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BARDAWIL WA, TOY BL. THE NATURAL HISTORY OF CHORIOCARCINOMA: PROBLEMS OF IMMUNITY AND SPONTANEOUS REGRESSION*. Ann N Y Acad Sci 2006; 80:197-261. [PMID: 13796690 DOI: 10.1111/j.1749-6632.1959.tb49205.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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52
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Scharpf J, Strome M, Siemionow M. Immunomodulation with anti-αβ T-cell receptor monoclonal antibodies in combination with cyclosporine a improves regeneration in nerve allografts. Microsurgery 2006; 26:599-607. [PMID: 17066409 DOI: 10.1002/micr.20294] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the use of nerve allografts in animals treated with a short-term combined protocol of anti-alpha/beta T-cell receptor monoclonal antibodies and Cyclosporine A (CsA) to induce tolerance and allow for nerve regeneration. STUDY DESIGN An established rat sciatic nerve model was used. A total of 76 rats were used in this experiment (Lew RT1L n=44, Lewis-Brown-Norway (LBN RT1L+N, n=22), Brown-Norway (BN RT1N, n=10). Sciatic nerve (1.5 cm) deficits were created in the Lewis rats and the animals were randomized to seven treatment groups to allow for repair with isograft controls (LEW-LEW) and with both semiallogeneic (LBN-LEW) and full major histocompatability (MHC) mismatched (BN-Lew) allografts. METHODS Nerve regeneration was evaluated at 6 and 12 weeks by somatosensory evoked potentials (SSEP) and standardized pin-prick and toe-spread tests. Nerve samples were harvested at 12 weeks and stained with toluidine blue to assess the total number of myelinated axons, axon area, and myelin sheath thickness. Muscle denervation atrophy was evaluated by gastrocnemius weights. Immunocompetence was investigated through skin grafting and fluorescent activated cell sorting (FACS) analysis. RESULTS Improved functional, electrophysiologic, and histomorphometric outcomes were observed in animals treated with anti-alpha/betaTCR mAbs and CsA after nerve allograft transplantation when compared to animals receiving no treatment and CsA alone. CONCLUSIONS The immunomodulating protocol of combination anti-alpha/beta TCR mAbs and CsA for a 5 week period altered the rejection process, affording nerve regeneration. It may provide for an expanded source of nerve tissue to alleviate the morbidity of harvesting peripheral nerves from multiple sites for those afflicted with extensive peripheral nerve injuries.
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Affiliation(s)
- Joseph Scharpf
- Head and Neck Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Wong BW, Rahmani M, Rezai N, McManus BM. Progress in heart transplantation. Cardiovasc Pathol 2005; 14:176-80. [PMID: 16009314 DOI: 10.1016/j.carpath.2005.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 05/09/2005] [Indexed: 11/20/2022] Open
Abstract
The field of heart transplantation was built upon the discoveries of immunity and tolerance by Landsteiner, Medawar, Burnet, and others, as well as technical advancements in surgical technique by Carrel. Since the first successful human heart transplant performed by Christiaan Barnard in 1967, there has been substantial progress in the field of heart transplantation, especially over the last several decades. With advances in immunosuppression and surgical techniques, the rates of acute rejection and infection leading to graft failure have declined. However, the detection of acute and chronic allograft rejection remains one of the most important yet unsettled matters. As such, many new horizons exist for further advancement of the field of heart transplantation and for improving the outcomes of the patients we serve.
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Affiliation(s)
- Brian W Wong
- The James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, Department of Pathology and Laboratory Medicine, St. Paul's Hospital/Providence Health Care, University of British Columbia, Vancouver, BC, Canada, V6Z 1Y6
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54
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Affiliation(s)
- Jonathan Sprent
- Department of Immunology, IMM4, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
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55
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Siemionow M, Ozer K, Izycki D, Unsal M, Klimczak A. A New Method of Bone Marrow Transplantation Leads to Extention of Skin Allograft Survival. Transplant Proc 2005; 37:2309-14. [PMID: 15964406 DOI: 10.1016/j.transproceed.2005.03.054] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Indexed: 11/27/2022]
Abstract
Tolerance induction through allogeneic bone marrow transplantation is an alternative method to chronic immunosuppression in maintaining long-term allograft survival. In this article, we introduce a new method of bone marrow allotransplantation, which preserves its natural microenvironment and does not require marrow processing or recipient conditioning. A total of 43 skin graft transplantations were performed in nine experimental groups between isogeneic [Lewis to Lewis (LEW, RT1(1))] and allogeneic [Lewis x Brown Norway (LBN --> F1, RT1(1+n)) to Lewis] rats under 35-day protocol of alphabeta T-cell receptor (TCR) monoclonal antibody (mAb) and cyclosporine (CsA) protocol. Monotherapies combined with "crude" bone marrow transplantation resulted in extended survival up to 21 days under CsA and up to 10 days under alphabeta-TCR mAb protocol. The use of combined protocol of alphabeta-TCRmAb/CsA with crude bone marrow transplantation resulted in the extension of skin allograft survival up to 65 days (P < .05). This new simple method of "crude" bone marrow allotransplantation without recipient conditioning is a promising, minimally invasive technique with a potential for direct clinical application.
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Affiliation(s)
- M Siemionow
- Department of Plastic Surgery A-60, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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56
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Simpson E. Reminiscences of Sir Peter Medawar: in hope of antigen-specific transplantation tolerance. Am J Transplant 2004; 4:1937-40. [PMID: 15575894 DOI: 10.1111/j.1600-6143.2004.00687.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Peter Medawar's career in medical research (he always described himself as a medical research scientist) began as a student of zoology in Oxford. He obtained a first class degree in 1936, aged 21, and undertook postgraduate studies with Florey. His work was anchored in a broad field; he was adept at addressing novel questions in the context of prior ideas and knowledge. His earlier interest in growth, driven as much by mathematics as biology, gave way to transplantation at the beginning of World War II, treatment of burns patients being the driver. He interpreted the results of grafting autologous and allogeneic human skin, observed clinically and microscopically, as immunological; he identified accelerated donor-specific reactions to subsequent grafts as 'second set', and described cell (lymphocyte) mediated infiltration of allo- but not auto-grafts following initial vascularization, both in the patient context and in experimental animals. He became intrigued by the consequences of hematopoietic chimerism, from which his landmark discoveries on the induction of transplantation tolerance derive. These results, his interpretation and dissemination of them, gave hope to transplant surgeons that donor-specific transplant tolerance would be achievable. Many immunosuppressive drugs later, we are now reapproaching this hope, from various angles.
