Microchimerism does not correlate with survival of murine cardiac allografts

The development of microchimerism was evaluated at different time points after infusion of a mixed population of bone marrow and spleen cells from (BALB/c x C57Bl/6)F1 mice in the presence or absence of a cardiac transplant. Microchimerism was observed in the spleen, bone marrow and thymus of transplanted BALB/c mice even after graft rejection. In the absence of transplantation, donor cells persisted especially in the thymus. The results show that despite augmentation of graft survival after donor cell infusion compared to nontreated controls, the development of microchimerism did not sustain cardiac semihistocompatible grafts. Moreover, the persistence of donor cells in the thymus in both situations suggests a role for this organ in the increased graft survival in our model.     

Successful islet/abdominal testis transplantation does not require Leydig cells

Pancreatic islet allo- and xenografts are not rejected and exhibit long-term beta-cell function if transplanted into the abdominal testis of the diabetic host. Successful transplantation appears dependent on local factors unique to the abdominal testis. Because Leydig cells remain viable in abdominal testes, which also retain high levels of testosterone, the following question was addressed: do Leydig cells and/or their secretory products influence islet transplantability in the successful islet/abdominal testis transplantation model? Streptozotocin-induced diabetic rats (Sprague-Dawley) were injected with 75 mg/kg ethane dimethanesulfonate (EDS) to selectively eliminate Leydig cells prior to or following transplantation with islets isolated from the BBWORdr rat. Subcutaneous silastic tubes packed with estradiol prevented Leydig cell repopulation in the EDS-treated recipient. Grafted diabetic animals, including the EDS-treated rats with serum testosterone at castration levels, became nornoglycemic following islet transplantation and remained so far for up to ten months. Leydig cells were not observed in testes of the EDS- or EDS/estradiol-treated rats, whereas the transplanted islets within these testes appeared structurally normal and highly vascularized. Islets resided within the testicular interstitial compartment and contained alpha-, beta and delta-cells, as identified by electron microscopy. Beta cells were most prominent, contained secretory granules and exhibited a close structural and functional relationship with adjacent intraislet capillaries. We conclude that Leydig cells and Leydig cell secretory products, including testosterone, are not necessary for protecting islets against rejection and they do not play an obligatory role in the success of the islet/abdominal testis transplantation protocol. Leydig cells and Leydig cell secretory products do not promote long-term beta-cell function and are not required for the return to and maintenance of normoglycemia in the grafted diabetic rat.     

Osteoclast formation during tumor osteolysis does not require proliferating osteoclast precursor cells

The cellular mechanism or mechanisms through which tumors induce osteoclast formation at sites of tumor osteolysis is unknown. To test the hypothesis that osteoclast formation at sites of tumor osteolysis reflects influences that tumors have on proliferating osteoclast precursor cells, a novel in vivo experimental model was developed that produced mice that were deficient in osteoclasts (op/op) and were depleted (by way of total body irradiation) of proliferating osteoclast precursor cells. The femora of irradiated op/op mice were injected with tumor cells (2472 clone) that had been previously shown to form osteolytic tumors and to induce focal osteoclastogenesis, and the influence of these tumor cells on osteoclast formation was determined in op/op mice that were depleted of proliferating osteoelast precursor cells. The results indicated that 2472 tumor cells induced osteoclast formation in op/op mice despite the absence of proliferating osteoclast precursor cells. This finding disproved the hypothesis under investigation and suggests that osteoclast formation at sites of tumor osteolysis reflects influences of tumors on postmitotic, not proliferating, osteoclast precursor cells.     

Cryopreservation does not alter antigenic expression of aortic allografts

Cryopreserved aortic homografts are reportedly viable, but no cross-matching or immunosuppression is utilized. Alterations of the antigenic expression by cryo-preservation must be assumed. We designed a protocol to test this premise. Fisher 344 rats served as recipients in all cases. Lewis rats, a mildly disparate strain, were utilized as donors. Four cohorts of animals were utilized. Group I (N = 11) served as a "first set" control. All animals received a syngeneic skin graft. After 28 days an allogeneic skin graft was placed; rejection was seen at 10.3 +/- 0.5 days. Group II (N = 16) first received allogeneic skin grafts with a similar "first set" rejection pattern of 10.4 +/- 0.47 days. A second skin graft was placed and demonstrated an accelerated rejection response of 6.06 days +/- 0.25 days. Group III (N = 17) received two leaflets from a "fresh" Lewis heart valve inserted into a subcutaneous pouch. Allogeneic skin grafts in this group demonstrated a similar second set rejection at 7.05 +/- 0.82 days. Group IV (N = 22) also underwent implantation of heart valve leaflets, except "cryopreserved" Lewis leaflets were implanted into the subcutaneous pouch. An allogeneic skin graft was placed and demonstrated a second set rejection at 7.18 +/- 0.39 days. A one-way analysis of variance shows no significant difference in Groups III and IV, but a significant difference with respect to Group I (P less than 0.00001). Cryopreservation does not alter the antigenic expression in this model, and at present we strongly recommend that at least ABO compatibility be utilized in all patients undergoing aortic homograft implantation.     

