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Purified Allogeneic Hematopoietic Stem Cell Transplantation Blocks Diabetes Pathogenesis in NOD Mice

¹ Department of Medicine, Division of Bone Marrow Transplantation, Stanford University Medical Center, Stanford, California
² Department of Medicine, Division of Rheumatology and Immunology, Stanford University Medical Center, Stanford, California
³ Department of Pathology, Stanford University Medical Center, Stanford, California

	ABSTRACT

TOP ABSTRACT RESEARCH DESIGN AND METHODS RESULTS DISCUSSION REFERENCES

 
Purified hematopoietic stem cells (HSCs) were transplanted into NOD mice to test whether development of hyperglycemia could be prevented. Engraftment of major histocompatibility complex-mismatched HSCs was compared with bone marrow (BM) grafts. HSCs differed from BM because HSCs were more strongly resisted and HSC recipients retained significant levels of NOD T-cells, whereas BM recipients were full donor chimeras. Despite persistent NOD T-cells, all HSC chimeras were protected from hyperglycemia, and attenuation of islet lesions was observed. T-cell selection was altered in allogeneic HSC recipients as demonstrated by deletion of both donor and host superantigen-specific T-cells. Syngeneic and congenic hematopoietic cell transplants were also performed to differentiate the influence of the preparative regimen(s) versus the allografts. Unlike the allogeneic HSC transplantations, syngeneic or congenic grafts did not retard diabetes development. In a pilot study, overtly diabetic NOD mice were cured by co-transplantation of allogeneic HSCs and donor-matched islets. We conclude that allogeneic HSC transplants block allo- and autoimmunity, despite residual host T-cell presence. These data demonstrate for the first time that purified HSC grafts block development of autoimmune diabetes and illuminate how HSC grafts alter thymic and peripheral T-cell responses against auto- and alloantigens.

In this report we studied the transplantation of purified HSC compared with BM in prediabetic NOD mice. Several differences exist between HSCs and BM transplantations (9). HSCs are the most primitive cells in BM and are present at a frequency of 1 in 2,000 cells (10). Only HSCs have the capacity to self-renew and regenerate all blood lineages. Thus, HSC are the only population that can establish permanent engraftment after a BM transplantation. Highly purified HSCs can now be isolated from mouse and human hematopoietic sources (10,11) using phenotypic markers and fluorescence-activated cell sorting (FACS). Because of their primitive developmental stage, HSCs are immunologically naïve, and thus the antigen-specific immune cells arising from an HSC graft are generated de novo in the environment of the recipient. In contrast, BM contains multiple populations at different developmental stages, and the majority have either completed or initiated maturation in the donor. These differences in cellular composition have an impact on both the biology of host immune reconstitution and the potential clinical consequences of transplanting HSC versus unfractionated hematopoietic cells (9).

We previously reported in nonautoimmune strains that transplantation of allogeneic BM as compared with HSCs results in differences in engraftment as well as the pattern of hematopoietic chimerism (9). Quantitative comparison of HSCs grafts with BM that contain equivalent numbers of HSCs demonstrates that HSCs encounter greater resistance to engraftment manifested by increased graft failures. In addition, hematopoietic cell transplantation (HCT) results in significantly higher levels of surviving host T-cells, as compared with BM that have been transplanted into mice. These differences between HSCs and BM have been attributed to the actions of donor BM T-cells, which can facilitate HSC engraftment by elimination of host immune cell populations (12). The major advantage that HSC grafts offer over BM for clinical transplantation is the elimination of graft-versus-host disease (GVHD). GVHD remains the primary cause of morbidity and mortality after allogeneic BM transplantation (13) and the main reason that this approach has been considered too high of a risk for patients with autoimmune afflictions. GVHD develops when mature immune cells, primarily T-cells, contained in the BM graft, recognize and respond against normal recipient tissues. The naïve immune state of HSCs precludes the possibility of GVHD development.

