免疫检查点阻断疗法。
Immune checkpoint blockade therapy.
机构信息
Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
出版信息
J Allergy Clin Immunol. 2018 Nov;142(5):1403-1414. doi: 10.1016/j.jaci.2018.02.042. Epub 2018 Mar 27.
Immune checkpoints are accessory molecules that either promote or inhibit T-cell activation. Two inhibitory molecules, cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1), got high attention, as inhibition of CTLA-4 or PD-1 signaling provides the first immune therapy that significantly improves the survival of patients with metastatic solid cancers. Inhibition of CTLA-4 or PD-1 was first studied in and approved for patients with metastatic melanoma. Blocking immune checkpoints is also efficient in non-small-cell lung cancer, renal cell cancers, hypermutated gastrointestinal cancers, and others. Immune responses, whether directed against infections or against tumors, are divided into 2 phases: an initiation phase and an activation phase, where the immune system recognizes a danger signal and becomes activated by innate signals to fight the danger. This reaction is fundamental for the control of infections and cancer, but needs to be turned off once the danger is controlled, because persistence of this activation ultimately causes severe tissue damage. Therefore, each activation of the immune system is followed by a termination phase, where endogenous immune suppressor molecules arrest immune responses to prevent harmful damage. In the case of cancer immune therapies, therapeutic approaches classically enhanced the initiation and activation of immune responses to increase the emergence and the efficacy of cytotoxic T lymphocytes (CTL) against cancers. In sharp contrast, immune checkpoint blockade focuses on the termination of immune responses by inhibiting immune suppressor molecules. It thus prevents the termination of immune responses or even awakes those CTLs that became exhausted during an immune response. Therefore, blocking negatively regulating immune checkpoints restores the capacity of exhausted CTL to kill the cancer they infiltrate. In addition, they drive surviving cancer cells into a still poorly defined state of dormancy. As the therapy also awakes self-reactive CTL, one downside of the therapy is the induction of organ-specific autoimmune diseases. The second downside is the exorbitant drug price that withdraws patients in need from a therapy that was developed by academic research, which impairs further academic treatment development and financially charges the public health system.
免疫检查点是辅助分子,可促进或抑制 T 细胞的激活。两种抑制性分子,细胞毒性 T 淋巴细胞相关抗原 4(CTLA-4)和程序性死亡蛋白 1(PD-1)受到了高度关注,因为抑制 CTLA-4 或 PD-1 信号转导提供了第一种显著改善转移性实体瘤患者生存的免疫疗法。在转移性黑色素瘤患者中首次研究并批准了 CTLA-4 或 PD-1 的抑制作用。阻断免疫检查点在非小细胞肺癌、肾细胞癌、高突变胃肠道癌等中也有效。针对感染或肿瘤的免疫反应分为两个阶段:启动阶段和激活阶段,在这个阶段,免疫系统识别危险信号,并通过先天信号激活以对抗危险。这种反应对于控制感染和癌症是基础,但一旦危险得到控制,就需要关闭,因为这种激活的持续存在最终会导致严重的组织损伤。因此,每次免疫系统的激活都会随之进入终止阶段,内源性免疫抑制分子会阻止免疫反应以防止有害损伤。在癌症免疫治疗中,治疗方法通常增强免疫反应的启动和激活,以增加细胞毒性 T 淋巴细胞(CTL)对癌症的出现和疗效。与此形成鲜明对比的是,免疫检查点阻断侧重于通过抑制免疫抑制分子来终止免疫反应。因此,它防止了免疫反应的终止,甚至唤醒了在免疫反应中已经衰竭的 CTL。因此,阻断负调节免疫检查点恢复了衰竭的 CTL 杀死其浸润的癌症的能力。此外,它们将存活的癌细胞驱赶到一种仍然定义不明确的休眠状态。由于该疗法还唤醒了自身反应性 CTL,该疗法的一个缺点是诱导器官特异性自身免疫疾病。第二个缺点是药物价格过高,这使需要的患者无法接受由学术研究开发的治疗,从而损害了进一步的学术治疗发展并使公共卫生系统的经济负担加重。