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Biomedical subjects

D A Hullett

Publications and source records attributed to D A Hullett.

At least 19 recordsLinked to original sources

Decreased immunogenicity of human fetal pancreas allografts following hyperbaric oxygen culture.

Human fetal pancreas (HFP) is a potential source of transplantable islets for the treatment of type 1 insulin-dependent diabetes mellitus (IDDM). Pretransplant culture techniques such as long-term culture, high-oxygen culture, UVB irradiation, and low-temperature culture have previously been used to reduce the immunogenicity of tissue for transplantation. In this study, we use hyperbaric oxygen culture (HOC) to modify MHC Class I expression on HFP and to reduce the immunological response of human peripheral blood mononuclear cells (PBMC) to HFP using a sponge matrix allograft model. To study the interaction of naïve PBMC with HOC-treated or untreated HFP allografts, sponges embedded with HFP tissue were implanted into the peritoneal cavity of NOD-SCID mice and injected with 1 x 10(7) freshly isolated human PBMC at the time of transplant. By day 14, human CD45 cells represented less than 2% of the cells recovered from the sponges implanted with HOC-treated HFP. In contrast, human CD45(+) cells represented nearly 15% (P =.0018) of the cells isolated from sponges implanted with conventionally cultured HFP grafts. Approximately 75% of the human CD45(+) cells from conventionally cultured HFP allografts were producing IFNgamma as determined by intracellular cytokine analysis. These data suggest that HOC treatment of HFP abrogates the activation and proliferation of PBMC. Pretransplant HOC treatment of islets is a simple technique that could be used to reduce immunogenicity and increase allograft survival while decreasing the requirement for immunosuppressive drugs.

Animals↗

Removal of CD45+ cells from human fetal pancreas alters immunogenicity in vitro.

Human fetal pancreas (HFP) is a potential source of islets for the treatment of diabetes mellitus with the potential for growth and differentiation after transplantation. However, because of the small mass of a given HFP, multiple donors would be required for transplantation, thereby increasing the immunological challenge to the recipient. In this study, we investigate the contribution of hematopoietic cells to the immunogenicity of HFP. Single cell suspensions of HFP were depleted of CD45(+) cells using antibody-conjugated magnetic beads. In vitro mixed lymphocyte islet cultures were established using with CD45-depleted or nondepleted HFP. Depletion of CD45(+) cells resulted in the low levels of IFNgamma production at early time points (day 4), which increased to near normal levels by day 7. The development of donor-specific CTL was not consistently inhibited by CD45 cell depletion. The data suggests that CD45(+) cells within HFP are capable of stimulating immune responses by the direct pathway of antigen presentation, but that the indirect pathway is also involved in the development of CTL. The inhibition of early IFNgamma release, however, may be beneficial for the survival of transplanted islets. Therefore, the combination of CD45 depletion strategies with standard immunosuppressive drug therapies could result in better long-term survival of transplanted islets.

Abortion, Induced↗

Type 2 angiotensin II receptor expression in human renal allografts: an association with chronic allograft nephropathy.

