The authors would like to acknowledge the contributions of A.M. VanBuskirk to the development of our understanding of the regulated DTH response in transplant recipients. This work was supported NIH grants PO1AI084853 and R01AI066219-06,and by the EU-sponsored One Study.

1. Preparation of Lymphocytes
<ol>
	<li>Collect blood into ACD (Acid Citrate Dextrose) tubes.</li>
	<li>Isolate PBMC from fresh human peripheral blood using Lymphocyte Separation Medium according to standard methods.</li>
	<li>Wash the PBMC three times with PBS to remove contaminating platelets. Platelets were found to interfere with trans-vivo DTH assay. Maximal allowable platelet contamination of PBMC preparation is &le;1x107/injection.</li>
	<li>If there is a noticeable red blood cell contamination, perfo...

<ol>
	<li>Carrodeguas, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Trans+vivo+analysis+of+human+delayed-type+hypersensitivity+reactivity.">Trans vivo analysis of human delayed-type hypersensitivity reactivity.</a> Hum. Immunol. 60, 640-651 (1999).</li><li>VanBuskirk, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+allograft+acceptance+is+associated+with+immune+regulation.">Human allograft acceptance is associated with immune regulation.</a> J. Clin. Invest. 106, 145-155 (2000).</li><li>Burlingham, W. J., Jankowska-Gan, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mouse+strain+and+injection+site+are+crucial+for+detecting+linked+suppression+in+transplant+recipients+by+trans-vivo+DTH+assay.">Mouse strain and injection site are crucial for detecting linked suppression in transplant recipients by trans-vivo DTH assay.</a> Am. J. Transplant. 7, 466-470 (2007).</li><li>Burlingham, W. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Loss+of+tolerance+to+a+maternal+kidney+transplant+is+selective+for+HLA+class+II:+Evidence+from+trans-vivo+DTH+and+alloantibody+analysis.">Loss of tolerance to a maternal kidney transplant is selective for HLA class II: Evidence from trans-vivo DTH and alloantibody analysis.</a> Human Immunology. 61, 1395-1402 (2000).</li><li>Geissler, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+liver+allograft+acceptance+and+the+'tolerance+assay':+In+vitro+anti-donor+T+cell+assays+show+hyporeactivity+to+donor+cells+but,+unlike+DTH,+fail+to+detect+linked+suppression.">Human liver allograft acceptance and the 'tolerance assay': In vitro anti-donor T cell assays show hyporeactivity to donor cells but, unlike DTH, fail to detect linked suppression.</a> Transplantation. 72, 571-580 (2001).</li><li>Jankowska-Gan, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+liver+allograft+acceptance+and+the+'tolerance+assay'.+II.+donor+HLA-A,+-B+but+not+DR+antigens+are+able+to+trigger+regulation+of+DTH.">Human liver allograft acceptance and the 'tolerance assay'. II. donor HLA-A, -B but not DR antigens are able to trigger regulation of DTH.</a> Hum. Immunol. 63, 862 (2002).</li><li>Cai, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minor+H+Antigen+HA-1-specific+Regulator+and+Effector+CD8++T+Cells,+and+HA-1+Microchimerism,+in+Allograft+Tolerance.">Minor H Antigen HA-1-specific Regulator and Effector CD8+ T Cells, and HA-1 Microchimerism, in Allograft Tolerance.</a> J. Exp. Med. 199, 1017-1023 (2004).</li><li>Rodriguez, D. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immune+regulation+and+graft+survival+in+kidney+transplant+recipients+are+both+enhanced+by+human+leukocyte+antigen+matching.">Immune regulation and graft survival in kidney transplant recipients are both enhanced by human leukocyte antigen matching.</a> Am. J. Transplant. 4, 537-543 (2004).</li><li>Xu, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+CD4+CD25low+adaptive+T+regulatory+cells+suppress+delayed-type+hypersensitivity+during+transplant+tolerance.">Human CD4+CD25low adaptive T regulatory cells suppress delayed-type hypersensitivity during transplant tolerance.</a> J. Immunol. 178, 3983-3995 (2007).</li><li>Derks, R. A., Jankowska-Gan, E., Xu, Q., Burlingham, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dendritic+cell+type+determines+the+mechanism+of+bystander+suppression+by+adaptive+T+regulatory+cells+specific+for+the+minor+antigen+HA-1.">Dendritic cell type determines the mechanism of bystander suppression by adaptive T regulatory cells specific for the minor antigen HA-1.</a> J. Immunol. 179, 3443-3451 (2007).</li><li>Jankowska-Gan, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Successful+reduction+of+immunosuppression+in+older+renal+transplant+recipients+who+exhibit+donor-specific+regulation.">Successful reduction of immunosuppression in older renal transplant recipients who exhibit donor-specific regulation.</a> Transplantation. 88, 533-541 (2009).</li><li>Jankowska-Gan, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pretransplant+immune+regulation+predicts+allograft+outcome:+bidirectional+regulation+correlates+with+excellent+renal+transplant+function+in+living-related+donor-recipient+pairs.">Pretransplant immune regulation predicts allograft outcome: bidirectional regulation correlates with excellent renal transplant function in living-related donor-recipient pairs.</a> Transplantation. 93, 283-290 (2012).</li><li>Knechtle, S. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+and+limited+use+of+tacrolimus+to+avoid+rejection+in+an+alemtuzumab+and+sirolimus+regimen+for+kidney+transplantation:+clinical+results+and+immune+monitoring.">Early and limited use of tacrolimus to avoid rejection in an alemtuzumab and sirolimus regimen for kidney transplantation: clinical results and immune monitoring.</a> Am. J. Transplant. 9, 1087-1098 (2009).</li><li>Haynes, L. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Donor-specific+indirect+pathway+analysis+reveals+a+B-cell-independent+signature+which+reflects+outcomes+in+kidney+transplant+recipients.">Donor-specific indirect pathway analysis reveals a B-cell-independent signature which reflects outcomes in kidney transplant recipients.</a> Am. J. Transplant. 12, 640-648 (2012).</li><li>Burlingham, W. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=IL-17-dependent+cellular+immunity+to+collagen+type+V+predisposes+to+obliterative+bronchiolitis+in+human+lung+transplants.">IL-17-dependent cellular immunity to collagen type V predisposes to obliterative bronchiolitis in human lung transplants.</a> J. Clin. Invest. 117, 3498-3506 (2007).</li><li>Bobadilla, J. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=TH-17,+Monokines,+Collagen+Type+V,+and+Primary+Graft+Dysfunction+in+Lung+Transplantation.">TH-17, Monokines, Collagen Type V, and Primary Graft Dysfunction in Lung Transplantation.</a> Am. J. Respir. Crit. Care Med. 177 (6), (2008).</li><li>Olson, B. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+prostate+tumor+antigen-specific+CD8++regulatory+T+cells+are+inhibited+by+CTLA-4+or+IL-35+blockade.">Human prostate tumor antigen-specific CD8+ regulatory T cells are inhibited by CTLA-4 or IL-35 blockade.</a> J. Immunol. 189, 5590-5601 (2012).</li></ol>

