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Chen M, Zhou Y, Fu Y, Wang Q, Wu C, Pan X, Quan G. Biomaterials-assisted cancer vaccine delivery: preclinical landscape, challenges, and opportunities. Expert Opin Drug Deliv 2024. [PMID: 39096307 DOI: 10.1080/17425247.2024.2388832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/23/2024] [Accepted: 08/01/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION Cancer vaccines (protein and peptide, DNA, mRNA, and tumor cell) have achieved remarkable success in the treatment of cancer. In particular, advances in the design and manufacture of biomaterials have made it possible to control the presentation and delivery of vaccine components to immune cells. AREAS COVERED This review summarizes findings from major databases, including PubMed, Scopus, and Web of Science, focusing on articles published between 2005 and 2024 that discuss biomaterials in cancer vaccine delivery. EXPERT OPINION The development of cancer vaccines is hindered by several bottlenecks, including low immunogenicity, instability of vaccine components, and challenges in evaluating their clinical efficacy. To transform preclinical successes into viable treatments, it is essential to pursue continued innovation, collaborative research, and address issues related to scalability, regulatory pathways, and clinical validation, ultimately improving outcomes against cancer.
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Affiliation(s)
- Minglong Chen
- Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Yue Zhou
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Yanping Fu
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Qingqing Wang
- Faculty of Pharmacy, Bengbu Medical College, Bengbu, China
| | - Chuanbin Wu
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Xin Pan
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Guilan Quan
- College of Pharmacy, Jinan University, Guangzhou, China
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Wu H, Zhang G, Liu Z, Liu W, Wang X, Zhao Y. Enhanced anti-tumor activity mediated by combination chimeric antigen receptor T cells targeting GD2 and GPC2 in high-risk neuroblastoma. Cytotherapy 2024:S1465-3249(24)00732-1. [PMID: 38904586 DOI: 10.1016/j.jcyt.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AIMS Chimeric antigen receptor T (CAR-T) cells targeting single antigens show limited activity against solid tumors due to poor T cell persistence, low efficiency infiltration, and exhaustion together with heterogeneous tumor-associated antigen (TAA) expression. This is also true in high-risk neuroblastoma (HRNB), a lethal pediatric extracranial malignancy. To overcome these obstacles, a combinational strategy using GD2-specific and GPC2-specific CAR-T cells was developed to improve immunotherapeutic efficacy. METHODS We individually developed GD2-specific and GPC2-specific CARs containing a selective domain (sCAR) which was a peptide of 10 amino acids derived from human nuclear autoantigen La/SS-B. These constructs allowed us to generate two different HRNB antigen-specific CAR-T cells with enhanced biological activity through stimulating sCAR-engrafted T cells via a selective domain-specific monoclonal antibody (SmAb). Binding affinity and stimulation of GD2- and GPC2-specific sCARs by SmAb were measured, and transient and persistent anti-tumor cytotoxicity of GD2sCAR-T and GPC2sCAR-T cells were quantified in neuroblastoma cell lines expressing different TAA levels. The anti-tumor pharmaceutical effects and cellular mechanisms mediated by single or combinational sCAR-T cells were evaluated in vitro and in vivo. RESULTS GD2- and GPC2-specific sCARs had antigen-specific binding affinity similar to their parental counterparts and were recognized by SmAb. SmAb-mediated stimulation selectively activated sCAR-T proliferation and increased central memory T cells in the final products. SmAb-stimulated sCAR-T cells had enhanced transient cytolytic activity, and combination therapy extended long-term anti-tumor activity in vitro through TNF-α and IL-15 release. Stimulated sCAR-T cells overcame heterogeneous antigen expression in HRNB, and the multi-TAA-targeting strategy was especially efficacious in vivo, inducing apoptosis through the caspase-3/PARP pathway and inhibiting the release of several tumor-promoting cytokines. CONCLUSIONS These data suggest that combined targeting of multiple TAAs is a promising strategy to overcome heterogenous antigen expression in solid tumors and extend CAR-T cell persistence for HRNB immunotherapy.
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Affiliation(s)
- Huantong Wu
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, and Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Guangji Zhang
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, and Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongfeng Liu
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, and Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Weihua Liu
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, and Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Xuan Wang
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong Province, China
| | - Yu Zhao
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, and Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, China; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China.
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Jin W, Zhang Y, Zhao Z, Gao M. Developing targeted therapies for neuroblastoma by dissecting the effects of metabolic reprogramming on tumor microenvironments and progression. Theranostics 2024; 14:3439-3469. [PMID: 38948053 PMCID: PMC11209723 DOI: 10.7150/thno.93962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/18/2024] [Indexed: 07/02/2024] Open
Abstract
Rationale: Synergic reprogramming of metabolic dominates neuroblastoma (NB) progression. It is of great clinical implications to develop an individualized risk prognostication approach with stratification-guided therapeutic options for NB based on elucidating molecular mechanisms of metabolic reprogramming. Methods: With a machine learning-based multi-step program, the synergic mechanisms of metabolic reprogramming-driven malignant progression of NB were elucidated at single-cell and metabolite flux dimensions. Subsequently, a promising metabolic reprogramming-associated prognostic signature (MPS) and individualized therapeutic approaches based on MPS-stratification were developed and further validated independently using pre-clinical models. Results: MPS-identified MPS-I NB showed significantly higher activity of metabolic reprogramming than MPS-II counterparts. MPS demonstrated improved accuracy compared to current clinical characteristics [AUC: 0.915 vs. 0.657 (MYCN), 0.713 (INSS-stage), and 0.808 (INRG-stratification)] in predicting prognosis. AZD7762 and etoposide were identified as potent therapeutics against MPS-I and II NB, respectively. Subsequent biological tests revealed AZD7762 substantially inhibited growth, migration, and invasion of MPS-I NB cells, more effectively than that of MPS-II cells. Conversely, etoposide had better therapeutic effects on MPS-II NB cells. More encouragingly, AZD7762 and etoposide significantly inhibited in-vivo subcutaneous tumorigenesis, proliferation, and pulmonary metastasis in MPS-I and MPS-II samples, respectively; thereby prolonging survival of tumor-bearing mice. Mechanistically, AZD7762 and etoposide-induced apoptosis of the MPS-I and MPS-II cells, respectively, through mitochondria-dependent pathways; and MPS-I NB resisted etoposide-induced apoptosis by addiction of glutamate metabolism and acetyl coenzyme A. MPS-I NB progression was fueled by multiple metabolic reprogramming-driven factors including multidrug resistance, immunosuppressive and tumor-promoting inflammatory microenvironments. Immunologically, MPS-I NB suppressed immune cells via MIF and THBS signaling pathways. Metabolically, the malignant proliferation of MPS-I NB cells was remarkably supported by reprogrammed glutamate metabolism, tricarboxylic acid cycle, urea cycle, etc. Furthermore, MPS-I NB cells manifested a distinct tumor-promoting developmental lineage and self-communication patterns, as evidenced by enhanced oncogenic signaling pathways activated with development and self-communications. Conclusions: This study provides deep insights into the molecular mechanisms underlying metabolic reprogramming-mediated malignant progression of NB. It also sheds light on developing targeted medications guided by the novel precise risk prognostication approaches, which could contribute to a significantly improved therapeutic strategy for NB.
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Affiliation(s)
- Wenyi Jin
- Department of Orthopedics, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China, 325041
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, China, 430060
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China, 999077
| | - Yubiao Zhang
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, China, 430060
| | - Zhijie Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai, China, 200011
| | - Mingyong Gao
- Department of Orthopedics, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, China, 325041
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Hu X, Zhou Y, Hill C, Chen K, Cheng C, Liu X, Duan P, Gu Y, Wu Y, Ewing RM, Li Z, Wu Z, Wang Y. Identification of MYCN non-amplified neuroblastoma subgroups points towards molecular signatures for precision prognosis and therapy stratification. Br J Cancer 2024; 130:1841-1854. [PMID: 38553589 PMCID: PMC7616008 DOI: 10.1038/s41416-024-02666-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Despite the extensive study of MYCN-amplified neuroblastomas, there is a significant unmet clinical need in MYCN non-amplified cases. In particular, the extent of heterogeneity within the MYCN non-amplified population is unknown. METHODS A total of 1566 samples from 16 datasets were identified in Gene Expression Omnibus (GEO) and ArrayExpress. Characterisation of the subtypes was analysed by ConsensusClusterPlus. Independent predictors for subgrouping were constructed from the single sample predictor based on the multiclassPairs package. Findings were verified using immunohistochemistry and CIBERSORTx analysis. RESULTS We demonstrate that MYCN non-amplified neuroblastomas are heterogeneous and can be classified into 3 subgroups based on their transcriptional signatures. Within these groups, subgroup_2 has the worst prognosis and this group shows a 'MYCN' signature that is potentially induced by the overexpression of Aurora Kinase A (AURKA); whilst subgroup_3 is characterised by an 'inflamed' gene signature. The clinical implications of this subtype classification are significant, as each subtype demonstrates a unique prognosis and vulnerability to investigational therapies. A total of 420 genes were identified as independent subgroup predictors with average balanced accuracy of 0.93 and 0.84 for train and test datasets, respectively. CONCLUSION We propose that transcriptional subtyping may enhance precision prognosis and therapy stratification for patients with MYCN non-amplified neuroblastomas.
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Affiliation(s)
- Xiaoxiao Hu
- Department of Paediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Department of Paediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- Division of Paediatric Oncology, Shanghai Institute of Paediatric Research, Shanghai, 200092, China
| | - Yilu Zhou
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
- Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Charlotte Hill
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Kai Chen
- Department of Paediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Paediatric Oncology, Shanghai Institute of Paediatric Research, Shanghai, 200092, China
| | - Cheng Cheng
- Department of Paediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Paediatric Oncology, Shanghai Institute of Paediatric Research, Shanghai, 200092, China
| | - Xiaowei Liu
- Department of Paediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Paediatric Oncology, Shanghai Institute of Paediatric Research, Shanghai, 200092, China
| | - Peiwen Duan
- Department of Paediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Paediatric Oncology, Shanghai Institute of Paediatric Research, Shanghai, 200092, China
| | - Yaoyao Gu
- Department of Paediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Paediatric Oncology, Shanghai Institute of Paediatric Research, Shanghai, 200092, China
| | - Yeming Wu
- Department of Paediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Paediatric Oncology, Shanghai Institute of Paediatric Research, Shanghai, 200092, China
- Department of Paediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Rob M Ewing
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
- Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Zhongrong Li
- Department of Paediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Zhixiang Wu
- Department of Paediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
- Division of Paediatric Oncology, Shanghai Institute of Paediatric Research, Shanghai, 200092, China.
- Department of Paediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215003, China.
| | - Yihua Wang
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
- Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
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Sweeney EE, Sekhri P, Muniraj N, Chen J, Feng S, Terao J, Chin SJ, Schmidt DE, Bollard CM, Cruz CRY, Fernandes R. Photothermal Prussian blue nanoparticles generate potent multi-targeted tumor-specific T cells as an adoptive cell therapy. Bioeng Transl Med 2024; 9:e10639. [PMID: 38818122 PMCID: PMC11135148 DOI: 10.1002/btm2.10639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 06/01/2024] Open
Abstract
Prussian blue nanoparticle-based photothermal therapy (PBNP-PTT) is an effective tumor treatment capable of eliciting an antitumor immune response. Motivated by the ability of PBNP-PTT to potentiate endogenous immune responses, we recently demonstrated that PBNP-PTT could be used ex vivo to generate tumor-specific T cells against glioblastoma (GBM) cell lines as an adoptive T cell therapy (ATCT). In this study, we further developed this promising T cell development platform. First, we assessed the phenotype and function of T cells generated using PBNP-PTT. We observed that PBNP-PTT facilitated CD8+ T cell expansion from healthy donor PBMCs that secreted IFNγ and TNFα and upregulated CD107a in response to engagement with target U87 cells, suggesting specific antitumor T cell activation and degranulation. Further, CD8+ effector and effector memory T cell populations significantly expanded after co-culture with U87 cells, consistent with tumor-specific effector responses. In orthotopically implanted U87 GBM tumors in vivo, PBNP-PTT-derived T cells effectively reduced U87 tumor growth and generated long-term survival in >80% of tumor-bearing mice by Day 100, compared to 0% of mice treated with PBS, non-specific T cells, or T cells expanded from lysed U87 cells, demonstrating an enhanced antitumor efficacy of this ATCT platform. Finally, we tested the generalizability of our approach by generating T cells targeting medulloblastoma (D556), breast cancer (MDA-MB-231), neuroblastoma (SH-SY5Y), and acute monocytic leukemia (THP-1) cell lines. The resulting T cells secreted IFNγ and exerted increased tumor-specific cytolytic function relative to controls, demonstrating the versatility of PBNP-PTT in generating tumor-specific T cells for ATCT.