AIMS: The renin-angiotensin system (RAS) has been implicated in renal fibrosis through activation of the type I angiotensin II (Ang II) receptor (AT1R). Whether the other predominant Ang II receptor, the type 2 Ang II receptor (AT2R), has a fibrotic or sparing role in adult human renal tissue is unknown. MATERIALS AND METHODS: We used the reverse-transcription polymerase chain reaction (RT-PCR) to assess intragraft AT2R mRNA expression in biopsy samples from 23 renal transplant recipients. Potential correlations between intragraft AT2R mRNA. matrix-modulating genes and histologic evidence of chronic rejection were assessed. RESULTS: AT2R mRNA was confirmed by sequence analysis of the RT-PCR product. AT2R mRNA expression directly correlated with angiotensinogen (Spearman correlation coefficient (r(s)) 0.72; p = 0.0011) mRNA expression, and interestingly, AT2R mRNA inversely correlated with inflammatory gene expression in the biopsy samples. However, AT2R mRNA directly correlated with transforming growth factor-beta (TGF-beta) (r(s) 0.59: p = 0.044), matrix metalloproteinase-1 (MMP-1) (r(s) 0.83; p = 0.001), tissue inhibitor of metalloproteinase-2 (TIMP-2) (r(s) 0.74; p = 0.001) and TIMP-3 (r(s) 0.80; p = 0.001) mRNA expression. Moreover, AT2R mRNA and protein expression was significantly greater in the patients with biopsy-proven chronic allograft nephropathy (n = 9; p = 0.045 vs. no chronic allograft nephropathy and donor biopsy samples for mRNA analyses). CONCLUSIONS: These data demonstrate that AT2R mRNA is expressed in adult human renal tissue in the setting of renal transplantation. Its apparent association with matrix-modulating genes raises the hypothesis that AT2R mRNA expression may be linked with extracellular matrix regulation in the setting of chronic allograft nephropathy.

Adult↗

1,25-(OH(2))D(3) alters the transforming growth factor beta signaling pathway in renal tissue.

BACKGROUND: 1,25-dihydroxyvitamin D(3) (1,25-(OH)(2)D(3)) plays an important role in regulating immune responses, in addition to its effects on bone metabolism. The cytokine transforming growth factor beta (TGF-beta) regulates diverse biological processes, including cellular proliferation and differentiation, immune modulation, and modulation of extracellular matrix deposition. 1,25-(OH)(2)D(3) interacts in vitro with Smad proteins, important regulators of TGF-beta signal transduction. We hypothesized that exogenous 1,25-(OH)(2)D(3) would alter levels of TGF-beta(1) and TGF-beta(1) signaling proteins in renal tissue. METHODS: C57BL6 mice and Lewis rats were placed on diets with or without 1,25-(OH)(2)D(3) for 14 days. Renal lysates were examined for TGF-beta(1), vitamin D receptor (VDR), and Smad3 protein levels using a cell proliferation assay and Western blot analysis. Coimmunoprecipitation was used to determine if any interaction between VDR and Smad3 proteins occurs in vivo. Reverse transcription-polymerase chain reaction (RT-PCR) was used to assess messenger RNA (mRNA) levels for all of these molecules. RESULTS: Vitamin D supplementation decreased VDR and Smad3 protein levels. Coimmunoprecipitation of VDR and Smad3 revealed a Smad3-VDR interaction in vivo. Vitamin D-treated rats had a significant (P = 0.001) reduction in bioactive renal TGF-beta(1). RT-PCR demonstrated no difference in mRNA expression for either VDR or TGF-beta(1). CONCLUSION: Our results suggest that vitamin D has a significant effect in regulating levels of bioactive TGF-beta(1) and appears to affect aspects of the TGF-beta(1) signaling system. These effects, in combination with the immunomodulatory actions of vitamin D, may alter the evolution of chronic rejection in renal transplants.

Animals↗

Role of CD4+ regulatory T cells in hyperbaric oxygen-mediated immune nonresponsiveness.

We have previously shown that hyperbaric oxygen culture (HOC [95% O(2), 5% CO(2), 25 psi]) is an effective pretransplant tissue-modification technique that results in long-term allograft survival and the induction of systemic immune tolerance in a murine model. Here we address the immune modulatory effects of HOC-treatment of human immune responses using the in vitro mixed lymphocyte reaction (MLR). Pretreatment of allogeneic stimulator cells with HOC results in abrogation of cytotoxic T lymphocyte (CTL) activity, proliferative responses, and IFN gamma production in a 7-day MLR. These responses can be restored either by the addition of IFN gamma or IL-2 on day 0, or by blocking the activity of IL-4 and IL-10. The addition of IL-2 on day 4 does not restore allospecific CTL activity. The failure of HOC-treated cells to induce allospecific CTL is not due to the induction of anergy, demonstrated by the failure to restore responses after restimulation with allogeneic cells in the presence of IL-2. Removal of CD4(+) cells prior to restimulation, results in restoration of CTL activity in MLR cultures restimulated with HOC-treated allogeneic cells. These results suggest that HOC-induced immune nonresponsiveness is mediated by the development of CD4(+) regulatory cells in a Th2-type environment.

