TCR-transgenic T cells and YB-1-based oncolytic virotherapy improve survival in a preclinical Ewing sarcoma xenograft mouse model

Abstract

Background:

Ewing sarcoma (EwS) is an aggressive and highly metastatic bone and soft tissue tumor in pediatric patients and young adults. Cure rates are low when patients present with metastatic or relapsed disease. Therefore, innovative therapy approaches are urgently needed. Cellular- and oncolytic virus-based immunotherapies are on the rise for solid cancers.

Methods:

Here, we assess the combination of EwS tumor-associated antigen CHM1³¹⁹-specific TCR-transgenic CD8⁺ T cells and the YB-1-driven (i.e. E1A13S-deleted) oncolytic adenovirus XVir-N-31 in vitro and in a xenograft mouse model for antitumor activity and immunostimulatory properties.

Results:

In vitro both approaches specifically kill EwS cell lines in a synergistic manner over controls. This effect was confirmed in vivo, with increased survival using the combination therapy. Further in vitro analyses of immunogenic cell death and antigen presentation confirmed immunostimulatory properties of virus-infected EwS tumor cells. As dendritic cell maturation was also increased by XVir-N-31, we observed superior proliferation of CHM1³¹⁹-specific TCR-transgenic CD8⁺ T cells only in virus-tested conditions, emphasizing the superior immune-activating potential of XVir-N-31.

Conclusion:

Our data prove synergistic antitumor effects in vitro and superior tumor control in a preclinical xenograft setting. Combination strategies of EwS-redirected T cells and YB-1-driven virotherapy are a highly promising immunotherapeutic approach for EwS and warrant further evaluation in a clinical setting.

1 Introduction

Immunotherapeutic targeting of Ewing sarcoma (EwS) has proven to be very complex. Both systemic immunosuppression as well as a T cell-hostile tumor microenvironment (TME) have to be overcome for successful therapy (1–3). In this regard, the effectiveness of targeting immune checkpoint molecules (ICB, immune checkpoint blockade), such as PD-1 or CTLA-4, has not shown to be a promising therapy option in its present form as mono/dual-ICB (4, 5). A possible explanation for current failure of ICB is the low mutational, hence neoantigen burden, resulting in a relatively narrow T cell receptor (TCR) repertoire and scarce T cell infiltration of tumors, as compared to many adult cancers (6, 7). Apart from this, a TME with immunosuppressive soluble and cellular factors, such as tumor-associated macrophages with tumorigenic and T cell inhibiting features, has to be addressed, especially as factors like abundant M2-macrophage signatures correlate with poor survival (3, 8). EwS are characterized by specific oncogenic fusion products, which could not have been targeted by drugs directly until now (9). Therefore, targeted molecular therapy only can be applied in an individualized setting against actionable targets other than the specific oncogenic product (10) and all relapsed/therapy refractory patients are still dependent on conventional radio-/chemotherapies, with current survival rates not exceeding 10-30% (9, 11, 12).

Direct immunotherapeutic targeting of natural peptides derived from the oncogenic fusion protein EWS-FLI1 has not been successful due to low peptide/MHC binding affinity and consecutive weak T cell responses (13, 14). Hence, the focus of TCR-based adoptive T cell transfer in EwS has mainly been on addressing cancer/testis antigens and overexpressed tumor-associated antigens (15–17). In this context, our group identified and characterized several TCRs derived from the allorepertoire with antitumor activity in vitro and in vivo (18–21). The most promising candidate TCR directed against a nonameric peptide from chrondromodulin-1 (CHM1³¹⁹, CHM1, CNMD), a direct downstream target of EWS-FLI1 mediating metastasis is applied in this work (22). Despite promising in vivo result, demonstrating the feasibility of T cell therapy in EwS, T cell-mediated tumor control in solid tumor has remained an exception for most pediatric entities until today (23). Novel combination strategies are urgently needed in order to break physical and immunosuppressive barriers before adoptively transferring TCR or CAR (chimeric antigen receptor) T cells.

One elegant and currently reborn approach is the application of oncolytic viruses (OVs) which allows tumor targeting in a more general way. Pediatric sarcomas express high levels of the multifunctional Y-box binding protein 1 (YB-1), which is associated with drug resistance and metastatic properties. Additionally, survival probabilities decrease with higher YB-1 levels and nuclear location (24, 25). The application of the YB-1-dependent oncolytic adenovirus XVir-N-31 for these patient population is obvious (26). Certainly, OV monotherapies are very promising but long-lasting tumor control are only observed in a minority of patients, hence current strategies aim at optimizing replicative capacity or inducing stronger antitumor immune activity (27–30). This direction of impact is reflected clinically by combination approaches primarily using ICB, which have already shown an impressive increase in response and survival rates (31, 32). Adaptive immune system responses after OV are described to be mainly directed against viral epitopes or even neoepitopes and the combination of OVs together with tumor-redirected T cells is not only thought to increase tumor cell killing but also to reduce immune-evasion (33–35).

We herein hypothesized that CHM1³¹⁹-specific T cells can be successfully combined with XVir-N-31 to address EwS, resulting in synergistic antitumor and immunostimulatory effects.

2 Materials and methods

2.1 Cell lines

A673 and HEK293 were purchased from the American Type Culture Collection (ATCC). LCL, MHH-ES1, THP-1, SK-N-MC were obtained from the German Collection of Microorganisms and Cell Cultures (DSMZ). TC32 was a kind gift from Prof. Poul Sorensen (University of British Columbia, Canada), which was originally purchased from the Childhood Cancer Repository (CCR, Alex’s Lemonade Stand Foundation, Children’s Oncology Group, COG). SB-KMS-KS1 was established at the Children’s Cancer Research Center, Kinderklinik Schwabing (Technical University Munich, Germany). HLA types of utilized cell lines are given in Table 1. IL15-producing NSO cells were a kind gift from Prof. Stanley Riddell (University of Washington School of Medicine), and the packaging cell line (293Vec.) RD114 was kindly provided by Prof. Manuel Caruso (Centre de recherche de Québec, Université Laval). Healthy peripheral blood mononuclear cells (PBMC) were purchased from DRK-Blutspendedienst after informed consent and approval of local government regulatory authorities. Mycoplasma testing was performed regularly (e.g., before in vivo usage, MycoAlert Mycoplasma Detection Kit, Lonza) and cell lines were cultures in accordance with the supplier’s recommendation.

2.2 Retroviral TCR construct

Detailed information on the identification and characterization of the herein used CHM1³¹⁹/HLA-A*02:01-restricted TCR as well as the synthesis of retroviral constructs can be found in previous publications (18, 37).

2.3 Isolation of PBMC

Healthy donor PBMC were isolated by density-gradient-centrifugation as described previously (39). The Ficoll-Paque (GE Healthcare) was used according to supplier’s recommendation with subsequent application of ACK Lysis buffer (Thermo Fisher Scientific) to deplete remaining red blood cells.

