In humans, the success rate of bone marrow transplantation (BMT) across major histocompatibility complex (MHC) barriers is not high due to: (1) graft-versus-host reaction (GvHR); (2) graft rejection, and (3) incomplete T cell recovery. In mice, GvHR can be prevented if T cell- depleted bone marrow cells (BMCs; <2% T cells) are used. Graft rejection can be prevented by either bone grafts (to recruit donor-derived stromal cells) or the injection of donor BMCs via the portal vein (p.v; to induce donor-specific tolerance). T cell functions are recovered by BMT plus bone grafts if the thymic functions of recipients are not completely lost. After the complete loss of thymic functions (due to aging), BMT plus embryonal thymus grafts should be carried out.Recently, we have found that persistent donor-specific tolerance can be induced if allogeneic hemopoietic stem cells are injected via the p.v. Based on these findings, we have established new strategies for organ allografts. Without irradiation, donor BMCs should be injected from the p.v. injection on day 0 plus i.v. injection on day 5, and an immunosuppressant (CsA or FK506) should be used on days 2 and 5. Without using immunosuppressants, sublethal irradiation (7 Gy) followed by skin allografts plus allogeneic BMC injection via the p.v. should be carried out. This leads to a 100% acceptance of skin and pancreas allografts for more than 300 days. The recipient mice show mixed allogeneic chimerism, and spleen cells from the recipients show tolerance to both donor-type and host-type MHC determinants in the assays for mixed lymphocyte reaction and generation of cytotoxic T lymphocytes. We have confirmed that these strategies are applicable to other animals such as pigs and rats. We therefore believe that they will become viable and valuable strategies for human organ allografts.

1.
Ikehara S, Good RA, Nakamura T, Sekita K, Inoue S, Oo MM, Muso E, Ogawa K, Hamashima Y: Rationale for bone marrow transplantation in the treatment of autoimmune diseases. Proc Natl Acad Sci USA 1985;82:2483–2487.
2.
Ikehara S, Ohtsuki H, Good RA, Asamoto H, Nakamura T, Sekita K, Muso E, Tochino Y, Ida T, Kuzuya, H, Imura H, Hamashima Y: Prevention of type I diabetes in nonobese diabetic mice by allogeneic bone marrow transplantation. Proc Natl Acad Sci USA 1985;82:7743–7747.
3.
Yasumizu R, Sugiura K, Iwai H, Inaba M, Makino S, Ida T, Imura H, Hamashima Y, Good RA, Ikehara S: Treatment of type 1 diabetes mellitus in non-obese diabetic mice by transplantation of allogeneic bone marrow and pancreatic tissue. Proc Natl Acad Sci USA 1987;84:6555–6557.
4.
Oyaizu N, Yasumizu R, Inaba-Miyama M, Nomura S, Yoshida H, Miyawaki S, Shibata Y, Mitsuoka S, Yasunaga K, Morii S, Good RA, Ikehara S: (NZW × BXSB)F1 mouse. A new model of idiopathic thrombocytopenic purpura. J Exp Med 1988;167:2017–2022.
5.
Ikehara S, Yasumizu R, Inaba M, Izui S, Hayakawa K, Sekita K, Toki J, Sugiura K, Iwai H, Nakamura T, Muso E, Hamashima Y, Good RA: Long-term observations of autoimmune-prone mice treated for autoimmune disease by allogeneic bone marrow transplantation. Proc Natl Acad Sci USA 1989;86:3306–3310.
6.
Adachi Y, Inaba M, Amoh Y, Yoshifusa H, Nakamura Y, Suzuki H, Akamatu S, Nakai S, Haruna H, Adachi M, Ikehara S: Effects of bone marrow transplantation on antiphospholipid antibody syndrome in murine lupus mice. Immunobiology 1995;192:218–230.
7.
Than S, Ishida H, Inaba M, Fukuba Y, Seino Y, Adachi M, Imura H, Ikehara S: Bone marrow transplantation as a strategy for treatment of non-insulin-dependent diabetes mellitus in KK-Ay mice. J Exp Med 1992;176:1233–1238.
8.
Nishimura M, Toki J, Sugiura K, Hashimoto F, Tomita T, Fujishima H, Hiramatsu Y, Nishioka N, Nagata N, Takahashi Y, Ikehara S: Focal glomerulonephritis is a stem cell disorder. J Exp Med 1994;179:1053–1058.
9.
Ikehara S, Kawamura M, Takao F, Inaba M, Yasumizu R, Than S, Hisha H, Sugiura K, Koide Y, Yoshida TO, Ida T, Imura H, Good RA: Organ-specific and systemic autoimmune diseases originate from defects in hematopoietic stem cells. Proc Natl Acad Sci USA 1990;87:8341–8344.
10.
Kawamura M, Hisha H, Li Y, Fukuhara S, Ikehara S: Distinct qualitative differences between normal and abnormal hemopoietic stem cells in vivo and in vitro. Stem Cells 1997;15:56–62.
11.
Ishida T, Inaba M, Hisha H, Sugiura K, Adachi Y, Nagata N, Ogawa R, Good RA, Ikehara S: Requirement of donor-derived stromal cells in the bone marrow for successful allogeneic bone marrow transplantation: Complete prevention of recurrence of autoimmune diseases in MRL/MP-lpr/lpr mice by transplantation of bone marrow plus bone (stromal cells) from the same donor. J Immunol 1994;152:3119–3127.
12.
