T cell repertoire following autologous stem cell transplantation for multiple sclerosis

J Clin Invest. 2014 Mar;124(3):1168-72. doi: 10.1172/JCI71691. Epub 2014 Feb 17.

Abstract

Autologous hematopoietic stem cell transplantation (HSCT) is commonly employed for hematologic and non-hematologic malignancies. In clinical trials, HSCT has been evaluated for severe autoimmunity as a method to "reset" the immune system and produce a new, non-autoimmune repertoire. While the feasibility of eliminating the vast majority of mature T cells is well established, accurate and quantitative determination of the relationship of regenerated T cells to the baseline repertoire has been difficult to assess. Here, in a phase II study of HSCT for poor-prognosis multiple sclerosis, we used high-throughput deep TCRβ chain sequencing to assess millions of individual TCRs per patient sample. We found that HSCT has distinctive effects on CD4+ and CD8+ T cell repertoires. In CD4+ T cells, dominant TCR clones present before treatment were undetectable following reconstitution, and patients largely developed a new repertoire. In contrast, dominant CD8+ clones were not effectively removed, and the reconstituted CD8+ T cell repertoire was created by clonal expansion of cells present before treatment. Importantly, patients who failed to respond to treatment had less diversity in their T cell repertoire early during the reconstitution process. These results demonstrate that TCR characterization during immunomodulatory treatment is both feasible and informative, and may enable monitoring of pathogenic or protective T cell clones following HSCT and cellular therapies.

Trial registration: ClinicalTrials.gov NCT00288626.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • CD4-Positive T-Lymphocytes / immunology*
  • CD4-Positive T-Lymphocytes / metabolism
  • CD8-Positive T-Lymphocytes / immunology*
  • CD8-Positive T-Lymphocytes / metabolism
  • Clinical Trials, Phase II as Topic
  • Hematopoietic Stem Cell Transplantation*
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Immunosuppression
  • Multicenter Studies as Topic
  • Multiple Sclerosis / immunology
  • Multiple Sclerosis / therapy*
  • Receptors, Antigen, T-Cell, alpha-beta / genetics
  • Transplantation, Autologous
  • Treatment Outcome

Substances

  • Receptors, Antigen, T-Cell, alpha-beta

Associated data

  • ClinicalTrials.gov/NCT00288626