Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
Department of Radiological Techniques, Al-Mustaqbal University College, Babylon, Iraq.
BMC Cancer. 2022 Nov 25;22(1):1220. doi: 10.1186/s12885-022-10320-0.
Owing to non-responsiveness of a high number of patients to the common melanoma therapies, seeking novel approaches seem as an unmet requirement. Chimeric antigen receptor (CAR) T cells were initially employed against recurrent or refractory B cell malignancies. However, advanced stages or pretreated patients have insufficient T cells (lymphopenia) amount for collection and clinical application. Additionally, this process is time-consuming and logistically cumbersome. Another limitation of this approach is toxicity and cytokine release syndrome (CRS) progress and neurotoxicity syndrome (NS). Natural killer (NK) cells are a versatile component of the innate immunity and have several advantages over T cells in the application for therapies such as availability, unique biological features, safety profile, cost effectiveness and higher tissue residence. Additionally, CAR NK cells do not develop Graft-versus-host disease (GvHD) and are independent of host HLA genotype. Notably, the NK cells number and activity is affected in the tumor microenvironment (TME), paving the way for developing novel approaches by enhancing their maturation and functionality. The CAR NK cells short lifespan is a double edge sword declining toxicity and reducing their persistence. Bispecific and Trispecific Killer Cell Engagers (BiKE and Trike, respectively) are emerging and promising immunotherapies for efficient antibody dependent cell cytotoxicity (ADCC). CAR NK cells have some limitations in terms of expanding and transducing NK cells from donors to achieve clinical response. Clinical trials are in scarcity regarding the CAR NK cell-based cancer therapies. The CAR NK cells short life span following irradiation before infusion limits their efficiency inhibiting their in vivo expansion. The CAR NK cells efficacy enhancement in terms of lifespan TME preparation and stability is a goal for melanoma treatment. Combination therapies using CAR NK cells and chemotherapy can also overcome therapy limitations.
由于大量患者对常见的黑色素瘤疗法没有反应,因此寻求新的方法似乎是一项未满足的需求。嵌合抗原受体 (CAR) T 细胞最初用于治疗复发性或难治性 B 细胞恶性肿瘤。然而,晚期或预处理患者的 T 细胞(淋巴细胞减少症)数量不足以采集和临床应用。此外,这个过程既耗时又繁琐。该方法的另一个限制是毒性和细胞因子释放综合征 (CRS) 进展和神经毒性综合征 (NS)。自然杀伤 (NK) 细胞是先天免疫的多功能组成部分,在应用于治疗方面具有许多优势,例如可用性、独特的生物学特性、安全性、成本效益和更高的组织驻留。此外,CAR NK 细胞不会发生移植物抗宿主病 (GvHD),并且不依赖于宿主 HLA 基因型。值得注意的是,NK 细胞的数量和活性在肿瘤微环境 (TME) 中受到影响,为通过增强其成熟和功能来开发新方法铺平了道路。CAR NK 细胞的短寿命是一把双刃剑,既降低了毒性,又降低了它们的持久性。双特异性和三特异性杀伤细胞衔接器 (BiKE 和 Trike) 分别是一种新兴的、有前途的免疫疗法,可实现有效的抗体依赖性细胞细胞毒性 (ADCC)。CAR NK 细胞在从供体扩展和转导 NK 细胞以实现临床反应方面存在一些限制。关于基于 CAR NK 细胞的癌症疗法的临床试验很少。CAR NK 细胞在输注前照射后的短寿命限制了它们的效率,抑制了它们在体内的扩增。CAR NK 细胞在 TME 准备和稳定性方面的寿命延长是治疗黑色素瘤的一个目标。CAR NK 细胞与化疗的联合治疗也可以克服治疗限制。
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