Article(id=1199335107107586824, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199335100786766058, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1986.2023.0524, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1663689600000, receivedDateStr=2022-09-21, revisedDate=null, revisedDateStr=null, acceptedDate=1667491200000, acceptedDateStr=2022-11-04, onlineDate=1763873372103, onlineDateStr=2025-11-23, pubDate=1709049600000, pubDateStr=2024-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763873372103, onlineIssueDateStr=2025-11-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763873372103, creator=13701087609, updateTime=1763873372103, updator=13701087609, issue=Issue{id=1199335100786766058, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='2', pageStart='123', pageEnd='244', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763873370596, creator=13701087609, updateTime=1763874072387, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1199338044361896535, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199335100786766058, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1199338044361896536, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199335100786766058, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=220, endPage=228, ext={EN=ArticleExt(id=1199335107388605208, articleId=1199335107107586824, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Advances in the study of neoantigen pulsed dendritic cell vaccines in tumor immunotherapy, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Neoantigen pulsed dendritic cell vaccine (Neo-DCVac) is a new type of tumor immunotherapy. Neoantigen is strong immunologic and tumor-specific mutated peptides expressed in a tumor. Neo-DCVac is a therapeutic modality based on the uptake and processing of neoantigens by dendritic cells and their delivery and activation of T cells to trigger the body's immune response for anti-tumor effects. The development of individualized Neo-DCVac based on high-throughput sequencing is expected to be a new direction for precision immunotherapy of tumors. In this review, we discuss construction of individualized Neo-DCVac, clinical application of combination therapy in solid tumors, suitable population for vaccination and the current limitations of Neo-DCVac, aiming to provide a theoretical reference for research on tumor immunotherapy.

, correspAuthors=Yu-Min Li, authorNote=null, correspAuthorsNote=
E-mail:
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新抗原脉冲树突状细胞疫苗(Neo-DCVac)是一种新型肿瘤免疫治疗手段。新抗原是指肿瘤细胞突变产生的具有较强免疫原性和肿瘤特异性的肽段。Neo-DCVac是基于新抗原被树突状细胞摄取、加工后递呈并激活T细胞引发机体免疫反应,从而发挥抗肿瘤作用。在高通量测序基础上发展而来的个体化Neo-DCVac有望成为肿瘤精准免疫治疗的新方向。本文从个体化Neo-DCVac构建、在实体瘤中联合治疗的临床应用、适宜接种人群和目前存在的局限性等方面进行综述,旨在为肿瘤免疫治疗的相关研究提供参考。

, correspAuthors=李玉民, authorNote=null, correspAuthorsNote=
李玉民,E-mail:
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王彤昕,硕士研究生,主要从事消化系统肿瘤治疗方面的研究

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王彤昕,硕士研究生,主要从事消化系统肿瘤治疗方面的研究

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王彤昕,硕士研究生,主要从事消化系统肿瘤治疗方面的研究

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DC. 树突状细胞;IL. 白细胞介素;GM-CSF. 粒细胞-巨噬细胞集落刺激因子;TNF-ɑ. 肿瘤坏死因子-ɑ;PGE2. 地诺前列酮;Neo-DCVac. 新抗原脉冲树突状细胞疫苗

, figureFileSmall=P4TCJEGruG+v6PTyaFk/pw==, figureFileBig=uJpLV3ebmUeNf7JCgypURg==, tableContent=null), ArticleFig(id=1199335113021554703, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335107107586824, language=EN, label=Tab.1, caption=

Summary of clinical trials conducted for the new antigen pulse DC vaccine (ClinicalTrials.gov)