Antibodies, Blocking↗

Does transforming growth factor beta 1 play a role in the pathogenesis of chronic allograft rejection?

To investigate the potential role of Transforming Growth Factor beta 1 (TGF beta 1) in the pathogenesis of chronic allograft rejection, we studied TGF beta 1 expression in a rat aortic allograft model. mRNA and protein expression of total and endogenously active TGF beta 1 were analysed in infra-renal orthotopic aortic syngeneic and allogeneic grafts and matched with the histological appearances of the grafts, 2, 4 and 12 weeks post-transplantation. Serum levels of TGF beta 1 were also measured. The level of TGF beta 1 m RNA and protein expression appeared highest 2 and 4 weeks following transplantation in both syngeneic and allogeneic grafts, with significantly elevated levels of mRNA expression in the 2 week allograft specimens. These time-points correlate histologically with maximal inflammatory cell infiltration of the grafts. By 12 weeks post-transplantation, TGF beta 1 mRNA expression is reduced in allogeneic grafts compared to syngeneic grafts. However, detectable levels of total and endogenously active TGF beta 1 protein levels in the allografts exceed those measured in the syngeneic grafts at this time point. These results demonstrate the complex expression pattern of this growth factor during the progression of chronic rejection and suggest an aetiological link between TGF beta 1 and the process of accelerated graft atherosclerosis.

Animals↗

Prolongation of allograft survival by 1,25-dihydroxyvitamin D3.

BACKGROUND: 1,25-Dihydroxyvitamin D3, the hormonal form of vitamin D, is now believed to play a significant role in the immune responses, both in vitro and in vivo, preventing the development of several autoimmune diseases. These studies suggest that 1,25-dihydroxyvitamin D3 may be effective in prolonging allograph survival. METHODS: To test the hypothesis that 1,25-dihydroxyvitamin D3 would prolong allograft survival, neonatal heart grafts were transplanted to allogeneic recipients receiving either 19-nor-1,25-dihydroxyvitamin D2 (200 ng/day) or 1,25-dihydroxyvitamin D3 (50 ng/mouse/day) orally through the diet. The efficacy of 1,25-dihydroxyvitamin D3 in prolonging graft survival in a vascularized model was determined by heterotopic ACI to Lewis heart transplants. RESULTS: The provision of exogenous 1,25-dihydroxyvitamin D3 or an analog, 19-nor-1,25-dihydroxyvitamin D2, to mice markedly prolonged the survival of neonatal mouse heart allografts. Similar results were obtained with a vascularized heterotopic heart transplant model in rats. Cyclosporine at a maximum 25 mg/kg dose for mice proved less effective than 1,25-dihydroxyvitamin D3. Graft survival in mice differing at class I and class II loci (B10.A(4R) --> C57BL/10) increased from 13.0+/-1.1 days to 51.0+/-5.6 days and was significantly better than cyclosporine monotherapy (33.2+/-3.6). Rat heart survival in a high responder strain combination (ACI --> Lewis) increased from 6.2+/-0.3 to 25.2+/-2.8 days. The increased survival of the transplants brought about with 1,25-dihydroxyvitamin D3 was not accompanied by hypercalcemia in rats. CONCLUSION: These results suggest that 1,25-dihydroxyvitamin D3 can be used as an effective agent in preventing graft rejection.

Animals↗

1,25-Dihydroxyvitamin D3 prolongs graft survival without compromising host resistance to infection or bone mineral density.

