<em>Rapid and Efficient Engineering of Primary NK Cells with NKG2A Knockout and A/C Switch to Overcome HLA-E-mediated Immune Suppression</em> — ASN Events

Rapid and Efficient Engineering of Primary NK Cells with NKG2A Knockout and A/C Switch to Overcome HLA-E-mediated Immune Suppression (#240)

Lamberto Torralba-Raga 1 2 , Emil B. Christensen 3 , Kasper Melchers 1 , Karen E. Martin 1 2 , Silje Krokeide 1 2 , Karl-Johan Malmberg 1 2 4
  1. Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
  2. Precision Immunotherapy Alliance, Institute for Clinical Medicine, The University of Oslo, Oslo, Norway
  3. Odense, University Hospital, Denmark
  4. Center for Infectious Medicine, Department of Medicine Huddinge, Stockholm, Sweden

HLA-E, a non-classical MHC class I molecule, is frequently overexpressed in tumors, facilitating immune evasion by engaging the inhibitory receptor NKG2A on NK cells and CD8+ T cells. Targeting this axis is crucial for restoring immune activity in both hematologic and solid tumors. To address this, we developed a chimeric NKG2A/NKG2C (A/C) chimeric receptor that combines the high HLA-E affinity of NKG2A with the activating signaling of NKG2C. CD8+ T cells engineered to express the A/C Switch displayed potent cytotoxicity against a broad range of tumor cells expressing high levels of HLA-E and complete tumor control in an orthotopic glioblastoma model (Saetersmoen et al, MED 2024). In NK cells, high endogenous NKG2A expression limits the efficacy of the A/C Switch-based approach due to competition for the ligand. To overcome this, we developed a dual-engineering system combining NKG2A knockout (KO) and A/C Switch integration. Two CRISPR/Cas9-based protocols were compared for NKG2A KO: a short cytokine-driven approach and a feeder-cell-based extended protocol. This comparison evaluated both knockout efficiency and suitability for subsequent viral transduction. Both methods achieved >90% KO efficiency, with post-knockout A/C Switch-transduced NK cells representing >60% of the population. The engineered A/C Switch+ NKNKG2A-KO cells exhibited robust degranulation, pro-inflammatory cytokine secretion, and superior killing of HLA-E-high tumor cells, effectively overcoming immune evasion through the HLA-E checkpoint. These findings establish a rapid and efficient dual-engineering platform, providing an intrinsic check-point converter, combining signaling from the A/C Switch with an unleashed cytotoxic response of NK cells, providing a scalable framework for therapies targeting HLA-E overexpressing tumors.