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Affiliation(s)
- Elizabeth E. Sweeney
- Department of Biochemistry & Molecular Medicine, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
| | - Palak Sekhri
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
- The Integrated Biomedical Sciences Program, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Nethaji Muniraj
- The Integrated Biomedical Sciences Program, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Jie Chen
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
| | - Sally Feng
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
- George Washington Cancer Center, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Joshua Terao
- The Integrated Biomedical Sciences Program, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Samantha J. Chin
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
- George Washington Cancer Center, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Danielle E. Schmidt
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
| | - Catherine M. Bollard
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
- The Integrated Biomedical Sciences Program, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Conrad Russell Y. Cruz
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
- The Integrated Biomedical Sciences Program, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Rohan Fernandes
- Center for Cancer and Immunology ResearchChildren's National HospitalWashingtonDistrict of ColumbiaUSA
- George Washington Cancer Center, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
- Department of Medicine, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
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Kembuan GJ, Kim JY, Maus MV, Jan M. Targeting solid tumor antigens with chimeric receptors: cancer biology meets synthetic immunology. Trends Cancer 2024; 10:312-331. [PMID: 38355356 PMCID: PMC11006585 DOI: 10.1016/j.trecan.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 02/16/2024]
Abstract
Chimeric antigen receptor (CAR) T cell therapy is a medical breakthrough in the treatment of B cell malignancies. There is intensive focus on developing solid tumor-targeted CAR-T cell therapies. Although clinically approved CAR-T cell therapies target B cell lineage antigens, solid tumor targets include neoantigens and tumor-associated antigens (TAAs) with diverse roles in tumor biology. Multiple early-stage clinical trials now report encouraging signs of efficacy for CAR-T cell therapies that target solid tumors. We review the landscape of solid tumor target antigens from the perspective of cancer biology and gene regulation, together with emerging clinical data for CAR-T cells targeting these antigens. We then discuss emerging synthetic biology strategies and their application in the clinical development of novel cellular immunotherapies.
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Affiliation(s)
- Gabriele J Kembuan
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Joanna Y Kim
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Marcela V Maus
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Max Jan
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
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Zheng M, Kumar A, Sharma V, Behl T, Sehgal A, Wal P, Shinde NV, Kawaduji BS, Kapoor A, Anwer MK, Gulati M, Shen B, Singla RK, Bungau SG. Revolutionizing pediatric neuroblastoma treatment: unraveling new molecular targets for precision interventions. Front Cell Dev Biol 2024; 12:1353860. [PMID: 38601081 PMCID: PMC11004261 DOI: 10.3389/fcell.2024.1353860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Neuroblastoma (NB) is the most frequent solid tumor in pediatric cases, contributing to around 15% of childhood cancer-related deaths. The wide-ranging genetic, morphological, and clinical diversity within NB complicates the success of current treatment methods. Acquiring an in-depth understanding of genetic alterations implicated in the development of NB is essential for creating safer and more efficient therapies for this severe condition. Several molecular signatures are being studied as potential targets for developing new treatments for NB patients. In this article, we have examined the molecular factors and genetic irregularities, including those within insulin gene enhancer binding protein 1 (ISL1), dihydropyrimidinase-like 3 (DPYSL3), receptor tyrosine kinase-like orphan receptor 1 (ROR1) and murine double minute 2-tumor protein 53 (MDM2-P53) that play an essential role in the development of NB. A thorough summary of the molecular targeted treatments currently being studied in pre-clinical and clinical trials has been described. Recent studies of immunotherapeutic agents used in NB are also studied in this article. Moreover, we explore potential future directions to discover new targets and treatments to enhance existing therapies and ultimately improve treatment outcomes and survival rates for NB patients.
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Affiliation(s)
- Min Zheng
- Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Ankush Kumar
- Amity School of Pharmaceutical Sciences, Amity University, Mohali, Punjab, India
| | - Vishakha Sharma
- Amity School of Pharmaceutical Sciences, Amity University, Mohali, Punjab, India
| | - Tapan Behl
- Amity School of Pharmaceutical Sciences, Amity University, Mohali, Punjab, India
| | - Aayush Sehgal
- GHG Khalsa College of Pharmacy, Ludhiana, Punjab, India
| | - Pranay Wal
- Pranveer Singh Institute of Technology, Pharmacy, Kanpur, Uttar Pradesh, India
| | | | | | - Anupriya Kapoor
- School of Pharmaceutical Sciences, Chhatrapati Shahu Ji Maharaj University, Kanpur, Uttar Pradesh, India
| | - Md. Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
- Australian Research Consortium in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Bairong Shen
- Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Rajeev K. Singla
- Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Simona Gabriela Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea, Romania
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8
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García-García L, G. Sánchez E, Ivanova M, Pastora K, Alcántara-Sánchez C, García-Martínez J, Martín-Antonio B, Ramírez M, González-Murillo Á. Choosing T-cell sources determines CAR-T cell activity in neuroblastoma. Front Immunol 2024; 15:1375833. [PMID: 38601159 PMCID: PMC11004344 DOI: 10.3389/fimmu.2024.1375833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The clinical success of chimeric antigen receptor-modified T cells (CAR-T cells) for hematological malignancies has not been reproduced for solid tumors, partly due to the lack of cancer-type specific antigens. In this work, we used a novel combinatorial approach consisting of a versatile anti-FITC CAR-T effector cells plus an FITC-conjugated neuroblastoma (NB)-targeting linker, an FITC-conjugated monoclonal antibody (Dinutuximab) that recognizes GD2. Methods We compared cord blood (CB), and CD45RA-enriched peripheral blood leukapheresis product (45RA) as allogeneic sources of T cells, using peripheral blood (PB) as a control to choose the best condition for anti-FITC CAR-T production. Cells were manufactured under two cytokine conditions (IL-2 versus IL-7+IL-15+IL-21) with or without CD3/CD28 stimulation. Immune phenotype, vector copy number, and genomic integrity of the final products were determined for cell characterization and quality control assessment. Functionality and antitumor capacity of CB/45RA-derived anti-FITC CAR-T cells were analyzed in co-culture with different anti-GD2-FITC labeled NB cell lines. Results The IL-7+IL-15+IL-21 cocktail, in addition to co-stimulation signals, resulted in a favorable cell proliferation rate and maintained less differentiated immune phenotypes in both CB and 45RA T cells. Therefore, it was used for CAR-T cell manufacturing and further characterization. CB and CD45RA-derived anti-FITC CAR-T cells cultured with IL-7+IL-15+IL-21 retained a predominantly naïve phenotype compared with controls. In the presence of the NB-FITC targeting, CD4+ CB-derived anti-FITC CAR-T cells showed the highest values of co-stimulatory receptors OX40 and 4-1BB, and CD8+ CAR-T cells exhibited high levels of PD-1 and 4-1BB and low levels of TIM3 and OX40, compared with CAR-T cells form the other sources studied. CB-derived anti-FITC CAR-T cells released the highest amounts of cytokines (IFN-γ and TNF-α) into co-culture supernatants. The viability of NB target cells decreased to 30% when co-cultured with CB-derived CAR-T cells during 48h. Conclusion CB and 45RA-derived T cells may be used as allogeneic sources of T cells to produce CAR-T cells. Moreover, ex vivo culture with IL-7+IL-15+IL-21 could favor CAR-T products with a longer persistence in the host. Our strategy may complement the current use of Dinutuximab in treating NB through its combination with a targeted CAR-T cell approach.
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Affiliation(s)
- Lorena García-García
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elena G. Sánchez
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Mariya Ivanova
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Keren Pastora
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Cristina Alcántara-Sánchez
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Jorge García-Martínez
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Progenitor and Cell Therapy Research Group, La Princesa Institute of Health Research, Madrid, Spain
| | - Beatriz Martín-Antonio
- Department of Experimental Hematology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Manuel Ramírez
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Progenitor and Cell Therapy Research Group, La Princesa Institute of Health Research, Madrid, Spain
| | - África González-Murillo
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Progenitor and Cell Therapy Research Group, La Princesa Institute of Health Research, Madrid, Spain
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9
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Dalal S, Shan KS, Thaw Dar NN, Hussein A, Ergle A. Role of Immunotherapy in Sarcomas. Int J Mol Sci 2024; 25:1266. [PMID: 38279265 PMCID: PMC10816403 DOI: 10.3390/ijms25021266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
Sarcomas are a group of malignancies of mesenchymal origin with a plethora of subtypes. Given the sheer heterogeneity of various subtypes and the rarity of the disease, the management of sarcomas has been challenging, with poor patient outcomes. Surgery, radiation therapy and chemotherapy have remained the backbone of treatment in patients with sarcoma. The introduction of immunotherapy has revolutionized the treatment of various solid and hematological malignancies. In this review, we discuss the basics of immunotherapy and the immune microenvironment in sarcomas; various modalities of immunotherapy, like immune checkpoint blockade, oncolytic viruses, cancer-targeted antibodies, vaccine therapy; and adoptive cell therapies like CAR T-cell therapy, T-cell therapy, and TCR therapy.
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Affiliation(s)
- Shivani Dalal
- Memorial Healthcare, Division of Hematology and Oncology, Pembroke Pines, FL 33028, USA; (K.S.S.); (N.N.T.D.); (A.H.); (A.E.)
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10
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Radosevich MT, Bornheimer SJ, Mehrpouryan M, Sahaf B, Oak JS, Mackall CL, Heitzeneder S. Antigen density quantification of cell-surface immunotherapy targets by flow cytometry: Multi-antigen assay of neuroblastoma bone marrow metastasis. STAR Protoc 2023; 4:102709. [PMID: 37967014 PMCID: PMC10684814 DOI: 10.1016/j.xpro.2023.102709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/17/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023] Open
Abstract
The central role of target antigen density on chimeric antigen receptor T cell potency highlights the need for accurate measurement of antigen levels on clinical tumor samples. Here, we present a protocol for quantifying antigen density for six cell-surface antigens on neuroblastoma cells metastatic to bone marrow. We describe steps for patient sample acquisition, flow cytometry panel development, instrument setup, and compensation and detail procedures for running clinical samples and data analysis. For complete details on the use and execution of this protocol, please refer to Heitzeneder et al. (2022).1.
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Affiliation(s)
- Molly T Radosevich
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | | | | | - Bita Sahaf
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Jean S Oak
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Crystal L Mackall
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA 941209, USA; Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sabine Heitzeneder
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
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11
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Kim Y, Lee HM. CRISPR-Cas System Is an Effective Tool for Identifying Drug Combinations That Provide Synergistic Therapeutic Potential in Cancers. Cells 2023; 12:2593. [PMID: 37998328 PMCID: PMC10670858 DOI: 10.3390/cells12222593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
Despite numerous efforts, the therapeutic advancement for neuroblastoma and other cancer treatments is still ongoing due to multiple challenges, such as the increasing prevalence of cancers and therapy resistance development in tumors. To overcome such obstacles, drug combinations are one of the promising applications. However, identifying and implementing effective drug combinations are critical for achieving favorable treatment outcomes. Given the enormous possibilities of combinations, a rational approach is required to predict the impact of drug combinations. Thus, CRISPR-Cas-based and other approaches, such as high-throughput pharmacological and genetic screening approaches, have been used to identify possible drug combinations. In particular, the CRISPR-Cas system (Clustered Regularly Interspaced Short Palindromic Repeats) is a powerful tool that enables us to efficiently identify possible drug combinations that can improve treatment outcomes by reducing the total search space. In this review, we discuss the rational approaches to identifying, examining, and predicting drug combinations and their impact.
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Affiliation(s)
| | - Hyeong-Min Lee
- Department of Computational Biology, St. Jude Research Hospital, Memphis, TN 38105, USA;
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12
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Callahan C, Haas L, Smith L. CAR-T cells for pediatric malignancies: Past, present, future and nursing implications. Asia Pac J Oncol Nurs 2023; 10:100281. [PMID: 38023730 PMCID: PMC10661550 DOI: 10.1016/j.apjon.2023.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/30/2023] [Indexed: 12/01/2023] Open
Abstract
The treatment landscape for pediatric cancers over the last 11 years has undergone a dramatic change, especially with relapsed and refractory B-cell acute lymphoblastic leukemia (ALL), due to the introduction of chimeric antigen receptor-T (CAR-T) cell therapy. Because of the success of CAR-T cell therapy in patients with relapsed and refractory B-cell ALL, this promising therapy is undergoing trials in multiple other pediatric malignancies. This article will focus on the introduction of CAR-T cell therapy in pediatric B-cell ALL and discuss past and current trials. We will also discuss trials for CAR-T cell therapy in other pediatric malignancies. This information was gathered through a comprehensive literature review along with using first hand institutional experience. Due to the potential severe toxicities related to CAR-T cell therapy, safe practices and monitoring are key. These authors demonstrate that nurses have a profound responsibility in preparing and caring for patients and families, monitoring and managing side effects in these patients, ensuring that study guidelines are followed, and providing continuity for patients, families, and referring providers. Education of nurses is crucial for improved patient outcomes.
