Understanding tolerance following immune reconstitution in MS

Progress to Date

To date, several aims of the study have been realised using the St Vincent’s Hospital MS database and biobank. A deep exploration of white blood cells called lymphocytes has been performed in patients that have undergone AHSCT to better understand the immune reconstitution.  The key findings are around the patterns of immune reconstruction following AHSCT, measuring lymphocyte subsets, and identifying important markers that may be implicated in MS relapses or worsening disease.

During AHSCT, there is initial immune depletion (by chemotherapy) and re-infusion of the stored immune stem cells. Immediately following these procedures, there is a very low count of immune cells called lymphocytes in the blood, or “lymphopenia”. Dr Massey has found that a state of lymphopenia favours the regrowth of particular immune T cells that can suppress autoimmunity. By measuring immune cells up to 3 years after transplant, the study also showed that even after the number of immune cells has full restored, changes in T cell balance achieved by the transplant remain stable at 3 years post-transplant. Interestingly, a specific clone of T cells was detected after AHSCT in one patient at the time of a clinical relapse, and may potentially be associated with relapse, although further work is required to understand this phenomenon.  The findings of this part of the study are being prepared for publication during 2021.

During the next year, Dr Massey plans to explore T memory stem cells in more detail and track patients over time pre- and post-AHSCT to determine if these cells have any influence on the outcome of AHSCT.

Updated: 15 April 2021