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ARTICLE |
CORRESPONDENCE Christian P. Larsen: clarsen{at}emory.edu
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0.5% and CD8+ T cells to
5% precipitated graft rejection despite CD28/CD154 blockade. Antigenic rechallenge of equal numbers of cells stimulated at high or low frequency revealed that cells retained an imprint of the frequency at which they were primed. These results demonstrate a critical role for initial precursor frequency in determining the CD8+ T cell requirement for CD28- and CD154-mediated costimulatory signals during graft rejection.
Organ and cell transplantation represents an important means of effectively treating a wide range of genetic and acquired diseases. A major challenge in transplantation is inhibiting the immune response mounted by the recipient against donor tissue. This immune attack, comprised of many cell types, is orchestrated by T cells that become activated after recognizing allo-antigens and receiving appropriate costimulatory signals (1, 2). One promising therapy designed to regulate the immune response to donor tissue and thereby prevent the rejection response involves the use of reagents that block the costimulatory signals required for T cell activation (3). The most well characterized of these are CD28, which is ligated by CD80 or CD86 (4) and can be blocked via a CTLA-4 Ig fusion protein (4), and the CD40 pathway, which can be blocked using mAbs reactive against CD40 or CD154 (CD40L) (5).
Although very effective in many experimental rejection models, it is widely recognized and of considerable interest that combined blockade of the CD28 and CD40 pathways does not uniformly control rejection responses, indicating that not all allo-reactive T cell responses are dependent on these costimulatory signals during primary activation. For example, CD28/CD154 blockade results in graft survival of >120 d when BALB/c skin is grafted onto treated C3H recipients, whereas engraftment of BALB/c skin onto B6 recipients treated with the same regimen results in only moderate prolongation of graft survival (610). This breakthrough rejection could not be overcome simply by increasing the dose or duration of costimulation blockade treatment, further demonstrating that some T cell responses are fundamentally less dependent on CD28- and CD154-mediated costimulatory signals (7). The factors governing this observed relative independence of CD28/CD154-mediated signals are not well understood.
In recent years, the programmed differentiation model has emerged as a new paradigm to describe T cell responses based on evidence that after a brief period of antigenic stimulation, T cells become committed to a program of autonomous clonal expansion and differentiation into effector cells (1114). T cell programs are flexible and can be altered by the initial priming conditions as well as by extrinsic factors during the execution of the program. Of particular relevance to transplantation immunology are two recent studies indicating that the initial T cell precursor frequency of the responding population is a powerful influence on the program, and that T cells that undergo activation at high frequency differ from those that become activated under conditions of low frequency in their ability to differentiate into central and effector memory T cells (15) and in their ability to survive as memory cells (16). In addition, evidence suggests that, in infection models, responding T cells can achieve the same clone burst size over a wide range of initial precursor frequencies (17, 18). In these instances, T cells that begin at low frequency must undergo many more rounds of division and hence may be more susceptible to antigen-induced cellular deletion (15, 19). Furthermore, studies in models of autoimmunity have revealed that high initial CD8+ frequencies can convert helper-dependent responses into helper-independent responses (20).
Comparatively little is known about the instructional developmental T cell programs that are executed during allograft rejection and whether they are influenced by initial precursor frequency. The initial frequencies of alloreactive T cells span a much broader range than those of pathogen-specific or autoreactive T cells. For responses across fully mismatched MHC disparities, up to 1 in 10100 T cells may participate in the response (21), a number that is 23 logs greater than the estimated precursor frequency of pathogen-specific T cells. Although there is less quantitative information on the frequencies of donor-reactive T cells in the setting of MHC-identical transplants, the frequencies are likely to be closer to those observed in response to pathogens (1:104106) (22, 23). Varying degrees of MHC class I and II matching would be expected to affect the initial frequency of responding CD8+ and CD4+ T cells, respectively. For this reason, the issue of how initial antigen-specific T cell precursor frequency influences the kinetics, magnitude, and functionality of the T cell program is particularly pertinent to the field of transplantation.
