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:Harnessing the potential of gene-editing technology to overcome the current bottlenecks of CAR-T cell therapy in T-cell malignancies.
T 细胞恶性肿瘤(TCMs)包括一系列生物学复杂且具有侵袭性的血液肿瘤。
T 细胞恶性肿瘤(TCM)包括多种血液系统癌症,其生物学复杂且具有侵袭性。标准治疗应答不佳,治疗 TCM 仍是肿瘤学领域亟待满足的需求。嵌合抗原受体(CAR)T 细胞疗法是最成功的免疫疗法之一,已凭借多种获批用于 CD19 阳性 B 细胞恶性肿瘤和多发性骨髓瘤的产品改变癌症治疗。然而,CAR-T 细胞相互杀伤、产品被恶性细胞污染及严重 T 细胞再生障碍等独特障碍,使这一治疗方法向 TCM 转化并不成功。此外,无论治疗何种癌症,CAR-T 疗法还可能面临复杂问题和潜在副作用,例如制备流程繁琐且昂贵、体内功能受损、细胞因子释放综合征(CRS)、神经毒性,以及 CAR-T 细胞恶性转化。基因编辑技术的突破性进展,以及 CRISPR/Cas9 系统及其衍生精准工具的发展,为克服上述瓶颈、推动 CAR-T 治疗 TCM 开辟了新道路。本综述阐述如何将基因编辑纳入 CAR-T 疗法,以应对当前障碍、增强疗效并改善其治疗 TCM 的安全性特征。文章也讨论正在开展或已经完成的临床试验,全面呈现基因组编辑 CAR-T 治疗 TCM 不断演进的格局。
T-cell malignancies (TCMs) include a diverse spectrum of hematologic cancers marked by complex biology and aggressive nature. Treating TCMs remains a critical unmet need in oncology with poor response to standard therapies. Chimeric antigen receptor (CAR)-T cell therapy is one of the most successful types of immunotherapy that has revolutionized cancer treatment, as evidenced by various approved products for CD19 B-cell malignancies and multiple myeloma. Nonetheless, due to some unique hurdles, such as the risk of CAR-T cell fratricide, product contamination with malignant cells, and severe T-cell aplasia, the translation of this treatment approach to TCMs has not been particularly successful. Moreover, irrespective of the type of treated cancer, CAR-T cell therapy can also present some complexities and potential side effects, such as cumbersome and costly manufacturing processes, impaired in vivo function, cytokine release syndrome (CRS), neurotoxicity, and leukemic transformation of CAR-T cells. Recent groundbreaking advances in gene-editing technology and the evolution of precise gene-editing tools such as the CRISPR/Cas9 system and its derivatives have opened a new way to overcoming the mentioned bottlenecks and paving the way for CAR-T cell therapy in TCMs. This review sheds light on how gene editing is being incorporated into CAR-T cell therapy to address current hurdles, enhance therapeutic efficacy, and improve the safety profile of CAR-T cell therapy in TCMs. Ongoing/conducted clinical trials are also discussed to provide a comprehensive view of the evolving landscape of genome-edited CAR-T cell therapy for TCMs.
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