VOLUME 2 - APPENDICES

No description available.

No description available.

No description available.

This thesis aims to place corneal allograft rejection in the context of general transplantation immunology, examine the role of lymphocyte subsets in the rejection process and consider the potential application of monoclonal antibody therapy in clinical corneal graft rejection. The literature relating to the current clinical practice of corneal grafting, with particular reference to corneal allograft rejection, is reviewed in chapter 1 to present the extent of the problem. Chapter 2 then reviews the mechanisms of allograft rejection from the literature of transplantation immunology, much of which has arisen from studies of kidney, heart, pancreatic islets and liver in animal models. The materials and methods are described in detail in chapter 3, and only the relevant experimental design is detailed in the Materials and Methods sections of the succeeding chapters. The experimental mouse model of transplanting corneal tissue into the renal subcapsular is evaluated in chapter 4, demonstrating that isografts survive indefinitely whereas allografts are rejected typically by 30 days. Pretransplant sensitisation decreased allograft survival time to 10 days. Immunohistochemistry demonstrated the presence of CD4⁺ and CD8⁺ lymphocytes and macrophages at the rejection site. Heterotopic corneal graft recipients were then treated with various monoclonal antibody regimes. Chapter 5 demonstrates that allograft survival can be increased by either anti-CD4 or anti-CD8 therapy, providing near total depletion of the respective lymphocyte subset is achieved. Xenograft rejection is shown to depend on mainly CD4⁺ lymphocytes in chapter 6, with no benefit being found of depleting the CD8⁺ subset in addition. A mild immunosuppressive effect of anti-Vβ8 monoclonal antibody is demonstrated and discussed in chapter 7. The final chapter discusses these results in the light of recent, related work in other transplant systems, and presents a case for a trial of intracameral pan-T-cell monoclonal antibody treatment.

No description available.

No description available.

Diabetes can be considered to be one of the main health epidemics of the 21st century. Studies conducted by the World Health Organisation (WHO) indicate that the number of people with diabetes in the year 2000 was 171 million and this is projected to increase to 366 million by 2030 (Wild et al. 2004). The increasing incidence of both Type 1 and Type 2 diabetes is due to population growth, aging, urbanisation, obesity and physical inactivity. The current treatment by insulin injections for individuals with Type 1 diabetes fails to overcome the long term microvascular and macrovascular complications associated with the disease. A major challenge in the treatment of diabetes is to provide patients with an insulin source that is capable of regulating blood glucose levels (BGL) on a minute to minute basis. Advances in medical research have enabled the investigation of a variety of potential alternative therapies that may provide Type 1 diabetic patients with a more superior control of BGL and consequently minimise complications. The utilisation of pancreases obtained from fetal pigs offers potential therapeutic value in the treatment of Type 1 diabetes. Islet-like cell clusters (ICCs) are obtained from such tissue following partial mechanical and enzymatic digestive procedures. ICCs are primarily composed of immature duct cells which, when transplanted, will mainly differentiate into insulin producing ?? cells. Such cells are able to normalise BGL in immunodeficient diabetic recipients and in immunocompetent recipients when anti-rejection drugs are administered. This study investigates microencapsulation as an immunoprotective strategy that has the potential to remove the need for immunosuppression when such cells are transplanted. A review of the literature related to current medical research in the field of diabetes is presented in Chapter 1. In order to achieve the aims of the study, an understanding of how fetal pig ICCs behave when placed within a barium alginate microcapsule both in vitro and in vivo is essential and this data is presented in Chapter 3. This chapter demonstrates that ICCs will survive and differentiate in their typical manner when enclosed within microcapsules and transplanted. Such encapsulated cells will function to normalise BGL when transplanted into diabetic immunodeficent mice for at least 25 weeks and the animals exhibit increased bodyweight. Microcapsules retrieved at this time point were observed to be intact with no breakages or evidence of cellular overgrowth. Transplantation of encapsulated insulin-producing cells into immunocompetent mice are described in Chapter 4. Allotransplantation of a microencapsulated mouse insulin-producing cell line into these diabetic mice also exhibited graft function, resulting in normal BGL in recipients. Large animal experiments are described in Chapter 5. Allotransplantation of microencapsulated fetal pig ICCs into diabetic pig recipients displayed evidence of transient graft function in terms of lower BGL and reduced exogenous insulin requirements. The xenotransplantion of encapsulated fetal pIg ICCs into diabetic immunocompetent mice described in Chapter 4 proved to be more challenging. The transplantation of such cells in this environment did not yield particularly positive results. BGL remained elevated in these recipients and the animals lost bodyweight post transplantation. This area of research warrants further investigation as it is likely that further measures such as transient immunosuppression in combination with microencapsulation will allow fetal pig ICCs to function in a xenograft setting.

