An in vivo CRISPR screen unveils top target genes to improve CAR-T cell efficacy in a solid tumor model

ABSTRACT CAR-T cell therapies are revolutionizing the treatment of refractory and relapsed haematological malignancies, but many patients do not exhibit long-term responses, and these therapies are less effective against solid tumors. Poor persistence of CAR-T cells in patients is associated with therapeutic failure, highlighting the need to identify strategies promoting in vivo expansion. Here, we developed an in vivo competitive screening method to identify genes whose inactivation confers a selective advantage to CAR-T cells. Inactivation of 50 genes in a heterogeneous population of T cells expressing an EGFR-targeting CAR revealed that disruption of REGNASE-1, SOCS1, PTPN2 , and P16/NK4A conferred a selective advantage to CAR-T cells in human lung tumor-bearing mice. Consistently, inactivation of these genes improved tumor eradication by CAR-T cells. Interestingly disruption of other genes, described to improve CAR-T cell function in other contexts, had a negative impact in this orthotopic lung tumor model. Further evaluation of long-term effects in a subcutaneous model, highlighted SOCS1 ablation as the most promising strategy for in vivo CAR-T cell amelioration. These results support the importance of evaluating CAR-T cell editing strategies in tumor-specific models and highlight the versatility of our screening approach as a pre-clinical tool for context-specific studies on CAR-T cells amelioration.