TIGIT agonism alleviates costimulation blockade-resistant rejection in a regulatory T cell-dependent manner

Belatacept-based immunosuppression in kidney transplantation confers fewer off-target toxicities than calcineurin inhibitors but comes at a cost of increased incidence and severity of acute rejection, potentially due to its deleterious effect on both the number and function of Foxp3+ regulatory T cells (Tregs). TIGIT is a CD28 family coinhibitory receptor expressed on several subsets of immune cells including Tregs. We hypothesized that coinhibition through TIGIT signaling could function to ameliorate costimulation blockade-resistant rejection. The results demonstrate that treatment with an agonistic anti-TIGIT antibody, when combined with costimulation blockade by CTLA-4Ig, can prolong allograft survival in a murine skin graft model compared with CTLA-4Ig alone. Further, this prolongation of graft survival is accompanied by an increase in the frequency and number of graftinfiltrating Tregs and a concomitant reduction in the number of CD8+ T cells in the graft. Through the use of Tregspecific TIGIT conditional knockout animals, we demonstrated that the TIGIT-mediated reduction in the graftinfiltrating CD8+ T cell response is dependent on signaling of TIGIT on Foxp3+ Tregs. Our results highlight both the key functional role of TIGIT on Foxp3+ Tregs under conditions in which CTLA-4 is blocked and the therapeutic potential of TIGIT agonism to optimize costimulation blockade-based immunosuppression.

Automated summary

Belatacept-based immunosuppression in kidney transplantation has fewer off-target toxicities than calcineurin inhibitors, but increases the incidence and severity of acute rejection. TIGIT, a CD28 family coinhibitory receptor expressed on immune cells including Tregs, may ameliorate rejection resistant to costimulation blockade. Treatment with an agonistic anti-TIGIT antibody in combination with costimulation blockade prolonged allograft survival in a murine skin graft model by increasing infiltrating Tregs and reducing CD8+ T cells in the graft.