Immune-privileged Tissue Research Articles

Unresolved inflammation: ‘immune tsunami’ or erosion of integrity in immune-privileged and immune-responsive tissues and acute and chronic inflammatory diseases or cancer

Introduction: Unresolved inflammation is loss of balance between two biologically opposing arms of acute inflammation, ‘Yin’ (tumoricidal) and ‘Yang’ (tumorigenic) processes that cause disruption of protective mechanisms of immune system.Areas covered: Hypothesis: Unresolved inflammation-induced exaggerated expression of apoptotic and/or wound healing mediators lead to fundamental erosion (‘immune tsunami’ or ‘immune meltdown’) of integrity in tissues that are naturally immune-responsive (immune surveillance); or immune-privileged (immune tolerance). ‘Immune tsunami’ refers to end results of acute or chronic immune dysfunction leading to inflammatory diseases or cancer. Acute inflammatory diseases including drug-induced cancer cachexia, would fit features of ‘immune meltdown’ that are otherwise described for end results of age-associated diseases. Pathogens induce rapid destruction of vascular integrity, gain access to tissues and cause excessive expression of apoptotic factors leading to multiple organ failure (MOF). Significant disruptions of immunological barriers and response shifts lead to chronic neurodegenerative and autoimmune diseases, tumor growth, malignancies and angiogenesis and loss of natural immune response balances.Expert opinion: Strategies to promote (stabilize) inherent properties of innate immune cells (‘tumoricidal’ versus ‘tumorigenesis’) that would influence polarization of adaptive immune (T or B) cells are key in reducing or preventing incidence of inflammatory and vascular diseases or cancer during aging process.

Retinal cells suppress intraocular inflammation (uveitis) through production of interleukin-27 and interleukin-10

Neuronal or photoreceptor deficit observed in uveitis and multiple sclerosis derives in part from inability to control inflammatory responses in neuroretina or brain. Recently, IL-27 was found to play a role in suppressing experimental autoimmune uveitis and experimental autoimmune encephalomyelitis, two animal models that share essential pathological features of human uveitis and multiple sclerosis, respectively. However, the mechanism by which interleukin-27 (IL-27) inhibits central nervous system (CNS) inflammation is not clear. In this study we have investigated mechanisms that mitigate or curtail intraocular inflammation (uveitis) and examined whether inhibitory effects of IL-27 are mediated locally by neuroretinal cells or by regulatory T cells. We show here that microglia cells in the neuroretina constitutively secrete IL-27 and its expression is up-regulated during uveitis. We further show that photoreceptors constitutively express IL-27 receptor and respond to IL-27 signalling by producing anti-inflammatory molecules, IL-10 and suppressor of cytokine signalling 1 (SOCS1) through signal transducer and activator of transcription 1 (STAT1) -dependent mechanisms. Moreover, STAT1-deficient mice produced reduced amounts of IL-27, IL-10 and SOCS1 and developed more severe uveitis. Surprisingly, IL-10-producing regulatory T cells had marginal roles in suppressing uveitis. These results suggest that suppression of intraocular inflammation might be mediated through endogenous production of IL-27 and IL-10 by retinal cells, whereas SOCS proteins induced by IL-27 during uveitis may function to protect the neuroretinal cells from the toxic effects of pro-inflammatory cytokines. Targeted delivery of IL-27 into immune privileged tissues of the CNS may therefore be beneficial in the treatment of CNS inflammatory diseases, such as uveitis and multiple sclerosis.

Deciphering Membrane-Associated Molecular Processes in Target Tissue of Autoimmune Uveitis by Label-Free Quantitative Mass Spectrometry

