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Christofi P, Pantazi C, Psatha N, Sakellari I, Yannaki E, Papadopoulou A. Promises and Pitfalls of Next-Generation Treg Adoptive Immunotherapy. Cancers (Basel) 2023; 15:5877. [PMID: 38136421 PMCID: PMC10742252 DOI: 10.3390/cancers15245877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Regulatory T cells (Tregs) are fundamental to maintaining immune homeostasis by inhibiting immune responses to self-antigens and preventing the excessive activation of the immune system. Their functions extend beyond immune surveillance and subpopulations of tissue-resident Treg cells can also facilitate tissue repair and homeostasis. The unique ability to regulate aberrant immune responses has generated the concept of harnessing Tregs as a new cellular immunotherapy approach for reshaping undesired immune reactions in autoimmune diseases and allo-responses in transplantation to ultimately re-establish tolerance. However, a number of issues limit the broad clinical applicability of Treg adoptive immunotherapy, including the lack of antigen specificity, heterogeneity within the Treg population, poor persistence, functional Treg impairment in disease states, and in vivo plasticity that results in the loss of suppressive function. Although the early-phase clinical trials of Treg cell therapy have shown the feasibility and tolerability of the approach in several conditions, its efficacy has remained questionable. Leveraging the smart tools and platforms that have been successfully developed for primary T cell engineering in cancer, the field has now shifted towards "next-generation" adoptive Treg immunotherapy, where genetically modified Treg products with improved characteristics are being generated, as regards antigen specificity, function, persistence, and immunogenicity. Here, we review the state of the art on Treg adoptive immunotherapy and progress beyond it, while critically evaluating the hurdles and opportunities towards the materialization of Tregs as a living drug therapy for various inflammation states and the broad clinical translation of Treg therapeutics.
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Affiliation(s)
- Panayiota Christofi
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (P.C.); (C.P.); (I.S.); (E.Y.)
- University General Hospital of Patras, 26504 Rio, Greece
| | - Chrysoula Pantazi
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (P.C.); (C.P.); (I.S.); (E.Y.)
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Institute of Applied Biosciences (INAB), Centre for Research and Technology Hellas (CERTH), 57001 Thessaloniki, Greece
| | - Nikoleta Psatha
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Ioanna Sakellari
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (P.C.); (C.P.); (I.S.); (E.Y.)
| | - Evangelia Yannaki
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (P.C.); (C.P.); (I.S.); (E.Y.)
- Department of Medicine, University of Washington, Seattle, WA 98195-7710, USA
| | - Anastasia Papadopoulou
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (P.C.); (C.P.); (I.S.); (E.Y.)
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Lysandrou M, Stamou P, Kefala D, Pierides C, Kyriakou M, Savvopoulos N, Christofi P, Papadopoulou A, Yannaki E, Costeas P, Spyridonidis A. Hypomethylation-induced regulatory programs in T cells unveiled by transcriptomic analyses. Front Immunol 2023; 14:1235661. [PMID: 37828996 PMCID: PMC10565652 DOI: 10.3389/fimmu.2023.1235661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/21/2023] [Indexed: 10/14/2023] Open
Abstract
Regulatory T cells (Tregs) are essential mediators of tolerance mitigating aberrant immune responses. While naturally occurring Treg (nTreg) development and function are directed by epigenetic events, induced Treg (iTreg) identity and mechanisms of action remain elusive. Mirroring the epigenetic circuits of nTregs, we and others have used hypomethylation agents (HAs) to ex vivo convert T cells into iTregs (HA-iTregs) and further showed that the suppressive properties of the HA-iTregs are predominantly confined in an emergent population, which de novo expresses the immunomodulatory molecule HLA-G, consequently providing a surface marker for isolation of the suppressive HA-iTreg compartment (G+ cells). We isolated the HA-induced G+ cells and their G- counterparts and employed high-throughput RNA-sequencing (RNA-seq) analyses to uncover the G+-specific transcriptomic changes guiding T cells toward a regulatory trajectory upon their exposure to HA. We found a distinct transcriptional upregulation of G+ cells accompanied by enrichment of immune-response-related pathways. Although single-cell RNA-seq profiling revealed regulatory G+ cells to have molecular features akin to nTregs, when assessed in conjunction with the comparative transcriptomic analysis and profiling of secreted cytokines against the non-suppressive G- cells, FOXP3 and other T-helper signatures appear to play a minor role in their suppressive phenotype. We found an ectopic expression of IDO-1 and CCL17/22 in G+ cells, denoting that in vitro exposure of T cells to HA may well unlock myeloid suppressor genes. This report provides transcriptional data shaping the molecular identity of a highly purified and potent HA-iTreg population and hints toward ectopic myeloid-specific molecular mechanisms mediating HA-iTreg function.
