programmed death-1 (pd-1) in sle t cells: “that which does not kill us, makes us stronger” maida...
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Programmed Death-1 (PD-1) in SLE T cells:
“That which does not kill us, makes us stronger”
Maida Wong. M.D.Assistant Clinical ProfessorDivision of Rheumatology
UCLA David Geffen School of Medicine
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Systemic Lupus Erythematosus
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Fate of a T cell
Von Herrath MG et al. Nature Imunology 2003
Fully activated APCCostimulation +++
Partially activated APCCostimulation +/-
Block activation
Suppression
Normal T cell response
Deletion
Naïve T cell
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Why are Tregs important?
Stimulating self-Ag:
Tolerance
Immunological tolerance: Unresponsiveness to an Ag by exposing lymphocytes to that Ag (tolerogen)
• Breakdown of self-tolerance results in autoimmunity
Von Herrath MG et al. Nature Imunology 2003
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Why does it matter?
Therapeutic potential Restore immune tolerance
Treat autoimmune & allergic diseases
Prevent graft rejection
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PD-1 controls dysregulated T cell activation
Normal T cell activation
Bc-xLIL-2IFN-ϒ
activated T cells
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PD-1 controls dysregulated T cell activation
Normal T cell activation
Bc-xLIL-2IFN-ϒ
activated T cells
Anergy
PD-1
Functional unresponsiveness
Bc-xLIL-2IFN-ϒ
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PD-1 controls dysregulated T cell activation
Normal T cell activation
Bc-xLIL-2IFN-ϒ
activated T cells
Anergy
PD-1
Functional unresponsiveness
Bc-xLIL-2IFN-ϒ
glucose metabolismprotein synthesisproliferationcell survival
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PD-1 controls dysregulated T cell activation
Normal T cell activation
Bc-xLIL-2IFN-ϒ
activated T cells
Anergy
PD-1
Functional unresponsiveness
Bc-xLIL-2IFN-ϒ
glucose metabolismprotein synthesisproliferationcell survival
Abatacept (anti-CTLA-4)
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What happens to a T after PD-1 is activated?
+TGF-β
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What happens to a T after PD-1 is activated?
High PD-1: Cancer Infectious
disease
Low PD-1: Autoimmunity Allergy Transplant
rejection
+TGF-β
Okazaki, T et al. Int. Immunol. 2007
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Anti-PD1 drugsFDA approvedNivolumab (Opdivo)Pembrolizumab (Keytruda)
In the pipelinePidilizumabREGN2810MDX1106-02
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Anti-PD1 drugsFDA approvedNivolumab (Opdivo): melanoma, NSCL
Pembrolizumab (Keytruda): melanoma, NSCL
glioma, SCC (H&N)
In the pipelinePidilizumab: diffuse intrinsic pontine glioma, GBM
REGN2810MDX1106-02: Hepatitis C
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Francisco LM, Sharpe A et al, Immunological Reviews, 2010.
What cells are we targeting with PD-1 & its ligand?
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What cells are we targeting with PD-1 & its ligand?
Francisco LM, Sharpe A et al, Immunological Reviews, 2010.
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Francisco LM, Sharpe A et al, Immunological Reviews, 2010.
What cells are we targeting with PD-1 & its ligand?
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Francisco LM, Sharpe A et al, Immunological Reviews, 2010.
What cells are we targeting with PD-1 & its ligand?
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PD-1 & SLE
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Background: PD1/PDL1 plays a role in lupus-like autoimmunity1. Normal mouse (B6) KO PD1
2. Lupus mouse (BXSB) with increased PDL1 expression
• Protects from lupus nephritis Hypercellularity & IgG deposition in glomerulio Inhibited IgG productiono Delay onset of proteinuria & anti-dsDNA
IgG
C3
Inflammatory arthritisGlomerulonephritis
Nishimura H et al, Immunity, 1999
Ding H et al; Clin Immun 2006
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PD-1 and T cells in SLE
Hahn LabLupus mouse (BWF1) tolerized with pCons (suppresses SLE):
• CD8+PD1+ cells
• mRNA of PD1 in CD8+ cells
Singh RP, Hahn BH et al. JImmunol 2007
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Hypothesis•Regulation of signaling through PD-1 controls Tregs and autoimmunity in BWF1 lupus mice.