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Affiliation(s)
- Colleen Callahan
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Lauren Haas
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Laura Smith
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, USA
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13
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Wang W, Al-Hajj M, Alavi AS. Detection and quantification of integrated vector copy number by multiplex droplet digital PCR in dual-transduced CAR T cells. Mol Ther Methods Clin Dev 2023; 30:403-410. [PMID: 37622159 PMCID: PMC10445099 DOI: 10.1016/j.omtm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
The success of chimeric antigen receptor (CAR) T cell therapies in refractory hematologic malignancies has prompted investigation of their efficacy in solid tumors. AUTO6NG is a dual-transduced GD2-targeting CAR that encodes distinct modules designed to enhance T cell activity in relapsed/refractory neuroblastoma. The ability to detect and precisely quantify vector copy number (VCN) for each integrated vector is essential for assessing the effect of each module on T cell tumor infiltration, persistence, and clinical activity. Droplet digital PCR (ddPCR) enables accurate, sensitive, and absolute quantification of specific nucleic acid sequences. Compared to standard detection of two targets, multiplex ddPCR assays allow simultaneous detection of up to four targets by selective modulation of signal amplitude while retaining the ability to quantify the target. We have developed a multiplex assay based on the two-channel system for simultaneous detection and quantification of three targets in AUTO6NG CAR T cells. The assay was highly specific, sensitive, accurate, and reproducible across time and samples. No differences were observed in measuring VCN between standard duplex and multiplex assays. Our results demonstrate that ddPCR is an accurate and cost-effective method for simultaneous detection of multiple targets in genomic DNA derived from engineered CAR T cells.
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Affiliation(s)
- Wei Wang
- Autolus Therapeutics, The MediaWorks, 191 Wood Lane, W12 7FP London, UK
| | - Muhammad Al-Hajj
- Autolus Therapeutics, The MediaWorks, 191 Wood Lane, W12 7FP London, UK
| | - Alireza S. Alavi
- Autolus Therapeutics, The MediaWorks, 191 Wood Lane, W12 7FP London, UK
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14
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Shahabifard H, Zarei M, Kookli K, Esmalian Afyouni N, Soltani N, Maghsoodi S, Adili A, Mahmoudi J, Shomali N, Sandoghchian Shotorbani S. An updated overview of the application of CAR-T cell therapy in neurological diseases. Biotechnol Prog 2023; 39:e3356. [PMID: 37198722 DOI: 10.1002/btpr.3356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
Genetically modified immune cells, especially CAR-T cells, have captured the attention of scientists over the past 10 years. In the fight against cancer, these cells have a special place. Treatment for hematological cancers, autoimmune disorders, and cancers must include CAR-T cell therapy. Determining the therapeutic targets, side effects, and use of CAR-T cells in neurological disorders, including cancer and neurodegenerative diseases, is the goal of this study. Due to advancements in genetic engineering, CAR-T cells have become crucial in treating some neurological disorders. CAR-T cells have demonstrated a positive role in treating neurological cancers like Glioblastoma and Neuroblastoma due to their ability to cross the blood-brain barrier and use diverse targets. However, CAR-T cell therapy for MS diseases is being researched and could be a potential treatment option. This study aimed to access the most recent studies and scientific articles in the field of CAR-T cells in neurological diseases and/or disorders.
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Affiliation(s)
- Hesam Shahabifard
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Zarei
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Keihan Kookli
- International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Nazgol Esmalian Afyouni
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Soltani
- School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sairan Maghsoodi
- Department of Laboratory Sciences, Faculty of Paramedical Sciences, Kurdistan University of Medical Sciences (MUK), Sanandaj, Iran
| | - Ali Adili
- Department of Oncology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Mahmoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Navid Shomali
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Bodden M, Häcker A, Röder J, Kiefer A, Zhang C, Bhatti A, Pfeifer Serrahima J, Ullrich E, Kühnel I, Wels WS. Co-Expression of an IL-15 Superagonist Facilitates Self-Enrichment of GD 2-Targeted CAR-NK Cells and Mediates Potent Cell Killing in the Absence of IL-2. Cancers (Basel) 2023; 15:4310. [PMID: 37686586 PMCID: PMC10486391 DOI: 10.3390/cancers15174310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/10/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
In contrast to T lymphocytes, natural killer (NK) cells do not require prior sensitization but are rapidly activated upon encountering virally infected or neoplastic cells. In addition, NK cells can be safely applied in an allogeneic setting, making them important effector cells for the development of off-the-shelf therapeutics for adoptive cancer immunotherapy. To further enhance their therapeutic potential, here, we engineered continuously expanding NK-92 cells as a clinically relevant model to express a humanized second-generation chimeric antigen receptor (CAR) with a composite CD28-CD3ζ signaling domain (hu14.18.28.z) that targets the disialoganglioside GD2, which is expressed at high levels by neuroblastoma cells and other tumors of neuroectodermal origin. In a separate approach, we fused an IL-15 superagonist (RD-IL15) to the GD2-CAR via a P2A processing site. Lentivirally transduced NK-92/hu14.18.28.z and NK-92/hu14.18.28.z_RD-IL15 cells both displayed high and stable CAR surface expression and specific cytotoxicity toward GD2-positive tumor cells. GD2-CAR NK cells carrying the RD-IL15 construct in addition expressed the IL-15 superagonist, resulting in self-enrichment and targeted cell killing in the absence of exogenous IL-2. Furthermore, co-culture with RD-IL15-secreting GD2-CAR NK cells markedly enhanced proliferation and cytotoxicity of bystander immune cells in a paracrine manner. Our results demonstrate that GD2-CAR NK cells co-expressing the IL-15 superagonist mediate potent direct and indirect antitumor effects, suggesting this strategy as a promising approach for the further development of functionally enhanced cellular therapeutics.
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Affiliation(s)
- Malena Bodden
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, Goethe University, 60590 Frankfurt, Germany
| | - Aline Häcker
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
| | - Jasmin Röder
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, Goethe University, 60590 Frankfurt, Germany
| | - Anne Kiefer
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
| | - Congcong Zhang
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
| | - Anita Bhatti
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
| | - Jordi Pfeifer Serrahima
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
| | - Evelyn Ullrich
- Frankfurt Cancer Institute, Goethe University, 60590 Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, a Partnership between DKFZ and University Hospital Frankfurt, 60590 Frankfurt, Germany
- Department of Pediatrics, Experimental Immunology and Cell Therapy, Goethe University, 60590 Frankfurt, Germany
| | - Ines Kühnel
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
| | - Winfried S. Wels
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, Goethe University, 60590 Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, a Partnership between DKFZ and University Hospital Frankfurt, 60590 Frankfurt, Germany
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16
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Chehelgerdi M, Chehelgerdi M. The use of RNA-based treatments in the field of cancer immunotherapy. Mol Cancer 2023; 22:106. [PMID: 37420174 PMCID: PMC10401791 DOI: 10.1186/s12943-023-01807-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
Over the past several decades, mRNA vaccines have evolved from a theoretical concept to a clinical reality. These vaccines offer several advantages over traditional vaccine techniques, including their high potency, rapid development, low-cost manufacturing, and safe administration. However, until recently, concerns over the instability and inefficient distribution of mRNA in vivo have limited their utility. Fortunately, recent technological advancements have mostly resolved these concerns, resulting in the development of numerous mRNA vaccination platforms for infectious diseases and various types of cancer. These platforms have shown promising outcomes in both animal models and humans. This study highlights the potential of mRNA vaccines as a promising alternative approach to conventional vaccine techniques and cancer treatment. This review article aims to provide a thorough and detailed examination of mRNA vaccines, including their mechanisms of action and potential applications in cancer immunotherapy. Additionally, the article will analyze the current state of mRNA vaccine technology and highlight future directions for the development and implementation of this promising vaccine platform as a mainstream therapeutic option. The review will also discuss potential challenges and limitations of mRNA vaccines, such as their stability and in vivo distribution, and suggest ways to overcome these issues. By providing a comprehensive overview and critical analysis of mRNA vaccines, this review aims to contribute to the advancement of this innovative approach to cancer treatment.
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Affiliation(s)
- Mohammad Chehelgerdi
- Novin Genome (NG) Lab, Research and Development Center for Biotechnology, Shahrekord, Iran.
- Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.
| | - Matin Chehelgerdi
- Novin Genome (NG) Lab, Research and Development Center for Biotechnology, Shahrekord, Iran
- Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
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17
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Fetahu IS, Esser-Skala W, Dnyansagar R, Sindelar S, Rifatbegovic F, Bileck A, Skos L, Bozsaky E, Lazic D, Shaw L, Tötzl M, Tarlungeanu D, Bernkopf M, Rados M, Weninger W, Tomazou EM, Bock C, Gerner C, Ladenstein R, Farlik M, Fortelny N, Taschner-Mandl S. Single-cell transcriptomics and epigenomics unravel the role of monocytes in neuroblastoma bone marrow metastasis. Nat Commun 2023; 14:3620. [PMID: 37365178 DOI: 10.1038/s41467-023-39210-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
Metastasis is the major cause of cancer-related deaths. Neuroblastoma (NB), a childhood tumor has been molecularly defined at the primary cancer site, however, the bone marrow (BM) as the metastatic niche of NB is poorly characterized. Here we perform single-cell transcriptomic and epigenomic profiling of BM aspirates from 11 subjects spanning three major NB subtypes and compare these to five age-matched and metastasis-free BM, followed by in-depth single cell analyses of tissue diversity and cell-cell interactions, as well as functional validation. We show that cellular plasticity of NB tumor cells is conserved upon metastasis and tumor cell type composition is NB subtype-dependent. NB cells signal to the BM microenvironment, rewiring via macrophage mgration inhibitory factor and midkine signaling specifically monocytes, which exhibit M1 and M2 features, are marked by activation of pro- and anti-inflammatory programs, and express tumor-promoting factors, reminiscent of tumor-associated macrophages. The interactions and pathways characterized in our study provide the basis for therapeutic approaches that target tumor-to-microenvironment interactions.
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Affiliation(s)
- Irfete S Fetahu
- St. Anna Children's Cancer Research Institute, Vienna, Austria.
| | - Wolfgang Esser-Skala
- Department of Biosciences and Medical Biology, University of Salzburg, Salzburg, Austria
| | - Rohit Dnyansagar
- Department of Biosciences and Medical Biology, University of Salzburg, Salzburg, Austria
| | - Samuel Sindelar
- Department of Biosciences and Medical Biology, University of Salzburg, Salzburg, Austria
| | | | - Andrea Bileck
- University of Vienna, Department of Analytical Chemistry, Faculty of Chemistry, Vienna, Austria
- Joint Metabolomics Facility, University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Lukas Skos
- University of Vienna, Department of Analytical Chemistry, Faculty of Chemistry, Vienna, Austria
| | - Eva Bozsaky
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Daria Lazic
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Lisa Shaw
- Medical University of Vienna, Department of Dermatology, Vienna, Austria
| | - Marcus Tötzl
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | | | - Marie Bernkopf
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Magdalena Rados
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Wolfgang Weninger
- Medical University of Vienna, Department of Dermatology, Vienna, Austria
| | - Eleni M Tomazou
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Medical University of Vienna, Institute of Artificial Intelligence, Center for Medical Data Science, Vienna, Austria
| | - Christopher Gerner
- University of Vienna, Department of Analytical Chemistry, Faculty of Chemistry, Vienna, Austria
- Joint Metabolomics Facility, University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Ruth Ladenstein
- St. Anna Children's Hospital and St. Anna Children's Cancer Research Institute, Department of Studies and Statistics for Integrated Research and Projects, Vienna, Austria
- Medical University of Vienna, Department of Pediatrics, Vienna, Austria
| | - Matthias Farlik
- Medical University of Vienna, Department of Dermatology, Vienna, Austria
| | - Nikolaus Fortelny
- Department of Biosciences and Medical Biology, University of Salzburg, Salzburg, Austria.
