title: Recollective homeostasis and the immune consequences of peritransplant depletional induction therapy.
abstract: One's cellular immune repertoire is composed of lymphocytes in multiple stages of maturation - the dynamic product of their responses to antigenic challenges and the homeostatic contractions necessary to accommodate immune expansions within physiologic norms. Given that alloreactivity is predominantly a cross-reactive phenomenon that is stochastically distributed throughout the overall T-cell repertoire, one's allospecific repertoire is similarly made up of cells in a variety of differentiation states. As such, the continuous expansion and elimination of activated memory populations, producing a 'recollective homeostasis' of sorts, has the potential over time to alter the maturation state and effector composition of both ones protective and alloreactive T-cell repertoire. Importantly, a T cell's maturation state significantly influences its response to numerous immunomodulatory therapies used in organ transplantation, including depletional antibody induction. In this review, we discuss clinically utilized depletional induction strategies, how their use alters a transplant recipient's cellular immune repertoire, and how a recipient's repertoire influences the clinical effects of induction therapy.
authors: Department of Surgery, Emory University, Atlanta, GA, USA.
authors: Joshua M
authors: JM
authors: Rosenblum
authors: Allan D
authors: AD
authors: Kirk
mesh_terms: D000818:Animals; D000906:Antibodies / Q000009:adverse effects / Q000627:therapeutic use*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006706:Homeostasis; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects*; D007156:Immunologic Memory / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008212:Lymphocyte Depletion / Q000009:adverse effects / Q000379:methods*; D016377:Organ Transplantation / Q000009:adverse effects; D013601:T-Lymphocytes / Q000187:drug effects* / Q000276:immunology; D023001:Transplantation Tolerance / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D007166:Immunosuppressive Agents
keywords: homeostasis; induction; memory T cell; tolerance; transplantation