Improved outcomes of islet autotransplant after total pancreatectomy by combined blockade of IL-1ß and TNFα.

The efficacy of islet transplant is compromised by a significant loss of islet mass posttransplant due to an innate inflammatory reaction. We report the use of a combination of etanercept and anakinra (ANA+ETA) to block inflammatory islet damage in 100 patients undergoing total pancreatectomy with islet autotransplant. The patients were divided into 3 groups: no treatment (control [CTL]), etanercept alone (ETA), or a combination of etanercept and anakinra (ANA+ETA). Peritransplant serum samples were analyzed for protein markers of islet damage and for inflammatory cytokines. Graft function was assessed by fasting blood glucose, basal C-peptide, secretory unit of islet transplant objects (SUITO) index, and hemoglobin A1c . Administration of both antiinflammatory drugs was well tolerated without any major adverse events. Reductions in interleukin-6, interleukin-8, and monocyte chemoattractant protein 1 were observed in patients receiving ANA+ETA compared with the CTL group, while also showing a modest improvement in islet function as assessed by basal C-peptide, glucose, hemoglobin A1c , and SUITO index but without differences in insulin dose. These results suggest that double cytokine blockade (ANA+ETA) reduces peritransplant islet damage due to nonspecific inflammation and may represent a promising strategy to improve islet engraftment, leading to better transplant outcomes.

Evidence for instant blood-mediated inflammatory reaction in clinical autologous islet transplantation.

A nonspecific inflammatory and thrombotic reaction termed instant blood-mediated inflammatory reaction (IBMIR) has been reported when allogenic or xenogenic islets come into contact with blood. This reaction is known to cause significant loss of transplanted islets. We hypothesized that IBMIR occurs in patients undergoing total pancreatectomy followed by autologous islet transplantation (TP-AIT) and tested this hypothesis in 24 patients and in an in vitro model. Blood samples drawn during the peritransplant period showed a significant and rapid increase of thrombin-anti-thrombin III complex (TAT) and C-peptide during islet infusion, which persisted for up to 3 h, along with a decreased platelet count. A concomitant increase in levels of inflammatory proteins IL-6, IL-8 and interferon-inducible protein-10 was observed. An in vitro model composed of pure islets plus autologous blood also demonstrated significantly increased levels of TAT (p<0.05), C-peptide (p<0.05), tumor necrosis factor-alpha (p<0.05) and MCP-1 (p<0.05), as well as strong tissue factor expression in islets. Islet viability decreased significantly but was rescued by the presence of low-molecular-weight dextran sulfate. In conclusion, AIT-induced elevation of TAT and destruction of islets suggests that IBMIR might occur during AIT. Modulating this process may help improve islet engraftment and the insulin independence rate in TP-AIT patients.

Islet product characteristics and factors related to successful human islet transplantation from the Collaborative Islet Transplant Registry (CITR) 1999-2010.

The Collaborative Islet Transplant Registry (CITR) collects data on clinical islet isolations and transplants. This retrospective report analyzed 1017 islet isolation procedures performed for 537 recipients of allogeneic clinical islet transplantation in 1999-2010. This study describes changes in donor and islet isolation variables by era and factors associated with quantity and quality of final islet products. Donor body weight and BMI increased significantly over the period (p<0.001). Islet yield measures have improved with time including islet equivalent (IEQ)/particle ratio and IEQs infused. The average dose of islets infused significantly increased in the era of 2007-2010 when compared to 1999-2002 (445.4±156.8 vs. 421.3±155.4×0(3) IEQ; p<0.05). Islet purity and total number of ß cells significantly improved over the study period (p<0.01 and <0.05, respectively). Otherwise, the quality of clinical islets has remained consistently very high through this period, and differs substantially from nonclinical islets. In multivariate analysis of all recipient, donor and islet factors, and medical management factors, the only islet product characteristic that correlated with clinical outcomes was total IEQs infused. This analysis shows improvements in both quantity and some quality criteria of clinical islets produced over 1999-2010, and these parallel improvements in clinical outcomes over the same period.

Withaferin A inhibits pro-inflammatory cytokine-induced damage to islets in culture and following transplantation.

