Go to JCI Insight
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Publication ethics
  • Publication alerts by email
  • Advertising
  • Job board
  • Contact
  • Clinical Research and Public Health
  • Current issue
  • Past issues
  • By specialty
    • COVID-19
    • Cardiology
    • Gastroenterology
    • Immunology
    • Metabolism
    • Nephrology
    • Neuroscience
    • Oncology
    • Pulmonology
    • Vascular biology
    • All ...
  • Videos
    • Conversations with Giants in Medicine
    • Video Abstracts
  • Reviews
    • View all reviews ...
    • Pancreatic Cancer (Jul 2025)
    • Complement Biology and Therapeutics (May 2025)
    • Evolving insights into MASLD and MASH pathogenesis and treatment (Apr 2025)
    • Microbiome in Health and Disease (Feb 2025)
    • Substance Use Disorders (Oct 2024)
    • Clonal Hematopoiesis (Oct 2024)
    • Sex Differences in Medicine (Sep 2024)
    • View all review series ...
  • Viewpoint
  • Collections
    • In-Press Preview
    • Clinical Research and Public Health
    • Research Letters
    • Letters to the Editor
    • Editorials
    • Commentaries
    • Editor's notes
    • Reviews
    • Viewpoints
    • 100th anniversary
    • Top read articles

  • Current issue
  • Past issues
  • Specialties
  • Reviews
  • Review series
  • Conversations with Giants in Medicine
  • Video Abstracts
  • In-Press Preview
  • Clinical Research and Public Health
  • Research Letters
  • Letters to the Editor
  • Editorials
  • Commentaries
  • Editor's notes
  • Reviews
  • Viewpoints
  • 100th anniversary
  • Top read articles
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Publication ethics
  • Publication alerts by email
  • Advertising
  • Job board
  • Contact
Posttransplantation cyclophosphamide prevents graft-versus-host disease by inducing alloreactive T cell dysfunction and suppression
Lucas P. Wachsmuth, … , Ronald E. Gress, Christopher G. Kanakry
Lucas P. Wachsmuth, … , Ronald E. Gress, Christopher G. Kanakry
Published March 26, 2019
Citation Information: J Clin Invest. 2019;129(6):2357-2373. https://doi.org/10.1172/JCI124218.
View: Text | PDF
Research Article Immunology

Posttransplantation cyclophosphamide prevents graft-versus-host disease by inducing alloreactive T cell dysfunction and suppression

  • Text
  • PDF
Abstract

Posttransplantation cyclophosphamide (PTCy) recently has had a marked impact on human allogeneic hematopoietic cell transplantation (HCT). Yet our understanding of how PTCy prevents graft-versus-host disease (GVHD) largely has been extrapolated from MHC-matched murine skin-allografting models that were highly contextual in their efficacy. Herein, we developed a T cell–replete, MHC-haploidentical, murine HCT model (B6C3F1→B6D2F1) to test the putative underlying mechanisms: alloreactive T cell elimination, alloreactive T cell intrathymic clonal deletion, and suppressor T cell induction. In this model and as confirmed in four others, PTCy did not eliminate alloreactive T cells identified using either specific Vβs or the 2C or 4C T cell receptors. Furthermore, the thymus was not necessary for PTCy’s efficacy. Rather, PTCy induced alloreactive T cell functional impairment, which was supported by highly active suppressive mechanisms established within one day after PTCy that were sufficient to prevent new donor T cells from causing GVHD. These suppressive mechanisms included the rapid, preferential recovery of CD4+CD25+Foxp3+ regulatory T cells, including those that were alloantigen specific, which served an increasingly critical function over time. Our results prompt a paradigm shift in our mechanistic understanding of PTCy. These results have direct clinical implications for understanding tolerance induction and for rationally developing novel strategies to improve patient outcomes.

Authors

Lucas P. Wachsmuth, Michael T. Patterson, Michael A. Eckhaus, David J. Venzon, Ronald E. Gress, Christopher G. Kanakry

×

Figure 6

PTCy-treated alloreactive T cells become functionally impaired, but not anergic, in response to alloantigen.

Options: View larger image (or click on image) Download as PowerPoint
PTCy-treated alloreactive T cells become functionally impaired, but not ...
Transplantation was performed as in Figure 1. PTCy was 25 mg/kg/d on days +3 and +4 where not otherwise specified. (A) High-level proliferation (Ki-67+) of liver-infiltrating alloreactive (Vβ6+) CD4+CD25–Foxp3– donor (H2kk+) conventional T cells at days +21 and +200. (B–F) At day +21, liver-infiltrating cells were isolated and restimulated (stim) in vitro with irradiated (30 Gy) donor-parental (C3H) or host-parental (DBA/2) splenocytes at 2 × 105 each of donors and stimulators per well. (B) Donor (H2kk+H2kb+) T cells from PTCy-treated mice had low proliferation to C3H at 5 days. (C) Proliferation was robust to alloantigen (DBA/2), although CD8+ T cell proliferation was reduced. (D) Cytokine production at 24 hours to alloantigen by PTCy-treated cells was markedly lower. (E and F) Procedures similar to those shown in B–D were followed, except responder T cells were flow cytometrically purified including removing CD4+CD25+ T cells (Tregs) prior to coculture. Similarly impaired (E) proliferation and (F) cytokine production by PTCy-treated T cells were seen. (G) The procedures in B–D were repeated at day +150. PTCy-treated T cells continued to proliferate and produce IFN-γ and IL-2 in response to alloantigen but not self-antigen; these differences were not due to disparities in the CD4+CD25+Foxp3+ T cell content of the restimulated cells (P = 0.21; not shown). Combined results from 2 independent experiments are shown for all parts. n = 8 mice/group for all parts except the 100 mg/kg PTCy group shown in the left panel in A (n = 5), the right panel in A (which shows all mice from Figure 1A surviving to day 200), E–F (n = 5-6/group), and the 25 mg/kg PTCy groups in G (n = 7). *P ≤ 0.05; **P ≤ 0.01; ***P ≤ 0.001; ****P ≤ 0.0001, unpaired t test with Welch’s correction. ND, not detectable. Statistical testing of cytokines was adjusted for multiple comparisons by the Holm-Šidák method.

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

Sign up for email alerts