The studies in this article were performed both to determine whether HSCs alone can confer protection from diabetes in NOD mice and to understand the way in which allogeneic HSC grafts can alter host immune responses. Substantial resistance to engraftment of HSCs was overcome, and we observed that hyperglycemia was prevented despite persistence in recipients of significant levels of NOD T-cells. We show that HSC grafts alter negative selection of donor as well as host T-cells. Furthermore, because hematopoietic cell grafts are known to induce tolerance to donor-matched solid organs, engraftment of HSCs in conjunction with transplantation of donor strain islets was performed.

	RESEARCH DESIGN AND METHODS

TOP ABSTRACT RESEARCH DESIGN AND METHODS RESULTS DISCUSSION REFERENCES

 
Mice.
Our NOD (H-2^g7, Thy-1.2) mouse colony was the gift of Y. Mullen (Los Angeles, CA) and M. Hattori (Boston, MA). AKR/J mice (H-2^k, Thy-1.1) and NOD.Thy-1.1 mice (NOD.NON-Thy-1^a/J) and SWR (H-2^q) mice were purchased from The Jackson Laboratory (Bar Harbor, ME) and bred in our facility. All mice were kept in filter-top cages in temperature-controlled, light-cycled rooms.

HSC purification.
Purified HSCs were obtained by modification of the methods described by Spangrude et al. (10). BM cells were positively selected for c-Kit using the MACS system (Miltenyi Biotech, Auburn, CA). The c-Kit-enriched fraction was stained with fluorescein isothiocyanate (FITC)-conjugated Thy1.1 (19xE5), TX red (TR)-conjugated Sca-1 (E13–161), allophycocyanin (APC)-conjugated c-Kit (2B8), and a mixture of phycoerythrin (PE)-conjugated lineage-specific monoclonal antibodies (mAbs) as follows: B220 (6B2), CD3 (145–2C11), CD5 (53–7.8), CD4 (GK-1.5), CD8 (53–6.7), GR-1 (8C5), Mac-1 (M1/70), and TER119 (TER119). The conjugated mAbs were produced in our laboratory, except for CD3 mAb (145–2C11) and CD8 mAb (53–6.7), which were obtained from Pharmingen (San Diego, CA). Propidium iodide staining (1 mg/ml) was used to exclude dead cells. Cells were sorted on a dual laser FACS (Becton Dickinson, Mountain View, CA) made available through the FACS shared-user group at Stanford University. After sorting for FITC^lo, TR^hi, APC^hi, and PE^-/lo, the Thy-1^loLin^-/loSca⁺c-Kit⁺ cells were checked by FACS reanalysis and determined to be >99% pure. (14) BM from NOD.SCID mice (Thy1.2⁺) was harvested and processed as described above with the difference that CD38^bright instead of Thy1.1^lo expression was used for selection of HSCs (14).

HCT.
Eight- to 12-week-old NOD mice were prepared for transplant with radiation alone or in combination with the rabbit anti-serum ASGM1 (-ASGM1; WAKO Chemicals, Dallas, TX) plus -CD4 mAb (produced from hybridoma GK-1.5). A Phillips Unit Irradiator (250 kv, 15 milliamp) delivered a total of 950 cGy (in two doses 3–4 h apart) on day 0 relative to transplant. The -ASGM1 was administered at 50 µg intravenously on day -7 and by intraperitoneal injection on day -1. -CD4 mAb (100 µg intravenously) was given on days -3, -2, and -1. HSCs or whole bone marrow were introduced intravenously by tail vein. Each HSC inoculum was tested by injection of 100 or 200 cells into lethally irradiated syngeneic hosts, which were killed for day +12 spleen colony formation unit assay.

Chimerism and Vß subset analysis.
Blood chimerism was assessed by FACS analysis at 6–8 weeks posttransplantation and subsequently 2 months later to assess graft stability. Donor versus host cells were differentiated by mAbs (Pharmingen) specific for the donor major histocompatibility complex (MHC) class I (H-2^k) or CD45 allele. NOD mice are CD45.1 (mAb A20), and AKR mice are CD45.2 (mAb 104). Double staining for lineage-specific markers included B-cells (B220, RA3–6B2), monocytes (Mac-1, M1/70.15), or granulocytes (Gr-1, 8C5). T-cell chimerism was assessed by Thy-1.1 (AKR) and Thy-1.2 (NOD; 53–2.1) allelic markers, or CD3 versus CD45.1 staining. FACS analysis was performed by a modified FACS II system equipped with logarithmic amplifiers. Data are presented as contour plots on log-10 scales of increasing intensity.

