Transplantation Direct (Feb 2018)

Pilot Study of Delayed ICOS/ICOS-L Blockade With αCD40 to Modulate Pathogenic Alloimmunity in a Primate Cardiac Allograft Model

  • Natalie A. O’Neill, MD,
  • Tianshu Zhang, MD, PhD,
  • Gheorghe Braileanu, PhD,
  • Xiangfei Cheng, MD, PhD,
  • Alena Hershfeld, MS,
  • Wenji Sun, MD, PhD,
  • Keith A. Reimann, PhD,
  • Sia Dahi, MD,
  • Natalia Kubicki, MD,
  • Wessam Hassanein, MD,
  • Christopher Laird, MD,
  • Arielle Cimeno, MD,
  • Agnes M. Azimzadeh, PhD,
  • Richard N. Pierson, MD

DOI
https://doi.org/10.1097/TXD.0000000000000761
Journal volume & issue
Vol. 4, no. 2
p. e344

Abstract

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Background. Inducible costimulator (ICOS) is rapidly upregulated with T-cell stimulation and may represent an escape pathway for T-cell costimulation in the setting of CD40/CD154 costimulation blockade. Induction treatment exhibited no efficacy in a primate renal allograft model, but rodent transplant models suggest that the addition of delayed ICOS/ICOS-L blockade may prolong allograft survival and prevent chronic rejection. Here, we ask whether ICOS-Ig treatment, timed to anticipate ICOS upregulation, prolongs NHP cardiac allograft survival or attenuates pathogenic alloimmunity. Methods. Cynomolgus monkey heterotopic cardiac allograft recipients were treated with αCD40 (2C10R4, d0-90) either alone or with the addition of delayed ICOS-Ig (d63-110). Results. Median allograft survival was similar between ICOS-Ig + αCD40 (120 days, 120-125 days) and αCD40 (124 days, 89-178 days) treated animals, and delayed ICOS-Ig treatment did not prevent allograft rejection in animals with complete CD40 receptor coverage. Although CD4+ TEM cells were decreased in peripheral blood (115 ± 24) and mLNs (49 ± 1.9%) during ICOS-Ig treatment compared with monotherapy (214 ± 27%, P = 0.01; 72 ± 9.9%, P = 0.01, respectively), acute and chronic rejection scores and kinetics of alloAb elaboration were similar between groups. Conclusions. Delayed ICOS-Ig treatment with the reagent tested is probably ineffective in modulating pathogenic primate alloimmunity in this model.