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OBJECTIVES: Non-human primates are immunologically closely related to humans providing relevant models of inflammatory disorders often used to evaluate new immunomodulating therapies. The aim of the study was to compare inflammatory infiltrates of acute graft rejection (AR) and collagen-induced arthritis (CIA) to delayed-type hypersensitivity (DTH) reactions as the latter model may serve as a less invasive animal model. MATERIALS AND METHODS: Tissue samples of AR, CIA and DTH were obtained from rhesus monkeys used in several pre-clinical studies. The infiltrate composition was determined by immunohistochemical analysis. RESULTS: The infiltrates in AR consisted of T cells, macrophages and B cells. The presence of lymphoid structures in AR suggested ongoing intragraft immune activation. The synovia of CIA contained predominantly macrophages and few T cells. The DTH infiltrates were dominated by T cells when the challenged was ovalbumin (OVA) and by macrophages when the challenge was tetanus toxoid (TT). CONCLUSIONS: The histology of AR resembles aspects of DTH to OVA while that of CIA showed similarities of the DTH to TT. The DTH reaction could serve as a model to study immunomodulating drugs for acute rejection and the acute inflammatory phase of autoimmunity.
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Artritis Experimental/inmunología , Rechazo de Injerto/inmunología , Hipersensibilidad Tardía/inmunología , Animales , Antígenos/inmunología , Artritis Experimental/patología , Linfocitos B/inmunología , Citocinas/inmunología , Células Dendríticas/inmunología , Rechazo de Injerto/patología , Hipersensibilidad Tardía/patología , Trasplante de Riñón/efectos adversos , Macaca mulatta , Macrófagos/inmunología , Ovalbúmina/inmunología , Linfocitos T/inmunología , Toxoide Tetánico/inmunologíaAsunto(s)
Antineoplásicos/uso terapéutico , Linfocitos B/inmunología , Vacunas contra el Cáncer/inmunología , Doxorrubicina/uso terapéutico , Memoria Inmunológica , Neoplasias/inmunología , Neoplasias/terapia , Animales , Antineoplásicos/farmacología , Linfocitos B/efectos de los fármacos , Linfocitos B/metabolismo , Modelos Animales de Enfermedad , Doxorrubicina/farmacología , Memoria Inmunológica/efectos de los fármacos , Macaca mulatta , Linfocitos T/efectos de los fármacos , Linfocitos T/inmunología , Linfocitos T/metabolismoRESUMEN
OBJECTIVES: Loss of vaccine-induced antibodies (Abs) after chemotherapy against paediatric acute lymphoblastic leukaemia (ALL) is common and often necessitates re-immunisation after cessation of treatment. Even so, some ALL survivors fail to mount or to maintain protective Abs. Germinal centres (GCs) are clusters of proliferating B cells in follicles of secondary lymphoid tissues (SLTs) formed during adaptive immune responses and the origins of long-lived memory B and plasma cells that are the source of Abs. Furthermore, productive GC reactions depend on T follicular helper (TFH) cells. To understand why chemotherapy induces deficits in Ab responses, we examined how SLTs were affected by chemotherapy. METHODS: Rhesus macaques were infused with either three cycles of the anthracycline doxorubicin or saline, followed by immunisation with a de novo and booster antigen. Spleen and lymph nodes were removed, and memory B, bulk T and TFH cells were examined. RESULTS: Despite adequate GC morphology, a diminished memory and IgG+ B-cell population along with diminished total and booster vaccine-specific IgG-producing memory B cells were noted in the spleens of macaques with past doxorubicin exposure compared to the saline-treated controls (P < 0.05). Intact bulk T and TFH cells were found in the SLTs of treated macaques, which displayed higher CD40L upregulation capacity by their splenic CXCR5+ helper T cells (P < 0.01). In contrast to the spleen, the immune cell populations studied were comparable between the lymph nodes of both saline- and doxorubicin-treated macaques. CONCLUSION: Our findings suggest that the splenic memory B-cell subset, compared to its lymph node counterpart, is more severely altered by anthracycline treatment.
