The induction of transplantation tolerance involves a T-cell-mediated process of immune regulation. In clinical transplantation, the use of immunosuppressive drugs that promote or facilitate this process would be highly desirable. Here, we investigated the tolerance-promoting potential of the immunosuppressive drug FK778, currently under development for clinical therapy. Using a human allogeneic in vitro model we showed that, upon T-cell receptor (TCR) triggering, FK778 induced a regulatory phenotype in CD4 ؉ CD25 ؊ T cells. Purified CD4 ؉ CD25 ؊ T cells primed in the presence of FK778 showed hyporesponsiveness upon restimulation with alloantigen in the absence of the drug. This anergic state was reversible by exogenous interleukin-2 (IL-2) and was induced independent of naturally occurring CD4 ؉ CD25 ؉ regulatory T cells. Pyrimidine restriction was a crucial requirement for the de novo induction of regulatory activity by FK778. The FK778-induced anergic cells showed suppressor activity in a cell-cell contactdependent manner; were CD25 high , CD45RO ؉ , CD27 ؊ , and CD62L ؊ ; and expressed cytotoxic T-lymphocyteassociated antigen-4 (CTLA-4), glucocorticoid-induced tumor necrosis factor receptor (GITR), and FoxP3. The cells revealed delayed p27 kip1 degradation and enhanced phosphorylation of STAT3. In conclusion, the new drug
IntroductionThe use of immunosuppressive agents after solid-organ transplantation is crucial for the prevention of transplant rejection. In the past few decades, potent immunosuppressive regimens have been developed, currently leading to 1-year graft survival rates exceeding 85%. 1 However, in the long run, a considerable number of grafts are lost, mainly due to chronic rejection. Moreover, the continuous suppression of the immune system increases the risk for infections and malignancies. Therefore, the preferable approach to improve transplantation outcome is the induction of transplant tolerance: the acceptance of the graft in the absence of chronic immunosuppression. 2 Tolerance induction is believed to involve, at least in part, a T-cellmediated process of immune regulation. 3 Indeed, animal studies have revealed that regulatory T (Treg) cells form an intricate part of the tolerance-maintaining network. 4 Consequently, it is crucial that immunosuppressive drugs, administered to prevent acute graft rejection, do not interfere with the development of Treg cells. The ideal drug should not only inhibit effector T-cell function, but also enhance or facilitate Treg-cell function.FK778 is an immunosuppressive drug currently under development for use in organ transplantation. 5 FK778 is a synthetic analog of the active metabolite of leflunomide, A77 1726. FK778 has a much shorter half-life than the parent drug, making it suitable for use in transplantation settings. These compounds belong to the malononitrilamides (MNAs), a family of lowmolecular-weight substances structurally different from other currently applied drugs. 6 Their primary mode of action is the restriction of the de novo pyrimid...