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Hypothesis•Regulation of signaling through PD-1 controls Tregs and autoimmunity in BWF1 lupus mice.
[PD-1]
Dis
eas
e-fr
ee
SLE SLE
No SLE
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Experiment to examine PD-1 in Tregs
10 wk old BWF1
In vivo
• Apoptosis• Flow cytometry• ELISA• Microarray• Clinical data
splenocytes
PBMC
anti-PD1 mAb 100 g IP qod x3
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Clinical Results in Mouse SLE
anti-dsDNA
proteinuria
survival
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Clinical Results in Mouse SLE
anti-dsDNA
proteinuria
survival
Wong M, Hahn BH et al. JImmunol 2011
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Clinical Results in Mouse SLE
anti-dsDNA
proteinuria
survival
Wong M, Hahn BH et al. JImmunol 2011
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Clinical Results in Mouse SLE
• PD-1 blockade results in suppression of autoantibody production.
• Anti-PD-1 delays nephritis and prolongs survival.
anti-dsDNA
proteinuria
survival
Wong M, Hahn BH et al. JImmunol 2011
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Clinical Results in Mouse SLE
• PD-1 blockade results in suppression of autoantibody production.• Anti-PD1 added to pCons abrogates immune tolerance.
• Anti-PD-1 delays nephritis and prolongs survival.
anti-dsDNA
proteinuria
survival
Wong M, Hahn BH et al. JImmunol 2011
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Does the timing of PD-1 blockade matter?
30 32 34 36 38 40
0
25
50
75
100
Age (weeks)
% m
ice
with
pro
tein
uri
a >2
+
35 37 39 41 43 45 47 490
25
50
75
100 IgG isotypeanti-PD-1 (early)anti-PD-1 (late)
Age (weeks)
% s
urvi
val
Wong M, Hahn BH et al. JImmunol 2011
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Does the timing of PD-1 blockade matter?
30 32 34 36 38 40
0
25
50
75
100
Age (weeks)
% m
ice
with
pro
tein
uri
a >2
+
35 37 39 41 43 45 47 490
25
50
75
100 IgG isotypeanti-PD-1 (early)anti-PD-1 (late)
Age (weeks)
% s
urvi
val
Wong M, Hahn BH et al. JImmunol 2011
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Does the timing of PD-1 blockade matter?
30 32 34 36 38 40
0
25
50
75
100
Age (weeks)
% m
ice
with
pro
tein
uri
a >2
+
35 37 39 41 43 45 47 490
25
50
75
100 IgG isotypeanti-PD-1 (early)anti-PD-1 (late)
Age (weeks)
% s
urvi
val
•Later in disease, PD-1 blockade can delay disease progression, but the effect is diminished.
Wong M, Hahn BH et al. JImmunol 2011
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anti-PD1 in vivoIgG isotype in vivo
What is PD-1 blockade actually doing in Tregs?
