The costimulatory receptor OX40 is expressed on activated T cells and regulates T-cell responses. Here, we show the efficacy and mechanism of action of an OX40 blocking antibody using the chronic house dust mite (HDM) mouse model of lung inflammation and in vitro HDM stimulation of cells from HDM allergic human donors. We have demonstrated that OX40 blockade leads to a reduction in the number of eosinophils and neutrophils in the lavage fluid and lung tissue of HDM sensitized mice. This was accompanied by a decrease in activated and memory CD4 + T cells in the lungs and further analysis revealed that both the Th2 and Th17 populations were inhibited. Improved lung function and decreased HDM-specific antibody responses were also noted. Significantly, efficacy was observed even when anti-OX40 treatment was delayed until after inflammation was established. OX40 blockade also inhibited the release of the Th2 cytokines IL-5 and IL-13 from cells isolated from HDM allergic human donors. Altogether, our data provide evidence of a role of the OX40/OX40L pathway in ongoing allergic lung inflammation and support clinical studies of a blocking OX40 antibody in Th2 high severe asthma patients.Keywords: Allergic asthma r House dust mite r Lung inflammation r Memory T cells r OX40Additional supporting information may be found in the online version of this article at the publisher's web-site Introduction OX40 (also known as CD134, TNFRSF4, ACT35, or TXGP1L) is a membrane-bound receptor belonging to the TNF receptor superfamily, which includes 4-1BB, CD27, CD30, and CD40. This costimulatory receptor is not expressed on resting T cells, but is transiently expressed on activated T cells after ligation of the TCR, with sequential engagement of CD28 and OX40 being required for optimal T-cell proliferation and survival [1]. Ligation of OX40 on activated T cells leads to enhanced cytokine production and proliferation of both CD4 + and CD8 + T cells [2,3] and can contribute to both ongoing Th1 and Th2 responses [4,5]. OX40 costimulationCorrespondence: Diane Marshall e-mail: diane.marshall@ucb.com prolongs T-cell survival beyond the initial effector phase of the immune response and increases the number of memory T cells through inhibition of effector T-cell death. This long-term survival of T cells via OX40 is thought to be a consequence of maintaining high levels of antiapoptotic proteins, such as Bcl-2, 7]. The ligand for OX40, OX40L, is a member of the TNF family and is expressed on activated APC, including B cells, macrophages, Langerhans cells, and dendritic cells (DCs). Other cell types that are reported to express OX40L include mast cells, NK cells, airway smooth muscle cells, endothelial cells, and platelets [8]. * These authors are co-first authors.C 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim www.eji-journal.eu Eur. J. Immunol. 2015. 45: 1116-1128 Immunomodulation 1117Asthma is a chronic inflammatory disease of the airways in which many cells and mediators are involved. It is now clear that asthma is a heterogenic disease a...