Work from several groups has provided correlative evidence that systems with low donor-reactive T cell frequency are more susceptible to the inhibitory effects of CD28 and CD154 blockade than systems with high precursor frequency (2426). However, direct assessment of the effect of increased donor-reactive T cell precursor frequency has been limited by the availability of tools to incrementally increase both the donor-reactive CD4+ and CD8+ T cell compartments and to systematically analyze the magnitude and character of the responding T cell population under these conditions. In this study, we used a novel model in which membrane-bound OVA (mOVA) is constitutively expressed in all tissues under the control of the ß-actin promoter (27). The mOVA protein contains the epitopes recognized by T cells that can be isolated from the TCR transgenic mice OT-I and OT-II (OVA 257264/Kb and OVA 323339/I-Ab, respectively). Thus, the frequency of alloreactive T cells can be manipulated by titrating into naive recipients increasing numbers of OT-I and OT-II T cells. We therefore sought to address whether costimulation blockade-induced tolerance is influenced by the precursor frequency of naive donor-reactive T cells. The results indicate that a critical threshold exists above which antigen-specific T cells cannot be tolerized by CD28 and CD154 costimulatory pathway blockade, suggesting that variation in the initial precursor frequencies of donor-reactive CD4+ and/or CD8+ T cells is a critical determinant in the susceptibility or resistance to CD28/CD154 costimulation blockade-induced graft acceptance. We demonstrate that the initial frequency not only determines the fate of the graft, but also dictates both important quantitative and qualitative aspects of the developmental differentiation program executed by donor-specific T cell populations. These results therefore imply that antigen-specific T cell frequency during the priming phase of the immune response may influence the requirement for CD28- and CD154-mediated costimulation during T cell activation and create distinct opportunities for therapeutic interventions.
| RESULTS |
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To assess the effect of antigen-specific precursor frequency on the functional differentiation of the responding T cell populations after allogeneic tissue transplantation, recipients were killed at various time points after transplantation for analysis of the donor antigenspecific T cell response. The transferred OT-I T cells were identified as CD8+ Thy1.1+, and CFSE division profiles were examined. Division of the transferred populations was detectable in the draining LN (DLN) by day 3, with increased cell division in the low frequency group (Fig. 1 A).
Remarkably, by day 10 the population that began as
10-fold lower than the high frequency population attained nearly identical absolute numbers in the DLN at the peak of the response (Fig. 1 B). Similar results were obtained after analysis of CD8+ Thy1.1+ OT-I T cells isolated from the spleens of these recipients (not depicted). The convergence in absolute cell numbers is likely due to the observed increase in cell division of the low precursor frequency population (Fig. 1 A), as annexin V and propidium iodide staining of donor-reactive CD8+ Thy1.1+ T cells did not suggest increased death rates in the cells stimulated at high frequency (not depicted). In fact, the kinetics of contraction of the cell populations after the peak of the response was more rapid in the cells stimulated at low frequency than in those stimulated at high frequency (Fig. 1 B). These results suggest that very significant differences exist in terms of the rates of T cell expansion and contraction for T cell populations responding from low versus high precursor frequency.
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and TNF-
after peptide challenge in vitro. A higher percentage of CD8+ Thy1.1+ T cells stimulated under low frequency conditions produced IFN-
at day 14 (55.2%) as compared with those stimulated at high frequency (14.5%) (Fig. 1 C). However, the total number of IFN-
producing cells per DLN was similar in both the high and low precursor frequency groups, suggesting that cells stimulated at lower frequency reached the same peak number of effector cells (Fig. 1 D). We also examined the number of OT-I cells that produced TNF-
after antigen rechallenge and found that although the DLNs of mice containing cells stimulated at high frequency had similar numbers of IFN-
and TNF-
secreting cells, the DLNs of mice containing cells stimulated at low frequency had only about half the number of TNF-
producing cells as IFN-
producing cells (Fig. 1 D), suggesting a difference in the quality of the response. Indeed, substantial evidence in the literature supports the idea that high quality effector cells are multifunctional in nature (2830). Collectively, these results demonstrate that although cells stimulated at high and low frequency are eventually sufficient to reject a skin graft, cell populations stimulated at low frequency must undergo much more extensive expansion to achieve this and possess fewer "high quality" multifunctional T cells.
