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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 Professor Division of Rheumatology UCLA David Geffen School of Medicine

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Page 1: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 2: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Systemic Lupus Erythematosus

Page 3: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 4: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 5: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Why does it matter?

Therapeutic potential Restore immune tolerance

Treat autoimmune & allergic diseases

Prevent graft rejection

Page 6: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

PD-1 controls dysregulated T cell activation

Normal T cell activation

Bc-xLIL-2IFN-ϒ

activated T cells

Page 7: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 8: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 9: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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)

Page 10: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

What happens to a T after PD-1 is activated?

+TGF-β

Page 11: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 12: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Anti-PD1 drugsFDA approvedNivolumab (Opdivo)Pembrolizumab (Keytruda)

In the pipelinePidilizumabREGN2810MDX1106-02

Page 13: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 14: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Francisco LM, Sharpe A et al, Immunological Reviews, 2010.

What cells are we targeting with PD-1 & its ligand?

Page 15: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

What cells are we targeting with PD-1 & its ligand?

Francisco LM, Sharpe A et al, Immunological Reviews, 2010.

Page 16: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Francisco LM, Sharpe A et al, Immunological Reviews, 2010.

What cells are we targeting with PD-1 & its ligand?

Page 17: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Francisco LM, Sharpe A et al, Immunological Reviews, 2010.

What cells are we targeting with PD-1 & its ligand?

Page 18: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

PD-1 & SLE

Page 19: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 20: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 21: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Hypothesis•Regulation of signaling through PD-1 controls Tregs and autoimmunity in BWF1 lupus mice.

Page 22: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 23: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 24: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Clinical Results in Mouse SLE

anti-dsDNA

proteinuria

survival

Page 25: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Clinical Results in Mouse SLE

anti-dsDNA

proteinuria

survival

Wong M, Hahn BH et al. JImmunol 2011

Page 26: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Clinical Results in Mouse SLE

anti-dsDNA

proteinuria

survival

Wong M, Hahn BH et al. JImmunol 2011

Page 27: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 28: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 29: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 30: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 31: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 32: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 33: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 34: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 35: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 36: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 37: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 38: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 39: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 40: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 41: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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.

Page 42: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 43: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 44: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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)

Page 45: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 46: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 47: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 48: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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.

Page 49: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Human Data

Page 50: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 51: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 52: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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+

Page 53: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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+

Page 54: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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)

Page 55: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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)

Page 56: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 57: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 58: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 59: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 60: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 61: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 62: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Future DirectionsMouse• Bone marrow chimeric model• PD-1 on/off switch

Human• PDL1 expression on target cells• TNFR: OX40• Renal disease• Clinical application

Page 63: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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.

Page 64: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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.

Page 65: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

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

Page 66: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology
Page 67: Programmed Death-1 (PD-1) in SLE T cells: “That which does not kill us, makes us stronger” Maida Wong. M.D. Assistant Clinical Professor Division of Rheumatology

Acute infection

Chronic infection

Revival of exhausted cells

Revival of “Exhausted” T cells

Williams MA et al. Nature Immunology, 2006.