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Full-length version of this article is also available, published online February 10, 2006 as doi:10.1096/fj.05-4791fje.
Published as doi: 10.1096/fj.05-4791fje.
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(The FASEB Journal. 2006;20:776-778.)
© 2006 FASEB

Heme oxygenase-1 is essential for and promotes tolerance to transplanted organs

Kenichiro Yamashita*,{ddagger},1, Robert Öllinger*,{dagger},{ddagger},1, James McDaid*, Hideyasu Sakahama*, Hongjun Wang*, Shivraj Tyagi*, Eva Csizmadia*, Neal R. Smith§, Miguel P. Soares*,1 and Fritz H. Bach*,1,2

* Immunobiology Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
{dagger} Department of Surgery, Medical University of Innsbruck, Austria;
§ Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; and
Instituto Gulbenkian de Ciência, Oeiras, Portugal

2Correspondence: Immunobiology Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 99 Brookline Ave., Boston, MA 02215, USA. E-mail: fritz.bach{at}hms.harvard.edu

SPECIFIC AIMS

Heme oxygenase-1 (HO-1) expression and/or administration of the products of heme degradation by HO-1 have proved salutary in several phases of transplantation: suppression of ischemia-reperfusion injury, inhibition of acute (T cell-mediated) rejection, and in amelioration of chronic rejection. It was our goal to study the potential role of HO-1 in tolerance induction.

PRINCIPAL FINDINGS

1. Heme oxygenase-1 activity is required for induction of tolerance with donor specific transfusion (DST) + CD40L/CD40 blockade or DST alone
The combination of DST, given 7 days before transplantation, and anti-CD40L mAb (MR-1) resulted in 100% long-term survival of C57BL/6 hearts transplanted into Balb/c mice. While donor hearts that lacked HO-1 expression also survived long-term (>100 days), DST plus MR-1 failed to promote long-term graft survival when C57BL/6 hearts were transplanted into BALB/c HO-1-deficient (HO-1–/–) recipients (P<0.02 vs. HO-1+/+ recipients) (Fig. 1 ).


Figure 1
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Figure 1. HO-1 expression is essential for long-term survival of grafts after signal 2 blockade. a) C57Bl/6 recipients treated with DST + MR-1 accept heart allografts from Balb/c wild-type (WT) or HO-1–/– mice long-term. b) Balb/c recipients treated with DST + MR-1 accept C57BL/6 grafts for > 100 days in contrast to what was seen in Balb/c mice deficient in HO-1 under the same treatment, indicating that HO-1 is required for tolerance induction mediated by signal 2 blockade plus DST.

Similarly, DST given on day –7 before transplantation, without further treatment, led to 50% of DBA/2 heart grafts surviving for > 100 days in B6AF1 recipients (P<0.005 vs. untreated control). Inhibition of HO activity by ZnPPIX administration to the recipient from day –8 (one day before DST) to day 6 after transplantation abrogated the tolerogenic effect of DST (day –7) with none (0/9) of the grafts surviving long-term (P<0.002 vs. DST alone, data not shown). These data show that HO-1 expression in the recipient is obligatory to sustain long-term graft survival and tolerance induction afforded by DST plus CD40/CD40L blockade or DST alone.

2. Induced HO-1 activity can synergize with DST in tolerance induction
When DST was given to B6AF1 recipients of DBA/2 hearts mice immediately after transplantation (day 0), these grafts were promptly rejected with a tempo similar to those transplanted into untreated controls (MST=10.3±0.8). Induction of HO-1 expression by CoPPIX administration to the recipient from day –1 to day +13 post-transplant together with DST (day 0) prolonged graft survival significantly (P<0.001 vs. DST alone) with 7 of 8 (87.5%) grafts surviving long-term (>100 days). Induced HO-1 expression also promoted tolerance induction when DST was given on day –7, which by itself led to 50% long-term survival. Induction of HO-1 expression by CoPPIX administration plus DST (day –7) led to 100% (7/7) of the grafts surviving for > 100 days (P<0.001 vs. DST alone). CoPPIX treatment of the recipient without DST resulted in a significant prolongation of allograft survival, with 2 of 6 grafts surviving long-term (i.e., >100 days). The combined effect of DST (day 0) plus HO-1 in terms of achieving long-term survival (tolerance) was significantly greater than HO-1 induction alone (P<0.03).

