OKT3 is a murine monoclonal antibody directed against the CD3epsilon chain
of the T cell receptor complex on human T-cells. OKT3 has been widely
used over the past decade in transplantation to treat corticosteroid-
resistant organ graft rejections, and more recently, as prophylaxis of
rejection. This mAb induces an efficient and rapid immunosuppression, at
least in part due to, the prevention of allorecognition as a result of
modulation of the T cell receptor (TCR) from the surface of T lymphocytes
and clearance of T cells from the circulation. However, there are several
clinical and scientific issues that remain unresolved regarding anti-CD3
therapy. First, a variety of side effects are associated with OKT3 that
limits its usefulness in other diseases such as autoimmunity and bone
marrow transplantation. These limitations are, in large part, a result of
the first dose toxicity as a consequence of T cell activation and the
subsequent massive cytokine release. In addition, the therapy has been
limited by the generation of a potent humoral antibody response against
the murine mAb limiting the potential for retreatment. During the past 4
years, Dr. Bluestone's laboratory has systematically evaluated the use of
anti-CD3 to suppress transplantation responses in vivo first in a well-
defined, small animal model and then in the hu-SPL-SCID model in
collaboration with Dr. Thistlethwaite. The toxic effects of the mAb were
defined and largely eliminated, immunosuppressive agents such as
deoxyspergualin and CTLA4Ig were used in conjunction with anti-CD3 to
potentiate immunosuppression and block the humoral response, and
genetically-engineered monoclonal anti-CD3 antibodies were developed to
examine the role of T cell activation and Co-stimulation in immune
suppression. However, many questions remain including: the relative
efficacy of "activating" and "non-activating" anti-CD3 mAbs; the signal
transducing ability of "non-activating" anti-CD3 mAbs and how it regulates
T cell activation; the role of co-stimulatory in the activating and
toleragenic effects of anti-CD3; and the role of other inhibitors of T
cell signalling, such as cyclosporin A in the efficacy of anti-CD3
therapy. In order to answer these questions the following specific aims
are proposed: 1. To study the in vivo effects of non-mitogenic anti-CD3
mAbs alone and in conjunction with donor antigen; 2. To determine the role
of CD28/B7 interactions in anti-CD3-mediated immunosuppression; 3. To
determine the molecular mechanism(s) controlling apoptosis and anergy in
mice treated with mitogenic anti-CD3.
The results of these studies will provide important insights into the
effects of anti-CD3 and the CD28/B7 family of cell surface molecules in
the regulation of transplant rejection that may translate into clinical
application.
National Institute of Allergy and Infectious Diseases
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