GSNOR overexpression enhances CAR-T cell stemness and anti-tumor function by enforcing mitochondrial fitness.

Chimeric antigen receptor-T (CAR-T) cell has been developed as a promising agent for patients with refractory or relapsed lymphoma and leukemia, but not all the recipients could achieve a long-lasting remission. The limited capacity of in vivo expansion and memory differentiation post activation is one of the major reasons for suboptimal CAR-T therapeutic efficiency. Nitric oxide (NO) plays multifaceted roles in mitochondrial dynamics and T cell activation, but its function on CAR-T cell persistence and anti-tumor efficacy remains unknown. Herein, we found the continuous signaling from CAR not only promotes excessive NO production, but also suppressed S-nitrosoglutathione reductase (GSNOR) expression in T cells, which collectively led to increased protein S-nitrosylation, resulting in impaired mitochondrial fitness and deficiency of T cell stemness. Intriguingly, enforced expression of GSNOR promoted memory differentiation of CAR-T cell after immune activation, rendered CAR-T better resistance to mitochondrial dysfunction, further enhanced CAR-T cell expansion and anti-tumor capacity in vitro and in a mouse tumor model. Thus, we revealed a critical role of NO in restricting CAR-T cell persistence and functionality, and defined that GSNOR overexpression may provide a solution to combat NO stress and render patients with more durable protection from CAR-T therapy.

Autologous CD7 CAR T cells generated without T-cell pre-selection in pediatric patients with relapsed/refractory T-ALL: a phase I trial.

Chimeric antigen receptor (CAR) T-cell therapy showed preliminary activity in patients with refractory or relapsed T-cell acute lymphoblastic leukemia (r/r T-ALL). However, many obstacles remain, including manufacturing difficulties and risk of infections. This phase I study (NCT04840875) evaluated autologous CD7 CAR T cells manufactured without pre-selection of healthy T cells in r/r T-ALL. Thirty patients (29 children and one adult) with a median of two lines of prior therapy but without detectable peripheral leukemia were enrolled. Excluding three cases of manufacturing failures, a total of 27 (90%) patients received infusions after products were confirmed free of leukemia contamination, including 16 (59%) meeting planned target doses. Common adverse events within 30 days included grade 3-4 cytopenias (100%), grade 1-2 (70%) and 3-4 (7%; including one dose-limiting toxicity) cytokine release syndrome, grade 1 neurotoxicity (7%), grade 2 infection (4%), and grade 2 graft-versus-host disease (4%). Two patients developed grade 2 infections after day 30. At day 30, 96% responded and 85% achieved CR or CRi. 74% underwent transplantation. Twelve-month progression-free survival with and without censoring transplantation was 22% (95%CI 4-100) and 57% (41-81), respectively. These results support that autologous CD7 CAR T-cell therapy without T-cell pre-selection is feasible in patients with r/r T-ALL.

Asymmetric Three-Component Radical Alkene Carboazidation by Direct Activation of Aliphatic C-H Bonds.

Azide compounds are widely present in natural products and drug molecules, and their easy-to-transform characteristics make them widely used in the field of organic synthesis. The merging of transition-metal catalysis with radical chemistry offers a versatile platform for radical carboazidation of alkenes, allowing the rapid assembly of highly functionalized organic azides. However, the direct use of readily available hydrocarbon feedstocks as sp3-hybridized carbon radical precursors to participate in catalytic enantioselective carboazidation of alkenes remains a significant challenge that has yet to be addressed. Herein, we describe an iron-catalyzed asymmetric three-component radical carboazidation of electron-deficient alkenes by direct activation of aliphatic C-H bonds. This approach involves intermolecular hydrogen atom transfer between a hydrocarbon and an alkoxy/aryl carboxyl radical, leading to the formation of a carbon-centered radical. The resulting radical then reacts with electron-deficient alkenes to generate a new radical species that undergoes chiral iron-complex-mediated C-N3 bond coupling. An array of valuable chiral azides bearing a quaternary stereocenter were directly accessed from widely available chemical feedstocks, and their synthetic potential is further demonstrated through more facile transformations to give other valuable enantioenriched building blocks.

