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Research Article
Maider Garnica*1, Patxi San Martin-Uriz*1,2, Paula Rodriguez-Marquez1,2, Maria E. Calleja-Cervantes1,3, Saray Rodriguez-Diaz1, Rebeca Martinez-Turrillas1,2, Mikel Hernaez2,3,4,5, Felipe Prosper1,2,4,6, Juan R. Rodriguez-Madoz1,2,4
1Hemato-Oncology Program,Cima Universidad de Navarra, IdiSNA, 2Centro de Investigacion Biomedica en Red de Cancer (CIBERONC), 3Computational Biology and Translational Genomics Program,Cima Universidad de Navarra, IdiSNA, 4Cancer Center Clinica Universidad de Navarra (CCUN), 5Data Science and Artificial Intelligence Institute (DATAI),Universidad de Navarra, 6Hematology and Cell Therapy Department,Clinica Universidad de Navarra, IdiSNA
Erratum Notice
Important: There has been an erratum issued for this article. View Erratum Notice
Retraction Notice
The article Assisted Selection of Biomarkers by Linear Discriminant Analysis Effect Size (LEfSe) in Microbiome Data (10.3791/61715) has been retracted by the journal upon the authors' request due to a conflict regarding the data and methodology. View Retraction Notice
We developed an optimized CRISPR-Cas9 knockout screening protocol for primary CAR T cells. By reducing gDNA carryover through enzymatic digestion and sgRNA cassette pulldown, this approach minimizes PCR artifacts, ensuring accurate sgRNA detection and robust identification of functional gene targets.
Chimeric antigen receptor (CAR) T cell therapies have demonstrated remarkable efficacy in several hematological malignancies, yet their success has not been fully replicated in solid tumors. Moreover, even in hematological cancers, relapse after CAR T cell infusion continues to compromise long-term outcomes. These challenges highlight the urgent need to develop strategies that enhance CAR T cell efficacy, persistence, overcoming tumor and microenvironment-mediated resistance. Clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9-based screening platforms provide a powerful approach to systematically identify genes that regulate CAR T cell function. By linking genetic perturbations to phenotypic outcomes, these assays enable the discovery of pathways controlling activation, proliferation, memory formation, and cytotoxicity. Standard workflows involve transduction of substantial numbers of cells with a single guide RNA (sgRNA) library, Cas9-mediated editing, selection of edited cells, and PCR amplification of sgRNA cassettes from genomic DNA (gDNA) prior to sequencing. However, PCR amplification using large amounts of gDNA poses significant challenges and often fails to selectively amplify and retrieve sgRNAs. Here, we describe an optimized CRISPR-Cas9 knockout screening protocol, which we have tested on primary human CAR T cells. The method here incorporates an intermediate step during sgRNA library preparation that reduces gDNA carryover through enzymatic digestion and selective pulldown of the sgRNA cassette, thereby increasing the efficiency of the first PCR amplification. This modification allowed us to retrieve sgRNA information across our CAR T cell screens, which had remained elusive in our previous attempts using traditional 1 and 2-step PCR amplification protocols. In conclusion, this optimized workflow facilitates CRISPR screening library preparation in challenging samples and enables the identification of key genetic determinants that can be targeted to improve therapeutic efficacy.
Immunotherapy has revolutionized cancer treatment, offering novel strategies to harness and modulate the immune system. Among these, chimeric antigen receptor (CAR) T cell therapy has emerged as one of the most transformative approaches. This therapy involves the genetic engineering of a patient's T cells ex vivo with a synthetic receptor designed to recognize a specific tumor antigen, thereby enhancing antitumor activity1. CAR T cells have shown remarkable success in hematological malignancies, with outcomes ranging from short-lived remissions to prolonged disease-free survival with minimal toxicity in patients receiving CD19 or BCMA-targeted therapies2. To date, the FDA has approved seven CAR T cell products for hematological cancers3. Despite these advances, significant limitations remain. Challenges arise from the CAR T cell product itself, often influenced by the manufacturing process or the fitness of the patient's T cells, which may be impaired by disease progression, prior therapies, or age. Tumor-intrinsic resistance mechanisms, such as antigen downregulation, can also compromise efficacy4. Furthermore, the immunosuppressive tumor microenvironment poses an additional barrier that severely limits CAR T cell persistence and function, particularly in patients with solid tumor5. Consequently, there is an urgent need to enhance both the initial and long-term efficacy of CAR T cell therapies.
