An update on potentials and promises of T cell co‐signaling molecules in transplantation

The promising outcomes of immune‐checkpoint based immunotherapies in cancer have provided a proportional perspective ahead of exploiting similar approaches in allotransplantation. Belatacept (CTLA‐4‐Ig) is an example of costimulation blockers successfully exploited in renal transplantation. Due to the wide range of regulatory molecules characterized in the past decades, some of these molecules might be candidates as immunomodulators in the case of tolerance induction in transplantation. Although there are numerous attempts on the apprehension of the effects of co‐signaling molecules on immune response, the necessity for a better understanding is evident. By increasing the knowledge on the biology of co‐signaling pathways, some pitfalls are recognized and improved approaches are proposed. The blockage of CD80/CD28 axis is an instance of evolution toward more efficacy. It is now evident that anti‐CD28 antibodies are more effective than CD80 blockers in animal models of transplantation. Other co‐signaling axes such as PD‐1/PD‐L1, CD40/CD154, 2B4/CD48, and others discussed in the present review are examples of critical immunomodulatory molecules in allogeneic transplantation. We review here the outcomes of recent experiences with co‐signaling molecules in preclinical studies of solid organ transplantation. T cell co‐signaling molecules pose an exclusive opportunity for management of destructive immune responses during allogeneic transplantation. The manipulation in specific arms of the immune system is the hallmark of interventions in co‐signaling molecules in transplantation.