A Phase I Clinical Trial with Ex Vivo Expanded Recipient Regulatory T cells in Living Donor Kidney Transplants

There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have shown the safety of Tregs in hematopoietic stem cell transplant recipients and subjects with juvenile diabetes. Our hypothesis is that infusion...

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Published inScientific reports Vol. 8; no. 1; pp. 7428 - 12
Main Authors Mathew, James M., H.-Voss, Jessica, LeFever, Ann, Konieczna, Iwona, Stratton, Cheryl, He, Jie, Huang, Xuemei, Gallon, Lorenzo, Skaro, Anton, Ansari, Mohammed Javeed, Leventhal, Joseph R.
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 09.05.2018
Nature Publishing Group
Nature Portfolio
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ISSN2045-2322
2045-2322
DOI10.1038/s41598-018-25574-7

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Abstract There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have shown the safety of Tregs in hematopoietic stem cell transplant recipients and subjects with juvenile diabetes. Our hypothesis is that infusion(s) of Tregs may induce transplant tolerance thus avoiding long-term use of toxic immunosuppressive agents that cause increased morbidity/mortality. Towards testing our hypothesis, we conducted a phase I dose escalation safety trial infusing billions of ex vivo expanded recipient polyclonal Tregs into living donor kidney transplant recipients. Despite variability in recipient’s renal disease, our expansion protocol produced Tregs which met all release criteria, expressing >98% CD4 + CD25 + with <1% CD8 + and CD19 + contamination. Our product displayed >80% FOXP3 expression with stable demethylation in the FOXP3 promoter. Functionally, expanded Tregs potently suppressed allogeneic responses and induced the generation of new Tregs in the recipient’s allo-responders in vitro . Within recipients, expanded Tregs amplified circulating Treg levels in a sustained manner. Clinically, all doses of Treg therapy tested were safe with no adverse infusion related side effects, infections or rejection events up to two years post-transplant. This study provides the necessary safety data to advance Treg cell therapy to phase II efficacy trials.
AbstractList There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have shown the safety of Tregs in hematopoietic stem cell transplant recipients and subjects with juvenile diabetes. Our hypothesis is that infusion(s) of Tregs may induce transplant tolerance thus avoiding long-term use of toxic immunosuppressive agents that cause increased morbidity/mortality. Towards testing our hypothesis, we conducted a phase I dose escalation safety trial infusing billions of ex vivo expanded recipient polyclonal Tregs into living donor kidney transplant recipients. Despite variability in recipient’s renal disease, our expansion protocol produced Tregs which met all release criteria, expressing >98% CD4+CD25+ with <1% CD8+ and CD19+ contamination. Our product displayed >80% FOXP3 expression with stable demethylation in the FOXP3 promoter. Functionally, expanded Tregs potently suppressed allogeneic responses and induced the generation of new Tregs in the recipient’s allo-responders in vitro. Within recipients, expanded Tregs amplified circulating Treg levels in a sustained manner. Clinically, all doses of Treg therapy tested were safe with no adverse infusion related side effects, infections or rejection events up to two years post-transplant. This study provides the necessary safety data to advance Treg cell therapy to phase II efficacy trials.