CTLA-4 Ig and anti-CD154induced tolerance can be overcome by increasing CD4+ and CD8+ T cell precursor frequencies
Based on these studies demonstrating that T cell stimulation at high precursor frequency resulted in less rigorous proliferation and more multifunctional effector T cells, we hypothesized that high initial precursor frequency of donor-specific T cells might also reduce the cells' requirement for CD28- and CD154-mediated costimulation during primary activation. To directly test this, TCR transgenic OT-I and OT-II T cells were adoptively transferred into naive B6 recipients, incrementally raising the precursor frequency of antigen-specific cells before engraftment with mOVA skin and treatment with CTLA-4 Ig/anti-CD154 mAbs (costimulation blockade) (Fig. 2 A).
To quantify the "artificial" precursor frequency resulting from the adoptive transfer of increasing numbers of antigen-specific T cells, splenocytes and LN cells from recipients of 105, 106, or 107 OT-I and OT-II T cells were analyzed for the presence of Thy1.1+ OT-I or OT-II T cells 48 h after transfer. Results indicated that the percentage of Thy1.1+ OT-I and OT-II T cells both increased in a step-wise fashion, with recipients of 105 cells having a precursor frequency of
0.04%, recipients of 106 cells having a frequency of
0.4%, and recipients of 107 cells having a frequency of
4% (Fig. 2 A). The artificial precursor frequencies of these adoptive transfer recipients therefore span the range that is thought to represent the frequencies normally observed for allogeneic T cell responses (21).
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CD8+ OT-I T cells become "costimulation independent" at a lower precursor frequency than do CD4+ OT-II T cells
Next, we sought to identify the contribution of a high precursor frequency of each T cell compartment to the development of costimulation blockade-resistant rejection by independently varying the frequencies of either compartment before mOVA skin transplantation and CTLA-4 Ig/anti-CD154. Results demonstrate that high frequencies of either subset alone were insufficient to overcome the tolerizing effects of costimulation blockade and induce rapid and consistent costimulation blockade-resistant rejection (Table I).
Furthermore, although CD4+ T cell frequency of 0.05% was not sufficient to precipitate maximum rejection even at high frequencies of OT-I cells, CD4+ cell frequencies of 0.5 and 5% both provided adequate help for 107 OT-I T cells to induce maximum costimulation blockade-resistant rejection (Table I). Importantly, even 107 OT-II T cells were insufficient to induce costimulation blockade-resistant rejection at lower frequencies of OT-I T cells (0.05 and 0.5%, or 105 and 106 transferred cells), implicating a high precursor frequency of antigen-specific CD8+ T cells as a major barrier to costimulation blockade-induced allograft tolerance.
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We also performed CFSE analysis to compare the amount of cell division occurring under each set of conditions. We observed that the more rapid division of the low frequency groups is dramatically stunted by costimulation blockade on days 3 and 7 after transplant (Fig. 4 A, top two rows). Strikingly, division was less notably inhibited by costimulation blockade at high T cell frequency (Fig. 4 A, bottom two rows). Comparisons of absolute numbers of OT-I T cells that had undergone each number of rounds of division (0, 1, 2, etc.) revealed that more of the cells stimulated at low frequency had divided more than five times, whereas the majority of the cells stimulated at high frequency had divided fewer than five times (Fig. 4 B). Notably, cells stimulated at low frequency in the presence of CTLA-4 Ig/anti-CD154 were present at lower numbers in all stages of division and failed to accumulate in the later stages of division (more than seven rounds). In contrast, the division profile of cells stimulated at high frequency in the presence of costimulation blockade exhibited minimal cell loss relative to untreated controls (Fig. 4 B). These experiments suggest that costimulation blockade quantitatively impacts the expansion of donor-reactive T cell populations when primed under low frequency conditions, but has relatively little impact on cells primed under high antigen-specific precursor frequency conditions.
