Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Center for Cellular Immunotherapies, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Cancer Discov. 2020 Apr;10(4):552-567. doi: 10.1158/2159-8290.CD-19-0813. Epub 2020 Jan 30.
Primary resistance to CD19-directed chimeric antigen receptor T-cell therapy (CART19) occurs in 10% to 20% of patients with acute lymphoblastic leukemia (ALL); however, the mechanisms of this resistance remain elusive. Using a genome-wide loss-of-function screen, we identified that impaired death receptor signaling in ALL led to rapidly progressive disease despite CART19 treatment. This was mediated by an inherent resistance to T-cell cytotoxicity that permitted antigen persistence and was subsequently magnified by the induction of CAR T-cell functional impairment. These findings were validated using samples from two CAR T-cell clinical trials in ALL, where we found that reduced expression of death receptor genes was associated with worse overall survival and reduced T-cell fitness. Our findings suggest that inherent dysregulation of death receptor signaling in ALL directly leads to CAR T-cell failure by impairing T-cell cytotoxicity and promoting progressive CAR T-cell dysfunction. SIGNIFICANCE: Resistance to CART19 is a significant barrier to efficacy in the treatment of B-cell malignancies. This work demonstrates that impaired death receptor signaling in tumor cells causes failed CART19 cytotoxicity and drives CART19 dysfunction, identifying a novel mechanism of antigen-independent resistance to CAR therapy..
原发性抵抗 CD19 导向嵌合抗原受体 T 细胞疗法(CART19)发生在 10%至 20%的急性淋巴细胞白血病(ALL)患者中;然而,这种抵抗的机制仍不清楚。使用全基因组功能丧失筛选,我们发现 ALL 中的死亡受体信号受损导致尽管进行了 CART19 治疗,但疾病仍迅速进展。这是由对 T 细胞细胞毒性的固有抵抗介导的,这种抵抗允许抗原持续存在,并随后通过诱导 CAR T 细胞功能障碍而放大。这些发现使用来自 ALL 的两个 CAR T 细胞临床试验中的样本得到了验证,我们发现死亡受体基因表达降低与总生存期较差和 T 细胞适应性降低相关。我们的研究结果表明,ALL 中死亡受体信号的固有失调通过损害 T 细胞细胞毒性并促进进行性 CAR T 细胞功能障碍,直接导致 CAR T 细胞失效。意义:对 CART19 的抵抗是治疗 B 细胞恶性肿瘤疗效的一个重大障碍。这项工作表明,肿瘤细胞中死亡受体信号的受损导致 CART19 细胞毒性失败,并驱动 CART19 功能障碍,确定了对 CAR 治疗的抗原非依赖性抵抗的新机制。
J Natl Cancer Inst. 2022-3-8
J Cancer Res Clin Oncol. 2020-5-24
Ann Med Surg (Lond). 2025-7-18
Mol Ther Nucleic Acids. 2025-7-1
Cancer Drug Resist. 2025-5-28
Blood Neoplasia. 2024-11-29
Cell. 2019-6-6
Proc Natl Acad Sci U S A. 2019-5-31
J Clin Invest. 2019-3-12