chapter 19 transplantation immunology
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Chapter 19 Transplantation Immunology. Contents. Introduction Immunologic Basis of Allograft Rejection Classification and Effector Mechanisms of allograft rejection Prevention and Treatment of Allograft Rejection Xenotransplantation. Introduction. Conceptions. Transplantation Grafts - PowerPoint PPT PresentationTRANSCRIPT
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Chapter 19 Chapter 19 Transplantation Transplantation
ImmunologyImmunology
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Contents• Introduction• Immunologic Basis of Allograft Rejection • Classification and Effector Mechanisms of allograft rejection• Prevention and Treatment of Allograft Rejection• Xenotransplantation
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IntroductionIntroduction
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Conceptions• Transplantation• Grafts• Donors• Recipients or hosts• Orthotopic transplantation• Heterotopic transplantation
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Nobel Prize in Physiology or Medicine 1912
• Alexis Carrel (France)• Work on vascular suture
and the transplantation of blood vessels and organs
Great events in history of transplantation
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Nobel Prize in Physiology or Medicine 1960
• Peter Brian Medawar (1/2) • Discovery of acquired immunological tolerance
– The graft reaction is an immunity phenomenon – 1950s, induced immunological tolerance to skin allografts in mice by neonatal injection of allogeneic cellsGreat events in history of transplantation
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Nobel Prize in Physiology or Medicine 1990
• Joseph E. Murray (1/2) • Discoveries concerning
organ transplantation in the treatment of human disease – In 1954, the first successful
human kidney transplant was performed between twins in Boston.
– Transplants were possible in unrelated people if drugs were taken to suppress the body's immune reactionGreat events in history of transplantation
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Nobel Prize in Physiology or Medicine 1980• George D. Snell (1/3), Jean Dausset (1/3)
• Discoveries concerning genetically determined structures on the cell surface that regulate immunological reactions – H-genes (histocompatibility genes), H-2 gene – Human transplantation antigens (HLA) ----MHC
Great events in history of transplantation
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Nobel Prize in Physiology or Medicine 1988
• Gertrude B. Elion (1/3) , George H. Hitchings (1/3) • Discoveries of important principles for drug treatment
– Immunosuppressant drug (The first cytotoxic drugs) ----- azathioprine
Great events in history of transplantation
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Today, kidney, pancreas, heart, lung, liver, bone marrow, and cornea transplantations are performed among non-identical individuals with ever increasing frequency and success
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Classification of grafts• Autologous grafts (Autografts)– Grafts transplanted from one part of the body to another in the same individual
• Syngeneic grafts (Isografts) – Grafts transplanted between two genetically identical individuals of the same species
• Allogeneic grafts (Allografts)– Grafts transplanted between two genetically different individuals of the same species
• Xenogeneic grafts (Xenografts) – Grafts transplanted between individuals of different species
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Skin from an inbred mouse grafted onto the same strain of mouse
Skin from an inbred mouse grafted onto a different strain of mouse
ACCEPTED
REJECTED
Genetic basis of transplant rejectionInbred mouse strains - all genes are identical
Transplantation of skin between strains showed thatrejection or acceptance was dependent upon
the genetics of each strain
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6 months
Transplant rejection is due to an antigen-specific immune response with immunological memory
Immunological basis of graft rejection
Primary rejection of strain skin
e.g. 10 days
Secondary rejection of strain skin
e.g. 3 days
Primary rejection ofstrain skin
e.g. 10 days
Naïve mouse
LycTransfer lymphocytesfrom primed mouse
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• Grafts rejection is a kind of specific immune response– Specificity– Immune memory
• Grafts rejection– First set rejection– Second set rejection
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Part onePart one Immunologic Basis of Immunologic Basis of
Allograft RejectionAllograft Rejection
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• Major histocompatibility antigens (MHC molecules)• Minor histocompatibility antigens• Other alloantigens
I. Transplantation antigens
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1. Major histocompatibility antigens• Main antigens of grafts rejection • Cause fast and strong rejection• Difference of HLA types is the
main cause of human grafts rejection
