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Du XX, Guo YL, Zhao YP, Yang M, Chang S, Liu B, Cai LJ, Chen ZK. Accumulation of High Levels of Monocytic Myeloid-Derived Suppressor Cells Enhances Graft Survival in Almost-Tolerant Kidney Transplant Recipients. Transplant Proc 2018; 50:3314-3320. [PMID: 30577201 DOI: 10.1016/j.transproceed.2018.04.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/03/2018] [Accepted: 04/12/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immature cells that suppress immune responses during organ transplantation and participate in mediating long-term graft survival and immune tolerance in animal transplant models. However, their role in regulating transplant tolerance in human subjects is not well understood. In the present study, we investigated the role of MDSCs in mediating long-term graft survival in almost-tolerant kidney transplant recipients (ATKTRs) and the mechanism(s) responsible for increasing MDSC numbers in these recipients. METHODS Peripheral blood mononuclear cells (PBMCs) from whole blood samples were collected from 30 ATKTRs (graft survival, > 10 years after kidney transplant [KTx]) treated with low doses of immunosuppressive drugs and with stable kidney function, 10 short-term graft survival kidney transplant recipients (STKTRs; graft survival, ∼1-3 years post-KTx) with stable kidney function, and 10 healthy donors (HDs). MDSC and regulatory T cell (Tregs) levels were analyzed using multicolor flow cytometry in PBMCs. RESULTS ATKTRs had significantly higher levels of monocytic MDSCs (P < .001) and CD4+CD25+FoxP3+ Tregs than STKTRs and HDs. Furthermore, the M-MDSC levels correlated positively with the survival rates, estimated glomerular filtration rates (eGFRs) of grafts, and the levels of CD4+CD25+FoxP3+ Tregs in ATKTRs. CONCLUSIONS Accumulation of high levels of MDSCs was observed in ATKTRs. Changes in MDSC levels may play important roles in mediating transplant tolerance and regulating Tregs. Therefore, we propose that MDSCs may be potentially used for recognizing tolerant transplant recipients and guiding dosage reduction for immunosuppressive drugs for KTx.
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Affiliation(s)
- X X Du
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, and Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Y L Guo
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, and Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Y P Zhao
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, and Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - M Yang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, and Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - S Chang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, and Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - B Liu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, and Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - L J Cai
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Z K Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, and Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.
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Composite tissue allotransplantation immunology. Arch Plast Surg 2013; 40:141-53. [PMID: 23529264 PMCID: PMC3605559 DOI: 10.5999/aps.2013.40.2.141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 01/20/2023] Open
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Siemionow M, Klimczak A. Immunodepletive anti-alpha/beta-TCR antibody in transplantation of composite tissue allografts: Cleveland Clinic research experience. Immunotherapy 2011; 1:585-98. [PMID: 20635989 DOI: 10.2217/imt.09.34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The immunologic characteristics of composite tissue allografts (CTA), which contain skin, lymphoid elements and bone with bone marrow, raise new challenges for transplant immunologists. Owing to the heterogeneity of transplanted tissues in limb or face transplant models, researchers are focusing on the new tolerance-inducing strategies facilitating CTA acceptance. A number of immunosuppressive protocols have been designed to develop tolerance in experimental models; however, only a few protocols have been introduced to clinical transplantation. In this review, based on own experiences, we discuss the major strategies for tolerance induction in limb and face allograft models in experimental studies. This review is focused on tolerance induction strategies by establishment of donor-specific chimerism using different immunomodulatory protocols, including nonselective T-cell depletion with polyclonal antibody antilymphocyte serum and selective inhibition of alphabeta-T-cell receptors on the alloreactive T cells.
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Affiliation(s)
- Maria Siemionow
- Department of Plastic & Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA.
