MEK inhibitors selectively suppress alloreactivity and graft-versus-host disease in a memory stage-dependent manner

Blood. 2013 Jun 6;121(23):4617-26. doi: 10.1182/blood-2012-12-476218. Epub 2013 Apr 10.

Abstract

Immunosuppressive strategies currently used in hematopoietic stem cell transplantation reliably decrease graft-versus-host disease (GVHD) rates, but also impair pathogen-specific immunity. Experimental transplant studies indicate that GVHD-initiating alloreactive T cells reside primarily in naive and central memory T-cell compartments. In contrast, virus-specific T cells comprise a more differentiated memory population. After finding that the rat sarcoma/mitogen-activated protein kinase kinase/extracellular receptor kinase (RAS/MEK/ERK) pathway is preferentially activated in naive and central memory human T cells, we hypothesized that MEK inhibitors would preferentially inhibit alloreactive T cells, while sparing more differentiated virus-specific T cells. Confirming our hypothesis, we found that MEK inhibitors including selumetinib preferentially inhibited cytokine production and alloreactivity mediated by naive and central memory human CD4(+) and CD8(+) T cells while sparing more differentiated T cells specific for the human herpesviruses cytomegalovirus and Epstein-Barr virus. We then demonstrated that short-term posttransplant administration of selumetinib in a major histocompatibility complex major- and minor-mismatched murine model significantly delayed the onset of GVHD-associated mortality without compromising myeloid engraftment, demonstrating the in vivo potential of MEK inhibitors in the setting of hematopoietic stem cell transplantation. These findings demonstrate that targeting memory-dependent differences in T-cell signaling is a potent and selective approach to inhibition of alloreactivity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Benzimidazoles / administration & dosage*
  • Blotting, Western
  • Bone Marrow Transplantation*
  • CD4-Positive T-Lymphocytes / immunology*
  • CD4-Positive T-Lymphocytes / metabolism
  • CD4-Positive T-Lymphocytes / virology
  • CD8-Positive T-Lymphocytes / immunology*
  • CD8-Positive T-Lymphocytes / metabolism
  • CD8-Positive T-Lymphocytes / virology
  • Cells, Cultured
  • Cytokines / metabolism
  • Cytomegalovirus / pathogenicity
  • Cytomegalovirus Infections / immunology
  • Cytomegalovirus Infections / metabolism
  • Cytomegalovirus Infections / virology
  • Epstein-Barr Virus Infections / immunology
  • Epstein-Barr Virus Infections / metabolism
  • Epstein-Barr Virus Infections / virology
  • Flow Cytometry
  • Graft vs Host Disease / immunology
  • Graft vs Host Disease / pathology
  • Graft vs Host Disease / prevention & control*
  • Herpesvirus 4, Human / pathogenicity
  • Humans
  • Immunologic Memory / immunology*
  • MAP Kinase Kinase 1 / antagonists & inhibitors*
  • MAP Kinase Kinase 1 / metabolism
  • MAP Kinase Signaling System
  • Mice
  • Mice, Inbred BALB C
  • Mice, Inbred C57BL
  • Phosphorylation / drug effects
  • Rats
  • Transplantation Tolerance / immunology*
  • Transplantation, Homologous

Substances

  • AZD 6244
  • Benzimidazoles
  • Cytokines
  • MAP Kinase Kinase 1