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and TNF-
. Although cells stimulated at high frequency in the presence or absence of costimulation blockade exhibited similar frequencies of IFN-
and TNF-
producing cells 4 h after in vitro peptide rechallenge, cells primed at low precursor frequency in the presence of costimulation blockade exhibited a dramatically diminished ability to make IFN-
and TNF-
as compared with their untreated counterparts (Fig. 5 A and not depicted).
The same result was observed when the total number of IFN-
or TNF-
secreting cells per spleen was analyzed (Fig. 5 B). This striking result closely parallels the observed clinical outcome of graft rejection, as mice that received a low precursor frequency of OT-I T cells in the presence of costimulation blockade were the only group in which long-term tolerance was induced (Fig. 3 A).
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| DISCUSSION |
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We also addressed the effect of initial T cell frequency on the requirement for CD28/CD154-mediated costimulatory signals during immune activation. The results of our studies reveal a significant negative effect of CTLA-4 Ig and anti-CD154 on the proliferative burst size and effector function of cells stimulated at low frequency (Fig. 3). Analysis of absolute numbers of donor-reactive T cells that had undergone 0, 1, 2, etc. rounds of divisions revealed that CD28/CD154 blockade did not inhibit cells from entering cycle; rather, it resulted in abortive proliferation, failure of cells that had divided more than five times to accumulate as early as 7 d after transplantation (Fig. 4 B), and a dramatic decrease in the number of cytokine-producing effector cells (Fig. 5). The persistence of antigen-specific but functionally ineffective T cells is a phenotype reminiscent of the state of anergy originally described by Schwartz (39), but with some important differences. Although anergy is defined as diminished proliferation and IL-2 production after antigenic rechallenge with the relative sparing of effector cytokine secretion (IFN-
/IL-4) (39), we observed abortive proliferation and a dramatic inhibition of IFN-
and TNF-
secretion after in vitro rechallenge of cells stimulated at low frequency in the presence of costimulation blockade. This phenotype may be more closely related to that observed in exhausted T cells in models of chronic viral infection (35). In contrast, our data reveal that at initial high frequency, costimulation blockade had a very limited impact on the magnitude of the response, CFSE division profile, and acquisition of effector function of graft-specific CD8+ T cells (Figs. 3 and 4). Based on these results, we conclude that high initial precursor frequency of antigen-specific CD8+ T cells can obviate the need for CD28/CD154-mediated costimulatory molecules and is a powerful determinant of the susceptibility or resistance to costimulation blockade-induced graft acceptance. Although it is commonplace for high frequencies of cells to be used in in vivo adoptive transfer experiments investigating the effects of costimulation on primary T cell responses to facilitate their identification and analysis (15, 40, 41), our findings suggest that experimental design should take into account the precursor frequency appropriate for the model being studied.
Although our study demonstrated that one of the critical factors impacting CD8+ T cell requirement for CD28- and CD40L-mediated costimulatory signals during primary immune activation is initial precursor frequency, the precise mechanism of this phenomenon remains to be determined. Our results demonstrate that a hallmark characteristic of costimulation-independent cells primed at high frequency is that they undergo fewer cell divisions after antigen encounter than those primed at lower cell frequency. We speculate that this increase is due to reduced competition for antigen or access to APCs among the antigen-specific T cells, as has been demonstrated for CD4+ T cells (42), and that reduced competition manifests as a stronger antigenic stimulus. A lack of costimulatory signals during T cell priming in cells that receive this stronger stimulus and thus are programmed to divide many times may be a catastrophic event. In this way, cells may calibrate the amount of costimulation they require against the amount they receive, and in the absence of sufficient costimulation, cells may fail to accumulate at later rounds of division and to differentiate into competent effector cells.
