Targeting Alloreactive Donor T-Cells to Hematopoietic System-Restricted Minor Histocompatibility Antigens to Dissect Graft-versus-Leukemia Effects from Graft-versus-Host Disease after Allogeneic Stem Cell Transplantation

2003 ◽  
Vol 78 (3) ◽  
pp. 208-212 ◽  
Author(s):  
Tuna Mutis
Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3742-3742
Author(s):  
LeShara M Fulton ◽  
Michael J Carlson ◽  
James Coghill ◽  
Michelle L. West ◽  
Angela Panoskaltisis-Mortari ◽  
...  

Abstract Abstract 3742 CD4+ T helper (Th) cells play a critical role in the development of Graft-versus-Host Disease (GvHD). The relative contributions of particular Th subsets to GVHD pathogenesis, however, are incompletely understood. In order to clarify the contribution of the Th17 subset to GVHD induction, we made use of mice knocked out at the RORgt locus (RORgt−/−), a transcription factor crucial for Th17 polarization. Methods: Haplotype matched and complete MHC mismatched murine HSCT models were used. For the haploidentical model C57BL/6 (H-2b, B6) mice served as donors while C57BL/6 × DBA2 F1 (H-2bxd, B6D2) mice functioned as recipients. Effector T cells (Teffs) were isolated from the spleens of wild type (WT) B6 and RORgt knockout mice backcrossed 7–8 generations onto a B6 background. B6D2 mice were lethally irradiated with 900 rads on day -1 and injected intravenously with 4 × 106 Teffs from WT or RORgt−/− mice supplemented with 3 × 106 WT T cell depleted bone marrow cells (TCD BM) on day 0. For the completely MHC mismatched model, BALB/c mice (H-2d) were lethally irradiated with 800 rads on day -1 and administered 5 × 105 WT or RORgt−/− Teffs supplemented with 5 × 106 B6 TCD BM on day 0. Results: B6D2 mice that received RORgt−/− Teffs displayed significantly attenuated GvHD, recovering from weight loss by day +31 and demonstrating 100% survival on day +60. Conversely, mice that received WT Teffs showed intense disease progression with 100% mortality by day +31 (Figure A, p<0.0001 for survival comparison between WT and RORgt−/− recipients using Fisher's exact test). Similar results were seen using the completely MHC mismatched model, with superior overall survival noted in those animals receiving RORgt −/− Teffs (put in p value here). Recipients of RORgt −/− T cells demonstrated statistically significant decreased TNF in serum compared to WT recipients (Figure B, p=0.001 comparing WT and RORgt−/− recipients using student's t test). Interestingly, despite the decreased severity of GvHD, serum concentrations of IFN-g were increased in recipients transplanted with RORgt −/− T cells. Chimerism studies post-transplant revealed complete donor reconstitution in recipients of both RORgt−/− and WT Teffs. Donor Teffs isolated from recipient livers post-transplant consistently demonstrated an activated phenotype, with low L selectin and high CD25 expression. Conclusions: T cell expression of the Th17 transcription factor, RORgt, is critical for the development of lethal GvHD following allogeneic stem cell transplantation in both the haploidentical and MHC complete mismatch models. GvHD attenuation in the absence of RORgt is not the result of an inability for donor T cells to undergo activation or to engraft in vivo. Interestingly, the absence of RORgt from donor T cells led to enhanced IFN-g in serum. Thus, in vivo, the Th17 pathway is critical for the induction of GvHD. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. SCI-3-SCI-3
Author(s):  
Jerome Ritz

