Synergistic CRISPR/Cas9 Gene Editing and CAR T-cell Therapy for FLT3-Mutated in AML
DOI:
https://doi.org/10.47611/jsrhs.v13i1.6131Keywords:
AML, FLT3 mutation, CRISPR/Cas9, CAR T-cell therapy, Precision oncology, Combination therapy, Personalized treatmentAbstract
Acute Myeloid Leukemia (AML) with FLT3 (FMS-like Tyrosine Kinase 3) mutations poses a significant challenge in oncology. This paper explores the potential of a combined treatment approach involving CRISPR/Cas9 gene editing and CAR T-cell therapy. CRISPR/Cas9 technology can precisely target and correct the FLT3 gene mutation responsible for AML proliferation. Simultaneously, CAR T-cell therapy harnesses the immune system to target FLT3-mutated AML cells using engineered T cells. While promising, these approaches come with challenges, such as off-target effects for CRISPR/Cas9 and complications like cytokine release syndrome for CAR T-cell therapy. Nevertheless, they offer a groundbreaking paradigm shift in AML treatment, potentially providing more effective and personalized therapies for patients with FLT3 mutations. Further research and clinical trials are essential to fully realize their potential and address associated hurdles. This combination therapy offers hope for improving outcomes in AML patients with FLT3 mutations, representing a significant advancement in precision oncology.
Downloads
References or Bibliography
“About Acute Myeloid Leukemia (AML).” Cancer.org, 2023, www.cancer.org/cancer/types/acute-myeloid-leukemia/about.html. Accessed 3 Sep. 2023.
“Acute Lymphocytic Leukemia - Symptoms and Causes.” Mayo Clinic, 2022, www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/symptoms-causes/syc-20369077. Accessed 3 Sep. 2023.
“Acute Myeloid Leukemia.” Abbviescience.com, 2023, www.abbviescience.com/tumor-types/acute-myeloid-leukemia.html. Accessed 3 Sep. 2023.
“Acute Myeloid Leukemia - Cancer Stat Facts.” SEER, 2018, seer.cancer.gov/statfacts/html/amyl.html. Accessed 3 Sep. 2023.
Adithya Chennamadhavuni, et al. “Leukemia.” Nih.gov, StatPearls Publishing, 17 Jan. 2023, www.ncbi.nlm.nih.gov/books/NBK560490/. Accessed 3 Sept. 2023.
Allodji, Rodrigue S, et al. “Role of Radiotherapy and Chemotherapy in the Risk of Leukemia after Childhood Cancer: An International Pooled Analysis.” International Journal of Cancer, vol. 148, no. 9, 9 Nov. 2020, pp. 2079–2089, www.ncbi.nlm.nih.gov/pmc/articles/PMC8174089/, https://doi.org/10.1002/ijc.33361. Accessed 3 Sept. 2023.
Anusha Vakiti, and Prerna Mewawalla. “Acute Myeloid Leukemia.” Nih.gov, StatPearls Publishing, 8 Aug. 2023, www.ncbi.nlm.nih.gov/books/NBK507875/. Accessed 3 Sept. 2023.
Arber, Daniel A, et al. “The 2016 Revision to the World Health Organization Classification of Myeloid Neoplasms and Acute Leukemia.” Blood, vol. 127, no. 20, 19 May 2016, pp. 2391–2405, pubmed.ncbi.nlm.nih.gov/27069254/#full-view-affiliation-2, https://doi.org/10.1182/blood-2016-03-643544. Accessed 3 Sept. 2023.
Bresnick, Emery H, et al. “Human GATA2 Mutations and Hematologic Disease: How Many Paths to Pathogenesis?” Blood Advances, vol. 4, no. 18, 22 Sept. 2020, pp. 4584–4592, www.ncbi.nlm.nih.gov/pmc/articles/PMC7509867/, https://doi.org/10.1182/bloodadvances.2020002953. Accessed 3 Sept. 2023.
Cassier, Philippe, et al. “Targeting Apoptosis in Acute Myeloid Leukaemia.” British Journal of Cancer, vol. 117, no. 8, 24 Aug. 2017, pp. 1089–1098, www.ncbi.nlm.nih.gov/pmc/articles/PMC5674101/, https://doi.org/10.1038/bjc.2017.281. Accessed 3 Sept. 2023.
