Ingeniería de citoquinas en la terapia de células CAR-T: estrategias de próxima generación

Chimeric Ag receptor (CAR)-T cell therapy has demonstrated success primarily in B-cell malignancies, but efficacy in solid tumors remains limited by Ag heterogeneity, immunosuppressive tumor microenvironments, and restricted infiltration. Cytokine engineering has emerged as a promising strategy to overcome these barriers. Fourth-generation CAR-T cells, known as T cells redirected for universal cytokine-mediated killing, demonstrated the feasibility of localized immune modulation through activation-induced IL-12 release, and this concept has been extended to various cytokines. Receptor engineering strategies, including switch/inverted and orthogonal designs, restrict cytokine signaling to CAR-T cells, thereby enhancing both specificity and safety. Beyond CAR-T engineering, external cell-based 'cytokine factories' and immune-cytokines further underscore the versatility of localized cytokine delivery strategies. In addition, fifth-generation CAR-T cells, incorporating approaches that enhance or mimic cytokine-mediated JAK-STAT signaling pathways, highlight a new direction toward programmable intracellular signaling. These strategies remain in the early stages of clinical application due to substantial limitations related to safety and clinical translation, including risks of uncontrolled cytokine activation and complexities in manufacturing. Nevertheless, they offer significant potential to improve therapeutic outcomes not only in hematologic malignancies but also across a broad range of solid tumors.