, figureFileSmall=null, figureFileBig=null, tableContent=
登记号时间肿瘤类型用药方案研究阶段发起单位招募例数(n)
NCT036740732018.10.15-2020.12.15肝细胞癌肝细胞癌(3 cm≤肿瘤直径≤5 cm,少于3个肿瘤)患者接受微波消融和7个疗程的Neo-DCVac治疗。在微波消融完成后30 d进行第1剂Neo-DCVac注射。疫苗接种的时间表是 1、8、15、22、50、78、106 dⅠ期解放军总医院24
NCT049127652021.4.15-2025.5肝癌、结直肠癌每2周皮内注射10剂Neo-DCVac,剂量为300~500万个细胞,共10剂,从第2剂疫苗开始静脉输注30 min 240 mg纳武鲁单抗联合治疗;完成10剂Neo-DCVac后,每4周静脉输注480 mg纳武单抗,最多9剂,总持续时间为1年Ⅱ期新加坡国家癌症中心60
NCT033008432018.4.11-2019.9.16黑色素瘤、胃肠道癌、乳腺癌、卵巢癌、胰腺癌在0 d、14 d(+/- 5 d)、 28 d(+/- 5 d)和 42 d(+/- 5 d)静脉输注或皮下注射肽负载DC疫苗Ⅱ期美国国家癌症研究所/美国国立卫生研究院临床中心1
NCT038712052019.4.1-2020.12.30难治性肺癌每周在患者相邻淋巴结皮下注射1次Neo-DCVac,总共6剂Ⅰ期深圳市人民医院30
NCT040782692019.8.26-2021.12.31非小细胞肺癌每 2 周静脉输注 MIDRIXNEO-LUNG DC疫苗,使用患者内剂量递增方案:10×106 DC(最小剂量)、20×106 DC、40×106 DC、80×106 DC、100×106 DC(最大剂量),直到最大剂量或发生 ≥3 级毒性事件Ⅰ期根特大学医院6
NCT052707202022.9.1-2024.4.1复发性卵巢癌标准化疗+负载肿瘤相关抗原和患者特异性新抗原的DC疫苗,总DC剂量为5×106,若出现不可接受的不良反应,则剂量降为2.5×106;若未出现不可接受的不良反应,则总剂量增为1×107Ⅰ期四川大学华西第二医院9
NCT053173252022.4.1-2024.4.1食管鳞状细胞癌首阶段注射HOCl-氧化自体肿瘤裂解物(OCDC)脉冲的自体DC疫苗,增强阶段注射Neo-DCVacⅠ期四川大学20
NCT041055822019.8.1-2022.3.1三阴性乳腺癌完成常规治疗(化疗或手术)的患者接种Neo-DCVacⅠ期哥伦比亚国立大学5
NCT018857022010.10-2022.10结直肠癌——Ⅰ/Ⅱ期拉德堡大学医学中心25
NCT049683662021.7.30-2024.8脑多形性胶质母细胞瘤在接受替莫唑胺辅助化疗期间,于化疗后2、3、4、7、11周在患者腹股沟和腋窝淋巴结区域静脉注射5~8剂负载多种肿瘤新抗原肽的自体DC疫苗,每剂疫苗含2~1000万个DC细胞及5~20个肿瘤新抗原肽Ⅰ期北京天坛医院10
NCT009239102008.2.22-2016.11.15血液系统恶性肿瘤每 2 周于上臂或大腿注射 2次Wilm's Tumor 1(WT1) 疫苗,在疫苗注射后约1 h,静脉输注15~30 min供体淋巴细胞,持续 6 周(第 0、2、4、6、8、10 周)Ⅰ/Ⅱ期美国国家癌症研究所/美国国立卫生研究院临床中心10
NCT037355892022.5.15-2024.5.1原发性卵巢癌试验前2周、0 d和28 d皮内注射α-1型极化DC疫苗联合自然杀伤细胞样细胞毒性T淋巴细胞(nCTLs)Ⅰ/Ⅱa期罗斯威尔公园癌症研究所18
NCT029565512016.11.30-2020.6.1非小细胞肺癌每2周皮下注射 1次Neo-DCVac,共5剂Ⅰ期四川大学20
NCT041470782019.6.1-2023.6.1胃癌、肝癌、非小细胞肺癌、结直肠癌间隔2~3周皮下注射1次Neo-DCVac,共3~5次Ⅰ期四川大学80
NCT038701132019.4.1-2022.12.30宫颈上皮内瘤变每周在相邻淋巴结注射1次负载HPV 16/18 E6/E7的自体成熟DC疫苗,共6剂Ⅰ期深圳市人民医院80
NCT047496412021.3.8-2024.4.1弥漫性内源性脑桥胶质瘤分别在1、3、15、29、57、85 d皮下注射含有H3.3-K27M靶向新抗原肽和聚ICLC的疫苗,此后每8周注射1次。采用"6+3"剂量递增设计。该疫苗有3个剂量。剂量1:0.5 mg肽+聚 ICLC;剂量2:1.0 mg肽+聚ICLC;剂量3:2.0 mg肽+聚ICLCⅠ期北京天坛医院30
NCT048798882016.8-2017.7.30乳腺癌术后每周用患者血清中的200 μl肽脉冲自体DC疫苗进行皮内接种,共6剂Ⅰ期哥伦比亚国立大学医学院9
NCT040729002020.4.21-2022.9.1黑色素瘤注射前6 h在注射部位局部涂抹5%咪喹莫特外用药膏,在第84、87、91、98、105、133、161 d给予4×3 mg总肽+3 mg/kg托里帕利单抗,在第81、82、83、95、96、97、102、103、104、130、131、132、158、159、160 d给予3 μg/kg rhGM-CSFⅠ期中南大学湘雅医院30
NCT039147682019.3.31-2022.12.31弥漫性内源性脑桥胶质瘤/胶质母细胞瘤接种前静脉注射环磷酰胺(200 mg/m2)或口服环磷酰胺,次日在肿瘤附近的淋巴组织周围注射Neo-DCVac并静脉注射贝伐珠单抗(15 mg/kg),连续6个月,每月重复输注,每次注射的DC疫苗细胞量基于先前报告的(5~10)×106,实施初始剂量递增方案Ⅰ期深圳市基因免疫医学研究所10
NCT050201192021.4.9-2023.6.30晚期实体瘤低、中、高3种不同剂量的新抗原细胞疗法(n=3+3):(1±20%)×109个,(3±20%)×109个,(9±20%)×109个个体化新抗原扩增T(CIK)细胞/ 200 ml,每14 d给药,共10剂Ⅰ期长庚纪念医院9
NCT006836702008.8-2016.6黑色素瘤接种前3 d静脉注射环磷酰胺300mg/m2,每3周静脉注射1次Neo-DCVac,共6剂,疫苗含有2种gp100黑色素瘤肽(G209-2M和G280-9V)及10种黑色素瘤特异性肽Ⅰ期华盛顿大学医学院17
), ArticleFig(id=1199335113118023700, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335107107586824, language=CN, label=表1, caption=

新抗原脉冲DC疫苗的临床试验开展情况(ClinicalTrials.gov)