Daver, Naval, et al. “FLT3Mutations in Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia.” American Journal of Hematology, vol. 88, no. 1, 31 Oct. 2012, pp. 56–59, www.ncbi.nlm.nih.gov/pmc/articles/PMC4085099/, https://doi.org/10.1002/ajh.23345. Accessed 3 Sept. 2023.
DiNardo, Courtney D, and Jorge Cortes. “Mutations in AML: Prognostic and Therapeutic Implications.” Hematology, vol. 2016, no. 1, 2 Dec. 2016, pp. 348–355, www.ncbi.nlm.nih.gov/pmc/articles/PMC6142505/, https://doi.org/10.1182/asheducation-2016.1.348. Accessed 3 Sept. 2023.
---. “Mutations in AML: Prognostic and Therapeutic Implications.” Hematology, vol. 2016, no. 1, 2 Dec. 2016, pp. 348–355, www.ncbi.nlm.nih.gov/pmc/articles/PMC6142505/, https://doi.org/10.1182/asheducation-2016.1.348. Accessed 3 Sept. 2023.
Eden, Rina E, and Jean M Coviello. “Chronic Myelogenous Leukemia.” Nih.gov, StatPearls Publishing, 16 Jan. 2023, www.ncbi.nlm.nih.gov/books/NBK531459/. Accessed 3 Sept. 2023.
Fedorov, Kateryna, et al. “Targeting FLT3 Mutation in Acute Myeloid Leukemia: Current Strategies and Future Directions.” Cancers, vol. 15, no. 8, 15 Apr. 2023, pp. 2312–2312, www.ncbi.nlm.nih.gov/pmc/articles/PMC10136888/, https://doi.org/10.3390/cancers15082312. Accessed 3 Sept. 2023.
Fennell, Katie, et al. “Epigenetic Therapies in Acute Myeloid Leukemia: Where to from Here?” Blood, vol. 134, no. 22, 28 Nov. 2019, pp. 1891–1901, ashpublications.org/blood/article/134/22/1891/387149/Epigenetic-therapies-in-acute-myeloid-leukemia, https://doi.org/10.1182/blood.2019003262. Accessed 3 Sept. 2023.
---. “Epigenetic Therapies in Acute Myeloid Leukemia: Where to from Here?” Blood, vol. 134, no. 22, 28 Nov. 2019, pp. 1891–1901, ashpublications.org/blood/article/134/22/1891/387149/Epigenetic-therapies-in-acute-myeloid-leukemia, https://doi.org/10.1182/blood.2019003262. Accessed 3 Sept. 2023.
Gostimskaya, Irina. “CRISPR–Cas9: A History of Its Discovery and Ethical Considerations of Its Use in Genome Editing.” Biokhimiya, vol. 87, no. 8, 1 Aug. 2022, pp. 777–788, www.ncbi.nlm.nih.gov/pmc/articles/PMC9377665/, https://doi.org/10.1134/s0006297922080090. Accessed 3 Sept. 2023.
He, Peijie, et al. “Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia: An Overview of Systematic Reviews.” International Journal of Clinical Practice, vol. 2022, 7 Oct. 2022, pp. 1–10, www.ncbi.nlm.nih.gov/pmc/articles/PMC9568333/, https://doi.org/10.1155/2022/1828223. Accessed 3 Sept. 2023.
Hitoshi Kiyoi, et al. “FLT3 Mutations in Acute Myeloid Leukemia: Therapeutic Paradigm beyond Inhibitor Development.” Cancer Science, vol. 111, no. 2, 30 Dec. 2019, pp. 312–322, www.ncbi.nlm.nih.gov/pmc/articles/PMC7004512/, https://doi.org/10.1111/cas.14274. Accessed 3 Sept. 2023.
Ho, Tzu-Chieh, et al. “Scaffold-Mediated CRISPR-Cas9 Delivery System for Acute Myeloid Leukemia Therapy.” Science Advances, vol. 7, no. 21, 21 May 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8133753/, https://doi.org/10.1126/sciadv.abg3217. Accessed 3 Sept. 2023.
“Home - Gene - NCBI.” Nih.gov, 2023, www.ncbi.nlm.nih.gov/gene. Accessed 3 Sept. 2023.
