(s) with a suitable amount of the activated T cells and the mixture thus formed is subject to electroporation under suitable conditions allowing for delivery of the RNPs into the cells. In some instances, the suitable amount of the activated T cells may range from about 100×10⁶ cells/mL to about 300×10⁶ cells/mL. For example, suitable amount of the T cells for the electroporation step may range from about 200×10⁶ cells/mL to about 300×10⁶ cells/mL. In some examples, the concentration of the activated T cells may be about 100×10⁶ cells/mL. In some embodiments, the concentration of activated T cells may be about 200×10⁶ cells/mL. In some embodiments, the concentration of activated T cells may be about 300×10⁶ cells/mL.

[0111] In some embodiments, the suitable amount of the activated T cells may range from about 1×10⁸ to about 1×10¹⁰ cells, e.g., about 5×10⁸ to about 8×10⁹ cells, about 1×10⁹ to about 5×10⁹ cells, or about 1×10⁹ to about 3×10⁹ cells.

[0112] The T cells for use in electroporation may be placed in multiple cell cassettes, depending upon the electroporation instrument used. Suitable electroporation instruments are known to those skilled in the art and could include static and flow electroporators, including the Lonza Nucleofector, Maxcyte GT, and MaxCyte GTx. In some instances, multiple cell cassettes may be used in an electroporation process. More details are provided in Example 10 below.

[0113] In specific examples, the two RNPs disclosed above, comprising about 0.3 mg/ml of the Cas9 enzyme in total (e.g., the Cas9 enzyme of SEQ ID NO:1), about 0.08 mg/ml of the gRNA of TA-1, and about 0.2 mg/ml of the gRNA of B2M-1, may be mixed with the activated T cells in the amount of about 100×10⁶ cells/mL to about 300×10⁶ cells/mL (e.g., about 300×10⁶ cells/mL). The mixture is then subject to electroporation for delivery of the RNPs into the T cells.

[0114] After electroporation, the cells may be cultured in a fresh medium or electroporation buffer for a suitable period for recovery. Gene editing efficiency may be performed following routine practice. The genetically edited T cells thus produced may be subjected to viral vector transduction for delivery of a nucleic acid configured for CAR expression.

(iv) T Cell Transduction

[0115] The genetically edited T cells, having TRAC and β2M genes knocked out, may be subject to transduction with a viral vector such as an adeno-associated viral (AAV) vector that comprises a nucleic acid sequence encoding a chimeric antigen receptor (CAR) to produce a population of T cells expressing the CAR.

Chimeric Antigen Receptor (CAR)

[0116] A chimeric antigen receptor (CAR) refers to an artificial immune cell receptor that is engineered to recognize and bind to an antigen expressed by undesired cells, for example, disease cells such as cancer cells. A T cell that expresses a CAR polypeptide is referred to as a CAR T cell. CARs have the ability to redirect T-cell specificity and reactivity toward a selected target in a non-MHC-restricted manner. The non-MHC-restricted antigen recognition gives CAR-T cells the ability to recognize an antigen independent of antigen processing, thus bypassing a major mechanism of tumor escape. Moreover, when expressed on T-cells, CARs advantageously do not dimerize with endogenous T-cell receptor (TCR) alpha and beta chains.

[0117] There are various generations of CARs, each of which contains different components. First generation CARs join an antibody-derived scFv to the CD3zeta (ζ or z) intracellular signaling domain of the T-cell receptor through hinge and transmembrane domains. Second generation CARs incorporate an additional co-stimulatory domain, e.g., CD28, 4-1BB (41BB), or ICOS, to supply a costimulatory signal. Third-generation CARs contain two costimulatory domains (e.g., a combination of CD27, CD28, 4-1BB, ICOS, or OX40) fused with the TCR CD3ζ chain. Maude et al., Blood. 2015; 125(26):4017-4023; Kakarla and Gottschalk, Cancer J. 2014; 20(2):151-155). Any of the various generations of CAR constructs is within the scope of the present disclosure.

[0118] Generally, a CAR is a fusion polypeptide comprising an extracellular domain that recognizes a target antigen (e.g., a single-chain variable fragment (scFv) of an antibody or other antibody fragment) and an intracellular domain comprising a signaling domain of the T-cell receptor (TCR) complex (e.g., CD3ζ) and, in most cases, a co-stimulatory domain. (Enblad et al., Human Gene Therapy. 2015; 26(8):498-505). A CAR construct may further comprise a hinge and transmembrane domain between the extracellular domain and the intracellular domain, as well as a signal peptide at the N-terminus for surface expression. Examples of signal peptides include MLLLVTSLLLCELPHPAFLLIP (SEQ ID NO: 44) and MALPVTALLLPLALLLHAARP (SEQ ID NO: 75). Other signal peptides may be used.

(a) Antigen Binding Extracellular Domain

[0119] The antigen-binding extracellular domain is the region of a CAR polypeptide that is exposed to the extracellular fluid when the CAR is expressed on cell surface. In some instances, a signal peptide may be located at the N-terminus to facilitate cell surface expression. In some embodiments, the antigen binding domain can be a single-chain variable fragment (scFv, which may include an antibody heavy chain variable region (V_H) and an antibody light chain variable region (V_L) (in either orientation). In some instances, the V_H and V_L fragment may be linked via a peptide linker. The linker, in some embodiments, includes hydrophilic residues with stretches of glycine and serine for flexibility as well as stretches of glutamate and lysine for added solubility. The scFv fragment retains the antigen-binding specificity of the parent antibody, from which the scFv fragment is derived. In some embodiments, the scFv may comprise humanized V_H and/or V_L domains. In other embodiments, the V_H and/or V_L domains of the scFv are fully human.

[0120] The antigen-binding extracellular domain may be specific to a target antigen of interest, for example, a pathologic antigen such as a tumor antigen. In some embodiments, a tumor antigen is a “tumor associated antigen,” referring to an immunogenic molecule, such as a protein, that is generally expressed at a higher level in tumor cells than in non-tumor cells, in which it may not be expressed at all, or only at low levels. In some embodiments, tumor-associated structures, which are recognized by the immune system of the tumor-harboring host, are referred to as tumor-associated antigens. In some embodiments, a tumor-associated antigen is a universal tumor antigen, if it is broadly expressed by most types of tumors. In some embodiments, tumor-associated antigens are differentiation antigens, mutational antigens, overexpressed cellular antigens or viral antigens. In some embodiments, a tumor antigen is a “tumor specific antigen” or “TSA,” referring to an immunogenic molecule, such as a protein, that is unique to a tumor cell. Tumor specific antigens are exclusively expressed in tumor cells, for example, in a specific type of tumor cells.

[0121] In some examples, the CAR constructs disclosed herein comprise a scFv extracellular domain capable of binding to CD19. In some examples, the CAR constructs disclosed herein comprise a scFv extracellular domain capable of binding to BCMA. Examples of anti-CD19 CAR and anti-BCMA CAR are provided in Examples below.

(b) Transmembrane Domain

[0122] The CAR polypeptide disclosed herein may contain a transmembrane domain, which can be a hydrophobic alpha helix that spans the membrane. As used herein, a “transmembrane domain” refers to any protein structure that is thermodynamically stable in a cell membrane, preferably a eukaryotic cell membrane. The transmembrane domain can provide stability of the CAR containing such.

[0123] In some embodiments, the transmembrane domain of a CAR as provided herein can be a CD8 transmembrane domain. In other embodiments, the transmembrane domain can be a CD28 transmembrane domain. In yet other embodiments, the transmembrane domain is a chimera of a CD8 and CD28 transmembrane domain. Other transmembrane domains may be used as provided herein. In some embodiments, the transmembrane domain is a CD8a transmembrane domain containing the sequence of:

[0124]

	(SEQ ID NO: 49)
	FVPVFLPAKPTTTPAPRPPTPAPTIASQPLSLRPEACRPAAG
	GAVHTRGLDFACDIYIWAPLAGTCGVLLLSLVITLYCNHRNR;
	or
	(SEQ ID NO: 31)
	IYIWAPLAGTCGVLLLSLVITLY.

[0125] Other transmembrane domains may also be used.

(c) Hinge Domain

[0126] In some embodiments, a hinge domain may be located between an extracellular domain (comprising the antigen binding domain) and a transmembrane domain of a CAR, or between a cytoplasmic domain and a transmembrane domain of the CAR. A hinge domain can be any oligopeptide or polypeptide that functions to link the transmembrane domain to the extracellular domain and/or the cytoplasmic domain in the polypeptide chain. A hinge domain may function to provide flexibility to the CAR, or domains thereof, or to prevent steric hindrance of the CAR, or domains thereof.

[0127] In some embodiments, a hinge domain may comprise up to 300 amino acids (e.g., 10 to 100 amino acids, or 5 to 20 amino acids). In some embodiments, one or more hinge domain(s) may be included in other regions of a CAR. In some embodiments, the hinge domain may be a CD8 hinge domain. Other hinge domains may be used.

(d) Intracellular Signaling Domains

[0128] Any of the CAR constructs contain one or more intracellular signaling domains (e.g., CD3ζ, and optionally one or more co-stimulatory domains), which are the functional end of the receptor. Following antigen recognition, receptors cluster and a signal is transmitted to the cell.

[0129] CD3ζ is the cytoplasmic signaling domain of the T cell receptor complex. CD3ζ contains three (3) immunoreceptor tyrosine-based activation motif (ITAM)s, which transmit an activation signal to the T cell after the T cell is engaged with a cognate antigen. In many cases, CD3ζ provides a primary T cell activation signal but not a fully competent activation signal, which requires a co-stimulatory signaling.

[0130] In some embodiments, the CAR polypeptides disclosed herein may further comprise one or more co-stimulatory signaling domains. For example, the co-stimulatory domains of CD28 and/or 4-1BB may be used to transmit a full proliferative/survival signal, together with the primary signaling mediated by CD3ζ. In some examples, the CAR disclosed herein comprises a CD28 co-stimulatory molecule. In other examples, the CAR disclosed herein comprises a 4-1BB co-stimulatory molecule. In some embodiments, a CAR includes a CD3ζ signaling domain and a CD28 co-stimulatory domain. In other embodiments, a CAR includes a CD3ζ signaling domain and 4-1BB co-stimulatory domain. In still other embodiments, a CAR includes a CD3ζ signaling domain, a CD28 co-stimulatory domain, and a 4-1BB co-stimulatory domain.

[0131] It should be understood that methods described herein encompasses more than one suitable CAR that can be used to produce genetically engineered T cells expressing the CAR, for example, those known in the art or disclosed herein. Examples can be found in, e.g., PCT/IB2018/001619, filed May 11, 2018, which published as WO 2019/097305A2, the relevant disclosures of which are incorporated by reference herein for the purpose and subject matter referenced herein. In another example, the CAR binds CD19 (also known as a “CD19 CAR” or an “anti-CD19 CAR”). The amino acid sequence of an exemplary CAR that binds CD19 is provided in SEQ ID NO: 37 (see Example 7 below, Table 11). In yet another example, the CAR binds BCMA (also known as a “BCMA CAR” or an “anti-BCMA CAR”). The amino acid sequence of an exemplary CAR that binds to BCMA is provided in SEQ ID NO: 61 (see Example 8 below, Tables 16 and 17).

AAV Vectors for Delivery of CAR Constructs to T Cells

[0132] A nucleic acid encoding a CAR construct can be delivered to a cell using an adeno-associated virus (AAV). AAVs are small viruses which integrate site-specifically into the host genome and can therefore deliver a transgene, such as CAR. Inverted terminal repeats (ITRs) are present flanking the AAV genome and/or the transgene of interest and serve as origins of replication. Also present in the AAV genome are rep and cap proteins which, when transcribed, form capsids which encapsulate the AAV genome for delivery into target cells. Surface receptors on these capsids which confer AAV serotype, which determines which target organs the capsids will primarily bind and thus what cells the AAV will most efficiently infect. There are twelve currently known human AAV serotypes. In some embodiments, the AAV for use in delivering the CAR-coding nucleic acid is AAV serotype 6 (AAV6).

[0133] Adeno-associated viruses are among the most frequently used viruses for gene therapy for several reasons. First, AAVs do not provoke an immune response upon administration to mammals, including humans Second, AAVs are effectively delivered to target cells, particularly when consideration is given to selecting the appropriate AAV serotype. Finally, AAVs have the ability to infect both dividing and non-dividing cells because the genome can persist in the host cell without integration. This trait makes them an ideal candidate for gene therapy.

[0134] A nucleic acid encoding a CAR can be designed to insert into a genomic site of interest in the host T cells. In some embodiments, the target genomic site can be in a safe harbor locus.

[0135] In some embodiments, a nucleic acid encoding a CAR (e.g., via a donor template, which can be carried by a viral vector such as an adeno-associated viral (AAV) vector) can be designed such that it can insert into a location within a TRAC gene to disrupt the TRAC gene in the genetically engineered T cells and express the CAR polypeptide. Disruption of TRAC leads to loss of function of the endogenous TCR. For example, a disruption in the TRAC gene can be created with an endonuclease such as those described herein and one or more gRNAs targeting one or more TRAC genomic regions. Any of the gRNAs specific to a TRAC gene and the target regions can be used for this purpose, e.g., those disclosed herein.

[0136] In some examples, a genomic deletion in the TRAC gene and replacement by a CAR coding segment can be created by homology directed repair or HDR (e.g., using a donor template, which may be part of a viral vector such as an adeno-associated viral (AAV) vector). In some examples, the gRNA target sequence, or portion thereof, is deleted (e.g., SEQ ID NO: 17). In some embodiments, a disruption in the TRAC gene can be created with an endonuclease as those disclosed herein and one or more gRNAs targeting one or more TRAC genomic regions, and inserting a CAR coding segment into the TRAC gene.

[0137] A donor template as disclosed herein can contain a coding sequence for a CAR. In some examples, the CAR-coding sequence may be flanked by two regions of homology to allow for efficient HDR at a genomic location of interest, for example, at a TRAC gene using CRISPR-Cas9 gene editing technology. In this case, both strands of the DNA at the target locus can be cut by a CRISPR Cas9 enzyme guided by gRNAs specific to the target locus. HDR then occurs to repair the double-strand break (DSB) and insert the donor DNA coding for the CAR. For this to occur correctly, the donor sequence is designed with flanking residues which are complementary to the sequence surrounding the DSB site in the target gene (hereinafter “homology arms”), such as the TRAC gene. These homology arms serve as the template for DSB repair and allow HDR to be an essentially error-free mechanism. The rate of homology directed repair (HDR) is a function of the distance between the mutation and the cut site so choosing overlapping or nearby target sites is important. Templates can include extra sequences flanked by the homologous regions or can contain a sequence that differs from the genomic sequence, thus allowing sequence editing.

[0138] Alternatively, a donor template may have no regions of homology to the targeted location in the DNA and may be integrated by NHEJ-dependent end joining following cleavage at the target site.

[0139] A donor template can be DNA or RNA, single-stranded and/or double-stranded, and can be introduced into a cell in linear or circular form. If introduced in linear form, the ends of the donor sequence can be protected (e.g., from exonucleolytic degradation) by methods known to those of skill in the art. For example, one or more dideoxynucleotide residues are added to the 3′ terminus of a linear molecule and/or self-complementary oligonucleotides are ligated to one or both ends. See, for example, Chang et al., (1987) Proc. Natl. Acad. Sci. USA 84:4959-4963; Nehls et al., (1996) Science 272:886-889. Additional methods for protecting exogenous polynucleotides from degradation include, but are not limited to, addition of terminal amino group(s) and the use of modified internucleotide linkages such as, for example, phosphorothioates, phosphoramidates, and O-methyl ribose or deoxyribose residues.

[0140] A donor template can be introduced into a cell as part of a vector molecule having additional sequences such as, for example, replication origins, promoters and genes encoding antibiotic resistance. Moreover, a donor template can be introduced into a cell as naked nucleic acid, as nucleic acid complexed with an agent such as a liposome or poloxamer, or can be delivered by viruses (e.g., adenovirus, AAV, herpesvirus, retrovirus, lentivirus and integrase defective lentivirus (IDLY)).

[0141] A donor template, in some embodiments, can be inserted at a site nearby an endogenous promoter (e.g., downstream or upstream) so that its expression can be driven by the endogenous promoter. In other embodiments, the donor template may comprise an exogenous promoter and/or enhancer, for example, a constitutive promoter, an inducible promoter, or tissue-specific promoter to control the expression of the CAR gene. In some embodiments, the exogenous promoter is an EF1α promoter. Other promoters may be used.

[0142] Furthermore, exogenous sequences may also include transcriptional or translational regulatory sequences, for example, promoters, enhancers, insulators, internal ribosome entry sites, sequences encoding 2A peptides and/or polyadenylation signals.

T Cell Transduction

[0143] A suitable amount of any of the viral vectors such as an AAV vector, which encodes a CAR construct disclosed herein (e.g., an anti-CD19 CAR or an anti-BCMA CAR) may be incubated with a suitable amount of T cells, such as the genetically edited T cells disclosed herein for a suitable period to allow for entry of the viral vector into the T cells. For example, the transduction process may involve the use of a range of optimized multiplicity of infection (MOI) that increases percentages of CAR⁺ T cells. In some instances, the MOI of an AAV vector in the transduction process may range from about 1,000 to about 150,000, such as from about 10,000 to about 80,000. In some examples, the MOI of the AAV vector used in the transduction process may be about 1,000 to about 150,000, about 5,000 to about 100,000, about 10,000 to about 100,000, about 10,000 to about 90,000, about 10,000 to about 80,000, about 10,000 to about 70,000, about 10,000 to about 60,000, about 10,000 to about 50,000, about 10,000 to about 40,000, about 10,000 to about 30,000, about 10,000 to about 20,000, about 20,000 to about 80,000, about 30,000 to about 80,000, about 40,000 to about 80,000, about 50,000 to about 80,000, about 60,000 to about 80,000, or about 70,000 to about 80,000. In some examples, the MOI of the AAV vector used in the transduction process may be about 1,000, about 2,500, about 5,000, about 10,000, about 15,000, about 20,000, about 25,000, about 30,000, about 31,000, about 32,000, about 33,000, about 34000, about 35,000, about 40,000, about 50,000, about 60,000, about 70,000, about 80,000, about 90,000, about 100,000, about 110,000, about 120,000, about 130,000, about 140,000, or about 150,000.

[0144] In some embodiments, the AAV vector encodes an anti-CD19 CAR (e.g., as disclosed in Example 7 below) and the MOI of such an AAV vector for use in the transduction process is about 20,000. In other embodiments, the AAV vector encodes an anti-BCMA CAR (e.g., as disclosed in Example 8 below) and the MOI of such an AAV vector for use in the transduction process is about 20,000.

[0145] After transduction, the T cells may be cultured in a suitable cell culture medium for a suitable period for recovery. The genetically engineered T cells, having TRAC and B2M genes knocked-out and expressing the CAR, may be expanded in vitro as disclosed below.

(v) T Cell Expansion

[0146] The genetically engineered T cells as disclosed herein may be expanded in vitro under suitable conditions to produce a population of genetically engineered T cells to a clinically relevant scale. Cell culture conditions used in this expansion step intend to, at least in part, achieve higher final cell densities in shorter incubation periods (thereby reducing manufacturing cost) and higher potent T cells for use in cell therapy. Potency may be indicated by various T cell functions, e.g., proliferation, target cell killing, cytokine production, activation, migration, and combinations thereof.

[0147] In some embodiments, the T cell expansion step may be performed by seeding a population of T cells (e.g., the genetically engineered T cells as disclosed herein) in a cell culture vessel at a seeding density of about 150,000 cells/cm² to about 600,000 cells/cm² in a cell vessel. For example, the T cells may be seeded at about 300,000 cells/cm² to about 500,000 cells/cm², in a cell vessel. In some aspects, the T cell expansion is performed by seeding a population of T cells in a cell culture vessel at a seeding density of at least about 60,000 cells/cm², at least about 62,500 cells/cm², or at least about 83,000 cells/cm². In some aspects, the T cell expansion is performed by seeding a population of T cells in a cell culture vessel at a seeding density of at least about 150,000 cells/cm², or at least about 250,000 cells/cm², or at least about 300,000 cells/cm², or at least about 400,000 cells/cm², or at least about 500,000 cells/cm², or at least about 600,000 cells/cm². In some aspects, the seeding density is about 250,000 cells/cm². In other aspects, the seeding density is about 500,000 cells/cm². In other aspects, the seeding density is about 600,000 cells/cm².

[0148] In some embodiments, the T cell expansion step may be performed by seeding a population of T cells (e.g., the genetically engineered T cells as disclosed herein) in a cell culture vessel at a seeding density of about 2×10⁵ cells/cm² to about 7×10⁵ cells/cm², and culturing the cells for about 6 days to about 12 days. In some examples, the T cell expansion is performed by seeding a population of T cells in a cell culture vessel at a seeding density of about 2×10⁵ cells/cm² to about 7×10⁵ cells/cm², about 2×10⁵ cells/cm² to about 5×10⁵ cells/cm², about 2×10⁵ cells/cm² to about 4×10⁵ cells/cm², 2×10⁵ cells/cm² to about 3×10⁵ cells/cm², 3×10⁵ cells/cm² to about 5×10⁵ cells/cm², or 4×10⁵ cells/cm² to about 5×10⁵ cells/cm², and culturing the cells for about 6 days to about 12 days, about 6 days to about 11 days, about 6 days to about 10 days, about 6 days to about 9 days, about 6 days to about 8 days, about 6 days to about 7 days, about 7 days to about 12 days, about 7 days to about 11 days, about 7 days to about 10 days, about 7 days to about 9 days, about 7 days to about 8 days, about 8 days to about 12 days, about 8 days to about 9 days, about 9 days to about 12 days, about 10 days to about 12 days, or about 11 days to about 12 days. In some embodiments, the T cell expansion is performed by seeding a population of T cells in a cell culture vessel at a seeding density of about 3×10⁵ cells/cm² to about 5×10⁵ cells/cm² and culturing the cells for about 7 days to about 9 days.

[0149] In some embodiments, the T cell expansion step may include replating the cell culture (i.e., splitting the cell culture into new culture vessels). In some embodiments, the cell culture can be replated at day 3, 4, 5, 6, or 7 post editing at a 1:4 ratio (1 vessel split into 4 new vessels) for further expansion.

[0150] T cell expansion may be performed in a static culture vessel, which allows expansion of the T cells without medium change. For example, T cells can be expanded in a static culture vessel for at about 7 days to about 12 days, or at about 7 days to about 9 days without medium change.

(vi) Depletion of TCRαβ⁺ T Cells

[0151] In some embodiments, TCRαβ⁺ T cells may be depleted from the expanded T cell population disclosed herein to produce a population of allogenic T cells for use in cell therapy. As used herein, “TCRαβ⁺ T cell depletion” refers to depleting TCRαβ⁺ T cells from a population of cells comprising such. Following TCRαβ⁺ T cell depletion, the resultant T cell population may have a substantially low level of TCRαβ⁺ T cell (e.g., less than 3% in the total cell population, or less than 2%, less than 1%, or less than 0.5% in the total cell population). In some examples, the resultant T cell population may be free of TCRαβ⁺ T cell, i.e., presence of TCRαβ⁺ T cell is not dateable via a conventional method (e.g., in an immune assay using an antibody binding to TCRαβ⁺ or by flow cytometry).

