title: Intestinal ischemia reperfusion and lipopolysaccharide transform a tolerogenic signal into a sensitizing signal and trigger rejection.
abstract: BACKGROUND
  After intestinal transplantation (ITx), rejection is vigorous and tolerance is difficult to achieve. A possible reason for this phenomenon is that ITx and ischemia reperfusion injury are accompanied by translocation of lipopolysaccharide (LPS), a "danger" signal capable of activating adaptive alloimmunity against Tx antigens.
  
  
  METHODS
  To study that, we used our previously described rat model where donor-specific blood transfusion (DSBT) induces tolerance to fully mismatched heart allografts.
  
  
  RESULTS
  In this model, control grafts are rejected within 9 days, whereas 100% of DSBT pretreated grafts survive long term. In contrast with heart Tx, an identical DSBT protocol failed to induce tolerance in 57% of recipients after ITx (P<0.05). We hypothesized that DSBT promotes tolerance to heart but not intestinal allografts (partly) because of ischemia/reperfusion injury and LPS translocation associated with ITx. We tested this hypothesis by adding to DSBT an inflammatory signal in the form of a remote intestinal/ischemia reperfusion injury or by administrating 0.1 mg of LPS. These maneuvers (partially) abrogated tolerance induction (P<0.05).
  
  
  CONCLUSIONS
  Addition of a danger signal (remote intestinal ischemia/reperfusion) transforms a tolerogenic signal (DSBT) into a sensitizing signal and may lead to graft rejection. This effect is mediated in part by LPS. This may, partly, account for the high rejection rate and the difficulty to induce graft acceptance after ITx.
authors.affiliation: Abdominal Transplant Surgery Department, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kawai
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitade
authors.forename: Takaaki
authors.initials: T
authors.lastname: Koshiba
authors.forename: Mark
authors.initials: M
authors.lastname: Waer
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
mesh_terms: D000818:Animals; D001803:Blood Transfusion; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006085:Graft Survival / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology*; D006650:Histocompatibility Testing; D007108:Immune Tolerance / Q000187:drug effects / Q000276:immunology*; D007422:Intestines / Q000098:blood supply* / Q000502:physiology / Q000637:transplantation*; D007511:Ischemia / Q000503:physiopathology*; D008070:Lipopolysaccharides / Q000627:therapeutic use*; D023421:Models, Animal; D051381:Rats; D015424:Reperfusion; D050378:T-Lymphocytes, Regulatory / Q000276:immunology
chemical_list: D008070:Lipopolysaccharides