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BACKGROUND: Translational research in a relevant preclinical model is recommended before Treg-inducing protocols can be implemented in humans. We have characterized rhesus monkey CD25 cells phenotypically and functionally. METHODS: The phenotype of CD4(+)CD25(high) cells was determined by FACS, focusing on established markers of mouse and human Treg cells. Percentages of cells positive for CD45RA, CD62L, and intracellular CTLA-4 and FOXP3 were compared between CD4(+)CD25(high) and CD4(+)CD25(-) cells. CD25 cells stimulated with anti-CD3, ConA, and/or allogeneic peripheral blood mononuclear cells were mixed with freshly isolated CD25 cells. The suppressive activity of the CD25 cells in vitro was assessed using several experimental conditions. RESULTS: Rhesus monkey CD4(+)CD25(high) cells expressed high intracellular levels of CTLA-4 and FOXP3, whereas expression was negligible in CD4(+)CD25(-) cells. The CD25(high) population was mostly CD45RA(-), indicative of a memory phenotype. The CD25(+) cells were anergic, because they showed low proliferative responses, no interleukin-2 production, and some interferon-gamma and interleukin-10 production. Proliferation of CD4(+)CD25(-) cells stimulated by anti-CD3 or allogeneic cells was decreased when CD4(+)CD25(-) cells were added at a 1:1 ratio. In addition, we found that CD25 cells inhibited the interleukin-2 and interferon-gamma production by anti-CD3-stimulated CD25 cells in a dose-dependent fashion, through a cell-cell contact-dependent mechanism. CONCLUSIONS: Rhesus monkey CD4(+)CD25(+) cells have similar phenotypic and functional characteristics as natural Tregs in humans. These findings allow testing of Treg expansion and induction protocols in a relevant preclinical model, the rhesus monkey.
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Macaca mulatta/inmunología , Linfocitos T Reguladores/fisiología , Animales , Antígenos CD/análisis , Antígenos de Diferenciación/análisis , Antígeno CTLA-4 , Comunicación Celular , Citocinas/biosíntesis , Memoria Inmunológica , Antígenos Comunes de Leucocito/análisis , Linfocitos T Reguladores/inmunologíaRESUMEN
The costs for the development of new drugs have increased dramatically over the past 30 years. One of the main reasons for this increase is the low success rate of new drugs being approved for patient use, which is, in part, a consequence of the common use of rodent models for preclinical validation of efficacy. Especially in the development of biologicals, which are now successfully used in the treatment of rheumatoid arthritis, the selection of the right animal model is pivotal. Non-human primates could help to bridge the evolutionary gap between rodent models and human patients.
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Artritis Experimental/tratamiento farmacológico , Artritis Reumatoide/tratamiento farmacológico , Evaluación Preclínica de Medicamentos/métodos , Animales , Artritis Experimental/metabolismo , Artritis Experimental/fisiopatología , Artritis Reumatoide/metabolismo , Artritis Reumatoide/fisiopatología , Biomarcadores/análisis , Diseño de Fármacos , Humanos , Macaca mulatta , RatonesRESUMEN
Autoantibodies against ion channels are the cause of numerous neurologic autoimmune disorders. Frequently, such pathogenic autoantibodies have a restricted epitope-specificity. In such cases, competing antibody formats devoid of pathogenic effector functions (blocker antibodies) have the potential to treat disease by displacing autoantibodies from their target. Here, we have used a model of the neuromuscular autoimmune disease myasthenia gravis in rhesus monkeys (Macaca mulatta) to test the therapeutic potential of a new blocker antibody: MG was induced by passive transfer of pathogenic acetylcholine receptor-specific monoclonal antibody IgG1-637. The effect of the blocker antibody (IgG4Δhinge-637, the hinge-deleted IgG4 version of IgG1-637) was assessed using decrement measurements and single-fiber electromyography. Three daily doses of 1.7 mg/kg IgG1-637 (cumulative dose 5 mg/kg) induced impairment of neuromuscular transmission, as demonstrated by significantly increased jitter, synaptic transmission failures (blockings) and a decrease in the amplitude of the compound muscle action potentials during repeated stimulations (decrement), without showing overt symptoms of muscle weakness. Treatment with three daily doses of 10 mg/kg IgG4Δhinge-637 significantly reduced the IgG1-637-induced increase in jitter, blockings and decrement. Together, these results represent proof-of principle data for therapy of acetylcholine receptor-myasthenia gravis with a monovalent antibody format that blocks binding of pathogenic autoantibodies.
