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Combining the proven efficacy of CAR therapy with the promising advantages of extracellular vesicle (EV)-based therapy may improve the effectiveness of cancer treatments, as demonstrated in studies targeting breast and lung cancers12,13. The CAR-EV therapeutic approach addresses current limitations of CAR therapy, such as delivery challenges and associated toxicity, while leveraging the biocompatibility and targeting capabilities of EVs. Integrating these modalities may facilitate the development of new therapeutic strategies for cancer, expanding opportunities for the application of EVs in a clinical setting. In addition, engineering and enrichment of functional EVs provides a safer (via encapsulation of cytolytic cargo) and more precise method (i.e., the addition of targeting domains) for delivering therapeutic cargo, especially to challenging locations such as the tumor core, bone marrow, and areas protected by barriers like the blood-brain or blood-testis barrier14,15,16. Despite the well-established method of EV enrichment using ultracentrifugation, several limitations remain. Notable constraints include: scalability, co-isolation of impurities, and limited post-production yield17. There is a clear need for improved processes for generating therapeutic EVs at scale.
This proof-of-concept study demonstrates that IEX is a scalable and effective method for producing, isolating, and enriching functional CAR-EVs, using clarified CM from CAR-expressing cells as input. IEX enables high-throughput processing and supports both research and cGMP-scale production, allowing for quality control throughout the workflow-from EV generation to final drug product testing18,19. While EV characterization is essential to confirm function, yield can vary significantly due to differences in sample volume, input concentration, and EV-specific properties such as surface charge and binding properties. In-house data using MCF-7 cells shows an average pre-purification yield of ~2.85 × 108 particles/mL, with post-purification concentrations typically ranging from 3 × 1011 to 1 × 1012 particles/mL. These levels can be adjusted by modifying the resuspension volume during buffer exchange to match downstream needs. Given this variability, users are strongly encouraged to optimize the protocol with CM relevant to their experimental setup, to ensure reproducible and robust yields.
Several steps within the protocol are critical to the successful production of CAR-EVs, with particular emphasis on the sample loading and elution phases. These steps directly influence the efficiency of EV capture by the column and, consequently, the overall yield. The buffer exchange step is crucial, as incomplete removal of excess solutes can compromise EV stability, leading to degradation over time. EVs can then be characterized by using methods such as NTA or proteomic profiling. If CAR-EVs are intended for functional assays, such as cellular uptake studies or therapeutic interventions, sterility is of utmost importance. A final 'terminal' (0.22 µm) sterilization step is essential to prevent microbial contamination, which may confound experimental outcomes or pose biosafety risks. Given these factors, users are strongly advised to exercise particular care during these steps to maintain reproducibility and functional integrity of the final EV preparation.
Several protocol modifications may be necessary to address common issues encountered during CAR-EV production. Low yield is most commonly caused by suboptimal loading of CM, either exceeding or falling short of the column's binding capacity. To determine the optimal input volume, it is advisable to conduct a CM titration study, incrementally increasing the load to identify the point of maximal EV recovery. Filter clogging, typically observed during the final sterile filtration step, often results from excessive sample concentration and viscosity, which can promote EV aggregation. In such cases, dilution of the final EV preparation is recommended. If dilution is not feasible, sterile filtration may be performed prior to buffer exchange; however, this approach necessitates that all subsequent steps be conducted under strict aseptic conditions to maintain sterility.
The development of EVs as cancer therapeutics requires reproducible production processes and robust validation of their efficacy against target cancer cell lines. A common limitation of IEX in EV enrichment is the co-isolation of non-EV particles – a challenge identifiable through downstream analysis of EV-specific markers, and reducible via further CM optimization. Control release characterization of EVs should include: NTA to determine particle number and size, and EV concentration post-enrichment; genetic and transcript analysis of CAR construct expression; determination of cellular and EV protein expression of the CAR, canonical EV biomarkers and cytolytic markers (e.g., granzyme B and perforin); and on- and off- target effects.The incorporation of additional techniques, such as transmission electron microscopy (TEM), will provide morphological validation to complement size-based characterization, supporting a more comprehensive analysis. To maintain quality control, EV products should undergo mycoplasma and endotoxin contamination testing to verify sterility and suitability for clinical production. The employment of suitable formulations for long-term storage of functional CAR-EVs may offer opportunities to enhance their stability, including maintaining quality, quantity, and therapeutic efficacy. Consistent evaluation of functional performance is essential for ensuring product integrity. Notably, the MTS assay utilized in this study offers an indirect evaluation of cytotoxicity via measurement of metabolic activity. Future studies would benefit from integrating standardized cytotoxicity assays, such as lactate dehydrogenase (LDH) release, Annexin V/PI staining, or caspase activation profiling, to delineate cytotoxic effects more accurately. Furthermore, incorporating CAR cell comparators (not incorporated in the current study due to sourcing limitations) either alone or in combination with CAR-EVs, and including parallel treatment of control non-cancer cell lines, could deepen the interpretative value of the findings.
This study highlights the potential use of EGFR/HER2 CAR EVs as a viable therapeutic strategy for specific cancers. Enhancing the efficacy of CAR EVs can be achieved through multiple dosing or pre-activation of parent T-cells to augment cytotoxicity. Moreover, advancements in emerging approaches, such as siRNA cargoes, and improvements in EGFR/HER2 binding capacity present opportunities to refine the design of these therapeutic platforms20,21. The promising application of dual chimeric antigen receptors (dual-CARs) in cell therapy offers an additional opportunity for advancement. Extending the use of dual-CARs by the utilization of their EV counterparts in therapeutics could be a pivotal step in broadening their therapeutic scope and enhancing treatment modalities22,23. Real-time monitoring of CAR EV-driven cancer cell cytotoxicity (e.g., caspase 3/7 activation, impedance reading) provides valuable insights for determining optimal dosage regimens, facilitating streamlined translation into future in vivo applications.