Induction and maintenance of peripheral tolerance are important mechanisms to maintain the balance of the immune system. In addition to the deletion of T cells and their failure to respond in certain circumstances, active suppression mediated by T cells or T-cell factors has been proposed as a mechanism for maintaining peripheral tolerance. However, the inability to isolate and clone regulatory T cells involved in antigen-specific inhibition of immune responses has made it difficult to understand the mechanisms underlying such active suppression. Here we show that chronic activation of both human and murine CD4+ T cells in the presence of interleukin (IL)-10 gives rise to CD4+ T-cell clones with low proliferative capacity, producing high levels of IL-10, low levels of IL-2 and no IL-4. These antigen-specific T-cell clones suppress the proliferation of CD4+ T cells in response to antigen, and prevent colitis induced in SCID mice by pathogenic CD4+CD45RB(high) splenic T cells. Thus IL-10 drives the generation of a CD4+ T-cell subset, designated T regulatory cells 1 (Tr1), which suppresses antigen-specific immune responses and actively downregulates a pathological immune response in vivo.

Metachromatic leukodystrophy (MLD) is an inherited lysosomal storage disease caused by arylsulfatase A (ARSA) deficiency. Patients with MLD exhibit progressive motor and cognitive impairment and die within a few years of symptom onset. We used a lentiviral vector to transfer a functional ARSA gene into hematopoietic stem cells (HSCs) from three presymptomatic patients who showed genetic, biochemical, and neurophysiological evidence of late infantile MLD. After reinfusion of the gene-corrected HSCs, the patients showed extensive and stable ARSA gene replacement, which led to high enzyme expression throughout hematopoietic lineages and in cerebrospinal fluid. Analyses of vector integrations revealed no evidence of aberrant clonal behavior. The disease did not manifest or progress in the three patients 7 to 21 months beyond the predicted age of symptom onset. These findings indicate that extensive genetic engineering of human hematopoiesis can be achieved with lentiviral vectors and that this approach may offer therapeutic benefit for MLD patients.

SummaryInterleukin 10 (IL-10) and viral Ibl0 (v-IL-10) strongly reduced antigen-specific proliferation of human T cells and CD4 + T cell clones when monocytes were used as antigen-presenting cells. In contrast, IL-10 and v-Ibl0 did not affect the proliferative responses to antigens presented by autologous Epstein-Barr virus-lymphoblastoid cell line (EBV-LCL). Inhibition of antigen-specific T cell responses was associated with downregulation of constitutive, as well as interferon 3'-or Ib4-induced, class II MHC expression on monocytes by IL-10 and v-Ibl0, resulting in the reduction in antigen-presenting capacity of these ceUs. In contrast, IL-10 and v-Ibl0 had no effect on class II major histocompatibility complex (MHC) expression on EBV-LCL. The reduced antigenpresenting capacity of monocytes correlated with a decreased capacity to mobilize intracellular Ca 2 + in the responder T cell clones. The diminished antigen-presenting capacities of monocytes were not due to inhibitory effects of II.-10 and v-Ibl0 on antigen processing, since the proliferative T cell responses to antigenic peptides, which did not require processing, were equaUy well inhibited. Furthermore, the inhibitory effects of Ibl0 and v-IL-10 on antigen-specific proliferative T cell responses could not be neutralized by exogenous Ib2 or Ib4. Although IL-10 and v-IL-10 suppressed IL-lc~, IL-1B, tumor necrosis factor ot (TNF-c~), and IL-6 production by monocytes, it was excluded that these cytokines played a role in antigen-specific T cell proliferation, since normal antigenspecific responses were observed in the presence of neutralizing anti-Ibl, -IL-6, and -TNF-tx mAbs. Furthermore, addition of saturating concentrations of IL-lot, IL-I~, IL-6, and TNF-o~ to the cultures had no effect on the reduced proliferative T cell responses in the presence of Ibl0, or v-Ibl0. Collectively, our data indicate that IL-10 and v-IL-10 can completely prevent antigen-specific T cell proliferation by inhibition of the antigen-presenting capacity of monocytes through downregulation of class II MHC antigens on monocytes.

