Emerging role of innate immunity in organ transplantation part III: the quest for transplant tolerance via prevention of oxidative allograft injury and its consequences.

In parts I and II of this tripartite review, the innate immune system was briefly described, focusing on its emerging role in organ transplantation and by emphasizing the oxidative injury-induced allograft inflammation that promotes the generation of immunostimulatory donor- and recipient-derived dendritic cells (DCs) translating innate immune events into adaptive alloimmunity. This part III of the review discusses the possibility to induce adaptive antigen-specific T regulatory cells (Tregs) in the clinical situation by harnessing donor- and recipient-derived tolerogenic DCs (tolDCs) as inducers for alloantigen-specific adaptive Tregs, an effort that follows current trends to harnessing DCs for immunotherapy. This challenge is based on accumulating evidence from basic immunological work in support of the notion that presentation of antigens, including weak transplantation antigens under subimmunogenic conditions within a noninflammatory microenvironment, promotes generation of tolDCs. With respect to these basic immunological studies, which are expressively reviewed, prevention of oxidative allograft injury can be regarded as an efficient tool in the clinical situation to present alloantigens under subimmunogenic conditions within an intragraft noninflammatory milieu, thereby potentially generating tolDCs able to induce Tregs-mediated innate allotolerance. Various therapeutic strategies to prevent oxidative allograft injury occurring in both the brain-dead donor before/during organ removal and the recipient during/after donor organ reperfusion as well as therapeutic options to inhibit injury-induced molecular and cellular consequences are finally discussed.