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.
CAR-T(CAR-T)细胞在血液系统恶性肿瘤中的应用推动了这种免疫治疗形式的显著进展。
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题:Novel combination of irreversible electroporation and allogenic chimeric antigen receptor (CAR) T-cell therapy synergizes therapeutic outcomes in a preclinical human pancreatic cancer mouse model.
Novel combination of irreversible electroporation and allogenic chimeric antigen receptor (CAR) T-cell therapy synergizes therapeutic outcomes in a preclinical human pancreatic cancer mouse model.
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不可逆电穿孔(IRE)是一种非热消融方式,临床用于治疗不可切除肿瘤,通过可控施加脉冲电场保留重要结构。既往数据提示,诱导抗肿瘤免疫应答可改善患者结局;但当前研究主要关注免疫检查点抑制剂,其作用依赖常规免疫通路,而这些通路可能被癌症下调,或被化疗诱导的淋巴细胞清除打乱。CAR-T 可克服这一局限,因为它通过合成受体工程化改造淋巴细胞,使其识别并靶向表达肿瘤特异性结构的细胞。CAR 经设计具有高于原位 T 细胞结合的结合亲和力,可放大细胞内刺激级联反应,并释放促炎细胞因子以调节内源性免疫系统。
然而,实体瘤 ACT 仍有重大局限,包括危及生命的靶向肿瘤外细胞毒性、抗原逃逸,以及难以浸润并持续存在于实体瘤。大量证据显示,IRE 可克服实体瘤免疫浸润和细胞持久性的多个障碍,因此在 IRE 后使用靶向细胞疗法具有充分依据,后续疗法可靶向可能使病灶再生的残余癌细胞。本文首次提出 IRE 联合 ACT 的概念验证。研究证实,存活于 IRE 电穿孔后的细胞中,细胞膜 CAR 靶点未受影响,因此后续 CAR 可结合并清除残余肿瘤。
本研究证明了两种临床已用技术新型联合方案的可行性和协同作用。
Irreversible electroporation (IRE) is a non-thermal ablation modality used clinically for treating unresectable tumors while preserving vital structures through controlled application of pulsed electric fields. Previous data suggest that patient outcomes are enhanced with the induction of an anti-tumor immune response, but current research focuses on using immune checkpoint inhibitors, which function through conventional immune pathways that may be downregulated by cancer or dysregulated by chemo-induced lymphodepletion.
Chimeric Antigen Receptor (CAR) T-cells overcome this limitation, as they are engineered with synthetic receptors that redirect lymphocytes to recognize and target cells expressing tumor-specific structures. CARs are engineered to have an increased binding affinity compared to in-situ T-cell binding, amplify internal stimulation cascades, and release pro-inflammatory cytokines that can modulate the endogenous immune system.
However, there are still major limitations for adoptive cell therapies in solid tumors, including life-threatening on-target off-tumor cytotoxicity, antigen escape, and failure to infiltrate and persist in solid tumors. Given the substantial evidence that IRE overcomes many of the challenges associated with immune infiltration and persistence in solid tumors, there is a strong premise for using targeted cell therapies following IRE, which would then target residual cancer that could repopulate the lesion.
Here, we present the first proof-of-concept combination of IRE with an adoptive cell therapy.
We validated that the cell membrane CAR target is not affected in electroporated cells that survive IRE, allowing for subsequent binding and elimination of residual tumor. The research demonstrates the feasibility and synergy of a novel combination of two clinically used techniques.
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