Autoimmune uveitis is a blinding disease presenting with autoantibodies against eye-specific proteins as well as autoagressive T cells invading and attacking the immune-privileged target tissue retina. The molecular events enabling T cells to invade and attack the tissue have remained elusive. Changes in membrane protein expression patterns between diseased and healthy stages are especially interesting because initiating events of disease will most likely occur at membranes. Since disease progression is accompanied with a break-down of the blood-retinal barrier, serum-derived proteins mask the potential target tissue-related changes. To overcome this limitation, we used membrane-enriched fractions derived from retinas of the only available spontaneous animal model for the disease equine recurrent uveitis, and compared expression levels by a label-free LC-MSMS-based strategy to healthy control samples. We could readily identify a total of 893 equine proteins with 57% attributed to the Gene Ontology project term "membrane." Of these, 179 proteins were found differentially expressed in equine recurrent uveitis tissue. Pathway enrichment analyses indicated an increase in proteins related to antigen processing and presentation, TNF receptor signaling, integrin cell surface interactions and focal adhesions. Additionally, loss of retina-specific proteins reflecting decrease of vision was observed as well as an increase in Müller glial cell-specific proteins indicating glial reactivity. Selected protein candidates (caveolin 1, integrin alpha 1 and focal adhesion kinase) were validated by immunohistochemistry and tissue staining pattern pointed to a significant increase of these proteins at the level of the outer limiting membrane which is part of the outer blood-retinal barrier. Taken together, the membrane enrichment in combination with LC-MSMS-based label-free quantification greatly increased the sensitivity of the comparative tissue profiling and resulted in detection of novel molecular pathways related to equine recurrent uveitis.

Response of corneal epithelial cells to Staphylococcus aureus

Staphylococcus aureus is a leading cause of invasive infection. It also infects wet mucosal tissues including the cornea and conjunctiva. Conflicting evidence exists on the expression of Toll-like receptors by human corneal epithelial cells. It was therefore of interest to determine how epithelial cells from this immune privileged tissue respond to S. aureus. Further, it was of interest to determine whether cytolytic toxins, with the potential to cause ion flux or potentially permit effector molecule movement across the target cell membrane, alter the response. Microarrays were used to globally assess the response of human corneal epithelial cells to S. aureus. A large increase in abundance of transcripts encoding the antimicrobial dendritic cell chemokine, CCL20, was observed. CCL20 release into the medium was detected, and this response was found to be largely TLR2 and NOD2 independent. Corneal epithelial cells also respond to S. aureus by increasing the intracellular abundance of mRNA for inflammatory mediators, transcription factors, and genes related to MAP kinase pathways, in ways similar to other cell types. The corneal epithelial cell response was surprisingly unaffected by toxin exposure. Toxin exposure did, however, induce a stress response. Although model toxigenic and non-toxigenic strains of S. aureus were employed in the present study, the results obtained were strikingly similar to those reported for stimulation of vaginal epithelial cells by clinical toxic shock toxin expressing isolates, demonstrating that the initial epithelial cellular responses to S. aureus are largely independent of strain as well as epithelial cell tissue source.

Stratification of antigen-presenting cells within the normal cornea (39.57)

Abstract The composition and location of professional antigen presenting cells (APC) varies in different mucosal surfaces. The cornea, long considered an immune privileged tissue devoid of APCs is now known to host a network of bone marrow-derived cells. Here, we utilized transgenic mice that express EGFP from the CD11c promoter in conjunction with immunohistochemical staining to demonstrate an interesting stratification of APCs within non-inflamed murine corneas. CD11c+ DCs reside in the basal epithelium, many seemingly embedded in the basement membrane. Most DCs express MHC class II on at least some dendrites, which extended up to 50 µm in length and traversed up 20 µm tangentially nearly to the apical surface of the epithelium. The DC density diminished from peripheral to central cornea. Beneath the DCs and adjacent to the stromal side of the basement membrane reside CD11c-CD11b+ presumed macrophages that expressed low levels of MHC class II. Finally, MHC class II- CD11b+ cells filled the remainder of the stroma. This highly reproducible stratification of bone marrow-derived cells is suggestive of progression from APC to barrier function.

Human Amniotic Mesenchymal Cells Differentiate into Chondrocytes

Recently, cartilage diseases have been treated by auto- or allogenic chondrocyte transplantation. However, such treatments are limited by the necessity of having a large amount of cells for transplantation, the risk of rejection, and donor shortage. Since the human amnion is immune-privileged tissue suitable for allotransplantation, the potential of human amniotic mesenchymal cells (HAMc) to differentiate into chondrocytes was assessed. The expression of gene encoding transcription factors SOXs and bone morphogenetic proteins (BMPs) as well as BMP receptors were assessed. Chondrocyte phenotype was characterized by positive expression of the cartilage marker genes collagen type II and aggrecan by RT-PCR, collagen type II protein were analyzed by immunofluorescence analysis. HAMc expressed chondrocyte-related genes, including SOXs, BMPs, as well as BMP receptors. Collagen type II and aggrecan were detected after the induction of chondrogenesis with BMP-2. HAMc, transplanted into noncartilage tissue of mice with BMP-2, or implanted with collagen-scaffold into the defects generated in a rat's bone, underwent morphological changes with deposition of collagen type II. These results showed that HAMc have the potential to differentiate into chondrocytes in vitro and in vivo, suggesting that they have therapeutic potential for the treatment of damaged or diseased cartilage.

