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:CAR-cell therapy in the era of solid tumor treatment: current challenges and emerging therapeutic advances.
过去十年间,嵌合抗原受体(CAR)-T 细胞疗法已成为一种有前景的抗肿瘤免疫治疗手段。
过去十年,嵌合抗原受体(CAR)T细胞疗法已成为抗癌的有前景免疫治疗方法。该策略通过基因工程改造免疫细胞,使其表达一种名为CAR的表面受体,以特异性靶向肿瘤细胞表面抗原。CAR-T细胞过继疗法已显示可有效治疗白血病、多发性骨髓瘤和非霍奇金B细胞淋巴瘤等血液系统恶性肿瘤中对化疗耐药的患者。然而,该疗法在实体瘤中的价值尚不确定,且受多项障碍限制,包括肿瘤迁移和浸润不足、免疫抑制性肿瘤微环境,以及治疗相关不良事件。近期,CARNK 细胞(CAR-NK)和CAR巨噬细胞(CAR-M)被提出,作为实体瘤CAR-T疗法的补充或替代。CAR-NK细胞无需HLA相容,且毒性有限,因此可能是CAR-T细胞的有利替代方案。此外,CAR-NK细胞可从多种来源大规模制备,有望成为现货型产品。CAR-M免疫疗法具备吞噬、呈递肿瘤抗原和广泛浸润肿瘤的能力,目前正在研究中。本文探讨CAR-T、CAR-NK和CAR-M细胞治疗实体瘤的新兴作用,重点比较CAR-NK和CAR-M相对于CAR-T细胞的优势与不足,并提出潜在联合治疗等前景策略,以增强CAR细胞免疫疗法的疗效。
In the last decade, Chimeric Antigen Receptor (CAR)-T cell therapy has emerged as a promising immunotherapeutic approach to fight cancers. This approach consists of genetically engineered immune cells expressing a surface receptor, called CAR, that specifically targets antigens expressed on the surface of tumor cells. In hematological malignancies like leukemias, myeloma, and non-Hodgkin B-cell lymphomas, adoptive CAR-T cell therapy has shown efficacy in treating chemotherapy refractory patients. However, the value of this therapy remains inconclusive in the context of solid tumors and is restrained by several obstacles including limited tumor trafficking and infiltration, the presence of an immunosuppressive tumor microenvironment, as well as adverse events associated with such therapy. Recently, CAR-Natural Killer (CAR-NK) and CAR-macrophages (CAR-M) were introduced as a complement/alternative to CAR-T cell therapy for solid tumors. CAR-NK cells could be a favorable substitute for CAR-T cells since they do not require HLA compatibility and have limited toxicity. Additionally, CAR-NK cells might be generated in large scale from several sources which would suggest them as promising off-the-shelf product. CAR-M immunotherapy with its capabilities of phagocytosis, tumor-antigen presentation, and broad tumor infiltration, is currently being investigated. Here, we discuss the emerging role of CAR-T, CAR-NK, and CAR-M cells in solid tumors. We also highlight the advantages and drawbacks of CAR-NK and CAR-M cells compared to CAR-T cells. Finally, we suggest prospective solutions such as potential combination therapies to enhance the efficacy of CAR-cells immunotherapy.
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