Takeuchi K, Inaba M, Miyashima S, Ogawa R, Ikehara S: A new strategy for treatment of autoimmune diseases in chimeric resistant MRL/lpr mice. Blood 1998;91:4616–4623.
13.
Nakamura T, Good RA, Inoue S, Oo MM, Hamashima Y, Ikehara S: Successful liver allografts in mice by combination with allogeneic bone marrow transplantation. Proc Natl Acad Sci USA 1986;83:4529–4532.
14.
Zhang Y, Yasumizu R, Sugiura K, Hashimoto F, Amoh Y, Lian Z, Cherry, Nishio N, Ikehara S: Fate of allogeneic or syngeneic cells in intravenous or portal vein injection: Possible explanation for the mechanism of tolerance induction by portal vein injection. Eur J Immunol 1994;24:1558–1565.
15.
Hashimoto F, Sugiura K, Inoue K, Ikehara S: Major histocompatibility complex restriction between hematopoietic stem cells and stromal cells in vivo. Blood 1997;89:49–54.
16.
Cherry, Yasumizu R, Toki J, Asou H, Nishino T, Komatsu Y, Ikehara S: Production of hemopoietic stem cell-chemotactic factor by bone marrow stromal cells. Blood 1994;83:964–971.
17.
Drizlikh G, Schmidt-Sole J, Yankelevich B: Involvement of the K and I regions of the H-2 complex in resistance to hemopoietic allografts. J Exp Med 1984;159:1070–1082.
18.
Onoe K, Fernandes G, Good RA: Humoral and cell-mediated immune response in fully allogeneic bone marrow chimera in mice. J Exp Med 1980;151:115–132.
19.
Rayfiel LS, Brent L: Tolerance, immunocompetence, and secondary disease in fully allogeneic radiation chimeras. Transplantation 1983;36:183–189.
20.
Krown SE, Coico R, Scheid MP, Fernandes G, Good RA: Immune function in fully allogeneic mouse bone marrow chimeras. Clin Immunol Immunopathol 1981;19:268–283.
21.
Li Y, Hisha H, Inaba M, Lian Z, Yu C, Kawamura M, Yamamoto Y, Nishio N, Nishimura T, Habu S, Kasai M, Hirokawa K, Fan H, Ikehara S: Evidence for migration of donor bone marrow stromal cells into recipient thymus after bone marrow transplantation plus bone grafts; a role of the stromal cells in positive selection. Submitted.
22.
Marmont AM: Immune ablation followed by allogeneic or autologous bone marrow transplantation: A new treatment for severe autoimmune diseases? Stem Cells 1994;12:125–135.
23.
Euler HH, Marmont AM, Bacigalupo A, Fastenrath S, Dreger P, Hoffknecht M, Zander AR, Schalke B, Hahn Y, Haas R, Schmitz N: Early recurrence or persistence of autoimmune diseases after unmanipulated autologous stem cell transplantation. Blood 1996;88:3621–3625.
24.
Nelson JL, Torrez R, Louie FM, Choe OS, Strob R, Sullivan KM: Pre-existing autoimmune diseases in patients with long-term survival after allogeneic bone marrow transplantation. J Rheumatol 1997;24:23–29.
25.
Karussis DM, Vourka-Karussis U, Lehmann D, Abramsky O, Ben-Nun A, Slavin S: Immunomodulation of autoimmunity in MRL/lpr mice with syngeneic bone marrow transplantation. Clin Exp Immunol 1995;100:111.
26.
Hosaka N, Nose M, Kyogoku M, Nagata N, Miyashima S, Good RA, Ikehara S: Thymus transplantation, a critical factor for correction of autoimmune disease in aging MRL/+ mice. Proc Natl Acad Sci USA 1996;93:8558–8562.
27.
Sugiura K, Kato K, Hashimoto F, Jin T, Amoh Y, Yamamoto Y, Morita H, Okumura K, Ikehara S: Induction of donor-specific T cell anergy by portal venous injection of allogeneic cells. Immunobiology 1997;197:460–477.
28.
Vriens PW, Nisco S, Hoyt EG, Lyu S, Pierre P, Reitz BA, Clayberger C: Tissue-specific differences in the establishment of tolerance. Tolerogenic effects of lung allografts in rats. Transplantation 1994;57:1795–1798.
29.
Starzl TE, Demetris AJ, Murase N, Ildstad S, Ricordi C, Trucco M: Cell migration, chimerism, and graft acceptance. Lancet 1992;339:1579–1582.
30.
Starzl TE, Demetris AJ, Trucco M, Ricordi C, Ildstad C, Terasaki PI, Murase N, Kendall RS, Kocova M, Rudert WA: Chimerism after liver transplantation for type IV glycogen storage disease and type 1 Gaucher’s disease. N Engl J Med 1993;328:745–749.
31.
Morita H, Sugiura K, Inaba M, Jin T, Ishikawa J, Lian Z, Adachi Y, Sogo S, Yamanishi K, Taki H, Adachi M, Noumi T, Kamiyama Y, Good RA, Ikehara S: A strategy for organ allografts without using immunosuppressants or irradiation. Proc Natl Acad Sci USA 1998;95:6947–6952.
32.
Morita H, Nakamura N, Sugiura K, Satoi S, Wei T, Sakakura Y, Yoshida K, Oda M, Inoue T, Inui H, Nagahama T, Kamiyama Y, Ikehara S: Acceptance of skin allografts in pigs by portal venous injection of donor bone marrow cells. Submitted.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.