Abstract (eng)
IgE-mediated allergy is a hypersensitivity disorder whose prevalence is still increasing. IgE is produced by plasma cells after class switching which requires T cell help, costimulation and TH2 cytokines. To date, immunotherapy is the only causative treatment but, next to limited effectiveness, it harbors risks such as anaphylaxis or additional sensitization. Therefore, development of strategies for tolerance induction towards allergens remains a desirable goal. Here we examined costimulation blockade and molecular chimerism as two potential solutions.
Costimulation blockade prolongs graft survival in transplantation but its potential in the treatment of allergy still has to be fully investigated. Recently, OX40L was suggested to play an important role in TH2-mediated and memory T cell responses. We therefore analyzed the tolerizing potential of blocking OX40L alone or in addition to CD28 and CD40L blockade in a well-described model of IgE-mediated allergy using clinically relevant major allergens. Blocking OX40L alone had no therapeutic effect. Combination of anti-CD40L/CTLA4Ig significantly delayed production of allergen-specific antibodies. T cell response was suppressed even after established antibody production. Additional anti-OX40L treatment to anti-CD40L/CTLA4Ig showed no synergistic effect.
In the second part of my work we examined molecular chimerism as a promising concept in tolerance induction, which is brought about through the transplantation of autologous hematopoietic cells genetically modified in vitro to express a disease-causing antigen. Recently, our group has published a proof of principle study showing robust long-term tolerance towards the grass pollen allergen, Phl p 5, through molecular chimerism. Since allergens are structurally and functionally different, we investigated whether molecular chimerism establishes tolerance towards the major birch pollen allergen, Bet v 1. VSV-Bet v 1-GFP transduced BMC were transplanted into preconditioned recipients. Engraftment of allergen-expressing stem cells was supported by inhibition of CD26 and tracked by the reportergene GFP. Molecular chimerism was detectable throughout long-term follow-up, preventing sensitization even after repeated challenges with Bet v 1. Production of Bet v 1-specific antibodies was completely abrogated throughout follow-up. Moreover, Bet v 1-specific T cell proliferation was suppressed.
Our findings show that combined costimulation blockade including OX40L blockade at the time of immunization with an allergen delays but does not prevent the humoral allergic response. In contrast, molecular chimerism induced robust long-term tolerance. Chimerism is a promising strategy to achieve life-long tolerance on the B-, T cell and effector cell levels towards a wide range of allergens.