Janke, Hanna, et al. “Activating FLT3 Mutants Show Distinct Gain-of-Function Phenotypes in Vitro and a Characteristic Signaling Pathway Profile Associated with Prognosis in Acute Myeloid Leukemia.” PLOS ONE, vol. 9, no. 3, 7 Mar. 2014, pp. e89560–e89560, www.ncbi.nlm.nih.gov/pmc/articles/PMC3946485/#:~:text=FLT3%2DITD%20and%20FLT3%20point,potential%20targets%20for%20therapeutic%20interventions., https://doi.org/10.1371/journal.pone.0089560. Accessed 3 Sept. 2023.
Jogalekar, Manasi P, et al. “CAR T-Cell-Based Gene Therapy for Cancers: New Perspectives, Challenges, and Clinical Developments.” Frontiers in Immunology, vol. 13, 22 July 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9355792/, https://doi.org/10.3389/fimmu.2022.925985. Accessed 3 Sept. 2023.
Joshi, Kanak, et al. “Leukemia Stem Cells in the Pathogenesis, Progression, and Treatment of Acute Myeloid Leukemia.” Springer EBooks, 1 Jan. 2019, pp. 95–128, www.ncbi.nlm.nih.gov/pmc/articles/PMC9056110/, https://doi.org/10.1007/978-981-13-7342-8_5. Accessed 3 Sept. 2023.
Kasidet Hiranniramol, Chen, Y., Wei Jun Liu, & Wang, X. (2020). Generalizable sgRNA design for improved CRISPR/Cas9 editing efficiency. Bioinformatics, 36(9), 2684–2689. https://doi.org/10.1093/bioinformatics/btaa041
“Key Statistics for Acute Myeloid Leukemia (AML).” Cancer.org, 2023, www.cancer.org/cancer/types/acute-myeloid-leukemia/about/key-statistics.html. Accessed 3 Sept. 2023.
KRISHNA BILAS GHIMIRE, and BINAY KUMAR SHAH. “Second Primary Malignancies in Adult Acute Myeloid Leukemia - a US Population-Based Study.” Anticancer Research, vol. 34, no. 7, July 2014, pp. 3855–3859, ar.iiarjournals.org/content/34/7/3855#T4. Accessed 3 Sept. 2023.
Li, Shuping, et al. “FLT3-TKD in the Prognosis of Patients with Acute Myeloid Leukemia: A Meta-Analysis.” Frontiers in Oncology, vol. 13, 17 Feb. 2023, www.ncbi.nlm.nih.gov/pmc/articles/PMC9982020/#:~:text=Fms%2Dlike%20tyrosine%20kinase%203,distinct%20types%20of%20FLT3%20mutations., https://doi.org/10.3389/fonc.2023.1086846. Accessed 3 Sept. 2023.
Magnani, Chiara F, et al. “Transposon-Based CAR T Cells in Acute Leukemias: Where Are We Going?” Cells, vol. 9, no. 6, 27 May 2020, pp. 1337–1337, www.ncbi.nlm.nih.gov/pmc/articles/PMC7349235/, https://doi.org/10.3390/cells9061337. Accessed 3 Sept. 2023.
Mardiana, Sherly, and Saar Gill. “CAR T Cells for Acute Myeloid Leukemia: State of the Art and Future Directions.” Frontiers in Oncology, vol. 10, 6 May 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7218049/, https://doi.org/10.3389/fonc.2020.00697. Accessed 3 Sept. 2023.
Neubauer, Andreas, et al. “Patients with Acute Myeloid Leukemia and RAS Mutations Benefit Most from Postremission High-Dose Cytarabine: A Cancer and Leukemia Group B Study.” Journal of Clinical Oncology, vol. 26, no. 28, 1 Oct. 2008, pp. 4603–4609, www.ncbi.nlm.nih.gov/pmc/articles/PMC2653132/, https://doi.org/10.1200/jco.2007.14.0418. Accessed 3 Sept. 2023.
Paresh Vishwasrao, et al. “Emerging CAR T Cell Strategies for the Treatment of AML.” Cancers, vol. 14, no. 5, 27 Feb. 2022, pp. 1241–1241, www.ncbi.nlm.nih.gov/pmc/articles/PMC8909045/, https://doi.org/10.3390/cancers14051241. Accessed 3 Sept. 2023.