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Autoanticuerpos/metabolismo , Inmunoglobulina G/administración & dosificación , Miastenia Gravis/tratamiento farmacológico , Receptores Colinérgicos/metabolismo , Animales , Células CHO , Antagonistas Colinérgicos , Cricetulus , Modelos Animales de Enfermedad , Regulación de la Expresión Génica/efectos de los fármacos , Células HEK293 , Exones de la Región Bisagra , Humanos , Inmunoglobulina G/farmacología , Macaca mulatta , Miastenia Gravis/inmunología , Miastenia Gravis/metabolismo , Transmisión Sináptica/efectos de los fármacos , Resultado del TratamientoRESUMEN
BACKGROUND: Costimulation blockade with antibodies directed against human CD40 and CD86 leads to prolonged kidney allograft survival in rhesus monkeys, but fails to induce permanent graft acceptance. We have tested whether costimulation blockade is more effective after peripheral T-cell ablation with antithymocyte globulin (ATG), with the aim to remove already primed autoreactive cells present in the normal repertoire. METHODS: Rhesus monkeys were transplanted with a mismatched kidney allograft. ATG was given around the time of transplantation (day -1 and 0). Costimulation blockade with anti-CD40+anti-CD86 was given at tapering dosages from day -1 to 56. Cyclosporin A (CsA) was given from day 42 onwards and first rejections occurring after day 42 were treated with prednisone. RESULTS: We observed accelerated rejection in ATG-treated monkeys, compared to animals receiving only costimulation blockade. The accelerated rejection of the kidney allograft occurred despite the application of rejection therapy with steroids and CsA. Three of the five ATG-treated animals were found seropositive for donor-specific alloantibodies. Early biopsies (day 21) from animals treated with ATG and anti-CD40+anti-CD86 show substantially reduced expression of cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) and forkhead box P3 (FOXP3) in focal infiltrates as compared to animals treated with only costimulation blockade. Furthermore, we observed the rapid reappearance of CD8 T-cells with a memory phenotype (disappearance of naive CD95/CD11a T-cells) in peripheral blood. CONCLUSION: We conclude that (subtotal) T-cell depletion using ATG does not add to costimulation blockade induced kidney allograft survival.
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Anticuerpos Bloqueadores/administración & dosificación , Suero Antilinfocítico/administración & dosificación , Supervivencia de Injerto/efectos de los fármacos , Terapia de Inmunosupresión , Trasplante de Riñón , Animales , Antígenos CD/análisis , Antígenos de Diferenciación/análisis , Antígeno B7-2/efectos de los fármacos , Antígenos CD40/antagonistas & inhibidores , Antígeno CTLA-4 , Sinergismo Farmacológico , Factores de Transcripción Forkhead/análisis , Rechazo de Injerto/inmunología , Rechazo de Injerto/patología , Rechazo de Injerto/prevención & control , Memoria Inmunológica , Riñón/química , Riñón/patología , Depleción Linfocítica , Macaca mulatta , Linfocitos T/química , Linfocitos T/efectos de los fármacosRESUMEN
Aging western societies are facing an increasing prevalence of chronic inflammatory and degenerative diseases for which often no effective treatments exist, resulting in increasing health-care expenditure. Despite high investments in drug development, the number of promising new drug candidates decreases. We propose that preclinical research in non-human primates can help to bridge the gap between drug discovery and drug prescription. Translational research covers various stages of drug development of which preclinical efficacy tests in valid animal models is usually the last stage. Preclinical research in non-human primates may be essential in the evaluation of new drugs or therapies when a relevant rodent model is not available. Non-human primate models for life-threatening or severely debilitating diseases in humans are available at the Biomedical Primate Research Centre (BPRC). These have been instrumental in translational research for several decades. In order to stimulate European health research and innovation from bench to bedside, the European Commission has invested heavily in access to non-human primate research for more than 20 years. BPRC has hosted European users in a series of transnational access programs covering a wide range of research areas with the common theme being immune-mediated inflammatory disorders. We present an overview of the results and give an account of the studies performed as part of European Union Framework Programme (EU FP)-funded translational non-human primate research performed at the BPRC. These data illustrate the value of translational non-human primate research for the development of new therapies and emphasize the importance of EU FP funding in drug development.