Stratification of Antigen-presenting Cells within the Normal Cornea

The composition and location of professional antigen presenting cells (APC) varies in different mucosal surfaces. The cornea, long considered an immune-privileged tissue devoid of APCs, is now known to host a heterogeneous network of bone marrow-derived cells. Here, we utilized transgenic mice that express enhanced green fluorescent protein (EGFP) from the CD11c promoter (pCD11c) in conjunction with immunohistochemical staining to demonstrate an interesting stratification of APCs within non-inflamed murine corneas. pCD11c(+) dendritic cells (DCs) reside in the basal epithelium, seemingly embedded in the basement membrane. Most DCs express MHC class II on at least some dendrites, which extend up to 50 µm in length and traverse up 20 µm tangentially towards the apical surface of the epithelium. The DC density diminishes from peripheral to central cornea. Beneath the DCs and adjacent to the stromal side of the basement membrane reside pCD11c(-) CD11b(+) putative macrophages that express low levels of MHC class II. Finally, MHC class II(-)pCD11c(-) CD11b(+) cells form a network throughout the remainder of the stroma. This highly reproducible stratification of bone marrow-derived cells is suggestive of a progression from an APC function at the exposed corneal surface to an innate immune barrier function deeper in the stroma.

Innate and adaptive immune responses to ocular Acanthamoeba infections

The resurgence of Acanthamoeba keratitis in the USA and UK has increased the level of awareness of this contact lens-associated disease. Results from animal models have revealed that conventional T-cell-dependent immune mechanisms are ineffective in controlling corneal infections with Acanthamoeba spp. However, activation of the mucosal immune response in the form of secretory IgA antibodies in the tears is an effective method for preventing Acanthamoeba keratitis in animal models. Elements of the innate immune system, namely macrophages and neutrophils, are instrumental in mitigating and resolving Acanthamoeba keratitis in the Chinese hamster model of this disease. The unique biology of Acanthamoeba spp. and their residence in an immune-privileged tissue enhances their capacity to escape immunological detection and elimination.

Noninvasive Measurement of Protein Aggregation by Mutant Huntingtin Fragments or α-Synuclein in the Lens

Many diverse human diseases are associated with protein aggregation in ordered fibrillar structures called amyloid. Amyloid formation may mediate aberrant protein interactions that culminate in neurodegeneration in Alzheimer, Huntington, and Parkinson diseases and in prion encephalopathies. Studies of protein aggregation in the brain are hampered by limitations in imaging techniques and often require invasive methods that can only be performed postmortem. Here we describe transgenic mice in which aggregation-prone proteins that cause Huntington and Parkinson disease are expressed in the ocular lens. Expression of a mutant huntingtin fragment or alpha-synuclein in the lens leads to protein aggregation and cataract formation, which can be monitored in real time by noninvasive, highly sensitive optical techniques. Expression of a mutant huntingtin fragment in mice lacking the major lens chaperone, alphaB-crystallin, markedly accelerated the onset and severity of aggregation, demonstrating that the endogenous chaperone activity of alphaB-crystallin suppresses aggregation in vivo. These novel mouse models will facilitate the characterization of protein aggregation in vivo and are being used in efficient and economical screens for chemical and genetic modifiers of disease-relevant protein aggregation.

