肿瘤的过继性细胞免疫治疗

本文简述ＬＡＫ细胞、ＴＩＬ细胞的基本特征,经及经过体外淋巴因子激活后它们细胞毒功能的变化。概要叙述它们在体外培养过程中的一些影响其活性的因素及治疗晚期肿瘤的临床应用情况。     

过继性免疫细胞治疗临床应用中的几个问题

过继性免疫细胞治疗(adoptive cell therapy,ACT)是肿瘤免疫治疗的重要组成部分,在我国发展非常迅速,然而其临床应用一直存在很大争议,甚至在有关临床疗效的争议中一度沉寂。而近几年,随着免疫技术的提高,ACT技术再次引起临床工作者的重视,作者就ACT技术发展历程和临床应用过程中细胞类型选择、细胞数量确定、疗效评价等问题作一简要综述。     

嵌合抗原受体疗法在肿瘤免疫治疗中的研究进展

嵌合抗原受体(chimeric antigen receptor, CAR)是通过基因工程技术构建的融合蛋白,经其修饰的免疫细胞可以特异性靶向和杀伤表达特定抗原的肿瘤细胞。到目前为止,大多数关于CAR的研究主要集中在T细胞上。CAR-T细胞疗法在治疗恶性血液疾病方面取得了突破性进展,目前已有7款药物获批上市,研究者在不断深入研究CAR-T细胞疗法的同时也开始寻找新的免疫效应细胞, CAR自然杀伤细胞(CAR natural killer cell, CAR-NK)疗法、CAR自然杀伤T细胞(CAR NK T cell,CAR-NKT)疗法以及CAR巨噬细胞(CAR macrophage, CAR-MP)疗法逐渐成为免疫治疗的新策略。尽管围绕CAR的研究策略不断增加,该领域也依然面临一些挑战,例如有效地靶向实体瘤、减少治疗时的毒副作用。该文对以CAR为基础修饰不同效应细胞的细胞疗法的研究进展进行了综述。     

胃癌的过继性免疫治疗研究进展

胃癌是目前世界上发病率及致死率较高的恶性肿瘤之一,在东亚地区尤其显著。针对胃癌的治疗手段仍是传统的手术联合化疗、放疗为主,尽管靶向药物治疗提供了新的选择,但其对晚期胃癌的疗效仍然有限。胃癌的免疫治疗作为独特的治疗手段,在近十多年发展较为活跃,特别是过继性免疫治疗手段不断有创新。过继性免疫治疗主要依赖回输具有抗肿瘤活性的细胞,目前回输的细胞由具有非特异性抗肿瘤作用向具有特异性抗肿瘤作用演变,特别是嵌合性抗原T细胞治疗的出现,为进展期胃癌患者提供了有一种潜在的选择。本文对胃癌过继性免疫治疗中采用的不同免疫活性细胞的作用机制、临床应用等进行总结,并针对其不足提出利用基因工程技术增强治疗靶向性、降低免疫逃逸的研究方向。     

放化疗联合DC-CIK治疗脑胶质瘤复发40例的临床观察

目的:探讨放化疗联合DC-CIK治疗脑胶质瘤复发的临床疗效和安全性.方法:选择我院自2006年1月至2011年9月收治的40例脑胶质瘤复发患者,采用放化疗联合DC-CIK治疗.统计记录治疗效果、生存期、治疗并发症和生活质量评分.结果:40例患者完全缓解8例,部分缓解11例,稳定10例,恶化11例,总治疗有效率为47.5％,在消化道反应、血象异常、内分泌紊乱、感染发热、呼吸道炎症等项目上并发症的发生率均维持在低水平,3、9、15个月生存率分别为85.7％、65.7％、40.0％,KPS评分为78.5± 8.6,组间差异有统计学意义(P＜0.05).结论:放疗联合DC-CIK能提高脑胶质瘤复发患者的生活质量,延长生存期.     

树突状细胞在肿瘤免疫治疗中的应用研究进展

树突状细胞（DC）是人体内最强的抗原提呈细胞。未成熟的DC可摄取抗原并迁移至淋巴器官,将抗原信息传递给免疫系统,引发免疫应答。研究表明,DC在启动抗肿瘤免疫中发挥着强大的功能。近年来,以DC为基础的肿瘤疫苗已成为肿瘤免疫治疗的热点。简要综述了各种DC疫苗的制备和临床应用。     