Visible-Light-Promoted Enantioselective Acylation and Alkylation of Aldimines Enabled by 9-Fluorenone Electron-Shuttle Catalysis.

Chiral acyclic α-tertiary amino ketones are widely present in various natural products and pharmaceuticals; however, the direct synthesis of this pharmacophore through a robust strategy still presents significant challenges. The emerging photocatalysis provides a powerful approach to construct chemical bonds that are difficult to form via a traditional two-electron pathway. Herein, we developed visible-light-induced chiral Lewis acid-catalyzed highly enantioselective acylation/alkylation of aldimines enabled by cooperative FLN (9-fluorenone) electron-shuttle catalysis via radical addition. An array of α-tertiary amino ketones, ß-amino alcohols, and chiral amines were achieved with high yields and good to excellent stereocontrol (87 examples, up to 84% yield, 96% ee). These products can be easily transformed into valuable and bioactive skeletons. Extensive control experiments, detailed mechanism studies, and density functional theory calculations elucidated the reaction process and highlighted the crucial role played by FLN.

Iron-Catalyzed Asymmetric Imidation of Sulfides via Sterically Biased Nitrene Transfer.

Transition-metal-catalyzed enantioselective nitrene transfer to sulfides has emerged as one of the most powerful strategies for rapid construction of enantioenriched sulfimides. However, achieving stereocontrol over highly active earth-abundant transition-metal nitrenoid intermediates remains a formidable challenge compared with precious metals. Herein, we disclose a chiral iron(II)/N,N'-dioxide-catalyzed enantioselective imidation of dialkyl and alkyl aryl sulfides using iminoiodinanes as nitrene precursors. A series of chiral sulfimides were obtained in moderate-to-good yields with high enantioselectivities (56 examples, up to 99% yield, 98:2 e.r.). The utility of this methodology was demonstrated by late-stage modification of complex molecules and synthesis of the chiral insecticide sulfoxaflor and the intermediates of related bioactive compounds. Based on experimental studies and theoretical calculations, a water-bonded high-spin iron nitrenoid species was identified as the key intermediate. The observed stereoselectivity was original from the steric repulsion between the amide unit of the ligand in the chiral cave and the bulky substituent of sulfides. Additionally, dioxazolones proved to be suitable acylnitrene precursors in the presence of an iron(III)/N,N'-dioxide complex, resulting in the formation of enantioselectivity-reversed sulfimides (14 examples, up to 81% yield, 97:3 e.r.).

Catalytic Asymmetric Dearomative [2 + 2] Photocycloaddition/Ring-Expansion Sequence of Indoles with Diversified Alkenes.

Developing novel strategies for catalytic asymmetric dearomatization (CADA) reactions is highly valuable. Visible light-mediated photocatalysis is demonstrated to be a powerful tool to activate aromatic compounds for further synthetic transformations. Herein, a catalytic asymmetric dearomative [2 + 2] photocycloaddition/ring-expansion sequence of indoles with simple alkenes was reported, providing a facile access to enantioenriched cyclopenta[b]indoles with good to high yields and enantioselectivities by means of chiral lanthanide photocatalysis. This protocol exhibited a broad substrate scope and good functional group tolerance, as well as potential applications in the synthesis of bioactive molecules. Mechanistic studies, including control experiments, UV-vis absorption spectroscopy, emission spectroscopy, and DFT calculations, were carried out, shedding insights into the reaction mechanism and the origin of enantioselectivity.

Myeloid leukemia-derived galectin-1 downregulates CAR expression to hinder cytotoxicity of CAR T cells.