[0152] TCRαβ⁺ T cell depletion may be performed using an agent that recognizes TCRαβ⁺ T cells to capture the TCRαβ⁺ T cells, thereby separating them from those lacking TCRαβ⁺, e.g., by performing a magnetic cell separation. Such methods may be carried out by contacting the expanded T cells disclosed above to beads on which anti-TCRαβ antibodies are immobilized, and collecting unbound cells. Unbound cells (those lacking TCRαβ⁺) thus collected may be cultured to allow cell recovery prior, for example, unbound cells may be cultured overnight to allow cells to recover.

(vii) Harvest of Genetically Engineered T Cells

[0153] The genetically engineered T cells produced by any of the methods disclosed herein can then be harvested for therapeutic uses using conventional methods known in the art. For example, harvesting genetically engineered T cells may comprise collecting cells from which TCRαβ⁺ has been depleted. The harvested population of genetically engineered T cells may be used as the drug substance. As used herein, a “drug substance” refers to a population of genetically engineered T cells that may be administered to patients. The drug substance may be formulated for therapeutic uses, e.g., formulated in storage media (e.g., CryoStor CS5) and cryopreserved for future use.

[0154] Drug substance may be tested for one or more contaminants, e.g., mycoplasma, human viruses (e.g., HIV, HBV, HCV, CMV), and bacterial endotoxins. Alternatively, or in addition to, drug substance may be tested for sterility. Contamination free drug substance may be aliquoted into individual patient doses. Alternatively, or in addition to, contamination free drug substance may be stored for therapeutic use.

[0155] Accordingly, aspects of the present disclosure provide a population of genetically engineered T cells (drug substance). The population of genetically engineered T cells has a disrupted TRAC gene, a disrupted β2M gene, and a nucleic acid encoding a CAR, e.g., those described herein. In some embodiments, the CAR binds an antigen expressed on a pathological cell. In some embodiments, the CAR binds CD19. In some embodiments, the CAR binds BCMA.

[0156] In some embodiments, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or at least 95% of the population of genetically engineered T cells produced by methods described herein express a CAR. In other aspects, these cells that express a CAR further do not express a detectable level of surface TCR and/or a detectable level of surface β2M.

[0157] In other embodiments, where at least 30% of the population of genetically engineered T cells produced by methods described herein express a CAR, that population of cells comprises not more than about 1.0%, not more than about 0.5%, not more than about 0.4%, or not more than about 0.15% T cells that express surface TCR (e.g., TCRα/β⁺ cells).

[0158] In other embodiments, where at least 30% of the population of genetically engineered T cells produced by methods described herein express a CAR, that population of cells comprises not more than about 50%, not more than about 40%, or not more than about 30%, T cells that express surface β2M.

[0159] Also within the scope of the present disclosure is a genetically engineered T cell population produced by methods described herein comprising a Cas9 enzyme, a gRNA targeting a TRAC gene, a gRNA targeting a β2M gene, and an AAV vector comprising a nucleic acid sequence encoding a CAR (e.g., a CD19 CAR or a BCMA CAR).

II. Therapeutic Applications

[0160] A population of genetically engineered T cells produced by methods described herein may be administered to a subject for therapeutic purposes, for example, treatment of a cancer targeted by the CAR construct expressed by the population of genetically engineered T cells.

[0161] A subject may be any subject for whom diagnosis, treatment, or therapy is desired. In some embodiments, the subject is a mammal. In some embodiments, the subject is a human.

[0162] Non-limiting examples of cancers that may be treated using a genetically engineered T cell population produced by methods described herein include, but are not limited to, multiple myeloma, leukemia (e.g., T cell leukemia, B-cell acute lymphoblastic leukemia (B-ALL), and/or chronic lymphocytic leukemia (C-CLL)), lymphoma (e.g., B-cell non-Hodgkin's lymphoma (B-NHL), Hodgkin's lymphoma, and/or T cell lymphoma), and/or clear cell renal cell carcinoma (ccRCC), pancreatic cancer, gastric cancer, ovarian cancer, cervical cancer, breast cancer, renal cancer, thyroid cancer, nasopharyngeal cancer, non-small cell lung (NSCLC), glioblastoma, and/or melanoma.

[0163] Administering may include placement (e.g., transplantation) of the genetically engineered T cell population into a subject by a method or route that results in at least partial localization of the genetically engineered T cell population at a desired site, such as a tumor site, such that a desired effect(s) can be produced. The genetically engineered T cell population can be administered by any appropriate route that results in delivery to a desired location in the subject where at least a portion of the implanted cells or components of the cells remain viable. The period of viability of the cells after administration to a subject can be as short as a few hours, e.g., twenty-four hours, to a few days, to as long as several years, or even the life time of the subject, i.e., long-term engraftment. For example, in some aspects described herein, an effective amount of the genetically engineered T cell population can be administered via a systemic route of administration, such as an intraperitoneal or intravenous route.

[0164] In some embodiments, the genetically engineered T cell population is administered systemically, which refers to the administration of a population of cells other than directly into a target site, tissue, or organ, such that it enters, instead, the subject's circulatory system and, thus, is subject to metabolism and other like processes. Suitable modes of administration include injection, infusion, instillation, or ingestion. Injection includes, without limitation, intravenous, intramuscular, intra-arterial, intrathecal, intraventricular, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intraarticular, sub capsular, subarachnoid, intraspinal, intracerebro spinal, and intrasternal injection and infusion. In some embodiments, the route is intravenous.

[0165] An effective amount refers to the amount of a genetically engineered T cell population needed to prevent or alleviate at least one or more signs or symptoms of a medical condition (e.g., cancer), and relates to a sufficient amount of a genetically engineered T cell population to provide the desired effect, e.g., to treat a subject having a medical condition. An effective amount also includes an amount sufficient to prevent or delay the development of a symptom of the disease, alter the course of a symptom of the disease (for example but not limited to, slow the progression of a symptom of the disease), or reverse a symptom of the disease. It is understood that for any given case, an appropriate effective amount can be determined by one of ordinary skill in the art using routine experimentation.

[0166] An effective amount of a genetically engineered T cell population may comprise at least 10² cells, at least 5×10² cells, at least 10³ cells, at least 5×10³ cells, at least 10⁴ cells, at least 5×10⁴ cells, at least 10⁵ cells, at least 2×10⁵ cells, at least 3×10⁵ cells, at least 4×10⁵ cells, at least 5×10⁵ cells, at least 6×10⁵ cells, at least 7×10⁵ cells, at least 8×10⁵ cells, at least 9×10⁵ cells, at least 1×10⁶ cells, at least 2×10⁶ cells, at least 3×10⁶ cells, at least 4×10⁶ cells, at least 5×10⁶ cells, at least 6×10⁶ cells, at least 7×10⁶ cells, at least 8×10⁶ cells, at least 9×10⁶ cells, or multiples thereof.

[0167] The efficacy of a treatment using the genetically engineered T cell population manufactured as described herein can be determined by one of ordinary skill in the art. A treatment is considered “effective”, if any one or all of the signs or symptoms of, as but one example, levels of functional target are altered in a beneficial manner (e.g., increased by at least 10%), or other clinically accepted symptoms or markers of disease (e.g., cancer) are improved or ameliorated. Efficacy can also be measured by failure of a subject to worsen as assessed by hospitalization or need for medical interventions (e.g., progression of the disease is halted or at least slowed). Methods of measuring these indicators are known to those of skill in the art and/or described herein. Treatment includes any treatment of a disease in subject and includes: (1) inhibiting the disease, e.g., arresting, or slowing the progression of symptoms; or (2) relieving the disease, e.g., causing regression of symptoms; and (3) preventing or reducing the likelihood of the development of symptoms.

[0168] Genetically engineered T cell populations manufactured as described herein may also be used in combination therapies. For example, the genetically engineered T cell population manufactured as described herein may be co-used with other therapeutic agents, for treating the same indication, or for enhancing efficacy of the genetically engineered T cell population and/or reducing side effects of the genetically engineered T cell population.

General Techniques

[0169] The practice of the present disclosure will employ, unless otherwise indicated, conventional techniques of molecular biology (including recombinant techniques), microbiology, cell biology, biochemistry, and immunology, which are within the skill of the art. Such techniques are explained fully in the literature, such as Molecular Cloning: A Laboratory Manual, second edition (Sambrook, et al., 1989) Cold Spring Harbor Press; Oligonucleotide Synthesis (M. J. Gait, ed. 1984); Methods in Molecular Biology, Humana Press; Cell Biology: A Laboratory Notebook (J. E. Cellis, ed., 1989) Academic Press; Animal Cell Culture (R. I. Freshney, ed. 1987); Introduction to Cell and Tissue Culture (J. P. Mather and P. E. Roberts, 1998) Plenum Press; Cell and Tissue Culture: Laboratory Procedures (A. Doyle, J. B. Griffiths, and D. G. Newell, eds. 1993-8) J. Wiley and Sons; Methods in Enzymology (Academic Press, Inc.); Handbook of Experimental Immunology (D. M. Weir and C. C. Blackwell, eds.): Gene Transfer Vectors for Mammalian Cells (J. M. Miller and M. P. Calos, eds., 1987); Current Protocols in Molecular Biology (F. M. Ausubel, et al. eds. 1987); PCR: The Polymerase Chain Reaction, (Mullis, et al., eds. 1994); Current Protocols in Immunology (J. E. Coligan et al., eds., 1991); Short Protocols in Molecular Biology (Wiley and Sons, 1999); Immunobiology (C. A. Janeway and P. Travers, 1997); Antibodies (P. Finch, 1997); Antibodies: a practice approach (D. Catty., ed., IRL Press, 1988-1989); Monoclonal antibodies: a practical approach (P. Shepherd and C. Dean, eds., Oxford University Press, 2000); Using antibodies: a laboratory manual (E. Harlow and D. Lane (Cold Spring Harbor Laboratory Press, 1999); The Antibodies (M. Zanetti and J. D. Capra, eds. Harwood Academic Publishers, 1995); DNA Cloning: A practical Approach, Volumes I and II (D. N. Glover ed. 1985); Nucleic Acid Hybridization (B. D. Hames & S. J. Higgins eds. (1985; Transcription and Translation (B. D. Hames & S. J. Higgins, eds. (1984; Animal Cell Culture (R. I. Freshney, ed. (1986; Immobilized Cells and Enzymes (1RL Press, (1986; and B. Perbal, A practical Guide To Molecular Cloning (1984); F. M. Ausubel et al. (eds.).

[0170] Without further elaboration, it is believed that one skilled in the art can, based on the above description, utilize the present invention to its fullest extent. The following specific embodiments are, therefore, to be construed as merely illustrative, and not limitative of the remainder of the disclosure in any way whatsoever. All publications cited herein are incorporated by reference for the purposes or subject matter referenced herein.

[0171] In order that the invention described may be more fully understood, the following examples are set forth. The examples described in this application are offered to illustrate the methods and compositions provided herein and are not to be construed in any way as limiting their scope.

[0172] This Example reports identification of optimized conditions for T cell enrichment, using an automated cell processing system to enrich CD4⁺ and CD8⁺ T cells from leukopaks.

Methods

Leukopak and Buffer Preparation

[0173] Human leukopaks were collected from HemaCare or Stem Express and processed for T cells enrichment. PBS/EDTA Buffer (phosphate buffered saline, pH 7.2, supplemented with 1 mM EDTA) was supplemented with 0.5% Human Serum Albumin (HSA) and used for processing, priming, washing, and elution during T cell selection.

[0174] The leukopak donors were screened for the following:

• • [0175] Hepatitis B Surface Antigen (HBsAg EIA)
  • [0176] Hepatitis C Virus Antibody (Anti-HCV EIA)
  • [0177] Human Immunodeficiency Virus Antibody (HIV 1/2 plus 0)
  • [0178] Human T-Lymphotropic Virus Antibody (HTLV-I/II)
  • [0179] HIV-1/HCV/HBV Nucleic Acid Testing
  • [0180] WNV Nucleic Acid Testing
  • [0181] Trypanosoma Cruzi Antibody (Selective Chagas Disease Testing, a single lifetime test per donor)
  • [0182] HIV/HBV/HCV
  • [0183] CMV

[0184] Donors showing positive results of any of the above tests were excluded. Demographic information of the donors used in the Examples disclosed herein is shown in Table 1.

[0185]

TABLE 1
Donor demographic and hematology parameters. All donors were male.
		Donor		Donor				Product
		source		weight			ABO/	volume	WBC	Lymphocyte
Batch	Supplier	ID	Age	(lb)	BMI	Ethnicity	Rh	(mL)	(×109)	%
1	HemaCare	D327083	26	144	19.0	Hispanic/	O-	279	9.77	79
						Latino	POS
2	HemaCare	141402	29	160	22.9	Caucasian	A-	302	13.59	75.9
							POS
3	HemaCare	141121	26	154	24.8	Hispanic	O-POS	250	8.75	74.7
4	HemaCare	136723	20	130	20.9	Caucasian	A-POS	305	12.81	70.1
5	HemaCare	D64140	28	272	42.6	Hispanic/	A-	339	21.36	81.1
						Latino	POS
6	Stem	D001003864	33	176	24.0	Caucasian	A-POS	140	8.14	70.9
	Express
7	HemaCare	141722	20	135	19.9	Hispanic	O-POS	308	13.24	78.5
8	HemaCare	D327737	36	200	26.4	African	B-POS	310	14.57	81.3
						American
9	HemaCare	D326737	31	225	29.7	African	AB-POS	314	10.99	77.9
						American

Leukopak Hematology Analysis with Sysmex

[0186] Samples from incoming leukopaks were processed for hematology analysis with Sysmex XP300 (Sysmex, Serial No: B0628) following manufacturer's instructions. White blood cell (WBC) count was used to calculate the total cell mass loaded into the automated cell processing system.

T cell Enrichment

[0187] Process buffer, leukopak, CD4 microbeads, and CD8 microbeads were loaded in the automated cell processing system prior to starting the run. Cells were washed and labeled in the chamber and directed to the magnet column for separation. CD4⁺ and CD8⁺ T cells were captured and further eluted into the target bag in processing buffer.

Cell Count and Viability

[0188] Cell count and viability assessment were performed with COUNTESS® II (Life Technologies, Cat: AMQAX1000) using a default profile. Cells (20 μL) were mixed with Trypan blue (20 μL) by pipetting up and down a few times without introducing bubbles. Cell/Trypan blue mixture (10 μL) was loaded into COUNTESS® II cell counting chamber slides.

Flow Cytometry

[0189] About 1×10⁶ total nuclei cells were blocked with 5 μL of human TruStain FcX™ in 95 μL of staining buffer (0.5% Bovine Serum Albumin (BSA)/DPBS)) at room temperature (RT) for 10 minutes. Cells were further incubated with Pacific blue-conjugated anti-human CD45 antibody (1:50), BV510-conjugated anti-human CD3 antibody (1:50), APC-Cy7-conjugated anti-human CD4 antibody (1:50), PE-Cy7-conjugated anti-human CD8 antibody (1:50), APC-conjugated anti-human CD19 antibody (1:50), FITC-conjugated anti-human CD56 antibody (1:50) and PE-conjugated anti-human CD33 antibody (1:50) at 4° C. for 30 minutes. Then, 1 mL of Ammonium-Chloride-Potassium (ACK) lysis buffer containing 5 μL 7-amino-actinomycin D (7-AAD) viability staining solution was applied to each sample. After incubation with ACK lysing buffer at RT for 10 minutes, cells were acquired with NovoCyte-3000 flow cytometer.

Results

White Blood Cells (WBCs) in Leukopak Samples

[0190] WBC in the tested leukopaks ranged from 8.14×10⁹ to 21.36×10⁹ cells with lymphocyte number ranging from 5.77×10⁹ to 17.32×10⁹.

CD4 and CD8 Enrichment—Purity, Viability, Cell Recovery, and Yield

[0191] Among the 9 batches tested, four were evaluated with program A and five were evaluated with program B. All batches yielded T cells with >90% purity and with >90% viability (Table 2). Cell recovery from program A was 31% whereas cell recovery from program B was 55.69%.

[0192]

TABLE 2
CD4 and CD8 enrichment results
				Target Cell
		Leukopak	Non-Target	Cell Number		Viability	Recovery
Batch	Program	CD3 %	Cell CD3 %	(×109)	CD3 %	(%)	(%)
1	A	73.20	50.80	1.32	96.20	96.50	29.24
2		72.30	60.40	2.76	96.30	93.50	27.00
3		64.90	46.00	2.32	96.80	95.00	39.15
4		63.50	55.00	2.59	89.70	94.00	30.77
Avg (A)	68.48	53.05	2.25	94.75	94.75	31.54
5	B	70.30	15.70	6.00	94.50	93.00	39.75
6		56.00	3.17	2.14	92.80	96.00	47.10
7		69.00	16.80	4.68	96.60	93.00	49.10
8		59.40	15.20	6.82	92.60	96.00	75.87
9		55.50	11.20	3.88	93.60	98.00	61.65
Avg (B)	62.04	12.41	4.70	94.02	95.20	54.69

[0193] Taken together, these results demonstrate that T cells from healthy donor (HD) leukopaks were enriched with high purity (>90%) and high viability (>90%) for CD4⁺ and CD8⁺ T cells.

[0194] This Example reports identification of optimized conditions for T cell activation, using a colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists.

Identification of Optimized Conditions for T Cell Activation in a Static Culture Vessel

[0195] In brief, cryopreserved T cells from healthy donor leukopaks were thawed, and activated with recombinant humanized CD3 and CD28 agonists conjugated to a polymeric nanomatrix for 48 hours in a T-flask as a control or a static culture vessel. T cell activation was evaluated by monitoring the surface expression of cell activation marker CD25 and CD69, and by monitoring cell proliferation. Various T cell activation conditions for activation in static culture vessels were tested including cell seeding density, medium volume, and recombinant humanized CD3 and CD28 agonists conjugated to a polymeric nanomatrix concentration (“CD3/CD28 agonists”) (Table 3). T cell activation was evaluated by monitoring the surface expression of cell activation marker CD25 and CD69, and by monitoring cell proliferation. T cell activation in a T-flask was used as a positive control (PC) (Table 3).

[0196]

TABLE 3
T cell activation conditions tested
						CD3/CD28
						agonists to
		cell number	Volume of Medium	cell density per	CD3/CD28 agonists	Medium
Condition	Vessel	per cm2	(mL)	mL	(μl per 1 × 106 cells)	ratio
1	Static	1.00 × 107	8	2.50 × 106	40	1:10
2	Vessel	1.00 × 107	4	5.00 × 106	40	1:5
3		1.00 × 107	2	1.00 × 107	40	1:2.5
4		1.00 × 107	4	5.00 × 106	8	1:25
5		1.00 × 107	2	1.00 × 107	4	1:25
6		2.00 × 106	4	1.00 × 106	40	1:25
7		2.00 × 106	2	2.00 × 106	40	1:12.5
8		2.00 × 106	2	2.00 × 106	20	1:12.5
Positive	T-Flask		10	1.00 × 106	40	1:25
Control
(PC)

[0197] As shown in FIG. 1A, the percentage of cells expressing CD25 and CD69 were similar among the conditions tested. A slightly higher (~10% higher) population of CD69⁺ cells and CD25+CD69+ cells were observed in condition 3 (FIG. 1A).

[0198] The cell expansion rate, however, was not correlated with the expression level of CD69 but rather, it was correlated with the expression level of CD25, as measured by the mean florescent intensity (MFI) of CD25 (FIG. 1B). Among the conditions tested, condition 7 had the most similar correlation between CD25 MFI and cell expansion when compared to that of the positive control (FIG. 1B). CD25 and CD69 are T-cell activation markers, where early upregulation and late upregulation are correlated with activation status.

[0199] In sum, these results demonstrate that Condition 7 in Table 3 led to superior T cell activation effect (Condition 7: 2.00×10⁶ cells/cm²; 2.00×10⁶ cells/mL; 40 μL of colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists/1×10⁶ cells; and 1:12.5 colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists to medium ratio) in a static culture vessel.

Validation of Optional T Cell Activation Conditions in a Small-Scale Manufacturing Process

[0200] Next, the identified T cell activation conditions (Condition 7: 2.00×10⁶ cells/cm²; 2.00×10⁶ cells/mL; 40 μL of colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists/1×10⁶ cells; and 1:12.5 colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists to medium ratio) were tested in a small scale manufacturing process (in a static culture vessel) and the activated T cells were investigated for their gene editing efficiency with respect to expression of a chimeric antigen receptor (CAR), T cell receptor alpha chain constant region (TRAC) knock-out, and/or beta-2-microglobulin (β2M) knock-out. Activation and editing of T cells in a T-flask (Flask) was compared to that in a static cell culture vessel (Vessel). TRAC and β2M electroporated T cells (EP) and untreated T cells (UT) were used as controls.

Small Scale Manufacturing Process

[0201] Cryovials were retrieved from liquid nitrogen storage and were thawed in a water bath until a small amount of frozen material remained. Cells were then added dropwise to a 10× volume of full growth medium (X-VIVO™ 15 (Lonza), 5% Human AB Serum, 100 U/mL IL2, 100 U/mL IL7), and pelleted by centrifugation at 300 g for 10 minutes at room temperature. Cells were resuspended to a concentration of 1×10⁶ cells/mL and subjected to colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists-mediated activation, which improved downstream modification. In brief, isolated T cells were activated with recombinant CD3 and CD28 covalently attached to a colloidal polymeric nanomatrix. The colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists was applied to cells at a 1:25 ratio or 40 μL per 1×10⁶ cells in a nontreated flask. Cells were maintained in the colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists for 2 days in an incubator at 37° C., 5% CO₂ for 48 hours. Following incubation, cells are centrifuged at 300 g for 10 minutes at room temperature. Cell pellets were then resuspended in full growth media and cultured overnight at a concentration of 1×10⁶ cells/mL prior to gene modification.

[0202] Following overnight culture in full media without the colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists, total cell numbers and cell viability were quantified by addition of Trypan blue and counting on the COUNTESS® cytometer. Then, cells were centrifuged at 300 g for 10 minutes at room temperature. Cell pellets were washed in 10 mL of electroporation buffer and centrifuged again. While cells were being centrifuged, ribonucleoprotein (RNP) complexes were prepared. Two separate RNP complexes were formed. One RNP was formed containing B2M sgRNA and Cas9 at concentrations of 150 μg/mL and 150 μg/mL, respectively. The other RNP was formed containing TCR sgRNA and Cas9 at concentrations of 150 μg/mL and 150 μg/mL respectively. RNP complexes containing sgRNAs and Cas9 were formed by incubation at room temperature for 10 minutes. One RNP complex was formed containing Cas9 (Cas9; SEQ ID NO: 1) and a gRNA targeting the β2M gene (B2M-1; SEQ ID NO: 6), and the other RNP complex was formed containing Cas9 (Cas9; SEQ ID NO: 1) and a gRNA targeting the TCR gene (TA-1; SEQ ID NO: 2). Following centrifugation, cell pellets were resuspended in electroporation buffer to a concentration of 400×10⁶ cells/mL. Using the resulting cell suspension, further dilutions were generated bearing final cell concentrations of 300×10⁶ cells/mL, 200×10⁶ cells/mL, 150×10⁶ cells/mL, and 100×10⁶ cells/mL. Separate RNP complexes were combined and pipetted into electroporation cuvettes. Cells at the varying concentrations were added to the RNP complexes and pipetted up and down 5 times.