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BACKGROUND: Chronic allograft nephropathy (CAN) is a common late complication of kidney transplantation. Antibodies to both human leukocyte antigen and nonhuman leukocyte antigen antigens have been implicated in the development of this condition. Here we investigated the presence of antivimentin antibodies in nonhuman primate recipients of kidney allografts as a possible predictor of CAN and the effects of immunosuppression. METHODS: Thirty seven rhesus monkeys received a kidney allograft to study the potency of several different immunosuppressive regimens (conventional immunosuppression, n=19, vs. costimulatory blockade, n=18). Monkeys were tested for antivimentin antibody by enzyme-linked immunosorbent assay and for anti-donor antibody by staining donor spleen cells with recipient serum. The appearance of antibodies was correlated with the graft pathology in biopsy and necropsy material. RESULTS: Antivimentin antibodies were found in 31 of 37 animals, whereas only 15 of 32 animals made anti-donor antibodies. Conventional immunosuppression did not prevent antivimentin antibody formation. Costimulation blockade, in particular blocking CD40 and CD86, significantly delayed or prevented antivimentin antibody formation, but did not prevent CAN. Antivimentin antibodies were not significantly associated with development of CAN. CONCLUSIONS: We postulate that vimentin acts as an autoantigen after renal transplantation; it elicits an autoimmune response that is not regulated by cyclosporine. This autoimmune response may be part of the complex immunologic events occurring posttransplantation and may contribute to the development of CAN, but cannot be considered as a major cause of CAN because this condition also develops without antivimentin antibodies.
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Autoinmunidad , Terapia de Inmunosupresión , Inmunosupresores/farmacología , Trasplante de Riñón/métodos , Vimentina/farmacología , Animales , Antígenos/química , Antígenos CD/biosíntesis , Antígeno B7-2 , Biopsia , Antígenos CD40/biosíntesis , Ensayo de Inmunoadsorción Enzimática , Antígenos HLA/inmunología , Humanos , Tolerancia Inmunológica , Inmunoglobulina G/química , Inmunoglobulina M/química , Trasplante de Riñón/efectos adversos , Macaca mulatta , Glicoproteínas de Membrana/biosíntesis , Factores de Tiempo , Trasplante Homólogo , Resultado del Tratamiento , Vimentina/antagonistas & inhibidores , Vimentina/químicaRESUMEN
Costimulation blockade as a single immunosuppressive treatment modality is not sufficient to prevent graft rejection. Here, we report an induction therapy using antagonistic antibodies against CD40 and CD86, given twice weekly from day -1 until day 56, followed by a delayed 12-week course of low-dose cyclosporine A (CsA) treatment in the rhesus monkey kidney-allograft model. Low-dose CsA treatment was initiated on day 42 and tapered until total cessation of all treatment on day 126. Treatment with anti-CD40/86 alone resulted in graft survival of 61, 71, 75, 78, and 116 days. Costimulation blockade followed by CsA resulted in more than 3-year drug-free survival in two of four animals. None of the animals developed donor-specific alloantibodies. Transforming growth factor-beta producing cells are present in early as well as in late kidney-graft biopsies and could play a role in the observed long-term drug-free graft survival.
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Supervivencia de Injerto/inmunología , Trasplante de Riñón/inmunología , Animales , Anticuerpos/uso terapéutico , Antígenos CD/inmunología , Antígeno B7-2 , Antígenos CD40/inmunología , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Trasplante de Riñón/patología , Macaca mulatta , Glicoproteínas de Membrana/inmunología , Factores de Tiempo , Trasplante HomólogoRESUMEN
Kidney allograft biopsies were analyzed for the presence of B cell clusters/aggregates using CD20 staining. Few B cells were found in the diffuse interstitial infiltrates, but clusters of B cells were found in nodular infiltrates. These nodular infiltrates were smaller shortly after transplantation, and their size increased over time. At the time of clinical rejection, the nodules often presented as tertiary lymphoid structures (TLS) with lymphoid-like follicles. The presence of small B cell clusters during the first 2 months after transplantation was not associated with early rejection. Even in animals that did not reject their allograft, TLS-like structures were present and could disappear over time. Although TLS were more often found in samples with interstitial fibrosis and tubular atrophy (IFTA), TLS were also present in samples without IFTA. The presence and density of clusters resembling tertiary lymphoid structures most likely reflect an ongoing immune response inside the graft and do not necessarily signify a poor graft outcome or IFTA.
