Two teams have created a new generation of highly specific CAR T cells, which safely cleared solid tumours in mice with mesothelioma, ovarian cancer, and the deadly brain cancer glioblastoma while outlasting and outperforming conventional CAR T cell designs.
The results suggest these cells could minimise the risk of dangerous side effects and address the traditionally poor performance of CAR T cells against solid tumours in the clinic. CAR T cells are genetically modified human T cells and have shown impressive performance in patients with leukaemia.
However, CAR T cells don't work as well against solid tumours, as these cancers lack molecular targets that the cells can easily recognise.
Furthermore, the targets that do exist also frequently appear on healthy tissues, meaning that CAR T cells can have devastating side effects in patients with solid tumours. To address these obstacles for the treatment of glioblastoma, Joseph Choe and colleagues engineered new "prime-and-kill" molecular circuits for synNotch-CAR T cells, a cell design that only activates when it recognises tumour antigens.
The circuits integrate receptors that recognise multiple "imperfect" tumour antigens, including either the EGFRvIII receptor on glioblastoma cells or the protein MOG in healthy brain tissue.
The receptors prime and activate the CAR T cells only when all the antigens are present, meaning the CAR T cells only target cancerous cells in the nervous system.
The synNotch-CAR T cells shrunk glioblastoma tumours and maintained remission in mice without affecting other tissues, while more traditional CAR T cells were either ineffective or couldn't prevent tumour recurrence.
Similarly, Axel Hyrenius-Wittsten and colleagues engineered synNotch-CAR T cells bearing receptors that recognise ALPPL2, a protein that appears specifically on solid tumours such as mesothelioma.
This design showed strong effects and extended survival in mouse models of mesothelioma and ovarian cancer. Compared with traditional cells, the synNotch-CAR T cell designs also showed fewer signs of exhaustion, a state where CAR T cells lose their effectiveness over time.
"These circuits essentially give the improved capability for nuanced recognition of a tumour... and thus open up many new possibilities for how to recognise and attack tumours in safer and more specific ways," Choe et al. say.
The World Cancer Declaration recognises that to make major reductions in premature deaths, innovative education and training opportunities for healthcare workers in all disciplines of cancer control need to improve significantly.
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