BACKGROUND: Recently, we have shown that 1,25-dihydroxyvitamin D3 prolongs graft survival in mice and rats when the donor and recipient differ at two or more major histocompatability loci. Among the most serious side effects encountered with the currently available transplantation antirejection drugs are an increased susceptibility to infection and decreased bone mineralization. Our results suggest that 1,25-dihydroxyvitamin D3 prolongs graft survival without these side effects of bone loss and susceptibility to infection. METHODS: We compared the ability of 1,25-dihydroxyvitamin D3-treated, nontreated, or cyclosporine (CsA)-treated mice to resist infection with Candida albicans and herpes simplex virus-1. To determine bone density, femurs were collected from nontreated, 1,25-dihydroxyvitamin D3-treated (50 ng/mouse/day), or CsA-treated (25 mg/kg/day) mice, and bone ash was determined. RESULTS: Here we show that 1,25-dihydroxyvitamin D3 treatment does not increase the susceptibility of the host to fungal or viral infection. Furthermore, CsA causes bone loss, whereas 1,25-dihydroxyvitamin D3 actually increases bone mass. CONCLUSIONS: The use of 1,25-dihydroxyvitamin D3 and its analogs to increase transplant survival will avoid bone loss and opportunistic infection, two important disadvantages of the most widely used transplant antirejection drugs--CsA and the glucocorticoids.

Animals↗

[Antisense TGF-beta 1 transfection decreases acute and chronic rejection in allografts].

The process of chronic rejection (CR) threatens long-term organ graft survival and is the major remaining barrier preventing successful clinical transplantation. The etiology of CR remains speculative, but its correlation with acute rejection episodes, HLA mismatch and immunosuppressive non-compliance suggests that active immune attack is responsible. The authors hypothesize that transforming growth factor beta-1 (TGF beta-1) plays a causal role in regulating and modulating both the acute and the chronic rejection. To investigate this hypothesis in rats, recombinant adenoviruses (rAdv)-mediated gene transfer encoding downregulating antisense--or upregulating bioactive TGF beta-1 transgene were used to infect orthotopic aortic grafts. In a high responder MHC class I histocompatibility difference (ACI to Lewis rat) and in syngeneic controls (Lewis to Lewis) both expression vectors were detected 1, 2 and 12 weeks following transplantation by intragraft cytokine transcription. Aortic segments were divided and processed for histology and RNA extraction. TGF beta-1 RNA expression was then evaluated by semi-quantitative RT-PCR (s26 standardized, HPLC quantitated). Histological evaluation was performed by a transplant pathologist in a blinded fashion. All analysis were prospective and repeated in triplicate. Untreated allografts were used as background controls for the acute and chronic rejection showing an endogenous up-regulation of TGF beta-1 at early time points (1 wk 2.7 +/- 0.5; 2 wk 9.2 +/- 6.1) and a decreased TGF beta-1/s26 ratio in chronic rejection (12 wk 1.2 +/- 0.11). Successful rAdv-transgene activity was, however, detected in low levels in all aortic layers showing a 25%-35% transfection rate whereas beta-galactosidase control gene expression was found as far as 35 days post transplant. Administration of down-regulating antisense TGF beta-1 gene into transplant segments significantly decreased the intragraft TGF beta-1 transcription (1 wk 0.8 +/- 0.2; 2 wk 1.9 +/- 0.5; 12 wk 0.7 +/- 0.15) and was correlated with absence of ongoing acute graft rejection in allografts (p < 0.01) during the first 2 weeks. The degree of intimal hyperplasia proliferation was also decreased by 40% in chronic allograft rejection. The transfection of upregulating bioactive TGF beta-1 vector led to clear increase of the TGF beta 1 gene expression but had no significant effect on immune response either on syngeneic nor allogeneic grafts. These data suggest that TGF beta-1 plays a key role in modulating the early stage of acute rejection and is a crucial mediator of the outcome of chronic rejection. Down regulation of intragraft TGF beta-1 gene expression shows immunosuppresisve property and could be used to develop clinically relevant strategies in transplantation.

Adenoviridae↗

Enhancement of thyroid allograft survival following organ culture: II. Induction of recipient peripheral tolerance.

