Correlation between graft-versus-host induced immunosuppression and host natural killer cell activity in small bowel transplantation

Future strategies for tolerance induction: a comparative study between hematopoietic stem cells and macrophages

So far, clinical benefit of hematopoietic stem cell induced donor-specific tolerance across major histocompatibility complex (MHC) barriers was hampered by either graft rejection or graft-versus-host disease. An alternative approach focuses on the use of donor-derived cells that bear an inherent mechanism to circumvent allospecific rejection upon injection into non-immunosuppressed hosts. Using a myeloablative conditioning model in the rat, full donor chimeric recipients were generated and their potential to induce long-term cardiac allograft survival was compared with the fate of grafts transferred to non-immunosuppressed host rats pretreated with donor-macrophages derived from the peritoneal cavity in the LEW to DA inbred strain combination. The induction of full multilineage long-term donor-chimerism (> 150 days) after initial host conditioning using two doses of cyclophosphamide and one shot of busulphan prevented acute graft rejection, whereas non-chimeric animals experienced acute and complete rejection. Conversely, vigorous T-cell depletion is required to protect conditioned animals from lethal graft-versus-host disease. Instead, the use of donor intraperitoneal macrophages achieved a state of transient chimerism and subsequent long-term graft survival in fully immunocompetent rats without the need of lethal conditioning regimens. In conclusion, the complex immunologic interactions, observed after allogeneic bone marrow transplantation as a means to induce donor chimerism, and subsequent long-term graft acceptance can be avoided if appropriate cell populations can be identified that, by themselves, induce a transient state of donor chimerism prevailing long enough to deviate allospecific immune responses, as outlined in this study.

Bacterial translocation during graft-versus-host disease after small bowel transplantation is reduced following inhibition of inducible nitric oxide synthesis

BACKGROUND

Increased nitric oxide (NO) production may contribute to intestinal barrier dysfunction and increased bacterial translocation (BT). Since BT may play a major role in graft-versus-host disease (GVHD) after small bowel transplantation (SBTx), we evaluated the role of NO production in GVHD after SBTX in the rat.

METHODS

Using the standard model of semiallogeneic SBTx in the rat, we prepared three experimental groups. Recipients in group 1 received LBNF1-LBNF1 transplants and were treated with aminoguanidine (AG) (200 mg/kg), recipients in group 2 received Lewis-LBNF1 grafts and were injected with saline, and recipients in group 3 received Lewis-LBNF1 transplants and AG (200 mg/kg). Urine nitrite/nitrate levels were measured daily, and BT was determined by culturing peritoneal swabs, mesenteric lymph nodes, spleen, liver, and blood.

RESULTS

In group 1 we detected indefinite survival with normal histology. In group 2 a survival of 10.5 +/- 1.1 days was reached, and the typical histological features of acute GVHD were observed. The animals in group 3 showed a mean survival of 14.8 +/- 0.6 days (P<0.02 compared with group 2) and the histological features of acute GVHD, although with a prolonged time course. Comparing NO production and BT between groups 2 and 3 we detected significantly reduced NO production on postoperative days 2-9 (P<0.03) and significantly decreased BT on postoperative days 3 and 9 (P<0.03).

CONCLUSION

Inhibition of inducible NO synthesis with AG reduces NO production, decreases BT, and prolongs survival during GVHD after SBTx and therefore may be a useful addition to standard treatment protocols for GVHD.