CAR-T(CAR-T)细胞疗法在非肿瘤性疾病中的应用
Chimeric antigen receptor T (CAR-T) cell therapy in non-oncological diseases.
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题:Advances and challenges of CAR T therapy and suitability of animal models (Review).
Advances and challenges of CAR T therapy and suitability of animal models (Review).
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嵌合抗原受体(CAR)近期在癌症治疗中取得进展,因其能够促进T细胞介导的对特定肿瘤相关抗原的反应。CAR是过继性细胞转移(ACT)策略的一部分,该策略利用患者的T淋巴细胞,通过基因工程改造使其能够杀伤癌细胞。然而,尽管该疗法在血液系统恶性肿瘤中取得了成功,但治疗实体瘤尚未达到其最大潜力。原因包括复杂的抑制性肿瘤微环境、癌细胞靶受体上的突变、致命的副作用、向肿瘤内转运受限、体内持久性欠佳以及缺乏能够忠实再现人类肿瘤免疫反应的动物模型。目前,啮齿动物模型被用于研究CAR疗法的安全性和有效性。然而,这些模型在忠实代表人类疾病方面存在局限,无法预测不良治疗事件,并高估了疗法的有效性。另一方面,犬自发性发展的肿瘤更适合CAR研究,其有效性已在多种疾病中得到证实,包括淋巴瘤、骨肉瘤和乳腺肿瘤。本综述讨论了CAR的设计与演变、CAR在实体瘤中的挑战、人类和犬类临床试验以及犬模型的优势。
Chimeric antigen receptors (CARs) recently gained momentum in cancer treatment due to their ability to promote T-cell mediated responses to a specific tumor-associated antigen. CARs are part of the adoptive cell transfer (ACT) strategies that utilize patients' T lymphocytes, genetically engineered to kill cancer cells.
However, despite the therapy's success against blood-related malignancies, treating solid tumors has not reached its fullest potential yet. The reasons include the complex suppressive tumor microenvironment, mutations on cancer cells' target receptors, lethal side-effects, restricted trafficking into the tumor, suboptimal persistence in vivo and the lack of animal models that faithfully resemble human tumor's immunological responses. Currently, rodent models are used to investigate the safety and efficacy of CAR therapies.
However, these models are limited in representing the human disease faithfully, fail to predict the adverse treatment events and overestimate the efficacy of the therapy. On the other hand, spontaneously developed tumors in dogs are more suited in CAR research and their efficacy has been demonstrated in a number of diseases, including lymphoma, osteosarcoma and mammary tumors. The present review discusses the design and evolution of CARs, challenges of CAR in solid tumors, human and canine clinical trials and advantages of the canine model.
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