Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Feb 24, 2017; 7(1): 1-25
Published online Feb 24, 2017. doi: 10.5500/wjt.v7.i1.1
Old game, new players: Linking classical theories to new trends in transplant immunology
Marina Burgos da Silva, Flavia Franco da Cunha, Fernanda Fernandes Terra, Niels Olsen Saraiva Camara
Marina Burgos da Silva, Fernanda Fernandes Terra, Niels Olsen Saraiva Camara, Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508- 900, Brazil
Flavia Franco da Cunha, Niels Olsen Saraiva Camara, Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04039-032, Brazil
Niels Olsen Saraiva Camara, Renal Pathophysiology Laboratory, Faculty of Medicine, University of São Paulo, São Paulo 01246- 903, Brazil
Author contributions: da Silva MB, da Cunha FF and Terra FF contributed equally to this work; da Silva MB, da Cunha FF and Terra FF performed the research and wrote the paper; Camara NOS analyzed the paper, discussed the topic and supervised the publication of this review.
Supported by São Paulo Research Foundation - FAPESP, Nos. 2012/23347-3, 2014/14147-6, 2012/02270-2 and CNPq.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Niels Olsen Saraiva Camara, MD, Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, 1730 Av. Prof Lineu Prestes - Cidade Universitária, São Paulo 05508- 900, Brazil. niels@icb.usp.br
Telephone: +55-11-30917388 Fax: +55-11-30917324
Received: August 15, 2016
Peer-review started: August 23, 2016
First decision: September 28, 2016
Revised: November 16, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 24, 2017
Abstract

The evolutionary emergence of an efficient immune system has a fundamental role in our survival against pathogenic attacks. Nevertheless, this same protective mechanism may also establish a negative consequence in the setting of disorders such as autoimmunity and transplant rejection. In light of the latter, although research has long uncovered main concepts of allogeneic recognition, immune rejection is still the main obstacle to long-term graft survival. Therefore, in order to define effective therapies that prolong graft viability, it is essential that we understand the underlying mediators and mechanisms that participate in transplant rejection. This multifaceted process is characterized by diverse cellular and humoral participants with innate and adaptive functions that can determine the type of rejection or promote graft acceptance. Although a number of mediators of graft recognition have been described in traditional immunology, recent studies indicate that defining rigid roles for certain immune cells and factors may be more complicated than originally conceived. Current research has also targeted specific cells and drugs that regulate immune activation and induce tolerance. This review will give a broad view of the most recent understanding of the allogeneic inflammatory/tolerogenic response and current insights into cellular and drug therapies that modulate immune activation that may prove to be useful in the induction of tolerance in the clinical setting.

Keywords: Transplant immunology, Immune rejection, Inflammation, Adaptive immunity, Innate immunity, Graft tolerance

Core tip: Although the basic mechanisms of transplant allorecognition have been the object of intense study for the last 80 years, graft rejection is still an important obstacle in clinical practice. This review focuses on the principal concepts of transplant immunology and how they apply to the most recent discoveries in the field. It also reviews current treatments used to prolong graft survival and recent approach trends toward tolerance induction in the translational setting.