Prolongation of skin graft survival in mice by in vitro PUVA treatment and failure of induction of specific immunological memory by PUVA-treated grafts

Prolonged skin allograft survival after photodynamic therapy associated with modification of donor skin antigenicity

BACKGROUND

The ability to prolong graft survival, in some cases by depleting donor antigen-presenting cells (APCs), and the subsequent demonstration that lymphocytes stimulated by non-APCs become anergic, suggested that graft survival and tolerance induction might be achieved by manipulating donor APCs to render them incompetent. This possibility was tested in histoincompatible murine skin allograft with photodynamic therapy (PDT).

METHODS

Skin sections (C57BL/6) were exposed in vitro to low doses of benzoporphyrin derivative monoacid ring A (BPD) (verteporfin) and light (A=690+/-10 nm; low-dose PDT) before implantation on recipients (BALB/c). Furthermore, the effect of the treatment on the surface molecules of donor-derived Langerhans cells (LC) was evaluated by fluorescence-activated cell sorter analysis; the effect of treatment on the LC alloreactivity in the mixed epidermal cell lymphocyte reaction was also evaluated.

RESULTS

Pretreating skin to be grafted with low-dose PDT can significantly prolong the survival of allografts from 9.3+/-2.2 (n=42) days (control group) to 16.9+/-1.7 days (n=20; treated group). Moreover, low-dose PDT significantly down-regulated the major histocompatibility complex and costimulatory (B7) molecules (60-90% reduction) on LC, but not LC-specific endocytic receptor (DEC-205), CD45, intercellulr adhesion molecule 1, LC viabilities, and ectophosphatase activity on LC. Additionally, this treatment significantly suppressed the ability of LC to stimulate alloreactive T cells to proliferate.

CONCLUSIONS

Since engaging T cell receptors in the absence of costimulation results in suboptimal activation of T cells and ultimately anergy, it appears that the immunomodulatory effects of low-dose PDT associated with extended engraftment may depend upon decreased LC expression of major histocompatibility complex and costimulatory molecules.

Products of psoralen photooxidation possess immunomodulative and antileukemic effects

It has been proposed that the therapeutic effect of PUVA (psoralens+UVA radiation) is connected to its immunomodulative properties, and that the molecular basis of such properties is the oxygen-independent photoaddition of psoralens to DNA. We have investigated effects of preliminary photooxidized psoralens (POP) on the delayed-type hypersensitivity reaction (DTH) to sheep red blood cells and on growth of grafted T-cell lymphoma EL-4 in mice. We have shown that intravenous injection of POP at low concentrations activated, and at high concentrations suppressed, DTH. The POP products are thermolabile. They preserved their immunosuppressive activity for 3 days at room temperature and lost it in several min at 58 degrees C. Incubation of POP in the presence of Fe2+ during 2 h before intravenous injection leads to complete loss of its immunomodulative activity, suggesting a peroxidic nature of POP products. The POP-inhibited growth of grafted T-cell lymphoma independent of the mode of POP application in mice (intravenous or subcutaneous injections, oral or nasal administration). Our data suggest that photooxidative reactions of psoralens, in addition to oxygen-independent photoaddition to DNA, form the basis for biological activity of these drugs.

Inhibition of skin allograft rejection and acute graft-versus-host disease by cis-urocanic acid

Ultraviolet B radiation initiates a suppression of the delayed-type hypersensitivity response accompanied by a generation of antigen-specific suppressor cells and an alteration of antigen-presenting function. In previous studies we and other investigators could achieve a prolongation of graft survival by a treatment of the recipient with UVB light or 8-methoxy-psoralen plus UVA light (PUVA). One of the mediators of the systemic immunomodulatory effects of ultraviolet light or PUVA may be urocanic acid, which is isomerized in the skin by ultraviolet light from its cis- to the trans-isomer. In this work we present evidence that cis-urocanic acid, generated in vitro by a treatment with UVB light or PUVA, is able to prolong the survival of allogeneic MHC disparate skin grafts in mice. In contrast, the rejection of second set grafts was not suppressed. Unirradiated (trans-urocanic acid) had no effect on allograft rejection. In a murine model cis-, but not trans-urocanic acid, prevented or delayed an acute lethal graft-versus-host disease. These experiments demonstrate the potent systemic immunomodulatory effects of cis-urocanic acid in vivo.

