title: Role of indirect allorecognition in experimental late acute rejection.
abstract: BACKGROUND
  Late acute rejection affects up to 28% of renal allograft recipients and remains a major risk factor for late graft loss. As donor-origin antigen-presenting cells are depleted with time, T-cell recognition of donor-derived alloantigenic peptides presented by self antigen-presenting cells (the "indirect pathway" of allorecognition) may play a key role in the initiation of late acute rejection episodes.
  
  
  METHODS
  To test this hypothesis, we developed a clinically relevant experimental model in the rat (Wistar-Furth/Lewis) in which allograft recipients received cyclosporine for 1 month after transplantation and were then allowed to reject the graft upon discontinuation of immunosuppression. Lymphocyte proliferation assays to synthetic class II MHC allopeptides of donor origin and also to intact donor (Wistar-Furth) cells were performed at this time. The effector mechanisms studied included delayed-type hypersensitivity (DTH) responses, lymphocyte-mediated cytotoxicity, and alloantibody production.
  
  
  RESULTS
  Lymphocytes from recipients undergoing late acute rejection had marked suppression of mixed lymphocyte reaction proliferation to intact donor cells. Significant proliferation to donor-derived 25-mer polymorphic class II MHC allopeptides was elicited, however. In vivo, significant DTH responses were observed to both MHC allopeptides and intact Wistar-Furth cells. Recipient lymphocytes also exhibited significant killing of donor cells, although not third-party cells, and anti-donor alloantibodies were detected by flow cytometry.
  
  
  CONCLUSIONS
  Our results indicate that T cells primed via the indirect pathway are present during acute rejection that occurs after discontinuation of cyclosporine. Mixed lymphocyte reactivity is markedly reduced at this time. Furthermore, there is an association between such allopeptide-primed T cells and the elicitation of specific DTH responses and provision of help to B cells to produce alloantibodies and activation of CD8+ T cells to become effector cytotoxic cells.
authors.affiliation: Laboratory of Immunogenetics and Transplantation, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Vella
authors.forename: L
authors.initials: L
authors.lastname: Vos
authors.forename: C B
authors.initials: CB
authors.lastname: Carpenter
authors.forename: M H
authors.initials: MH
authors.lastname: Sayegh
mesh_terms: D000595:Amino Acid Sequence; D000818:Animals; D016572:Cyclosporine / Q000008:administration & dosage; D003602:Cytotoxicity, Immunologic; D004334:Drug Administration Schedule; D006084:Graft Rejection / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006968:Hypersensitivity, Delayed / Q000276:immunology; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007518:Isoantibodies / Q000032:analysis; D008213:Lymphocyte Activation; D007959:Lymphocyte Culture Test, Mixed; D008969:Molecular Sequence Data; D010455:Peptides / Q000276:immunology; D051381:Rats; D011917:Rats, Inbred Lew; D011920:Rats, Inbred WF; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D007518:Isoantibodies; D010455:Peptides; D016572:Cyclosporine