In selected mice, peripheral blood lymphocytes were analyzed by FACS for Vß subsets. Biotin-conjugated Vß3⁺ (KJ25), Vß6⁺ (RR4–7), or Vß8⁺ (KJ16) mAbs were used with second-step streptavidin-FITC labeling and then double-stained with PE-conjugated -CD4 (H129–19) or -CD3 (145–2C11). A mouse Vß screening panel containing FITC-conjugated mAbs was also used to stain splenocytes from chimeric mice. All mAbs were obtained from Pharmingen except for -Mac-1, -H-2^b, and -Vß8⁺, which were obtained from Caltag (Burlingame, CA).

Histology evaluation.
Selected HSC chimeric mice were killed 4 months posttransplantation, and their pancreata were snap-frozen in OCT compound (Tissue-Tek, Torrance, CA). Tissue sections (0.4 µm) were fixed in cold acetone, blocked, and stained with biotinylated mAbs against CD3, Thy 1.2, Thy-1.1 (Pharmingen), and insulin (Linco, St. Charles, MO) incubated with secondary antibody and streptavidin-horseradish peroxidase, visualized with 3-amino-9-ethylcarbazole, and counterstained with hematoxylin.

Islet transplantation.
Diabetic NOD mice (blood glucose levels >450 mg/dl) received 4 units of insulin (Humulin Ultralente; Lilly, Indianapolis, IN) every other day until the time of islet transplant. Diabetic mice were prepared for combined HSC and islet transplant with 700 or 950 cGy plus the -ASGM1 and -CD4 mAbs as described above. On day 0, recipients received 10,000 AKR HSCs, and on day 1, islet transplants into the portal vein were performed as previously described (15). Briefly, islets were isolated by collagenase digestion (Collagenase P; Boehringer Mannheim, Mannheim, Germany) and Ficoll gradient separation. Islets (700–800) were handpicked under a dissecting microscope and infused into the livers of recipient mice by intraportal vein injection. Mice were anesthetized by intraperitoneal injection of pentobarbital 0.05 mg/g body wt. Blood glucose values were obtained every 2–3 days for the first week posttransplantation and weekly thereafter.

Statistical analysis.
Time to diabetes onset among groups was compared using the log-rank test with the program GraphPad Prism version 2.01 (GraphPad Software, San Diego, CA). P < 0.05 was considered statistically significant.

	RESULTS

TOP ABSTRACT RESEARCH DESIGN AND METHODS RESULTS DISCUSSION REFERENCES

 
Generation of NOD allogeneic HSC chimeras.
Similar to our previous experience in nonautoimmune strains (9), transplants of AKR HSCs in NOD mice demonstrated high levels of engraftment resistance as compared with unfractionated BM. Death between days 10 and 30 posttransplantation or absence of long-term donor blood chimerism is indicative of hematopoietic graft failure. As shown in Fig. 1A, 50% of NOD mice died before day 30 when prepared with lethal radiation (950 cGy) and rescued with 10,000 AKR HSCs, and only one of six surviving mice had detectable donor chimerism. In contrast, >90% of NOD mice transplanted with 1–2 x 10⁷ AKR BM (an inoculum containing 5,000–10,000 HSCs, respectively) survived and demonstrated complete donor chimerism. Stable engraftment of purified AKR HSCs was achieved, however, by addition to the radiation regimen of antibodies directed against natural killer cell determinants (-ASGM1) and CD4⁺ T-cells (CD4). Such treatment resulted in >90% survival, and phenotypic analysis of their blood revealed that 16 of the 18 surviving mice were chimeras.