BACKGROUND: Chimeric antigen receptor (CAR) T cells have shown significant activity in B-lineage malignancies. However, their efficacy in myeloid leukemia has not been successful due to unclear molecular mechanisms. METHODS: We conducted in vitro and in vivo experiments to investigate whether myeloid leukemia cells directly induce CAR down-regulation. Furthermore, we designed a CD33 CARKR in which all lysines in the cytoplasmic domain of CAR were mutated to arginine and verified through in vitro experiments that it could reduce the down-regulation of surface CARs and enhance the killing ability. Transcriptome sequencing was performed on various AML and ALL cell lines and primary samples, and the galectin-1-specific inhibitory peptide (anginex) successfully rescued the killing defect and T-cell activation in in vitro assays. RESULTS: CAR down-regulation induced by myeloid leukemia cells under conditions of low effector-to-tumor ratio, which in turn impairs the cytotoxicity of CAR T cells. In contrast, lysosomal degradation or actin polymerization inhibitors can effectively alleviate CAR down-regulation and restore CAR T cell-mediated anti-tumor functions. In addition, this study identified galectin-1 as a critical factor used by myeloid leukemia cells to induce CAR down-regulation, resulting in impaired T-cell activation. CONCLUSION: The discovery of the role of galectin-1 in cell surface CAR down-regulation provides important insights for developing strategies to restore anti-tumor functions.

Hierarchical Structure with Microcrater Covered with Nanograss Enhancing Condensation and Its Antifrosting/Anti-Icing Performance Inspired by Euphorbia helioscopia L.

Over an extended period of evolution and natural selection, a multitude of species developed a diverse array of biological interface features with specific functions. These biological structures provide a rich source of inspiration for the design of bionic structures on superhydrophobic surfaces. Understanding the functional mechanism of plant leaves is of paramount importance for the advancement of new engineering materials and the further promotion of engineering applications of bionic research. The hierarchical structure of microcrater-covered nanograss (MCNG) on the surface of E. helioscopia L. leaf provided the inspiration for the bionic MCNG surface, which was successfully prepared on a copper substrate by hybrid laser micromachining technology and chemical etching. The combined action of texture structure and surface chemistry resulted in a contact angle of 169° ± 1° for MCNG surface droplets and a rolling angle of less than 1°. Notably, the condensation-induced adhesion force does not augment with the increase of the temperature difference, which facilitated the shedding of hot droplets from the surface. The microscope observation revealed a high density of condensed droplets on the MCNG surface and the tangible jumping behavior of the droplets. The fabricated MCNG also demonstrated excellent antifrost/anti-icing abilities in low-temperature and high-humidity environments. Finally, the study confirmed the exceptional mechanical durability and reusability of the MCNG surface through various tests, including scratch damage, sandpaper wear, water flow impact and flushing, and condensation-drying cycle tests. The nanograss can be effectively protected within the microcrater structure. This research presents a promising approach for preventing and/or removing unwanted droplets in numerous engineering applications.

Laser-Constructed Bionic Composite Fog-Collecting Surfaces with Efficient Nucleation Sites and Enhanced Water Transport.

Fog collection effectively alleviates the current freshwater shortage; thus, enhancing its efficiency is crucial. Here, we report a novel bionic fog collection surface (Al@B-V) comprising composite superhydrophobic bumps integrated with superhydrophilic V-channel grooves. This surface, which has efficient fog nucleation points and enhanced water transport capabilities, effectively balances fog capture and water transport during the collection process, thereby achieving high-efficiency fog collection. Compared to ordinary aluminum-based surfaces, Al@B-V achieves a fog collection efficiency of up to 3.08 g·cm-2·h-1, three times higher than the original aluminum-based surface. Furthermore, the V-channel groove proposed in this study exhibits a water transport speed of up to 165 mm·s-1, which is remarkably approximately 80 times faster than the commonly used U-channel groove. Additionally, this V-channel groove can overcome gravity, transporting approximately 10 µL of liquid to the top even when placed at 90° inclination. It can directionally transport 10 µL of liquid over a distance of up to 151 mm on a plane. This novel microgroove design can be effectively applied in various fields, including liquid collection, directional transport, seawater desalination, microfluidics, and drug delivery.

Superhydrophobic Surfaces with Excellent Ice Prevention and Drag Reduction Properties Inspired by Iridaceae Leaf.

