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Institut National de la Santé et de la Recherche Médicale U437, Institut de Transplantation et Recherche en Transplantation, Nantes, France; and
Molecular Medicine and Gene Therapy Unit, Manchester University, Manchester, United Kingdom
Blockade of the CD28/B7 T cell costimulatory pathway prolongs
allograft survival and induces tolerance in some animal models. We
analyzed the efficacy of a CTLA4Ig-expressing adenovirus in preventing
cardiac allorejection in rats, the mechanisms underlying heart
transplant acceptance, and whether the effects of CTLA4Ig were
restricted to the graft microenvironment or were systemic. CTLA4Ig gene
transfer into the myocardium allowed indefinite graft survival (>100
days vs 9 ± 1 days for controls) in 90% of cases, whereas
CTLA4Ig protein injected systemically only prolonged cardiac allograft
survival (by up to 22 days). CTLA4Ig could be detected in the graft and
in the serum for at least 1 year after gene transfer. CTLA4Ig gene
transfer induced local intragraft immunomodulation at day 5 after
transplantation, as shown by decreased expression of the IL-2R and MHC
II Ags; decreased levels of mRNA encoding for IFN-
, inducible NO
synthase, and TGF-ß; and inhibited proliferative responses of
graft-infiltrating cells. Systemic immune responses were also
down-modulated, as shown by the suppression of Ab production against
donor alloantigens and cognate Ags, up to at least 120 days after gene
transfer. Alloantigenic and mitogenic proliferative responses of
graft-infiltrating cells and total splenocytes were inhibited and were
not reversed by IL-2. In contrast, lymph node cells and T cells
purified from splenocytes showed normal proliferation. Recipients of
long-term grafts treated with adenovirus coding for CTLA4Ig showed
organ and donor-specific tolerance. These data show that expression of
CTLA4Ig was high and long lasting after adenovirus-mediated gene
transfer. This expression resulted in down-modulation of responses
against cognate Ags, efficient suppression of local and systemic
allograft immune responses, and ultimate induction of donor-specific
tolerance.
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