Anti-idiotypic like Antibodies Detected Following Alloimmunization: Their Characterization and Relevance to Allograft Acceptance

Abstract

Anti-idiotypic-like antibodies (Ab2) develop during the course of HLA alloimmunization. Several reports indicate that their presence in alloimmunized patients is associated with superior allograft survival, and their appearance correlates inversely with specific HLA antibodies. These features suggest that the induced auto-Ab2 may interact with regulatory idiotypes of HLA-specific antibodies, and may be part of an early immune regulatory mechanism that facilitates the induction of donor-specific immunosuppression. The observations have great potential clinical implications for pretransplant manipulations of the immune response to facilitate donor-specific immunosuppression, and to predict the fate of allografts in previously alloimmunized recipients. Further development and general application of Ab2 testing, however, require better documentation that regulatory immune networks between HLA antibodies and T cells exist, and that improved methods of Ab2 detection that could be used routinely and duplicated in the clinical laboratory, can be developed.