In vivo CAR-T double knockout screen maps synergistic antitumour gene pairs.

Chimeric antigen receptor (CAR)-T cell therapy has transformed the treatment of haematological malignancies, but its efficacy remains limited by multiple negative regulatory mechanisms intrinsic to T cells 1-4 . Here we perform a high-throughput in vivo CAR-T double-knockout (DKO) CRISPR screen, and identify multiple DKO gene pairs that are both effective and synergistic. The top pair, NR4A1-SOCS3 DKO, has multiple favourable immunological features. Whole-transcriptome profiling and in vivo
Chimeric antigen receptor (CAR)-T cell therapy has transformed the treatment of haematological malignancies, but its efficacy remains limited by multiple negative regulatory mechanisms intrinsic to T cells 1-4 . Here we perform a high-throughput in vivo CAR-T double-knockout (DKO) CRISPR screen, and identify multiple DKO gene pairs that are both effective and synergistic. The top pair, NR4A1-SOCS3 DKO, has multiple favourable immunological features. Whole-transcriptome profiling and in vivo single-cell RNA sequencing reveal that NR4A1-SOCS3 DKO specifically upregulates metabolic pathways in CAR-T cells, which show significantly higher metabolic fitness and mitochondrial activity. NR4A1-SOCS3 DKO CAR-T cells and T cells exhibit exceptionally potent antitumour efficacy and long-term tumour control across different tumour models without compromising safety features. NR4A1-SOCS3 DKO outperforms several benchmark single-gene and dual-gene modifications in T cells and CAR-T cells 5-9 . These data demonstrate high-throughput in vivo CAR-T DKO screening for rapid discovery of combination targets, and establish NR4A1-SOCS3 as a promising pair of intracellular checkpoints to engineer high-performance CAR-T therapies against cancer.