3. HO-1 promotes donor-specific "peripheral dominant" tolerance to cardiac allografts
To assess whether up-regulation of HO-1 plus DST induced antigen-specific and "peripheral dominant" tolerance in recipients of long-term surviving DBA/2 (H-2d) cardiac allografts, B6AF1 (H-2b,k/d) recipients carrying a DBA/2 transplanted heart for >100 days were, with no further treatment, challenged with a second heart from 1) DBA/2 mice, 2) FVB (H-2q) third-party mice or 3) DBA/2 x FVB F1 mice (H-2d/q). All DBA/2 hearts survived indefinitely, all FVB hearts were rejected promptly, and all DBA/2 x FVB F1 grafts were accepted for >100 days. These observations indicate that antigen-specific, peripheral dominant tolerance was established since as second transplants DBA/2 hearts survived indefinitely while FVB hearts did not, and tolerance to H-2d was propagated to H-2q when the H-2q antigens were presented by the same antigen-presenting cells (Fig. 2 a).


Figure 2
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Figure 2. a) Induction of HO-1 expression plus DST induces donor-specific dominant peripheral tolerance to cardiac allografts. Long-term DBA/2 allograft accepting B6AF1 recipients (achieved by HO-1 induction plus DST on day –7) allowed permanent survival of second heart grafts from DBA/2 (donor strain) and (DBA/2xFVB) F1 mice but not from FVB (third party) mice. b) Tolerance induction by HO-1 plus DST requires CD4+CD25+ T cells. Kaplan-Meier analysis of naïve DBA/2 cardiac allograft survival in sublethally irradiated B6AF1 mice. Leukocytes (50 million) obtained either from naïve or CoPPIX and DST (day –7) treated tolerant animals were adoptively transferred to B6AF1 recipients immediately after transplantation (n=4–6 per each group). Transplant recipients did not receive any further treatment. Sublethally irradiated B6AF1 mice receiving leukocytes from naive B6AF1 mice were capable of rejecting the allograft in a prompt manner, whereas DBA/2 allografts survived for >100 days in B6AF1 mice receiving leukocytes from tolerant B6AF1 animals (P<0.001). Depletion of CD4+CD25+ T cells from the tolerizing cells abolished the graft survival prolonging effect of adoptive transfer of these cells; DBA/2 hearts were promptly rejected (P<0.005 vs. tolerant cells).

4. Induction of HO-1 expression plus DST promotes generation of CD4+CD25+ regulatory T cells that are involved in maintenance of tolerance
Induction of HO-1 expression by CoPPIX combined with DST (day –7) led to a significant decrease in the number of CD4+ T cells (P<0.01 vs. controls) in the lymph nodes on day 14 post-transplantation of DBA/2 hearts to B6AF1 recipients.) However, among the remaining CD4+ T cells there was a significant increase in the percentage of CD4+CD25+ T cells compared with controls (P<0.05), which was paralleled by a significant increase in the expression of Foxp3 as well as increases in TGF-ß, IL-10, and CTLA4. In adoptive transfer experiments, depletion of the CD4+CD25+ cells from a cell population that otherwise transferred tolerance, removed the tolerizing effect (Fig. 2b ).

