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Gated CD123 CAR-T cells are an engineered cellular immunotherapy designed to treat acute myeloid leukemia (AML) with improved precision. The therapy utilizes a Synthetic Notch (SynNotch) circuit that functions as an AND logic gate: the T cells constitutively express a SynNotch receptor for CD33, which, upon binding, induces the expression of a chimeric antigen receptor (CAR) specific for CD123. This sequential activation mechanism is intended to limit on-target, off-tumor toxicity by ensuring that the potent CD123-directed CAR activity is restricted to environments where both CD33 and CD123 are present, such as AML blasts, while sparing healthy tissues that express only one of the antigens. Developed by researchers at the University of Southern California and Children's Hospital Los Angeles, recent optimizations include the incorporation of high-intensity signaling modules (e.g., ZAP70-based or modified CD3ζ ITAMs) to improve cytotoxicity and metabolic fitness.
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