The cluster of differentiation 47 (CD47)
protein is abundantly expressed on various malignant cells and suppresses the phagocytic function of macrophages and dendritic cells. High CD47 expression levels are correlated with poor
cancer survival. Antagonizing CD47
antibodies with potent antitumor effects have been developed in clinical trials, but have critical side effects, inducing
anemia and
thrombocytopenia. To develop a safe and potent CD47 blockade, we designed extracellular vesicles (EVs) harboring signal regulatory
protein alpha (SIPRα)-EV-SIRPα (EVs that express SIPRα). EV-SIRPα showed minimal toxic effects on hematologic parameters and utilized RBCs as delivery vehicles to
tumors rather than inducing
anemia. EV-SIRPα inhibited
ligation of residual CD47 molecules, which attribute to the EV-endocytosis-mediated CD47 depletion and steric hindrance of EV. In an immunologically cold
tumor model, EV-SIRPα induced
tumor-specific T-cell-mediated antitumor effects. When directly administered to the accessible lesions, EV-SIRPα monotherapy elicited an abscopal effect in the B16F10
tumor model by increasing immune cell infiltration and CD8+-mediated immunity against non-treated
tumors. The combinational approach by loading
doxorubicin into the EV-SIRPα dramatically reduced the
tumor burden and led to 80% complete remission rate. Thus, a potent EV-based CD47 blockade that is hematologically safe, has efficient signaling blocking efficacy, and has systemic antitumor immunity against
cancer is recommended.