决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
肿瘤细胞治疗研究
英文原题:Exercise as an Immune Adjuvant for Allogeneic Cell Therapies
Exercise as an Immune Adjuvant for Allogeneic Cell Therapies
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这是一项早期 I 期、随机的注册临床试验,比较细胞治疗与安慰剂对照在白血病、淋巴瘤中的疗效与安全性。研究设计:随机、3 个分组。当前状态:招募中。计划入组 200 例。试验地点:美国 · 图森(共 1 个中心)。登记号:NCT06643221。
不限性别 · ≥ 21 Years 且 ≤ 55 Years · 接受健康志愿者
本研究通过健康筛查确定资格,并在运动和异丙肾上腺素输注期间进行医学监测,设有明确的试验终止标准,以尽量降低健康志愿者及匹配亲属供者的身体风险。为降低运动或输注期间发生心脏不良事件的风险,仅招募按美国运动医学会(ACSM)及美国心脏协会(AHA)标准评估为最大负荷运动试验“低风险”的志愿者,即无症状且心血管疾病危险因素不超过1项的男性或女性。输注在亚利桑那大学临床与转化科学研究中心(CATS)输注室进行,该场所配备医护人员和心电监护设备。运动负荷试验和异丙肾上腺素输注由持证专科心脏科医生指导。 纳入标准: • 年龄21–55岁。 • 按ACSM-AHA标准,分级运动/负荷试验风险为低风险。 • 按FDA指南,无异丙肾上腺素、卡维地洛、比索洛尔、纳多洛尔或罗氟司特的使用禁忌。 排除标准: • 目前使用烟草,或过去6个月内戒烟。 • BMI>34 kg/m²,或腰围男性>102 cm、女性>88 cm。 • 使用已知影响免疫系统的药物,或经常服用布洛芬/阿司匹林、抗抑郁药或影响血压/心血管功能的药物。 • 正在接受激素替代治疗;妊娠或哺乳。 • 慢性或致残性关节炎,或过去3个月卧床。 • 过去6周内患常见疾病(如感冒)。 • 有中枢或周围神经系统疾病、卒中史或重性情感障碍。 • HIV或肝炎感染,或任何自身免疫病。 • 已知心血管疾病,或使用异丙肾上腺素、卡维地洛、比索洛尔、纳多洛尔、罗氟司特的禁忌。 • 正在服用任何处方药,或对β受体阻滞剂过敏。 • 静息心率<50次/分钟。 • 患有哮喘、肺气肿、支气管炎、肾病、嗜铬细胞瘤、糖尿病、甲状腺功能亢进或既往严重过敏性休克。 • 计划接受手术。 • 即使符合纳入标准,若下列心血管病危险因素中超过1项且未获心脏科医生许可,也排除:家族史(父亲/男性一级亲属55岁前,或母亲/女性一级亲属65岁前发生心肌梗死、冠脉血运重建或猝死);高血压(收缩压>140 mmHg或舒张压>90 mmHg);血脂异常(总胆固醇>200 mg/dL);糖尿病前期(空腹血糖100–126 mg/dL)。
Procedures are in place for protecting against or minimizing the risks to the healthy volunteers recruited for this study. Physical risk to volunteers and matched related donors will be protected through health screening to determine study eligibility, and medical monitoring with an established test termination criterion during the exercise and isoproterenol infusion trials. To protect against the remote risk of an adverse cardiac event occurring during exercise and isoproterenol infusion, the study will only enroll volunteers who are considered "low risk" for maximal stress testing in accordance with the guidelines published by the American College of Sports Medicine (ACSM) and American Heart Association (AHA). Individuals who are considered "low risk" are men and women who are asymptomatic and have no more than one risk factor for cardiovascular disease (CVD). The risks to subjects are therefore extremely low. All infusions will take place in the Clinical and Translational Sciences Research Center (CATS) Infusion Suite, which is a designated University of Arizona campus facility for infusion trials and equipped with appropriate medical personnel and monitoring equipment (i.e. ECG). The graded exercise tests and isoproterenol infusions procedures will be performed under the direction of a licensed and board-certified cardiologist Inclusion Criteria: Participants must: * Be between 21 and 55 years of age. * Be classified as 'low-risk' for graded exercise/stress testing according to ACSM-AHA criteria. * Have no contraindications for the use of isoproterenol, carvedilol, bisoprolol, nadolol, or roflumilast as per FDA guidelines. Exclusion Criteria: Participants will be excluded if they: * Currently use tobacco products or have quit within the last 6 months. * Have a body mass index (BMI) greater than 34 kg/m² or waist circumference exceeding 102 cm for men and 88 cm for women. * Use any medications known to affect the immune system or regularly take ibuprofen/aspirin, antidepressants, or medications that alter blood pressure or cardiovascular function. * Use of hormone replacement therapy. * Are pregnant or breastfeeding. * Have chronic or debilitating arthritis or have been bedridden in the past three months. * Experienced a common illness (e.g., colds) within the past 6 weeks. * Have central or peripheral nervous disorders, a history of stroke, or major affective disorder. * Are infected with HIV or hepatitis or have any autoimmune disease. * Have known cardiovascular disease or contraindications for the use of isoproterenol, carvedilol, bisoprolol, nadolol, or roflumilast. * Use any prescription medications or have an