[0203] Cells were electroporated using a transfection system based on flow electroporation. Once each individual cuvette was electroporated, the cell and RNP solution was aliquoted into a non-treated 12-well plate, with each well containing 500 μL of X-VIVO™ 15 media (without Human AB serum, IL2 and IL7). Cells were allowed to rest for 20 minutes in the incubator. Total cell numbers and cell viability were quantified by addition of Trypan blue and counting on the COUNTESS® cytometer or NC-200.

[0204] Based on total cell numbers after resting, cells may need to be further diluted with X-VIVO™ 15 (without Human AB serum, IL2 or IL7) to reach the desired concentration. Total cell numbers are needed to calculate the volume of AAV needed to perform the transduction.
μL of AAV needed=(Total cell numbers)(desired MOI (i.e., 20,000))/(virus vgc/mL (i.e., 1.5×10¹³))

[0205] AAV and cell suspension was mixed and allowed to incubate in a non-treated flask at 37° C. and 5% CO₂ for 1 hour. The entire volume, including AAV, was added to a static culture vessel containing 100 mL of full media. The static culture vessel was incubated for 3 days to allow cell expansion.

[0206] After electroporation, each well of a static culture vessel was filled with 100 mL of full growth media. Gene modified cells were seeded at a concentration of 5×10⁵ cells/mL to 1×10⁶ cells/mL in full growth media. IL2 or IL7 were replenished every three to four days to a final working concentration of 100 U/mL. Total cell numbers were quantified every three to four days by addition of Trypan blue and counting on the COUNTESS® cytometer. Cells were maintained in culture for nine to twelve days after electroporation to achieve maximal total cell numbers based on a saturation concentration of 30×10⁶ cells/mL. Once cells reached this threshold, depletion of any remaining unedited cells that expressed TCR alpha or beta was performed to remove these cellular impurities.

[0207] During the expansion phase in a static culture vessel, cells may reach a plateau phase, thereby attaining a maximal number of cells in the static culture vessel. At this stage, the total cell population comprised 6% or less of TCR alpha and beta positive expressing cells. TCR alpha and beta positive cells may be depleted from the population because they may contribute to graft versus host response. Volume reduction was performed on the static culture vessel to remove 90% of the volume, with the remaining 10% of the volume containing cells. Cells were loaded into a transfer bag which was sterile welded to the tubing set used to perform the depletion. TCR alpha and beta positive cells were removed from the main population using a TCR alpha beta depletion kit comprising biotin anti-TCR alpha beta, which may be captured by anti-biotin beads. Cells depleted of TCR alpha beta positive were eluted into the target bag and are transferred back into a static culture vessel and cultured for an additional day. Cells were then cryopreserved in CS5 and stored at −145° C.

[0208] Cells fresh from culture or thawed from cryovials were washed in staining buffer and centrifuged at 1500 rpm for 5 minutes. As a negative control, 1×10⁶ cells were incubated with Fab-Biotin or IgG-Biotin antibodies. Cells were washed with staining buffer and incubated with mouse anti-IgG to capture excess primary antibodies. Cells were washed again and incubated with the full panel of secondary antibodies (CD45, CD5, CD4, CD8, B2M, TCR, Streptavidin-APC) and viability dye. Cells were washed a final time with staining buffer and run on the flow cytometer to capture various stained populations.

[0209] Flow cytometry was used to quantify the diverse populations present in in-process samples as well as cryopreserved product. The gating strategy described herein was used to differentiate subpopulations. In brief, the strategy used is based on initially gating the lymphocyte population, selecting singlet cell populations, and gating CD45⁺ or CD5⁺ populations. Editing efficiency was determined by visualizing B2M⁻ and TRAC⁻ stained cells as a proportion of the parental CD45⁺ or CD5⁺ population. Similarly, ratios of CD4 and CD8 subpopulations were plotted as a proportion of the CD45⁺ or CD5⁺ population. Isotype controls were used to set the gate for CAR⁺ expression in the APC channel.

Results

[0210] In the small-scale manufacturing process disclosed herein, T cells were activated in a static culture vessel and in a T-flask under the same activation conditions (Condition 7) and the resultant activated T cells were then electroporated in the presence of two ribonucleoprotein (RNP) complexes using a transfection system based on flow electroporation. After electroporation, the cells were transduced with a rAAV vector for expressing an anti-CD19 CAR (anti-CD19 CAR; SEQ ID NO: 53) at multiplicity of infection (MOI) of 20,000 and expanded. Knockout efficiency of TCRαβ and β2M, anti-CD19 CAR expression, and cell expansion were assessed during cell expansion. TCRαβ depletion was performed using the automated cell processing system. Process buffer, cell product, and a TCRαβ kit that includes anti-TCRα/β monoclonal antibodies conjugated to biotin were loaded in the automated cell processing system prior to the run. Cells were washed and labeled in the chamber and directed to the magnet column for separation. Unbound cells (TCRαβ⁻) were collected into the target bag in processing buffer.

[0211] The cells thus obtained were analyzed by flow cytometry to examine T cell activation efficiency (as represented by CD25⁺ %, CD69⁺ % and fluorescence intensity or MFI), gene editing efficiency (αβ % and β2M %), TCDαβ depletion efficiency, and CAR expression efficiency. See Table 4 below.

[0212]

TABLE 4
Flow panels for flow cytometry.
		Unconjugated
Panel	Purpose	Antibody	Unconjugated Antibody
T cell	T cell activation status:		CD45-Pacific Blue; CD5-FITC;
activation	CD25%, CD25 mean		CD4-APC-Cy7; CD3-BV510;
panel	fluorescence intensity		CD4-APC-Cy7; CD8-Percp5.5;
	(MFI), CD69%		CD25-PE; CD69-APC; 7-AAD
CAR full	Editing outcome and	Biotin-Anti-	CD45-Pacific Blue; CD5-FITC;
panel	TCRαβ depletion	Mouse Fab'	CD4-APC-Cy7; CD8-Percp5.5;
(In-process)	efficiency:		TCRab-PE; B2M-PE-Cy7;
	αβ−%, β2M−%		Live-Dead-HV500
	and CAR+%
CAR reduced	Editing outcome:	Biotin-Anti-	CD45-Pacific Blue;
panel (Post	CAR+%	Mouse Fab'	Streptavidin-APC;
Thaw)			Live-Dead-HV500
TCR panel	Editing		CD45-Pacific Blue; CD5-FITC;
(Post thaw)	outcome:		CD4-APC-Cy7; CD8-Percp5.5;
	TCRαβ−%,		TCRab-PE; B2M-PE-Cy7; Live-
	β2M−%		Dead-HV500

[0213] Briefly, a total 0.5×10⁶ to 1×10⁶ cells were incubated in primary un-conjugated antibody for CAR full panel and CAR reduced panel at 4° C. for 20 min. Unbound antibody was removed by washing with 1 mL of staining buffer (DPBS/0.5% BSA), and then cells were incubated with 1 μg control mouse IgG in 100 μL of staining buffer at room temperature (RT) for 10 min. Then, cells were stained with conjugated antibodies (all panels) including LIVE/DEAD™ Fixable Dead Cell Stain (Thermo Fisher) (except for T cell activation panel) at 4° C. for 30 min protected from light. After incubation, cells were washed with staining buffer and resuspended in staining buffer except for T cell activation panel, which was resuspended in staining buffer containing 7-AAD.

[0214] T cells activated in the static culture vessel showed comparable or higher TCRαβ and β2M knockout efficiency, and CAR % expression as compared to T cells activated in the T-flask (FIGS. 2A-2D). Editing remained persistent over a 12-day time period in which editing efficiency was monitored (FIGS. 2A-2D). An elevated level of CAR % expression in untreated T cells (UT) on day 9 resulted from a technical issue during flow cytometry and was inconsistent with the CAR % expression measured on days 3, 6, and 12 (FIG. 2D).

[0215] T cells activated in the static culture vessel showed significantly higher fold expansion post editing compared to T cells activated in T-flasks (98.66 fold compared to 58.46 fold; FIG. 3). Fold expansion post editing of untreated T cells (84.61 fold) and mock electroporated T cells (71.77 fold) was higher than that observed for T cells activated in the T-flask (58.46 fold), but lower than that observed for T cells activated in the static culture vessel (98.66 fold) (FIG. 3).

[0216] Taken together, these results demonstrate that the identified optimal conditions for T cell activation showed similar high T cell activation efficiency in a small scale manufacturing process (represented by a static culture vessel) as compared with a control T-flask. Further, the resultant activated T cells produced in the static culture vessel showed comparable or higher editing efficiency, CAR expression efficiency, and greater cell expansion post editing compared to activated T cells manufactured in T-flasks.

[0217] This Example reports identification of optimized conditions for gene editing of T cells via electroporation, including the range of T cell concentrations for optimal CRISPR-Cas9-dependent gene editing at the TRAC and the β2M loci. In this Example, fixed concentrations of gsRNA and Cas9 were introduced into increasing T cell concentrations by electroporation, and editing efficiency was determined by flow cytometry.

Cell Concentrations of 100×10⁶ Cells/mL to 300×10⁶ Cells/mL Permits Efficient Editing

[0218] Using a fixed concentration of B2M sgRNA (B2M-1; SEQ ID NO: 6), TRAC sgRNA (TA-1, SEQ ID NO: 2) and CAS9 (SEQ ID NO: 1) at 150 μg/mL, 150 μg/mL and 300 μg/mL respectively, electroporation was performed with an increasing cell concentration (100×10⁶ cells/mL to 400×10⁶ cells/mL). Editing efficiency was monitored every three days after gene editing using flow cytometry. Concentrations in each sample are summarized in Table 5.

[0219]

TABLE 5
Cell concentrations for electroporation.
Cell	B2M-1	TA-1	CAS9
Concentration	256117	256116	E0417		Volume
(106/mL)	(μg/mL)	(μg/mL)	(μg/mL)	Cassette	(μL)
100	150	150	150	100 μL volume	100
150	150	150	150	100 μL volume	100
200	150	150	150	100 μL volume	100
300	150	150	150	100 μL volume	100
200	150	150	150	100 μL volume	50
300	150	150	150	100 μL volume	50
400	150	150	150	100 μL volume	50

[0220] At cell concentrations ranging from 100×10⁶ cells/mL to 300×10⁶ cells/mL, B2M(−) and TCR(−) subpopulations in edited cells were >80% and >98%, respectively (FIGS. 4A-4B). CAR⁺ expression was >40% when cells were electroporated at concentrations ranging from 100×10⁶ cells/mL to 300×10⁶ cells/mL (FIG. 4C). For a cell concentration of 400×10⁶ cells/mL, B2M(−) and TCR(−) subpopulations were <80% and <87%, respectively (FIGS. 4D-4E). CAR⁺ expression was also slightly reduced in cells electroporated at a density of 400×10⁶ cells/mL (FIG. 4F).

[0221] In sum, these results demonstrate that a range of cell concentration between 100×10⁶ cells/mL to 300×10⁶ cells/mL allows efficient editing at the endogenous β2M and TCR loci.

[0222] This Example reports identification of the range of MOI for optimal T cell transduction of an rAAV vector coding for a chimeric antigen receptor, leading to CAR⁺ expression in T cells. In this Example, T cells were transduced by the rAAV vector with increasing MOI, and CAR⁺ expression was quantified by flow cytometry.

[0223] In brief, cryopreserved T cells from healthy donor leukopak were thawed and activated for 48 hours. Cells were electroporated in bulk at a cell concentration of 1×10⁶ in the presence of RNP complexes comprising Cas9 and sgRNA targeting TCR (TA-1; SEQ ID NO: 2/Cas9; SEQ ID NO: 1), and Cas9 and sgRNA targeting β2M (B2M-1; SEQ ID NO: 6/Cas9; SEQ ID NO: 1), with 150 μg/mL of sgRNA and 150 μg/mL in each complex (Table 6). See also Examples 1-3 above.

[0224] Following electroporation, cells were resuspended and allowed to rest in the incubator for 20 minutes. Electroporated cells were then separated into various aliquots and transduced with increasing MOI of rAAV for 1 hour at 37° C. (Table 6). CAR⁺ expression was determined by flow cytometry after electroporation and transduction on days 3, 6, 10, and 13.

[0225]

TABLE 6
T cell transduction conditions tested.
	B2M-1	TA-1	CAS9
	256162	256161	E0417			MOI
	(μg/mL)	(μg/mL)	(μg/mL)	Cuvette	Volume	(vg/cell)
1	150	150	150	400 μL volume	400	80K
2	150	150	150	400 μL volume	400	40K
3	150	150	150	400 μL volume	400	20K
4	150	150	150	400 μL volume	400	10K
5	150	150	150	400 μL volume	400	5K
6	150	150	150	400 μL volume	400	1.25K
7	Untreated	Untreated	Untreated	NA	NA	NA

[0226] As shown in FIG. 5A, a MOI of 20K was sufficient to achieve CAR⁺ expression of at least 50% over the time period tested. CAR⁺ expression was saturated at MOIs of 10K, 20K, 40K, and 80K (FIG. 5A). Varying MOI had no effect on cell viability and cell expansion (data not shown). Differences in CAR⁺ expression were not due to inefficiencies in gene editing, as bulk electroporation was performed, and B2M and TRAC knockdown was consistent across all samples, with the exception of untreated cells (data not shown). MOIs between 1.25K and 10K appeared to correlate linearly with decreased CAR⁺ expression (FIG. 5A). Additional experiments in which T cells were incrementally transduced at MOI between OK to 23K showed a linear correlation between CAR⁺ expression and MOIs in the range of 0.12K to 4.7K (FIG. 5B).

[0227] Taken together, these results demonstrate that CAR⁺ expression was saturated in T cells transduced at an MOI between 10K and 80K, and that CAR⁺ expression was linearly correlated to MOI in T cells transduced at an MOI between 0.12K and 4.7K.

[0228] This Example reports identification of optional cell seeding densities for superior T cell expansion. In this Example, T cells were seeded at increasing densities and cell expansion was monitored over time.

[0229] In brief, cryopreserved T cells from healthy donor leukopak were thawed and activated for 48 hours. Cells were then electroporated in the presence of RNP complexes comprising Cas9 and sgRNA targeting TCR (TA-1; SEQ ID NO: 2/Cas9; SEQ ID NO: 1) and Cas9 and sgRNA targeting β2M (B2M-1; SEQ ID NO: 6/Cas9; SEQ ID NO: 1), with 150 μg/mL of sgRNA and 150 μg/mL in each complex. After electroporation, cells were transduced with the rAAV at MOI of 20,000, and then expanded in a static culture vessel. See Examples 1-4 above for details.

[0230] After editing, cells were seeded in a static culture vessel at 5×10⁴ cells/cm² (50,000), 1×10⁵ cells/cm² (100,000), 2×10⁵ cells/cm² (200,000), 3×10⁵ cells/cm² (300,000), and 5×10⁵ cells/cm² (500,000) for expansion of up to 12 days. Cell count and viability were assessed every 3 days. Fold expansion was calculated as the ratio of ending cell number and starting cell number.

[0231] As shown in FIGS. 6A-6B, cells seeded at a density of 5×10⁵ cells/cm² reached a growth plateau in 9 days. By day 12, cells seeded at a density of 3×10⁵/cm² reached cell numbers comparable to those reached by cells seeded at 5×10⁵ cells/cm² on day 9 (FIGS. 6A-6B). Cells seeded at densities of 2×10⁵ cells/cm² and 1×10⁵ cells/cm² showed modest expansion without reaching a growth plateau by day 12 (FIGS. 6A-6B). Among the tested seeding densities, the lowest levels of proliferation were observed for cells seeded at a density of 5×10⁴ cells/cm² cells (FIGS. 6A-6B). Cells seeded at a density of 1×10⁵ cells/cm² showed more robust fold expansion rate (223.4 fold) compared to cells seeded at densities of 2×10⁵ cells/cm² (185.5 fold) and 3×10⁵ cells/cm² (164.6 fold) (FIG. 6C), although they resulted in smaller total cells. Fold expansion rate for cells seeded at either 5×10⁵ cells/cm² and 5×10⁴ cells/cm² were around 100-fold (FIG. 6C).

[0232] In sum, these results demonstrate that a range of cell seeding densities between 3×10⁵ cells/cm² to 5×10⁵ cells/cm² provided efficient T cell expansion post editing.

[0233] This Example reports identification of conditions for optimal depletion of TCRαβ⁺ cells that remain after editing. CRISPR-Cas9-mediated gene-editing typically leads to an ablation of TCRαβ expression in >90% of T cells. To minimize the potential of graft versus host disease (GvHD), the remaining TCRαβ⁺ T cells may be further reduced through a TCRαβ⁺ depletion process.

[0234] In brief, cells were incubated with biotin conjugated-TCRαβ antibody and anti-biotin microbeads. After removal of excess unbound antibody and microbeads, cells were passed through a magnet column, and labeled TCRαβ⁺ cells were captured on the column. Unbound TCRαβ⁻ cells are eluted into a target bag with 0.5% HSA in PBS/EDTA buffer. Eluted cells were cultured overnight to allow cell recovery, and then harvested for drug product formulation.

[0235] Four batches of CAR-expressing T cell product were processed for TCRαβ depletion. Three batches were generated from a full scale process, and one batch (CTX110-18-01) was generated from a medium size process. Input cell number varied from 7.4×10⁹ cells to 32.0×10⁹ cells due to donor variation and expansion scale (Table 7). Post depletion cell number recovery ranged from 75% to 113.33% (Table 7). Cell number recovery of 100% or 113% may have been caused by an under estimation of input cell number (Table 7). Viability of input and output cells were above 90%, except input cells from the CTX110-18-01 batch (84.5%) (Table 7). Average percent of TCRαβ⁺ in input cells and output cells was 2.06% and 0%, respectively.

[0236]

TABLE 7
TCRαβ Depletion of Four Batches of Drug Product.
					Output Cells
Input Cells					TCRαβ+
	Cell			TCRαβ+	Cell		Cell		cell
	number	Viability		cell number	number	Viability	Recovery		number
Batch	(×109)	(%)	TCRαβ+ %	(×109)	(×109)	(%)	(%)	TCRαβ+ %	(×109)
CTX110-	7.40	84.50	1.98	0.15	6.32	93.00	85.41	0.000	0.00
18-01
CTX110-	32.00	93.50	0.71	0.23	24.00	96.00	75.00	0.000	0.00
18-02
CTX110-	8.48	93.50	2.76	0.23	9.61	97.00	113.33	0.000	0.00
18-03
CTX110-	14.30	92.00	2.78	0.40	14.40	96.00	100.70	0.003	0.00
18-04
Average	15.55	90.88	2.06	0.25	13.58	95.50	93.61	0.00	0.00

[0237] In sum, these results demonstrate efficient depletion of TCRαβ from CAR-expressing T cells in which the TRAC gene and the β2M gene has been genetically disrupted.

Overview

[0238] CTX110 is a CD19-directed T cell immunotherapy comprised of allogeneic T cells that are genetically modified ex vivo using CRISPR/Cas9 (Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR associated protein 9) gene editing components (sgRNA and Cas9 nuclease).

[0239] The modifications include targeted disruption of the TRAC and β2M genes. The disruption of the TRAC locus results in loss of expression of the T cell receptor (TCR) and is intended to reduce the probability of Graft versus Host Disease (GvHD), while the disruption of the β2M locus results in lack of expression of the major histocompatibility complex type I (MHC I) proteins and is intended to improve persistence by reducing the probability of host rejection. The addition of the anti-CD19 CAR directs the modified T cells towards CD19-expressing tumor cells.

[0240] The CAR is composed of an anti-CD19 scFv, the CD8 transmembrane domain, a CD28 co-stimulatory domain, and a CD3 signaling domain. Expression of the CTX110 CAR is driven by the EF-1α promoter.

[0241] An exemplary manufacturing process for CTX110 is depicted in FIG. 7A.

Evolution of Manufacturing Process

[0242] The CTX110 manufacturing process was performed at three production scales including research scale, development scale, and clinical scale. The Research Scale Process was performed at small scale, and the Research Scale Process was scaled up and transferred for Development Scale Process and Clinical Scale Process. Initial development campaigns (4 lots) were conducted using laboratory-grade starting materials for the drug substance for feasibility and adjustment of the operating parameters. Subsequently, use of GMP-sourced starting materials (sgRNAs, Cas9 and rAAV-138) and quantitative acceptance criteria were implemented for the Clinical Scale Process, which is operationally identical to the Development Scale Process.

Selection of the Starting Materials

[0243] The starting materials for production of CTX110 include:

• • [0244] leukopaks collected from healthy donors,
  • [0245] bacterially-derived Cas9 nuclease,
  • [0246] two single guide RNAs (sgRNA), TA-1 which targets the TRAC locus and β2M-1 which targets the β2M locus, and
  • [0247] the recombinant AAV-6 vector (rAAV-138), which encodes the anti-CD19 CAR gene.

