Immunosuppressive antigen-specific chimeric antigen receptor Treg cells for the prevention and / or treatment of autoimmune and alloimmune disorders

Abstract

The immunoresponsive cells described herein are useful for the prevention and treatment of autoimmune disease and solid organ transplant rejection.Specifically, the present disclosure provides an immunoresponsive cell, comprising a chimeric antigen receptor (CAR) that binds to glutamic acid decarboxylase 65kDA (GAD65) in the cell; and a method for preventing or treating type I diabetes (T1D), comprising administering an effective amount of the immunoresponsive cell to a subject.

Description

Related Applications

[0001] Inventors: Juan C. Jaume, Shahnawaz Imam CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Application No. 17 / 320,663, filed under 35 U.S.C. §111(a) on May 14, 2021, the entire disclosure of which is incorporated herein by reference for all purposes.

[0002] Sequence Listing

[0002] This application contains a Sequence Listing that has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. The ASCII copy created on May 14, 2021 is named 62708-US-NP_SL.txt and is 9,019 bytes in size.

[0003] Statement regarding federally sponsored research

[0003] This invention was not made with government support. The government has no rights in the invention. [Background technology]

[0004]

[0004] Autoimmune disorders are caused by a dysfunctional immune response directed against the body's own tissues, resulting in chronic multisystem disorders that differ in clinical manifestations, course, and outcome.

[0005] The therapeutic application of regulatory T cells (Tregs) for the treatment of autoimmune diseases is limited by the rarity of antigen-specific Tregs.

[0005]

[0006] One approach to confer the desired antigen specificity to effector T cells is to use chimeric T cell antigen receptors with antibody-type specificity. Cellular therapy using cytotoxic T cells redirected with antibody-type specific chimeric antigen receptors (CARs) has shown efficacy in the treatment of hematological malignancies.

[0006]

[0007] Therefore, redirecting Tregs to sites of autoimmune attack using such chimeric immune receptors may represent a useful therapy to alleviate a wide range of diseases in which uncontrolled autoimmune responses play a major role.

[0007]

[0008] If antigen-specific Tregs could be generated on demand against desired autoimmune targets, antigen-specific immunosuppression of autoimmune diseases could be achieved.

[0009] Thus, there is an urgent need for compositions and approaches for treating immune-related disorders or defective T cell tolerance-mediated immune disorders. Summary of the Invention

[0008]

[0010] The present disclosure relates to reagents, compositions and methods for modulating T cell activation, and for modulating immune responses, including but not limited to type 1 diabetes (T1D), self-tolerance and transplant tolerance.

[0009]

[0011] Generally, described herein is the development of pancreatic beta cell-specific CAR-Tregs with preventive and therapeutic capabilities against T1D.

[0012] The present disclosure describes the use of CAR technology to generate potent, functional, stable, GAD65 antigen-specific CAR-Tregs that can prevent the onset of autoimmune diabetes or T1D.

[0010]

[0013] Also described herein is the development of antigen-specific CAR-Tregs for the prevention and treatment of other autoimmune diseases and solid organ transplant rejection.

[0014] In a specific embodiment, the subject suffers from an autoimmune disease, host-versus-graft disease (HVGD), or the subject is an organ transplant recipient.

[0011]

[0015] Provided herein is an immunoresponsive cell comprising a chimeric antigen receptor (CAR) that binds to glutamic acid decarboxylase 65 kDA (GAD65) in a cell; the CAR comprises a) an intracellular signaling domain of a CD3ζ polypeptide and an intracellular signaling domain of a CD28 hinge-transmembrane-intracellular region, and b) an extracellular polypeptide comprising an amino acid sequence of either SEQ ID NO:7 or SEQ ID NO:8, or an amino acid sequence having at least 95% identity to either SEQ ID NO:7 or SEQ ID NO:8. In certain embodiments, the extracellular polypeptide comprises SEQ ID NO:7. In certain embodiments, the extracellular polypeptide comprises SEQ ID NO:8. In certain embodiments, the extracellular polypeptide consists of SEQ ID NO:7. In certain embodiments, the extracellular polypeptide consists of SEQ ID NO:8. SEQ ID NO:7 has the amino acid sequence of MDMRVPAQLLGLLLLWLPGAKCDIQLTQSPTFLSASVGDRVTITCRASQGISSYLAWYQQKPGKAPNLLIYVASTLQSGVPSRFSGSGSGTEFTLTISSLQPEDFATYYCQQLNNYPLTFGGGTKVEIKRPPPPRPPPPRPPPPRQLQLQESGPGLLKPSETLSLTCSVSGGSIGSSSYSWGWIRQPPGKGLEYIGIIYHSGRTYYNPSLKSRVTISVDTSKNQFSLKLSSVTAADTAMYYCARQVPYQPLLDGGNWFDPWGQGTLVTVSS. SEQ ID NO:8 has the amino acid sequence of MAWTVLLLGLLSHCTGSVTSYVLTHPPSVSVAPGKTGTITCGGSNIGSKSVHWYQQKPGQAPKLVIYYDSDRPSGIPERFSGSTSGNTATLTISSVEAGDEADYYCQVWDSSGDHMVVFFGGTKLTVLPPPPRPPPPRPPPPRQVQLVESGGGVVQPGRSLRLSCAASGLTFSHHGMHWVRQAPGKGLEWVAFISYDETKKYYVKSVMGRFTIARDNSKNTLYLHLKSLRPDDAAVYYCAKAFSTTIFGVVTYGMDVWGQGTTVIVSS.

[0012]

[0016] In certain embodiments, the immunoresponsive cell further comprises a spacer between the intracellular signaling domain of the CD28 hinge-transmembrane-intracellular region and the extracellular polypeptide. In certain embodiments, the spacer comprises glycine, serine, or threonine. In certain embodiments, the intracellular signaling domain of the CD28 hinge-transmembrane-intracellular region is linked to the spacer by a peptide bond. In certain embodiments, the extracellular polypeptide is linked to the spacer by a peptide bond. In certain embodiments, the CD3ζ polypeptide is linked to the intracellular signaling domain of the CD28 hinge-transmembrane-intracellular region by a peptide bond. In certain embodiments, the extracellular polypeptide comprises SEQ ID NO:7. In certain embodiments, the extracellular polypeptide comprises SEQ ID NO:8. In certain embodiments, the extracellular polypeptide consists of SEQ ID NO:7. In certain embodiments, the extracellular polypeptide consists of SEQ ID NO:8.

[0013]

[0017] In certain embodiments, the immune responsive cells are selected from the group consisting of T cells, cytotoxic T cells, regulatory T cells, and combinations thereof. In certain embodiments, the cells include pancreatic beta cell-specific chimeric antigen receptor (CAR) regulatory T cells (Tregs) that express at least one extracellular polypeptide and can affect Teff cells. In certain embodiments, the extracellular polypeptide enhances the immune response in the subject by binding to a specific antigen in the target cell. In certain embodiments, the target cell is a cell in a subject suffering from an autoimmune endocrine disease, an organ-specific autoimmune disease, or an autoimmune transplant intolerance.

[0014]

[0018] Further provided is a pharmaceutical composition comprising an effective amount of the immunoresponsive cells described herein and a pharma- ceutically acceptable excipient. In certain embodiments, the immunoresponsive cells are T cells. Further provided is a kit for the prophylactic or therapeutic treatment of type 1 diabetes (T1D), comprising a) a pharmaceutical composition described herein, and b) instructions for use in the therapeutic treatment of T1D.

[0015]

[0019] Also provided is a method of extending survival of a subject having type 1 diabetes (T1D), comprising administering to the subject an effective amount of an immunoresponsive cell as described herein, thereby extending survival of the subject. In certain embodiments, the subject is a human. In certain embodiments, the immunoresponsive cell is selected from the group consisting of T cells, cytotoxic T cells, regulatory T cells, and combinations thereof.

[0016]

[0020] Also provided is a method of preventing or treating type 1 diabetes (T1D), comprising administering to a subject an effective amount of an immunoresponsive cell described herein, thereby treating or preventing T1D in the subject. In certain embodiments, the subject is a human. In certain embodiments, the immunoresponsive cell is selected from the group consisting of T cells, cytotoxic T cells, regulatory T cells, and combinations thereof.

[0017]

[0021] Also provided herein is an immunoresponsive cell having a chimeric antigen receptor (CAR) that binds to glutamic acid decarboxylase 65 kDA (GAD65) in the cell.

[0018]

[0022] The CAR comprises: a) an intracellular signaling domain of a CD3ζ polypeptide and an intracellular signaling domain of a CD28 hinge-transmembrane-intracellular region; and b) an extracellular polypeptide that recognizes at least a portion of an amino acid sequence selected from the amino acid sequences having SEQ ID NOs: 1-6; or at least one complete amino acid sequence selected from the amino acid sequences having SEQ ID NOs: 1-6.

[0019]

[0023] In certain embodiments, the immunoresponsive cells are selected from the group consisting of T cells, cytotoxic T cells, regulatory T cells, and combinations thereof.

[0024] In certain embodiments, the cells comprise pancreatic beta cell-specific chimeric antigen receptor (CAR) regulatory T cells (Tregs) that express at least one extracellular polypeptide and are capable of influencing Teff cells.

[0020]

[0025] In certain embodiments, the extracellular polypeptide is a GAD65 MAb antigen binding domain that recognizes at least a portion of an amino acid sequence selected from those having SEQ ID NOs: 1-6; or at least one complete amino acid sequence selected from those having SEQ ID NOs: 1-6.

[0021]

[0026] In another aspect, provided herein is a pharmaceutical composition comprising an effective amount of an immunoresponsive cell described herein and a pharma- ceutically acceptable excipient.