AIMS/HYPOTHESIS: Beta cell death triggered by pro-inflammatory cytokines plays a central role in the pathogenesis of type 1 diabetes and loss of transplanted islets. The nuclear factor κB (NF-κB) signalling pathway is a key regulator of beta cell stress response, survival and apoptosis. Withaferin A (WA), a steroidal lactone derived from Withania somnifera, has been demonstrated to be a potent, safe, anti-inflammatory molecule that can inhibit NF-κB signalling. Therefore, we evaluated the ability of WA to protect mouse and human islets from the damaging effects of pro-inflammatory cytokines in vitro and following intraportal transplantation. METHODS: Mouse and human islets were treated with a cytokine cocktail, and NF-κB activation was measured by immunoblots, p65 nuclear translocation and chromatin immunoprecipitation of p65-bound DNA. Intraportal transplantation of a marginal mass of syngeneic mouse islets was performed to evaluate the in vivo protective effect of WA. RESULTS: Treatment with WA substantially improved islet engraftment of syngeneic islets (83% for infusion with 200 islets + WA; 0% for 200 islets + vehicle) in a mouse model of diabetes, compared with marginal graft controls with superior islet function in WA-treated mice confirmed by glucose tolerance test. Treatment of human and mouse islets with WA prevented cytokine-induced cell death, inhibited inflammatory cytokine secretion and protected islet potency. CONCLUSIONS: WA was shown to be a strong inhibitor of the inflammatory response in islets, protecting against cytokine-induced cell damage while improving survival of transplanted islets. These results suggest that WA could be incorporated as an adjunctive treatment to improve islet transplant outcome.

Evaluation of engraftment after single islet transplantation from a brain-dead donor by the secretory unit of islet transplant objects (SUITO) index.

BACKGROUND: Evaluation of engraftment is important to assess the success of islet transplantation. Recently, we developed a simple index of islet engraftment, the secretory unit of islet transplant objects (SUITO) index. The formula is: 1500 x fasting C-peptide level [ng/dL]/(fasting blood glucose levels [mg/dL]-63). A SUITO index of more than 26 was associated with insulin independence. MATERIALS AND METHODS: In this study, we compared islet engraftment efficacy using the SUITO index after a single infusion of islets from brain-dead donors into 6 recipients. We calculated the SUITO index from postoperative days 3 to 30. We compared the insulin reduction rate with the SUITO index and islet equivalent per kilogram body weight (IE/Kg). We also measured the level of glycosylated hemoglobin (HbA 1C) at 3 months posttransplantation to assess glycemic control after islet transplantation. RESULTS: In 5 cases, islets were cultured before transplantation and in 1 case they were transplanted without culture. Without culture, the SUITO index and insulin reduction rate were highest. The SUITO index significantly correlated with the insulin reduction rate (P = .031, R2 = .728), but the IE/kg was not significantly correlated (P = .303) with the rate of insulin reduction. All cases showed improved HbA 1C to the normal range. CONCLUSIONS: Immediate transplantation without culture substantially improved the efficacy of engraftment of transplanted islets. The SUITO index was a better predictor than islet mass per body weight for clinical outcomes.

Estimation of donor usability for islet isolation with the modified Ricordi method.

BACKGROUND: The quality of donor pancreata is important for successful islet isolation. However, in some countries like Japan, the number of donor pancreata is low. Therefore, marginal donor pancreata have been used with less restrictive donor criteria. In order to use marginal donor pancreata, we established the modified Ricordi method. According to the United Network for Organ Sharing (UNOS) in 2005, more than 6000 pancreata were not clinically usable in the United States. In this study, we reevaluated donor usability based on the Japanese islet donor criteria. MATERIALS AND METHODS: We reviewed donor charts with well-documented cases in Texas from 2005 to 2006. We counted the number of pancreata for pancreas transplantation or islet transplantation. If not used clinically, the reason was also reviewed. Donors were reevaluated based on the Japanese islet donor criteria. RESULTS: We reviewed 236 donor charts, including 29 pancreata used for whole pancreas transplantations and 13 for islet isolation; therefore, 194 pancreata were not used. Among the 194 cases, we were able to identify the reasons that the pancreata were not used in 186 cases. When we applied the Japanese acceptance criteria, an additional 82 of 186 cases (44%) seemed suitable for islet isolations. CONCLUSIONS: With the modified Ricordi method, more than 2500 donor pancreata might be used for islet isolation in the United States when the Japanese criteria are applied.

