Use of Monoclonal Antibodies to T-Cell Subsets for Immunologic Monitoring and Treatment in Recipients of Renal Allografts

TLDR

The study aims to use monoclonal antibodies to precisely monitor T‑cell subset changes and to develop targeted immunotherapy protocols for renal allograft recipients. The authors serially measured lymphocyte subpopulations in renal‑allograft recipients using monoclonal antibodies and flow cytometry under conventional or monoclonal‑antibody therapy. In 29 patients, changes in T‑cell subsets correlated strongly with rejection; high OKT4/OKT8 ratios predicted rejection unless HLA‑identical or T‑cell counts were low, while low ratios rarely led to rejection, and OKT3 therapy caused rapid loss of OKT3‑reactive cells and reversal of rejection.

Abstract

Using monoclonal antibodies and flow cytometry, wer serially monitored lymphocyte subpopulations in renal-allograft recipients treated with either conventional immunosuppression or a monoclonal antibody. In 29 patients given conventional suppression, highly significant correlations between changes in T-cell subsets and rejection were noted. Normal or elevated ratios of OKT4 (helper/inducer) to OKT8 (suppressor/cytotoxic) cells were associated with rejection unless the donor was HLA identical or the total number of T cells was extremely low. In patients with low ratios, rejection seldom occurred. Two patients treated with OKT3 monoclonal antibody for acute rejection had rapid disappearance of OKT3-reactive cells from the peripheral blood and prompt reversal of rejection. The use of monoclonal antibodies allows the precise determination of changes in T-cell subsets and promises the development of therapeutic protocols that can be designed to manipulate selected lymphocyte populations.