[0248] Structure information for the components used in making the genetic modifications of CTX110, as well as edited TRAC and β2M gene loci, is provided below:

[0249]

	Amino acid sequence of Cas9
	nuclease (SEQ ID NO: 1):
	MDKKYSIGLDIGTNSVGWAVITDEYKVPSKKF
	KVLGNTDRHSIKKNLIGALLEDSGETAEATRL
	KRTARRRYTRRKNRICYLQEIFSNEMAKVDDS
	FFHRLEESFLVEEDKKHERHPIFGNIVDEVAY
	HEKYPTIYHLRKKLVDSTDKADLRLIYLALAH
	MIKFRGHFLIEGDLNPDNSDVDKLFIQLVQTY
	NQLFEENPINASGVDAKAILSARLSKSRRLEN
	LIAQLPGEKKNGLFGNLIALSLGLTPNEKSNE
	DLAEDAKLQLSKDTYDDDLDNLLAQIGDQYAD
	LFLAAKNLSDAILLSDILRVNTEITKAPLSAS
	MIKRYDEHHQDLTLLKALVRQQLPEKYKEIFF
	DQSKNGYAGYIDGGASQEEFYKFIKPILEKMD
	GTEELLVKLNREDLLRKQRTFDNGSIPHQIHL
	GELHAILRRQEDFYPFLKDNREKIEKILTFRI
	PYYVGPLARGNSRFAWMTRKSEETITPWNFEE
	VVDKGASAQSFIERMTNFDKNLPNEKVLPKHS
	LLYEYFTVYNELTKVKYVTEGMRKPAFLSGEQ
	KKAIVDLLEKTNRKVTVKQLKEDYFKKIECFD
	SVEISGVEDRFNASLGTYHDLLKIIKDKDFLD
	NEENEDILEDIVLTLTLFEDREMIEERLKTYA
	HLFDDKVMKQLKRRRYTGWGRLSRKLINGIRD
	KQSGKTILDFLKSDGFANRNFMQLIHDDSLTF
	KEDIQKAQVSGQGDSLHEHIANLAGSPAIKKG
	ILQTVKVVDELVKVMGRHKPENIVIEMARENQ
	TTQKGQKNSRERMKRIEEGIKELGSQILKEHP
	VENTQLQNEKLYLYYLQNGRDMYVDQELDINR
	LSDYDVDHIVPQSFLKDDSIDNKVLTRSDKNR
	GKSDNVPSEEVVKKMKNYWRQLLNAKLITQRK
	FDNLTKAERGGLSELDKAGFIKRQLVETRQIT
	KHVAQILDSRMNTKYDENDKLIREVKVITLKS
	KLVSDERKDFQFYKVREINNYHHAHDAYLNAV
	VGTALIKKYPKLESEFVYGDYKVYDVRKMIAK
	SEQEIGKATAKYFFYSNIMNFEKTEITLANGE
	IRKRPLIETNGETGEIVWDKGRDFATVRKVLS
	MPQVNIVKKTEVQTGGFSKESILPKRNSDKLI
	ARKKDWDPKKYGGFDSPTVAYSVLVVAKVEKG
	KSKKLKSVKELLGITIMERSSFEKNPIDFLEA
	KGYKEVKKDLIIKLPKYSLFELENGRKRMLAS
	AGELQKGNELALPSKYVNFLYLASHYEKLKGS
	PEDNEQKQLFVEQHKHYLDEIIEQISEFSKRV
	ILADANLDKVLSAYNKHRDKPIREQAENIIHL
	FTLTNLGAPAAFKYFDTTIDRKRYTSTKEVLD
	ATLIHQSITGLYETRIDLSQLGGD

[0250]

TABLE 8
sgRNA Sequences and Target Gene Sequences.
	SEQ
	ID
	NO:
sgRNA Sequences
TRAC	Modified	A*G*A*GCAACA	2
sgRNA		GUGCUGUGGCCg
(TA-1)		uuuuagagcuag
		aaauagcaaguu
		aaaauaaggcua
		guccguuaucaa
		cuugaaaaagug
		gcaccgagucgg
		ugcU*U*U*
		U
	Unmodified	AGAGCAACAGUG	3
		CUGUGGCCguuu
		uagagcuagaaa
		uagcaaguuaaa
		auaaggcuaguc
		cguuaucaacuu
		gaaaaaguggca
		ccgagucggugc
		UUUU
TRAC	Modified	A*G*A*GCAACA	4
sgRNA		GUGCUGUGGCC
spacer	Unmodified	AGAGCAACAGUG	5
		CUGUGGCC
β2M	Modified	G*C*U*ACUCUC	6
sgRNA		UCUUUCUGGCCg
(B2M-1)		uuuuagagcuag
		aaauagcaaguu
		aaaauaaggcua
		guccguuaucaa
		cuugaaaaagug
		gcaccgagucgg
		ugcU*U*U*U
	Unmodified	GCUACUCUCUCU	7
		UUCUGGCCguuu
		uagagcuagaaa
		uagcaaguuaaa
		auaaggcuaguc
		cguuaucaacuu
		gaaaaaguggca
		ccgagucggugc
		UUUU
β2M	Modified	G*C*U*ACUCUC	8
sgRNA		UCUUUCUGGCC
spacer	Unmodified	GCUACUCUCUCU	9
		UUCUGGCC
Target Sequences (PAM)
TRAC	AGAGCAACAGTG	10
sgRNA	CTGTGGCC(TGG)
TRAC	AGAGCAACAGTG	11
sgRNA	CTGTGGCC
β2M	GCTACTCTCTCTT	12
sgRNA	TCTGGCC(TGG)
β2M	CCTACTCTCTCTT	13
sgRNA	TCTGGCC
Exemplary sgRNA Formulas
sgRNA	nnnnnnnnnnnnnnnnnnnng	14
sequence	uuuuagagcuagaaauagcaa
	guuaaaauaaggcuaguccgu
	uaucaacuugaaaaaguggca
	ccgagucggugcuuuu
sgRNA	nnnnnnnnnnnnnnnnnnnng	15
sequence	uuuuagagcuagaaauagcaa
	guuaaaauaaggcuaguccgu
	uaucaacuugaaaaaguggca
	ccgagucggugc
sgRNA	n(17-30)guuuuagagcuag	16
sequence	aaauagcaaguuaaaauaagg
	cuaguccguuaucaacuugaa
	aaaguggcaccgagucggug
	cu(1-8)
*indicates a nucleotide with a 2′-O-methyl phosphorothioate modification
“n” refers to the spacer sequence at the 5′ end

[0251]

TABLE 9
Edited TRAC Gene Sequence
		Sequence (Deletions indicated	SEQ
		by dashes (-);insertions	ID
	Description	indicated by bold)	NO:
	TRAC	AA---------------------GAGC	17
	gene	AACAAATCTGACT
	edit
	TRAC	AAGAGCAACAGTGCTGT-GCCTGGAGC	18
	gene	AACAAATCTGACT
	edit
	TRAC	AAGAGCAACAGTG-------CTGGAGC	19
	gene	AACAAATCTGACT
	edit
	TRAC	AAGAGCAACAGT------GCCTGGAGC	20
	gene	AACAAATCTGACT
	edit
	TRAC	AAGAGCAACAGTG--------------	21
	gene	-------CTGACT
	edit
	TRAC	AAGAGCAACAGTGCTGTGGGCCTGGAG	22
	gene	CAACAAATCTGACT
	edit
	TRAC	AAGAGCAACAGTGC--TGGCCTGGAGC	23
	gene	AACAAATCTGACT
	edit
	TRAC	AAGAGCAACAGTGCTGTGTGCCTGGAG	24
	gene	CAACAAATCTGACT
	edit

[0252]

TABLE 10
Edited β2M Gene Sequence.
	Sequence (Deletions indicated	SEQ
	by dashes (-); insertions	ID
Description	indicated by bold)	NO:
β2M	CGTGGCCTTAGCTGTGCTCGCGCTACTCTC	25
gene-	TCTTTCT-GCCTGGAGGCTATCCAGCGTGA
edit	GTCTCTCCTACCCTCCCGCT
β2M	CGTGGCCTTAGCTGTGCTCGCGCTACTCTC	26
gene-	TCTTTC--GCCTGGAGGCTATCCAGCGTGA
edit	GTCTCTCCTACCCTCCCGCT
β2M	CGTGGCCTTAGCTGTGCTCGCGCTACTCTC	27
gene-	TCTTT-----CTGGAGGCTATCCAGCGTGA
edit	GTCTCTCCTACCCTCCCGCT
β2M	CGTGGCCTTAGCTGTGCTCGCGCTACTCTC	28
gene-	TCTTTCTGGATAGCCTGGAGGCTATCCAGC
edit	GTGAGTCTCTCCTACCCTCCCGCT
β2M	CGTGGCCTTAGCTGTGCTCGC---------	29
gene-	----------------GCTATCCAGCGTGA
edit	GTCTCTCCTACCCTCCCGCT
β2M	CGTGGCCTTAGCTGTGCTCGCGCTACTCTC	30
gene-	TCTTTCTGTGGCCTGGAGGCTATCCAGCGT
edit	GAGTCTCTCCTACCCTCCCGCT

[0253]

