双特异性抗体免疫疗法在胶质瘤治疗中的研究进展
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1.山东第二医科大学临床医学院;2.烟台毓璜顶医院(青岛大学附属烟台毓璜顶医院)

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Research Progress on Bispecific Antibody Immunotherapy in the Treatment of Glioma
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1.山东第二医科大学临床医学院;2.School of Clinical Medicine, Shandong Second Medical University;3.Neurosurgery Department of Yantai Yuhuangding Hospital

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    摘要:

    本文探讨了双特异性抗体(BsAbs)和双特异性抗体结合剂(BiTE)在胶质母细胞瘤(GBM)免疫治疗中的应用及挑战。GBM被称为“免疫冷瘤”,其免疫抑制性肿瘤微环境(TME)、血脑屏障(BBB)及肿瘤异质性限制了传统治疗的效果。免疫检查点抑制剂(ICB)在GBM中的疗效有限,联合治疗尚未取得显著突破。相比之下,BsAbs通过同时结合肿瘤细胞和T细胞,增强免疫反应,在血液恶性肿瘤中已取得突破,展示了在GBM治疗中的潜力。研究表明,靶向不同免疫分子的BsAbs(如EGFRvIII、HER2、B7-H3、L1CAM等)能有效提高免疫反应,增强T细胞浸润并促进肿瘤杀伤。特别是靶向EGFRvIII和CD3的BsAbs在小鼠模型中展现了显著的抗肿瘤活性,并提高生存率。此外,BiTE疗法通过激活T细胞,增强其免疫攻击,在动物模型中已显示持久治愈效果。尽管BsAbs和BiTE在GBM治疗中具有潜力,但仍面临血脑屏障穿透、免疫原性、毒副作用等挑战。本文建议结合免疫检查点抑制剂、放疗等手段提高治疗效果。同时,利用自我组装平台技术,优化抗体亲和力和空间构型,能够增强治疗特异性,减少对正常组织的损伤。总的来说,随着技术进步,BsAbs有望成为GBM治疗的有效工具,改善患者预后。

    Abstract:

    Glioblastoma (GBM) is a highly aggressive and immunologically challenging tumor, often referred to as an "immune-cold tumor." Its treatment is hampered by a variety of factors, including a highly immunosuppressive tumor microenvironment (TME), the presence of the blood-brain barrier (BBB), and tumor heterogeneity. These challenges limit the efficacy of conventional therapies. Immune checkpoint inhibitors (ICBs), while effective in many cancers, show limited success in GBM, with response rates ranging from 10% to 30%. To overcome these limitations, novel immunotherapeutic approaches, such as bispecific antibodies (BsAbs) and bispecific T-cell engagers (BiTEs), have emerged as promising alternatives. BsAbs, which can simultaneously bind tumor cells and T cells to enhance immune responses, have shown remarkable success in hematologic cancers like acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). In GBM, targeting overexpressed proteins such as EGFRvIII, HER2, L1CAM,and B7-H3 with BsAbs has demonstrated the potential to improve immune responses and induce T-cell infiltration, leading to enhanced tumor killing. Among these, EGFRvIII-targeted BsAbs have shown significant anti-tumor activity in preclinical models, with prolonged survival observed in glioma-bearing mice. These findings suggest a promising clinical application for EGFRvIII-targeted BsAbs in GBM therapy. In addition to BsAbs, BiTEs, which are designed to activate T cells and induce tumor cell lysis, have been tested in GBM models. BiTE therapies targeting EGFRvIII, such as AMG596 and hEGFRvIII-CD3, are currently undergoing clinical trials. Preclinical studies have shown that BiTEs can trigger a strong and sustained anti-tumor immune response, leading to significant tumor regression in mouse models. Furthermore, the combination of BiTEs with immune checkpoint inhibitors or radiotherapy holds potential to further enhance therapeutic efficacy. Despite the promising results, the application of BsAbs and BiTEs in GBM faces several challenges. These include overcoming the BBB to ensure effective drug delivery, minimizing immune-related side effects such as cytokine release syndrome (CRS), and optimizing antibody affinity and specificity to avoid damage to normal tissues. Additionally, strategies that combine BsAbs or BiTEs with other therapeutic modalities, such as immune checkpoint inhibitors or targeted radiation, could improve treatment outcomes. Emerging self-assembling and disassembling (SADA) platform technologies offer a new approach to enhance treatment specificity and reduce toxicity. In conclusion, while BsAbs and BiTEs represent promising therapeutic strategies for GBM, further research and clinical trials are needed to address the challenges associated with their application. With continued innovation and optimization, these therapies hold the potential to improve patient prognosis and provide new treatment options for this devastating disease.

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  • 收稿日期:2024-10-15
  • 最后修改日期:2024-12-31
  • 录用日期:2025-01-06
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