Repurposing base editors for targeted knockin and simultaneous multiplex knockouts to generate allo-CAR T cells with minimal translocations

Authors:
Glaser V, Becker L, Fuster-García C, , Jackson Aird E, Huth L, Nitulescu AM, Pu Y, Kassing I, Hartmann LM, Flugel CL, Karklinš R, Shaji S, Pouzolles M, Stein M, Andrieux G, Ellery Corn J, Cathomen T, Volk HD, Reinke P, Kath J, Wagner DL
In:
Source: Mol Ther
Publication Date: (2026)
Issue: :
Research Area:
Cancer Research/Cell Biology
Immunotherapy / Hematology
Basic Research
Molecular Biology
Regenerative medicine
Drug Discovery
Cells used in publication:
T cell, human stim.
Species: human
Tissue Origin: blood
Platform:
4D-Nucleofector® X-Unit
Experiment

Gene editing
Primary human T cells were harvested ~48 h after anti-CD3/CD28 stimulation, counted, and washed twice in sterile PBS by centrifugation at 100 ×g for 10 min at RT.

mRNA-based knockin
Double-nick-mediated knockins were performed by co-electroporating: (1) HDR donor template (1 µL, 1–2 µg/µL), (2) two strand-specific sgRNAs (0.48 µL each, 100 µM; IDT), and (3) mRNA encoding the base or nuclease editor (1 µL, 2 µg/µL). Optionally, additional sgRNAs for base editing were included. Reagents were assembled in PCR strips by adding components sequentially. Synthetic, chemically modified sgRNAs (or crRNAs for Cas12a; IDT) were resuspended in nuclease-free 1×TE buffer and stored at 20°C (Table S2). sgRNAs for splice site disruption using base editors were designed using SpliceR.29Previously published sgRNAs targeting TRAC, B2M,40CIITA,40CD54, CD58, CD38, CD2,73CD5,74and CD774 were used.

Cas12a ribonucleoprotein-based knockin
For Cas12a RNP assembly, 0.5 µL of 100 µg/µL poly(L-glutamic acid) (PGA; 15–50 kDa; Sigma-Aldrich) was combined with 0.48 µL TRAC-specific CRISPR-RNA (crRNA) (IDT) and mixed thoroughly. Then, 0.4 µL of Alt-R A.s. Cas12a Ultra (IDT; 10 µg/µL) was added and incubated for 15 min at RT to form RNPs, followed by addition of 1 µL HDRT (1–2 µg/µL). The mixture was kept on ice until electroporation.

Electroporation
Cells were resuspended in 20 µL of ice-cold P3 electroporation buffer (Lonza) at a concentration of 1–1.5 ×10^6 cells per reaction and immediately used for electroporation. The cell suspensions were mixed with the prepared reagent mix and transferred to a 16-well electroporation strip (Lonza). To ensure proper contact and eliminate air bubbles, strips were gently tapped on the bench before electroporation.
Electroporation was performed on a 4D-Nucleofector (Lonza) using program EH-115. Immediately after, 100 µL of pre-warmed T cell medium was added per well and the cells were placed in the incubator for 10 min. Cells were then gently resuspended and equally divided into two separate wells of a 96-well round-bottom plate, each containing 150 µL of pre-warmed T cell medium, resulting in a final density of 0.5– 0.75 ×10^6 cells per well. For the animal experiment, three electroporation reactions were performed and subsequently seeded together in one well of a G-Rex24 Well Plate (3 M cells per well).

Abstract

Multiplex genome editing of cellular therapies frequently requires multiple DNA double-strand breaks (DSBs), which can induce genotoxicity through chromosomal rearrangements and large deletions. Base editors enable targeted sequence changes with minimal DSBs and are widely used for gene disruption, but their capacity for transgene insertion has remained unexplored. Here, we have developed base editor–mediated knockin (BEKI), a non-viral platform combining transgene insertion with multiplex gene disruption using a single enzyme. BEKI repurposes the base editor’s Cas9 nickase domain to generate paired nicks (inducing a localized DSB) at the knockin locus while achieving multiplex knockouts through base editing. Optimized guide RNA orientation and spacing enabled efficient transgene insertion across multiple T cell-relevant genomic loci. DNA-PK inhibition enhanced knockin efficiency but increased kilobase-scale deletions, which were mitigated by co-inhibition of Pol?. Compared with multiplex Cas9 editing, BEKI markedly reduced chromosomal translocations while preserving cell viability. BEKI supported targeted chimeric antigen receptor (CAR) knockin alongside up to 10 simultaneous gene knockouts, enabling the generation of allogeneic CAR T cells with enhanced cytokine secretion and resistance to immunosuppressants and allo-rejection. Together, BEKI provides a streamlined and scalable strategy for multiplex CAR T cell engineering with improved genomic stability, advancing safer next-generation cell therapies for cancer and autoimmune diseases.