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18
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Bhavsar SP. Metastasis in neuroblastoma: the MYCN question. Front Oncol 2023; 13:1196861. [PMID: 37274289 PMCID: PMC10233040 DOI: 10.3389/fonc.2023.1196861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023] Open
Abstract
Oncogenic drivers like MYCN in neuroblastoma subsets continues to present a significant challenge owing to its strong correlation with high-risk metastatic disease and poor prognosis. However, only a limited number of MYCN-regulatory proteins associated with tumor initiation and progression have been elucidated. In this minireview, I summarize the recent progress in understanding the functional role of MYCN and its regulatory partners in neuroblastoma metastasis.
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19
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Rivera Z, Escutia C, Madonna MB, Gupta KH. Biological Insight and Recent Advancement in the Treatment of Neuroblastoma. Int J Mol Sci 2023; 24:ijms24108470. [PMID: 37239815 DOI: 10.3390/ijms24108470] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
One of the most frequent solid tumors in children is neuroblastoma, which has a variety of clinical behaviors that are mostly influenced by the biology of the tumor. Unique characteristics of neuroblastoma includes its early age of onset, its propensity for spontaneous tumor regression in newborns, and its high prevalence of metastatic disease at diagnosis in individuals older than 1 year of age. Immunotherapeutic techniques have been added to the previously enlisted chemotherapeutic treatments as therapeutic choices. A groundbreaking new treatment for hematological malignancies is adoptive cell therapy, specifically chimeric antigen receptor (CAR) T cell therapy. However, due to the immunosuppressive nature of the tumor microenvironment (TME) of neuroblastoma tumor, this treatment approach faces difficulties. Numerous tumor-associated genes and antigens, including the MYCN proto-oncogene (MYCN) and disialoganglioside (GD2) surface antigen, have been found by the molecular analysis of neuroblastoma cells. The MYCN gene and GD2 are two of the most useful immunotherapy findings for neuroblastoma. The tumor cells devise numerous methods to evade immune identification or modify the activity of immune cells. In addition to addressing the difficulties and potential advancements of immunotherapies for neuroblastoma, this review attempts to identify important immunological actors and biological pathways involved in the dynamic interaction between the TME and immune system.
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Affiliation(s)
- Zoriamin Rivera
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Carlos Escutia
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Mary Beth Madonna
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kajal H Gupta
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
- Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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20
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Sasaki T, Sakoda Y, Adachi K, Tokunaga Y, Tamada K. Therapeutic effects of anti-GM2 CAR-T cells expressing IL-7 and CCL19 for GM2-positive solid cancer in xenograft model. Cancer Med 2023. [PMID: 37031457 DOI: 10.1002/cam4.5907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND While chimeric antigen receptor (CAR)-T cell therapy has demonstrated excellent efficacy in hematopoietic malignancies, its clinical application in solid cancers has yet to be achieved. One of the reasons for such hurdle is a lack of suitable CAR targets in solid cancers. METHODS GM2 is one of the gangliosides, a group of glycosphingolipids with sialic acid in the glycan, and overexpressed in various types of solid cancers. In this study, by using interleukin (IL)-7 and chemokine (C-C motif) ligand 19 (CCL19)-producing human CAR-T system which we previously developed, a possibility of GM2 as a solid tumor target for CAR-T cell therapy was explored in a mouse model with human small-cell lung cancer. RESULTS Treatment with anti-GM2 IL-7/CCL19-producing CAR-T cells induced complete tumor regression along with an abundant T cell infiltration into the solid tumor tissue and long-term memory responses, without any detectable adverse events. In addition, as measures to control cytokine-release syndrome and neurotoxicity which could occur in association with clinical use of CAR-T cells, we incorporated Herpes simplex virus-thymidine kinase (HSV-TK), a suicide system to trigger apoptosis by administration of ganciclovir (GCV). HSV-TK-expressing anti-GM2 IL-7/CCL19-producing human CAR-T cells were efficiently eliminated by GCV administration in vivo. CONCLUSIONS Our study revealed the promising therapeutic efficacy of anti-GM2 IL-7/CCL19-producing human CAR-T cells with an enhanced safety for clinical application in the treatment of patients with GM2-positive solid cancers.
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Affiliation(s)
- Takahiro Sasaki
- Department of Immunology, Yamaguchi University Graduate School of Medicine, Ube, Japan
- Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yukimi Sakoda
- Department of Immunology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Keishi Adachi
- Department of Immunology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshihiro Tokunaga
- Department of Immunology, Yamaguchi University Graduate School of Medicine, Ube, Japan
- Department of Endocrinology, Metabolism, Hematological Science and Therapeutics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Koji Tamada
- Department of Immunology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Del Bufalo F, De Angelis B, Caruana I, Del Baldo G, De Ioris MA, Serra A, Mastronuzzi A, Cefalo MG, Pagliara D, Amicucci M, Li Pira G, Leone G, Bertaina V, Sinibaldi M, Di Cecca S, Guercio M, Abbaszadeh Z, Iaffaldano L, Gunetti M, Iacovelli S, Bugianesi R, Macchia S, Algeri M, Merli P, Galaverna F, Abbas R, Garganese MC, Villani MF, Colafati GS, Bonetti F, Rabusin M, Perruccio K, Folsi V, Quintarelli C, Locatelli F. GD2-CART01 for Relapsed or Refractory High-Risk Neuroblastoma. N Engl J Med 2023; 388:1284-1295. [PMID: 37018492 DOI: 10.1056/nejmoa2210859] [Citation(s) in RCA: 144] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Immunotherapy with chimeric antigen receptor (CAR)-expressing T cells that target the disialoganglioside GD2 expressed on tumor cells may be a therapeutic option for patients with high-risk neuroblastoma. METHODS In an academic, phase 1-2 clinical trial, we enrolled patients (1 to 25 years of age) with relapsed or refractory, high-risk neuroblastoma in order to test autologous, third-generation GD2-CAR T cells expressing the inducible caspase 9 suicide gene (GD2-CART01). RESULTS A total of 27 children with heavily pretreated neuroblastoma (12 with refractory disease, 14 with relapsed disease, and 1 with a complete response at the end of first-line therapy) were enrolled and received GD2-CART01. No failure to generate GD2-CART01 was observed. Three dose levels were tested (3-, 6-, and 10×106 CAR-positive T cells per kilogram of body weight) in the phase 1 portion of the trial, and no dose-limiting toxic effects were recorded; the recommended dose for the phase 2 portion of the trial was 10×106 CAR-positive T cells per kilogram. Cytokine release syndrome occurred in 20 of 27 patients (74%) and was mild in 19 of 20 (95%). In 1 patient, the suicide gene was activated, with rapid elimination of GD2-CART01. GD2-targeted CAR T cells expanded in vivo and were detectable in peripheral blood in 26 of 27 patients up to 30 months after infusion (median persistence, 3 months; range, 1 to 30). Seventeen children had a response to the treatment (overall response, 63%); 9 patients had a complete response, and 8 had a partial response. Among the patients who received the recommended dose, the 3-year overall survival and event-free survival were 60% and 36%, respectively. CONCLUSIONS The use of GD2-CART01 was feasible and safe in treating high-risk neuroblastoma. Treatment-related toxic effects developed, and the activation of the suicide gene controlled side effects. GD2-CART01 may have a sustained antitumor effect. (Funded by the Italian Medicines Agency and others; ClinicalTrials.gov number, NCT03373097.).
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Affiliation(s)
- Francesca Del Bufalo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Biagio De Angelis
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Ignazio Caruana
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giada Del Baldo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria A De Ioris
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Annalisa Serra
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Angela Mastronuzzi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria G Cefalo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Daria Pagliara
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Matteo Amicucci
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giuseppina Li Pira
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giovanna Leone
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Valentina Bertaina
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Matilde Sinibaldi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefano Di Cecca
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Marika Guercio
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Zeinab Abbaszadeh
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Laura Iaffaldano
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Monica Gunetti
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefano Iacovelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Rossana Bugianesi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefania Macchia
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Mattia Algeri
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Pietro Merli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Federica Galaverna
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Rachid Abbas
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria C Garganese
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria F Villani
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giovanna S Colafati
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Federico Bonetti
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Marco Rabusin
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Katia Perruccio
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Veronica Folsi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Concetta Quintarelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Franco Locatelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
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CAR T-Cell Therapy in Children with Solid Tumors. J Clin Med 2023; 12:jcm12062326. [PMID: 36983330 PMCID: PMC10051963 DOI: 10.3390/jcm12062326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
The limited efficacy of traditional cancer treatments, including chemotherapy, radiotherapy, and surgery, emphasize the significance of employing innovative methods. CAR (Chimeric Antigen Receptor) T-cell therapy remains the most revolutionizing treatment of pediatric hematological malignancies and solid tumors. Patient’s own lymphocytes are modified ex-vivo using gene transfer techniques and programmed to recognize and destroy specific tumor cells regardless of MHC receptor, which probably makes CAR-T the most personalized therapy for the patient. With continued refinement and optimization, CAR-T cell therapy has the potential to significantly improve outcomes and quality of life for children with limited treatment options. It has shown remarkable success in treating hematological malignancies, such as acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). However, its effectiveness in treating solid tumors is still being investigated and remains an area of active research. In this review we focus on solid tumors and explain the concept of CAR modified T cells, and discuss some novel CAR designs that are being considered to enhance the safety of CAR T-cell therapy in under-mentioned cancers. Furthermore, we summarize the most crucial recent reports concerning the solid tumors treatment in children. In the end we provide a short summary of many challenges that limit the therapeutic efficacy of CAR-T in solid tumors, such as antigen escape, immunosuppressive microenvironment, poor trafficking, and tumor infiltration, on-target off-tumor effects and general toxicity.
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23
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Wang J, Wang Y, Pan H, Zhao L, Yang X, Liang Z, Shen X, Zhang J, Yang J, Zhu Y, Xun J, Liang Y, Lin Q, Liang H, Li M, Zhu H. Chemokine Receptors CCR6 and PD1 Blocking scFv E27 Enhances Anti-EGFR CAR-T Therapeutic Efficacy in a Preclinical Model of Human Non-Small Cell Lung Carcinoma. Int J Mol Sci 2023; 24:ijms24065424. [PMID: 36982500 PMCID: PMC10056525 DOI: 10.3390/ijms24065424] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/14/2023] Open
Abstract
Chimeric antigen receptor (CAR)-T cells, a therapeutic agent for solid tumors, are not completely effective due to a lack of infiltration of T cells into the tumor site and immunity caused by Programmed Death Receptor 1(PD1). Here, an epidermal growth factor receptor (EGFR) CAR-T cell was engineered to express the chemokine receptor CCR6 and secrete PD1 blocking Single-chain antibody fragment (scFv) E27 to enhance their anti-tumor effects. The findings showed that CCR6 enhanced the migration of EGFR CAR-E27-CCR6 T cells in vitro by the Transwell migration assay. When incubated with tumor cells, EGFR CAR-E27-CCR6 T cells specifically exerted potent cytotoxicity and produced high levels of pro-inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), and interferon-γ (IFN-γ). A non-small cell lung carcinoma (NSCLC) cell line-derived xenograft model was constructed by implanting modified A549 cell lines into immunodeficient NOD.PrkdcscidIl2rgem1/Smoc (NSG) mice. In comparison with traditional EGFR CAR-T cells, live imaging indicated that EGFR CAR-E27-CCR6 T cells displayed superior anti-tumor function. In addition, the histopathological examination of mouse organs showed no obvious organic damage. Our findings confirmed that PD1 blocking and CCR6 can enhance the anti-tumor function of EGFR CAR-T cells in an NSCLC xenograft model, providing an effective treatment strategy to improve the efficacy of CAR-T in NSCLC.
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Affiliation(s)
- Jing Wang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Yanan Wang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Hanyu Pan
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Lin Zhao
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Xinyi Yang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Zhiming Liang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Xiaoting Shen
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Jing Zhang
- School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Jinlong Yang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Yuqi Zhu
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Jingna Xun
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Yue Liang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Qinru Lin
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Huitong Liang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Min Li
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
| | - Huanzhang Zhu
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai 200082, China
- Correspondence: ; Tel./Fax: +86-021-31246728
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24
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Huang Z, Dewanjee S, Chakraborty P, Jha NK, Dey A, Gangopadhyay M, Chen XY, Wang J, Jha SK. CAR T cells: engineered immune cells to treat brain cancers and beyond. Mol Cancer 2023; 22:22. [PMID: 36721153 PMCID: PMC9890802 DOI: 10.1186/s12943-022-01712-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/29/2022] [Indexed: 02/01/2023] Open
Abstract
Malignant brain tumors rank among the most challenging type of malignancies to manage. The current treatment protocol commonly entails surgery followed by radiotherapy and/or chemotherapy, however, the median patient survival rate is poor. Recent developments in immunotherapy for a variety of tumor types spark optimism that immunological strategies may help patients with brain cancer. Chimeric antigen receptor (CAR) T cells exploit the tumor-targeting specificity of antibodies or receptor ligands to direct the cytolytic capacity of T cells. Several molecules have been discovered as potential targets for immunotherapy-based targeting, including but not limited to EGFRvIII, IL13Rα2, and HER2. The outstanding clinical responses to CAR T cell-based treatments in patients with hematological malignancies have generated interest in using this approach to treat solid tumors. Research results to date support the astounding clinical response rates of CD19-targeted CAR T cells, early clinical experiences in brain tumors demonstrating safety and evidence for disease-modifying activity, and the promise for further advances to ultimately assist patients clinically. However, several variable factors seem to slow down the progress rate regarding treating brain cancers utilizing CAR T cells. The current study offers a thorough analysis of CAR T cells' promise in treating brain cancer, including design and delivery considerations, current strides in clinical and preclinical research, issues encountered, and potential solutions.