Restoration of tolerance to rat hepatic allografts by spleen-derived passenger leukocytes

The tolerance induced by orthotopic liver transplantation (OLT) in certain combinations of rat strains can be prevented by total body irradiation (TBI) of the donor. We demonstrate here that the intravenous inoculation of splenic leukocytes into irradiated donors before OLT could re-establish tolerance in association with a state of microchimerism detected in the recipients. When donor DA (RT1^a) strain rats were irradiated with 1000 rad 24 h before liver harvesting and subsequent liver implantation into PVG recipients, five out of six rats died from rejection in this normally tolerogenic OLT (DA-PVG) combination. Injection of 1.5x10⁸ splenic leukocytes from naive DA rats into the irradiated DA donor rats 24 h before OLT restored the tolerogenic potential of the liver allografts. Immunofluorescence assay revealed an increased number of donor (DA) type cells in the PVG recipient bearing a repopulated DA liver, compared to the PVG recipient of an irradiated liver. These results suggest that passenger leukocytes reconstituted by splenic leukocytes have the capacity to protect liver allografts.     

Evidence that long-term cardiac allograft survival induced by anti-CD4 monoclonal antibody does not require depletion of CD4+ T cells.

Monoclonal antibodies that deplete cells carrying their target antigen are being used increasingly for immunosuppression in clinical and experimental transplantation. We have characterized a panel of rat antimouse CD4 monoclonal antibodies with the aim of establishing, in a vascularized organ transplant model, whether prolonged graft survival can be induced without recipient T cell depletion. The spatial relationship of the epitopes recognized by the anti-CD4 mabs was established. Mabs of the IgG2b isotype were found to profoundly deplete CD4+ T cells in vivo, whereas IgG2a mabs did not. The IgG2b anti-CD4 mab YTS191 and the IgG2a mab KT6 both blocked proliferation of C3H/He leukocytes in mixed leukocyte culture. Potent suppression of rejection and indefinite survival of cardiac allografts, mismatched for both major and multiple minor histocompatibility antigens (C57BL/10, H-2b into C3H/He, H-2k), was achieved with the IgG2b anti-CD4 mab YTS191 that depleted CD4+ T cells, (n = 9, median survival time (MST) greater than 100 days, P less than 0.001). The non-depleting IgG2a anti-CD4 mab, KT6, which had been shown to recognize and epitope on the CD4 molecule closely related to that recognized by YTS191 and to block comparably in MLC, was also shown to be capable of producing long-term cardiac graft survival in this strain combination (n = 6, MST greater than 100 days P less than 0.001). The kinetics of the KT6 therapy on the blocking of the CD4 molecule in vivo were investigated and shown to correlate with the effectiveness of the mab in prolonging graft survival.     

新生大鼠胸腺内脾细胞注射对同种移植心存活的影响

目的探讨诱导新生大鼠免疫耐受的方法.方法分别给新生SD大鼠胸腺或腹腔内注射2.5×107个Wistar大鼠脾淋巴细胞,8～10周龄时行Wistar及第三品系大鼠供心移植.结果胸腺或腹腔注射Wistar大鼠脾淋巴细胞者移植Wistar大鼠心脏后移植物的存活时间显著延长,胸腺注射者平均存活时间超过60.4*!d(P＜0.001),腹腔注射者平均存活时间为15.8*!d(P＜0.02),而第三品系大鼠的心脏移植后平均存活9.2*!d(P＞0.05).结论单一胸腺或腹腔内注射同种脾细胞可以诱导新生大鼠的特异性免疫耐受.     

MHC class II-mediated antigen presentation by alloreactive rat CD4+ T cells does not induce regulatory properties

Activated CD4+ T cells have the capacity to express major histocompatibility complex (MHC) class II molecules and to present processed antigens to T cells. Because the role of MHC class II positive T cells in allograft rejection is unknown, the purpose of this study was to investigate their function as antigen-presenting cells (APCs) in the allogeneic immune response. For this, alloreactive CD4+ T cells were induced in Lewis rats by immunization with the allogeneic peptide P1. The P1-specific T cells are involved in the rejection of allografts from Wistar Furth rats. With monoclonal antibodies specific for the αβ T-cell receptor (clone R73) and MHC class II molecules (clone Ox6), the presence of antigen-specific T cells, with and without expression of MHC class II molecules, was demonstrated. Concerning their ability to bind these antibodies they were characterized as R73^pos, Ox6^pos and R73^pos, Ox6^neg, respectively. The R73^pos, Ox6^pos T cells loaded with P1 were indeed very effective in restimulating R73^pos, Ox6^neg T cells but not vice versa. Further on, R73^pos, Ox6^pos T cells, but not R73^pos, Ox6^neg T cells, were able to activate naïve allogeneic T cells demonstrating their capacity to express co-stimulatory molecules. In addition, specific mRNA for CD86, MHC class II, and CIITA, the master regulator of MHC class II expression, were detectable in the R73^pos, Ox6^pos T cells only. In conclusion, the R73^pos, Ox6^pos T cells act as professional APCs with the possible biological capability of amplifying the local immune response to the allograft.     

