Mechanisms of transplant rejection after the establishment of donor-specific tolerance

Abstract

Abstract Patients weaned from immunosuppressive drugs can reject their graft after years of stability, often after an infection. We have modeled this in mice: infection with Listeria monocytogenes (Lm) at the maintenance phase of tolerance can precipitate rejection of a cardiac allograft. Here, we investigated which alloreactive Tconvs may mediate rejection after Lm infection. To track the function of allospecific Tconvs, we seeded tracer TCR75 cells, which recognize I-Ab-restricted donor Kd peptide, into B6 mice prior to Balb/c cardiac transplantation with or without tolerance induction by anti-CD154 + Balb/c splenocytes. ≥35 days post-transplantation, TCR75 cells persisting in tolerant mice developed a PD-1hi CD127lo exhausted-like phenotype and expressed the anergy markers FR4 and CD73. TCR75 cells were dysfunctional, exhibiting 10-fold less recall expansion compared to memory cells and lacked IFNγ and TNF production upon re-stimulation. Intriguingly, TCR75 cells in tolerant hosts remained dysfunctional after Lm infection, suggesting that they may not participate in infection-triggered rejection. Having found that programming T cell dysfunction in tolerance required persistence of the allograft for ~3 weeks, we tested whether T cells specific for alloantigens expressed transiently after transplantation, such as donor MHC Class II, remain functional during tolerance and may mediate rejection after Lm infection. We used tracer TEa cells specific for a donor Class II Eα peptide presented on I-Ab. During tolerance, TEa cells remained PD-1lo and CD73lo, and retained recall expansion and TNF production. We conclude that functional allospecific Tconvs present during tolerance may pose a previously unappreciated risk to the graft.