Depletion of Naïve Lymphocytes with Fas Ligand Ex Vivo Prevents Graft-versus-Host Disease without Impairing T Cell Support of Engraftment or Graft-versus-Tumor.

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Depletion of Naïve Lymphocytes with Fas Ligand Ex Vivo Prevents Graft-versus-Host Disease without Impairing T Cell Support of Engraftment or Graft-versus-Tumor Activity Nadir Askenasy, Keren Mizrahi, Shifra Ash, Enosh M. Askenasy, Isaac Yaniv, Jerry Stein Biology of Blood and Marrow Transplantation Volume 19, Issue 2, Pages 185-195 (February 2013) DOI: 10.1016/j.bbmt.2012.10.004 Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Fas-mediated elimination of presensitized GVHD effectors. (A) H2Kb donors were immunized twice with 107 allogeneic H2Kd splenocytes at 3-day intervals. Three days after second immunization, splenocytes (imH2Kb) were cultured in medium and with 50 ng/mL FasL for 24 hours. (B) Splenic lymphocytes of immunized mice display increased responses to the irradiated (3000 rad) allogeneic antigens (H2Kd) used for immunization as compared with third-party stimulators (H2Kk), which persist after incubation in medium and are significantly suppressed by incubation with FasL, while sustaining responsiveness to third-party stimuli. Proliferation was determined from CFSE dilution and quantified using the ModFit software (n = 5 individual incubations). (C) Viable lymphocytes (1.5 × 106) from the immunized donors were adoptively transferred into sublethally irradiated (650 rad) F1 recipients (H2Kb→H2Kb/d) after ex vivo incubation in medium and with FasL. Differences in survival were polarized by administration of 10 μg LPS on day +7 (n = 8 in each group). Biology of Blood and Marrow Transplantation 2013 19, 185-195DOI: (10.1016/j.bbmt.2012.10.004) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Fas cross-linking of unstimulated lymphocytes prevents severe GVHD. (A) Naïve H2Kb splenocytes were incubated for 24 hours in medium and with 50 ng/mL FasL. (B) Splenic lymphocytes that survived incubation with FasL retained responses to irradiated (3000 rad) allogeneic stimulators (H2Kd) similar to lymphocytes incubated in medium (n = 5 independent incubations). (C) After incubation in medium (n = 20) and with FasL (n = 10), 1.5 × 106 viable lymphocytes were infused into sublethally irradiated (650 rad) F1 recipients (H2Kb/d), and lethal GVHD was precipitated by 10 μg LPS administered on day +7. (D) Changes in body weight and (E) clinical score on day +7 are shown for recipients of various numbers of semiallogeneic donor lymphocytes (H2Kb→H2Kb/d) preincubated in medium and with FasL (n = 5-10 in each group). (E) Clinical score on day +7 after infusion of various numbers of semiallogeneic lymphocytes pretreated in medium and with FasL (n = 5-10 in each group). (F) Reconstitution of the major splenic lineages at 1 week after adoptive transfer of 3 × 106 splenocytes preincubated in medium and with FasL into irradiated mice (H2Kb→H2Kb/d): CD4+ and CD8+ T cells, B220+ B lymphocytes and GR-1+ granulocytes (n = 5). (G) Mice that survived the LPS challenge after infusion of unstimulated lymphocytes preincubated in medium (LPS medium) and with FasL (LPS FasL) were assessed for changes in splenic CD4+ and CD8+ T cells (n = 5 in each group). Biology of Blood and Marrow Transplantation 2013 19, 185-195DOI: (10.1016/j.bbmt.2012.10.004) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Elimination of Fas-sensitive naïve immune cells in haploidentical transplants. F1 recipients (H2Kb/d) irradiated at 850 rad were grafted with 5 × 106 T cell–depleted BMCs (H2Kb, CD45.1) and various numbers of viable donor lymphocytes (H2Kb, CD45.2, GFP) as shown in Figure 2A. (A) Survival of mice infused with 2 × 107 donor splenocytes with and without pre-exposure to FasL (n = 10 in each group). (B) Weight loss was blunted by donor lymphocyte pretreatment with FasL (n = 8 in each group). (C) Clinical score with incidence of gastrointestinal involvement (GI) at 3 weeks after transplantation were reduced in recipients of