scholarly journals NK cell education after allogeneic transplantation: dissociation between recovery of cytokine-producing and cytotoxic functions

Blood ◽  
2011 ◽  
Vol 118 (10) ◽  
pp. 2784-2792 ◽  
Author(s):  
Bree Foley ◽  
Sarah Cooley ◽  
Michael R. Verneris ◽  
Julie Curtsinger ◽  
Xianghua Luo ◽  
...  

Abstract Natural killer (NK) cells mediate GVL effects after allogeneic hematopoietic cell transplantation (allo-HCT) by the production of inflammatory cytokines and by direct target lysis. The acquisition of both functions was presumed to be developmentally linked, but this linkage remained unstudied after allo-HCT. We tested the cytokine production and degranulation of reconstituting NK cells after adult unrelated donor or umbilical cord blood grafting. Recipients of T cell–depleted transplants, receiving no immune suppression, showed diminished NK cell degranulation. In contrast, degranulation was normal or increased after T-cell replete transplants given with immune suppression. Strikingly, target cell-induced IFNγ production was markedly diminished in all transplant settings, especially with T cell–depleted or naive T cell–containing umbilical cord blood grafts, suggesting a role for T cells in NK education. Although degranulation was similar in the KIR+ and KIR− populations that coexpressed NKG2A, target cell-induced IFNγ production was limited to the subset of NK cells expressing KIR inhibited by self-ligands. Thus, cytokine production and cytotoxic function do not consistently coexist in NK cells reconstituting after allo-HCT. Exposure to IL-15 rapidly increased target-inducible IFNγ production, indicative of IL-15's potential as a therapeutic tool to enhance NK cell function to protect against infection and relapse after allo-HCT.

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4496-4496
Author(s):  
Harry Dolstra ◽  
Jeannette Cany ◽  
Anniek B. van der Waart ◽  
Marleen Tordoir ◽  
Basav Nagaraj Hangalapura ◽  
...  

Natural killer (NK) cell-based immunotherapy is a promising adjuvant, relatively non-toxic therapy approach for AML. However, further improvement of NK cell-based therapy is needed to increase the clinical effect. In this regard, NK cells generated ex vivo from hematopoietic progenitor cells (HPC) may have significant clinical benefits over enriched NK cells from adult donors, including the ability to choose an appropriate killer-cell immunoglobuline-like receptor (KIR)-ligand or KIR B haplotype alloreactive donor, as well as the capacity to reach high therapeutic dosages. Previously, we reported a GMP-compliant, cytokine/heparin-based culture protocol for the ex vivo generation of highly active NK cells from CD34+ HPC isolated from cryopreserved umbilical cord blood (UCB) units. Expansion in closed, large-scale bioreactors yields a clinically relevant dose of NK cells with high purity and cytolytic activity against AML cells in vitro. Currently, a clinical phase I trial with these HPC-NK cells is ongoing in our hospital. Trafficking studies in NOD/SCID/IL2Rgnull (NSG) mice demonstrated that these HPC-NK cells migrate to the bone marrow (BM) as well as to lymphoid organs where in vivo expansion and maturation can take place. Analysis of the chemokine receptor expression profile of UCB-NK cells matched in vivo findings. Particularly, a firm proportion of UCB-NK cells functionally expressed CXCR4, what could trigger BM homing in response to its ligand CXCL12. In addition, high expression of CXCR3 and CCR6 supported the capacity of UCB-NK cells to migrate to inflamed tissues via the CXCR3/CXCL10-11 and CCR6/CCL20 axis. Importantly, a single HPC-NK cell infusion combined with supportive IL-15 administration was shown to efficiently inhibit growth of K562 leukemia cells implanted in the femur of NSG mice, resulting in significant prolongation of mice survival. Furthermore, we investigated whether modulation by the DNA methyltransferase (DNMT) inhibitors Azacytidine (Aza) and Decitabine (Deci) could further potentiate the antileukemic effect of HPC-NK cells against AML cells. In concordance with previous reports, we observed a dose-dependent effect of Aza and Deci on the growth of the AML cell lines THP1 and KG1a. In subsequent NK cell killing assays, we used clinical relevant low drug concentrations to pre-treat AML cells that did not affect HPC-NK cell viability and cytolytic function. Interestingly, increased killing of pre-treated THP1 and KG1a cells by HPC-NK cells could be observed, which was correlated with an increase in the NKG2D ligand ULBP2, the DNAM-1 ligands CD112 and CD155 as well as TRAIL-R2. Notably, maintenance of low-dose DNMT inhibitors during the KG1a/NK co-culture resulted in pronounced AML growth inhibition. To examine the effect of DNMT inhibitors in vivo, THP1.LucGFP-bearing NSG mice were treated with increasing dose of both agents, which were administered according to current standard protocols applied in humans. Data indicated that treatment with Aza or Deci at dosage equivalent in human to 12.5 and 5 mg/m2 respectively was well tolerated with minimal and/or transient weight loss, and efficiently reduced the progression of THP-1.LucGFP cells in vivo. Currently, we explore whether HPC-NK cells and DNMT inhibitors can work together to combat AML in our xenograft models. These preclinical studies may provide a rationale to investigate the possible additive and/or synergistic anti-AML effects of adoptive HPC-NK cell transfer in combination with these DNMT inhibitors in AML patients. Disclosures: Tordoir: Glycostem Therapeutics: Employment. Spanholtz:Glycostem Therapeutics: Employment.