Generation of urinary albumin fragments does not require proximal tubular uptake

Urinary albumin excretion is an important diagnostic and prognostic marker of renal function. Both animal and human urine contain large amounts of albumin fragments, but whether these fragments originate from renal tubular degradation of filtered albumin is unknown. Here, we used mice with kidneys lacking megalin and cubilin, the coreceptors that mediate proximal tubular endocytosis of albumin, to determine whether proximal tubular degradation of albumin forms the detectable urinary albumin fragments. After intravenous administration of (125)I-labeled mouse albumin to knockout and control mice, we examined kidney uptake of albumin and urinary excretion of both intact albumin and its fragments using size exclusion chromatography. In control mice, all labeled albumin eluted as albumin fragments in the urine. In megalin/cubilin-deficient mice, we observed decreased uptake and degradation of albumin and increased urinary excretion of intact albumin; we did not, however, detect a decrease in the excretion of albumin fragments. These results show that the generation of urinary albumin fragments occurs independently of renal tubular uptake and degradation of albumin, suggesting that the pathophysiological implications of changes in urinary albumin fragments require reevaluation.     

Studies on infiltrating host cells harvested from acutely rejecting rat cardiac allografts.

Although the cellular events of rejection of organ allografts have been fully described histologically, little information exists regarding actual mechanisms of graft destruction. Available concepts are based primarily upon assays performed in vitro. This study describes a model designed to correlate such in vitro information with events occurring in vivo within acutely rejecting organ allografts. Infiltrating host cells had been harvested by two techniques from heterotopic cardiac allografts in rats. The various cell classes have been noted and their differential rates of accumulation compared to serial histological observations. Subpopulations of cells have been identified by surface markers, and specific cytotoxicity against donor alloantigen has been determined as a T lymphocyte function. These techniques may be of aid in unraveling the complexities of graft rejection.     

Use of split-liver allografts does not impair pediatric recipient growth.

The use of split-liver (SL) allografts continues to be an excellent option for many pediatric recipients. Patient and graft survival with this graft type are comparable to patient and graft survival with whole organ grafts. Quality-of-life issues, specifically growth, for SL recipients have not been compared to those of recipients of more conventional whole-organ recipients. Pediatric recipients of SL and whole allografts at 2 institutions were identified. Height, z score, and delta z score were calculated for all recipients for each year after transplant. Between 1995 and 2004, 201 pediatric liver transplants were analyzed. Data were collected on 39 split-graft recipients and 36 whole-size recipients. Only subjects 3 years or younger were included in the study. Growth retardation was present in all recipients at transplant. Height z score post split and whole-size transplant were not statistically different at 1- (P = 0.65), 2- (P = 0.13), and 3-year (P = 0.32) anniversaries, respectively. Catch-up growth was present only in recipients of split grafts. In conclusion, the use of split grafts as opposed to whole-size grafts revealed no significant differences in terms of linear growth. Our report indicates that split-liver transplantation does not impair recipient growth.     

Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans

Introduction  Natural orifice translumenal endoscopic surgery (NOTES) is a rapidly evolving field that provides endoscopic access to the peritoneum via a natural orifice. One important requirement of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in ten patients who underwent diagnostic transgastric endoscopic peritoneoscopy. Methods  Patients participating in this trial were scheduled to undergo diagnostic laparoscopy for evaluation of presumed pancreatic cancer. Findings at diagnostic laparoscopy were compared with those of diagnostic transgastric endoscopic peritoneoscopy, using an orally placed gastroscope, blinding the endoscopist to the laparoscopic findings. We performed no gastric decontamination. Diagnostic findings, operative times, and clinical course were recorded. Gastroscope and peritoneal fluid aspirates were obtained prior to and after the gastrotomy. Each sample was sent for bacterial colony counts, culture, and identification of species. Results  Ten patients, with an average age of 63.7 years, have completed the protocol. All patients underwent diagnostic laparoscopy followed by successful transgastric access and diagnostic peritoneoscopy. The average time for laparoscopy was 7.2 min, compared with 18 min for transgastric instrumentation. Bacterial sampling was obtained in all ten patients. The average number of colony-forming units (CFU) in the gastroscope aspirate was 132.1 CFU/ml, peritoneal aspirates prior to creation of a gastrotomy showed 160.4 CFU/ml, and peritoneal sampling after gastrotomy had an average of 642.1 CFU/ml. There was no contamination of the peritoneal cavity with species isolated from the gastroscope aspirate. No infectious complications or leaks were noted at 30-day follow-up. Conclusions  There was no clinically significant contamination of the peritoneal cavity from the gastroscope after transgastric endoscopic instrumentation in humans. Transgastric instrumentation does contaminate the abdominal cavity but, the pathogens do not mount a clinically significant response in terms of either the species or the bacterial load.