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中和 IFNγ 可提高 CAR-T 细胞疗法治疗 B 细胞恶性肿瘤的安全性而不影响疗效。

Neutralizing IFNγ improves safety without compromising efficacy of CAR-T cell therapy in B-cell malignancies.

机构信息

Department of Haematology-Oncology and Cell and Gene Therapy, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.

Department of Pathological Anatomy, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.

出版信息

Nat Commun. 2023 Jun 9;14(1):3423. doi: 10.1038/s41467-023-38723-y.


DOI:10.1038/s41467-023-38723-y
PMID:37296093
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10256701/
Abstract

Chimeric antigen receptor T (CAR-T) cell therapy may achieve long-lasting remission in patients with B-cell malignancies not responding to conventional therapies. However, potentially severe and hard-to-manage side effects, including cytokine release syndrome (CRS), neurotoxicity and macrophage activation syndrome, and the lack of pathophysiological experimental models limit the applicability and development of this form of therapy. Here we present a comprehensive humanized mouse model, by which we show that IFNγ neutralization by the clinically approved monoclonal antibody, emapalumab, mitigates severe toxicity related to CAR-T cell therapy. We demonstrate that emapalumab reduces the pro-inflammatory environment in the model, thus allowing control of severe CRS and preventing brain damage, characterized by multifocal hemorrhages. Importantly, our in vitro and in vivo experiments show that IFNγ inhibition does not affect the ability of CD19-targeting CAR-T (CAR.CD19-T) cells to eradicate CD19+ lymphoma cells. Thus, our study provides evidence that anti-IFNγ treatment might reduce immune related adverse effect without compromising therapeutic success and provides rationale for an emapalumab-CAR.CD19-T cell combination therapy in humans.

摘要

嵌合抗原受体 T(CAR-T)细胞疗法可能为对常规疗法无反应的 B 细胞恶性肿瘤患者实现持久缓解。然而,包括细胞因子释放综合征(CRS)、神经毒性和巨噬细胞活化综合征在内的潜在严重且难以控制的副作用,以及缺乏生理病理实验模型,限制了这种治疗形式的适用性和发展。在这里,我们提出了一种全面的人源化小鼠模型,通过该模型我们表明,临床批准的单克隆抗体 emapalumab 中和 IFNγ 可减轻与 CAR-T 细胞治疗相关的严重毒性。我们证明,emapalumab 降低了模型中的促炎环境,从而能够控制严重的 CRS 并防止脑损伤,其特征是多灶性出血。重要的是,我们的体外和体内实验表明,IFNγ 抑制不会影响针对 CD19 的 CAR-T(CAR.CD19-T)细胞消除 CD19+淋巴瘤细胞的能力。因此,我们的研究提供了证据表明,抗 IFNγ 治疗可能在不影响治疗成功的情况下减轻免疫相关不良事件,并为 emapalumab-CAR.CD19-T 细胞联合治疗提供了依据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/cd34b8e07c85/41467_2023_38723_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/30a04ebb88da/41467_2023_38723_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/4e8a500cd585/41467_2023_38723_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/ee48a5a3dbdd/41467_2023_38723_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/616125b3b793/41467_2023_38723_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/fcd162f195ad/41467_2023_38723_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/0f129ca3708f/41467_2023_38723_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/eb3be3aaac9a/41467_2023_38723_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/cd34b8e07c85/41467_2023_38723_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/30a04ebb88da/41467_2023_38723_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/4e8a500cd585/41467_2023_38723_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/ee48a5a3dbdd/41467_2023_38723_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/616125b3b793/41467_2023_38723_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/fcd162f195ad/41467_2023_38723_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/0f129ca3708f/41467_2023_38723_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/eb3be3aaac9a/41467_2023_38723_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/278c/10256701/cd34b8e07c85/41467_2023_38723_Fig8_HTML.jpg

相似文献

[1]
Neutralizing IFNγ improves safety without compromising efficacy of CAR-T cell therapy in B-cell malignancies.

Nat Commun. 2023-6-9

[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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引用本文的文献

[1]
Current Advances and Challenges in CAR-T Therapy for Hematological and Solid Tumors.

Immunotargets Ther. 2025-6-27

[2]
Latest updates on pathogenesis mechanisms and management strategies for cytokine release syndrome, neurotoxicity, and hemophagocytic lymphohistiocytosis related to CAR-T cell therapies.

Ann Hematol. 2025-6-19

[3]
Toxicities Associated with CAR-T Cell Therapies.

Mediterr J Hematol Infect Dis. 2025-5-1

[4]
European survey on CAR T-Cell analytical methods from apheresis to post-infusion immunomonitoring.

Front Immunol. 2025-4-24

[5]
Case Report: Successful use of emapalumab in adult B-cell acute lymphoblastic leukemia experiencing severe neurotoxicity and hemophagocytic lymphohistiocytosis-like features after CAR-T cell therapy.

Front Immunol. 2025-4-4

[6]
Emapalumab for severe cytokine release syndrome in solid tumor CAR-T: a case report.

Front Oncol. 2025-4-1

[7]
Effect of interferon induced transmembrane protein 1 ( IFITM1 ) upregulation to cytokine release syndrome in CAR-T-treated B-cell acute lymphoblastic leukemia.

Chin Med J (Engl). 2025-5-20

[8]
Single-cell dynamics of breakthrough toxicities after anakinra prophylaxis for axicabtagene ciloleucel in lymphoma.

Blood Adv. 2025-5-13

[9]
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Nat Rev Drug Discov. 2025-5

[10]
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J Immunother Cancer. 2025-1-14

本文引用的文献

[1]
Potential Role of IFNγ Inhibition in Refractory Cytokine Release Syndrome Associated with CAR T-cell Therapy.

Blood Cancer Discov. 2022-3-1

[2]
Blockade or Deletion of IFNγ Reduces Macrophage Activation without Compromising CAR T-cell Function in Hematologic Malignancies.

Blood Cancer Discov. 2022-3-1

[3]
Emapalumab in primary haemophagocytic lymphohistiocytosis and the pathogenic role of interferon gamma: A pharmacometric model-based approach.

Br J Clin Pharmacol. 2022-5

[4]
Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association (EHA).

Ann Oncol. 2022-3

[5]
Mechanisms of cytokine release syndrome and neurotoxicity of CAR T-cell therapy and associated prevention and management strategies.

J Exp Clin Cancer Res. 2021-11-18

[6]
Inclusion of the Inducible Caspase 9 Suicide Gene in CAR Construct Increases Safety of CAR.CD19 T Cell Therapy in B-Cell Malignancies.

Front Immunol. 2021

[7]
Incidence and risk factors associated with bleeding and thrombosis following chimeric antigen receptor T-cell therapy.

Blood Adv. 2021-11-9

[8]
Tumor Burden Measured by 18F-FDG PET/CT in Predicting Efficacy and Adverse Effects of Chimeric Antigen Receptor T-Cell Therapy in Non-Hodgkin Lymphoma.

Front Oncol. 2021-8-4

[9]
Hemophagocytic lymphohistiocytosis-like toxicity (carHLH) after CD19-specific CAR T-cell therapy.

Br J Haematol. 2021-8

[10]
Ciltacabtagene autoleucel, a B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy in patients with relapsed or refractory multiple myeloma (CARTITUDE-1): a phase 1b/2 open-label study.

Lancet. 2021-7-24

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