The research described in this thesis investigates the effect of viral infection on the risk of rejection. It was previously thought that a viral specific T-cell receptor could not crossreact... Show moreThe research described in this thesis investigates the effect of viral infection on the risk of rejection. It was previously thought that a viral specific T-cell receptor could not crossreact against allogeneic HLA molecules, however here it is proven that this is not only possible but is also common. The research performed in this thesis has important clinical implications for solid organ (kidney) and bone marrow transplantation. Viral infection commonly generates alloreactive T-cells, and may therefore be responsible for the failure of tolerance inducing regimens in primates and humans. It is shown that vaccination can also induce HLA-specific alloreactive T-cell responses and it is therefore recommended that vaccines be given to transplantation candidates at least three months prior to expected transplantation date. It is also shown that alloreactive T-cells can be tissue specific. In the final chapter of the thesis thesis it is shown that allogeneic cell therapy could conversely be useful to elicit a viral specific T-cell response in patients with infections, such as HIV. Show less
Over the last decades, restoration of renal function by renal allograft transplantation has evolved into the preferred treatment option for patients with end stage renal disease. The introduction... Show moreOver the last decades, restoration of renal function by renal allograft transplantation has evolved into the preferred treatment option for patients with end stage renal disease. The introduction of the calcineurin inhibitors (CNI) cyclosporine and tacrolimus have significantly contributed to this success. Adverse drug effects, together with the large inter-individual variation in pharmacokinetics of both drugs necessitates therapeutic drug monitoring (TDM). Nowadays, TDM is routinely performed by drug concentration measurement in blood. Unfortunately, the incidence of acute allograft rejection episodes is still 10-20% within first year after transplantation. A strategy to improve clinical immunesuppresion early after transplantation is improved monitoring. Next to advanced pharmacokinetic monitoring, such as estimated AUC monitoring, the development of pharmacodynamic markers could theoretically contribute to improve CNI therapy. Pharmacodynamic monitoring strategies, however, are still in an experimental phase and have not proven clinical benefit yet. They carry the theoretical advantage of monitoring the true effectiveness of immunosuppressive therapy. This led us to investigate pharmacodynamic monitoring as potential tool to guide drug dosing. We choose calcineurin activity as pharmacodynamic marker for monitoring and in this thesis, the analytical aspects, fundamental characteristics and insights in clinical usefulness of calcineurin activity measurement as a pharmacodynamic marker for CNI were investigated. Show less
Antibody-mediated rejection is increasingly recognised within the transplantation community as a cause or contributing factor in the rejection of transplanted organs. The humoral immune response... Show moreAntibody-mediated rejection is increasingly recognised within the transplantation community as a cause or contributing factor in the rejection of transplanted organs. The humoral immune response towards allografts involves B cells that, after T cell dependent activation, can differentiate into antibody producing cells. Whereas there are several therapeutic entities to treat cellular rejection, at present, no standard treatment for humoral rejection exists. The first part of this thesis describes the effects of different maintenance immunosuppressive drugs directly on B cells, as well as the effect on T cell help in vitro. The data presented in these chapters show differential effects of the drugs on B cells and T cell help. Furthermore, the effects of novel, experimental drugs on the in vitro activation of B cells are described. The second part of this thesis describes the development of a novel technique for monitoring the humoral alloimmune response. By using this technique, patients at risk for humoral rejection may be identified. The last part describes the difficulties and pitfalls of monitoring T cells that respond to alloantigen via the indirect pathway of allorecognition. In an alloimmune response, these are the T cells that provide help to B cells to become fully activated. Show less
