FN18-CRM9 immunotoxin promotes tolerance in primate renal allografts

Background. Transplant tolerance, rather than immunity, may be favored in the setting of a lower mature lymphoid mass in the recipient induced by anti-T cell agents. A novel immunosuppressive agent, FN18-CRM9, known to specifically kill T cells with great potency, was evaluated in a transplant model. Methods. In order to ablate recipient T cells, the immunotoxin FN18- CRM9 was administered to rhesus monkey recipients of MHC-mismatched renal allografts. Donor lymphocytes were injected intrathymically into some animals. Results. All monkeys with T-cell depletion by immunotoxin had prolonged allograft survival, and tolerance confirmed by skin grafting has been confirmed in five of six long-surviving recipients. Conclusions. In this clinically relevant model, profound but transient T-cell depletion by a single agent substantially promotes tolerance.