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* Department of Pediatrics,
Department of Immunology,
Department of Surgery,
Center of Human Genetics, Department of Medicine, and
¶ Department of Pathology, Duke University Medical Center, Durham, NC 27710
Thymus allograft biopsies were performed in athymic infants with complete DiGeorge anomaly after thymus transplantation to assess whether the thymus allograft tissue was able to support thymopoiesis. Forty-four consecutive infants were treated with postnatal cultured thymus allografts. Thirty biopsies and six autopsies evaluating the allograft site were obtained in 33 infants, 23 of whom survive. The allograft was examined by immunohistochemistry for evidence of thymopoiesis. Grafted thymus tissue was found in 25 of 30 biopsies, 23 of which showed thymopoiesis. All 19 survivors with thymopoiesis on biopsy developed naive T cells and T cell function. Autopsies were done in six subjects, three of whom had biopsies. All autopsy samples contained thymus tissue including one for which the biopsy had not contained graft. Of the six autopsies, one had evidence of thymopoiesis. Epithelium without thymopoiesis was seen in two of 25 biopsies in which thymus tissue was detected and in five of six autopsies. Graft rejection was seen in one autopsy. Biopsies were important for showing the following: 1) the damaging effect of pulse steroids on thymopoiesis; 2) the need for adequate immunosuppression of atypical subjects; and 3) the presence of thymopoiesis in the presence of ongoing immunosuppression. In addition, the biopsy could rule out graft rejection in the atypical subjects who had oligoclonal T cells that could cause rejection. In summary, combining biopsy and autopsy data, allogeneic thymus tissues showed thymopoiesis in 24 of 29 (86%) evaluable transplants. The results of these biopsies led to improved care of these complex patients.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
1 This work was supported by National Institute of Health Grants R01 AI 47040, R01 AI 54843, R21 AI 60967, UL1 RR024128, and M03 RR60 (Duke General Clinical Research Center, National Center for Research Resources, National Institute of Health), and by Office of Orphan Products Development, Food and Drug Administration, Grant FD-R-002606.
2 Address correspondence and reprint requests to Dr. M. Louise Markert, Box 3068, Duke University Medical Center, Room 109B Research Park 4, Durham, NC 27710. E-mail address: marke001{at}mc.duke.edu
3 Current address: Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390.
4 Abbreviations used in this paper: GVHD, graft vs host disease; CK, cytokeratin; RSV, respiratory syncytial virus; TCRBV, TCR β-chain variable region.
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