Modulating metabolism to improve the therapeutic outcomes of CAR cell therapies: From bench to bedside

Abstract

Chimeric antigen receptor (CAR) cell therapies have emerged as a groundbreaking approach in cancer treatment, offering new hope for patients with refractory tumors. Despite their success, the therapeutic efficacy of CAR cell therapies is often undermined by metabolic factors within the tumor microenvironment (TME), which impede CAR cell function and lead to treatment resistance. Current literature has not fully explored how these metabolic processes contribute to CAR cell therapy failure, particularly in the context of solid tumors, where the TME presents unique challenges. Addressing this gap is crucial for enhancing the effectiveness of CAR cell therapies across a broader range of cancers. Here, we review the latest research on the metabolic mechanisms that influence CAR cell therapy outcomes, from preclinical studies to clinical applications. We conducted a comprehensive analysis of studies from PubMed and Web of Science, focusing on how various metabolic processes—such as hypoxia, immune cytokine signaling, glycolysis, adenine metabolism, cellular senescence, lactic acid increment, and cholesterol metabolism—affect CAR cell functions, including cytotoxicity, proliferation, stemness, and activation. Additionally, we examine how interactions between CAR cells and other components of the TME, such as tumor cells, stromal cells, and the extracellular matrix, contribute to an immune-suppressive environment that diminishes CAR cell efficacy. We also discuss potential strategies for overcoming these metabolic barriers, including the development of CAR cells with enhanced metabolic regulation, gene expression modulation, and the combination of CAR cell therapy with existing pharmacological treatments. Our findings underscore the critical role of metabolism in shaping the anti-tumor efficacy of CAR cell therapies in both hematologic and solid tumors. By targeting metabolic pathways within the TME, it is possible to enhance CAR cell infiltration, function, and persistence, thereby overcoming resistance and improving therapeutic outcomes. This approach not only addresses a key limitation in current CAR cell therapies but also paves the way for more effective cancer treatments in the future.