Enhanced cytotoxicity of natural killer cells following the acquisition of chimeric antigen receptors through trogocytosis
Natural killer (NK) cells have the capacity to target tumors and are ideal candidates for immunotherapy. Viral vectors have been used to genetically modify in vitro expanded NK cells to express chimeric antigen receptors (CARs), which confer cytotoxicity against tumors. However, use of viral transdu...
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creator | Cho, Fu-Nan Chang, Tsung-Hsien Shu, Chih-Wen Ko, Ming-Chin Liao, Shuen-Kuei Wu, Kang-Hsi Yu, Ming-Sun Lin, Shyh-Jer Hong, Ying-Chung Chen, Chien-Hsun Hung, Chien-Hui Chang, Yu-Hsiang |
description | Natural killer (NK) cells have the capacity to target tumors and are ideal candidates for immunotherapy. Viral vectors have been used to genetically modify in vitro expanded NK cells to express chimeric antigen receptors (CARs), which confer cytotoxicity against tumors. However, use of viral transduction methods raises the safety concern of viral integration into the NK cell genome. In this study, we used trogocytosis as a non-viral method to modify NK cells for immunotherapy. A K562 cell line expressing high levels of anti-CD19 CARs was generated as a donor cell to transfer the anti-CD19 CARs onto NK cells via trogocytosis. Anti-CD19 CAR expression was observed in expanded NK cells after these cells were co-cultured for one hour with freeze/thaw-treated donor cells expressing anti-CD19 CARs. Immunofluorescence analysis confirmed the localization of the anti-CD19 CARs on the NK cell surface. Acquisition of anti-CD19 CARs via trogocytosis enhanced NK cell-mediated cytotoxicity against the B-cell acute lymphoblastic leukemia (B-ALL) cell lines and primary B-ALL cells derived from patients. To our knowledge, this is the first report that describes the increased cytotoxicity of NK cells following the acquisition of CARs via trogocytosis. This novel strategy could be a potential valuable therapeutic approach for the treatment of B-cell tumors. |
doi_str_mv | 10.1371/journal.pone.0109352 |
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Viral vectors have been used to genetically modify in vitro expanded NK cells to express chimeric antigen receptors (CARs), which confer cytotoxicity against tumors. However, use of viral transduction methods raises the safety concern of viral integration into the NK cell genome. In this study, we used trogocytosis as a non-viral method to modify NK cells for immunotherapy. A K562 cell line expressing high levels of anti-CD19 CARs was generated as a donor cell to transfer the anti-CD19 CARs onto NK cells via trogocytosis. Anti-CD19 CAR expression was observed in expanded NK cells after these cells were co-cultured for one hour with freeze/thaw-treated donor cells expressing anti-CD19 CARs. Immunofluorescence analysis confirmed the localization of the anti-CD19 CARs on the NK cell surface. Acquisition of anti-CD19 CARs via trogocytosis enhanced NK cell-mediated cytotoxicity against the B-cell acute lymphoblastic leukemia (B-ALL) cell lines and primary B-ALL cells derived from patients. To our knowledge, this is the first report that describes the increased cytotoxicity of NK cells following the acquisition of CARs via trogocytosis. This novel strategy could be a potential valuable therapeutic approach for the treatment of B-cell tumors.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0109352</identifier><identifier>PMID: 25313995</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute lymphoblastic leukemia ; Antigens ; Antigens, CD19 - genetics ; Antigens, CD19 - metabolism ; Apoptosis ; Automobiles ; Biology and Life Sciences ; Bone marrow ; Cancer therapies ; CD19 antigen ; Cell adhesion & migration ; Cell surface ; Cells, Cultured ; Chemotherapy ; Chimeric antigen receptors ; Coculture Techniques ; Cytotoxicity ; Cytotoxicity, Immunologic ; Freeze-thawing ; Genetic modification ; Genomes ; Health education ; Hematology ; Humans ; Immunofluorescence ; Immunophenotyping ; Immunotherapy ; K562 Cells ; Killer Cells, Natural - cytology ; Killer Cells, Natural - immunology ; Killer Cells, Natural - metabolism ; Leukemia ; Localization ; Lymphatic leukemia ; Lymphocytes ; Lymphocytes B ; Lymphoma, B-Cell - metabolism ; Lymphoma, B-Cell - pathology ; Medical research ; Medicine ; Medicine and Health Sciences ; Methods ; Natural killer cells ; Oncology ; Pediatrics ; Plasma membranes ; Receptors ; Receptors, Antigen - genetics ; Receptors, Antigen - metabolism ; T cell receptors ; Toxicity ; Tumor cell lines ; Tumors</subject><ispartof>PloS one, 2014-10, Vol.9 (10), p.e109352-e109352</ispartof><rights>2014 Cho et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Cho et al 2014 Cho et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-5946a604183d92f36eb2cd347e2a4bff025780c450dc4c8f6a20002c9b0418613</citedby><cites>FETCH-LOGICAL-c526t-5946a604183d92f36eb2cd347e2a4bff025780c450dc4c8f6a20002c9b0418613</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196898/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196898/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25313995$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cho, Fu-Nan</creatorcontrib><creatorcontrib>Chang, Tsung-Hsien</creatorcontrib><creatorcontrib>Shu, Chih-Wen</creatorcontrib><creatorcontrib>Ko, Ming-Chin</creatorcontrib><creatorcontrib>Liao, Shuen-Kuei</creatorcontrib><creatorcontrib>Wu, Kang-Hsi</creatorcontrib><creatorcontrib>Yu, Ming-Sun</creatorcontrib><creatorcontrib>Lin, Shyh-Jer</creatorcontrib><creatorcontrib>Hong, Ying-Chung</creatorcontrib><creatorcontrib>Chen, Chien-Hsun</creatorcontrib><creatorcontrib>Hung, Chien-Hui</creatorcontrib><creatorcontrib>Chang, Yu-Hsiang</creatorcontrib><title>Enhanced cytotoxicity of natural killer cells following the acquisition of chimeric antigen receptors through trogocytosis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Natural killer (NK) cells have the capacity to target tumors and are ideal candidates for immunotherapy. Viral vectors have been used to genetically modify in vitro expanded NK cells to express chimeric antigen receptors (CARs), which confer cytotoxicity against tumors. However, use of viral transduction methods raises the safety concern of viral integration into the NK cell genome. In this study, we used trogocytosis as a non-viral method to modify NK cells for immunotherapy. A K562 cell line expressing high levels of anti-CD19 CARs was generated as a donor cell to transfer the anti-CD19 CARs onto NK cells via trogocytosis. Anti-CD19 CAR expression was observed in expanded NK cells after these cells were co-cultured for one hour with freeze/thaw-treated donor cells expressing anti-CD19 CARs. Immunofluorescence analysis confirmed the localization of the anti-CD19 CARs on the NK cell surface. Acquisition of anti-CD19 CARs via trogocytosis enhanced NK cell-mediated cytotoxicity against the B-cell acute lymphoblastic leukemia (B-ALL) cell lines and primary B-ALL cells derived from patients. To our knowledge, this is the first report that describes the increased cytotoxicity of NK cells following the acquisition of CARs via trogocytosis. This novel strategy could be a potential valuable therapeutic approach for the treatment of B-cell tumors.</description><subject>Acute lymphoblastic leukemia</subject><subject>Antigens</subject><subject>Antigens, CD19 - genetics</subject><subject>Antigens, CD19 - metabolism</subject><subject>Apoptosis</subject><subject>Automobiles</subject><subject>Biology and Life Sciences</subject><subject>Bone marrow</subject><subject>Cancer therapies</subject><subject>CD19 antigen</subject><subject>Cell adhesion & migration</subject><subject>Cell surface</subject><subject>Cells, Cultured</subject><subject>Chemotherapy</subject><subject>Chimeric antigen receptors</subject><subject>Coculture Techniques</subject><subject>Cytotoxicity</subject><subject>Cytotoxicity, Immunologic</subject><subject>Freeze-thawing</subject><subject>Genetic modification</subject><subject>Genomes</subject><subject>Health