Inhibition of vascular adhesion protein‐1 suppresses endotoxin‐induced uveitis

Inflammatory leukocyte accumulation is a common feature of major ocular diseases, such as uveitis, diabetic retinopathy, and age-related macular degeneration. Vascular adhesion protein-1 (VAP-1), a cell surface and soluble molecule that possesses semicarbazide-sensitive amine oxidase (SSAO) activity, is involved in leukocyte recruitment. However, the expression of VAP-1 in the eye and its contribution to ocular inflammation are unknown. Here, we investigated the role of VAP-1 in an established model of ocular inflammation, the endotoxin-induced uveitis (EIU), using a novel and specific inhibitor. Our inhibitor has a half-maximal inhibitory concentration (IC(50)) of 0.007 microM against human and 0.008 microM against rat SSAO, while its IC(50) against the functionally related monoamine oxidase (MAO) -A and MAO-B is >10 microM. In the retina, VAP-1 was exclusively expressed in the vasculature, and its expression level was elevated during EIU. VAP-1 inhibition in EIU animals significantly suppressed leukocyte recruitment to the anterior chamber, vitreous, and retina, as well as retinal endothelial P-selectin expression. Our data suggest an important role for VAP-1 in the recruitment of leukocytes to the immune-privileged ocular tissues during acute inflammation. VAP-1 inhibition may become a novel strategy in the treatment of ocular inflammatory diseases.

Structural Studies on HLA-G: Implications for Ligand and Receptor Binding

Human leukocyte antigen-G (HLA-G) is a class Ib major histocompatibility complex (MHC) molecule that is specifically expressed in immune-privileged tissues. The overall structure of HLA-G resembles other class I MHC molecules, in which a heavy chain comprised of three domains is noncovalently associated with β 2microglobulin (β 2m). A nine-residue self-peptide is bound within a cleft formed by two α-helices and a β-sheet floor. An extensive network of contacts is formed between the peptide and the binding cleft, leading to a constrained mode of binding reminiscent of that observed in HLA-E. The α3 domain of HLA-G, the putative binding site for leukocyte immunoglobulinlike receptor-1 (LIR-1) and -2, is structurally distinct from class Ia MHC molecules, providing a basis for the observed differences in affinity for these ligands. In addition, a disulfide-bonded dimer adopts an oblique conformation, providing the possibility of a 1:2 (HLA-G dimer:receptor) complex stoichiometry. The relative orientation of the HLA-G protomers in the dimer structure suggests that it is unlikely that dimerization is involved in killer immunoglobulinlike receptor 2DL4 (KIR2DL4) binding.

Immune privilege: a recurrent theme in immunoregulation?

The word ‘privilege’ implies a special status. The concept of immune privilege was coined in the mid-20th century to describe observations that immunogenic tissues and tumors placed at certain anatomical locations survived longer than anticipated or were accepted indefinitely. The implication was that these anatomical sites were in someway specialized because otherwise potent antigenic stimuli failed to elicit effective immune responses. Historically, passive mechanisms, notably physical and physiologic barriers that maintained local segregation between tissues and immune cells and antibodies, were thought to offer the most likely explanations for localized immune privilege. However, the recognition that multiple mechanisms exist to suppress and subvert adaptive immunity and promote tolerance raises the prospect that active suppressive mechanisms help to maintain immune privilege. This volume of Immunological Reviews was inspired by the original concept of immune privilege and by recent rapid progress in identifying immunoregulatory processes that suppress immunity and promote immune tolerance. Our goal in this issue is to assess contemporary thinking on classical immune privilege and to determine if the concept of immune privilege might have wider implications and value for understanding immunoregulation in general. To this end, we solicited reviews from experts working on traditional immuneprivileged tissues and on immunoregulatory processes. The classical definition of immune privilege and the consequences of active immunoregulation overlap in the sense that these processes prevent elaboration of effective immunity following challengeswith otherwise potent antigenic stimuli. In each case, antigenic challenge provokes weak and ineffective responses,

Inhibition of MHC class II gene expression in uveal melanoma cells is due to methylation of the CIITA gene or an upstream activator

Most cells with an intact interferon-gamma receptor and signaling pathway are able to express MHC class II molecules when treated with cytokines such as interferon-gamma and tumor necrosis factor-a. Interestingly, primary uveal melanocytes and most ocular melanoma cells are resistant to interferon-gamma mediated induction of class II MHC genes. This unusual phenotype is hypothesized to be germane to the immune-privileged status to the eye. Via a series of experiments, we have probed the molecular basis of this class II MHC resistant phenotype. We have analyzed the methylation status of the gene encoding the class II transactivator (CIITA), and asked whether treatment of class II MHC resistant ocular melanoma cells with the demethylating agent 5′-azacytidine can restore interferon-gamma inducibility of these class II MHC genes in these cells. The data obtained suggest that the specific blockade in cytokine-induced class II MHC gene expression is due to a suppression of the gene encoding the class II transactivator (CIITA). Treatment with 5′ azacytidine restores the ability of these cells to express class II MHC genes upon interferon-gamma treatment. Whilst this is reminiscent of what occurs in another immune-privileged tissue – the placental trophoblast – we show here that silencing of the CIITA gene in uveal melanocytes either involves methylation of distinct nucleotides from those detected in trophoblasts, or involves an upstream activator of CIITA gene expression.