, figureFileSmall=null, figureFileBig=null, tableContent=
登记号时间肿瘤类型用药方案研究阶段发起单位招募例数(n)
NCT036740732018.10.15-2020.12.15肝细胞癌肝细胞癌(3 cm≤肿瘤直径≤5 cm,少于3个肿瘤)患者接受微波消融和7个疗程的Neo-DCVac治疗。在微波消融完成后30 d进行第1剂Neo-DCVac注射。疫苗接种的时间表是 1、8、15、22、50、78、106 dⅠ期解放军总医院24
NCT049127652021.4.15-2025.5肝癌、结直肠癌每2周皮内注射10剂Neo-DCVac,剂量为300~500万个细胞,共10剂,从第2剂疫苗开始静脉输注30 min 240 mg纳武鲁单抗联合治疗;完成10剂Neo-DCVac后,每4周静脉输注480 mg纳武单抗,最多9剂,总持续时间为1年Ⅱ期新加坡国家癌症中心60
NCT033008432018.4.11-2019.9.16黑色素瘤、胃肠道癌、乳腺癌、卵巢癌、胰腺癌在0 d、14 d(+/- 5 d)、 28 d(+/- 5 d)和 42 d(+/- 5 d)静脉输注或皮下注射肽负载DC疫苗Ⅱ期美国国家癌症研究所/美国国立卫生研究院临床中心1
NCT038712052019.4.1-2020.12.30难治性肺癌每周在患者相邻淋巴结皮下注射1次Neo-DCVac,总共6剂Ⅰ期深圳市人民医院30
NCT040782692019.8.26-2021.12.31非小细胞肺癌每 2 周静脉输注 MIDRIXNEO-LUNG DC疫苗,使用患者内剂量递增方案:10×106 DC(最小剂量)、20×106 DC、40×106 DC、80×106 DC、100×106 DC(最大剂量),直到最大剂量或发生 ≥3 级毒性事件Ⅰ期根特大学医院6
NCT052707202022.9.1-2024.4.1复发性卵巢癌标准化疗+负载肿瘤相关抗原和患者特异性新抗原的DC疫苗,总DC剂量为5×106,若出现不可接受的不良反应,则剂量降为2.5×106;若未出现不可接受的不良反应,则总剂量增为1×107Ⅰ期四川大学华西第二医院9
NCT053173252022.4.1-2024.4.1食管鳞状细胞癌首阶段注射HOCl-氧化自体肿瘤裂解物(OCDC)脉冲的自体DC疫苗,增强阶段注射Neo-DCVacⅠ期四川大学20
NCT041055822019.8.1-2022.3.1三阴性乳腺癌完成常规治疗(化疗或手术)的患者接种Neo-DCVacⅠ期哥伦比亚国立大学5
NCT018857022010.10-2022.10结直肠癌——Ⅰ/Ⅱ期拉德堡大学医学中心25
NCT049683662021.7.30-2024.8脑多形性胶质母细胞瘤在接受替莫唑胺辅助化疗期间,于化疗后2、3、4、7、11周在患者腹股沟和腋窝淋巴结区域静脉注射5~8剂负载多种肿瘤新抗原肽的自体DC疫苗,每剂疫苗含2~1000万个DC细胞及5~20个肿瘤新抗原肽Ⅰ期北京天坛医院10
NCT009239102008.2.22-2016.11.15血液系统恶性肿瘤每 2 周于上臂或大腿注射 2次Wilm's Tumor 1(WT1) 疫苗,在疫苗注射后约1 h,静脉输注15~30 min供体淋巴细胞,持续 6 周(第 0、2、4、6、8、10 周)Ⅰ/Ⅱ期美国国家癌症研究所/美国国立卫生研究院临床中心10
NCT037355892022.5.15-2024.5.1原发性卵巢癌试验前2周、0 d和28 d皮内注射α-1型极化DC疫苗联合自然杀伤细胞样细胞毒性T淋巴细胞(nCTLs)Ⅰ/Ⅱa期罗斯威尔公园癌症研究所18
NCT029565512016.11.30-2020.6.1非小细胞肺癌每2周皮下注射 1次Neo-DCVac,共5剂Ⅰ期四川大学20
NCT041470782019.6.1-2023.6.1胃癌、肝癌、非小细胞肺癌、结直肠癌间隔2~3周皮下注射1次Neo-DCVac,共3~5次Ⅰ期四川大学80
NCT038701132019.4.1-2022.12.30宫颈上皮内瘤变每周在相邻淋巴结注射1次负载HPV 16/18 E6/E7的自体成熟DC疫苗,共6剂Ⅰ期深圳市人民医院80
NCT047496412021.3.8-2024.4.1弥漫性内源性脑桥胶质瘤分别在1、3、15、29、57、85 d皮下注射含有H3.3-K27M靶向新抗原肽和聚ICLC的疫苗,此后每8周注射1次。采用"6+3"剂量递增设计。该疫苗有3个剂量。剂量1:0.5 mg肽+聚 ICLC;剂量2:1.0 mg肽+聚ICLC;剂量3:2.0 mg肽+聚ICLCⅠ期北京天坛医院30
NCT048798882016.8-2017.7.30乳腺癌术后每周用患者血清中的200 μl肽脉冲自体DC疫苗进行皮内接种,共6剂Ⅰ期哥伦比亚国立大学医学院9
NCT040729002020.4.21-2022.9.1黑色素瘤注射前6 h在注射部位局部涂抹5%咪喹莫特外用药膏,在第84、87、91、98、105、133、161 d给予4×3 mg总肽+3 mg/kg托里帕利单抗,在第81、82、83、95、96、97、102、103、104、130、131、132、158、159、160 d给予3 μg/kg rhGM-CSFⅠ期中南大学湘雅医院30
NCT039147682019.3.31-2022.12.31弥漫性内源性脑桥胶质瘤/胶质母细胞瘤接种前静脉注射环磷酰胺(200 mg/m2)或口服环磷酰胺,次日在肿瘤附近的淋巴组织周围注射Neo-DCVac并静脉注射贝伐珠单抗(15 mg/kg),连续6个月,每月重复输注,每次注射的DC疫苗细胞量基于先前报告的(5~10)×106,实施初始剂量递增方案Ⅰ期深圳市基因免疫医学研究所10
NCT050201192021.4.9-2023.6.30晚期实体瘤低、中、高3种不同剂量的新抗原细胞疗法(n=3+3):(1±20%)×109个,(3±20%)×109个,(9±20%)×109个个体化新抗原扩增T(CIK)细胞/ 200 ml,每14 d给药,共10剂Ⅰ期长庚纪念医院9
NCT006836702008.8-2016.6黑色素瘤接种前3 d静脉注射环磷酰胺300mg/m2,每3周静脉注射1次Neo-DCVac,共6剂,疫苗含有2种gp100黑色素瘤肽(G209-2M和G280-9V)及10种黑色素瘤特异性肽Ⅰ期华盛顿大学医学院17
), ArticleFig(id=1199335114300817434, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335107107586824, language=EN, label=Tab.2, caption=

