CTLA4 antagonists in phase I and phase II clinical trials,current status and future perspectives for cancer therapy

Introduction: In cancer, the immune response to tumor antigens is often suppressed by inhibitors and ligands. Checkpoint blockade, considered one of the most promising frontiers for anti-cancer therapy, aims to stimulate the immune anti-cancer response. Agents such as cytotoxic T lymphocyte–associated antigen 4 (CTLA-4) inhibitors offer prolonged survival with manageable side effects.

Areas covered: We summarize the recent clinical successes of CTLA-4 inhibitors and place a strong emphasis on those in early phase clinical trials, often in combination with other immune check-point inhibitors, i.e., programmed cell death protein 1 (PD-1) and BRAF/mitogen-activated protein kinase inhibitors.

Expert opinion: Recent phase I and phase II clinical trials confirm the efficacy of anti-CTLA-4 therapy for treatment of cancers such as renal cell carcinoma. These studies also indicated increased efficacy with combined immune checkpoint blockade with PD-1 or Ras/Raf/mitogen-activated protein kinase/ERK kinase (MEK)/extracellular-signal-regulated kinase (ERK) inhibitors. Researchers must search for new immune targets that may enable more effective and safe immune checkpoint blockade and cancer therapy. This goal may be achieved by next-generation combination therapies to overcome immune checkpoint therapy resistance.     

转hCTLA4Ig树突状细胞诱导T细胞免疫耐受的实验研究

目的　通过逆转录病毒载体将人CTLA4Ig转染DCs ,探讨转人CTLA4Ig(hCTLA4Ig)树突状细胞 (DCsRev)诱导T细胞免疫耐受的可能性。方法　通过重组逆转录病毒将目的基因hCTLA4Ig转染到大鼠骨髓来源的DCs中 ,通过流式细胞检测目的基因hCTLA4Ig表达及DCs表面分子的改变 ;通过混合淋巴细胞反应 (MLR)检测DCsRev抑制T细胞免疫反应的能力。 结果　重组逆转录病毒转染DCs的最大效率为 91 2 5 % ;在功能上 ,DCsRev不但丧失了刺激MLR的能力 ,并且能够强烈抑制MLR中反应T细胞的增殖 ,而且抑制率与加入DCsRev的数量和DCsRev预处理反应T细胞的时间长短有关。具体来说 ,DCsRev数量在 10 3 ～ 10 4之间时 ,抑制率与剂量呈正相关 ,最高为 71 96%。而当DCsRev数量达到 5× 10 4抑制率下降为 5 9 2 %。在 12～ 48h之间 ,随着预处理时间的延长 ,抑制率却不断下降 ,预处理 12h抑制率最高 ,为 99 6%。但不做预处理 ,在反应开始时同时加入DCsRev ,则抑制率明显降低 ,仅为 5 9 2 %。对腹腔注射DCsRev大鼠脾T淋巴细胞体外分析表明 ,DCsRev也能在动物体内诱导耐受 ,但这种免疫耐受状态不能维持终身。结论　通过逆转录病毒载体将人CTLA4Ig转染DCs,不但DCs表面CD86分子被CTLA4Ig有效的封闭 ,并且能够诱导抗原特异性T细胞的免疫耐受     

CTLA4-Ig在异体移植方面的相关研究进展

CTLA4-Ig是一种融合免疫球蛋白,可以选择性地阻断CD28与B7的信号传导通路,导致T细胞免疫失能,诱导对特异性抗原的免疫耐受. 本文介绍了其生物学特性、免疫诱导耐受机制及在异体移植方面的研究进展和局限性,其在异体移植方面展示了良好的应用前景.     

