CAR-T 细胞治疗与美国 Medicare 受益者的心血管结局
Chimeric antigen receptor T-cell therapy and cardiovascular outcomes in US Medicare beneficiaries.
在接受 CAR-T 的最大规模全国性老年人群样本中,5.8% 的患者发生 MACE,且与院内死亡率和 1 年死亡率升高相关。
英文原题:An ICAM1-Targeting Chimeric Costimulatory Receptor Mimics the Immune Synapse and Enhances Tumor-Specific T-cell Function.
An ICAM1-Targeting Chimeric Costimulatory Receptor Mimics the Immune Synapse and Enhances Tumor-Specific T-cell Function.
工程化T细胞疗法,如嵌合抗原受体(CAR)和T细胞受体(TCR)为基础的方法,已经改变了血液恶性肿瘤的治疗结果,然而在实体瘤中的疗效仍受限于肿瘤抗原逃逸、免疫抑制微环境以及CAR或TCR信号激活不足。
工程化T细胞疗法,如基于嵌合抗原受体(CAR)和T细胞受体(TCR)的方法,已改变了血液系统恶性肿瘤的治疗结局,但其在实体瘤中的疗效仍受限于肿瘤抗原逃逸、免疫抑制微环境以及CAR或TCR信号激活不足。为克服这些障碍,我们开发了一种针对细胞间黏附分子1(ICAM1)的嵌合共刺激受体(ICCR),经工程化改造后在T细胞中表达,以增强其激活。ICAM1在实体瘤中广泛表达,并可在T细胞早期接触过程中由释放的IFNγ进一步上调,形成前馈环路以强化肿瘤识别。ICCR与ICAM1的结合可不依赖于TCR-肽(p)/MHC结合而触发NF-κB信号;然而,T细胞的完全激活和细胞毒功能仍依赖于完整的TCR信号。在原代T细胞中,ICCR增加了增殖、细胞因子产生和细胞毒性,从而在接受同种异体或自体ICCR-T细胞治疗的两个未分化甲状腺癌异种移植模型中改善了肿瘤控制。在机制上,ICCR增强了与肿瘤细胞的接触,促进了肿瘤特异性TCR克隆型的选择和扩增,并放大了下游信号通路。这些发现表明,ICCR是一种利用免疫突触模拟机制来增强低活性肿瘤特异性TCR功能并改善实体瘤微环境中T细胞应答的策略。
Engineered T-cell therapies, such as chimeric antigen receptor (CAR)- and T-cell receptor (TCR)-based approaches, have transformed outcomes in hematologic malignancies, yet their efficacy in solid tumors remains limited by tumor antigen escape, immunosuppressive microenvironments, and insufficient activation of CAR or TCR signaling. To overcome these barriers, we developed an intercellular adhesion molecule 1 (ICAM1)-specific chimeric costimulatory receptor (ICCR) engineered for expression in T cells to augment their activation. ICAM1 is broadly expressed across solid tumors and is further upregulated by IFNγ released during early T-cell engagement, creating a feed-forward loop that reinforces tumor recognition. ICCR engagement with ICAM1 triggered NF-κB signaling independently of TCR-peptide (p)/MHC engagement; however, full T-cell activation and cytotoxic function remained dependent on intact TCR signaling. In primary T cells, ICCR increased proliferation, cytokine production, and cytotoxicity, resulting in improved tumor control in two anaplastic thyroid cancer xenograft models treated with allogeneic or autologous ICCR-T cells. Mechanistically, ICCR strengthened tumor cell engagement, promoted selection and expansion of tumor-specific TCR clonotypes, and amplified downstream signaling pathways. These findings identify ICCR as a strategy that leverages an immune synapse-mimetic mechanism to enhance the function of low-activity tumor-specific TCRs and improve T-cell responses in solid tumor microenvironments.
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