[0027] In another aspect, provided herein is a kit for the prophylactic or therapeutic treatment of type 1 diabetes (T1D), comprising: a) a pharmaceutical composition described herein; and b) instructions for use in the therapeutic treatment of T1D.

[0022]

[0028] In another aspect, provided herein is a method of extending survival of a subject having type 1 diabetes (T1D), comprising administering to the subject an effective amount of an immunoresponsive cell described herein, thereby extending survival of the subject.

[0023]

[0029] In another aspect, provided herein is a method for preventing or treating type 1 diabetes (T1D), comprising administering to a subject an effective amount of an immunoresponsive cell described herein, thereby treating or preventing T1D in the subject.

[0024]

[0030] In certain embodiments, the subject is a human.

[0031] In another aspect, what is provided herein is an immunoresponsive cell for treating autoimmune endocrine disease, which has a chimeric antigen receptor (CAR) that binds to at least one antigen.The CAR comprises a) an intracellular signaling domain, b) an extracellular polypeptide that comprises an antigen-binding region MAb that recognizes the amino acid sequence of at least one antigen.The autoimmune endocrine disease and the antigen can be selected as described herein.

[0025]

[0032] In another aspect, provided herein is a method of treating or preventing an autoimmune endocrine disease in a subject, the method comprising administering to the subject an effective amount of an immunoresponsive cell, thereby treating or preventing the autoimmune endocrine disease in the subject.

[0026]

[0033] In another aspect, provided herein is a method of extending survival of a subject having an autoimmune endocrine disease, the method comprising administering to the subject an effective amount of an immunoresponsive cell, thereby extending survival of the subject.

[0027]

[0034] In another aspect, provided herein is an immunoresponsive cell for treating organ-specific autoimmune disease, which has a chimeric antigen receptor (CAR) that binds to at least one antigen. CAR comprises a) an intracellular signaling domain, b) an extracellular polypeptide that comprises an antigen-binding region MAb that recognizes the amino acid sequence of at least one antigen. Organ-specific autoimmune disease and antigen can be selected as described herein.

[0028]

[0035] In another aspect, provided herein is a method of treating or preventing an organ-specific autoimmune disease in a subject, the method comprising administering to the subject an effective amount of an immunoresponsive cell, thereby treating or preventing the organ-specific autoimmune disease in the subject.

[0029]

[0036] In another aspect, provided herein is a method of extending survival of a subject having an organ-specific autoimmune disease, the method comprising administering to the subject an effective amount of an immunoresponsive cell, thereby extending survival of the subject.

[0030]

[0037] In another aspect, what is provided herein is an immunoresponsive cell for treating allogeneic immune transplant intolerance, which has a chimeric antigen receptor (CAR) that binds to at least one antigen.CAR comprises a) an intracellular signaling domain, b) an extracellular polypeptide that comprises an antigen binding region MAb that recognizes the amino acid sequence of at least one antigen.Allogeneic immune transplant and antigen can be selected as described herein.

[0031]

[0038] In another aspect, provided herein is a method of treating or preventing allogeneic immune transplant intolerance in a subject, the method comprising administering to the subject an effective amount of immunoresponsive cells, thereby treating or preventing allogeneic immune transplant intolerance in the subject.

[0032]

[0039] In another aspect, provided herein is a method of extending survival of a subject having allogeneic immune transplant intolerance, the method comprising administering to the subject an effective amount of immunoresponsive cells, thereby extending survival of the subject.

[0033]

[0040] In certain embodiments, the MAb variable region of the CAR enhances the immune response in a subject by binding to a specific antigen within a target cell.

[0041] In certain embodiments, the target cells are cells in a subject suffering from an autoimmune endocrine disease, an organ-specific autoimmune disease, or an allogeneic immune transplant intolerance.

[0034]

[0042] Other systems, methods, features, and advantages of the present disclosure will be, or will become, apparent to one with skill in the art upon examination of the following figures and detailed description. All such additional systems, methods, features, and advantages are intended to be included within this description, be within the scope of the present disclosure, and be protected by the accompanying claims.

[0035]

[0043] The patent or application file may contain one or more drawings and / or one or more photographs executed in color. Copies of this patent or patent application publication with color drawings and / or photographs will be provided by the Office upon request and payment of the necessary fee. [Brief description of the drawings]

[0036] [Figure 1A]

[0044] Figure 1A: CAR-Treg design scheme. [Figure 1B]

[0045] FIG. 1B: Schematic diagram of Teff downregulation. [Diagram 2]

[0046] Figure 2: Humanized mouse models of T1D - Comparison of genetic predisposition and target antigen availability between humans and mouse models; as well as confocal microscopy of pancreatic frozen sections (8 μm) from humanized T1D mice. Red = insulin; blue = GAD65; green = HLA-DQ8. [Figure 3-1]

[0047] Figure 3: Flow cytometry tracking of GFP-GAD65 CAR-Treg cells in blood, pancreatic lymph nodes (PLN), pancreas (PN) and spleen. Single cells were acquired using a flow cytometer (BD FACSCANTO) by detecting GFP in the FITC channel. Five million GFP-GAD65 CAR-Treg cells were injected into a spontaneously developing humanized mouse model (co-expressing green fluorescent protein (GFP), 24 hours before sacrifice). [Figure 3-2] Continued from Figure 3. [Figure 4]

[0048] Figure 4: 3D iDISCO. Islet morphology and CAR-Treg cell localization. Top to bottom: magnification of islets (100x), (10x), (4x). A. Green = GFP, B. Red = insulin, overlay of CA and B, D. Blue = GAD65, EA, overlay of B and D. [Figure 5A]

[0049] Figures 5A-5E: Flow cytometry. Immune cell profiling of animals treated with different CAR-Treg and conventional Treg cells. [Figure 5B] Figures 5A-5E: Flow cytometry. Immune cell profiling of animals treated with different CAR-Treg and conventional Treg cells. [Figure 5C] Figures 5A-5E: Flow cytometry. Immune cell profiling of animals treated with different CAR-Treg and conventional Treg cells. [Figure 5D] Figures 5A-5E: Flow cytometry. Immune cell profiling of animals treated with different CAR-Treg and conventional Treg cells. [Figure 5E] Figures 5A-5E: Flow cytometry. Immune cell profiling of animals treated with different CAR-Treg and conventional Treg cells. [Figure 6]

[0050] Figure 6: Glucose tolerance test (GTT) measurements one month after CAR-M Treg / CAR-N Treg / conventional Treg / non-islet specific CAR-Treg (EPCAM) treatment. GTT at 30 day follow-up. Glucose tolerance was significantly improved in the GAD65-specific CAR Treg treatment group compared to the conventional Treg and non-specific EPCAM (control CAR-Treg) groups. Treatment with conventional Tregs is no different compared to the non-islet specific EPCAM (control CAR-Treg) group. [Figure 7A]

[0051] Figures 7A-7B: Suppression / proliferation assay of CAR-Treg (CD25+) and Tresp (CD4+CD25-) (n=3-4): Figure 7A = Tresp. (CD4+CD25); Figure 7B = CAR-Treg (CD25+). [Figure 7B]Figures 7A-7B: Suppression / proliferation assay of CAR-Treg (CD25+) and Tresp (CD4+CD25-) (n=3-4): Figure 7A = Tresp. (CD4+CD25); Figure 7B = CAR-Treg (CD25+). [Figure 7C]

[0052] FIG. 7C: Percentage of Treg proliferation. [Figure 7D]

[0053] FIG. 7D: Percentage of proliferation of Tresp. [Figure 7E]

[0054] Figure 7E: Summary data of in vitro suppression assays at different ratios of Tresp and CAR-Treg, as well as a table of their proliferation / replication indexes from Figures 7C-7D. [Figure 8A]

[0055] Figures 8A-8B: Analysis of in vivo proliferation assays: EPCAM-specific CAR-Treg cells (Figure 8A) and GAD65-specific CAR-Treg cells (Figure 8B). [Figure 8B] Figures 8A-8B: Analysis of in vivo proliferation assays: EPCAM-specific CAR-Treg cells (Figure 8A) and GAD65-specific CAR-Treg cells (Figure 8B). [Figure 8C]

[0056] Figures 8C-8D: Analysis of in vitro proliferation assays: Treg cells (Figure 8C) and CAR-Treg cells (Figure 8D). [Figure 8D] Figures 8C-8D: Analysis of in vitro proliferation assays: Treg cells (Figure 8C) and CAR-Treg cells (Figure 8D). DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0037]

[0057] Throughout this disclosure, various publications, patents, and published patent specifications are referenced by an identifying citation. The disclosures of these publications, patents, and published patent specifications are incorporated by reference into this disclosure in order to more fully describe the state of the art to which this invention pertains.

[0038]

[0058] Before the present methods and compositions are described, it is to be understood that this invention is not limited to the particular methods or compositions described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.

[0039]

[0059] General methods in molecular and cellular biochemistry can be found in standard textbooks such as Molecular Cloning: A Laboratory Manual, 3rd Edition (Sambrook et al., CSH Laboratory Press 2001); Short Protocols in Molecular Biology, 4th Edition (Ausubel et al., eds., John Wiley & Sons 1999); Protein Methods (Bollag et al., John Wiley & Sons 1996); Nonviral Vectors for Gene Therapy (Wagner et al., eds., Academic Press 1999); Viral Vectors (Kaplift & Loewy, eds., Academic Press 1995); Immunology Methods Manual (I. Lefkovits, ed., Academic Press 1997); and Cell and Tissue Culture: Laboratory Procedures in Biotechnology (Doyle & Griffiths, John Wiley & Sons 1998), the disclosures of which are incorporated herein by reference. Reagents, cloning vectors and kits for the genetic manipulations referred to in this disclosure are available from commercial vendors.

