Comparative study of the role of professional versus semiprofessional or nonprofessional antigen presenting cells in the rejection of vascularized organ allografts.

The immune systems of transplant recipients are progressively challenged with exposure to the multiple lineages of donor cells that comprise the vascularized organ allograft. Each lineage of such donor tissue constitutively expresses or can be induced to express varying densities of MHC antigens ranging from no expression of MHC to MHC class I only to both MHC class I and class II. In addition, the cell surface expression of a diverse assortment of costimulatory and cell adhesion molecules also varies in density in a tissue specific fashion within the allograft. The MHC class I/II molecules displayed on the donor cells contain within their clefts a constellation of processed protein antigens in the form of peptides derived from intracellular and to some extent extracellular sources. Therefore, the potential for each cell lineage to induce alloactivation and serve as a target for allospecific immune responses is dependent on the diversity and density of peptide-bearing MHC molecules, costimulatory molecules, and cell adhesion molecules. In addition, the T cell receptor repertoire of the recipient also contributes to the magnitude of the allogeneic response. Consequently, the variety of clinical outcomes following organ transplantation even with the institution of potent immunosuppressive (drug) therapies is not surprising, as it appears reasonable for such therapies to influence the allogeneic response against distinct lineages differentially. Our failure to prevent chronic human allograft rejection may therefore be due to our limited appreciation of the full spectrum of alloactivating experiences encountered by host T cells as they interact with donor cells of diverse tissue lineages. Investigations by our laboratory of the immunopathogenesis of chronic cardiac allograft rejection have revealed an intrinsic inability of human cardiac myocytes to process and present antigens, not only for primary but also for secondary alloimmune responses. One obvious explanation for this phenomenon is the fact that cardiac myocytes do not constitutively express MHC class II molecules and express only low levels of class I molecules. However, this immunological unresponsiveness is maintained even after the induction of MHC class II and upregulation of MHC class I on these cells by interferon-gamma (IFN-gamma). Similar results have also been reported for cells of different tissue lineages (e.g. chondrocytes, keratinocytes, neural cells). Until now, cells have been defined as professional or nonprofessional for the purposes of defining their potential for antigen presentation to T cells. Professional antigen presenting cells have been identified as cells that are of haematopoietic origin, that constitutively express MHC class I and class II molecules as well as potent costimulatory molecules, and that are able to induce both primary and secondary immune responses, whereas nonprofessional antigen presenting cells are not bone marrow derived, do not constitutively express MHC class II, but may in some cases initiate primary and secondary immune responses after induction of MHC class II antigen by proinflammatory cytokines (e.g. IFN-gamma). The findings of our laboratory and others suggest that cells of certain lineages be considered in the separate class of 'nonantigen presenting cells'. Indeed, nonprofessional antigen presenting cells can be reclassified into three categories: semiprofessional-, nonprofessional-, or nonantigen presenting cells that are able to present antigen to and activate naive T cells, activated T cells, or no T Cells, respectively. The aim of this review is to identify and (re)examine the antigen presentation characteristics of cells of different tissue lineages in terms of their ability to activate different subsets of T cells. This approach is taken in an attempt to synthesize these concepts into a unified picture of T cell activation in the context of antigen processing and presentation by different cell types.