An alternate, but not mutually exclusive, possibility that may explain the relative costimulation independence of T cells stimulated at high frequency is that the number of T cells on a given APC may affect the outcome of the T cell response. It is possible that the low amounts of soluble factors such as IL-2 that are secreted even in the presence of CTLA-4 Ig/anti-CD154 are sufficient to provide external growth signals when produced by many cells in the same microenvironment. Alternatively, the presence of many T cells on a single APC may lead to increased or differential activation of the APC, such that it is now better able to stimulate the responding T cells. Such changes could include increased expression of costimulatory molecules other than CD80/CD86 and CD40, such that costimulation is provided by molecules other than the ones blocked in our study. Increased frequency of antigen-specific T cells within the LN environment could also increase the likelihood of these cells interacting with nontraditional APCs that express costimulatory molecules other than CD80, CD86, and CD40.
The fact that the number of competent effector cells reaches a similar apex in mice that reject their grafts, regardless of initial precursor frequency, indicates that some critical threshold exists for the successful rejection of an allogeneic skin graft. Studies by Jones et al. (36) have provided additional evidence that T cellmediated allograft rejection requires the generation of a critical threshold of differentiated effector T cells. Interestingly, this rejection threshold is specific to the allograft type, with larger numbers of effectors being required for the rejection of heart as compared with skin or islet allografts (36); therefore, differences in the initial precursor frequency of donor-specific CD8+ and/or CD4+ T cells may result in distinct effects on graft survival and the character and magnitude of the T cell program elicited by different allograft types. Certainly, the signals and feedback loops used by the immune system to determine the critical number of cells needed to reject a particular graft are unknown and represent new areas for study that may result in novel targets for therapeutic intervention.
The studies described here have important potential clinical implications. As new costimulation blockade-based modalities enter clinical trials in transplantation, it will be important to understand the circumstances that predict a greater likelihood of success or portend breakthrough rejection, such as high initial CD8+ T cell frequency. If initial precursor frequency also proves to have a powerful effect in human allo-specific T cell responses, this knowledge could be used to prompt consideration of alternative approaches to organ allocation, for example, reemphasizing class I matching as a means to effectively lower the graft-specific CD8+ T cell frequency. More likely, knowledge of low CD8+ donor-reactive precursor frequency in a particular patient could be used to direct the reduction of immunosuppression or prompt attempts at tolerance induction, whereas detection of high frequencies could direct the intensification of immunosuppression for the control of breakthrough CD8+ T cell responses. In addition, our studies predict that costimulatory blockade may synergize with agents designed to reduce the initial frequency of all T cells, such as anti-CD52 (43, 44) or anti-CD3 mAbs (45), in that these agents would effectively lower the initial frequency of graft-specific T cells and thereby increase the efficacy of treatment with costimulatory blockade.
| MATERIALS AND METHODS |
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Skin grafting and costimulation blockade.
Full thickness dorsal ear and tail skin grafts (
1 cm2) were transplanted onto the dorsal thorax of recipient mice and secured with a plastic adhesive bandage for 5 d. Graft survival was monitored by daily visual inspection. Rejection was defined as the complete loss of viable epidermal tissue. Where indicated, recipients of skin grafts received treatment with 500 µg each of hamster antimouse CD154 mAb (MR-1; Bioexpress) and human CTLA-4 Ig (Bristol-Meyers Squibb) administered i.p. on the day of transplantation (day 0) as well as after transplant on days 2, 4, and 6.
T cell adoptive transfers.
OT-I and OT-II TCR transgenic T cells were harvested from the spleens of OT-IxThy1.1+xRAG/ and OT-IIxThy1.1+xRAG/ mice, respectively. Single cell suspensions were prepared and counted, and the frequency of OT-I or OT-II T cells within the splenocyte preparation was determined before adoptive transfer by staining with anti-V
2 (used by both TCRs) and anti-CD8 or anti-CD4, respectively (BD Biosciences). Cells were labeled with 5 µM CFSE before adoptive transfer. Mice received a single i.v. injection of the indicated number of OT-I or OT-II T cells along with syngeneic B6 carrier splenocytes.
