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嵌合抗原受体 T 细胞疗法的免疫原性:证据、机制与缓解策略。

Immunogenicity of CAR-T Cell Therapeutics: Evidence, Mechanism and Mitigation.

机构信息

Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India.

出版信息

Front Immunol. 2022 May 23;13:886546. doi: 10.3389/fimmu.2022.886546. eCollection 2022.

Abstract

Chimeric antigen receptor T cell (CAR-T) therapy demonstrated remarkable success in long-term remission of cancers and other autoimmune diseases. Currently, six products (Kymriah, Yescarta, Tecartus, Breyanzi, Abecma, and Carvykti) are approved by the US-FDA for treatment of a few hematological malignancies. All the six products are autologous CAR-T cell therapies, where delivery of CAR, which comprises of scFv (single-chain variable fragment) derived from monoclonal antibodies for tumor target antigen recognition is through a lentiviral vector. Although available CAR-T therapies yielded impressive response rates in a large number of patients in comparison to conventional treatment strategies, there are potential challenges in the field which limit their efficacy. One of the major challenges is the induction of humoral and/or cellular immune response in patients elicited due to scFv domain of CAR construct, which is of non-human origin in majority of the commercially available products. Generation of anti-CAR antibodies may lead to the clearance of the therapeutic CAR-T cells, increasing the likelihood of tumor relapse and lower the CAR-T cells efficacy upon reinfusion. These immune responses influence CAR-T cell expansion and persistence, that might affect the overall clinical response. In this review, we will discuss the impact of immunogenicity of the CAR transgene on treatment outcomes. Finally, this review will highlight the mitigation strategies to limit the immunogenic potential of CARs and improve the therapeutic outcome.

摘要

嵌合抗原受体 T 细胞(CAR-T)疗法在癌症和其他自身免疫性疾病的长期缓解方面取得了显著的成功。目前,六种产品(Kymriah、Yescarta、 Tecartus、Breyanzi、Abecma 和 Carvykti)已获得美国 FDA 批准,用于治疗少数血液恶性肿瘤。所有这六种产品都是自体 CAR-T 细胞疗法,其中 CAR 的传递,包括源自单克隆抗体的肿瘤靶抗原识别的 scFv(单链可变片段),是通过慢病毒载体进行的。尽管与传统治疗策略相比,现有的 CAR-T 疗法在大量患者中产生了令人印象深刻的反应率,但该领域存在一些限制其疗效的潜在挑战。其中一个主要挑战是由于 CAR 构建体的 scFv 结构域,在大多数商业上可获得的产品中,CAR-T 细胞疗法诱导患者产生体液和/或细胞免疫反应。产生抗 CAR 抗体可能导致治疗性 CAR-T 细胞清除,增加肿瘤复发的可能性,并降低再次输注时 CAR-T 细胞的疗效。这些免疫反应影响 CAR-T 细胞的扩增和持久性,从而可能影响整体临床反应。在这篇综述中,我们将讨论 CAR 转基因的免疫原性对治疗结果的影响。最后,本文将重点介绍减轻 CAR 免疫原性的策略,以提高治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1c8d/9169153/b1b1554711c3/fimmu-13-886546-g001.jpg

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