allergy to beta-blockers. * Have a resting heart rate of less than 50 beats per minute. * Suffer from asthma, emphysema, bronchitis, kidney disease, pheochromocytoma, diabetes, overactive thyroid, or a history of severe anaphylactic reactions. * Are scheduled for surgery. Additionally, participants who meet the inclusion criteria but present with more than one of the following cardiovascular disease (CVD) risk factors will be excluded unless cleared by a cardiologist: * Family History: Myocardial infarction, coronary revascularization, or sudden death before 55 years of age in a father or male first-degree relative, or before 65 years of age in a mother or female first-degree relative. * Hypertension: Systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg. * Dyslipidemia: Total serum cholesterol exceeding 200 mg/dl. * Pre-diabetes: Fasting blood glucose levels between 100 mg/dl and 126 mg/dl.
以上为辅助阅读译文。是否适合入组须由主治医生判断,最终以登记平台与研究者确认为准。
主要终点:Immune Cell Enumeration and Phenotyping · Whole blood samples will be analyzed for complete blood counts and to quantify lymphocyte and monocyte subtypes using flow cytometry and a comprehensive immunophenotyping panel. This panel is designed to identify major immune cell populations, as well as markers related to differentiation, exhaustion, migration, activation, and inhibition. Specific cell types expressing a surface protein, or combinations of surface proteins, will be reported as the percentage of cells positive for expression and/or by mean fluorescent intensity (MFI). For descriptive purposes, the cell counts of all major lymphocyte and monocyte subtypes will be expressed as cells per microliter (cells/µL) of whole blood. Additionally, isolated peripheral blood mononuclear cells (PBMCs) and expanded cell products will be quantified and phenotyped in a similar manner. · immediately after the intervention;Cytolysis in vitro · We will assess whether lymphocytes collected during or after exercise, as well as cell products manufactured from these lymphocytes, are more effective at killing hematologic cancer target cells. Using in vitro assays, such as flow cytometry and bioluminescence-based assays, we will compare the cytolytic activity of both the collected lymphocytes and the manufactured cell products to those obtained under resting conditions. Results will be measured as the time required to achieve 10%, 20%, 30%, 40%, and 50% cytolysis, or as the percentage of target cells killed at specific time points (e.g., 4, 8, 24, and 48 hours). We will also evaluate the impact of combination therapies, such as monoclonal antibodies targeting the tumor model, as appropriate. · immediately after the intervention;Tumor Burden and Tumor Free Survival · Tumor burden will be evaluated in immunocompromised mice engrafted with human tumors by measuring the size, number, and progression of tumors using imaging techniques such as bioluminescence, MRI, or CT scans, along with physical measurements where applicable. Overall tumor burden will be assessed through metrics like peak tumor size and photon intensity in bioluminescence imaging. Tumor-free survival will be defined as the time from treatment until either the recurrence of detectable tumors or the last follow-up without tumor recurrence. Data will be reported as overall tumor reduction (e.g., percentage decrease in tumor size or number), peak tumor burden, and photon intensity, as well as the duration of tumor-free survival in days. Additional analyses will explore the effects of treatment on delaying tumor progression and improving overall survival. · up to 120-days;Clinical xGvHD Score · The development of xGvHD (xenogeneic graft-versus-host disease) will be assessed using a clinical scoring system with a possible aggregate score ranging from 0 to 10. Animals will be monitored regularly, and a total score of 5 or higher on two consecutive assessment days will indicate the presence of moderate xGvHD. This