Immunotherapy of cytomegalovirus infection by low-dose adoptive transfer of antiviral CD8 T cells relies on substantial post-transfer expansion of central memory cells but not effector-memory cells

• Published in: PLoS pathogens Vol. 19; no. 11; p. e1011643
• Main Authors: Holtappels, Rafaela, Becker, Sara, Hamdan, Sara, Freitag, Kirsten, Podlech, Jürgen, Lemmermann, Niels A, Reddehase, Matthias J
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 16.11.2023; Public Library of Science (PLoS)
• Subjects: Ablation; Adoptive transfer; Analysis; Animal models; Antiviral agents; Biology and life sciences; Care and treatment; CD8 antigen; Cells; Clinical trials; Complications and side effects; Cytomegalovirus; Cytomegalovirus infections; Disease prevention; Dosage and administration; Drug dosages; Drug therapy; Effector cells; Genetic engineering; Health aspects; Hematopoietic stem cells; Histopathology; Immune response; Immune system; Immunological memory; Immunosurveillance; Immunotherapy; Infections; Latency; Latent infection; Leukemia; Lymphocytes; Lymphocytes T; Medicine and health sciences; Memory (Computers); Memory cells; Pathogenesis; Patient outcomes; Peptides; Prevention; Research and Analysis Methods; Signs and symptoms; Stem cell transplantation; T cells; Transplantation; Transplants & implants; Viral infections; Germany
• ISSN: 1553-7374; 1553-7366; 1553-7374
• DOI: 10.1371/journal.ppat.1011643

Cytomegaloviruses (CMVs) are host species-specific in their replication. It is a hallmark of all CMVs that productive primary infection is controlled by concerted innate and adaptive immune responses in the immunocompetent host. As a result, the infection usually passes without overt clinical symptoms and develops into latent infection, referred to as “latency”. During latency, the virus is maintained in a non-replicative state from which it can reactivate to productive infection under conditions of waning immune surveillance. In contrast, infection of an immunocompromised host causes CMV disease with viral multiple-organ histopathology resulting in organ failure. Primary or reactivated CMV infection of hematopoietic cell transplantation (HCT) recipients in a “window of risk” between therapeutic hemato-ablative leukemia therapy and immune system reconstitution remains a clinical challenge. Studies in the mouse model of experimental HCT and infection with murine CMV (mCMV), followed by clinical trials in HCT patients with human CMV (hCMV) reactivation, have revealed a protective function of virus-specific CD8 T cells upon adoptive cell transfer (AT). Memory CD8 T cells derived from latently infected hosts are a favored source for immunotherapy by AT. Strikingly low numbers of these cells were found to prevent CMV disease, suggesting either an immediate effector function of few transferred cells or a clonal expansion generating high numbers of effector cells. In the murine model, the memory population consists of resting central memory T cells (TCM), as well as of conventional effector-memory T cells (cTEM) and inflationary effector-memory T cells (iTEM). iTEM increase in numbers over time in the latently infected host, a phenomenon known as ‘memory inflation’ (MI). They thus appeared to be a promising source for use in immunotherapy. However, we show here that iTEM contribute little to the control of infection after AT, which relies almost entirely on superior proliferative potential of TCM.