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2. Minor histocompatibility antigens• Also cause grafts rejection, but slow and weak• Mouse H-Y antigens encoded by Y chromosome • HA-1 ~ HA-5 linked with non-Y chromosome
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3. Other alloantigens • Human ABO blood group antigens • Some tissue specific antigens
– Skin > kidney > heart > pancreas > liver– VEC antigen – SK antigen
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• Cell-mediated Immunity • Humoral Immunity • Role of NK cells
II. Mechanism of allograft rejection
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1. Cell-mediated Immunity
• Recipient's T cell-mediated cellular immune response against alloantigens on grafts
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Molecular Mechanisms of Allogeneic Recognition ? T cells of the recipient recognize the allogenetic MHC molecules? Many T cells can recognize allogenetic MHC molecules
– 10-5-10-4 of specific T cells recognize conventional antigens– 1%-10% of T cells recognize allogenetic MHC molecules
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? The recipient’ T cells recognize the allogenetic MHC molecules• Direct Recognition • Indirect Recognition
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Direct Recognition• Recognition of an intact allogenetic MHC molecule displayed by donor APC in the graft• Cross recognition
– An allogenetic MHC molecule with a bound peptide can mimic the determinant formed by a self MHC molecule plus foreign peptide– A cross-reaction of a normal TCR, which was selected to recognize a self MHC molecules plus foreign peptide, with an allogenetic MHC molecule plus peptide
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• Passenger leukocytes– Donor APCs that exist in grafts, such as DC, MΦ– Early phase of acute rejection ?– Fast and strong ?
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? Many T cells can recognize allogenetic MHC molecules• Allogenetic MHC molecules (different residues)• Allogenetic MHC molecules–different peptides• All allogenetic MHC molecules on donor APC can be epitopes recognized by TCR
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Indirect recognition• Uptake and presentation of allogeneic donor MHC molecules by recipient APC in “normal way”• Recognition by T cells like conventional foreign antigens
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Recipient T cell
TCRPeptide
Donor MHC molecule
Donor MHC molecule
Donor APC Recipient APC
Recipient MHC molecule
Peptide from donor MHC molecule
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• Slow and weak• Late phase of acute rejection and chronic
rejection • Coordinated function with direct recognition
in early phase of acute rejection
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Difference between Direct Recognition and Indirect
RecognitionDirect Recognition
Indirect Recognition
Allogeneic MHC molecule Intact allogeneic MHC molecule Peptide of allogeneic MHC moleculeAPCs Recipient APCs are not necessary Recipient APCs
Activated T cells CD4 + T cells and/or CD8 + T cells CD4 + T cells and/or CD8 + T cellsRoles in rejection Acute rejection Chronic rejection
Degree of rejection Vigorous Weak
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• Activated CD4+T by direct and indirect recognition– CK secretion– MΦ activation and recruitment
• Activated CD8+T by direct recognition– Kill the graft cells directly
• Activated CD8+T by indirect recognition– Can not kill the graft cells directly
Role of CD4 + T cells and CD8 + T cells
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Role of CD4 + T cells and CD8 + T cellsCD4+TH1
CD8+CTL
CD8+preCTL
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• Important role in hyperacute rejection (Preformed antibodies)
– Complements activation– ADCC– Opsonization
• Enhancing antibodies /Blocking antibodies
2. Humoral immunity
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3 .Role of NK cells• KIR can’t recognize allogeneic MHC on graft• CKs secreted by activated Th cells can promote NK activation
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Inflammation
lysis
ADCC
lysis
IL2, IFN
TNF, NO2
IL2, IL4, IL5
IL2, TNF, IFN
Rejection
Mechanisms of graft rejection
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Part twoPart two Classification and Effector MClassification and Effector Mechanisms of Allograft Rejectechanisms of Allograft Rejectionion
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• Host versus graft reaction (HVGR) – Conventional organ transplantation
• Graft versus host reaction (GVHR)– Bone marrow transplantation– Immune cells transplantation
Classification of Allograft Rejection
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I. Host versus graft reaction (HVGR)
• Hyperacute rejection• Acute rejection• Chronic rejection
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• Occurrence time– Occurs within minutes to hours after host blood vessels are anastomosed to graft vessels
• Pathology – Thrombotic occlusion of the graft vasculature – Ischemia, denaturation, necrosis
1. Hyperacute rejection
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• Mechanisms– Preformed antibodies
•Antibody against ABO blood type antigen