lymphocytes preincubated with FasL for 48 hours rather than medium (n = 8 in each group). (D) Histologic evaluation of ear skin and liver in recipients of 3 × 106 splenocytes incubated in medium and with FasL (n = 5). (E) Donor chimerism in peripheral blood (n = 5). Representative plots are shown for reduced donor (H2Kb) and increased host (H2Kb/d) chimerism in recipients of 4.5 × 106 lymphocytes preincubated in medium as compared with cells preincubated with FasL. (F) Grafted donor lymphocytes (3 × 106 CD45.2+GFP+) make a small contribution to spleen cellularity (n = 5), which largely originates from the BMCs (CD45.1+GFP−). (G) The reconstituted spleens of recipients grafted with 3 × 106 lymphocytes preincubated in medium and with FasL display similar responses against third-party antigens (H2Kk, upper panels) and are unresponsive to the host (H2Kd, lower panels). Proliferation was determined from CFSE dilution and quantified with the ModFit software (n = 4). Biology of Blood and Marrow Transplantation 2013 19, 185-195DOI: (10.1016/j.bbmt.2012.10.004) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Impact of Fas-mediated depletion on engraftment, donor lymphocyte infusion, and GVT. (A-C) Irradiated (800 rad) H2Kd recipients were grafted with allogeneic (H2Kb) BMCs, and chimerism was determined in peripheral blood. (A) Peripheral blood chimerism at 3 weeks after simultaneous transplantation of 106 lineage-negative allogeneic (H2Kb) BMCs (n = 7) and 106 F1 lymphocytes (H2Kb/d) preincubated in medium (n = 5) and with FasL (n = 6) for 24 hours. (B) Peripheral blood chimerism at 6 weeks after transplantation of 2 × 106 allogeneic (H2Kb) lineage-negative BMCs (n = 6) and with additional donor lymphocyte infusion (DLI) on day +10: 106 allogeneic lymphocytes (H2Kb) preincubated in medium and with FasL for 24 hours (n = 5). (C) Peripheral blood chimerism at 3 weeks post-transplantation of 2 × 106 allogeneic (H2Kb) whole BMCs, after preincubation of the whole graft for 24 hours in medium and with FasL (n = 6). (D) CT26 murine colon carcinoma was implanted subcutaneously in congenic H2Kd mice, and after 3 days they were irradiated (800 rad) and reconstituted with 5 × 106 BMCs alone (BMC, n = 8) and with 107 splenocytes from 5-week-old allogeneic (H2Kb) donors, preincubated for 24 hours in medium (n = 9) and with FasL (n = 8) before transplantation. Biology of Blood and Marrow Transplantation 2013 19, 185-195DOI: (10.1016/j.bbmt.2012.10.004) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 The impact of ex vivo Fas cross-linking on unstimulated splenocytes. Measurements of apoptosis and proliferation were performed by gating on the appropriate subsets within bulk splenocyte preparations. (A) Incubation with FasL induces apoptosis in splenic CD4+ and CD8+ T cells from naïve H2Kb mice (n = 5-8), superposed on spontaneous apoptosis in medium. (B) Differential sensitivity to spontaneous (medium) and FasL-induced apoptosis of CD4+ T cell subsets in reference to the intensity of CD25 expression (n = 4-8). Apoptosis of CD4+FoxP3+ T cells was measured in splenocytes from transgenes expressing GFP under control of the FoxP3 promoter. (C) The CD25+ subset of CD4+ T cells cycles at slower rates than the CD25− subset, and both are slightly slowed by exposure to FasL (n = 4-7), as determined from CFSE dilution. (D) Fractional expression of CD25, the activation marker CD69, and adhesion molecules L-selectin (CD62L) and integrin (VLA-4) in gated CD4+ T cells after incubation in medium and with FasL for 24 hours. The right panel shows representative histograms of CD69 (upper) and CD62L (lower) expression after incubation in medium and with FasL. (E) GFP+ lymphocytes (H2Kb) preincubated with medium and FasL home to the mesenteric lymph nodes of sublethally irradiated (650 rad) F1 recipients (H2Kb/d), as determined at 24 hours after transplantation. Biology of Blood and Marrow Transplantation 2013 19, 185-195DOI: (10.1016/j.bbmt.2012.10.004) Copyright © 2013 American Society for Blood and Marrow Transplantation Terms and Conditions