Abstract Ocular infection with HSV-1 results in a chronic immunoinflamammtory reaction in the cornea, which is primarily orchestrated by CD4 T cells. Hence, targeting proinflammatory CD4 T cells or increasing the representation of cells that regulate their function are relevant therapeutic strategies. In the present report, we use an agonistic mAb (4C12) to TNF receptor 25 (TNFR25) that selectively expands numbers of regulatory T cells (Tregs). Treatment early after ocular HSV infection with 4C12 caused a three fold increase in the Treg numbers in the cornea along with a consequent reduction in SK lesion severity. However, 4C12 treatment was less effective if given 6 days after infection since it expanded proinflammatory T effectors that also express TNFR25. To suppress the latter population, galectin-9 (Gal-9) was used which causes apoptosis of Th1 cells. When therapy with both 4C12 and gal-9 was used in combination, the recipients showed significantly reduced angiogenesis and SK lesions over single treatment controls. The beneficial outcome of the combination therapy was attributed to the expansion of the Treg population that expressed CD103 needed for trafficking to inflammatory sites along with a marked reduction in the infiltration of pathogenic CD4 T cells. Levels of several proinflammatory cytokines and chemokines were also reduced. Our results demonstrate that combination therapy may be a promising approach to control HSV induced SK lesions, a common cause of human blindness.
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