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Linfocitos B/inmunología , Rechazo de Injerto/inmunología , Trasplante de Riñón/efectos adversos , Riñón/inmunología , Riñón/cirugía , Tejido Linfoide/inmunología , Aloinjertos , Animales , Antígenos CD20/metabolismo , Atrofia , Linfocitos B/metabolismo , Linfocitos B/patología , Biomarcadores/metabolismo , Biopsia , Fibrosis , Rechazo de Injerto/metabolismo , Rechazo de Injerto/patología , Inmunohistoquímica , Riñón/metabolismo , Riñón/patología , Tejido Linfoide/metabolismo , Tejido Linfoide/patología , Macaca mulatta , Modelos Animales , Factores de TiempoRESUMEN
The last few decades of the 20th century have shown an intensified search for safer and more effective medications against chronic diseases that burden ageing societies of the western world. The impressive development of biotechnological production techniques has greatly facilitated the pharmaceutical development of relatively non-toxic biological molecules. However, despite the huge investments, only a few effective therapies for immune-based diseases have reached the clinic. In this article we use examples from monoclonal antibody trials to discuss the validity and predictive strength of the animal models currently used for the development of effective therapies.
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Modelos Animales de Enfermedad , Enfermedades del Sistema Inmune/terapia , Adyuvantes Inmunológicos/uso terapéutico , Animales , Anticuerpos Monoclonales/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/inmunología , Evaluación Preclínica de Medicamentos/métodos , Encefalomielitis Autoinmune Experimental/tratamiento farmacológico , Encefalomielitis Autoinmune Experimental/inmunología , Enfermedades del Sistema Inmune/inmunología , Inmunoterapia/métodos , Esclerosis Múltiple/tratamiento farmacológico , Esclerosis Múltiple/inmunología , Trasplante de ÓrganosRESUMEN
The induction of tolerance for allografts, obviating the need for immunosuppression, is the ultimate goal in transplantation. Immunoregulatory antibodies preventing graft rejection are promising candidates for the induction of tolerance. Costimulation blockade could be a useful approach to inducing donor-specific nonresponsiveness in organ transplantation. Rodent studies and in vitro studies using human or nonhuman primate peripheral blood mononuclear cells indicated that this approach might indeed lead to specific T-cell anergy. Nonhuman primate studies, in which the B7 costimulation pathway was blocked, have so far not led to permanent drug-free graft acceptance. The results are promising, however, because during the treatment period with B7 costimulation blockade alone or combined with anti-CD40 or cyclosporine, no graft loss was observed and donor-specific antibody formation was prevented. Based on these findings, new approaches to inducing drug-free graft acceptance should be investigated.
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Antígeno B7-1/inmunología , Glicoproteínas de Membrana/antagonistas & inhibidores , Tolerancia al Trasplante , Animales , Antígenos CD , Antígeno B7-2 , Humanos , Primates/inmunologíaRESUMEN
BACKGROUND: CD154 (CD40 ligand) monoclonal antibody prevents allograft rejection in rodents and monkeys. Inasmuch as calcineurin inhibitors (CI) inhibit CD154 expression by pharmacologic agents in vitro, we investigated whether CD154 is also inhibited by CI in vivo and in vitro during allogeneic stimulation. METHODS: CD154 expression was determined by immunohistochemistry and flow cytometry in human lymph nodes and spleen sections from rhesus monkeys with or without CI treatment. The effect of CI on induction of CD154 expression was studied by stimulating lymphocytes with phorbol 12-myristate 13-acetate (PMA) and ionomycin or with allogeneic monocyte-derived mature dendritic cells. RESULTS: Lymph nodes from patients with or without CI cyclosporine (CsA) or FK506 (FK) treatment showed comparable CD154 expression, which was present on the cell surface of T cells. CD154-expressing cells were also present in spleens from monkeys treated with CsA in comparable numbers to those in the nontreated group. Moreover, in several liver transplant rejection biopsies taken during CI therapy CD154-expressing cells were observed. In vitro, CsA and FK strongly inhibited induction of CD154 expression on peripheral blood mononuclear cells by pharmacologic stimuli. Maximum inhibition was found at 50 ng/ml CsA and 20 ng/ml FK. CD154 expression induced by dendritic cells in peripheral blood mononuclear cells or spleen cells was also almost completely inhibited by CsA. CONCLUSION: Although CI strongly suppressed pharmacologic and allogeneic induction of CD154 expression on T cells in vitro at concentrations at approximately clinical trough levels, CD154 is prominently expressed during CI therapy in lymphoid tissue and (sporadically) in liver allografts. This suggests that the CD154-CD40 pathway remains functional during CI therapy, which may contribute to allograft rejections in the clinical setting.