The authors of this manuscript have no conflicts of interest to disclose.

The trans-vivo DTH assay is a novel diagnostic test with a potential clinical application in assessing cell-mediated responses in transplant, cancer and autoimmune patients. It is valuable because it is not only useful in monitoring recall T effector responses, but also it can detect T regulatory responses. A reliable way to detect human DTH regulation might predict safety of immunosuppression withdrawal in patients who are candidates for monotherapy or tolerance trials.
The Tv-DTH is very sen...

<table border="1">
	<tbody>
		<tr>
			<td>Name of the reagent</td>
			<td>Company</td>
			<td>Catalogue number</td>
			<td>Comments (optional)</td>
		</tr>
		<tr>
			<td>ACD tube for blood collection</td>
			<td>BD</td>
			<td>02-684-26</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Lymphocyte Separation Medium</td>
			<td>Cellgro</td>
			<td>25-072-CV</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Dulbecco's Phosphate-Buffered Saline</td>
			<td>Cellgro</td>
			<td>21-031-CM</td>
			<td>Without calcium &amp; magnesium</td>
		</tr>
		<tr>
			<td>ACK Lysis Buffer</td>
			<td>BioWhittaker</td>
			<td>10-548E</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>TT/DT or EBV</td>
			<td>Sanofi Pasteur Inc./ Meridian Life Science, Inc.</td>
			<td>&nbsp;</td>
			<td>TT/DT 25 &mu;g/injection EBV 8 &mu;g/injection</td>
		</tr>
		<tr>
			<td>Protease inhibitor PMSF</td>
			<td>Sigma-Aldrich</td>
			<td>78830</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Eosine for cell count</td>
			<td>Sigma-Aldrich</td>
			<td>E-6003</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Alloantigen</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Purified HLA antigens, synthetic allopeptides can be used instead of donor cell-free lysates</td>
		</tr>
		<tr>
			<td>50 ml sterile centrifuge tubes</td>
			<td>Fisher Scientific</td>
			<td>06-443-18</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>10 ml pipettes and pipettor</td>
			<td>BD Falcon</td>
			<td>13-675-20</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>2 ml safe-lock tubes</td>
			<td>Costar</td>
			<td>3213</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>1000 &mu;l, 100 &mu;l , 10 &mu;l pipettes with sterile tips</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Hemocytometer</td>
			<td>Fisher</td>
			<td>02-671-10</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Full size centrifuge and microfuge</td>
			<td>Beckman Coulter/Eppendorf</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>1/2cc or 1cc insulin syringes</td>
			<td>Becton Dickinson</td>
			<td>14-826-79</td>
			<td>28 gauge</td>
		</tr>
		<tr>
			<td>Vibracell sonicator</td>
			<td>Divtech Equipment Co. Sonocs&amp; Materials Inc</td>
			<td>&nbsp;</td>
			<td>2 mm probe</td>
		</tr>
		<tr>
			<td>Dial thickness gauge</td>
			<td>Mitutoyo, Japan</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>SCID mice</td>
			<td>Harlan</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Isoflurane</td>
			<td>Piramal Healthcare</td>
			<td>&nbsp;</td>
			<td>Inhalant anesthesia</td>
		</tr>
	</tbody>
</table>

