Therapies that promote tolerance will improve outcomes in solid organ transplantation by eliminating the need for long-term immunosuppression. This thesis investigates two possible tolerance induction mechanisms: rapamycin induced expression of regulatory T cells and re-education of the immune system using syngeneic hematopoietic stem cell transplantation. Fibrinogen-like protein 2, a effector molecule of regulatory T cells, was also determined as a key mediator in the tolerance induction pathway as depletion of fibrinogen-like protein 2 lead to allograft rejection. The feasibility of using syngeneic hematopoietic stem cells for inducing allograft tolerance was studied by setting up a murine heart and bone marrow transplant model. Syngeneic T-depleted bone marrow transplantation resulted in a slight prolongation of the graft survival time compared to the animals reconstituted with total bone marrow cells. We provide compelling evidence to suggest that fibrinogen-like protein 2 and syngeneic hematopoietic stem cells can possibly be used to induce transplantation tolerance.

The long-term survival of heart transplants is limited by the development of allograft vasculopathy (AV), a vascular pathology that develops in spite of the use of modern immunosuppressive therapies. Although it is widely accepted that T cells play a major role in the development of AV, the contribution of B cells and antibody has been less well characterized. A fully MHC-mismatched cell transfer model was used to mimic the antigenic stimulus of a cardiac graft, we examined the production of antibody under conditions of clinically relevant immunosuppression in the form of the calcineurin inhibitor cyclosporine A (CyA). Anti-donor antibody with the capacity to mediate complement-dependent cytotoxicity of donor strain cells, but not third-party cells, developed in the presence of two different doses of CyA (30 mg/kg and 50 mg/kg). When this antibody was passively transferred into immunodeficient B6.RAG1-/- abdominal aortic graft recipients, the antibody alone had the capacity to mediate formation of a neointimal lesion and induce the loss of medial smooth muscle cells. These are two hallmark characteristics of AV in this animal model. A wild-type model, where BALB/c grafts were transplanted into B6 recipients and received daily CyA immunosuppression was used to test the de novo antibody response to the transplant itself. Again, anti-donor antibody was produced with the capacity to mediate complement-dependent cytotoxicity of donor cells. In addition, grafts showed evidence of C4d deposition in the medial area, indicating that area as a sit of antibody binding and activation of the classical complement cascade. The presence of anti-donor antibody has been demonstrated to correlate with poorer graft outcome and a higher risk of developing AV in patients. Examination of human epicardial coronary artery tissue from patients with cardiac transplants demonstrated the presence in the adventitia of ectopic lymphoid structures (ELS) containing CD20+ B cells, plasma cells, IgM, and IgG. These findings illustrate active, antibody-producing ELS in close proximity to the vessels developing AV. Of note was the finding of CD20+CD27+ memory B cells in these ectopic lymphoid structures. Memory B cells are rapidly re-activated following exposure to their cognate antigen and easily differentiate into plasma cells. Taken together, these data suggest that memory B cells and antibody may be contributing to long-term allograft rejection and therapeutic options should be considered to target these immune mechanisms.

Hyperlipidemia is prevalent following heart transplantation, and may play a role in the development of late graft atherosclerosis. The charts of 35 heart transplant recipients (n = 32 males and 3 females) were reviewed retrospectively up until three years post transplantation, to describe a time-course of hypercholesterolemia after transplantation, and to determine the mechanisms involved in its pathogenesis. All patients received prednisone, cyclosporine, and azathioprine for immunosuppression. A progressive rise in both serum cholesterol (2.4 $ pm$ 0.4 mmol/l, p $<$ 0.01), and body weight (8.4 $ pm$ 1.6 kg, p $<$ 0.01) were observed during the first 8 and 10 months respectively. Levels stabilized thereafter, remaining above pretransplant levels. Triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol concentrations were all above normal limits following transplantation. Tapering of prednisone dose had a significant effect on serum cholesterol levels, whereas diet had a beneficial effect on body weight. A randomized, controlled, dietary intervention study then followed to further assess the effect of dietary intervention on minimizing or preventing post transplantation hyperlipidemia and weight gain. Five patients were counselled the Step One Lipid-Lowering diet, two patients were controls. All study patients demonstrated a lower overall increase in serum cholesterol levels than other transplant recipients. Reported nutritional intakes were similar between both groups. Increases in body weight were related to increases in body fat. Patients in the diet group demonstrated improvements in their level of nutrition knowledge, which correlated with lower serum cholesterol levels. Changes in serum cholesterol were also associated with appetite, hunger, perceived interest, perceived benefits, perceived barriers, and attitudes toward food. Changes in body weight were associated with appetite, hunger, perceived barriers, and stress. As

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The specific anti-T lymphocyte immunosuppressive drugs cyclosporine A (CsA), FK-506 (FK) and rapamycin (RPM) have revolutionized the field of allograft transplantation and have recently been evaluated for use in autoimmune diseases. Effects of immunosuppressive drugs on adhesion molecule expression in the putative autoimmune conditions psoriasis, through the use of keratinocyte (KC) cell culture techniques, and alopecia areata were investigated. In the Dundee Experiment Bald Rat, a model of alopecia areata, hair regrowth was only apparent with CsA therapy and FK had a high toxicity profile. <I>In vivo</I> the observed cutaneous reduction of ICAM-1 and LFA-1 expression particularly around the hair bulbs was due to the effects of CsA and FK on the inflammatory cell infiltrate, especially since the associated cutaneous lymphocyte populations were reduced with drug. This is corroborated by the results obtained from <I>in vitro</I> culture of human KC, since cytokine-induced expression and release of ICAM-1 by KC was unaffected by CsA, RPM or FK treatment. CsA and RPM, but not FK, however, had an observable cytostatic effect on unstimulated and more especially, cytokine-stimulated KC proliferation and may, therefore, clinically inhibit KC hyperplasia, which is characteristic of psoriasis. This study shows that CsA, FK and RPM may inhibit either directly but more likely in an indirect manner, cellular adhesion molecule expression during immune reactions. This effect will lower the possible number of cellular interactions and furthermore, reduce intracellular co-signalling events necessary for cellular activation which accounts for the overall inhibition of cell-mediated immune responses by these novel immunosuppressive drugs.

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Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 4 uppsatser.