2.4 Generation and expansion of CHM1³¹⁹/HLA-A*02:01-restricted TCR-transgenic T cells

Therapeutic TCR-transgenic T cells were generated as reported before (18, 37). Starting material were health donor PBMC (HLA-A*02 negative). Then CD8⁺ T cells were selected negatively by using Miltenyi Biotech equipment (CD8⁺ T cell Isolation Kit, magnets, and L-size columns). TCR-transduction of T cells was performed retrovirally (pMP71 vector). CHM1³¹⁹-specific multimers were used to detect and purify transgenic cells. Using anti-PE microbead enrichment (Miltenyi Biotech), purities > 95% were achieved. Purified TCR-transgenic T cells were expanded with feeder cells in 25 mL T cell medium (AIM-V, containing 5% hAB serum, penicillin 100 U/mL, streptomycin 100 g/mL). Feeder cells were utilized as follows: 5 x 10⁶ irradiated LCL (100 Gray, Gy) and 2.5 x 10⁷ irradiated PBMC (30 Gy, five different healthy PBMC donors were pooled) per 25 mL. For cell irradiation a BioBeam8000 machine was used. T cell cytokines were supplemented every 2 – 3 days (100 U/mL recombinant human IL2 from Novartis and 2 ng/mL recombinant human IL15 from R&D Systems).

2.5 Adenoviral vectors and infection

AdWT was used as a control when indicated and was originally obtained from Prof. David Curiel (Washington University, St. Louis, Missouri). Furthermore, a E1-deleted Ad vector expressing GFP und the control of a CMV promotor with the additional RGD motif was used to study the infectivity of tumor cells and was provided by Prof. Per Sonne Holm and Klaus Mantwill (Technical University of Munich). The YB-1-dependent oncolytic adenovirus XVir-N-31, first described as Ad-Delo3-RGD, was also provided by Prof. Per Sonne Holm and Klaus Mantwill. Here, deletions within the virome include the CR3-region of E1A, E1B19k as well as the E3-region, complemented by alterations at the fiber knob to express an RGD-motif (26, 40). All adenoviral constructs were produced in HEK293 cells and purified via CsCl-gradient (two-step) centrifugation followed by size-exclusion chromatography with PD-10 desalting columns (GE Healthcare). Viral infection was performed in 6-, 24-well-plates or 10cm-dishes with given MOI as described before. Downstream processing after viral infection is described in more detail in the results section or in corresponding figure legends (29).

2.6 Determination of adenoviral IFU

A hexon titer test was used to determine infectious viral units (IFU), as described before (29). In short, IFU were quantified with HEK293 cells and immunocytochemistry staining. Seeding of HEK293 and infection was performed simultaneously in 24-well-plates. After approximately 44 hours, cells were fixed with ice-cold methanol and stained with a primary anti-hexon (#AB1056, Merck Millipore, 1:1000) and a secondary horseradish peroxidas-conjugated antibody (#R0449, Dako, 1:1000). Liquid DAB + Substrate Chromogen System (Dako) was used for development. Hexon-expressing cells were counted (10 visual fields per well, 20x magnification) and viral titers were determined: titer (IFU/mL) = (average number of positive cells/field x fields/well)/[volume of diluted virus per well (mL) x dilution factor]. Error bars in Figure 1G show the SD.

Figure 1

2.7 Cell survival assays

Tumor cell killing by XVir-N-31 or therapeutic T cells was studied using either the sulforhodamine B (SRB) or the xCELLigence assay (Roche/ACEA). For the SRB assay, tumor cells were seeded overnight in 24-well-plates (20,000 - 30,000 cells per well; if different cell numbers were used, respective numbers are given in the figure legends). After viral infection cells were fixed 3-5 days afterwards with trichloroacetic acid (10%, at 4°C overnight), stained with SRB (Sigma-Aldrich, 0,5% SRB in 1% acetic acid for 30min) and washed afterwards before quantification of the cytopathic effect by dissolving SRB-stained cells in 10 mmol/L Tris buffer (pH 10). Extinction was determined at 510nm (Infinite M Nano, Tecan).

For determination of real-time cytotoxicity, the xCELLigence assay was used. Here, 10,000-20,000 tumor cells were plated in 96-well-E-plates in triplicates or quadruplicates. XVir-N-31 or therapeutic T cells were added at indicated time points and different MOI as well as E:T-ratios were used. Virus infection was performed at a cell index to 0.5 – 1.0 and addition of T cells at a cell index of 1.0 - 2.0.

2.8 Immunofluorescence microscopy

GFP-expressing tumor cells after viral infection (Figure 1D) were acquired and imaged at 10x magnification with an Axiovert 100 microscope using fluorescent light.

2.9 Generation of tumor conditioned medium

Tumor conditioned medium (CM) was harvested 72 hours after viral infection. Therefore, 150,000 tumor cells per well were plated in 6-well-plates, and infected at indicated MOI. Supernatant was collected, centrifuged (1,000 x g per minute, 10 minutes), used directly for co-culture experiments or stored at -80°C for downstream experimentation.

2.9 Multiplex cell death and IFN-g assay

In this work, the Cell Death 4-Plex Human ProcartaPlex™ Panel as well as Bio-Plex Pro Humane Cytokine IFN-g Singleplex was used according to manufacturer’s recommendations to characterize collected CM (see above). Sample acquisition was performed with a Bio-Plex 200 System (Luminex 200). Detection ranges of analytes are as follows: HMGB1 190 – 776200 pg/mL, HSP70 88 – 358900 pg/mL, HSP90 152 – 624500 pg/mL, IFN-g 2.3 - 20236 pg/mL.

2.10 T cell proliferation assay

The proliferation of CHM1³¹⁹/HLA-A*02:01-restricted TCR-transgenic CD8⁺ T cells was measured by flow cytometry after T cell labelling with 10 M eFluor450 dye according to supplier’s recommendation (#65-0842-85, Thermo Fisher Scientific). T cells were co-cultured with CHM1³¹⁹-peptide-pulsed THP-1 cells [4 hours with 10 g/mL peptide (Thermo Fisher Scientific) and 20 g/mL β₂-microglobulinSigma Aldrich)], which were pre-cultured in CM for 72 hours, at a 2:1 ratio in T cell medium supplemented with 30 U/mL IL2, as described before (41). 75.000 THP-1 cells were seeded in 1 mL of CM in 24-well-plates. At start of T cell co-culture, THP-1 cells were counted, pulsed with peptide (-control) and T cells were added at a 2:1 ratio. 5 days after start of co-culture, T cell proliferation was analyzed in a MACSQuant Analyzer 10 after dead cell exclusion using DAPI or Viobility dye (both Miltenyi Biotech), also see Supplementary Figure 4. Furthermore, supernatant of one representative experiment was used to determine IFNγ-release.

2.11 Flow cytometry

All flow cytometric analyses were performed on a MACSQuant Analyzer 10. A single cell suspension with PBS was stained in 96-well-plates with primary fluorochrome-coupled antibodies. For REA antibodies, incubation time was 15 minutes at 4°C. Antibody concentrations for staining are provided as supplemental material. Single cell suspension from xenografts were used at a maximum of 2 x 10⁶ cells per well, using REA antibodies. Cells from in vitro experiments were used at a maximum of 2 x 10⁶ cells per well. Multicolor staining panels (ex vivo, in vitro DC maturation and T cell activation experiments) were auto-compensated according to supplier’s recommendation (MACSQuant Comp Bead Kit anti-REA). Dead cell exclusion was either done by DAPI, PI, or the fixable Viobility 405/520 dye). At the respective figure (legends) controls are indicated: i.e. fluorescence-minus one (FMO)- or isotype controls. Washing steps with were included before and after staining, after using fixable dye and before acquisition.