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Affiliation(s)
- Zoufang Huang
- grid.452437.3Department of Hematology, Ganzhou Key Laboratory of Hematology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Saikat Dewanjee
- grid.216499.10000 0001 0722 3459Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032 India
| | - Pratik Chakraborty
- grid.216499.10000 0001 0722 3459Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032 India
| | - Niraj Kumar Jha
- grid.412552.50000 0004 1764 278XDepartment of Biotechnology, School of Engineering & Technology, Sharda University, Greater Noida, Uttar Pradesh 201310 India
| | - Abhijit Dey
- grid.412537.60000 0004 1768 2925Department of Life Sciences, Presidency University, 86/1 College Street, Kolkata, West Bengal 700032 India
| | - Moumita Gangopadhyay
- grid.502979.00000 0004 6087 8632Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Barasat, Kolkata, West Bengal 700126 India
| | - Xuan-Yu Chen
- grid.264091.80000 0001 1954 7928Institute for Biotechnology, St. John’s University, Queens, New York, 11439 USA
| | - Jian Wang
- Department of Radiotherapy, the Affiliated Jiangyin People’s Hospital of Nantong University, Jiangyin, 214400 China
| | - Saurabh Kumar Jha
- grid.412552.50000 0004 1764 278XDepartment of Biotechnology, School of Engineering & Technology, Sharda University, Greater Noida, Uttar Pradesh 201310 India ,grid.448792.40000 0004 4678 9721Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, 140413 India ,grid.449906.60000 0004 4659 5193Department of Biotechnology, School of Applied & Life Sciences (SALS), Uttaranchal University, Dehradun, 248007 India
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25
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Li Q, Wang J, Cheng Y, Hu A, Li D, Wang X, Guo Y, Zhou Y, Chen G, Bao B, Gao H, Song J, Du X, Zheng L, Tong Q. Long-Term Survival of Neuroblastoma Patients Receiving Surgery, Chemotherapy, and Radiotherapy: A Propensity Score Matching Study. J Clin Med 2023; 12:jcm12030754. [PMID: 36769402 PMCID: PMC9918249 DOI: 10.3390/jcm12030754] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 01/20/2023] Open
Abstract
Neuroblastoma is the most common extracranial solid malignancy in children. This study was undertaken to determine the long-term survival of neuroblastoma patients receiving conventional therapeutics (surgery, chemotherapy, and radiotherapy). The neuroblastoma patients examined were registered in the Surveillance, Epidemiology and End Results (SEER) database (1975-2016). Using propensity score matching analysis, the patients were paired by record depending on whether they received surgery, chemotherapy, or radiotherapy. Univariate and multivariate analyses of the disease-specific survival of the paired patients were performed by the log-rank test and Cox regression assay. A total of 4568 neuroblastoma patients were included in this study. During 1975-2016, the proportion of histopathological grade III/IV cases receiving surgery gradually increased, while the number of patients with tumors of grade I to IV undergoing chemotherapy or radiotherapy was stable or even decreased. After propensity score analysis, for Grade I + II and Grade III tumors, surgery obviously improved the disease-specific survival of patients, while chemotherapy was unfavorable for patient prognosis, and radiotherapy exerted no obvious effect on the patients. However, no matter what treatment was chosen, the patients with advanced-histopathological-grade tumors had a poor prognosis. Meanwhile, for all histopathological grades, the patients receiving surgery and subsequent chemotherapy or radiotherapy suffered from worsen disease-specific survival than those simply undergoing surgery. Fortunately, the negative effects of surgery, chemotherapy, or radiotherapy improved gradually over time. Surgery improved the long-term survival of the neuroblastoma patients, while chemotherapy and radiotherapy exerted an unfavorable impact on patient outcome. These results provide an important reference for the clinical treatment of neuroblastoma.
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Affiliation(s)
- Qilan Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Jianqun Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yang Cheng
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Anpei Hu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Dan Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Xiaojing Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
- Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yanhua Guo
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yi Zhou
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Guo Chen
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Banghe Bao
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Haiyang Gao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Jiyu Song
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Xinyi Du
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Liduan Zheng
- Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
- Correspondence: (L.Z.); (Q.T.); Tel.: +86-27-8572-6129 (L.Z.); +86-27-8535-0762 (Q.T.); Fax: +86-27-8572-6821 (L.Z. & Q.T.)
| | - Qiangsong Tong
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
- Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
- Correspondence: (L.Z.); (Q.T.); Tel.: +86-27-8572-6129 (L.Z.); +86-27-8535-0762 (Q.T.); Fax: +86-27-8572-6821 (L.Z. & Q.T.)
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26
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Zhou X, Wang X, Li N, Guo Y, Yang X, Lei Y. Therapy resistance in neuroblastoma: Mechanisms and reversal strategies. Front Pharmacol 2023; 14:1114295. [PMID: 36874032 PMCID: PMC9978534 DOI: 10.3389/fphar.2023.1114295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Neuroblastoma is one of the most common pediatric solid tumors that threaten the health of children, accounting for about 15% of childhood cancer-related mortality in the United States. Currently, multiple therapies have been developed and applied in clinic to treat neuroblastoma including chemotherapy, radiotherapy, targeted therapy, and immunotherapy. However, the resistance to therapies is inevitable following long-term treatment, leading to treatment failure and cancer relapse. Hence, to understand the mechanisms of therapy resistance and discover reversal strategies have become an urgent task. Recent studies have demonstrated numerous genetic alterations and dysfunctional pathways related to neuroblastoma resistance. These molecular signatures may be potential targets to combat refractory neuroblastoma. A number of novel interventions for neuroblastoma patients have been developed based on these targets. In this review, we focus on the complicated mechanisms of therapy resistance and the potential targets such as ATP-binding cassette transporters, long non-coding RNAs, microRNAs, autophagy, cancer stem cells, and extracellular vesicles. On this basis, we summarized recent studies on the reversal strategies to overcome therapy resistance of neuroblastoma such as targeting ATP-binding cassette transporters, MYCN gene, cancer stem cells, hypoxia, and autophagy. This review aims to provide novel insight in how to improve the therapy efficacy against resistant neuroblastoma, which may shed light on the future directions that would enhance the treatment outcomes and prolong the survival of patients with neuroblastoma.
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Affiliation(s)
- Xia Zhou
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiaokang Wang
- Department of Pharmacy, Shenzhen Longhua District Central Hospital, Shenzhen, China.,Guangdong Provincial Key Laboratory of Research and Development of Natural Drugs, School of Pharmacy, Guangdong Medical University, Dongguan, China.,The Marine Biomedical Research Institute of Guangdong Zhanjiang, Zhanjiang, China
| | - Nan Li
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Yu Guo
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Xiaolin Yang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuhe Lei
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
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27
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Lee-Theilen M, Fadini DD, Hadhoud JR, van Dongen F, Kroll G, Rolle U, Fiegel HC. Hepatoblastoma Cancer Stem Cells Express PD-L1, Reveal Plasticity and Can Emerge upon Chemotherapy. Cancers (Basel) 2022; 14:cancers14235825. [PMID: 36497307 PMCID: PMC9736435 DOI: 10.3390/cancers14235825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
The biology of cancer stem cells (CSCs) of pediatric cancers, such as hepatoblastoma, is sparsely explored. This is mainly due to the very immature nature of these tumors, which complicates the distinction of CSCs from the other tumor cells. Previously, we identified a CSC population in hepatoblastoma cell lines expressing the CSC markers CD34 and CD90, cell surface Vimentin (csVimentin) and binding of OV-6. In this study, we detected the co-expression of the immune escape factor PD-L1 in the CSC population, whereas the other tumor cells remained negative. FACS data revealed that non-CSCs give rise to CSCs, reflecting plasticity of CSCs and non-CSCs in hepatoblastoma as seen in other tumors. When we treated cells with cisplatin and decitabine, a new CD34+/lowOV-6lowCD90+ population emerged that lacked csVimentin and PD-L1 expression. Expression analyses showed that this new CSC subset shared similar pluripotency and EMT features with the already-known CSCs. FACS results further revealed that this subset is also generated from non-CSCs. In conclusion, we showed that hepatoblastoma CSCs express PD-L1 and that the biology of hepatoblastoma CSCs is of a plastic nature. Chemotherapeutic treatment leads to another CSC subset, which is highly chemoresistant and could be responsible for a poor prognosis after postoperative chemotherapy.
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28
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Zhuo Z, Lin L, Miao L, Li M, He J. Advances in liquid biopsy in neuroblastoma. FUNDAMENTAL RESEARCH 2022; 2:903-917. [PMID: 38933377 PMCID: PMC11197818 DOI: 10.1016/j.fmre.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022] Open
Abstract
Even with intensive treatment of high-risk neuroblastoma (NB) patients, half of high-risk NB patients still relapse. New therapies targeting the biological characteristics of NB have important clinical value for the personalized treatment of NB. However, the current biological markers for NB are mainly analyzed by tissue biopsy. In recent years, circulating biomarkers of NB based on liquid biopsy have attracted more and more attention. This review summarizes the analytes and methods for liquid biopsy of NB. We focus on the application of liquid biopsy in the diagnosis, prognosis assessment, and monitoring of NB. Finally, we discuss the prospects and challenges of liquid biopsy in NB.
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Affiliation(s)
- Zhenjian Zhuo
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
- Laboratory Animal Center, School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen 518055, China
| | - Lei Lin
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Lei Miao
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Meng Li
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jing He
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
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29
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Song J, Ni C, Dong X, Sheng C, Qu Y, Zhu L. bub1 as a potential oncogene and a prognostic biomarker for neuroblastoma. Front Oncol 2022; 12:988415. [PMID: 36237324 PMCID: PMC9552328 DOI: 10.3389/fonc.2022.988415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNeuroblastoma is the most common malignant extracranial tumor for children. Molecular mechanisms underpinning the pathogenesis of this disease are yet to be fully clarified. This study aimed to identify a novel oncogene that could be used as a biomarker informing the prognosis of neuroblastoma, and to predict its biological functions, using bioinformatics and molecular biology tools.MethodsThree data sets from the TARGET, GSE62564, and GSE85047 databases were used for analysis. Survivals of patients with high or low expression of bub1 were compared, using the Kaplan-Meier curve and log-rank test. Immune infiltration was evaluated using ESTIMATE and MCP-counter algorithms. Synthetic small interfering RNAs (siRNAs) were employed to silence bub1 expression in neuroblastoma cell lines SH-SY5Y and SK-N-SH, in order to characterize its biological functions. Gene enrichment analyses of bub1 were carried out, using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses.ResultsExpression of bub1 was found to significantly affect overall survival and event-free survival of patients with neuroblastoma, positively correlate with the expressions of tpx2 and the ASPM gene, and negatively correlate with host immune infiltration. Expression of bub1 was elevated in patients with neuroblastoma. Silencing bub1 expression using siRNAs in SH-SY5Y and SK-N-SH resulted in decreased cell growth (p < 0.05), reduced migration (p < 0.05), and increased apoptosis (p < 0.05). Function analysis of bub1 revealed cancer-promoting effects, probably via regulating several important downstream molecules, including that related to the apoptosis process and epithelial-mesenchymal transition.ConclusionWe identified a potential tumor-promoting gene bub1 for neuroblastoma that could also serve as a prognostic biomarker.