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Ligando de CD40/genética , Inhibidores de la Calcineurina , Rechazo de Injerto/prevención & control , Trasplante Homólogo/inmunología , Anticuerpos Monoclonales/uso terapéutico , Ciclosporina/uso terapéutico , Trasplante de Corazón/inmunología , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Trasplante de Hígado/inmunología , Ganglios Linfáticos/inmunología , Bazo/inmunología , Tacrolimus/uso terapéuticoRESUMEN
BACKGROUND: Transplantation of islets of Langerhans can restore insulin production in diabetic patients. Because of the shortage of human donor organs, transplantation of porcine islets may be an alternative solution. The present study was aimed at the characterization of rejection mechanisms of porcine islets transplanted into eight nondiabetic monkeys under the kidney capsule. METHODS: Cultured adult pig islets were used, which showed no expression of the galactose(alpha1,3)galactose epitope, major histocompatibility complex class II, or CD45, and no binding of antibodies or complement after exposure to monkey serum. Immunosuppression consisted of cyclophosphamide, cyclosporine A (CsA), and steroids (group 1); or antithymocyte globulin, anti-interleukin-2 receptor antibody, CsA, and steroids (group 2). In three animals of group 2, islets were also transplanted in the portal vein. RESULTS: Although all monkeys had preformed anti-pig antibodies, no correlation was found between antibody titers and rejection and no deposition of antibodies or complement was observed in the grafts. Group 1 showed islets up to day 11, followed by T-cell infiltration and rejection at approximately day 14. In group 2, two monkeys showed infiltrates consisting predominantly of T cells starting at approximately day 29, whereas two monkeys showed well-preserved islets without infiltration up to day 53. In the livers of the three monkeys that also received islets intraportally and were resectioned on days 21, 33, and 49, no islets could be detected. CONCLUSIONS: This study demonstrates that cultured adult pig islets can survive in the monkey for more than 53 days without signs of rejection under standard immunosuppression.
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Ciclosporina/uso terapéutico , Supervivencia de Injerto/inmunología , Terapia de Inmunosupresión/métodos , Trasplante de Islotes Pancreáticos/inmunología , Linfocitos T/inmunología , Trasplante Heterólogo/inmunología , Animales , Técnicas de Cultivo de Célula/métodos , Ciclosporina/administración & dosificación , Femenino , Supervivencia de Injerto/efectos de los fármacos , Inmunosupresores/uso terapéutico , Inyecciones Intramusculares , Islotes Pancreáticos/citología , Trasplante de Islotes Pancreáticos/patología , Trasplante de Islotes Pancreáticos/fisiología , Macaca fascicularis , Macaca mulatta , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Porcinos , Trasplante Heterólogo/patologíaRESUMEN
BACKGROUND: Costimulation blockade has been proposed to induce allograft tolerance. We combined an antagonist anti-CD40 monoclonal antibody (mAb) with an antagonist anti-CD86 mAb in a rhesus monkey kidney allograft model. We chose this combination because it leaves CD80-CD152 signaling unimpaired, allowing for the down-regulatory effect of CD152 signaling to take place through this pathway. METHODS: Rhesus monkeys underwent transplantation with a major histocompatibility complex-mismatched kidney. One group of animals received anti-CD40 alone, and a second group received the combination of anti-CD40 and anti-CD86, twice weekly for 56 days. RESULTS: Three animals with low levels of anti-CD40 rejected the transplanted kidney while still receiving treatment. Three animals with high levels of anti-CD40 rejected at days 91, 134, and 217 with signs of chronic rejection. Animals treated with the combination of anti-CD40 and anti-CD86 mAbs rejected their kidneys at days 61, 75, and 78, shortly after cessation of treatment. Two animals were killed on days 71 and 116 with a blocked ureter. These animals developed virtually no signs of tubulitis or infiltration during treatment and no donor-specific alloantibodies. CONCLUSIONS: Both treatment protocols prevented rejection for the duration of the treatment in most animals. Blocking costimulation by anti-CD40 or by anti-CD40 plus anti-CD86 may be an effective method to prevent graft rejection and may obviate the need for other immunosuppressive drugs, especially in the immediate posttransplantation period.