Method for isolation of mouse pancreatic stem cells.

Replacement of beta-cell mass offers an alternative to standard insulin treatment for diabetes and may overcome the long-term side effects associated with current therapies. Pancreatic stem/progenitor cells could become a useful target for beta-cell replacement therapy in diabetic patients. We have established a method for isolating mouse pancreatic stem cells. In this study, pancreatic stem cells were isolated from 8-week-old mice. After purification on a density gradient, the density range of 1.062-1.11 contained pancreatic stem cells. The islets from the layers were deleted by dithizone staining and hand-picking under a dissecting microscope. The remnant cells were then cultured, inoculated into 96-well plates, and cloned by limiting dilution. One of the wells contained cells, named HN#5 cells, which expressed ductal cell markers, such as cytokeratin-19. HN#5 cells differentiated into insulin-producing cells and albumin-producing cells by induction medium. The isolation technique described here may be useful for identification and isolation of human pancreatic stem/progenitor cells.

Gene expression profiling of human pancreatic islets undergoing a simulated process of instant blood-mediated inflammatory reaction.

OBJECTIVE: Islet cell transplantation, as a treatment for type 1 diabetes mellitus, has historically required islet infusions from more than one donor organ to achieve insulin independence. Significant islet mass may be destroyed upon infusion due to a yet undefined process known as instant blood-mediated inflammatory reaction (IBMIR). Our objective was to identify gene expression changes in islets undergoing a simulated process of IBMIR. MATERIALS AND METHODS: Human pancreatic islets were isolated from 2 cadaveric donors and divided into 3 groups each for a total of 18 samples. Group one (n = 3) was treated with autologous sera, group two (n = 3) with allogeneic sera, and group three (n = 3) with type 1 diabetic sera (T1DM). Each group was treated for 3 hours at 37 degrees C. Islets were washed, lysed using TRI reagent, and mRNA was isolated using the Total Prep mRNA isolation kit. Isolated cRNA was used for microarray analysis using Illumina Gene Chips Hu6_v2. GeneSpring GX software was used for statistical analysis. Results were significant at P < .05. RESULTS: One-way ANOVA statistical analysis of the microarray data revealed that interleukin-11 (IL-11), interleukin-12A (IL-12A), and Ras related associated with diabetes (RRAD) were overexpressed in islets exposed to diabetic sera when normalized to autologous control (P < .01). Under the same conditions, islet cells exposed to T1DM serum had down-regulation of IL-1 receptor antagonist (IL-1RN). CONCLUSION: These findings suggested that T1DM serum elicited an adaptive and innate immune response to the transplanted islet mass making them more susceptible to cytokine-mediated destruction.

Effect of JNK inhibitor during islet isolation and transplantation.

Although islet transplantation has been remarkably improved by the Edmonton protocol, the insulin independence rate after islet transplantation from one donor pancreas has remained low. The c-Jun NH2-terminal kinases (JNKs) are classic stress-activated protein kinases; many cellular stresses have been shown to stimulate JNK activation. JNK in the pancreas is activated during brain death, pancreas procurement, and organ preservation, and its activity is progressively increased during the isolation procedure. Moreover, JNK activity in the transplanted liver after islet transplantation increases markedly within 24 hours. In this study, we show the effect of a JNK inhibitor during islet isolation and transplantation. Use of the JNK inhibitor in pancreas preservation, islet culture, and/or islet transplantation prevents islet cell apoptosis and improves islet graft function. These findings suggest that inhibition of JNK could prevent the impairment of islet cells and improve outcomes after pancreatic islet transplantation.

Continuous, but not occasional, oral ethanol intake reduces the success of intraportal transplanted islets of Langerhans: an experimental study.

