Restoring T cell competence is a significant clinical challenge in patients whose thymic function is severely compromised due to age or cytoreductive conditioning. Here, we demonstrate in mice that mesenteric LNs (MLNs) support extrathymic T cell development in euthymic and athymic recipients of bone marrow transplantation (BMT). Furthermore, in aged murine BMT recipients, the contribution of the MLNs to the generation of T cells was maintained, while the contribution of the thymus was significantly impaired. Thymic impairment resulted in a proportional increase in extrathymic-derived T cell progenitors. Extrathymic development in athymic recipients generated conventional naive TCRαβ T cells with a broad Vβ repertoire and intact functional and proliferative potential. Moreover, in the absence of a functional thymus, immunity against known pathogens could be augmented using engineered precursor T cells with viral specificity. These findings demonstrate the potential of extrathymic T cell development for T cell reconstitution in patients with limited thymic function.
IntroductionThe scarcity of T cells in recipients of BM transplantation (BMT) leads to a devastating susceptibility to pathogens and is associated with increased malignant relapse (1-4). Moreover, age-related thymic involution leads to inefficient thymopoiesis and T cell regeneration in adult BMT patients, who are often decades into the process of thymic involution (5). Thymic involution results in the dramatic diminution of thymic function over time, with a loss of thymic epithelial cells as early as 1 year after birth and the decline of thymopoiesis hastened by hormones during puberty (6-9). Recent evidence suggests that naive T cell export from the thymus is completely absent in aging humans, where the primary source of T cell repopulation is homeostatic proliferation (10). Expansion of peripheral T cells after BMT can lead to a pool of memory phenotype T cells with limited T cell receptor diversity (11, 12), leading to decreased immune function as well as poorer prognosis for older BMT patients (13-15). Consequently, mechanisms to circumvent the thymus to generate functional T cells could drastically improve not only BMT outcomes, but outcomes for all immunodeficient patients.We have previously demonstrated that adoptive transfer of T cell precursors (preTs) generated ex vivo on the OP9-DL1 system into BMT recipients significantly increased thymopoiesis, circulating T cell numbers, and protection against bacterial infection (16,17). While this is primarily dependent on improved thymopoiesis, based on studies in thoracically thymectomized BMT recipients, we hypothesized that extrathymic T cell development could contribute to the regeneration of the posttransplant T cell pool (16).Extrathymic development of conventional TCRαβ + CD4 + and CD8αβ + T cells in physiologic settings is controversial, though recent evidence indicates that extrathymic T cell development occurs in human tonsil (18). In oncostatin-M (OM) transgenic mice, which