Year 3

Stem cell therapy involves transfer of stem cells to patients. Transferring stem cells from a donor to a patient holds particular promise, because the stem cells may be reliably modified to rectify a specific defect and restore a particular function. This approach is limited by the patient’s immune response, which may reject the foreign transplant. Immune suppressive drugs can be used to prevent rejection of the stem cell, but these drugs leave patients sensitive to infections. We aim to find new, less debilitating methods to facilitate transplantation of foreign stem cell derived tissues. One approach is to establish a state of immune tolerance in the patient, by transplanting blood cells to generate blood cell mixing, called chimerism— that the patient tolerates. Once that is successful, stem cells of other tissues will also be tolerated, as long as they are from the same donor as the donor blood cells. Our efforts have focused on enabling patients to accept foreign blood cells—the first step in this approach. Natural killer cells are immune cells that are known to reject foreign blood cells, when the donor cells are mismatched at genes that control tissue rejection. We have shown that natural killer cells can be rapidly converted to a tolerant state when exposed to specific foreign cells from a donor. Subsequently, they will ignore transplants from the same donor. These findings suggested we could develop methods to readily prevent rejection of foreign blood cells by natural killer cells, but we also learned that this tolerance is fragile: when infections occurred, the tolerance could be reversed and the donor cells rejected. If this occurred after stem cell therapy, the donor stem cells would be rejected, abrogating the benefit of stem cell therapy. However, we also learned that this outcome did not occur in all circumstances. We learned that the fragile state of tolerance occurred when natural killer cells were exposed to foreign blood cells, but a distinct or deeper state of tolerance occurred when NK cells were exposed to other types of foreign cells, not of the blood cell lineages. In that case, tolerance was much less fragile and was sustained even when infections occurred. Our research is geared to identifying the key cell types that induce a deeper and less fragile form of tolerance of natural killer cells, in order to improve the effectiveness of therapeutic stem cell therapy.