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:CDK4/6 inhibition enhances CAR-T cell therapy in solid tumors.
这些发现共同表明,曲拉西利和 CAR-T 细胞疗法可能是实体瘤的有效联合治疗。
CDK4/6抑制剂可通过多种机制促进抗肿瘤免疫,因此有望作为癌症免疫疗法的辅助药物。尽管在多种临床前癌症模型中,CDK4/6抑制剂与免疫检查点抑制剂已显示出显著协同作用,但其与CAR-T细胞疗法的联合应用尚未得到研究。本研究在多种临床前血液肿瘤和实体瘤模型中,评估了CDK4/6抑制剂曲拉西利(trilaciclib)联合CAR-T疗法的效果。体外实验显示,曲拉西利增强了人CAR-T细胞的细胞毒作用和代谢适应能力,但降低了其扩增。在体内,针对视网膜母细胞瘤蛋白(RB)表达完整且对曲拉西利敏感的CD19阳性白血病,联合治疗优于单药治疗。然而,在相应的RB缺失模型中,联合治疗并不优于单用CAR-T细胞,提示CAR-T细胞功能增强的获益可能被其扩增减少所抵消。相比之下,在实体瘤模型中,联合治疗的疗效始终优于任一单药。值得注意的是,在免疫功能完整的小鼠模型中,联合治疗效果最为明显,其中包括一个对曲拉西利单药治疗不敏感的模型。机制上,CDK4/6抑制减少了肿瘤浸润性调节性T细胞,同时增强了CD8阳性CAR-T细胞的持续存在、向肿瘤迁移及其在肿瘤内的细胞毒功能。总体而言,这些发现提示,曲拉西利联合CAR-T细胞疗法可能是治疗实体瘤的有效方案。
CDK4/6 inhibitors promote anti-tumor immunity through diverse mechanisms, positioning them as promising adjuvants to cancer immunotherapies. While CDK4/6 inhibitors have demonstrated strong synergy with immune checkpoint inhibitors across numerous preclinical cancer models, their combination with CAR-T cell therapy remains unexplored. In this study, we examined the efficacy of combined CDK4/6 inhibition (trilaciclib) and CAR-T therapy across a range of preclinical blood and solid cancer models. In vitro, trilaciclib enhanced human CAR-T cell cytotoxicity and metabolic fitness while reducing expansion. In vivo, the combination outperformed single agents against retinoblastoma protein (RB)-proficient, trilaciclib-sensitive CD19+ leukemia. However, in an equivalent RB-deficient model, the combination therapy was no more effective than CAR-T cells alone, suggesting that enhanced CAR-T cell function may be offset by reduced expansion. In contrast, in solid cancer models the combination was consistently more efficacious than either monotherapy. Notably, combination effects were most pronounced in immunocompetent mouse models, including a model with poor sensitivity to trilaciclib as a monotherapy. Mechanistically, CDK4/6 inhibition reduced tumor-infiltrating T-regulatory cells while enhancing CD8+ CAR-T cell persistence, tumor trafficking, and cytotoxic function within the tumor. Together, these findings suggest that trilaciclib and CAR-T cell therapy may be an effective combinatorial treatment for solid cancers.
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