title: How can we measure immunologic tolerance in humans?
abstract: Prevention and treatment of allograft rejection in organ transplant recipients relies primarily on non-antigen-specific immunosuppression, with all its associated potential hazards and costs. Currently, the status of the recipient immune response is measured by monitoring pharmacologic drug levels and clinical/pathologic evaluation of graft function. Development of reliable assays that can measure accurately the status of the immune response not only would help clinicians customize the prescription of immunosuppressive drugs in individual patients but also may allow their complete withdrawal in some patients with immunologic tolerance. Furthermore, these assays would facilitate the safe evaluation of novel tolerogenic regimens. Achieving this goal has proved to be very difficult because it requires both a more in-depth understanding of complex mechanisms of tolerance and also identification of transplant patients with acquired tolerance to an allograft that can be studied. This review discusses the current understanding of tolerance mechanisms and outlines the unique and specific challenges in development of tolerance/monitoring assays in the field of transplantation. In addition, several of the most promising candidate assays are discussed in detail.
authors.affiliation: Transplantation Research Center, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA. nnajafian@rics.bwh.harvard.edu
authors.forename: Nader
authors.initials: N
authors.lastname: Najafian
authors.forename: Monica J
authors.initials: MJ
authors.lastname: Albin
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Newell
mesh_terms: D000818:Animals; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007107:Immune System / Q000276:immunology; D007108:Immune Tolerance; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016377:Organ Transplantation
chemical_list: D007166:Immunosuppressive Agents