C-reactive protein orchestrates acute allograft rejection in vascularized composite allotransplantation via subset-selective monocyte activation.

Jurij Kiefer; Johannes Zeller; Laura Schneider; Julia Thomé; James D McFadyen; Isabel A Hoerbrand; Friederike Lang; Emil Deiss; Balázs Bogner; Anna-Lena Schaefer; Nina Chevalier; Verena K Horner; Sheena Kreuzaler; Ulrich Kneser; Martin Kauke-Navarro; David Braig; Kevin J Woollard; Bohdan Pomahac; Karlheinz Peter; Steffen U Eisenhardt
Abstract
Despite recent substantial progress in vascularized composite allotransplantation (VCA), such as face transplantations, short- and long-term allograft survival is severely limited by allograft rejection. The acute-phase response, directly after allogeneic transplantation, represents an immune-inflammatory reaction to ischemia/reperfusion and acts as an early initiator of graft rejection. Acute-phase reactants mediate this immune response via crosstalk with the mononuclear phagocyte system. C-reactive protein (CRP), a well-known marker of inflammation, has pro-inflammatory properties and aggravates ischemia/reperfusion injury. Thus, we investigated how CRP impacts acute allograft rejection. Based on clinical observations in facial VCAs, we applied a complex hindlimb transplantation model in rats to investigate whether CRP directly affects transplant rejection. We further analyzed subset-specific infiltration and tissue distribution of recipient-derived monocytes in the early phase of acute rejection and assessed their differential regulation by CRP using intravital imaging. We demonstrate that CRP accelerates allograft rejection and reduces allograft survival via selectively activating non-classical monocytes. The therapeutic stabilization of CRP abrogates this activating effect on monocytes, consequently attenuating acute allograft rejection. Intravital imaging of graft-infiltrating, recipient-derived monocytes during the early phase of acute rejection confirmed their differential regulation by CRP and their crucial role in driving the early stage of graft rejection. Differential activation of recipient-derived monocytes by CRP aggravates innate immune response and accelerates clinical allograft rejection Thus, therapeutic targeting of CRP represents a novel promising strategy for preventing acute allograft rejection and potentially reducing chronic allograft rejection.
Journal JOURNAL OF ADVANCED RESEARCH
ISSN 2090-1224
Published 09 Jul 2024
Volume
Issue
Pages
DOI 10.1016/j.jare.2024.07.007
Type Journal Article
Sponsorship