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Vaccination against hepatitis B in liver transplant recipients: Pilot analysis of cellular immune response shows evidence of HBsAg‐specific regulatory T cells

After liver transplantation for hepatitis‐B‐related diseases, patients currently receive lifelong treatment with hepatitis B immunoglobulin to prevent endogenous reinfection with hepatitis B virus (HBV). Active immunization with hepatitis B vaccine would be a preferable alternative; however, most attempts to immunize these patients with standard vaccine have failed. A recent study with a new adjuvanted hepatitis B vaccine was exceptionally successful, leading to a high‐titered long‐lasting antibody response in 80% of all vaccinees. To identify the immunological mechanisms behind these unexpected results, the successfully vaccinated participants were tested for hepatitis B surface antigen (HBsAg)‐specific T and B cells, and their cellular responses to revaccination with conventional vaccine were studied. HBsAg‐specific CD4+ T lymphocytes could be detected in 13 of 16 patients after immunization with the new vaccine. Unexpectedly, these T cells produced almost exclusively interleukin (IL)‐10 and had a CD4+/CD25+ phenotype. They were functionally active, suppressing cytokine secretion in HBsAg‐specific (Th1) cells, thus representing antigen‐specific regulatory T cells (TReg). Following a booster dose with conventional vaccine 22‐31 months after completion of the initial vaccination series, the T‐cell pattern in the revaccinated individuals changed substantially: 7 days after revaccination 9 of 11 individuals showed a switch to a Th1‐type immune response with HBsAg‐specific T cells secreting IL‐2, interferon gamma and tumor necrosis factor alpha as observed in healthy controls. Four weeks after the booster, 4 patients still showed a Th1‐type cytokine pattern, whereas in 5 patients only IL‐10‐secreting cells were detectable. After 1 year, in 3 of 4 revaccinated individuals only IL‐10‐secreting cells could be found, whereas the specific T cells of the fourth patient still showed a Th1‐type of response. HBsAg‐specific TReg cells could be demonstrated in HBV‐positive liver transplant recipients successfully immunized with a new adjuvanted vaccine. Revaccination led to immediate disappearance of the these cells and the appearance of HBsAg‐specific T cells with a Th1‐type cytokine profile, which in most cases were replaced by the IL‐10‐secreting regulatory cells during the following months. The specific induction of TReg cells could contribute to the poor response of liver transplant recipients to conventional vaccine. In conclusion,, for successful vaccination of these patients, a vaccine with a strong inhibitory effect on TReg cells would be desirable. Liver Transpl 13:434–442, 2007. © 2007 AASLD.