Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Sci Transl Med. 2023 Oct 11;15(717):eadf4287. doi: 10.1126/scitranslmed.adf4287.
Immune cell-based therapies are promising strategies to facilitate immunosuppression withdrawal after organ transplantation. Regulatory dendritic cells (DCreg) are innate immune cells that down-regulate alloimmune responses in preclinical models. Here, we performed clinical monitoring and comprehensive assessment of peripheral and allograft tissue immune cell populations in DCreg-infused live-donor liver transplant (LDLT) recipients up to 12 months (M) after transplant. Thirteen patients were given a single infusion of donor-derived DCreg 1 week before transplant (STUDY) and were compared with 40 propensity-matched standard-of-care (SOC) patients. Donor-derived DCreg infusion was well tolerated in all STUDY patients. There were no differences in postoperative complications or biopsy-confirmed acute rejection compared with SOC patients up to 12M. DCreg administration was associated with lower frequencies of effector T-betEomesCD8 T cells and CD16 natural killer (NK) cells and an increase in putative tolerogenic CD141CD163 DCs compared with SOC at 12M. Antidonor proliferative capacity of interferon-γ (IFN-γ) CD4 and CD8 T cells was lower compared with antithird party responses in STUDY participants, but not in SOC patients, at 12M. In addition, lower circulating concentrations of interleukin-12p40 (IL-12p40), IFN-γ, and CXCL10 were detected in STUDY participants compared with SOC patients at 12M. Analysis of 12M allograft biopsies revealed lower frequencies of graft-infiltrating CD8 T cells, as well as attenuation of cytolytic T1 effector genes and pathways among intragraft CD8 T cells and NK cells, in DCreg-infused patients. These reductions may be conducive to reduced dependence on immunosuppressive drug therapy or immunosuppression withdrawal.
免疫细胞疗法是一种有前途的策略,可以促进器官移植后免疫抑制的撤除。调节树突状细胞(DCreg)是先天免疫细胞,可在临床前模型中下调同种免疫反应。在此,我们对接受供体来源的 DCreg 输注的活体供肝移植(LDLT)受者进行了临床监测和外周及移植物组织免疫细胞群的综合评估,时间长达移植后 12 个月(M)。13 例患者在移植前 1 周给予单次输注供体来源的 DCreg(研究组),并与 40 例匹配倾向性的标准护理(SOC)患者进行比较。所有研究组患者均耐受良好的供体来源的 DCreg 输注。与 SOC 患者相比,在 12M 时,术后并发症或经活检证实的急性排斥反应没有差异。与 SOC 相比,DCreg 给药与效应性 T-betEomesCD8 T 细胞和 CD16 自然杀伤(NK)细胞频率降低以及假定的耐受性 CD141CD163 DC 增加有关。与 SOC 患者相比,研究组患者在 12M 时抗供体增殖能力的干扰素-γ(IFN-γ)CD4 和 CD8 T 细胞较低,但在 SOC 患者中则没有。此外,与 SOC 患者相比,研究组患者在 12M 时循环中白细胞介素-12p40(IL-12p40)、IFN-γ和 CXCL10 的浓度较低。对 12M 移植物活检的分析显示,输注 DCreg 的患者中,移植物浸润的 CD8 T 细胞频率较低,以及细胞毒性 T1 效应基因和途径在移植物内 CD8 T 细胞和 NK 细胞中的减弱。这些减少可能有利于减少对免疫抑制药物治疗或免疫抑制撤除的依赖。