EXTH-47. ENHANCING GD2.CART THERAPY FOR DIFFUSE MIDLINE GLIOMA WITH LSD1 AND HDAC INHIBITORS

Abstract Chimeric antigen receptor T cells against the glycolipid GD2 (GD2.CARTs) are showing promise in diffuse midline glioma (DMG) but are not yet curative. Since low target antigen expression is one potential mechanism by which tumor cells can escape CART therapy, we profiled GD2 expression levels on 9 different H3K27M-mutant DMG cell lines using flow cytometry. This analysis shows that only 5 of the 9 cell lines exhibit high GD2 expression while the remaining 4 lines have low GD2-expressing cells. When treating these cell lines with GD2.CARTs in co-culture assays and xenograft mice, we find that low GD2 expression on DMG cells correlates with tumor cell escape from GD2.CARTs and therapeutic resistance in vivo. Our lab previously found that simultaneous inhibition of histone deacetylases (HDACs) and lysine-demethylase 1 (LSD1) in DMG cells causes synergistic increases in gene expression and tumor cell death. Previous studies in neuroblastoma also demonstrate that HDAC inhibitor (HDACi) treatment can increase GD2 on tumor cells and improve targeting by GD2.CARTs. We therefore decided to assess whether treating GD2-low DMG cell lines with combinations of LSD1 inhibitors (LSD1i) and HDACi improves DMG response to GD2.CARTs. Immunofluorescence and flow cytometric analyses show that GD2 expression is increased on LSD1i+HDACi-treated GD2-low DMG cells and that there is enhanced tumor cell targeting by GD2.CARTs in subsequent co-culture assays. Treating mice transplanted with GD2-low DMG cells with LSD1i+HDACi followed by intravenous GD2.CART infusion also led to reduced tumor growth. These results suggest that LSD1i+HDACi pre-treatment may provide a way to improve DMG patient responses to GD2.CART therapy by increasing target antigen expression.