A Review of Cyclophosphamide-Induced Transplantation Tolerance in Mice and Its Relationship With the HLA-Haploidentical Bone Marrow Transplantation/Post-Transplantation Cyclophosphamide Platform

Abstract

The bone marrow transplantation (BMT) between haplo-identical combinations (haploBMT) could cause unacceptable bone marrow graft rejection and graft-versus-host disease (GVHD). To cross such barriers, Johns Hopkins platform consisting of haploBMT followed by post-transplantation (PT) cyclophosphamide (Cy) has been used. Although the central mechanism of the Johns Hopkins regimen is Cy-induced tolerance with bone marrow cells (BMC) followed by Cy on days 3 and 4, the mechanisms of Cy-induced tolerance may not be well understood. Here, I review our studies in pursuing skin-tolerance from minor histocompatibility (H) antigen disparity to xenogeneic antigen disparity through fully allogeneic antigen disparity. To overcome fully allogeneic antigen barriers or xenogeneic barriers for skin grafting, pretreatment of the recipients with monoclonal antibodies (mAb) against T cells before cell injection was required. In the cells-followed-by-Cy system providing successful skin tolerance, five mechanisms were identified using the correlation between super-antigens and T-cell receptor (TCR) Vβ segments mainly in the H-2-identical murine combinations. Those consist of: 1) clonal destruction of antigen-stimulated-thus-proliferating mature T cells with Cy; 2) peripheral clonal deletion associated with immediate peripheral chimerism; 3) intrathymic clonal deletion associated with intrathymic chimerism; 4) delayed generation of suppressor T (Ts) cells; and 5) delayed generation of clonal anergy. These five mechanisms are insufficient to induce tolerance when the donor-recipient combinations are disparate in MHC antigens plus minor H antigens as is seen in haploBMT. Clonal destruction is incomplete when the antigenic disparity is too strong to establish intrathymic mixed chimerism. Although this incomplete clonal destruction leaves the less-proliferative, antigen-stimulated T cells behind, these cells may confer graft-versus-leukemia (GVL) effects after haploBMT/PTCy.

Accumulation of Dystrophin-Positive Muscle Fibers and Improvement of Neuromuscular Junctions in mdx Mouse Muscles after Bone Marrow Transplantation under Different Conditions

“…Cyclophosphamide (Endoxan) was chosen as the immunosuppressor. Studies have reported that the post-transplantation administration of cyclophosphamide induces transplantation tolerance in mice and is also considered a form of graft-versus-host disease prevention [66][67][68][69]. Allogeneic nonmyeloablative bone marrow transplantation with post-transplantation cyclophosphamide administration has also been applied in the treatment of nonmalignant hematological disorders [70,71].…”

Abatacept and T-cell costimulation blockade—shifting the paradigm in the prevention of graft-versus-host disease

“…The existing approaches to serotherapy or immunomagnetic depletion of T cells are largely non-selective if the aim of the process is to restrict the alloreactive T-cell population alone. In a series of preclinical studies, groups from Japan and Johns Hopkins U n i v e r s i t y i n t h e U S A h a v e s h o w n t h a t hi g h -d o s e cyclophosphamide (Cy), if administered 2-3 days after graft infusion, can result in long-term tolerance in mismatched mice models (26,27). Cy and its active metabolite are rapidly metabolized by aldehyde dehydrogenase (ALDH) and cells that lack ALDH are far more susceptible to Cy-induced death.…”