Using an Adaptor CAR System to Target Fibroblast Activation Protein for Diagnostic and Therapeutic Purposes

T-cells genetically modified to express chimeric antigen receptors (CARs) are playing a more and more
important role in targeted cancer immunotherapy. However, these living drugs can also cause lifethreatening
side effects. To overcome such limitations and improve the safety of CAR T-cell therapy,
adaptor CAR platforms such as the universal CAR (UniCAR) have been developed. This platform consists
of the UniCAR T-cell and a target module (TM) cross-linkage effector and tumor cells. Here, we have
established a novel UniCAR system targeting Fibroblast Activation Protein (FAP) that is highly expressed
in the tumor microenvironment of epithelial cancers and a marker for cancer-associated fibroblasts. For
that, we constructed two novel FAP-directed TMs possessing different sizes and pharmacokinetic
properties, in which one is based on a single-chain variable fragment (scFv), and the other is based on an
IgG4 backbone. We have shown that both TMs were able to bind to FAP-expressing cells and redirect
UniCAR T-cells in vitro to monolayer and spheroid target cells inducing effective killing. Furthermore, we
could show infiltration and activation of T-cells in the spheroid setting. Using in vivo models, the TMs were
proven to be suitable to be used for PET imaging showing FAP-specific accumulation at the tumor site.
Moreover, the immunotherapeutic effect of UniCAR T-cells in combination with FAP TMs was
demonstrated using mouse models. In conclusion, in this work, we could show that the two novel anti-
FAP TMs prove to hold great theranostic potential for diagnostic imaging and immunotherapy.