2.12 Flow cytometry data analysis and gating strategy

FCS raw data was processed using FlowJo V10. Gating strategy was applied in all analyses as follows: doublet discrimination in FSC-H versus FSC-A ➔ identification of cells in SSC-A versus FSC-A ➔ dead cell exclusion using DAPI (V1 vs. V2) PI (B3 vs. B2), or Viobility dye (V2 vs. V1 or B1). When several populations were present, specific cells were identified as follows: human T cells by double-positivity for CD45/CD3 (or CD3/CD4 or CD3/CD8), human tumor cells by mouse and humane double-negativity for CD45. If a specific marker expression in respective subsets was analyzed, isotype or FMO controls were applied (indicated in figure legends).

2.13 RT-qPCR

For explanted xenografted tumors, the RNeasy Mini Kit (Quiagen) was used according to manufacturer’s recommendation and RNA concentration was determined with the Nano Photometer Pearl (Implen). cDNA was produced using the High-Capacity cDNA Reverse Transcription Kit (Applied Biosystems) according to the supplier’s protocol. Reverse transcription was done using the iCycler (Bio-Rad Laboratories) with a 3-step-setup (1): initiation at 25°C for 10 minutes (2), elongation at 37°C for 120 minutes, and (3) inactivation at 85°C for 5 minutes. Human gene transcripts from explanted tumors were detected using 50 ng cDNA per reaction. Total reaction volume was adjusted in 96-well MicroAmp Fast Optical Reaction Plates was 15 μL, comprised of 7.5 μL GoTaq qPCR master mix, 0.75 μL of forward and reverse primers each, 1 μL of DEPC-H2O, and 5 μL of cDNA in DEPC-H2O. Reaction and recording of fluorescence were done in a StepOnePlus Real-Time PCR System (Applied Biosystems), according to manufacturer’s recommendation. To confirm specific PCR products, a melting curve analysis was performed. Applied primers are further described in the supplemental methods section. Relative quantification was done using the ΔΔCT-method. Beta-actin was used as housekeeping gene.

2.14 In vivo experiments

Animal experiments were approved by the local regulatory authorities in accordance with the German Federal Law and institutional guidelines (permission number of Regierung von Oberbayern: 55.2-2532-Vet_02-15-102). Rag2^-/- γc^-/- mice were bred and maintained in our animal facility center for Preclinical Research, School of Medicine and Health, TUM) under SPF conditions. Animals used for experimental and control conditions were bred and co-housed in the same rooms. The experiments were performed on 12-30-week-old male and female mice. A673 tumors were subcutaneously injected with 2 x 10⁶ cells in PBS per animal. Tumor size was determined every second day by caliper measurement und the tumor volume was calculated using the formula: volume = 0.5 x length x width². Mice were randomly assigned to treatment/control groups when the tumor volume exceeded 150 – 300 mm³. Mice received intratumoral injections of 50 μL of XVir-N-31 (1 x 10¹¹ viral particles, VP) or PBS. Two days afterwards, 5 x 10⁶ therapeutic T cells were injected intraperitoneally (i.p.) together with 1.5 x 10⁷ IL15-producing NSO cells (irradiated before with 100 Gy). NSO application was continued biweekly until the end of the experiment (tumor volume ≥ 1000 mm³, or other health-related reasons for experimental discontinuation as defined in the approval of the Regierung von Oberbayern). The experimental setup and timeline are given in Figure 2A.

Figure 2

2.15 Harvesting and processing of tumors and spleens

Mice were euthanized by isoflurane narcosis and cervical dislocation. Tumors and spleens were dissected with a scalpel as a whole in 3 mL PBS. Next, 1 mL of digestion buffer, consisting of RPMI1640, collagenase IV (200 U/mL, Sigma Aldrich), and DNase I (100 μg/mL, Thermo Fisher Scientific) was added. Enzymatic digestion was performed for 30 minutes at 37°C. Afterwards, samples were washed, filtered (70 μm) and acquired in standard medium for RNA isolation, flow cytometry or cryopreservation. All steps were performed on ice.

2.16 Computational analyses

Prism 9 was used for statistical analyses. Student’s t-test was applied for normally distributed values. For more than 2-group comparison the one-way ANOVA was applied. Differences in animal survival were assessed by Mantel-Cox log-rank testing. Additional information for analysis of animal data is provided in Figure 2. For Figure 1A, the Cell Line Selector-tool from the DepMap Portal (Broad Institute: depmap.org) was used as described in respective figure legend. In Figure 3, the likelihood of synergistic interaction was analyzed using the Synergy Finder tool in R as recommended (42, 43). For input data, an excel file of biological replicates of experimental groups, controlled for mock-treatment, were used. Experiments were repeated at least twice. Data presented in Supplementary Figure 1 was extracted from the R2 database (44).

Figure 3

3 Results

3.1 Ewing sarcoma cell lines are susceptible to adenovirus cell entry and XVir-N-31-infection induces tumor lysis and release of viral progeny

As a first step, EwS cell lines used in this project were examined for surface receptors associated with Ad species C type 5 cell entry, namely the natural Coxsackie and Adenovirus Receptor (CAR, CXADR) and additional receptors associated with adenovirus (Ad) entry equipped with the RGD-motif according to published reports consisting of Integrin Subunit Alpha V (ITGAV), Integrin Subunit Beta 3 and Beta 5 (ITGB3/ITGB5). Respective gene expression values (Expression 21Q3 Public) were extracted with the online-tool Cell Line Selector from the DepMap Portal of the Cancer Cell Line Encyclopedia (CCLE) for a selection of EwS and other pediatric sarcoma cell lines (Figure 1A). From available cell line data, EwS cell line A673 and CHLA9 showed the lowest expression of CAR. ITGAV expression was comparable, ITGB3 was close to absent and ITGB5 showed high variation in EwS cells. To get a better understanding about efficacy of XVir-N-31 virotherapy for downstream experiments, we examined CAR surface expression by FACS analysis on the 3 representative EwS cell lines A673, SK-N-MC, and TC32 used in later analyses. Interestingly, CAR surface expression correlated with relative gene expression analyses for A673 showing lowest expression, as compared to SK-N-MC with both higher CAR surface and relative expression levels (Figures 1B, C).

Furthermore, we exploited published transcriptome data from patient biopsies from the R2 database regarding aforementioned receptors associated with Ad cell entry (44). For EwS all 4 available data sets were examined, showing lower CAR expression than in other entities which were used for comparison (e.g glioblastoma or medulloblastoma). Of note, CAR expression was still higher than in healthy tissues blood and muscle, also included as controls. The expression of ITGAV, ITGB3, and ITGB5 in EwS was comparable to other tumor entities (Supplementary Figure 1).

Analyzing susceptibility of EwS for Ad infection, we infected a panel of cell lines with an E1A-deleted adenovirus carrying GFP as transgene and the RGD-motif for best comparability with XVir-N-31. Here, tested cell lines could all be infected but to a lesser degree than HEK293 cells (positive control), which are also used for Ad production (Figure 1D).