trans-vivo delayed type hypersensitivity assay for antigen specific regulation

Delayed-type hypersensitivity response (DTH) is a rapid in vivo manifestation of T cell-dependent immune response to a foreign antigen (Ag) that the host immune system has experienced in the recent past. DTH reactions are often divided into a sensitization phase, referring to the initial antigen experience, and a challenge phase, which usually follows several days after sensitization. The lack of a delayed-type hypersensitivity response to a recall Ag demonstrated by skin testing is often regarded as an evidence of anergy. The traditional DTH assay has been effectively used in diagnosing many microbial infections.
Despite sharing similar immune features such as lymphocyte infiltration, edema, and tissue necrosis, the direct DTH is not a feasible diagnostic technique in transplant patients because of the possibility of direct injection resulting in sensitization to donor antigens and graft loss. To avoid this problem, the human-to-mouse "trans-vivo" DTH assay was developed 1,2. This test is essentially a transfer DTH assay, in which human peripheral blood mononuclear cells (PBMCs) and specific antigens were injected subcutaneously into the pinnae or footpad of a na&iuml;ve mouse and DTH-like swelling is measured after 18-24 hr 3. The antigen presentation by human antigen presenting cells such as macrophages or DCs to T cells in highly vascular mouse tissue triggers the inflammatory cascade and attracts mouse immune cells resulting in swelling responses. The response is antigen-specific and requires prior antigen sensitization. A positive donor-reactive DTH response in the Tv-DTH assay reflects that the transplant patient has developed a pro-inflammatory immune disposition toward graft alloantigens.
The most important feature of this assay is that it can also be used to detect regulatory T cells, which cause bystander suppression. Bystander suppression of a DTH recall response in the presence of donor antigen is characteristic of transplant recipients with accepted allografts 2,4-14. The monitoring of transplant recipients for alloreactivity and regulation by Tv-DTH may identify a subset of patients who could benefit from reduction of immunosuppression without elevated risk of rejection or deteriorating renal function.
A promising area is the application of the Tv-DTH assay in monitoring of autoimmunity15,16 and also in tumor immunology 17.

1. Evaluation of renal transplant recipients for donor antigen-specific response using Tv-DTH assay
To test the donor-reactive cellular immunity in renal transplant recipients we injected PBMC from these patients with donor antigens alone or with a recall antigen tetanus toxoid (TT). As a positive control cells were injected with TT alone. We observe three main patterns of delayed type hypersensitivity in transplant recipients (Figure 1). All patients responded strongly to Recall...

Watch this Scientific Journal Video about Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation at JoVE.com

Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation

We describe a valuable diagnostic assay that could potentially be used to decide the withdrawal of immunosuppression after transplant without elevated risk of graft rejection. The assay uses the principles of Delayed Type Hypersensitivity and provides accurate assessment of both donor specific effector and regulatory immune responses mounted by recipients.

Delayed-type hypersensitivity response (DTH) is a rapid in vivo manifestation of T cell-dependent immune response to a foreign antigen (Ag) that the host ...

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Immunology and Infection

15.9K Views.  University of Wisconsin-Madison, School of Medicine and Public Health. We describe a valuable diagnostic assay that could potentially be used to decide the withdrawal of immunosuppression after transplant without elevated risk of graft rejection. The assay uses the principles of Delayed Type Hypersensitivity and provides accurate assessment of both donor specific effector and regulatory immune responses mounted by recipients.