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.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Engineering off-the-shelf universal CAR T cells: A silver lining in the cloud.
CAR 疗法在治疗侵袭性血液系统恶性肿瘤方面具有前景。
CAR 疗法在治疗侵袭性血液系统恶性肿瘤方面前景广阔。然而,现有自体 CAR 疗法的产品数量、质量和纯度不足,使许多患者无法接受治疗。此外,及时生产符合基准的细胞产品在后勤上具有挑战性且成本高昂。为克服自体 CAR 疗法在生物学、临床和生产方面的局限,可能需要广泛基因改造。鉴于 CAR 疗法构型多样,工程化“现货型”通用 CAR T 细胞(UCART)正成为传统 CAR T 细胞更安全、有效且经济的替代方案。UCART 疗法可在较短时间内批量生产经过质量控制且接受多重基因改造的产品。目前绝大多数 UCART 项目靶向 CD19,其次为 BCMA 和 CD70。要实现通用 CAR T 细胞疗法,必须采用工程策略抑制移植物抗宿主病(GvHD)和移植物排斥(GR)。还需优化替代强化预处理化疗、感染控制和 CAR T 细胞持续存在能力的策略。理想的通用免疫受体(UIR)设计应能克服抗原逃逸,并进一步提升治疗价值和可负担性;UIR 还应允许根据特定恶性肿瘤特征灵活制定个体化疗法。诱导型分子开关、分体式 CAR 设计、CRISPR/Cas9 介导的基因靶向、合理的细胞亚群组成和冷冻保存等创新,正推动通用 CAR T 疗法从实验室快速走向临床。
CAR therapy holds promise in treating aggressive hematological malignancies. Nonetheless, the present autologous CAR therapy regimen makes multiple patients ineligible for the therapy due to inadequate quantity, quality and purity of the product. Furthermore, timely manufacturing of benchmarked cell products is logistically challenging and unaffordable. Extensive genetic modifications may be required to overcome the biological, clinical and manufacturing limitations of the autologous CAR therapy. n the light of the numerous configurations of CAR therapy, engineering "off-the-shelf" universal CAR T cells (UCART) is emerging as a safer, effective and affordable alternative to conventional CAR T cells With UCART therapy, batch production of a quality-controlled product with multiplex genetic modification can be feasible in a shorter period of time. Currently vast majority of the UCART programs target CD19 followed by BCMA and CD70. In order to make universal CAR T cell therapy possible, it is imperative to have engineering strategies to curb graft versus host disease (GvHD) and graft rejection (GR). Moreover, approaches to offer alternate strategies for intense preparative chemotherapy, infection control and CAR T cell persistence need to be optimized. An ideal universal immune receptor (UIR) design should counter the antigen escape and further the therapeutic value and affordability. UIRs would allow flexibility to personalize the therapy based on the specific malignancy characteristics as well. With the innovations in the inducible molecular switch, split CAR design, CRISPR/Cas9 mediated gene targeting, rational subset composition and cryopreservation, the strategies to engineer universal CAR T therapy is fast advancing from bench to bedside.
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