Next, we tested the oncolytic potential of XVir-N-31 in EwS cell lines using increasing multiplicities of infection (MOI) to assess dose-dependent effects. All cell lines were lysed at MOI 100 after 4-5 days post infection (dpi), including A673 which presented to be least sensitive to XVir-N-31-mediated oncolysis (Figures 1E, F). Of note, all analyzed cell lines supported viral replication resulting in novel viral progeny, assessed 48 hours post infection (hpi) and 72hpi by hexon-titer-tests (Figure 1G). As the replication of XVir-N-31 depends on any factors, including nuclear YB-1 expression and the capacity of E1A12S to activate viral expression, infectivity and oncolysis should be considered separately.

After establishing productive XVir-N-31-infection with consequent EwS cell lysis and de novo production of infectious particles, EwS-redirected CD8⁺ T cells retrovirally transduced to express an HLA-A*02:01-restricted TCR recognizing the nonameric peptide CHM1₃₁₉ (VIMPCSWWW) derived from the source protein Chondromodulin-1 were tested in combination with XVir-N-31.

3.2 CHM1³¹⁹-specific TCR-transgenic CD8⁺ T cells (CHM1 CD8 T cells) and XVir-N-31 synergistically lyse EwS in vitro

First, contact-dependent tumor growth and detachment of tumor cells (i.e. cell killing) after mono- and combination therapy were studied using the xCELLigence assay. Therefore, T cell killing activity of non-specific (n.-sp.) purified CD8⁺ T cells at an effector-to-target (E:T) ratio of 1:1 with XVir-N-31 at MOI10 and MOI100 was examined initially. Infection of tumor cells was performed 24h before addition of T cells. Here, an increase of T cell-mediated killing was only observed with MOI100 (Figures 3A–C) indicating that peptide-HLA/TCR-independent mechanisms might be in place after infection with high MOI (45).

When using CHM1 CD8 T cells in combination with XVir-N-31, an increase of tumor cell killing was measured already 12h after addition of T cells with an increase of killing activity in a MOI/dose-dependent manner (Figures 3D–F).

For additional assessment of synergistic effects, tumor cell survival of cell lines A673 and TC32 were analyzed 48hpi and 24h after addition of CHM1 CD8 T cells using SRB assays and the R tool SynergyFinder (42, 43). Synergistic effects were predicted at MOI50-100 and E:T ratios of 1:1 to 0.25:1. Lower MOI were associated with mostly additive effects in these settings (Figures 3G, H; Supplementary Figure 2).

3.3 The combination of CHM1³¹⁹/HLA-A*02:01-restricted TCR-transgenic CD8⁺ T cells (CHM1 CD8 T cells) and XVir-N-31 improves therapy response and survival in a preclinical mouse model

After the establishment of possible synergistic effects, when combining CHM1 T cells and XVir-N-31 in vitro, we moved to in vivo testing. Here, we used an adaption of our established xenograft mouse model, consisting of subcutaneously xenografted A673 tumors, with intratumoral administration of XVir-N-31 (XVir) and consecutive intraperitoneal application of therapeutic T cells (39, 41), as illustrated in Figure 2A.

We could demonstrate improved tumor control of the combination approach (XVir + CHM1 T cells) as compared to all monotherapies and controls when assessing therapy response at day 8-10 after start of treatment (Figures 2B–D). Furthermore, when taking the longitudinal tumor growth into account, we also could demonstrate a significant improvement in tumor control for the combination (Table 2). When comparing survival proportions, animals having received the combination exhibited a significant increase in median survival of 22 days as compared to 9 days for mock, 10.5 days for XVir-N-31 only, and 11 days for CHM1 CD8 T cell only (Figure 2E). Tumor-infiltration of human adoptively transferred T cells (TILs) was analyzed at the end of experiment. Here, TILs could only be detected in the experimental group of XVir + CHM1 T cells, albeit in very low frequencies (Figure 2F).

We did not detect significant differences between treatment groups CHM1 T cells only monotherapy and the XVir + CHM1 T cells combination with regard to antigen presentation (Major Histocompatibility Complex, MHC class I expression), expression of the ‘don’t-eat-me’-signal CD47, lymphocyte adhesion molecule ICAM-1 (Intercellular Adhesion Molecule 1), the T cell co-stimulatory molecule CD83, immune checkpoint molecules PD-1, PD-L1, or PD-L2 by flow cytometry staining (Supplementary Figure 3A). Also, transcriptomic data including HLA-A, HLA-B and CXCL10 expression did not differ (Supplementary Figure 3B). Only a tendency of improved T cell engraftment in analyzed spleens was observed for the combination therapy as compared to CHM1 T cells only (Supplementary Figure 3C). Of note, the number of analyzed animals and FACS staining without isotype controls constitutes a limitation of this conclusion.

3.4 XVir-N-31 induces immunogenic cell death markers and maturation of antigen-presenting cells, increasing CHM1³¹⁹/HLA-A*02:01-restricted TCR-transgenic CD8⁺ T cell (CHM1 CD8 T cell) activity

To elucidate further immunostimulatory components of XVir-N-31, we performed further in vitro analyses, focusing on markers of immunogenic cell death (ICD), maturation of antigen-presenting cells and consecutive abilities to stimulate antigen-specific T cell activity, using the experimental setup described in Figure 4A. First, markers of immunogenic cell death HMGB1, HSP70 and HSP90 were analyzed in the supernatant of XVir-N-31- and adenovirus wildtype (AdWT)-infected EwS cell lines A673 and SK-N-MC. Here, conditions of XVir-N-31 induced the highest release of ICD markers in mostly a dose-dependent manner for all analytes (compare Figure 4B).

Figure 4

When exposing THP-1 cells to respective tumor-conditioned media (i.e. A673 supernatants; CM), which represents a published model to study activation of antigen-presenting cells (41, 47, 48), analyses of surface markers after co-culture indicated increased activation and expression of the T cell-co-stimulatory receptor CD80 and CD86. Furthermore, decrease of MHC-I expression by CM from non-infected EwS cells (mock) was partly compensated by XVir-N-31 in this model (Figure 4C). Also, CD80/CD86 expression was induced by increasing MOI of XVir (Figures 4C, D).

As a last step, we utilized CHM1 CD8 T cells for further co-culture experiments with respective conditioned THP-1 cells after loading them with the cognate peptide CHM1³¹⁹ and studied T cell proliferation. We could demonstrate as well an increase of antigen-specific T cell proliferation for all tested MOI of XVir (Figures 4E, G; Supplementary Figure 4G) and a significant higher release of IFNγ in XVir-versus mock-conditions (Figure 4F), complementing the results of T cell proliferation.

4 Discussion

Immunotherapeutic targeting of solid pediatric malignancies is challenging. EwS is considered a poorly-T cell-infiltrated tumor entity with high metastatic potential (8, 49). A recent report described a dynamic intrapersonal heterogeneity concerning the immune cells composition within the TME, depending on treatment-naïve or 1^st/2^nd relapsed biopsy status (3). Hence, further immunological insight is urgently needed. Cellular immunotherapy approaches have to address a multitude of obstacles: physical barriers, low to absent MHC class I expression, immunosuppressive innate cells of myelomonocytic origin, cancer-associated fibroblast-like tumor cells, chemo- and cytokines as well non-classical MHCs in the TME preventing an impactful T cell attack (8, 50–54). They additionally have to include properties to revert immunosuppressive systemic factors, such as fibroblastic/myeloid-derived suppressor cells, chronic inflammation or tumor-derived extracellular vesicles hampering proper antigen presentation and activation of DC to enable formation of antitumor T cell immunity (1, 2, 55).