过继免疫治疗中DC-CIK的研究进展

目前,免疫细胞生物学和免疫分子生物学发展迅猛,由于其具备低毒性和高效率的特性,肿瘤免疫治疗在恶性肿瘤治疗中所起的作用引起了学者们的广泛关注,其中细胞介导的过继免疫治疗为当前研究的热点之一。过继免疫治疗(adoptive cellular immunotherapy,ACI)是目前恶性肿瘤治疗的新方向,它通过向细胞免疫功能低下者回输具有抗肿瘤活性的免疫细胞,直接杀伤或间接杀伤肿瘤细胞,使其获得抗肿瘤免疫力。树突状细胞(Dendritic cell DC)是专职抗原递呈细胞(antigen presenting cell APC)之一,在机体免疫应答的启始、调节、维持中发挥核心作用。细胞因子诱导的杀伤(cytokine induced killer CIK)细胞具有高效的MHC非限制性溶瘤活性,具有极其广泛的杀瘤范围。近年来,国内外大量研究表明,联合培养的DC-CIK抗肿瘤活性提升明显,患者预后生存期延长,效果显著。本文就DC与CIK生物学特点及抗肿瘤作用予以简要综述。     

肿瘤免疫治疗中NK细胞的激活策略及研究进展

NK细胞(natural killer cell)是机体固有免疫系统中一类重要的淋巴样细胞,在免疫调节中发挥重要作用.NK细胞MHC Ⅰ非限制性杀伤肿瘤细胞的特性受到人们广泛关注.然而肿瘤组织浸润难、杀伤活性弱、免疫监视功能低的缺陷极大限制了NK细胞的活性.因此,本文总结了肿瘤免疫治疗中NK细胞激活的机制,探讨了NK细...     

以前列腺干细胞抗原为靶点的前列腺癌免疫治疗研究进展

前列腺干细胞抗原(PSCA)为细胞膜表面抗原,在正常前列腺组织中低表达,在雄激素依赖性和非依赖性前列腺癌组织中高表达,有较高的组织特异性,是前列腺癌治疗的理想靶标,近年来以PSCA为靶点的前列腺癌治疗性疫苗的研究已成为热点。我们简要综述以PSCA为靶点治疗前列腺癌的研究进展。     

A closed,autologous bioprocess optimized for TCR-T cell therapies

Autologous cell therapy has proven to be an effective treatment for hematological malignancies. Cell therapies for solid tumors are on the horizon, however the high cost and complexity of manufacturing these therapies remain a challenge. Routinely used open steps to transfer cells and reagents through unit operations further burden the workflow reducing efficiency and increasing the chance for human error. Here we describe a fully closed, autologous bioprocess generating engineered TCR-T cells. This bioprocess yielded 5–12 × 10e9 TCR-expressing T cells, transduced at low multiplicity of infections, within 7–10 days, and cells exhibited an enriched memory T-cell phenotype and enhanced metabolic fitness. It was demonstrated that activating, transducing, and expanding leukapheresed cells in a bioreactor without any T-cell or peripheral blood mononuclear cell enrichment steps had a high level of T-cell purity (~97%). Several critical process parameters of the bioreactor, including culturing at a high cell density (7e6 cells/mL), adjusting rocking agitations during phases of scale-up, lowering glycolysis through the addition of 2-deoxy- d -glucose, and modulating interleukin-2 levels, were investigated on their roles in regulating transduction efficiency, cell growth, and T-cell fitness such as T-cell memory phenotype and resistance to activation-induced cell death. The bioprocess described herein supports scale-out feasibility by enabling the processing of multiple patients' batches in parallel within a Grade C cleanroom.     

Identification of tumor antigens as potential target antigens for immunotherapy by serological expression cloning

The presence of tumor infiltrating T cells has been shown to be associated with a favorable prognosis in different tumor types. Several strategies have been developed to identify relevant tumor antigens which can be used for active immunotherapy strategies. The SEREX technique (serological analysis of cDNA expression libraries) identifies tumor antigens based on a spontaneous humoral immune response in cancer patients. This technique is not limited to tumor types that can be grown in cell culture or depends on established T cell clones recognizing the autologous tumor. Several steps of analysis are mandatory to evaluate SEREX-defined antigens before they become new target antigens for active immunotherapy: expression analysis; serological analysis with sera from tumor patients and normal individuals; identification of potential peptide epitopes for CD8 T cells and evaluation in T cell assays. This article summarizes our approach of antigen identification and evaluation giving the example of the recently cloned breast cancer antigen NY-BR-1.This work was presented at the first Cancer Immunology and Immunotherapy Summer School, 8–13 September 2003, Ionian Village, Bartholomeio, Peloponnese, Greece.     

Novel antigens of CAR T cell therapy: New roads; old destination

Chimeric antigen receptor T cell (CAR-T) therapy has so far proved itself as a reliable therapeutic option for the treatment of relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL), diffuse large B-cell lymphoma (DLBCL), multiple myeloma (MM), and mantle cell lymphoma (MCL). However, this picture is not as colorful when it comes to the treatment of solid tumors mainly due to the lack of definitive tumor antigens, as well as the immunosuppressive tumor microenvironments and poor CAR-T infiltration. The recent developments in bioinformatics and cell biology, such as single-cell RNA sequencing, have offered silver linings in the subject of tumor antigen discovery. In the current review, we summarize the development of some CAR-T therapies that target novel tumor antigens, rather than the traditionally CAR-T-targeted ones, and briefly discuss the clinical antitumor achievements of those evaluated in patients, so far. Furthermore, we propose some tumor antigens that might someday be therapeutically beneficial while targeted by CAR-Ts based on the experimental evaluations of their specific monoclonal antibodies.     

