Immunotherapy with virus-specific cytotoxic T lymphocytes after organ transplantation

Post-transplant lymphoproliferative disorders following solid-organ transplantation

A post-transplant lymphoproliferative disorder (PTLD) is an uncommon but serious complication following solid-organ transplantation. The incidence varies, depending on the type of organ transplanted, the degree of immunosuppression, the number of episodes of acute rejection and a patient's immune status to Epstein-Barr virus. The incidence of PTLD is thought to be bimodal; cases in the first year after solid-organ transplantation are typically related to Epstein-Barr virus. A second incidence occurs more than 1 year following transplantation and is typically not related to Epstein-Barr virus. A variety of therapeutic approaches has been used for these patients, with more recent strategies including the use of rituximab, with or without combination chemotherapy. Efforts continue to be made to improve the outcome of patients with PTLD.

Adenovirus infections in solid organ transplant recipients

PURPOSE OF REVIEW

Adenoviruses are emerging as important viral pathogens in solid organ transplant recipients, impacting morbidity, graft survival and even mortality. This review will discuss the current understanding of the epidemiology, diagnosis and therapy of adenovirus infection in transplant recipients.

RECENT FINDINGS

Advances in the field include the use of polymerase chain reaction in the diagnosis of adenoviral infection, a better understanding of the epidemiology, immune response and potential new therapies, including preemptive and adoptive immunotherapy strategies. Adenoviral infections appear to be common, especially in pediatric solid organ transplant. Generally well tolerated, some high-risk patients may develop disseminated disease causing graft failure, which may lead to retransplant and/or death. Antiviral therapy and immunotherapy may play a role in these patients, although prospective controlled data are not available at this time.

SUMMARY

Although new tools and a better understanding of the epidemiology, risk factors and therapies for adenovirus are beginning to materialize, prospective, controlled trials, using careful definitions, and standardized methodologies need to be performed to more fully clarify these issues in solid organ transplant recipients.

Selective modification of antigen-specific T cells by RNA electroporation

It has been observed that the efficient transfection of T cells by RNA electroporation requires prior activation of T cells with mitogens or by anti-CD3 antibody stimulation. We hypothesized that this requirement for T cell activation could be leveraged to express marker genes within activated T cells responding to antigen-pulsed dendritic cells and allow for the selective enrichment and modification of antigen-specific T cells. Using electroporation of mRNA encoding green fluorescent protein as a marker gene, we demonstrate that RNA electroporation can efficiently allow for the separation of cytomegalovirus-specific CD8+ and CD4+ T cells from bulk culture responding to cytomegalovirus pp65 antigen-pulsed dendritic cells. Furthermore, we demonstrate that cytomegalovirus-specific T cells can be functionally modified by RNA transfection of the C-X-C chemokine receptor, CXCR2, to migrate efficiently toward a variety of CXCR2-specific chemokines in vitro and in vivo. These studies demonstrate the utility of RNA transfection as a simple method by which to purify and selectively modify the function of antigen-specific T cells for use in adoptive immunotherapy, and importantly provide evidence that transient expression of proteins by RNA transfection is an efficient means of modulating the in vivo function of activated T cells.