Blood ◽  
1999 ◽  
Vol 94 (9) ◽  
pp. 3101-3107 ◽  
Author(s):  
Suzanne Kadereit ◽  
Shaden F. Mohammad ◽  
Robin E. Miller ◽  
Kathleen Daum Woods ◽  
Chad D. Listrom ◽  
...  

Abstract Umbilical cord blood (UCB) stem cells from related and unrelated allogeneic donors have emerged as novel treatment for patients with hematologic malignancies. The incidence and severity of acute graft-versus-host disease (GVHD) after UCB transplantation compares favorably with that observed in recipients of matched unrelated donor allogeneic grafts, but remains a major cause of morbidity and mortality. It has been shown that stimulated lymphocytes from UCB have reduced production of cytokines including interferon-γ (IFN-γ) and tumor necrosis factor- (TNF-), which play a role in GVHD pathophysiology. We investigated the molecular mechanisms underlying this reduced cytokine production by analyzing expression of nuclear factor of activated T cells-1 (NFAT1) in UCB T cells. We detected no constitutive expression of NFAT1 protein in unstimulated UCB T cells compared with adult T cells. Moreover, although NFAT1 expression in UCB T cells was upregulated after prolonged (40 hours) T-cell stimulation, it was only partially upregulated when compared with adult controls. Our observation of minimal NFAT1 expression after stimulation correlated with reduced cytoplasmic IFN-γ and TNF- production in UCB T cells studied simultaneously. Reduced NFAT1 expression may blunt amplification of donor UCB T-cell alloresponsiveness against recipient antigens, thereby potentially limiting GVHD incidence and severity after allogeneic UCB transplantation.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1462-1462
Author(s):  
Bree Foley ◽  
Sarah Cooley ◽  
Julie Curtsinger ◽  
Michael Verneris ◽  
Daniel J. Weisdorf ◽  
...  