Summary of clinical trials conducted for the new antigen pulse DC vaccine (Chinese Clinical Trial Registry)

, figureFileSmall=null, figureFileBig=null, tableContent=
注册号注册题目注册时间干预措施研究所处阶段研究单位
ChiCTR2100054020肿瘤新抗原致敏的自体DC细胞制剂治疗晚期恶性实体肿瘤的安全性及有效性的I/II期临床研究2021/12/6肿瘤新抗原致敏的自体DC细胞制剂治疗Ⅰ期+Ⅱ期北京大学肿瘤医院
ChiCTR2100051604靶向恶性实体肿瘤新抗原的个体化免疫细胞治疗转化研究2021/9/28输注靶向突变新抗原的 DC-T 细胞Ⅰ期临床试验四川大学华西医院
ChiCTR2100042735肿瘤新抗原负载的个体化DC疫苗治疗肝癌脊柱转移的前瞻性临床试验研究2021/1/27DC疫苗免疫治疗探索性研究/预试验海军军医大学长征医院
ChiCTR2000040901肿瘤新抗原负载的个体化DC疫苗治疗肾癌脊柱转移的前瞻性临床试验研究2020/12/14DC疫苗免疫治疗探索性研究/预试验上海长征医院
ChiCTR2000040715肿瘤新抗原负载的个体化DC疫苗治疗肺癌脊柱转移的前瞻性临床试验研究2020/12/8DC疫苗免疫治疗Ⅱ期临床试验上海长征医院
ChiCTR2000040482肿瘤新抗原负载的个体化DC疫苗治疗乳腺癌脊柱转移的前瞻性、单中心临床试验研究2020/11/30DC疫苗免疫治疗Ⅱ期临床试验上海长征医院
ChiCTR2000040158肿瘤新抗原负载的个体化DC疫苗治疗脊柱转移瘤的前瞻性、单中心临床试验研究2020/11/23DC疫苗免疫治疗Ⅱ期临床试验上海长征医院
ChiCTR1900022835嵌合型新抗原反应性T细胞(cnTs)联合负载个体化新抗原的DC肿瘤细胞(neoDC-Vx)治疗进展期难治性恶性肿瘤前瞻性单臂临床研究方案2019/4/27免疫治疗探索性研究/预试验西南医科大学附属医院
ChiCTR1900021842靶向肿瘤新抗原的高反应性疫苗治疗复发难治性肺癌2019/3/12负载新抗原的DC疫苗皮下注射Ⅰ期临床试验深圳市人民医院
ChiCTR1900020883个体化新抗原复合多肽肿瘤免疫治疗临床试验研究2019/1/21肿瘤新抗原多肽负载 DCCs.Ⅰ期临床试验甘肃省人民医院
ChiCTR1800016805个体化多靶点肿瘤新抗原免疫细胞治疗实体瘤的安全性、耐受性和有效性的I/II期临床试验2018/6/26新抗原反应性DC细胞疫苗Ⅰ期+Ⅱ期郑州大学第一附属医院
), ArticleFig(id=1199335114422452254, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199335107107586824, language=CN, label=表2, caption=

新抗原脉冲DC疫苗的临床试验开展情况(中国临床试验注册中心)

, figureFileSmall=null, figureFileBig=null, tableContent=
注册号注册题目注册时间干预措施研究所处阶段研究单位
ChiCTR2100054020肿瘤新抗原致敏的自体DC细胞制剂治疗晚期恶性实体肿瘤的安全性及有效性的I/II期临床研究2021/12/6肿瘤新抗原致敏的自体DC细胞制剂治疗Ⅰ期+Ⅱ期北京大学肿瘤医院
ChiCTR2100051604靶向恶性实体肿瘤新抗原的个体化免疫细胞治疗转化研究2021/9/28输注靶向突变新抗原的 DC-T 细胞Ⅰ期临床试验四川大学华西医院
ChiCTR2100042735肿瘤新抗原负载的个体化DC疫苗治疗肝癌脊柱转移的前瞻性临床试验研究2021/1/27DC疫苗免疫治疗探索性研究/预试验海军军医大学长征医院
ChiCTR2000040901肿瘤新抗原负载的个体化DC疫苗治疗肾癌脊柱转移的前瞻性临床试验研究2020/12/14DC疫苗免疫治疗探索性研究/预试验上海长征医院
ChiCTR2000040715肿瘤新抗原负载的个体化DC疫苗治疗肺癌脊柱转移的前瞻性临床试验研究2020/12/8DC疫苗免疫治疗Ⅱ期临床试验上海长征医院
ChiCTR2000040482肿瘤新抗原负载的个体化DC疫苗治疗乳腺癌脊柱转移的前瞻性、单中心临床试验研究2020/11/30DC疫苗免疫治疗Ⅱ期临床试验上海长征医院
ChiCTR2000040158肿瘤新抗原负载的个体化DC疫苗治疗脊柱转移瘤的前瞻性、单中心临床试验研究2020/11/23DC疫苗免疫治疗Ⅱ期临床试验上海长征医院
ChiCTR1900022835嵌合型新抗原反应性T细胞(cnTs)联合负载个体化新抗原的DC肿瘤细胞(neoDC-Vx)治疗进展期难治性恶性肿瘤前瞻性单臂临床研究方案2019/4/27免疫治疗探索性研究/预试验西南医科大学附属医院
ChiCTR1900021842靶向肿瘤新抗原的高反应性疫苗治疗复发难治性肺癌2019/3/12负载新抗原的DC疫苗皮下注射Ⅰ期临床试验深圳市人民医院
ChiCTR1900020883个体化新抗原复合多肽肿瘤免疫治疗临床试验研究2019/1/21肿瘤新抗原多肽负载 DCCs.Ⅰ期临床试验甘肃省人民医院
ChiCTR1800016805个体化多靶点肿瘤新抗原免疫细胞治疗实体瘤的安全性、耐受性和有效性的I/II期临床试验2018/6/26新抗原反应性DC细胞疫苗Ⅰ期+Ⅱ期郑州大学第一附属医院
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新抗原脉冲树突状细胞疫苗在肿瘤免疫治疗中的作用
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王彤昕 1, 2 , 张凡 1, 2 , 闫鑫 1, 2 , 张雅婷 1, 2 , 李玉民 1, 2, *
解放军医学杂志 | 综述 2024,49(2): 220-228
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解放军医学杂志 | 综述 2024, 49(2): 220-228
新抗原脉冲树突状细胞疫苗在肿瘤免疫治疗中的作用
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王彤昕1, 2, 张凡1, 2, 闫鑫1, 2, 张雅婷1, 2, 李玉民1, 2, *
作者信息
  • 1甘肃省消化系肿瘤重点实验室,甘肃兰州 730030
  • 2兰州大学第二医院肿瘤外科,甘肃兰州 730030
  • 王彤昕,硕士研究生,主要从事消化系统肿瘤治疗方面的研究