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Affiliation(s)
- Elizabeth Simpson
- Transplantation Biology Group, Clinical Sciences Centre, Imperial College, London, Hammersmith Hospital, London W12 ONN, UK.
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57
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Abstract
Studies in experimental models (1953-1956) demonstrated that acquired donor-specific allotolerance in immunologically immature or irradiated animals is strongly associated with donor leukocyte chimerism. Bone marrow transplantation in immune-deficient or cytoablated human recipients was a logical extension (1968). In contrast, clinical (1959) and then experimental organ transplantation was systematically accomplished in the apparent absence of leukocyte chimerism. Consequently, it was assumed for many years that success with organ and bone marrow transplantation involved fundamentally different mechanisms. With the discovery in 1992 of small numbers of donor leukocytes in the tissues or blood of long-surviving organ recipients (microchimerism), we concluded that organ engraftment was a form of leukocyte chimerism-dependent partial tolerance. In this initially controversial paradigm, alloengraftment after both kinds of transplantation is the product of a double immune reaction in which responses, each to the other, of coexisting donor and recipient immune systems results in variable reciprocal clonal exhaustion, followed by peripheral clonal deletion. It was proposed with Rolf Zinkernagel that the individual alloresponses are the equivalent of the MHC-restricted T cell recognition of, and host response to, intracellular parasites and that the mechanisms of immune responsiveness, or nonresponsiveness, are governed by the migration and localization of the respective antigens. Elucidation of the mechanisms of nonresponsiveness (clonal exhaustion-deletion and immune ignorance) and their regulation removed much of the historical mystique of transplantation. The insight was then applied to improve the timing and dosage of immunosuppression of current human transplant recipients.
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Affiliation(s)
- Thomas E Starzl
- Transplantation Institute, University of Pittsburgh Medical Center, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
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58
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Abstract
Many methods for reducing the immunosuppressive requirements of allotransplantation have been proposed based on a growing understanding of physiological and allospecific immunity. As these regimens are developed for clinical application, they require validation in models that are reasonably predictive of their performance in humans. This article provides an overview of the large animal models commonly used to test immunomodulatory organ transplant protocols. The rationale for the use of large animals and the effects of common immunosuppressants in the dog, pig, and non-human primate are reviewed. Promising methods for the induction of allospecific tolerance are surveyed with references to early human trials where appropriate.
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Affiliation(s)
- Allan D Kirk
- Transplantation Section, Transplantation and Autoimmunity Branch, National Institute of Diabetes, Digestive and Kidney Diseases/NIH/DHHS, Building 10, Room 11S/219, Bethesda, MD 20892, USA.
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Abstract
Tolerance of T lymphocytes to self-antigens is mainly achieved at the level of the primary lymphoid organ, the thymus, and probably to a lesser extent in the secondary lymphoid tissues. Whether self-reactive lymphocytes ignore their target autoantigen, or are tolerized by the various mechanisms discussed, depends on the circumstances.
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Affiliation(s)
- Jacques Miller
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria 3050, Australia.
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60
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Kurtz J, Shaffer J, Lie A, Anosova N, Benichou G, Sykes M. Mechanisms of early peripheral CD4 T-cell tolerance induction by anti-CD154 monoclonal antibody and allogeneic bone marrow transplantation: evidence for anergy and deletion but not regulatory cells. Blood 2004; 103:4336-43. [PMID: 14962909 DOI: 10.1182/blood-2003-08-2642] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Anti-CD154 (CD40L) monoclonal antibody (mAb) plus bone marrow transplantation (BMT) in mice receiving CD8 cell-depleting mAb leads to long-term mixed hematopoietic chimerism and systemic donor-specific tolerance through peripheral and central deletional mechanisms. However, CD4(+) T-cell tolerance is demonstrable in vitro and in vivo rapidly following BMT, before deletion of donor-reactive CD4 cells is complete, suggesting the involvement of other mechanisms. We examined these mechanisms in more detail. Spot enzyme-linked immunosorbent (ELISPOT) analysis revealed specific tolerization (within 4 to 15 days) of both T helper 1 (Th1) and Th2 cytokine responses to the donor, with no evidence for cytokine deviation. Tolerant lymphocytes did not significantly down-regulate rejection by naive donor-reactive T cells in adoptive transfer experiments. No evidence for linked suppression was obtained when skin expressing donor alloantigens in association with third-party alloantigens was grafted. T-cell receptor (TCR) transgenic mixing studies revealed that specific peripheral deletion of alloreactive CD4 T cells occurs over the first 4 weeks following BMT with anti-CD154. In contrast to models involving anti-CD154 without BMT, BMT with anti-CD154 leads to the rapid induction of anergy, followed by deletion of pre-existing donor-reactive peripheral CD4(+) T cells; the rapid deletion of these cells obviates the need for a regulatory cell population to suppress CD4 cell-mediated alloreactivity.
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Affiliation(s)
- Josef Kurtz
- Bone Marrow Transplantation Section, Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02129, USA
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61
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Abstract
In less than 50 years the field of organ transplantation has transitioned from an experimental concept to clinical commonplace. Notwithstanding the dramatic improvements in patient and allograft outcomes, chronic rejection and the complications from life-long immunosuppressive therapy remain significant problems. The induction of transplantation tolerance, indefinite allograft acceptance independent of chronic immunosuppressive therapy, remains the ultimate objective in transplantation. Many strategies have achieved tolerance to transplanted tissue in rodents; however, few, if any, have shown equal efficacy when tested in non-human primate transplant models or human patients. A critical distinction between specific pathogen-free mice and primates or human patients is the exposure of the latter to environmental pathogens and the resultant-acquired immune history. Recent data has shown that virally induced, alloreactive immune responses can provide a potent barrier to tolerance. In this review, we discuss one of the most robust methods for tolerance, the induction of hematopoietic chimerism as well as the influence of viral infections on the alloimmune response.