BACKGROUND: Islet transplantation is gradually gaining acceptance for the treatment of type 1 diabetes mellitus. One of the unknown questions is alcohol intake; we have prohibited alcohol intake after islet transplantation although there is no solid evidence to support this. MATERIALS AND METHODS: In this study, we employed a mouse model to determine the effect of oral ethanol intake on transplanted islets. Either 500 or 150 islets were infused selectively into the right liver lobe of chemically induced diabetic mice. After transplantation, mice were orally administered either water (as a control) or various concentrations of ethanol for 14 consecutive days occasionally (once per day) or continuously (all intake was alcohol). Blood glucose levels were monitored and oral glucose tolerance tests (OGTT) performed. RESULTS: After 500 islets had been transplanted, all mice were cured from diabetes, but the continuous alcohol intake group showed significantly prolonged time to diabetes reversal and significantly lower glucose clearance rates by OGTT compared with the control group. After 150 islet transplantations, the diabetes cure rate in the continuous alcohol intake group was significantly lower than the control group (continuous alcohol vs control: 3/8 vs 11/12, P < .05). However, the occasional alcohol intake group showed no difference from the control group, even with as few as 150 islets transplanted per mouse. CONCLUSION: The present results demonstrated that continuous but not occasional alcohol intake reduced the success of intraportal islet transplantation.

Biochemical and functional characterization of xenoreactive natural antibodies in hu-PBL-SCID mice.

An in vivo model system to understand the mechanism of xenograft rejection was established using human peripheral blood leukocyte-reconstituted SCID (hu-PBL-SCID) mice. Human xenoreactive natural antibodies (XNA), of IgM and IgG subtypes, capable of binding to pig aortic endothelial cells (PAEC) were detected in the sera of hu-PBL-SCID by ELISA and flowcytometric methods. Western blot analysis of PAEC lysates showed that IgM and IgG XNA from hu-PBL-SCID recognized xenoantigens with similar molecular mass as those recognized by XNA from normal human serum (NHS). This result demonstrated that hu-PBL-SCID contained XNA representing the same repertoire as that of the NHS. XNA from NHS and hu-PBL-SCID were also able to induce intracellular Ca2+ signals in cultured PAEC several fold above the basal level. This result revealed their functional similarity and demonstrated for the first time that XNA in the absence of C can activate PAEC, which may lead to the pathology of xenograft rejection. In vivo, PAEC transplanted under the kidney capsule of hu-PBL-SCID mice showed deposition of human IgM and mouse C. In summary, the present study demonstrates that hu-PBL-SCID can serve as a useful model to characterize innate immunity against xenograft.

Polymeric structure of human respiratory mucin: studies on two protein components released upon reduction of disulfide bonds.

A major mucus glycoprotein (mucin) was purified from the tracheobronchial secretions of an asthmatic patient. Upon SDS-composite gel electrophoresis, the purified native (non-reduced) mucin gave a single band. SDS-gel electrophoresis on 6% polyacrylamide gels showed the absence of low molecular mass protein contaminants. However, SDS-PAGE (6% gels) of the reduced mucin showed the presence of a major high molecular mass mucin component and two low molecular mass components of 118 and 70 kDa, respectively. The 118 and 70 kDa components were purified by preparative electroelution of the reduced mucin. These components were also separated from the reduced mucin by gel-permeation chromatography on a Superose 6 column. Chemical compositional analyses showed that the 118 kDa component was a glycoprotein while the 70 kDa component was non-glycosylated. The effect of disulfide bond reduction on mucin structure and the hydrophobic probe binding properties of native and reduced mucin were studied using the fluorescent probe technique. Mansylphenylalanine was used as the fluorescent probe. The native mucin showed the presence of a large number of low-affinity (KD approximately 10(-5) M) binding sites for the probe. On the other hand, reduced-alkylated mucin containing the 118 and 70 kDa components showed the presence of additional high-affinity (KD approximately 10(-6) M) binding sites as well as low-affinity binding sites for the probe. Reduced alkylated mucin devoid of the 118 and 70 kDa components showed the presence of only low-affinity binding sites. These observations suggest that the availability of high-affinity probe binding sites upon reduction of mucin disulfide bonds may be either due to binding of the probe to the released component(s) and/or due to noncovalent interaction of the released component(s) with the mucin causing a conformational change in the mucin structure. Thus, the 118 and 70 kDa components appear to be an integral part of the total polymeric structure of the human respiratory mucin.

