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.
Nat Commun. 2023 Jun 9;14(1):3423. doi: 10.1038/s41467-023-38723-y.
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.
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。
Blood Cancer Discov. 2022-3-1
Hum Vaccin Immunother. 2022-12-31
Zhonghua Zhong Liu Za Zhi. 2021-12-23
Immunotargets Ther. 2025-6-27
Mediterr J Hematol Infect Dis. 2025-5-1
Front Oncol. 2025-4-1
Nat Rev Drug Discov. 2025-5
J Immunother Cancer. 2025-1-14
Blood Cancer Discov. 2022-3-1
J Exp Clin Cancer Res. 2021-11-18