Mayo Clinic Medical Scientist Training Program, Mayo Clinic College of Medicine and Science, Rochester, MN.
Department of Immunology.
Blood. 2019 Feb 14;133(7):697-709. doi: 10.1182/blood-2018-10-881722. Epub 2018 Nov 21.
Chimeric antigen receptor T (CAR-T) cell therapy is a new pillar in cancer therapeutics; however, its application is limited by the associated toxicities. These include cytokine release syndrome (CRS) and neurotoxicity. Although the IL-6R antagonist tocilizumab is approved for treatment of CRS, there is no approved treatment of neurotoxicity associated with CD19-targeted CAR-T (CART19) cell therapy. Recent data suggest that monocytes and macrophages contribute to the development of CRS and neurotoxicity after CAR-T cell therapy. Therefore, we investigated neutralizing granulocyte-macrophage colony-stimulating factor (GM-CSF) as a potential strategy to manage CART19 cell-associated toxicities. In this study, we show that GM-CSF neutralization with lenzilumab does not inhibit CART19 cell function in vitro or in vivo. Moreover, CART19 cell proliferation was enhanced and durable control of leukemic disease was maintained better in patient-derived xenografts after GM-CSF neutralization with lenzilumab. In a patient acute lymphoblastic leukemia xenograft model of CRS and neuroinflammation (NI), GM-CSF neutralization resulted in a reduction of myeloid and T cell infiltration in the central nervous system and a significant reduction in NI and prevention of CRS. Finally, we generated GM-CSF-deficient CART19 cells through CRISPR/Cas9 disruption of GM-CSF during CAR-T cell manufacturing. These GM-CSF CAR-T cells maintained normal functions and had enhanced antitumor activity in vivo, as well as improved overall survival, compared with CART19 cells. Together, these studies illuminate a novel approach to abrogate NI and CRS through GM-CSF neutralization, which may potentially enhance CAR-T cell function. Phase 2 studies with lenzilumab in combination with CART19 cell therapy are planned.
嵌合抗原受体 T(CAR-T)细胞疗法是癌症治疗的新支柱;然而,其应用受到相关毒性的限制。这些毒性包括细胞因子释放综合征(CRS)和神经毒性。虽然白细胞介素 6 受体拮抗剂托珠单抗已被批准用于治疗 CRS,但针对 CD19 靶向 CAR-T(CART19)细胞疗法相关神经毒性的治疗方法尚未获批。最近的数据表明,单核细胞和巨噬细胞有助于 CAR-T 细胞治疗后 CRS 和神经毒性的发展。因此,我们研究了中和粒细胞-巨噬细胞集落刺激因子(GM-CSF)作为管理 CART19 细胞相关毒性的潜在策略。在这项研究中,我们表明使用仑珠单抗中和 GM-CSF 不会抑制体外或体内的 CART19 细胞功能。此外,在使用仑珠单抗中和 GM-CSF 后,患者来源的异种移植模型中,CART19 细胞的增殖增强,白血病疾病的持续控制得到更好的维持。在 CRS 和神经炎症(NI)的患者急性淋巴细胞白血病异种移植模型中,GM-CSF 中和导致中枢神经系统中髓样细胞和 T 细胞浸润减少,NI 显著减少并预防 CRS。最后,我们通过在 CAR-T 细胞制造过程中使用 CRISPR/Cas9 敲除 GM-CSF 生成 GM-CSF 缺陷型 CART19 细胞。与 CART19 细胞相比,这些 GM-CSF CAR-T 细胞保持正常功能,在体内具有增强的抗肿瘤活性,并提高总生存率。总之,这些研究阐明了通过 GM-CSF 中和来消除 NI 和 CRS 的新方法,这可能潜在地增强 CAR-T 细胞的功能。计划进行仑珠单抗联合 CART19 细胞疗法的 2 期研究。
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