[0040]

[0060] definition

[0061] Where a range of values ​​is provided, unless the context clearly dictates otherwise, it is understood that each intervening value, to the tenth of the unit of the lower limit, between the upper and lower limits of that range is also specifically disclosed. Each smaller range between any stated or intervening value in a stated range and any other stated or intervening value in that stated range is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included or excluded in the range, and each range in which either, both or both limits are included in the smaller range is also encompassed within the invention, but with the reservation of any specifically excluded limit in the stated range. Where a stated range includes one or both of the limits, ranges excluding either or both of the included limits are also included in the invention.

[0041]

[0062] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by those skilled in the art to which this invention belongs.Although any method and material similar or equivalent to those described herein can be used for carrying out or testing this invention, some possible and preferred methods and materials are described below.All publications mentioned herein are incorporated herein by reference, and disclose and describe the method and / or material in which the publication is cited in connection.It is understood that this disclosure takes precedence over the disclosure of the incorporated publication in case of discrepancy.

[0042]

[0063] It should be noted that as used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural references unless the context clearly indicates otherwise. Thus, for example, reference to a "cell" includes a plurality of such cells, and reference to a "peptide" includes reference to one or more peptides and equivalents thereof known to those skilled in the art, such as polypeptides.

[0043]

[0064] As used herein and in the claims, the singular includes plural references and vice versa, unless the context clearly indicates otherwise. The term "or" is inclusive, unless modified, for example, by "either". Other than in the working examples or where otherwise indicated, all numbers expressing quantities of ingredients or reaction conditions used herein should be understood in all instances as being modified by the term "about". The term "about" with respect to a numerical value means within 5%.

[0044]

[0065] As used herein, the term "administer" or "administration" refers to the placement of an agent into a subject by a method or route that results in at least partial localization of such agent at a desired site, such as a site of inflammation or a tumor site, so that a desired effect occurs.

[0045]

[0066] As used herein, "modulating" or "modulate" generally means to reduce or inhibit the expression and / or activity of a target molecule, or alternatively to increase the expression and / or activity, as measured, for example, using a suitable in vitro, cellular, or in vivo assay. In particular, "modulating" or "modulate" can mean to reduce or inhibit the expression and / or activity of a target molecule, or alternatively to increase the (associated or intended) biological activity and / or expression, as measured, using a suitable in vitro, cellular, or in vivo assay (often depending on the target involved), by at least 5%, at least 10%, at least 25%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or more, inclusive, as compared to the activity of the target in the same assay under the same conditions but without the agent. Thus, as used herein, the term "modulating" can refer to an increase or decrease in expression and / or activity as compared to a subject not treated with an agent that modulates expression and / or activity. An "increase" or "decrease" refers to a statistically significant increase or decrease, respectively. For the avoidance of doubt, an increase or decrease relative to baseline is at least 10%, e.g., inclusively, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 97%, at least 98% or more, and including at least 100% or more, and in the case of an increase, e.g., at least 2-fold, at least 3-fold, at least 4-fold, at least 5-fold, at least 6-fold, at least 7-fold, at least 8-fold, at least 9-fold, at least 10-fold, at least 50-fold, at least 100-fold or more.

[0046]

[0067] As used herein, the term "composition" is intended to encompass a product comprising the specified ingredients in the specified amounts, as well as any product that results directly or indirectly from combining the specified ingredients in the specified amounts.

[0047]

[0068] "Comprising" means that the recited element is required in the composition / method / kit, but other elements may be included to form the composition / method / kit etc. within the scope of the claim.

[0048]

[0069] "Consisting essentially of" means that the scope of the described composition or process is limited to particular materials or steps that do not materially affect the basic and novel characteristics of the subject invention.

[0049]

[0070] "Consisting of" means that any element, step or ingredient not specified in the claim is excluded from the composition, method, or kit.

[0071] As used herein, the terms "treatment", "treating" and the like generally refer to obtaining a desired pharmacological and / or physiological effect. The effect may be prophylactic, in that it completely or partially prevents the disease or its symptoms, and / or it may be therapeutic, in that it partially or completely cures the disease and / or the side effects caused by the disease. As used herein, "treatment" encompasses any treatment of a disease in a mammal, including: (a) preventing the disease from occurring in a subject who is predisposed to the disease but has not yet been diagnosed as having the disease; (b) inhibiting the disease, i.e., arresting its development; or (c) relieving the disease, i.e., causing regression of the disease. Therapeutic agents may be administered before, during, or after the onset of the disease or injury. Of particular interest are treatments of ongoing diseases, where the treatment stabilizes or reduces unfavorable clinical symptoms in the patient. It is desirable for such treatments to occur before complete loss of function of the affected tissue. Treatment of the subject may be administered during, and in some cases after, the symptomatic stage of the disease.

[0050]

[0072] "Therapeutically effective amount" refers to the amount of active agent required to provide a therapeutic benefit to a subject. For example, a "therapeutically effective amount" is an amount that induces, ameliorates or otherwise causes an improvement in pathological symptoms, disease progression or physiological condition associated with a disease, or improves resistance to a disorder.

[0051]

[0073] The term "genetic modification" means any process that adds, deletes, alters, or disrupts an endogenous nucleotide sequence, including, but not limited to, viral-mediated gene transfer, liposome-mediated transfer, CRISPER CAS9-mediated gene transformation, transfection, and transduction.

[0052]

[0074] As used herein, the term "antibody" refers not only to complete antibody molecules, but also to fragments of antibody molecules that retain immunogen-binding ability. Such fragments are well known in the art and are routinely used both in vitro and in vivo. Thus, as used herein, the term "antibody" refers not only to complete immunoglobulin molecules, but also to the well-known active fragments F(ab')2 and Fab. F(ab')2 and Fab fragments that lack the Fe fragment of complete antibodies are cleared from circulation more rapidly and may have less non-specific tissue binding than complete antibodies. Antibodies can be whole natural antibodies, bispecific antibodies; chimeric antibodies; Fab, Fab', single chain V region fragments (scFv), fusion polypeptides, and non-conventional antibodies.

[0053]

[0075] As used herein, the term "antigen-recognizing receptor" refers to a receptor that can activate an immune cell (e.g., a T cell) in response to antigen binding. An exemplary antigen-recognizing receptor can be a natural or endogenous T cell receptor, or a chimeric antigen receptor in which an antigen-binding domain is fused to an intracellular signaling domain that can activate an immune cell (e.g., a T cell).

[0054]

[0076] As used herein, the term "chimeric antigen receptor" or "CAR" refers to an antigen binding domain that is fused to an intracellular signaling domain that can activate or stimulate immune cells. Most commonly, the extracellular binding domain of a CAR is composed of a single chain variable fragment (scFv) derived from the fusion of the variable heavy and light chain regions of a murine or humanized monoclonal antibody. Alternatively, an scFv derived from a Fab (e.g., rather than derived from an antibody obtained from a Fab library) may be used. In various embodiments, the scFv is fused to a transmembrane domain and then fused to an intracellular signaling domain. "First generation" CARs include those that provide only a CD3ζ signal upon antigen binding, and "second generation" CARs include those that provide both costimulation (e.g., CD28 or CD137) and activation (CD3ζ). "Third generation" CARs include those that provide multiple costimulation (e.g., CD28 or CD137) and activation (CD3). In various embodiments, the CARs are selected to have high affinity or avidity for the antigen.

[0055]

[0077] As used herein, the term "single-chain variable fragment" or "scFv" is a fusion protein of the variable regions of the heavy (VH) and light (VL) chains of immunoglobulins covalently linked to form a VH::VL heterodimer. The heavy (VH) and light (VL) chains are either directly linked or linked by a peptide-encoding linker (e.g., 10, 15, 20, 25 amino acids) that connects the N-terminus of VH to the C-terminus of VL or the C-terminus of VH to the N-terminus of VL. The linker / spacer can be glycine for flexibility, as well as serine or threonine for solubility. Despite the removal of the constant regions and the introduction of the linker, the scFv protein retains the specificity of the original immunoglobulin.

[0056]

[0078] By "substantially identical" is meant a polypeptide or nucleic acid molecule that exhibits at least 50% identity to a reference amino acid sequence (e.g., any one of the amino acid sequences described herein) or nucleic acid sequence (e.g., any one of the nucleic acid sequences described herein). Preferably, such a sequence is at least 60%, more preferably 80% or 85%, even more preferably 90%, 95%, or even 99% identical at the amino acid or nucleic acid level to the sequence used for comparison.

[0057]

[0079] Sequence identity is typically measured using sequence analysis software (e.g., Sequence Analysis Software Package, BLAST, BESTFIT, GAP, or PILEUP / PRETTYBOX program, Genetics Computer Group, University of Wisconsin Biotechnology Center, 1710 University Avenue, Madison, Wis. 53705). Such software matches identical or similar sequences by assigning degrees of homology to various substitutions, deletions, and / or other modifications. Conservative substitutions typically include substitutions within the following groups: glycine, alanine; valine, isoleucine, leucine; aspartic acid, glutamic acid, asparagine, glutamine; serine, threonine; lysine, arginine; and phenylalanine, tyrosine. In an exemplary approach for determining the degree of identity, the BLAST program may be used, and a probability score between e-3 and e-100 indicates closely related sequences.

[0058]

[0080] "Exogenous" refers to a nucleic acid molecule or polypeptide that is not present endogenously in a cell or that is not present at levels sufficient to achieve a functional effect when overexpressed. Thus, the term "exogenous" is intended to encompass any recombinant nucleic acid molecule or polypeptide expressed in a cell, including foreign, heterologous, and overexpressed nucleic acid molecules and polypeptides.

[0059]

[0081] By "heterologous nucleic acid molecule or polypeptide" is meant a nucleic acid molecule (e.g., a cDNA, DNA or RNA molecule) or polypeptide that is not normally present in a cell or a sample obtained from a cell. The nucleic acid may be from another organism or may be, for example, an mRNA molecule that is not normally expressed in the cell or sample.