•Antibody against VEC antigen •Antibody against HLA antigen
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– Complement activation• Endothelial cell damage
– Platelets activation• Thrombosis, vascular occlusion, ischemic
damage
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• Occurrence time– Occurs within days to 2 weeks after transplantation, 80-90% of cases occur within 1 month
• Pathology– Acute humoral rejection
• Acute vasculitis manifested mainly by endothelial cell damage– Acute cellular rejection
• Parenchymal cell necrosis along with infiltration of lymphocytes and MΦ
2. Acute rejection
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• Mechanisms – Vasculitis
• IgG antibodies against alloantigens on endothelial cell • CDC
– Parenchymal cell damage • Delayed hypersensitivity mediated by CD4+Th1• Killing of graft cells by CD8+Tc
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• Occurrence time– Develops months or years after acute
rejection reactions have subsided• Pathology
– Fibrosis and vascular abnormalities with loss of graft function
3. Chronic rejection
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• Mechanisms – Not clear– Extension and results of cell necrosis in acute rejection– Chronic inflammation mediated by CD4+T cell/MΦ– Organ degeneration induced by non immune factors
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2006-7year Immunology 56Kidney Transplantation----Graft Rejection
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2006-7year Immunology 57Chronic rejection in a kidney allograft with arteriosclerosis
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II.Graft versus host reaction (GVHR)• Graft versus host reaction (GVHR)
– Allogenetic bone marrow transplantation– Rejection to host alloantigens– Mediated by immune competent cells in bone marrow
• Graft versus host disease (GVHD)– A disease caused by GVHR, which can damage the host
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• Graft versus host disease
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2006-7year Immunology 60• Graft versus host disease
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Conditions • Enough immune competent cells in grafts• Immunocompromised host• Histocompatability differences between host and graft
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• Bone marrow transplantation • Thymus transplantation• Spleen transplantation• Blood transfusion of neonate In most cases the reaction is directed against minor histocompatibility antigens of the host
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1. Acute GVHD• Endothelial cell death in the skin,
liver, and gastrointestinal tract• Rash, jaundice, diarrhea,
gastrointestinal hemorrhage • Mediated by mature T cells in the
grafts
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• Acute graft-versus-host reaction with vivid palmar erythema
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2. Chronic GVHD• Fibrosis and atrophy of one or
more of the organs• Eventually complete dysfunction
of the affected organ
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Both acute and chronic GVHD are commonly treated with intense immunosuppresion• Uncertain• Fatal
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Part threePart threePrevention and Therapy Prevention and Therapy
of Allograft Rejectionof Allograft Rejection
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• Tissue Typing • Immunosuppressive Therapy• Induction of Immune Tolerance
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I. Tissue Typing • ABO and Rh blood typing• Crossmatching (Preformed antibodies)• HLA typing
– HLA-A and HLA-B– HLA-DR
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2006-7year Immunology 71• Laws of transplantation
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II. Immunosuppressive Therapy
• Cyclosporine(CsA), FK506– Inhibit NFAT transcription factor
• Azathioprine, Cyclophosphamide– Block the proliferation of lymphocytes
• Ab against T cell surface molecules – Anti-CD3 mAb----Deplete T cells
• Anti-inflammatory agents – Corticosteroids----Block the synthesis and secretion of cytokines
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Removal of T cells from marrow graft
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III. Induction of Immune Tolerance
• Inhibition of T cell activation– Soluble MHC molecules– CTLA4-Ig – Anti-IL2R mAb
• Th2 cytokines– Anti-TNF-α , Anti-IL-2 , Anti-IFN-γ mAb
• Microchimerism– The presence of a small number of cells of donor, genetically distinct from those of the host individual
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Part IVPart IVXenotransplantationXenotransplantation
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• Lack of organs for transplantation• Pig-human xenotransplantation• Barrier
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• Hyperacute xenograft rejection (HXR)– Human anti-pig nature Abs reactive with Galα1,3Gal– Construct transgenic pigs expressing human proteins that inhibit complement activation
• Delayed xenograft rejection (DXR) – Acute vascular rejection– Incompletely understood
• T cell-mediated xenograft rejection