In short, all major interconnections within the cancer immunity cycle, which need to be intact for successful sarcoma rejection by the immune system, are defective in EwS (56–58). The inherent features of EwS cells exhibiting embryofetal and mesenchymal features, leading to this highly stress adaptive and metastatic tumor, may explain why monotherapies thus far were ineffective (9). Next to breaking physical and local barriers limiting T cell attacks, circumvention of peripheral immune tolerance is most likely key for eliciting a long-lasting anti-EwS immunity (59).

In this regard, analyses of outcomes from advanced EwS patients treated with HLA-matched versus -mismatched hematopoietic stem cell transplants did not show a clinically reproduced graft-versus-EwS effect (60), although additional donor lymphocyte infusions and other immunostimulatory combinations might have indeed the ability to induce antitumor immunity in a subset of pediatric sarcoma patients (61). Consequently, addressing more than one interconnection within the cancer immunity cycle, aiming to overcome the threshold of immune activation to break immune tolerance, is the next logical step. Therefore, we analyzed if YB-1-based virotherapy in combination with tumor-redirected TCR-transgenic T cells has the capacity to overcome some of the immunosuppressive factors, leading to an increase in T cell activity and direct T cell killing of tumor-redirected TCR-transgenic T cells. The results obtained in this study show that this is the case.

We herein propose a combination approach exploiting (a) the oncolytic adenovirus XVir-N-31 not only to mediate direct EwS cell lysis, next to the induction immunogenic cell death and reversal of lacking antigen presentation, but also to increase (b) activity and direct T cell killing of tumor-redirected TCR-transgenic T cells. Furthermore, we depict differences of T cell activation by comparing the OV XVir-N-31 with AdWT and could carve out the specific advantage of XVir-N-31 to increase tumor-redirected T cell activity in an antigen-dependent manner. We did not perform phenotyping of TCR-transgenic T cells before in vivo application, which could have been helpful to determine possible improvements for future work, such as the addition of further immunostimulatory transgenes in our therapeutic setting. Despite TILs were very low in the combination approach, they were still detectable compared to the CHM1T cells only group, indicating that the addition of XVir-N-31 can be used to induce TILs. In addition, the observation of enhanced human T cell engraftment in spleens, suggests supportive effects of XVir-N-31 to increase in vivo persistence of adoptively transferred TCR-transgenic T cells.

We showed before that the combination of XVir-N-31 and CDK4/6 inhibition (CDK4/6i) has the capacity to jointly activate innate and adaptive immunity in EwS with superior tumor control and signs of an abscopal effect (41). Other recent work provides in vitro evidence that therapy with XVir-N-31 can increase the phagocytic potential of macrophages and DCs, which can be further enhanced by CD47 blockade (von Ofen et al., 2023 in revision). Colleagues also implementing XVir-N-31 and a derivate with a PD-L1 transgene, again observed signs of an abscopal effect in a humanized glioblastoma mouse model associated with the induction of ICD in vivo (62).

For our established tumor-redirected TCR-transgenic T cells, we now provide with XVir-N-31 an additional tool, to increase the efficacy of tumor-redirected T cells, as demonstrated here for CHM1 T cells in vitro and in vivo.

Concerning the high variability of CAR (CXADR) expression in EwS patient samples, the introduction of the RGD motif into the viral genome broadens the receptor repertoire for Ad entry, although virus-resistant tumor clones are a common phenomenon in clinical reality, reflected by the relatively high rate of non-responders in OV monotherapy approaches (27, 28). Nevertheless, OV not only targets (i) tumor cells directly but also (ii) the TME by triggering inflammatory responses, e.g. release of interferons in myeloid cells, as well as the (iii) tumor stroma, inducing the abrogation of immune cell-excluding matrix structures and tumor-promoting vasculature (63, 64). This emphasizes the simultaneous need to (a) increase viral replication through combination approaches, aiming at maximizing the antiviral/antitumor immune response, and to (b) select viral constructs with the inherent capability to trigger tumor-rejecting inflammatory pathways. Our results show that the CM of XVir-N-31-infected tumor cells efficiently render antigen presenting THP-1 cells into a state of superior T cell-stimulatory capacity, compared to AdWT, which actually is more potent in tumor cell killing than XVir-N-31 (65). This strongly indicates that not the superior cell killing of AdWT but rather the induction of an ICD by XVir-N-31 is playing a decisive role for this effect.

Regarding the reversion of an immunosuppressive TME as well as increased cell killing capacity by CDK4/6i and XVir-N-31, as shown by us, combined with recently published results on preconditioning of mouse or human CAR T cells with CDK4/6i and thereby enhancing their persistence and antitumor efficacy in murine models, we are particularly interested in including CDK4/6i in this combination approach (29, 41, 66). Prospectively, XVir-N-31 equipped with an anti-PD-L1 will be implemented as well, very likely minimizing toxicities observed in clinical trials using systemic application of ICB.

When studying oncolytic adenoviruses and therapeutic T cells in preclinical mouse models for translational purposes, one has to be aware of the inherent limitation. The herein applied xenograft model with transient humanization is lacking the crosstalk of innate and adaptive immunity. But as oncolytic Ads, as therapeutic products, only possess the characteristic to properly replicate in human cancer cells, and tumor-redirected T cell therapy for EwS has not yet been established in immunocompetent animal models, our approach addresses best the current need to develop immunotherapeutic combination strategies for EwS patients. A BMBF-funded phase-I clinical trial for pediatric sarcoma patients is in preparation using XVir-N-31, the CDK4/6i ribociclib and ICB with pembrolizumab (XVIR-RIB-PEM, 01EN2009). In case good tolerability and signs of antitumor immune activity is observed, the addition of tumor-redirected T cells boosting the adaptive arm of the immune system would be a highly attractive addition.

References

• 1

  ZhangHMaricIDiPrimaMJKhanJOrentasRJKaplanRNet al. Fibrocytes represent a novel MDSC subset circulating in patients with metastatic cancer. Blood. (2013) 122(7):1105–13. doi: 10.1182/blood-2012-08-449413

  • CrossRef
  • Google Scholar
  • View reference in article

• 2

  GassmannHSchneiderKEvdokimovaVRuzanovPSchoberSJXueBet al. Ewing sarcoma-derived extracellular vesicles impair dendritic cell maturation and function. Cells (2021) 10(8). doi: 10.3390/cells10082081

  • CrossRef
  • Google Scholar
  • View reference in article

• 3

  CilloARMukherjeeEBaileyNGOnkarSDaleyJSalgadoCet al. Ewing sarcoma and osteosarcoma have distinct immune signatures and intercellular communication networks. Clin Cancer Res (2022) 28(22):4968–82. doi: 10.1158/1078-0432.CCR-22-1471

  • CrossRef
  • Google Scholar
  • View reference in article

• 4

  DavisKLFoxEMerchantMSReidJMKudgusRALiuXet al. Nivolumab in children and young adults with relapsed or refractory solid tumours or lymphoma (ADVL1412): a multicentre, open-label, single-arm, phase 1-2 trial. Lancet Oncol (2020) 21(4):541–50. doi: 10.1016/S1470-2045(20)30023-1