Acute and chronic rejection continue to be the most important problems in maintaining a functioning organ allograft. Despite advances in immunosuppression, organs are still damaged or destroyed by the recipient's immune system. In order to protect the transplanted organ it is necessary to overwhelm the host's immune system and thus expose the host to the complications of invasion from fungi, bacteria, protazoa, reduction in oncologic surveillance, and reduction of stem cell production. Donor specific immunosuppression would provide graft protection and allow maintenance of the host's immunologic competence. Graft enhancement has been described for many years. Current practice uses this principle by pretransfusing prospective kidney transplant recipients with type specific blood. Previous work has supported the concept that this clinical effort can be produced by certain cells in the blood, specifically, lymphocytes. To study the effects of preimmunization with T or B lymphocytes and platelets in a rat heterotopic heart transplant model, the following experiments were performed. Experiment 1: The effect of pretransplant immunization with lxlO7 donor specific T cells or B cells showed that T cells have little affect on rejection of heterotopic heart allograft and B cells caused prolongation of graft function. This effect is species specific and not due to a pure anti-idiotype phenomenon. Experiment 2: The effect of heating the purified T and B cells at 56°C for 30 minutes is known to denature the presenting protein antigens on the cell membranes without destroying the cell membrane. After pretransplant immunization, seven days prior to heterotopic heart transplant in the rat model, the previously observed prolongation of graft survival after nonheated B cell immunization was still present but not as marked. Experiment 4: The effect of pretransplant immunization of donor specific T and B cells treated by heating to 85°C for 10 minutes followed by heterotopic heart graft showed that there was a significant prolongation of the engrafted heart following immunization with the denatured B cells. Cellular proteins are denatured by this pretreatment but polysaccharides are not. Experiment 5: The effect of pretransplant immunization with purified donor specific platelets followed by heterotopic heart rat transplant showed no prolongation or shortening of graft survival. It is concluded that, in the heterotopic rat heart transplant model, immunization with purified T cells 7 days prior to transplant has little effect on rejection. When B cells are immunized in the same way, graft survival is prolonged. If the cells are heated to 56°C for 30 minutes this effect is reduced but not eliminated. This effect indicates that denaturation of protein HLA antigens on the presenting cell surface reduces the enhancing effect of the intact antigens on B cells. By denaturing, the presenting B cell protein graft enhancement is still present, suggesting the phenomenon of graft enhancement is not totally dependent on protein antigens but may have a contribution from mucopolysaccharides or other carbohydrates. Donor specific purified platelet pretransplant immunizations produced no statistically significant prolongation of either PV6 or F₁ heart grafts. This observation is consistent with the findings that purified T cell immunization do not produce graft enhancement. / Surgery, Department of / Medicine, Faculty of / Graduate

Orthotopic liver transplantation is the treatment of choice for many patients with end-stage liver disease. Despite advances in immunosuppression, acute rejection remains common (up to 70%) and results in significant patient morbidity. It is frequently difficult to distinguish abnormal liver function due to rejection from that due to infection, biliary obstruction or ischaemic injury without performing invasive procedures such as a liver biopsy or angiography which may be Clinically, the diagnosis of rejection is usually once the immunological process is already hazardous. made late, established. In this study, we evaluated standard biochemical parameters and cytokine concentrations (IL-1, IL-6 and TNF-alpha) in serial samples of bile obtained post-operatively via the Ttubes of patients following orthotopic liver transplantation in order to determine whether there are any biochemical or immunological pointers to the early diagnosis of rejection which would enable earlier administration of appropriate antirejection therapy. Biliary cytokines did not prove to be useful and reliable markers of early rejection. Serial measurement of biliary bilirubin levels showed an early and significant decrease a few days prior to rejection, and were a more sensitive marker of graft function than serum bilirubin levels.