Sensitization and desensitization of burn patients as potential candidates for vascularized composite allotransplantation

Sensitization describes the acquired ability of the immune system to react to foreign human leukocyte antigens (HLA) by producing antibodies and developing memory cells. In the field of transplantation, recipient preformed HLA antibodies due to previous sensitization have been identified - beneath ABO incompatibility - as a major factor for acute graft rejection. Several reasons for sensitization have largely been studied, such as previous blood transfusions, pregnancies or former transplants. Recent studies indicate that the use of assist devices (e.g. ECMO) or cadaveric skin allotransplantation providing temporary coverage in burn patients may lead to additional sensitization. As vascularized composite allotransplantation (VCA) has become a rapidly advancing therapeutic option for reconstruction of complex tissue defects in burns, it seems even more important to become familiar with immunological principles and to be cautiously aware of both sources of sensitization and therapeutic concepts in burns avoiding sensitization. This may also include emergency VCAs in burn patients as potential strategy for early definitive reconstruction avoiding procedures triggering HLA antibody formation. We hereby provide an overview on current evidence in the field of pre- and peritrans-plant sensitization, followed by posttransplant strategies of desensitization and their potential impact on future treatments of burn patients. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.Peer reviewe

Apoptotic cell-based therapies against transplant rejection: role of recipient’s dendritic cells

One of the ultimate goals in transplantation is to develop novel therapeutic methods for induction of donor-specific tolerance to reduce the side effects caused by the generalized immunosuppression associated to the currently used pharmacologic regimens. Interaction or phagocytosis of cells in early apoptosis exerts potent anti-inflammatory and immunosuppressive effects on antigen (Ag)-presenting cells (APC) like dendritic cells (DC) and macrophages. This observation led to the idea that apoptotic cell-based therapies could be employed to deliver donor-Ag in combination with regulatory signals to recipient’s APC as therapeutic approach to restrain the anti-donor response. This review describes the multiple mechanisms by which apoptotic cells down-modulate the immuno-stimulatory and pro-inflammatory functions of DC and macrophages, and the role of the interaction between apoptotic cells and APC in self-tolerance and in apoptotic cell-based therapies to prevent/treat allograft rejection and graft-versus-host disease in murine experimental systems and in humans. It also explores the role that in vivo-generated apoptotic cells could have in the beneficial effects of extracorporeal photopheresis, donor-specific transfusion, and tolerogenic DC-based therapies in transplantation

Lezha [Lissos, Alessio] (Albanie) : espace des morts et organisation de l’habitat médiéval : la mission de fouilles 2009

Buchet Luc, Metalla Elvana, Nallbani Etleva, Bitri Eduart, Bregu B., Buchet M., Hivelin Ondine, Julien M., Lela Surja, Pérez Elsa, Quagliarello A., Vatteoni Sophie. Lezha [Lissos, Alessio] (Albanie) : espace des morts et organisation de l’habitat médiéval : la mission de fouilles 2009. In: Mélanges de l'École française de Rome. Moyen-Age, tome 121, n°2. 2009. pp. 461-465

Lezha [Lissos, Alessio] (Albanie) : espace des morts et organisation de l’habitat médiéval : la mission de fouilles 2009

Buchet Luc, Metalla Elvana, Nallbani Etleva, Bitri Eduart, Bregu B., Buchet M., Hivelin Ondine, Julien M., Lela Surja, Pérez Elsa, Quagliarello A., Vatteoni Sophie. Lezha [Lissos, Alessio] (Albanie) : espace des morts et organisation de l’habitat médiéval : la mission de fouilles 2009. In: Mélanges de l'École française de Rome. Moyen-Age, tome 121, n°2. 2009. pp. 461-465