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Gerbaux M, Roos E, Willemsen M, Staels F, Neumann J, Bücken L, Haughton J, Yshii L, Dooley J, Schlenner S, Humblet-Baron S, Liston A. CTLA4-Ig Effectively Controls Clinical Deterioration and Immune Condition in a Murine Model of Foxp3 Deficiency. J Clin Immunol 2023:10.1007/s10875-023-01462-2. [PMID: 37156988 DOI: 10.1007/s10875-023-01462-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/28/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE FOXP3 deficiency results in severe multisystem autoimmunity in both mice and humans, driven by the absence of functional regulatory T cells. Patients typically present with early and severe autoimmune polyendocrinopathy, dermatitis, and severe inflammation of the gut, leading to villous atrophy and ultimately malabsorption, wasting, and failure to thrive. In the absence of successful treatment, FOXP3-deficient patients usually die within the first 2 years of life. Hematopoietic stem cell transplantation provides a curative option but first requires adequate control over the inflammatory condition. Due to the rarity of the condition, no clinical trials have been conducted, with widely unstandardized therapeutic approaches. We sought to compare the efficacy of lead therapeutic candidates rapamycin, anti-CD4 antibody, and CTLA4-Ig in controlling the physiological and immunological manifestations of Foxp3 deficiency in mice. METHOD We generated Foxp3-deficient mice and an appropriate clinical scoring system to enable direct comparison of lead therapeutic candidates rapamycin, nondepleting anti-CD4 antibody, and CTLA4-Ig. RESULTS We found distinct immunosuppressive profiles induced by each treatment, leading to unique protective combinations over distinct clinical manifestations. CTLA4-Ig provided superior breadth of protective outcomes, including highly efficient protection during the transplantation process. CONCLUSION These results highlight the mechanistic diversity of pathogenic pathways initiated by regulatory T cell loss and suggest CTLA4-Ig as a potentially superior therapeutic option for FOXP3-deficient patients.
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Affiliation(s)
- Margaux Gerbaux
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
- Department of Medicine, Université Libre de Bruxelles, 1050, Brussels, Belgium
| | - Evelyne Roos
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
- VIB Center for Brain and Disease Research, 3000, Louvain, Belgium
| | - Mathijs Willemsen
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
- VIB Center for Brain and Disease Research, 3000, Louvain, Belgium
| | - Frederik Staels
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
- VIB Center for Brain and Disease Research, 3000, Louvain, Belgium
| | - Julika Neumann
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
- VIB Center for Brain and Disease Research, 3000, Louvain, Belgium
| | - Leoni Bücken
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
| | - Jeason Haughton
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
| | | | - James Dooley
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
- VIB Center for Brain and Disease Research, 3000, Louvain, Belgium
- Immunology Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK
| | - Susan Schlenner
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium
| | - Stephanie Humblet-Baron
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium.
| | - Adrian Liston
- KU Leuven, Department of Microbiology, Immunology and Transplantation, 3000, Leuven, Belgium.
- VIB Center for Brain and Disease Research, 3000, Louvain, Belgium.
- Immunology Programme, The Babraham Institute, Babraham Research Campus, Cambridge, CB22 3AT, UK.
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van Vollenhoven RF, Keystone EC, Strand V, Pacheco-Tena C, Vencovský J, Behrens F, Racewicz A, Zipp D, Rharbaoui F, Wolter R, Knierim L, Schmeidl R, Zhou X, Aigner S, Dälken B, Wartenberg-Demand A. Efficacy and safety of tregalizumab in patients with rheumatoid arthritis and an inadequate response to methotrexate: results of a phase IIb, randomised, placebo-controlled trial. Ann Rheum Dis 2018; 77:495-499. [PMID: 29343509 DOI: 10.1136/annrheumdis-2017-212478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the efficacy, biological activity and safety of tregalizumab in patients with active rheumatoid arthritis (RA) and an inadequate response to methotrexate (MTX). METHODS 321 patients were randomised (1:1:1:1) to placebo or tregalizumab 25, 100 or 200 mg once-weekly subcutaneously in addition to MTX treatment. Responders at week 12 continued the same treatment, and non-responders at week 12 were escalated to the next higher tregalizumab dose level or re-randomised from placebo to active treatment. After 24 weeks, patients could continue treatment with tregalizumab for 24 weeks (extension phase). The primary endpoint was the American College of Rheumatology 20% improvement criteria (ACR20) response rate at week 12. Safety and biological activity were monitored through week 48. RESULTS At week 12, ACR20 response rates were not statistically significantly different between placebo and any of the tregalizumab doses. Tregalizumab injections were well tolerated; most adverse events were mild to moderate and comparable among treatment and placebo groups. Biological activity was shown by dose-dependent CD4 downmodulation. CONCLUSION Treatment with tregalizumab did not show significant clinical efficacy in patients with active RA compared with placebo but resulted in the expected biological effect on CD4 modulation. Tregalizumab was generally well tolerated, and no new safety findings were identified. TRIAL REGISTRATION NUMBER NCT01999192; Results.
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Affiliation(s)
- Ronald F van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center ARC, Amsterdam, The Netherlands
| | - Edward Clark Keystone
- The Rebecca MacDonald Centre For Arthritis, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | | | | | - Frank Behrens
- Center for Innovative Diagnostics and Therapy in Rheumatology/Immunology (CIRI), Goethe University Frankfurt, Frankfurt, Germany
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Impact of Pre-Transplant Anti-T Cell Globulin (ATG) on Immune Recovery after Myeloablative Allogeneic Peripheral Blood Stem Cell Transplantation. PLoS One 2015; 10:e0130026. [PMID: 26098781 PMCID: PMC4476691 DOI: 10.1371/journal.pone.0130026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/15/2015] [Indexed: 02/01/2023] Open
Abstract
Background Pre-transplant infusion of rabbit anti-T cell globulin (ATG) is increasingly used as prevention of graft-versus-host disease (GVHD) after allogeneic peripheral blood stem cell transplantation (PBSCT). However, the precise impact of pre-transplant ATG on immune recovery after PBSCT is still poorly documented. Methods In the current study, we compared immune recovery after myeloablative PBSCT in 65 patients who either received (n = 37) or did not (n = 28) pre-transplant ATG-Fresenius (ATG-F). Detailed phenotypes of circulating T, B, natural killer (NK) and invariant NKT (iNKT) cells were analyzed by multicolor flow cytometry at serial time-points from day 40 to day 365 after transplantation. Thymic function was also assessed by sjTREC quantification. Serious infectious events were collected up to 2 years post-transplantation. Results Pre-transplant ATG-F had a prolonged (for at least up to 1-year) and selective negative impact on the T-cell pool, while it did not impair the recovery of B, NK nor iNKT cells. Among T cells, ATG-F selectively compromised the recovery of naïve CD4+, central memory CD4+ and naïve CD8+ cells, while it spared effector memory T and regulatory T cells. Levels of sjTRECs were similar in both cohorts at 1-year after PBSCT, suggesting that ATG-F unlikely impaired thymopoiesis at long-term after PBSCT. Finally, the incidence and rate of serious infections were similar in both groups, while ATG-F patients had a lower incidence of grade II-IV acute graft-versus-host disease. Conclusions Pre-transplant ATG-F induces long-lasting modulation of the circulating T-cell pool after myeloablative PBSCT, that may participate in preventing graft-versus-host disease without deeply compromising anti-pathogen defenses.
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