# Enzymatic Remodelling of Tumour Microenvironment Enhances Anti‐CEACAM5 CAR T‐Cell Efficacy Against Colorectal Cancer

## TL;DR

Anti-CEACAM5 CAR T-cells struggle against colorectal cancer due to a thick glycocalyx and hidden antigens, but enzyme treatments can improve their effectiveness.

## Contribution

Identifies CEACAM5 sequestration and glycocalyx as barriers to CAR T-cell efficacy and proposes enzymatic solutions.

## Key findings

- CRC cells have a thick glycocalyx that delays CAR T-cell activation.
- CEACAM5 becomes less accessible over time, likely due to sequestration in cell junctions.
- Trypsin and hyaluronidase treatments enhance CAR T-cell cytotoxicity and TNF-α secretion.

## Abstract

Chimeric antigen receptor (CAR) T‐cell therapy has shown unprecedented success in haematological cancers but faces challenges in solid tumours. Although carcinoembryonic antigen‐related cell adhesion molecule 5 (CEACAM5) is differentially expressed in many solid tumours, anti‐CEACAM5 CAR T‐cells are ineffective. Here, we have studied the interaction of CEACAM5 targeting primary CAR T‐cells with colorectal cancer (CRC) cells using fluorescence microscopy. We found that CRC cells’ glycocalyx is much thicker than that of the CAR T cell causing delayed activation. Oscillating calcium fluxes, indicative of non‐sustained CAR T cell activation, are observed when CAR T cells interacted with CRC cells, which increased with increasing cell‐seeding time. Significant reduction in cytotoxicity is observed on going from early to longer‐seeded CRC monolayers. Imaging revealed that this effect correlated with a progressive loss of accessible CEACAM5 antigen on the CRC cell surface, possibly due to their sequestration in the intercellular junction, rendering CAR T cell engagement less effective. Local proteolytic treatment with trypsin to disrupt the CRC cell monolayer, using a micropipette, increased CEACAM5 availability, decreased glycocalyx thickness, and restored sustained CAR T cell calcium fluxes. Similar enhanced interaction is observed after treatment of CRC cell monolayer with hyaluronidase, approved for use in humans. Enzymatic treatment significantly enhanced CAR T cell‐mediated cytotoxicity and increased the percentage of TNF‐α–secreting CAR T cells. We observed limited availability of CEACAM5 on human colorectal cancer tissues, whereas treatment with trypsin or hyaluronidase increased accessibility. Our results reveal why CAR T cells targeting CEACAM5 are ineffective and suggest possible routes to improved therapy for CRC.

This study shows anti‐CEACAM5 CAR T‐cells are ineffective against colorectal cancer (CRC) because of CEACAM5 sequestration at intercellular junctions and the thick tumour cell glycocalyx. Enzymatic treatments of CRC cell monolayer/tissue section with trypsin or hyaluronidase restore CEACAM5 availability, enhance CAR T‐cell activation, increase cytotoxicity, and boost TNF‐α secretion, improving therapeutic outcomes.