Interleukin 1 Receptor Antagonist Suppresses Allosensitization in Corneal Transplantation

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Abstract
CORNEAL transplantation is the most successful type of solid tissue transplantation in humans.1 However, immune rejection remains a significant clinical problem, and many patients lose sight from corneal graft failure.1 The extraordinary ability of allografts of cornea to survive when placed orthotopically has been ascribed to "immune privilege."2,3 Many features of the cornea and the ocular graft bed have been identified as pertinent to the existence of immune privilege.4,5 In general, major histocompatibility complex (MHC)–encoded class I and class II molecules expressed on cells within solid tissue grafts play a central role as targets of recipient T-cell–mediated alloimmunity,6 and bone marrow–derived antigen-presenting cells (APCs) located within grafts play a central role in the induction of alloimmunity.7,8 Both of these features are unusual in the normal cornea. The MHC class I and class II molecules are poorly expressed on cells of the normal cornea, especially the endothelial cells.4,9,10 Moreover, APCs, such as Langerhans cells (LCs), are essentially absent from the cornea,4,8 except at the limbus11; hence, donor buttons are devoid of these cells.