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:Intrathecal CRISPR-edited allogeneic IL-13Rα2 CAR T Cells for recurrent high-grade Glioma: preclinical characterization and phase I trial.
复发高级别胶质母细胞瘤患者的中位生存期为 6-8 个月,治疗选择有限。
复发性高级别胶质母细胞瘤患者生存期中位数仅为6–8个月,治疗选择有限。近年来,CAR-T(CAR-T)细胞用于包括晚期胶质瘤在内的实体瘤,受到越来越多关注。本研究通过CRISPR-Cas9编辑构建现货型IL-13Rα2特异性异体通用CAR-T细胞MT026:敲除内源性T细胞受体(TCR)以预防移植物抗宿主病,并敲除HLA I类分子以减轻宿主抗移植物反应;临床前研究中观察到NK细胞介导的排斥极少。在一项首次人体、单中心、开放标签、研究者发起的试验(ChiCTR2000028801)中,既往治疗失败且预期寿命较短的高级别胶质瘤患者经腰椎穿刺鞘内注射MT026,每剂1.0–3.0×10⁷个细胞。主要终点显示其耐受性和安全性良好;次要终点显示药代动力学特征可接受并有初步临床活性。5例入组患者中,1例完全缓解,3例部分缓解。未观察到3级不良事件;主要治疗相关毒性为1–2级发热、低氧和呕吐。首批5例入组后试验停止招募,但这些初步临床数据支持局部给予异体通用CAR-T治疗复发性胶质母细胞瘤的潜在获益。
Patients with recurrent high-grade glioblastoma have a median survival of 6-8 months, with limited therapeutic options. In recent years, interest has grown in applying chimeric antigen receptor T (CAR-T) cells to solid cancers, including advanced gliomas. Here we generated off-the-shelf CRISPR-Cas9-edited IL-13R 2-specific allogeneic universal CAR-T cells (MT026) by disrupting the endogenous TCR to prevent graft-versus-host disease and knocking out HLA class I molecules to mitigate the host-versus-graft response, and observed minimal NK-cell-mediated rejection in preclinical studies. In a first-in-human, single-center, open-label investigator-initiated trial (ChiCTR2000028801) in patients with high-grade glioma with prior therapy failure and short life expectancy, intrathecal injection of MT026 via lumbar puncture (1.0-3.0 10^7 cells per dose) demonstrated favorable tolerability and safety (primary outcome), pharmacokinetic characteristics, and preliminary clinical activity (secondary outcomes). Among the five patients enrolled, one achieved a complete response and three achieved partial responses. No grade 3 adverse events were observed; the predominant treatment-related toxicities were grade 1-2 pyrexia, hypoxia, and vomiting. Trial enrolment was halted after enrolment of the first five patients, however these preliminary clinical data support the potential benefit of locally administered allogeneic universal CAR-T cell therapy for recurrent glioblastoma.
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