Abstract Abstract 1462 NK cells are the first lymphocyte subset to reconstitute following hematopoietic stem cell transplantation (HSCT) and they play a pivotal role in mediation of the graft versus leukemia (GvL) effect in myeloid leukemia. We hypothesized that for NK cells to mediate GvL, they must be fully functional via a process termed “licensing” or “education”. Although it has been presumed that NK cell functions (cytotoxicity and cytokine production) develop in parallel through interactions with their class I recognizing inhibitory receptors, new data suggests that this may not be the case. To address this issues we developed a 9-color flow cytometric-based assay to simultaneously measure both CD107a expression and IFNy production by CD56+ NK cells in the context of expression of inhibitory receptors for self-class I human leukocyte antigen (HLA). We tested a cohort of 30 patients who received either unmanipulated (T cell replete) or potently T cell depleted (CD34+ selected) grafts from adult unrelated donors. Thawed peripheral blood mononuclear cells (PBMC) were rested overnight in cytokine free media and then incubated with K562 cells to trigger cytotoxicity and cytokine production. PBMC were stained with CD107a (a surrogate for cytotoxicity), IFNy, CD56, CD3, CD45, CD158a, CD158b, CD158e and CD159a simultaneously. The same normal volunteer and the actual transplant donor were used as positive controls in each assay. Cytotoxicity or IFNy production was calculated as a percentage of the normal positive control. Cytotoxicity was intact but modestly suppressed (∼35%) at 3 months after both T cell deplete and T cell replete HSCT with further recovery of killing at 6 months. By contrast, at 3 months after T cell replete HSCT there was potent and sustained suppression of IFNy production by CD56+ cells (57%±11% suppression, p=0.009). The cohort of patients receiving T cell deplete (CD34-selected) grafts also exhibited significant suppression of IFNy at 3 months after HSCT (73%±9.6%, p=0.018), suggesting that the use of post-transplant immune suppression medications did not explain the effect. Suppression of IFNy production when exposed to targets continued through 6 months post-transplant in both cohorts and was partially restored with low concentrations of IL-15. Cells stimulated overnight with IL-12 and IL-18 produced IFNy at 3 and 6 months. Thus the cells were not globally hyporesponsive, suggesting the defect was based on physiologic interactions with the target. NK cells become educated following engagement of inhibitory receptors (eg. Killer-immunoglobulin-like receptors [KIR]) with self class I HLA. Therefore we compared NK cells that expressed at least one KIR with KIR negative NK cells. At 3 months post transplant, KIR expression had no effect on cytotoxicity. In contrast, KIR positive cells produced significantly higher amounts of IFNy than KIR negative cells at 3 (Figure 1) and 6 (data not shown) months post-transplant. Therefore following HSCT, expression of KIR discriminates a population of NK cells that produce IFNy, but does not correlate with cytotoxicity. While NK cell cytotoxicity is only partially suppressed following HSCT, IFNy production is significantly reduced. Consistent with this we found that while all IFNy producing cells degranulate, only a small fraction of CD107a+ cells also make IFNy. This effect is not a result of post-transplant immune suppression or graft versus host disease, as patients receiving CD34+ selected grafts had neither. Perhaps NKG2A, highly expressed on almost all NK cells early after transplant, selectively mediates education for cytotoxcity. In conclusion, our data shows distinct defects in NK cell education for either cytotoxicity or cytokine production. This highlights the importance of analyzing both cytotoxicity and cytokine production when assessing NK cell function post HSCT. Because of their critical anti-tumor and infection protection roles, methods to enhance broad in vivo NK cell function, such as the use of post-transplant IL-15 administration, are warranted. Disclosures: No relevant conflicts of interest to declare.


2003 ◽  
Vol 71 (1) ◽  
pp. 29-38 ◽  
Author(s):  
Hidehisa Tanaka ◽  
Shunro Kai ◽  
Masao Yamaguchi ◽  
Mahito Misawa ◽  
Yoshihiro Fujimori ◽  
...  

eLife ◽  
2020 ◽  
Vol 9 ◽  
Author(s):  
Sabrina Bianca Bennstein ◽  
Sandra Weinhold ◽  
Angela Riccarda Manser ◽  
Nadine Scherenschlich ◽  
Angela Noll ◽  
...  

Despite their identification several years ago, molecular identity and developmental relation between human ILC1 and NK cells, comprising group 1 ILCs, is still elusive. To unravel their connection, thorough transcriptional, epigenetic, and functional characterization was performed from umbilical cord blood (CB). Unexpectedly, ILC1-like cells lacked Tbet expression and failed to produce IFNγ. Moreover, in contrast to previously described ILC1 subsets they could be efficiently differentiated into NK cells. These were characterized by highly diversified KIR repertoires including late stage NKG2A-KIR+ effector cells that are commonly not generated from previously known NK cell progenitor sources. This property was dependent on stroma cell-derived Notch ligands. The frequency of the novel ILC1-like NK cell progenitor (NKP) significantly declined in CB from early to late gestational age. The study supports a model in which circulating fetal ILC1-like NKPs travel to secondary lymphoid tissues to initiate the formation of diversified NK cell repertoires after birth.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1476-1476
Author(s):  
Giuseppina Bonanno ◽  
Maria Corallo ◽  
Annabella Procoli ◽  
Andrea Mariotti ◽  
Luca Pierelli ◽  
...  

