CD4+CD25bright+ regulatory T cells can mediate donor nonreactivity in long-term immunosuppressed kidney allograft patients

Am J Transplant. 2006 Dec;6(12):2955-64. doi: 10.1111/j.1600-6143.2006.01566.x.

Abstract

CD4+ CD25bright+ FoxP3+ T cells are potent regulators of T-cell reactivity, but their possible involvement in donor-specific nonresponsiveness after clinical kidney transplantation remains to be elucidated. We assessed the proliferative donor-reactivity in 33 kidney allograft recipients who were maintained on a combination of proliferation inhibitors (mycophenolate mofetil (MMF) or Azathioprine (Aza)) and prednisone, long (> 5 years) after transplantation. Of the 33 patients, 8 still exhibited donor-reactivity, whereas 25 were classified as donor nonreactive patients. Within these 25 donor nonreactive patients, we assessed the involvement of CD4+ CD25bright+ regulatory T cells both by depleting them from the responder population as well as by reconstituting them to the CD25(-/dim) effector population. The absence of proliferation in these 25 patients, was abolished in 7 (28%) recipients upon depletion of the CD4+ CD25bright+ T cells. Reconstitution of these cells suppressed the donor-reactivity in a dose-dependent manner. Adding-back CD4+ CD25bright+ T cells inhibited the anti-third party response in all recipients, indicating that functional CD4+ CD25bright+ T cells circulate despite more then 5 years of immunosuppressive treatment. Altogether, we conclude that in long-term immunosuppressed kidney allograft patients functional regulatory CD4+ CD25bright+ T cells circulate but that these cells mediate donor non reactivity only in a subset of patients.

MeSH terms

  • Antigens, CD / blood
  • Azathioprine / therapeutic use
  • CD4 Antigens / blood
  • Drug Therapy, Combination
  • Flow Cytometry
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Interleukin-2 Receptor alpha Subunit / blood*
  • Isoantibodies / blood*
  • Kidney Transplantation / immunology*
  • Living Donors*
  • Lymphocyte Activation*
  • Lymphocyte Culture Test, Mixed
  • Lymphocyte Depletion
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Prednisone / therapeutic use
  • T-Lymphocytes, Regulatory / immunology*
  • Transplantation, Homologous / immunology

Substances

  • Antigens, CD
  • CD4 Antigens
  • Immunosuppressive Agents
  • Interleukin-2 Receptor alpha Subunit
  • Isoantibodies
  • Mycophenolic Acid
  • Azathioprine
  • Prednisone