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Tatapudi RR, Muthukumar T, Dadhania D, Ding R, Li B, Sharma VK, Lozada-Pastorio E, Seetharamu N, Hartono C, Serur D, Seshan SV, Kapur S, Hancock WW, Suthanthiran M. Noninvasive detection of renal allograft inflammation by measurements of mRNA for IP-10 and CXCR3 in urine. Kidney Int 2004; 65:2390-7. [PMID: 15149352 DOI: 10.1111/j.1523-1755.2004.00663.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We explored the hypothesis that measurements of mRNA encoding interferon-inducible protein-10 (IP-10) or the chemokine receptor CXCR3 in urinary cells offer a noninvasive means of elucidating cellular traffic causing acute rejection of human renal allografts. METHODS We obtained 63 urine specimens from 58 renal allograft recipients who underwent 63 allograft biopsies to resolve the basis for graft dysfunction, and 27 additional urine samples from 24 other patients with stable allograft function. Twenty-seven of the 63 biopsies were classified as acute rejection, 20 as other, and 16 as chronic allograft nephropathy. We measured the levels of transcripts for IP-10 and CXCR3, and a constitutively expressed gene 18S rRNA in the urine specimens and correlated transcript levels with renal allograft diagnosis. RESULTS mRNA levels of IP-10 (P < 0.0001) or CXCR3 (P < 0.0001) but not the levels of 18S rRNA (P= 0.56) predicted intragraft cellular traffic causing acute rejection. Receiver-operating characteristic curve analysis demonstrated that acute rejection can be predicted with a sensitivity of 100% and a specificity of 78% using the (log-transformed) cutoff value of 9.11 copies of IP-10, and with a sensitivity of 63% and a specificity of 83% using the cutoff value of 11.59 copies of CXCR3. Immunohistologic analysis of allograft biopsies showed exuberant expression of IP-10 and CXCR3 during acute rejection whereas both were absent in grafts with stable function. CONCLUSION Our investigation demonstrates that intragraft cellular events associated with acute rejection of human renal allografts can be noninvasively identified by measurements of mRNA for IP-10 and CXCR3 in urinary cells.
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Affiliation(s)
- Ravi Raju Tatapudi
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, USA
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Bluestone JA, Tang Q. Therapeutic vaccination using CD4+CD25+ antigen-specific regulatory T cells. Proc Natl Acad Sci U S A 2004; 101 Suppl 2:14622-6. [PMID: 15322272 PMCID: PMC521996 DOI: 10.1073/pnas.0405234101] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Autoimmune disease results from the dysregulation of basic tolerogenic processes designed to control self/non-self-discrimination. Approaches to treat autoimmunity have focused historically on potent immunosuppressives that block the activation and expansion of antigen-specific T cells before they differentiate into pathogenic T cell responses. These therapies are very efficient in reducing clonal expansion and altering early signaling pathways. However, once the pathogenic responses are established (i.e., autoimmunity), the interventions are less effective on activated and differentiated T cell subsets (including memory T cells) or acting in the presence of an inflammatory milieu to abort immune responses at the target tissue and systemically. Moreover, the current immunotherapies require continuous use because they do not redirect the immune system to a state of tolerance. The continuous treatment leads to long-term toxicities and can profoundly suppress protective immune responses targeted at viruses, bacteria, and other pathogens. Over the past decade, there have been tremendous advances in our understanding of the basic processes that control immune tolerance. Among the most exciting has been the identification of a professional regulatory T cell subset that has shown enormous potential in suppressing pathologic immune responses in autoimmune diseases, transplantation, and graft vs. host disease. In this review, we summarize current efforts to induce and maintain tolerance in the autoimmune diabetes setting by using therapeutic vaccination with CD4(+)CD25(+) regulatory T cells. Emphasis will be placed on approaches to exploit regulatory T cells either directly or through the use of anti-CD3 immunotherapy.
