F. Pazderka

Pathologic features of acute renal allograft rejection associated with donor-specific antibody : Analysis using the banff grading schema

Alloantibody frequently appears during the immune response to alloantigens in renal transplant recipients. We studied whether the presence of antibody against donor class I antigens correlated with the clinical and pathologic features of acute rejection episodes. We identified patients who had (1) clinical evidence of acute rejection, (2) a renal biopsy showing pathologic features of acute rejection, defined by the Banff criteria, and (3) pre- and posttransplant sera screened against donor T cells. We divided these patients into those with or without donor-specific alloantibody reactive with donor T cells. Of 44 patients with biopsy-proven rejection, 20 were antibody negative (Ab-R) and 24 were antibody positive (Ab+R). The biopsies from Ab+R patients had a higher incidence of severe vasculitis (P=0.0009) and glomerulitis (P=0.01). Fibrin thrombi in the glomeruli and/or vessels, fibrinoid necrosis, and dilatation of peritubular capillaries were also more frequent in the Ab+R group. Infarction was present in biopsy specimens from 9/24 Ab+R patients versus none in the Ab-R group (P=0.002). The Ab+R biopsy specimens more often had polymorphonuclear leukocytes in the peritubular capillaries (P=0.003). In contrast, specimens of Ab-R patients showed tubulitis more often than the specimens of Ab+R patients: moderate and severe tubulitis was present in 19/20 (95%) Ab-R patients versus 12/24 (50%) Ab+R patients (P=0.002). Graft loss was increased in Ab+R patients, particularly in the first 3 months (12/24 compared with 3/20, P=0.025). Thus, during biopsy-proven acute rejection episodes, anti-class I antibody correlates with severe vascular lesions, glomerulitis, and infarction, whereas more severe tubulitis predominates in rejection episodes without antibody.

Calcineurin activity is only partially inhibited in leukocytes of cyclosporine-treated patients.

Measurement of the degree of immunosuppression induced clinically by drugs such as cyclosporine is an important but elusive goal. In lymphocytes in vitro, cyclosporine (CsA) blocks the phosphatase activity of the enzyme calcineurin, preventing cytokine induction. We sought to measure the degree of calcineurin blockade in patients on CsA. Calcineurin activity was measured in peripheral blood mononuclear cells (PBL) from stable CsA-treated renal transplant patients, compared with controls. Cytokine expression was assessed by challenging ex vivo PBL with calcium ionophore A23187 (5 microM) for 60 min and measuring interferon-gamma (IFN-gamma) and interleukin 2 (IL-2) mRNA induction. In vitro, CsA inhibited both calcineurin activity and cytokine induction with an IC50 of 10-20 micrograms/L. In CsA-treated patients with therapeutic CsA levels (mean trough CsA blood level = 180 +/- 55 micrograms/L), calcineurin activity was detectable but reduced by 50% compared with controls (P < or = 0.001) and correlated with CsA trough levels (r = -0.390, P < or = 0.01). The induction of cytokine mRNA in such patients was not blocked, but was sensitive to CsA in vitro, suggesting that CsA is much less available in vivo in body fluids than it is for isolated cells in vitro. In lymphocytes of patients on CsA, calcineurin activity is reduced but 50% of the activity persists, permitting strong signals to trigger cytokine expression. Partial calcineurin inhibition may explain why the immune responsiveness of patients on CsA is reduced but still sufficient for host defense.

Cyclosporine inhibition of calcineurin activity in human leukocytes in vivo is rapidly reversible.

Despite increasing information about the mechanism of action of cyclosporine A (CsA), little is known about the way lymphocytes recover from CsA. Recovery is central to understanding the pharmacodynamics of CsA in vivo. We studied the recovery of calcineurin phosphatase (CN) activity in CsA-treated cells. Single dose kinetics in renal transplant patients showed that inhibition of CN activity in PBL increased and fell concomitant with CsA blood vessels. In vitro, control PBL treated with CsA 100 micrograms/l, washed, and resuspended in CsA-free medium showed little recovery (0-20%) after 24 h. Erythrocytes or anti-CsA Ab added to the recovery medium increased recovery to 50% within 4 h. Similar recovery was seen in the ability of cells to produce IFN-gamma after OKT3 stimulation. Recovery of CN activity was associated with the efflux of [3H]CsA, was not blocked by cycloheximide and was temperature sensitive. A cell line with high expression of surface P glycoprotein (PGP), showed rapid recovery. However, PGP blockade did not prevent recovery in PBL, indicating a different PGP-independent mechanism. In PBL, recovery from CsA is slow and limited in vitro, but rapid in vivo, where CsA equilibrates among a complex set of extralymphocytic binding sites.

