Biological therapy of bone defects: the immunology of bone allo-transplantation.
BACKGROUND
Bone is one of the most transplanted tissues worldwide. Autograft is the ideal bone graft but is not widely used because of donor site morbidity and restricted availability. Allograft is easily accessible but can transmit infections and elicit an immune response.


METHODS
This review identifies all in vitro and in vivo evidence of immune responses following bone transplantation and highlights methods of improving host tolerance to bone allotransplantation.


RESULTS
In humans, the presence of anti-HLA specific antibodies against freeze-dried and fresh-frozen bone allografts has been demonstrated. Fresh-frozen bone allograft can still generate immune reactions whilst freeze-dried bone allografts present with less immunogenicity but have less structural integrity. This immune response can have an adverse effect on the graft's incorporation and increase the incidence of rejection. Decreasing the immune reaction against the allograft by lowering the immunogenic load of the graft or lowering the host immune response, would result in improved bone incorporation.


CONCLUSIONS
It is essential that the complex biological processes related to bone immunogenicity are understood, since this may allow the development of safer and more successful ways of controlling the outcome of bone allografting.
Graham
Simon M
SM
Academic Department of Trauma and Orthopaedics, University of Leeds, School of Medicine, Clarendon Wing A, Leeds General Infirmary Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK.
Leonidou
Andreas
A
Aslam-Pervez
Nayef
N
Hamza
Ahmed
A
Panteliadis
Pavlos
P
Heliotis
Manolis
M
Mantalaris
Athanasios
A
Tsiridis
Eleftherios
E
D000818:Animals; D000941:Antigens / Q000276:immunology; D001847:Bone Diseases / Q000276:immunology* / Q000628:therapy*; D001857:Bone Matrix / Q000276:immunology; D016025:Bone Transplantation / Q000009:adverse effects / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D000941:Antigens; D007166:Immunosuppressive Agents