The advent of CRISPR-Cas9 gene editing has provided powerful tools to dissect gene function through large-scale screening approaches. In these assays, cells are transduced with a single-guide RNA (sgRNA) library, typically delivered by lentiviral vectors, ensuring one sgRNA per cell and stable genomic integration. Following Cas9-mediated editing and selection of transduced cells, genomic DNA (gDNA) is extracted, and sgRNA cassettes are amplified by PCR for library preparation. High-throughput sequencing then enables the quantification of sgRNA distributions across different phenotypes, thereby identifying genes that positively or negatively regulate the process under study6.
CRISPR screening has been widely applied to explore T cell biology and, more recently, to enhance CAR T cell performance. Genome-wide screens have identified regulators of fundamental T cell processes, including activation, proliferation, and differentiation. For example, FAM49B was identified as a regulator of T cell receptor signaling7, while SOCS1, TCEB2, RASA2, and CBLB were shown to be essential for proliferation following stimulation8. Beyond these core pathways, CRISPR screening has also elucidated genes involved in T cell memory and exhaustion. In vivo studies identified Fli1 as a candidate to enhance effector responses without disrupting memory or exhaustion precursors9, and the chromatin remodeler Arid1a as a regulator whose loss reduces T cell exhaustion10. Regulators of T helper type 2 (Th2) differentiation have also been characterized with this approach11. Using a custom sgRNA library targeting 25 kinases, p38 was found to promote expansion, memory formation, and protection from oxidative and genomic stress12. Similarly, REGNASE-1 knockout in CD8+ T cells conferred a long-lived effector phenotype that improved tumor control in melanoma and leukemia models13. Additional genome-wide screens identified Dhx37 as a regulator of T cell activation and cytotoxicity14, while LTBR and other genes were validated as enhancers of T cell function in CAR T and γδ T cells15. More recently, CRISPR screening has been applied directly in CAR T cells, revealing novel targets such as PRODH2, an enzyme involved in proline metabolism that enhances CAR T antitumor activity16, and TLE4 and IKZF2, whose inactivation improved CAR T efficacy in glioblastoma models17.
A critical step in CRISPR screens is precisely the selective amplification of sgRNA cassettes from exceedingly large amounts of gDNA, a challenge difficult to circumvent given the vast number of cells used in CRISPR screenings. PCR amplification from such large amounts of DNA carryover poses several technical challenges, including molecular crowding that limits the physical diffusion of DNA and polymerase molecules, transient non-specific binding of the primers and the polymerase to the DNA background, off-target amplification resulting in primer depletion, or Mg2+ sequestration by the DNA phosphate backbone, among other challenges18,19,20,21. These often result in PCR failure and/or bias. To mitigate these issues, different strategies have been proposed, including separating sgRNA amplification from adaptor addition into two PCR steps22, using target enrichment with biotinylated oligos and magnetic bead capture23,24, or designing plasmids with restriction sites flanking the sgRNA cassette for fragment enrichment25.
In this study, we present an optimized CRISPR-Cas9 knockout screening protocol for primary human CAR T cells. The CRISPR library used is Brunello Kinome 1, a library that contains 3052 unique 20nt-long sgRNAs targeting 763 human kinase genes (4 sgRNAs per target). T cells were isolated through CD4+ and CD8+ magnetic positive selection from the peripheral blood mononuclear cells (PBMC)-enriched fraction of blood samples from healthy donors. Upon activation with anti-CD3 and anti-CD28, T cells were spinfected with the CRISPR screening library, then transduced with the CAR lentivirus. Cells were expanded, then nucleofected to introduce the Cas9 protein. CRISPR-bearing cells were selected with puromycin, and CAR-positive T cells were sorted. Following extraction, genomic DNA was digested with restriction enzymes (RE), and the sgRNA-containing fragments were pulled down by biotin probe-streptavidin capture. Next, sgRNA were selectively amplified and indexed via two consecutive PCRs, and the resulting libraries were sequenced. By incorporating an intermediate step to reduce gDNA carryover, we were able to selectively retrieve and amplify our sgRNA of interest, which allows us to study the role of the kinases in CAR T cells.
