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@ARTICLE{Lu:302801,
author = {I.-N. Lu and L. Müller-Miny and C. Krekeler and P. F.
Cheung$^*$ and G. Antonopoulou and A. Jeibmann and A.
Schulte-Mecklenbeck and K. Kerl and S. Call and C. Reicherts
and A. Bleckmann and M. Stelljes and G. Lenz and H. Wiendl
and G. M. Zu Hörste and O. M. Grauer},
title = {{T}he {CXCL}16/{CXCR}6 axis is linked to immune effector
cell-associated neurotoxicity in chimeric antigen receptor
({CAR}) {T} cell therapy.},
journal = {Genome medicine},
volume = {17},
number = {1},
issn = {1756-994X},
address = {London},
publisher = {BioMed Central},
reportid = {DKFZ-2025-01341},
pages = {71},
year = {2025},
abstract = {Immune effector cell-associated neurotoxicity syndrome
(ICANS) is a common and potentially life-threatening
complication of chimeric antigen receptor (CAR) T cell
therapy. The underlying mechanisms of ICANS remain
incompletely understood and are unlikely to be explained by
cytokine excess alone.We analyzed paired peripheral blood
and cerebrospinal fluid (CSF) samples from CAR T
cell-treated patients who developed ICANS (n = 11) within
5-21 days post-infusion. ICANS severity was graded as
follows: grade 1 (n = 3), grade 2 (n = 4), grade 3 (n = 1),
and grade 4 (n = 3). Control samples were obtained from
patients with idiopathic intracranial hypertension,
functional neurological disorders, and multiple sclerosis.
We employed single-cell RNA sequencing (scRNA-seq) and flow
cytometry to profile immune cell populations and performed
multi-modal spatial transcriptomics and immunofluorescence
on postmortem choroid plexus and brain tissue from a patient
with fatal grade 4 ICANS.We identified a distinct population
of proliferating, cytotoxic T cells characterized by CXCR6
expression, enriched in CD4 + CAR T cells and predominantly
localized in ICANS CSF. These CXCR6 + T cells were largely
absent from control CSF samples. Spatial mapping of
postmortem brain tissue revealed widespread infiltration of
myeloid cells and a striking spatial association between
CXCR6 + T cells and CXCL16-expressing myeloid cells in both
the choroid plexus and brain parenchyma. Notably, CSF levels
of CXCL16 positively correlated with ICANS severity across
the cohort, from grade 1 to grade 4.Our findings implicate
the CXCL16/CXCR6 axis in the recruitment of cytotoxic CAR
CD4 + T cells to the central nervous system (CNS) during
ICANS. This interaction may be linked to neuroinflammatory
processes and severity stratification in ICANS pathogenesis.
These results provide a mechanistic rationale for exploring
CXCL16/CXCR6 as a potential biomarker and therapeutic target
in CAR T cell-associated neurotoxicity.},
keywords = {Humans / Receptors, CXCR6: metabolism / Receptors, CXCR6:
genetics / Neurotoxicity Syndromes: etiology / Neurotoxicity
Syndromes: metabolism / Chemokine CXCL16: metabolism /
Chemokine CXCL16: genetics / Male / Receptors, Chimeric
Antigen: metabolism / Immunotherapy, Adoptive: adverse
effects / Female / Middle Aged / Adult / Aged /
T-Lymphocytes: immunology / T-Lymphocytes: metabolism /
Receptors, CXCR6 (NLM Chemicals) / Chemokine CXCL16 (NLM
Chemicals) / CXCR6 protein, human (NLM Chemicals) /
Receptors, Chimeric Antigen (NLM Chemicals) / CXCL16
protein, human (NLM Chemicals) / cell-associated
neurotoxicity (NLM Chemicals)},
cin = {ED01},
ddc = {610},
cid = {I:(DE-He78)ED01-20160331},
pnm = {899 - ohne Topic (POF4-899)},
pid = {G:(DE-HGF)POF4-899},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:40588764},
pmc = {pmc:PMC12210444},
doi = {10.1186/s13073-025-01498-6},
url = {https://inrepo02.dkfz.de/record/302801},
}