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6. EN-BLOC HEART AND THYMUS TRANSPLANTATION IN CYNOMOLGUS MONKEYS

Author

Muniappan, A, primary, Johnston, D R., additional, Guenther, D A., additional, Shoji, T, additional, Boskovic, S, additional, Hoerbelt, R, additional, Houser, S L., additional, Allan, J S., additional, Yamada, K, additional, Kawai, T, additional, Wain, J C., additional, Sachs, D H., additional, and Madsen, J C., additional

Published
2004
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12. In vivo generation of C4d, Bb, iC3b, and SC5b-9 after OKT3 administration in kidney and lung transplant recipients.

Author

Vallhonrat H, Williams WW, Cosimi AB, Tolkoff-Rubin N, Ginns LC, Wain JC, Preffer F, Olszak I, Wee S, Delmonico FL, and Pascual M

Subjects
Adult, Aged, Blood Pressure, Complement Activation, Complement C3 Convertase, Alternative Pathway, Enzyme-Linked Immunosorbent Assay, Female, Heart Rate, Humans, Kidney Transplantation physiology, Lung Transplantation physiology, Male, Methylprednisolone therapeutic use, Middle Aged, Models, Chemical, Complement C3b biosynthesis, Complement C4 biosynthesis, Complement C4b, Complement Membrane Attack Complex biosynthesis, Hemodynamics, Immunosuppressive Agents therapeutic use, Kidney Transplantation immunology, Lung Transplantation immunology, Muromonab-CD3 therapeutic use, Peptide Fragments biosynthesis
Abstract

Background: OKT3 monoclonal antibody therapy results in an acute clinical syndrome (ACS) associated with the release of tumor necrosis factor and sequestration of neutrophils in the lungs. We have previously shown that inhibition of tumor necrosis factor does not completely eliminate OKT3-ACS, suggesting that other factors also contribute to the ACS. The current studies analyzed complement activation in vivo during the first hour after OKT3 administration., Methods: Renal (n=4) and lung (n=4) transplant recipients received OKT3 as treatment for rejection and induction therapy, respectively. Complement activation products C4d, Bb, iC3b, and SC5b-9 were measured by ELISA. Hemodynamic parameters were also monitored in the lung transplant recipients. Neutrophil expression of CD11a, CD11b, and CD18 was monitored by flow cytometry. Controls included patients receiving methylprednisolone for rejection (n=4), two adults with adult respiratory distress syndrome who received extracorporeal membrane oxygenation, and normal volunteers (n=5). P values less than 0.05 (*) were considered significant., Results: Increases in the plasma levels of C4d, Bb, iC3b, and SC5b-9 were observed in seven of eight patients after OKT3 administration. Mean values (n=8) at 0, 15, and 60 min (in microg/ml) were as follows-C4d: 1.865, 2.644*, and 2.607*; Bb: 0.245, 0.411, and 0.385; iC3b: 10.881, 17.242*, and 15.145*; and SC5b-9: 0.232, 0.269, and 0.302*. An increase in CD11b and CD18 and a decrease of CD11a on neutrophils in parallel with complement activation was observed. In lung transplant recipients, C3 activation correlated with increases in mean pulmonary and central venous pressures (P<0.05). As compared with extracorporeal membrane oxygenation, which activated classical and alternative pathways, OKT3 predominantly activated complement by the classical pathway. Methylprednisolone pulses did not activate complement., Conclusions: Complement activation is an early event after OKT3 administration and is associated with the increased expression of adhesion molecules on neutrophils and with pulmonary hemodynamic changes. Effective therapeutic approaches to the control of early monoclonal antibody side effects may require measures that limit complement activation in addition to reducing cytokine activity.

Published
1999
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