Department of Immunology, Leiden University Medical Center, Leiden, Netherlands.
Department of Hematology, Leiden University Medical Center, Leiden, Netherlands.
Front Immunol. 2022 May 26;13:874157. doi: 10.3389/fimmu.2022.874157. eCollection 2022.
Solid organ transplantation is the treatment of choice for various end-stage diseases, but requires the continuous need for immunosuppression to prevent allograft rejection. This comes with serious side effects including increased infection rates and development of malignancies. Thus, there is a clinical need to promote transplantation tolerance to prevent organ rejection with minimal or no immunosuppressive treatment. Polyclonal regulatory T-cells (Tregs) are a potential tool to induce transplantation tolerance, but lack specificity and therefore require administration of high doses. Redirecting Tregs towards mismatched donor HLA molecules by modifying these cells with chimeric antigen receptors (CAR) would render Tregs far more effective at preventing allograft rejection. Several studies on HLA-A2 specific CAR Tregs have demonstrated that these cells are highly antigen-specific and show a superior homing capacity to HLA-A2+ allografts compared to polyclonal Tregs. HLA-A2 CAR Tregs have been shown to prolong survival of HLA-A2+ allografts in several pre-clinical humanized mouse models. Although promising, concerns about safety and stability need to be addressed. In this review the current research, obstacles of CAR Treg therapy, and its potential future in solid organ transplantation will be discussed.
实体器官移植是治疗各种终末期疾病的首选方法,但需要持续进行免疫抑制治疗,以防止移植物排斥反应。这会带来严重的副作用,包括感染率增加和恶性肿瘤的发展。因此,临床上需要促进移植耐受,以最小化或不使用免疫抑制治疗来预防器官排斥。多克隆调节性 T 细胞(Tregs)是诱导移植耐受的一种潜在工具,但缺乏特异性,因此需要给予高剂量。通过嵌合抗原受体(CAR)对这些细胞进行修饰,使 Tregs 针对 mismatched donor HLA 分子,将使 Tregs 在预防移植物排斥方面更有效。几项关于 HLA-A2 特异性 CAR Tregs 的研究表明,这些细胞具有高度的抗原特异性,并表现出比多克隆 Tregs 更强的归巢能力到 HLA-A2+同种异体移植物。HLA-A2 CAR Tregs 已被证明可延长几种临床前人源化小鼠模型中 HLA-A2+同种异体移植物的存活时间。尽管前景广阔,但仍需要解决安全性和稳定性方面的问题。在这篇综述中,将讨论 CAR Treg 治疗的当前研究、障碍及其在实体器官移植中的潜在未来。