Tolerance of kidney allografts has been achieved in nonhuman primates (NHPs) and in humans using a combination of nonmyeloablative conditioning and donor bone marrow transplantation (DMBT) that results in transient donor chimerism. However, mixed chimerism protocols that achieve long term tolerance of kidney allografts in NHPs fail to induce tolerance in recipients of heart allografts. It is well known that some organs, such as kidney and liver, are tolerance-prone while others, such as heart and lung, are tolerance-resistant. In earlier studies using miniature swine, we took advantage of the tolerogenicity of kidney allografts and, through donor kidney cotransplantation, achieved long-term stable tolerance of heart allografts which, if transplanted alone, would have rejected acutely. Mechanistic studies in swine showed that kidney allografts were able to confer tolerance upon co-transplanted hearts by promoting the expansion of regulatory T cells (Tregs). We have now extrapolated those findings to NHPs. By combining a mixed chimerism protocol that induces transient donor chimerism with donor kidney cotransplantation, we have succeeded in achieving long-term, stable tolerance of MHC mismatched heart allografts. These results are the first to demonstrate tolerance induction in NHP heart allograft recipients and the first to show that unresponsiveness to a tolerant-resistant organ can be achieved without durable donor chimerism. Based on preliminary results, we hypothesize that amplifying the contributions of host Tregs in NHP heart allograft recipients undergoing mixed chimerism conditioning will achieve long-term, stable tolerance without the need for kidney cotransplantation or durable chimerism. To test this hypothesis, we will first study the characteristics of Tregs generated by kidney cotransplantation and attempt to identify the cells or cell products within the kidney allograft capable of promoting those Tregs. These results will be applied to our subsequent studies aimed at finding a clinically relevant strategy of Treg amplification that effectively substitutes for simultaneous donor kidney transplantation. Our goal is to develop a Treg-amplified, mixed chimerism protocol that can be rapidly translated to human heart transplant recipients. Of note, results from Project 2, which will use novel but related strategies to achieve tolerance of stringent lung allografts, and Project 3, which will use humanized mice to evaluate novel Treg-stabilizing agents will guide the ongoing design of these experiments.

Public Health Relevance

Achieving long term survival of organ transplants without the need for chronic immunosuppression will provide transplants recipients with a healthier and longer life. These studies will explore ways to eliminate the need for chronic immunosuppressive drugs in patients undergoing heart transplantation.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Program Projects (P01)
Project #
Application #
Study Section
Heart, Lung, and Blood Initial Review Group (HLBP)
Program Officer
Schwartz, Lisa
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Massachusetts General Hospital
United States
Zip Code
Kean, Leslie S; Turka, Laurence A; Blazar, Bruce R (2017) Advances in targeting co-inhibitory and co-stimulatory pathways in transplantation settings: the Yin to the Yang of cancer immunotherapy. Immunol Rev 276:192-212
Tanimine, Naoki; Turka, Laurence A; Priyadharshini, Bhavana (2017) Navigating T Cell Immunometabolism in Transplantation. Transplantation :
Alessandrini, Alessandro; Turka, Laurence A (2017) FOXP3-Positive Regulatory T Cells and Kidney Allograft Tolerance. Am J Kidney Dis 69:667-674
Wang, Zhaohui; Zheng, Qian; Zhang, Huiping et al. (2017) Ontak-like human IL-2 fusion toxin. J Immunol Methods 448:51-58
Zheng, Qian; Wang, Zhaohui; Zhang, Huiping et al. (2017) Diphtheria toxin-based anti-human CD19 immunotoxin for targeting human CD19+ tumors. Mol Oncol 11:584-594
Adam, B A; Smith, R N; Rosales, I A et al. (2017) Chronic Antibody-Mediated Rejection in Nonhuman Primate Renal Allografts: Validation of Human Histological and Molecular Phenotypes. Am J Transplant 17:2841-2850
Zuber, Julien; Sykes, Megan (2017) Mechanisms of Mixed Chimerism-Based Transplant Tolerance. Trends Immunol 38:829-843
Benichou, Gilles; Gonzalez, Bruno; Marino, Jose et al. (2017) Role of Memory T Cells in Allograft Rejection and Tolerance. Front Immunol 8:170
Purroy, Carolina; Fairchild, Robert L; Tanaka, Toshiaki et al. (2017) Erythropoietin Receptor-Mediated Molecular Crosstalk Promotes T Cell Immunoregulation and Transplant Survival. J Am Soc Nephrol 28:2377-2392
Hotta, Kiyohiko; Aoyama, Akihiro; Oura, Tetsu et al. (2016) Induced regulatory T cells in allograft tolerance via transient mixed chimerism. JCI Insight 1:

Showing the most recent 10 out of 288 publications