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Tolerance and Future Directions for Composite Tissue Allograft Transplants: Part II. Plast Reconstr Surg 2009; 123:7e-17e. [DOI: 10.1097/prs.0b013e318193467d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Farney A, Sundberg A, Moore P, Hartmann E, Rogers J, Doares W, Jarrett A, Adams P, Stratta R. A randomized trial of alemtuzumab vs. anti-thymocyte globulin induction in renal and pancreas transplantation. Clin Transplant 2008; 22:41-9. [PMID: 18217904 DOI: 10.1111/j.1399-0012.2007.00742.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The role of alemtuzumab as an immunosuppressive agent is evolving. We conducted a prospective randomized trial comparing alemtuzumab and rabbit anti-thymocyte globulin (rATG) induction in adult kidney and pancreas transplantation using similar maintenance immunosuppression. Between February 1, 2005 and June 15, 2006 (median follow-up six months), 98 patients were randomized either to alemtuzumab (n = 48) or to rATG (n = 50) induction; 77 (79%) underwent kidney alone (KA) transplant, 17 (17%) pancreas-kidney transplant, and four (4%) pancreas after kidney transplant. Of 77 KA transplants, 66 (86%) were from deceased donors and 31 (40%) from expanded criteria donors (ECD). Re-transplantation, HLA-match, antibody titer, ECD, race, cytomegalovirus status, steroid use, delayed graft function, preservation time, and immunological risk were similar between the two induction groups. Patient, kidney, and pancreas graft survival rates were 100%, 96%, and 95%, respectively. Survival, initial length of stay, delayed graft function, and overall acute rejection rates were similar between alemtuzumab and rATG groups, but acute rejection occurred in nine (20%) rATG patients compared with zero (0%) alemtuzumab patients who received KA transplants (p = 0.007). Mean induction costs differed in the alemtuzumab ($1474) and rATG ($4996, p < 0.001) groups. In the short term after kidney and pancreas transplantation, alemtuzumab and rATG induction therapies are similarly safe and effective.
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Affiliation(s)
- Alan Farney
- Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA.
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Abstract
The functional and aesthetic outcome following application of conventional reconstructive procedures or prosthetic materials is not satisfactory, especially in patients who have severe deformities and disabilities. Since the first successful hand transplantation in France in 1998, composite tissue allograft transplantation has gained a great deal of interest in the field of plastic surgery. It is obvious that composite tissue allograft transplantation will improve patients' life quality, but this might be at the expense of decreasing life expectancy. Currently, the main obstacle for composite tissue allograft transplantation is the use of life-long immunosuppression therapy because of their well-known side effects. In addition, the ethical, social, and psychologic issues are raised when discussing face transplantation. The long-term results of the recently performed partial face transplantations will be critical to judge the future applications of partial or total face transplantation.
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Affiliation(s)
- Maria Siemionow
- Department of Plastic Surgery A/60, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Akpinar E, Craighead N, Smoot D, Hale DA. Potent Skin Allograft Survival Prolongation Using a Committed Progenitor Fraction of Bone Marrow in Mice. Transplantation 2004; 78:383-91. [PMID: 15316366 DOI: 10.1097/01.tp.0000128833.38229.4f] [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 The infusion of donor bone marrow (BM) into mice conditioned with antilymphocyte serum (ALS) and sirolimus (Sir) prolongs skin allograft survival and produces chimerism. This study identifies the BM cell(s) responsible for this effect and determines whether enrichment for these cells will improve efficacy. METHODS Skin grafts from BALB/C mice were transplanted into C57BL/6 or C57BL/10 recipients by using ALS, Sir, and BM (or fractions). BM was fractionated by using immunomagnetic beads. Flow cytometry was used for phenotyping and detecting chimerism. RESULTS The median graft survival in mice receiving 25 million BM cells was 61 days. Infusion of BM depleted of cells expressing CD19, CD3, CD11c, and c-kit had no effect on median graft survival, whereas infusion of fractions enriched for those cells resulted in median graft survival of 38, 48, 28, and 83 days, respectively. The administration of higher doses (4 x 10(6) and 8x10(6)) of fractions enriched for c-kit resulted in median graft survival of 124 and 197 days, respectively, without chimerism. This favorably compared with mice receiving 150 million BM cells that demonstrated transient mixed chimerism and a median graft survival of 190 days. The majority of cells in the c-kit+-enriched fraction expressed lineage markers. Removal of lineage positive cells from BM before infusion shortened median graft survival (90 days), indicating that the c-kit+ lin+ population is largely responsible for prolongation of graft survival. CONCLUSIONS Cells enriched for C-kit+lin+ constitute approximately 5% of murine BM cells and are more potent than whole BM at prolonging skin allograft survival in mice treated with ALS and Sir.