The granzyme B inhibitor, PI-9, is differentially expressed during placental development and up-regulated in hydatidiform moles

The intracellular serpin Proteinase Inhibitor-9 (PI-9) is a potent inhibitor of the cytotoxic lymphocyte (CL) proteinase granzyme B, a major effector molecule used by CLs to induce target cell apoptosis. PI-9 is produced by CLs to protect against mis-directed granzyme B. However, PI-9 expression has also been reported in immune privileged tissues. In the present study, cell-specific expression of PI-9 in placental tissue of various gestational ages was examined by immunohistochemistry. PI-9 is highly expressed by the extravillous trophoblasts that have invaded the decidua, and this high expression is maintained throughout pregnancy. Similar levels were also observed in proliferative villous cytotrophoblasts. Syncytial trophoblasts generally do not produce PI-9 to a significant level until the last few weeks of pregnancy. The villous stroma contains mixed populations of PI-9 positive and negative cells throughout pregnancy, with highest expression during the second trimester. Compared to first trimester placentas, syncytial trophoblasts of partial and complete hydatidiform moles showed marked up-regulation of PI-9. Examination of choriocarcinoma cell lines also demonstrated a very high level of PI-9 is produced by these cells, which may provide protection from granzyme B-mediated apoptosis. The cell-specific expression of PI-9 in the placenta is consistent with a function in the maintenance of immune privilege, and it is proposed that up-regulated expression of PI-9 in gestational trophoblastic diseases contributes to disease pathogenesis via immune evasion.

Esophageal adenocarcinoma cells do not traffic Fas Ligand to the cell surface: Evidence against the “Counterattack” hypothesis

Introduction. The expression of Fas Ligand (FasL) in normal tissues is limited to activated lymphocytes, macrophages, and immune-privileged tissues such as the testis, eye, brain, and placenta. The finding that many tumors also express FasL spawned the “Counterattack” hypothesis, which suggests that FasL-expressing tumors evade immune surveillance by inducing apoptosis of infiltrating lymphocytes that abundantly express the Fas receptor. We hypothesized that EA cell lines express FasL but do not traffic it to the cell surface, making them incapable of inducing Fas-mediated apoptosis of immune cells. Methods. FasL-expressing Jurkat T cells (positive control), immortalized squamous esophagus cells (SE), immortalized Barrett’s esophagus (BE), and three esophageal adenocarcinoma (EA) cell lines were studied for FasL expression by immunoblotting. Subcellular localization was analyzed by immunostaining using laser-scanning confocal microscopy and FACScan analysis of cell-surface expression. Culture media were examined for soluble FasL by ELISA. Results. FasL expression was observed in all three EA cell lines and to a lesser degree in the SE cell line, but not in the immortalized BE cell line. Immunofluorescence of EA cells demonstrated that FasL protein was localized to the cytoplasm, predominantly in a perinuclear distribution. FACScan analysis confirmed the EA cell lines lack cell-surface expression, even after inhibition of matrix metalloproteinases. Trace amounts of FasL were detected in the media of all cell lines, but these levels did not differ from media supplemented with 10% fetal bovine serum alone (ANOVA). Conclusions. EA cells express FasL but do not traffic it to the cell surface. Thus, the function of FasL in EA is unlikely to be a “Counterattack” of immune cells. FasL expression in tumors may confer other advantages to the cancer cell.