Lymphoma induced by herpesvirus: Resistance associated with a major histocompatibility gene

Studies with crosses of inbred chicken lines demonstrate that resistance to Mareks disease, a herpesvirus-induced lymphoma of chickens, is associated with an allele (B21) of the major histocompatibility locus (theB locus). TheB21 allele is thus the first genetic marker for resistance to herpesvirus-induced neoplastic disease, and our studies suggest the means whereby similar associations might be found in man.

The major histocompatibility complex of the chicken

SummaryB identifies a system of two or more loci which have major effects on hostversus-graft and graft-versus-host reactions. LikeH-2 andHL-A, B encodes lymphocyte antigens which react with alloantibodies and allogenic lymphocytes. Like the mammalian MHCs,B has many alleleic variants. LikeH-2 alleles, some of these are associated with specific differences in immune competence and susceptibility to viral oncogenesis. UnlikeH-2, there is no evidence thatB histocompatibility andB serology represent separable genetic systems. In addition,B is associated with functional differences unknown in mammals. These include a general difference in immune competence and differences in the frequency of herpesvirus lymphoma and in reproductive and general fitness. We conclude that the different kinds of information available forB and the mammalian MHCs reflect differences in circumstance, sampling, and technique, and should be regarded as less fundamental than the immunogenetic similarities. We suggest thatB is the phylogenetic homologue ofH-2 andHL-A.

Cyclosporine inhibition of leukocyte calcineurin is much less in whole blood than in culture medium.

Recent reports have shown that cyclosporine (CsA)-treated patients have abundant calcineurin phosphatase (CN) activity in vivo despite CsA blood concentrations that would be completely inhibitory in vitro. We sought to determine whether this disparity was a result of altered distribution of CsA in culture medium (CM) compared with whole blood (WB). CN activity was measured in peripheral blood leukocytes (PBL) that had been exposed in vitro to CsA in either WB or CM. Cells from both groups were also stimulated with OKT3 to determine the effect of CsA on the induction of IFN-gamma synthesis. CsA accumulation in PBL was determined by liquid scintillation counting of PBL exposed to 3H-CsA. The IC50 for CsA inhibition of CN activity was significantly lower for PBL in CM (2 micrograms/L) compared with PBL in WB (102 micrograms/L, P < or = 0.005). Likewise, for CsA inhibition of IFN-gamma induction, the IC50 was 18 micrograms/L for PBL in CM compared with 690 micrograms/L for PBL in WB (P < or = 0.005). The shift in IC50 was accompanied by a 10-fold increase in 3H-CsA in PBL in CM compared with PBL in WB. We conclude that PBL exposed to CsA in CM accumulate significantly more CsA than PBL in WB. The result is that CsA inhibition of CN activity and cytokine induction appears at least an order of magnitude greater than its true effect in biologic fluids. This disparity is due to partitioning of CsA to irrelevant CsA binding sites, which are abundant in WB and in vivo, but absent in culture medium.

Role of the Major Histocompatibility Complex in Resistance to Marek’s Disease: Restriction of the Growth of JMV-MD Tumor Cells in Genetically Resistant Birds

B21 is associated with resistance to Mareks disease (MD). Forty populations of chickens from all over the world were examined for the presence of the B21 allele. B21 was found in twelve of these populations and its presence was confirmed by GVH testing in all ten populations which were tested. The populations in which B21 was detected represent the extreme production types of the species and include the progenitor of the species, the Red Jungle Fowl. Our studies suggest that B21 may have strong survival value for the species. An allogeneic transplantable lymphoma of MD, the JMV tumor cell line, grows more slowly in MD resistant (B21/B21) chicks than in MD susceptible (B2/B2) chicks. This is the first direct evidence that genetic resistance to MD may involve an active (immunological?) restriction of tumor cell growth. JMV cells were further characterized as a transplant of B1 carrying lymphoblastoid cells, an allele which may be associated with susceptibility to MD.