This protocol was performed in accordance with Universidad de Navarra guidelines. All subjects provided written informed consent. The reagents and the equipment used in this study are listed in the Table of Materials.
1. T cell isolation and activation
2. CAR T cell production and CRISPR screening
3. Isolation of gDNA
NOTE: Avoid any cell or gDNA losses throughout the process, as this may compromise the representativity of the sgRNAs. Aim for a sgRNA coverage of at least 500x.
4. Enrichment of sgRNA cassette (and elimination of gDNA carryover)
5. sgRNA library preparation
6. Analysis
As described in the Protocol Section, CAR T cells were generated following our established protocol26. For CRISPR screening, we adapted the workflow developed by Wang et al.17 (Figure 1A). Briefly, T cells from two independent donors were isolated and activated for 24 hours before consecutive transduction with both the CRISPR sgRNA library and the CAR lentiviral vector, reaching 67 and 72% CAR-positive cells at day 5. A fraction of cells was nucleofected with Cas9 protein to induce knockouts, while the remaining cells served as a baseline for sgRNA representation. Transduced cells were selected with antibiotics, and distinct populations were subsequently sorted according to the phenotypes under study. CAR T cell proliferation was monitored throughout the screen using AOPI-based cell counts and expressed as fold change (Figure 1B). Following puromycin supplementation at days 8, 10, and 12, we confirmed successful enrichment of CAR T cells transduced with the CRISPR library in both donors, as evidenced by continued survival and proliferation. Untransduced T cells (UTD) and CAR T cells lacking CRISPR library transduction were used as controls of antibiotic selection.
After genomic DNA extraction, sgRNA libraries were prepared via PCR amplification. To overcome issues arising from excessive gDNA carryover, we implemented a protocol incorporating restriction enzyme digestion and biotin-streptavidin pulldown of the sgRNA cassette (Figure 2A,B). gDNA was digested with restriction enzymes NdeI and PspXI targeting sites flanking the sgRNA cassette (Figure 2C). Biotinylated oligos, designed to bind upstream of PCR1 primer annealing sites, were used to capture sgRNA cassette fragments, then pulled down with streptavidin beads to eliminate carryover gDNA. Fragments containing sgRNA were then selectively amplified (Figure 2D) and indexed through 2 consecutive PCRs.
Libraries from each sample were sequenced using Next Generation Sequencing (NGS). After demultiplexing, quality control, and sgRNA identification, data were analyzed with the MAGeCK pipeline. First, the count command quantified and normalized sgRNA read counts in control (basal) and Cas9-edited samples (Figure 3A,B). Pearson and Spearman correlations indicate that the representativity of sgRNA was maintained during the experiment (donor gDNA) compared with the plasmidic library (Figure 3C). Next, the test command compared both conditions, assigning robust rank aggregation (RRA) scores to each gene (Figure 3D). Significantly enriched or depleted genes were identified using thresholds of p < 0.05 and log fold change (LFC) > 0.5 (Figure 3E). Finally, pathway enrichment analysis of candidate genes was performed using Metascape, revealing top Gene Ontology terms associated with the identified regulators (Figure 3F).

Figure 1: CRISPR screening in CAR T cells. (A) Scheme of the CRISPR screening in CAR T cells. (B) Selection of transduced cells with puromycin (P). Plasmidic libraries include a puromycin resistance gene for positive selection. Antibiotic was added at day 8 to the media in non-transduced samples of untransduced (UTD) and CAR T cells and transduced CAR T cells. Samples without puromycin were used as a control of proliferation. Data from two independent donors is shown. Please click here to view a larger version of this figure.

Figure 2: Library preparation for sgRNA enrichment analysis. (A) Scheme of the protocol for library preparation. (B) Scheme of the relative localization of the cut sizes of the restriction enzyme (scissors) and the annealing regions of PCR1 primers (arrow) and biotinylated primers (arrow with green dot). (C) Electrophoresis of the gDNA pre- and post-RE digestion. (D) Selective enrichment of sgRNA cassettes after PCR1. Data from two independent donors from basal and Cas9 samples of the two phenotypes is shown. Please click here to view a larger version of this figure.

