帕博利珠单抗联合二甲双胍治疗转移性头颈部癌的 II 期可行性研究
A Phase II Feasibility Study Combining Pembrolizumab and Metformin in Patients with Metastatic Head and Neck Cancer.
二甲双胍联合帕博利珠单抗耐受性良好,仅出现轻度胃肠道不良事件,并展现出有前景的活性,值得在随机试验中进一步研究。
英文原题:Sequential Release of mRNA Complex and T Cells by a Double-Layered Implantable Scaffold for Combination Therapy of Head and Neck Squamous Cell Carcinoma.
Sequential Release of mRNA Complex and T Cells by a Double-Layered Implantable Scaffold for Combination Therapy of Head and Neck Squamous Cell Carcinoma.
DMP-mBim基因复合物与T细胞疗法的联合代表了一种有效的免疫治疗策略,双层水凝胶中mRNA基因治疗与T细胞的序贯释放延长了抗肿瘤疗效。该策略为HNSCC提供了一种潜在的免疫治疗途径,值得进一步验证以支持其未来的临床转化。在本研究中,我们开发了一种基于光固化GelMA水凝胶的可植入球形双层支架,用于联合基因治疗和ACT。在该系统中,DMP-mBim基因治疗复合物存在于外层,原代T细胞存在于内层。将可植入支架植入HNSCC小鼠肿瘤模型附近以进行免疫基因治疗。植入后,外层首先释放以发挥直接杀伤肿瘤的作用,诱导肿瘤细胞凋亡和抗原释放。随后释放的活化T细胞维持抗肿瘤免疫应答。
头颈部鳞状细胞癌(HNSCC)具有较高的发病率和死亡率,因此需要开发新的治疗策略。过继细胞疗法(ACT)和基因治疗是治疗 HNSCC 的有效策略;然而,这两种策略单独用于 HNSCC 时均存在局限性,其协同整合仍需进一步探索以建立有效的递送平台。在本研究中,我们设计了一种基于光固化水凝胶的双层支架,以结合 mRNA 基因治疗和 ACT。我们旨在验证这种共递送支架在 HNSCC 治疗中的潜力。
设计了一种可植入的双层球形支架,使用具有合适机械强度和压缩性能的光固化水凝胶甲基丙烯酰化明胶(GelMA)。该支架在内层包埋了来源于小鼠淋巴结的原代T细胞,在外层包埋了基于DOTAP-mPEG-PCL(DMP)/mBim mRNA的基因治疗复合物。首先测量了支架的特性和DMP纳米颗粒的递送能力。然后分别测试了两种治疗组分的活性功能。进一步使用小鼠皮下和下颌骨侵袭模型验证了支架的协同治疗效果。在此过程中测量了与序贯释放相关的免疫激活和杀伤过程。
制备了双层球形支架并对DMP-mBim复合物进行了表征。首先在体外证实了该基因治疗复合物释放后对HNSCC细胞的增殖抑制作用,并确认了T细胞生物活性的维持。结果揭示了支架降解过程中两种组分的释放过程。最初释放的DMP-mBim复合物可诱导免疫原性肿瘤细胞死亡。随后,此过程中产生的肿瘤抗原随招募的树突状细胞(DCs)迁移进入支架内。内层中活化的T细胞在释放后发挥杀肿瘤效应。在HNSCC皮下肿瘤和下颌骨侵袭模型中,局部植入双层支架有效利用了基因治疗和细胞治疗的协同效应,抑制了肿瘤生长和进展。
BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is associated with considerable morbidity and mortality, necessitating the development of novel therapeutic strategies. Adoptive cell therapy (ACT) and gene therapy are validated strategies for HNSCC treatment; however, both strategies have limitations when used alone in HNSCC and their synergistic integration requires further exploration to establish effective delivery platforms. In this study, we designed a double-layered scaffold based on photocurable hydrogel to combine mRNA gene therapy and ACT. And we aimed to validate the potential of this co-delivery scaffold in HNSCC treatment. METHODS: An implantable, double-layered, spherical scaffold was designed using a photocurable hydrogel gelatin methacryloyl (GelMA) with suitable mechanical strength and compressive properties. This scaffold incorporated primary T cells derived from mouse lymph nodes within the inner layer and a DOTAP-mPEG-PCL (DMP)/mBim mRNA-based gene therapy complex within the outer layer. Characteristics of the scaffold and delivery capacity of DMP nanoparticles were first measured. Then the active functions of both therapeutic components were tested separately. The synergistic therapeutic efficacy of the scaffold was further validated using mouse subcutaneous and mandibular invasion models. The immune activation and killing processes associated with sequential release were measured in this process. RESULTS: A double-layered spherical scaffold was produced and the DMP-mBim complex was characterized. The proliferation-inhibiting effect of the gene therapy complex on HNSCC cells was first demonstrated in vitro upon release, and the maintenance of T-cell bioactivity was confirmed. Results revealed the release process of two components during degradation of scaffold. The initially released DMP-mBim complex could induce immunogenic tumor cell death. Subsequently, tumor antigens generated during this process migrated into the scaffold along with the recruited dendritic cells (DCs). Activated T cells within the inner layer subsequently exerted tumor-killing effects after release. In HNSCC subcutaneous tumor and mandibular invasion models, local implantation of the double-layered scaffold effectively harnessed the synergistic effects of gene and cell therapies, inhibiting tumor growth and progression. CONCLUSION: The combination of DMP-mBim gene complex and T-cell therapies represents an effective immunotherapeutic strategy, and the sequential release of mRNA gene therapy and T cells within a double-layered hydrogel prolongs antitumor efficacy. This strategy presents a potential immunotherapeutic approach for HNSCC that warrants further validation to support its future clinical translation. In this study, we developed an implantable spherical double-layered scaffold based on a photocurable GelMA hydrogel to combine gene and ACT. In this system, DMP-mBim gene therapy complexes are present in the outer layer, and primary T cells are present in the inner layer. Implantable scaffolds were implanted adjacent to a HNSCC mouse tumor model to perform immunogene therapy. After implantation, the outer layer was first released to exert a direct tumor-killing effect, inducing tumor cell apoptosis and antigen release. The subsequent release of activated T cells sustains an antitumor immune response. The therapeutic effects were confirmed in HNSCC subcutaneous xenograft and mandibular invasion models. This design provides a potential strategy for combined immunotherapy for the treatment of HNSCC.
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