通讯作者:

李玉民,E-mail:
Advances in the study of neoantigen pulsed dendritic cell vaccines in tumor immunotherapy
Tong-Xin Wang1, 2, Fan Zhang1, 2, Xin Yan1, 2, Ya-Ting Zhang1, 2, Yu-Min Li1, 2, *
Affiliations
  • 1Gansu Provincial Key Laboratory of Gastrointestinal Tumors, Lanzhou, Gansu 730030, China
  • 2Department of Tumor Surgery, the Second Hospital of Lanzhou University, Lanzhou, Gansu 730030, China
出版时间: 2024-02-28 doi: 10.11855/j.issn.0577-7402.1986.2023.0524
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新抗原脉冲树突状细胞疫苗(Neo-DCVac)是一种新型肿瘤免疫治疗手段。新抗原是指肿瘤细胞突变产生的具有较强免疫原性和肿瘤特异性的肽段。Neo-DCVac是基于新抗原被树突状细胞摄取、加工后递呈并激活T细胞引发机体免疫反应,从而发挥抗肿瘤作用。在高通量测序基础上发展而来的个体化Neo-DCVac有望成为肿瘤精准免疫治疗的新方向。本文从个体化Neo-DCVac构建、在实体瘤中联合治疗的临床应用、适宜接种人群和目前存在的局限性等方面进行综述,旨在为肿瘤免疫治疗的相关研究提供参考。

新抗原  /  树突状细胞疫苗  /  肿瘤  /  免疫治疗

Neoantigen pulsed dendritic cell vaccine (Neo-DCVac) is a new type of tumor immunotherapy. Neoantigen is strong immunologic and tumor-specific mutated peptides expressed in a tumor. Neo-DCVac is a therapeutic modality based on the uptake and processing of neoantigens by dendritic cells and their delivery and activation of T cells to trigger the body's immune response for anti-tumor effects. The development of individualized Neo-DCVac based on high-throughput sequencing is expected to be a new direction for precision immunotherapy of tumors. In this review, we discuss construction of individualized Neo-DCVac, clinical application of combination therapy in solid tumors, suitable population for vaccination and the current limitations of Neo-DCVac, aiming to provide a theoretical reference for research on tumor immunotherapy.