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Affiliation(s)
- Andrew B Adams
- Emory Transplant Center and Department of Surgery, Emory University School of Medicine, 1639 Pierce Drive, Atlanta, GA 30322, USA
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63
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64
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Ichim TE, Zhong R, Min WP. Prevention of allograft rejection by in vitro generated tolerogenic dendritic cells. Transpl Immunol 2003; 11:295-306. [PMID: 12967783 DOI: 10.1016/s0966-3274(03)00048-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Achieving immunological tolerance in transplantation has been a long sought-after goal since the 1960s. It is, therefore, interesting that the dendritic cells (DC), which are classically known as the most potent stimulators of T cell activation, are now also considered putative tools for tolerance induction. In line with this, much work has been performed using DC for vaccination and immune stimulation. Recently, great interest has been generated regarding the ability of DC to act as immune regulatory cells. Specific subsets of DC or immature DC (iDC) appear to be responsible for maintaining self-tolerance. In this review we will highlight our efforts at elucidating the contribution of DC in transplant tolerant in mice. Specifically, four strategies will be outlined that are currently being used for the generation of DC that have tolerogenic properties in the prevention of allograft rejection. The present study demonstrates that modulated iDC with blunted T cell stimulatory or antigen presentation abilities can afford transplant tolerance by minimizing T cell activation and proinflammatory cytokine production. Moreover, in an alternate strategy, normally matured DC have also been modulated such that alloreactive T cells are specifically targeted for deletion.
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Affiliation(s)
- Thomas E Ichim
- Department of Surgery, University of Western Ontario, London, Ont., Canada
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65
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Zijlstra A, Testa JE, Quigley JP. Targeting the proteome/epitome, implementation of subtractive immunization. Biochem Biophys Res Commun 2003; 303:733-44. [PMID: 12670472 DOI: 10.1016/s0006-291x(03)00357-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Monoclonal antibody technology has generated invaluable tools for both the analytical and clinical sciences. However, standard immunization approaches frequently fail to provide monoclonal antibodies with the desired specificity. Subtractive immunization provides a powerful alternative to standard immunization and allows for the production of truly unique antibodies. With the intent of targeting specific epitopes within the proteome, subtractive immunization has been broadly and successfully implemented for the production of monoclonal antibodies otherwise unobtainable by standard immunization. Subtractive immunization utilizes a distinct immune tolerization approach that can substantially enhance the generation of monoclonal antibodies to desired antigens. The approach is based on tolerizing the host animal to immunodominant or otherwise undesired antigen(s) (tolerogen) that may be structurally or functionally related to the antigen of interest. Tolerization of the host animal can be achieved through one of three methods: High Zone, Neonatal, or Drug-induced tolerization. The tolerized animal is then inoculated with the desired antigen (immunogen) and antibodies generated by the subsequent immune response are screened for the desired antigenic reactivity. Over the past 15 years a large number of investigators have used the subtractive approach with cleverly chosen tolerogen-immunogen combinations and successfully generated uniquely reactive antibodies which are often neutralizing or function-blocking. This review will focus on the implementation of subtractive immunization for the production of antibodies otherwise unobtainable by standard immunization.
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Affiliation(s)
- Andries Zijlstra
- Division of Vascular Biology, Department of Cell Biology, The Scripps Research Institute, 10550 N. Torrey Pine Road, La Jolla, CA, USA
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66
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Affiliation(s)
- A P Monaco
- Harvard Medical School, Boston, Massachusetts, USA
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67
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David A, Cook T, Waddington S, Peebles D, Nivsarkar M, Knapton H, Miah M, Dahse T, Noakes D, Schneider H, Rodeck C, Coutelle C, Themis M. Ultrasound-guided percutaneous delivery of adenoviral vectors encoding the beta-galactosidase and human factor IX genes to early gestation fetal sheep in utero. Hum Gene Ther 2003; 14:353-64. [PMID: 12659676 DOI: 10.1089/104303403321208952] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In utero gene therapy may provide treatment of genetic diseases before significant organ damage, allow permanent genetic correction by reaching stem cell populations, and provide immune tolerance against the therapeutic transgenes and vectors. We have used percutaneous ultrasound-guided injection as a minimally invasive fetal procedure. First-generation adenoviruses encoding the nuclear localizing beta-galactosidase reporter gene or the human factor IX (hFIX) gene, or colloidal carbon were delivered via the umbilical vein (UV, n = 4), heart (intracardiac [IC], n = 2), liver parenchyma (intrahepatic [HE], n = 11), peritoneal cavity (intraperitoneal [IP], n = 14), skeletal musculature ([intramuscular [IM], n = 11), or the amniotic cavity (intraamniotic [IA], n = 14) to early-gestation fetal sheep (0.3 gestation = day 33-61). Postmortem analysis was performed at 2, 9, or 28 days after injection. Although fetal survival was between 77% and 91% for IP, HE, IA, and IM routes, no fetuses survived UV or IC procedures. The hFIX levels reaching 1900 and 401 ng/ml (IP), 30 ng/ml (HE), 66.5 and 39 ng/ml (IA), and 83 and 65.5 ng/ml (IM), respectively, were determined 2 days after injection and decreased at birth to 16.5 ng/ml (IP), 7 ng/ml (HE), 4.5 ng/ml (IA), and 4 and 0 ng/ml (IM). Polymerase chain reaction (PCR) and immunohistochemistry showed broadest hFIX transgene spread and highest localised beta-galactosidase expression, respectively, after IP administration. Antibodies were observed against vector but not against hFIX.
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Affiliation(s)
- Anna David
- Department of Obstetrics and Gynaecology, Royal Free and University College Medical School, 86-96 Chenies Mews, London, WC1E 6HX, United Kingdom.
