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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.
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Research Article Immunology

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

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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

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Figure 7

PTCy-treated alloreactive T cells have impaired intrinsic ability to induce GVHD on serial transplant.

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PTCy-treated alloreactive T cells have impaired intrinsic ability to ind...
Irradiated B6D2F1 recipient mice were transplanted with 40 × 106 2C TCR+ admixed B6C3F1 splenocytes and 10 × 106 WT TCD BM cells as described in Figure 3 (8% of CD8+ T cells were 2C TCR+) or with 40 × 106 splenocytes and 10 × 106 TCD BM from 2C TCR+ B6C3F1 donors. Mice received either vehicle or 25 mg/kg/d PTCy on days +3 and +4. On day +5, splenocytes from these mice were flow cytometrically sorted to isolate viable 2C TCR+ T cells (LIVE/DEAD–CD8+Vβ8.1/8.2+1B2+). 0.5 × 106 2C TCR+ T cells from mice that had received 2C/WT admixed grafts or 1 × 106 2C TCR+ T cells from mice that had received only 2C splenocytes were combined with 5 × 106 2C TCD BM cells (BM from new 2C donors that was flow cytometrically depleted of Thy1.2+ cells). These grafts then were transplanted into new, irradiated (10.5 Gy), thymectomized, B6D2F1 recipients. These recipients did not receive any posttransplant treatment (i.e., no PTCy or vehicle on days +3/+4). Combined results from mice receiving 2C TCR+ T cells from 2C only grafts (n = 5 vehicle treated, n = 5 PTCy treated) or from 2C/WT admixed grafts (n = 5 vehicle treated, n = 4 PTCy treated) are shown as are data for 5 mice receiving TCD BM only. Results of each individual experiment are shown in Supplemental Figure 15. (A) Although the GVHD induced was not fatal for either treatment group, mice receiving PTCy-treated cells had superior weights and clinical scores compared with mice receiving vehicle-treated cells. AUC values were compared using Wilcoxon’s rank sum test. (B) These differences were seen even though similar numbers of 2C TCR+ T cells persisted in the liver at day +150 in mice receiving vehicle-treated or PTCy-treated cells.

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ISSN: 0021-9738 (print), 1558-8238 (online)

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