Hyperbaric oxygen culture (HOC) prolongs endocrine graft survival and decreases major histocompatibility complex (MHC) class I surface expression. If graft prolongation were the result of passenger cell inactivation and decreased class I expression, then simultaneous transplantation of both a nontreated and a HOC-treated graft should result in rejection of the nontreated graft and acceptance of the HOC-treated graft. Simultaneous transplant of a nontreated and a HOC-treated thyroid allograft beneath the kidney capsule of recipient mice resulted in prolonged survival of both grafts in three strain combinations differing at class I (K(K), D(d), D(b)). In vitro analysis of the recipient splenic population revealed the presence of primed donor-specific cytotoxic T cells. These results suggest that recipient tolerance was not because of anergy or clonal deletion. Splenectomy at the time of transplant, revealed that both graft prolongation and the induction of recipient tolerance were dependent on the spleen. Finally, analysis of graft infiltrating cells reveals the presence of CD8+ cells but no CD4+ cells in tolerant recipients, whereas graft infiltrating cells from rejecting recipients contained both populations. The results suggest that active peripheral tolerance can be generated following transplantation of a HOC-treated allograft and that tolerance results from redirection of the recipients immune response.

Animals↗

Monocyte chemotactic protein-1 expression is associated with the development of vein graft intimal hyperplasia.

Infiltration of immunologically active cells into vein grafts is concomitant with the development of intimal hyperplasia (IH) and often leads to obliterative stenosis and graft failure. Previous work has demonstrated the prolonged presence of monocytes and macrophages in vein grafts. The stimuli attracting these macrophages remain unidentified. Monocyte chemotactic protein-1 (MCP-1), a potent and specific chemokine for monocytes/macrophages, is secreted by smooth muscle cells, endothelial cells, fibroblasts, and leukocytes, all of which are present in grafted veins. In this study, we examined the temporal profile of MCP-1 gene expression in rat vein grafts by using reverse transcription-polymerase chain reaction (PCR) and immunohistochemistry. Epigastric vein-to-femoral artery bypass grafts were microsurgically placed and harvested at various time points after grafting. Histological analysis confirmed the consistent development of IH. PCR was performed and relative levels of MCP-1 quantified by autoradiography. Our results show that MCP-1 mRNA levels increased 28-fold by 4 hours after grafting and up to 117-fold by 1 week. After this time MCP-1 mRNA levels decreased; nonetheless, even at 8 weeks after grafting, message levels remained elevated 7-fold above baseline. Immunoreactive MCP-1 protein and ED1+ macrophages were detected at all time points; the degree of immunostaining correlated with MCP-1 mRNA levels. Our results support the hypothesis that upregulation of MCP-1 gene expression in vein grafts results in the recruitment of monocytes and tissue macrophages to the vein wall, which leads to IH. The correlation between monocyte/ macrophage infiltration and IH suggests a critical role for these cells in IH development.

Animals↗

The impact of acute rejection on the development of intimal hyperplasia associated with chronic rejection.

The rat aortic model of chronic rejection was used to study the effect of acute rejection on the development of intimal hyperplasia (IH). Two model systems were studied. In the first, continuous monotherapy with mycophenolate mofetil (MM) (40 mg/dx14 d followed by 30 mg/kg/d) was initiated 2 or 4 weeks posttransplant. Digital computer image analysis was used to quantify IH. While the development of IH was delayed, it was not prevented. In allografts where MM treatment was delayed for 2 wk, a 35.5% reduction in the amount of IH was observed. Delaying drug treatment for 4 wk resulted in a 42.2% reduction of IH. In contrast, continuous therapy from the time of transplant resulted in a 76.3% reduction in the amount of IH in comparison with untreated allograft controls. To further define the role of acute rejection in the development of IH, aortic allografts, ACI or (ACIxLewis)F1 (F1), were orthotopically transplanted to Lewis recipients and then retransplanted to donor strain secondary recipients after 2 or 4 wk. Grafts were harvested at 12 weeks posttransplant. When the retransplant was performed at 2 wk, intimal hyperplasia was decreased by 55.9% in ACI and by 66.7% in F1 allografts in comparison to conventional (ACI-->Lewis) allograft controls. When retransplantation was delayed until 4 wk, IH was not decreased in ACI allografts (105.9%) and was only marginally decreased in F1 allografts (26.2%). Syngeneic control F1 grafts (F1-->F1-->F1) did not develop significant IH at 12 or 20 wk when retransplanted at 2 wk (10% and 12%, respectively) or when retransplanted at 4 wk and harvested at 12 wk (18.6%). A common feature of IH is the development of medial acellularity. Unlike conventional allograft recipients (ACI-->Lewis; no retransplantation), F1 retransplanted grafts did not develop significant medial myocyte dropout. In contrast, delayed MM immunosuppressive therapy or retransplantation of ACI allografts at 4 weeks to ACI secondary recipients resulted in significant loss of medial myocytes. Our results show that acute rejection, which occurs during the first 4 wk posttransplant, is sufficient to mediate the development of IH associated with CR. However the lack of a continued allogenic environment slows the process.