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68
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Abstract
In the past 40 years, many protocols have been extensively studied for the induction of sustainable transplantation tolerance which might lead to protection of allografts from immunological injury in the clinical setting. Despite the enormous success in rodents, there is still no established protocol available yet for widespread clinical trials. Whilst clonal deletion, clonal anergy and suppression, now coined regulation, have been elucidated as the key immunological elements of tolerance, a better understanding of these mechanisms has so far done little to improve on the survival of organ transplants in humans. Haematopoietic chimaerism, as previously described by Medawar and colleagues [1], remains the most robust tool for tolerance induction. Unfortunately, bone marrow or haematopoietic stem cell transplantation for patients awaiting solid organ transplantation remains a high risk therapy, due to the dangers of graft-versus-host disease. Most recent data, however, indicate the potential of embryonic stem cells (ESC) to offer a possible solution for low risk induction of multilineage mixed chimaerism and tolerance not involving any immunosuppression, due to their unique property of low immunogenicity and high plasticity. Here, what we know about ESC in various species, and the potency and drawbacks of ESC for widespread clinical use, will be discussed.
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Affiliation(s)
- Nicholas Zavazava
- University of Iowa Hospitals and Clinics Clinics & VA Medical Center Iowa City, Department of Internal Medicine, 200 Hawkins Dr, IA 52242, Iowa City, USA.
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69
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Beschorner WE, Sudan DL, Radio SJ, Yang T, Franco KL, Hill AC, Shearon CC, Thompson SC, Dixon RS, Johnson ND, Kuszynski CA, Rubocki RJ, Lechtenberg KF, Matamoros A, Goertzen TC, Fox IJ, Langnas AN. Heart xenograft survival with chimeric pig donors and modest immune suppression. Ann Surg 2003; 237:265-72. [PMID: 12560785 PMCID: PMC1522128 DOI: 10.1097/01.sla.0000048456.81319.da] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the use of donor pigs with cellular chimerism for prevention of acute rejection with modest immune suppression. The clinical use of pig organ xenografts is currently precluded by severe acute rejection, which resists standard immune suppression. SUMMARY BACKGROUND DATA For long-term survival of pig organ xenografts, immune suppression significantly greater than used with allografts would currently be necessary, leaving the recipient immune deficient and at increased risk for infections. Induction of immune tolerance and tissue accommodation could enhance xenograft survival but would lead to complications and frequent graft failure. Induction of cellular chimerism within the donor pigs, however, could accomplish these goals before transplantation, significantly reducing the risk. METHODS Marrow cells from sheep were infused into fetal pigs. Heart xenografts from chimeric or nonchimeric pigs were transplanted heterotopically into recipient sheep, simultaneous with infusion of splenocytes. Posttransplant suppression consisted of cyclosporine and tapered corticosteroids, comparable with allotransplants. RESULTS All of the control grafts (n = 12) were rejected by acute vascular rejection in 4 to 8 days. In contrast, only one episode of vascular rejection was observed in the experimental group (n = 13). Four experimental recipients had an episode of moderate diffuse cellular rejection (grade 3) and one had moderate focal cellular rejection (grade 2). Each episode responded to pulse steroids. Seven grafts showed no significant rejection. There was little evidence of immune deficiency, infection, or toxicity. CONCLUSIONS Acute vascular rejection was prevented in a large animal model without the need for severe immune suppression.
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Affiliation(s)
- William E Beschorner
- Department of Surgery, Transplantation Section, University Nebraska Medical Center, Omaha, NE 68198-3285, USA.
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Donahue J, Carrier E. Non-myeloablative transplants for congenital diseases. Cancer Treat Res 2002; 110:177-211. [PMID: 11908198 DOI: 10.1007/978-1-4615-0919-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The morbidity and mortality associated with postnatal HSCT, toxicity of HSCT conditioning regimens, lifelong immunosuppressive therapy, and lack of compatible donors discourages many patients and physicians from utilizing postnatal HSCT as a treatment for congenital disease. Non-myeloblative in utero HSCT is now being considered as an alternate treatment with the hope that it will be more therapeutic with less toxicity to a wider spectrum of patients with congenital disorders. Prenatal stem cell transfer may eliminate many of the risks and hazards associated with postnatal HSCT, as the fetus may be less reactive than an immunologically mature individual such that tolerance to donor cells could be developed. GVHD and rejection of postnatal therapeutic grafts may be minimized thus reducing or eliminating altogether the need for postnatal myeloablation and immunosuppression. Much work must be done both in animal studies as well as in clinical trials. By using well-designed murine models such as the beta-thalassemic mouse outlined above, we believe we can determine the optimal conditions for non-myeloablative postnatal transplants with allogeneic or haplocompatible HSC following prenatal tolerance induction with these cells. In addition, we may answer basic immunology questions regarding the development and regulation of immunity and tolerance in both mice and humans.
