Recent focus in transplant pharmacology has been T cell co-stimulation. Here is a nice graphic from Nature Reviews in Immunology on interaction between T cell and Antigen Presenting Cell(APC). As you can see in the picture, both CD28 and CTLA-4 on T cells interact with same receptor CD80/CD86(B7-1/B7-2) on antigen presenting cells. While CD28 is co-stimulatory, CTLA-4 is required for immune regulation and inhibition. While Belatacept blocks CD80/86, thus interfering with both CD28 and CTLA-4 pathways, a newly identifiied true CD28 antagonist was shown to be preserve CTLA-4 dependent immune regulation and improve allograft survival in primates (Poirier et al, Science Translational Medicine 2010).
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