Flow cytometric analyses for frequency and absolute number.
At the indicated time points, recipients of OT-I and/or OT-II T cell transfers were killed, spleens and draining axillary LNs were harvested, and single cell suspensions were prepared. Cells were stained with Thy1.1-PerCP, CD8-PacOrange, and CD4-PacBlue (all BD Biosciences) for flow cytometric analysis on a BD LSRII multicolor flow cytometer. In some cases, the absolute number of antigen-specific T cells was determined by TruCount Bead Analysis (BD Biosciences) according to the manufacturer's instructions. Flow cytometric data were analyzed using FlowJo Software (Treestar).
Intracellular cytokine staining.
For measurement of IFN-
and TNF-
secreting cells, single cell suspensions of splenocytes or draining axillary LN cells from adoptive transfer/skin graft recipients (106 per well) were incubated in a 96-well plate with 10 µM OVA257264 (SIINFEKL; Emory University Microchemical Core Facility) and 10 µg/ml brefeldin A (BD Biosciences). After 6 h in culture, cells were processed using an intracellular staining kit (BD Biosciences) according to the manufacturer's instructions and stained with antiTNF-
PE, antiIFN-
APC, antiThy1.1-PerCP, anti-CD8Pacific Orange, and anti-CD4Pacific Blue (all from BD Biosciences).
In vitro T cell stimulation, separation, and adoptive transfer.
OT-I T cells were stimulated with OVA peptide at high (3 x 106 cells/well) or low frequency (3 x 105 cells/well) in a 24-well plate in the presence of 100 µg/ml CTLA-4 Ig and anti-CD154. B6 splenocytes were added to the low frequency cultures to keep the total number of cells per well consistent. Culture media consisted of RPMI 1640 supplemented with 10% FBS (Mediatech), 2 mM L-glutamine, 0.01 M Hepes buffer, 100 µg/ml gentamycin (Mediatech), and 5 x 105 M 2-mercaptoethanol (Sigma-Aldrich). 3 d later, live cells were isolated by Ficoll-Hypaque centrifugation (Mediatech) and 5 x 106 T cells from cultures primed at an initial high or low antigen-specific T cell frequency were adoptively transferred into P14xRAG/ recipients as described above.
Statistical analyses.
Skin graft rejection is represented by Kaplan-Meier survival curves. Statistical comparisons of mean survival times were performed using nonparametric one-way ANOVA (Kruskal-Wallis test), followed by Dunn's multiple comparisons posttest comparing the relevant datasets (GraphPad Prism Software).
Online supplemental material.
Fig. S1 shows donor skin graft tissue that was harvested on day 14 after transplant, and 100% acetone-fixed tissue was frozen in OCT compound (Tissue-Tek) to test for the presence of Thy1.1+ OT-I/OT-II T cell infiltrates. Frozen tissue sections were counterstained with hematoxylin, labeled with biotinylated anti-Thy1.1, and visualized using the Dako LSAB + labeled streptavidin-HRP kit. Tissue sections from three mice per group (representative samples are shown) revealed the presence of Thy1.1+ cells in both groups receiving no treatment (both left panels) and the mice receiving a high frequency of OT-I T cells with CTLA-4 Ig/anti-CD154 (bottom right). No Thy1.1+ cells were detectable in the tissue of mice receiving a low frequency of OT-I T cells and CTLA-4 Ig/anti-CD154 (top right). Fig. S1 is available at http://www.jem.org/cgi/content/full/jem.20062319/DC1.
| Acknowledgments |
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This work was supported by National Institutes of Health grants AI040519 and AI044644 to C.P. Larsen and the Carlos and Marguerite Mason Trust. M.L. Ford was supported by a Ruth L. Kirschstein National Research Service Award.
The authors have no conflicting financial interests.
Submitted: 3 November 2006
Accepted: 27 December 2006
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