TNF-α priming enhances CD4+FoxP3+ regulatory T-cell suppressive function in murine GVHD prevention and treatment

CD4(+)CD25(+)FoxP3(+) regulatory T cells (Tregs) have been shown to effectively prevent graft-versus-host disease (GVHD) when adoptively transferred in murine models of hematopoietic cell transplantation and in phase 1/2 clinical trials. Critical limitations to Treg clinical application are the paucity of cells and limited knowledge of the mechanisms of in vivo function. We hypothesized that inflammatory conditions in GVHD modify Treg characteristics and activity. We found that peripheral blood of recipient animals during acute GVHD (aGVHD) induces Treg activation and enhances their function. The serum contains high levels of tumor necrosis factor-alpha (TNF-alpha) that selectively activates Tregs without impacting CD4(+)FoxP3(-)T cells. TNF-alpha priming induces Treg in vivo proliferation, whereas it limits the ability of CD4 and CD8 conventional T cells (Tcons) to proliferate and induce GVHD. TNF-alpha-primed Tregs prolong animal survival as compared with unprimed Tregs when used at an unfavorable Treg: Tcon ratio, demonstrating enhanced in vivo efficacy of TNF-alpha-primed Tregs. Because TNF-alpha is produced by several immune cells during inflammation, our work elucidates aspects of the physiologic mechanisms of Treg function. Furthermore, TNF-alpha priming of Tregs provides a new tool to optimize Treg cellular therapies for GVHD prevention and treatment. (Blood. 2016;128(6):866-871)