Abstract Abstract 1476 Poster Board I-499 Background: Umbilical cord blood (UCB) is increasingly used as an alternative source of transplantable CD34+ haematopoietic stem cells (HSC) for neoplastic and non-neoplastic diseases. In addition to CD34-expressing HSC, human UCB contains a rare population of CD34−lineage− cells endowed with the ability to differentiate along the T/NK pathway in response to interleukin (IL)-15 and in the presence of a stromal cell support. IL-21 is a four-helix bundle cytokine released by activated CD4+ T cells and by NKT cells. IL-21 is a crucial regulator of NK cell function, whose influence on IL-15-induced differentiation of CD34−lineage− cells has not been investigated previously. The present study was designed and conducted to address whether IL-21 might replace the stromal cell requirements and foster the IL-15-induced NK differentiation of human UCB CD34−lineage− cells. Methods: CD34−lineage− cells were maintained in liquid culture with 10−6M hydrocortisone, 20 ng/ml Flt3-L and 20 ng/ml SCF, with the addition of 50 ng/ml IL-15 and 20 ng/ml IL-21, either alone or in combination. Cultures were established in the absence of feeder cells or serum supplementation. Cytokine-treated cells were used to evaluate the following parameters: a) cell surface phenotype; b) expression of molecular determinants of lymphoid/NK cell differentiation; c) secretion of IFN-γ, GM-CSF, TNF-α and CCL3/MIP-1α; d) cytolytic activity against NK-sensitive tumour cell targets and e) relative amount of Stat1 (Tyr701), Stat3 (Tyr705) and Stat5 (Tyr694) phosphorylation in response to IL-21. For all the above detailed experiments, control cultures were established with UCB-derived CD34+ HSC. Results: Freshly isolated CD34−lineage− cells stained negatively for stem cell-associated (CD34, CD133) and NK/lymphoid surface antigens (CD7, CD56, CD16, CD3, TCRαβ), and comprised 0.22% on average of UCB mononuclear cells (samples analyzed = 8). CD34−lineage− cells proliferated vigorously in response to IL-15 and IL-21 (average fold expansion at week +4 of culture = 42.5) but not to IL-21 alone, and up-regulated phosphorylated Stat1 and Stat3 proteins, in good agreement with previously published reports on the IL-21-induced activation of Stat signaling. CD34−lineage− cells expanded by IL-21 in combination with IL-15 acquired a peculiar lymphoid morphology with heavy cytoplasmic granules. When compared with CD34-derived NK cells, CD34−lineage− cells emerging from IL-15+IL-21-containing cultures expressed very low levels of CD16 and killer-cell immunoglobulin-like receptor (KIR), but high levels of CD56, NKG2D and IL-21 receptor, consistent with pseudo-mature NK cells. IL-21/IL-15-differentiated cells up-regulated mRNA signals for Bcl-2, GATA-3 and Id2, a master switch required for NK-cell development, and harboured un-rearranged TCRγ genes, suggesting that NK commitment under the experimental conditions here established occurs through a pathway that does not include TCR rearrangement. From a functional standpoint, IL-21/IL-15-treated cells secreted copious amounts of IFN-γ, GM-CSF and CCL3/MIP-1α, and expressed cell surface CD107a upon contact with NK-sensitive tumour targets, a measure of exocytosis of NK secretory granules. Specifically, an average 65±11% of CD56+ NK cells differentiated with IL-15+IL-21 stained positively for CD107a in co-cultures established with NK-sensitive K562 cells. NK cell degranulation occurred at significantly lower levels in co-cultures containing K562 cells and IL-15-differentiated CD34−lineage− cells (mean percentage of CD107a+CD56+ NK cells equal to 35±6 at E:T ratio = 1; p < 0.01 compared with cultures containing IL-15+IL-21-matured NK cells), suggesting that IL-15 and IL-21 exerted synergistic effects on NK activity. Finally, NK cells differentiated from CD34+ HSC with either IL-15 alone or IL-15+IL-21 manifested a similar cytotoxic activity to that of cytokine-differentiated CD34−lineage− cells. Conclusions: This study suggests that considerable numbers of highly pure, lytic CD56+CD16−/+ NK cells for adoptive immunotherapy can be obtained from UCB CD34−lineage− cells using a serum-free, feeder cell-free culture system. The findings highlighted herein also shed some light into the developmental intermediates of NK cells that can be differentiated after the exposure of CD34−lineage− cells to IL-21. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 61-61
Author(s):  
Qin Tang ◽  
Bartosz Grzywacz ◽  
Hongbo Wang ◽  
Nandini Kataria ◽  
John E. Wagner ◽  
...  