scoring system allows for the systematic evaluation of disease severity and progression in response to treatment. · up to 120-days;Survival · Survival will be monitored as a critical endpoint in this study. Death will be recorded when any of the following criteria are met: (1) the animal experiences greater than 20% weight loss compared to its baseline weight at two consecutive weigh-ins, indicating significant deterioration in health; or (2) the animal exhibits signs of severe morbidity, characterized by an xGvHD score exceeding 7. These criteria ensure that any adverse effects related to treatment or disease progression are accurately captured, allowing for a comprehensive assessment of the survival outcomes in the context of xGvHD. · up to 120 days
次要终点:Single-Cell Secretome;CITE-Seq Analysis of Immune Cell Populations;Human Cell Engraftment and Immune Reconstitution:;Pathology and Immunohistochemistry
先进行最大分级运动试验以测定最大摄氧量和最高骑车功率;随后进行20分钟分级骑车运动,强度依次为VO₂max的50%、60%、70%、80%,每阶段5分钟。
健康志愿者完成20分钟骑车运动,强度为最大摄氧量的50%–80%。不同试验条件包括安慰剂、口服比索洛尔10 mg、纳多洛尔80 ng、卡维地洛50 ng,或比索洛尔10 mg联合罗氟司特100 μg。所有药物/安慰剂均在运动前2–3小时服用。采用双盲交叉设计,每位参与者作为自身对照。
为判断药理学激活β肾上腺素能受体能否诱发类似运动的免疫反应,健康志愿者接受异丙肾上腺素静脉输注,剂量50 ng/kg/min。
本研究探索通过运动采集更具活性的供者免疫细胞,以改善血液肿瘤治疗。异体过继细胞治疗是将健康供者的免疫细胞给予癌症患者,常用于造血干细胞移植后预防或治疗复发;细胞可直接输注,也可在实验室扩增并制备为靶向肿瘤的免疫细胞。尽管该疗法已使许多患者获益,仍需提升疗效并降低移植物抗宿主病(GvHD)等副作用,即供者免疫细胞攻击患者正常组织。本早期Ⅰ期试验评估运动能否帮助供者产生更好的免疫细胞。健康志愿者参加三个研究组之一或多个:运动组进行20分钟骑车,研究人员在运动前、运动中和运动后采血,分析免疫细胞数量及质量,并将细胞制备成免疫疗法,在体外和小鼠中测试杀癌能力;运动加β受体阻滞剂组最多进行5次骑车,每次间隔至少1周,运动前服用安慰剂或阻断肾上腺素等应激激素的药物,并采血评估阻断激素对运动影响的作用;异丙肾上腺素组接受20分钟异丙肾上腺素输注,并采血观察是否产生类似运动的免疫变化。研究旨在了解运动能否改善血液肿瘤细胞治疗并降低GvHD风险。
This study aims to improve the treatment of blood cancer by using exercise to collect healthier immune cells from donors. Allogeneic adoptive cell therapy is a treatment where immune cells from a healthy donor are given to a cancer patient, usually to help prevent or treat cancer relapse after a stem cell transplant. These donor cells can either be directly infused into the patient or grown in a lab to create more specialized immune cells that target and kill cancer. While this therapy has been helpful for many patients, there is a need to make it more effective for a larger group and reduce side effects like graft-versus-host disease (GvHD), where the donor's immune cells attack the patient's healthy tissue. This Early Phase 1 trial will test whether exercise can help produce better immune cells from donors. The investigators will recruit healthy participants for three study groups: 1. Exercise Group: Participants will complete a 20-minute cycling exercise session. The investigators will collect blood samples before, during, and after exercise to study the number and quality of immune cells. The investigators will also use the collected cells to create immune therapies and test their ability to kill cancer cells in the lab and control cancer growth in mice. 2. Exercise and Beta Blocker Group: In this group, participants will complete up to five cycling sessions, with at least a week between each session. Before each session, participants will take either a placebo or a drug (beta blocker) that blocks stress hormones like adrenaline. The investigators will collect blood samples before and during exercise to see how blocking these hormones changes the effect of exercise on immune cells. 3. Isoproterenol Group: Participants in this group will receive a 20-minute infusion of isoproterenol, a drug that mimics the effects of adrenaline. The investigators will collect blood samples before, during, and after the infusion to see if the drug causes similar immune changes to those caused by exercise. Participants can join one, two, or all three groups. This research will help understand whether exercise can improve immune cell therapies for treating blood cancer and reduce the risk of GvHD, making these treatments safer and more effective.
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