Gene editing to induce FOXP3 expression in human CD4+ T cells leads to a stable regulatory phenotype and function

Y Honaker, N Hubbard, Y Xiang, L Fisher… - Science translational …, 2020 - science.org
Y Honaker, N Hubbard, Y Xiang, L Fisher, D Hagin, K Sommer, Y Song, SJ Yang, C Lopez…
Science translational medicine, 2020science.org
Thymic regulatory T cells (tTregs) are potent inhibitors of autoreactive immune responses,
and loss of tTreg function results in fatal autoimmune disease. Defects in tTreg number or
function are also implicated in multiple autoimmune diseases, leading to growing interest in
use of Treg as cell therapies to establish immune tolerance. Because tTregs are present at
low numbers in circulating blood and may be challenging to purify and expand and also
inherently defective in some subjects, we designed an alternative strategy to create …
Thymic regulatory T cells (tTregs) are potent inhibitors of autoreactive immune responses, and loss of tTreg function results in fatal autoimmune disease. Defects in tTreg number or function are also implicated in multiple autoimmune diseases, leading to growing interest in use of Treg as cell therapies to establish immune tolerance. Because tTregs are present at low numbers in circulating blood and may be challenging to purify and expand and also inherently defective in some subjects, we designed an alternative strategy to create autologous Treg-like cells from bulk CD4+ T cells. We used homology-directed repair (HDR)–based gene editing to enforce expression of FOXP3, the master transcription factor for tTreg. Targeted insertion of a robust enhancer/promoter proximal to the first coding exon bypassed epigenetic silencing, permitting stable and robust expression of endogenous FOXP3. HDR-edited T cells, edTregs, manifested a transcriptional program leading to sustained expression of canonical markers and suppressive activity of tTreg. Both human and murine edTregs mediated immunosuppression in vivo in models of inflammatory disease. Further, this engineering strategy permitted generation of antigen-specific edTreg with robust in vitro and in vivo functional activity. Last, edTreg could be enriched and expanded at scale using clinically relevant methods. Together, these findings suggest that edTreg production may permit broad future clinical application.
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