Purpose of review
Chronic rejection is associated with persistent mononuclear cell recruitment, endothelial activation and proliferation, local tissue hypoxia and related biology that enhance effector immune responses. Despite similarities, the tumor microenvironment elicits signals/factors that inhibit effector T cell responses and promote local immunoregulation. The identification of immunoregulatory check points and/or secreted factors that are deficient within allografts is of great importance in the understanding and prevention of chronic rejection.
Recent findings
The relative expression of immunomodulatory molecules (cell surface and secreted) on microvascular endothelial cells are deficient within rejecting allografts, and this deficiency is of functional importance in shaping the phenotype of rejection. Furthermore, the expression of co-inhibitory molecules/factors that enhance local immunoregulation are modulated, and the identification of intracellular regulatory signals or secreted factors are the subject of ongoing research. For example, semaphorins may interact with endothelial cells and regulatory T cells to promote local tolerance. Additionally, metabolites and electrolytes within the allograft microenvironment may regulate local effector and regulatory cell responses.
Summary
Multiple factors within allografts shape the microenvironment either towards local immunoregulation or proinflammation. Promoting the expression of intragraft cell surface or secreted molecules that support immunoregulation will be critical for long-term graft survival and/or alloimmune tolerance.