Rubio Marie-Thérèse, Galaine Jeanne, Borg Christophe, Daguindau Étienne
Service d'hématologie, CHRU Nancy, Hopital Brabois, et CNRS UMR 7365, Équipe 6, Biopole de L'Université de Lorraine, 54500 Vandœuvre-les-Nancy, France.
EFS Bourgogne Franche Comté, Activité de médicaments de thérapie innovante, UMR1098 INSERM/UBFC/EFS, 25020 Besançon, France.
Bull Cancer. 2018 Dec;105 Suppl 2:S135-S146. doi: 10.1016/S0007-4551(19)30044-X.
BIOLOGY, CONCEPTS AND PRINCIPLES: The development of new anti-tumor immunotherapy approaches has recently dramatically increased. Progresses made in molecular biology and the development of various genetic manipulation tools allow the "reprogrammation" of T cells in order to make them express a chimeric receptor including the variable part of an immunoglobulin capable of recognizing a tumor antigen along with the expression of molecules involved in T-lymphocyte activation signaling. Genetically modified T-cells, called "CAR (chimeric antigen receptors) -T cells", have yielded impressive clinical results in the treatment of relapsed or refractory lymphoid hematological malignancies after conventional treatments and are in development in solid tumors. Different generations of CAR-T cells have been developed and technological progress makes it possible to envisage modulations of gene constructs that could further optimize the efficacy and tolerance of CAR-T cells. The first challenge of these approaches concerns the identification of specific tumor antigen targets in order to limit the on-target/off-tumor effects and the loss of expression of the target. Approaches i) targeting several antigens or ii) limiting the duration of expression of CAR in lymphocytes or iii) destroying CAR-T cells by a suicide gene. Interesting approaches are the second objective of improvement concerns the accessibility of CAR-T cells to tumor sites and the control of the immune escape mechanisms of tumor cells to the cytotoxicity of CAR-T cells. This issue is currently under the way of search of innovative strategies that should improve the clinical effectiveness of CAR-T cells, especially in solid tumors. Cet article fait partie du numéro supplément Les cellules CAR-T : une révolution thérapeutique ? réalisé avec le soutien institutionnel des partenaires Gilead : Kite et Celgene.
生物学、概念与原理:近年来,新型抗肿瘤免疫疗法的发展显著加速。分子生物学的进展以及各种基因操作工具的开发使得T细胞能够进行“重编程”,从而使其表达一种嵌合受体,该受体包含能够识别肿瘤抗原的免疫球蛋白可变部分,同时表达参与T淋巴细胞激活信号传导的分子。经过基因改造的T细胞,即“嵌合抗原受体(CAR)-T细胞”,在传统治疗后复发性或难治性淋巴血液系统恶性肿瘤的治疗中取得了令人瞩目的临床效果,目前也正在实体瘤治疗中进行研发。不同代的CAR-T细胞已经被开发出来,技术进步使得设想对基因构建体进行调控成为可能,这可能会进一步优化CAR-T细胞的疗效和耐受性。这些方法面临的首要挑战涉及识别特定的肿瘤抗原靶点,以限制靶向肿瘤外效应和靶点表达缺失。方法包括:i)靶向多种抗原;ii)限制CAR在淋巴细胞中的表达持续时间;iii)通过自杀基因破坏CAR-T细胞。有趣的是,第二个改进目标涉及CAR-T细胞到达肿瘤部位的可及性以及控制肿瘤细胞对CAR-T细胞细胞毒性的免疫逃逸机制。目前正在探索创新策略以解决这个问题,这些策略应能提高CAR-T细胞的临床疗效,尤其是在实体瘤治疗中。本文是在吉利德合作伙伴Kite和新基的机构支持下完成的特刊《CAR-T细胞:一场治疗革命?》的一部分。