neoantigen  /  dendritic cell vaccine  /  tumor  /  immunotherapy
王彤昕, 张凡, 闫鑫, 张雅婷, 李玉民. 新抗原脉冲树突状细胞疫苗在肿瘤免疫治疗中的作用. 解放军医学杂志, 2024 , 49 (2) : 220 -228 . DOI: 10.11855/j.issn.0577-7402.1986.2023.0524
Tong-Xin Wang, Fan Zhang, Xin Yan, Ya-Ting Zhang, Yu-Min Li. Advances in the study of neoantigen pulsed dendritic cell vaccines in tumor immunotherapy[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (2) : 220 -228 . DOI: 10.11855/j.issn.0577-7402.1986.2023.0524
据国际癌症研究机构统计显示,2020年全球新发癌症约1930万例,癌症死亡近1000万例[1]。我国预计2022年新发癌症482万例,癌症死亡321万例[2]。近年我国癌症的发病率总体呈上升趋势,疾病负担日益加重,严重威胁民众健康。对于早期实体瘤患者,根治性肿瘤切除联合全身治疗是目前的标准治疗方案;但多数恶性肿瘤患者确诊时已进展至晚期,失去外科手术治疗的最佳时机,预后较差[3]。因此,临床上迫切需要新的肿瘤治疗方法。肿瘤免疫治疗主要包括基于抗体的治疗、肿瘤疫苗、免疫检查点抑制剂(immune checkpoint inhibitor,ICI)治疗及过继细胞疗法等[4]。近年来,基于新生抗原的个体化树突状细胞(dendritic cell,DC)疫苗成为肿瘤免疫治疗的又一研究热点[5-6]。新抗原脉冲树突状细胞疫苗(neoantigen pulsed dendritic cell vaccine,Neo-DCVac)是利用肿瘤表面因基因突变产生的具有较强免疫原性和肿瘤特异性的的新生抗原制作,可激活并增强机体的主动免疫反应,产生大量可识别新生抗原的淋巴细胞的新型肿瘤免疫治疗手段[7-8]。Neo-DCVac可在不损伤正常组织的同时杀伤表达此抗原的肿瘤细胞,靶向性更强[9]。Neo-DCVac回输体内后可活化免疫细胞,激活免疫系统的抗肿瘤反应,还可产生特异性记忆免疫细胞,阻止肿瘤复发。研究显示Neo-DCVac是安全、可行的肿瘤免疫治疗方法[9-10],为肿瘤精准免疫治疗提供了新途径。本文综述近年来Neo-DCVac的相关研究及临床应用进展,旨在为肿瘤免疫治疗的相关研究提供理论参考。
新抗原是指肿瘤细胞中外显子发生基因突变所表达产生的新的肽段[11-12],其中基因突变包括非同义突变、基因融合、移码突变、插入/缺失突变、单核苷酸变异及复杂的空间结构改变等[13]。新抗原属于肿瘤抗原中的肿瘤特异性抗原(tumor specific antigen,TSA),为肿瘤细胞所特有,不存在于正常组织中,具有较强的肿瘤特异性和免疫原性。因此,基于新抗原的DC疫苗脱靶效应低[14],且不受胸腺阴性选择的限制,可避免中枢免疫耐受,用于治疗时不易引起自身免疫性疾病[15],因此新抗原可作为抗肿瘤靶点。突变基因经翻译表达的氨基酸序列需加工成短肽片段,以肽-主要组织相容性复合体(major histocompatibility complex,MHC)的形式在细胞表面表达,被免疫系统识别,激活机体特异性T细胞的杀伤作用,从而引发抗肿瘤反应[16]
突变的DNA序列可在蛋白质水平表达和加工成短肽片段,且短肽与MHC分子的亲和力、短肽-MHC复合物与T细胞抗原受体(T cell receptor,TCR)的亲和力均较强,满足以上条件的突变基因才可产生有效的个体化新抗原[17]。基因突变的类型、突变的表达程度、抗原提呈细胞的呈递能力及肿瘤微环境(tumor microenvironment,TME)等因素可决定产生的新抗原能否诱导有效的抗肿瘤免疫反应。
产生新抗原的突变基因可分为“驱动基因”和“乘客基因”。“驱动基因”多为原癌基因或抑癌基因发生突变,可影响细胞周期、细胞增殖和DNA损伤过程。“乘客基因”为随机突变产生,占新抗原突变基因的90%。因此,新抗原的产生具有随机性,加之肿瘤的高度异质性,导致在肿瘤患者间仅有少量新抗原相同。因此,负载新抗原的疫苗需根据患者情况进行个体化定制[18-21]。鉴于实体瘤的异质性和多种抗原的存在,需要开发可靶向多种新抗原的疫苗,以提高抗肿瘤免疫应答的效能[22]
不同类型肿瘤的基因突变率存在较大差异。突变频率可用肿瘤突变负荷(tumor mutational burden,TMB)衡量,高TMB提示肿瘤突变产生的候选新抗原数量多,制备出Neo-DCVac的概率大[14,23-24]。癌症基因组图谱( The Cancer Genome Atlas,TCGA)中来自18种实体瘤的数千个样本的RNA测序数据显示,TMB较高肿瘤的免疫原性也较高,更易被免疫系统识别,使体内T细胞反应强度增加,免疫治疗的效果更好,患者预后也更好[25]。在黑色素瘤、非小细胞肺癌、结直肠癌等多种实体瘤患者中,肿瘤TMB较高与患者生存率增高有关[26-29];而较低的TMB常会导致免疫逃逸[3]
1973年,Steinman等[30]首次报告DC。单核细胞-树突状细胞祖细胞(monocyte-dendritic cell progenitor,MDP)是普通树突状细胞祖细胞(common dendritic cell progenitor,CDP)和单核细胞(monocyte,MC)的直接前体,CDP和MC均可分化产生DC。CDP可在骨髓中成为前体DC(pre-DC),并分化为成熟和未成熟的浆细胞样DC(plasmacytoid dendritic cells,pDC)。pre-DC离开骨髓通过血液进入次级淋巴器官和非造血组织后可分化为常规DC(CD103+cDC、CD11b+cDC)。MC可在白细胞介素(interleukin,IL)-4、粒细胞-巨噬细胞集落刺激因子(granulocyte-macrophage colony stimulating factor,GM-CSF)、IL-1β、IL-6和肿瘤坏死因子(TNF)-α、地诺前列酮存在的情况下诱导分化为成熟的单核细胞来源的髓样DC(myeloid dendritic cells,mDC)[31]。