Date of Award

January 2019

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Dan Jane-Wit

Abstract

Perioperative ischemia reperfusion injury (IRI) is a consequence of solid organ allograft transplantation that primes the graft for future rejection. Using humanized in vitro and in vivo models of IRI previously developed in the Jane-wit lab, we found that IRI-like treatment of human umbilical vein endothelial cells causes non-lytic terminal complement deposition and subsequent up-regulation of co-stimulatory molecules including ICOS-L and PD-L2, replicating findings from human renal biopsies with confirmed complement deposition. Because ICOS-L and PD-L2 are cognate ligands of surface markers for both follicular T helper cells (Tfh) and peripheral T helper cells (Tph), we investigated how these T cell subsets respond to IRI-treated endothelial cells. In co-culture, IRI-treated endothelial cells induced selective expansion of Tph compared to Tfh cells (p<0.01) and production of donor specific antibodies by B cells. In vivo, IRI-mediated complement activation caused increased infiltration by Tph but not Tfh into the neo-intima (p<0.05), and resulted in the production of anti-HLA antibodies. These findings represent a mechanistic link between IRI-induced complement activation and future antibody-mediated rejection.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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