[0060]

[0082] By "immunoresponsive cell" is meant a cell, or a precursor or progeny thereof, that functions in the immune response.

[0083] By "increase" we mean a positive change of at least 5%. The change could be 5%, 10%, 25%, 30%, 50%, 75% or even 100%.

[0061]

[0084] By "isolated cell" is meant a cell that has been separated from the molecular and / or cellular components that naturally accompany the cell.

[0085] The term "isolated" means that the material is removed from its original environment (e.g., the natural environment if it occurs in nature). For example, a polynucleotide or polypeptide that occurs naturally in a living animal is not isolated, but the same polynucleotide or polypeptide separated from some or all of the coexisting materials in a natural system is isolated. Such a polynucleotide may be part of a vector, and / or such a polynucleotide or polypeptide may be part of a composition, but still be isolated in that such a vector or composition is not part of its natural environment.

[0062]

[0086] The terms "isolated," "purified," or "biologically pure" refer to material that is free to various degrees from components that normally accompany it as found in its native state. "Isolate" indicates some degree of separation from the original source or surrounding environment. "Purify" indicates a degree of separation greater than isolation. A "purified" or "biologically pure" protein is one that is sufficiently free of other substances, such as endotoxin-free, so that impurities do not significantly affect the biological properties of the protein or cause other deleterious consequences. That is, a nucleic acid or peptide is purified if it is substantially free of cellular material, viral material, or culture medium if produced by recombinant DNA technology, or chemical precursors or other chemicals if chemically synthesized. Purity and homogeneity are typically determined using analytical chemistry techniques, such as polyacrylamide gel electrophoresis or high performance liquid chromatography. The term "purified" may indicate that the nucleic acid or protein gives rise to essentially one band in an electrophoretic gel. For example, in the case of proteins that can be modified, such as phosphorylation or glycosylation, different modifications may give rise to different isolated proteins that can be purified separately.

[0063]

[0087] As used herein, "linker" or "spacer" is intended to mean a functional group (e.g., a chemical or polypeptide) that covalently links two or more polypeptides or nucleic acids such that they are linked to one another. As used herein, a "peptide linker" refers to one or more amino acids used to link two proteins together (e.g., to link a VH domain and a VL domain).

[0064]

[0088] "Variant" refers to a polypeptide having an amino acid sequence that differs to some extent from a native sequence polypeptide. Typically, an amino acid sequence variant has at least about 80% sequence identity, more preferably at least about 90% sequence homology. An amino acid sequence variant may have substitutions, deletions, and / or insertions at specific positions within the reference amino acid sequence.

[0065]

[0089] A "variant" of a protein of interest, as used herein, refers to an amino acid sequence in which one or more amino acids have been altered. A variant may have "conservative" changes, where the substituted amino acid has similar structural or chemical properties (e.g., replacement of leucine with isoleucine). More rarely, a variant may have "non-conservative" changes (e.g., replacement of glycine with tryptophan). Similar minor variations may also include amino acid deletions or insertions, or both. Guidance for determining which amino acid residues may be substituted, inserted, or deleted without losing biological or immunological activity may be found using computer programs well known in the art, such as DNASTAR software.

[0066]

[0090] As used herein, the term "graft" refers to an organ and / or tissue that can be obtained from a first mammal (or donor) and transplanted into a second mammal (recipient), preferably a human. The term "graft" encompasses organs such as, for example, skin, heart, lung, heart-lung (e.g., heart and one lung, heart and both lungs), liver, kidney, pancreas (e.g., islet cells, beta cells), parathyroid, intestine (e.g., colon, small intestine, duodenum), etc. Grafts can be obtained from any suitable mammal (e.g., human, pig, baboon, chimpanzee), and under certain circumstances, grafts can be generated in vitro by culturing cells obtained from a suitable mammal. Grafts are preferably obtained from humans.

[0067]

[0091] As used herein, the term "subject" refers to mammals, such as dogs, cats, horses, cows, sheep and primates, particularly humans. Animal models, particularly small mammals, such as mice, may be used in experimental investigations. Preferably, the subject is a human.

[0068]

[0092] "Non-immunogenic" refers to a substance that does not initiate, induce or enhance an immune response, where the immune response includes an adaptive immune response and / or an innate immune response.

[0093] The term "gene" refers to a segment of DNA involved in producing a polypeptide chain; it includes the "leader and trailer" regions preceding and following the coding region, as well as the intervening sequences (introns) between individual coding segments (exons). Genes may be developed that lack all or part of an intron. Some leader sequences may facilitate translation of a nucleic acid into a polypeptide.

[0069]

[0094] The term "nucleic acid" refers to polynucleotides such as deoxyribonucleic acid (DNA), and, where appropriate, ribonucleic acid (RNA). The term should also be understood to include, as equivalents, either RNA or DNA analogs made from nucleotide analogs, and, as applicable to the described embodiments, single-stranded (sense or antisense) and double-stranded polynucleotides.

[0070]

[0095] The terms "polypeptide" and "protein" are used interchangeably herein. The term "preventing" is art-recognized and, when used in reference to a condition, is well understood in the art and includes administering a composition that reduces the frequency, reduces the severity, or delays the onset of a condition in a subject compared to a subject who does not receive the composition prior to the onset of the condition.

[0071]

[0096] As used herein, "type 1 diabetes" includes one or more of type 1 diabetes, insulin-dependent diabetes, idiopathic diabetes, juvenile type 1 diabetes, and latent autoimmune diabetes in adults. Conditions associated with type 1 diabetes include neuropathy, including polyneuritis, mononeuritis, peripheral neuritis, and autonomic neuritis; ocular complications: glaucoma, cataracts, and / or retinopathy; and renal complications: diabetic nephropathy.

[0072]

[0097] Prevention of an infectious disease includes, for example, reducing the number of diagnoses of an infectious disease in a treated population versus an untreated / control population and / or delaying the onset of symptoms of an infectious disease in a treated population versus an untreated control population.

[0073]

[0098] General Description

[0099] Generally, the immunoresponsive cells contain a chimeric antigen receptor (CAR) having an extracellular polypeptide that recognizes an epitope of the recognition domain. The extracellular polypeptide is a MAb (monoclonal antibody) variable region.

[0074]

[0100] In one embodiment, the extracellular peptide GAD65 MAb is part of a CAR that recognizes at least a portion of the amino acid sequence (epitope) of one of SEQ ID NOs: 1-6. The term "extracellular" is used herein to distinguish from intracellular (CD3ζ and CD28 shown in FIG. 1A). In this CAR, the GAD65 MAb variable region is an extracellular recombinant polypeptide expressed by immune responsive (Treg) cells.

[0075]

[0101] For example, the extracellular polypeptide (the GAD65 MAb variable region of the CAR) is a GAD65 antigen-binding domain that recognizes at least a portion of one amino acid sequence selected from one of SEQ ID NOs: 1 to 6.

[0076]

[0102] In some embodiments, the extracellular polypeptide has the sequence: MDMRVPAQLLGLLLLWLPGAKCDIQLTQSPTFLSASVGDRVTITCRASQGISSYLAWYQQKPGKAPNLLIYVASTLQSGVPSRFSGSGSGTEFTLTISSLQPEDFATYYCQQLNNYPLTFGGGTKVEIKRPPPPRPPPPRPPPPRQLQLQESGPGLLKPSETLSLTCSVSGGSIGSSSYSWGWIRQPPGKGLEYIGIIYHSGRTYYNPSLKSRVTISVDTSKNQFSLKLSSVTAADTAMYYCARQVPYQPLLDGGNWFDPWGQGTLVTVSS (SEQ ID NO: 7). In such embodiments, CAR-Treg may be referred to as CAR-N. In some embodiments, the extracellular polypeptide has the sequence MAWTVLLLGLLSHCTGSVTSYVLTHPPSVSVAPGKTGTITCGGSNIGSKSVHWYQQKPGQAPKLVIYYDSDRPSGIPERFSGSTSGNTATLTISSVEAGDEADYYCQVWDSSGDHMVVFFGGTKLTVLPPPPRPPPPRPPPPRQVQLVESGGGVVQPGRSLRLSCAASGLTFSHHGMHWVRQAPGKGLEWVAFISYDETKKYYVKSVMGRFTIARDNSKNTLYLHLKSLRPDDAAVYYCAKAFSTTIFGVVTYGMDVWGQGTTVIVSS (SEQ ID NO: 8). In such embodiments, the CAR-Treg may be referred to as CAR-M.

[0077]

[0103] The MAb variable region of the CAR (including the GAD65 CAR) of the immunoresponsive cell is activated (the immune response is enhanced) by binding to a specific antigen (either GAD65 or other desired antigens for autoimmune disease and solid organ transplant rejection).

[0078]

[0104] Thus, in one embodiment, GAD65 CAR-Treg cells are essentially made from Treg cells (e.g., isolated from the peripheral blood of a subject) and a construct (CAR) that recognizes a specific antigen via the MAb variable region.

[0079]

[0105] The CAR components (expressed by CAR-Treg cells) include an intracellular component (CD3ζ and CD28), a spacer, and an extracellular component (MAb variable region), as shown in Figure 1A. CAR expression follows the expression pathway of any cellular protein (DNA->RNA->protein). The different components (polypeptides CD3ζ, CD8, spacer, and MAb variable region) are linked together by peptide bonds.

[0080]

[0106] For example, a MAb variable region that recognizes the GAD65 epitope (to which humans with T1D make antibodies) is assembled together with other components (CD3ζ, CD8, spacer).

