Bioartificial Organ Rejection

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The process of rejection may begin with the diffusion of immunogens from the graft across the membrane barrier. There are several possible sources for these antigens, including molecules shed from the cell surface, protein secreted by live cells and cytoplasmic protein liberated from dead cells. Recognition and display of these antigens by antigen presenting cells initiates the cellular and humoral immune response. The former leads to activation of cytotoxic cells, macrophages and other cells of the immune system. These cells must be prevented from contacting grafted tissue, a requirement relatively easy to meet. More difficult is keeping out components of the humoral immune response. These include cytokines, for example, interleukin-1, which can have detrimental effects on beta cells, as well as the antibodies formed as a response to the antigens, which have leaked across the barrier. In addition, there may always be some antibodies already present in the antibody spectrum of the blood serum which correspond to cell surface antigens (e.g., major histocompatibility complexes) on allo- or xenografts. Antibodies produced during preexisting autoimmune disease, such as type I diabetes, might also bind to surface antigens on allogeneic cells. Finally, macrophages and certain other immune cells can secrete low-molecular weight reactive metabolites of oxygen and nitrogen including free radicals, hydrogen peroxide, and nitric oxide that are toxic to cells in a nonspecific manner. These agents can diffuse large distances if their lifetime exceeds 1 s.6

Any attempts to evaluate biocompatibility in vitro would show some lack of predictability for in vivo experiments. Therefore, implantation experiments are necessary to correlate these phenomena. The majority of experiments have been performed on rodents,26 and there are only a few reports on systematic experiments in large animal models.109 The choice of an animal model should reflect the human situation. In diabetes research, the diabetic BB-rat, NOD-mice and STZ-treated mice have generally been accepted to be a representative animal model of autoimmune diabetes.27,110

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