4.7 Review

Natural killer cells in clinical development as non-engineered, engineered, and combination therapies

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Summary: Using IL-15 for allogeneic cellular therapy may paradoxically limit therapeutic efficacy as it accelerates CD8 T-cell activation, leading to rejection of donor NK cells.
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CD38 knocKout natural killer cells expressing an affinity optimized CD38 chimeric antigen receptor successfully target acute myeloid leukemia with reduced effector cell fratricide

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Summary: There is strong biological rationale for combining alloeneic natural killer (NK) cell therapies with a chimeric antigen receptor (CAR) to improve the targeting of acute myeloid leukemia (AML). However, CD38 expression on NK cells and its induction during ex vivo NK cell expansion pose challenges to the development of a CD38 CAR-NK cell therapy. This study successfully used gene editing technology to reduce CD38 expression in expanded NK cells, resulting in reduced fratricide and enhanced targeting of primary AML cells. Additionally, pretreatment of AML cells with all-trans retinoic acid further augmented the cytotoxic potential of CD38 CAR-NK cells. These findings support the investigation of CD38 knockdown - CD38 CAR-NK cells as a promising immunotherapeutic approach for AML treatment.

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Natural Receptor- and Ligand-Based Chimeric Antigen Receptors: Strategies Using Natural Ligands and Receptors for Targeted Cell Killing

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Summary: This article discusses the success of CAR T-cell therapy in treating B-cell malignancies and the issues in CAR design. It explores the advantages and disadvantages of scFv-based and natural receptor- or ligand-based CAR designs. Additionally, it examines the translational aspects of natural receptor- and ligand-based CAR approaches being investigated in preclinical and clinical studies.
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CXCR4 and anti-BCMA CAR co-modified natural killer cells suppress multiple myeloma progression in a xenograft mouse model

Yu Yang Ng et al.

Summary: The study demonstrates that the co-expression of CXCR4 and anti-BCMA CAR on NK cells is an effective way to control MM progression by enhancing NK cell infiltration into the bone marrow and reducing tumor burden, leading to prolonged survival of patients.

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Decrease post-transplant relapse using donor-derived expanded NK-cells

Stefan O. Ciurea et al.

Summary: In this phase I/II clinical trial, high doses of mb-IL21 ex vivo expanded donor-derived NK cells were administered to 25 patients with myeloid malignancies undergoing haploidentical stem-cell transplantation. The results showed a significant decrease in the relapse rate and improved disease-free survival compared to the control group, with a particular benefit in patients without donor-specific anti-HLA antibodies. The administration of expanded NK cells post-transplantation was safe and led to NK cell-dominant immune reconstitution, preserved T-cell reconstitution, and better clinical outcomes.

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Human placental hematopoietic stem cell derived natural killer cells (CYNK-001) mediate protection against influenza a viral infection

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Innovative Strategies to Improve the Clinical Application of NK Cell-Based Immunotherapy

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Summary: This article summarizes the key challenges and innovative strategies in the clinical application of natural killer cell research.

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Yang Zhou et al.

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Natural killer cells in antitumour adoptive cell immunotherapy

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Summary: This review provides an overview of NK cell-based immunotherapies, discussing strategies to increase NK cell cytotoxicity and persistence and highlighting the current challenges and future opportunities for the design of next-generation NK cell therapies.

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Exploring the NK cell platform for cancer immunotherapy

Jacob A. Myers et al.

Summary: NK cells have innate potential to kill cancer cells, leading to the development of various NK cell-based therapies for cancer treatment. The main focus of NK cell therapy research is on optimizing sources of therapeutic NK cells and enhancing their cytotoxicity and persistence in the body.

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NK cell-based cancer immunotherapy: from basic biology to clinical development

Sizhe Liu et al.

Summary: NK cells, as a specialized immune effector cell type, play a critical role in immune activation against abnormal cells. Unlike T cell activation, NK cell activation is governed by interactions between NK receptors and target cells, leading to significant attention in cancer immunotherapy. Many efforts are focused on developing and engineering NK cell-based cancer immunotherapy.

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Engineering NK Cells for CAR Therapy-Recent Advances in Gene Transfer Methodology

Paula Schmidt et al.

Summary: The development of CAR-NK cells allows for harnessing the innate anti-tumor ability of NK cells against target tumor antigens, with the potential for creating an off-the-shelf therapeutic product applicable to most patients.

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Implications of hematopoietic stem cells heterogeneity for gene therapies

Jeremy Epah et al.

Summary: Hematopoietic stem cell transplantation (HSCT) is a therapeutic concept for curing blood/immune system diseases, but carries significant risks. Gene modified autologous HSC transplantation shows promise for treating blood/immune cell diseases, but the observed heterogeneity of HSCs in situ and ex vivo has important implications for gene therapy development and manufacturing.

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Optimizing the Procedure to Manufacture Clinical-Grade NK Cells for Adoptive Immunotherapy

Adrian Fernandez et al.

Summary: NK cells have shown promise in cancer immunotherapy, and an NK cell activation-expansion process was optimized and validated on a clinical scale in this study. Various cell culture media and artificial antigen presenting cells were used to obtain GMP-grade NK cells suitable for clinical use. NK cells derived from PBMC yielded higher purity and total cell numbers compared to CD45RA(+) cells, and the use of K562mbIL21-41BBL cells resulted in the highest fold expansion and NK purity.