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Affiliation(s)
- Jeffrey A Bluestone
- Diabetes Center, Department of Medicine, University of California, San Francisco, CA 94143-0540, USA.
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Deuse T, Schrepfer S, Schäfer H, Koch-Nolte F, Schwedhelm E, Böger RH, Reichenspurner H. FK778 Attenuates Lymphocyte-Endothelium Interaction After Cardiac Transplantation: In Vivo and In Vitro Studies. Transplantation 2004; 78:71-7. [PMID: 15257041 DOI: 10.1097/01.tp.0000128629.53843.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The malononitrilamide FK778 is a novel derivate of leflunomide and interacts with T- and B-cell function by inhibiting de novo pyrimidine synthesis. We investigated the effects of FK778 upon acute cardiac allograft rejection and upon adhesion molecule upregulation in experimental transplantation and by using in vitro cell culture. METHODS Heterotopic, abdominal cardiac transplantations were performed in the Brown Norway (BN) to Lewis (Lew) rat model. The study groups received daily low- or high-dose FK778 immunosuppression. FK778 plasma levels were quantified by HPLC. Grafts were harvested on the fifth postoperative day for histologic and immunohistologic examinations using computerized morphometry. Purified BN aortic endothelial cell cultures were pretreated with low- or high-dose FK778 according to FK778 plasma levels and were stimulated with tumor necrosis factor (TNF)-alpha. Adhesion molecule expression was quantified by immunofluorescence, FACS analysis, and Western blotting. Lymphocyte-endothelium adhesion assays were performed using purified Lew lymphocytes and radiolabeled TNF-alpha was used for receptor binding assays. RESULTS FK778 treatment dose-dependently reduced graft mononuclear infiltration of CD4(+), CD8(+), and ED1(+) cells, but only high-dose FK778 treatment significantly reduced early upregulation of ICAM-1 and VCAM-1 in vivo. FK778 also dose-dependently reduced TNF-alpha-stimulated endothelial adhesion molecule upregulation in vitro, whereas the effect on VCAM-1 was more dominant. We did not find evidence that FK778 interferes with surface receptor binding of TNF-alpha. Lymphocyte adhesion to endothelial cell monolayers was significantly attenuated by FK778. CONCLUSION Besides its inhibitory effect on pyrimidine synthesis, FK778 directly reduces endothelial adhesion molecule upregulation and attenuates lymphocyte-endothelium interaction, which is a critical step in graft rejection.
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Affiliation(s)
- Tobias Deuse
- Department of Cardiovascular Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Arnold CN, Butcher EC, Campbell DJ. Antigen-Specific Lymphocyte Sequestration in Lymphoid Organs: Lack of Essential Roles for αL and α4 Integrin-Dependent Adhesion or Gαi Protein-Coupled Receptor Signaling. THE JOURNAL OF IMMUNOLOGY 2004; 173:866-73. [PMID: 15240673 DOI: 10.4049/jimmunol.173.2.866] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Selective lymphocyte sequestration was described over 30 years ago as the transient withdrawal of Ag-specific lymphocytes from the circulation as a result of their activation in secondary lymphoid organs. We used a TCR-transgenic adoptive transfer system to further characterize the Ag and adjuvant dependence of this process in mice. In addition, we examined the contribution of the alpha(L) and alpha(4) integrin chains as well as Galpha(i) protein-coupled receptor signaling to the retention of Ag-specific T cells in peripheral lymph nodes. Our results demonstrate that selective lymphocyte sequestration is T cell autonomous and adjuvant independent, and that the duration of sequestration is not controlled by the continued presence of Ag in secondary lymphoid organs. This process is not critically dependent on the alpha(L) and alpha(4) integrin chains or Galpha(i) protein-coupled receptor signaling. Selective lymphocyte sequestration may be mediated by redundant mechanisms and/or controlled by novel or nonclassical adhesion or trafficking molecules.
