title: CD28-B7 T-cell co-stimulatory blockade potentiates the effects of intrathymic immunomodulation in sensitized graft recipients.
abstract: BACKGROUND
  Peripheral and central immune mechanisms contribute to the induction of tolerance in acute rejection rodent transplant models after systemic administration of CTLA4Ig and intrathymic infusion of donor alloantigen, respectively. We have investigated the effects of CTLA4Ig-induced blockade of CD28-B7 T-cell co-stimulation in conjunction with intrathymic immunomodulation on cellular and humoral immune responses leading to accelerated rejection of cardiac allografts in presensitized rats.
  
  
  RESULTS
  Lewis rats were challenged with Wistar-Furth (WF) skin transplants, followed 7 days later by transplantation of WF hearts. These cardiac allografts were rejected in a fulminant manner in <24 hr. A single infusion of human CTLA4Ig (0.5 mg/rat i.v.) at the time of cardiac engraftment (day 0) did not affect accelerated rejection. Intrathymic injection of WF spleen cells (2x10[7]) at the time of skin transplantation (day -7) abrogated <24-hr rejection and extended cardiac allograft survival to 6.6+/-0.6 days. Moreover, intrathymic host immunomodulation combined with administration of human CTLA4Ig (days 0-14, every other day) extended cardiac allograft survival synergistically to 27.7+/-7.5 days, and immunomodulation combined with murine CTLA4Ig extended survival to >42.5+/-4.8 days. The prolongation of allograft survival required the blockade of both B7-1 and B7-2 ligands and was accompanied by reduction of host proliferative responses (mixed lymphocyte response) and depression of anti-donor cytotoxic T-cell generation/function (lymphocyte-mediated cytotoxicity). CTLA4Ig therapy did not affect the strong systemic IgM and IgG alloantibody response seen otherwise after intrathymic immunomodulation.
  
  
  CONCLUSIONS
  CTLA4Ig enhances the effects of intrathymic donor-type cell infusion in sensitized rat recipients of cardiac allografts, indicating that "peripheral" blockade of CD28-B7 T-cell co-stimulation synergizes with the "central" immunosuppressive effects of intrathymic immunomodulation.
authors.affiliation: Harvard Medical School, and Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Stadlbauer
authors.forename: M
authors.initials: M
authors.lastname: Schaub
authors.forename: S
authors.initials: S
authors.lastname: Korom
authors.forename: K
authors.initials: K
authors.lastname: Onodera
authors.forename: M H
authors.initials: MH
authors.lastname: Sayegh
authors.forename: J W
authors.initials: JW
authors.lastname: Kupiec-Weglinski
mesh_terms: D000069594:Abatacept; D000276:Adjuvants, Immunologic; D000818:Animals; D015703:Antigens, CD; D000943:Antigens, Differentiation / Q000276:immunology; D018122:B7-1 Antigen / Q000276:immunology*; D018106:CD28 Antigens / Q000276:immunology*; D060908:CTLA-4 Antigen; D003602:Cytotoxicity, Immunologic; D006084:Graft Rejection / Q000276:immunology*; D018796:Immunoconjugates; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D007518:Isoantibodies / Q000276:immunology; D007959:Lymphocyte Culture Test, Mixed; D008297:Male; D051381:Rats; D011914:Rats, Inbred BN; D011917:Rats, Inbred Lew; D011920:Rats, Inbred WF; D016038:Skin Transplantation / Q000276:immunology; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology*; D013950:Thymus Gland / Q000276:immunology
chemical_list: D000276:Adjuvants, Immunologic; D015703:Antigens, CD; D000943:Antigens, Differentiation; D018122:B7-1 Antigen; D018106:CD28 Antigens; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; C556708:Ctla4 protein, rat; D018796:Immunoconjugates; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007518:Isoantibodies; D000069594:Abatacept