Studies of Regulatory T cells with Implications for Clinical Applications

Sammanfattning: Regulatory T cells (Tregs) are vital for regulating immune homeostasis and for preventing immunopathology. The immunosuppressive functions of Tregs have raised hope for their potential use in clinical applications. This thesis investigates features of Treg that may be relevant for their use in clinical applications and includes the first-in-man study of Treg infusion in clinical islet transplantation. In paper I we explored the immunological profile of haemodialysis patients and young healthy individuals; haemodialysis patients are a prospective target for adoptive Treg therapy following kidney transplantation. Flowcytometric gating strategies were analyzed to optimize the isolation of Tregs. We found that both groups presented a similar Treg profile, and sorting for CD25 in combination with CD127low was preferable in terms of Treg yield and purity. In paper II we compared the effects of mTOR inhibitors Azithromycin (AZM) and Rapamycin (RAP) on in vitro Tregs cultures, as compounds that improve the quality of Treg cultures are sought. While RAP can improve the purity of Treg expansions by suppressing the proliferation of non-Treg cells, the effects of AZM on Treg expansions had not been previously studied. We found that RAP induced a FoxP3+Helios + phenotype and increased suppressive function, but may also inhibit Treg expansion. In comparison, AZM promoted a FoxP3+ phenotype, but to a lesser extent than RAP and the AZM treated Tregs are possibly less suppressive. In Paper III we performed the first-in-man study of autologous Treg infusion in clinical allogenic pancreatic islet transplantation. Patients underwent leaukapheresis from which polyclonal Tregs were purified by magnetic-activated cell sorting (MACS) and cryopreserved until transplantation. The Tregs were thawed and co-infused with pancreatic islets in the portal vein. No negative effects were seen related to the Treg infusion, regardless of cell dose. This indicates the procedure is safe and feasible. Future efficacy studies can be performed based on these results, with aim of minimizing the need for chronic immunosuppressive medication in islet transplantation. In summary, the studies included in this thesis supports the development of clinical Treg applications.