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Affiliation(s)
- Carrie N Arnold
- Department of Pathology, Laboratory of Immunology and Vascular Biology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Abstract
Over the past several decades, many factors have led to higher rates of patient and graft survival in organ transplantation. These factors include enhanced immunosuppressants available in recent years such as Neoral, Prograf, sirolimus, mycophenolate mofetil and anti-interleukin-2 receptor monoclonal antibodies. In addition, other new drugs, such as FTY 720, FK 778, anti-CD20, anti-CD40, and anti-CH52 monoclonal antibodies, are now being tested in clinical studies. Furthermore, there have been advances in surgical techniques, such as the piggyback method without venovenous bypass, side-to-side anastomosis of the hepatic veins, use of vascular staplers, biliary duct-to-duct anastomosis with or without tube drainage, microsurgical hepatic artery anastomosis and laparoscopic donor nephrectomy. Finally, better patient and donor selection criteria with regard to HBV- and HCV-seropositive donors, diabetic donors, donors with malignancies, older donors, ABO-incompatible donors, and non-heart-beating donors have been combined with optimal timing of transplantation, better options for treating early surgical and late medical complications, and improved management in intensive-care units. Other noteworthy scientific and social development are on the horizon namely genetic advances in xenografting and cell transplantation, and induction of immunologic tolerance. This article reviews the current developments that have significantly improved graft and patient survival among solid-organ transplants.
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Affiliation(s)
- M Haberal
- Baskent University Faculty of Medicine, Department of General Surgery and Transplantation, Ankara, Turkey.
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Midha R, Munro CA, Ramakrishna V, Matsuyama T, Gorczynski RM. CHEMOKINE EXPRESSION IN NERVE ALLOGRAFTS. Neurosurgery 2004; 54:1472-8; discussion 1478-9. [PMID: 15157305 DOI: 10.1227/01.neu.0000125544.46576.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2003] [Accepted: 10/09/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Chemokines (chemoattractant cytokines) play a major role in trafficking of cells to areas of inflammation. Infiltration of allograft tissues by immunocompetent cells is critical for rejection of donor tissues. The role of chemokines in nerve allograft rejection is not clear. We hypothesized that chemokines are responsible for attracting macrophages and T lymphocytes into nerve allograft tissue, initiating the graft rejection process. METHODS Lewis rats received 4-cm-long peroneal nerve allografts and isografts from ACI and Lewis rats, respectively. Twelve hours to 10 days after transplantation, grafts were removed and total cellular ribonucleic acid was extracted. Intragraft gene expression of several chemokines (cytokine-induced neutrophil chemoattractant, macrophage inflammatory protein [MIP]-2, monocyte chemoattractant protein-1, MIP-1 alpha, and regulated upon activation normal T-cell expressed and secreted [RANTES]) were analyzed by reverse transcription-polymerase chain reaction. RESULTS The cytokine-induced neutrophil chemoattractant was expressed in allografts and isografts at early time points (12 h to 6 d). Monocyte chemoattractant protein-1 messenger ribonucleic acid expression was similarly high in both isografts and allografts from 12 hours until 8 days after transplantation. MIP-1 alpha, MIP-2, and RANTES were expressed only in allografts. Kinetics of the neutrophil (MIP-2) and macrophage (MIP-1 alpha) chemokines revealed an early onset (12-24 h), a plateau from 1 to 4 days, and expression abruptly declining by Day 6. The lymphocyte chemoattractant RANTES had delayed kinetics, with a rise at Day 3, a peak at Day 4, and a gradual decline. CONCLUSION Induction of specific chemokine genes precedes nerve allograft infiltration by immunocompetent cells. MIP-1 alpha, MIP-2, and RANTES may be responsible for recruiting macrophages, granulocytes, and lymphocytes, respectively, to the rejecting allograft. In future studies, blockade of these specific chemokines or their receptors may prove to delay or prevent nerve allograft rejection.