The anti-icing and drag-reduction properties of diverse microstructured surfaces have undergone extensive study over the past decade. Nonetheless, tough environments enforce stringent demands on the composite characteristics of superhydrophobic surfaces (SHS). In this study, fresh composite structures were fabricated on a metal substrate by nanosecond laser machining technology, drawing inspiration from the hardy plant Iridaceae. The prepared sample surface mainly consists of a periodic microrhombus array and irregular nanosheets. To comprehensively investigate the effect of its special structure on surface properties, three surfaces with different sizes of rhombic structures were used for comparative analysis, and the results show that the SH-S2 sample is optimal. This can significantly delay the freezing time by an impressive 1404 s at -10 °C while revealing the sample surface anti-icing strategy. In addition, the rheological experiments determined over 300 µm of slip length for the SH-S2 sample, and the drag reduction rate of the surface reaches nearly 40%, which is well aligned with the results of the delayed icing experiments. Finally, the mechanical durability of the SH-S2 surface was investigated through scratch damage, sandpaper abrasion, reparability trials, and icing and melting cycle tests. This research presents a new approach and methodology for the application of SHS on polar ship surfaces.

Fluid-Solid Interfacial Properties and Drag-Reducing Characterization of the Flexible Conical Microstructured Film Inspired by the Streamlined Body Surface of the Pufferfish.

Given the challenges in accurately replicating the surface of the pufferfish, this study employed three-dimensional (3D) printing to create a model based on inverse modeling. The morphology of the pufferfish exhibits a streamlined configuration, characterized by a gradual widening from the anterior oral region to the central ocular area, followed by a progressive narrowing from the midabdominal region toward the caudal extremity. The RNG k-ε turbulence simulation results demonstrate that the streamlined body surface of the pufferfish diminishes differential pressure resistance. This enhancement promotes laminar flow formation, delays fluid separation, minimizes turbulence-induced vortices, and reduces frictional resistance. Moreover, the pufferfish's supple and uneven outer epidermis was simplified into a flexible, nonsmooth planar film to conduct fluid-solid coupling simulations. These revealed that the pufferfish's unique skin can absorb turbulent energy and minimize momentum transfer between the fluid and the solid film, lowering the fluid resistance during swimming. In summary, The high-efficiency swimming capacity of pufferfish stems not only from their streamlined body surface but also significantly from the unique structural characteristics and mechanical properties of their flexible skin. This research provides critical theoretical underpinnings for the design of functional bionic surfaces aimed at drag reduction.

Water-enabling strategies for asymmetric catalysis.

Water possesses unique advantages, including abundance, environmental friendliness and mild effects. Undoubtedly, it is an ideal solvent or reagent in chemical syntheses. Water also shows unique abilities in catalytic asymmetric synthesis. It can accelerate reaction rates, improve diastereo- or enantioselectivities, initiate reactions, diversify chemo, diastereo- or enantioselectivities through various effects (hydrophobic, hydrogen bonding, protonation). Several reviews have demonstrated the positive effects of water in asymmetric synthesis. In this review, we summarize water-enabling strategies in the last decade, and focus on advances which reveal how water affects a reaction.

Loss of Lkb1 in CD11c+ myeloid cells protects mice from diet-induced obesity while enhancing glucose intolerance and IL-17/IFN-γ imbalance.

Adipose tissue CD11c+ myeloid cell is an independent risk factor associated with obesity and metabolic disorders. However, the underlying molecular basis remains elusive. Here, we demonstrated that liver kinase B1 (Lkb1), a key bioenergetic sensor, is involved in CD11c+ cell-mediated immune responses in diet-induced obesity. Loss of Lkb1 in CD11c+ cells results in obesity resistance but lower glucose tolerance, which accompanies tissue-specific immune abnormalities. The accumulation and CD80's expression of Lkb1 deficient adipose-tissue specific dendritic cells but not macrophages is restrained. Additionally, the balance of IL-17A and IFN-γ remarkably tips towards the latter in fat T cells and CD11c- macrophages. Mechanistically, IFN-γ promotes apoptosis of preadipocytes and inhibits their adipogenesis while IL-17A promotes the adipogenesis in vitro, which might account in part for the fat gain resistant phenotype. In summary, these findings reveal that Lkb1 is essential for fat CD11c+ dendritic cells responding to HFD exposure and provides new insights into the IL-17A/IFN-γ balance in HFD-induced obesity.

