The incidence and mortality of cancer are rising rapidly worldwide. This poses a threat to human survival and societal development. Gastric cancer is the third leading cause of cancer-related deaths globally and is highly prevalent1. Due to low rates of early diagnosis, a significant proportion of patients are diagnosed at advanced stages. Traditional treatments include surgery, radiotherapy, and chemotherapy. Surgical resection for patients with mid-to-late-stage or complex gastric cancer may be incomplete. Furthermore, the significant surgical trauma and prolonged postoperative recovery can adversely affect patients' quality of life and potentially lead to complications. Radiotherapy and chemotherapy severely compromise normal tissues, generating numerous side effects during treatment. In contrast, targeted and cell therapies offer precision and efficacy. These treatments have emerged as crucial contemporary care modalities and represent the prevailing trend in the selection of future therapeutic strategies.
The advent of chimeric antigen receptor T-cell (CAR-T) therapy has propelled cell therapy toward a landmark breakthrough. It has demonstrated potent efficacy in treating hematologic malignancies2,3. CAR-T therapy utilizes the patient's own T cells, which are genetically modified in vitro by inserting a specific chimeric antigen receptor (CAR). This receptor recognizes specific antigens on the surfaces of tumor cells and activates T cells to attack cancer cells. In recent years, CAR-T therapy research for gastric cancer has also advanced. The selection of therapeutic targets is particularly critical as it determines the targeting precision and efficacy of CAR-T cells. Following HER2, Claudin18.2 has emerged as another prominent therapeutic target in gastric cancer, exhibiting expression rates of 40% to 87% among patients. Claudin18.2 is typically buried within the gastric mucosa. When malignant tumors disrupt the tight junctions responsible for intercellular molecular exchange, Claudin18.2 becomes exposed on the surface of tumor cells. This makes it a specific therapeutic target for these tumors4.
Typically, the standard manufacturing process for CAR-T cells involves cell collection, T-cell selection and enrichment, T-cell activation, CAR gene construction, gene transduction, expansion, quality control, storage and transportation, followed by patient infusion. The entire CAR-T cell preparation process is highly complex, requiring sterile conditions and demanding stringent environmental and equipment specifications. This results in the high cost of CAR-T therapy, limiting its clinical application. To address the complexities of ex vivo CAR-T production, the concept of in vivo CAR-T preparation has been proposed. This approach involves directly programming CAR-T cells within the patient's body, eliminating the need for ex vivo cell collection, modification, and expansion. This strategy aims to reduce costs, enhance safety and accessibility, and enable broader applications of disease treatment5.
The key to in vivo CAR-T preparation lies in selecting an optimal delivery vector. Currently, vectors are categorized as viral or non-viral. Among viral options, lentiviral (LV) and adeno-associated viral (AAV) vectors are predominantly utilized. However, the significant risks and limited payload capacity associated with viral vectors create major obstacles for clinical research6. A primary disadvantage of viral vectors for in vivo delivery is their potential for genomic integration, which may result in genetic toxicity and insertional mutations. Previous cases have documented fatal immune responses or cancer in a small portion of patients following treatment. Moreover, the inherent toxicity and immunogenicity of viruses severely restrict their application for repeated in vivo administration. Another challenge is the limited payload capacity of viral vectors, which prevents the simultaneous delivery of multiple genes.
Non-viral mRNA delivery systems effectively address these shortcomings. They avoid integrating into the host genome and thus circumvent many risks. Their transient action prevents off-target toxicity, enabling short-term, controllable CAR-T cell expression, thereby reducing side effects and safety risks. Among non-viral systems, lipid nanoparticles (LNPs) offer a safer approach. They overcome the size limitations of viral vectors. LNPs also resolve issues of insertion mutations and immunogenicity. This positions them as promising candidates in CAR-T cell therapy, with the potential to reduce toxicity, enhance safety, and lower costs7.
Current research on immunotherapy for solid tumors primarily focuses on LNP formulation optimization, targeted modification, and mRNA sequence engineering across various cancer models, including melanoma8, breast cancer, and colorectal cancer9. Efforts have also been directed toward constructing chimeric antigen receptor macrophages (CAR-M)10 and dendritic cells (CAR-DC)11 via LNP delivery systems to breach the complex physical barriers and immunosuppressive tumor microenvironment (TME) of solid tumors. The platform presented herein provides a versatile, non-viral mRNA delivery system characterized by high modularity. By simply exchanging the mRNA sequence, this platform can be rapidly adapted to solid tumor models targeting other antigens or extended to non-oncology therapeutic areas such as autoimmune, cardiovascular, and fibrotic diseases.
However, a technical gap remains in gastric cancer treatments using these platforms: prior studies have predominantly focused on myeloid cell editing, while strategies for highly efficient in vivo T-cell reprogramming remain largely exploratory. To address this gap, this protocol details a method for generating transient CAR-T cells via LNP-mediated mRNA delivery. This approach aims to overcome the limitations inherent to conventional CAR-T cell therapies, including prohibitive costs, complex manufacturing processes, and systemic toxicities, thereby offering a more efficacious and accessible therapeutic alternative for patients. It is demonstrated that transfection of T cells with an optimized mRNA sequence encoding a specific CAR targeting Claudin18.2 enables robust cell-surface CAR expression, directing the modified T cells to exert targeted cytotoxic activity against specific tumor cells. This protocol is structured into five distinct sections: in vitro transcription of CAR mRNA, LNP preparation and characterization, T-cell activation and transfection, detection of CAR expression, and evaluation of CAR-T cell cytolytic efficacy in vitro and in vivo.
Compared with existing mRNA-LNP delivery technologies, the core methodological innovation of this protocol lies in the kinetic optimization of transient expression. A synergistic optimization was performed on the 5' UTR, 3' UTR, 5' Cap, and a 120-bp poly(A) tail. This tailored design modulates the mRNA half-life within the tumor microenvironment, achieving highly efficient translation within a defined therapeutic window followed by safe degradation. Characterized by rapid and transient CAR generation, this platform serves as an "off-the-shelf" formulation for immediate use, preventing disease progression during the prolonged manufacturing window required for conventional therapies. Furthermore, this transient expression profile offers a controllable safety advantage when targeting antigens with potential "on-target, off-tumor" toxicities, or for patients unable to tolerate severe cytokine release syndrome (CRS) associated with conventional CAR-T therapies.
Despite the profound advantages of in vivo in situ CAR-T cell generation, namely the elimination of complex ex vivo manufacturing and reduced economic burdens, certain limitations persist. In systemic circulation, LNPs are prone to non-specific accumulation in the liver and rapid internalization by macrophages and dendritic cells. Without specific targeting moieties directed toward T cells, the transfection efficiency of the target T-cell population is inevitably compromised. Furthermore, upon entering the tumor tissue, in situ generated CAR-T cells are subjected to the hostile TME; under hypoxic, acidic, and immunosuppressive conditions, these T cells are highly susceptible to immune exhaustion, thereby restricting their cytotoxic potency. Additionally, while the transient nature of mRNA expression enhances safety, it restricts the duration of the therapeutic window. To achieve sustained antitumor efficacy, intermittent and repeated administrations are often required. Consequently, future investigations will focus on addressing these limitations by refining LNP delivery efficiency to achieve precise, lineage-specific targeting.