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Blood, 15 September 2005, Vol. 106, No. 6, pp. 2215-2220.
Prepublished online as a Blood First Edition Paper on May 31, 2005; DOI 10.1182/blood-2005-04-1391.


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Submitted April 5, 2005
Accepted May 19, 2005

Long-term mixed chimerism after immunological conditioning and MHC-mismatched stem cell transplantation is dependent on NK cell tolerance

Geert Westerhuis, Wendy G Maas, Roel Willemze, Rene E Toes, and Willem E Fibbe*

Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands

* Corresponding author; email: W.E.Fibbe{at}lumc.nl.

T cell tolerance is mandatory for MHC-mismatched stem cell transplantation without cytoreduction. Here, we used a cytotoxicity assay based on the infusion of differentially CFSE-labeled syngeneic and donor splenocytes to determine the survival of donor cells in vivo. In vivo cytotoxicity data showed that treatment with anti-CD40Ligand mAb in combination with a low dose of MHC-mismatched bone marrow cells was sufficient to induce T cell tolerance. However, CFSE-labeled donor cells were still eliminated. A similar elimination pattern was observed in T and NKT cell deficient mice, suggesting the involvement of NK cells. Indeed, in vivo NK cell depletion resulted in a prolonged survival of CFSE-labeled donor cells, confirming the role of NK cells in this process. Transplantation of a megadose of MHC-mismatched bone marrow cells was required for a complete survival of CFSE-labeled donor cells. This NK cell tolerance was donor-specific and associated with mixed chimerism. Additional NK cell depletion significantly enhanced engraftment and allowed long-term chimerism after transplantation of a relatively low dose of donor bone marrow cells. These data demonstrate the importance of NK cells in the rejection of MHC-mismatched hematopoietic cells and may explain the high numbers of bone marrow cells required for transplantation over MHC barriers.


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