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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Stem Cells. Sep 26, 2026; 18(9): 122513
Published online Sep 26, 2026. doi: 10.4252/wjsc.122513
Induced pluripotent stem cell-derived chimeric antigen receptor natural killer cells: Engineering innovations, translational hurdles and clinical prospects in immune therapy
Xu-Lin Liu, Si-Min Han, Gang-Hui Ye, Qing-Lu Wang, Ying Luo, Yan-Mei Liu
Xu-Lin Liu, Gang-Hui Ye, Yan-Mei Liu, Department of Radiation Oncology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
Xu-Lin Liu, Si-Min Han, Qing-Lu Wang, College of Sport and Health, Shandong Sport University, Jinan 250102, Shandong Province, China
Ying Luo, Department of Clinical Laboratory, Zibo Central Hospital, Zibo 255000, Shandong Province, China
Co-corresponding authors: Ying Luo and Yan-Mei Liu.
Author contributions: Liu XL, Ye GH, and Liu YM contributed to the conception and the work design; Liu XL, Han SM, Wang QL, and Luo Y contributed to acquisition and analysis of data; Liu XL, Luo Y, and Ye GH contributed to writing and preparing the original draft; Luo Y and Liu YM contributed to writing, reviewing and editing the paper. Liu YM and Luo Y contributed equally as co-corresponding authors. All authors read and approved the final manuscript.
AI contribution statement: ChatGPT (GPT-5.5 Thinking, OpenAI) was used during manuscript preparation as an auxiliary tool for preliminary language checking, bilingual consistency checking, formatting assistance, and wording suggestions for selected manuscript components, including figure legends and revision-related text. No AI tool was used to generate research data, independently select or verify references, interpret evidence, formulate scientific conclusions, or replace the authors’ responsibility for the content of the manuscript. All AI-assisted outputs were critically reviewed, verified, and revised by the authors. The authors take full responsibility for the accuracy, originality, integrity, and final content of the manuscript.
Supported by Zhejiang Medical Health Science & Technology Project, No. 2022KY1403; and Natural Scientific Foundation of Shandong Province, No. ZR2025MS1369.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Yan-Mei Liu, MD, PhD, Department of Radiation Oncology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China. meilijindou@126.com
Received: April 22, 2026
Revised: June 30, 2026
Accepted: August 28, 2026
Published online: September 26, 2026
Processing time: 156 Days and 17.3 Hours
Abstract

Induced pluripotent stem cell-derived chimeric antigen receptor natural killer (iPSC-CAR-NK) cells are an evolving off-the-shelf cellular immunotherapy platform with potential for scalable manufacturing, product standardization, and multiplex engineering. This review summarizes recent progress in clinical-grade manufacturing, quality-attribute definition, and natural killer cell-adapted engineering strategies, including chimeric antigen receptor design, gene editing, tumor microenvironment adaptation, single-cell and multi-omics-guided optimization, and synthetic biology-based control. In addition, this review discusses recent progress in the application of iPSC-CAR-NK cells to hematologic malignancies and solid tumors and cautiously examines the early translational signal suggested by a single compassionate-use report in systemic sclerosis. To move beyond a descriptive listing of engineering strategies, we propose a multilevel analytical framework encompassing product definition, effector execution, tissue delivery, host interaction, and translational implementation. This framework is used to evaluate the functional roles, interrelationships, and limiting factors of engineering modules during clinical translation. Current evidence suggests manageable safety profiles and preliminary antitumor or immunomodulatory activity in some settings, but major barriers remain, including limited persistence, insufficient solid-tumor infiltration, host immune clearance, antigen escape, multiplex-engineering risks, and immature quality-control and regulatory standards.

Keywords: Induced pluripotent stem cells; Chimeric antigen receptor natural killer cells; Off-the-shelf immunotherapy; Cell engineering; Clinical translation; Tumor microenvironment; Genome editing; Synthetic biology

Core Tip: Induced pluripotent stem cell-derived chimeric antigen receptor (CAR) natural killer cells provide a candidate standardized, cell-bank-driven platform for off-the-shelf immunotherapy. Their translational value should not be judged solely by CAR expression, enhanced cytotoxicity, or accumulated engineering modules. This review proposes a multilevel framework integrating product definition, effector execution, tissue delivery, host interaction, and translational implementation, and emphasizes dominant bottlenecks, evidence levels, engineering trade-offs, and the gap between preclinical functional enhancement and established clinical benefit.

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