The immune response is the result of complex interactions among cells of innate immunity, the vascular system and cells of adaptive immunity including T and B lymphocytes. Interactions among effector T cells, regulatory T cells (Tregs) and antigen‐presenting cells determine the outcome of the immune response. Activated effector T cells and Tregs express high levels of glucocorticoid‐induced tumour necrosis factor receptor‐related protein (GITR, also known as TNFRSF18 or CD357), which is triggered by the ligands GITRL and SECTM1. The effect of GITR triggering on the immune system is complex, with GITR playing a physiological role in inflammation, response to infection, graft rejection, autoimmunity and tumours. Antibodies and fusion proteins capable of modulating GITR and GITRL activity produce meaningful effects in animal models of advanced tumours and boost the effectiveness of vaccines. GITR triggering also shows potential for curing autoimmune diseases and preventing graft rejection and graft‐versus‐host disease.
Key Concepts
GITR is a costimulatory molecule that is overexpressed by activated T lymphocytes and promotes their activation/expansion following activation by its ligand (GITRL).
GITR triggering can treat infection, particularly chronic viral infection, and boost the effectiveness of vaccines.
Inhibition of GITR triggering by fusion proteins has an anti‐inflammatory effect.
The highest levels of GITR expression are found in regulatory T cells (Tregs).
GITR plays a crucial role in the development of FoxP3
+
Tregs in the thymus (tTregs) and the expansion of tTregs and peripherally derived Tregs (pTregs).
A subset of CD4
+
pTregs that expresses GITR, but not FoxP3 or CD25, is expanded in patients with autoimmune diseases who show low disease activity.
In mouse models, GITR triggering by anti‐GITR antibodies promotes the rejection of established tumours via effector T lymphocyte activation and, more importantly, via Treg killing by antibody‐dependent cell‐mediated cytotoxicity, Treg inhibition/differentiation and modulation of Treg trafficking.
The GITR/GITRL system is structurally different in mice and humans, suggesting that functional differences also exist.
Phase I studies testing anti‐human GITR antibodies in cancer patients are underway.