PD1hi
PD1lo
CD4+CD25+
49
16
PD
1 30
33
Wong M, Hahn BH et al. JImmunol 2013
PD1hi
PD1lo
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10 15 20 25 300
1
2
3
4
IgG isotypeAge (weeks)
%C
D4
+ CD
25+ Fo
xp3
+ cel
ls
Wong M, Hahn BH et al. JImmunol 2013
PD-1 blockade in Tregs increases Foxp3 expression
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10 15 20 25 300
1
2
3
4
IgG isotypeanti-PD1
** *
Age (weeks)
%C
D4
+ CD
25+ F
ox
p3
+ cel
ls
* p < 0.05** p < 0.01
Wong M, Hahn BH et al. JImmunol 2013
PD-1 blockade in Tregs increases Foxp3 expression
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10 wk old BWF1
Treg +/- anti-PD1
In vitro
• Apoptosis• Flow cytometry•Functional assays• ELISA
Splenocytesfor Treg, Th & B cells
Th B
Experiment to examine PD-1 in Tregs
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In vitro blockade of PD-1 expression in Tregs
PD1hiPD1hi
CD4+Treg from IgG isotype control mice:
without anti-PD1 [anti-PD1] 75 mg/mL in vitro
PD1loPD1lo
CD4+CD25+
PD
1 64
17
19
44
Wong M, Hahn BH et al. JImmunol 2013
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0 25 50 75 1000
5
10
15
20
25
30
35
40
[anti-PD1] (g/ml)
%7
AA
D- A
nn
ex
V+ C
D4
+ CD
25+ c
ells
0 25 50 75 1000
25
50
75
[anti-PD1] (g/ml)
%7
AA
D- A
nn
ex
V+ C
D19
+ cel
ls
Does the degree of PD-1 blockade matter?
Wong M, Hahn BH et al. JImmunol 2013
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0 25 50 75 1000
5
10
15
20
25
30
35
40
[anti-PD1] (g/ml)
%7
AA
D- A
nn
ex
V+ C
D4
+ CD
25+ c
ells
0 25 50 75 1000
25
50
75
[anti-PD1] (g/ml)
%7
AA
D- A
nn
ex
V+ C
D19
+ cel
ls
Does the degree of PD-1 blockade matter?
Wong M, Hahn BH et al. JImmunol 2013
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0 25 50 75 1000
5
10
15
20
25
30
35
40** *
[anti-PD1] (g/ml)
%7
AA
D- A
nn
ex
V+ C
D4
+ CD
25+ c
ells
0 25 50 75 1000
25
50
75
* *
[anti-PD1] (g/ml)%
7A
AD
- An
ne
xV
+ CD
19+ c
ells
Does the degree of PD-1 blockade matter?
* p < 0.05** p < 0.01
Wong M, Hahn BH et al. JImmunol 2013
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0 25 50 75 1000
5
10
15
20
25
30
35
40** *
[anti-PD1] (g/ml)
%7
AA
D- A
nn
ex
V+ C
D4
+ CD
25+ c
ells
0 25 50 75 1000
25
50
75
* *
[anti-PD1] (g/ml)%
7A
AD
- An
ne
xV
+ CD
19+ c
ells
Does the degree of PD-1 blockade matter?
* p < 0.05** p < 0.01
Wong M, Hahn BH et al. JImmunol 2013
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0 25 50 75 1000
5
10
15
20
25
30
35
40** *
[anti-PD1] (g/ml)
%7
AA
D- A
nn
ex
V+ C
D4
+ CD
25+ c
ells
0 25 50 75 1000
25
50
75
* *
[anti-PD1] (g/ml)%
7A
AD
- An
ne
xV
+ CD
19+ c
ells
Does the degree of PD-1 blockade matter?
* p < 0.05** p < 0.01
Wong M, Hahn BH et al. JImmunol 2013
•The amount of PD-1 expression has to be finely tuned – neither absent nor high – for effective suppressive function in Tregs.