View larger version (66K): [in this window] [in a new window]   FIG. 1. Survival and chimerism in mice that received HSC and BM transplants. A: Survival (black bars) and chimerism (hatched bars) in NOD mice that received AKR HSCs prepared with lethal radiation only (n = 12) or radiation plus -ASGM1 and -CD4 antibodies (n = 20). Control NOD mice were prepared with radiation and received AKR BM (n = 11) or congenic NOD.Thy-1.1 HSCs (n = 10) or were prepared with radiation plus the antibodies and received syngeneic NOD BM (n = 10). B: FACS profiles of blood from representative NOD mice at 8 weeks posttransplantation with AKR HSCs or AKR BM. AKR and NOD type T-cells are differentiated based on Thy-1.1 and Thy-1.2 staining, respectively. For the other non-T-cell lineages (B-cell, granulocyte, macrophage), staining for the CD45.1 allele was used to distinguish AKR from NOD. Note the presence of NOD T-cells (Thy1.2+) in AKR HSC recipient. C: Donor T-cell chimerism increased slowly in the blood of NOD mice that received AKR HSC versus AKR BM. Solid squares and inverted triangles represent the percentage of donor T-cell chimerism as measured in the peripheral blood of individual mice that received HCT. The same set of mice were evaluated at 5 and 10 weeks post-HCT, respectively (n = 13). These data are compared with AKR BM recipients (triangles; n = 4) that were complete T-cell chimeras early posttransplantation.

Effect of allogeneic HCT on diabetes.
Recipient NOD mice were evaluated posttransplantation for evidence of hyperglycemia. Diabetic mice had blood glucose levels >500 mg/dl, and all nondiabetic mice had levels <125 mg/dl. In our NOD colony, the incidence of diabetes is roughly 90% in female mice and 84% in male mice by 6 months of age. For these studies, NOD mice were 8–12 weeks old and thus had an expected onset of hyperglycemia beginning at 3–4 months posttransplantation. Data in Fig. 2 demonstrate that diabetes development was blocked in all mice engrafted with AKR HSCs, because none of such treated mice developed hyperglycemia with a follow-up time of >6 months posttransplant. Diabetes development was also blocked in all mice engrafted with AKR BM (data not shown).

View larger version (25K): [in this window] [in a new window]   FIG. 2. Diabetes-free survival in NOD mice after congenic and syngeneic HCT. Top panel shows diabetes onset in NOD mice that were treated with 950 cGy and 200–1,000 NOD.Thy-1.1 congenic HSCs (circles, n = 10), NOD mice treated with 950 cGy plus -CD4 and -ASGM1 antibodies and 107 NOD syngeneic BM (triangles, n = 10), or NOD mice treated with 950 cGy plus CD4 and -ASGM1 antibodies and 104 allogeneic AKR HSCs (squares, n = 15). Bottom panel shows diabetes onset in control male (n = 15) and female (n = 15) NOD mice. No statistical differences were noted between the age of diabetes onset in control mice versus mice that received syngeneic BM (P = 0.77) or congenic HSC (P = 0.19). However, significant differences were noted for mice that received AKR HSC versus mice in all other groups shown (all P < 0.001).

Residual host T-cells alone can mediate diabetes pathogenesis.
We next addressed the issue of whether the NOD T-cells that persisted after the conditioning regimen were capable of causing islet destruction. To study this question, we used NOD.SCID mice as donors. Because HSCs from NOD.SCID mice cannot give rise to T- or B-cells, such grafts are incapable of generating pathogenic T-cells. Thus, diabetes could occur only if the residual host cells destroyed the islets. The NOD.SCID donors used in these experiments expressed the Thy-1.2 allele and not Thy-1.1. Therefore, purified HSCs were isolated on the basis of CD38 marker selection (14). This method of purification was tested in control studies wherein as few as 250 Lin^-/loSca-1⁺c-Kit⁺CD38⁺ selected NOD HSCs rescued lethally irradiated NOD mice (data not shown). Figure 3A demonstrates that NOD.SCID HSC engrafted mice still developed diabetes within 6 months posttransplantation despite very low numbers of endogenous T-cells. As compared with unmanipulated NOD mice, the age at which NOD.SCID HSC transplanted mice developed diabetes was delayed, but only by 2 months. NOD.SCID engrafted mice had persistently reduced absolute counts of CD3⁺ cells in their peripheral blood as compared with unmanipulated mice. Figure 3B shows that at 2 months posttransplantation, the CD3⁺ cells were significantly reduced (P < 0.001). Thus, even very low numbers of residual NOD T-cells are capable of mediating diabetes pathogenesis. Taken together with the allogeneic and congenic HCT data, these studies demonstrate that the allogeneic hematopoietic grafts alter the capacity of residual host cells to mediate autoimmune pathogenesis, whereas congenic hematopoietic grafts do not.