Uncovering leveraging and hindering factors in socio-ecological interactions: Agricultural production in the Yellow River Basin as an example.

Agricultural production and sustainable human livelihoods in large river basins are threatened by climate change, human activities, and resource constraints. However, due to the complexity of socio-ecological interactions and agricultural sustainability, current studies are still limited by a priori knowledge and systematic analyses, as well as by the lack of quantification and identification of key factors and valuable pathway structures for agricultural production activities. Here, we combined observation-based causal inference and network analysis to quantify and assess the complex interactions in agricultural production in the Yellow River Basin (YRB) based on data from 12 factors relevant to agriculture over 40 years. We quantitatively assessed the leveraging and hindering roles of the factors in the interacting network system and provided managers with optimization priorities and possible causal pathways to achieve sustainable agriculture in the basin. For example, the fruit yield and income of rural households were identified as leveraging factors that positively affect the agricultural economy. Groundwater was seen as a hindering factor in dampening the negative impacts of the system, highlighting the importance of preventing groundwater depletion. Moreover, the findings suggest that spatially diverse causal interaction structures exist in the YRB and have shaped a variety of distinctive agricultural development modes. Our research ideas and results highlight both systemic considerations and the amplifying or dampening role of factors in interaction pathways, providing valuable quantitative insights into the management and intervention of sustainable agriculture in large river basins. Owing to replaceable and extensible network models, the methodology has the potential to be utilized in a variety of study areas and topics with complex socio-ecological interactions.

Cross-scale coupling of ecosystem service flows and socio-ecological interactions in the Yellow River Basin.

As research on the full spectrum of ecosystem service (ES) generation and utilization within coupled human and natural systems (CHANS) has expanded, many studies have shown that the spatiotemporal dynamics of ESs are managed and influenced by human activities. However, there is insufficient research on how ESs are affected by bidirectional coupling between societal and ecological factors during spatial flow, particularly in terms of cross-scale impacts. These bidirectional influences between humans and nature are closely related to the utilization and transfer of ESs and affect the perception of spatiotemporal patterns of ESs and the formulation of management strategies. To fill this research gap, this study focuses on the Yellow River Basin (YRB), using network models to track the spatial dynamics of ES flows (ESFs) and the interactions between ecosystems and socio-economic systems within the basin on an annual scale from 2000 to 2020. The results highlight cross-scale impacts and feedback processes between local subbasins and the larger regional basin: As the supply-demand ratios of freshwater ESs, soil conservation ESs, and food ESs increase within individual subbasins of the YRB, more surplus ESs flow among subbasins. This not only alleviates spatial mismatches in ES supply and demand across the entire basin but also enhances the connectivity of the basin's ESF network. Subsequently, the cascading transfer and accumulation of ESs feedback into local socio-ecological interactions, with both socio-economic factors and the capacity for ES output within subbasins becoming increasingly reliant on external ES inflows. These results underscore the crucial role of ESFs within the CHANS of the YRB and imply the importance of cross-regional cooperation and cross-scale management strategies in optimizing ES supply-demand relationships. Furthermore, this study identifies the potential risks and challenges inherent in highly coupled systems. In conclusion, this work deepens the understanding of the spatial flow characteristics of ESs and their socio-ecological interactions; the analytical methods used in this study can also be applied to research on large river basins like the YRB, and even larger regional ecosystems.

Evaluation of ecosystem quality and stability based on key indicators and ideal reference frame: A case study of the Qinghai-Tibet Plateau.

