Resetting the T cell compartment in autoimmune diseases with autologous hematopoietic stem cell transplantation: An update

Lisanne Lutter, Julia Spierings, Femke C.C. van Rhijn-Brouwer, Jacob M. van Laar, Femke van Wijk*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Autologous hematopoietic stem cell transplantation (aHSCT) for autoimmune diseases has been applied for two decades as a treatment for refractory patients with progressive disease. The rationale behind aHSCT is that high-dose immunosuppression eliminates autoreactive T and B cells, thereby resetting the immune system. Post-aHSCT the cytotoxic CD8+ T cells normalize via clonal expansion due to homeostatic proliferation within a few months. CD4+ T cells recover primarily via thymopoiesis resulting in complete renewal of the T cell receptor (TCR) repertoire which requires years or never normalize completely. The increase in naïve T cells inducing immune tolerance, renewal of especially the regulatory TCR repertoire, and a less pro-inflammatory functional profile of the CD4+ T cells seem essential for successful immune reconstitution inducing long-term remission. There is currently a knowledge gap regarding the immune response in tissue sites post-aHSCT, as well as disease-specific factors that may determine remission or relapse. Future studies on lymphocyte dynamics and function may pave the way for optimized conditioning regimens with a more individualized approach.

Original languageEnglish
Article number767
JournalFrontiers in Immunology
Volume9
Issue numberAPR
DOIs
Publication statusPublished - 20 Apr 2018

Keywords

  • Animals
  • Autoimmune Diseases/immunology
  • Hematopoietic Stem Cell Transplantation/methods
  • Humans
  • T-Lymphocytes/immunology
  • Transplantation, Autologous
  • T cell receptor repertoire
  • autologous hematopoietic stem cell transplantation
  • regulatory T cell
  • T cell reconstitution
  • autoimmune disease

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