Indication-specific immunomodulatory effects of extracorporeal photopheresis: A pilot study in heart transplanted patients

Background The clinical use of extracorporeal photopheresis (ECP) is based on its ability to induce cell-mediated immune tolerance towards foreign and self-antigens. Up-to-date, no clear consensus consists on how to use ECP after heart transplantation (HTx). In this pilot study, we evaluated the stimulatory effects of ECP on immune cells in HTx patients. MethodsResultsHTx patients received ECP therapy as prophylaxis of rejection (PRX, n=15), to treat acute cellular rejection (ACR, n=13) or cardiac allograft vasculopathy (CAV, n=5). Three ECP cycles with monthly frequency were performed. Blood samples were taken before every ECP cycle and 2 months after the last ECP cycle and were analyzed for cytokines and the tolerance-inducing cell subsets regulatory T cells (T-regs), myeloid (mDCs), and plasmacytoid dendritic cells (pDCs). While ECP treatment induced first an increase of pDCs in the CAV group (baseline: 22.0%9.6%, prior third ECP cycle: 8.6%+/- 3.2%, follow-up: 31.5%+/- 8.4%, P=.009), no significant changes of DC subsets and T-regs were observed in the ACR- and in the PRX group. Furthermore, analysis of the immune balance showed different response profiles of pro- and anti-inflammatory cytokines among prophylactically ECP-treated patients and ECP-treated patients suffering from CAV or ACR. ConclusionsIn our pilot study, we showed different stimulatory effects of ECP on pDCs and cytokines among prophylactic and therapeutic ECP therapy after HTx. Immunological monitoring should be included in a larger clinical study of ECP treatment following HTx and to identify predictable parameters for ECP efficacy.