抗 CD22/CD19 CAR-T 细胞疗法 CART2219.1 在成人和儿童复发/难治性 B-ALL 中的 I/II 期试验
A Phase I/II Trial of Anti-CD22/CD19 CAR-T Cell Therapy, CART2219.1, in Adult and Pediatric Relapsed/Refractory B-ALL.
在一项多中心I/II期试验中,所有患者(n=11;7名儿童,4名成人)在第28天均达到完全缓解(91%为微小残留病阴性)。
英文原题:Downregulation of HLA class II is associated with relapse after allogeneic stem cell transplantation and alters recognition by antigen-specific T cells.
白血病细胞中供受者错配 HLA 等位基因的基因组缺失是异基因造血干细胞移植(HSCT)后复发的主要原因。
供者与患者不匹配的HLA等位基因在白血病细胞中发生基因组缺失,是异基因造血干细胞移植(HSCT)后复发的重要原因。HLA不匹配通常以单个等位基因或HLA-I类区域整体丢失的形式出现,而HLA-II类则表现为下调。我们推测,针对HLA-I类和HLA-II类相关表位的T细胞识别能力可能不同,从而在异基因免疫压力下诱发白血病细胞HLA改变。为此,研究者开展体外实验,使用转导T细胞受体的T细胞(TCR-T)。针对低表达HLA-A*02:01的K562细胞,NY-ESO-1特异性TCR-T细胞表现出相近的细胞毒活性。然而,当HLA-DPB1*05:01表达降低时,细胞因子生成逐渐减少;与正常表达细胞相比,表达量约降低2个数量级时即可观察到这一现象。研究者对HSCT前后分选纯化的白血病细胞进行下一代测序,发现若干HLA-II类等位基因显著下调,而且这些等位基因在移植前即持续处于低表达水平。HLA-II类显著下调可能降低抗原特异性T细胞识别能力,或是与HLA-II类下调相关的免疫逃逸机制之一。
Genomic deletion of donor-patient-mismatched HLA alleles in leukemic cells is a major cause of relapse after allogeneic hematopoietic stem cell transplantation (HSCT). Mismatched HLA is frequently lost as an individual allele or a whole region in HLA-class I, however, it is downregulated in HLA-class II. We hypothesized that there might be a difference in T cell recognition capacity against epitopes associated with HLA-class I and HLA-class II and consequently such allogeneic immune pressure induced HLA alterations in leukemic cells. To investigate this, we conducted in vitro experiments with T cell receptor-transduced T (TCR-T) cells. The cytotoxic activity of NY-ESO-1-specific TCR-T cells exhibited similarly against K562 cells with low HLA-A*02:01 expression. However, we demonstrated that the cytokine production against low HLA-DPB1*05:01 expression line decreased gradually from the HLA expression level approximately 2-log lower than normal expressors. Using sort-purified leukemia cells before and after HSCT, we applied the next-generation sequencing, and revealed that there were several marked downregulations of HLA-class II alleles which demonstrated consistently low expression from pre-transplantation. The marked downregulation of HLA-class II may lead to decreased antigen recognition ability of antigen-specific T cells and may be one of immune evasion mechanism associated with HLA-class II downregulation.
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