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:Repurposing Tumor Cells: A Paradigm Shift in Cell-Based Therapies for Cancer.
最后,我们勾勒出临床路线图与合理的联合策略,提出若能克服这些障碍,基于肿瘤细胞的疗法有望成为免疫检查点抑制剂和过继性细胞疗法的补充,从而将肿瘤从对手转变为其自身失败的催化剂。
传统癌症治疗强调根除,往往以损害健康组织和导致免疫妥协为代价。本文探讨一个范式转变的概念:将肿瘤细胞重新利用,不仅作为靶点,更作为主动的治疗剂。通过利用其自我归巢能力、抗原多样性和适应性生存机制,这些工程化肿瘤细胞可被重新利用以递送治疗载荷、重塑肿瘤微环境,甚至发挥抗原呈递细胞(APC)的功能。我们首先批判性分析早期全细胞疫苗方法的机制性失败,强调其有限疗效源于低估了肿瘤强大的适应性耐药及其微环境深度免疫抑制的本质。随后我们讨论旨在克服这些障碍的下一代策略,方法范围从“杀手疫苗”和APC样重编程到溶瘤病毒的特洛伊木马递送。转化挑战,从多层次安全工程、GMP生产、监管路径、患者选择到伦理考量,均被深入审视,关键见解取自CAR-T 细胞治疗的临床演变。最后我们概述临床路线图和合理的联合策略,提出如果这些障碍被克服,基于肿瘤细胞的疗法可能作为免疫检查点抑制剂和过继细胞疗法的补充而出现,从而将肿瘤从对手转变为其自身失败的催化剂。
Conventional cancer therapies emphasize eradication, often at the expense of harming healthy tissue and causing immune compromise. This article explores a paradigm-shifting concept: repurposing tumor cells not merely as targets but as active therapeutic agents. By harnessing their self-homing ability, antigen diversity, and adaptive survival mechanisms, these engineered tumor cells can be repurposed to deliver therapeutic payloads, remodel the tumor microenvironment, and even function as antigen-presenting cells (APC). We begin by critically analyzing the mechanistic failures of early whole-cell vaccine approaches, highlighting how their limited efficacy stemmed from underestimating both the tumor's potent adaptive resistance and the deeply immunosuppressive nature of its microenvironment. We then discuss next-generation strategies designed to overcome these hurdles, with approaches ranging from "killer vaccines" and APC-like reprogramming to Trojan horse delivery of oncolytic viruses. The translational challenges, ranging from multilayered safety engineering, GMP manufacturing, regulatory navigation, patient selection, to ethical considerations, are examined in depth, with key insights drawn from the clinical evolution of chimeric antigen receptor T-cell therapy. We conclude by outlining a clinical roadmap and rational combinatorial strategies, proposing that if these barriers are overcome, tumor cell-based therapies could emerge as complements to immune checkpoint inhibitors and adoptive cell therapies, thus transforming the tumor from an adversary into a catalyst of its own defeat.
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