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:Unlocking the code: The role of molecular and genetic profiling in revolutionizing glioblastoma treatment.
Unlocking the code: The role of molecular and genetic profiling in revolutionizing glioblastoma treatment.
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尽管采用了包括手术切除、放疗和化疗在内的多模式治疗,中位生存期仍约为 15 个月。
胶质母细胞瘤(GBM)是最具侵袭性的原发性脑癌,其特征是显著的分子和细胞异质性,这导致了其对常规治疗的耐药性和不良预后。尽管采用了包括手术切除、放疗和化疗在内的多模式治疗,中位生存期仍约为15个月。近年来,分子和遗传学分析技术的进步阐明了GBM的关键基因改变和分子亚型,例如EGFR扩增、PTEN和ATRX缺失以及TP53改变,这些改变具有重要的预后和治疗意义。这些发现推动了靶向治疗的发展,旨在破坏RTK/RAS/PI3K和TP53等异常信号通路。然而,治疗耐药性仍然是一个严峻的挑战,其驱动因素包括肿瘤异质性、复杂的肿瘤微环境(TME)以及内在的适应性机制。新兴的治疗方法旨在应对这些挑战,包括使用免疫检查点抑制剂和CAR-T 细胞疗法等免疫疗法,这些疗法靶向特定的肿瘤抗原,但由于免疫抑制性TME而面临障碍。此外,基于生物聚合物的间质疗法、用于破坏血脑屏障的聚焦超声以及基于纳米颗粒的药物递送系统等新策略,在提高GBM治疗的疗效和精准度方面显示出前景。本综述探讨了GBM治疗不断演变的格局,强调了通过分子分型实现个性化医疗的重要性、联合治疗的潜力,以及需要创新方法来克服治疗耐药性。对GBM生物学和治疗方式的持续研究为改善患者预后带来了希望。
Glioblastoma (GBM) is the most aggressive primary brain cancer, characterized by profound molecular and cellular heterogeneity, which contributes to its resistance to conventional therapies and poor prognosis. Despite multimodal treatments including surgical resection, radiation, and chemotherapy, median survival remains approximately 15 months. Recent advances in molecular and genetic profiling have elucidated key genetic alterations and molecular subtypes of GBM, such as EGFR amplification, PTEN and ATRX loss, and TP53 alterations, which have significant prognostic and therapeutic implications. These discoveries have spurred the development of targeted therapies aimed at disrupting aberrant signaling pathways like RTK/RAS/PI3K and TP53. However, treatment resistance remains a formidable challenge, driven by tumor heterogeneity, the complex tumor microenvironment (TME), and intrinsic adaptive mechanisms. Emerging therapeutic approaches aim to address these challenges, including the use of immunotherapies such as immune checkpoint inhibitors and CAR T-cell therapies, which target specific tumor antigens but face hurdles due to the immunosuppressive TME. Additionally, novel strategies like biopolymer-based interstitial therapies, focused ultrasound for blood-brain barrier disruption, and nanoparticle-based drug delivery systems show promise in enhancing the efficacy and precision of GBM treatments. This review explores the evolving landscape of GBM therapy, emphasizing the importance of personalized medicine through molecular profiling, the potential of combination therapies, and the need for innovative approaches to overcome therapeutic resistance. Continued research into GBM's biology and treatment modalities offers hope for improving patient outcomes.
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