  • CrossRef
  • Google Scholar
  • View reference in article

• 5

  D'AngeloSPMahoneyMRVan TineBAAtkinsJMilhemMMJahagirdarBNet al. Nivolumab with or without ipilimumab treatment for metastatic sarcoma (Alliance A091401): two open-label, non-comparative, randomised, phase 2 trials. Lancet Oncol (2018) 19(3):416–26. doi: 10.1016/S1470-2045(18)30006-8

  • CrossRef
  • Google Scholar
  • View reference in article

• 6

  GoelSDeCristoMJWattACBrinJonesHSceneayJLiBBet al. CDK4/6 inhibition triggers anti-tumour immunity. Nature. (2017) 548(7668):471–5. doi: 10.1038/nature23465

  • CrossRef
  • Google Scholar
  • View reference in article

• 7

  van ErpAEMVersleijen-JonkersYMHHillebrandt-RoeffenMHSvan HoudtLGorrisMAJvan DamLSet al. Expression and clinical association of programmed cell death-1, programmed death-ligand-1 and CD8(+) lymphocytes in primary sarcomas is subtype dependent. Oncotarget. (2017) 8(41):71371–84. doi: 10.18632/oncotarget.19071

  • CrossRef
  • Google Scholar
  • View reference in article

• 8

  StahlDGentlesAJThieleRGutgemannI. Prognostic profiling of the immune cell microenvironment in Ewing s Sarcoma Family of Tumors. Oncoimmunology. (2019) 8(12):e1674113. doi: 10.1080/2162402X.2019.1674113

  • CrossRef
  • Google Scholar
  • View reference in article

• 9

  GrunewaldTGPCidre-AranazFSurdezDTomazouEMde AlavaEKovarHet al. Ewing sarcoma. Nat Rev Dis Primers. (2018) 4(1):5. doi: 10.1038/s41572-018-0003-x

  • CrossRef
  • Google Scholar
  • View reference in article

• 10

  van TilburgCMPfaffEPajtlerKWLangenbergKPSFieselPJonesBCet al. The pediatric precision oncology INFORM registry: clinical outcome and benefit for patients with very high-evidence targets. Cancer Discovery (2021) 11(11):2764–79. doi: 10.1158/2159-8290.CD-21-0094

  • CrossRef
  • Google Scholar
  • View reference in article

• 11

  GasparNHawkinsDSDirksenULewisIJFerrariSLe DeleyMCet al. Ewing sarcoma: current management and future approaches through collaboration. J Clin Oncol (2015) 33(27):3036–46. doi: 10.1200/JCO.2014.59.5256

  • CrossRef
  • Google Scholar

• 12

  FelixABerlangaPToulmondeMLandman-ParkerJDumontSVassalGet al. Systematic review of phase-I/II trials enrolling refractory and recurrent Ewing sarcoma: Actual knowledge and future directions to optimize the research. Cancer Med (2021) 10(5):1589–604. doi: 10.1002/cam4.3712

  • CrossRef
  • Google Scholar
  • View reference in article

• 13

  EvansCHLiuFPorterRMO'SullivanRPMerghoubTLunsfordEPet al. EWS-FLI-1-targeted cytotoxic T-cell killing of multiple tumor types belonging to the Ewing sarcoma family of tumors. Clin Cancer Res (2012) 18(19):5341–51. doi: 10.1158/1078-0432.CCR-12-1985

  • CrossRef
  • Google Scholar
  • View reference in article

• 14

  Meyer-WentrupFRichterGBurdachS. Identification of an immunogenic EWS-FLI1-derived HLA-DR-restricted T helper cell epitope. Pediatr Hematol Oncol (2005) 22(4):297–308. doi: 10.1080/08880010590935194

  • CrossRef
  • Google Scholar
  • View reference in article

• 15

  GallegosZRTausPGibbsZAMcGlynnKGomezNCDavisIet al. EWSR1-FLI1 activation of the cancer/testis antigen FATE1 promotes ewing sarcoma survival. Mol Cell Biol (2019) 39(14). doi: 10.1128/MCB.00138-19

  • CrossRef
  • Google Scholar
  • View reference in article

• 16

  LiuXFHelmanLJYeungCBeraTKLeeBPastanI. XAGE-1, a new gene that is frequently expressed in Ewing's sarcoma. Cancer Res (2000) 60(17):4752–5.

  • Google Scholar
  • View reference in article

• 17

  MahlendorfDEStaegeMS. Characterization of Ewing sarcoma associated cancer/testis antigens. Cancer Biol Ther (2013) 14(3):254–61. doi: 10.4161/cbt.23298

  • CrossRef
  • Google Scholar
  • View reference in article

• 18

  ThielUPirsonSMuller-SpahnCConradHBuschDHBernhardHet al. Specific recognition and inhibition of Ewing tumour growth by antigen-specific allo-restricted cytotoxic T cells. Br J Cancer. (2011) 104(6):948–56. doi: 10.1038/bjc.2011.54

  • CrossRef
  • Google Scholar
  • View reference in article

• 19

  SchirmerDGrunewaldTGKlarRSchmidtOWohlleberDRubioRAet al. Transgenic antigen-specific, HLA-A*02:01-allo-restricted cytotoxic T cells recognize tumor-associated target antigen STEAP1 with high specificity. Oncoimmunology. (2016) 5(6):e1175795. doi: 10.1080/2162402X.2016.1175795

  • CrossRef
  • Google Scholar
  • View reference in article

• 20

  ThielUSchoberSJEinspielerIKirschnerAThiedeMSchirmerDet al. Ewing sarcoma partial regression without GvHD by chondromodulin-I/HLA-A*02:01-specific allorestricted T cell receptor transgenic T cells. Oncoimmunology. (2017) 6(5):e1312239. doi: 10.1080/2162402X.2017.1312239

  • CrossRef
  • Google Scholar
  • View reference in article

• 21

  KirschnerAThiedeMGrunewaldTGAlba RubioRRichterGHKirchnerTet al. Pappalysin-1 T cell receptor transgenic allo-restricted T cells kill Ewing sarcoma in vitro and in vivo. Oncoimmunology (2017) 6(2):e1273301. doi: 10.1080/2162402X.2016.1273301

  • CrossRef
  • Google Scholar
  • View reference in article

• 22

  von HeykingKCalzada-WackJGollnerSNeffFSchmidtOHenselTet al. The endochondral bone protein CHM1 sustains an undifferentiated, invasive phenotype, promoting lung metastasis in Ewing sarcoma. Mol Oncol (2017) 11(9):1288–301. doi: 10.1002/1878-0261.12057

  • CrossRef
  • Google Scholar
  • View reference in article

• 23

  HegdeMJosephSKPashankarFDeRenzoCSanberKNavaiSet al. Tumor response and endogenous immune reactivity after administration of HER2 CAR T cells in a child with metastatic rhabdomyosarcoma. Nat Commun (2020) 11(1):3549. doi: 10.1038/s41467-020-17175-8

  • CrossRef
  • Google Scholar
  • View reference in article

• 24

  El-NaggarAMVeinotteCJChengHGrunewaldTGNegriGLSomasekharanSPet al. Translational activation of HIF1alpha by YB-1 promotes sarcoma metastasis. Cancer Cell (2015) 27(5):682–97. doi: 10.1016/j.ccell.2015.04.003

