Yuh D D, Gandy K L, Hoyt G, Reitz B A, Robbins R C
Department of Cardiothoracic Surgery, Stanford University Medical Center, California 94305-5247, USA.
J Heart Lung Transplant. 1997 Feb;16(2):222-30.
In utero tolerance induction has potential application in pediatric heart transplantation. Immunotolerance appears to be more easily induced in the fetus before full immunocompetence is established; however, the mechanisms behind this phenomenon are still undefined.
One hundred thirty Lewis (RT1l) rat fetuses from 10 litters were inoculated intraperitoneally at 18 days gestation with 1 x 10(7) ACI (RT1a) rat fetal liver cells. Fifty of the 100 viable neonates successfully brought to term were grafted with neonatal ACI skin within 24 hours of birth and heterotopic ACI hearts at 8 to 10 weeks of age (group 1A); the remaining 50 neonates only received heterotopic ACI heart grafts at 8 to 10 weeks (group 1B). Control groups consisted of 50 Lewis fetuses (five litters) inoculated in utero with phosphate-buffered saline solution (group 2) and 50 Lewis fetuses (five litters) that received no inoculum (group 3); all of these surviving progeny received both neonatal ACI skin and adult ACI cardiac allografts. Skin and cardiac grafts were monitored by daily visual inspection and palpation, respectively. Limiting dilution analysis was performed among all groups to assess precursor cytotoxic lymphocyte frequencies. Likewise, peripheral blood lymphocyte and splenocyte populations were analyzed with flow cytometry to detect allogeneic chimerism.
Abortion rates among groups 1, 2, and 3 were 23% (30/130 abortions), 10% (5/50 abortions), and 6% (3/50 abortions), respectively. Tolerance to both ACI skin and cardiac allografts was induced in 14 of the 50 group 1A Lewis recipients (28%). Tolerance was not achieved in any of the recipients in groups 1B, 2, or 3. Limiting dilution analysis among all groups revealed a marked reduction of precursor cytotoxic T-lymphocytes in tolerant allograft recipients compared with recipients in the other groups. Flow cytometry detected significant splenocyte chimerism among tolerant rats; significant peripheral blood chimerism was not noted.
We describe allogeneic tolerance induction in utero to both rat skin and heart tissue by use of donor-strain fetal liver cells. Compared with previous studies with adult splenocytes as the tolerogen, we achieved a higher frequency of tolerance with a markedly lower cell inoculum and lower abortion rate. Allogeneic chimerism was noted in the tolerant recipients, suggesting hematopoietic stem cell engraftment. Cytotoxic T-lymphocyte precursor frequencies were markedly depressed in tolerant animals. Interestingly, both donor-strain fetal liver cells and neonatal skin grafts were required to induce tolerance. These data suggest a period of hematopoietic "education" during and shortly after hematopoietic stem cell engraftment.
子宫内诱导免疫耐受在小儿心脏移植中具有潜在应用价值。在完全免疫能力建立之前,胎儿似乎更容易诱导产生免疫耐受;然而,这一现象背后的机制仍不明确。
选取来自10窝的130只Lewis(RT1l)大鼠胎儿,在妊娠18天时经腹腔接种1×10⁷个ACI(RT1a)大鼠胎儿肝细胞。100只存活至足月的新生儿中,50只在出生后24小时内移植了新生ACI皮肤,并在8至10周龄时移植了异位ACI心脏(1A组);其余50只新生儿仅在8至10周时接受了异位ACI心脏移植(1B组)。对照组包括50只在子宫内接种磷酸盐缓冲盐水溶液的Lewis胎儿(2组)和50只未接种的Lewis胎儿(3组);所有这些存活后代均接受了新生ACI皮肤和成年ACI心脏同种异体移植。分别通过每日肉眼观察和触诊监测皮肤和心脏移植情况。对所有组进行有限稀释分析以评估前体细胞毒性淋巴细胞频率。同样,用流式细胞术分析外周血淋巴细胞和脾细胞群体以检测同种异体嵌合现象。
1组、2组和3组的流产率分别为23%(30/130次流产)、10%(5/50次流产)和6%(3/50次流产)。50只1A组Lewis受体中有14只(28%)诱导产生了对ACI皮肤和心脏同种异体移植的耐受。1B组、2组或3组的任何受体均未实现耐受。所有组的有限稀释分析显示,与其他组的受体相比,耐受同种异体移植受体的前体细胞毒性T淋巴细胞明显减少。流式细胞术在耐受大鼠中检测到显著的脾细胞嵌合现象;未发现显著的外周血嵌合现象。
我们描述了通过使用供体品系胎儿肝细胞在子宫内诱导对大鼠皮肤和心脏组织的同种异体耐受。与以往以成年脾细胞作为耐受原的研究相比,我们以明显更低的细胞接种量和更低的流产率实现了更高的耐受频率。在耐受受体中观察到同种异体嵌合现象,提示造血干细胞植入。耐受动物的细胞毒性T淋巴细胞前体频率明显降低。有趣的是,诱导耐受需要供体品系胎儿肝细胞和新生皮肤移植。这些数据表明在造血干细胞植入期间及植入后不久存在一个造血“教育”阶段。