TABLE 11
Sequences of Anti-CD19 CAR Construct Components
Name		SEQ
Description	Sequence	ID NO:
CD8a	IYIWAPLAGTCGVLLLSLVITLY	31
transmembrane
domain
CD28 nucleotide	TCAAAGCGGAGTAGGTTGTTGCATTCCGATTACATGAATATGACT	32
sequence	CCTCGCCGGCCTGGGCCGACAAGAAAACATTACCAACCCTATGCC
	CCCCCACGAGACTTCGCTGCGTACAGGTCC
CD28 amino acid	SKRSRLLHSDYMNMTPRRPGPTRKHYQPYAPPRDFAAYRS	33
sequence
CD3-zeta	CGAGTGAAGTTTTCCCGAAGCGCAGACGCTCCGGCATATCAGCAA	34
nucleotide	GGACAGAATCAGCTGTATAACGAACTGAATTTGGGACGCCGCGAG
sequence	GAGTATGACGTGCTTGATAAACGCCGGGGGAGAGACCCGGAAATG
	GGGGGTAAACCCCGAAGAAAGAATCCCCAAGAAGGACTCTACAAT
	GAACTCCAGAAGGATAAGATGGCGGAGGCCTACTCAGAAATAGGT
	ATGAAGGGCGAACGACGACGGGGAAAAGGTCACGATGGCCTCTAC
	CAAGGGTTGAGTACGGCAACCAAAGATACGTACGATGCACTGCAT
	ATGCAGGCCCTGCCTCCCAGA
CD3-zeta amino	RVKFSRSADAPAYQQGQNQLYNELNLGRREEYDVLDKRRGRDPEM	35
acid sequence	GGKPRRKNPQEGLYNELQKDKMAEAYSEIGMKGERRRGKGHDGLY
	QGLSTATKDTYDALHMQALPPR
Anti-CD19 CAR	ATGCTTCTTTTGGTTACGTCTCTGTTGCTTTGCGAACTTCCTCAT	36
FMC63-28Z (FMC63-	CCAGCGTTCTTGCTGATCCCCGATATTCAGATGACTCAGACCACC
CD8[tm]-CD28[co-	AGTAGCTTGTCTGCCTCACTGGGAGACCGAGTAACAATCTCCTGC
stimulatory	AGGGCAAGTCAAGACATTAGCAAATACCTCAATTGGTACCAGCAG
domain]-CD3z)	AAGCCCGACGGAACGGTAAAACTCCTCATCTATCATACGTCAAGG
Nucleic Acid	TTGCATTCCGGAGTACCGTCACGATTTTCAGGTTCTGGGAGCGGA
	ACTGACTATTCCTTGACTATTTCAAACCTCGAGCAGGAGGACATT
	GCGACATATTTTTGTCAACAAGGTAATACCCTCCCTTACACTTTC
	GGAGGAGGAACCAAACTCGAAATTACCGGGTCCACCAGTGGCTCT
	GGGAAGCCTGGCAGTGGAGAAGGTTCCACTAAAGGCGAGGTGAAG
	CTCCAGGAGAGCGGCCCCGGTCTCGTTGCCCCCAGTCAAAGCCTC
	TCTGTAACGTGCACAGTGAGTGGTGTATCATTGCCTGATTATGGC
	GTCTCCTGGATAAGGCAGCCCCCGCGAAAGGGTCTTGAATGGCTT
	GGGGTAATATGGGGCTCAGAGACAACGTATTATAACTCCGCTCTC
	AAAAGTCGCTTGACGATAATAAAAGATAACTCCAAGAGTCAAGTT
	TTCCTTAAAATGAACAGTTTGCAGACTGACGATACCGCTATATAT
	TATTGTGCTAAACATTATTACTACGGCGGTAGTTACGCGATGGAT
	TATTGGGGGCAGGGGACTTCTGTCACAGTCAGTAGTGCTGCTGCC
	TTTGTCCCGGTATTTCTCCCAGCCAAACCGACCACGACTCCCGCC
	CCGCGCCCTCCGACACCCGCTCCCACCATCGCCTCTCAACCTCTT
	AGTCTTCGCCCCGAGGCATGCCGACCCGCCGCCGGGGGTGCTGTT
	CATACGAGGGGCTTGGACTTCGCTTGTGATATTTACATTTGGGCT
	CCGTTGGCGGGTACGTGCGGCGTCCTTTTGTTGTCACTCGTTATT
	ACTTTGTATTGTAATCACAGGAATCGCTCAAAGCGGAGTAGGTTG
	TTGCATTCCGATTACATGAATATGACTCCTCGCCGGCCTGGGCCG
	ACAAGAAAACATTACCAACCCTATGCCCCCCCACGAGACTTCGCT
	GCGTACAGGTCCCGAGTGAAGTTTTCCCGAAGCGCAGACGCTCCG
	GCATATCAGCAAGGACAGAATCAGCTGTATAACGAACTGAATTTG
	GGACGCCGCGAGGAGTATGACGTGCTTGATAAACGCCGGGGGAGA
	GACCCGGAAATGGGGGGTAAACCCCGAAGAAAGAATCCCCAAGAA
	GGACTCTACAATGAACTCCAGAAGGATAAGATGGCGGAGGCCTAC
	TCAGAAATAGGTATGAAGGGCGAACGACGACGGGGAAAAGGTCAC
	GATGGCCTCTACCAAGGGTTGAGTACGGCAACCAAAGATACGTAC
	GATGCACTGCATATGCAGGCCCTGCCTCCCAGA
Anti-CD19 CAR	MLLLVTSLLLCELPHPAFLLIPDIQMTQTTSSLSASLGDRVTISC	37
FMC63-28Z (FMC63-	RASQDISKYLNWYQQKPDGTVKLLIYHTSRLHSGVPSRFSGSGSG
CD8[tm]-CD28	TDYSLTISNLEQEDIATYFCQQGNTLPYTEGGGTKLEITGSTSGS
[co-stimulatory	GKPGSGEGSTKGEVKLQESGPGLVAPSQSLSVTCTVSGVSLPDYG
domain]-CD3z)	VSWIRQPPRKGLEWLGVIWGSETTYYNSALKSRLTIIKDNSKSQV
Amino Acid	FLKMNSLQTDDTAIYYCAKHYYYGGSYAMDYWGQGTSVTVSSAAA
	FVPVFLPAKPTTTPAPRPPTPAPTIASQPLSLRPEACRPAAGGAV
	HTRGLDFACDIYIWAPLAGTCGVLLLSLVITLYCNHRNRSKRSRL
	LHSDYMNMTPRRPGPTRKHYQPYAPPRDFAAYRSRVKFSRSADAP
	AYQQGQNQLYNELNLGRREEYDVLDKRRGRDPEMGGKPRRKNPQE
	GLYNELQKDKMAEAYSEIGMKGERRRGKGHDGLYQGLSTATKDTY
	DALHMQALPPR
Left ITR (5′ ITR)	CCTGCAGGCAGCTGCGCGCTCGCTCGCTCACTGAGGCCGCCCGGG	38
(alternate)	CGTCGGGCGACCTTTGGTCGCCCGGCCTCAGTGAGCGAGCGAGCG
	CGCAGAGAGGGAGTGGCCAACTCCATCACTAGGGGTTCCT
Right ITR (3′ ITR)	AGGAACCCCTAGTGATGGAGTTGGCCACTCCCTCTCTGCGCGCTC	39
(alternate)	GCTCGCTCACTGAGGCCGGGCGACCAAAGGTCGCCCGACGCCCGG
	GCTTTGCCCGGGCGGCCTCAGTGAGCGAGCGAGCGCGCAGCTGCC
	TGCAGG
TRAC-LHA (800 bp)	GAGATGTAAGGAGCTGCTGTGACTTGCTCAAGGCCTTATATCGAG	40
	TAAACGGTAGTGCTGGGGCTTAGACGCAGGTGTTCTGATTTATAG
	TTCAAAACCTCTATCAATGAGAGAGCAATCTCCTGGTAATGTGAT
	AGATTTCCCAACTTAATGCCAACATACCATAAACCTCCCATTCTG
	CTAATGCCCAGCCTAAGTTGGGGAGACCACTCCAGATTCCAAGAT
	GTACAGTTTGCTTTGCTGGGCCTTTTTCCCATGCCTGCCTTTACT
	CTGCCAGAGTTATATTGCTGGGGTTTTGAAGAAGATCCTATTAAA
	TAAAAGAATAAGCAGTATTATTAAGTAGCCCTGCATTTCAGGTTT
	COTTGAGTGGCAGGCCAGGCCTGGCCGTGAACGTTCACTGAAATC
	ATGGCCTCTTGGCCAAGATTGATAGCTTGTGCCTGTCCCTGAGTC
	CCAGTCCATCACGAGCAGCTGGTTTCTAAGATGCTATTTCCCGTA
	TAAAGCATGAGACCGTGACTTGCCAGCCCCACAGAGCCCCGCCCT
	TGTCCATCACTGGCATCTGGACTCCAGCCTGGGTTGGGGCAAAGA
	GGGAAATGAGATCATGTCCTAACCCTGATCCTCTTGTCCCACAGA
	TATCCAGAACCCTGACCCTGCCGTGTACCAGCTGAGAGACTCTAA
	ATCCAGTGACAAGTCTGTCTGCCTATTCACCGATTTTGATTOTCA
	AACAAATGTGTCACAAAGTAAGGATTCTGATGTGTATATCACAGA
	CAAAACTGTGCTAGACATGAGGTCTATGGACTTCA
TRAC-RHA (800 bp)	TGGAGCAACAAATCTGACTTTGCATGTGCAAACGCCTTCAACAAC	41
	AGCATTATTCCAGAAGACACCTTCTTCCCCAGCCCAGGTAAGGGC
	AGCTTTGGTGCCTTCGCAGGCTGTTTCCTTGCTTCAGGAATGGCC
	AGGTTCTGCCCAGAGCTCTGGTCAATGATGTCTAAAACTCCTCTG
	ATTGGTGGTCTCGGCCTTATCCATTGCCACCAAAACCCTCTTTTT
	ACTAAGAAACAGTGAGCCTTGTTCTGGCAGTCCAGAGAATGACAC
	GGGAAAAAAGCAGATGAAGAGAAGGTGGCAGGAGAGGGCACGTGG
	CCCAGCCTCAGTCTCTCCAACTGAGTTCCTGCCTGCCTGCCTTTG
	CTCAGACTGTTTGCCCCTTACTGCTCTTCTAGGCCTCATTCTAAG
	CCCCTTCTCCAAGTTGCCTCTCCTTATTTCTCCCTGTCTGCCAAA
	AAATCTTTCCCAGCTCACTAAGTCAGTCTCACGCAGTCACTCATT
	AACCCACCAATCACTGATTGTGCCGGCACATGAATGCACCAGGTG
	TTGAAGTGGAGGAATTAAAAAGTCAGATGAGGGGTGTGCCCAGAG
	GAAGCACCATTCTAGTTGGGGGAGCCCATCTGTCAGCTGGGAAAA
	GTCCAAATAACTTCAGATTGGAATGTGTTTTAACTCAGGGTTGAG
	AAAACAGCTACCTTCAGGACAAAAGTCAGGGAAGGGCTCTCTGAA
	GAAATGCTACTTGAAGATACCAGCCCTACCAAGGGCAGGGAGAGG
	ACCCTATAGAGGCCTGGGACAGGAGCTCAATGAGAAAGG
EF1α	GGCTCCGGTGCCCGTCAGTGGGCAGAGCGCACATCGCCCACAGTC	42
	CCCGAGAAGTTGGGGGGAGGGGTCGGCAATTGAACCGGTGCCTAG
	AGAAGGTGGCGCGGGGTAAACTGGGAAAGTGATGTCGTGTACTGG
	CTCCGCCTTTTTCCCGAGGGTGGGGGAGAACCGTATATAAGTGCA
	GTAGTCGCCGTGAACGTTCTTTTTCGCAACGGGTTTGCCGCCAGA
	ACACAGGTAAGTGCCGTGTGTGGTTCCCGCGGGCCTGGCCTCTTT
	ACGGGTTATGGCCCTTGCGTGCCTTGAATTACTTCCACTGGCTGC
	AGTACGTGATTCTTGATCCCGAGCTTCGGGTTGGAAGTGGGTGGG
	AGAGTTCGAGGCCTTGCGCTTAAGGAGCCCCTTCGCCTCGTGCTT
	GAGTTGAGGCCTGGCCTGGGCGCTGGGGCCGCCGCGTGCGAATCT
	GGTGGCACCTTCGCGCCTGTCTCGCTGCTTTCGATAAGTCTCTAG
	CCATTTAAAATTTTTGATGACCTGCTGCGACGCTTTTTTTCTGGC
	AAGATAGTCTTGTAAATGCGGGCCAAGATCTGCACACTGGTATTT
	CGGTTTTTGGGGCCGCGGGCGGCGACGGGGCCCGTGCGTCCCAGC
	GCACATGTTCGGCGAGGCGGGGCCTGCGAGCGCGGCCACCGAGAA
	TCGGACGGGGGTAGTCTCAAGCTGGCCGGCCTGCTCTGGTGCCTG
	GCCTCGCGCCGCCGTGTATCGCCCCGCCCTGGGCGGCAAGGCTGG
	CCCGGTCGGCACCAGTTGCGTGAGCGGAAAGATGGCCGCTTCCCG
	GCCCTGCTGCAGGGAGCTCAAAATGGAGGACGCGGCGCTCGGGAG
	AGCGGGCGGGTGAGTCACCCACACAAAGGAAAAGGGCCTTTCCGT
	CCTCAGCCGTCGCTTCATGTGACTCCACGGAGTACCGGGCGCCGT
	CCAGGCACCTCGATTAGTTCTCGAGCTTTTGGAGTACGTCGTCTT
	TAGGTTGGGGGGAGGGGTTTTATGCGATGGAGTTTCCCCACACTG
	AGTGGGTGGAGACTGAAGTTAGGCCAGCTTGGCACTTGATGTAAT
	TCTCCTTGGAATTTGCCCTTTTTGAGTTTGGATCTTGGTTCATTC
	TCAAGCCTCAGACAGTGGTTCAAAGTTTTTTTCTTCCATTTCAGG
	TGTCGTGA
GM-CSF signal	ATGCTTCTTTTGGTTACGTCTCTGTTGCTTTGCGAACTTCCTCAT	43
peptide	CCAGCGTTCTTGCTGATCCCC
GM-CSF signal	MLLLVTSLLLCELPHPAFLLIP	44
peptide
Anti-CD19 scFv	GATATTCAGATGACTCAGACCACCAGTAGCTTGTCTGCCTCACTG	45
	GGAGACCGAGTAACAATCTCCTGCAGGGCAAGTCAAGACATTAGC
	AAATACCTCAATTGGTACCAGCAGAAGCCCGACGGAACGGTAAAA
	CTCCTCATCTATCATACGTCAAGGTTGCATTCCGGAGTACCGTCA
	CGATTTTCAGGTTCTGGGAGCGGAACTGACTATTCCTTGACTATT
	TCAAACCTCGAGCAGGAGGACATTGCGACATATTTTTGTCAACAA
	GGTAATACCCTCCCTTACACTTTCGGAGGAGGAACCAAACTCGAA
	ATTACCGGGTCCACCAGTGGCTCTGGGAAGCCTGGCAGTGGAGAA
	GGTTCCACTAAAGGCGAGGTGAAGCTCCAGGAGAGCGGCCCCGGT
	CTCGTTGCCCCCAGTCAAAGCCTCTCTGTAACGTGCACAGTGAGT
	GGTGTATCATTGCCTGATTATGGCGTCTCCTGGATAAGGCAGCCC
	CCGCGAAAGGGTCTTGAATGGCTTGGGGTAATATGGGGCTCAGAG
	ACAACGTATTATAACTCCGCTCTCAAAAGTCGCTTGACGATAATA
	AAAGATAACTCCAAGAGTCAAGTTTTCCTTAAAATGAACAGTTTG
	CAGACTGACGATACCGCTATATATTATTGTGCTAAACATTATTAC
	TACGGCGGTAGTTACGCGATGGATTATTGGGGGCAGGGGACTTCT
	GTCACAGTCAGTAGT
CD19 scFv amino	DIQMTQTTSSLSASLGDRVTISCRASQDISKYLNWYQQKPDGTVK	46
acid sequence	LLIYHTSRLHSGVPSRFSGSGSGTDYSLTISNLEQEDIATYFCQQ
Linker underlined	GNTLPYTFGGGTKLEITGSTSGSGKPGSGEGSTKGEVKLQESGPG
	LVAPSQSLSVTCTVSGVSLPDYGVSWIRQPPRKGLEWLGVIWGSE
	TTYYNSALKSRLTIIKDNSKSQVFLKMNSLQTDDTAIYYCAKHYY
	YGGSYAMDYWGQGTSVTVSS
CD8a	GCTGCTGCCTTTGTCCCGGTATTTCTCCCAGCCAAACCGACCACG	47
extracellular +	ACTCCCGCCCCGCGCCCTCCGACACCCGCTCCCACCATCGCCTCT
CD8a	CAACCTCTTAGTCTTCGCCCCGAGGCATGCCGACCCGCCGCCGGG
transmembrane +	GGTGCTGTTCATACGAGGGGCTTGGACTTCGCTTGTGATATTTAC
5′ Linker	ATTTGGGCTCCGTTGGCGGGTACGTGCGGCGTCCTTTTGTTGTCA
(underlined)	CTCGTTATTACTTTGTATTGTAATCACAGGAATCGC
CD8a	TTTGTCCCGGTATTTCTCCCAGCCAAACCGACCACGACTCCCGCC	48
extracellular +	CCGCGCCCTCCGACACCCGCTCCCACCATCGCCTCTCAACCTCTT
CD8a	AGTCTTCGCCCCGAGGCATGCCGACCCGCCGCCGGGGGTGCTGTT
transmembrane	CATACGAGGGGCTTGGACTTCGCTTGTGATATTTACATTTGGGCT
(without linker)	CCGTTGGCGGGTACGTGCGGCGTCCTTTTGTTGTCACTCGTTATT
	ACTTTGTATTGTAATCACAGGAATCGC
CD8a	FVPVFLPAKPTTTPAPRPPTPAPTIASQPLSLRPEACRPAAGGAV	49
extracellular +	HTRGLDFACDIYIWAPLAGTCGVLLLSLVITLYCNHRNR
CD8a
transmembrane
CD19 VH	EVKLQESGPGLVAPSQSLSVTCTVSGVSLPDYGVSWIRQPPRKGL	50
	EWLGVIWGSETTYYNSALKSRLTIIKDNSKSQVFLKMNSLQTDDT
	AIYYCAKHYYYGGSYAMDYWGQGTSVTVSS
CD19 VL	DIQMTQTTSSLSASLGDRVTISCRASQDISKYLNWYQQKPDGTVK	51
	LLIYHTSRLHSGVPSRFSGSGSGTDYSLTISNLEQEDIATYFCQQ
	GNTLPYTFGGGTKLEIT
CD19 linker	GSTSGSGKPGSGEGSTKG	52
rAAV	CCTGCAGGCAGCTGCGCGCTCGCTCGCTCACTGAGGCCGCCCGGG	53
	CGTCGGGCGACCTTTGGTCGCCCGGCCTCAGTGAGCGAGCGAGCG
	CGCAGAGAGGGAGTGGCCAACTCCATCACTAGGGGTTCCTGCGGC
	CGCACGCGTGAGATGTAAGGAGCTGCTGTGACTTGCTCAAGGCCT
	TATATCGAGTAAACGGTAGTGCTGGGGCTTAGACGCAGGTGTTCT
	GATTTATAGTTCAAAACCTCTATCAATGAGAGAGCAATCTCCTGG
	TAATGTGATAGATTTCCCAACTTAATGCCAACATACCATAAACCT
	CCCATTCTGCTAATGCCCAGCCTAAGTTGGGGAGACCACTCCAGA
	TTCCAAGATGTACAGTTTGCTTTGCTGGGCCTTTTTCCCATGCCT
	GCCTTTACTCTGCCAGAGTTATATTGCTGGGGTTTTGAAGAAGAT
	CCTATTAAATAAAAGAATAAGCAGTATTATTAAGTAGCCCTGCAT
	TTCAGGTTTCCTTGAGTGGCAGGCCAGGCCTGGCCGTGAACGTTC
	ACTGAAATCATGGCCTCTTGGCCAAGATTGATAGCTTGTGCCTGT
	CCCTGAGTCCCAGTCCATCACGAGCAGCTGGTTTCTAAGATGCTA
	TTTCCCGTATAAAGCATGAGACCGTGACTTGCCAGCCCCACAGAG
	CCCCGCCCTTGTCCATCACTGGCATCTGGACTCCAGCCTGGGTTG
	GGGCAAAGAGGGAAATGAGATCATGTCCTAACCCTGATCCTCTTG
	TCCCACAGATATCCAGAACCCTGACCCTGCCGTGTACCAGCTGAG
	AGACTCTAAATCCAGTGACAAGTCTGTCTGCCTATTCACCGATTT
	TGATTCTCAAACAAATGTGTCACAAAGTAAGGATTCTGATGTGTA
	TATCACAGACAAAACTGTGCTAGACATGAGGTCTATGGACTTCAG
	GCTCCGGTGCCCGTCAGTGGGCAGAGCGCACATCGCCCACAGTCC
	CCGAGAAGTTGGGGGGAGGGGTCGGCAATTGAACCGGTGCCTAGA
	GAAGGTGGCGCGGGGTAAACTGGGAAAGTGATGTCGTGTACTGGC
	TCCGCCTTTTTCCCGAGGGTGGGGGAGAACCGTATATAAGTGCAG
	TAGTCGCCGTGAACGTTCTTTTTCGCAACGGGTTTGCCGCCAGAA
	CACAGGTAAGTGCCGTGTGTGGTTCCCGCGGGCCTGGCCTCTTTA
	CGGGTTATGGCCCTTGCGTGCCTTGAATTACTTCCACTGGCTGCA
	GTACGTGATTCTTGATCCCGAGCTTCGGGTTGGAAGTGGGTGGGA
	GAGTTCGAGGCCTTGCGCTTAAGGAGCCCCTTCGCCTCGTGCTTG
	AGTTGAGGCCTGGCCTGGGCGCTGGGGCCGCCGCGTGCGAATCTG
	GTGGCACCTTCGCGCCTGTCTCGCTGCTTTCGATAAGTCTCTAGC
	CATTTAAAATTTTTGATGACCTGCTGCGACGCTTTTTTTCTGGCA
	AGATAGTCTTGTAAATGCGGGCCAAGATCTGCACACTGGTATTTC
	GGTTTTTGGGGCCGCGGGCGGCGACGGGGCCCGTGCGTCCCAGCG
	CACATGTTCGGCGAGGCGGGGCCTGCGAGCGCGGCCACCGAGAAT
	CGGACGGGGGTAGTCTCAAGCTGGCCGGCCTGCTCTGGTGCCTGG
	CCTCGCGCCGCCGTGTATCGCCCCGCCCTGGGCGGCAAGGCTGGC
	CCGGTCGGCACCAGTTGCGTGAGCGGAAAGATGGCCGCTTCCCGG
	CCCTGCTGCAGGGAGCTCAAAATGGAGGACGCGGCGCTCGGGAGA
	GCGGGCGGGTGAGTCACCCACACAAAGGAAAAGGGCCTTTCCGTC
	CTCAGCCGTCGCTTCATGTGACTCCACGGAGTACCGGGCGCCGTC
	CAGGCACCTCGATTAGTTCTCGAGCTTTTGGAGTACGTCGTCTTT
	AGGTTGGGGGGAGGGGTTTTATGCGATGGAGTTTCCCCACACTGA
	GTGGGTGGAGACTGAAGTTAGGCCAGCTTGGCACTTGATGTAATT
	CTCCTTGGAATTTGCCCTTTTTGAGTTTGGATCTTGGTTCATTCT
	CAAGCCTCAGACAGTGGTTCAAAGTTTTTTTCTTCCATTTCAGGT
	GTCGTGACCACCATGCTTCTTTTGGTTACGTCTCTGTTGCTTTGC
	GAACTTCCTCATCCAGCGTTCTTGCTGATCCCCGATATTCAGATG
	ACTCAGACCACCAGTAGCTTGTCTGCCTCACTGGGAGACCGAGTA
	ACAATCTCCTGCAGGGCAAGTCAAGACATTAGCAAATACCTCAAT
	TGGTACCAGCAGAAGCCCGACGGAACGGTAAAACTCCTCATCTAT
	CATACGTCAAGGTTGCATTCCGGAGTACCGTCACGATTTTCAGGT
	TCTGGGAGCGGAACTGACTATTCCTTGACTATTTCAAACCTCGAG
	CAGGAGGACATTGCGACATATTTTTGTCAACAAGGTAATACCCTC
	CCTTACACTTTCGGAGGAGGAACCAAACTCGAAATTACCGGGTCC
	ACCAGTGGCTCTGGGAAGCCTGGCAGTGGAGAAGGTTCCACTAAA
	GGCGAGGTGAAGCTCCAGGAGAGCGGCCCCGGTCTCGTTGCCCCC
	AGTCAAAGCCTCTCTGTAACGTGCACAGTGAGTGGTGTATCATTG
	CCTGATTATGGCGTCTCCTGGATAAGGCAGCCCCCGCGAAAGGGT
	CTTGAATGGCTTGGGGTAATATGGGGCTCAGAGACAACGTATTAT
	AACTCCGCTCTCAAAAGTCGCTTGACGATAATAAAAGATAACTCC
	AAGAGTCAAGTTTTCCTTAAAATGAACAGTTTGCAGACTGACGAT
	ACCGCTATATATTATTGTGCTAAACATTATTACTACGGCGGTAGT
	TACGCGATGGATTATTGGGGGCAGGGGACTTCTGTCACAGTCAGT
	AGTGCTGCTGCCTTTGTCCCGGTATTTCTCCCAGCCAAACCGACC
	ACGACTCCCGCCCCGCGCCCTCCGACACCCGCTCCCACCATCGCC
	TCTCAACCTCTTAGTCTTCGCCCCGAGGCATGCCGACCCGCCGCC
	GGGGGTGCTGTTCATACGAGGGGCTTGGACTTCGCTTGTGATATT
	TACATTTGGGCTCCGTTGGCGGGTACGTGCGGCGTCCTTTTGTTG
	TCACTCGTTATTACTTTGTATTGTAATCACAGGAATCGCTCAAAG
	CGGAGTAGGTTGTTGCATTCCGATTACATGAATATGACTCCTCGC
	CGGCCTGGGCCGACAAGAAAACATTACCAACCCTATGCCCCCCCA
	CGAGACTTCGCTGCGTACAGGTCCCGAGTGAAGTTTTCCCGAAGC
	GCAGACGCTCCGGCATATCAGCAAGGACAGAATCAGCTGTATAAC
	GAACTGAATTTGGGACGCCGCGAGGAGTATGACGTGCTTGATAAA
	CGCCGGGGGAGAGACCCGGAAATGGGGGGTAAACCCCGAAGAAAG
	AATCCCCAAGAAGGACTCTACAATGAACTCCAGAAGGATAAGATG
	GCGGAGGCCTACTCAGAAATAGGTATGAAGGGCGAACGACGACGG
	GGAAAAGGTCACGATGGCCTCTACCAAGGGTTGAGTACGGCAACC
	AAAGATACGTACGATGCACTGCATATGCAGGCCCTGCCTCCCAGA
	TAATAATAAAATCGCTATCCATCGAAGATGGATGTGTGTTGGTTT
	TTTGTGTGTGGAGCAACAAATCTGACTTTGCATGTGCAAACGCCT
	TCAACAACAGCATTATTCCAGAAGACACCTTCTTCCCCAGCCCAG
	GTAAGGGCAGCTTTGGTGCCTTCGCAGGCTGTTTCCTTGCTTCAG
	GAATGGCCAGGTTCTGCCCAGAGCTCTGGTCAATGATGTCTAAAA
	CTCCTCTGATTGGTGGTCTCGGCCTTATCCATTGCCACCAAAACC
	CTCTTTTTACTAAGAAACAGTGAGCCTTGTTCTGGCAGTCCAGAG
	AATGACACGGGAAAAAAGCAGATGAAGAGAAGGTGGCAGGAGAGG
	GCACGTGGCCCAGCCTCAGTCTCTCCAACTGAGTTCCTGCCTGCC
	TGCCTTTGCTCAGACTGTTTGCCCCTTACTGCTCTTCTAGGCCTC
	ATTCTAAGCCCCTTCTCCAAGTTGCCTCTCCTTATTTCTCCCTGT
	CTGCCAAAAAATCTTTCCCAGCTCACTAAGTCAGTCTCACGCAGT
	CACTCATTAACCCACCAATCACTGATTGTGCCGGCACATGAATGC
	ACCAGGTGTTGAAGTGGAGGAATTAAAAAGTCAGATGAGGGGTGT
	GCCCAGAGGAAGCACCATTCTAGTTGGGGGAGCCCATCTGTCAGC
	TGGGAAAAGTCCAAATAACTTCAGATTGGAATGTGTTTTAACTCA
	GGGTTGAGAAAACAGCTACCTTCAGGACAAAAGTCAGGGAAGGGC
	TCTCTGAAGAAATGCTACTTGAAGATACCAGCCCTACCAAGGGCA
	GGGAGAGGACCCTATAGAGGCCTGGGACAGGAGCTCAATGAGAAA
	GGTAACCACGTGCGGACCGAGGCTGCAGCGTCGTCCTCCCTAGGA
	ACCCCTAGTGATGGAGTTGGCCACTCCCTCTCTGCGCGCTCGCTC
	GCTCACTGAGGCCGGGCGACCAAAGGTCGCCCGACGCCCGGGCTT
	TGCCCGGGCGGCCTCAGTGAGCGAGCGAGCGCGCAGCTGCCTGCA
	GG
LHA to RHA	GAGATGTAAGGAGCTGCTGTGACTTGCTCAAGGCCTTATATCGAG	54
	TAAACGGTAGTGCTGGGGCTTAGACGCAGGTGTTCTGATTTATAG
	TTCAAAACCTCTATCAATGAGAGAGCAATCTCCTGGTAATGTGAT
	AGATTTCCCAACTTAATGCCAACATACCATAAACCTCCCATTCTG
	CTAATGCCCAGCCTAAGTTGGGGAGACCACTCCAGATTCCAAGAT
	GTACAGTTTGCTTTGCTGGGCCTTTTTCCCATGCCTGCCTTTACT
	CTGCCAGAGTTATATTGCTGGGGTTTTGAAGAAGATCCTATTAAA
	TAAAAGAATAAGCAGTATTATTAAGTAGCCCTGCATTTCAGGTTT
	CCTTGAGTGGCAGGCCAGGCCTGGCCGTGAACGTTCACTGAAATC
	ATGGCCTCTTGGCCAAGATTGATAGCTTGTGCCTGTCCCTGAGTC
	CCAGTCCATCACGAGCAGCTGGTTTCTAAGATGCTATTTCCCGTA
	TAAAGCATGAGACCGTGACTTGCCAGCCCCACAGAGCCCCGCCCT
	TGTCCATCACTGGCATCTGGACTCCAGCCTGGGTTGGGGCAAAGA
	GGGAAATGAGATCATGTCCTAACCCTGATCCTCTTGTCCCACAGA
	TATCCAGAACCCTGACCCTGCCGTGTACCAGCTGAGAGACTCTAA
	ATCCAGTGACAAGTCTGTCTGCCTATTCACCGATTTTGATTCTCA
	AACAAATGTGTCACAAAGTAAGGATTCTGATGTGTATATCACAGA
	CAAAACTGTGCTAGACATGAGGTCTATGGACTTCAGGCTCCGGTG
	CCCGTCAGTGGGCAGAGCGCACATCGCCCACAGTCCCCGAGAAGT
	TGGGGGGAGGGGTCGGCAATTGAACCGGTGCCTAGAGAAGGTGGC
	GCGGGGTAAACTGGGAAAGTGATGTCGTGTACTGGCTCCGCCTTT
	TTCCCGAGGGTGGGGGAGAACCGTATATAAGTGCAGTAGTCGCCG
	TGAACGTTCTTTTTCGCAACGGGTTTGCCGCCAGAACACAGGTAA
	GTGCCGTGTGTGGTTCCCGCGGGCCTGGCCTCTTTACGGGTTATG
	GCCCTTGCGTGCCTTGAATTACTTCCACTGGCTGCAGTACGTGAT
	TCTTGATCCCGAGCTTCGGGTTGGAAGTGGGTGGGAGAGTTCGAG
	GCCTTGCGCTTAAGGAGCCCCTTCGCCTCGTGCTTGAGTTGAGGC
	CTGGCCTGGGCGCTGGGGCCGCCGCGTGCGAATCTGGTGGCACCT
	TCGCGCCTGTCTCGCTGCTTTCGATAAGTCTCTAGCCATTTAAAA
	TTTTTGATGACCTGCTGCGACGCTTTTTTTCTGGCAAGATAGTCT
	TGTAAATGCGGGCCAAGATCTGCACACTGGTATTTCGGTTTTTGG
	GGCCGCGGGCGGCGACGGGGCCCGTGCGTCCCAGCGCACATGTTC
	GGCGAGGCGGGGCCTGCGAGCGCGGCCACCGAGAATCGGACGGGG
	GTAGTCTCAAGCTGGCCGGCCTGCTCTGGTGCCTGGCCTCGCGCC
	GCCGTGTATCGCCCCGCCCTGGGCGGCAAGGCTGGCCCGGTCGGC
	ACCAGTTGCGTGAGCGGAAAGATGGCCGCTTCCCGGCCCTGCTGC
	AGGGAGCTCAAAATGGAGGACGCGGCGCTCGGGAGAGCGGGCGGG
	TGAGTCACCCACACAAAGGAAAAGGGCCTTTCCGTCCTCAGCCGT
	CGCTTCATGTGACTCCACGGAGTACCGGGCGCCGTCCAGGCACCT
	CGATTAGTTCTCGAGCTTTTGGAGTACGTCGTCTTTAGGTTGGGG
	GGAGGGGTTTTATGCGATGGAGTTTCCCCACACTGAGTGGGTGGA
	GACTGAAGTTAGGCCAGCTTGGCACTTGATGTAATTCTCCTTGGA
	ATTTGCCCTTTTTGAGTTTGGATCTTGGTTCATTCTCAAGCCTCA
	GACAGTGGTTCAAAGTTTTTTTCTTCCATTTCAGGTGTCGTGACC
	ACCATGCTTCTTTTGGTTACGTCTCTGTTGCTTTGCGAACTTCCT
	CATCCAGCGTTCTTGCTGATCCCCGATATTCAGATGACTCAGACC
	ACCAGTAGCTTGTCTGCCTCACTGGGAGACCGAGTAACAATCTCC
	TGCAGGGCAAGTCAAGACATTAGCAAATACCTCAATTGGTACCAG
	CAGAAGCCCGACGGAACGGTAAAACTCCTCATCTATCATACGTCA
	AGGTTGCATTCCGGAGTACCGTCACGATTTTCAGGTTCTGGGAGC
	GGAACTGACTATTCCTTGACTATTTCAAACCTCGAGCAGGAGGAC
	ATTGCGACATATTTTTGTCAACAAGGTAATACCCTCCCTTACACT
	TTCGGAGGAGGAACCAAACTCGAAATTACCGGGTCCACCAGTGGC
	TCTGGGAAGCCTGGCAGTGGAGAAGGTTCCACTAAAGGCGAGGTG
	AAGCTCCAGGAGAGCGGCCCCGGTCTCGTTGCCCCCAGTCAAAGC
	CTCTCTGTAACGTGCACAGTGAGTGGTGTATCATTGCCTGATTAT
	GGCGTCTCCTGGATAAGGCAGCCCCCGCGAAAGGGTCTTGAATGG
	CTTGGGGTAATATGGGGCTCAGAGACAACGTATTATAACTCCGCT
	CTCAAAAGTCGCTTGACGATAATAAAAGATAACTCCAAGAGTCAA
	GTTTTCCTTAAAATGAACAGTTTGCAGACTGACGATACCGCTATA
	TATTATTGTGCTAAACATTATTACTACGGCGGTAGTTACGCGATG
	GATTATTGGGGGCAGGGGACTTCTGTCACAGTCAGTAGTGCTGCT
	GCCTTTGTCCCGGTATTTCTCCCAGCCAAACCGACCACGACTCCC
	GCCCCGCGCCCTCCGACACCCGCTCCCACCATCGCCTCTCAACCT
	CTTAGTCTTCGCCCCGAGGCATGCCGACCCGCCGCCGGGGGTGCT
	GTTCATACGAGGGGCTTGGACTTCGCTTGTGATATTTACATTTGG
	GCTCCGTTGGCGGGTACGTGCGGCGTCCTTTTGTTGTCACTCGTT
	ATTACTTTGTATTGTAATCACAGGAATCGCTCAAAGCGGAGTAGG
	TTGTTGCATTCCGATTACATGAATATGACTCCTCGCCGGCCTGGG
	CCGACAAGAAAACATTACCAACCCTATGCCCCCCCACGAGACTTC
	GCTGCGTACAGGTCCCGAGTGAAGTTTTCCCGAAGCGCAGACGCT
	CCGGCATATCAGCAAGGACAGAATCAGCTGTATAACGAACTGAAT
	TTGGGACGCCGCGAGGAGTATGACGTGCTTGATAAACGCCGGGGG
	AGAGACCCGGAAATGGGGGGTAAACCCCGAAGAAAGAATCCCCAA
	GAAGGACTCTACAATGAACTCCAGAAGGATAAGATGGCGGAGGCC
	TACTCAGAAATAGGTATGAAGGGCGAACGACGACGGGGAAAAGGT
	CACGATGGCCTCTACCAAGGGTTGAGTACGGCAACCAAAGATACG
	TACGATGCACTGCATATGCAGGCCCTGCCTCCCAGATAATAATAA
	AATCGCTATCCATCGAAGATGGATGTGTGTTGGTTTTTTGTGTGT
	GGAGCAACAAATCTGACTTTGCATGTGCAAACGCCTTCAACAACA
	GCATTATTCCAGAAGACACCTTCTTCCCCAGCCCAGGTAAGGGCA
	GCTTTGGTGCCTTCGCAGGCTGTTTCCTTGCTTCAGGAATGGCCA
	GGTTCTGCCCAGAGCTCTGGTCAATGATGTCTAAAACTCCTCTGA
	TTGGTGGTCTCGGCCTTATCCATTGCCACCAAAACCCTCTTTTTA
	CTAAGAAACAGTGAGCCTTGTTCTGGCAGTCCAGAGAATGACACG
	GGAAAAAAGCAGATGAAGAGAAGGTGGCAGGAGAGGGCACGTGGC
	CCAGCCTCAGTCTCTCCAACTGAGTTCCTGCCTGCCTGCCTTTGC
	TCAGACTGTTTGCCCCTTACTGCTCTTCTAGGCCTCATTCTAAGC
	CCCTTCTCCAAGTTGCCTCTCCTTATTTCTCCCTGTCTGCCAAAA
	AATCTTTCCCAGCTCACTAAGTCAGTCTCACGCAGTCACTCATTA
	ACCCACCAATCACTGATTGTGCCGGCACATGAATGCACCAGGTGT
	TGAAGTGGAGGAATTAAAAAGTCAGATGAGGGGTGTGCCCAGAGG
	AAGCACCATTCTAGTTGGGGGAGCCCATCTGTCAGCTGGGAAAAG
	TCCAAATAACTTCAGATTGGAATGTGTTTTAACTCAGGGTTGAGA
	AAACAGCTACCTTCAGGACAAAAGTCAGGGAAGGGCTCTCTGAAG
	AAATGCTACTTGAAGATACCAGCCCTACCAAGGGCAGGGAGAGGA
	CCCTATAGAGGCCTGGGACAGGAGCTCAATGAGAAAGG

(i) Cell Editing Performance Across Healthy Donors

[0254] T cells from healthy donors (male, n=10) were isolated from leukopaks and frozen in cryotubes. Editing efficiency was evaluated on thawed cells of each donor using the following concentrations of the gene-editing components: Cas9 (300 μg/mL), TA-1 (75 μg/mL), and B2M-1 (150 μg/mL and 200 μg/mL).

