Aurelio, J. | bioRxiv Science

bioRxiv2026

Dual stimulation of CD40 and 41BB pathways during ex-vivo TIL expansion enhances CD8+ T cell expansion

BackgroundTumor-infiltrating lymphocyte (TIL) therapy has demonstrated clinical efficacy in malignant melanoma; however, inefficient ex vivo expansion remains a major limitation. We previously showed that stimulation of tumor-infiltrating B cells via CD40-CD40L axis improves TIL expansion, and that direct activation of the 41BB-41BBL pathway on T cells enhances CD8 T cell outgrowth. We hypothesized that adding simultaneous targeting of both pathways would augment the growth and activity of CD8+ cytotoxic T cells. We conducted a study with the objective of determining the feasibility of dual stimulation with human tumors as justification for a Phase I trial. MethodsCD40L variants were generated by yeast display selection and evaluated for B cell binding and activation. The effects of CD40L variants on TIL expansion were evaluated using tumors derived from standard of care resections using fragment method. Based on these findings, a bi-specific molecule was designed and generated fusing a CD40L variant and 41BB to the N- and C-termini of a trimeric leucine zipper. The effects of the bi-specific molecule (termed CD40LEPC6-41BBL) on TIL expansion were evaluated in TIL cultures derived from lung tumor and melanoma fragments. TIL phenotypes were assessed by flow cytometry, including high-dimensional FlowSOM analysis, and tumor reactivity by autologous tumor co-culture assays. ResultsEach of our engineered CD40L variants bound B cells and induced CD80/CD86 expression at levels comparable to wild-type CD40L. Supplementation of TIL cultures with CD40L variants increased the success rate of TIL expansion compared to control. We then developed a bi-specific CD40LEPC6-41BBL molecule capable of binding to both B and T cells. Addition of CD40LEPC6-41BBL significantly increased total TIL yield and improved expansion success rates in both lung tumor and melanoma cultures. In particular, CD40LEPC6-41BBL promoted preferential expansion of CD8 T cells. High-dimensional analysis revealed enrichment of CD8 T cell clusters expressing CD39, CD69, TIM3, and CD56 in cultures supplemented with CD40LEPC6-41BBL. Furthermore, treated cultures displayed increased frequencies of CD27 CD4 T cells. Functional assessment suggested a trend toward enhanced tumor reactivity in melanoma-derived TIL products expanded with CD40LEPC6-41BBL. ConclusionsSimultaneous stimulation of CD40 and 41BB pathways using a novel bi-specific molecule resulted in qualitative and quantitative enhancement of TIL products. These findings support dual targeting of tumor-infiltrating B cells and T cells as a promising strategy to optimize TIL manufacturing for adoptive cell therapy in Phase I trials.

immunology↗

bioRxiv2026

Pharmacokinetic Acceleration via CYP3A4 Hyperactivation as a Clinically Actionable Mechanism of Targeted Therapy Resistance in NSCLC

Resistance of cancers to targeted therapies is traditionally framed as a tumor-intrinsic phenomenon, mediated by tumor cell-intrinsic or microenvironmental mechanisms. Here, we identify a tumor-extrinsic, systemic resistance mechanism resulting from hyperactivation of the hepatic cytochrome P450 enzyme, CYP3A4. This tumor-extrinsic resistance mechanism can function independently of, or in tandem with, tumor-intrinsic resistance. Focusing on experimental mouse models of targetable lung cancer, we find that xenobiotic-mediated induction of CYP3A4 results in accelerated drug metabolism and a drastic reduction in systemic and tumor-drug exposure in vivo. CYP3A4 activation can be triggered by chemically unrelated xenobiotics, leading to resistance to a wide range of targeted therapies, including ALK, EGFR, and KRASG12C inhibitors. Retrospective analysis of clinical cohorts suggests that variability in CYP3A4 activity might be a major contributor to variability in clinical outcomes. While higher CYP3A4 activity leads to sub-therapeutic tumor drug exposure and shorter progression-free survival, reduced drug metabolism is expected to result in supratherapeutic exposure and increased systemic toxicity. To address the consequences of abnormal CYP3A4 activity, we utilized mathematical modeling to demonstrate that drug concentrations can be restored through the optimization of dosing amounts and intervals. Further, we show that tumor sensitivity to targeted therapies can be rescued through pharmacological inhibition of CYP3A4. Our findings establish systemic metabolic variability as a bona fide resistance and toxicity driver, providing a translational framework for personalized dosing to maximize both safety and efficacy.

cancer biology↗