Integration of exogenous and endogenous co-stimulatory signals by CAR-Tregs

Regulatory T cells (Tregs) expressing chimeric antigen receptors (CAR) are a promising tool to promote transplant tolerance. The relationship between CAR structure and Treg function was studied in xenogeneic, immunodeficient mice, revealing advantages of CD28-encoding CARs. However, these models could underrepresent interactions between CAR-Tregs, antigen-presenting cells (APCs) and donor-specific antibodies. We generated mouse Tregs expressing HLA-A2-specific CARs with different costimulatory domains and compared their function in vitro and in vivo. In vitro assays revealed the CD28-encoding CAR had superior antigen-specific suppression, proliferation and cytokine production. In contrast, in vivo protection from skin allograft rejection and alloantibody production was similar between Tregs expressing CARs encoding CD28, ICOS or PD1, but not GITR, 41BB or OX40, co-stimulatory domains. To reconcile in vitro and in vivo data, we analyzed effects of a CAR encoding CD3{zeta} but no co-stimulatory domain. These data revealed that exogenous co-stimulation via APCs can compensate for the lack of a CAR-encoded CD28 domain. Thus, Tregs expressing a CAR with or without CD28 are functionally equivalent in vivo. This study reveals a new dimension of CAR-Treg biology and has important implications for the design of CARs for clinical use in Tregs.