单核细胞来源的DC可用于治疗性疫苗接种[32]。DC可有效摄取肿瘤抗原,处理加工后呈递给CD4+和CD8+ T细胞,使其活化[33]。此外,DC还可产生IL-12和干扰素(interferon,IFN),增强共刺激作用,扩增活化的肿瘤特异性CD4+和CD8+ T细胞[34]。DC还可与体内自然杀伤细胞、B细胞等其他免疫细胞相互作用,启动肿瘤特异性免疫反应而识别和杀死肿瘤,在抗肿瘤免疫中发挥重要作用近50年来,DC在T细胞介导的抗肿瘤免疫过程中的作用已得到深入研究[35]。恶性肿瘤常导致机体免疫功能下降,抗原呈递细胞的功能受到抑制,不能有效激活T细胞,难以启动抗肿瘤免疫应答。而肿瘤患者由于免疫系统受到抑制导致自体DC较少,为了取得良好的临床疗效,肿瘤免疫治疗应确保体内的抗原呈递细胞功能良好[36]。需在体外分离和扩增足够数量的DC,完成疫苗制备,再回输至患者体内[37]。基于肿瘤抗原脉冲的DC制作的疫苗安全性较高[38],可诱导有效的临床、免疫反应[39]
收集患者的肿瘤和正常组织样本,对样本中的DNA进行全外显子组测序(whole exome sequencing,WES)筛选体细胞非同义突变,同时对肿瘤样本进行RNA测序,确认突变基因的表达状态;使用生物信息学技术和预测算法鉴定并合成新抗原肽[40];通过白细胞分离术收集患者外周血单个核细胞(peripheral blood mononuclear cell,PBMC),并在人GM-CSF和IL-4存在下培养诱导分化为成熟DC,负载肿瘤新抗原后回输至患者体内[41]。相关流程见图1
Neo-DCVac的治疗效果与DC迁移到淋巴结的效率密切相关[35]。目前多数临床试验采用皮下注射接种Neo-DCVac(如NCT04912765、NCT03871205、NCT02956551、NCT04147078)。有研究指出,通过静脉、皮下、皮内等途径注射接种Neo-DCVac,仅有极少的DC到达淋巴结[42-44]。而通过淋巴结内给药,部分DC可被直接输送到T细胞致敏部位,故推荐接种Neo-DCVac时采用成熟DC的结内给药技术[45]
Zhang等[37]研究显示,Neo-DCVac和新抗原佐剂疫苗均可诱导肺癌模型小鼠的脾产生强烈的T细胞特异性反应,致免疫抑制调节性T细胞(regulatory cells,Tregs)显著减少,所有新抗原表位均产生诱导反应并抑制肿瘤生长;但在激活免疫反应和抑制肿瘤生长方面,Neo-DCVac优于新抗原佐剂疫苗。此外,Neo-DCVac还可增加中枢记忆T细胞和效应记忆T细胞的数量,诱导效应CD8+ T细胞分泌IFN-γ,防止肿瘤复发。该研究为肿瘤个体化免疫治疗中新抗原免疫方法的选择提供了实验依据。
TME与多种免疫逃逸机制相关,如高表达细胞程序性死亡-配体1(programmed cell death 1-ligand 1,PD-L1)[46]、产生吲哚胺2,3双加氧酶(indoleamine2,3-dioxygenase,IDO)[47]、募集Tregs[48-49],从而降低肿瘤免疫治疗的疗效;而Neo-DCVac可减少TME相关的免疫逃逸 。Sun等[50]使用抗CD38抗体、CpG联合L82 Neo-DCVac治疗LLC1肺癌细胞系模型小鼠[该小鼠对ICI治疗——抗程序性死亡受体1(programmed cell death protein 1,PD-1)、抗细胞毒性T淋巴细胞相关蛋白4(cytotoxic T-lymphocyte-associated protein 4,CTLA-4)的单克隆抗体均存在耐药性,其原因可能是T细胞浸润缺失和免疫识别功能不足],结果显示该疗法增加了CD8+和CD4+ T细胞浸润,减少了小鼠肿瘤中的Tregs数量,通过减弱TME中的抑制信号来增强T细胞反应,最终将免疫“冷”肿瘤转化为“热”肿瘤,抑制了肿瘤生长。Wang等[51]设计并制备了一种基于DC的酸性/光敏新抗原纳米疫苗治疗H22肝细胞癌(hepatocellular carcinoma,HCC)小鼠。HCC常处于免疫“冷”状态,免疫原性较低,导致HCC患者对ICI的总体缓解率较低[52]。结果显示该疫苗通过增强特异性T细胞免疫应答,重塑TME,有效地将肿瘤免疫“冷”状态转化为“热”状态,提高了肝癌免疫治疗应答率和远期疗效。
上述动物实验研究结果显示Neo-DCVac安全且有效,具有强免疫原性,不仅可诱导效应CD8+ T细胞分泌IFN-γ,还增加了记忆T细胞的数量阻止肿瘤复发。Neo-DCVac还可联合其他治疗手段来增加T细胞浸润,中和免疫抑制信号,改善TME,从而减弱对免疫检查点治疗耐药的现象。
Neo-DCVac已用于肿瘤免疫治疗的多项临床试验。2015年,Carreno等[53]设计了个体化Neo-DCVac 用于治疗晚期黑色素瘤的Ⅰ期临床试验,其后基于DC的肿瘤疫苗用于肿瘤免疫治疗的临床研究进展迅速。根据ClinicalTrials.gov网站的数据,全世界已完成或正在进行20项已注册的Neo-DCVac临床试验,其中16项处于临床Ⅰ期,3项为Ⅰ/Ⅱ期,2项处于临床Ⅱ期(表1)。已有3项临床试验完成并报告了研究结果。其中NCT03300843研究显示,患者对治疗有部分临床反应,但存在恶心、疲劳、注射部位反应、头痛、皮肤硬结等不良事件。NCT04879888研究显示,给药后患者T细胞对多克隆刺激的反应性功能恢复,接种肽脉冲DC疫苗后特异性CD8+ T细胞扩增。NCT00923910研究显示,给药后3~12周患者产生免疫反应,未发生急性移植物抗宿主病(graft-versus-host disease,GVHD),但存在血小板、白细胞、中性粒细胞数量降低和皮疹、皮肤瘙痒等不良事件。中国临床试验注册中心网站数据显示,目前有11项Neo-DCVac临床试验正在开展(表2)。
Ott等[54]针对黑色素瘤患者制备了免疫原性个体化Neo-DCVac,6例患者接种疫苗25个月后,4例没有肿瘤复发,2例肿瘤复发患者随后接受了PD-1抑制剂——派姆单抗联合治疗,结果显示患者肿瘤完全消退,预后良好;治疗过程中患者出现轻度流感样症状、注射部位红肿、皮疹等不良事件。该研究表明Neo-DCVac安全、可行,可联合派姆单抗诱导强烈的T细胞免疫应答,且不良反应较小,不受先前治疗的干扰[55]