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Affiliation(s)
- Memnon Lysandrou
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Panagiota Stamou
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Dionysia Kefala
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Chryso Pierides
- The Center for the Study of Haematological and other Malignancies and Karaiskakio Foundation, Nicosia, Cyprus
| | - Maria Kyriakou
- The Center for the Study of Haematological and other Malignancies and Karaiskakio Foundation, Nicosia, Cyprus
| | - Nikolaos Savvopoulos
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Panayiota Christofi
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Anastasia Papadopoulou
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, “George Papanikolaou” Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, “George Papanikolaou” Hospital, Thessaloniki, Greece
| | - Paul Costeas
- The Center for the Study of Haematological and other Malignancies and Karaiskakio Foundation, Nicosia, Cyprus
| | - Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
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Lysandrou M, Kefala D, Christofi P, Savvopoulos N, Papayanni PG, Theodorellou R, Sagiadinou E, Zacharioudaki V, Moukouli M, Tsokanas D, Karavalakis G, Liga M, Stavrinos K, Papadopoulou A, Yannaki E, Spyridonidis A. Study protocol: Phase I/II trial of induced HLA-G + regulatory T cells in patients undergoing allogeneic hematopoietic cell transplantation from an HLA-matched sibling donor. Front Med (Lausanne) 2023; 10:1166871. [PMID: 37275377 PMCID: PMC10237041 DOI: 10.3389/fmed.2023.1166871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/19/2023] [Indexed: 06/07/2023] Open
Abstract
Regulatory T-cell (Treg) immunotherapy has emerged as a promising and highly effective strategy to combat graft-versus-host disease (GvHD) after allogeneic hematopoietic cell transplantation (allo-HCT). Both naturally occurring Treg and induced Treg populations have been successfully evaluated in trials illustrating the feasibility, safety, and efficacy required for clinical translation. Using a non-mobilized leukapheresis, we have developed a good manufacturing practice (GMP)-compatible induced Treg product, termed iG-Tregs, that is enriched in cells expressing the potent immunosuppressive human leucocyte antigen-G molecule (HLA-G+). To assess the safety and the maximum tolerable dose (MTD) of iG-Tregs, we conduct a phase I-II, two-center, interventional, dose escalation (3 + 3 design), open-label study in adult patients undergoing allo-HCT from an HLA-matched sibling donor, which serves also as the donor for iG-Treg manufacturing. Herein, we present the clinical protocol with a detailed description of the study rationale and design as well as thoroughly explain every step from patient screening, product manufacturing, infusion, and participant follow-up to data collection, management, and analysis (registered EUDRACT-2021-006367-26).
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Affiliation(s)
- Memnon Lysandrou
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Dionysia Kefala
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Panayiota Christofi
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, “George Papanikolaou” Hospital, Thessaloniki, Greece
| | - Nikolaos Savvopoulos
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Penelope Georgia Papayanni
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, “George Papanikolaou” Hospital, Thessaloniki, Greece
| | | | - Eleftheria Sagiadinou
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Vassiliki Zacharioudaki
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | | | - Dimitrios Tsokanas
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | - Georgios Karavalakis
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, “George Papanikolaou” Hospital, Thessaloniki, Greece
| | - Maria Liga
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
| | | | - Anastasia Papadopoulou
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, “George Papanikolaou” Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Gene and Cell Therapy Center, Hematopoietic Cell Transplantation Unit, Hematology Department, “George Papanikolaou” Hospital, Thessaloniki, Greece
| | - Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Rio, Greece
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Kefala D, Lysandrou M, Christofi P, Pieridou C, Papayanni P, Savvopoulos N, Kyriakou M, Chatzidaniil A, Stamou P, Anagnostopoulos A, Papadopoulou A, Costeas P, Yannaki E, Spyridonidis A. Immunotherapy: PRE-CLINICAL DEVELOPMENT OF A DECITABINE-INDUCED REGULATORY HLAG+CD4+-T CELL-ENRICHED CELL PRODUCT (IG-TREG) AGAINST GRAFT-VS-HOST-DISEASE. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00322-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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