View larger version (9K): [in this window] [in a new window]   FIG. 3. Diabetes-free survival and absolute T-cell levels in NOD mice posttransplantation of NOD.SCID HSCs. A: Diabetes onset in NOD mice that were conditioned with 950 cGy and received 1,000 NOD.SCID HSCs (closed triangles, n = 9) was compared with untreated NOD control mice (open circles, n = 15). B: Absolute counts of residual peripheral blood CD3+ cells of NOD mice engrafted with NOD.SCID HSCs were fourfold reduced even at 2 months posttransplantation (n = 9) as compared with unmanipulated NOD mice (n = 3; P < 0.001).

View larger version (143K): [in this window] [in a new window]   FIG. 4. Pancreas histology in NOD mice after HCT. The pancreas from a 6-week-old control NOD mouse was compared with a NOD mouse that received AKR HSCs at 10 weeks posttransplantation. A–D: Serial sections through the control pancreas. E–H: Serial pancreas sections from the mouse that received the transplant. The sections were stained for insulin (A and E), CD3 (B and F), the host allele Thy-1.2 (C and G), and the donor allele Thy-1.1 (D and H). Note that the Thy-1.2 stain also nonspecifically marks connective tissue.

View larger version (23K): [in this window] [in a new window]   FIG. 5. Negative selection of T-cells is nonrandom in HSC engrafted mice. Bars depict percentage of Vß expression on CD4+ splenocytes from AKR into NOD chimeras (n = 2) at 8 weeks post-HCT compared with control NOD and AKR mice. NOD mice delete Vß3, whereas AKR mice delete Vß5, -6, -7, -8.1, -9, -11, and -12. Neither NOD nor AKR mice express a functional Vß17a (32).

View larger version (42K): [in this window] [in a new window]   FIG. 6. HSC plus islet transplantation. A: Diabetes-free survival of hyperglycemic NOD mice that underwent cotransplantation with AKR HSC plus AKR or third-party SWR islets. All myeloablated mice were AKR chimeras (n = 2), three of four nonmyeloablated mice that received AKR islets (n = 4) were blood chimeras with the pattern described in B, and one of two mice that received SWR islets (n = 2) were documented chimeras. B: Representative FACS profiles of NOD mouse that received nonmyeloablative regimen (700 cGy + -ASGM1 + -CD4 antibodies). CD45.1 marks NOD and CD45.2 (CD45.1 negative) marks AKR hematopoietic cells. NOD recipient was partially chimeric in T-, B-, granulocyte, macrophage, and natural killer cell (DX5+) lineages.

	DISCUSSION

TOP ABSTRACT RESEARCH DESIGN AND METHODS RESULTS DISCUSSION REFERENCES

 
Our studies show that engraftment of purified MHC-mismatched HSCs in prediabetic NOD mice uniformly blocks islet destruction despite active insulitis at the time of transplantation and persistence of host T-cells. By contrast, syngeneic or congenic recipients prepared with the same regimens were not protected from disease. Donor- and host-specific superantigens mediated T-cell deletion, and both developing and mature T-cells were effectively eliminated. In pilot studies, when overtly diabetic NOD mice were converted to near full AKR donor chimeras, they were tolerant to AKR islet grafts and were cured of their diabetes.

Consistent with our previous report in non-autoimmune-prone mice (9), we noted here in the AKR to NOD transplants that engraftment of HSCs differs significantly from BM. HSCs were more strongly resisted than BM, and BM transplantation resulted in full donor chimerism, whereas host T-cells persisted in mice that received HCT. One reason that BM engraftment is superior is explained in part by the observations that BM contains non-HSC populations that can facilitate HSC engraftment (9,12,22,23). We have characterized two distinct "facilitator" populations in mouse BM. Both express the CD8 molecule; one is a classical CD8⁺TCR/ß⁺ T-cell, and the other lacks expression of both CD3 and the /ß TCR (12). We observed that transplantation of HSC plus facilitator cells leads to full donor chimerism and thus hypothesized that one mechanism of facilitation is to eliminate radioresistant host cells that act as barriers to HSC engraftment.