Pohl-Guimarães, Fernanda, et al. “RNA-Electroporated T Cells for Cancer Immunotherapy.” OncoImmunology, 1 Jan. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7553534/, https://doi.org/10.1080/2162402x.2020.1792625. Accessed 3 Sept. 2023.
Pratz, Keith W, and Mark J Levis. “Incorporating FLT3 Inhibitors into Acute Myeloid Leukemia Treatment Regimens.” Leukemia & Lymphoma, vol. 49, no. 5, 1 Jan. 2008, pp. 852–863, www.ncbi.nlm.nih.gov/pmc/articles/PMC3031857/, https://doi.org/10.1080/10428190801895352. Accessed 3 Sept. 2023.
Puckett, Yana, and Onyee Chan. “Acute Lymphocytic Leukemia.” Nih.gov, StatPearls Publishing, 26 June 2023, www.ncbi.nlm.nih.gov/books/NBK459149/. Accessed 3 Sept. 2023.
Redman, Melody, et al. “What Is CRISPR/Cas9?” Archives of Disease in Childhood-Education and Practice Edition, vol. 101, no. 4, 8 Apr. 2016, pp. 213–215, www.ncbi.nlm.nih.gov/pmc/articles/PMC4975809/, https://doi.org/10.1136/archdischild-2016-310459. Accessed 3 Sept. 2023.
“RUNX1 RUNX Family Transcription Factor 1 [Homo Sapiens (Human)] - Gene - NCBI.” Nih.gov, 2023, www.ncbi.nlm.nih.gov/gene/861. Accessed 3 Sept. 2023.
Shephard, Elizabeth A, et al. “Symptoms of Adult Chronic and Acute Leukaemia before Diagnosis: Large Primary Care Case-Control Studies Using Electronic Records.” British Journal of General Practice, vol. 66, no. 644, 25 Feb. 2016, pp. e182–e188, www.ncbi.nlm.nih.gov/pmc/articles/PMC4758497/, https://doi.org/10.3399/bjgp16x683989. Accessed 3 Sept. 2023.
---. “Symptoms of Adult Chronic and Acute Leukaemia before Diagnosis: Large Primary Care Case-Control Studies Using Electronic Records.” British Journal of General Practice, vol. 66, no. 644, 25 Feb. 2016, pp. e182–e188, www.ncbi.nlm.nih.gov/pmc/articles/PMC4758497/, https://doi.org/10.3399/bjgp16x683989. Accessed 3 Sept. 2023.
Singh, Nathan, et al. “Genome-Editing Technologies in Adoptive T Cell Immunotherapy for Cancer.” Current Hematologic Malignancy Reports, vol. 12, no. 6, 16 Oct. 2017, pp. 522–529, www.ncbi.nlm.nih.gov/pmc/articles/PMC5709224/, https://doi.org/10.1007/s11899-017-0417-7. Accessed 3 Sept. 2023.
“Types of Leukemia: Common, Rare & More.” City of Hope, 12 Sept. 2022, www.cancercenter.com/cancer-types/leukemia/types. Accessed 3 Sept. 2023.
Zhang, Chen, et al. “Chimeric Antigen Receptor T-Cell Therapy.” Nih.gov, StatPearls Publishing, 3 Oct. 2022, www.ncbi.nlm.nih.gov/books/NBK537294/. Accessed 3 Sept. 2023.
Zhang, Cheng, et al. “Engineering CAR-T Cells.” Biomarker Research, vol. 5, no. 1, 24 June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5482931/, https://doi.org/10.1186/s40364-017-0102-y. Accessed 3 Sept. 2023.
Zhao, Jennifer, et al. “A Review of FLT3 Inhibitors in Acute Myeloid Leukemia.” Blood Reviews, vol. 52, 1 Mar. 2022, pp. 100905–100905, pubmed.ncbi.nlm.nih.gov/34774343/, https://doi.org/10.1016/j.blre.2021.100905. Accessed 3 Sept. 2023.
Published
How to Cite
Issue
Section
Copyright (c) 2024 Derrick Lee
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright holder(s) granted JSR a perpetual, non-exclusive license to distriute & display this article.