Abstract The clinical outcomes of allogeneic hematopoietic stem cell transplantation (HSCT) have steadily improved in the last two decades, but this remains a potentially toxic treatment approach and further improvements are needed. Both the benefits and potential toxicities of allogeneic HSCT derive from the replacement of the recipient’s immune system with donor cells. Donor T cells clearly play a critical role as the primary mediators of both graft-versus-leukemia (GVL) and graft-versus-host-disease (GVHD) after transplant. In this setting, donor T cells targeting tumor-specific antigens provide specific GVL activity and donor T cells targeting broadly expressed minor histocompatibility antigens (allo-antigens) lead to GVHD. Donor T cells targeting minor histocompatibility antigens with restricted expression on both normal and malignant hematopoietic cells in the recipient contribute to GVL as well as to the elimination of recipient hematopoietic cells and the establishment of full donor hematopoiesis. Although donor B cells do not contribute to acute GVHD, considerable evidence now suggests that donor B cells also play an important role in chronic GVHD (cGVHD). In male patients with female donors, Y chromosome encoded (HY) proteins represent a clinically relevant set of widely expressed minor histocompatibility antigens (mHA) that are frequently recognized by both donor T cells and B cells. HY antibodies typically develop four to eight months after HSCT and the development of HY antibodies is significantly associated with the development of cGVHD. Antibodies to autosomal mHA and tumor-associated antigens have also been detected. Development of antibodies to mHA has also been associated with a lower risk of relapse suggesting a role for donor B cells in GVL. Murine models have clearly demonstrated that donor B cell reconstitution after allogeneic HSCT contributes to the development of cGVHD. In one of these models, depletion of germinal center B cells prevents the development of bronchiolitis obliterans and other pathologic features of cGVHD. The homeostatic cytokine B-cell activating factor (BAFF) plays an important role in the regulation of donor B cell reconstitution. BAFF promotes B-cell proliferation, differentiation, and survival; but persistent, high levels of BAFF also support the survival of auto and allo-reactive B cells. Patients with cGVHD typically have delayed B-cell reconstitution and low numbers of circulating B cells associated with high levels of BAFF. A high BAFF to B-cell ratio promotes survival of antigen-activated B cells and prevents or delays the development of B-cell tolerance after transplant. The important role of B cells in cGVHD has been confirmed by numerous clinical reports demonstrating the efficacy of B-cell directed therapy with rituximab in patients with established cGVHD. Overall response rates of 40 to 70 percent have been reported, and clinical responses have been associated with reduced titers of allo-reactive antibodies and restoration of normal B-cell homeostasis, with increased numbers of circulating B cells and lower levels of BAFF after recovery from treatment. The efficacy of rituximab in the treatment of established cGVHD has led to recent studies evaluating rituximab as a prophylactic therapy for cGVHD. The results of single institution trials suggest that this may be an effective approach and further randomized multi-center trials evaluating the role of rituximab for cGVHD prophylaxis are currently in development. The efficacy of rituximab has also led to the evaluation of other B cell directed therapies in murine models. In particular, selective inhibitors of B cell signaling pathways have been developed and appear to be effective in preventing cGVHD in these model systems. Further evaluation of these new agents in the treatment and prevention of cGVHD is in development. Disclosures: Off Label Use: Rituximab - Use in treatment of chronic GVHD..


Blood ◽  
2003 ◽  
Vol 101 (4) ◽  
pp. 1645-1652 ◽  
Author(s):  
Leo Luznik ◽  
Jill E. Slansky ◽  
Sanju Jalla ◽  
Ivan Borrello ◽  
Hyam I. Levitsky ◽  
...  

A frequent outcome of allogeneic stem cell transplantation (alloSCT) in the treatment of leukemia is the destruction of the host hematolymphoid compartment and, thus, the malignancy, through the combined action of high-dose chemoradiotherapy and a T-cell–mediated graft-versus-host effect. Unfortunately, alloSCT is frequently limited by toxicity, including graft-versus-host disease (GVHD), and has not been successful in the treatment of tumors derived from solid organs. Here we report a novel cooperation between host and donor T cells in the response to a tumor cell vaccine given after a nonmyeloablative allogeneic stem cell transplantation (NST) protocol that achieves stable mixed bone marrow chimerism. Treatment of animals with NST, posttransplantation donor lymphocyte infusions (DLIs), and a vaccine, comprising irradiated autologous tumor cells mixed with a granulocyte-macrophage colony-stimulating factor (GM-CSF)–producing bystander line, results in potent and specific antitumor immunity. This combined modality immunotherapy, administered after surgical removal of the primary tumor, cured metastatic mammary cancer in most animals without inducing GVHD. Cured animals contained tumor-specific T cells of both host and donor origin, but immunodeficient hosts could not be cured by NST, DLI, and vaccine administration. Thus, transfer of allogeneic donor T cells may help break functional tolerance of a host immune system to a solid tumor, thereby providing a rationale for the generation of mixed hematopoietic chimerism by NST prior to tumor cell vaccination.


Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3239-3239
Author(s):  
Robbert van der Voort ◽  
Jurjen Ruben ◽  
Annemieke Vos ◽  
Marielle Philippens ◽  
T.M. de Witte ◽  
...  

Abstract Allogeneic stem cell transplantation is a potent treatment for patients with leukemia. This therapeutic effectiveness is largely attributed to the graft-versus-leukemia (GVL) response during which alloreactive donor CD8+ T cells eradicate minor histocompatibility antigens (MiHA)-expressing leukemic cells. Unfortunately, recognition of MiHA expressed in healthy tissues, including the liver, skin and gut, often results in morbidity and even mortality due to the development of graft-versus-host disease (GVHD). Antigen presenting cells (APC) play an essential role in the activation of alloreactive T cells and thus in the induction of GVL responses and GVHD. Using several in vivo models it has been suggested that host APC, which present endogenous MiHA to donor CD8+ T cells, are more potent inducers of alloreactive responses than donor APC. Here, we compared the ability of host APC versus donor APC to activate alloreactive T cells in vitro and to induce alloreactions in vivo. For this purpose, we isolated T cells and cultured bone marrow-derived dendritic cells (DC), the most potent APC, from B6.SJL ‘host’ mice and MHC (H-2b)-matched but MiHA-mismatched C3.SW ‘donor’ mice. Following their activation by the TLR4 ligand lipopolysaccharide for no longer than 5 hours, both host and donor DC showed a fully mature phenotype (MHCIhigh MHCIIhigh CD40+ CD80high CD86high), and comparable migratory behavior towards lymph node-specific chemokines. In primary mixed leukocyte reactions host DC were 2–3 times more potent than donor DC in inducing donor CD8+ T cell proliferation. To determine the role of host and donor DC in the development of GVL and GVHD, we established a preclinical mouse model (C3>B6) for allogeneic stem cell transplantation. Repopulation analyses demonstrated that T cells, B cells and myeloid cells from blood and spleen of transplanted mice were for more than 95% of donor origin. Transplanted mice were subsequently vaccinated intravenously with 3 weekly doses of 3 × 105 host or donor DC. DC vaccination, which did not lead to significant GVHD, was followed by an intravenous challenge with 106 GFP-expressing mouse AML (C1498) cells. While sham-vaccinated mice died quickly due to leukemia progression, vaccination with both host and donor DC resulted in diminished leukemia growth. However, only vaccination with host DC, and not donor DC, resulted in a (partial) rescue from challenge. These results suggest that host DC are the most potent inducers of GVL reactions without causing significant GVHD. We believe that these data will be instrumental in designing appropriate DC-based immunotherapies in transplanted leukemia patients.


Blood ◽  
2013 ◽  
Vol 121 (18) ◽  
pp. 3745-3758 ◽  
Author(s):  
Emily Blyth ◽  
Leighton Clancy ◽  
Renee Simms ◽  
Chun K. K. Ma ◽  
Jane Burgess ◽  
...  

Key Points Infusion of CMV-specific T cells early posttransplant does not increase acute or chronic graft-versus-host disease. CMV-specific T cells early posttransplant reduce the need for pharmacotherapy without increased rates of CMV-related organ damage.


Blood ◽  
2018 ◽  
Vol 131 (1) ◽  
pp. 5-7
Author(s):  
Frederick L. Locke ◽  
Claudio Anasetti

In this issue of Blood, Dossa et al report the engineering of T-cell receptor (TCR) transgenic T cells against the human minor histocompatibility antigen HA-1 for the prevention or treatment of leukemia relapse after allogeneic stem cell transplantation.1


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