Immune Cell Therapy in IBD

被引:7
作者
Dunkin, David [1 ]
Mehandru, Saurabh [1 ]
Colombel, Jean-Frederic [1 ]
机构
[1] Icahn Sch Med Mt Sinai, Div Gastroenterol, New York, NY 10029 USA
关键词
Crohn's disease; Gastrointestinal inflammation; Regulatory T cells; REGULATORY T-CELLS; ORAL TOLERANCE; EPICUTANEOUS IMMUNOTHERAPY; DENDRITIC CELLS; DELIVERY-SYSTEM; CUTTING EDGE; PROTECTIVE T; DOUBLE-BLIND; INTACT SKIN; EXPRESSION;
D O I
10.1159/000367827
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The therapeutic landscape of IBD has undergone a dramatic transformation since the advent of biologic therapies, especially TNF inhibitors. However, 30% of patients are primary nonresponders to biologic therapy and secondary failures are frequent. Due to substantial progress in our understanding of the biology of regulatory T cells (Tregs) and in the pathways of homing to the gastrointestinal tract, novel cell-based therapies for IBD have become possible. For example, although a reductionist view, one could envisage IBD as an imbalance between the proinflammatory effectors (such as Th17 cells) and the anti-inflammatory regulators (like Tregs). Here we focus on the development of ex vivo and in vivo approaches to enhance Tregs in the gastrointestinal tract. Specifically, herein we highlight a recently concluded phase 1/2a clinical trial that investigated the safety and efficacy of a single injection of escalating doses of autologous ovalbumin-specific Tregs in patients with active Crohn's disease refractory to conventional therapy. This therapy was well tolerated and demonstrated dose-related efficacy. We also discuss the potential of directing Tregs derived through intranasal as well as epicutaneous immunization to the gastrointestinal tract by enhancing their gut homing signature and their potential to decrease gastrointestinal inflammation. Finally, the strengths and pitfalls of these new therapeutic approaches are discussed as we move forward in this largely uncharted territory. (C) 2014 S. Karger AG, Basel
引用
收藏
页码:61 / 66
页数:6
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