As kidney transplant recipients know, long-term use of triple immunosuppressants is routine after kidney transplantation to prevent rejection. However, long-term use of immunosuppressants will lead to many adverse reactions, often to bring us a lot of trouble. Reducing the dosage of immunosuppressants and inducing transplantation tolerance become one of the difficult problems to be overcome. At present, new immunosuppressive regimens, new immunosuppressants and cell therapy are being developed. Among them, cell therapy has received more and more attention. in-depth research on cell therapy provides a new entry point for the research and development of immunosuppressants, which has great clinical significance.
At present, a large-scale clinical trial is being carried out abroad, including four regulatory T cells (Treg) , one regulatory macrophage (Mreg) and one tolerogenic dendritic cell for cell therapy. The team included 104 adult patients who received living donor kidney transplants. In the control group, 66 patients, 73% male, with a median age of 47 years, received standard immunosuppressive therapy (basiliximab, steroid taper, mycophenolate mofetil, and tacrolimus) . There were 38 patients in the cell therapy trial group, 71% of whom were male, with a median age of 45 years, and the patient characteristics were matched to the control group, but immunosuppressive therapy was similar but somewhat simplified (cell therapy instead of basiliximab induction, gradually reducing mycophenolate mofetil) , and on this basis received one of six cell therapies. The results showed that the incidence of biopsy-proven acute rejection in the control group receiving standard immunosuppressive therapy was 12% (expected range 3.2-18.0) . The overall incidence of acute rejection in the six parallel cell therapy trial groups was 16% . Fifteen (40%) patients who received cell therapy had successfully discontinued mycophenolate mofetil and maintained only tacrolimus monotherapy. Compared with the control group, the data on adverse events and the pooled outcome of acute discharge occurred in all six cell therapy trial groups showed no safety concerns. Fewer infection events were registered in the cell therapy trial group compared with controls.
This clinical study amply demonstrates that modulating cell therapy is achievable and safe in living donor kidney transplant recipients with fewer infectious complications but similar rates of rejection in the first year. Therefore, immune cell therapy is a potentially useful treatment in kidney transplant patients that can minimize the use of conventional immunosuppressants. It is believed that in the future, cell therapy will benefit more organ transplant patients and bring them a better quality of life after transplantation.
References:[1] Sawitzki, B., et al., Regulatory cell therapy in kidney transplantation (The ONE Study): aharmonised design and analysis of seven non-randomised, single-arm, phase 1/2A trials.Lancet, 2020. 395(10237): p. 1627-1639.[2] Wood, K.J., A. Bushell, and J. Hester, Regulatory immune cells in transplantation. Nat Rev Immunol, 2012. 12(6): p. 417-30.
ext | Chen Juntao, illustrations | Zou Garland
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