China has explicitly prioritized the enhancement of ecosystem quality and stability(EQS) as a governmental objective. However, our understanding of systematic and comprehensive assessment methods for EQS remains limited. The development and investigation of corresponding evaluation frameworks and their underlying mechanisms remain insufficiently explored. This study employs the concept of an "ideal reference system and key indicators," integrating diverse ecosystem and human activity characteristics from perspectives such as ecosystem structure, function, and landscape vulnerability, to determine indicator weights using the Analytic Hierarchy Process(AHP) and entropy weight method, thereby constructing an evaluation framework for assessing the quality and stability of the Qinghai-Tibet Plateau(QTP) ecosystem. The spatiotemporal variations in EQS from 2000 to 2018 were examined, and the key driving factors were identified using the optimal parameter-based geographical detector (OPGD). The results indicate that the EQS of the QTP exhibit a spatial distribution pattern characterized by higher values in the southeast and lower values in the northwest. From 2000 to 2018, there has been a consistent improvement in the overall ecosystem quality and stability across the QTP. The EQS exhibit a significant synergistic effect, with high-high(26.59 ± 1.26%) and low-low(32.61 ± 1.45%) matching combinations becoming the predominant regional patterns. However, in climatic transition zones and glacial areas, the relationship between these factors is particularly distinctive, indicating ecosystem response mechanisms specific to certain natural environmental conditions. Vegetation cover(>0.697), evapotranspiration(>0.620), and precipitation(>0.688) are the primary natural factors influencing EQS, while the impact of human activities has become increasingly significant. Furthermore, the research findings underscore the positive effects of the variable climatic conditions of the QTP on ecosystems within the context of global climate warming, while the stringent implementation of ecological protection measures has collectively contributed to the enhancement of EQS. The proposed evaluation framework not only facilitates a comprehensive and precise assessment of regional EQS, but also provides a scientific basis for understanding and managing the adaptive responses of plateau ecosystems under the complex interplay of natural and anthropogenic factors.

Imbalance in lake variability but not embodying driving factors on the Qinghai-Tibetan Plateau calls on heterogeneous lake management.

Comprehensive regional remote analysis tends to neglect lakes in exorheic basins on the Qinghai-Tibetan Plateau (QTP), and a concurrent lack of discussions on whether there exist imbalanced explanations for the driving forces of both internal and external lakes is also present. We integrate multisourced lake datasets, high-resolution information, and available altimetry datasets to establish multiple mathematical models to meta-simulate lake volume changes, extend current lake variation datasets, and quantify the imbalance of variations and factors driving the water mass budget. The results showed that the primary cause of lake variations in QTP is net precipitation (57.75 ± 31.46%), followed by glacier runoff (33.53 ± 31.42%), and permafrost (8.34 ± 7.87%). Even though glacier runoff is currently considered as a weak factor of lake variation, heterogeneous results call for remaining attention in glacier-induced lake basins. Imbalance embodying in lake variability but not in contributions of driving factors, which calls for special lake management ways in different watersheds.

Iron-Catalyzed Asymmetric α-Alkylation of 2-Acylimidazoles via Dehydrogenative Radical Cross-Coupling with Alkanes.

The direct α-alkylation of acyclic carbonyls with nonactivated hydrocarbons through C(sp3 )-H functionalization is both extremely promising and notably challenging, especially when attempting to achieve enantioselectivity using iron-based catalysts. We have identified a robust chiral iron complex for the oxidative cross-coupling of 2-acylimidazoles with benzylic and allylic hydrocarbons, as well as nonactivated alkanes. The readily available and tunable N,N'-dioxide catalysts of iron in connection with oxidants exhibit precise asymmetric induction (up to 99 % ee) with good compatibility in moderate to good yields (up to 88 % yield). This protocol provides an elegant and straightforward access to optically active acyclic carbonyl derivatives starting from simple alkanes without prefunctionalization. Density functional theory (DFT) calculations and control experiments were made to gain insight into the nature of C-C bond formation and the origin of enantioselectivity. We propose a radical-radical cross-coupling process enabled by the immediate interconversion between chiral ferric species and ferrous species.

Asymmetric Catalytic Synthesis of Allylic Sulfenamides from Vinyl α-Diazo Compounds by a Rearrangement Route.

The asymmetric rearrangement of allylic sulfilimines is an effective route to synthetic attractive targets such as allylic sulfenamides and others. The current methods are limited to chirality transfer from chiral allylic sulfilimine precursors. Herein, we report a general and fundamentally new rearrangement route accessing optically enriched allylic sulfenamides and their derivatives. The process involves a S-alkylation and an unusual S-to-N rearrangement step. The chiral nickel complex enables the transformation of a broad scope of sulfenamides and vinyl α-diazo pyrazoleamides under mild conditions. Various allylic sulfenamides have been synthesized with excellent γ-regioselectivity and enantioselectivity, which can be efficiently converted to sulfinamide and 4-aminobutenoic acid derivatives. In addition, DFT calculations demonstrate the connection between the spin state and conformation of nickel vinyl carbenoid, as well as an unknown rearrangement process.