A T-cell antigen system of chickens: Ly-4 and Marek's disease

A search was made for lymphocyte antigens associated with resistance or susceptibility to the T-cell lymphoma induced by the herpes virus of Mareks disease (MD), the experimental model for Burkitts lymphoma of humans. Antisera were produced by reciprocal immunization with whole blood between an MD-resistant and susceptible line of chickens compatible at the major histocompatibility complex (MHC), and were tested against lymphocytes of both lines. The lymphocytes were not agglutinated, immobilized, or lysed, but their ability to evoke graft-versus-host (GVH) splenomegaly was reduced. This inhibitory activity was line-specific, and these sera had a maximum limiting effect on GVH splenomegaly at a dilution of 1/50 and a minimum at 1/800 dilution. A test based on the differential limitation of GVH splenomegaly by a pair of alloantisera was used to identify the antigens in F1 and F2 generations. The segregation results established a locus,Ly-4, with two codominant alleles,Ly- 4a andLy-4b.Ly-4 is distinct from theA, B, orC blood group loci and from theBu-1 locus determining B-cell antigens, but may be linked to theTh-1 locus determining T-cell antigens (recombination frequency of 32 percent). Tentative evidence was obtained from comparisons of homozygous F2 and F3 progeny for association of theLy-4 allele characteristic of the susceptible line with increased incidence of MD.

Genetic control of graft-versus-host competence.

A small proportion of the peripheral lymphocytes responds to a first exposure to transplantation antigens. The number of responsive cells varies 3− to 5-fold among inbred and hybrid lines of White Leghorn chickens, and this variation is independent of the total numbers of lymphocytes and leukocytes. The lowest numbers were found in lines homozygous for blood group allele B2 and the highest numbers were found in lines homozygous for B14, both of which are principal determinants of specific histoincompatibility. The number of effective cells in the F1 and F2 B heterozygotes is the geometric mean of the numbers present in the parental and F2 homozygotes. The exactness with which the B heterozygotes fit the geometric mean is interpreted to mean that the number of mitoses which occur during the differentiation of responsive cells, prior to their first contact with antigen, is associated in some way with the B locus.

The functional consequences of partial calcineurin inhibition in human peripheral blood mononuclear leucocytes

Calcium-dependent signal transduction is essential to the induction of cytokine expression by stimuli acting through the T cell receptor. In vitro, the immunosuppressant cyclosporine (CyA) blocks this pathway by inhibition of calcineurin (CN) phosphatase activity. But in vivo, patients on CyA have only 50% inhibition of CN and can mount cytokine responses. To simulate this state of partial inhibition, we studied the responses of human peripheral blood mononuclear leucocytes (PBL) in vitro at low CyA concentrations. PBL were challenged in vitro with calcium ionophores or anti-CD3 monoclonal antibody. The induction of IFN-gamma (interferon-gamma) and IL-2 (interleukin 2) steady-state mRNA was studied by Northern blotting and reverse transcriptase-polymerase chain reaction. IFN-gamma was assessed in a radiolabelled antibody binding assay or by ELISA (enzyme-linked immunosorbent assay). CN was assessed by dephosphorylation of a 32P-serine labelled 19 amino acid substrate. CyA inhibited CN with an IC50 (concentration giving 50% inhibition) of 10 ng/ml (95% confidence interval, CI = 8-13 ng/ml). Likewise, the induction of IFN-gamma and IL-2 mRNA by calcium ionophore A23187 was inhibited with IC50 of 14 ng/ml (95% CI = 8-27 ng/ml) and 32 ng/ml (95% CI = 5-178 ng/ml), respectively, while the IC50 for inhibition of IFN-gamma protein secretion was 8 ng/ml (95% CI = 9-18 ng/ml). Partial inhibition of CN also altered the threshold for IFN-gamma induction. CyA 10 ng/ml inhibited IFN-gamma induction by anti-CD3 monoclonal antibody OKT3 significantly more at low OKT3 concentrations (10 ng/ml, mean +/- SEM = 72 +/- 9% inhibition) compared to high OKT3 concentrations (1000 ng/ml, 47 +/- 6%, p < 0.01). Similar results were seen using high and low concentrations of A23187. Finally, cells pretreated with CyA recovered the ability to respond to high concentrations of A23187 (5 microM) faster than low concentrations (0.5 microM). We conclude that the principal defect in lymphocytes with partial CN inhibition is a reduction in maximum cytokine output which is closely related to the degree of CN inhibition. In addition, there is significantly greater inhibition of weak stimuli compared to maximal stimuli. These defects may explain why patients on CyA can have a reduction in immune responsiveness but still retain protection from infection.