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NKG2D CAR T cells are a form of autologous or allogeneic cell therapy in which T cells are engineered to express a chimeric antigen receptor (CAR) encoding the extracellular domain of the **NKG2D receptor** fused to one or more intracellular signaling domains (commonly CD3ζ, CD28, or 4-1BB)[2][4][6]. NKG2D is an activating immunoreceptor that recognizes multiple stress-induced ligands found on the surface of a broad range of solid and hematologic tumor cells, but is minimally expressed on healthy cells[2][4][6]. Upon binding to these ligands, the CAR T cells are activated to induce cytotoxicity against the tumor, secrete pro-inflammatory cytokines, and modify the tumor microenvironment[4][5][6]. Unlike most FDA-approved CAR T cells that use antibody fragments to recognize a single tumor antigen, NKG2D CAR T cells take advantage of NKG2D’s ability to simultaneously target multiple ligands, improving potential coverage against antigen escape[1][2][4][6]. Early phase clinical trials have shown safety and disease stabilization in cancer patients, including those with acute myeloid leukemia, myelodysplastic syndrome, multiple myeloma, and certain solid tumors, but expansion and persistence in vivo are limited and clinical efficacy has been modest so far[2][3][5]. NKG2D CAR T cell research is ongoing, including studies on enhancing efficacy via combination with chemotherapy, radiotherapy, or agents that upregulate NKG2D ligands on tumors[3][5][6].
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