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Affiliation(s)
- Jody Donahue
- Blood and Marrow Transplantation Division, University of California San Diego, La Jolla, CA 92093-0062, USA
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71
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Sefrioui H, Donahue J, Srivastava AS, Gilpin E, Lee TH, Carrier E. Alloreactivity following in utero transplantation of cytokine-stimulated hematopoietic stem cells: the role of recipient CD4(-) cells. Exp Hematol 2002; 30:617-24. [PMID: 12063030 DOI: 10.1016/s0301-472x(02)00803-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We have previously reported immunity to donor antigens following in utero transplantation (IUT) of cytokine-stimulated allogeneic hematopoietic stem cells (sca(+)/lin(-)) (day 9 of gestation). Transplanted mice showed accelerated rejection of donor skin grafts and high anti-donor cytotoxic response, a finding not seen in the control mice. This was accompanied by an enhancement of Th1 over Th2 cytokine production and persistent donor microchimerism. In order to assess the role of the thymus in allograft rejection, prenatal transplants were performed under similar experimental conditions at a later gestational age, when the thymus is more developed (day 13). MATERIALS AND METHODS Cytokine-stimulated stem cell factor (SCF) and granulocyte colony-stimulating factor (G-CSF)-purified sca(+)/lin(-) cells of C57BL/6 (H-2b, 1E(+)) background were injected into MHC-mismatched BALB/c (H-2d, 1E(-)) fetal mouse recipients at day 13 of gestation. Chimerism was determined by highly sensitive (0.001%) semiquantitative polymerase chain reaction (PCR). Mixed lymphocyte reaction (MLR) and cytotoxic T-cell assay (CTL) were used to evaluate tolerance vs immunity. Cytokine levels were quantified in MLR supernatants using ELISA assay. The percent of T cells was determined by flow cytometry (FACS) and CD4/CD8 ratio calculated. Postnatal boosts (transplants without conditioning) were performed at 6 months of age to enhance donor chimerism and test the degree of tolerance. RESULTS When assayed at 4 months of age, donor-type cells were not detected in the spleen or in the peripheral blood of BALB/c mice inoculated with C57BL/6 sca(+)/lin(-) cells. Transplanted but not control animals demonstrated high anti-donor MLR but not CTL responses. The increase of MLR reactivity was correlated with high levels of IL-2. Furthermore, transplanted mice showed higher resistance to postnatal boosts with allogeneic bone marrow (BM) cells, when compared to the control mice. The later resistance was accompanied by the expansion of host-type CD4 cells. CONCLUSION These data demonstrate that transplantation of cytokine-stimulated sca(+)/lin(-) allogeneic cells at 13 days of fetal development leads to the allosensitization, characterized by an enhancement of MLR alloreactivity and by the rejection of postnatal boosts (transplants without conditioning). Host-type CD4 cells might play a central role in this rejection. These findings indicate that the late injection of allogeneic cells may result in the development of allosensitization with subsequent donor graft rejection. Precise conditions for the development of tolerance must be established before prenatal transplants in humans with conditions other than SCID can be done.
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Affiliation(s)
- Hassan Sefrioui
- Department of Medicine and Pediatrics, University of California, San Diego, USA
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72
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West LJ. Developmental aspects of immunomodulation: exploiting the immature immune system for organ transplantation. Transpl Immunol 2002; 9:149-53. [PMID: 12180823 DOI: 10.1016/s0966-3274(02)00044-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- L J West
- The Hospital for Sick Children, Toronto, ON, Canada.
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Borenstein SH, Tao KS, West LJ, Chamberlain JW. Extrathymic deletion of CD8+ alloreactive T cells in a transgenic T cell receptor model of neonatal tolerance. Transplantation 2001; 72:1807-16. [PMID: 11740393 DOI: 10.1097/00007890-200112150-00017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immunological tolerance to foreign antigen is most easily achieved during the neonatal period. Although deletion of T cells has been demonstrated in neonatal tolerance models in which donor and recipient express different MHC class II molecules, the requirement for deletion in MHC class I-disparate models is less clear. To address this issue, we used as recipient the T cell receptor (TCR) transgenic mouse (TgM) strain 2C in which the majority of CD8+ T cells express a single alpha/beta TCR alloreactive to H-2Ld, thus facilitating direct monitoring of the class I alloreactive population. METHODS Newborn (less than 24 hr of age) 2C TgM received injections i.v.with syngeneic C57BL/6J (H-2b) (B6) or semiallogeneic (B6xDBA)F1 (H-2bd; H-2Ld+) splenocytes. Adults were subsequently analyzed in terms of tolerance, deletion of 2C+ T cells, and chimerism. RESULTS The results showed that semiallogeneic-, but not syngeneic-, injected neonates were unresponsive as adults to H-2Ld-expressing target cells in vitro and the majority of these mice accepted H-2Ld+ skin grafts. Delaying the injection to 72 hr after birth or reducing the number of cells injected essentially abolished in vivo unresponsiveness in 2C recipients. Thus, the 2C TCR Tg model demonstrates the characteristics typical of neonatal tolerance. Injection of 2C neonates within 24 hr of birth with semiallogeneic versus syngeneic cells led to more than a 12-fold reduction of CD8+ 2C+ T cells in adult spleen and LNCs. In contrast, deletion of CD8+ 2C+ cells in adult thymus was not consistently observed. Based on MHC class II expression to distinguish donor (I-E+) and recipient (I-E-) cells, semiallogeneic-injected mice were chimeric in spleens and lymph nodes (LNs). CONCLUSIONS These results demonstrate that neonatal MHC class I tolerance in the adult is associated with low level hematopoietic chimerism and extrathymic deletion of alloreactive CD8+ T cells.
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Affiliation(s)
- S H Borenstein
- Research Institute, Program in Infection, Immunity, Injury and Repair, The Hospital for Sick Children, Toronto, Ontario, Canada
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75
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Abstract
Although transplantation immunology as a distinctive field began with the development of experimental models that showed the feasibility of bone marrow transplantation, organ engraftment was accomplished first in humans, and was thought for many years to occur by drastically different mechanisms. Here, we present our view of the concepts of allograft acceptance and acquired tolerance from a historical perspective, and attempt to amalgamate them into simple and unifying rules that might guide improvements in clinical therapy.
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Affiliation(s)
- T E Starzl
- Transplantation Institute, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
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76
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Monaco AP, Maki T, Hale D, Umemura A, Morita H. The enigma of tolerance and chimerism: variable role of T cells and chimerism in induction of tolerance with bone marrow. Transplant Proc 2001; 33:3837-9. [PMID: 11750635 DOI: 10.1016/s0041-1345(01)02625-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- A P Monaco
- Transplant Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA
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77
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Affiliation(s)
- R M Zinkernagel
- Department of Pathology, Institute of Experimental Immunology, University Hospital Zurich, Zurich, Switzerland
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78
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Affiliation(s)
- A P Monaco
- Harvard Medical School Director, The Transplant Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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79
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A History of Clinical Transplantation. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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80
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Abstract
Neonates often respond poorly to conventional vaccines or microbial infections. Immaturity of the immune system has been considered to play a role in this regard. However, accumulating evidence shows that in certain conditions, neonatal inoculation of antigens leads to protective immunity. In the particular case of DNA vaccines administered to neonates, the rule is immunity rather than tolerance. Exceptions to the rule give opportunities to further understand the neonatal responsiveness and the mechanism of DNA vaccination. Due to the very nature of the vaccine vector, inhibition of neonatal DNA vaccination by maternal antibodies may be limited to the humoral immunity.
