Factors Influencing Reconstitution of Mucosal-Associated Invariant T Cells Following Allogeneic Hematopoietic Stem Cell Transplantation

Background: Mucosal-associated invariant T (MAIT) cells are innate-like T cells characterized by high expression of CD161 and a semi-invariant T cell receptor (TCR) comprised of a Vα7.2-Jα33 alpha chain and a limited Vβ repertoire that enables their activation by riboflavin metabolites produced by distinct bacterial and fungal species. MAIT cells are infrequent in cord blood, but undergo TCR-dependent accumulation in neonates in response to gastrointestinal (GI) commensal colonization to comprise approximately 10% of T cells in adult blood. The GI localization of MAIT cells, their capacity to secrete IL-17, and their activation by microbial metabolites suggests a role in mucosal immunity that may be particularly important after allogeneic hematopoietic stem cell transplantation (HCT) when the GI mucosal barrier is compromised and adaptive immunity is impaired. After HCT, the composition of the GI microbiota may be modified by antibiotics, mucositis and immunosuppression, yet its impact on MAIT cell reconstitution, function and post-transplant immunity remain unknown.

Aims: To characterize and identify factors influencing MAIT cell reconstitution and function after HCT.

Methods: Blood and stool samples were collected from healthy donors and HCT patients prior to and at distinct times after HCT. Absolute counts of MAIT cells, identified as CD3⁺/CD161^hi/Vα7.2⁺events, were determined in peripheral blood using flow cytometry performed in conjunction with a complete blood count. The bacterial composition of stool was characterized using bacterial 16S rRNA gene PCR with high throughput sequencing and phylogenetic assignment of the amplified fragments. TCR signaling pathway activation in MAIT cells and conventional T cells was evaluated using flow cytometry analysis of phosphoprotein expression after stimulation through the TCR-CD3 complex with anti-CD3/anti-CD28 monoclonal antibodies. TCR Vβ repertoire assessment was performed using high throughput TCRBV gene sequencing.

Results: High throughput TCRBV gene sequencing showed that MAIT cells from different donors (n = 3) shared TCRBV sequences, consistent with their capacity to be activated by common GI microbial TCR ligands. Despite GI microbial colonization, MAIT cells from adult donor blood were quiescent and did not proliferate to TCR stimulation. Phosphoprotein flow cytometry established that phosphorylation of proximal TCR signaling pathway molecules (CD3ζ, Lck, and ZAP-70) was diminished and responsible for impaired TCR signaling in adult MAIT cells compared to conventional αβ T cells. MAIT cell proliferation was restored by TCR stimulation in the presence of IL-1β, IL-12, IL-18 and IL-23, raising the possibility that the post-HCT inflammatory environment might be permissive for MAIT cell proliferation driven by GI microbial TCR ligands. We examined the kinetics of MAIT cell reconstitution in HCT patients (n = 163). MAIT cell numbers were lower in patients before conditioning compared to healthy individuals, and were further depleted on the day of stem cell infusion; however, they proliferated in the post-HCT environment in association with induction of Ki67 expression and reached a plateau after day 30 post-HCT (healthy, 56.8/μL; day 30, 6.7/μL). MAIT cell reconstitution after peripheral blood stem cell (PBSC) transplantation was similar comparing myeloablative (MA) and reduced intensity conditioning (RIC) regimens and related compared to unrelated donors, but was highly variable between individuals. Short tandem repeat PCR chimerism studies showed that MAIT cells were of donor origin early after MA and RIC PBSC transplantation. MAIT cell reconstitution was markedly impaired in recipients of cord blood, which contains few MAIT cells, compared to those receiving PBSC, in which MAIT cells are plentiful, suggesting that early MAIT cell reconstitution is primarily derived from mature cells transferred with the HCT graft. Analysis of stool samples from HCT recipients (n = 17) has shown that the relative abundance of distinct gut bacterial species is highly variable between recipients and changed during the course of HCT. Analyses of the relationship between the microbiota and MAIT cell reconstitution will be presented.

Conclusions: MAIT cell recovery following HCT varies between different types of transplants and may be influenced by the transferred graft source, the post-HCT environment, and the gut microbiome.