Cellular strategies to induce immune tolerance after liver transplantation: Clinical perspectives

Liver transplantation (LT) has become the most efficient treatment for pediatric and adult end-stage liver disease and the survival time after transplantation is becoming longer due to the development of surgical techniques and perioperative management. However, long-term side-effects of immunosuppressants, like infection, metabolic disorders and malignant tumor are gaining more attention. Immune tolerance is the status in which LT recipients no longer need to take any immunosuppressants, but the liver function and intrahepatic histology maintain normal. The approaches to achieve immune tolerance after transplantation include spontaneous, operational and induced tolerance. The first two means require no specific intervention but withdrawing immunosuppressant gradually during follow-up. No clinical factors or biomarkers so far could accurately predict who are suitable for immunosuppressant withdraw after transplantation. With the understanding to the underlying mechanisms of immune tolerance, many strategies have been developed to induce tolerance in LT recipients. Cellular strategy is one of the most promising methods for immune tolerance induction, including chimerism induced by hematopoietic stem cells and adoptive transfer of regulatory immune cells. The safety and efficacy of various cell products have been evaluated by prospective preclinical and clinical trials, while obstacles still exist before translating into clinical practice. Here, we will summarize the latest perspectives and concerns on the clinical application of cellular strategies in LT recipients.

Messengers of tolerance

The use of immunosuppressant drugs after organ transplantation has brought great success in the field of organ transplantation with respect to short-term outcome. However, major challenges (i.e., limited improvement of long-term survival, immunosuppressant toxicity, infections and carcinoma) demand alternate treatment approaches that minimizes the use of immunosuppressants. Interestingly, few studies have identified groups of transplant patients who developed operational tolerance and thereby keep their allograft without complications in absence of immunosuppressants. These rare groups of patients are of particular interest as study subjects for understanding mechanisms of graft tolerance that could be leveraged in future for inducing tolerance and for understanding mechanisms involved in improving long-term allograft outcomes. Also, biomarkers from these studies could benefit the larger transplant population by their application in immunosuppressant tailoring and identification of tolerant patients among patients with stably functioning allografts. This review compiles several gene expression studies performed in samples from tolerant patients in different solid organ transplantations to identify key genes and associated molecular pathways relevant to tolerance. This review is aimed at putting forth all this important work done thus far and to identify research gaps that need to be filled, in order to achieve the greater purpose of these studies.

Evidence for a rhizobia-induced drought stress response strategy in Medicago truncatula

Drought stress hampers plant energy and biomass production; however it is still unknown how internal C:N balance and rhizobial symbiosis impact on plant response to water limitation. Here, the effect of differential optimal nitrogen nutrition and root nodule symbiosis on drought stress and rehydration responses of Medicago truncatula was assessed. Two groups of plants were nodulated with Sinorhizobium medicae or Sinorhizobium meliloti--differing in the performance of N fixation; the third group grew in a rhizobia-free medium and received mineral nitrogen fertilizer. In addition to growth analyses, physiological and molecular responses of the two systems were studied using ionomic, metabolomic and proteomic techniques. We found a significant delay in drought-induced leaf senescence in nodulated relative to non-nodulated plants, independent of rhizobial strain and uncoupled from initial leaf N content. The major mechanisms involved are increased concentrations of potassium and shifts in the carbon partitioning between starch and sugars under well-watered conditions, as well as the enhanced allocation of reserves to osmolytes during drought. Consequently, nodulated plants recovered more effectively from drought, relative to non-nodulated M. truncatula. Proteomic data suggest that phytohormone interactions and enhanced translational regulation play a role in increased leaf maintenance in nodulated plants during drought.