Physicochemical characterization of a minor mucin component from cystic fibrosis tracheobronchial secretions.

A minor mucin glycoprotein component (HTM-2) was purified from the tracheobronchial secretions of two cystic fibrosis patients using a protocol established in our laboratory. The secretions were solubilized in 0.1 M Tris-HCl buffer (pH 7.5) containing 0.22 M potassium thiocyanate and fractionated on a Bio-Gel A-5m column, followed by digestion with DNAase, rechromatography on the same column and chromatography on hydroxyapatite which resolved the major mucin (HTM-1) from the minor mucin component (HTM-2). The mucin component HTM-2 was further purified using Superose 6 chromatography. SDS-composite gel (2% polyacrylamide + 0.5% agarose) and 6% polyacrylamide gel electrophoresis showed that the purified HTM-2 was totally free of low-molecular-weight contaminants. Equilibrium density sedimentation centrifugation of purified HTM-2 using CsCl gradients also showed the absence of proteoglycans and other low-molecular-weight proteins. Comparison of carbohydrate and amino acid compositions of the two mucin components indicated that HTM-2 was quite different from the major mucin, HTM-1, reported earlier from our laboratory (Biochemistry, 24, 7334, 1985). This suggested that HTM-2 has a different polypeptide core and is perhaps a different gene product. The effects of 6 M guanidine-HCl and different concentrations of NaCl on the molecular size of HTM-2 and its ability to form aggregates was also investigated using the technique of static light scattering. In buffer containing 6 M guanidine-HCl, HTM-2 had a weight-average molecular weight of approximately 4.5 x 10(6). However, in the presence of buffer containing 0.03, 0.10 or 0.15 M NaCl, the molecular weight of HTM-2 was estimated to be approximately 11 x 10(6). These data suggest aggregation of HTM-2 in the presence of a range of NaCl concentrations. In contrast to HTM-1, which is a more anionic glycoprotein, the apparent molecular size of HTM-2 did not decrease at the higher NaCl concentration.

Gadolinium chloride inhibits Kupffer cell nitric oxide synthase (iNOS) induction.

Kupffer cells (KC) are the phagocytic macrophages of the liver. The rare earth metal, gadolinium (GdCl3), is a lanthanide, which, after phagocytosis by the KC, has been found to alter various aspects of KC physiology. In this study, we describe for the first time that the in vivo administration of GdCl3 to rats decreases the release of NO by isolated rat KC in response to lipopolysaccharide. Western blot analysis shows decreased expression of both inducible nitric oxide synthase as well as total cellular calmodulin after GdCl3 treatment. Possible mechanisms for this phenomenon are suggested.

CD32C (Fc gamma RIIC) mRNA expression and regulation.

The cell surface expression of the CD32 receptors for the Fc portion of immunoglobulin G (Fc gamma RII-CD32) is regulated by agents such as phorbol esters (PMA) and cytokines. In this study, we investigated the effects of PMA and interferon-gamma (IFN-gamma) on the expression of CD32C mRNA in U937 cells. When U937 (CD32+) cells are incubated with either PMA or IFN-gamma a significant enhancement of CD32C mRNA expression is observed with maximum enhancement at 18 hrs post-PMA and IFN-gamma addition. The addition of actinomycin D (ActD), a transcriptional inhibitor, together with either PMA or IFN-gamma diminishes the enhanced levels of CD32C mRNA to the basal levels, indicating that transcriptional regulation is involved in this modulatory process. The addition of cyclohexamide (CX), a protein synthesis inhibitor, to cultures undergoing stimulation with either PMA or IFN-gamma, increased the levels of CD32C mRNA synthesis suggesting that regulatory degradation proteins may be involved. The PMA and IFN-gamma stimulated CD32C mRNA is degraded within 2 hr post-stimulation and this degradation is delayed by the inhibition of de novo protein synthesis. These results, taken together with our previous studies of CD32A mRNA regulation in U937 cells stimulated with PMA, indicate that both the CD32A and C isomer mRNAs are rapidly degraded; however, CD32A and C isomer mRNAs are differentially regulated. At the optimal PMA dose, the time of mRNA stimulation of CD32A and C mRNA varies and the addition of CX to U937 cells together with PMA enhanced the levels of CD32C mRNA but had no effect on CD32A mRNA levels. These results imply that the differential regulation of the two CD32 isomers may result in differential function.