An important difference between HSC transplants into NOD versus wild-type mice was the need to modify the preparative regimen. In nonautoimmune recipients, HSC engraftment can be achieved with lethal radiation plus -ASGM1 only, whereas engraftment of AKR HSC into NOD mice required the addition of -CD4 mAbs (9). NOD mice are known to have infiltration by autoreactive CD4⁺ T-cells in multiple organs, including islets (24,25). Furthermore, activated T-cells are highly radiation-resistant (26). Thus, the rationale for adding -CD4⁺ mAbs to the NOD preparative regimen was to eliminate both autoreactive cells and radioresistant cells that could confer engraftment resistance.

It is interesting that although addition of -CD4 mAbs to the preparative regimen permitted HSC engraftment, significant levels of residual NOD T-cells (a mixture of CD4⁺ and CD8⁺ cells) remained. These NOD T-cells were unlikely to have arisen de novo, because other host-derived blood lineages (i.e., granulocytes, monocytes) were not present, indicating the lack of active NOD-derived hematopoiesis. Theoretically, these persistent NOD cells could be autoreactive and perpetuate an anti-islet response. Thus, it was of particular interest that not only were the allogeneic HSC chimeras protected from progression to hyperglycemia but also histologic analysis of their pancreata revealed minimal islet lesions that were primarily confined to the perivascular/periductal areas. Furthermore, the majority of lymphocytes in these infiltrates were of donor, not host, origin. Studies from other laboratories have shown that allogeneic BMT in young NOD mice can prevent diabetes (1–3,27,28). In those reports, either donor/host chimerism was not evaluated extensively (1,3,27) or, in the studies in which chimerism was measured, the recipients were complete or near complete donor chimeras (2,28). In contrast to those reports, we show that complete replacement of the endogenous T-cell repertoire is not required to block diabetes pathogenesis.

Because replacement of the host immune system is not required to abrogate autoimmunity, how, then, does HCT mediate disease protection? We considered both the effect of the preparative regimen and the influence of the graft. Studies by van Bekkum et al. (29,30) and others (31,32) showed that for certain autoimmune diseases, preparation of rodents with lethal radiation plus syngeneic or "pseudoautologous" HCT conferred some disease protection, suggesting that the preparative regimen(s) can play a major curative role. In contrast, our data show that neither syngeneic BM nor congenic HCT prevented diabetes using regimens identical to allografted mice. It should be noted that these regimens resulted in dramatic reduction of endogenous T-cells. In light of the fact that human clinical trials are under way to treat severe autoimmune diseases with autologous HCT, it is important to use preclinical models to address certain fundamental and yet unanswered questions. One central issue is to differentiate whether regimen-resistant host immune cells versus the cells transferred within an autologous graft perpetuate autoimmune reactivity. To study this point, we used NOD.SCID mice as donors because NOD.SCID mice cannot generate T- or B-cells. Our data showed that myeloablated NOD.SCID HSC recipients develop hyperglycemia, indicating that regimen-resistant host cells can mediate islet destruction. Thus, we favor the conclusion that elements in the allograft play a major role in altering pathogenic responses.

Our studies here and elsewhere (21) on superantigen-mediated Vß deletion showed that in HSC chimeras, both donor and host elements mediate nonrandom negative T-cell selection. AKR cells as well as residual NOD T-cells were deleted, suggesting that HSC-mediated negative selection occurred during both the intrathymic and the postthymic phases. In previous studies, we demonstrated that HSC grafts can also dictate positive T-cell selection (21). Because of the central role of MHC class II molecules in T-cell selection, the strong association of the NOD I-A^g7 with diabetes susceptibility, and the protective effects that alteration, replacement, or addition of a "nonsusceptible" class II molecule has on NOD disease, it is logical to conclude that the MHC class II⁺ cells are the critical protective elements that arise from an allogeneic HSC graft. Indeed, it has been shown that turnover of donor-type antigen-presenting cells (including dendritic cells) is relatively rapid post-HCT (33,34). We have noted in the thymus of long-term HSC chimeras that most class II⁺ cells were donor type by 16 weeks (21). To test further the importance of class II⁺ cells, we are now using C57BL/6.H-2^g7 mice as HSC donors to determine whether MHC-matched HSC grafts can confer similar disease protection. We must emphasize that our data showed that allogeneic HSC grafts caused superantigen-mediated negative selection of both donor and host T-cell populations. However, superantigen-mediated deletion is a surrogate assay, and we have not ruled out the possibility that HSC grafts have eliminated anti-islet-specific cells. Thus, we are currently studying HCT into T-cell receptor transgenic NOD mice (BDC2.5) that have high levels of anti-islet-specific T-cells that can be monitored posttransplantation. We are also examining whether other mechanisms, such as induction of regulatory cells or alterations in T-cell functional activity (i.e., induction of anergy), are responsible for altering the diabetes pathogenesis in HSC allografted mice.