Acute Disease↗

Vascular smooth muscle cells and neointimal hyperplasia in chronic transplant rejection.

Intimal hyperplasia is the characteristic pathological hallmark in the arterial tree of chronically rejecting solid organ grafts. Mechanisms underlying the development of this lesion are poorly understood. One strongly held hypothesis is that vascular smooth muscle cells (vs.mcs) migrate from the medial layer of arteries contained within the graft into the intima forming the "neointima" characteristic of intimal hyperplasia. This study investigated this theory in a rat aortic allograft model of intimal hyperplasia. It also examined the possibility, using a combination of immunocytochemistry and electron microscopy, that aortic vs.mcs may undergo a phenotypic change during this process. Intimal area in syngeneic grafts was 3509 +/- 4325 pixels (n = 5) compared with 240,896 +/- 87,042 in allogenic grafts (n = 9, P < 0.001) 12 weeks after transplantation. At that time medial nuclear density was markedly reduced in the same allografts compared with corresponding syngeneic grafts (0.83 +/- 0.14 versus 2.64 +/- 0.60, P < 0.001, respectively). The most striking finding was that there was strongly positive staining for alpha-actin cells in the neointima in association with an almost acellular medial layer. Immunocytochemical staining also demonstrated the presence of beta-actin cells in the neointima of allografts while electron microscopy showed these cells to be secretory in phenotype. These results support the hypothesis that vs.mcs form an important component of the lesion of intimal hyperplasia and also propose that a phenotypic change may occur in these cells once they are present in the neointima.

Actins↗

Acute graft rejection of human fetal pancreas allografts using donor-specific human peripheral blood lymphocytes in the SCID mouse.

Transplantation of human fetal pancreas (HFP) is being considered as a potential treatment for insulin-dependent diabetes mellitus (IDDM). Therefore, it is necessary to have an experimental model of HFP-specific allograft rejection in order to understand all the fators that contribute to allograft rejection, and in which to test potential immunomodulatory protocols. The severe combined immunodeficient (SCID) mouse provides such a model. Previously, it has been reported that human allograft rejection can be observed in SCID mice engrafted with human lymphocytes. However, graft rejection is inconsistent and depends on both the number of lymphocytes injected and on the activation state. Here, we describe a model in which SCID mice are injected intraperitoneally with donor-specific lymphocytes generated by an in vitro culture period with irradiated donor splenocytes. Injection of the donor-sensitized PBL results in an acute rejection of HFP allografts (as early as 4 days post-transplant). This model does not require the establishment of chimerism. in the SCID mice, as demonstrated by the lack of detectable human CD45 cells in the peripheral blood of rejecting mice. Allograft rejection was due to human CD4+ and CD8+ cells, as determined by immunohistochemical analysis of graft-infiltrating cells. The advantages of this model include the potential to specifically manipulate either the phenotype of the responding cells or the mechanism in which the responding population is generated. This model can provide a rapid method to test the efficacy of immunomodulatory regimens designed to protect allografts from an acute rejection response.