[0081]

[0107] In another example, CAR-Tregs are generated using selected autoantigens to treat autoimmune diseases and solid organ transplant rejection. Non-limiting examples of such antigens (for which humans make antibodies) are listed in Tables 1-3 below. Epitopes of these antigens are selected (such as GAD65) to generate epitope-specific CAR-Tregs.

[0082]

[0108] According to at least some embodiments, there is provided the use of an isolated soluble paratope polypeptide, or a fragment or variant or homologue thereof, or a fusion protein or conjugate comprising same, or a polypeptide comprising the extracellular domain of any one of the amino acids that bind to SEQ ID NOs: 1-6, or a fragment or variant or homologue thereof, or a fusion protein or conjugate comprising same, or a pharmaceutical composition comprising any of the foregoing, adapted for the treatment of immune-related disorders including T1D.

[0083]

[0109] Optionally, the paratope polypeptide comprises a sequence of amino acid residues having at least 95% sequence identity to the amino acid residues bound to any of SEQ ID NOs: 1-6, or a therapeutically compatible fragment, or variant, or homolog thereof. Optionally, the polypeptide is conjugated to a detectable or therapeutic moiety. In some embodiments, the paratope polypeptide comprises a sequence of MDMRVPAQLLGLLLLWLPGAKCDIQLTQSPTFLSASVGDRVTITCRASQGISSYLAWYQQKPGKAPNLLIYVASTLQSGVPSRFSGSGSGTEFTLTISSLQPEDFATYYCQQLNNYPLTFGGGTKVEIKRPPPPRPPPPRPPPPRQLQLQESGPGLLKPSETLSLTCSVSGGSIGSSSYSWGWIRQPPGKGLEYIGIIYHSGRTYYNPSLKSRVTISVDTSKNQFSLKLSSVTAADTAMYYCARQVPYQPLLDGGNWFDPWGQGTLVTVSS (SEQ ID NO: 7), or a sequence having at least 95% sequence identity thereto. In other embodiments, the paratope polypeptide comprises a sequence of MAWTVLLLGLLSHCTGSVTSYVLTHPPSVSVAPGKTGTITCGGSNIGSKSVHWYQQKPGQAPKLVIYYDSDRPSGIPERFSGSTSGNTATLTISSVEAGDEADYYCQVWDSSGDHMVVFFGGTKLTVLPPPPRPPPPRPPPPRQVQLVESGGGVVQPGRSLRLSCAASGLTFSHHGMHWVRQAPGKGLEWVAFISYDETKKYYVKSVMGRFTIARDNSKNTLYLHLKSLRPDDAAVYYCAKAFSTTIFGVVTYGMDVWGQGTTVIVSS (SEQ ID NO: 8), or a sequence having at least 95% sequence identity thereto.

[0084]

[0110] According to at least some embodiments, there is provided a method for preventing and / or treating an immune-related disorder, wherein the treatment does not cause overall immunosuppression of the immune system in the subject, comprising administering to a subject in need thereof a pharmaceutical composition comprising a paratope polypeptide that binds an amino acid residue set forth in any of SEQ ID NOs: 1-6, or a fragment or variant or homolog thereof, optionally provided as the pharmaceutical composition.

[0085]

[0111] According to at least some embodiments, there is provided a method for preventing and / or treating an immune-related disorder, wherein the treatment does not cause a general immunosuppression of the immune system in the subject, comprising administering to a subject in need thereof a pharmaceutical composition comprising a paratope polypeptide having an amino acid sequence of either SEQ ID NO:7 or SEQ ID NO:8, or a fragment or variant or homolog thereof, optionally provided as said pharmaceutical composition.

[0086]

[0112] In some cases, treating includes one or more of curing, managing, reversing, attenuating, mitigating, minimizing, inhibiting, managing, or stopping the deleterious effects of the above-mentioned diseases.

[0113] Common methods

[0114] Generally, Tregs modified with the desired construct are cultured under selective conditions and cells selected as carrying the construct may be expanded and further analyzed, for example, using polymerase chain reaction / Western blot to determine the presence of the construct in the host cells. After a modified host cell is identified, it may be used as intended, for example, expanded in culture or introduced into a host organism.

[0087]

[0115] Depending on the nature of the cells, the cells may be introduced into a host organism, such as a mammal, including a human, in a variety of ways. For example, the cells may be introduced into the site of an inflammatory lesion.

[0116] Working Example

[0117] Certain embodiments of the present invention are defined in the examples herein. It should be understood that these examples, although they indicate preferred embodiments of the present invention, are given for illustrative purposes only. From the above discussion and these examples, those skilled in the art can ascertain the essential characteristics of the present invention, and can make various changes and modifications to the present invention to suit various applications and conditions without departing from the spirit and scope thereof.

[0088]

[0118] More specifically, various aspects of the present embodiments provide methods and compositions for the treatment and / or therapeutic monitoring of immune-related diseases or disorders.

[0119] In some embodiments, the methods and compositions described herein are directed to the treatment and / or treatment monitoring of type 1 diabetes (T1D).

[0089]

[0120] In other embodiments, the methods and compositions described herein are directed to the treatment and / or therapeutic monitoring of autoimmune diseases and / or transplant rejection.

[0121] In one specific embodiment, the subject is a recipient of allogeneic transplantation.Transplantation can be any organ or tissue transplantation, including but not limited to pancreas, kidney, heart, lung, liver, intestine, bone, cartilage or skin.As used herein, transplantation tolerance refers to the absence of rejection of donor organ by recipient's immune system.Furthermore, this agent can be used to prevent or reduce the possibility of suffering from rejection of tissue or cell transplantation.

[0090]

[0122] Table 1 below provides non-limiting examples of antigens useful for specific autoimmune endocrinopathy.

[0091] [Table 1]

[0092]

[0123] Table 2 below provides non-limiting examples of antigens useful for various organ-specific autoimmune diseases.

[0093] [Table 2]

[0094]

[0124] Table 3 below provides non-limiting examples of antigens useful for various organ allografts.

[0095] [Table 3]

[0096]

[0125] Table 4 below provides non-limiting examples of amino acid sequences of useful GAD65 epitopes.

[0097] [Table 4]

[0098]

[0126] Table 5 below provides non-limiting examples of amino acid sequences of GAD65 epitope-recognizing paratopes useful in the extracellular polypeptides of CAR-Tregs described herein.

[0099] [Table 5]

[0100]

[0127] Optionally, one or more of the paratopes that recognize the CAR GAD65 epitope may be included in a vector, which may be the same vector (bicistronic) or separate vectors. Each of the amino acids encoding the CAR GAD65 paratopes may be operably linked to a promoter, which may be the same or different promoters. Optionally, one or more may be included in a vector, which may be the same vector (bicistronic) or separate vectors. Each of the CAR GAD65 paratopes may be operably linked to a promoter, which may be the same or different promoters. EXAMPLES

[0101]

[0128] Example 1 – Type 1 Diabetes

[0129] method:

[0130] For the assembly of the T cell receptor (CD28 hinge-transmembrane-intracellular region and CD3 ζ intracellular domain), two GAD65 B cell epitopes were selected that interact with two immunodominant regions, the N-terminal region (CAR-N) and the middle region (CAR-M). CAR-N contains the extracellular polypeptide sequence MDMRVPAQLLGLLLLWLPGAKCDIQLTQSPTFLSASVGDRVTITCRASQGISSYLAWYQQKPGKAPNLLIYVASTLQSGVPSRFSGSGSGTEFTLTISSLQPEDFATYYCQQLNNYPLTFGGGTKVEIKRPPPPRPPPPRPPPPRQLQLQESGPGLLKPSETLSLTCSVSGGSIGSSSYSWGWIRQPPGKGLEYIGIIYHSGRTYYNPSLKSRVTISVDTSKNQFSLKLSSVTAADTAMYYCARQVPYQPLLDGGNWFDPWGQGTLVTVSS (SEQ ID NO: 7). and CAR-M comprises the extracellular polypeptide sequence MAWTVLLLGLLSHCTGSVTSYVLTHPPSVSVAPGKTGTITCGGSNIGSKSVHWYQQKPGQAPKLVIYYDSDRPSGIPERFSGSTSGNTATLTISSVEAGDEADYYCQVWDSSGDHMVVFFGGTKLTVLPPPPRPPPPRPPPPRQVQLVESGGGVVQPGRSLRLSCAASGLTFSHHGMHWVRQAPGKGLEWVAFISYDETKKYYVKSVMGRFTIARDNSKNTLYLHLKSLRPDDAAVYYCAKAFSTTIFGVVTYGMDVWGQGTTVIVSS (SEQ ID NO: 8).

[0102]

[0131] These GAD65 CAR-Tregs were used to prevent / treat diabetes in a humanized mouse model of T1D.

[0132] result:

[0133] Confocal images showed that CAR-Tregs homed to the peri-islet region 24 h after intravenous immunization. At 30-day follow-up, fasting glucose and GTT / insulin secretion tests were significantly improved in the GAD65-specific CAR Treg treatment group compared with the normal Treg and nonspecific EPCAM (control CAR-Treg) groups. Islet localization of GAD65 CAR-Tregs was still demonstrated after 30 days. Flow cytometry confirmed the regression of CD8+ T effector (Teff) cells and the proliferation of GAD65 CAR-Tregs.

[0103]

[0134] Figure 1A provides the design scheme of CAR Treg.

[0135] Figure 1B shows that antigen-specific regulatory T cells (CAR-Tregs) must be abundant and in close proximity to beta cells to downregulate Teff. When CAR-Tregs are activated against GAD65, they silence nearby Teff cells and rescue islet beta cells.