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Affiliation(s)
- Jingjing Song
- Department of Pediatric Surgery, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Pediatric Allergy and Immunology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao Ni
- Second Clinical College, Wenzhou Medical University, Wenzhou, China
| | - Xubin Dong
- Department of Breast Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenang Sheng
- Department of Pediatric Surgery, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yue Qu
- Wenzhou Medical University-Monash Biomedicine Discovery Institute (BDI) Alliance in Clinical and Experimental Biomedicine, Wenzhou, China
| | - Libin Zhu
- Department of Pediatric Surgery, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Libin Zhu,
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Keshavarz A, Salehi A, Khosravi S, Shariati Y, Nasrabadi N, Kahrizi MS, Maghsoodi S, Mardi A, Azizi R, Jamali S, Fotovat F. Recent findings on chimeric antigen receptor (CAR)-engineered immune cell therapy in solid tumors and hematological malignancies. Stem Cell Res Ther 2022; 13:482. [PMID: 36153626 PMCID: PMC9509604 DOI: 10.1186/s13287-022-03163-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
Advancements in adoptive cell therapy over the last four decades have revealed various new therapeutic strategies, such as chimeric antigen receptors (CARs), which are dedicated immune cells that are engineered and administered to eliminate cancer cells. In this context, CAR T-cells have shown significant promise in the treatment of hematological malignancies. However, many obstacles limit the efficacy of CAR T-cell therapy in both solid tumors and hematological malignancies. Consequently, CAR-NK and CAR-M cell therapies have recently emerged as novel therapeutic options for addressing the challenges associated with CAR T-cell therapies. Currently, many CAR immune cell trials are underway in various human malignancies around the world to improve antitumor activity and reduce the toxicity of CAR immune cell therapy. This review will describe the comprehensive literature of recent findings on CAR immune cell therapy in a wide range of human malignancies, as well as the challenges that have emerged in recent years.
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Affiliation(s)
- Ali Keshavarz
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Salehi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Islamic Azad University,, Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Setareh Khosravi
- Department of Orthodontics, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Yasaman Shariati
- Department of General Surgery, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Navid Nasrabadi
- Department of Endodontics, School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Sairan Maghsoodi
- Department of Paramedical, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amirhossein Mardi
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramyar Azizi
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samira Jamali
- Department of Endodontics, College of Stomatology, Stomatological Hospital, Xi’an Jiaotong University, Shaanxi, People’s Republic of China
| | - Farnoush Fotovat
- Department of Prosthodontics, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
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Birley K, Leboreiro-Babe C, Rota EM, Buschhaus M, Gavriil A, Vitali A, Alonso-Ferrero M, Hopwood L, Parienti L, Ferry G, Flutter B, Himoudi N, Chester K, Anderson J. A novel anti-B7-H3 chimeric antigen receptor from a single-chain antibody library for immunotherapy of solid cancers. Mol Ther Oncolytics 2022; 26:429-443. [PMID: 36159778 PMCID: PMC9467911 DOI: 10.1016/j.omto.2022.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
B7-H3 (CD276) has emerged as a target for cancer immunotherapy by virtue of consistent expression in many malignancies, relative absence from healthy tissues, and an emerging role as a driver of tumor immune inhibition. Recent studies have reported B7-H3 to be a suitable target for chimeric antigen receptor-modified T cell (CAR-T) therapy using CARs constructed from established anti-B7-H3 antibodies converted into single-chain Fv format (scFv). We constructed and screened binders in an scFv library to generate a new anti-B7-H3 CAR-T with favorable properties. This allowed access to numerous specificities ready formatted for CAR evaluation. Selected anti-human B7-H3 scFvs were readily cloned into CAR-T and evaluated for anti-tumor reactivity in cytotoxicity, cytokine, and proliferation assays. Two binders with divergent complementarity determining regions were found to show optimal antigen-specific cytotoxicity and cytokine secretion. One binder in second-generation CD28-CD3ζ CAR format induced sustained in vitro proliferation on repeat antigen challenge. The lead candidate CAR-T also demonstrated in vivo activity in a resistant neuroblastoma model. An empirical approach to B7-H3 CAR-T discovery through screening of novel scFv sequences in CAR-T format has led to the identification of a new construct with sustained proliferative capacity warranting further evaluation.
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Espinosa-Cotton M, Cheung NKV. Bispecific antibodies for the treatment of neuroblastoma. Pharmacol Ther 2022; 237:108241. [PMID: 35830901 PMCID: PMC10351215 DOI: 10.1016/j.pharmthera.2022.108241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
Bispecific antibodies (BsAb) are a new generation of antibody-based therapy, conveying artificial specificity to polyclonal T cells or radiohaptens. These drugs have been successfully implemented to cure hematologic malignancies and are under clinical investigation for solid tumors including HRNB. BsAbs designed to engage T cells or increase the therapeutic index of radiotherapy hold the potential to significantly improve the long-term survival of HRNB patients by shrinking bulky tumors and more effectively eliminating micrometastases and preventing relapse. BsAbs can also be used to arm T cells, yielding a product analogous to CAR T cells, possibly with an improved safety profile. A thoughtful and realistic integration of these therapies into the standard of care should benefit more patients worldwide. Here we describe the history of development of BsAbs for HRNB, which dates back almost three decades. We discuss the merits and pitfalls of all relevant BsAbs, including T cell-engagers and agents used for radioimmunotherapy, highlighting the importance of structural design and interdomain spacing for anti-tumor efficacy.
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Affiliation(s)
- Madelyn Espinosa-Cotton
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY 10065, New York.
| | - Nai-Kong V Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, NY 10065, New York
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Yu EY, Cheung NKV, Lue NF. Connecting telomere maintenance and regulation to the developmental origin and differentiation states of neuroblastoma tumor cells. J Hematol Oncol 2022; 15:117. [PMID: 36030273 PMCID: PMC9420296 DOI: 10.1186/s13045-022-01337-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
A cardinal feature that distinguishes clinically high-risk neuroblastoma from low-risk tumors is telomere maintenance. Specifically, neuroblastoma tumors with either active telomerase or alternative lengthening of telomeres exhibit aggressive growth characteristics that lead to poor outcomes, whereas tumors without telomere maintenance can be managed with observation or minimal treatment. Even though the need for cancer cells to maintain telomere DNA-in order to sustain cell proliferation-is well established, recent studies suggest that the neural crest origin of neuroblastoma may enforce unique relationships between telomeres and tumor malignancy. Specifically in neuroblastoma, telomere structure and telomerase activity are correlated with the adrenergic/mesenchymal differentiation states, and manipulating telomerase activity can trigger tumor cell differentiation. Both findings may reflect features of normal neural crest development. This review summarizes recent advances in the characterization of telomere structure and telomere maintenance mechanisms in neuroblastoma and discusses the findings in the context of relevant literature on telomeres during embryonic and neural development. Understanding the canonical and non-canonical roles of telomere maintenance in neuroblastoma could reveal vulnerabilities for telomere-directed therapies with potential applications to other pediatric malignancies.
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Affiliation(s)
- Eun Young Yu
- Department of Microbiology & Immunology, W. R. Hearst Microbiology Research Center, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
| | - Nai-Kong V Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Neal F Lue
- Department of Microbiology & Immunology, W. R. Hearst Microbiology Research Center, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA.
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA.
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Cancer Immunotherapy and Delivery System: An Update. Pharmaceutics 2022; 14:pharmaceutics14081630. [PMID: 36015256 PMCID: PMC9413869 DOI: 10.3390/pharmaceutics14081630] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023] Open
Abstract
With an understanding of immunity in the tumor microenvironment, immunotherapy turns out to be a powerful tool in the clinic to treat many cancers. The strategies applied in cancer immunotherapy mainly include blockade of immune checkpoints, adoptive transfer of engineered cells, such as T cells, natural killer cells, and macrophages, cytokine therapy, cancer vaccines, and oncolytic virotherapy. Many factors, such as product price, off-target side effects, immunosuppressive tumor microenvironment, and cancer cell heterogeneity, affect the treatment efficacy of immunotherapies against cancers. In addition, some treatments, such as chimeric antigen receptor (CAR) T cell therapy, are more effective in treating patients with lymphoma, leukemia, and multiple myeloma rather than solid tumors. To improve the efficacy of targeted immunotherapy and reduce off-target effects, delivery systems for immunotherapies have been developed in past decades using tools such as nanoparticles, hydrogel matrix, and implantable scaffolds. This review first summarizes the currently common immunotherapies and their limitations. It then synopsizes the relative delivery systems that can be applied to improve treatment efficacy and minimize side effects. The challenges, frontiers, and prospects for applying these delivery systems in cancer immunotherapy are also discussed. Finally, the application of these approaches in clinical trials is reviewed.
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Lin L, Miao L, Lin H, Cheng J, Li M, Zhuo Z, He J. Targeting RAS in neuroblastoma: Is it possible? Pharmacol Ther 2022; 236:108054. [PMID: 34915055 DOI: 10.1016/j.pharmthera.2021.108054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
Neuroblastoma is a common solid tumor in children and a leading cause of cancer death in children. Neuroblastoma exhibits genetic, morphological, and clinical heterogeneity that limits the efficacy of current monotherapies. With further research on neuroblastoma, the pathogenesis of neuroblastoma is found to be complex, and more and more treatment therapies are needed. The importance of personalized therapy is growing. Currently, various molecular features, including RAS mutations, are being used as targets for the development of new therapies for patients with neuroblastoma. A recent study found that RAS mutations are frequently present in recurrent neuroblastoma. RAS mutations have been shown to activate the MAPK pathway and play an important role in neuroblastoma. Treating RAS mutated neuroblastoma is a difficult challenge, but many preclinical studies have yielded effective results. At the same time, many of the therapies used to treat RAS mutated tumors also have good reference values for treating RAS mutated neuroblastoma. The success of KRAS-G12C inhibitors has greatly stimulated confidence in the direct suppression of RAS. This review describes the biological role of RAS and the frequency of RAS mutations in neuroblastoma. This paper focuses on the strategies, preclinical, and clinical progress of targeting carcinogenic RAS in neuroblastoma, and proposes possible prospects and challenges in the future.
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Affiliation(s)
- Lei Lin
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Lei Miao
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Huiran Lin
- Faculty of Medicine, Macau University of Science and Technology, Macau 999078, China
| | - Jiwen Cheng
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China
| | - Meng Li
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Zhenjian Zhuo
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China; Laboratory Animal Center, School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen 518055, China.
| | - Jing He
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China.
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Tian M, Cheuk AT, Wei JS, Abdelmaksoud A, Chou HC, Milewski D, Kelly MC, Song YK, Dower CM, Li N, Qin H, Kim YY, Wu JT, Wen X, Benzaoui M, Masih KE, Wu X, Zhang Z, Badr S, Taylor N, Croix BS, Ho M, Khan J. An optimized bicistronic chimeric antigen receptor against GPC2 or CD276 overcomes heterogeneous expression in neuroblastoma. J Clin Invest 2022; 132:155621. [PMID: 35852863 PMCID: PMC9374382 DOI: 10.1172/jci155621] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Meijie Tian
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Adam T. Cheuk
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Jun S. Wei
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Abdalla Abdelmaksoud
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
- Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Hsien-Chao Chou
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - David Milewski
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Michael C. Kelly
- Single Cell Analysis Facility, Center for Cancer Research, NIH, Bethesda, Maryland, USA
| | - Young K. Song
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Christopher M. Dower
- Mouse Cancer Genetics Program, Center for Cancer Research, NCI, Frederick, Maryland, USA
| | - Nan Li
- Laboratory of Molecular Biology, Center for Cancer Research and
| | - Haiying Qin
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Yong Yean Kim
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Jerry T. Wu
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Xinyu Wen
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Mehdi Benzaoui
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Katherine E. Masih
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Xiaolin Wu
- Cancer Research Technology Program, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Zhongmei Zhang
- Experimental Immunology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Sherif Badr
- Experimental Immunology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Naomi Taylor
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
| | - Brad St. Croix
- Mouse Cancer Genetics Program, Center for Cancer Research, NCI, Frederick, Maryland, USA
| | - Mitchell Ho
- Laboratory of Molecular Biology, Center for Cancer Research and
| | - Javed Khan
- Genetics Branch, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
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Chen K, Wang S, Qi D, Ma P, Fang Y, Jiang N, Wu E, Li N. Clinical Investigations of CAR-T Cell Therapy for Solid Tumors. Front Immunol 2022; 13:896685. [PMID: 35924243 PMCID: PMC9339623 DOI: 10.3389/fimmu.2022.896685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Cell therapy is a distinguished targeted immunotherapy with great potential to treat solid tumors in the new era of cancer treatment. Cell therapy products include genetically engineered cell products and non-genetically engineered cell products. Several recent cell therapies, especially chimeric antigen receptor (CAR)-T cell therapies, have been approved as novel treatment strategies for cancer. Many clinical trials on cell therapies, in the form of cell therapy alone or in combination with other treatments, in solid tumors, have been conducted or ongoing. However, there are still challenges since adverse events and the limited efficacy of cell therapies have also been observed. Here, we concisely summarize the clinical milestones of the conducted and ongoing clinical trials of cell therapy, introduce the evolution of CARs, discuss the challenges and limitations of these therapeutic modalities taking CAR-T as the main focus, and analyze the disparities in the regulatory policies in different countries.
