4.8 Article

Inverted direct allorecognition triggers early donor-specific antibody responses after transplantation

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SCIENCE TRANSLATIONAL MEDICINE
卷 14, 期 663, 页码 -

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AMER ASSOC ADVANCEMENT SCIENCE
DOI: 10.1126/scitranslmed.abg1046

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  1. Hospices Civils de Lyon
  2. Societe Francophone de Transplantation
  3. Institut Hospitalo-Universitaire-Organ Protection and Replacement (IHU-OPeRa) [ANR-10-IBHU-004]
  4. Agence Nationale pour la Recherche [ANR-12-PDOC-0019.01, ANR-16-CE17-0007-01]
  5. Fondation pour la Recherche Medicale [PME20180639518]
  6. Etablissement Francais du Sang
  7. Agence Nationale de la Recherche (ANR) [ANR-12-PDOC-0019, ANR-16-CE17-0007] Funding Source: Agence Nationale de la Recherche (ANR)

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Generation of antibodies against donor-specific MHC antigens after transplantation requires help from recipient's T cells, but our study shows that CD3e knockout recipient mice lacking T cells can still generate antibodies due to the presence of donor CD4+ T cells within the graft. This inverted direct pathway may also be operant in patients after transplantation.
The generation of antibodies against donor-specific major histocompatibility complex (MHC) antigens, a type of donor-specific antibodies (DSAs), after transplantation requires that recipient's allospecific B cells receive help from T cells. The current dogma holds that this help is exclusively provided by the recipient's CD4+ T cells that recognize complexes of recipient's MHC II molecules and peptides derived from donor-specific MHC alloantigens, a process called indirect allorecognition. Here, we demonstrated that, after allogeneic heart transplantation, CD3e knockout recipient mice lacking T cells generate a rapid, transient wave of switched alloantibodies, predominantly directed against MHC I molecules. This is due to the presence of donor CD4+ T cells within the graft that recog-nize intact recipient's MHC II molecules expressed by B cell receptor-activated allospecific B cells. Indirect evidence suggests that this inverted direct pathway is also operant in patients after transplantation. Resident memory donor CD4+ T cells were observed in perfusion liquids of human renal and lung grafts and acquired B cell helper functions upon in vitro stimulation. Furthermore, T follicular helper cells, specialized in helping B cells, were abun-dant in mucosa-associated lymphoid tissue of lung and intestinal grafts. In the latter, more graft-derived passenger T cells correlated with the detection of donor T cells in recipient's circulation; this, in turn, was associated with an early transient anti-MHC I DSA response and worse transplantation outcomes. We conclude that this inverted direct allorecognition is a possible explanation for the early transient anti-MHC DSA responses frequently observed after lung or intestinal transplantations.

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