Biondi, M.; Galeone, A.; Arsuffi, C.; My, B.; Grassenis, E.; Firpo, C.; Rotiroti, M. C.; Pievani, A.; Alviano, A. M.; Cerina, B.; Gigli, G.; Lia, A.; Biondi, A.; Tettamanti, S.; Serafini, M.

Chimeric Antigen Receptor (CAR) therapy for Acute Myeloid Leukemia (AML) is hindered by disease heterogeneity, antigen overlap with normal hematopoiesis, and the persistence of leukemic stem cells (LSCs). To overcome these barriers, we employed the IF-BETTER strategy to simultaneously target CD33 and the LSC-associated marker TIM-3 by pairing a second-generation CAR with a Cytokine-Costimulatory Receptor (CCR) in two dual CAR configurations (CD33.CAR/TIM-3.CCR and TIM-3.CAR/CD33.CCR). Both constructs displayed potent antigen-restricted cytotoxicity against AML cell lines and primary blasts, achieving leukemia clearance, while sparing normal immune and hematopoietic cells. Mechanistic studies revealed that the TIM-3.CAR single-chain fragment variable (scFv) recognizes a protein-proximal epitope whose interaction is selectively enhanced by AML-specific hyper-fucosylated and hyper-sialylated N-glycans. Fucosylation blockade reduced TIM-3.CAR avidity and cytotoxicity, confirming a glycosylation-modulated interaction. Integrating this glycosylation-tolerant TIM-3 scFv into a dual CAR framework enables selective targeting of AML cells, providing a rational strategy for safer and more effective AML-directed immunotherapy.