Inverted direct allorecognition triggers early donor-specific antibody responses after transplantation

Sci Transl Med. 2022 Sep 21;14(663):eabg1046. doi: 10.1126/scitranslmed.abg1046. Epub 2022 Sep 21.

Abstract

The generation of antibodies against donor-specific major histocompatibility complex (MHC) antigens, a type of donor-specific antibodies (DSAs), after transplantation requires that recipient's allospecific B cells receive help from T cells. The current dogma holds that this help is exclusively provided by the recipient's CD4+ T cells that recognize complexes of recipient's MHC II molecules and peptides derived from donor-specific MHC alloantigens, a process called indirect allorecognition. Here, we demonstrated that, after allogeneic heart transplantation, CD3ε knockout recipient mice lacking T cells generate a rapid, transient wave of switched alloantibodies, predominantly directed against MHC I molecules. This is due to the presence of donor CD4+ T cells within the graft that recognize intact recipient's MHC II molecules expressed by B cell receptor-activated allospecific B cells. Indirect evidence suggests that this inverted direct pathway is also operant in patients after transplantation. Resident memory donor CD4+ T cells were observed in perfusion liquids of human renal and lung grafts and acquired B cell helper functions upon in vitro stimulation. Furthermore, T follicular helper cells, specialized in helping B cells, were abundant in mucosa-associated lymphoid tissue of lung and intestinal grafts. In the latter, more graft-derived passenger T cells correlated with the detection of donor T cells in recipient's circulation; this, in turn, was associated with an early transient anti-MHC I DSA response and worse transplantation outcomes. We conclude that this inverted direct allorecognition is a possible explanation for the early transient anti-MHC DSA responses frequently observed after lung or intestinal transplantations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antibody Formation*
  • Graft Rejection
  • Histocompatibility Antigens Class I
  • Histocompatibility Antigens Class II
  • Humans
  • Isoantibodies*
  • Isoantigens
  • Mice
  • Mice, Inbred BALB C
  • Peptides
  • Receptors, Antigen, B-Cell

Substances

  • Histocompatibility Antigens Class I
  • Histocompatibility Antigens Class II
  • Isoantibodies
  • Isoantigens
  • Peptides
  • Receptors, Antigen, B-Cell