PROLONGATION OF SURVIVAL OF ALLOSKIN GRAFTS WITH NO CONCURRENT GENERAL SUPPRESSION OF THE BURNED PATIENTS IMMUNE-SYSTEM - A PRELIMINARY CLINICAL INVESTIGATION

The adequate management of burns is the requisite to save the patient' s life, to prevent the onset of secondary infections and to obtain hea ling with acceptable cosmetic results. Previous data have shown that t he use of alloskin grafts in the acute phase of barns yields the best clinical results. Unfortunately, this approach is curbed by the patien t's immune response which induces the rejection of the allografts. In this report we endeavoured to solve this problem by ways that would no t imply the general suppression of the patient's immune system. Thus, we can now report that a longer survival of alloskin grafts can be ind uced in situ by pretreating the alloskin samples to be grafted with bo th an anti-beta(2)- microglobulin monoclonal antibody (beta 2mAb) and irradiation with ultraviolet-C light (UVC). The advantage of our novel approach is that it does not need any concomitant administration of i mmunosuppressive agent(s) to the burned patients. In this study, we fo llowed five severely burned patients grafted with alloskin samples pre treated with either beta 2mAb or beta 2mAb plus UVC irradiation. In co mparison with untreated alloskin samples from the same source grafted in parallel, the mean survival time (MST) of the beta 2mAb-pretreated alloskin specimens increased by 35 per cent (i.e. from 18.3 +/- 3.2 da ys to 24.7 +/- 5.5 days) in three patients. Moreover the MST of the al loskin grafts pretreated with both beta 2mAb and UVC irradiation was l engthened by 100 per cent (i.e. from 18.5 +/- 4.5 days to 37.0 +/- 8.0 days) in the remaining two patients. These preliminary results lend c redence to the view that local immune suppression could be achieved in situ by our approach via: (1) the impairment of the proper functions of the HLA-class I antigen by the bound beta 2mAb; and (2) the inhibit ion of immune reactions taking place inside the alloskin grafts by som e immunosuppressive signal(s) generated by the UVC-pretreated alloepid ermal cells. Hence, our approach stands as an exciting and useful alte rnative to the otherwise well-known, deleterious general suppression o f the burned patient's immune system. Copyright (C) 1996 Elsevier Scie nce Ltd for ISBI.