Interleukin-10 (IL-10)-secreting T regulatory type 1 (Tr1) cells are defined by their specific cytokine production profile, which includes the secretion of high levels of IL-10 and transforming growth factor-beta(TGF-beta), and by their ability to suppress antigen-specific effector T-cell responses via a cytokine-dependent mechanism. In contrast to the naturally occurring CD4+ CD25+ T regulatory cells (Tregs) that emerge directly from the thymus, Tr1 cells are induced by antigen stimulation via an IL-10-dependent process in vitro and in vivo. Specialized IL-10-producing dendritic cells, such as those in an immature state or those modulated by tolerogenic stimuli, play a key role in this process. We propose to use the term Tr1 cells for all IL-10-producing T-cell populations that are induced by IL-10 and have regulatory activity. The full biological characterization of Tr1 cells has been hampered by the difficulty in generating these cells in vitro and by the lack of specific marker molecules. However, it is clear that Tr1 cells play a key role in regulating adaptive immune responses both in mice and in humans. Further work to delineate the specific molecular signature of Tr1 cells, to determine their relationship with CD4+ CD25+ Tregs, and to elucidate their respective role in maintaining peripheral tolerance is crucial to advance our knowledge on this Treg subset. Furthermore, results from clinical protocols using Tr1 cells to modulate immune responses in vivo in autoimmunity, transplantation, and chronic inflammatory diseases will undoubtedly prove the biological relevance of these cells in immunotolerance.

Wiskott-Aldrich Syndrome (WAS) is an inherited immunodeficiency caused by mutations in the gene encoding WASP, a protein regulating the cytoskeleton. Hematopoietic stem/progenitor cell (HSPC) transplants can be curative but, when matched donors are unavailable, infusion of autologous HSPCs modified ex vivo by gene therapy is an alternative approach. We used a lentiviral vector encoding functional WASP to genetically correct HSPCs from three WAS patients and re-infused the cells after reduced-intensity conditioning regimen. All three patients showed stable engraftment of WASP-expressing cells and improvements in platelet counts, immune functions, and clinical score. Vector integration analyses revealed highly polyclonal and multi-lineage haematopoiesis resulting from the gene corrected HSPCs. Lentiviral gene therapy did not induce selection of integrations near oncogenes and no aberrant clonal expansion was observed after 20–32 months. Although extended clinical observation is required to establish long-term safety, lentiviral gene therapy represents a promising treatment for WAS.