[0104]

[0136] Figure 2 shows the characteristics of a humanized mouse model of T1D. The top panel of Figure 2 compares the genetic predisposition and the presence or absence of the target antigen between humans and mouse models. The bottom panel of Figure 2 shows confocal micrographs of pancreatic cryosections (8 μm) from humanized T1D mice. Red = insulin; blue = GAD65; green = HLA-DQ8. The left photograph shows a pancreatic islet. GAD65 is present in and around the islet region, but is also in close contact with APCs (HLA-DQ8). In the left center photograph, GAD65 (blue) is recognized and internalized by macrophages (green 20.4 μm); beta cells were stained for insulin (red). The right photographs show increasing magnifications (from right to left) of the peri-islet region of a T1D mouse. White arrows point to the interaction of GAD65 (beta cells) with APCs HLA-DQ8.

[0105]

[0137] Figure 3 shows flow cytometry tracking of GFP-GAD65 CAR-Treg cells in blood, pancreatic lymph nodes (PLN), pancreas (PN) and spleen. Single cells were acquired using a flow cytometer (BD FACSCANTO) by detecting GFP in the FITC channel. Five million GFP-GAD65 CAR-Treg cells were injected into a spontaneous humanized mouse model (co-expressing green fluorescent protein (GFP), 24 hours before sacrifice).

[0106]

[0138] Figure 4 shows 3D iDISCO, islet morphology and localization of GFP-GAD65 CAR-Treg cells. Humanized mice (T1D model) were injected with CAR-Treg cells (expressing green fluorescent protein, GFP) and euthanized 24 hours later.

[0107]

[0139] Figure 4, top to bottom (pancreas at three different magnifications: 100x, 10x, and 4x): islets were recorded individually at three different positions (lower panel, 4x magnification).

[0140] Figure 4, from left to right (stained): Column A: The green filter shows CAR-Treg cells expressing GFP. Column B: Red filter indicates insulin-expressing islet cells. Column C: Superposition of A and B. Column D: Blue filter shows GAD65-expressing islet cells. Column E: Superposition of A, B, and D.

[0108]

[0141] Figures 5A-5E include a series of graphs showing flow cytometry of immune cells. Immune cell profiling of different CAR-Treg and control cell treated animals: Autologous Tregs were isolated from spleens and expanded in vitro with IL-2 (2000ng / ml). Autologous expanded Tregs were then transduced with CAR-M and CAR-N Treg constructs. Treg expression of CAR-M / N constructs was confirmed by PCR and Western blot. Humanized mice (T1D model) were administered 5 million GAD65-specific CAR-M Treg / CAR-N Treg cells, regular Treg cells, and EPCAM (control CAR-Treg cells). Mice were euthanized 30 days after treatment. Pancreas (PN), pancreatic lymph nodes (PLN) and spleens were processed into single cell suspensions.

[0109]

[0142] FIG. 5A shows the Treg cell populations in pancreatic lymph nodes (PLN), pancreas (PN), and spleen 30 days after treatment with either conventional Treg, EPCAM (control CAR-Treg), or GAD65 CAR-M or CAR-N Treg cells. Statistical significance ( * and ** ) was judged at P<0.05.

[0110]

[0143] FIG. 5B shows the T helper (Th1) cell populations in the pancreatic lymph nodes (PLN), pancreas (PN), and spleen 30 days after injection. Statistical significance ( * and ** ) was judged at P<0.05.

[0111]

[0144] FIG. 5C shows the T helper (Th17) cell populations in the pancreatic lymph nodes (PLN), pancreas (PN), and spleen 30 days after injection. Statistical significance ( * and ** ) was judged at P<0.05.

[0112]

[0145] FIG. 5D shows the interferon gamma (IFNg)-producing T cell (CD3) cell populations in the pancreatic lymph nodes (PLN), pancreas (PN), and spleen 30 days after injection. Statistical significance ( * and ** ) was judged at P<0.05.

[0113]

[0146] FIG. 5E shows the interferon gamma (IFNg)-producing CD8 T cell (CTL) populations in the pancreatic lymph nodes (PLN), pancreas (PN), and spleen 30 days after injection. Statistical significance ( * and ** ) was judged at P<0.05.

[0114]

[0147] Figure 6 shows glucose tolerance test (GTT) measurements one month after CAR-M Treg / CAR-N Treg / conventional Treg / EPCAM (control CAR-Treg) treatment. GTT at 30 days follow-up: glucose tolerance was significantly improved in the GAD65-specific CAR Treg treatment group compared to the conventional Treg and non-specific EPCAM (control CAR-Treg) groups. Treatment with conventional Tregs was no different compared to EPCAM (control CAR-Treg).

[0115]

[0148] Figures 7A-7B show CAR-Treg (CD25 + ) and Tresp(CD4 + CD25 - ) suppression / proliferation assay (n=3-4). Figure 7A shows Treg (CD4 + CD25 + ); Fig. 7B = CAR-Treg (CD25 + Flow cytometry analysis of in vitro suppression assay: Naive CD4 T cells (Tresp CD4 + CD25 - ) and GAD65 CAR-Treg cells (CD25 +) were co-cultured with recombinant hGAD65 antigen (4 μg / ml) at different ratios (table in Figure 7C). After 5 days, cells were immunofluorescently stained with CD4 and CD25 antibodies. Lymphocytes were gated according to FSC and SSC. CD4 T cells were gated according to CD4 (y-axis) and FSC (x-axis). CAR-Treg cells (CD25 + ) are CD4 according to CD25 (y-axis) + CD25 - Tresp cells were differentiated. Both cell populations were incubated in CellTrace (CFSE-FITC, x-axis). Histogram plots show the proliferation index / replication index analyzed using the proliferation assay software FLOW JO_V10.

[0116]

[0149] Figure 7C shows the summary data of the in vitro suppression assay. Tresp cells (CD4 + CD25 - , isolated from mouse spleens using a CD4 T Cell Isolation Kit) and GAD65-specific CAR-Treg cells (CD25 + ) were co-cultured for 5 days in the presence of recombinant hGAD65 antigen (4 μg / ml). The suppressive / proliferative potential of the cells was determined by analyzing the proliferation of GAD65 CAR-Treg cells and Tresp cells at different co-culture ratios.

[0117]

[0150] FIG. 7D shows a table of summary data of proliferation / replication index of in vitro suppression / proliferation assays at different ratios of Tresp and CAR-Treg as shown in FIGS. 7A-7B.

[0118]

[0151] Figures 8A-8B show the analysis of an in vivo proliferation assay: EPCAM-specific CAR-Treg cells co-expressing green fluorescent protein (GFP) and GAD65-specific CAR-Treg cells were injected into humanized T1D mice. Mice were sacrificed 48 hours later. CAR-Treg (EPCAM and GAD65) were isolated based on co-expression of GFP. Both cell populations were incubated in (cell proliferation dye eFluor 670). These cells were analyzed on a BD Canto flow cytometer and lymphocytes were gated according to FSC and SSC. CAR-Treg cells were further gated based on CD25 +ve cells (y-axis) and cell proliferation dye eFluor 670 (x-axis).

[0119]

[0152] The frequency of proliferating cells was analyzed using the FLOW JO proliferation assay. Histogram plots were used to determine the proliferation index / replication index. The in vivo expansion of GAD65-specific CAR-Treg cells was doubled compared to non-diabetic CAR-Treg (EPCAM), demonstrating the specificity and antigen-specific proliferation capacity of GAD65 CAR Treg.

[0120]

[0153] Figures 8C-8D show the analysis of in vitro proliferation assays: Regular Treg cells (Figure 8C) and GAD65 CAR-Treg cells (Figure 8D) were expanded under high concentrations of IL-2 (2000ng / ml) and recombinant hGAD65 (4μg / ml). Lymphocytes were gated according to FSC and SSC. Treg cells (CD25 +ve) were differentiated from CD25 -ve cells (y-axis). Both cell populations were incubated in CellTrace (CFSE-FITC, x-axis).

[0121]

[0154] The frequency of proliferating cells was analyzed using the FLOW JO proliferation assay. Histogram plots were used to determine the proliferation index / replication index. CAR-Tregs were specific for the GAD65 antigen, and their proliferation rate was approximately three times higher than that of normal Treg cells.

[0122]

[0155] Thus, redirection and expansion of antigen-specific Tregs using antigen-specific CAR-Tregs and the resulting downregulation of Teffs may allow beta cell recovery and reconstitution and may behave similarly in humans.

[0123]

[0156] It is understood that Teff includes CD4, T helper 1, T helper 17, CD8, and cytotoxic lymphocytes (CTL).

[0124]

[0157] Examples of T1D prevention and / or treatment

[0158] In some embodiments, the subject is diagnosed with T1D or IDDM, or pre-IDDM or pre-T1D.Those skilled in the art can determine the patient who will potentially benefit from the therapeutic agent that reduces or prevents the onset of overt diabetes.Those skilled in the art can determine the therapeutically effective amount of the composition that is administered to the subject based on several considerations, such as local effect, pharmacodynamics, absorption, metabolism, delivery method, age, body weight, disease severity, and response to treatment.

[0125]

[0159] The improvement of diabetes parameters can be any observable or measurable improvement.Thus, those skilled in the art recognize that treatment may improve the condition of a patient or subject, but may not completely cure the disease.In certain embodiments, the composition is administered in an amount effective to reduce, reduce, inhibit, or eliminate the level of immune response against host tissue and / or donor organ rejection.

[0126]

[0160] Efficacy can be monitored in treated patients, for example by monitoring body weight, and a weight increase of at least about 5%, at least about 10%, at least about 15% or more can indicate successful treatment. Measurement of insulin is another relevant marker for monitoring efficacy, and successful treatment can result in an increase in values ​​of at least about 10%, at least about 25%, or at least about 50% or more.

[0127]

[0161] In one embodiment of the disclosure, the modified Treg composition is administered in an amount effective to decrease, reduce, inhibit, or eliminate inflammation and toxicity.