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Affiliation(s)
- Kun Chen
- National Health Commission (NHC) Key Laboratory of Pulmonary Immune-Related Diseases, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Shuhang Wang
- Clinical Cancer Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Qi
- Department of Neurosurgery and Neuroscience Institute, Baylor Scott & White Health, Temple, TX, United States
| | - Peiwen Ma
- Clinical Cancer Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Fang
- Clinical Cancer Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Jiang
- Clinical Cancer Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Erxi Wu
- Department of Neurosurgery and Neuroscience Institute, Baylor Scott & White Health, Temple, TX, United States
- Texas A&M University Colleges of Medicine and Pharmacy, College Station, TX, United States
- LIVESTRONG Cancer Institutes and Department of Oncology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Ning Li
- Clinical Cancer Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Stem cell like memory T cells: A new paradigm in cancer immunotherapy. Clin Immunol 2022; 241:109078. [PMID: 35840054 DOI: 10.1016/j.clim.2022.109078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 11/03/2022]
Abstract
Stem cell like memory T (TSCM) cells have emerged as the apex of memory T cell differentiation for their properties of self-renewal and replenishing progenies. With potent long-term persistence, proliferative capacity and antitumor activity, TSCM cells were thought to be the ideal candidate for cancer immunotherapies. Several strategies have been proposed, such as manipulations of cytokines, metabolic factors, signal pathways, and T cell receptor signal intensity, to induce more TSCM cells in vitro, in the hope that they could reach a clinical order of magnitude to provide more long-lasting and effective anti-tumor effects in vivo. In this review, we summarized the differentiation characteristics of TSCM cells and strategies to generate more TSCM cells. We focused on their roles and application in the cancer immunotherapy especially in adoptive cell transfer therapy and cancer therapeutic vaccines, and hopefully provided clues for future understanding and researches.
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Neganova ME, Aleksandrova YR, Sukocheva OA, Klochkov SG. Benefits and limitations of nanomedicine treatment of brain cancers and age-dependent neurodegenerative disorders. Semin Cancer Biol 2022; 86:805-833. [PMID: 35779712 DOI: 10.1016/j.semcancer.2022.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023]
Abstract
The treatment of central nervous system (CNS) malignancies, including brain cancers, is limited by a number of obstructions, including the blood-brain barrier (BBB), the heterogeneity and high invasiveness of tumors, the inaccessibility of tissues for early diagnosis and effective surgery, and anti-cancer drug resistance. Therapies employing nanomedicine have been shown to facilitate drug penetration across the BBB and maintain biodistribution and accumulation of therapeutic agents at the desired target site. The application of lipid-, polymer-, or metal-based nanocarriers represents an advanced drug delivery system for a growing group of anti-cancer chemicals. The nanocarrier surface is designed to contain an active ligand (cancer cell marker or antibody)-binding structure which can be modified to target specific cancer cells. Glioblastoma, ependymoma, neuroblastoma, medulloblastoma, and primary CNS lymphomas were recently targeted by easily absorbed nanocarriers. The metal- (such as transferrin drug-loaded systems), polymer- (nanocapsules and nanospheres), or lipid- (such as sulfatide-containing nanoliposomes)-based nano-vehicles were loaded with apoptosis- and/or ferroptosis-stimulating agents and demonstrated promising anti-cancer effects. This review aims to discuss effective nanomedicine approaches designed to overcome the current limitations in the therapy of brain cancers and age-dependent neurodegenerative disorders. To accent current obstacles for successful CNS-based cancer therapy, we discuss nanomedicine perspectives and limitations of nanodrug use associated with the specificity of nervous tissue characteristics and the effects nanocarriers have on cognition.
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Affiliation(s)
- Margarita E Neganova
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, 1, Severnii pr., Chernogolovka, 142432, Russia
| | - Yulia R Aleksandrova
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, 1, Severnii pr., Chernogolovka, 142432, Russia
| | - Olga A Sukocheva
- School of Health Sciences, Flinders University of South Australia, Bedford Park, SA 5042, Australia.
| | - Sergey G Klochkov
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, 1, Severnii pr., Chernogolovka, 142432, Russia
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El Moukhtari SH, Garbayo E, Fernández-Teijeiro A, Rodríguez-Nogales C, Couvreur P, Blanco-Prieto MJ. Nanomedicines and cell-based therapies for embryonal tumors of the nervous system. J Control Release 2022; 348:553-571. [PMID: 35705114 DOI: 10.1016/j.jconrel.2022.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
Embryonal tumors of the nervous system are neoplasms predominantly affecting the pediatric population. Among the most common and aggressive ones are neuroblastoma (NB) and medulloblastoma (MB). NB is a sympathetic nervous system tumor, which is the most frequent extracranial solid pediatric cancer, usually detected in children under two. MB originates in the cerebellum and is one of the most lethal brain tumors in early childhood. Their tumorigenesis presents some similarities and both tumors often have treatment resistances and poor prognosis. High-risk (HR) patients require high dose chemotherapy cocktails associated with acute and long-term toxicities. Nanomedicine and cell therapy arise as potential solutions to improve the prognosis and quality of life of children suffering from these tumors. Indeed, nanomedicines have been demonstrated to efficiently reduce drug toxicity and improve drug efficacy. Moreover, these systems have been extensively studied in cancer research over the last few decades and an increasing number of anticancer nanocarriers for adult cancer treatment has reached the clinic. Among cell-based strategies, the clinically most advanced approach is chimeric-antigen receptor (CAR) T therapy for both pathologies, which is currently under investigation in phase I/II clinical trials. However, pediatric drug research is especially hampered due not only to ethical issues but also to the lack of efficient pre-clinical models and the inadequate design of clinical trials. This review provides an update on progress in the treatment of the main embryonal tumors of the nervous system using nanotechnology and cell-based therapies and discusses key issues behind the gap between preclinical studies and clinical trials in this specific area. Some directions to improve their translation into clinical practice and foster their development are also provided.
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Affiliation(s)
- Souhaila H El Moukhtari
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, Universidad de Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra, IdiSNA, C/Irunlarrea 3, 31008 Pamplona, Spain
| | - Elisa Garbayo
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, Universidad de Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra, IdiSNA, C/Irunlarrea 3, 31008 Pamplona, Spain
| | - Ana Fernández-Teijeiro
- Pediatric Onco-Hematology Unit, Hospital Universitario Virgen Macarena, School of Medicine, Universidad de Sevilla, Avenida Dr, Fedriani 3, 41009 Sevilla, Spain; Sociedad Española de Hematología y Oncología Pediátricas (SEHOP), Spain
| | - Carlos Rodríguez-Nogales
- School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland
| | - Patrick Couvreur
- Institut Galien Paris-Sud, UMRCNRS8612,Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry 92296, France
| | - María J Blanco-Prieto
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, Universidad de Navarra, C/Irunlarrea 1, 31008 Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra, IdiSNA, C/Irunlarrea 3, 31008 Pamplona, Spain.
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41
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Yoda H, Weiss WA. CD55, a potential immunotherapeutic target for MYCN-amplified neuroblastoma. Neuro Oncol 2022; 24:886-887. [PMID: 35090034 PMCID: PMC9159426 DOI: 10.1093/neuonc/noac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Hiroyuki Yoda
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - William A Weiss
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- Departments of Neurology, Pediatrics, and Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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42
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Boettcher M, Joechner A, Li Z, Yang SF, Schlegel P. Development of CAR T Cell Therapy in Children-A Comprehensive Overview. J Clin Med 2022; 11:jcm11082158. [PMID: 35456250 PMCID: PMC9024694 DOI: 10.3390/jcm11082158] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 01/27/2023] Open
Abstract
CAR T cell therapy has revolutionized immunotherapy in the last decade with the successful establishment of chimeric antigen receptor (CAR)-expressing cellular therapies as an alternative treatment in relapsed and refractory CD19-positive leukemias and lymphomas. There are fundamental reasons why CAR T cell therapy has been approved by the Food and Drug administration and the European Medicines Agency for pediatric and young adult patients first. Commonly, novel therapies are developed for adult patients and then adapted for pediatric use, due to regulatory and commercial reasons. Both strategic and biological factors have supported the success of CAR T cell therapy in children. Since there is an urgent need for more potent and specific therapies in childhood malignancies, efforts should also include the development of CAR therapeutics and expand applicability by introducing new technologies. Basic aspects, the evolution and the drawbacks of childhood CAR T cell therapy are discussed as along with the latest clinically relevant information.
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Affiliation(s)
- Michael Boettcher
- Department of Pediatric Surgery, University Medical Centre Mannheim, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Alexander Joechner
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia;
- Cellular Cancer Therapeutics Unit, Children’s Medical Research Institute, Sydney 2145, Australia; (Z.L.); (S.F.Y.)
| | - Ziduo Li
- Cellular Cancer Therapeutics Unit, Children’s Medical Research Institute, Sydney 2145, Australia; (Z.L.); (S.F.Y.)
| | - Sile Fiona Yang
- Cellular Cancer Therapeutics Unit, Children’s Medical Research Institute, Sydney 2145, Australia; (Z.L.); (S.F.Y.)
| | - Patrick Schlegel
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia;
- Cellular Cancer Therapeutics Unit, Children’s Medical Research Institute, Sydney 2145, Australia; (Z.L.); (S.F.Y.)
- Department of Pediatric Hematology and Oncology, Westmead Children’s Hospital, Sydney 2145, Australia
- Correspondence:
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43
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Jonus HC, Burnham RE, Ho A, Pilgrim AA, Shim J, Doering CB, Spencer HT, Goldsmith KC. Dissecting the cellular components of ex vivo γδ T cell expansions to optimize selection of potent cell therapy donors for neuroblastoma immunotherapy trials. Oncoimmunology 2022; 11:2057012. [PMID: 35371623 PMCID: PMC8966991 DOI: 10.1080/2162402x.2022.2057012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
γδ T lymphocytes represent an emerging class of cellular immunotherapy with preclinical promise to treat cancer, notably neuroblastoma. The innate-like immune cell subset demonstrates inherent cytoxicity toward tumor cells independent of MHC recognition, enabling allogeneic administration of healthy donor-derived γδ T cell therapies. A current limitation is the substantial interindividual γδ T cell expansion variation among leukocyte collections. Overcoming this limitation will enable realization of the full potential of allogeneic γδ T-based cellular therapy. Here, we characterize γδ T cell expansions from healthy adult donors and observe that highly potent natural killer (NK) lymphocytes expand with γδ T cells under zoledronate and IL-2 stimulation. The presence of NK cells correlates with both the expansion potential of γδ T cells and the overall potency of the γδ T cell therapy. However, the potency of the cell therapy in combination with an antibody-based immunotherapeutic, dinutuximab, appears to be independent of γδ T/NK cell content both in vitro and in vivo, which minimizes the implication of interindividual expansion differences toward efficacy. Collectively, these studies highlight the utility of maintaining the NK cell population within expanded γδ T cell therapies and suggest a synergistic action of combined innate cell immunotherapy toward neuroblastoma.
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Affiliation(s)
- Hunter C. Jonus
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca E. Burnham
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew Ho
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Adeiye A. Pilgrim
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jenny Shim
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
- Division of Pediatric Hematology/Oncology, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Christopher B. Doering
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - H. Trent Spencer
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Kelly C. Goldsmith
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Division of Pediatric Hematology/Oncology, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
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44
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Abstract
CAR-T cell therapy has been heralded as a breakthrough in the field of immunotherapy, but to date, this success has been limited to hematological malignancies. By harnessing the chemokine system and taking into consideration the chemokine expression profile in the tumor microenvironment, CAR-T cells may be homed into tumors to facilitate direct tumor cell cytolysis and overcome a major hurdle in generating effective CAR-T cell responses to solid cancers.