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Anticuerpos Monoclonales/farmacología , Antígenos CD/inmunología , Antígenos CD40/inmunología , Rechazo de Injerto/prevención & control , Trasplante de Riñón , Glicoproteínas de Membrana/inmunología , Animales , Formación de Anticuerpos , Especificidad de Anticuerpos , Antígeno B7-2 , Quimera/inmunología , Combinación de Medicamentos , Supervivencia de Injerto , Histocompatibilidad , Isoanticuerpos/análisis , Isoanticuerpos/inmunología , Riñón/patología , Trasplante de Riñón/inmunología , Linfocitos/efectos de los fármacos , Macaca mulatta , Donantes de TejidosRESUMEN
BACKGROUND: In rodents it has been demonstrated that blockade of the CD40-CD154 (CD40L) pathway at the time of donor-specific blood transfusion (DST) can result in indefinite graft survival. Because it has been reported in the past that DST in monkeys can have a favorable effect on graft outcome and that blockade of the CD40-CD154 pathway can lead to prolonged kidney graft survival in monkeys, we have combined anti-CD154 treatment with DST in a monkey kidney graft model. The aim of this study was to investigate the immunosuppressive potential of blocking the CD40-CD154 interaction at the time of a DST in rhesus monkeys. METHODS: One donor-derived blood transfusion was given on day -15 after the first anti-CD154 injection. The anti-CD154 antibody was given on days -15, -13, -11, -9, and -7. The kidney was transplanted on day 0. Cyclosporine was given after kidney trans-plantation. RESULTS: No major difference in graft survival was observed between the groups. The animals died due to grade II acute rejection. At the time of transplantation, no antibody response could be detected directed against donor antigens. After transplantation, all animals surviving for more than 3 weeks had antidonor antibodies. There were no differences in the intragraft events analyzed by real time reverse transcriptase-polymerase chain reaction. CONCLUSIONS: DST under the cover of relatively high levels of anti-CD154 failed to result in prolonged graft survival or prevent the formation of antidonor antibodies, when cyclosporine was given after transplantation.
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Transfusión Sanguínea , Antígenos CD40/inmunología , Ligando de CD40/inmunología , Supervivencia de Injerto/inmunología , Trasplante de Riñón/inmunología , Animales , Femenino , Tolerancia Inmunológica , Isoanticuerpos/sangre , Macaca mulatta , Masculino , Donantes de Tejidos , Trasplante HomólogoRESUMEN
BACKGROUND: Tolerance to organ allografts in primates including man has been elusive, although in rodents and pigs tolerance can be achieved to organ allografts with relatively short courses of immunosuppressive treatment. In all varieties of graft acceptance that do not require full-dose maintenance immunosuppression, immunological engagement of donor and recipient and an early unstable period have been observed. On the basis of the hypothesis that elimination of aggressive T cell function should tip the balance in favor of an operationally tolerant state, experiments have been performed in monkeys allowing recipient-donor interaction before T-cell ablation and a short course of immunosuppression. METHODS: Rhesus monkeys received an allogeneic kidney graft from a MHC-mismatched donor. The animals either received anti-CD3 immunotoxin (FN18-CRM9) alone, started 2 days after transplantation, or in combination with a short course of cyclosporine (CsA) and/or rapamycin (RAPA), started at 5 days after transplantation. Kidney function was followed by monitoring serum creatinine levels and regular biopsies. Humoral and cellular antidonor immunity was tested in vitro before and at several time points after transplantation. RESULTS: Graft survival of monkeys that received CsA alone (mean survival time (MST)=29.3) was significantly prolonged compared with the controls (MST=6). FN18-CRM9 treatment alone also resulted in prolonged graft survival (MST=29.4). The combined treatment of FN18-CRM9 and CsA and/or RAPA resulted in prolonged graft survival after all immunosuppression was stopped (MST=207.8). CONCLUSIONS: It seems feasible to postpone immunosuppression posttransplantation and yet prevent allograft rejection without the need of permanent immunosuppression.
