Upon transplantation of T cells from a CD28 superagonist (CD28-SAKeywords: aGvHD r Conventional T cells r CD28 superagonist r GvT effect Additional supporting information may be found in the online version of this article at the publisher's web-site
IntroductionAcute graft versus host disease (aGvHD) still constitutes a major obstacle to successful treatment of hematological malignancies by the transplantation of allogeneic T cells [1]. It is the allogeneic T cells themselves that mediate the beneficial graft versus tumor (GvT) effect and induce the potentially life-threatening aGvHD [2]. Therefore, it has been a long-standing aim to establish protocols that prevent aGvHD while not abrogating the GvT effect [1][2][3]. In this respect, the use of CD4 + CD25 + Foxp3 + regulatory T cells (T reg cells) has proven very promising in that they have, indeed, been shown to suppress aGvHD [4][5][6][7][8][9], but not the GvT effect in experimental animal models [4][5][6][7][8][9][10]. In the human system, T reg cell numbers are very low in the peripheral blood to Correspondence: Dr. Niklas Beyersdorf e-mail: niklas.beyersdorf@vim.uni-wuerzburg.de begin with and it may, thus, well be that demanding protocols for large-scale amplification of still functional T reg cells in vitro prior to transplantation in vivo might have to be implicated to robustly achieve prevention of aGvHD in humans [11][12][13]. An alternative to the transplantation of T reg cells for aGvHD prevention is to manipulate, also in the human system amply available, conventional CD4 + T cells (CD4 + T conv cells). Published work indicates that effector memory-phenotype T cells [14][15][16][17][18] and in vitro preactivated CD4 + T cells induce less aGvHD in allogeneic recipients than resting CD4 + T cells [8,[19][20][21][22]. However, at least for some of these settings, including the stimulation of total CD4 + T cells with a superagonistic anti-CD28 monoclonal antibody (CD28-SA) in vitro, it has been shown that it is the preferential expansion of T reg cells over CD4 + T conv cells, which underlies the reduced induction of aGvHD [8,23]. Therefore, we determined whether polyclonal stimulation of T conv cells would be sufficient for protection from aGvHD while, ideally, maintaining the GvT effect. To this end we compared two protocols: one Eur. J. Immunol. 2015. 45: 1997 employing CD28-SA-coated beads and the other anti-CD3/anti-CD28 mAb-coated beads. One reason for immobilizing the CD28-SA on beads was to be able to separate the CD28-SA from the T cells so that only T cells, but not the CD28-SA is infused into the allogeneic host. This appeared to be an essential component of our protocol at the time we designed these experiments as a CD28-SA had elicited a cytokine storm during phase I clinical testing in healthy volunteers in vivo [24]. Very recent data from another phase I study, however, clearly show that low dosages of CD28-SA do not induce a cytokine storm in humans but lead to an IL-10-dominated immunoregulatory response [25]. This means that rigorou...