Selective unresponsiveness to beta cell autoantigens after induction immunosuppression in pancreas transplantation with anti-interleukin-2 receptor antibody versus anti-thymocyte globulin

Clin Exp Immunol. 2007 Jul;149(1):56-62. doi: 10.1111/j.1365-2249.2007.03400.x. Epub 2007 Apr 25.

Abstract

Pancreas transplantation in type 1 diabetes patients could result in (re)activation of allo- and autoreactive T lymphocytes. Anti-thymocyte globulin (ATG) induction treatment is a successful, but broadly reactive anti-lymphocyte therapy used in pancreas and islet transplantation. A more selective alternative is daclizumab, a monoclonal antibody directed against the interleukin-2 receptor (CD25) on activated lymphocytes. We tested the hypothesis that daclizumab is more selective and has less immunological side effects than ATG. Thirty-nine simultaneous pancreas-kidney transplantation patients with type 1 diabetes were randomized for induction therapy with ATG or daclizumab. Auto- and recall immunity was measured cross-sectionally by lymphocyte stimulation tests with a series of auto- and recall antigens in 35 successfully transplanted patients. T cell autoimmunity to islets was low in both groups, except for a marginal but significantly higher reactivity against glutamic acid decarboxylase (GAD)65 in daclizumab-treated patients. The memory responses to recall antigens were significantly higher in the daclizumab-treated group compared to ATG-treated patients, specifically against purified protein derivative (PPD) (anti-bacterial immunity), Haemophilus influenzae virus matrix protein-1 (anti-viral immunity) and p53 [anti-tumour (auto)immunity]. These data imply that daclizumab is more specifically affecting diabetes-related immune responses than ATG. The autoimmunity is affected effectively after daclizumab induction, while memory responses towards bacterial, viral and tumour antigens are preserved.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Antilymphocyte Serum / therapeutic use
  • Autoantigens / immunology*
  • CD4 Lymphocyte Count
  • Cross-Sectional Studies
  • Daclizumab
  • Diabetes Mellitus, Type 1 / immunology
  • Diabetes Mellitus, Type 1 / surgery*
  • Female
  • Graft Rejection / therapy
  • Humans
  • Immune Tolerance
  • Immunoglobulin G / therapeutic use
  • Immunologic Memory
  • Immunosuppression Therapy / methods*
  • Immunosuppressive Agents / therapeutic use
  • Insulin-Secreting Cells / immunology*
  • Interleukin-2 / immunology
  • Kidney Transplantation / immunology
  • Male
  • Middle Aged
  • Pancreas Transplantation / immunology*
  • Receptors, Interleukin-2 / immunology
  • Recombinant Proteins / immunology

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antilymphocyte Serum
  • Autoantigens
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Interleukin-2
  • Receptors, Interleukin-2
  • Recombinant Proteins
  • Daclizumab