CD19 as an attractive target for antibody-based therapy

Despite progress in the treatment of B cell disorders, novel treatment approaches are still highly needed. CD19 is a pan-B cell marker that is recognized as a potential immunotherapy target for B cell disorders, including blood-borne malignancies and autoimmune diseases. Although initial attempts to target CD19 were unsuccessful, a new wave of investigational agents is currently in development. These agents are based on novel antibody-based technologies and formats that appear to better exploit CD19''s therapeutic potential, and some promising clinical study data has already been reported. This review provides an overview and the rationale for the most advanced CD19-targeting programs in development.     

Adoptive immunotherapy for acute leukemia: New insights in chimeric antigen receptors

Relapses remain a major concern in acute leukemia. It is well known that leukemia stem cells (LSCs) hide in hematopoietic niches and escape to the immune system surveillance through the outgrowth of poorly immunogenic tumor-cell variants and the suppression of the active immune response. Despite the introduction of new reagents and new therapeutic approaches, no treatment strategies have been able to definitively eradicate LSCs. However, recent adoptive immunotherapy in cancer is expected to revolutionize our way to fight against this disease, by redirecting the immune system in order to eliminate relapse issues. Initially described at the onset of the 90’s, chimeric antigen receptors (CARs) are recombinant receptors transferred in various T cell subsets, providing specific antigens binding in a non-major histocompatibility complex restricted manner, and effective on a large variety of human leukocyte antigen-divers cell populations. Once transferred, engineered T cells act like an expanding “living drug” specifically targeting the tumor-associated antigen, and ensure long-term anti-tumor memory. Over the last decades, substantial improvements have been made in CARs design. CAR T cells have finally reached the clinical practice and first clinical trials have shown promising results. In acute lymphoblastic leukemia, high rate of complete and prolonged clinical responses have been observed after anti-CD19 CAR T cell therapy, with specific but manageable adverse events. In this review, our goal was to describe CAR structures and functions, and to summarize recent data regarding pre-clinical studies and clinical trials in acute leukemia.     

The prevention and treatment of cytomegalovirus infection in haematopoietic stem cell transplantation

Allogeneic haematopoietic stem cell transplantation (HSCT) is an intensive medical treatment involving myeloablative chemo-radiotherapy followed by stem cell rescue using allogeneic haematopoietic stem cells harvested from HLA-matched donors, which is primarily used for the treatment of haematological malignancies. Cytomegalovirus (CMV) infection is one of the major causes of morbidity and death after HSCT. This focused research review highlights the advances made with research into CMV in the HSCT setting. It provides the reader with an overview of current CMV research into the prevention and management of CMV infection. This paper is a Focussed Research Review from the meeting which took place 28–29 May 2008 in Nottingham, UK, celebrating the contribution of Prof. I. A. “Tony” Dodi (+29.1.2008) to the EU project “Network for the identification and validation of antigens and biomarkers in cancer and their application in clinical tumour immunology (ENACT)”.     

嵌合抗原受体T细胞介绍及抗肿瘤临床应用

过继性细胞免疫治疗（adoptive cellular immunotherapy,ACI）是目前较为有效的恶性肿瘤的治疗方法之一。随着技术的日趋成熟,已在多种实体瘤和血液肿瘤的t临床治疗中取得较好疗效。其中,嵌合抗原受体（chimeric antigen receptor,CAR）T细胞技术是近年来发展非常迅速的一种细胞治疗技术。通过基因改造技术,效应T细胞的靶向性、杀伤活性和持久性均较常规应用的免疫细胞高,并可克服肿瘤局部免疫抑制微环境和打破宿主免疫耐受状态。目前,CAR的信号域已从第一代的单一信号分子发展为包含CD28、4—1BB等共刺激分子的多信号结构域（第二、三代）,临床应用广泛。但是,该技术也存在脱靶效应、插入突变等临床应用风险。该文将就CAR—T细胞技术在恶性肿瘤免疫治疗中的应用及可能存在的问题作一综述。     

人类白细胞抗原半相合供者外周血细胞因子诱导的杀伤细胞治疗晚期原发性肝癌二例

目的 观察半相合供者细胞因子诱导的杀伤细胞(CIK)治疗晚期肝癌的临床疗效.方法 2 例无法手术且无法耐受化疗的晚期肝癌患者分别选取人类白细胞抗原(HLA)半相合健康供者体外培养CIK,14 d 后分次回输给相应患者,观察患者治疗前后瘤体大小、肿瘤标志物、免疫指标、临床症状、生活质量和卡氏评分等的变化.结果 2 例患者...