title: Intensity of transplant chronic rejection correlates with level of graft-infiltrating regulatory cells.
abstract: BACKGROUND
  The understanding of chronic rejection (transplant vascular sclerosis, or TVS) mechanisms is a major goal of transplantation. In this study we tested a cardiac transplant model for TVS development in connection with emerging T-regulatory cells (T-regs). We used 40-mer peptides derived from the donor MHC Class I alpha1 helix of the alpha1-domain to make recipients tolerant.
  
  
  METHODS
  ACI recipients were transplanted with either RT1.A(u) (WF), RT1.A(l) (LEW), RT1.A(c) (PVG), or RT1.A(b) (BUF) cardiac grafts. The grafts were analyzed 120 days later for TVS and development of T-regs.
  
  
  RESULTS
  Donor MHC peptides were injected through the portal vein (0.1 mg) into ACI recipients of WF hearts in addition to sub-therapeutic cyclosporine (CsA, 10 mg/kg for 3 days post-operatively). Peptide treatment specifically prolonged graft survival for >100 days (n = 31). ACI recipients of WF or LEW hearts treated with PVG peptides promptly rejected the transplanted grafts (15 +/- 4 and 20 +/- 1 days, respectively). Presence of T-regs in tolerant recipients was confirmed by the adoptive transfer of T cells into a new cohort of syngeneic recipients (mean survival time [MST] >100 days, n = 3). CD4(+) and FoxP3(+) cells were detected in 70% of the chronically rejected grafts vs 38% (CD4) and 22% (FoxP3) in the well-preserved transplants. IgG and IgM deposits were found in only half of surviving cardiac grafts with a high level of TVS. Blood vessels in grafts with attenuated TVS were 80% IgG and IgM positive. Interleukin (IL)-4 and IL-2 were markedly down-regulated in the hearts with high TVS compared with well-preserved grafts. Long-term-surviving hearts demonstrated increased IL-10 expression. Interferon-gamma (IFN-gamma) was more evident in the grafts with a high TVS.
  
  
  CONCLUSIONS
  Donor MHC Class I peptides can specifically prolong transplant survival and generate T-regs. The level of intragraft T-regs correlates with severity of TVS and IL-2/IL-4 down-regulation.
authors.affiliation: Department of Surgery, UCLA Medical School, Los Angeles, California 90095, USA. nsemiletova@mednet.ucla.edu
authors.forename: Natalya V
authors.initials: NV
authors.lastname: Semiletova
authors.forename: Xiu-Da
authors.initials: XD
authors.lastname: Shen
authors.forename: Boris
authors.initials: B
authors.lastname: Baibakov
authors.forename: Arthur
authors.initials: A
authors.lastname: Andakyan
mesh_terms: D000818:Animals; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism / Q000473:pathology; D002465:Cell Movement / Q000276:immunology; D051858:Forkhead Transcription Factors / Q000378:metabolism; D006084:Graft Rejection / Q000276:immunology* / Q000378:metabolism / Q000473:pathology*; D016027:Heart Transplantation / Q000276:immunology* / Q000473:pathology*; D006649:Histocompatibility Antigens / Q000378:metabolism; D007376:Interleukin-2 / Q000378:metabolism; D015847:Interleukin-4 / Q000378:metabolism; D008297:Male; D023421:Models, Animal; D051381:Rats; D011912:Rats, Inbred ACI; D011915:Rats, Inbred BUF; D011917:Rats, Inbred Lew; D011920:Rats, Inbred WF; D050378:T-Lymphocytes, Regulatory / Q000276:immunology* / Q000378:metabolism / Q000473:pathology*; D023001:Transplantation Tolerance / Q000276:immunology; D014184:Transplantation, Homologous
chemical_list: D051858:Forkhead Transcription Factors; C500522:Foxp3 protein, rat; D006649:Histocompatibility Antigens; D007376:Interleukin-2; D015847:Interleukin-4