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July 2018; 5 (4) ArticleOpen Access

Expanded autologous regulatory T-lymphocyte infusions in ALS

A phase I, first-in-human study

Jason R. Thonhoff, David R. Beers, Weihua Zhao, Milvia Pleitez, Ericka P. Simpson, James D. Berry, Merit E. Cudkowicz, Stanley H. Appel
First published May 18, 2018, DOI: https://doi.org/10.1212/NXI.0000000000000465
Jason R. Thonhoff
From the Houston Methodist Neurological Institute (J.R.T., D.R.B., W.Z., M.P., E.P.S., S.H.A.), Houston Methodist Hospital Research Institute, Stanley H. Appel Department of Neurology, Houston, TX; and Neurological Clinical Research Institute (J.D.B., M.E.C.), Massachusetts General Hospital, Boston, MA.
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David R. Beers
From the Houston Methodist Neurological Institute (J.R.T., D.R.B., W.Z., M.P., E.P.S., S.H.A.), Houston Methodist Hospital Research Institute, Stanley H. Appel Department of Neurology, Houston, TX; and Neurological Clinical Research Institute (J.D.B., M.E.C.), Massachusetts General Hospital, Boston, MA.
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Weihua Zhao
From the Houston Methodist Neurological Institute (J.R.T., D.R.B., W.Z., M.P., E.P.S., S.H.A.), Houston Methodist Hospital Research Institute, Stanley H. Appel Department of Neurology, Houston, TX; and Neurological Clinical Research Institute (J.D.B., M.E.C.), Massachusetts General Hospital, Boston, MA.
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Milvia Pleitez
From the Houston Methodist Neurological Institute (J.R.T., D.R.B., W.Z., M.P., E.P.S., S.H.A.), Houston Methodist Hospital Research Institute, Stanley H. Appel Department of Neurology, Houston, TX; and Neurological Clinical Research Institute (J.D.B., M.E.C.), Massachusetts General Hospital, Boston, MA.
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Ericka P. Simpson
From the Houston Methodist Neurological Institute (J.R.T., D.R.B., W.Z., M.P., E.P.S., S.H.A.), Houston Methodist Hospital Research Institute, Stanley H. Appel Department of Neurology, Houston, TX; and Neurological Clinical Research Institute (J.D.B., M.E.C.), Massachusetts General Hospital, Boston, MA.
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James D. Berry
From the Houston Methodist Neurological Institute (J.R.T., D.R.B., W.Z., M.P., E.P.S., S.H.A.), Houston Methodist Hospital Research Institute, Stanley H. Appel Department of Neurology, Houston, TX; and Neurological Clinical Research Institute (J.D.B., M.E.C.), Massachusetts General Hospital, Boston, MA.
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Merit E. Cudkowicz
From the Houston Methodist Neurological Institute (J.R.T., D.R.B., W.Z., M.P., E.P.S., S.H.A.), Houston Methodist Hospital Research Institute, Stanley H. Appel Department of Neurology, Houston, TX; and Neurological Clinical Research Institute (J.D.B., M.E.C.), Massachusetts General Hospital, Boston, MA.
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Stanley H. Appel
From the Houston Methodist Neurological Institute (J.R.T., D.R.B., W.Z., M.P., E.P.S., S.H.A.), Houston Methodist Hospital Research Institute, Stanley H. Appel Department of Neurology, Houston, TX; and Neurological Clinical Research Institute (J.D.B., M.E.C.), Massachusetts General Hospital, Boston, MA.
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Full PDF
Citation
Expanded autologous regulatory T-lymphocyte infusions in ALS
A phase I, first-in-human study
Jason R. Thonhoff, David R. Beers, Weihua Zhao, Milvia Pleitez, Ericka P. Simpson, James D. Berry, Merit E. Cudkowicz, Stanley H. Appel
Neurol Neuroimmunol Neuroinflamm Jul 2018, 5 (4) e465; DOI: 10.1212/NXI.0000000000000465

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    Figure 1 Treg percentage and suppressive function increased during each round of Treg infusions

    Arrows and vertical dotted lines represent Treg infusions. The 1st Treg infusion was administered on week 0 and then every 2 weeks for a total of 4 infusions. The 5th Treg infusion was administered in each patient on weeks 48, 27, and 33, respectively, and then every 4 weeks for a total of 4 infusions. The percentage of CD4+CD25+FOXP3+ Tregs within the total CD4+ cell population is shown for patient 1 (A), patient 2 (B), and patient 3 (C). Treg percentages are shown at baseline (weeks 4.6, 3.0, and 4.9 in each patient, respectively), the days of the 1st and 5th Treg infusions, the day after each Treg infusion, every 2 weeks during each round of infusions, and 1 month after each round. The data point collected the day after the 4th Treg infusion (week 6) in patient 3 was not determined because of a flow staining error. Treg suppressive function is shown on the same time points as the Treg percentages for patient 1 (D), patient 2 (E), and patient 3 (F).

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    Figure 2 Disease progression slowed during each round of Treg infusions and correlated with increased Treg suppressive function

    Arrows and vertical dotted lines represent Treg infusions. Clinical progression is depicted by the ALSFRS-R (white points) and AALS (black points) stages of the disease for patient 1 (A.a), patient 2 (B.a), and patient 3 (C.a). Clinical progression lines during each round of Treg infusions are enlarged in side panels for the early (1) and later (2) stages of disease. Correlation between changes in the AALS and Treg suppressive function is shown for patient 1 (A.b), patient 2 (B.b), and patient 3 (C.b). Lines represent the best fit as determined by linear regression analysis. Data were analyzed by Spearman correlation, and p values <0.05 were considered statistically significant. AALS = Appel Amyotrophic Lateral Sclerosis Rating Scale; ALSFRS-R = revised Amyotrophic Lateral Sclerosis Functional Rating Scale.

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    Figure 3 Maximal inspiratory pressures stabilized during Treg infusions

    Arrows and vertical dotted lines represent Treg infusions. FVC measurements are represented as % predicted values for patient 1 (A), patient 2 (B), and patient 3 (C). Measurements are shown at baseline (weeks 4.6, 3.0, and 4.9 in each patient, respectively), immediately before each Treg infusion, every 2 weeks during each round of infusions, and 1 month after each round. MIP measurements are shown in cm H2O for patient 1 (D), patient 2 (E), and patient 3 (F). MIPs are shown at the same time points as FVC measurements. The MIP values were erroneously not determined for patient 1 immediately before the 5th Treg infusion, and for patient 3, 1 month after the second round of infusions. The solid gray line connects the points between each round of infusions (A-F). FVC = forced vital capacity; MIP = maximal inspiratory pressure.

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