Cellular Strategies for Tolerance Induction

肾移植是终末期肾病患者的一线治疗，最新数据显示， 记录了显著的一年成功率。然而，患者继续面临高发病率， 移植后的死亡率，无论是慢性同种异体移植排斥反应， 标准免疫抑制方案。考虑到这些双重风险，该领域的最终目标是 诱导移植后的免疫耐受，这保证了同种异体移植物的终身接受， 而不需要持续的免疫抑制，重要的是，保护性免疫力的保留。 虽然新的药理学和基于抗体的疗法代表了真实的希望， 延长同种异体移植物存活和减少脱靶毒性，小鼠研究强烈表明， 诱导免疫耐受的稳健策略包括细胞疗法，包括混合嵌合体诱导（特别是与T细胞共刺激阻断相结合）和调节性T细胞 （Treg）为基础的方法。这两种疗法都有希望从根本上重置接受者 免疫有利于同种异体移植物接受，从而提供了一个直接的途径诱导免疫耐受。在这个项目中，我们将探讨以下目标，每个目标都旨在促进蜂窝网络的使用。 肾移植后诱导耐受的治疗：具体目标#1：诱导免疫耐受 通过诱导稳定的，全谱的混合造血嵌合体， 设置T细胞共刺激阻断。 具体目标#2：利用调节性T细胞诱导稳定的、全谱的混合嵌合体和免疫应答。 肾移植耐受性

Renal transplantation represents first-line therapy for patients with ESRD, with the most recent data documenting significant one-year success rates. However, patients continue to face high morbidity and mortality after transplant, both from chronic allograft rejection and from the toxicities associated with standard immunosuppressive regimens. Given these dual risks, the ultimate goal in this field is the induction of immune tolerance after transplantation, which promises life-long acceptance of an allograft, without the need for ongoing immunosuppression and importantly, with preservation of protective immunity. While novel pharmacologic and antibody-based therapies represent real promise in terms of greatly prolonging allograft survival and reducing off-target toxicities, murine studies strongly suggest that the most robust strategies for inducing immune tolerance incorporate cellular therapies, including both mixedchimerism induction (especially in combination with T cell costimulation blockade) and regulatory T cell (Treg)-based approaches. Both of these therapies hold the promise of fundamentally resetting recipient immunity in favor of allograft acceptance, and thus provide a direct pathway towards immune toleranceinduction. In this Project, we will explore the following Aims, each designed to advance the use of cellular therapies for tolerance induction after renal transplantation: Specific Aim #1: To induce immune tolerance to a renal allograft through the induction of stable, full-spectrum mixed-hematopoietic chimerism in the setting of T cell costimulation blockade. Specific Aim #2: To utilize regulatory T cells to induce stable, full-spectrum mixed-chimerism and immune tolerance during renal transplantation.