Bone marrow aplasia induced by passenger leukocytes from heart allografts

A Depleting Anti-CD45 Monoclonal Antibody as Isolated Conditioning for Bone Marrow Transplantation in the Rat

Objective

A monoclonal antibody (mAb) against the leukocyte common antigen CD45 (RT7 in rats) could facilitate bone marrow transplantation (BMT). This study in rats evaluates a depletive rat anti-RT7^a mAb as isolated tool for BMT conditioning without using irradiation or any chemotherapeutic / immunosuppressive agent.

Methods

The model used a CD45 di-allelic polymorphism (RT7^a/RT7^b). The anti-RT7^a mAb was intravenously administered to LEW.1W rats (RT1^uRT7^a) at 5, 10 and 15 mg/kg. 1x10⁸ BM cells of MHC syngeneic (RT1^u), MHC disparate (RT1^l) or MHC haploidentical (RT1^u/l) donors were transplanted. All BM donor strains carried the RT7^b allele so that their CD45⁺ cells were not affected by the anti-RT7^a mAb. Recipients were monitored for reconstitution and donor-chimerism in blood leukocytes.

Results

mAb dosages of 5 or 10 mg/kg were myelosuppressive, whereas 15 mg/kg was myeloablative. Multi-lineage donor-chimerism at day 100 indicated engraftment of MHC syngeneic BM after any used mAb dosage (5 mg/kg: 46+/-7%; 10 mg/kg: 62+/-5%; 15 mg/kg: 80+/-4%). MHC disparate BM resulted in autologous reconstitution after conditioning by 10 mg/kg of the mAb and caused transient chimerism ending up in death associated with aplasia after conditioning by 15 mg/kg of the mAb. MHC haploidentical BM (F1 to parental) engrafted only after conditioning by 15 mg/kg (chimerism at day 100: 78+/-7%). Abandonment of α/β TCR⁺ cell depletion from BM grafts impaired the engraftment process after conditioning using 15 mg/kg of the mAb in the MHC syngeneic setting (2 of 6 recipients failed to engraft) and the MHC haploidentical setting (3 of 6 recipients failed).

Conclusion

This depletive anti-RT7^a mAb is myelosuppressive and conditions for engraftment of MHC syngeneic BM. The mAb also facilitates engraftment of MHC haploidentical BM, if a myeloablative dose is used. RT7^b expressing, BM-seeded α/β TCR⁺ cells seem to impair the engraftment process after myeloablative mAb conditioning.

Non-self recognition by monocytes initiates allograft rejection

Maturation of T cell-activating APCs directly links innate and adaptive immunity and is typically triggered by microbial infection. Transplantation of allografts, which are sterile, generates strong T cell responses; however, it is unclear how grafts induce APC maturation in the absence of microbial-derived signals. A widely accepted hypothesis is that dying cells in the graft release "danger" molecules that induce APC maturation and initiate the adaptive alloimmune response. Here, we demonstrated that danger signals associated with dying cells are not sufficient to initiate alloimmunity, but that recognition of allogeneic non-self by the innate immune system is required. In WT as well as in T cell-, B cell-, and innate lymphoid cell-deficient mice, allogeneic grafts elicited persistent differentiation of monocytes into mature DCs that expressed IL-12 and stimulated T cell proliferation and IFN-γ production. In contrast, syngeneic grafts in the same mice elicited transient and less pronounced differentiation of monocytes into DCs, which neither expressed IL-12 nor stimulated IFN-γ production. In a model in which T cell recognition is restricted to a single foreign antigen on the graft, rejection occurred only if the allogeneic non-self signal was also sensed by the host's innate immune system. These findings underscore the importance of innate recognition of allogeneic non-self by monocytes in initiating graft rejection.

The Biology of CD45 and its Use as a Therapeutic Target

All mature hemopoietic lineage cells, with exclusion of platelets and mature erythrocytes, share the surface expression of a transmembrane phosphatase, the CD45 molecule. It is also present on hemopoietic stem cells and most leukemic clones and therefore presents as an appropriate target for immunotherapy with anti-CD45 antibodies. This short review details the biology of CD45 and its recent targeting for both treatment of malignant disorders and tolerance induction. In particular, the question of potential stem cell depletion for induction of central tolerance or depletion of malignant hemopoietic cells is addressed. Mechanisms underlying the effects downstream of CD45 binding to the cell surface are discussed.

Catastrophic graft-versus-host disease after lung transplantation proven by PCR-based chimerism analysis

Acute graft-versus-host disease (GvHD) is a rare complication after solid organ transplantation. We describe a 52-year-old female developing neutropenia and fever 48 days after single lung transplantation for chronic obstructive pulmonary disease. Bone marrow (BM) biopsy suggested drug-induced marrow failure, so immunosuppression was reduced. Five days later a maculopapular skin rash was observed, progressing to a generalized erythema with desquamation. Skin biopsy was suspectable for GvHD, so immunosuppression was re-initiated. PCR-based chimerism analysis of BM revealed 78% donor cells. Intensified immunosuppression resulted in temporary improvement, but BM aplasia recurred and the patient experienced severe GvHD of gut and liver. Despite extensive immunosuppression the patient died from multi-organ failure 99 days after transplantation. This report describes the occurrence of neutropenia as an early presenting sign of acute GvHD after lung transplantation. We therefore recommend incorporating GvHD in the differential diagnosis of neutropenia after solid organ transplantation, calling for early chimerism analyses.