Asunto(s)
Supervivencia de Injerto/inmunología , Trasplante de Riñón/inmunología , Linfocitos T/inmunología , Animales , Anticuerpos Monoclonales/farmacología , Ciclosporina/farmacología , Toxina Diftérica/farmacología , Inmunosupresores/farmacología , Isoanticuerpos/análisis , Isoanticuerpos/sangre , Depleción Linfocítica , Macaca mulatta , Modelos Animales , Proteínas Recombinantes de Fusión/farmacología , Sirolimus/farmacología , Bazo/inmunología , Factores de Tiempo , Trasplante Heterotópico , Trasplante Homólogo/inmunologíaRESUMEN
The development of an in vitro assay predicting the chances of graft survival after treatment with immunoregulatory agents is a major topic in transplantation. Antibodies (Abs) interfering in the costimulatory pathway are promising candidates for the induction of tolerance. To evaluate these antibodies for clinical use studies non-human primates are the only feasible option due to species specificity of the antibodies. Peripheral blood mononuclear cells, isolated from a large panel of rhesus monkeys, were used in a unidirectional mixed lymphocyte reaction to evaluate the ability of antibodies blocking the costimulatory pathway, to affect both primary and secondary proliferative and cytolytic allospecific immune responses in vitro. These blocking antibodies were also used in protocols prolonging allograft survival in a life-supporting kidney allotransplant model in rhesus macaques. The ultimate aim is to establish a correlation between parameters obtained in vitro and the success of transplantation in vivo. The combination of anti-CD80 and anti-CD86 resulted in a complete abrogation of the primary alloresponse as measured in a proliferation assay. Adding anti-CD40 significantly reduced this inhibitory effect although the in vivo effects of this antibody have been shown to be beneficial. The secondary response was most prominently inhibited by the combination of anti-CD80/86. Paradoxically, anti-CD40 alone markedly inhibited the secondary proliferative response, but did not add to the inhibitory effect of the combination of anti-CD80/86. The cytolytic response was inhibited maximally only when CsA was added to the combination of anti-CD80/86. Treatment with monoclonal antibodies alone without immunosuppressive drugs was sufficient to maintain graft survival during the time of treatment in most animals. However, rejection was initiated as soon as the treatment ceased and no tolerance, resulting in long-term graft and patient survival, was established. The complete inhibition of primary alloresponses and the partial inhibition of secondary proliferative alloresponses correlate with prolonged graft survival during treatment, but have no predictive value for the success of tolerance induction for kidney allografts in rhesus monkeys.
Asunto(s)
Anticuerpos Bloqueadores/uso terapéutico , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Trasplante de Riñón/inmunología , Linfocitos/efectos de los fármacos , Tolerancia al Trasplante , Animales , Anticuerpos Monoclonales/uso terapéutico , Antígenos CD/inmunología , Antígeno B7-1/inmunología , Antígeno B7-2 , Antígenos CD40/inmunología , Células Cultivadas , Supervivencia de Injerto/inmunología , Prueba de Cultivo Mixto de Linfocitos , Linfocitos/inmunología , Glicoproteínas de Membrana/inmunologíaRESUMEN
The overlapping epidemiology of multiple sclerosis (MS) and Epstein-Barr virus (EBV), the increased risk to develop MS after infectious mononucleosis (IM) and the localization of EBV-infected B-cells within the MS brain suggest a causal link between EBV and MS. However, the underlying mechanism is unknown. We hypothesize that EBV-infected B-cells are capable of eliciting a central nervous system (CNS) targeting autoimmune reaction. To test this hypothesis we have developed a novel experimental model in rhesus monkeys of IM-like disease induced by infusing autologous B-lymphoblastoid cells (B-LCL). Herpesvirus papio (HVP) is a lymphocryptovirus related to EBV and was used to generate rhesus monkey B-LCL. Three groups of five animals were included; each group received three intravenous infusions of B-LCL that were either pulsed with the encephalitogenic self peptide MOG(34-56) (group A), a mimicry peptide (981-1003) of the major capsid protein of cytomegalovirus (CMVmcp(981-1003); group B) or the citrullinated MOG(34-56) (cMOG(34-56); group C). Groups A and B received on day 98 a single immunization with MOG(34-56) in incomplete Freund's adjuvant (IFA). Group C monkeys were euthanized just prior to day 98 without booster immunization. We observed self-peptide-specific proliferation of T-cells, superimposed on similar strong proliferation of CD3(+)CD8(+) T-cells against the B-LCL as observed in IM. The brains of several monkeys contained perivascular inflammatory lesions of variable size, comprising CD3(+) and CD68(+) cells. Moreover, clusters of CD3(+) and CD20(+) cells were detected in the meninges. The only evident clinical sign was substantial loss of bodyweight (>15%), a symptom observed both in early autoimmune encephalitis and IM. In conclusion, this model suggests that EBV-induced B-LCL can elicit a CNS targeting inflammatory (auto)immune reaction.