Sequential CD19 and CD22 chimeric antigen receptor T-cell therapy for childhood refractory or relapsed B-cell acute lymphocytic leukaemia: a single-arm, phase 2 study.

BACKGROUND: Relapses frequently occur following CD19-directed chimeric antigen receptor (CAR) T-cell treatment for relapsed or refractory B-cell acute lymphocytic leukaemia in children. We aimed to assess the activity and safety of sequential CD19-directed and CD22-directed CAR T-cell treatments. METHODS: This single-centre, single-arm, phase 2 trial, done at Beijing GoBroad Boren Hospital, Beijing, China, included patients aged 1-18 years who had relapsed or refractory B-cell acute lymphocytic leukaemia with CD19 and CD22 positivity greater than 95% and an Eastern Cooperative Oncology Group performance status of 0-2. Patients were initially infused with CD19-directed CAR T cells intravenously, followed by CD22-directed CAR T-cell infusion after minimal residual disease-negative complete remission (or complete remission with incomplete haematological recovery) was reached and all adverse events (except haematological adverse events) were grade 2 or better. The target dose for each infusion was 0·5 × 106 to 5·0 × 106 cells per kg. The primary endpoint was objective response rate at 3 months after the first infusion. Secondary endpoints were duration of remission, event-free survival, disease-free survival, overall survival, safety, pharmacokinetics, and B-cell quantification. The prespecified activity analysis included patients who received the target dose and the safety analysis included all treated patients. This study is registered with ClinicalTrials.gov, NCT04340154, and enrolment has ended. FINDINGS: Between May 28, 2020, and Aug 16, 2022, 81 participants were enrolled, of whom 31 (38%) were female and 50 (62%) were male. Median age was 8 years (IQR 6-10), all patients were Asian. All 81 patients received the first infusion and 79 (98%) patients received sequential infusions, CD19-directed CAR T cells at a median dose of 2·7 × 106 per kg (IQR 1·1 × 106 to 3·7 × 106) and CD22-directed CAR T cells at a median dose of 2·2 × 106 per kg (1·1 × 106 to 3·7 × 106), with a median interval of 39 days (37-41) between the two infusions. 62 (77%) patients received the target dose, including two patients who did not receive CD22 CAR T cells. At 3 months, 60 (97%, 95% CI 89-100) of the 62 patients who received the target dose had an objective response. Median follow-up was 17·7 months (IQR 11·4-20·9). 18-month event-free survival for patients who received the target dose was 79% (95% CI 66-91), duration of remission was 80% (68-92), and disease-free survival was 80% (68-92) with transplantation censoring; overall survival was 96% (91-100). Common adverse events of grade 3 or 4 between CD19-directed CAR T-cell infusion and 30 days after CD22-directed CAR T-cell infusion included cytopenias (64 [79%] of 81 patients), cytokine release syndrome (15 [19%]), neurotoxicity (four [5%]), and infections (five [6%]). Non-haematological adverse events of grade 3 or worse more than 30 days after CD22-directed CAR T-cell infusion occurred in six (8%) of 79 patients. No treatment-related deaths occurred. CAR T-cell expansion was observed in all patients, with a median peak at 9 days (IQR 7-14) after CD19-directed and 12 days (10-15) after CD22-directed CAR T-cell infusion. At data cutoff, 35 (45%) of 77 evaluable patients had CAR transgenes and 59 (77%) had B-cell aplasia. INTERPRETATION: This sequential strategy induced deep and sustained responses with an acceptable toxicity profile, and thus potentially provides long-term benefits for children with this condition. FUNDING: The National Key Research & Development Program of China, the CAMS Innovation Fund for Medical Sciences (CIFMS), and the Non-Profit Central Research Institute Fund of Chinese Academy of Medical Sciences. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.