education</subject><subject>Hematology</subject><subject>Humans</subject><subject>Immunofluorescence</subject><subject>Immunophenotyping</subject><subject>Immunotherapy</subject><subject>K562 Cells</subject><subject>Killer Cells, Natural - cytology</subject><subject>Killer Cells, Natural - immunology</subject><subject>Killer Cells, Natural - metabolism</subject><subject>Leukemia</subject><subject>Localization</subject><subject>Lymphatic leukemia</subject><subject>Lymphocytes</subject><subject>Lymphocytes B</subject><subject>Lymphoma, B-Cell - metabolism</subject><subject>Lymphoma, B-Cell - pathology</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Natural killer cells</subject><subject>Oncology</subject><subject>Pediatrics</subject><subject>Plasma membranes</subject><subject>Receptors</subject><subject>Receptors, Antigen - genetics</subject><subject>Receptors, Antigen - metabolism</subject><subject>T cell receptors</subject><subject>Toxicity</subject><subject>Tumor cell lines</subject><subject>Tumors</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptUstu1DAUjRCIlsIfILDEhs0Mfk-8QUJVgUqV2MDacm6cxIPHntpOYfh6kk5atYiVLfu87tWpqtcErwnbkA_bOKZg_Hofg11jghUT9El1ShSjK0kxe_rgflK9yHmLsWC1lM-rEyoYYUqJ0-rPRRhMANsiOJRY4m8HrhxQ7FAwZUzGo5_Oe5sQWO8z6qL38ZcLPSqDRQauR5ddcTHMDBjcziYHyITiehtQsmD3JaY8oVMc-wGVFPs4O2WXX1bPOuOzfbWcZ9WPzxffz7-urr59uTz_dLUCQWVZCcWlkZiTmrWKdkzahkLL-MZSw5uuw1Rsagxc4BY41J00FGNMQTUzRxJ2Vr096u59zHpZW9ZEEiKUnHgT4vKIaKPZ6n1yO5MOOhqnbx9i6rVJxYG3Wk7WFgxpoCZcAJ2S1QBysuW4AeCT1sfFbWx2tgUbyrTFR6KPf4IbdB9vNCdK1qqeBN4vAilejzYXvXN53r4JNo63ualSmOF5snf_QP8_HT-iIMWck-3uwxCs5yrdsfRcJb1UaaK9eTjIPemuO-wvkMzKgA</recordid><startdate>20141014</startdate><enddate>20141014</enddate><creator>Cho, Fu-Nan</creator><creator>Chang, Tsung-Hsien</creator><creator>Shu, Chih-Wen</creator><creator>Ko, Ming-Chin</creator><creator>Liao, Shuen-Kuei</creator><creator>Wu, Kang-Hsi</creator><creator>Yu, Ming-Sun</creator><creator>Lin, Shyh-Jer</creator><creator>Hong, Ying-Chung</creator><creator>Chen, Chien-Hsun</creator><creator>Hung, Chien-Hui</creator><creator>Chang, Yu-Hsiang</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20141014</creationdate><title>Enhanced cytotoxicity of natural killer cells following the acquisition of chimeric antigen receptors through trogocytosis</title><author>Cho, Fu-Nan ; Chang, Tsung-Hsien ; Shu, Chih-Wen ; Ko, Ming-Chin ; Liao, Shuen-Kuei ; Wu, Kang-Hsi ; Yu, Ming-Sun ; Lin, Shyh-Jer ; Hong, Ying-Chung ; Chen, Chien-Hsun ; Hung, Chien-Hui ; Chang, Yu-Hsiang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c526t-5946a604183d92f36eb2cd347e2a4bff025780c450dc4c8f6a20002c9b0418613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute lymphoblastic leukemia</topic><topic>Antigens</topic><topic>Antigens, CD19 - genetics</topic><topic>Antigens, CD19 - metabolism</topic><topic>Apoptosis</topic><topic>Automobiles</topic><topic>Biology and Life Sciences</topic><topic>Bone marrow</topic><topic>Cancer therapies</topic><topic>CD19 antigen</topic><topic>Cell adhesion & migration</topic><topic>Cell surface</topic><topic>Cells, Cultured</topic><topic>Chemotherapy</topic><topic>Chimeric antigen receptors</topic><topic>Coculture Techniques</topic><topic>Cytotoxicity</topic><topic>Cytotoxicity, Immunologic</topic><topic>Freeze-thawing</topic><topic>Genetic modification</topic><topic>Genomes</topic><topic>Health education</topic><topic>Hematology</topic><topic>Humans</topic><topic>Immunofluorescence</topic><topic>Immunophenotyping</topic><topic>Immunotherapy</topic><topic>K562 Cells</topic><topic>Killer Cells, Natural - cytology</topic><topic>Killer Cells, Natural - immunology</topic><topic>Killer Cells, Natural - metabolism</topic><topic>Leukemia</topic><topic>Localization</topic><topic>Lymphatic leukemia</topic><topic>Lymphocytes</topic><topic>Lymphocytes B</topic><topic>Lymphoma, B-Cell - metabolism</topic><topic>Lymphoma, B-Cell - pathology</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Natural killer cells</topic><topic>Oncology</topic><topic>Pediatrics</topic><topic>Plasma membranes</topic><topic>Receptors</topic><topic>Receptors, Antigen - genetics</topic><topic>Receptors, Antigen - metabolism</topic><topic>T cell receptors</topic><topic>Toxicity</topic><topic>Tumor cell lines</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cho, Fu-Nan</creatorcontrib><creatorcontrib>Chang, Tsung-Hsien</creatorcontrib><creatorcontrib>Shu, Chih-Wen</creatorcontrib><creatorcontrib>Ko, Ming-Chin</creatorcontrib><creatorcontrib>Liao, Shuen-Kuei</creatorcontrib><creatorcontrib>Wu, Kang-Hsi</creatorcontrib><creatorcontrib>Yu, Ming-Sun</creatorcontrib><creatorcontrib>Lin, Shyh-Jer</creatorcontrib><creatorcontrib>Hong, Ying-Chung</creatorcontrib><creatorcontrib>Chen, Chien-Hsun</creatorcontrib><creatorcontrib>Hung, Chien-Hui</creatorcontrib><creatorcontrib>Chang, Yu-Hsiang</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Viral vectors have been used to genetically modify in vitro expanded NK cells to express chimeric antigen receptors (CARs), which confer cytotoxicity against tumors. However, use of viral transduction methods raises the safety concern of viral integration into the NK cell genome. In this study, we used trogocytosis as a non-viral method to modify NK cells for immunotherapy. A K562 cell line expressing high levels of anti-CD19 CARs was generated as a donor cell to transfer the anti-CD19 CARs onto NK cells via trogocytosis. Anti-CD19 CAR expression was observed in expanded NK cells after these cells were co-cultured for one hour with freeze/thaw-treated donor cells expressing anti-CD19 CARs. Immunofluorescence analysis confirmed the localization of the anti-CD19 CARs on the NK cell surface. Acquisition of anti-CD19 CARs via trogocytosis enhanced NK cell-mediated cytotoxicity against the B-cell acute lymphoblastic leukemia (B-ALL) cell lines and primary B-ALL cells derived from patients. To our knowledge, this is the first report that describes the increased cytotoxicity of NK cells following the acquisition of CARs via trogocytosis. This novel strategy could be a potential valuable therapeutic approach for the treatment of B-cell tumors.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25313995</pmid><doi>10.1371/journal.pone.0109352</doi><oa>free_for_read</oa></addata></record> |
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subjects | Acute lymphoblastic leukemia Antigens Antigens, CD19 - genetics Antigens, CD19 - metabolism Apoptosis Automobiles Biology and Life Sciences Bone marrow Cancer therapies CD19 antigen Cell adhesion & migration Cell surface Cells, Cultured Chemotherapy Chimeric antigen receptors Coculture Techniques Cytotoxicity Cytotoxicity, Immunologic Freeze-thawing Genetic modification Genomes Health education Hematology Humans Immunofluorescence Immunophenotyping Immunotherapy K562 Cells Killer Cells, Natural - cytology Killer Cells, Natural - immunology Killer Cells, Natural - metabolism Leukemia Localization Lymphatic leukemia Lymphocytes Lymphocytes B Lymphoma, B-Cell - metabolism Lymphoma, B-Cell - pathology Medical research Medicine Medicine and Health Sciences Methods Natural killer cells Oncology Pediatrics Plasma membranes Receptors Receptors, Antigen - genetics Receptors, Antigen - metabolism T cell receptors Toxicity Tumor cell lines Tumors |
title | Enhanced cytotoxicity of natural killer cells following the acquisition of chimeric antigen receptors through trogocytosis |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T00%3A00%3A18IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Enhanced%20cytotoxicity%20of%20natural%20killer%20cells%20following%20the%20acquisition%20of%20chimeric%20antigen%20receptors%20through%20trogocytosis&rft.jtitle=PloS%20one&rft.au=Cho,%20Fu-Nan&rft.date=2014-10-14&rft.volume=9&rft.issue=10&rft.spage=e109352&rft.epage=e109352&rft.pages=e109352-e109352&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0109352&rft_dat=%3Cproquest_plos_%3E1612990301%3C/proquest_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1611596450&rft_id=info:pmid/25313995&rft_doaj_id=oai_doaj_org_article_6cd3eca1bc8145c2a608cc68f640bcc4&rfr_iscdi=true |