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Affiliation(s)
- Rajiv Midha
- Division of Neurosurgery and Neuroscience Research Program, Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Deuse T, Schrepfer S, Reichenspurner H. The interaction between FK778 and tacrolimus in the prevention of rat cardiac allograft rejection is dose dependent. Transplantation 2004; 77:509-13. [PMID: 15084926 DOI: 10.1097/01.tp.0000113443.70993.8c] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The synthetic malononitrilamide FK778 inhibits T- and B-cell responsiveness, phagocyte effector function, exerts inhibitory activity against cytomegalovirus, and is thus one of the most promising new immunosuppressive drugs. The aim of this study was to evaluate the combination of FK778 and tacrolimus in a high-responder rat cardiac transplantation model. METHODS The Brown Norway-Lewis rat strain combination was used to investigate graft survival after 10 days of posttransplant oral therapy with FK778 (5 or 20 mg/kg), tacrolimus (2 or 8 mg/kg), or combination regimens at varying doses (5+2 mg/kg, 10+1 mg/kg, or 20+8 mg/kg). Grafts were harvested after cessation of cardiac contractions. Combination indices (CI) were calculated for drug combinations. RESULTS In untreated recipients, allograft survival was 6.2+/-0.4 days. FK778 at 20 mg/kg and tacrolimus at 2 or 8 mg/kg significantly prolonged graft survival to a mean survival time (MST) of 17.0+/-2.8, 18.5+/-2.7, and 25.0+/-2.5 days, respectively. The two low-dose drug combinations achieved a graft survival of 23.2+/-2.9 and 25.2+/-3.1 days, which was significantly longer compared with FK778 at 5 mg/kg, FK778 at 20 mg/kg, and tacrolimus at 2 mg/kg (P </=0.003) and was similar to that of high-dose tacrolimus therapy (8 mg/kg). The drugs showed synergistic interactions (CI values of 0.62 and 0.52, respectively). With the high-dose drug combination, MST was 30.0+/-4.1 days, which was significantly longer compared with all other groups (P </=0.012). However, drugs showed only additive interaction (CI=0.95), and recipients suffered enhanced toxic side effects. CONCLUSIONS This study provides evidence that FK778 and tacrolimus show supportive interaction in their immunosuppressive potency that is synergistic in low-dose combinations and additive in higher doses.
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Affiliation(s)
- Tobias Deuse
- Department of Cardiovascular Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Ghiggeri GM, Carraro M, Vincenti F. Recurrent focal glomerulosclerosis in the era of genetics of podocyte proteins: theory and therapy. Nephrol Dial Transplant 2004; 19:1036-40. [PMID: 15004256 DOI: 10.1093/ndt/gfh173] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
JAK(s)/STAT(s) relay cytokine signals through tyrosine site-specific phosphorylation of the proteins involved in cellular responses for the activation and proliferation of bone marrow-derived cells. In recent years, the constitutive or elevated expression of JAK/STAT has been found in cancer cells and oncogene transfected cells, and has been shown to be involved in the immune rejection of allografts and the inflammatory processes of autoimmune diseases. This review discusses the strategies for screening and rational design of selective, potent JAK/STAT and kinase inhibitors that are either ATP-competitive or non-ATP competitive, naturally derived or synthetic, as well as other unique inhibitors and analogues for different therapeutic indications.
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Affiliation(s)
- Cheng Luo
- Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.
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Lorber MI. What’s new in general surgery: transplantation. J Am Coll Surg 2004; 198:424-30. [PMID: 14992746 DOI: 10.1016/j.jamcollsurg.2003.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2003] [Accepted: 12/01/2003] [Indexed: 01/24/2023]
Affiliation(s)
- Marc I Lorber
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA
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Schulak JA. Steroid immunosuppression in kidney transplantation: a passing era. J Surg Res 2004; 117:154-62. [PMID: 15013726 DOI: 10.1016/j.jss.2003.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Indexed: 11/23/2022]
Affiliation(s)
- James A Schulak
- Department of Surgery, Case Western Reserve University, The Transplantation Service, University Hospitals of Cleveland, Cleveland, OH 44106, USA.