Abstract The natural cytotoxicity receptors (NCRs), NKp30, NKp44 and NKp46, are a recently identified group of receptors that play a central role in NK cell killing of malignant cells. Previous studies show that the NCRs are restricted to the NK cell lineage. However, we noted that a small fraction of freshly isolated umbilical cord blood (UCB) T cells expressed NKp30 (1.7±0.9%, n=8), but not NKp44 (0.4±0.4%, n=8) or NKp46 (0.5±0.4%, n=8). Thus, we investigated whether NCRs could be induced on either UCB or adult peripheral blood (PB) T cells after culture in IL-15 for 14 days. This cytokine was chosen since previous studies show that IL-15 induces other NK cell receptors on both UCB and PB T cells. Surprisingly, UCB, but not PB T cells, acquired NKp30 (37±10% vs 4±2%, p=0.01), NKp44 (41±20% vs. 1±0.6%, p=0.01) and NKp46 (13±7% vs 0.6±0.5%, p=0.01). NCRs were found mainly on CD8+ or CD3+CD56+ UCB T cells. Further studies addressed whether other cytokines could induce NCR expression on UCB T cells. Both IL-2 and IL-15 showed a dose dependent induction of NCRs. In contrast, IL-7 induced only NKp30 on UCB T cells, but in a non-dose dependent manner. IL-4 abrogated NCR expression, even in the presence of IL-15. Considering that the ligands for the NCRs are not yet elucidated, we performed functional studies using agonist mAbs and NK cells served as controls. Surprisingly, while all three NCRs were expressed on IL-15 expanded UCB T cells, only NKp30 was functional as demonstrated by degranulation (CD107a), IFN-γ release, and redirected killing assays (reverse ADCC). Previous studies show that the NKp30, −44 and −46 cooperate to induce NK killing. However, the simultaneous triggering of all 3 NCRs did not increase UCB T cell cytotoxicity. Some NK cell receptors modulate TCR triggering, but this was not the case with NCRs. We did find that another NK cell receptor, NKG2D, enhanced the cytoxic triggering of NKp30, but not other NCRs. To address the lack of function of NKp44 and −46 on UCB T cells, the expression of adapter proteins required for signaling through these receptors were determined. The proximal receptor for NKp44 signaling, DAP12, was absent in UCB T cells. Thus, the lack of DAP12 likely explains the absence of NKp44 signaling. Both of the adapters used by NKp30 and −46 (FcεR1γ and CD3ζ) were detected. As stated above, NKp46 was expressed on significantly fewer cells than NKp30 (13±7% vs 37±10%) and this likely accounts for the lack of NKp46 function. Considering that UCB contains mostly naive T cells, we hypothesized that PB naive T cells may also acquire NCRs. To test this, PB T cell subsets (naive, central memory and effector memory) were FACS sorted and cultured for 14 days in IL-15. NKp30 was induced on a small number of naive, but not memory PB T cells. Unlike UCB T cells, NKp30 on naive PB T cells was non-functional. PB T cells lacked FcεR1γ, while UCB T cells expressed it, suggesting that this adapter protein is critical for NKp30 signaling. Collectively, these results show that UCB T cells are unique in their ability to acquire NCRs. Moreover, only NKp30 is functional. The lack of function of NKp44 and -46 is due to the absence of DAP12 and the low level of NKp46 expression, respectively. Lastly, while some naive PB T cells can acquire NKp30, it is not functional due to the lack of FcεR1γ. Such studies highlight the differences between UCB and PB T cells and challenge the dogma that NCRs are NK cell specific.


Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3032-3032
Author(s):  
Elizabeth Hexner ◽  
Selina M. Luger ◽  
James K. Mangan ◽  
Noelle V. Frey ◽  
Grace R Jeschke ◽  
...  

