Failure of transplantation tolerance induction by autologous regulatory T cells in the pig-to-non-human primate islet xenotransplantation model

Background Islet allotransplantation is a promising way to treat some type 1 diabetic (T1D) patients with frequent hypoglycemic unawareness, and islet xenotransplantation is emerging to overcome the problem of donor organ shortage. Our recent study showing reproducible long‐term survival of porcine islets in non‐human primates (NHPs) allows us to examine whether autologous regulatory T‐cell (Treg) infusion at peri‐transplantation period would induce transplantation tolerance in xenotransplantation setting. Methods Two diabetic rhesus monkeys were transplanted with porcine islets from wild‐type adult Seoul National University (SNU) miniature pigs with immunosuppression by anti‐thymoglobulin (ATG), cobra venom factor, anti‐CD154 monoclonal antibody (mAb), and sirolimus. CD4+CD25highCD127low autologous regulatory T cells from the recipients were isolated, ex vivo expanded, and infused at the peri‐transplantation period. Blood glucose and porcine C‐peptide from the recipients were measured up to 1000 days. Maintenance immunosuppressants including a CD40‐CD154 blockade were deliberately discontinued to confirm whether transplantation tolerance was induced by adoptively transferred Tregs. Results After pig islet transplantation via portal vein, blood glucose levels of diabetic recipients became normalized and maintained over 6 months while in immunosuppressive maintenance with a CD40‐CD154 blockade and sirolimus. However, the engrafted pig islets in the long‐term period were fully rejected by activated immune cells, particularly T cells, when immunosuppressants were stopped, showing a failure of transplantation tolerance induction by autologous Tregs. Conclusions Taken together, autologous Tregs infused at the peri‐transplantation period failed to induce transplantation tolerance in pig‐to‐NHP islet xenotransplantation setting.