A New Era in Endothelial Injury Syndromes: Toxicity of CAR-T Cells and the Role of Immunity

International Journal of Molecular Sciences

Ioanna Sakellari¹  Eleni Gavriilaki¹  Achilles Anagnostopoulos¹  Maria Gavriilaki² 

[1] Hematology Department—BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece;Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;

关键词: CAR-T;    endothelial injury syndrome;    toxicity;    complement;    immunity;   

DOI  :  10.3390/ijms21113886

来源: DOAJ

【 摘 要 】

Immunotherapy with chimeric antigen receptor T (CAR-T cells) has been recently approved for patients with relapsed/refractory B-lymphoproliferative neoplasms. Along with great efficacy in patients with poor prognosis, CAR-T cells have been also linked with novel toxicities in a significant portion of patients. Cytokine release syndrome (CRS) and neurotoxicity present with unique clinical phenotypes that have not been previously observed. Nevertheless, they share similar characteristics with endothelial injury syndromes developing post hematopoietic cell transplantation (HCT). Evolution in complement therapeutics has attracted renewed interest in these life-threatening syndromes, primarily concerning transplant-associated thrombotic microangiopathy (TA-TMA). The immune system emerges as a key player not only mediating cytokine responses but potentially contributing to endothelial injury in CAR-T cell toxicity. The interplay between complement, endothelial dysfunction, hypercoagulability, and inflammation seems to be a common denominator in these syndromes. As the indications for CAR-T cells and patient populations expand, there in an unmet clinical need of better understanding of the pathophysiology of CAR-T cell toxicity. Therefore, this review aims to provide state-of-the-art knowledge on cellular therapies in clinical practice (indications and toxicities), endothelial injury syndromes and immunity, as well as potential therapeutic targets.

【 授权许可】

Unknown