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1. Attenuated PD-1 expression makes Treg more effective as suppressor cells:
survival:
• Treg
survival: • Th• B
Wong M, Hahn BH et al. JImmunol 2013
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2. Attenuated PD-1 expression alters cytokine production of Tregs that controls inflammation:
production: • TGF-β • IL-2
production: • anti-dsDNA• IgG• IFN-γ• IL-6• IL-10
1. Attenuated PD-1 expression makes Treg more effective as suppressor cells:
survival:
• Treg
survival: • Th• B
Wong M, Hahn BH et al. JImmunol 2013
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Genes influenced by PD-1 that alters Treg fitness
Gene Fold up- or t-test down regulation p-value
Tcf7 7.54 0.018Bcl2l1 7.16 0.002Birc5 4.47 0.002Ccl2 -3.59 0.012Hk2 -4.2 0.028
Brca1 -4.94 0.001Cd5 -5.89 0.015
Cdkn1a -9.09 0.06Tfrc -10.41 0.0001Fasl -23.12 0.027Fn1 -23.97 0.034
Zap70/Syk
NFATNFB
Gene Up-/down- t-test regulation (fold) p-value
Prdx2 4.47 0.002Bcl2 3.84 0.002Birc5 3.36 0.05Traf2 -3.24 0.06
Tnfsf10 -3.61 0.01Card6 -3.67 0.002
Casp8 -5.43 0.002Tbfrsf10b -6.35 0.002
Traf3 -6.41 0.002Pycard -6.58 0.002Traf1 -6.6 0.002Fasl -7.39 0.002
Cd40lg -18.71 0.002
Pro-apoptotic
anti-apoptotic(TNFR)
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Genes influenced by PD-1 that alters Treg fitness
Gene Fold up- or t-test down regulation p-value
Tcf7 7.54 0.018Bcl2l1 7.16 0.002Birc5 4.47 0.002Ccl2 -3.59 0.012Hk2 -4.2 0.028
Brca1 -4.94 0.001Cd5 -5.89 0.015
Cdkn1a -9.09 0.06Tfrc -10.41 0.0001Fasl -23.12 0.027Fn1 -23.97 0.034
Zap70/Syk
NFATNFB
Gene Up-/down- t-test regulation (fold) p-value
Prdx2 4.47 0.002Bcl2 3.84 0.002Birc5 3.36 0.05Traf2 -3.24 0.06
Tnfsf10 -3.61 0.01Card6 -3.67 0.002
Casp8 -5.43 0.002Tbfrsf10b -6.35 0.002
Traf3 -6.41 0.002Pycard -6.58 0.002Traf1 -6.6 0.002Fasl -7.39 0.002
Cd40lg -18.71 0.002
Pro-apoptotic
anti-apoptotic(TNFR) - OX40
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Genes influenced by PD-1 that alters Treg fitness
Gene Fold up- or t-test down regulation p-value
Tcf7 7.54 0.018Bcl2l1 7.16 0.002Birc5 4.47 0.002Ccl2 -3.59 0.012Hk2 -4.2 0.028
Brca1 -4.94 0.001Cd5 -5.89 0.015
Cdkn1a -9.09 0.06Tfrc -10.41 0.0001Fasl -23.12 0.027Fn1 -23.97 0.034
Zap70/Syk
NFATNFB
Gene Up-/down- t-test regulation (fold) p-value
Prdx2 4.47 0.002Bcl2 3.84 0.002Birc5 3.36 0.05Traf2 -3.24 0.06
Tnfsf10 -3.61 0.01Card6 -3.67 0.002
Casp8 -5.43 0.002Tbfrsf10b -6.35 0.002
Traf3 -6.41 0.002Pycard -6.58 0.002Traf1 -6.6 0.002Fasl -7.39 0.002
Cd40lg -18.71 0.002
Pro-apoptotic
anti-apoptotic(TNFR)- OX40
Arrest: DNA damage Anti-proliferative factors UV Lack of growth factors
Cell Cycle
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High PD-1 signaling arrests cell cycle progression to the G1 phase in Tregs
IgG
anti-
PD10
10
20
30
40
50
60p =0.006
%S
ph
ase
IgG
anti-
PD10
50
100
150
200p = 0.05
G1
arre
st i
nd
ex
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Summary
• Regulation of PD-1 appears critical to the generation and maintenance of regulatory CD4+ T cells during immune tolerance.