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Affiliation(s)
- Edip Akpinar
- Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
Bidirectional cell trafficking occurs between a mother and fetus during pregnancy. This trafficking is associated with the persistence of non-self cells and is termed chimerism or, because of the low levels of non-self cells, microchimerism. Persistence of these cells has been demonstrated for many years after birth in the child and mother. Children with juvenile dermatomyositis, juvenile idiopathic inflammatory myositis, and healthy adults have all demonstrated persistence of maternal microchimerism, which is increased in the diseased population and thought associated with human leukocyte antigen genes of the offspring and the mother.
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Affiliation(s)
- Ann M Reed
- Division of Rheumatology, Mayo Clinic, 200 First Street, SW, E15, Rochester, MN 55905, USA.
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Abstract
Bidirectional cell trafficking occurs between a mother and fetus during pregnancy. The trafficking is associated with the persistence of non-self cells. Persistence of these cells has been demonstrated after birth for many years in the child and mother. Children and adults with inflammatory myositis are reported to have persistence of microchimeric cells more often than healthy individuals in their peripheral blood and muscle tissue.
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Affiliation(s)
- Ann M Reed
- Division of Rheumatology, Mayo Clinic, 200 First Street, SW, E15, Rochester, MN 55905, USA.
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Light J, Salomon DR, Diethelm AG, Alexander JW, Hunsicker L, Thistlethwaite R, Reinsmoen N, Stablein DM. Bone marrow transfusions in cadaver renal allografts: pilot trials with concurrent controls. Clin Transplant 2002; 16:317-24. [PMID: 12225426 DOI: 10.1034/j.1399-0012.2002.02056.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The safety and immune tolerance potential of donor marrow infusion with cadaveric source renal transplants was evaluated in a series of non-randomized multicenter pilot trials by the NIH Cooperative Clinical Trials in Transplantation (CCTT) Group. PATIENTS AND METHODS Three strategies were tested: (1) immunosuppression with cyclosporin, azathioprine and prednisone with a single post-transplant day 1 infusion of 5 x 107 viable cells/kg, (2) OKT3 induction with triple drug therapy and marrow transfusion on day 1, or (3) same therapy as (2) but with an additional marrow transfusion on day 10-12. RESULTS Thirty-eight marrow recipients and 35 contemporaneous controls were entered with a mean follow-up of over 5 yr. Graft survival was initially better in the marrow recipients than the controls but was similar after 5 yr. Microchimerism rates were similar for the marrow infusion and control groups throughout the follow-up period, regardless of the immunosuppression strategies. DISCUSSION Bone marrow infusions were well tolerated by a group of cadaver renal allograft recipients. There were no complications from the infusion(s), no episodes of graft-vs.-host disease (GVHD) and no increase in infections or other complications. There was a trend toward early improved graft survival in marrow recipients. Decreased rejection rates were observed in black recipients.
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Affiliation(s)
- Jimmy Light
- Transplant Services, Washington Hospital Center, Washington, DC 20010,
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Abstract
The immune system is organized so as to react to pathogens without risking damage to self. Harnessing those processes that prevent self-reactivity will have enormous potential in clinical medicine. This review outlines the efforts of this laboratory over the last 25 years to exploit tolerance so as to reprogram the immune system for therapeutic purposes.
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Affiliation(s)
- Herman Waldmann
- Sir William Dunn School of Pathology, South Parks Road, Oxford, UK.
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Abstract
Our understanding of tolerance mechanisms has progressed to the point that tolerance-induction protocols are being tested in humans for organ transplantation. However, a range of scientific, ethical, logistic and commercial issues have arisen, and must be resolved before tolerance induction for human allograft patients can become a reality.
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Affiliation(s)
- H Waldmann
- Sir William Dunn School of Pathology South Parks Road Oxford OX13RE United Kingdom.
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