Immune tolerance in multiple sclerosis and neuromyelitis optica with peptide-loaded tolerogenic dendritic cells in a phase 1b trial

Proc Natl Acad Sci U S A. 2019 Apr 23;116(17):8463-8470. doi: 10.1073/pnas.1820039116. Epub 2019 Apr 8.


There are adaptive T-cell and antibody autoimmune responses to myelin-derived peptides in multiple sclerosis (MS) and to aquaporin-4 (AQP4) in neuromyelitis optica spectrum disorders (NMOSDs). Strategies aimed at antigen-specific tolerance to these autoantigens are thus indicated for these diseases. One approach involves induction of tolerance with engineered dendritic cells (tolDCs) loaded with specific antigens. We conducted an in-human phase 1b clinical trial testing increasing concentrations of autologous tolDCs loaded with peptides from various myelin proteins and from AQP4. We tested this approach in 12 patients, 8 with MS and 4 with NMOSD. The primary end point was the safety and tolerability, while secondary end points were clinical outcomes (relapses and disability), imaging (MRI and optical coherence tomography), and immunological responses. Therapy with tolDCs was well tolerated, without serious adverse events and with no therapy-related reactions. Patients remained stable clinically in terms of relapse, disability, and in various measurements using imaging. We observed a significant increase in the production of IL-10 levels in PBMCs stimulated with the peptides as well as an increase in the frequency of a regulatory T cell, known as Tr1, by week 12 of follow-up. In this phase 1b trial, we concluded that the i.v. administration of peptide-loaded dendritic cells is safe and feasible. Elicitation of specific IL-10 production by peptide-specific T cells in MS and NMOSD patients indicates that a key element in antigen specific tolerance is activated with this approach. The results warrant further clinical testing in larger trials.

Keywords: Tr1 cells; dendritic cells; immune tolerance; multiple sclerosis; neuromyelitis optica.

Publication types

  • Clinical Trial, Phase I
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aquaporin 4 / genetics
  • Cell- and Tissue-Based Therapy / adverse effects
  • Cell- and Tissue-Based Therapy / methods*
  • Cells, Cultured
  • Dendritic Cells* / metabolism
  • Dendritic Cells* / transplantation
  • Female
  • Humans
  • Immune Tolerance* / genetics
  • Immune Tolerance* / immunology
  • Immune Tolerance* / physiology
  • Immunotherapy
  • Interleukin-10 / metabolism
  • Male
  • Middle Aged
  • Multiple Sclerosis / immunology
  • Multiple Sclerosis / therapy*
  • Myelin Proteins / genetics
  • Neuromyelitis Optica / immunology
  • Neuromyelitis Optica / therapy*
  • Recombinant Proteins / genetics
  • Recombinant Proteins / immunology
  • Recombinant Proteins / metabolism
  • T-Lymphocytes, Regulatory / metabolism


  • AQP4 protein, human
  • Aquaporin 4
  • IL10 protein, human
  • Myelin Proteins
  • Recombinant Proteins
  • Interleukin-10