CAR-T cell therapy is an effective method for treating cancer. CAR receptor proteins give T lymphocyte the ability to bind to a specific antigen which is expressed on the surface of cancer cells. CAR receptors are constructed from multiple domains that allow efficient activation and proliferation of CAR T cells. However toxic side effects do occur due to excessive cytokine production and CAR T cell activation in healthy tissue. The most common and threatening side effects are cytokine release syndrome and neurotoxicity, which in some cases result in death. There are some drugs avaliable to relieve symptoms, but due to incomplete knowledge of the pathogenesis of diseases, their use is limited. Various modifications of CAR receptors and other methods are emerging that would prevent the occurrence of side effects or, in the case of severe side effects, stop the functioning of CAR T cells and thus further development of the disease. Currently the main solutions are suicidal genes that destroy CAR T cells in the presence of an inducer and target activation, which includes targeting two tumor-associated antigens, switch-mediated activation and activation of CAR T cells by an inducer. The mechanisms of target activation are based primarily on a more specific separation between tumor cells and healthy tissue. In addition to these, there are other methods in the research phases which appear promising.
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