Detection of distinct species in purified human respiratory mucin using monoclonal antibodies.

The purpose of this investigation was to demonstrate the presence of different species (subpopulations) in the purified human tracheobronchial mucin (HTM-1). Mucin was highly purified from sputum specimens collected from a cystic fibrosis (CF) patient using a protocol involving sequential chromatography on Bio-Gel A-5m and hydroxylapatite columns. SDS-composite gel electrophoresis followed by periodic acid-Schiff's reagent staining was unable to detect mucin species. However, using enzyme-linked immunoelectrotransfer blot (EITB) method and polyclonal antibodies raised against HTM-1, at least four different migrating mucin species were detected. Further immunological characterization of these mucin species was carried out using a library of 16 monoclonal antibodies (MAbs) developed against the purified mucin. Nine MAbs belonged to the IgM class, two MAbs were IgG1, one IgG2a and remaining four were of the IgG3 subclass. Periodate oxidation of the mucin antigen was used to establish the nature of the mucin epitopes recognized by the MAbs. 11 MAbs recognized carbohydrate epitopes in the mucin molecule that were sensitive to periodate, while five MAbs reacted with periodate resistant carbohydrate epitopes or the protein portion of the mucin molecule. Enzyme-linked immunoelectrotransfer blot analysis of the MAbs against HTM-1 showed the presence of at least three distinct mucin species. Chromatography of the mucin on immunoaffinity columns (MAbs H(13.3), M(33.3) and CCK 061 conjugated to CNBr-activated Sepharose 4B), followed by ELISA and EITB analyses, established the mucin species recognized by the antibodies. These experiments further indicated that both unique and shared epitopes were present in the mucin species. These monoclonal antibodies may provide a promising approach to differentiate the secretory products of the tracheobronchial tree.

Recognition of porcine major histocompatibility complex class I antigens by human CD8+ cytolytic T cell clones.

To evaluate the nature of the human cellular immune response to porcine xenoantigens, cytolytic T lymphocyte (CTL) cell lines were generated against porcine aortic endothelial cells (PAEC). After four stimulations, the phenotypes of the T cell lines were primarily CD8+ (79.7+/-19.6%). Natural killer cells were not detected. Functional analysis of the T cell lines showed specific cytotoxicity against syngeneic porcine targets with no lysis of unrelated porcine cells, human cells, or K562, a natural killer target. The major histocompatibility complex (MHC) specificity of this response was confirmed when T cell lines established against PAEC from partially inbred SLAdd miniature swine lysed only PAEC and phytohemagglutinin-stimulated lymphocytes from SLAdd origin but not SLAgg targets. Both CD8+ (7/12) and CD4+ (5/12) T cell clones were generated from the bulk cell lines. All of the CD8+ T cell clones specifically lysed stimulator PAEC and swine leukocyte antigen (SLA)-matched, phytohemagglutinin-stimulated lymphocyte targets but not unrelated porcine targets. CD4+ T cell clones, as expected, showed no lysis of any porcine target cells. The lysis of porcine targets by the human CD8+ cytotoxic T lymphocyte clones was inhibited by monoclonal antibodies against SLA class I antigens and human CD8, which indicates that human CD8+ T cells recognize porcine MHC class I molecules. These results, which show that human T cells differentiate between porcine MHC alleles, have relevance in the clinical application of xenografts.

Indirect recognition of porcine xenoantigens by human CD4+ T cell clones.

