Time to evolve: predicting engineered T cell-associated toxicity with next-generation models.

Despite promising clinical results in a small subset of malignancies, therapies based on engineered chimeric antigen receptor and T-cell receptor T cells are associated with serious adverse events, including cytokine release syndrome and neurotoxicity. These toxicities are sometimes so severe that they significantly hinder the implementation of this therapeutic strategy. For a long time, existing preclinical models failed to predict severe toxicities seen in human clinical trials after engineered T-cell infusion. However, in recent years, there has been a concerted effort to develop models, including humanized mouse models, which can better recapitulate toxicities observed in patients. The Accelerating Development and Improving Access to CAR and TCR-engineered T cell therapy (T2EVOLVE) consortium is a public-private partnership directed at accelerating the preclinical development and increasing access to engineered T-cell therapy for patients with cancer. A key ambition in T2EVOLVE is to design new models and tools with higher predictive value for clinical safety and efficacy, in order to improve and accelerate the selection of lead T-cell products for clinical translation. Herein, we review existing preclinical models that are used to test the safety of engineered T cells. We will also highlight limitations of these models and propose potential measures to improve them.
Competing Interests: Competing interests: ML is an inventor on a patent application related to CAR T-cell therapy filed by Philipps-University Marburg and the University of Würzburg. SA is an inventor of a patent in the field of adoptive T-cell therapy. CB received a research contract from Intellia Therapeutics and participated in the advisory boards of Molmed, Intellia Therapeutics, TxCell, Novartis, GSK, Allogene, and Kiadis, and is an inventor of patents in the field of adoptive T-cell therapy. DE’s PhD is cofunded between the academic lab led by ED as PhD supervisor and the industrial partner Invectys. ER is an inventor of a patent in the field of adoptive T-cell therapy. MT holds licensed patent related to CAR T cells. MH is an inventor on patents related to CAR T-cell therapy filed by the University of Würzburg. MC is an inventor of patents in the field of adoptive T-cell therapy. CH is an employee of Janssen R&D and shareholder of Johnson & Johnson stock. IM, BL, CH, and HN are full-time employees of Servier. RC, CKa, and JM are employees of Takeda Pharmaceuticals. MJ discloses research support from Kite/Gilead; honoraria for advisory boards, presentations and travel support from Kite/Gilead, Novartis, Celgene/BMS and Miltenyi Biotech (all to institution). All other authors state no potential competing interests.
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