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Affiliation(s)
- A Bot
- Department of Exploratory Biological Research, Alliance Pharmaceutical Corp., San Diego, CA 92121, USA.
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82
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Abstract
Calves which were the progeny of rinderpest-susceptible dams were inoculated with lapinized rinderpest virus when 1 day to 2 months old. Their serological response, as measured by neutralizing antibody titre 21 days later, did not differ from that of adult susceptible cattle.In calves born of rinderpest-immune cows, the serological response to caprinized rinderpest virus depended upon the level of maternally derived antibody. There were two critical levels, one below which all calves produced antibodies (serum titre of 0.7 or less) and another above which no antibody was formed (serum titre of 2.2 or more). Thus all animals aged 8 months or more at the time of inoculation were actively immunized but no calf aged 3 months or less reacted in this manner.The response of calves with maternally derived antibody titres between 0.9 and 2.0 varied. There was a significant inverse relationship between the preinoculation titre and the amount of antibody formed during the following 3 weeks. A similar inverse relationship was shown between the pre-inoculation titre and the rate of production of antibody and its titre 1 year following inoculation.Calves which possessed colostral antibody, and which were actively immunized by caprinized virus inoculation, did not necessarily show the usual clinical reaction. When such animals failed to become actively immunized there was no sensitization of the antibody-forming mechanism, a fact demonstrated by the lack of an anamnestic response to subsequent exposure to rinderpest virus antigen.I owe thanks to many people: to Dr S. E. Piercy, Deputy Director, E.A.V.R.O., for advice and encouragement; to Mr G. R. Scott, Senior Virologist, E.A.V.R.O., for advice and encouragement and, with Mr G. J. Knight, for help in the statistical analysis of the data; to Dr M. H. French lately head of Division and Mr G. Lampkin, Joint Animal Industry Division of E.A.A.F.R.O. and E.A.V.R.O. for facilities for the inoculation of calves from rinderpest-immune dams with rinderpest vaccine; Mr J. M. Nightingale, Sasamua Estate, South Kinangop, and Mr J. Armstrong, Naivasha, for facilities for immunizing calves from rinderpest-susceptible dams; Mr C. S. Rampton, Mr N. Kerani and Mr F. Mwithiga for technical assistance.This and the previous paper (see p. 427) are published by permission of the Director, East African Veterinary Research Organization.
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83
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CANNON JA, TERASAKI PI, LONGMIRE WP. Unexpected manifestations of induced tolerance to skin homografts in the chicken. Ann N Y Acad Sci 2000; 73:862-8. [PMID: 13617898 DOI: 10.1111/j.1749-6632.1959.tb40866.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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84
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Morelli AE, Antonysamy MA, Takayama T, Hackstein H, Chen Z, Qian S, Zurowski NB, Thomson AW. Microchimerism, donor dendritic cells, and alloimmune reactivity in recipients of Flt3 ligand-mobilized hemopoietic cells: modulation by tacrolimus. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2000; 165:226-37. [PMID: 10861056 DOI: 10.4049/jimmunol.165.1.226] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Flt3 ligand (FL) is a potent hemopoietic growth factor that strikingly enhances stem cells and dendritic cells (DC) in vivo. We examined the impact of infusing FL-mobilized bone marrow (BM) cells on microchimerism and anti-donor reactivity in normal and tacrolimus-immunosuppressed, noncytoablated allogeneic recipients. BM from B10 (H2b) mice given FL (10 microg/day; days 0-8; FL-BM) contained a 7-fold higher incidence of potentially tolerogenic immature CD11c+ DC (CD40low, CD80low, CD86low, MHC IIlow) that induced alloantigen-specific T cell hyporesponsiveness in vitro. C3H (H2k) mice received 50 x 106 normal or FL-BM cells (day 0) and tacrolimus (2 mg/kg/day; days 0-12). On day 15, enhanced numbers of donor (IAb+) cells were detected in the thymi and spleens of FL-BM recipients. Tacrolimus markedly enhanced microchimerism, which declined as a function of time. Ex vivo splenocyte proliferative and CTL responses and Th1 cytokine (IFN-gamma) production in response to donor alloantigens were augmented by FL-BM infusion, but reduced by tacrolimus. Systemic infusion of purified FL-BM immature DC, equivalent in number to that in corresponding whole BM, confirmed their capacity to sensitize, rather than tolerize, recipient T cells in vivo. In vitro, tacrolimus suppressed GM-CSF-stimulated growth of myeloid DC from normal BM much more effectively than from FL-BM without affecting MHC class II or costimulatory molecule expression. Infusion of normal B10 BM cells at the time of transplant prolonged C3H heart allograft survival, whereas FL-BM cells did not. A therapeutic effect of tacrolimus on graft survival was observed in combination with normal, but not FL-BM cells. These findings suggest the need for alternative immunosuppressive strategies to calcineurin inhibition to enable the engraftment, survival, and immunomodulatory function of FL-enhanced, immature donor DC.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/pharmacology
- Animals
- Bone Marrow Transplantation/immunology
- Cell Differentiation/drug effects
- Cell Differentiation/immunology
- Cell Separation
- Cells, Cultured
- Cytotoxicity, Immunologic/drug effects
- Dendritic Cells/cytology
- Dendritic Cells/drug effects
- Dendritic Cells/metabolism
- Dendritic Cells/transplantation
- Drug Administration Schedule
- Drug Combinations
- Epitopes, T-Lymphocyte/immunology
- Graft Survival/drug effects
- Heart Transplantation/immunology
- Hematopoietic Stem Cell Mobilization
- Hematopoietic Stem Cell Transplantation
- Histocompatibility Antigens Class II/biosynthesis
- Immunosuppressive Agents/administration & dosage
- Infusions, Intravenous
- Injections, Intraperitoneal
- Isoantigens/immunology
- Ligands
- Lymphocyte Activation/drug effects
- Lymphocyte Activation/immunology
- Lymphocyte Culture Test, Mixed
- Lymphocyte Depletion
- Lymphoid Tissue/cytology
- Lymphoid Tissue/immunology
- Lymphoid Tissue/metabolism
- Male
- Membrane Proteins/administration & dosage
- Membrane Proteins/immunology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C3H
- Mice, Inbred C57BL
- Radiation Chimera/immunology
- Spleen/cytology
- Spleen/immunology
- Spleen/metabolism
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Tacrolimus/administration & dosage
- Tacrolimus/pharmacology
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Affiliation(s)
- A E Morelli
