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Adoptive Cell Therapy with Tregs to Improve Transplant Outcomes: the Promise and the Stumbling Blocks

  • Immunology (R Fairchild, Section Editor)
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Abstract

The contribution of regulatory T cells (Treg) to the induction and maintenance of tolerance is well-recognized in rodents and may contribute to long-term human organ allograft survival. The therapeutic efficacy of adoptively transferred Treg in promoting tolerance to organ allografts is well-recognized in mouse models. Early phase 1/2 clinical studies of Treg therapy have been conducted in patients with type-1 (autoimmune) diabetes and refractory Crohn’s disease and for inhibition of graft-versus-host disease following bone marrow transplantation with proven safety. The feasibility of adoptive Treg therapy in the clinic is subject to various parameters, including optimal cell source, isolation procedure, expansion, target dose, time of infusion, as well as generation of a GMP-cell product. Several phase 1/2 Treg dose-escalation studies are underway in organ transplantation. Recent evidence suggests that additional factors are critical to ensure Treg safety and efficacy in allograft recipients, including Treg characterization, stability, longevity, trafficking, concomitant immunosuppression, and donor antigen specificity. Accordingly, Treg therapy in the context of organ transplantation may prove more challenging in comparison to other prospective clinical settings of Treg immunotherapy, such as type-1 diabetes.

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Authors and Affiliations

  1. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, E1558 BST, Pittsburgh, PA, 15213, USA

    Mohamed B. Ezzelarab & Angus W. Thomson

  2. Department of Immunology, University of Pittsburgh School of Medicine, 200 Lothrop Street, E1558 BST, Pittsburgh, PA, 15213, USA

    Angus W. Thomson

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  1. Mohamed B. Ezzelarab
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  2. Angus W. Thomson
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Correspondence to Mohamed B. Ezzelarab.

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Conflict of Interest

Angus Thomson and Mohamed Ezzelarab report a grant from the NOH (AI U01 911297) part of the NIH NHP Transplantation Tolerance Cooperative Study Group and sponsored by the NIAID and NIDDK, during the conduct of this study.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Immunology

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Ezzelarab, M.B., Thomson, A.W. Adoptive Cell Therapy with Tregs to Improve Transplant Outcomes: the Promise and the Stumbling Blocks. Curr Transpl Rep 3, 265–274 (2016). https://doi.org/10.1007/s40472-016-0114-9

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