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2013 ; ä (ä): 325-32
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Role of alloimmunity and autoimmunity in allograft rejection
#MMPMID25095525
Banan B
; Xu Z
; Gunasekaran M
; Mohanakumar T
Clin Transpl
2013[]; ä (ä): 325-32
PMID25095525
show ga
Pathophysiology of chronic rejection strongly supports that inflammation and
subsequent tissue remodeling during the post-transplant period cause exposure of
cryptic self-antigens (SAgs) or their determinants within the graft, which, along
with a subsequent cytokine response, leads to loss of peripheral tolerance. These
events lead to the activation of cell-mediated immunity towards development of de
novo immune responses to SAgs. There is also evidence for a role for interplay
between allo- and autoimmunity in the development of chronic rejection.
Experimental results using murine models of Obliterative Airway Disease (OAD)
akin to chronic lung allograft rejection have clearly demonstrated that
autoimmune responses to Collagen V (ColV) and K-alpha 1 Tubulin (KalT) were
induced by administration of antibodies (Abs) against class I major
histocompatibility complex antigens. Further, inhibition of interleukin (IL)-17
abrogated the autoimmune response and development of OAD. This shows an important
relationship between alloimmunity, autoimmunity to SAgs such as KalT, and a
significant role for IL-17 pathway of immune activation. Recent reports
demonstrate that in addition to lung transplant recipients, kidney transplant
recipients diagnosed with transplant glomerulopathy can develop de novo Abs to
Sags, including Col-IV and fibronectin and heart transplant recipients can
develop immune responses to cardiac myosin and vimentin. Abs to SAgs were
identified frequently with donor specific anti-human leukocyte antigen
antibodies, supporting the concept of crosstalk between auto- and alloimmunity.
The increased frequency of SAg specific interferon-gamma and IL-17 cells with
reduction in IL-10 demonstrates tolerance breakdown to SAgs which may play a
significant role in the pathogenesis of chronic rejection.