There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have shown the safety of Tregs in hematopoietic stem cell transplant recipients and subjects with juvenile diabetes. Our hypothesis is that infusion(s) of Tregs may induce transplant tolerance thus avoiding long-term use of toxic immunosuppressive agents that cause increased morbidity/mortality. Towards testing our hypothesis, we conducted a phase I dose escalation safety trial infusing billions of ex vivo expanded recipient polyclonal Tregs into living donor kidney transplant recipients. Despite variability in recipient's renal disease, our expansion protocol produced Tregs which met all release criteria, expressing >98% CD4+CD25+ with <1% CD8+ and CD19+ contamination. Our product displayed >80% FOXP3 expression with stable demethylation in the FOXP3 promoter. Functionally, expanded Tregs potently suppressed allogeneic responses and induced the generation of new Tregs in the recipient's allo-responders in vitro. Within recipients, expanded Tregs amplified circulating Treg levels in a sustained manner. Clinically, all doses of Treg therapy tested were safe with no adverse infusion related side effects, infections or rejection events up to two years post-transplant. This study provides the necessary safety data to advance Treg cell therapy to phase II efficacy trials.There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have shown the safety of Tregs in hematopoietic stem cell transplant recipients and subjects with juvenile diabetes. Our hypothesis is that infusion(s) of Tregs may induce transplant tolerance thus avoiding long-term use of toxic immunosuppressive agents that cause increased morbidity/mortality. Towards testing our hypothesis, we conducted a phase I dose escalation safety trial infusing billions of ex vivo expanded recipient polyclonal Tregs into living donor kidney transplant recipients. Despite variability in recipient's renal disease, our expansion protocol produced Tregs which met all release criteria, expressing >98% CD4+CD25+ with <1% CD8+ and CD19+ contamination. Our product displayed >80% FOXP3 expression with stable demethylation in the FOXP3 promoter. Functionally, expanded Tregs potently suppressed allogeneic responses and induced the generation of new Tregs in the recipient's allo-responders in vitro. Within recipients, expanded Tregs amplified circulating Treg levels in a sustained manner. Clinically, all doses of Treg therapy tested were safe with no adverse infusion related side effects, infections or rejection events up to two years post-transplant. This study provides the necessary safety data to advance Treg cell therapy to phase II efficacy trials.
There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have shown the safety of Tregs in hematopoietic stem cell transplant recipients and subjects with juvenile diabetes. Our hypothesis is that infusion(s) of Tregs may induce transplant tolerance thus avoiding long-term use of toxic immunosuppressive agents that cause increased morbidity/mortality. Towards testing our hypothesis, we conducted a phase I dose escalation safety trial infusing billions of ex vivo expanded recipient polyclonal Tregs into living donor kidney transplant recipients. Despite variability in recipient’s renal disease, our expansion protocol produced Tregs which met all release criteria, expressing >98% CD4 + CD25 + with <1% CD8 + and CD19 + contamination. Our product displayed >80% FOXP3 expression with stable demethylation in the FOXP3 promoter. Functionally, expanded Tregs potently suppressed allogeneic responses and induced the generation of new Tregs in the recipient’s allo-responders in vitro . Within recipients, expanded Tregs amplified circulating Treg levels in a sustained manner. Clinically, all doses of Treg therapy tested were safe with no adverse infusion related side effects, infections or rejection events up to two years post-transplant. This study provides the necessary safety data to advance Treg cell therapy to phase II efficacy trials.
Abstract There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have shown the safety of Tregs in hematopoietic stem cell transplant recipients and subjects with juvenile diabetes. Our hypothesis is that infusion(s) of Tregs may induce transplant tolerance thus avoiding long-term use of toxic immunosuppressive agents that cause increased morbidity/mortality. Towards testing our hypothesis, we conducted a phase I dose escalation safety trial infusing billions of ex vivo expanded recipient polyclonal Tregs into living donor kidney transplant recipients. Despite variability in recipient’s renal disease, our expansion protocol produced Tregs which met all release criteria, expressing >98% CD4+CD25+ with <1% CD8+ and CD19+ contamination. Our product displayed >80% FOXP3 expression with stable demethylation in the FOXP3 promoter. Functionally, expanded Tregs potently suppressed allogeneic responses and induced the generation of new Tregs in the recipient’s allo-responders in vitro. Within recipients, expanded Tregs amplified circulating Treg levels in a sustained manner. Clinically, all doses of Treg therapy tested were safe with no adverse infusion related side effects, infections or rejection events up to two years post-transplant. This study provides the necessary safety data to advance Treg cell therapy to phase II efficacy trials.
There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have shown the safety of Tregs in hematopoietic stem cell transplant recipients and subjects with juvenile diabetes. Our hypothesis is that infusion(s) of Tregs may induce transplant tolerance thus avoiding long-term use of toxic immunosuppressive agents that cause increased morbidity/mortality. Towards testing our hypothesis, we conducted a phase I dose escalation safety trial infusing billions of ex vivo expanded recipient polyclonal Tregs into living donor kidney transplant recipients. Despite variability in recipient's renal disease, our expansion protocol produced Tregs which met all release criteria, expressing >98% CD4 CD25 with <1% CD8 and CD19 contamination. Our product displayed >80% FOXP3 expression with stable demethylation in the FOXP3 promoter. Functionally, expanded Tregs potently suppressed allogeneic responses and induced the generation of new Tregs in the recipient's allo-responders in vitro. Within recipients, expanded Tregs amplified circulating Treg levels in a sustained manner. Clinically, all doses of Treg therapy tested were safe with no adverse infusion related side effects, infections or rejection events up to two years post-transplant. This study provides the necessary safety data to advance Treg cell therapy to phase II efficacy trials.
