# An in vitro co-culture model with CAR-T cells, antigen-presenting cells, and tumor cells to evaluate CAR-T cell-induced cytokine release syndrome

## TL;DR

This study develops an in vitro model using CAR-T cells, antigen-presenting cells, and tumor cells to evaluate cytokine release syndrome, a serious side effect of CAR-T therapy.

## Contribution

The study introduces a triple-cell co-culture system to effectively model cytokine release syndrome in vitro.

## Key findings

- A co-culture of CAR-T cells and tumor cells alone does not produce significant IL-6, a key CRS cytokine.
- Including macrophages or iDCs with CAR-T cells and tumor cells significantly elevates IL-6, mimicking CRS.
- Macrophages are the primary source of IL-6 during CRS in this model.

## Abstract

Chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable efficacy in hematological malignancies. However, it can also cause severe systemic toxicity, known as cytokine release syndrome (CRS). Therefore, the potential of CAR-T cells to cause toxicity in vivo should be evaluated in preclinical models prior to first-in-human trials. Although murine models exist for this purpose, they are typically complex xenograft systems available only to a limited number of laboratories. Therefore, development of an in vitro assay to assess CRS elicited by CAR-T cells is warranted.

CAR-T cells, macrophages, or immature dendritic cells (iDCs), along with tumor target cells, were co-cultured under different conditions. The release of CRS-related cytokines, IFN-γ and IL-6, was measured to simulate cytokine release during CAR-T-induced CRS. Additionally, the cellular source of the key CRS cytokine IL-6 was investigated.

A co-culture system containing only CAR-T cells and tumor cells failed to recapitulate the key feature of CRS, specifically a significant elevation of IL-6. However, when CAR-T cells were co-cultured with antigen-presenting cells (macrophages or iDCs) and tumor cells, the core CRS cytokine IL-6 was significantly elevated in an in vitro cell culture model, indicating that this system effectively mimics cytokine release during CAR-T-induced CRS. Furthermore, macrophages and iDCs are the primary cellular sources of IL-6 during CRS, with macrophages playing a central role in the development of CRS. Additionally, a co-culture system involving CAR-T cells, tumor cells, and macrophages under these conditions can indicate the occurrence of clinically severe-grade CRS.

Macrophages and iDCs play a critical role in the development of CAR-T therapy-induced CRS. The triple-cell co-culture system, comprising CAR-T cells, macrophages or iDCs, and tumor cells, provides a viable in vitro model for assessing CAR-T cell-induced CRS.