• Quantitative & timing of PD-1 expression to Ag has to be finely tuned – neither absent nor high – to enable Tregs to control autoimmunity.
• PD-1 blocks cell cycle progression and proliferation in Tregs, possibly between the G1-S phase.
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Human Data
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Patient Demographics
Patient Control n 60 30 Age (SD) 45.2 (15.7) 43.1 (13.5) % Female 91.7 93.3 Ethnicity
Causasian 0.52 0.67Black 0.07 0.07Asian 0.17 0.20
Hispanic 0.25 0.07 SLEDAI 10.8 (4.4) 0
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Higher intensity of PD-1 expression in Tregs of PBMC from SLE patients
Healthy ctrls SLE pts0.0
2.5
5.0
7.5p = 0.02
%C
D4
+C
D25
hi F
oxp
3+ c
ells
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Higher intensity of PD-1 expression in Tregs of PBMC from SLE patients
Healthy ctrls SLE pts0.0
2.5
5.0
7.5p = 0.02
%C
D4
+C
D25
hi F
oxp
3+ c
ells
Healthy ctrls SLE pts0
10
20
30
40
50
p < 0.002
%C
D4
+ CD
25h
i Fo
xp
3+ c
ells
be
ing
PD
1+
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Higher intensity of PD-1 expression in Tregs of PBMC from SLE patients
Healthy ctrls SLE pts0.0
2.5
5.0
7.5p = 0.02
%C
D4
+C
D25
hi F
oxp
3+ c
ells
Healthy ctrls SLE pts0
10
20
30
40
50
p < 0.002
%C
D4
+ CD
25h
i Fo
xp
3+ c
ells
be
ing
PD
1+
SLEDAI <4 SLEDAI >40
10
20
30
40
50
p = 0.07
%C
D4+ C
D2
5hi F
ox
p3+
ce
lls b
ein
g P
D1+
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Higher intensity of PD-1 expression in Tregs of PBMC from SLE patients
Healthy ctrls SLE pts0.0
2.5
5.0
7.5p = 0.02
%C
D4
+C
D25
hi F
oxp
3+ c
ells
Healthy ctrls SLE pts0
10
20
30
40
50
p < 0.002
%C
D4
+ CD
25h
i Fo
xp
3+ c
ells
be
ing
PD
1+
SLEDAI <4 SLEDAI >40
10
20
30
40
50
p = 0.07
%C
D4+ C
D2
5hi F
ox
p3+
ce
lls b
ein
g P
D1+
•SLE patients have increased PD-1 expression in Tregs compared to healthy individuals & patients with mild disease.
Wong M, Hahn BH et al. Arthritis Rheum 2014. (Abstract)
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Clinical symptoms associated with increased PD-1
Clinical manifestation %PD1hiCD4+CD25+ cells p-value
no symptoms with symptoms
Vasculitis 7.93 ± 1.59 15.54 ± 3.94 0.029
Renal 10.48± 5.26 21.45 ± 9.18 0.052
Thrombocytopenia (plt < 1K) 6.64 ± 1.03 11.55 ± 3.46 0.036
Leukopenia (WBC < 3.5) 6.61 ± 1.41 11.30 ± 2.69 0.014
Oral/Nasal ulcers 8.84 ± 1.47 11.19 ± 5.61 0.023
Rash (acute, subacute, discoid) 10.02 ± 1.93 6.79 ± 1.60 0.014
Photosensitivity 9.95 ± 1.68 3.52 ± 1.07 0.013
Wong M, Hahn BH et al. Arthritis Rheum 2014. (Abstract)
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Low PD-1 expression induced suppressivity in Treg of SLE patients
0 2.5 10 200
5
10
15
20
25
**
p <0.05 (1-way ANOVA)
[anti-PD1] (g/ml)
%A
nn
ex
inV
+ 7A
AD
- CD
4+ C
D25
hi ce
lls
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Low PD-1 expression induced suppressivity in Treg of SLE patients
0 2.5 10 200
5
10
15
20
25
**
p <0.05 (1-way ANOVA)
[anti-PD1] (g/ml)
%A
nn
ex
inV
+ 7A
AD
- CD
4+ C
D25
hi ce
lls
0 100
20
40
60
p < 0.05
[anti-PD1] to treat CD4+Treg (g/ml)
%A
nn
exin