- Thomas E. Starzl Transplantation Institute and Department of Surgery, University of Pittsburgh, PA 15213, USA
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85
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86
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87
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Hale DA, Gottschalk R, Umemura A, Maki T, Monaco AP. Establishment of stable multilineage hematopoietic chimerism and donor-specific tolerance without irradiation. Transplantation 2000; 69:1242-51. [PMID: 10798737 DOI: 10.1097/00007890-200004150-00008] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Induction of tolerance to organ transplants will increase graft survival and decrease patient mortality and morbidity. Radiation-induced cytoreduction/ablation followed by donor hematopoietic cell reconstitution has been the most consistently successful approach to experimental tolerance induction. However, reluctance of clinicians to expose recipients to radiation has hampered its clinical application. METHODS In the studies described, administration of polyclonal antilymphocyte serum (ALS), donor-specific bone marrow (DSBM) (150x10(6) cells), and sirolimus (24 mg/kg) in a completely mismatched murine model (B10.A donor, C57B/10 recipient) produced 100% indefinite (>250 days) skin graft survival. The level and character of donor-specific chimerism was evaluated with flow cytometry. RESULTS Specific tolerance was confirmed by continued acceptance of primary and secondary donor-specific skin allografts and rejection of third-party grafts. The level and duration of chimerism induced was directly related to the dose of DSBM administered. Mice given 150x10(6) DSBM cells showed levels of 8-10% donor peripheral blood mononuclear cell chimerism by 30 days, and these levels persisted indefinitely (>250 days) in association with permanent tolerance of donor grafts. Eighty percent of donor chimeric cells were B lymphocytes (MHC class I and II positive, Fc receptor positive, CD45/B220 positive but negative for CD4, CD8 and Thy 1.2) and 20% were sorted in the macrophage monocyte population. CONCLUSIONS These studies demonstrate for the first time that cytoreduction/ablation with ALS combined with sirolimus and reconstitution with donor bone marrow induces tolerance and chimerism in a completely mismatched murine combination. The use of ALS and sirolimus, currently employed therapies in clinical transplantation, and the lack of requirement for radiation make this tolerance protocol attractive for clinical application.
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Affiliation(s)
- D A Hale
- Division of Organ Transplantation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
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88
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Tran ND, Porada CD, Zhao Y, Almeida-Porada G, Anderson WF, Zanjani ED. In utero transfer and expression of exogenous genes in sheep. Exp Hematol 2000; 28:17-30. [PMID: 10658673 DOI: 10.1016/s0301-472x(99)00133-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We have previously reported that directly injecting low-titer retroviral vector supernatant into pre-immune sheep fetuses resulted in the transfer and long-term expression of the bacterial NeoR gene within the hematopoietic system of these animals for over 5 years. In the present studies, we investigated whether using a higher titer vector would enable more efficient transduction and expression of the transgenes within the hematopoetic cells in sheep injected in utero. MATERIALS AND METHODS Sixteen pre-immune sheep fetuses were injected intraperitoneally with the G1nBgSvNa8.1 helper-free retroviral vector supernatant encoding the bacterial NeoR and LacZ genes (titer: 1x10(7) cfu/mL). RESULTS Over the 2-year time course of these studies, the presence and expression of the NeoR and LacZ genes were demonstrated in 12 of the 14 animals evaluated by several immunological and biochemical methods. Seven of the 12 sheep examined by flow cytometric analysis contained > or =6% transduced peripheral blood lymphocytes. Vector distribution was widespread without any detectable pathology. Importantly, PCR analyses and breeding experiments demonstrated that the germ line was not altered. CONCLUSIONS These studies confirmed that direct injection of an engineered retrovirus is a feasible means of safely delivering foreign genes into a developing fetus and thus achieving long-term expression of the transgenes within the recipient's hematopoietic cells. Furthermore, expression of the NeoR gene from these studies was higher than that reported in our previous study in which a lower titer vector was used.
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Affiliation(s)
- N D Tran
- Department of Veterans Affairs Medical Center, University of Nevada, Reno 89520, USA
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89
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Hayamizu K, Lan F, Huie P, Sibley RK, Strober S. Comparison of chimeric acid and non-chimeric tolerance using posttransplant total lymphoid irradiation: cytokine expression and chronic rejection. Transplantation 1999; 68:1036-44. [PMID: 10532547 DOI: 10.1097/00007890-199910150-00023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies showed that an intravenous infusion of donor blood cells facilitates tolerance to ACI heart allografts in Lewis rat hosts given posttransplant total lymphoid irradiation (TLI) and anti-thymocyte globulin (ATG). The object of the current study was to compare tolerance induction using donor cells that do or do not induce chimerism. METHODS Normal peripheral blood mononuclear cells (PBMC), granulocyte colony-stimulating factor (G-CSF)-mobilized PBMC, and bone marrow (BM) cells from ACI donors were tested for their capacity to prolong ACI heart allograft survival in Lewis hosts. Chimerism, anti-donor cell reactivity, and cytokine gene expression in grafts were determined. RESULTS Intravenous injections of equal numbers of all three donor cells markedly prolonged graft survival (median: >164 to >175 days) as compared to uninjected controls (median: 53 days). Chimerism among T and B cells in the blood was determined by immunofluorescent staining in hosts bearing long-term (> 150 days) grafts. Although no chimerism was detected in hosts given normal or G-CSF-mobilized PBMC, chimerism was detected at variable levels in all hosts given BM cells. Vigorous anti-donor reactivity in the mixed leukocyte reaction was present only in non-chimeric hosts. Long-term grafts from hosts given normal ACI PBMC developed chronic rejection, but those from hosts given ACI BM cells did not. The latter hosts showed the lowest levels of intragraft cytokine mRNA. CONCLUSIONS Chimeric tolerance is more robust than non-chimeric tolerance in the model of posttransplant TLI, ATG, and donor cell infusion, and is associated with less chronic rejection.