Finally, to address the problem of overt diabetes, we tested whether HSC transplantation could induce immune tolerance to donor-matched islet grafts. The morbidity of the procedure in hyperglycemic NOD mice limited the experiments to pilot status. Nevertheless, in mice that tolerated the HCT and surgical intervention, long-term islet allograft survival was observed. We then tested a less morbid regimen that resulted in multilineage chimerism. Unfortunately, this approach did not allow long-term islet allograft survival. These latter data are to our knowledge the first demonstration that establishment of stable multilineage partial chimerism in NOD mice is insufficient to induce tolerance to donor-type islets. Previous reports using BM grafts to induce islet allograft tolerance occurred in recipients that were >95% donor type (35,36). The implications of our studies are that establishment of mixed hematopoietic chimerism with low-intensity regimens may not be sufficient to induce allograft tolerance in diabetic humans. We are currently exploring alternative nonmyeloablative regimens that may permit islet allograft survival. Furthermore, we are examining in partial NOD chimeras whether the lack of tolerance to allogeneic islets is specific to islets alone or extends to other organs.

In conclusion, we show for the first time that engraftment of purified allogeneic HSCs blocks an ongoing autoimmune response. Our data further suggest that allogeneic is superior to autologous HCT in disrupting autoimmune pathogenesis. We believe that transplantation of purified hematopoietic cell populations will significantly reduce the morbidity of clinical allogeneic HCT and make possible the use of this approach for the treatment of human autoimmune disease.

	ACKNOWLEDGMENTS

 
This work was supported by the Burroughs Wellcome Fund (J.A.S.), NIH RO1 AI49331-01, NIH PPG PO1 DK53005, a Stanford University Deans Fellowship (G.F.B.), and an Amgen Oncology Fellowship (G.F.B).

We thank T. Knaak for excellent assistance with FACS sorting and L. Hildalgo and B. Lavarro for breeding of mice.

	FOOTNOTES

 
Address correspondence and reprint requests to Judith A. Shizuru, PhD, MD, Department of Medicine, Division of Bone Marrow, Transplantation, Room H1353, Stanford University Medical Center, Stanford, CA 94305. E-mail: jshizuru{at}stanford.edu.

Received for publication 18 April 2002 and accepted in revised form 26 September 2002.

I.L.W. is co-founder, a director, and a consultant of Celtrans, LLC, a virtual company (not yet started). Celtrans, LLC will isolate and transplant autologous human hematopoietic stem cells in the cancer setting. It is conceivable that Celtrans, LLC will eventually carry out allogeneic stem cell transplants in the autoimmunity setting; if that occurs, then at that time a conflict of interest with the current article could arise. Although I.L.W. does not now receive honoraria or consulting fees, he will do so when Celtrans, LLC is established.

APC, allophycocyanin; BM, bone marrow; FACS, fluorescence-activated cell sorting; FITC, fluorescein isothiocyanate; GVHD, graft-versus-host disease; HCT, hematopoietic cell transplantation; HSC, hematopoietic stem cell; mAb, monoclonal antibody; MHC, major histocompatibility complex; PE, phycoerythrin; TR, TX red.

	REFERENCES

TOP ABSTRACT RESEARCH DESIGN AND METHODS RESULTS DISCUSSION REFERENCES

 

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