COSTIMULATION BLOCKADE FOR PRIMATE RENAL TRANSPLANTATION

目前预防同种异体移植排斥反应的治疗方法虽然相当有效， 然而，成本高，与显著的全身毒性相关， 不加选择地损害免疫系统功能， 接受者患各种传染病的风险增加， 癌的此外，传统的免疫抑制疗法已经证明， 不能防止潜在治愈性胰岛移植的排斥反应 胰岛素依赖型糖尿病（IDDM）患者。啮齿动物和 非人灵长类动物模型研究表明，抗CD 154（CD 40 L） 基于抗体的治疗，单独或与其他免疫疗法组合， 系统调节剂可以显著改善患者的治疗方法， 需要进行维持健康的同种异体移植初步数据提示 这种疗法可能会更具体地损害抗移植免疫， 反应，可以间歇给药，并可能与 毒性较小。我们的总体目标是开发这种新型疗法， 临床应用。我们将研究高度相关的非人类灵长类动物 胰岛和肾脏同种异体移植模型，过渡到临床试验， 通过临床前研究证明。在几个关键问题中， （1）免疫机制是什么？ 预防同种异体移植排斥反应？(2)是基于抗CD 154的疗法 与“传统”药物联合给药时安全有效 免疫抑制剂包括钙调磷酸酶抑制剂， 糖皮质激素和/或霉酚酸酯？。(3)是有效的 通过增加供体抗原负荷增强基于抗CD 154的治疗 以捐献者骨髓的形式(4)是 干扰抗CD 154治疗的药物增强抗CD 154治疗的疗效 与B7受体（CD 80和CD 86）相互作用的能力， 反受体和CTLA 4（CD 152）？(5)免疫系统的特异性如何 抑制？(6)基于抗CD 154的治疗是否会逆转和/或减少 慢性排斥反应的发生率？(7)排斥反应的发生 抗CD 154诱导治疗后是否可以安全挽救？和 (8)是抗CD 154抗体介导的阻断效应的结果 CD 154与CD 40的相互作用直接影响表达CD 154？的细胞。 还是两者都有

Current treatments to prevent allograft rejection while quite effective are nevertheless costly, associated with significant systemic toxicity, and indiscriminately impair immune system function so that transplant recipients are at increased risk for a variety of infectious illnesses and cancers. Furthermore, traditional immunosuppressive therapies have proven unable to prevent the rejection of potentially curative islet transplants in individuals with insulin dependent diabetes mellitus (IDDM). Rodent and non-human primate model studies have suggested that anti-CD154 (CD40L) antibody-based treatments, alone or in combination with other immune system modulators may significantly improve the approach to patients requiring health sustaining allo-transplants. Preliminary data suggests that this therapy may more specifically impair the anti-graft immune response, can be administered intermittently, and may be associated with less toxicity. Our overall goal is to develop this novel therapy for clinical application. We will study highly relevant non-human primate islet and kidney allograft models, transitioning into clinical trials as warranted by preclinical studies. Among the several critical questions to be addressed: (1) what is the immunological mechanism underlying the prevention of allograft rejection?. (2) are anti-CD154-based therapies safe and effective when co-administered with "traditional" immunosuppressive agents including calcineurin phosphatase inhibitors, glucocorticoids, and/or mycophenolate mofetil?. (3) is the efficacy of anti-CD154-based therapies enhanced by increasing the donor antigen load in the form of co-administered donor-specific bone marrow? (4) is the efficacy of anti-CD154-based therapies enhanced by agents that interfere with the B7 receptors (CD80 and CD86) ability to interact with their counter-receptors and CTLA4 (CD152)? (5) how specific is the immune inhibition? (6) will anti-CD154-based therapy reverse and/or decrease the incidence of chronic rejection?. (7) can rejection episodes occurring following induction therapy with anti-CD154 can be safely rescued?. and (8) are anti-CD154 antibody mediated effects the result of blocking CD154's interaction with CD40?. direct effects on cells expressing CD154?. or both?