Blockade of very late antigen-4 integrin binding to fibronectin in allograft recipients - I. Treatment with connecting segment-1 peptides prevents acute rejection by suppressing intragraft mononuclear cell accumulation, endothelial activation, and cytokine expression

Background. Allograft rejection is associated with infiltration of inflammatory cells and local deposition of fibronectin (FN). This study was carried out to examine the hypothesis that peptides known to specifically block adhesive interactions between the connecting segment-1 (CS1)-binding domain of FN and (alpha 4 beta 1 integrin on circulating cells may interfere with the immune cascade, which would lead to acute rejection in transplant recipients. Methods and Results. Cardiac allografts from Lewis x Brown Norway F-1 hybrids were rejected in 7+/-1 days in Lewis rats, Treatment with bioactive CS1 peptides (4 mg/kg/day i.v. for 7 days) abrogated acute rejection and prolonged cardiac allograft survival to 13+/-1 days (P<0.001). This effect correlated with decreased expression of total fibronectin and cell adhesion molecules, such as alpha 4 beta 1, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, as well as reduced infiltration by CD4(+) and CD8(+) T cells at the graft site. Treatment with CS1 peptides decreased alloantigen activation, as evidenced by decreased intragraft infiltration by CD25(+) cells, and diminished expression of mRNA coding for Th1 (interleukin [IL]-2, interferon-gamma)-and Th2 (IL-4, IL-5, IL-6)-type cytokines. CS1-mediated immunosuppressive effects could be reversed and acute rejection recreated after adjunctive treatment of rats with recombinant IL-2. Conclusion. Our data are consistent with the model in which in vivo interaction between the alpha 4 beta 1 integrin receptor and the cell-associated CS1 motif of FN is critical for rejection cascade. The novel therapeutic approach of selectively blocking the alpha 4 beta 1-FN activation pathway with CS1 peptides prevents acute allograft rejection by inhibiting expansion of antigen-specific T cells and inducing a transient state of cytokine-responsive anergy in the residual T-cell population.