Prevention of Acute Lung Allograft Rejection in Rat by CTLA4Ig

CTLA4 immunoglobulin (CTLA4Ig), which binds with a high affinity to B7-1 and B7-2, interrupts T-cell activation by inhibiting costimulatory signal. CTLA4Ig has been used in hopes of achieving antigen-specific tolerance induction in several solid organ transplants. In lung allograft rejection, however, its use has been controversial in terms of its effect on prevention of rejection. In the present study, the effect of murine CTLA4Ig on rat-lung allograft rejection was investigated. Rat left-lung transplantation was performed in an RT1 incompatible donor (Brown Norway; BN)-recipient (F344) combination. All allografts (n = 12) without any treatment were rejected within 7 days after transplantation. A single injection of murine form CTLA41g at a dose of 100 microg intraperitoneally (ip) or intravenously (iv) on day 1 post-transplantation achieved long-term graft survival (>90days) in 2/5 (40%) and 3/8 (38%), respectively. Moreover, 6/7 (86%) allografts in rats that received iv injection of 500 microg CTLA4Ig survived more than 90days. Allograft survival in the CTLA4Ig 500 microg iv recipient group was significantly longer than that in the no-treatment control or control immunoglobulin group (p <0.01). Four out of seven recipients bearing functional allografts for more than 90 days with the CTLA4Ig treatment accepted donor-specific skin grafts, whereas all third-party skin grafts (n=3) were rejected. Prevention of rat-lung allograft rejection could be achieved by intravenous administration of CTLA4Ig, resulting in long-term allograft survival with acceptance of donor-specific skin grafts.     

腺病毒载体介导CTLA4Ig基因治疗小鼠变应性鼻炎

目的 检测CTLA4Ig-重组腺病毒载体（Ad-CTLA4Ig）在变应性鼻炎治疗中的作用。方法 采用卵清蛋白（OVA）致敏和激发诱导小鼠变应性鼻炎。实验组在OVA激发前30min予以Ad-CTA4Ig腹腔注射。未转CTLA4IgcDNA的腺病毒载体（Adv）作对照。比较各组动物鼻部症状和鼻粘膜形态学改变，并采用ELISA法测定血清中OVA－特异性IgE水平。结果 CTLA4Ig重组腺病毒实验组小鼠鼻部症状和鼻粘膜病理改变不明显，并且血清中OVA－特异性IgE水平明显低于对照组（P＜0.05）。结论 Ad-CTLA4Ig可防治小鼠应变性鼻炎的发生，提示CTLA4Ig-重组腺病毒载体有可能运用于临床变应性鼻炎的治疗。     

Induction of B cell costimulatory function by recombinant murine CD40 ligand

T cell-dependent regulation of B cell growth and differentiation involves an interaction between CD40, a B cell surface molecule, and the CD40 ligand (CD40L) which is expressed on activated CD4⁺ T cells. In the current study, we show that recombinant membrane-bound murine CD40L induces B cells to express costimulatory function for the proliferation of CD4⁺ Tcells. CD40L- or lipopolysaccharide (LPS)-activated, but not control-cultured B cells were strong costimulators of anti-CD3 or alloantigen-dependent T cell responses. The molecular interactions responsible for the increased costimulatory functions were examined by analyzing the activated B cells for changes in the expression of two costimulatory molecules, B7 and heat-stable antigen (HSA), as well as by the use of antagonists of B7 and HSA (CTLA4.Fc and 20C9, respectively). The expression of both B7 and HSA was enhanced on B cells activated with LPS. As observed in previous studies, the costimulatory activity of the LPS-activated B cells was dependent on both B7 and HSA and was completely inhibited in the presence of a combination of CTLA4.Fc and 20C9. In contrast, activation of B cells with CD40L induced the expression of B7 but did not enhance the expression of HSA. In addition the costimulatory activity of the CD40L-activated B cells was partially, but not completely, inhibited by the combination of CTLA4.Fc and 20C9. These results demonstrate that CD40L regulates costimulatory function of B cells in part by inducing the expression of B7 and suggest that CD40L-activated B cells express an additional costimulatory activity that is not associated with LPS-activated B cells.     