[0162] Treatment regimens may also vary, but often depend on the health and age of the patient.Some diseases require more aggressive treatment, but at the same time, some patients cannot tolerate more toxic regimens.Clinicians are best placed to make such decisions based on the known efficacy and toxicity (if any) of therapeutic preparations.

[0128]

[0163] In certain embodiments, the composition is administered in a single dose or multiple doses. A single dose can be administered daily, or multiple times a day, or multiple times a week, or monthly, or multiple times a month, or once a month / year. A series of doses can be administered daily, or multiple times a day, weekly, or multiple times a week, or monthly, or multiple times a month.

[0129]

[0164] An improvement is any observable or measurable improvement. Thus, those skilled in the art recognize that a treatment may improve the condition of a patient or subject, but may not completely cure the disease. In certain embodiments, the composition is administered in an amount effective to reduce, reduce, inhibit, or eliminate the level of the recipient's immune response.

[0130]

[0165] The compositions of the invention may precede, be concurrent with, and / or follow the other agent by intervals ranging from minutes to weeks. In embodiments in which the composition and the other agent are applied separately to a cell, tissue or organism, generally no significant period of time will elapse between the respective delivery times so that the composition and the agent can still exert their advantageously combined effect on the cell, tissue or organism.

[0131]

[0166] Various combination regimens of the composition and one or more agents may be employed. Those skilled in the art will recognize that the compositions and agents of the present disclosure may be administered in any order or combination.

[0132]

[0167] Administration

[0168] Compositions comprising the genetically modified immunoresponsive cells described herein can be provided systemically or directly to a subject for the treatment of an autoimmune disorder or disease. In one embodiment, such cells are directly injected into an organ of interest (e.g., a transplanted organ, an organ affected by an autoimmune disorder, etc.).

[0133]

[0169] Alternatively, compositions containing genetically modified immunoresponsive cells are delivered indirectly to the organ of interest, for example, by administration to the circulatory system (e.g., the vascular system). Growth and differentiation agents can be provided to increase production of cells in vitro or in vivo before, during, or after administration of the cells.

[0134]

[0170] The modified cells may be administered in any physiologically acceptable vehicle, usually intravascularly, but may also be introduced into bone or other convenient site where the cells can find a suitable site for regeneration and differentiation (e.g., the thymus).

[0135]

[0171] For example, at least 1 × 10 5 cells were administered, eventually reaching 1 × 10 10The genetically modified immunoresponsive cells may comprise a purified cell population. Those skilled in the art can easily measure the proportion of genetically modified immunoresponsive cells in a population using various well-known methods, such as fluorescence-activated cell sorting (FACS). The preferred range of purity of a population containing genetically modified immunoresponsive cells is about 50% to about 55%, about 55% to about 60%, and about 65% to about 70%. More preferably, the purity is about 70% to about 75%, about 75% to about 80%, about 80% to about 85%; even more preferably, the purity is about 85% to about 90%, about 90% to about 95%, and about 95% to about 100%.

[0136]

[0172] Dosages can be readily adjusted by one of skill in the art (e.g., decreased purity may require increased dosage). Cells can be introduced by injection, catheter, etc. Optionally, factors can also be included, including, but not limited to, interleukins, e.g., IL-2, IL-3, IL-6, IL-10, IL12, IL13, IL21, IL1S, and other interleukins, colony stimulating factors, e.g., G-CSF, M-CSF, and GM-CSF, interferons, e.g., gamma-interferon, and erythropoietin.

[0137]

[0173] The compositions of the present disclosure include pharmaceutical compositions comprising genetically modified immunoresponsive cells or their progenitors and a pharma- ceutically acceptable carrier. Administration can be autologous or heterologous. For example, immunoresponsive cells or progenitors can be obtained from a subject and administered to the same subject or a different compatible subject. The peripheral blood-derived immunoresponsive cells or their progeny (e.g., derived in vivo, ex vivo, or in vitro) of the present disclosure can be administered via local injection, including catheter administration, systemic injection, local injection, intravenous injection, or parenteral administration. When administering a therapeutic composition (e.g., a pharmaceutical composition comprising genetically modified immunoresponsive cells), it is generally formulated in a unit dose injectable form (solution, suspension, emulsion).

[0138]

[0174] Pharmaceutical Compositions

[0175] The pharmaceutical compositions of the present disclosure include an effective amount of the compounds disclosed herein and / or additional agents dissolved or dispersed in a pharma- ceutically acceptable carrier. The phrases "pharmaceutical" or "pharmacologically acceptable" refer to molecular entities and compositions that do not produce adverse, allergic or other undesirable reactions when administered to an animal, such as a human. The preparation of pharmaceutical compositions containing at least one compound or additional active ingredient will be known to those skilled in the art in light of the present disclosure, as exemplified in Remington's Pharmaceutical Sciences, 2003, which is incorporated herein by reference. In addition, it is understood that for administration to animals (e.g., humans), preparations should meet the standards of sterility, pyrogenicity, general safety and purity required by the FDA Office of Biologics Standards.

[0139]

[0176] The compositions disclosed herein may contain different types of carriers depending on whether they are administered in solid, liquid or aerosol form and whether they need to be sterile for administration routes such as injection.The compositions disclosed herein may be administered intravenously, intradermally, transdermally, intrathecally, intraarterially, intraperitoneally, intranasally, intravaginally, intrarectally, intraosseous, periosteal, topically, intramuscularly, subcutaneously, intramucosally, intraosseous, periosteal, intrauterine, oral, topically, localized, by inhalation (e.g., aerosol inhalation), by injection, by infusion, by continuous infusion, by direct administration to target cells by local perfusion bath, via catheter, by lavage, in cream, in lipid composition (e.g., liposome), or by other methods or any combination of the above that will be known to those skilled in the art (see, for example, Remington's Pharmaceutical Sciences, 2003, which is incorporated herein by reference).

[0140]

[0177] The actual dosage of the compositions disclosed herein administered to an animal or human patient can be determined by physical and physiological factors such as body weight, severity of condition, type of disease to be treated, previous or concurrent therapeutic interventions, specific pathology of the patient, and route of administration. Depending on the dosage and route of administration, the preferred dosage and / or the number of administrations of an effective amount can vary depending on the subject's response. In any case, the physician responsible for administration will determine the concentration of active ingredient in the composition and the appropriate dose for each individual subject.

[0141]

[0178] In certain embodiments, the pharmaceutical composition may contain, for example, at least about 0.1% of the active compound (e.g., cell mixture). In other embodiments, the active compound may comprise, for example, about 2% to about 75% of the weight of the unit, or, for example, about 25% to about 60%, and any range derivable therein. Of course, the amount of active compound in a therapeutically useful composition may be prepared to obtain a suitable dosage in any unit dose of the compound. Factors such as solubility, bioavailability, biological half-life, route of administration, product shelf life, and other pharmacological considerations are contemplated by those skilled in the art of preparing such pharmaceutical formulations, and therefore various dosages and treatment regimes may be desired.

[0142]

[0179] In other non-limiting examples (e.g., active compound on a weight basis), dosages can also include from about 1 microgram / kg / body weight, about 5 micrograms / kg / body weight, about 10 micrograms / kg / body weight, about 50 micrograms / kg / body weight, about 100 micrograms / kg / body weight, about 200 micrograms / kg / body weight, about 350 micrograms / kg / body weight, about 500 micrograms / kg / body weight, about 1 milligram / kg / body weight, about 5 milligrams / kg / body weight, about 10 milligrams / kg / body weight, about 50 milligrams / kg / body weight, about 100 milligrams / kg / body weight, about 200 milligrams / kg / body weight, about 350 milligrams / kg / body weight, about 500 milligrams / kg / body weight, to about 1000 mg / kg / body weight or more per administration, and any range derivable therein. In non-limiting examples of ranges derivable from the numerical values ​​recited herein, based on the above numerical values, ranges such as about 5 mg / kg / body weight to about 100 mg / kg / body weight, about 5 micrograms / kg / body weight to about 500 milligrams / kg / body weight, etc. may be administered.

[0143]

[0180] In certain embodiments, the compositions herein and / or additional agents are formulated to be administered via the digestive tract. The digestive tract route includes all routes of administration where the composition may come into direct contact with the digestive tract. Specifically, the pharmaceutical compositions disclosed herein may be administered orally, bucally, rectally, or sublingually. Thus, these compositions may be formulated with an inert diluent or an assimilable edible carrier, encapsulated in hard or soft shell gelatin capsules, compressed into tablets, or directly incorporated into dietary foods.

[0144]

[0181] In further embodiments, the compositions described herein can be administered via parenteral route. As used herein, the term "parenteral" includes a route that bypasses the digestive tract. Specifically, the pharmaceutical compositions disclosed herein can be administered, for example, but not limited to, intravenously, intradermally, intramuscularly, intraarterially, intrathecally, subcutaneously, or intraperitoneally (U.S. Patent Nos. 6,753,514, 6,613,308, 5,466,468, 5,543,158, 5,641,515, and 5,399,363, each of which is specifically incorporated herein in its entirety by reference).

[0145]

[0182] Solutions of the compositions disclosed herein (e.g., cell mixtures) can be prepared in water suitably mixed with a surfactant such as hydroxypropylcellulose. Dispersions can also be prepared in glycerol, liquid polyethylene glycols, and mixtures thereof, as well as in oils. Under ordinary conditions of storage and use, these preparations may contain preservatives to prevent the growth of microorganisms. Pharmaceutical forms suitable for injectable use include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions (U.S. Patent No. 5,466,468, specifically incorporated herein by reference in its entirety). In most cases, the form must be sterile and must be fluid to the extent that easy syringability exists. It should be stable under the conditions of manufacture and storage and preserved against the contaminating action of microorganisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, a polyol (i.e., glycerol, propylene glycol, liquid polyethylene glycol, and the like), suitable mixtures thereof, and / or vegetable oils. Proper fluidity can be maintained, for example, by using a coating agent such as lecithin, by maintaining the required particle size in the case of dispersion, and / or by using surfactants. Prevention of microbial action can be achieved by various antibacterial and antifungal agents, including, but not limited to, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, etc. In many cases, it is preferable to include an isotonic agent, for example, sugar or sodium chloride. Prolonged absorption of injectable compositions can be achieved by using an agent that delays absorption in the composition, for example, aluminum monostearate or gelatin.

