Safety and Efficacy of Antigen-Specific Regulatory T-Cell Therapy for Patients with Refractory Crohn's Disease.

BACKGROUND & AIMS: New therapeutic strategies are needed for patients with refractory Crohn's Disease (CD). We evaluated data from the Crohn's and T-regulatory Cell Study (CATS)1 to determine safety and efficacy of antigen-specific T regulatory (Treg) cells for treatment of refractory CD. METHODS: We performed a 12-week, open-labelled, multicenter, single injection, escalating dose, phase I and IIa clinical study in 20 patients with refractory CD. Ovalbumin-specific Treg cells (ova-Tregs) were isolated from patients' peripheral blood mononuclear cells (PBMC), exposed to ovalbumin, and administrated intravenously. Safety and efficacy were assessed using clinical and laboratory parameters. We evaluated proliferation of PBMC in response to ovalbumin. RESULT: sInjections of Ova-Tregs were well tolerated, with 54 adverse events (2 related to the test reagent) and 11 serious adverse events (3 related to the test reagent, all recovered). Overall, a response, based on a CD Activity Index (CDAI) reduction of 100 points, was observed in 40% of patients at Weeks 5 and 8. Six out of the 8 patients (75%) that received doses of 106 cells had a response, at Weeks 5 and 8, with statistically significant reduction in CDAI. In this group, remission (based on CDAI ≤ 150) was observed in 3/8 patients (38%) at Week 5 and 2/8 patients (25%) at Week 8. CONCLUSIONS: Administration of antigen-specific Treg cells to patients with refractory CD (CATS1) was well tolerated and had dose-related efficacy. The ovalbumin-specific immune response correlated with clinical response, supporting immune-suppressive mechanisms of ova-Tregs. The consistency of results among different assessment methods supports the efficacy of ova-Tregs; this immune therapy approach warrants further clinical and mechanistic studies in refractory CD. Eudract N° 2006-004712-44.