Potent immunosuppressive drugs have significantly improved early patient survival after liver transplantation (LT). However, long-term results remain unsatisfactory because of adverse events that are largely associated with lifelong immunosuppression. To solve this problem, different strategies have been undertaken to induce operational tolerance, for example, maintenance of normal graft function and histology without immunosuppressive therapy, but have achieved limited success. In this pilot study, we aimed to induce tolerance using a novel regulatory T-cell-based cell therapy in living donor LT. Adoptive transfer of an ex vivo-generated regulatory T-cell-enriched cell product was conducted in 10 consecutive adult patients early post-LT. Cells were generated using a 2-week coculture of recipient lymphocytes with irradiated donor cells in the presence of anti-CD80/86 monoclonal antibodies. Immunosuppressive agents were tapered from 6 months, reduced every 3 months, and completely discontinued by 18 months. After the culture, the generated cells displayed cell-number-dependent donor-specific inhibition in the mixed lymphocyte reaction. Infusion of these cells caused no significant adverse events. Currently, all patients are well with normal graft function and histology. Seven patients have completed successful weaning and cessation of immunosuppressive agents. At present, they have been drug free for 16-33 months; 4 patients have been drug free for more than 24 months. The other 3 recipients with autoimmune liver diseases developed mild rejection during weaning and then resumed conventional low-dose immunotherapy. Conclusions: A cell therapy using an ex vivo-generated regulatory T-cell-enriched cell product is safe and effective for drug minimization and operational tolerance induction in living donor liver recipients with nonimmunological liver diseases. (HEPATOLOGY 2016;64:632-643) SEE EDITORIAL ON PAGE 347 E arly results after liver transplantation (LT) have been greatly improved by the evolution of potent antirejection agents. However, unfortunately, late outcomes remain unsatisfactory because of immunological and nonimmunological complications that are largely associated with lifelong immunosuppression (IS). They are infection, de novo malignancy, chronic rejection, and kidney, cardiovascular, and

Together, these findings indicate that V␣14͞V␤8.2 is a unique antigen receptor for NKT cells but not for conventional T cells. Because V␣14 NKT cell development was inhibited largely in mice that lack the MHC class I-like molecule CD1d, positive selection of V␣14-expressing immature NKT cells requires CD1d expression (14,15). Recently, it has been shown that glycolipid, ␣-galactosylceramide (␣-GalCer), and glycosylphosphatidylinositol-anchored proteins can be presented by murine CD1d (13, 16). Subsequently, it was demonstrated that NKT cells can recognize cellular lipids or purified phospholipids distinct from ␣-GalCer (17).Although physiological functions of NKT cells remain obscure, some studies have suggested that NKT cells can control autoimmune diseases (18-21) and Th1͞Th2 cell development Here, we have evaluated the role of V␣14 NKT cells in allograft rejection and tolerance by using a murine model of transplantation. We found that V␣14 NKT cells play a critical role in the induction of vascularized cardiac allograft tolerance by blockade of lymphocyte function-associated antigen-1 (LFA-1)͞intercellular adhesion molecule-1 (ICAM-1) or CD28͞B7 interactions. Possible mechanisms for the tolerogenic function of V␣14 NKT cells are examined. Materials and Methods mAbs and Reagents.Hybridomas producing anti-LFA-1 and anti-ICAM-1 mAbs (KBA and KAT-1, respectively) were described previously (32, 33). Hybridomas producing anti-B7-1 and anti-B7-2 mAbs (1G10 and GL1, respectively) were purchased from American Type Culture Collection (ATCC). Hybridoma producing anti-IL-4 mAb (11B11) also was purchased from ATCC. These mAbs were purified from ascites by using protein G column. mAbs against CD1d (1B1) and H-2K b (AF6-88.5, FITC-labeled) were purchased from PharMingen. An annexin V PE staining kit was purchased from PharMingen.

Anergic T cells generated ex vivo are reported to have immunosuppressive effects in vitro and in vivo. Here, we tested this concept in nonhuman primates. Alloreactive T cells were rendered anergic ex vivo by coculture with donor alloantigen in the presence of anti-CD80/CD86 mAbs before adoptive transfer via renal allograft to rhesus monkey recipients. The recipients were briefly treated with cyclophosphamide and cyclosporine A during the preparation of the anergic cells. Thirteen days after renal transplantation, the anergic T cells were transferred to the recipient, after which no further immunosuppressive agents were administered. Rejectionfree survival was prolonged in all treated recipients, and 3 of 6 animals survived long term (410-880 days at study's end). In the long-surviving recipients, proliferative responses against alloantigen were inhibited in a donor-specific manner, and donor-type, but not third-party, skin allografts were also accepted, which demonstrated that antigen-specific tolerance had been induced. We conclude that anergic T cells generated ex vivo by blocking CD28/B7 costimulation can suppress renal allograft rejection after adoptive transfer in nonhuman primates. This strategy may be applicable to the design of safe clinical trials in humans.

3C10 could control acute rejection by its suppressive effect on alloreactive T cells and induction of IL-10-dependent regulatory CD4 T cells.