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Säemann MD, Diakos C, Kelemen P, Kriehuber E, Zeyda M, Böhmig GA, Hörl WH, Baumruker T, Zlabinger GJ. Prevention of CD40-triggered dendritic cell maturation and induction of T-cell hyporeactivity by targeting of Janus kinase 3. Am J Transplant 2003; 3:1341-9. [PMID: 14525593 DOI: 10.1046/j.1600-6143.2003.00225.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pharmacological targeting of Janus kinase 3 (JAK3) has been employed successfully to control allograft rejection and graft-vs.-host disease (GVHD). Recent evidence suggests that in addition to its involvement in common-gamma chain (cgamma) signaling of cytokine receptors, JAK3 is also engaged in the CD40 signaling pathway of peripheral blood monocytes. In this study, we assessed the consequences of JAK3 inhibition during CD40-induced maturation of myeloid dendritic cells (DCs), and tested the impact thereof on the induction of T-cell alloreactivity. Dendritic cells triggering through CD40 induced JAK3 activity, the expression of costimulatory molecules, production of IL-12, and potent allogeneic stimulatory capacity. In contrast, JAK3 inhibition with the rationally designed JAK3 inhibitor WHI-P-154 prevented these effects arresting the DCs at an immature level. Interestingly, DCs exposed to the JAK3-inhibitor during CD40-ligation induced a state of hyporeactivity in alloreactive T cells that was reversible upon exogenous IL-2 supplementation to secondary cultures. These results suggest that immunosuppressive therapies targeting the tyrosine kinase JAK3 may also affect the function of myeloid cells. This property of JAK3 inhibitors therefore represents a further level of interference, which together with the well-established suppression of cgamma signaling could be responsible for their clinical efficacy.
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Affiliation(s)
- Filomena Conti
- Department of Surgery, Hôpital Cochin, 75674 Paris Cedex 14, France
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Matthews JB, Ramos E, Bluestone JA. Clinical trials of transplant tolerance: slow but steady progress. Am J Transplant 2003; 3:794-803. [PMID: 12814471 DOI: 10.1046/j.1600-6135.2003.0154.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The search for tolerance therapies that would thwart the alloimmune response following organ transplantation while preserving a patient's protective immune response has been a formidable goal for clinical immunologists. Over the past few decades, a more detailed understanding of the molecular events associated with T-cell recognition and activation has demonstrated the feasibility of various tolerance approaches, such as costimulation blockade, in numerous animal models of both autoimmunity and transplantation. Yet, only a few promising new therapies have reached the early stages of human clinical development. In contrast, the use of T-cell depleting induction therapy has become widespread, and new trials have been designed with immunosuppressive drug withdrawal in mind. Furthermore, nonmyeloablative mixed chimeric approaches have allowed complete immunosuppressive withdrawal in some limited cases. In the course of these investigations, however, what has become increasingly clear is that the distinctions between immunosuppression and tolerance have been blurred as the success and durability of the therapies rely as much on the state of the organ and organism as they do the mechanism of action of the drug. In this review, we provide a summary of the progress and lessons in promoting clinical transplant tolerance and an overview of promising agents.
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Affiliation(s)
- Jeffrey B Matthews
- Immune Tolerance Network, University of California, San Francisco, CA, USA
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Vincenti F. Immunosuppression minimization: current and future trends in transplant immunosuppression. J Am Soc Nephrol 2003; 14:1940-8. [PMID: 12819255 DOI: 10.1097/01.asn.0000076844.59963.cf] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Flavio Vincenti
- Kidney Transplant Service, University of California-San Francisco, 505 Parnassus Avenue, M884, San Francisco, CA 94143-0780, USA.
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