Gong Ningqiang, Han Xuexiang, Xue Lulu, El-Mayta Rakan, Metzloff Ann E, Billingsley Margaret M, Hamilton Alex G, Mitchell Michael J
Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.
Penn Institute for RNA Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Nat Mater. 2023 Dec;22(12):1571-1580. doi: 10.1038/s41563-023-01646-6. Epub 2023 Sep 11.
Chimeric antigen receptor T (CAR T) cell immunotherapy is successful at treating many cancers. However, it often induces life-threatening cytokine release syndrome (CRS) and neurotoxicity. Here, we show that in situ conjugation of polyethylene glycol (PEG) to the surface of CAR T cells ('PEGylation') creates a polymeric spacer that blocks cell-to-cell interactions between CAR T cells, tumour cells and monocytes. Such blockage hinders intensive tumour lysing and monocyte activation by CAR T cells and, consequently, decreases the secretion of toxic cytokines and alleviates CRS-related symptoms. Over time, the slow expansion of CAR T cells decreases PEG surface density and restores CAR T cell-tumour-cell interactions to induce potent tumour killing. This occurs before the restoration of CAR T cell-monocyte interactions, opening a therapeutic window for tumour killing by CAR T cells before monocyte overactivation. Lethal neurotoxicity is also lower when compared with treatment with the therapeutic antibody tocilizumab, demonstrating that in situ PEGylation of CAR T cells provides a materials-based strategy for safer cellular immunotherapy.
嵌合抗原受体T(CAR T)细胞免疫疗法在治疗多种癌症方面取得了成功。然而,它常常会引发危及生命的细胞因子释放综合征(CRS)和神经毒性。在此,我们表明,将聚乙二醇(PEG)原位偶联到CAR T细胞表面(“聚乙二醇化”)会形成一个聚合物间隔物,该间隔物会阻断CAR T细胞、肿瘤细胞和单核细胞之间的细胞间相互作用。这种阻断会阻碍CAR T细胞对肿瘤的强烈裂解和单核细胞的激活,从而减少毒性细胞因子的分泌并减轻与CRS相关的症状。随着时间的推移,CAR T细胞的缓慢扩增会降低PEG的表面密度,并恢复CAR T细胞与肿瘤细胞之间的相互作用以诱导有效的肿瘤杀伤。这一过程发生在CAR T细胞与单核细胞相互作用恢复之前,从而在单核细胞过度激活之前为CAR T细胞杀伤肿瘤打开了一个治疗窗口。与使用治疗性抗体托珠单抗治疗相比,致命性神经毒性也更低,这表明CAR T细胞的原位聚乙二醇化为更安全的细胞免疫疗法提供了一种基于材料的策略。