CTLA4 blockade expands FoxP3+ regulatory and activated effector CD4 ⁺ T cells in a dose-dependent fashion

Cytotoxic T lymphocyte-associated antigen 4 (CTLA4) delivers inhibitory signals to activated T cells. CTLA4 is constitutively expressed on regulatory CD4+ T cells (Tregs), but its role in these cells remains unclear. CTLA4 blockade has been shown to induce antitumor immunity. In this study, we examined the effects of anti-CTLA4 antibody on the endogenous CD4⁺ T cells in cancer patients. We show that CTLA4 blockade induces an increase not only in the number of activated effector CD4⁺ T cells, but also in the number of CD4⁺ FoxP3⁺ Tregs. Although the effects were dose-dependent, CD4⁺ FoxP3⁺ regulatory T cells could be expanded at lower antibody doses. In contrast, expansion of effector T cells was seen only at the highest dose level studied. Moreover, these expanded CD4 ⁺ FoxP3⁺ regulatory T cells are induced to proliferate with treatment and possess suppressor function. Our results demonstrate that treatment with anti-CTLA4 antibody does not deplete human CD4⁺ FoxP3⁺ Tregs in vivo, but rather may mediate its effects through the activation of effector T cells. Our results also suggest that CTLA4 may inhibit Treg proliferation similar to its role on effector T cells. This study is registered at http://www.clinicattrials.gov/ct2/show/NCT00064129, registry number NCT00064129.