Mechanisms of photodynamic effects of furocoumarins

The photosensitizing action of furocoumarins on biological systems occurs by both an oxygen-independent pathway, which involves the photoaddition of the sensitizer to nucleic acids, proteins and lipids, and an oxygen-dependent pathway, which includes furocoumarins in the category of photodynamic sensitizers. The photodynamic action of furocoumarins, as studied using isolated biomolecules, human erythrocytes and human skin, appears to involve both activated oxygen species (singlet oxygen, superoxide anion, and hydroxyl radicals) and radical species formed by electron transfer from or to photoexcited furocoumarins. Another oxygen-dependent process involves the formation of photo-oxidized furocoumarin derivatives, which can react in the dark with several substrates (in particular, membrane components), causing an irreversible damage of cells. The latter type of process is temperature dependent. The relative importance of the different photosensitization mechanisms under various experimental conditions is discussed.

Clinical results of grafting burns with epidermal Langerhans' cell depleted allograft overlay

Twenty-one severely burned patients have received widely meshed and expanded autografts and allografts of epidermis depleted of Langerhans' cells. In 18 patients 80% or more of the grafts took successfully. Six patients (29%) died, three of inhalation injuries. Using allografts of epidermis depleted of Langerhans' cells means that larger burned areas can safely be grafted during one procedure.

Reduced MHC class II antigen expression on rat heart and kidney cells after in vitro exposure to longwave ultraviolet irradiation

The pretreatment of both kidney and heart donor with the photosensitizer 8-methoxy-psoralen followed by in vitro longwave ultraviolet graft irradiation (PUVA therapy) significantly prolonged graft survival times in rats even across a strong major histocompatibility complex (MHC) barrier. Immunohistological studies using monoclonal antibodies (Mab) to rat MHC class I and II antigens showed a significant reduction of class II antigen expression after PUVA therapy in both Sprague-Dawley rat kidneys and hearts. Using MHC class I Mab there were no differences in distribution pattern in untreated as well as in PUVA treated organs. Thus, our results represent the first in vivo evidence that photochemotherapy-induced graft survival time prolongation is closely connected with its ability to reduce MHC class II antigen expression.

Psoralens and related compounds in the treatment of psoriasis

PUVA therapy has radically altered the management of severe psoriasis. It is of greatest benefit in those patients with extensive involvement, and in those unresponsive to conventional therapy. The long term side effects of PUVA currently limit its use to patients with disabling disease. The full extent of long term side effects has yet to be defined. In order to reduce the toxicity and improve the efficacy of PUVA, a better understanding of the molecular aspects of psoralen-DNA interaction, DNA repair, and mutagenesis is required. The action spectrum of PUVA in clearing psoriasis has yet to be defined. By limiting the spectrum of UVA exposure it may be possible to reduce some of the toxic effects of PUVA. The recent advances in the formulation of 8-MOP preparations has yielded a drug with more predictable pharmacokinetics and clinical response. Further research with newer psoralens may produce more effective and less toxic compounds. In the last ten years, PUVA has been both a valuable addition to dermatologists' clinical armamentarium and a useful tool in increasing our understanding of cellular biology and the interaction between ultraviolet radiation and biologic systems.

In vitro suppression of the epidermal Langerhans' cells in necro split skin

The effect of ultraviolet light B irradiation and glucocorticosteroid incubation on the epidermal Langerhans' cell density and tissue viability was investigated, in vitro, on human thin necro split skin.

Inhibition of HLA-DR antigen expression and of the allogeneic mixed leukocyte reaction by photochemical treatment

Treatment of human peripheral blood mononuclear cells with UVB light, the photosensitizing system 8-methoxypsoralen plus UVA light (PUVA), or hematoporphyrin derivative plus visible light leads to an inhibition of their stimulatory capacity in an allogeneic mixed leukocyte reaction despite unaltered expression of HLA-DR antigens when tested immediately after irradiation. However, HLA-DR positive cells disappear among mononuclear cells in the interval between 4 and 8 h after treatment with either UVB, PUVA, hematoporphyrin derivative and light, or heating to 45 degrees C. The expression of HLA-DQ, but not HLA-A,B,C, antigens, was similarly affected by these treatments. The significance of these results is discussed.

The influence of haematoporphyrin derivative and visible light on murine skin graft survival, epidermal Langerhans cells and stimulation of the allogeneic mixed leucocyte reaction

The influence of combined photochemical treatment with a haematoporphyrin derivative and visible light on antigen-presenting cells was evaluated. Treatment of murine skin grafts with this procedure prolonged their subsequent survival on allogeneic recipients. The haematoporphyrin derivative and light decreased the ATPase activity of epidermal Langerhans cells in murine skin. When stimulator cells in a human allogeneic mixed leucocyte reaction were treated with the haematoporphyrin derivative and light, they lost their stimulatory capacity. It is proposed that the haematoporphyrin derivative and visible light interfere, on analogy with ultraviolet radiation, with the function of antigen-presenting cells.