Zelltherapie in den Zeiten von SARS-CoV-2

Zusammenfassung

Ein breites Spektrum von Disruptionen, aber auch blitzschnelle Innovationen, hat die SARS-CoV-2 Pandemie gebracht. Dieser Übersichtsartikel betrachtet die Pandemie aus der Warte der Zelltherapie; konkret werden vier Aspekte untersucht: Wie unterscheiden sich die Risiken von Zelltherapie-Patienten mit SARS-CoV-2 Infektion und COVID von denen der Allgemeinbevölkerung? Sind Empfänger von Zelltherapien, hier speziell autologe und allogene Stammzelltransplantationsempfänger sowie Empfänger von CAR-T-Zell-Präparaten, klinisch relevant durch SARS-CoV-2 Vakzine immunisierbar? Welche Auswirkungen hat die Pandemie mit Spenderausfallrisiko und Zusammenbruch von Supply Chains auf die Versorgung mit Zelltherapeutika? Gibt es Zelltherapeutika, die bei schwerem COVID therapeutisch nutzbringend eingesetzt werden können? In aller Kürze, das erwartete massiv erhöhte Risiko von Zelltherapie-Patienten, im Infektionsfall einen schweren Verlauf zu erleiden oder zu sterben, wurde bestätigt. Die Vakzine induziert jedoch bei vielen dieser Patienten humorale und zelluläre Immunität, wenn auch weniger zuverlässig als bei Gesunden. Dank kreativer Lösungen gelang es, die Versorgung mit Zelltherapeutika im Wesentlichen uneingeschränkt aufrecht zu erhalten. SARS-CoV-2-spezifische T-Zell-Präparate für den adoptiven Immuntransfer wurden entwickelt, eine therapeutische Konstellation diese anzuwenden ergab sich jedoch nicht. Therapiestudien mit mesenchymalen Stromazellen beim schweren COVID laufen weltweit; die Frage der Wirksamkeit bleibt zurzeit offen, bei jedoch substanziellem Optimismus in der Szene. Einige der Erkenntnisse und Innovationen aus der SARS-CoV-2-Pandemie können möglicherweise verallgemeinert werden und so auf die Zeit nach ihrem Ende langfristig nachwirken.

Abstract

An entire spectrum of disruptions, but also some lightning fast innovations, were brought on by the SARS-CoV-2 pandemic. This focused review looks at the pandemic from the vantage point of cellular therapy; specifically four aspects are considered: How do risks of cell therapy patients with SARS-CoV-2 infection and COVID differ from the general population? Do recipients of cellular therapies, here specifically recipients of autologous and allogeneic stem cell transplants and CAR-T-cells, meaningfully respond to SARS-CoV-2 vaccines? What effects does the pandemic have on donor availability and cell therapy supply chains and hence, on the accessibility of cellular therapies? What cell therapies, if any, are therapeutically beneficial in severe COVID? Briefly, the excessive risk of an unfavorable, frequently lethal course of cell therapy patients with SARS-CoV-2 infection was confirmed. The vaccine frequently, albeit not with the same regularity as in healthy vaccinees, induces presumably clinically meaningful humoral and/or cellular immunity. Creative solutions have quantitatively maintained access to cellular therapeutics. SARS-CoV-2-specific T-cell products for adoptive immune transfer were developed, although an opportunity for their clinical evaluation did not arise. Clinical trials with mesenchymal stromal cells for severe COVID are being pursued world-wide; the question of efficacy currently remains unanswered, but initial data fuel considerable optimism of the scene. Some of the insights and innovations from the SARS-CoV-2-pandemic can possibly be generalized and may thus prevail.

Schlüsselwörter

Zelltherapie - Zelltherapeutika - zelluläre Immunität - Stammzelltransplantation - Kryokonservierung

Key words

Cell therapy - cellular therapeutics - cellular immunity - stem cell transplantation - cryopreservation

Publication History

Article published online:
11 August 2022

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