癌症免疫治疗学会(SITC)关于急性白血病免疫治疗的临床实践指南,2.0 版
Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of acute leukemia, version 2.0.
急性白血病是一种影响所有年龄段的血液系统恶性肿瘤。
英文原题:Modified Hematopoietic Stem Cell-Derived Dendritic Cell Therapy Retained Tumor-Inhibitory Function and Led to Regression of Primary and Metastatic Pancreatic Tumors in Humanized Mouse Models.
这些发现支持该第二代DC免疫疗法用于胰腺癌及其他潜在肿瘤的临床开发。
背景/目的:基于树突状细胞(DC)的免疫疗法为癌症治疗提供了一种有前景的策略,但受限于对细胞毒性T细胞的激活效率低下,进而对宿主免疫系统的激活不足。本报告证明,通过优化慢病毒载体(LVV)表达CD93、CD40配体(CD40L)和趋化因子(C-X-C基序)配体-13(CXCL13)所工程化的CD34+造血干细胞(HSC)来源的同种异体DC,可显著增强宿主免疫系统,激活肿瘤特异性细胞毒性T细胞,并在人源化小鼠模型中导致原发性和转移性胰腺肿瘤完全消退。该LVV与第一代载体相比显示出相当的临床前疗效,同时符合临床使用要求,这允许进一步开展临床前开发以推进人体试验。方法:该第二代(Gen)LVV整合了密码子优化的转基因(CD40L、CD93和CXCL13),其序列经过重排以增强表达,由强EF1α启动子驱动。用这种修饰后的第二代LVV转导CD34+ HSC,并分化为工程化DC。在胰腺肿瘤人源化小鼠模型上测试了使用修饰载体的DC疗法的治疗效果。这是通过建立早期疾病模型(使用MIA PaCa-2(MP2)肿瘤)和胰腺肿瘤晚期转移性疾病模型来实现的,后者使用表达荧光素酶的MP2-(Luc)胰腺肿瘤荷瘤人源化小鼠以模拟临床情况。结果:与前者相比,修饰后的慢病毒构建体CD40L表达量高6倍,毒性低2%,CD40L分泌量高4.5倍,CXCL13分泌量高2.2倍。体外实验中,工程化 DCs 可诱导高达 20% 的 T 细胞发生强效 T 细胞增殖,IFN-γ 分泌量最高可达对照组的 4 倍,并展现出 CD8+ T 细胞介导的抗原特异性细胞毒性。体内实验中,两剂皮内注射 2nd Gen DCs 可使原发性胰腺肿瘤及转移灶完全消退。接受治疗的小鼠生存期延长,表明诱导了持久的抗肿瘤免疫。结论:载体优化保留了 DC 疗法的疗效,在胰腺肿瘤模型中实现了治愈性应答。这些发现支持该 2nd Gen DC 免疫疗法用于胰腺肿瘤及潜在其他肿瘤的临床开发。
Background/Objectives : Dendritic cell (DC)-based immunotherapies offer a promising strategy for cancer treatment but are limited by inefficient activation of cytotoxic T cells and, in turn, the host immune system. This report demonstrated that CD34 + hematopoietic stem cell (HSC)-derived allogeneic DCs engineered by an optimized lentiviral vector (LVV) expressing CD93, CD40-ligand (CD40L), and Chemokine (C-X-C motif) ligand-13 (CXCL13) significantly enhanced the host immune system, activated tumor-specific cytotoxic T cells, and led to complete regression of both primary and metastatic pancreatic tumors in humanized mouse models. This LVV shows comparable pre-clinical efficacy compared to the first-generation vector, in addition to being compliant for clinical use, which allows further pre-clinical development towards the human trials. Methods : This 2nd generation (Gen) LVV incorporates codon-optimized transgenes (CD40L, CD93, and CXCL13) with rearranged sequence to enhance expression, driven by a strong EF1α promoter. CD34 + HSCs were transduced with this modified 2nd Gen LVV and differentiated to Engineered DCs. Therapeutic efficacy of the DC therapy with the modified vector was tested on humanized mouse models of pancreatic tumors. This was accomplished by establishing an early-stage disease model (using MIA PaCa-2 (MP2)-tumors) and late-stage metastatic disease model of the pancreatic tumors to mimic the clinical setting using luciferase-expressing MP2-(Luc)-pancreatic tumor-bearing humanized mice. Results : The modified lentiviral construct had 6-fold greater expression of CD40L, 2% less toxicity, 4.5-fold greater CD40L, and 2.2-fold greater CXCL13 secretion than its predecessor. In vitro, Engineered DCs induced robust T cell proliferation in up to 20% of T cells, up to 4-fold greater interferon-gamma (IFN-γ) secretion than controls, and showcased antigen-specific cytotoxicity by CD8 + T cells. In vivo, two intradermal doses of the 2nd Gen DCs led to complete regression of primary pancreatic tumors and metastases. Treated mice exhibited prolonged survival, indicating the induction of durable anti-tumor immunity. Conclusions : Vector optimization retained the efficacy of DC-based therapy, achieving curative responses in pancreatic tumor models. These findings support the clinical development of this 2nd Gen DC immunotherapy for pancreatic and potentially other tumors.
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