[0255] Greater than 40% of the edited cells from all donors expressed CAR. β2M and TRAC knockout rates were greater than 80% and 95% of the total cell population, respectively (Table 12). All of the T cell isolations across donors were deemed acceptable for CTX110 manufacturing, indicating a robust production process.

[0256]

TABLE 12
Editing Outcomes across 10 Male Donors.
Donor	Blood Type	Age	BMI	% TCRαβ−	% B2M−	% CAR+	Fold Expansion
TA-1 = 75 μg/mL, B2M-1 = 150 μg/mL, Cas9 = 300 μg/mL
1	A+	49	40.1	99.00	89.00	46.30	13.41
2	A+	28	42.6	99.99	95.00	68.20	62.64
3	A+	36	29	99.00	85.00	66.30	63.00
4	A+	33	24	99.96	91.00	53.10	42.16
TA-1 = 75 μg/mL, B2M-1 = 200 μg/mL, Cas9 = 300 μg/mL
40	A−	19	25.2	95.00	82.33	49.00	53.57
41	A+	31	24	98.00	86.33	59.67	76.07
43	O+	29	25.7	96.00	81.67	59.00	69.83
A	O+	23	24.4	98.00	86.67	63.00	63.53
44	O+	30	26.5	98.00	83.00	60.00	76.37
45	A+	35	27.2	97.00	84.33	62.00	59.40
Average	98.00	86.43	58.66	58.00
SD	1.54	3.98	6.78	17.72
% CV	1.57	4.61	11.55	30.56
Abbreviations.
B2M = β2 microglobulin, BMI = Body mass index, CAR = Chimeric antigen receptor, CV = Coefficient of variation, SD = Standard deviation, TCRαβ = T cell receptor alpha chain + T cell receptor beta chain.

(ii) Cas9 Nuclease

[0257] The Cas9 nuclease of SEQ ID NO:1 was used in this Example. The results, summarized in Table 14 below, indicate that similar levels of TCRαβ⁻ and B2M⁻ cells were present, as well as double-negative cells.

(iii) rAAV-138 Vector

[0258] rAAV-138 vector as disclosed above was used for evaluation of the impact of MOI to achieve desired CAR⁺ expression. Cells were transduced with increasing MOI and CAR⁺ expression was quantified. See Example 4 above. The data, presented in FIG. 7B, support the selection of a MOI of 20,000.

[0259] For scale-up development, a study was conducted to verify the suitability of the selected MOI with the starting materials noted above. Cells were transduced at MOIs ranging from 0 to 23,000. After electroporation and viral infection followed by 11 days of expansion, CAR⁺ expression was quantified by flow cytometry. The results are presented in FIG. 7C. CAR⁺ expression, which is AAV dose-dependent, ranged from 2.1% CAR+ at MOI of 0 to 56.2% CAR⁺ at MOI of 23,000. CAR⁺ expression saturated at MOI of 4,700.

[0260] CAR expression for cells infected with the GMP rAAV-138 (MOI of 23,000) was comparable to that obtained with the non-GMP vector (MOI of 20,000), 56.2% and 55.4%, respectively. The MOI of 20,000 was selected for scale-up manufacture.

(iv) In Situ Formation of the Ribonucleoprotein Complex (RNP)

[0261] Using a fixed concentration of cells, electroporation was performed with increasing concentrations of RNP complexes formed by incubation of Cas9 (SEQ ID NO: 1) with a sgRNA targeting TCR (TA-1, SEQ ID NO: 2) and a sgRNA targeting β2M (B2M-1; SEQ ID NO 6). In situ formation of the TA-1/Cas9 and β2M/Cas9 complexes was evaluated using a final combined concentration of 300 μg/mL Cas9 nuclease (equivalent to a final concentration of 150 μg/mL Cas9 nuclease combined with each guide). Final concentrations of TA-1 and B2M-1 varied from 37.5 μg/mL to 300 μg/mL.

[0262] As shown in FIG. 7D, TA-1 sgRNA concentrations from 37.5 μg/mL to 75 μg/mL resulted in higher editing of TCRαβ. TA-1 sgRNA concentrations from 150 μg/mL or 300 μg/mL did not provide additional editing of TCRαβ, and decreased editing of B2M. Among the concentrations tested, 75 μg/mL of TA-1 sgRNA provided the highest efficiency for editing of TCRαβ, β2M, and TCRαβ and β2M double knockout (DKO). As shown in FIG. 7E, B2M-1 sgRNA concentrations from 75 μg/mL to 150 μg/mL resulted in higher editing of β2M suggesting that efficient editing may be achieved using a concentration of B2M-1 sgRNA that is higher than the concentration of TA-1 sgRNA.

[0263] In sum, these results demonstrate efficient editing of T cells using final concentrations of Cas9, TA-1 sgRNA, and B2M-1 sgRNA of 0.3 mg/mL, 0.08 mg/mL, and 0.2 mg/mL, respectively. To achieve these concentrations, TA-1 sgRNA/Cas9 and B2M-1 sgRNA/Cas9 mixtures were prepared at molar ratios of 2.7:1 and 6.7:1, respectively.

[0264] To determine the percent of free Cas9 detected in RNP complexes, TA-1 sgRNA (TA-1; SEQ ID NO: 2) and Cas9 (Cas9; SEQ ID NO: 1), and B2M-1 sgRNA (B2M-1; SEQ ID NO: 6) and Cas9 (Cas9; SEQ ID NO: 1) mixtures were prepared at molar ratios of 2.7:1 and 6.7:1, respectively. Mixtures were incubated for 10 minutes and then analyzed by CEX HPLC to quantify the amount of free Cas9. As shown in Table 13, the low percent of free Cas9 detected in the mixtures suggests that RNP complexes were efficiently formed.

[0265]

TABLE 13
Percent of Free Cas9
in RNP Complexes.
		Free Cas9 (%)
	B2M-1	16 ± 2	(n = 9)
	TA-1	3 ± 2	(n = 9)

[0266] These results demonstrate that incubation of Cas9 and sgRNA results in the majority of Cas9 comprised within the RNP complex.

Development of Manufacturing Process

(i) Research Process

[0267] A total of 22 research lots were produced by Research Scale Processes using T cells from 17 healthy volunteers. Conditions identified for the Research Scale Process were verified and adjusted for scale-up to perform the Development Scale Process. Finally, GMP-sourced critical starting materials were evaluated for the preparation of clinical materials in the Clinical Scale Process. Effectively, the Development Scale Process and Clinical Scale Process are operationally identical.

[0268] The research scale process followed the same steps as the process illustrated in FIG. 7A. Briefly, T cells from either frozen vials of PBMC (Lots 1-14, 16, 21, 22) or frozen T cells enriched from leukapheresis products (Lots 12-15, 17-20) were activated with colloidal nanomatrix particles conjugated to CD3/CD28 agonists for 2-3 days in “T-cell media” consisting of X-VIVO™ 15 without gentamicin or phenol red, 5% human AB serum, rhIL-2 and rhIL-7. On the 2^nd or 3^rd day, the colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists was either diluted with fresh media or removed by washing the cells and centrifugation. On the next day, T cells were electroporated with Cas9 and sgRNAs using electroporation-based transfection systems, including a transfection system based on flow electroporation.

[0269] Approximately 20-60 minutes after electroporation, cells were left untreated or infected with AAV6 rAAV-138 at a MOI of either 20,000 or 50,000 genocopies per cell. After approximately 1 hour of infection, cells were washed and plated in T-cell media.

[0270] Approximately 1 week after genome editing, cells were assessed for TCRαβ/β2M knockout and CAR expression by flow cytometry. The percentage of cells that were TCRαβ⁻, B2M⁻, CD4⁺, CD8⁺ and CAR⁺ was subsequently calculated.

[0271] The percentage of cells that lost surface expression of the TCRαβ and B2M after gene editing, and that expressed cell-surface detectable CAR was evaluated by flow cytometry for each process (Table 14). Across the research lots (n=22), 43±16% (18-72%) of the cells achieved the desired surface expression of the anti-CD19 CAR, while also exhibiting surface loss of TCRαβ (98±0.66%, 97-99%) and B2M (79±9.6%, 54-86%) (Table 14). Similar results were obtained for the Development Scale Process and Clinical Scale Process (Table 14). On average the percentage of cells that were fully edited (TCRαβ⁻ B2M⁻CAR⁺) in the research lots was 31±13% (15-59%).

[0272] CD3ζ surface expression is dependent on the formation of a complex with the TCR. As such, it serves as a functional biochemical marker for loss of the TCR in addition to that of TCRαβ. Loss of CD3 surface expression averaged 96±3.5% (85-99%) in the research lots.

[0273] CD4/CD8 frequencies for subpopulations were compared to control T cells processed by electroporation with no gene-editing components. For research lots, edited cells (TCRαβ⁻ B2M⁻ CAR⁺, Lots 1-11, 16-22) contained, on average, 50±12% CD4 cells and 45±14% CD8 cells. Electroporated and control T cells (Lots 1-11, 16-21) contained 57±12% CD4 cells and 40±12% CD8 cells. No statistically-significant differences were observed between CD4 or CD8 frequencies when comparing edited to control T cells (unpaired 2-tailed Students t-test).

(ii) Development and Clinical Processes

[0274] The Research Process was transferred to a GMP facility, for scale-up and manufacture of the clinical material. Conditions identified for the Research Process were verified and adjusted for scale-up (Development Process). Finally, GMP-sourced critical starting materials were evaluated (Clinical Process) for the preparation of clinical materials. Effectively, the Development and Clinical Processes are operationally identical. Results are presented in Table 14 below.

(iii) Comparability of Gene Editing Across the Manufacturing Processes

[0275] The comparison of results from the clinical lots to the research process and initial scale-up and non-clinical lots is presented in Table 14.

[0276]

TABLE 14
Results Across Manufacturing Processes.
		Research	Development	Clinical
		Scale	Scale	Scale
	Parameter	Process	Process	Process
	Cell	N.D.	86.4 ± 7.1	92.5
	Viability (%)			(average, n = 2)
	% CAR+	43.0 ± 16.0	49.0 ± 12.7	58.0 ± 12.0
	T Cells
	CD3ζ	96 ± 3.5	N.D.	N.D.
	% TCRαβ−	98.0 ± 0.7	99.8 ± 0.2	99.8 ± 0.1
	% B2M−	79.0 ± 9.6	84.8 ± 1.6	83.9 ± 1.1

Evaluation of the Process Parameters

[0277] The manufacturing operating parameters were evaluated in a series of small-scale and full-scale experiments, which are summarized in Table 15.

[0278]

TABLE 15
Process Development Study Results
Parameter	Results and Conclusions
T Cell Enrichment
CD4_CD8 T cell Isolation	T cells isolated using a CD4_CD8 enrichment program were
with the automated cell	of high purity and viability
processing system
T Cell Activation
T cell activation in a gas	Conditions below were identified to achieve desirable
permeable rapid expansion	editing and cell expansion for CTX110 manufacture:
system: Cell density, cell	1) cell seeding density: 2 × 106/cm2
concentration, colloidal	2) cell seeding concentration: 2 × 106/mL
polymeric nanomatrix	3) colloidal polymeric nanomatrix conjugated to
conjugated to recombinant	recombinant humanized CD3 and CD28 agonists:
humanized CD3 and CD28	40 μL/1 × 106 cells
agonists dose and dilution	4) 10X colloidal polymeric nanomatrix conjugated to
	recombinant humanized CD3 and CD28 agonists dilution 48
	hours post-activation
Electroporation and Transduction
Concentration of sgRNAs	TA-1 sgRNA concentrations from 37.5 to 150 μg/mL, B2M-
and Cas9	1 sgRNA concentrations from 75 to 150 μg/mL and Cas9
	concentration of 300 μg/mL, achieves comparable TCRαβ
	and B2M editing efficiency.
	The following conditions were selected for the final
	manufacturing process: 0.08 mg/ml TA-1, 0.2 mg/nl B2M-1
	and 0.3 mg/ml Cas9
Cell concentration	Cell concentrations ranging from 100-400 × 106 cells/mL
	were incubated with fixed concentrations of RNP (B2M-1,
	TA-1 gRNAs and Cas9 at 150 μg/mL, 150 μg/mL and 300
	μg/mL, respectively).
	At cell concentrations of 100-300 × 106 cells/mL, B2M-and
	TCRαβ-subpopulations were > 80% and > 98%
	respectively.
	At a cell concentration of 400 × 106 cells/mL, the B2M-and
	TCRαβ-subpopulations were < 80% and < 87%,
	demonstrating lower efficiency.
Impact of EP medium during	Comparable TCRαβ and B2M editing efficiency and CAR
electroporation	expression were achieved with up to 10% medium during
	electroporation, indicating no negative impact of residual
	medium on CTX110 editing.
rAAV-138 transduction	The clinical AAV transduction process includes:
	1) removal of wash step before and after AAV transduction
	2) Cell density of AAV Transduction: 10 × 106/mL
	3) AAV MOI: 20,000 (determined on a lot by lot basis)
Cell Expansion
Seeding density for the gas	Seeding densities between 3 × 105 cells/cm2 to 5 × 105
permeable rapid expansion	cells/cm2 after electroporation were examined.
system culture vessel	Cells seeded between 3-5 × 105 cells/cm2 achieved a final
	cell density about 30 × 106 cells/cm2 and up to 50 × 106
	cells/cm2 after culture for 7-9 days.
Cell Expansion in different	The scalability of cell expansion with the gas permeable
sized gas permeable rapid	rapid expansion system was assessed by comparing cell
expansion system culture	expansion when seeded in 60 cm2, 100 cm2, and 500 cm2
vessels	gas permeable membrane surface gas permeable cell culture
	devices. Results indicate that modified T cells can achieve
	comparable fold-expansion in different vessel sizes with the
	same cell density at harvest, thus supporting the procedure
	of using satellite plating in 60 cm2 gas permeable membrane
	surface gas permeable cell culture device to monitor cell
	expansion in the 500 cm2 gas permeable membrane surface
	gas permeable cell culture device for the CTX110
	manufacturing process.
TCRαβ+ Cell Depletion
Evaluation of depletion	A customized program for TCRαβ depletion was developed
performance	using an automated cell processing system. The
	performance of the depletion process with this program was
	evaluated over 4 batches, demonstrating high depletion
	efficiency (input 2% → output < LOQ TCRαβ+ cells) with
	an average of 70% cell recovery and > 90% viability.

[0279] CTX120 is a BCMA-directed T cell immunotherapy comprised of human allogeneic T cells that are genetically modified ex vivo using CRISPR/Cas9 (Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR associated protein 9) gene editing components (sgRNA (single guide RNA) and Cas9 nuclease).

[0280] The modifications include targeted disruption of the TRAC and B2M loci, and the insertion of an anti-BCMA chimeric antigen receptor (CAR) transgene into the TRAC locus using a recombinant adeno-associated virus vector (rAAV166, a serotype 6 rAAV encoding anti-BCMA directed chimeric T cell antigen receptor).

[0281] The CAR is composed of a humanized single-chain variable fragment (scFv) specific for BCMA, followed by a CD8 hinge and transmembrane region that is fused to the intracellular signaling domains for CD137 (4-1BB) and CD3ζ. Expression of the CTX120 CAR is driven by the elongation factor 1 alpha (EF-1a) promoter.

[0282] The manufacturing process of CTX120 is illustrated in FIG. 8A. Structural information of the starting materials, including bacterially-derived Cas9 nuclease; two single guide RNAs (sgRNA), TA-1 which targets the TRAC locus and B2M-1 which targets the β2M locus, is provided in Example 7 above Amino acid sequences and nucleotide sequences of the anti-BCMA CAR in a rAAV vector are provided below (Tables 16 and 17):

[0283]