Figure 3: Guide enrichment analysis with MAGeCK. (A) Summary of the output of the MAGeCK count function. (B) Distribution of read counts. (C) Pearson and Spearman coefficients for correlation between donor gDNA and plasmid library counts. (D) Potential enriched/depleted genes ranked by a modified robust ranking aggregation (RRA score). (E) Volcano plot showing significant genes (p-value < 0.05, LFC > 0.5) in red. (F) Top Gene Ontology (GO) terms after Metascape pathway analysis of the enriched significant genes. Please click here to view a larger version of this figure.
Table 1: Sequence of primers. Please click here to download this Table.
Table 2: PCR conditions. Please click here to download this Table.
Supplementary Table 1: List of sgRNA in Kinome 1 library and sgRNAs lost during digestion with NdeI and PspXI Please click here to download this File.
CRISPR screening relies on the principle of single-guide perturbation, meaning that only one sgRNA should be integrated per cell. To achieve this, sgRNAs are typically delivered via lentiviral vectors, and the multiplicity of infection (MOI) must be carefully controlled. An MOI of ca. 0.3 is generally recommended, resulting in 25% to 30% of cells being transduced with a single viral particle6. Accurate titration is therefore essential to determine the volume of viral particles required. Another critical step is the loss of sgRNA coverage during the protocol. Cell loss during harvesting, inefficiencies during gDNA extraction (namely column overloading and incomplete elution of DNA), or excessive template during PCR amplification can all contribute to this loss, hence skewing our sgRNA analysis. Regarding the biotinylated oligos, it is best if they are HPLC purified to avoid that free biotin used in the synthesis saturates the streptavidin beads. Moreover, a 3' amino-modifier is strongly suggested to prevent amplification from the biotinylated primers in subsequent PCRs. Also, when designing these oligos, avoid any overlap with PCR1 primers to prevent competition during amplification. In addition, bioinformatic analysis requires careful attention: sgRNA extraction patterns depend on the plasmid backbone (e.g., lentiGuide-puro or lentiCRISPR v2), and alignment stringency can range from exact matching to some tolerance of mismatches. Furthermore, since this protocol includes a digestion step, some sgRNAs containing restriction sites may be lost, requiring adjustment of the reference library.
In this study, we propose an optimized CRISPR screening library preparation protocol that enriches sgRNA-containing fragments through digestion and, more importantly, a pulldown step. Restriction enzyme digestion has been previously suggested as a strategy to reduce gDNA input and enrich for sgRNA cassettes27. Similarly, biotinylated probes have been widely applied in molecular biology to capture specific nucleic acids or protein-nucleic acid complexes28,29,30,31.
Our protocol builds on these principles and adapts them for CRISPR screening in primary CAR T cells, although several limitations should be acknowledged. First, primary CAR T cells impose constraints on screening scale, as their expansion capacity is limited. To maintain adequate coverage and sgRNA representation, large numbers of starting cells are required. When this is not feasible, smaller custom libraries may be used12, though this reduces the breadth of genetic interrogation. Biological variability is another challenge; differences between donors are expected, and the overlap of significant hits is often modest17. Second, the enrichment strategy relies on the presence and position of restriction enzyme cutting sites. In rare cases, these sites may occur within sgRNA sequences, which is more problematic for small libraries with limited redundancy. However, most libraries, particularly genome-wide designs, include multiple sgRNAs per target, minimizing the overall impact of guide loss. Finally, alternative fragmentation-based enrichment strategies, such as sonication coupled with probe capture24, may provide some flexibility in cases where restriction enzyme digestion is not suitable.
Overall, the sgRNA cassette represents a tiny fraction of the total genomic DNA in CRISPR-edited cells, making efficient enrichment critical for successful library preparation. Compared with standard protocols, our optimized workflow reduces gDNA carryover and favours PCR amplification of the sgRNA of interest. While the combination of gDNA fragmentation and biotinylated probe pulldown with streptavidin beads is not conceptually new, its integration into CRISPR screening avoids common PCR pitfalls and increases CRISPR screen reproducibility. Moreover, incorporating standardized QC metrics at each key step (such as post-sorting T-cell purity, the proportion of puromycin-resistant cells, gDNA integrity, and CAR transduction efficiency) would further enhance the robustness and reproducibility of the workflow. In conclusion, although developed in the context of primary CAR T cells and with only two donors (that may represent a limitation, although several samples from each donor were used), this optimized protocol may be broadly applicable to other CRISPR screenings and NGS workflows with large gDNA carryovers.