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Investigation of product-derived lymphoma following infusion of piggyBac-modified CD19 chimeric antigen receptor T cells

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Summary: A phase 1 clinical trial using CAR T cells produced with the piggyBac transposon system resulted in the development of malignant lymphomas in two patients. One patient died as a result of the CAR T-cell derived lymphoma. The study highlights the importance of caution and regular follow-up in CAR T recipients, particularly when novel gene transfer methods are employed.
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Combining AFM13, a Bispecific CD30/CD16 Antibody, with Cytokine-Activated Blood and Cord Blood-Derived NK Cells Facilitates CAR-like Responses Against CD30+ Malignancies

Lucila N. Kerbauy et al.

Summary: The study suggests that using bispecific engagers and cytokine pre-activation can enhance NK-cell cytotoxicity against NK-resistant cancers. Additionally, there are differences in treatment response based on the source of NK cells.

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Cellular immunotherapy with multiple infusions of in vitro-expanded haploidentical natural killer cells after autologous transplantation for patients with plasma cell myeloma

Astrid Tschan-Plessl et al.

Summary: The study demonstrates the feasibility and safety of haploidentical NK cell infusions as consolidation immunotherapy after ASCT in patients with plasma cell myeloma. By manufacturing high numbers of activated NK cells for multiple-dose infusions, the treatment showed expected effects without evidence of graft-versus-host disease.

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Infusion reactions in natural killer cell immunotherapy: a retrospective review

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Summary: This study retrospectively analyzed infusion reactions associated with NK cell infusions, finding that most patients experienced grade 1 or 2 reactions, while a minority experienced grade 3 reactions mainly involving the cardiovascular system. Monocyte dose was associated with headaches and cardiovascular reactions, suggesting its significance in enhancing therapeutic outcomes.

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Current Perspectives on Off-The-Shelf Allogeneic NK and CAR-NK Cell Therapies

Erica L. Heipertz et al.

Summary: Natural killer (NK) cells are a crucial part of the immune system, with the ability to kill virally infected and malignant cells. Current research is focused on testing the efficacy of NK cell therapy for cancer and exploring the use of CAR-NK for treatment.

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piggyBac system to co-express NKG2D CAR and IL-15 to augment the in vivo persistence and anti-AML activity of human peripheral blood NK cells

Zhicheng Du et al.

Summary: Significant progress has been made in adoptive transfer of CAR-modified NK cells for treating relapsed or refractory AML. The co-expression of NKG2D CAR and IL-15 in NK cells enhances anti-leukemic activity and offers a promising approach for AML therapy.

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The emerging role of off-the-shelf engineered natural killer cells in targeted cancer immunotherapy

Kellsye P. Fabian et al.

Summary: This review outlines the importance of NK cells in cancer treatment and the development of NK-92 cell line in CAR-engineering, demonstrating robust antitumor activity and potential as a next-generation off-the-shelf cell therapy platform.

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NICOTINAMIDE REJUVENATES EX-VIVO EXPANDED NATURAL KILLER CELLS AND ENHANCES THEIR TUMOR KILLING CAPACITY

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Chimeric antigen receptor natural killer (CAR-NK) cell design and engineering for cancer therapy

Ying Gong et al.

Summary: NK cells, especially CAR-NK cells, play a crucial role in cancer treatment. Advances in CAR-NK technology show promising potential in efficiently targeting cancer cells with reduced side effects. These developments contribute to improving cancer treatment strategies.

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Lymphocyte expansion in bioreactors: upgrading adoptive cell therapy

Oscar Fabian Garcia-Aponte et al.

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Cryopreservation of NK and T Cells Without DMSO for Adoptive Cell-Based Immunotherapy

Xue Yao et al.

Summary: DMSO, commonly used as a cryoprotectant in clinical adoptive cell therapy, has broad toxicities and is associated with various clinical side effects in patients. Developing alternatives to DMSO for cryopreservation of NK and T cells remains challenging due to their sensitivity to freezing and thawing.

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Graft-versus-host disease risk after chimeric antigen receptor T-cell therapy: the diametric opposition of T cells

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Harnessing features of adaptive NK cells to generate iPSC-derived NK cells for enhanced immunotherapy

Karrune Woan et al.

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A Fusion Protein Complex that Combines IL-12, IL-15, and IL-18 Signaling to Induce Memory-Like NK Cells for Cancer Immunotherapy

Michelle K. Becker-Hapak et al.

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A Novel off-the-Shelf Trastuzumab-Armed NK Cell Therapy (ACE1702) Using Antibody-Cell-Conjugation Technology

Hao-Kang Li et al.

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One-Time Optimization of Advanced T Cell Culture Media Using a Machine Learning Pipeline

Paul Grzesik et al.

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Expanded human NK cells armed with CAR uncouple potent anti-tumor activity from off-tumor toxicity against solid tumors

Ana L. Portillo et al.

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iPSC-Derived Natural Killer Cells for Cancer Immunotherapy

Peter Karagiannis et al.

Summary: The discovery of human pluripotent stem cells (PSCs) has led to the exploration of induced pluripotent stem cells (iPSCs) as a potential universal cell source for therapies, including cancer immunotherapies using natural killer (NK cells). iPSCs offer advantages in quality and flexibility compared to primary NK cells, and there are various protocols for genetic modification and differentiation into NK cells. However, there are challenges that need to be addressed before iPSC-based NK cell immunotherapies can become mainstream in clinical settings.

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HSP70/IL-2 Treated NK Cells Effectively Cross the Blood Brain Barrier and Target Tumor Cells in a Rat Model of Induced Glioblastoma Multiforme (GBM)

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