Abstract Abstract 3032 Successful outcomes following umbilical cord blood transplantation (UCBT) are limited in large part by delayed engraftment, impaired immune reconstitution and an inability to give donor lymphocyte infusions (DLI) in the event of relapse or graft failure. Recent studies suggest double UCBT enhances hematopoietic recovery and may improve leukemia free survival, despite the engraftment of only one unit. Our previous work in a preclinical (xenograft) model showed that T cell activation can enhance hematopoietic recovery after single UCBT. Thus we performed a phase 1 study testing safety and defining the maximum tolerated dose (MTD) of ex vivo CD3/CD28 costimulated UCB-derived T cells co-infused with single UCB grafts in patients with advanced hematologic malignancies. A second objective was to test the feasibility of ex vivo expansion and cryopreservation of UCB T cells for administration as DLI in the event of disease relapse. Eligible subjects had no suitable related or unrelated donor, and had a single 4/6 (or better) HLA-matched UCB graft containing at least 2.5 × 107 nucleated cells/kg. Single umbilical cord blood units stored in 2 fractions were eligible for the intervention. The smaller fraction was thawed 10–14 days prior to infusion and cultured with magnetic beads conjugated to antibodies directed against CD3 and CD28. After myeloablative conditioning, the larger unmanipulated UCB fraction was infused, followed immediately by a fixed dose of the expanded CD3/CD28 costimulated T cells. The remainder of the costimulated T cells were cryopreserved for potential future use as DLI. Four dose levels of initial costimulated T cells (105-108 T cells/kg) were planned. 5 subjects enrolled on the trial; 4 underwent UCBT all of whom were treated at the first dose level (105cells/kg). There were no infusion related adverse events; the dose limiting toxicity (DLT) was conservative and defined as grade 3 or grade 4 GVHD within the first 90 days following UCBT. An MTD was reached at the 105 cells/kg dose level with two subjects experiencing grade 3 GVHD of the gut on days +40 and +27 respectively. For the first 3 subjects enrolled on study, neutrophil engraftment occurred on days +20, +12, and +17, while the fourth subject experienced primary graft failure and received a second mismatched unrelated donor graft. One subject experienced platelet engraftment on day +23. Early (day +11) donor T cell trafficking was documented in this subject's skin using fluorescence in situ hybridization directed at the Y chromosome, and one year post-transplant bone marrow morphologic findings were notable for an exuberant expansion (20% of cellularity) of physiologic precursor B lymphoblasts (hematogones) with a maturing B cell phenotype which correlated with CD4+ immune reconstitution in peripheral blood. Cytokines were measured in the supernatants from expanded T cells and in serum from all subjects. Supernatants contained supraphysiologic levels of cytokines important for engraftment/progenitor/dendritic cell development (GM-CSF, IL-3, FLT-3L) as well as T and B cell differentiation/function (IL-2, IL-4, IL-10, IFN- γ, BAFF). Serum cytokine measurements in recipients were notable for measurable increases in IL-10 following the infusion of expanded T cells for all subjects, with absolute levels lower in the two subjects with DLTs. 3 of 4 expansions yielded adequate numbers of cells for cryopreservation as future use for DLI. Taken together, these preliminary data are consistent with our preclinical observations of rapid engraftment in recipients of a single UCBT combined with relatively low doses of activated T cells. Additional safety studies are needed to determine the optimal T cell dose. If confirmed in larger numbers of patients, this represents an attractive strategy for improving engraftment, immune reconstitution, as well as a method to enable DLI following UCBT. Disclosures: Off Label Use: Investigational cellular therapy product tested under an IND.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4610-4610
Author(s):  
Rachel Joy Bergerson ◽  
Sarah Cooley ◽  
Julie Curtsinger ◽  
Ryan Shanley ◽  
Claudio Brunstein ◽  
...  

