Non-myeloablative autologous haematopoietic stem cell transplantation expands regulatory cells and depletes IL-17 producing mucosal-associated invariant T cells in multiple sclerosis

Sofia V. Abrahamsson, Daniela F. Angelini, Amy N. Dubinsky, Esther Morel, Unsong Oh, Joanne L. Jones, Daniele Carassiti, Richard Reynolds, Marco Salvetti, Peter A. Calabresi, Alasdair J. Coles, Luca Battistini, Roland Martin, Richard K. Burt, Paolo A. Muraro

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Autologous haematopoietic stem cell transplantation has been tried as one experimental strategy for the treatment of patients with aggressive multiple sclerosis refractory to other immunotherapies. The procedure is aimed at ablating and repopulating the immune repertoire by sequentially mobilizing and harvesting haematopoietic stem cells, administering an immunosuppressive conditioning regimen, and re-infusing the autologous haematopoietic cell product. 'Non-myeloablative' conditioning regimens to achieve lymphocytic ablation without marrow suppression have been proposed to improve safety and tolerability. One trial with non-myeloablative autologous haematopoietic stem cell transplantation reported clinical improvement and inflammatory stabilization in treated patients with highly active multiple sclerosis. The aim of the present study was to understand the changes in the reconstituted immune repertoire bearing potential relevance to its mode of action. Peripheral blood was obtained from 12 patients with multiple sclerosis participating in the aforementioned trial and longitudinally followed for 2 years. We examined the phenotype and function of peripheral blood lymphocytes by cell surface or intracellular staining and multi-colour fluorescence activated cell sorting alone or in combination with proliferation assays. During immune reconstitution post-transplantation we observed significant though transient increases in the proportion of CD4+FoxP3+ T cells and CD56high natural killer cell subsets, which are cell subsets associated with immunoregulatory function. CD8+CD57+ cytotoxic T cells were persistently increased after therapy and were able to suppress CD4 + T cell proliferation with variable potency. In contrast, a CD161high proinflammatory CD8+ T cell subset was depleted at all time-points post-transplantation. Phenotypic characterization revealed that the CD161highCD8+ T cells were mucosal-associated invariant T cells, a novel cell population originating in the gut mucosa but expressing the central nervous system-homing receptor CCR6. Detection of mucosal-associated invariant T cells in post-mortem multiple sclerosis brain white matter active lesions confirmed their involvement in the disease pathology. Intracellular cytokine staining demonstrated interferon γ and interleukin 17 production and lack of interleukin 10 production, a pro-inflammatory profile. Mucosal-associated invariant T cell frequency did not change in patients treated with interferon β; and was more depleted after autologous haematopoietic stem cell transplantation than in patients who had received high-dose cyclophosphamide (n = 7) or alemtuzumab (n = 21) treatment alone, suggesting an additive or synergistic effect of the conditioning regime components. We propose that a favourably modified balance of regulatory and pro-inflammatory lymphocytes underlies the suppression of central nervous system inflammation in patients with multiple sclerosis following non-myeloablative autologous haematopoietic stem cell transplantation with a conditioning regimen consisting of cyclophosphamide and alemtuzumab.

Original languageEnglish
Pages (from-to)2888-2903
Number of pages16
JournalBrain
Volume136
Issue number9
DOIs
Publication statusPublished - 2013

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Interleukin-17
Hematopoietic Stem Cell Transplantation
Multiple Sclerosis
T-Lymphocytes
Cyclophosphamide
Interferons
CCR6 Receptors
Central Nervous System
Transplantation
Lymphocytes
Staining and Labeling
T-Lymphocyte Subsets
Immunosuppressive Agents
Hematopoietic Stem Cells
Natural Killer Cells
Interleukin-10
Immunotherapy
Mucosal-Associated Invariant T Cells
Blood Cells
Flow Cytometry

Keywords

  • immune regulation
  • multiple sclerosis
  • proinflammatory cytokines
  • stem cells
  • T cells

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Non-myeloablative autologous haematopoietic stem cell transplantation expands regulatory cells and depletes IL-17 producing mucosal-associated invariant T cells in multiple sclerosis. / Abrahamsson, Sofia V.; Angelini, Daniela F.; Dubinsky, Amy N.; Morel, Esther; Oh, Unsong; Jones, Joanne L.; Carassiti, Daniele; Reynolds, Richard; Salvetti, Marco; Calabresi, Peter A.; Coles, Alasdair J.; Battistini, Luca; Martin, Roland; Burt, Richard K.; Muraro, Paolo A.

In: Brain, Vol. 136, No. 9, 2013, p. 2888-2903.

Research output: Contribution to journalArticle

Abrahamsson, SV, Angelini, DF, Dubinsky, AN, Morel, E, Oh, U, Jones, JL, Carassiti, D, Reynolds, R, Salvetti, M, Calabresi, PA, Coles, AJ, Battistini, L, Martin, R, Burt, RK & Muraro, PA 2013, 'Non-myeloablative autologous haematopoietic stem cell transplantation expands regulatory cells and depletes IL-17 producing mucosal-associated invariant T cells in multiple sclerosis', Brain, vol. 136, no. 9, pp. 2888-2903. https://doi.org/10.1093/brain/awt182
Abrahamsson, Sofia V. ; Angelini, Daniela F. ; Dubinsky, Amy N. ; Morel, Esther ; Oh, Unsong ; Jones, Joanne L. ; Carassiti, Daniele ; Reynolds, Richard ; Salvetti, Marco ; Calabresi, Peter A. ; Coles, Alasdair J. ; Battistini, Luca ; Martin, Roland ; Burt, Richard K. ; Muraro, Paolo A. / Non-myeloablative autologous haematopoietic stem cell transplantation expands regulatory cells and depletes IL-17 producing mucosal-associated invariant T cells in multiple sclerosis. In: Brain. 2013 ; Vol. 136, No. 9. pp. 2888-2903.
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AU - Morel, Esther

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AU - Jones, Joanne L.

AU - Carassiti, Daniele

AU - Reynolds, Richard

AU - Salvetti, Marco

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