Expression of HLA-G in human cornea, an immune-privileged tissue

Human leukocyte antigen (HLA)-G retains the capacity to modulate immune responses, favoring the establishment of tolerance in solid-tissue allotransplants. To better understand the mechanisms that promote corneal allograft survival, we investigated whether HLA-G was an immunoregulatory factor involved in corneal immunology. We therefore sought HLA-G expression in corneal tissues. Corneal transplantation consists in replacing the center of a diseased cornea with normal corneal tissue. Two corneal parts are not used in such surgery: diseased central corneal tissue and peripheral normal cornea. For this study, we used healthy corneas obtained from deceased donors and diseased corneas obtained from patients with pseudophakic bullous keratopathy or keratoconus who had undergone corneal transplantation. Immunohistochemical analysis carried out on the cryopreserved corneas showed a positive immunohistochemical staining with anti–HLA-G, anti–HLA-A, -B, and -C, and anti–HLA class I monoclonal antibodies. Staining was obtained for keratocytes, epithelial cells, and endothelial cells from both healthy and pathologic human corneas, revealing the presence of HLA class I proteins, including HLA-G. HLA-G transcripts were detected in normal cornea by reverse transcriptase–polymerase chain reaction with a classical pattern of alternative splicing. The detection of HLA-G protein in adult corneas leads to the conclusion that this protein may contribute to the maintenance of the privileged immune status of cornea.

Restored T-cell activation mechanisms in human tumour-infiltrating lymphocytes from melanomas and colorectal carcinomas after exposure to interleukin-2.

We investigated the effects of interleukin-2 (IL-2) exposure on T-cell signal transduction molecules and apoptosis markers in tumour-infiltrating lymphocytes (TIL) isolated from 20 melanoma and 16 colorectal carcinoma metastases and expanded in vitro for therapeutic reinfusion. Before IL-2 culture, TIL showed undetectable or very low levels of T-cell receptor (TCR) ɛ chain, p56lck, Fas ligand (FasL) and Bax expression, while Bcl-2 values were elevated. Cancer cells were characterised by low or absent Fas and Bcl-2 and high Bax expression. Notably, they also expressed FasL. After 41–48 days of IL-2 culture, TCR ɛ chain and p56lck expression of TIL rose to median values of approximately 80 and 30% positive cells, respectively (P<0.001), FasL expression was detected in 45% cells from melanomas (P<0.001) and in 3% from colorectal carcinomas (P=0.09), and Bax-positive cells increased from 17.5 to 70% (P=0.005). Moreover, TCR ζ chain-positive cells were significantly increased from baseline (P=0.001), Bcl-2-positive cells dropped from 50 to 1% (P=0.007) and perforin content was high, while Fas expression was not significantly modified by IL-2 culture. In conclusion, our data suggest that the degree of immunosuppression in TIL from melanomas and colorectal carcinomas is very high, and the apoptosis markers' repertoire of cancer cells resembles that of immune-privileged tissue. Interleukin-2 culture appears to restore lymphocyte activation mechanisms, resulting in consistent FasL expression and perforin production.

Immunoproteasome expression in a nonimmune tissue, the ocular lens

Interferon γ (IFNγ) induces the expression of three catalytic subunits of the 20S proteasome that can replace their constitutive homologues to form the “immunoproteasome,” named to reflect its antigen presentation function. However, immunoproteasome levels and their modulation in nonimmune tissues remain unknown. A disrupted lens differentiation program observed in transgenic mice that constitutively express IFNγ in the immune-privileged lens tissue suggests a role for this cytokine in differentiation. We have developed a competitive RT-PCR assay that demonstrates substantially increased levels of immuno subunits and unchanged levels of constitutive subunits in transgenic compared to wild-type lenses. Similar results were observed with IFNγ treated αTN4-1 lens epithelial cells. A comparison of these subunits in different immune and nonimmune mouse tissues revealed unique expression patterns. The presence of immuno subunits in nonimmune tissues such as lens suggests that the immunoproteasome may also have nonimmune functions, such as that in lens differentiation.

Immunobiology and privilege of neuronal retina and pigment epithelium transplants

Despite the existence of ocular immune privilege, immune rejection may be a barrier to successful retinal transplantation. We have examined in mice the extent to which the subretinal space (SRS) is an immune privileged site, and whether retinal pigment epithelium and neuronal retinal tissue have properties of immune privileged tissues. We report that (1) The SRS is an immune privileged site; (2) Neonatal RPE is an immune privileged tissue; (3) Neuronal retina is a partially immune privileged tissue; and (4) Microglia within neonatal neural retina grafts promote photoreceptor differentiation, become activated, and induce sensitization of the recipient and serve as targets of immune rejection.

New approaches to inducing the death of alloreactive lymphocytes

New approaches to inducing the death of alloreactive lymphocytes