Experimental Hematology and Bone Marrow Transplantation Unit, San Raffaele Hospital, Milano, ITALY.
J Cancer. 2011;2:378-82. doi: 10.7150/jca.2.378. Epub 2011 Jul 1.
Chimeric antigen receptors (CARs) are generated by fusing the antigen-binding motif of a monoclonal antibody (mAb) with the signal transduction machinery of the T-cell receptor (TCR). The genetic modification of T lymphocytes with chimeric receptors specific for tumor-associated antigens (TAAs) allows for the redirection towards tumor cells. Clinical experience with CAR-redirected T cells suggests that antitumor efficacy associates with some degree of toxicity, especially when TAA expression is shared with healthy tissues. This situation closely resembles the case of allogeneic hematopoietic stem cell transplantation (HSCT), wherein allorecognition causes both the graft-versus-leukemia (GVL) effect and graft-versus-host disease (GVHD). Suicide gene therapy, i.e. the genetic induction of a conditional suicide phenotype into donor T cells, enables dissociating the GVL effect from GVHD. Applying suicide gene modification to CAR-redirected T cells may therefore greatly increase their safety profile and facilitate their clinical development.
嵌合抗原受体(CAR)通过将单克隆抗体(mAb)的抗原结合结构域与 T 细胞受体(TCR)的信号转导机制融合而产生。用针对肿瘤相关抗原(TAA)的嵌合受体对 T 淋巴细胞进行基因修饰,可以将其重新定向到肿瘤细胞。CAR 靶向 T 细胞的临床经验表明,抗肿瘤疗效与一定程度的毒性相关,尤其是当 TAA 表达与健康组织共享时。这种情况与同种异体造血干细胞移植(HSCT)非常相似,其中同种异体识别导致移植物抗白血病(GVL)效应和移植物抗宿主病(GVHD)。自杀基因治疗,即将条件性自杀表型的基因诱导到供体 T 细胞中,可将 GVL 效应与 GVHD 分离。因此,将自杀基因修饰应用于 CAR 靶向 T 细胞可能会极大地提高其安全性,并促进其临床开发。