负载CTLA4Ig重组腺病毒的未成熟树突状细胞对大鼠Th细胞增殖的影响

目的探讨负载CTLA4Ig重组腺病毒的未成熟树突状细胞对大鼠Th细胞增殖的影响。方法将CTLA4Ig重组腺病毒与Wistar大鼠未成熟树突状细胞于37℃共孵育6h后,经尾静脉注射该大鼠作实验组,另外分别设立Wistar大鼠未成熟树突状细胞、CTLA4Ig重组腺病毒、生理盐水经尾静脉注射为对照。1周后,用0.3%戊巴比妥麻醉各组大鼠后抽血检测CTLA4Ig。取脾脏,经流式细胞术分选出Th1、Th2细胞及CD4 T细胞,行混合淋巴细胞培养检测Th细胞的增殖。用免疫组织化学法检测Th1、Th2细胞的比例。结果实验组血清CTLA4Ig水平(0.654±0.13)显著高于CTLA4Ig重组腺病毒组(0.392±0.10,P<0.01),树突状细胞组及生理盐水组未检出。实验组Th1细胞的增殖指数(742±161)、Th1/Th2(0.16±0.05)均显著低于各对照组(分别与未成熟树突状细胞组、CTLA4Ig重组腺病毒组、生理盐水组相比,P均<0.01);而Th2细胞的增殖指数(9162±598)显著高于各对照组(P均<0.01)。结论负载CTLA4Ig重组腺病毒的未成熟树突状细胞可显著抑制大鼠Th1细胞增殖,促进Th2细胞增殖,使Th细胞由Th1向Th2显著偏移,诱导有效的免疫耐受。     

Genetic analysis of the CD28/CTLA4/ICOS (CELIAC3) region in coeliac disease

Abstract:  In order to extend our previous findings of genetic linkage to the CD28/CTLA4/ICOS region on chromosome 2q33 ( CELIAC3 ) in coeliac disease (CD), we have investigated 22 genetic markers in 325 Norwegian/Swedish multiplex and simplex CD families. We found both linkage and association with several markers, primarily in the multiplex material. We observed strong linkage disequilibrium (LD) between SNPs (Single Nucleotide Polymorphisms) within an LD block delimited by MH30 and D2S72. A haplotype of this region marked by the alleles −1147*T: + 49*A:CT60*G:CT61*A was significantly associated with CD, suggesting that one or more polymorphisms of this haplotype, possibly −1147*T, are involved in CD susceptibility. The CT60 SNP, a polymorphism found to be most strongly associated with some other immune-mediated diseases, was not associated with CD, as this SNP was part of both associated and non-associated haplotypes. Moreover, our results suggest that CELIAC3 harbours several independent loci contributing to CD susceptibility.     

A new PCR-SSP typing method for six single-nucleotide polymorphisms impairing the blood-clotting cascade as well as T-cell stimulation

Single-nucleotide polymorphisms (SNPs) within the genes of factor V (FV) (G1691A; exon 10), prothrombin (FII) (G20210A; 3'untranslated - region) and methylenetetrahydrofolate reductase (MTHFR) (C677T; exon 4) are associated with hypercoagulability, and systematic screening of individuals being at higher risk of thrombosis has been suggested. SNPs in the 2q33 region within the genes of CD28 (+17T/C; intron 3) and CTLA4 (-318C/T; promoter and +49A/G; exon 1) are likely to affect T-cell proliferation and antigen presentation signaling, which may lead to altered sensitivity of allograft or self-tissue recognition and affect the incidence of autoimmune diseases. We developed primers that allow specific amplification of these six SNPs at test conditions identical with those used for HLA typing with the CTS PCR-SSP reagents. One hundred ninety-six healthy German Caucasian individuals were tested for the six SNPs. The genotype frequencies for all SNPs were in Hardy-Weinberg equilibrium. There was no significant difference in the distribution of genotypes when compared to other published studies in which these SNPs were tested. The described PCR-SSP method can be used to screen large numbers of patients for these SNPs.