Rapamycin is an immunosuppressive compound that is currently used to prevent acute graft rejection in humans. In addition, rapamycin has been shown to allow operational tolerance in murine models. However, a direct effect of rapamycin on T regulatory ( IntroductionRapamycin, a macrolide antibiotic produced by Streptomyces hygroscopicus, is a new effective drug used to prevent allograft rejection. 1 Similarly to the immunosuppressants FK506 and cyclosporin A (CsA), rapamycin exerts its effect by binding to the intracellular immunophilin FK506-binding protein (FKBP12). However, unlike FK506 and CsA, rapamycin does not inhibit T-cell receptor (TCR)-induced calcineurin activity. Rather, the rapamycin-FKBP12 complex inhibits the serine/threonine protein kinase called mammalian target of rapamycin (mTOR), the activation of which is required for protein synthesis and cell-cycle progression. Therefore, rapamycin blocks signaling in response to cytokines/ growth factors, whereas FK506 and CsA exert their inhibitory effects by blocking TCR-induced activation (for a review, see Abraham and Wiederrecht 2 ). Consistent with this mechanism of action, it has been shown that rapamycin (1) blocks T-cell-cycle progression from G 1 to S phase after activation, 3 (2) promotes TCR-induced T-cell anergy even in the presence of costimulation, 4 and (3) allows induction of operational tolerance. 5 However, a direct effect of rapamycin on T regulatory (Tr) cells has not been demonstrated so far.Tr cells are well-characterized T-cell subsets that play a key role in inducing and maintaining immunologic tolerance. Among the CD4 ϩ Tr cells, the Tr-cell subset that expresses the interleukin 2 receptor ␣ (IL-2R␣) chain (CD4 ϩ CD25 ϩ ) is one of the most extensively characterized so far (for a review, see Fehervari and Sakaguchi 6 ). CD4 ϩ CD25 ϩ Tr cells are generated in the thymus and are part of the normal peripheral T-cell repertoire. Suppressive CD4 ϩ CD25 ϩ Tr cells can be distinguished from activated T cells based on the high constitutive expression of CD25, cytotoxic T-lymphocyte antigen 4 (CTLA-4), glucocorticoid-induced tumor necrosis factor receptor (GITR), and the transcription factor forkhead box P3 (FoxP3). Once generated, thymic CD4 ϩ CD25 ϩ Tr cells migrate to peripheral tissues, where they potently suppress proliferation and cytokine production by both CD4 ϩ and CD8 ϩ T cells via a mechanism that requires cell-cell contact. 6 CD4 ϩ CD25 ϩ Tr cells contribute to tolerance induction after solid organ transplantation and protect from graft-versus-host disease lethality in bone marrow transplantation models. 7 Here, we provide new evidence that in vitro long-term exposure of murine CD4 ϩ T cells to rapamycin induces expansion of the naturally occurring CD4 ϩ CD25 ϩ FoxP3 ϩ Tr cells, which retain their suppressive functions in vitro and in vivo. Materials and methods MiceBalb/c, C57BL/6, and DO11.10 (TCR transgenic [tg] specific for ovalbumin [OVA]) female mice were purchased from Charles River Laboratories (Calco, Italy). All mic...

CD4(+) type 1 T regulatory (Tr1) cells are induced in the periphery and have a pivotal role in promoting and maintaining tolerance. The absence of surface markers that uniquely identify Tr1 cells has limited their study and clinical applications. By gene expression profiling of human Tr1 cell clones, we identified the surface markers CD49b and lymphocyte activation gene 3 (LAG-3) as being stably and selectively coexpressed on mouse and human Tr1 cells. We showed the specificity of these markers in mouse models of intestinal inflammation and helminth infection and in the peripheral blood of healthy volunteers. The coexpression of CD49b and LAG-3 enables the isolation of highly suppressive human Tr1 cells from in vitro anergized cultures and allows the tracking of Tr1 cells in the peripheral blood of subjects who developed tolerance after allogeneic hematopoietic stem cell transplantation. The use of these markers makes it feasible to track Tr1 cells in vivo and purify Tr1 cells for cell therapy to induce or restore tolerance in subjects with immune-mediated diseases.

Active suppression by T regulatory (Tr) cells plays an important role in the downregulation of T cell responses to foreign and self-antigens. Mouse CD4+ Tr cells that express CD25 possess remarkable suppressive activity in vitro and in autoimmune disease models in vivo. Thus far, the existence of a similar subset of CD25+CD4+ Tr cells in humans has not been reported. Here we show that human CD25+CD4+ Tr cells isolated from peripheral blood failed to proliferate and displayed reduced expression of CD40 ligand (CD40L), in response to T cell receptor–mediated polyclonal activation, but strongly upregulated cytotoxic T lymphocyte–associated antigen (CTLA)-4. Human CD25+CD4+ Tr cells also did not proliferate in response to allogeneic antigen-presenting cells, but they produced interleukin (IL)-10, transforming growth factor (TGF)-β, low levels of interferon (IFN)-γ, and no IL-4 or IL-2. Importantly, CD25+CD4+ Tr cells strongly inhibited the proliferative responses of both naive and memory CD4+ T cells to alloantigens, but neither IL-10, TGF-β, nor CTLA-4 seemed to be directly required for their suppressive effects. CD25+CD4+ Tr cells could be expanded in vitro in the presence of IL-2 and allogeneic feeder cells and maintained their suppressive capacities. These findings that CD25+CD4+ Tr cells with immunosuppressive effects can be isolated from peripheral blood and expanded in vitro without loss of function represent a major advance towards the therapeutic use of these cells in T cell–mediated diseases.