The authors have no conflicts of interest.
This study was supported by the PID2022-137914OB-I00 project financed by MICIU/AEI /10.13039/501100011033 and by FEDER, UE. This study was supported by Instituto de Salud Carlos III (ISCIII) through Red de Terapias Avanzadas TERAV and TERAV+ (RD21/0017/0009 and RD24/0014/0010) and through the Centro de Investigacion Biomedica en Red de Cancer CIBERONC (CB16/12/00489). This study was supported by Gobierno de Navarra Salud (GN2023/08 and GN2024/04) and Proyectos Estratégicos (DIAMANTE 0011-1411-2023-000105 and 0011-1411-2023-000074). Figure 1B and Figure 2A were created with BioRender.com
| 4200 TapeStation | Agilent | G2991A | |
| Acridine Orange | Invitrogen | A1301 | |
| AMPure XP | Beckman Coulter | A63881 | |
| autoMACS NEO Separator | Miltenyi | 130-120-327 | High-speed magnetic cell sorter |
| Biotinylated oligos | IDT | ||
| BSA | Sigma | A9647 | |
| Cellometer K2 Fluorescent Cell Counter | Revvity | CMT-K2-MX-150 | Fluorescent cell counter |
| CHT4 Counting Chambers | Revvity | CHT4-SD100-002 | |
| CytoSinct CD4 Nanobeads | GenScript | L00863-1 | |
| CytoSinct CD8 Nanobeads | GenScript | L00864-1 | |
| dNTP | Agilent | 200418-51 | |
| Dynabeads M-280 Streptavidin | Invitrogen | 11206D | |
| DynaMag-2 magnet | Invitrogen | 12321D | |
| EDTA 0.5 M pH 8.0 | Invitrogen | 15575-038 | |
| Ethanol | Merck | 1,00,98,31,000 | |
| ExPERT Atx Electroporator | MaxCyte | ExPERT ATx | |
| Ficoll-Paque | Cytiva | 17544203 | |
| Filtropur S 0.2 µm | Sarstedt | 83,18,26,001 | |
| GenCRISPR Ultra NLS-Cas9-Research | GenScript | Z03621-1 | |
| Herculase Buffer 5X | Agilent | 600675-52 | 5X buffer |
| Herculase II Fusion Enzyme | Agilent | 600679-51 | DNA polymerase |
| IL-15 | Miltenyi | 130-095-765 | |
| IL-7 | Miltenyi | 130-095-362 | |
| Mastercycler X50a | Eppendorf | 6313HG006059 | |
| MaxCyte Electroporation Buffer | Cytiva | EPB1 | |
| NdeI | New England Biolabs | R0111L | |
| Nucleospin Tissue | Macherey-Nagel | 74,09,52,250 | |
| PBS | Gibco | 14190-094 | |
| Polybrene | Merck | TR-1003-6 | |
| Primers | ThermoFisher | ||
| Propidium Iodine | Sigma | P4864 | |
| PspXI | New England Biolabs | R0656S | |
| Puromycin | Gibco | A11138-03 | |
| Qubit 3.0 Fluorometer | Invitrogen | Q33216 | |
| Qubit HS DNA assay | Invitrogen | Q32851 | |
| R-50x3 Sterile Well Processing Assembly | MaxCyte | LM243882 | |
| T Cell TransAct human | Miltenyi | 130-111-160 | T cell stimulation reagent |
| Tape Station HSD1000 | Agilent | 5067-5585 | |
| TEXMACS | Miltenyi | 130-097-196 | T cell growth medium |
| Tris Buffer, 1.0 M, pH 8.0, Molecular Biology Grade | EMD Milipore | 648314 | |
| Water, for molecular biology, DNAse, RNAse and Protease free | ThermoScientific | 327390010 |