Chimeric antigen receptor (CAR) T-cell therapy has significantly advanced the treatment of hematologic malignancies (such as leukemia and lymphoma), but its broader effect is still restricted by several limitations, such as limited in vivo expansion, persistence, and durable memory formation. In this chapter, we have explored different strategies that could help optimize the performance and durability of CAR T-cells. Firstly, advances in genetic engineering, such as second- to fifth-generation CAR designs and using CRISPR/Cas9 to disrupt inhibitory receptors, can finely control the activation, costimulation, and phenotype of T-cells. This improves cell proliferation and decreases exhaustion. Secondly, CK-based programming has been discussed, both during manufacturing and after infusion. Supplementation or transgenic expression of CKs or interleukins, for instance, IL-7, IL-12, IL-15, and IL-18, improves the development of central memory T-cells and remodels the tumor microenvironment. Additionally, metabolic modulation strategies such as selection of costimulatory domains that support oxidative phosphorylation, nutrient preconditioning, and engineering of kynurenine-degrading enzymes all enhance mitochondrial fitness and survival, especially when cells are in nutrient-poor and/or hypoxic conditions. Various combinatorial strategies have been addressed to overcome the immunosuppressive characteristics of the tumor microenvironment (TME), for example, using CAR T-cells with checkpoint inhibitors, using dominant-negative CK receptors, adding oncolytic viruses, or chemokine receptor engineering. All of these approaches improve cell trafficking, infiltration, and effector function. Tools for epigenetic reprogramming that include DNMT and HDAC inhibitors, miRNA modulation, and epigenome editing via CRISPR-dCas9 help maintain cells in a stem-like and exhaustion-resistant state. Finally, optimized manufacturing processes such as shortening culture time, use of serum-free media, incorporation of activation pathway inhibitors, and selection of less differentiated T-cell subsets are all essential steps in creating potent and long-lived CAR T-cell products. By integrating these genetic, CK, metabolic, microenvironmental, epigenetic, and manufacturing innovations, this chapter provides a roadmap toward the next generation of CAR T-cell therapies, which may be more powerful, longer-lasting, and clinically effective.

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Optimizing CAR T-Cell Efficacy: Enhancing Proliferation, Persistence, and Memory

  • Gagandeep Singh,
  • Lata Kumari,
  • Neelam Thakur,
  • Umesh Kumar

摘要

Chimeric antigen receptor (CAR) T-cell therapy has significantly advanced the treatment of hematologic malignancies (such as leukemia and lymphoma), but its broader effect is still restricted by several limitations, such as limited in vivo expansion, persistence, and durable memory formation. In this chapter, we have explored different strategies that could help optimize the performance and durability of CAR T-cells. Firstly, advances in genetic engineering, such as second- to fifth-generation CAR designs and using CRISPR/Cas9 to disrupt inhibitory receptors, can finely control the activation, costimulation, and phenotype of T-cells. This improves cell proliferation and decreases exhaustion. Secondly, CK-based programming has been discussed, both during manufacturing and after infusion. Supplementation or transgenic expression of CKs or interleukins, for instance, IL-7, IL-12, IL-15, and IL-18, improves the development of central memory T-cells and remodels the tumor microenvironment. Additionally, metabolic modulation strategies such as selection of costimulatory domains that support oxidative phosphorylation, nutrient preconditioning, and engineering of kynurenine-degrading enzymes all enhance mitochondrial fitness and survival, especially when cells are in nutrient-poor and/or hypoxic conditions. Various combinatorial strategies have been addressed to overcome the immunosuppressive characteristics of the tumor microenvironment (TME), for example, using CAR T-cells with checkpoint inhibitors, using dominant-negative CK receptors, adding oncolytic viruses, or chemokine receptor engineering. All of these approaches improve cell trafficking, infiltration, and effector function. Tools for epigenetic reprogramming that include DNMT and HDAC inhibitors, miRNA modulation, and epigenome editing via CRISPR-dCas9 help maintain cells in a stem-like and exhaustion-resistant state. Finally, optimized manufacturing processes such as shortening culture time, use of serum-free media, incorporation of activation pathway inhibitors, and selection of less differentiated T-cell subsets are all essential steps in creating potent and long-lived CAR T-cell products. By integrating these genetic, CK, metabolic, microenvironmental, epigenetic, and manufacturing innovations, this chapter provides a roadmap toward the next generation of CAR T-cell therapies, which may be more powerful, longer-lasting, and clinically effective.