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单核细胞衍生的白细胞介素-1 和白细胞介素-6 对于 CAR T 细胞引起的细胞因子释放综合征和神经毒性是有差异需求的。

Monocyte-derived IL-1 and IL-6 are differentially required for cytokine-release syndrome and neurotoxicity due to CAR T cells.

机构信息

Innovative Immunotherapies Unit, San Raffaele Hospital Scientific Institute, Milano, Italy.

Vita-Salute San Raffaele University, Milano, Italy.

出版信息

Nat Med. 2018 Jun;24(6):739-748. doi: 10.1038/s41591-018-0036-4. Epub 2018 May 28.

Abstract

In the clinic, chimeric antigen receptor-modified T (CAR T) cell therapy is frequently associated with life-threatening cytokine-release syndrome (CRS) and neurotoxicity. Understanding the nature of these pathologies and developing treatments for them are hampered by the lack of appropriate animal models. Herein, we describe a mouse model recapitulating key features of CRS and neurotoxicity. In humanized mice with high leukemia burden, CAR T cell-mediated clearance of cancer triggered high fever and elevated IL-6 levels, which are hallmarks of CRS. Human monocytes were the major source of IL-1 and IL-6 during CRS. Accordingly, the syndrome was prevented by monocyte depletion or by blocking IL-6 receptor with tocilizumab. Nonetheless, tocilizumab failed to protect mice from delayed lethal neurotoxicity, characterized by meningeal inflammation. Instead, the IL-1 receptor antagonist anakinra abolished both CRS and neurotoxicity, resulting in substantially extended leukemia-free survival. These findings offer a therapeutic strategy to tackle neurotoxicity and open new avenues to safer CAR T cell therapies.

摘要

在临床上,嵌合抗原受体修饰的 T 细胞(CAR T)疗法常伴有威胁生命的细胞因子释放综合征(CRS)和神经毒性。由于缺乏合适的动物模型,人们对这些病理的性质及其治疗方法的理解受到了阻碍。在此,我们描述了一种能够重现 CRS 和神经毒性关键特征的小鼠模型。在具有高白血病负担的人源化小鼠中,CAR T 细胞介导的癌症清除会引发高热和升高的白细胞介素-6(IL-6)水平,这些是 CRS 的标志。在 CRS 期间,人类单核细胞是白细胞介素-1(IL-1)和白细胞介素-6(IL-6)的主要来源。因此,通过单核细胞耗竭或用托珠单抗阻断 IL-6 受体可以预防该综合征。尽管如此,托珠单抗未能保护小鼠免受迟发性致命神经毒性的影响,其特征是脑膜炎症。相反,白细胞介素-1 受体拮抗剂阿那白滞素可消除 CRS 和神经毒性,从而显著延长无白血病生存时间。这些发现为解决神经毒性提供了一种治疗策略,并为更安全的 CAR T 细胞疗法开辟了新途径。

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