V+7A
AD
- CD
19+ c
ells
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Low PD-1 expression induced suppressivity in Treg of SLE patients
0 2.5 10 200
5
10
15
20
25
**
p <0.05 (1-way ANOVA)
[anti-PD1] (g/ml)
%A
nn
ex
inV
+ 7A
AD
- CD
4+ C
D25
hi ce
lls
0 100
20
40
60
p < 0.05
[anti-PD1] to treat CD4+Treg (g/ml)
%A
nn
exin
V+7A
AD
- CD
19+ c
ells
0 100.0
0.5
1.0
1.5
2.0 p <0.005
[anti-PD1] to treat CD4+Treg (g/ml)
CD
4+C
D25
- Th
cell
divi
sio
n in
dex
n = 11
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Low PD-1 expression induced suppressivity in Treg of SLE patients
0 2.5 10 200
5
10
15
20
25
**
p <0.05 (1-way ANOVA)
[anti-PD1] (g/ml)
%A
nn
ex
inV
+ 7A
AD
- CD
4+ C
D25
hi ce
lls
0 100
20
40
60
p < 0.05
[anti-PD1] to treat CD4+Treg (g/ml)
%A
nn
exin
V+7A
AD
- CD
19+ c
ells
0 100.0
0.5
1.0
1.5
2.0 p <0.005
[anti-PD1] to treat CD4+Treg (g/ml)
CD
4+C
D25
- Th
cell
divi
sio
n in
dex
•Tolerance can be induced in Treg by PD-1 blockade at a fine-tuned concentration.
Wong M, Hahn BH et al. Arthritis Rheum 2014. (Abstract)
n = 11
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Attenuated PD-1 expression alters cytokine production of Treg that controls inflammation:
production: • TGF-β • IL-2
production: • anti-dsDNA• IgG• IFN-γ• IL-6• IL-17
Attenuated PD-1 expression makes Treg more effective as suppressor cells:
survival:
• Treg
survival: • Th• B
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Attenuated PD-1 expression alters cytokine production of Treg that controls inflammation:
production: • TGF-β • IL-2
production: • anti-dsDNA• IgG• IFN-γ• IL-6• IL-17
Attenuated PD-1 expression makes Treg more effective as suppressor cells:
survival:
• Treg
survival: • Th• B
Reprise of lupus mouse data
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Future DirectionsMouse• Bone marrow chimeric model• PD-1 on/off switch
Human• PDL1 expression on target cells• TNFR: OX40• Renal disease• Clinical application
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Summary
• SLE patients have aberrant, increased PD-1 expression in their circulating Tregs that may reduce the regulatory function of Foxp3+
Tregs, which are important in the suppression of autoimmunity.
• One mechanism by which PD-1 sustains these Tregs is by reducing their susceptibility to apoptosis.
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Conclusion
PD-1 influences autoimmunity in part via its effect on Tregs.
PD-1 expression in Tregs must be tightly controlled in a graded fashion to maintain their numbers and suppressive functions.
PD-1 has the potential to be a target for treatment of SLE.
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Acknowledgements Bevra Hahn Betty Tsao Antonio La Cava Daniel Furst Jennifer Grossman Elaine Lourenço
Grant support NIH (T32) Arthritis Foundation (Local & National Chapter) American College of Rheumatology Arthritis National Research Foundation
George Tsokos
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Acute infection
Chronic infection
Revival of exhausted cells
Revival of “Exhausted” T cells
Williams MA et al. Nature Immunology, 2006.