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:Hydrogel-driven innovations for targeted delivery, immune modulation, and tissue repair in thyroid cancer therapy.
通过将精准药物递送、免疫调节和组织工程整合到一个平台中,水凝胶有望彻底改变甲状腺癌的治疗。
背景:甲状腺癌是全球增长最快的内分泌恶性肿瘤,在年轻人群中的发病率不断上升。手术、放射性碘(RAI)消融、内分泌抑制和多激酶抑制等传统疗法改善了患者结局,但仍受围手术期并发症、全身毒性、疗程长及耐药发生等因素限制。目的:本综述总结水凝胶治疗的最新进展,重点探讨其作为多功能平台应对甲状腺癌管理挑战的潜力。水凝胶不仅可作为多种药物的载体,也可作为甲状腺癌治疗的特定制剂,实现靶向递送、免疫调节和组织修复。内容:现代水凝胶具有良好生物相容性、可调机械性能,并能响应 pH、温度、光和酶等外部刺激,可在特定部位持续释放化疗药物、酪氨酸激酶抑制剂(TKI)和 ¹³¹I。局部递药可提高肿瘤药物暴露,同时保护重要颈部结构,这是甲状腺癌治疗中的关键优势。复合型及原位成胶水凝胶还可调节肿瘤免疫微环境,通过递送细胞因子、检查点抑制剂或疫苗佐剂,将低分化甲状腺癌(PDTC)等“冷”病灶转变为免疫应答性“热”病灶。此外,三维水凝胶基质可模拟细胞外基质,帮助术后组织修复、防止颈部粘连,并支持甲状腺类器官和 CAR-T 系统的生物打印。与光热和光动力药物结合时,水凝胶可协同消融肿瘤;含纳米银或抗生素的制剂则有助于降低术后感染风险。挑战与展望:仍需优化水凝胶降解动力学且不损害机械完整性,提高疏水性 TKI 的载药量,并深入了解水凝胶、免疫系统和体内肿瘤组织之间的相互作用。还需开展大型多中心试验,确认水凝胶疗法的长期安全性及其相较现行标准治疗的优势。未来可能重点开发“智能”多功能水凝胶,共同包载双靶点抑制剂(如 BRAFV600E + MEK)、PROTAC、溶瘤病毒和影像探针,并依据单细胞组学进行患者分层,以提高治疗精准度。结论:水凝胶将精准递药、免疫调节和组织工程整合于单一平台,有望革新甲状腺癌治疗。其有望改善局部区域控制、减少全身毒性,并提高分化型和未分化型甲状腺癌患者的生存和生活质量。水凝胶作为多类治疗药物载体的多功能性及其在甲状腺癌治疗中的特异性,显示了其重新定义未来靶向癌症治疗的潜力。
BACKGROUND: Thyroid cancer is the fastest-growing endocrine malignancy globally, with an increasing incidence in younger patients. Conventional therapies, including surgery, radioactive-iodine (RAI) ablation, endocrine suppression, and multi-kinase inhibition, have improved outcomes but are limited by peri-operative morbidity, systemic toxicity, long treatment durations, and the development of drug resistance. OBJECTIVE: This review synthesizes current advancements in hydrogel-based therapy, focusing on its potential as a multifunctional platform to overcome the challenges in thyroid cancer management. The review highlights the role of hydrogels not only as carriers for various drugs but also as specific agents for thyroid cancer treatment, offering targeted delivery, immune modulation, and tissue repair. CONTENT: Modern hydrogels, with their high biocompatibility, tunable mechanical properties, and responsiveness to external stimuli (pH, temperature, light, enzymes), provide site-specific, sustained release of chemotherapeutics, tyrosine kinase inhibitors (TKIs), and 131 I. This localised drug delivery increases tumor exposure while sparing vital cervical structures, a critical advantage in thyroid cancer therapy. Composite and in situ-forming hydrogels can also modify the tumour-immune microenvironment, delivering cytokines, checkpoint inhibitors, or vaccine adjuvants to transform immune "cold" lesions, such as poorly differentiated thyroid carcinoma (PDTC), into "hot" immune-responsive sites. Additionally, 3D hydrogel matrices mimic the extracellular matrix, aiding in post-resection tissue repair, preventing cervical adhesions, and enabling the bioprinting of thyroid organoids and CAR-T systems. When integrated with photothermal and photodynamic agents, hydrogels provide synergistic tumour ablation, while formulations with nanosilver or antibiotics help reduce the risk of post-surgical infection. CHALLENGES AND OUTLOOK: Several challenges remain, including optimising the degradation kinetics of hydrogels without compromising their mechanical integrity, improving the loading of hydrophobic TKIs, and better understanding the interactions between hydrogels, the immune system, and tumour tissues in vivo . Large, multi-centre trials are needed to confirm the long-term safety of hydrogel-based therapies and establish their superiority over current standard treatments. Future directions will likely focus on developing "smart" multifunctional hydrogels that can co-encapsulate dual-target inhibitors (e.g., BRAFV600E + MEK), PROTACs, oncolytic viruses, and imaging probes, all informed by single-cell omics-guided patient stratification to enhance therapeutic precision. CONCLUSION: By integrating precision drug delivery, immune modulation, and tissue engineering into a single platform, hydrogels are positioned to revolutionize the treatment of thyroid cancer. They offer a promising solution for improving locoregional control, minimizing systemic toxicity, and enhancing the survival and quality of life of patients with both differentiated and undifferentiated thyroid cancers. The versatility of hydrogels as carriers for a broad range of therapeutic agents, as well as their specificity for thyroid cancer treatment, highlights their potential to redefine the future of targeted cancer therapies.
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