Acute Disease↗

Gene therapy in transplantation.

The success of gene therapy in clinical transplantation depends largely on the further development of appropriate expression vectors. Currently available vectors all suffer from significant disadvantages. New vectors must overcome problems associated with lack of specific cell targeting in vivo, low transfection frequencies, and lack of long-term stable expression. Despite these problems, the results obtained in animal models show the potential of gene therapy techniques to modulate immune responses, enhance graft function, and correct genetic disorders.

Animals↗

Inhibition of intimal hyperplasia in rat aortic allografts with cyclosporine.

The rat aortic transplant model of chronic rejection was used to study the effect of cyclosporine (CsA) on the development of intimal hyperplasia. ACI and Lewis rat strains were used to create isograft and allograft CsA nontreated and treated groups. After orthotopic abdominal aortic transplantation, recipients received either no treatment, CsA 2.5 mg/kg/day, CsA 5 mg/kg/day, or CsA 10 mg/kg/day by gavage. Treated grafts were harvested at 3 and 6 months after transplantation, and computer image digital analysis was used to measure intimal and medial areas of graft cross-sections. At 3 months, the reduction in percent intima was 62% (P = 0.005), 74% (P = 0.002), and 97% (P < 0.0001) for the 2.5-, 5-, and 10-mg/kg allograft groups, respectively. There was a 93% (P < 0.0001) reduction in percent intima at 6 months in the 10-mg/kg allograft group. CsA treatment also preserved the aortic media. In comparison to nontreated isografts, medial area in nontreated allografts was decreased by 37% at 3 months after transplantation. In contrast, medial area was not significantly changed in CsA-treated recipients (10 mg/kg/day) in comparison to nontreated isografts. More importantly, medial nuclear density was preserved in the CsA-treated recipients in comparison to nontreated allografts and was similar to treated or nontreated isografts. In conclusion, daily high dose CsA treatment was found to markedly inhibit intimal hyperplasia in rat aortic allografts up to 6 months after transplantation, which suggests that CsA at an adequate dosage can suppress chronic rejection.

Animals↗

Evaluation of cyclosporine, mycophenolate mofetil, and Brequinar sodium combination therapy on hamster-to-rat cardiac xenotransplantation.

We examined the effect of CsA, mycophenolate mofetil (MM), and Brequinar sodium (BQR) combination therapy on hamster-to-rat cardiac xenotransplantation survival. Since the mechanism of rejection in concordant cardiac xenotransplantation may be antibody mediated as well as cellularly (CD4) mediated, we also examined the effect of these agents on antidonor antibody levels. In untreated controls, rejection occurred within 4 days, with elevation of cytotoxic antibody titers and severe humoral destruction of the xenografted hearts. It involved both IgM and IgG antibody-mediated humoral immunity. CsA alone (20 mg/kg/day) could not modify this pattern of rejection. High-dose MM (40/20 mg/kg/day)+BQR (12/6 mg/kg 3 times a week) combination therapy achieved slight prolongation of survival and suppressed the elevation of cytotoxic antibody titers relative to controls. While these grafts were rejected within 2 weeks, humoral destruction in the rejected xenografts and antibody deposition were reduced. Combination of CsA (20 mg/kg/day) with BQR (3 or 12 ng 3 times/week) dramatically increased graft survival. When CsA (20 mg/kg/day) was combined with MM (20 mg/kg/day) and BQR (3 mg/kg/day), xenograft survival was significantly prolonged (P < 0.002); however, significant toxicity was observed. Cytotoxic antibody formation was delayed for 1 month in most cases. Histological examination revealed cellular rejection with little evidence of humoral rejection. Thus, combination therapy consisting of CsA and BQR or CsA, MM, and BQR was effective in delaying the rejection of hamster-to-LEW rat concordant cardiac xenografts. The mechanism of prolonged graft survival may involve delayed humoral response and prevention of the cellular response.

Animals↗