[0146]

[0183] For example, for parenteral administration in an aqueous solution, the solution should be appropriately buffered if necessary, and the liquid diluent must first be made isotonic with sufficient saline or glucose for the cell mixture. These particular aqueous solutions are particularly suitable for intravenous, intramuscular, subcutaneous, and intraperitoneal administration. In this regard, employable sterile aqueous media will be known to those of skill in the art in light of this disclosure. For example, a single dose may be dissolved in 1 mL of isotonic NaCl solution and added to 1000 mL of subcutaneous infusion or injected at the intended site of infusion (see, for example, "Remington's Pharmaceutical Sciences," 15th Edition, pages 1035-1038 and 1570-1580). Some variation in dosage will necessarily occur depending on the condition of the subject being treated. In any event, the person responsible for administration will determine the appropriate dosage for the individual subject. Furthermore, for human administration, preparations should meet the standards of sterility, pyrogenicity, general safety, and purity required by the FDA Office of Biologics Standards.

[0147]

[0184] Sterile injectable solution is prepared by incorporating the composition in the required amount in a suitable solvent with various other components as listed above as necessary, and then sterilizing by filtration.Generally, dispersion is prepared by incorporating various sterile compositions into a sterile vehicle that contains a basic dispersion medium and other components as listed above.In the case of sterile powder for preparing sterile injectable solution, some methods of preparation are vacuum drying and freeze-drying technology, which produces a powder of active ingredient plus any additional desired ingredient from a previously sterile filtered solution.Powder composition is combined with a liquid carrier, such as water or physiological saline, with or without stabilizer.

[0148]

[0185] In other embodiments, the compositions may be formulated for administration by a variety of different routes, for example, topical (i.e., transdermal), mucosal (intranasal, vaginal, etc.) and / or via inhalation.

[0149]

[0186] Pharmaceutical compositions for topical administration may include compositions formulated for application of drugs, such as ointments, pastes, creams, or powders. Ointments include all compositions for topical application that are oleaginous, absorbent, emulsifying, or water-soluble based, while creams and lotions are compositions that contain only an emulsifying base. Drugs administered topically may include a penetration enhancer to promote the absorption of the active ingredient through the skin. Suitable penetration enhancers include glycerin, alcohol, alkyl methyl sulfoxides, pyrrolidones, and luarocapram. Possible bases for compositions for topical application include polyethylene glycol, lanolin, cold cream, and petrolatum, as well as other suitable absorption bases, emulsifying bases, or water-soluble ointment bases. Topical preparations may also include emulsifiers, gelling agents, and antimicrobial preservatives as necessary to preserve the composition and provide a homogenous mixture. Transdermal administration of compositions may also include the use of a "patch." For example, a patch may continuously deliver one or more compositions at a predetermined rate for a fixed period of time.

[0150]

[0187] In certain embodiments, the composition may be delivered by eye drops, intranasal spray, inhalation, and / or other aerosol delivery vehicles. Methods for delivering compositions directly to the lungs via nasal aerosol spray are described in U.S. Patent Nos. 5,756,353 and 5,804,212 (each of which is specifically incorporated herein by reference in its entirety). Similarly, drug delivery using nasal microparticle resins (Takenaga et al., 1998) and lysophosphatidyl-glycerol compounds (U.S. Patent No. 5,725,871, which is specifically incorporated herein by reference in its entirety) are also well known in the pharmaceutical art and may be employed to deliver the compositions described herein. Similarly, transmucosal drug delivery in the form of a polytetrafluoroethylene support matrix is ​​described in U.S. Patent No. 5,780,045 (which is specifically incorporated herein by reference in its entirety) and may be employed to deliver the compositions described herein.

[0151]

[0188] It is further envisioned that the compositions disclosed herein can be delivered via aerosol. The term aerosol refers to a colloidal system of finely divided solid or liquid particles dispersed in a liquefied or pressurized gas propellant. A typical aerosol for inhalation consists of a suspension of active ingredient in a liquid propellant, or a mixture of a liquid propellant and a suitable solvent. Suitable propellants include hydrocarbons and hydrocarbon ethers. Suitable containers vary according to the pressure requirements of the propellant. The administration of aerosol varies according to the age, weight, and severity and response of the subject.

[0152]

[0189] kit

[0190] It is further contemplated that the CAR-Treg cells disclosed herein may be packaged in the form of a kit, including a single or separate container. Many embodiments of such kits are possible. For example, the kit may contain two containers, a first container containing the CAR-Treg cells described herein, and a second container containing a pharma-ceutically acceptable carrier, excipient, diluent, or adjuvant. Many other variations and embodiments of such kits are envisioned. The kit typically further includes instructions for using the components of the kit to perform the subject method. The instructions for performing the subject method are generally recorded on a suitable recording medium. For example, the instructions may be present in the kit as a package insert or in a label on the container of the kit or its components. In other embodiments, the instructions are present as an electronic storage data file present on a suitable computer-readable storage medium, such as a flash drive or CD-ROM. In other embodiments, the actual instructions are not present in the kit, but a means is provided for obtaining the instructions from a remote source, such as via the Internet. An example of this embodiment is a kit that includes a web address where the instructions can be viewed and / or where the instructions can be downloaded. As with the instructions, the means for obtaining the instructions are recorded on a suitable substrate.

[0153]

[0191] While the present invention has been described with reference to various preferred embodiments, it should be understood by those skilled in the art that various changes can be made and equivalents substituted for elements thereof without departing from the essential scope of the invention. In addition, many modifications can be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope of the invention. Therefore, it is not intended that the invention be limited to the particular embodiments disclosed herein contemplated for carrying out the invention, but rather, the invention is intended to include all embodiments falling within the scope of the appended claims.

[0154]

[0192] Publications and other materials used herein to clarify the invention or to provide additional details regarding the practice of the invention, are incorporated herein by reference, and are conveniently set forth in the following reference list.

[0155]

[0193] Citation of any document herein is not intended as an admission that any of the foregoing is pertinent prior art. All statements as to the dates or contents of such documents are based on the information available to applicant and do not constitute any admission as to the accuracy of the dates or contents of such documents.

Claims

1. Immunoresponsive cells a chimeric antigen receptor (CAR) that binds to glutamic acid decarboxylase 65 kDa (GAD65) in the cell; CAR is, a) the intracellular signaling domain of a CD3ζ polypeptide and the intracellular signaling domain of the CD28 hinge-transmembrane-intracellular region, and b) an extracellular polypeptide comprising the amino acid sequence of either SEQ ID NO:7 or SEQ ID NO:8, or an amino acid sequence having at least 95% identity to either SEQ ID NO:7 or SEQ ID NO:

8. Immunoresponsive cells, including

2. The immunoresponsive cell of claim 1, further comprising a spacer between the intracellular signaling domain of the CD28 hinge-transmembrane-intracellular region and the extracellular polypeptide.

3. The immunoresponsive cell of claim 2 , wherein the spacer comprises glycine, serine, or threonine.

4. The immunoresponsive cell of claim 2, wherein the intracellular signaling domain of the CD28 hinge-transmembrane-intracellular region is linked to the spacer by a peptide bond.

5. The immunoresponsive cell of claim 4 , wherein the extracellular polypeptide is linked to the spacer by a peptide bond.

6. The immunoresponsive cell of claim 5, wherein the CD3ζ polypeptide is linked to the intracellular signaling domain of the CD28 hinge-transmembrane-intracellular region by a peptide bond.

7. The immunoresponsive cell of claim 6 , wherein the cell is a regulatory T cell.

8. The immunoresponsive cell of claim 1 , wherein the immunoresponsive cell is selected from the group consisting of T cells, cytotoxic T cells, regulatory T cells, and combinations thereof.

9. The immunoresponsive cell of claim 1, wherein the cell expresses at least one extracellular polypeptide and comprises a pancreatic beta cell-specific chimeric antigen receptor (CAR) regulatory T cell (Treg) capable of influencing Teff cells.

10. The immunoresponsive cell of claim 1 , wherein the extracellular polypeptide comprises SEQ ID NO:

7.

11. The immunoresponsive cell of claim 1 , wherein the extracellular polypeptide comprises SEQ ID NO:

8.

12. The immunoresponsive cell of claim 7 , wherein the extracellular polypeptide comprises SEQ ID NO:

7.

13. The immunoresponsive cell of claim 7 , wherein the extracellular polypeptide comprises SEQ ID NO:

8.

14. A pharmaceutical composition comprising an effective amount of the immunoresponsive cell of claim 1 and a pharma- ceutically acceptable excipient.

15. 15. The pharmaceutical composition of claim 14 for use in extending the survival of a subject with type 1 diabetes (T1D).

16. The pharmaceutical composition of claim 15, wherein the subject is a human.

17. 16. The pharmaceutical composition of claim 15, wherein the immunoresponsive cells are selected from the group consisting of T cells, cytotoxic T cells, regulatory T cells, and combinations thereof.

18. The pharmaceutical composition of claim 14 for use in preventing or treating type 1 diabetes (T1D) in a subject.

19. The pharmaceutical composition of claim 18, wherein the subject is a human.

20. 20. The pharmaceutical composition of claim 18, wherein the immunoresponsive cells are selected from the group consisting of T cells, cytotoxic T cells, regulatory T cells, and combinations thereof.

Images