Autologous stem cell transplantation aids autoimmune patients by functional renewal and TCR diversification of regulatory T cells

Eveline M. Delemarre, Theo Van Den Broek, Gerdien Mijnheer, Jenny Meerding, Ellen J. Wehrens, Sven Olek, Marianne Boes, Martijn J C Van Herwijnen, Femke Broere, Annet van Royen, Nico W. Wulffraat, Berent J. Prakken, Eric Spierings, Femke Van Wijk

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)

Abstract

Autologous hematopoietic stem cell transplantation (HSCT) is increasingly considered for patients with severe autoimmune diseases whose prognosis is poor with standard treatments. Regulatory T cells (Tregs) are thought to be important for disease remission after HSCT. However, eliciting the role of donor and host Tregs in autologous HSCT is not possible in humans due to the autologous nature of the intervention. Therefore, we investigated their role during immune reconstitution and re-establishment of immune tolerance and their therapeutic potential following congenic bone marrow transplantation (BMT)inaproteoglycan-inducedarthritis (PGIA) mousemodel. Inaddition, wedetermined Treg T-cell receptor (TCR) CDR3 diversity before and after HSCT in patients with juvenile idiopathic arthritis and juvenile dermatomyositis. In the PGIA BMT model, after an initial predominance of host Tregs, graft-derived Tregs started dominating and displayed a more stable phenotype with better suppressive capacity. Patient samples revealed a striking lack of diversity of the Treg repertoire before HSCT. This ameliorated after HSCT, confirming reset of the Treg compartment following HSCT. In the mouse model, a therapeutic approach was initiated by infusing extra Foxp3GFP+ Tregs during BMT. Infusion of Foxp3GFP+ Tregs did not elicit additional clinical improvement but conversely delayed reconstitution of the graft-derived T-cell compartment. These data indicate that HSCT-mediated amelioration of autoimmune disease involves renewal of the Treg pool. In addition, infusion of extra Tregs during BMT results in a delayed reconstitution of T-cell compartments. Therefore, Treg therapy may hamper development of long-term tolerance and should be approached with caution in the clinical autologous setting.

Original languageEnglish
Pages (from-to)91-101
Number of pages11
JournalBlood
Volume127
Issue number1
DOIs
Publication statusPublished - 7 Jan 2016

Keywords

  • Adding regulatory t cells to the graft does not lead to additional clinical improvement but results in delayed donor t-cell reconstitution
  • Autologous HSCT induces functional renewal of regulatory t cells as well as a strong treg TCR diversification in autoimmune patients

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