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TRAIL-CD28-armored anti-BCMA CAR T cells is an experimental cellular immunotherapy being investigated for the treatment of multiple myeloma. The therapy consists of T cells engineered to express a third-generation chimeric antigen receptor (CAR) targeting B-cell maturation antigen (BCMA), further modified with a 'chimeric armor' protein. This armor is a fusion of the extracellular and transmembrane domains of TNF-related apoptosis-inducing ligand (TRAIL) and the intracellular signaling domain of CD28. The TRAIL component is designed to trigger apoptosis in tumor cells via death receptors (DR4 and DR5), providing a secondary killing mechanism to overcome BCMA-independent resistance. Simultaneously, the CD28 intracellular domain provides constitutive costimulatory signaling to the CAR T cells, enhancing their survival, expansion, and memory phenotype while protecting them from TRAIL-induced fratricide. Preclinical studies have demonstrated enhanced efficacy against resistant multiple myeloma models and reduced exhaustion compared to conventional anti-BCMA CAR T cells.
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