title: Regulatory cell-mediated tolerance does not protect against chronic rejection.
abstract: BACKGROUND
  Regulatory cells prevent graft loss to acute rejection and induce tolerance, possibly by promoting Th2 deviation. Th2 cytokines stimulate B cells, which cause alloantibody-mediated chronic rejection. We searched to determine whether regulatory cell-mediated tolerance protects or not against chronic rejection.
  
  
  METHODS
  Heart transplantation (Htx) was performed using RA (RT1P) and PVG (RT1c) rats as donor and recipients. Donor-specific blood transfusion (DSBT) was given on preTx day 12. Secondary grafts were implanted at day 100. Splenocytes were transferred from tolerant rats (and controls) into lightly irradiated (450 rad) naive PVG, which received RA Htx. Primary Htx were investigated for the development of vascular occlusion (VO), the production of Th1/Th2 intragraft cytokines, and for the nature of graft infiltrate as well as for endothelial deposition of immunoglobulin (Ig)G isotypes and complement (C3) binding. Results were compared with rejecting controls (no DSBT) and syngeneic Htx.
  
  
  RESULTS
  RA Htx were rejected within 10 days (8, 9, 10x4). PreTx DSBT prolonged primary Htx survival indefinitely (>140 days) with acceptance of secondary donor-specific (but not third-party) grafts (P<0.001). Naive irradiated PVG rats given splenocytes from tolerant rats but not from controls accepted RA Htx, showing the existence of regulatory cells in allograft acceptors. Despite being tolerant, DSBT-treated rats displayed typical features of chronic rejection at day 90 (VO=77%; P<0.001 vs. VO=4% in syngeneic rats). An overt Th2 deviation, particularly intragraft production of interleukin (IL)-4, was observed at day 30. Simultaneously to this Th2 deviation, B cells emerged in the grafts and endothelial deposition of IgG1 (Th2 dependent) and C3 binding were observed.
  
  
  CONCLUSIONS
  Regulatory cells that prevent graft loss to acute rejection in primary and secondary grafts do not protect against the development of chronic rejection.
authors.affiliation: Abdominal Transplant Surgery Department, Catholic University Leuven (KUL), Belgium.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Koshiba
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitade
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Van Damme
authors.forename: Annapaula
authors.initials: A
authors.lastname: Giulietti
authors.forename: Lut
authors.initials: L
authors.lastname: Overbergh
authors.forename: Chantal
authors.initials: C
authors.lastname: Mathieu
authors.forename: Mark
authors.initials: M
authors.lastname: Waer
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
mesh_terms: D019264:Adoptive Transfer; D000818:Animals; D017209:Apoptosis; D001803:Blood Transfusion; D002908:Chronic Disease; D006084:Graft Rejection / Q000276:immunology*; D016027:Heart Transplantation; D007108:Immune Tolerance / Q000276:immunology*; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007150:Immunohistochemistry; D007959:Lymphocyte Culture Test, Mixed; D008297:Male; D051381:Rats; D018417:Th1 Cells / Q000502:physiology*; D018418:Th2 Cells / Q000502:physiology*
chemical_list: D007074:Immunoglobulin G; D007075:Immunoglobulin M