  • CrossRef
  • Google Scholar
  • View reference in article

• 25

  Fujiwara-OkadaYMatsumotoYFukushiJSetsuNMatsuuraSKamuraSet al. Y-box binding protein-1 regulates cell proliferation and is associated with clinical outcomes of osteosarcoma. Br J Cancer. (2013) 108(4):836–47. doi: 10.1038/bjc.2012.579

  • CrossRef
  • Google Scholar
  • View reference in article

• 26

  RognoniEWidmaierMHaczekCMantwillKHolzmullerRGansbacherBet al. Adenovirus-based virotherapy enabled by cellular YB-1 expression in vitro and in vivo. Cancer Gene Ther (2009) 16(10):753–63. doi: 10.1038/cgt.2009.20

  • CrossRef
  • Google Scholar
  • View reference in article

• 27

  Gallego Perez-LarrayaJGarcia-MoureMLabianoSPatino-GarciaADobbsJGonzalez-HuarrizMet al. Oncolytic DNX-2401 virus for pediatric diffuse intrinsic pontine glioma. N Engl J Med (2022) 386(26):2471–81. doi: 10.1056/NEJMoa2202028

  • CrossRef
  • Google Scholar
  • View reference in article

• 28

  LangFFConradCGomez-ManzanoCYungWKASawayaRWeinbergJSet al. Phase I study of DNX-2401 (Delta-24-RGD) oncolytic adenovirus: replication and immunotherapeutic effects in recurrent Malignant glioma. J Clin Oncol (2018) 36(14):1419–27. doi: 10.1200/JCO.2017.75.8219

  • CrossRef
  • Google Scholar
  • View reference in article

• 29

  KochJSchoberSJHindupurSVSchoningCKleinFGMantwillKet al. Targeting the Retinoblastoma/E2F repressive complex by CDK4/6 inhibitors amplifies oncolytic potency of an oncolytic adenovirus. Nat Commun (2022) 13(1):4689. doi: 10.1038/s41467-022-32087-5

  • CrossRef
  • Google Scholar
  • View reference in article

• 30

  NguyenTTShinDHSohoniSSinghSKRivera-MolinaYJiangHet al. Reshaping the tumor microenvironment with oncolytic viruses, positive regulation of the immune synapse, and blockade of the immunosuppressive oncometabolic circuitry. J ImmunoTherapy Cancer. (2022) 10(7):e004935. doi: 10.1136/jitc-2022-004935

  • CrossRef
  • Google Scholar
  • View reference in article

• 31

  RibasADummerRPuzanovIVanderWaldeAAndtbackaRHIMichielinOet al. Oncolytic virotherapy promotes intratumoral T cell infiltration and improves anti-PD-1 immunotherapy. Cell. (2017) 170(6):1109–19 e10. doi: 10.1016/j.cell.2017.08.027

  • CrossRef
  • Google Scholar
  • View reference in article

• 32

  NassiriFPatilVYefetLSSinghOLiuJDangRMAet al. Oncolytic DNX-2401 virotherapy plus pembrolizumab in recurrent glioblastoma: a phase 1/2 trial. Nat Med (2023) 29(6):1370–8. doi: 10.1038/s41591-023-02347-y

  • CrossRef
  • Google Scholar
  • View reference in article

• 33

  KeibAMeiYFCicin-SainLBuschDHDennehyKM. Measuring antiviral capacity of T cell responses to adenovirus. J Immunol (2019) 202(2):618–24. doi: 10.4049/jimmunol.1801003

  • CrossRef
  • Google Scholar
  • View reference in article

• 34

  WollerNGurlevikEFleischmann-MundtBSchumacherAKnockeSKloosAMet al. Viral infection of tumors overcomes resistance to PD-1-immunotherapy by broadening neoantigenome-directed T-cell responses. Mol Ther (2015) 23(10):1630–40. doi: 10.1038/mt.2015.115

  • CrossRef
  • Google Scholar
  • View reference in article

• 35

  WalshSRSimovicBChenLBastinDNguyenAStephensonKet al. Endogenous T cells prevent tumor immune escape following adoptive T cell therapy. J Clin Invest. (2019) 129(12):5400–10. doi: 10.1172/JCI126199

  • CrossRef
  • Google Scholar
  • View reference in article

• 36

  BairochA. The cellosaurus, a cell-line knowledge resource. J Biomol Tech. (2018) 29(2):25–38. doi: 10.7171/jbt.18-2902-002

  • CrossRef
  • Google Scholar
  • View reference in article

• 37

  BlaeschkeFThielUKirschnerAThiedeMRubioRASchirmerDet al. Human HLA-A*02:01/CHM1+ allo-restricted T cell receptor transgenic CD8+ T cells specifically inhibit Ewing sarcoma growth in vitro and in vivo. Oncotarget (2016) 7(28):43267–80. doi: 10.18632/oncotarget.9218

  • CrossRef
  • Google Scholar
  • View reference in article

• 38

  BrohlASSindiriSWeiJSMilewskiDChouHCSongYKet al. Immuno-transcriptomic profiling of extracranial pediatric solid Malignancies. Cell Rep (2021) 37(8):110047. doi: 10.1016/j.celrep.2021.110047

  • CrossRef
  • Google Scholar
  • View reference in article

• 39

  SchoberSJThiedeMGassmannHPrexlerCXueBSchirmerDet al. MHC class I-restricted TCR-transgenic CD4(+) T cells against STEAP1 mediate local tumor control of ewing sarcoma in vivo. Cells (2020) 9(7). doi: 10.3390/cells9071581

  • CrossRef
  • Google Scholar
  • View reference in article

• 40

  MantwillKNaumannUSeznecJGirbingerVLageHSurowiakPet al. YB-1 dependent oncolytic adenovirus efficiently inhibits tumor growth of glioma cancer stem like cells. J Transl Med (2013) 11:216. doi: 10.1186/1479-5876-11-216

  • CrossRef
  • Google Scholar
  • View reference in article

• 41

  SchoberSJSchoeningCEckJMiddendorfCLutschJKnochPet al. The oncolytic adenovirus XVir-N-31 joins forces with CDK4/6 inhibition augmenting innate and adaptive antitumor immunity in Ewing sarcoma. Clin Cancer Res (2023). doi: 10.1158/1078-0432.c.6516382.v3

  • CrossRef
  • Google Scholar
  • View reference in article

• 42

  IanevskiAGiriAKGautamPKononovAPotdarSSaarelaJet al. Prediction of drug combination effects with a minimal set of experiments. Nat Mach Intelligence. (2019) 1(12):568–77. doi: 10.1038/s42256-019-0122-4

  • CrossRef
  • Google Scholar
  • View reference in article

• 43

  R Core Team. R: A language and environment for statistical computing. (2021) Vienna, Austria: R Foundation for Statistical Computing. Available at: https://wwwR-projectorg/2021.

  • Google Scholar
  • View reference in article

• 44

  R2: genomics analysis and visualization platform . Available at: http://r2.amc.nl.

