In Vitro Profiling of Commonly Used Post-transplant Immunosuppressants Reveals Distinct Impact on Antiviral T-cell Immunity Towards CMV

• Published in: Transplant international 2024-04, Vol.37, p.12720-12720
• Main Authors: Krueger, Markus Benedikt, Bonifacius, Agnes, Dragon, Anna Christina, Santamorena, Maria Michela, Nashan, Björn, Taubert, Richard, Kalinke, Ulrich, Maecker-Kolhoff, Britta, Blasczyk, Rainer, Eiz-Vesper, Britta
• Format: Article
• Language: English
• Subjects: adoptive T-cell therapy; Cell Proliferation - drug effects; CMV-specific T cells; Cytomegalovirus - immunology; Cytomegalovirus Infections - immunology; Everolimus; Health Archive; hematopoietic stem cell transplantation; Humans; immunosuppression; Immunosuppressive Agents; Lymphocyte Activation - drug effects; Mycophenolic Acid; Organ Transplantation; Prednisolone - therapeutic use; Sirolimus - pharmacology; Sirolimus - therapeutic use; solid organ transplantation; T-Lymphocytes - drug effects; T-Lymphocytes - immunology; Tacrolimus
• ISSN: 1432-2277; 0934-0874; 1432-2277
• DOI: 10.3389/ti.2024.12720

Infectious complications, including widespread human cytomegalovirus (CMV) disease, frequently occur after hematopoietic stem cell and solid organ transplantation due to immunosuppressive treatment causing impairment of T-cell immunity. Therefore, in-depth analysis of the impact of immunosuppressants on antiviral T cells is needed. We analyzed the impact of mTOR inhibitors sirolimus (SIR/S) and everolimus (EVR/E), calcineurin inhibitor tacrolimus (TAC/T), purine synthesis inhibitor mycophenolic acid (MPA/M), glucocorticoid prednisolone (PRE/P) and common double (T+S/E/M/P) and triple (T+S/E/M+P) combinations on antiviral T-cell functionality. T-cell activation and effector molecule production upon antigenic stimulation was impaired in presence of T+P and triple combinations. SIR, EVR and MPA exclusively inhibited T-cell proliferation, TAC inhibited activation and cytokine production and PRE inhibited various aspects of T-cell functionality including cytotoxicity. This was reflected in an infection model, where elimination of CMV-infected human fibroblasts by CMV-specific T cells was reduced in presence of PRE and all triple combinations. CMV-specific memory T cells were inhibited by TAC and PRE, which was also reflected with double (T+P) and triple combinations. EBV- and SARS-CoV-2-specific T cells were similarly affected. These results highlight the need to optimize immune monitoring to identify patients who may benefit from individually tailored immunosuppression.