Beneath the radar: immune-evasive cell sources for stroke therapy.

The brain is not immune privileged, leading to new challenges for cell therapies. While cell therapies for stroke have been shown to enhance recovery in animal studies, their move into clinical reality needs to be reassessed from an immunological perspective. A major hurdle in allogeneic cell transplantation is the low immunocompatibility due to human leukocyte antigen (HLA) mismatches. Finding an HLA match for unrelated individuals is 1 in 100 000, and hundreds of homozygous cell lines are needed for most of the population. Modifying HLAs and related genes in cell grafts has improved immune compatibility in animal studies, setting the stage for human trials. HLA engineering offers a means to bypass the host immune response and reduce cells required for the HLA spectrum. However, these cell sources introduce safety challenges, addressed with genetic safety mechanisms. Stem cell therapy is an emerging treatment paradigm for stroke patients with remaining neurological deficits. While allogeneic cell transplants overcome the manufacturing constraints of autologous grafts, they can be rejected by the recipient's immune system, which identifies foreign cells through the human leukocyte antigen (HLA) system. The heterogeneity of HLA molecules in the human population would require a very high number of cell lines, which may still be inadequate for patients with rare genetic HLAs. Here, we outline key progress in genetic HLA engineering in pluripotent stem and derived cells to evade the host's immune system, reducing the number of allogeneic cell lines required, and examine safety measures explored in both preclinical studies and upcoming clinical trials. [ABSTRACT FROM AUTHOR]