CONCLUSIONS AND SIGNIFICANCE

We extend the salutary role that HO-1 expression can have in organ transplantation. In two models of tolerance induction in mice, both reported to involve T regulatory cells, expression/activity of HO-1 in the recipient were critical. In the absence of HO-1, it was not possible to induce tolerance. In one case we transplanted C57BL/6 hearts to Balb/c recipients that received DST + MR-1 using either wild-type recipients or Balb/c recipients deficient in HO-1 (HO-1–/–). In recipients lacking HO-1 expression, this protocol, which was effective at inducing tolerance in wild-type recipients, failed to do so in the HO-1–/– recipients. Likewise, tolerance induction with DST (day –7) alone failed when HO-1 activity was blocked in the recipient with ZnPPIX. These data demonstrate that HO-1 activity is essential for tolerance induction in these protocols that are thought to be based on T regulatory cell function. We hypothesize that this key role for HO-1 relates to the generation of T regulatory cells, perhaps via the need for HO-1 expression in dendritic cells that stimulate Treg.

It appears that tolerance in our studies was also based on T regulatory cell function. Induction of HO-1 expression plus DST increased the percentage of peripheral CD4+CD25+ T cells among CD4+ T cells in B6AF1 recipients carrying DBA/2 cardiac transplants. Emergence of a regulatory function associated with the appearance of these CD4+CD25+ T cells is supported by the increased expression of Foxp3, a transcription factor functionally involved in the immunoregulatory effect of CD4+CD25+ T cells. That these CD4+CD25+ T cells played a role in the establishment of donor-specific tolerance of DBA/2 (H-2d) hearts transplanted into B6AF1 (H-2k/d,b) recipients treated with DST plus HO-1 induction is suggested by the following. "Tolerizing leukocytes" from B6AF1 mice that were carrying a DBA/2 allograft long-term (after DST + HO-1 induction) failed to induce rejection of a DBA/2 heart when adoptively transferred into nonlethally irradiated B6AF1 recipients. However, B6AF1 recipients did reject DBA/2 (H-2d) hearts when CD25+CD4+ T cells were depleted from the tolerizing leukocytes and the remaining cells were adoptively transferred into nonlethally irradiated B6AF1 recipients. These observations suggest that the ability of DST plus HO-1 to induce antigen specific peripheral dominant tolerance is sustained functionally by regulatory CD25+CD4+ T cells.

In addition to the need for HO-1 expression to obtain tolerance by these protocols, induction of HO-1 expression appears to have beneficial effects in terms of promoting the tolerogenic effect of DST given at the time of transplantation. Most striking was our observation that induction of HO-1 led to tolerance in combination with DST (day 0), which by itself did not lead to any long-term surviving hearts. These data show synergy between HO-1 and DST. While we have shown this only for DST, it is possible that a similar synergistic, or an additive, effect of HO-1 induction would be observed for other approaches that are only partially effective for inducing tolerance. As a possible explanation for these findings, we and others have shown that expression of HO-1 is essential for the action of several immunomodulatory molecules (including IL-10 and rapamycin) to exert their therapeutic effects.

Given these results, treatment to induce HO-1 expression should perhaps become an important component of a feasible strategy to achieve tolerance in allogeneic transplantation.


Figure 3
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Figure 3. HO-1 expression is required for tolerance induction with either DST + MR-1 (to block CD40L) or with DST alone. In the case of DST + MR-1, tolerance is induced when a C57BL/6 heart is transplanted to a wild-type Balb/c recipient but not when the Balb/c recipient is deficient for HO-1 (HO-1–/–). Similarly, 50% of B6AF1 recipients become tolerant to DBA/2 hearts when DST is given on day –7 but not if the mice are treated with ZnPPIX to inhibit HO-1 activity. Induced HO-1 activity can boost tolerance induction. DST given on day 0 does not lead to tolerance, however, DST + CoPP (to induce HO-1) leads to tolerance in a significant number of recipients, showing synergy of these two treatments.

FOOTNOTES

1 These authors contributed equally to this paper.

To read the full text of this article, go to http://www.fasebj.org/cgi/doi/10.1096/fj.05-4791fje;




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