Myocyte growth in the failing heart

Adult ventricular myocytes can undergo mitotic division, resulting in an increase in the aggregate number of cells in the heart. The improvement in the methodological approach to the analysis of tissue sections by immunostaining and confocal microscopy has defeated the dogma that myocyte regeneration cannot occur in the adult heart. Most importantly, primitive and progenitor cells have been identified in the human heart. These cells express telomerase and have the capability of undergoing lineage commitment and rapid cell division, expanding significantly the contracting ventricular myocardium. These cell populations possess all the molecular components regulating the entry and progression through the cell cycle, karyokinesis, and cytokinesis. The recognition that myocyte hypertrophy and regeneration, as well as myocyte necrosis and apoptosis, occur in cardiac diseases has contributed to enhancing our understanding of the plasticity of the human heart.

Defect in the lymphoid compartment might account for CD8+-mediated effects in the pathophysiology of pure red cell aplasia

Pure red cell aplasia (PRCA) is a rare hematological syndrome characterized by the lack of red cell progenitors in an otherwise normocellular bone marrow. Many agents and mechanisms have been implicated in the pathophysiology of PRCA, including immune-mediated dysfunctions. This report describes three patients with PRCA with unknown underlying cause and showed that for each, increases in CD8+ cells blunted the maturation of early erythroid (BFU-E). Each patient subsequently responded to immunosuppressive therapy. Peripheral blood mononuclear cells from age- and sex-matched healthy controls showed comparable distribution of CD3, CD4 and CD16, but significant increase in CD8 and decreased CD19. The distribution of lymphocyte subsets correlated with mitogen responses, but showed no difference in allogeneic responses when compared to controls. The adherent population in PRCA is important for mediating the hyper-immune state of patients, when IL-2 levels were used as readout. There was a trend for decreased BFU-E in patients, but marked reduction for late erythroid progenitors (CFU-E). CD8+ cells from PRCA blunted the maturation of BFU-E, despite increasing erythropoietin concentrations. These results strongly suggest that there are defects in the lymphoid compartment that feedback on the erythroid lineage of PRCA.

Regulation of alloimmune responses (GvH reactions) in vitro by autologous donor bone marrow cell preparation used in clinical organ transplantation

BACKGROUND

Cadaver donor bone marrow cells (DBMC) are capable of a low-grade response to allogeneic stimulation in vitro, indicating their potential ability to cause graft versus host disease (GvHD). However, at this center, we have observed a lack of GvHD in kidney transplant recipients who received DBMC perioperatively. Therefore, we questioned whether an intrinsic immunoregulatory function of (subpopulations of) DBMC might play a role in this observation.

METHODS

In in vitro assays, DBMC was added to autologous splenic responder cells taking part in allogeneic mixed lymphocyte reaction (MLR) and cell-mediated lympholysis (CML) reactions.

RESULTS

When compared with autologous donor irradiated spleen cells as control modulators, DBMC significantly inhibited the CML, but to a much lesser extent than MLR, of autologous responding cells stimulated with allogeneic irradiated cells in a dose dependent manner. The down-regulation of CML responses was observed even in the presence of pharmacological concentrations FK506, mycophenolic acid, or cyclosporine-A. The inhibition could not be overcome by the addition of exogenous helper factors. Moreover, in contrast with findings previously reported from this laboratory of the in vitro inhibitory effect of DBMC on allogeneic responding cells in MLR and CML reactions to stimulating cells of the DBMC donor (allogeneic host versus graft inhibition), the following unique observations were made using DBMC inhibiting autologous reactions (GvH): (1) optimal restimulation of autologous responder cells in secondary cultures could not abrogate this inhibition; even activated responder cells could be inhibited by autologous DBMC, and (2) soluble factors were at least partially operative in this autologous (GvH) inhibition as indicated by experiments in transwells and by the CML inhibition caused by 50% supernatants from DBMC cultures.

CONCLUSION

These in vitro results indicate that DBMC treatment brings about a marked down-regulation of autologous immunocompetent cells in cytotoxicity reactions, partially at least through secreted soluble factor(s), (and in presence of immunosuppressive drugs in vivo) thereby preventing overt clinical GvHD.

In vivo depletion of hematopoietic stem cells in the rat by an anti-CD45 (RT7) antibody

Anti-CD45 monoclonal antibodies (mAbs) are potentially powerful tools for the depletion of mature leukocytes. As their application for immunotherapy also depends on their effects on bone marrow (BM) progeny, the in vivo effects of an anti-CD45 mAb (anti-RT7(a) mAb) on BM precursor cells were analyzed in a rat model. Anti-RT7(a) mAb treatment was performed in LEW.1W (RT1(u) RT7(a)) rats with the use of different dosages. In addition, major histocompatibility complex (MHC)-congenic BM transplantation making use of a diallelic polymorphism (RT7(a)/RT7(b)) of rat CD45 was applied. Following injection of anti-RT7(a) mAb into normal LEW.1W rats, T cells were profoundly depleted in blood, lymph nodes, and spleen, whereas B cells were coated only by the antibody. Single injection of anti-RT7(a) mAb in a high dose induced a lethal aplastic syndrome with severe thrombocytopenia. Rescue of antibody-treated animals with BM from congenic LEW.1W-7B rats (RT1(u) RT7(b)) and transplantation of BM from LEW.1W rats pretreated with anti-RT7(a) mAb into sublethally irradiated LEW.1W-7B recipients revealed a profound effect of the mAb on progeny of myeloid and T-cell lineage. Following repeated antibody treatment of stable mixed chimeras (RT7(b)/RT7(a)), very few RT7(a)-positive B cells were still detectable after 6 months and their number declined during the subsequent year. These observations show that this anti-RT7(a) mAb effectively depletes mature T cells as well as BM precursor cells of myeloid, T-cell, and thrombocytic lineage after in vivo application. In contrast, mature B cells are not depleted, but precursors also appear to be eliminated. Overall, the findings suggest that the anti-RT7(a) mAb efficiently depletes early rat hematopoietic stem cells.