Regulatory cell therapy in kidney transplantation (The ONE Study): a harmonised design and analysis of seven non-randomised, single-arm, phase 1/2A trials

Data sharing: We will follow the common controlled access principles outlined by the Medical Research Council Clinical Trials Unit. According to those principles, we will acknowledge that data with long-term value be preserved, and usable for future research. We do, however, want to ensure that there are legal, ethical, and commercial constraints maintained on the release of research data according to the following code. Research teams are entitled to receive appropriate recognition for their efforts in collecting and analysing data and should be given at least a limited period of sole access to use and publish the data, before key trial data are open for use by other researchers. If such requests are made to access the data, resources need to be available to process the request and prepare the data in a timely manner, if possible. Because of these demands, there must be an important scientific objective behind each request. Especially in the case of our international project, The ONE Study, any request must comply with regulations set by the competent authorities in the relevant countries that govern data security policies.Supplementary material is available online at: https://www.sciencedirect.com/science/article/pii/S0140673620301677#sec1 .Background: Use of cell-based medicinal products (CBMPs) represents a state-of-the-art approach for reducing general immunosuppression in organ transplantation. We tested multiple regulatory CBMPs in kidney transplant trials to establish the safety of regulatory CBMPs when combined with reduced immunosuppressive treatment. Methods: The ONE Study consisted of seven investigator-led, single-arm trials done internationally at eight hospitals in France, Germany, Italy, the UK, and the USA (60 week follow-up). Included patients were living-donor kidney transplant recipients aged 18 years and older. The reference group trial (RGT) was a standard-of-care group given basiliximab, tapered steroids, mycophenolate mofetil, and tacrolimus. Six non-randomised phase 1/2A cell therapy group (CTG) trials were pooled and analysed, in which patients received one of six CBMPs containing regulatory T cells, dendritic cells, or macrophages; patient selection and immunosuppression mirrored the RGT, except basiliximab induction was substituted with CBMPs and mycophenolate mofetil tapering was allowed. None of the trials were randomised and none of the individuals involved were masked. The primary endpoint was biopsy-confirmed acute rejection (BCAR) within 60 weeks after transplantation; adverse event coding was centralised. The RTG and CTG trials are registered with ClinicalTrials.gov, NCT01656135, NCT02252055, NCT02085629, NCT02244801, NCT02371434, NCT02129881, and NCT02091232. Findings: The seven trials took place between Dec 11, 2012, and Nov 14, 2018. Of 782 patients assessed for eligibility, 130 (17%) patients were enrolled and 104 were treated and included in the analysis. The 66 patients who were treated in the RGT were 73% male and had a median age of 47 years. The 38 patients who were treated across six CTG trials were 71% male and had a median age of 45 years. Standard-of-care immunosuppression in the recipients in the RGT resulted in a 12% BCAR rate (expected range 3·2–18·0). The overall BCAR rate for the six parallel CTG trials was 16%. 15 (40%) patients given CBMPs were successfully weaned from mycophenolate mofetil and maintained on tacrolimus monotherapy. Combined adverse event data and BCAR episodes from all six CTG trials revealed no safety concerns when compared with the RGT. Fewer episodes of infections were registered in CTG trials versus the RGT. Interpretation: Regulatory cell therapy is achievable and safe in living-donor kidney transplant recipients, and is associated with fewer infectious complications, but similar rejection rates in the first year. Therefore, immune cell therapy is a potentially useful therapeutic approach in recipients of kidney transplant to minimise the burden of general immunosuppression. Funding: The 7th EU Framework Programme.The 7th EU Framework Programme. This work was also supported by funds from IHU-CESTI (Investissement d'Avenir ANR-10-IBHU-005, Région Pays de la Loire and Nantes Métropole), the Labex IGO project (ANR-11-LABX-0016-01), and a donation from John Lang and Nancy Merrell. We also thank the Cell and Gene Therapy Manufacturing facility from Centre Hospitalier Universitaire de Nantes for the ATDC production. In addition, we thank apceth Biopharma (Munich, Germany) for Mreg production in the study. We thank the nurses, physicians, and patients who contributed to the study. The research leading to these results has received funding from the EU Seventh Framework Programme (FP7) under grant agreement number 260687. This research was funded and supported in part by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London and the NIHR Clinical Research Facility.

Diversity, Heterotrophy, Autotropy, and Relationships among Microorganisms in Antarctica

Campaña He52 del B.I.O Hespérides - Cruise He52 of R/V Hespérides.-- 5 pages, 2 figuresPeer reviewe