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Affiliation(s)
- Jade Foeng
- Chemokine Biology Laboratory, Department of Molecular and Biomedical Science, School of Biological Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- Carina Biotech, Innovation and Collaboration Centre, The University of South Australia, Adelaide, SA 5000, Australia
| | - Iain Comerford
- Chemokine Biology Laboratory, Department of Molecular and Biomedical Science, School of Biological Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Shaun R. McColl
- Chemokine Biology Laboratory, Department of Molecular and Biomedical Science, School of Biological Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- Carina Biotech, Innovation and Collaboration Centre, The University of South Australia, Adelaide, SA 5000, Australia
- Corresponding author
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45
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Abbas AA, Samkari AMN. High-Risk Neuroblastoma: Poor Outcomes Despite Aggressive Multimodal
Therapy. CURRENT CANCER THERAPY REVIEWS 2022. [DOI: 10.2174/1573394717666210805114226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
:
Neuroblastoma (NBL) is a highly malignant embryonal tumor that originates from the
primordial neural crest cells. NBL is the most common tumor in infants and the most common extracranial
solid tumor in children. The tumor is more commonly diagnosed in children of 1-4 years
of age. NBL is characterized by enigmatic clinical behavior that ranges from spontaneous regression
to an aggressive clinical course leading to frequent relapses and death. Based on the likelihood
of progression and relapse, the International Neuroblastoma Risk Group classification system categorized
NBL into very low risk, low risk, intermediate risk, and high risk (HR) groups. HR NBL is
defined based on the patient's age (> 18 months), disease metastasis, tumor histology, and MYCN
gene amplification. HR NBL is diagnosed in nearly 40% of patients, mainly those > 18 months of
age, and is associated with aggressive clinical behavior. Treatment strategies involve the use of intensive
chemotherapy (CTR), surgical resection, high dose CTR with hematopoietic stem cell support,
radiotherapy, biotherapy, and immunotherapy with Anti-ganglioside 2 monoclonal antibodies.
Although HR NBL is now better characterized and aggressive multimodal therapy is applied, the
outcomes of treatment are still poor, with overall survival and event-free survival of approximately
40% and 30% at 3-years, respectively. The short and long-term side effects of therapy are tremendous.
HR NBL carries a high mortality rate accounting for nearly 15% of pediatric cancer deaths.
However, most mortalities are attributed to the high frequency of disease relapse (50%) and disease
reactiveness to therapy (20%). Newer treatment strategies are therefore urgently needed. Recent
discoveries in the field of biology and molecular genetics of NBL have led to the identification
of several targets that can improve the treatment results. In this review, we discuss the different
aspects of the epidemiology, biology, clinical presentations, diagnosis, and treatment of HR
NBL, in addition to the recent developments in the management of the disease.
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Affiliation(s)
- Adil Abdelhamed Abbas
- College of Medicine King Saud bin Abdulaziz, University for Health Sciences Consultant Pediatric Hematology / Oncology
& BMT The Pediatric Hematology/Oncology Section Princess Nourah Oncology Centre King Abdulaziz Medical
City, Jeddah, Saudi Arabia
| | - Alaa Mohammed Noor Samkari
- College of Medicine King Saud bin Abdulaziz, University for Health Sciences Consultant
Anatomical Pathologist Department of Laboratory Medicine King Abdulaziz Medical City, Jeddah, Saudi Arabia
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46
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Anti-GD2 Directed Immunotherapy for High-Risk and Metastatic Neuroblastoma. Biomolecules 2022; 12:biom12030358. [PMID: 35327550 PMCID: PMC8945428 DOI: 10.3390/biom12030358] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
Neuroblastoma is one of the few childhood cancers that carries a tumor-specific antigen in the form of a glycolipid antigen known as GD2. It has restricted expression in normal tissue, such as peripheral afferent nerves. Monoclonal antibodies targeting GD2 have been applied clinically to high-risk neuroblastoma with significant success. However, there are different anti-GD2 products and administration regimens. For example, anti-GD2 has been used in combination with chemotherapy during the induction phase or with retinoic acid during the maintenance stage. Regimens also vary in the choice of whether to add cytokines (i.e., IL-2, GMCSF, or both). Furthermore, the addition of an immune enhancer, such as β-glucan, or allogeneic natural killer cells also becomes a confounder in the interpretation. The question concerning which product or method of administration is superior remains to be determined. So far, most studies agree that adding anti-GD2 to the conventional treatment protocol can achieve better short- to intermediate-term event-free and overall survival, but the long-term efficacy remains to be verified. How to improve its efficacy is another challenge. Late relapse and central nervous system metastasis have emerged as new problems. The methods to overcome the mechanisms related to immune evasion or resistance to immunotherapy represent new challenges to be resolved. The newer anti-GD2 strategies, such as bispecific antibody linking of anti-GD2 with activated T cells or chimeric antigen receptor T cells, are currently under clinical trials, and they may become promising alternatives. The use of anti-GD2/GD3 tumor vaccine is a novel and potential approach to minimizing late relapse. How to induce GD2 expression from tumor cells using the epigenetic approach is a hot topic nowadays. We expect that anti-GD2 treatment can serve as a model for the use of monoclonal antibody immunotherapy against cancers in the future.
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47
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Epigenetic state determines inflammatory sensing in neuroblastoma. Proc Natl Acad Sci U S A 2022; 119:2102358119. [PMID: 35121657 PMCID: PMC8832972 DOI: 10.1073/pnas.2102358119] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Immunotherapy has revolutionized cancer treatment, but many cancers are not impacted by currently available immunotherapeutic strategies. Here, we investigated inflammatory signaling pathways in neuroblastoma, a classically "cold" pediatric cancer. By testing the functional response of a panel of 20 diverse neuroblastoma cell lines to three different inflammatory stimuli, we found that all cell lines have intact interferon signaling, and all but one lack functional cytosolic DNA sensing via cGAS-STING. However, double-stranded RNA (dsRNA) sensing via Toll-like receptor 3 (TLR3) was heterogeneous, as was signaling through other dsRNA sensors and TLRs more broadly. Seven cell lines showed robust response to dsRNA, six of which are in the mesenchymal epigenetic state, while all unresponsive cell lines are in the adrenergic state. Genetically switching adrenergic cell lines toward the mesenchymal state fully restored responsiveness. In responsive cells, dsRNA sensing results in the secretion of proinflammatory cytokines, enrichment of inflammatory transcriptomic signatures, and increased tumor killing by T cells in vitro. Using single-cell RNA sequencing data, we show that human neuroblastoma cells with stronger mesenchymal signatures have a higher basal inflammatory state, demonstrating intratumoral heterogeneity in inflammatory signaling that has significant implications for immunotherapeutic strategies in this aggressive childhood cancer.
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48
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Heitzeneder S, Bosse KR, Zhu Z, Zhelev D, Majzner RG, Radosevich MT, Dhingra S, Sotillo E, Buongervino S, Pascual-Pasto G, Garrigan E, Xu P, Huang J, Salzer B, Delaidelli A, Raman S, Cui H, Martinez B, Bornheimer SJ, Sahaf B, Alag A, Fetahu IS, Hasselblatt M, Parker KR, Anbunathan H, Hwang J, Huang M, Sakamoto K, Lacayo NJ, Klysz DD, Theruvath J, Vilches-Moure JG, Satpathy AT, Chang HY, Lehner M, Taschner-Mandl S, Julien JP, Sorensen PH, Dimitrov DS, Maris JM, Mackall CL. GPC2-CAR T cells tuned for low antigen density mediate potent activity against neuroblastoma without toxicity. Cancer Cell 2022; 40:53-69.e9. [PMID: 34971569 PMCID: PMC9092726 DOI: 10.1016/j.ccell.2021.12.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 10/13/2021] [Accepted: 12/06/2021] [Indexed: 01/12/2023]
Abstract
Pediatric cancers often mimic fetal tissues and express proteins normally silenced postnatally that could serve as immune targets. We developed T cells expressing chimeric antigen receptors (CARs) targeting glypican-2 (GPC2), a fetal antigen expressed on neuroblastoma (NB) and several other solid tumors. CARs engineered using standard designs control NBs with transgenic GPC2 overexpression, but not those expressing clinically relevant GPC2 site density (∼5,000 molecules/cell, range 1-6 × 103). Iterative engineering of transmembrane (TM) and co-stimulatory domains plus overexpression of c-Jun lowered the GPC2-CAR antigen density threshold, enabling potent and durable eradication of NBs expressing clinically relevant GPC2 antigen density, without toxicity. These studies highlight the critical interplay between CAR design and antigen density threshold, demonstrate potent efficacy and safety of a lead GPC2-CAR candidate suitable for clinical testing, and credential oncofetal antigens as a promising class of targets for CAR T cell therapy of solid tumors.
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Affiliation(s)
- Sabine Heitzeneder
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Kristopher R Bosse
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zhongyu Zhu
- National Cancer Institute, Frederick, MD 21702, USA
| | - Doncho Zhelev
- University of Pittsburgh Department of Medicine, Pittsburgh, PA 15261, USA
| | - Robbie G Majzner
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Molly T Radosevich
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Shaurya Dhingra
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Elena Sotillo
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Samantha Buongervino
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Guillem Pascual-Pasto
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Garrigan
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Peng Xu
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Jing Huang
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Benjamin Salzer
- St. Anna Children's Cancer Research Institute, Vienna, Austria; Christian Doppler Laboratory for Next Generation CAR T Cells, Vienna, Austria
| | - Alberto Delaidelli
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V5Z 1L3, Canada
| | - Swetha Raman
- Program in Molecular Medicine, Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada
| | - Hong Cui
- Program in Molecular Medicine, Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada
| | - Benjamin Martinez
- Program in Molecular Medicine, Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada
| | | | - Bita Sahaf
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Anya Alag
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Irfete S Fetahu
- University of Pittsburgh Department of Medicine, Pittsburgh, PA 15261, USA
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Kevin R Parker
- Center for Personal Dynamic Regulomes, Stanford University, Stanford, CA 94305, USA
| | - Hima Anbunathan
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | | | - Min Huang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kathleen Sakamoto
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Norman J Lacayo
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dorota D Klysz
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - Johanna Theruvath
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA
| | - José G Vilches-Moure
- Department of Comparative Medicine, Animal Histology Services, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ansuman T Satpathy
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Howard Y Chang
- Center for Personal Dynamic Regulomes, Stanford University, Stanford, CA 94305, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA 941209, USA; Howard Hughes Medical Institute, Stanford University, Stanford, CA 94305, USA
| | - Manfred Lehner
- St. Anna Children's Cancer Research Institute, Vienna, Austria; Christian Doppler Laboratory for Next Generation CAR T Cells, Vienna, Austria
| | | | - Jean-Phillipe Julien
- Program in Molecular Medicine, Hospital for Sick Children Research Institute, Toronto, ON M5G 0A4, Canada; Departments of Biochemistry and Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Poul H Sorensen
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V5Z 1L3, Canada
| | - Dimiter S Dimitrov
- University of Pittsburgh Department of Medicine, Pittsburgh, PA 15261, USA
| | - John M Maris
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Crystal L Mackall
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Lorry Lokey Building, Suite G3141, MC: 5456, 265 Campus Drive, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA 941209, USA; Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
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49
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Abstract
There are encouraging signs in our collective progress to leverage the immune system to treat pediatric cancers. Here, we summarize interim successes in cancer immunotherapy and opportunities to translate from the adult world to pediatrics, and highlight challenges that could benefit from additional development, focusing on solid tumors. Just a decade ago, other than antibodies targeting disialoganglioside (GD2) in neuroblastoma, pediatric cancer immunotherapy was mostly relegated to obscure preclinical studies in a few academic labs. Today there are numerous clinical trials of a variety of antibody, cellular, gene, and viral therapies and vaccines designed to either promote antitumor immunity or specifically attack validated immunotherapy targets. Understanding those targets and their pediatric relevance is paramount. While much work is underway to evaluate the utility of numerous immunologic targets, the lack of regulatory approvals is emblematic of the challenges that remain. Herein we focus our review on the most promising targeted immunotherapies in clinical trials for children.
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Affiliation(s)
- Ajay Gupta
- Division of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
| | - Timothy P Cripe
- Division of Hematology/Oncology/Blood and Marrow Transplantation, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
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50
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Leruste A, Beccaria K, Doz F. CAR-T cells for pediatric brain tumors: Present and future. Bull Cancer 2021; 108:S109-S116. [PMID: 34920793 DOI: 10.1016/j.bulcan.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 10/19/2022]
Abstract
Chimeric Antigen Receptor T (CAR-T) cells are currently approved for B cell malignancies only, in children and adults. Despite a lack of robust evidence to approve such cellular immunotherapy for pediatric solid tumors, there is a growing interest for this approach in the treatment of pediatric brain tumors. Following the identification of tumor antigens as targets, the first clinical trials demonstrated some degree of clinical and biological responses to CAR-T cells for such tumor types. Additionaly, several preclinical studies have recently identified new attractive targets and antigen combination strategies, along with a superior tumor trafficking following locoregional administration. We review here the preclinical and clinical knowledge at the basis of the current clinical development of CAR-T cells for pediatric brain tumors.
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Affiliation(s)
- Amaury Leruste
- PSL Research University, SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France.
| | - Kevin Beccaria
- Université de Paris, AP-HP, Necker Hospital, Department of Pediatric Neurosurgery, 149, rue de Sèvres, 75015 Paris, France
| | - François Doz
- PSL Research University, SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
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