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:Development of a Fully Non-Viral 1XX-enhanced BCMA CAR-T Cell Therapy for Multiple Myeloma.
我们的GMP生产工艺在所有全规模批次中均稳定实现高CAR整合率(37.7-72.7%)和产量,并符合预设的身份、纯度、安全性和质量放行标准。
多发性骨髓瘤(MM)是一种克隆性浆细胞恶性肿瘤,其特征为骨髓浸润、单克隆免疫球蛋白产生以及微环境失调,进而导致全身性器官损害。靶向B细胞成熟抗原(BCMA)的嵌合抗原受体(CAR)T细胞疗法的出现,为复发/难治性MM患者带来了前所未有的缓解和持久性。这些结局在既往的挽救治疗策略中很少观察到,尽管对于大多数患者而言,复发仍然是主要的长期挑战。目前获批的两种BCMA CAR-T细胞产品使用病毒载体半随机插入CAR基因,这导致基因组组成异质性以及疗效、安全性和产品一致性方面的变异性。为应对这些挑战,我们将靶向CRISPR基因组工程与在T细胞受体α恒定区(TRAC)位点精确插入CAR转基因、1XX CAR信号架构以增强效力和持久性,以及使用单链DNA修复模板的非病毒制造以提高效率和产量相结合。该方法赋予生理性CAR表达,减少插入突变,并通过减轻强直信号和耗竭来改善持久性。我们的GMP制造工艺在所有全规模批次中始终实现高CAR整合率(37.7-72.7%)和产量,并满足身份、纯度、安全性和质量的预定放行标准。在MM的NSG小鼠模型中,UCCT-BCMA-1产品表现出异常强效的肿瘤控制,CAR-T细胞扩增比慢病毒构建体高100-1000倍,并在多次再攻击后持久清除骨髓瘤细胞。这些发现建立了一个基于CRISPR编辑、完全非病毒的生产平台,用于下一代1XX-BCMA CAR-T疗法,具有增强的持久性、安全性和疗效。
Multiple myeloma (MM) is a clonal plasma cell malignancy characterized by bone marrow infiltration, monoclonal immunoglobulin production, and microenvironmental dysregulation that leads to systemic organ damage. The advent of B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapy has induced unprecedented responses and durability for patients with relapsed/refractory MM. These outcomes are rarely observed with prior salvage strategies, although relapse remains the predominant long-term challenge for most patients. The two currently approved BCMA CAR-T cell products use viral vectors to semi-randomly insert the CAR gene, which results in heterogeneous genomic composition and variability in efficacy, safety, and product consistency. To address these challenges, we integrated targeted CRISPR genome engineering with precise CAR transgene insertion at the T-cell receptor alpha constant ( TRAC ) locus, 1XX CAR signaling architecture to enhance potency and durability, and non-viral manufacturing with a single-stranded DNA repair template to improve efficiency and yield. This approach confers physiological CAR expression, reduces insertional mutagenesis, and improves persistence by mitigating tonic signaling and exhaustion. Our GMP manufacturing process consistently achieved high CAR integration (37.7-72.7%) and yields across all full-scale runs and met predefined release criteria for identity, purity, safety, and quality. In NSG mouse models of MM, the UCCT-BCMA-1 product exhibited exceptionally potent tumor control, CAR-T cell expansion 100-1000-fold greater than that of lentiviral constructs, and durable clearance of myeloma cells after multiple rechallenges. These findings establish a CRISPR-edited, fully non-viral manufacturing platform for next-generation 1XX-BCMA CAR-T therapies with enhanced persistence, safety, and efficacy.
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