ArticleNumber 7428
Author He, Jie
Stratton, Cheryl
Ansari, Mohammed Javeed
LeFever, Ann
Konieczna, Iwona
Huang, Xuemei
H.-Voss, Jessica
Gallon, Lorenzo
Skaro, Anton
Mathew, James M.
Leventhal, Joseph R.
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  givenname: James M.
  orcidid: 0000-0002-5667-750X
  surname: Mathew
  fullname: Mathew, James M.
  email: james-mathew@northwestern.edu
  organization: Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Department of Microbiology and Immunology, Feinberg School of Medicine, Northwestern University
– sequence: 2
  givenname: Jessica
  surname: H.-Voss
  fullname: H.-Voss, Jessica
  organization: Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University
– sequence: 3
  givenname: Ann
  surname: LeFever
  fullname: LeFever, Ann
  organization: Mathews Center for Cellular Therapy, Northwestern Memorial Hospital
– sequence: 4
  givenname: Iwona
  surname: Konieczna
  fullname: Konieczna, Iwona
  organization: Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University
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  givenname: Cheryl
  surname: Stratton
  fullname: Stratton, Cheryl
  organization: Mathews Center for Cellular Therapy, Northwestern Memorial Hospital
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  givenname: Jie
  surname: He
  fullname: He, Jie
  organization: Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University
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  givenname: Xuemei
  surname: Huang
  fullname: Huang, Xuemei
  organization: Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University
– sequence: 8
  givenname: Lorenzo
  surname: Gallon
  fullname: Gallon, Lorenzo
  organization: Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Department of Medicine, Division of Nephrology, Feinberg School of Medicine, Northwestern University
– sequence: 9
  givenname: Anton
  surname: Skaro
  fullname: Skaro, Anton
  organization: Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University
– sequence: 10
  givenname: Mohammed Javeed
  surname: Ansari
  fullname: Ansari, Mohammed Javeed
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  surname: Leventhal
  fullname: Leventhal, Joseph R.
  email: jleventh@nm.org
  organization: Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, TRACT Therapeutics
BackLink https://www.ncbi.nlm.nih.gov/pubmed/29743501$$D View this record in MEDLINE/PubMed
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Copyright_xml – notice: The Author(s) 2018
– notice: 2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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Snippet There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical trials have...
Abstract There is considerable interest in therapeutic transfer of regulatory T cells (Tregs) for controlling aberrant immune responses. Initial clinical...
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SubjectTerms 13/106
13/107
13/21
13/31
631/250/1854/2812
692/308/2779/109/1940
CD19 antigen
CD25 antigen
CD4 antigen
CD8 antigen
Clinical trials
Contamination
Demethylation
Diabetes mellitus
Foxp3 protein
Graft rejection
Hematopoietic stem cells
Humanities and Social Sciences
Hypotheses
Immune response
Immunological tolerance
Immunoregulation
Immunosuppressive agents
Kidney transplantation
Kidney transplants
Lymphocytes T
Morbidity
multidisciplinary
Safety
Science
Science (multidisciplinary)
Side effects
Stem cell transplantation
Stem cells
Transplants & implants
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Title A Phase I Clinical Trial with Ex Vivo Expanded Recipient Regulatory T cells in Living Donor Kidney Transplants
URI https://link.springer.com/article/10.1038/s41598-018-25574-7
https://www.ncbi.nlm.nih.gov/pubmed/29743501
https://www.proquest.com/docview/2036771061
https://www.proquest.com/docview/2037056443
https://pubmed.ncbi.nlm.nih.gov/PMC5943280
https://doaj.org/article/2b03555479114b16b575707b43828b2b
Volume 8
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