  • Google Scholar
  • View reference in article

• 45

  SomersaloKAnikeevaNSimsTNThomasVKStrongRKSpiesTet al. Cytotoxic T lymphocytes form an antigen-independent ring junction. J Clin Invest (2004) 113(1):49–57. doi: 10.1172/JCI19337

  • CrossRef
  • Google Scholar
  • View reference in article

• 46

  EnotDPVacchelliEJacquelotNZitvogelLKroemerG. TumGrowth: An open-access web tool for the statistical analysis of tumor growth curves. Oncoimmunology. (2018) 7(9):e1462431. doi: 10.1080/2162402X.2018.1462431

  • CrossRef
  • Google Scholar
  • View reference in article

• 47

  WuTHLiYYWuTLChangJWChouWCHsiehLLet al. Culture supernatants of different colon cancer cell lines induce specific phenotype switching and functional alteration of THP-1 cells. Cell Immunol (2014) 290(1):107–15. doi: 10.1016/j.cellimm.2014.05.015

  • CrossRef
  • Google Scholar
  • View reference in article

• 48

  ForresterMAWassallHJHallLSCaoHWilsonHMBarkerRNet al. Similarities and differences in surface receptor expression by THP-1 monocytes and differentiated macrophages polarized using seven different conditioning regimens. Cell Immunol (2018) 332:58–76. doi: 10.1016/j.cellimm.2018.07.008

  • CrossRef
  • Google Scholar
  • View reference in article

• 49

  CotterillSJAhrensSPaulussenMJurgensHFVoutePAGadnerHet al. Prognostic factors in Ewing's tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing's Sarcoma Study Group. J Clin Oncol (2000) 18(17):3108–14. doi: 10.1200/JCO.2000.18.17.3108

  • CrossRef
  • Google Scholar
  • View reference in article

• 50

  BerghuisDde HoogeASSantosSJHorstDWiertzEJvan EggermondMCet al. Reduced human leukocyte antigen expression in advanced-stage Ewing sarcoma: implications for immune recognition. J Pathol (2009) 218(2):222–31. doi: 10.1002/path.2537

  • CrossRef
  • Google Scholar
  • View reference in article

• 51

  WrennEDApfelbaumAARudzinskiERDengXJiangWSudSet al. Cancer-associated fibroblast-like tumor cells remodel the Ewing sarcoma tumor microenvironment. Clin Cancer Res (2023). doi: 10.1101/2023.04.12.536619

  • CrossRef
  • Google Scholar
  • View reference in article

• 52

  BerghuisDSantosSJBaeldeHJTaminiauAHEgelerRMSchilhamMWet al. Pro-inflammatory chemokine-chemokine receptor interactions within the Ewing sarcoma microenvironment determine CD8(+) T-lymphocyte infiltration and affect tumour progression. J Pathol (2011) 223(3):347–57. doi: 10.1002/path.2819

  • CrossRef
  • Google Scholar
  • View reference in article

• 53

  AltvaterBKailayangiriSPérez LanuzaLFUrbanKGreuneLFlüggeMet al. HLA-G and HLA-E immune checkpoints are widely expressed in ewing sarcoma but have limited functional impact on the effector functions of antigen-specific CAR T cells. Cancers. (2021) 13(12):2857. doi: 10.3390/cancers13122857

  • CrossRef
  • Google Scholar
  • View reference in article

• 54

  EvdokimovaVGassmannHRadvanyiLBurdachSEG. Current state of immunotherapy and mechanisms of immune evasion in ewing sarcoma and osteosarcoma. Cancers (Basel). (2022) 15(1). doi: 10.3390/cancers15010272

  • CrossRef
  • Google Scholar
  • View reference in article

• 55

  ConsalvoSHinterwimmerFHarrasserNLenzeUMatziolisGvon Eisenhart-RotheRet al. C-reactive protein pretreatment-level evaluation for ewing's sarcoma prognosis assessment-A 15-year retrospective single-centre study. Cancers (Basel) (2022) 14(23). doi: 10.3390/cancers14235898

  • CrossRef
  • Google Scholar
  • View reference in article

• 56

  ChenDSMellmanI. Oncology meets immunology: the cancer-immunity cycle. Immunity. (2013) 39(1):1–10. doi: 10.1016/j.immuni.2013.07.012

  • CrossRef
  • Google Scholar
  • View reference in article

• 57

  MoralesEOlsonMIglesiasFDahiyaSLuetkensTAtanackovicD. Role of immunotherapy in Ewing sarcoma. J Immunother Cancer. (2020) 8(2). doi: 10.1136/jitc-2020-000653

  • CrossRef
  • Google Scholar
  • View reference in article

• 58

  MellmanIChenDSPowlesTTurleySJ. The cancer-immunity cycle: Indication, genotype, and immunotype. Immunity. (2023) 56(10):2188–205. doi: 10.1016/j.immuni.2023.09.011

  • CrossRef
  • Google Scholar
  • View reference in article

• 59

  GuramKKimSSWuVSandersPDPatelSSchoenbergerSPet al. A threshold model for T-cell activation in the era of checkpoint blockade immunotherapy. Front Immunol (2019) 10:491. doi: 10.3389/fimmu.2019.00491

  • CrossRef
  • Google Scholar
  • View reference in article

• 60

  ThielUSchoberSJRanftAGassmannHJabarSGallKet al. No difference in survival after HLA mismatched versus HLA matched allogeneic stem cell transplantation in Ewing sarcoma patients with advanced disease. Bone Marrow Transplant (2021). doi: 10.1038/s41409-020-01200-x

  • CrossRef
  • Google Scholar
  • View reference in article

• 61

  SchoberSJvon LuettichauIWawerASteinhauserMSalatCSchwingerWet al. Donor lymphocyte infusions in adolescents and young adults for control of advanced pediatric sarcoma. Oncotarget. (2018) 9(32):22741–8. doi: 10.18632/oncotarget.25228

  • CrossRef
  • Google Scholar
  • View reference in article

• 62

  KlawitterMEl-AyoubiABuchJRuttingerJEhrenfeldMLichteneggerEet al. The oncolytic adenovirus XVir-N-31, in combination with the blockade of the PD-1/PD-L1 axis, conveys abscopal effects in a humanized glioblastoma mouse model. Int J Mol Sci (2022) 23(17). doi: 10.3390/ijms23179965

  • CrossRef
  • Google Scholar
  • View reference in article

• 63

  EvertsABergemanMMcFaddenGKempV. Simultaneous tumor and stroma targeting by oncolytic viruses. Biomedicines. (2020) 8(11). doi: 10.3390/biomedicines8110474

  • CrossRef
  • Google Scholar
  • View reference in article

• 64

  SohnSYHearingP. Adenoviral strategies to overcome innate cellular responses to infection. FEBS Lett (2019) 593(24):3484–95. doi: 10.1002/1873-3468.13680

  • CrossRef
  • Google Scholar

• 65

  LichteneggerEKollFHaasHMantwillKJanssenKPLaschingerMet al. The oncolytic adenovirus XVir-N-31 as a novel therapy in muscle-invasive bladder cancer. Hum Gene Ther (2019) 30(1):44–56. doi: 10.1089/hum.2018.026

  • CrossRef
  • Google Scholar
  • View reference in article

• 66

  LelliottEJKongIYZethovenMRamsbottomKMMartelottoLGMeyranDet al. CDK4/6 inhibition promotes antitumor immunity through the induction of T-cell memory. Cancer Discovery (2021) 11(10):2582–601. doi: 10.1158/2159-8290.CD-20-1554

  • CrossRef
  • Google Scholar
  • View reference in article