Compared to traditional chemotherapy, allogeneic hematopoietic cell transplantation (allo-HCT) has the potential of triggering graft vs. leukemia (GVL) reactions that make this procedure uniquely curative. Despite this, relapse remains the most common cause of treatment failure. Early after allo-HCT the donor immune system reconstitutes within the host and natural killer (NK) cells are the earliest lymphocyte population to recover. Previous studies by us and other investigators have linked rapid lymphocyte recovery and/or high NK cell numbers early after transplant with less relapse. Mechanistically, the reasons for this are unknown. We hypothesized that NK cell proliferation would be associated with allo-HCT outcomes. In a large data set with short-term follow-up we compared stem cell source to NK cell proliferation at Day 28 after transplantation (using Ki67+ staining). In patients undergoing autologous (n=117), sibling (n=57), single umbilical cord blood (sUCB) (n=62) or double umbilical cord blood (dUCB) (n=50) transplantation there were significant differences in the median NK cell proliferation (2.1%, 3.3%, 3.8%, and 19.2%, respectively, p<0.0001). These results suggest that NK cell proliferation is increased when patients are transplanted with stem cell sources that have an increased number of HLA mismatches (dUCB). We next examined factors extrinsic to the NK cells to determine whether differences in the four patient groups were due to these factors. Regulatory T cells (Tregs) are known to negatively regulate the proliferation and activation of a variety of cell types, including NK cells. We utilized the percentage and absolute number of Tregs (defined as CD4+CD25highFoxP3+CD127low) at Day 28 (available for a subset of the above patient samples) and correlated it with the percentage of proliferating NK cells at Day 28 after allogeneic transplant (n=212). The median percentage of Tregs within the lymphocyte fraction was 1.49%. In patients with higher than 1.49% Tregs, the mean NK cell proliferation was 10.8% +/-16.4. In contrast, patients with lower than 1.49% Tregs had a mean NK cell proliferation of 21.2% +/-24.3 (p=0.0004). A nearly identical trend was observed for the absolute numbers of Tregs, suggesting that Tregs may play an extrinsic role in NK cell proliferation after allo-HCT. To further address differences in lymphocyte proliferation and clinical outcomes, we used Ki67 staining to assess T cell (CD4+ and CD8+) and NK cell (CD3-CD56+) proliferation at Day 28 in a different subset of patients undergoing dUCB transplant with acute leukemia or MDS (80%) or other malignant disorders using either myeloablative (42%) or reduced intensity conditioning (58%) and a median of one year follow-up (n=53). There was no association of transplant outcomes with T cell (CD4 or CD8) proliferation. In the NK cell compartment there was a wide range in the percentage of proliferating NK cells (0-86%), with a median of 20%. Patients were segregated into high (>20%) and low (<20%) NK cell proliferating groups and assessed for cytokine levels and transplant outcomes. At Day 28 soluble IL15 levels were not different between high and low NK cell proliferating patients. There was no significant association between NK cell proliferation and the probability or time to neutrophil recovery (p=0.15) or treatment related mortality (p=0.88). Excluding the 14 patients who developed aGVHD prior to day of NK cell assessment (Day 28), the high NK proliferating group had a trend toward a higher cumulative incidence of aGVHD (46% vs. 25%, p=0.17). Using multivariable analysis to control for a variety of patient and disease-associated variables, patients with high NK cell proliferation had significantly better disease-free survival (HR=0.29, 95%CI=0.12-0.71, p=0.01) (Figure 1). Strikingly, patients with high NK cell proliferation were 4-times less likely to relapse (HR=0.24, 95%CI=0.08-0.77, p=0.02). Collectively, these studies show that early NK cell proliferation is associated with superior outcomes after dUCB transplantation, due to reduced relapse, and that this is partly modulated by Tregs. Prospective strategies to increase NK cell proliferation may be of therapeutic benefit to improve transplant outcomes.Figure 1Disease Free Survival for patients undergoing dUCB transplant (n=53) based on low (blue) vs high (red) NK cell proliferation at Day 28 post transplant.Figure 1. Disease Free Survival for patients undergoing dUCB transplant (n=53) based on low (blue) vs high (red) NK cell proliferation at Day 28 post transplant. Disclosures: Wagner: Novartis: Research Funding. Miller:Coronado Biosciences: Scientific Advisory Board Other.


Blood ◽  
2012 ◽  
Vol 119 (2) ◽  
pp. 399-410 ◽  
Author(s):  
Mariella Della Chiesa ◽  
Michela Falco ◽  
Marina Podestà ◽  
Franco Locatelli ◽  
Lorenzo Moretta ◽  
...  

Abstract Natural killer (NK) cells play a crucial role in early immunity after hematopoietic stem cell transplantation because they are the first lymphocyte subset recovering after the allograft. In this study, we analyzed the development of NK cells after intrabone umbilical cord blood (CB) transplantation in 18 adult patients with hematologic malignancies. Our data indicate that, also in this transplantation setting, NK cells are the first lymphoid population detectable in peripheral blood. However, different patterns of NK-cell development could be identified. Indeed, in a group of patients, a relevant fraction of NK cells expressed a mature phenotype characterized by the KIR+NKG2A− signature 3-6 months after transplantation. In other patients, most NK cells maintained an immature phenotype even after 12 months. A possible role for cytomegalovirus in the promotion of NK-cell development was suggested by the observation that a more rapid NK-cell maturation together with expansion of NKG2C+ NK cells was confined to patients experiencing cytomegalovirus reactivation. In a fraction of these patients, an aberrant and hyporesponsive CD56−CD16+p75/AIRM1− NK-cell subset (mostly KIR+NKG2A−) reminiscent of that described in patients with viremic HIV was detected. Our data support the concept that cytomegalovirus infection may drive NK-cell development after umbilical CB transplantation.


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