Zhang, J., Hu, Y., Yang, J., et al. Non-viral, specifically targeted CAR-T cells achieve high safety and efficacy in B-NHL. Nature (2022).
Recently, chimeric antigen receptor (CAR)-T cell therapy has shown great promise in
treating haematological malignancies1–7
. However, CAR-T cell therapy currently has
several limitations8–12. Here we successfully developed a two-in-one approach to
generate non-viral, gene-specifc targeted CAR-T cells through CRISPR–Cas9. Using
the optimized protocol, we demonstrated feasibility in a preclinical study by inserting
an anti-CD19 CAR cassette into the AAVS1 safe-harbour locus. Furthermore, an
innovative type of anti-CD19 CAR-T cell with PD1 integration was developed and
showed superior ability to eradicate tumour cells in xenograft models. In adoptive
therapy for relapsed/refractory aggressive B cell non-Hodgkin lymphoma
(ClinicalTrials.gov, NCT04213469), we observed a high rate (87.5%) of complete
remission and durable responses without serious adverse events in eight patients.
Notably, these enhanced CAR-T cells were efective even at a low infusion dose
and with a low percentage of CAR+
cells. Single-cell analysis showed that the
electroporation method resulted in a high percentage of memory T cells in infusion
products, and PD1 interference enhanced anti-tumour immune functions, further
validating the advantages of non-viral, PD1-integrated CAR-T cells. Collectively, our
results demonstrate the high safety and efcacy of non-viral, gene-specifc integrated
CAR-T cells, thus providing an innovative technology for CAR-T cell therapy.
Fu, B., Liao, J., Chen, S. et al. CRISPR–Cas9-mediated gene editing of the BCL11A enhancer for pediatric β0/β0 transfusion-dependent β-thalassemia. Nature Medicine (2022).
Gene editing to disrupt the GATA1-binding site at the +58 BCL11A erythroid enhancer could induce γ-globin expression, which is a promising therapeutic strategy to alleviate β-hemoglobinopathy caused by HBB gene mutation. In the present study, we report the preliminary results of an ongoing phase 1/2 trial (NCT04211480) evaluating safety and efficacy of gene editing therapy in children with blood transfusion-dependent β-thalassemia (TDT). We transplanted BCL11A enhancer-edited, autologous, hematopoietic stem and progenitor cells into two children, one carrying the β0/β0 genotype, classified as the most severe type of TDT. Primary endpoints included engraftment, overall survival and incidence of adverse events (AEs). Both patients were clinically well with multilineage engraftment, and all AEs to date were considered unrelated to gene editing and resolved after treatment. Secondary endpoints included achieving transfusion independence, editing rate in bone marrow cells and change in hemoglobin (Hb) concentration. Both patients achieved transfusion independence for >18 months after treatment, and their Hb increased from 8.2 and 10.8 g dl−1 at screening to 15.0 and 14.0 g dl−1 at the last visit, respectively, with 85.46% and 89.48% editing persistence in bone marrow cells. Exploratory analysis of single-cell transcriptome and indel patterns in edited peripheral blood mononuclear cells showed no notable side effects of the therapy.