Ding等[41]采用纳武单抗联合个体化Neo-DCVac的方法治疗转移性晚期肺癌(ChiCTR-ONC-16009100,NCT02956551);将12例患者的新鲜活检组织进行WES、RNA测序及生物信息学分析以筛选和合成免疫原性新抗原,每例患者选择12~30种基于肽的新抗原,给药后客观有效率为25%,疾病控制率(disease control rate,DCR)为75%,中位无进展生存期为5.5个月,中位总生存期为7.9个月,发生的不良事件程度均较轻且短暂。该研究在单独使用Neo-DCVac进行治疗时,观察到患者肿瘤增大;联合纳武单抗治疗后,肿瘤发生空洞化,提示肿瘤复发后Neo-DCVac可重新诱导机体对ICI免疫疗法产生客观临床反应,Neo-DCVac联合ICI治疗可增强T细胞的抗肿瘤能力,为新抗原疫苗治疗提供了新证据。
Guo等[55]使用个体化新抗原脉冲单核细胞来源的DC疫苗联合纳武单抗治疗晚期转移性胃癌患者,联合治疗后肿瘤体积迅速缩小;结果表明该治疗方案可诱导外周血中新抗原特异性的CD4+和CD8+ T细胞发生活化,并显著提高新抗原特异性T细胞应答率。
Harari等[56]使用个体化肽(personalized peptides,PEP)-DC疫苗联合铂类化疗治疗1例错配修复基因完整(proficient DNA mismatch repair,pMMR)、p53突变的浆液性子宫内膜癌(endometrial cancer,EC),成功诱导患者体内产生持久的T细胞应答,且从患者PBMC中分离的T细胞可识别抗原肽,提示该疫苗具有较强的免疫原性。该研究表明Neo-DCVac联合化疗可治疗无法手术及转移复发的肿瘤患者。
由于肿瘤免疫微环境的抑制作用,作为单一治疗手段的新抗原疫苗难以完全清除肿瘤组织。研究显示ICI可在大多数TMB高的患者中引起显著临床反应,但持续时间有限;且ICI治疗期间发生的适应性耐药与新抗原的基因突变有关。因此,可考虑将Neo-DCVac与ICI联合应用,以取得更好的治疗效果[57-58]。已有多项研究显示采用ICI(纳武单抗)联合Neo-DCVac治疗肿瘤晚期转移的患者可取得明显临床效果[41,55]
上述研究提示,目前单独使用Neo-DCVac的临床疗效仍不理想,而联合其他肿瘤疗法可取得一定的临床效果且安全可靠,不良反应可耐受。预计未来Neo-DCVac的治疗应用将趋于多元化,如通过寻找多个新抗原表位、与其他肿瘤疗法联合应用等,以增强治疗效果。
上述Neo-DCVac临床研究提示,该类疫苗在多种实体瘤治疗中安全、有效,可恢复由TME导致的免疫系统无反应性,重建细胞毒性T细胞(cytotoxic T-lymphocyte,CTL)的抗肿瘤能力,增强机体自身免疫细胞的肿瘤杀伤效果,且不良反应较轻。肿瘤晚期或术后复发的患者接种Neo-DCVac后也取得了明显的治疗效果,且不良反应可耐受。因此,目前接受常规治疗、治疗后无疾病进展、复发风险高或晚期肿瘤患者均可接受Neo-DCVac治疗,以取得更好的临床效果;而对标准治疗无反应或恶病质严重的患者则不建议接种Neo-DCVac。
目前Neo-DCVac的应用面临以下挑战和阻碍:(1)DC分离技术不完善,制作流程繁琐、耗时较长,工艺复杂,提取到的DC细胞数较少;(2)新抗原高度个体化,难以实现批量生产[59];(3)新抗原可经内吞途径被大量降解,导致筛选合成的新抗原数量不足;(4)目前只可对部分肿瘤突变产生的新抗原进行测序,而通过基因融合、缺失、插入等产生的新抗原仍难以预测;(5)新抗原筛选技术在转录后修饰和蛋白质水平效果不佳,限制了新抗原筛选的范围;(6)肿瘤免疫微环境中存在的免疫抑制影响疫苗治疗效果[3];(7)缺乏合适的疫苗接种后临床疗效评估指标。以上局限导致Neo-DCVac的研发处于瓶颈期,发展较慢,限制了Neo-DCVac的临床应用。笔者认为,可通过提高新抗原的预测能力,开展联合治疗,使用临床前模型评估疫苗配方、佐剂、剂量、用药时间、给药途径等方法来进一步推进Neo-DCVac的治疗应用。
肿瘤免疫治疗旨在控制疾病进展、改善患者预后、降低肿瘤复发和转移率[60]。Neo-DCVac作为肿瘤免疫治疗方法之一,可诱导的免疫应答较强,高度靶向异质性肿瘤,减少免疫逃逸,有望解决传统肿瘤疫苗免疫耐受、引发自身免疫性疾病的缺点。此外,Neo-DCVac还可联合其他肿瘤免疫疗法发挥协同作用。随着基因组学、分子生物学及高通量测序的发展与进步,Neo-DCVac的相关研究也有望取得新的进展。总之,Neo-DCVac为肿瘤免疫治疗提供了安全、可行的新途径,应用前景广阔。
  • 国家自然科学基金(31770537)
  • 甘肃省重大科技项目(20ZD7FA003)
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2024年第49卷第2期
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doi: 10.11855/j.issn.0577-7402.1986.2023.0524
  • 接收时间:2022-09-21
  • 首发时间:2025-11-23
  • 出版时间:2024-02-28
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  • 收稿日期:2022-09-21
  • 录用日期:2022-11-04
基金
National Natural Science Foundation of China(31770537)
国家自然科学基金(31770537)
Grand Scientific and Technological Project of Gansu Province(20ZD7FA003)
甘肃省重大科技项目(20ZD7FA003)
作者信息
    1甘肃省消化系肿瘤重点实验室,甘肃兰州 730030
    2兰州大学第二医院肿瘤外科,甘肃兰州 730030

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2种不同金属材料的力学参数

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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