TABLE 16
Nucleotide Sequences of Anti-BCMA CAR Construct Components.
		SEQ
Name		ID
Description	Nucleotide Sequence	NO:
CTX-166b	CCTGCAGGCAGCTGCGCGCTCGCTCGCTCACTGAGGCCGCCCGGGCG	55
rAAV	TCGGGCGACCTTTGGTCGCCCGGCCTCAGTGAGCGAGCGAGCGCGCA
	GAGAGGGAGTGGCCAACTCCATCACTAGGGGTTCCTGCGGCCGCACG
	CGTGAGATGTAAGGAGCTGCTGTGACTTGCTCAAGGCCTTATATCGA
	GTAAACGGTAGTGCTGGGGCTTAGACGCAGGTGTTCTGATTTATAGT
	TCAAAACCTCTATCAATGAGAGAGCAATCTCCTGGTAATGTGATAGA
	TTTCCCAACTTAATGCCAACATACCATAAACCTCCCATTCTGCTAAT
	GCCCAGCCTAAGTTGGGGAGACCACTCCAGATTCCAAGATGTACAGT
	TTGCTTTGCTGGGCCTTTTTCCCATGCCTGCCTTTACTCTGCCAGAG
	TTATATTGCTGGGGTTTTGAAGAAGATCCTATTAAATAAAAGAATAA
	GCAGTATTATTAAGTAGCCCTGCATTTCAGGTTTCCTTGAGTGGCAG
	GCCAGGCCTGGCCGTGAACGTTCACTGAAATCATGGCCTCTTGGCCA
	AGATTGATAGCTTGTGCCTGTCCCTGAGTCCCAGTCCATCACGAGCA
	GCTGGTTTCTAAGATGCTATTTCCCGTATAAAGCATGAGACCGTGAC
	TTGCCAGCCCCACAGAGCCCCGCCCTTGTCCATCACTGGCATCTGGA
	CTCCAGCCTGGGTTGGGGCAAAGAGGGAAATGAGATCATGTCCTAAC
	CCTGATCCTCTTGTCCCACAGATATCCAGAACCCTGACCCTGCCGTG
	TACCAGCTGAGAGACTCTAAATCCAGTGACAAGTCTGTCTGCCTATT
	CACCGATTTTGATTCTCAAACAAATGTGTCACAAAGTAAGGATTCTG
	ATGTGTATATCACAGACAAAACTGTGCTAGACATGAGGTCTATGGAC
	TTCAGGCTCCGGTGCCCGTCAGTGGGCAGAGCGCACATCGCCCACAG
	TCCCCGAGAAGTTGGGGGGAGGGGTCGGCAATTGAACCGGTGCCTAG
	AGAAGGTGGCGCGGGGTAAACTGGGAAAGTGATGTCGTGTACTGGCT
	CCGCCTTTTTCCCGAGGGTGGGGGAGAACCGTATATAAGTGCAGTAG
	TCGCCGTGAACGTTCTTTTTCGCAACGGGTTTGCCGCCAGAACACAG
	GTAAGTGCCGTGTGTGGTTCCCGCGGGCCTGGCCTCTTTACGGGTTA
	TGGCCCTTGCGTGCCTTGAATTACTTCCACTGGCTGCAGTACGTGAT
	TCTTGATCCCGAGCTTCGGGTTGGAAGTGGGTGGGAGAGTTCGAGGC
	CTTGCGCTTAAGGAGCCCCTTCGCCTCGTGCTTGAGTTGAGGCCTGG
	CCTGGGCGCTGGGGCCGCCGCGTGCGAATCTGGTGGCACCTTCGCGC
	CTGTCTCGCTGCTTTCGATAAGTCTCTAGCCATTTAAAATTTTTGAT
	GACCTGCTGCGACGCTTTTTTTCTGGCAAGATAGTCTTGTAAATGCG
	GGCCAAGATCTGCACACTGGTATTTCGGTTTTTGGGGCCGCGGGCGG
	CGACGGGGCCCGTGCGTCCCAGCGCACATGTTCGGCGAGGCGGGGCC
	TGCGAGCGCGGCCACCGAGAATCGGACGGGGGTAGTCTCAAGCTGGC
	CGGCCTGCTCTGGTGCCTGGCCTCGCGCCGCCGTGTATCGCCCCGCC
	CTGGGCGGCAAGGCTGGCCCGGTCGGCACCAGTTGCGTGAGCGGAAA
	GATGGCCGCTTCCCGGCCCTGCTGCAGGGAGCTCAAAATGGAGGACG
	CGGCGCTCGGGAGAGCGGGCGGGTGAGTCACCCACACAAAGGAAAAG
	GGCCTTTCCGTCCTCAGCCGTCGCTTCATGTGACTCCACGGAGTACC
	GGGCGCCGTCCAGGCACCTCGATTAGTTCTCGAGCTTTTGGAGTACG
	TCGTCTTTAGGTTGGGGGGAGGGGTTTTATGCGATGGAGTTTCCCCA
	CACTGAGTGGGTGGAGACTGAAGTTAGGCCAGCTTGGCACTTGATGT
	AATTCTCCTTGGAATTTGCCCTTTTTGAGTTTGGATCTTGGTTCATT
	CTCAAGCCTCAGACAGTGGTTCAAAGTTTTTTTCTTCCATTTCAGGT
	GTCGTGACCACCATGGCGCTTCCGGTGACAGCACTGCTCCTCCCCTT
	GGCGCTGTTGCTCCACGCAGCAAGGCCGCAGGTGCAGCTGGTGCAGA
	GCGGAGCCGAGCTCAAGAAGCCCGGAGCCTCCGTGAAGGTGAGCTGC
	AAGGCCAGCGGCAACACCCTGACCAACTACGTGATCCACTGGGTGAG
	ACAAGCCCCCGGCCAAAGGCTGGAGTGGATGGGCTACATCCTGCCCT
	ACAACGACCTGACCAAGTACAGCCAGAAGTTCCAGGGCAGGGTGACC
	ATCACCAGGGATAAGAGCGCCTCCACCGCCTATATGGAGCTGAGCAG
	CCTGAGGAGCGAGGACACCGCTGTGTACTACTGTACAAGGTGGGACT
	GGGACGGCTTCTTTGACCCCTGGGGCCAGGGCACAACAGTGACCGTC
	AGCAGCGGCGGCGGAGGCAGCGGCGGCGGCGGCAGCGGCGGAGGCGG
	AAGCGAAATCGTGATGACCCAGAGCCCCGCCACACTGAGCGTGAGCC
	CTGGCGAGAGGGCCAGCATCTCCTGCAGGGCTAGCCAAAGCCTGGTG
	CACAGCAACGGCAACACCCACCTGCACTGGTACCAGCAGAGACCCGG
	ACAGGCTCCCAGGCTGCTGATCTACAGCGTGAGCAACAGGTTCTCCG
	AGGTGCCTGCCAGGTTTAGCGGCAGCGGAAGCGGCACCGACTTTACC
	CTGACCATCAGCAGCGTGGAGTCCGAGGACTTCGCCGTGTATTACTG
	CAGCCAGACCAGCCACATCCCTTACACCTTCGGCGGCGGCACCAAGC
	TGGAGATCAAAAGTGCTGCTGCCTTTGTCCCGGTATTTCTCCCAGCC
	AAACCGACCACGACTCCCGCCCCGCGCCCTCCGACACCCGCTCCCAC
	CATCGCCTCTCAACCTCTTAGTCTTCGCCCCGAGGCATGCCGACCCG
	CCGCCGGGGGTGCTGTTCATACGAGGGGCTTGGACTTCGCTTGTGAT
	ATTTACATTTGGGCTCCGTTGGCGGGTACGTGCGGCGTCCTTTTGTT
	GTCACTCGTTATTACTTTGTATTGTAATCACAGGAATCGCAAACGGG
	GCAGAAAGAAACTCCTGTATATATTCAAACAACCATTTATGAGACCA
	GTACAAACTACTCAAGAGGAAGATGGCTGTAGCTGCCGATTTCCAGA
	AGAAGAAGAAGGAGGATGTGAACTGCGAGTGAAGTTTTCCCGAAGCG
	CAGACGCTCCGGCATATCAGCAAGGACAGAATCAGCTGTATAACGAA
	CTGAATTTGGGACGCCGCGAGGAGTATGACGTGCTTGATAAACGCCG
	GGGGAGAGACCCGGAAATGGGGGGTAAACCCCGAAGAAAGAATCCCC
	AAGAAGGACTCTACAATGAACTCCAGAAGGATAAGATGGCGGAGGCC
	TACTCAGAAATAGGTATGAAGGGCGAACGACGACGGGGAAAAGGTCA
	CGATGGCCTCTACCAAGGGTTGAGTACGGCAACCAAAGATACGTACG
	ATGCACTGCATATGCAGGCCCTGCCTCCCAGATAATAATAAAATCGC
	TATCCATCGAAGATGGATGTGTGTTGGTTTTTTGTGTGTGGAGCAAC
	AAATCTGACTTTGCATGTGCAAACGCCTTCAACAACAGCATTATTCC
	AGAAGACACCTTCTTCCCCAGCCCAGGTAAGGGCAGCTTTGGTGCCT
	TCGCAGGCTGTTTCCTTGCTTCAGGAATGGCCAGGTTCTGCCCAGAG
	CTCTGGTCAATGATGTCTAAAACTCCTCTGATTGGTGGTCTCGGCCT
	TATCCATTGCCACCAAAACCCTCTTTTTACTAAGAAACAGTGAGCCT
	TGTTCTGGCAGTCCAGAGAATGACACGGGAAAAAAGCAGATGAAGAG
	AAGGTGGCAGGAGAGGGCACGTGGCCCAGCCTCAGTCTCTCCAACTG
	AGTTCCTGCCTGCCTGCCTTTGCTCAGACTGTTTGCCCCTTACTGCT
	CTTCTAGGCCTCATTCTAAGCCCCTTCTCCAAGTTGCCTCTCCTTAT
	TTCTCCCTGTCTGCCAAAAAATCTTTCCCAGCTCACTAAGTCAGTCT
	CACGCAGTCACTCATTAACCCACCAATCACTGATTGTGCCGGCACAT
	GAATGCACCAGGTGTTGAAGTGGAGGAATTAAAAAGTCAGATGAGGG
	GTGTGCCCAGAGGAAGCACCATTCTAGTTGGGGGAGCCCATCTGTCA
	GCTGGGAAAAGTCCAAATAACTTCAGATTGGAATGTGTTTTAACTCA
	GGGTTGAGAAAACAGCTACCTTCAGGACAAAAGTCAGGGAAGGGCTC
	TCTGAAGAAATGCTACTTGAAGATACCAGCCCTACCAAGGGCAGGGA
	GAGGACCCTATAGAGGCCTGGGACAGGAGCTCAATGAGAAAGGTAAC
	CACGTGCGGACCGAGGCTGCAGCGTCGTCCTCCCTAGGAACCCCTAG
	TGATGGAGTTGGCCACTCCCTCTCTGCGCGCTCGCTCGCTCACTGAG
	GCCGGGCGACCAAAGGTCGCCCGACGCCCGGGCTTTGCCCGGGCGGC
	CTCAGTGAGCGAGCGAGCGCGCAGCTGCCTGCAGG
5′ ITR	CCTGCAGGCAGCTGCGCGCTCGCTCGCTCACTGAGGCCGCCCGGGCG	38
	TCGGGCGACCTTTGGTCGCCCGGCCTCAGTGAGCGAGCGAGCGCGCA
	GAGAGGGAGTGGCCAACTCCATCACTAGGGGTTCCT
3′ ITR	AGGAACCCCTAGTGATGGAGTTGGCCACTCCCTCTCTGCGCGCTCGC	39
	TCGCTCACTGAGGCCGGGCGACCAAAGGTCGCCCGACGCCCGGGCTT
	TGCCCGGGCGGCCTCAGTGAGCGAGCGAGCGCGCAGCTGCCTGCAGG
LHA to	GAGATGTAAGGAGCTGCTGTGACTTGCTCAAGGCCTTATATCGAGTA	76
RHA	AACGGTAGTGCTGGGGCTTAGACGCAGGTGTTCTGATTTATAGTTCA
	AAACCTCTATCAATGAGAGAGCAATCTCCTGGTAATGTGATAGATTT
	CCCAACTTAATGCCAACATACCATAAACCTCCCATTCTGCTAATGCC
	CAGCCTAAGTTGGGGAGACCACTCCAGATTCCAAGATGTACAGTTTG
	CTTTGCTGGGCCTTTTTCCCATGCCTGCCTTTACTCTGCCAGAGTTA
	TATTGCTGGGGTTTTGAAGAAGATCCTATTAAATAAAAGAATAAGCA
	GTATTATTAAGTAGCCCTGCATTTCAGGTTTCCTTGAGTGGCAGGCC
	AGGCCTGGCCGTGAACGTTCACTGAAATCATGGCCTCTTGGCCAAGA
	TTGATAGCTTGTGCCTGTCCCTGAGTCCCAGTCCATCACGAGCAGCT
	GGTTTCTAAGATGCTATTTCCCGTATAAAGCATGAGACCGTGACTTG
	CCAGCCCCACAGAGCCCCGCCCTTGTCCATCACTGGCATCTGGACTC
	CAGCCTGGGTTGGGGCAAAGAGGGAAATGAGATCATGTCCTAACCCT
	GATCCTCTTGTCCCACAGATATCCAGAACCCTGACCCTGCCGTGTAC
	CAGCTGAGAGACTCTAAATCCAGTGACAAGTCTGTCTGCCTATTCAC
	CGATTTTGATTCTCAAACAAATGTGTCACAAAGTAAGGATTCTGATG
	TGTATATCACAGACAAAACTGTGCTAGACATGAGGTCTATGGACTTC
	AGGCTCCGGTGCCCGTCAGTGGGCAGAGCGCACATCGCCCACAGTCC
	CCGAGAAGTTGGGGGGAGGGGTCGGCAATTGAACCGGTGCCTAGAGA
	AGGTGGCGCGGGGTAAACTGGGAAAGTGATGTCGTGTACTGGCTCCG
	CCTTTTTCCCGAGGGTGGGGGAGAACCGTATATAAGTGCAGTAGTCG
	CCGTGAACGTTCTTTTTCGCAACGGGTTTGCCGCCAGAACACAGGTA
	AGTGCCGTGTGTGGTTCCCGCGGGCCTGGCCTCTTTACGGGTTATGG
	CCCTTGCGTGCCTTGAATTACTTCCACTGGCTGCAGTACGTGATTCT
	TGATCCCGAGCTTCGGGTTGGAAGTGGGTGGGAGAGTTCGAGGCCTT
	GCGCTTAAGGAGCCCCTTCGCCTCGTGCTTGAGTTGAGGCCTGGCCT
	GGGCGCTGGGGCCGCCGCGTGCGAATCTGGTGGCACCTTCGCGCCTG
	TCTCGCTGCTTTCGATAAGTCTCTAGCCATTTAAAATTTTTGATGAC
	CTGCTGCGACGCTTTTTTTCTGGCAAGATAGTCTTGTAAATGCGGGC
	CAAGATCTGCACACTGGTATTTCGGTTTTTGGGGCCGCGGGCGGCGA
	CGGGGCCCGTGCGTCCCAGCGCACATGTTCGGCGAGGCGGGGCCTGC
	GAGCGCGGCCACCGAGAATCGGACGGGGGTAGTCTCAAGCTGGCCGG
	CCTGCTCTGGTGCCTGGCCTCGCGCCGCCGTGTATCGCCCCGCCCTG
	GGCGGCAAGGCTGGCCCGGTCGGCACCAGTTGCGTGAGCGGAAAGAT
	GGCCGCTTCCCGGCCCTGCTGCAGGGAGCTCAAAATGGAGGACGCGG
	CGCTCGGGAGAGCGGGCGGGTGAGTCACCCACACAAAGGAAAAGGGC
	CTTTCCGTCCTCAGCCGTCGCTTCATGTGACTCCACGGAGTACCGGG
	CGCCGTCCAGGCACCTCGATTAGTTCTCGAGCTTTTGGAGTACGTCG
	TCTTTAGGTTGGGGGGAGGGGTTTTATGCGATGGAGTTTCCCCACAC
	TGAGTGGGTGGAGACTGAAGTTAGGCCAGCTTGGCACTTGATGTAAT
	TCTCCTTGGAATTTGCCCTTTTTGAGTTTGGATCTTGGTTCATTCTC
	AAGCCTCAGACAGTGGTTCAAAGTTTTTTTCTTCCATTTCAGGTGTC
	GTGACCACCATGGCGCTTCCGGTGACAGCACTGCTCCTCCCCTTGGC
	GCTGTTGCTCCACGCAGCAAGGCCGCAGGTGCAGCTGGTGCAGAGCG
	GAGCCGAGCTCAAGAAGCCCGGAGCCTCCGTGAAGGTGAGCTGCAAG
	GCCAGCGGCAACACCCTGACCAACTACGTGATCCACTGGGTGAGACA
	AGCCCCCGGCCAAAGGCTGGAGTGGATGGGCTACATCCTGCCCTACA
	ACGACCTGACCAAGTACAGCCAGAAGTTCCAGGGCAGGGTGACCATC
	ACCAGGGATAAGAGCGCCTCCACCGCCTATATGGAGCTGAGCAGCCT
	GAGGAGCGAGGACACCGCTGTGTACTACTGTACAAGGTGGGACTGGG
	ACGGCTTCTTTGACCCCTGGGGCCAGGGCACAACAGTGACCGTCAGC
	AGCGGCGGCGGAGGCAGCGGCGGCGGCGGCAGCGGCGGAGGCGGAAG
	CGAAATCGTGATGACCCAGAGCCCCGCCACACTGAGCGTGAGCCCTG
	GCGAGAGGGCCAGCATCTCCTGCAGGGCTAGCCAAAGCCTGGTGCAC
	AGCAACGGCAACACCCACCTGCACTGGTACCAGCAGAGACCCGGACA
	GGCTCCCAGGCTGCTGATCTACAGCGTGAGCAACAGGTTCTCCGAGG
	TGCCTGCCAGGTTTAGCGGCAGCGGAAGCGGCACCGACTTTACCCTG
	ACCATCAGCAGCGTGGAGTCCGAGGACTTCGCCGTGTATTACTGCAG
	CCAGACCAGCCACATCCCTTACACCTTCGGCGGCGGCACCAAGCTGG
	AGATCAAAAGTGCTGCTGCCTTTGTCCCGGTATTTCTCCCAGCCAAA
	CCGACCACGACTCCCGCCCCGCGCCCTCCGACACCCGCTCCCACCAT
	CGCCTCTCAACCTCTTAGTCTTCGCCCCGAGGCATGCCGACCCGCCG
	CCGGGGGTGCTGTTCATACGAGGGGCTTGGACTTCGCTTGTGATATT
	TACATTTGGGCTCCGTTGGCGGGTACGTGCGGCGTCCTTTTGTTGTC
	ACTCGTTATTACTTTGTATTGTAATCACAGGAATCGCAAACGGGGCA
	GAAAGAAACTCCTGTATATATTCAAACAACCATTTATGAGACCAGTA
	CAAACTACTCAAGAGGAAGATGGCTGTAGCTGCCGATTTCCAGAAGA
	AGAAGAAGGAGGATGTGAACTGCGAGTGAAGTTTTCCCGAAGCGCAG
	ACGCTCCGGCATATCAGCAAGGACAGAATCAGCTGTATAACGAACTG
	AATTTGGGACGCCGCGAGGAGTATGACGTGCTTGATAAACGCCGGGG
	GAGAGACCCGGAAATGGGGGGTAAACCCCGAAGAAAGAATCCCCAAG
	AAGGACTCTACAATGAACTCCAGAAGGATAAGATGGCGGAGGCCTAC
	TCAGAAATAGGTATGAAGGGCGAACGACGACGGGGAAAAGGTCACGA
	TGGCCTCTACCAAGGGTTGAGTACGGCAACCAAAGATACGTACGATG
	CACTGCATATGCAGGCCCTGCCTCCCAGATAATAATAAAATCGCTAT
	CCATCGAAGATGGATGTGTGTTGGTTTTTTGTGTGTGGAGCAACAAA
	TCTGACTTTGCATGTGCAAACGCCTTCAACAACAGCATTATTCCAGA
	AGACACCTTCTTCCCCAGCCCAGGTAAGGGCAGCTTTGGTGCCTTCG
	CAGGCTGTTTCCTTGCTTCAGGAATGGCCAGGTTCTGCCCAGAGCTC
	TGGTCAATGATGTCTAAAACTCCTCTGATTGGTGGTCTCGGCCTTAT
	CCATTGCCACCAAAACCCTCTTTTTACTAAGAAACAGTGAGCCTTGT
	TCTGGCAGTCCAGAGAATGACACGGGAAAAAAGCAGATGAAGAGAAG
	GTGGCAGGAGAGGGCACGTGGCCCAGCCTCAGTCTCTCCAACTGAGT
	TCCTGCCTGCCTGCCTTTGCTCAGACTGTTTGCCCCTTACTGCTCTT
	CTAGGCCTCATTCTAAGCCCCTTCTCCAAGTTGCCTCTCCTTATTTC
	TCCCTGTCTGCCAAAAAATCTTTCCCAGCTCACTAAGTCAGTCTCAC
	GCAGTCACTCATTAACCCACCAATCACTGATTGTGCCGGCACATGAA
	TGCACCAGGTGTTGAAGTGGAGGAATTAAAAAGTCAGATGAGGGGTG
	TGCCCAGAGGAAGCACCATTCTAGTTGGGGGAGCCCATCTGTCAGCT
	GGGAAAAGTCCAAATAACTTCAGATTGGAATGTGTTTTAACTCAGGG
	TTGAGAAAACAGCTACCTTCAGGACAAAAGTCAGGGAAGGGCTCTCT
	GAAGAAATGCTACTTGAAGATACCAGCCCTACCAAGGGCAGGGAGAG
	GACCCTATAGAGGCCTGGGACAGGAGCTCAATGAGAAAGG
TRAC-	GAGATGTAAGGAGCTGCTGTGACTTGCTCAAGGCCTTATATCGAGTA	40
LHA	AACGGTAGTGCTGGGGCTTAGACGCAGGTGTTCTGATTTATAGTTCA
(800 bp)	AAACCTCTATCAATGAGAGAGCAATCTCCTGGTAATGTGATAGATTT
	CCCAACTTAATGCCAACATACCATAAACCTCCCATTCTGCTAATGCC
	CAGCCTAAGTTGGGGAGACCACTCCAGATTCCAAGATGTACAGTTTG
	CTTTGCTGGGCCTTTTTCCCATGCCTGCCTTTACTCTGCCAGAGTTA
	TATTGCTGGGGTTTTGAAGAAGATCCTATTAAATAAAAGAATAAGCA
	GTATTATTAAGTAGCCCTGCATTTCAGGTTTCCTTGAGTGGCAGGCC
	AGGCCTGGCCGTGAACGTTCACTGAAATCATGGCCTCTTGGCCAAGA
	TTGATAGCTTGTGCCTGTCCCTGAGTCCCAGTCCATCACGAGCAGCT
	GGTTTCTAAGATGCTATTTCCCGTATAAAGCATGAGACCGTGACTTG
	CCAGCCCCACAGAGCCCCGCCCTTGTCCATCACTGGCATCTGGACTC
	CAGCCTGGGTTGGGGCAAAGAGGGAAATGAGATCATGTCCTAACCCT
	GATCCTCTTGTCCCACAGATATCCAGAACCCTGACCCTGCCGTGTAC
	CAGCTGAGAGACTCTAAATCCAGTGACAAGTCTGTCTGCCTATTCAC
	CGATTTTGATTCTCAAACAAATGTGTCACAAAGTAAGGATTCTGATG
	TGTATATCACAGACAAAACTGTGCTAGACATGAGGTCTATGGACTTC
	A
TRAC-	TGGAGCAACAAATCTGACTTTGCATGTGCAAACGCCTTCAACAACAG	41
RHA	CATTATTCCAGAAGACACCTTCTTCCCCAGCCCAGGTAAGGGCAGCT
(800 bp)	TTGGTGCCTTCGCAGGCTGTTTCCTTGCTTCAGGAATGGCCAGGTTC
	TGCCCAGAGCTCTGGTCAATGATGTCTAAAACTCCTCTGATTGGTGG
	TCTCGGCCTTATCCATTGCCACCAAAACCCTCTTTTTACTAAGAAAC
	AGTGAGCCTTGTTCTGGCAGTCCAGAGAATGACACGGGAAAAAAGCA
	GATGAAGAGAAGGTGGCAGGAGAGGGCACGTGGCCCAGCCTCAGTCT
	CTCCAACTGAGTTCCTGCCTGCCTGCCTTTGCTCAGACTGTTTGCCC
	CTTACTGCTCTTCTAGGCCTCATTCTAAGCCCCTTCTCCAAGTTGCC
	TCTCCTTATTTCTCCCTGTCTGCCAAAAAATCTTTCCCAGCTCACTA
	AGTCAGTCTCACGCAGTCACTCATTAACCCACCAATCACTGATTGTG
	CCGGCACATGAATGCACCAGGTGTTGAAGTGGAGGAATTAAAAAGTC
	AGATGAGGGGTGTGCCCAGAGGAAGCACCATTCTAGTTGGGGGAGCC
	CATCTGTCAGCTGGGAAAAGTCCAAATAACTTCAGATTGGAATGTGT
	TTTAACTCAGGGTTGAGAAAACAGCTACCTTCAGGACAAAAGTCAGG
	GAAGGGCTCTCTGAAGAAATGCTACTTGAAGATACCAGCCCTACCAA
	GGGCAGGGAGAGGACCCTATAGAGGCCTGGGACAGGAGCTCAATGAG
	AAAGG
Anti-	ATGGCGCTTCCGGTGACAGCACTGCTCCTCCCCTTGGCGCTGTTGCT	56
BCMA	CCACGCAGCAAGGCCGCAGGTGCAGCTGGTGCAGAGCGGAGCCGAGC
CAR	TCAAGAAGCCCGGAGCCTCCGTGAAGGTGAGCTGCAAGGCCAGCGGC
(CTX-	AACACCCTGACCAACTACGTGATCCACTGGGTGAGACAAGCCCCCGG
166b)	CCAAAGGCTGGAGTGGATGGGCTACATCCTGCCCTACAACGACCTGA
	CCAAGTACAGCCAGAAGTTCCAGGGCAGGGTGACCATCACCAGGGAT
	AAGAGCGCCTCCACCGCCTATATGGAGCTGAGCAGCCTGAGGAGCGA
	GGACACCGCTGTGTACTACTGTACAAGGTGGGACTGGGACGGCTTCT
	TTGACCCCTGGGGCCAGGGCACAACAGTGACCGTCAGCAGCGGCGGC
	GGAGGCAGCGGCGGCGGCGGCAGCGGCGGAGGCGGAAGCGAAATCGT
	GATGACCCAGAGCCCCGCCACACTGAGCGTGAGCCCTGGCGAGAGGG
	CCAGCATCTCCTGCAGGGCTAGCCAAAGCCTGGTGCACAGCAACGGC
	AACACCCACCTGCACTGGTACCAGCAGAGACCCGGACAGGCTCCCAG
	GCTGCTGATCTACAGCGTGAGCAACAGGTTCTCCGAGGTGCCTGCCA
	GGTTTAGCGGCAGCGGAAGCGGCACCGACTTTACCCTGACCATCAGC
	AGCGTGGAGTCCGAGGACTTCGCCGTGTATTACTGCAGCCAGACCAG
	CCACATCCCTTACACCTTCGGCGGCGGCACCAAGCTGGAGATCAAAA
	GTGCTGCTGCCTTTGTCCCGGTATTTCTCCCAGCCAAACCGACCACG
	ACTCCCGCCCCGCGCCCTCCGACACCCGCTCCCACCATCGCCTCTCA
	ACCTCTTAGTCTTCGCCCCGAGGCATGCCGACCCGCCGCCGGGGGTG
	CTGTTCATACGAGGGGCTTGGACTTCGCTTGTGATATTTACATTTGG
	GCTCCGTTGGCGGGTACGTGCGGCGTCCTTTTGTTGTCACTCGTTAT
	TACTTTGTATTGTAATCACAGGAATCGCAAACGGGGCAGAAAGAAAC
	TCCTGTATATATTCAAACAACCATTTATGAGACCAGTACAAACTACT
	CAAGAGGAAGATGGCTGTAGCTGCCGATTTCCAGAAGAAGAAGAAGG
	AGGATGTGAACTGCGAGTGAAGTTTTCCCGAAGCGCAGACGCTCCGG
	CATATCAGCAAGGACAGAATCAGCTGTATAACGAACTGAATTTGGGA
	CGCCGCGAGGAGTATGACGTGCTTGATAAACGCCGGGGGAGAGACCC
	GGAAATGGGGGGTAAACCCCGAAGAAAGAATCCCCAAGAAGGACTCT
	ACAATGAACTCCAGAAGGATAAGATGGCGGAGGCCTACTCAGAAATA
	GGTATGAAGGGCGAACGACGACGGGGAAAAGGTCACGATGGCCTCTA
	CCAAGGGTTGAGTACGGCAACCAAAGATACGTACGATGCACTGCATA
	TGCAGGCCCTGCCTCCCAGA
Anti-	CAGGTGCAGCTGGTGCAGAGCGGAGCCGAGCTCAAGAAGCCCGGAGC	57
BCMA	CTCCGTGAAGGTGAGCTGCAAGGCCAGCGGCAACACCCTGACCAACT
scFv	ACGTGATCCACTGGGTGAGACAAGCCCCCGGCCAAAGGCTGGAGTGG
(CTX-166	ATGGGCTACATCCTGCCCTACAACGACCTGACCAAGTACAGCCAGAA
& CTX-	GTTCCAGGGCAGGGTGACCATCACCAGGGATAAGAGCGCCTCCACCG
166b)	CCTATATGGAGCTGAGCAGCCTGAGGAGCGAGGACACCGCTGTGTAC
	TACTGTACAAGGTGGGACTGGGACGGCTTCTTTGACCCCTGGGGCCA
	GGGCACAACAGTGACCGTCAGCAGCGGCGGCGGAGGCAGCGGCGGCG
	GCGGCAGCGGCGGAGGCGGAAGCGAAATCGTGATGACCCAGAGCCCC
	GCCACACTGAGCGTGAGCCCTGGCGAGAGGGCCAGCATCTCCTGCAG
	GGCTAGCCAAAGCCTGGTGCACAGCAACGGCAACACCCACCTGCACT
	GGTACCAGCAGAGACCCGGACAGGCTCCCAGGCTGCTGATCTACAGC
	GTGAGCAACAGGTTCTCCGAGGTGCCTGCCAGGTTTAGCGGCAGCGG
	AAGCGGCACCGACTTTACCCTGACCATCAGCAGCGTGGAGTCCGAGG
	ACTTCGCCGTGTATTACTGCAGCCAGACCAGCCACATCCCTTACACC
	TTCGGCGGCGGCACCAAGCTGGAGATCAAA
4-1BB	AAACGGGGCAGAAAGAAACTCCTGTATATATTCAAACAACCATTTAT	58
nucleotide	GAGACCAGTACAAACTACTCAAGAGGAAGATGGCTGTAGCTGCCGAT
sequence	TTCCAGAAGAAGAAGAAGGAGGATGTGAACTG
4-1BB	KRGRKKLLYIFKQPFMRPVQTTQEEDGCSCREPEEEEGGCEL	59
amino acid
sequence
CD3-zeta	CGAGTGAAGTTTTCCCGAAGCGCAGACGCTCCGGCATATCAGCAAGG	31
	ACAGAATCAGCTGTATAACGAACTGAATTTGGGACGCCGCGAGGAGT
	ATGACGTGCTTGATAAACGCCGGGGGAGAGACCCGGAAATGGGGGGT
	AAACCCCGAAGAAAGAATCCCCAAGAAGGACTCTACAATGAACTCCA
	GAAGGATAAGATGGCGGAGGCCTACTCAGAAATAGGTATGAAGGGCG
	AACGACGACGGGGAAAAGGTCACGATGGCCTCTACCAAGGGTTGAGT
	ACGGCAACCAAAGATACGTACGATGCACTGCATATGCAGGCCCTGCC
	TCCCAGA
EF-1α	GGCTCCGGTGCCCGTCAGTGGGCAGAGCGCACATCGCCCACAGTCCC	42
promoter	CGAGAAGTTGGGGGGAGGGGTCGGCAATTGAACCGGTGCCTAGAGAA
	GGTGGCGCGGGGTAAACTGGGAAAGTGATGTCGTGTACTGGCTCCGC
	CTTTTTCCCGAGGGTGGGGGAGAACCGTATATAAGTGCAGTAGTCGC
	CGTGAACGTTCTTTTTCGCAACGGGTTTGCCGCCAGAACACAGGTAA
	GTGCCGTGTGTGGTTCCCGCGGGCCTGGCCTCTTTACGGGTTATGGC
	CCTTGCGTGCCTTGAATTACTTCCACTGGCTGCAGTACGTGATTCTT
	GATCCCGAGCTTCGGGTTGGAAGTGGGTGGGAGAGTTCGAGGCCTTG
	CGCTTAAGGAGCCCCTTCGCCTCGTGCTTGAGTTGAGGCCTGGCCTG
	GGCGCTGGGGCCGCCGCGTGCGAATCTGGTGGCACCTTCGCGCCTGT
	CTCGCTGCTTTCGATAAGTCTCTAGCCATTTAAAATTTTTGATGACC
	TGCTGCGACGCTTTTTTTCTGGCAAGATAGTCTTGTAAATGCGGGCC
	AAGATCTGCACACTGGTATTTCGGTTTTTGGGGCCGCGGGCGGCGAC
	GGGGCCCGTGCGTCCCAGCGCACATGTTCGGCGAGGCGGGGCCTGCG
	AGCGCGGCCACCGAGAATCGGACGGGGGTAGTCTCAAGCTGGCCGGC
	CTGCTCTGGTGCCTGGCCTCGCGCCGCCGTGTATCGCCCCGCCCTGG
	GCGGCAAGGCTGGCCCGGTCGGCACCAGTTGCGTGAGCGGAAAGATG
	GCCGCTTCCCGGCCCTGCTGCAGGGAGCTCAAAATGGAGGACGCGGC
	GCTCGGGAGAGCGGGCGGGTGAGTCACCCACACAAAGGAAAAGGGCC
	TTTCCGTCCTCAGCCGTCGCTTCATGTGACTCCACGGAGTACCGGGC
	GCCGTCCAGGCACCTCGATTAGTTCTCGAGCTTTTGGAGTACGTCGT
	CTTTAGGTTGGGGGGAGGGGTTTTATGCGATGGAGTTTCCCCACACT
	GAGTGGGTGGAGACTGAAGTTAGGCCAGCTTGGCACTTGATGTAATT
	CTCCTTGGAATTTGCCCTTTTTGAGTTTGGATCTTGGTTCATTCTCA
	AGCCTCAGACAGTGGTTCAAAGTTTTTTTCTTCCATTTCAGGTGTCG
	TGA
3′ poly A	AATAAAATCGCTATCCATCGAAGATGGATGTGTGTTGGTTTTTTGTG	60
	TG