BACKGROUND: Human T-cell response against xenogeneic antigens may occur either by direct recognition of antigens on xenogeneic antigen-presenting cells (APCs) or by an indirect pathway mediated by autologous APCs. METHODS: The proliferative response of human CD4+ T cells to porcine aortic endothelial cells (PAECs) was measured. From these T-cell lines, eight CD4+ T-cell clones were obtained by limiting dilution. RESULTS: CD4+ T cells, in the absence of monocytes, proliferated in response to PAECs only after swine leukocyte antigen (SLA) class II molecules were induced on PAECs. The proliferation was significantly better when autologous human monocytes were added back as APCs. All of the eight CD4+ T-cell clones demonstrated specific proliferative response when stimulator PAECs, but not PAECs of other porcine origins, were preincubated with autologous human APCs before addition of these clones. These results indicated that the clones are recognizing porcine xenoantigens presented by self-APCs. The proliferative response of CD4+ T-cell clones was blocked by antibodies directed against human leukocyte antigen class II and human CD4, but not by anti-SLA class II monoclonal antibodies. A marked inhibition in proliferation was also noted when human APCs were incubated with chloroquine before addition to the cultures, indicating that xenoantigens had to be processed in order to be recognized by the clones. CONCLUSIONS: Human CD4+ T cells can recognize xenoantigens by either a direct or indirect pathway. The CD4+ T-cell clones developed against SLA class II-negative PAECs recognized strain-specific porcine xenoantigens indirectly.

Liver transplant recipient sera derived soluble HLA mediates allele specific CTL apoptosis.

BACKGROUND: Significant levels of donor soluble human leukocyte antigen (HLA) class I (sHLA) are present in patients after transplants. We investigated the possibility that sHLA may inhibit cytolytic T lymphocyte (CTL) activity by inducing apoptosis of the CTL, thereby serving as a mechanism for specific tolerance. METHODS: sHLA-A2 and A3 were isolated from the sera of liver transplant recipients by affinity chromatography. T cell bulk lines directed against HLA-A2 and HLA-A3 were generated by stimulation with HLA-A2, A3+ peripheral blood leukocytes and B-lymphoblastoid cells. Induction of T cell apoptosis by sHLA was analyzed by adding sHLA to allospecific CTL 4 or for 24 hr before flow cytometric analysis of propidium iodide and fluorescein isothiocyanate-conjugated annexin V stained cells. T cell receptor (TCR) engagement by sHLA was demonstrated using a monoclonal antibody specific for the TCR. RESULTS: sHLA-A3 inhibited CTL activity of a HLA-A3 T cell line by 53%, whereas sHLA-A2 had no effect. sHLA-A3 also increased T cell death by 77% over the control, whereas sHLA-A2 had no significant effect. However, sHLA-A2 induced 21% apoptosis of an anti-HLA-A2 T cell line, whereas sHLA-A3 caused only 3% apoptosis. The antibody complexed form of sHLA was ineffective in the induction of apoptosis. Preincubation of the T cells with anti-T cell receptor monoclonal antibody protected the T cells from sHLA-induced apoptosis, indicating that sHLA-TCR engagement is necessary for this process to occur. CONCLUSION: TCR-mediated apoptosis of alloreactive CTL may serve as a mechanism by which sHLA can modulate the immune response.

Clotrimazole inhibits lung fibroblast proliferation in vitro: implications for use in the prevention and treatment of obliterative bronchiolitis after lung transplantation.

BACKGROUND: Immunosuppressive therapy has limited activity against the mesenchymal cell proliferation of obliterative bronchiolitis. Clotrimazole (CLT) has been shown to inhibit proliferation in normal and cancer cell lines. Here we investigate whether CLT inhibits the proliferation of lung mesenchymal cells. METHODS: Proliferation of human lung fibroblasts (MRC-5) in the presence of CLT was determined by [3H]thymidine incorporation. Messenger ribonucleic acid (mRNA) expression of platelet-derived growth factor (PDGF)-B and transforming growth factor (TGF)-beta after treatment with CLT was measured by reverse transcriptase-polymerase chain reaction. RESULTS: Treatment of MRC-5 cells with CLT resulted in a significant reduction in proliferation as assessed by DNA incorporation and cell counts compared with dimethylsulfoxide alone. There was no cytotoxic effect associated with CLT treatment. Reverse transcriptase-polymerase chain reaction demonstrated a marked decrease in PDGF-B and TGF-beta mRNA levels in cells treated with CLT compared with those treated with dimethylsulfoxide. CONCLUSION: CLT inhibits proliferation of human lung fibroblasts. This inhibitory effect is associated with decreased levels of PDGF-B and TGF-beta mRNA expression and may have value in the prevention and treatment of obliterative bronchiolitis.