Cholesterol metabolism modulation facilitates CAR-T induced killing of ovarian cancer

Ovarian cancer is one of the most lethal gynecological cancers worldwide and has one of the highest recurrence rates. Recently developed Chimeric Antigen Receptor T (CAR-T) cell therapy has shown potent clinical efficacy against hematological malignancies. However, solid tumors, including ovarian cancer, possess several mechanisms that hinder T cell activity, and metabolic alteration of cancer cells has been shown to contribute to resistance to immune cell attack against solid tumors. Here, we explored the metabolic response of ovarian cancer cells to CAR-T cell attack using label-free high-content hyperspectral stimulated Raman scattering (h2SRS) imaging. Utilizing visible h2SRS imaging with much improved spatial resolution, we found an altered cholesterol metabolism, featured by increased storage of cholesteryl ester in lipid droplets and free cholesterol, in ovarian cancer cells that survived the CAR-T treatment. Administration of Avasimibe, an inhibitor of cholesteryl esterification, further enhanced CAR-T cytotoxicity. Our study shows the promise of implementing metabolic modulation to facilitate CAR-T cell treatment of solid tumors. Significance StatementOvarian cancer is a major global health challenge, mainly due to relapse driven by chemotherapy resistance development. Meanwhile, immunotherapies such as CAR-T have revolutionized treatment for blood cancers, but their application in solid tumors like ovarian cancer is hindered by limited efficacy. This study uses high-content stimulated Raman scattering (SRS) imaging to reveal metabolic adaptations that help ovarian cancer cells survive CAR-T-mediated cytotoxicity. Guided by these insights, we apply metabolic interventions that enhance CAR-T cytotoxicity efficacy. This approach reveals therapeutic vulnerabilities in ovarian cancer and demonstrates an investigative strategy applicable for overcoming resistance in solid tumors.