[0284]

TABLE 17
Amino Acid Sequences of Anti-BCMA CAR Construct Components.
		SEQ
Name Description	Amino Acid Sequence	ID NO:
CAR (CTX-166b)	MALPVTALLLPLALLLHAARPQVQLVQSGAELKKPGASVKVSC	61
	KASGNTLTNYVIHWVRQAPGQRLEWMGYILPYNDLTKYSQKFQ
	GRVTITRDKSASTAYMELSSLRSEDTAVYYCTRWDWDGFFDPW
	GQGTTVTVSSGGGGSGGGGSGGGGSEIVMTQSPATLSVSPGER
	ASISCRASQSLVHSNGMTHLHWYQQRPGQAPRLLIYSVSNRFS
	EVPARFSGSGSGTDFTLTISSVESEDFAVYYCSQTSHIPYTFG
	GGTKLEIKSAAAFVPVFLPAKPTTTPAPRPPTPAPTIASQPLS
	LRPEACRPAAGGAVHTRGLDFACDIYIWAPLAGTCGVLLLSLV
	ITLYCNHRNRKRGRKKLLYIFKQPFMRPVQTTQEEDGCSCRFP
	EEEEGGCELRVKFSRSADAPAYQQGQNQLYNELNLGRREEYDV
	LDKRRGRDPEMGGKPRRKNPQEGLYNELQKDKMAEAYSEIGMK
	GERRRGKGHDGLYQGLSTATKDTYDALHMQALPPR
scFv (CTX-166	QVQLVQSGAELKKPGASVKVSCKASGNTLTNYVIHWVRQAPGQ	62
(BCMA-11, &	RLEWMGYILPYNDLTKYSQKFQGRVTITRDKSASTAYMELSSL
CTX-166b)	RSEDTAVYYCTRWDWDGFFDPWGQGTTVTVSSGGGGSGGGGSG
	GGGSEIVMTQSPATLSVSPGERASISCRASQSLVHSNGNTHLH
	WYQQRPGQAPRLLIYSVSNRFSEVPARFSGSGSGTDFTLTISS
	VESEDFAVYYCSQTSHIPYTFGGGTKLEIK
VH (CTX-166)	QVQLVQSGAELKKPGASVKVSCKASGNTLTNYVIHWVRQAPGQ	63
	RLEWMGYILPYNDLTKYSQKFQGRVTITRDKSASTAYMELSSL
	RSEDTAVYYCTRWDWDGFFDPWGQGTTVTVSS
VL (CTX-166)	EIVMTQSPATLSVSPGERASISCRASQSLVHSNGNTHLHWYQQ	64
	RPGQAPRLLIYSVSNRFSEVPARFSGSGSGTDFTLTISSVESE
	DFAVYYCSQTSHIPYTFGGGTKLEIK
VL CDR1	(Kabat or	RASQSLVHSNGNTHLH	65
VL CDR2	Chothia)	SVSNR	66
VL CDR3		SQTSHIPYT	67
VH CDR1	(Kabat)	NYVIH	68
VH CDR2		YILPYNDLTKYSQKFQG	69
VH CDR3		WDWDGFFDP	70
VH CDR1	(Chothia)	GNTLTNY	71
VH CDR2		LPYNDL	72
VH CDR3		WDWDGFFDP	73
linker	GGGGSGGGGSGGGGS	74
CD8 signal peptide	MALPVTALLLPLALLLHAARP	75
CD8a transmembrane	IYIWAPLAGTCGVLLLSLVITLY	34
domain
4-1BB	KRGRKKLLYIFKQPFMRPVQTTQEEDGCSCRFPEEEEGGCEL	59
CD3-zeta	RVKFSRSADAPAYQQGQNQLYNELNLGRREEYDVLDKRRGRDP	35
	EMGGKPRRKNPQEGLYNELQKDKMAEAYSEIGMKGERRRGKGH
	DGLYQGLSTATKDTYDALHMQALPPR

[0285] Manufacture of the CTX120 Drug Substance involved thawing enriched T cells followed by activation and electroporation/transduction, at which point cells were expanded. After expansion, TCRαβ⁺ cells were depleted. Cells were cultured overnight, harvested and sampled for Drug Substance testing. See FIG. 8A. Reprocessing was not performed in any step of CTX120 manufacturing.

T Cell Enrichment

[0286] T cells were enriched from the leukapheresis materials (Leukopaks) via magnetic separation using a mixture of anti-CD8 and anti-CD4 antibody-coated magnetic beads using the automated cell processing system. Prior to enrichment, leukopaks were sampled for cell count and viability (≥80%). Enriched cells were isolated in PBS/EDTA Buffer with HSA, and then sampled for cell count, viability (≥80%), T cell purity (≥70% CD3), and sterility. The cells were then centrifuged at 4±1° C. and resuspended in CryoStor CS5 at a target concentration of 50×10⁶ viable cells/mL.

T Cell Cryopreservation

[0287] Cells were sampled for cell count, viability (≥80%) and then aliquoted into ethyl vinyl acetate cryobags at the target cell number of 2,500×10⁶ cells/bag (30-70 mL of cell suspension). One Leukopak was sufficient to produce 1-2 bags of T cells. Each bag was heat-sealed, labeled, stored at 2-8° C. until transferred to a controlled-rate freezer and subsequently transferred to vapor phase liquid nitrogen for storage.

T Cell Thawing and Activation

[0288] One frozen bag of enriched T cells was thawed, transferred into a 3 L bag and diluted into Supplemented X-VIVO™ 15 media (X-VIVO™ 15, 5% Human Serum, 100 IU/mL rhIL2, 100 IU/mL rhIL7). Cells were sampled for cell count and viability (≥70%). Cells were centrifuged at 540 g at 20±1° C. for 15 minutes. Cells were then resuspended in the Supplemented X-VIVO™ 15 media and sampled for cell count and viability (≥70%). Soluble colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists solution was added at the ratio of 1:12.5 (v/v) to activate the cells.

[0289] Cells were seeded to a target density 2×10⁶ viable cells/mL into two static cell culture vessels, each at a total volume of approximately 500 mL of Supplemented X-VIVO™ 15 media/colloidal polymeric nanomatrix conjugated to recombinant humanized CD3 and CD28 agonists. Static culture vessels were incubated at 37±1° C. and 5±1% CO₂ for 48±4 hours. Throughout the process, whenever the static culture vessels were handled, they were inspected for tears and leaks, and the presence of clear, yellow medium.

Dilution

[0290] Two (2) days later, supplemented X-VIVO™ 15 media was added to each static culture vessel to 5 L. Cells were further incubated at 37±1° C. and 5±1% CO₂ overnight.

Electroporation and Transduction

[0291] The volume of Supplemented X-VIVO™ 15 media was reduced to a final volume of approximately 500 mL using a pump connected to dip-tube in the static culture vessel, which was gently swirled to allow resuspension of cells to in the media. Cells were sampled for cell count, and viability (≥70%). Cells were transferred to 500 mL centrifuge tubes and centrifuged at 540 g, at 20±1° C. for 15 minutes. Cell pellets were resuspended in Electroporation Buffer and centrifuged again under the same conditions. Cells were resuspended in Electroporation Buffer a second time to a target concentration of 300×10⁶ cells/mL.

[0292] Cas9 nuclease was mixed with TA-1 sgRNA (targeting TCR) and with B2M-1 sgRNA (targeting β2M) in separate microcentrifuge tubes. Each solution was incubated for no less than 10 minutes at room temperature to form each ribonucleoprotein complex. The two Cas9/gRNA mixtures were combined, and mixed with the cells, bringing Cas9, TA-1 and B2M-1 to a final concentration of 0.3 mg/mL, 0.08 mg/mL and 0.2 mg/mL, respectively. The mixture was aliquoted and loaded into an electroporation cassette by pipetting. Cassettes were capped and sequentially electroporated using the transfection system based on flow electroporation. After electroporation, cells were pooled from each cassette in a 125 mL Erlenmeyer flask and incubated at 37° C. for no less than 20 minutes. Cells were sampled for viability (≥70%) and count. Cells were diluted to 10⁷ cells/mL with X-VIVO™ 15 media and freshly thawed rAAV-166b was added at a MOI of 20,000 vg/cell. Cells were incubated at 37° C. 5% CO₂ for no less than 60 minutes.

[0293] The impact of MOI to achieve desired CAR⁺ expression, was assessed using a development lot of vector (rAAV-166b). Cells were transduced with increasing MOI and % CAR⁺ was quantified. As shown in FIG. 8B, AAV dose-dependent CAR expression was observed. Expression of CAR was saturated around MOI of 10,000, supporting the selection of a MOI of 20,000.

[0294] Formation of the two ribonucleoprotein complexes (RNP) in situ was performed following the descriptions in Example 7 above. See also results provided in Table 13 above.

[0295] Homology directed-repair (HDR) is a high-fidelity cell repair mechanism for DNA double strand breaks. HDR is used to introduce a CAR gene from the AAV template into the desired TRAC locus by using a homologous sequence on each end of the CAR gene.

[0296] To assess the anti-BCMA CAR at the TRAC locus, a ddPCR assay was developed. A TRACsite specific PCR primer set was designed to amplify the integrated anti-BCMA CAR sequence and determine the percent of cells with the CAR gene insertion. Three lots of CTX120 were evaluated by ddPCR and the % HDR is shown in Table 18. These results confirm insertion of the anti-BCMA CAR at the TRAC locus.

[0297]

TABLE 18
Percent HDR in Development
Lots of CTX120
	Lot Number	% HDR
	CTX120-L-3	46.2%
	CTX120-L-4	43.2%
	P22T090	34.6%

Cell Expansion

[0298] Cells were diluted with Supplemented X-VIVO™ 15 media, sampled for cell viability (≥70%) and count, and seeded to a density between 0.2-0.5×10⁶ viable cells/cm² into two static culture vessels, and one additional static culture vessel (satellite culture for cell monitoring). The static culture vessels were incubated at 37±1° C. and 5±1% CO₂. The cell cultures were incubated for up to 9 days. During this time, the cultures were supplemented every 3 to 4 days with 100 IU of rhIL2 and rhIL7 per mL of culture volume. The satellite static cell culture vessel was tested for cell count, viability, and T cell purity throughout expansion. When the cell density in the satellite culture vessel reached approximately 30×10⁶/cm², the TCRαβ depletion was performed. If cell density in the satellite culture vessel did not reach 30×10⁶/cm², TCRαβ depletion on the main cultures was performed on Day 9.

TCRαβ Depletion

[0299] The medium of each static cell culture vessel was reduced to a final volume of approximately 500 mL using a pump connected to the dip-tube in the static culture vessel. After the bulk of the media was removed, the static culture vessels were gently swirled to resuspend the cells in the media.

[0300] The cells were transferred to 500 mL centrifuge tubes fitted with dip-tubes that connect to the static culture vessels. Cells were sampled for viability (>70%), count, and % CAR⁺ cells. Cells were then centrifuged at 540×g at 20±1° C. for 15 minutes. Cell pellets were resuspended and pooled in less than 650 mL PBS/EDTA containing 0.5% HSA. Cell suspensions were transferred to a sterile bag which is connected to the automated cell processing system. The automated cell processing system incubated cells with a biotin-conjugated anti-TCRαβ antibody. Cells were washed and incubated with anti-biotin magnetic beads to allow for depletion of the TCRαβ⁺ cells using the automated cell processing system. Cells were tested for cell count, viability (>70%), and % CAR⁺ cells.

Cell Recovery

[0301] The depleted cells were resuspended in Supplemented X-VIVO™ 15 media and transferred into 3 L bag(s), seeded into static cell culture vessel(s) and incubated overnight at 37±1° C. and 5±1% CO₂.

Cell Harvest (Drug Substance)

[0302] To harvest cells, static culture vessels were removed from the incubator and allowed to rest for sedimentation of cells. Growth medium was removed from each static culture vessel to a final volume of approximately 500 mL using a pump. Removed media was sampled for sterility. Static culture vessels were gently swirled to allow the cells to resuspend in the media. The contents of each static culture vessel were transferred in a 3 L transfer bag using a pump and was filtered through a 40 μm blood transfusion filter by gravity into a separate sterile 3 L bag. Cells were sampled for concentration and viability.

Cell Phenotypes of CTX120 Produced by the Manufacturing Process Disclosed Herein

[0303] CTX120 Drug Product development lots were analyzed for T cell populations. Flow panels are shown in Table 19.

[0304]

TABLE 19
Flow Panels for Characterization
of T Cell Populations
	Exhaustion	Subset
	CD4	CD4
	CD8	CD8
	CD95	CD45RO
	CAR	CD45RA
	CD57	CD62L
	Lag3	CD27
	PD1	CCR7

Exhaustion Markers

[0305] CD57, Lag3 and PD1 are markers associated with T cell exhaustion. The exhaustion status of the CTX120 Drug Product was assessed using the markers defined in Table 19. As shown in FIG. 8C and Table 20, low levels of exhaustion markers were found in CAR⁺ CTX120 Drug Product cells.

[0306]

TABLE 20
Percent CAR+ Cells with Various Exhaustion Markers
	Marker	CTX120-L-3	CTX120-L-4	P22T090
	% Lag3+	8.19	5.99	2.46
	% CD57+	4.86	5.31	0.62
	% PD1+	2.83	4.36	2.66
	% Tim3+	5.15	4.03	7.01

[0307] The CTX120 Drug product was assessed for memory cell markers. In the CD45RO gate, CD62 L, CCR7, and CD27 were markers associated with central memory. In the CD45RA gate CD62 L was a marker for stem cell memory. Cells that were CD62 L and CCR7⁺ were markers for central memory and stem cell memory. The results for CD8⁺ T cells are shown in FIG. 8D and Table 21. The results for CD4⁺ T cells are shown in FIG. 8E and Table 22.

[0308]

TABLE 21
Central Memory and Stem Cell
Memory Markers in CD8+ T Cells
	T Cell	CTX120-	CTX120-
Marker	Population	L-3	L-4	P22T090
CD45RA/	Stem Cell	36.97	37.63	66.13
CD62L	Memory
CD45RO/	Central Memory	48.93	50.77	59.90
CD27
CD45RO/	Central Memory	28.63	44.63	83.03
CD62L
CD45RO/	Central Memory	9.28	15.20	41.47
CCR7
CD62L/	Stem Cell	36.40	39.93	57.03
CCR7	Memory/
	Central
	Memory

[0309]

TABLE 22
Central Memory and Stem Cell Memory Markers in CD4+ T Cells
	T Cell	CTX120-	CTX120-
Marker	Population	L-3	L-4	P22T090
CD45RA/	Stem Cell	50.13	41.00	54.10
CD62L	Memory
CD45RO/	Central	24.30	26.13	45.33
CD27	Memory
CD45RO/	Central	34.63	55.03	71.87
CD62L	Memory
CD45RO/	Central	15.03	17.90	52.53
CCR7	Memory
CD62L/CCR7	Stem Cell	51.17	39.60	58.73
	Memory/
	Central
	Memory

Biological Activities of CTX120

[0310] Two assays which measure the biological activity of the CAR T cell Drug Product upon stimulation with BCMA antigen were developed. First, IFNγ secretion upon T cell activation was determined. In brief, CAR T cells were incubated with recombinant human BCMA. Upon CAR T cell activation, the level of secreted IFNγ was measured by Meso-Scale Delivery (MSD). Results are shown in FIG. 8F.

[0311] Next, the ability of CTX120 CAR-T cells to kill BCMA positive MM.1S target cells was assessed using a flow cytometry-based cytotoxicity assay. In brief, target cells were labeled with eFluor670 and incubated with CTX120 cells at varying ratios. CTX120 cytotoxicity was analyzed at 4 hours by assessing labeled cells in the live gate compared to control sample. The results are shown in FIG. 8G. All 3 development lots of CTX120 showed dose dependent target cell cytotoxicity.

[0312] Taken together, these results demonstrated production of anti-BCMA CAR expressing T cells. The anti-BCMA CAR expressing T cells manufactured, as described herein, displayed low expression levels of TCR and β2M, thereby reducing the probability of host rejection. Further, the anti-BCMA CAR expressing T cells displayed targeted cell killing of BCMA positive cells upon T cell activation.

[0313] This Example reports identification of optimal plating or replating conditions for superior T cell expansion and increasing yields. In this Example, T cells were either plated at lower density than 500 K/cm² on the same day post editing or seeded with 500 K/cm² densities and replated at different days post editing. Cell expansion was monitored over time.

[0314] In brief, cryopreserved T cells from healthy donor leukopak were thawed and activated for 48 hours. Cells were then electroporated in the presence of RNP complexes comprising Cas9 (150 μg/mL) and sgRNA targeting TCR (TA-1; SEQ ID NO: 2/Cas9; SEQ ID NO: 1) (80 μg/mL) and Cas9 (150 μg/mL) and sgRNA targeting β2M (B2M-1; SEQ ID NO: 6/Cas9; SEQ ID NO: 1) (200 μg/mL). After electroporation, cells were transduced with the rAAV at MOI of 20,000, and then expanded in a static culture vessel. See Examples 1-4 above for details.

[0315] After editing, cells were seeded at 166 K/cm², 125 K/cm², or 83 K/cm² in a static culture vessel for expansion. Another set of cells were seeded at 500 K/cm² post editing and replated at day 3, 4, 5, 6, or 7 post editing at a 1:4 ratio (1 vessel split into 4 new vessels) for further expansion. Cells that replated at 500 K/cm² without replating were used as CTX110 reference group. All groups expanded until the cell density reached 3-4×10⁶/mL at which point the cells were harvested (Table 23). Cell count and viability were assessed every 1-3 days.

[0316]

TABLE 23
	Harvest	Expected
Groups	point	Yield	Harvest date
1	CTX110 500K	3 × 106/mL	1×	day 7
	reference	4 × 106/mL
2	CTX110 166K	4 × 106/mL	3×	day 10 (+3 days)
3	CTX110 125K	4 × 106/mL	4×	day 11 (+3 days)
4	CTX110 83K	4 × 106/mL	6×	day 14 (+7 days)
5	CTX110 D3	4 × 106/mL	4×	day 10 (+3 days)
	replate 1:4 split
6	CTX110 D4	4 × 106/mL		day 10 (+3 days)
	replate 1:4 split
7	CTX110 D5	3 × 106/mL		day 10 (+3 days)
	replate 1:4 split	4 × 106/mL
8	CTX110 D6	3 × 106/mL		day 18 (+11 days)
	replate 1:4 split	4 × 106/mL		day 14 (+7 days)
9	CTX110 D7	3 × 106/mL		day 17 (+10 days)
	replate 1:4 split	4 × 106/mL		day 18 (+11 days)