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Affiliation(s)
- K Hayamizu
- Department of Medicine, Stanford University, California 94305-5111, USA
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90
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Affiliation(s)
- G L Ada
- John Curtin School of Medical Research, Canberra, ACT
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91
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Yokoi Y, Noorchashm H, Rostami SY, Barker CF, Naji A. Origin, kinetics, and function of chimeric B lymphocytes in liver allografts. Transplantation 1999; 68:118-23. [PMID: 10428278 DOI: 10.1097/00007890-199907150-00022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the well-recognized concordance of chimerism with spontaneous acceptance of rat liver allografts, the active role and the identity of chimeric cells mediating liver allograft tolerance are unknown. Because resting B cells are endowed with a tolerogenic antigen-presenting capacity, we assessed whether donor B cells propagated from the grafted liver may be responsible for liver allograft tolerance. METHODS Dark Agouti or Lewis rats were grafted with Lewis or Dark Agouti livers as a tolerogenic or a rejection combination, respectively. We followed the kinetics of donor B cells in recipients by flow cytometry, and we examined the fate of liver allografts depleted of passenger B cells in either B cell-sufficient or -deficient recipients. B-cell depletion was achieved by treatment of animals with polyclonal goat anti-rat IgM antibody from birth. RESULTS During the first 3 days after liver allografting, donor B cells rapidly migrated from graft-infiltrating cells and appeared in systemic circulation in both the tolerogenic and rejection combinations. However, systemic chimerism was detectable in the tolerogenic combination by day 14, whereas it was undetectable in the rejection combination by day 7. In graft-infiltrating cells, a significant expansion of chimeric IgM+ (newly formed) B cells was observed on day 5 in the tolerogenic, but not in the rejection, combination. However, depletion of B cells from liver grafts and the absence of antibodies failed to alter the outcome of liver allograft survival in the tolerogenic or immunogenic combination. CONCLUSION Although intragraft chimeric B cells proliferated in tolerogenic liver allografts, their clonal expansion does not seem to be essential for the promotion of liver allograft tolerance.
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Affiliation(s)
- Y Yokoi
- Department of Surgery, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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92
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93
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Affiliation(s)
- T E Starzl
- Division of Transplantation, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA 15213, USA
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94
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Starzl TE, Rao AS, Murase N, Demetris AJ, Thomson A, Fung JJ. Chimerism and xenotransplantation. New concepts. Surg Clin North Am 1999; 79:191-205. [PMID: 10073189 PMCID: PMC2974311 DOI: 10.1016/s0039-6109(05)70014-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In both transplant and infectious circumstances, the immune response is governed by migration and localization of the antigen. If the antigenic epitopes of transgenic xenografts are sufficiently altered to avoid evoking the destructive force of innate immunity, the mechanisms of engraftment should be the same as those that permit the chimerism-dependent immunologic confrontation and resolution that is the basis of allograft acceptance. In addition to "humanizing" the epitopes, one of the unanswered questions is whether the species restriction of complement described in 1994 by Valdivia and colleagues also necessitates the introduction of human complement regulatory genes in animal donors. Because the liver is the principal or sole source of most complement components, the complement quickly is transformed to that of the donor after hepatic transplantation. Thus, the need for complementary regulatory transgenes may vary according to the kind of xenograft used. Much evidence shows that physiologically important peptides produced by xenografts (e.g., insulin, clotting factors, and enzymes) are incorporated into the metabolic machinery of the recipient body. To the extent that this is not true, xenotransplantation could result in the production of diseases that are analogous to inborn errors of metabolism. In the climate of pessimism that followed the failures of baboon to human liver xenotransplantation in 1992-1993, it seemed inconceivable that the use of even more discordant donors, such as the pig, could ever be seriously entertained; however, this preceded insight into the xenogeneic and allogeneic barriers that has brought transplantation infectious immunity to common ground. With this new insight and the increasing ease of producing transgenic donors, the goal of clinical xenotransplantation may not be so distant.
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Affiliation(s)
- T E Starzl
- Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA
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Abstract
Advances in organ preservation, surgical technique, and postoperative care have permitted the rapid development of liver transplantation in children. Consequently, the applicability of this procedure has gone beyond the treatment of life-threatening complications of chronic liver disease and now includes disabling morbidities and quality-of-life issues. The use of hepatic segments for transplantation with reduced or split cadaveric grafts and living-related donors has decreased the mortality of children awaiting liver transplantation. We are presently armed with a new potent immunosuppressive drug, tacrolimus, and an understanding that the migration and grafting of passenger leukocytes of bone marrow origin is the seminal explanation for allograft acceptance. The next forefront will involve manipulation of the process not only for the transplantation of already successful whole organs--such as the liver, kidney, pancreas, and heart--but also in the development of the intestinal transplantation program. Thus, augmentation of leukocyte traffic in unconditioned recipients of cadaver allografts with concomitant intravenous infusion of donor bone marrow cells under the same immunosuppressive management of tacrolimus-prednisone treatment will be the path into the future.
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Affiliation(s)
- J Reyes
- Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA.
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RAPAPORT FT, THOMAS L, LAWRENCE HS, CONVERSE JM, TILLETT WS, MULHOLLAND JH. Skin homograft sensitivity cross reactions in man. Ann N Y Acad Sci 1998; 99:564-8. [PMID: 13973074 DOI: 10.1111/j.1749-6632.1962.tb45337.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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ASHLEY FL, McNALL EG, DUTT NR, GARCIA EN, SLOAN RF. The effects of nucleic acids on homograft tolerance. Ann N Y Acad Sci 1998; 87:429-44. [PMID: 13794749 DOI: 10.1111/j.1749-6632.1960.tb23210.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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BILLINGHAM RE, SILVERS WK. Quantitative studies on the ability of cells of different origins to induce tolerance of skin homografts and cause runt disease in neonatal mice. ACTA ACUST UNITED AC 1998; 146:113-29. [PMID: 13869203 DOI: 10.1002/jez.1401460202] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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