Background When hyperacute rejection, involving natural xenoreactive a
ntibodies (XAb) and/or complement (C), can be prevented, xenografts (X
gs) undergo delayed xenograft rejection associated with a progressive
mononuclear cell infiltration, We have previously shown that XAb forma
tion can be totally suppressed in leflunomide (LF)-treated, T-deficien
t nude rats receiving hamster hearts. Hence, this model was well-suite
d to study a role played by other factors, e,g,, natural killer (NK) c
ells and macrophages (M phi). The relative contribution of M phi to de
layed xenograft rejection was investigated, Methods. In addition to LF
(20 mg/kg/24 hr p,o,), anti-asialoGM-1 serum (1 mg/48 hr i,v,) and N
omega-nitro-L-arginine methyl ester (L-NAME; 100 mg/kg/24 hr i,v,) wer
e given. Craft-infiltrating cells, deposition of cytokines (interferon
-gamma [IFN-gamma] and tumor necrosis factor-alpha [TNF-alpha]), IgM a
nd C, and expression of endothelial cell (EC) P- and E-selectins were
investigated by immunohistochemistry. In some cases, rat rTNF-alpha or
anti-TNF-alpha antibodies were injected intravenously. Results. Xgs r
ejected after 3 days by LF-treated rats showed an absence of IgM, C, a
nd T cells, but the infiltration of NK cells and M phi, together with
the presence of IFN-gamma and TNF-alpha. Addition of NM cell depletion
resulted in a significantly prolonged survival of Xgs (6 days; P<0.00
1) in which NK cells and IFN-gamma had disappeared, but M phi were sti
ll prominent, Additional blockade of M phi nitric oxide (NO) with L-NA
ME further prolonged Xg survival (11 days; P<0.001), In these rejected
Xgs, M phi, TNF-alpha, and EC expression of P- and E-selectins was st
ill found, together with platelet thrombi, neutrophil-EC adhesion, and
vessel intima lesions, The role of TNF-alpha in initiating this Xg re
jection was further demonstrated by the acceleration of Xg rejection a
fter injection of rTNF-alpha and by a synergism between L-NAME and ant
i-TNF-alpha antibodies in hampering the acceleration of Xg rejection s
een after transfer of sensitized M phi. Conclusion. In the absence of
XAb, T cells, and NM cells, M phi can still reject Xgs, Both NO-depend
ent and NO-independent mechanisms are involved, In the latter case, M
phi-derived, TNF-alpha-associated EC activation may play a role.