1
|
Aspectos técnicos y clínicos de la prueba cruzada de histocompatibilidad en el trasplante de órganos sólidos. BIOMÉDICA 2022; 42:391-413. [PMID: 35867930 PMCID: PMC9467682 DOI: 10.7705/biomedica.6255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 11/21/2022]
Abstract
La presencia de anticuerpos dirigidos contra los antígenos leucocitarios humanos (Human Leukocyte Antigens, HLA) que se expresan en las células del donante, es uno de los factores de riesgo más importantes asociados con las complicaciones clínicas después del trasplante. La prueba cruzada es una de las pruebas de histocompatibilidad más eficaces para la detección de anticuerpos específicos contra el donante en los receptores de injertos. En los primeros métodos de la prueba cruzada, se utilizaba la citotoxicidad dependiente del complemento, que es útil para detectar dichos anticuerpos responsables del rechazo hiperagudo del injerto, pero carece de la sensibilidad adecuada. Por ello, se desarrollaron métodos de pruebas cruzadas más sensibles, entre ellas, la prueba cruzada por citometría de flujo que hoy se considera el método preferido. En este artículo se revisa la evolución de la prueba cruzada y los factores más importantes que deben tenerse en cuenta al realizarla y al interpretar los resultados de esta prueba fundamental para la supervivencia a largo plazo del injerto.
Collapse
|
2
|
Assessment of Safety and Immunogenicity of MHC homozygous iPSC-derived CD34+ Hematopoietic Progenitors in a NHP Model. Blood Adv 2022; 6:5267-5278. [PMID: 35404997 PMCID: PMC9631690 DOI: 10.1182/bloodadvances.2022006984] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022] Open
Abstract
Infusion of iHPs is safe and well tolerated in NHPs. iHPs are hypoimmunogenic and can be administered with a low risk of alloimmunization.
Administration of ex vivo expanded somatic myeloid progenitors has been explored as a way to facilitate a more rapid myeloid recovery and improve overall survival after myeloablation. Recent advances in induced pluripotent stem cell (iPSC) technologies have created alternative platforms for supplying off-the-shelf immunologically compatible myeloid progenitors, including cellular products derived from major histocompatibility complex (MHC) homozygous superdonors, potentially increasing the availability of MHC-matching cells and maximizing the utility of stem cell banking. However, the teratogenic and tumorigenic potential of iPSC-derived progenitor cells and whether they will induce alloreactive antibodies upon transfer remain unclear. We evaluated the safety and efficacy of using CD34+CD45+ hematopoietic progenitors derived from MHC homozygous iPSCs (iHPs) to treat cytopenia after myeloablative hematopoietic stem cell (HSC) transplantation in a Mauritian cynomolgus macaque (MCM) nonhuman primate (NHP) model. We demonstrated that infusion of iHPs was well tolerated and safe, observing no teratomas or tumors in the MCMs up to 1 year after HSC transplantation and iHP infusion. Importantly, the iHPs also did not induce significant levels of alloantibodies in MHC-matched or -mismatched immunocompetent MCMs, even after increasing MHC expression on iHPs with interferon-γ. These results support the feasibility of iHP use in the setting of myeloablation and suggest that iHP products pose a low risk of inducing alloreactive antibodies.
Collapse
|
3
|
Colvin MM, Cook JL, Chang PP, Hsu DT, Kiernan MS, Kobashigawa JA, Lindenfeld J, Masri SC, Miller DV, Rodriguez ER, Tyan DB, Zeevi A. Sensitization in Heart Transplantation: Emerging Knowledge: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e553-e578. [DOI: 10.1161/cir.0000000000000598] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sensitization, defined as the presence of circulating antibodies, presents challenges for heart transplant recipients and physicians. When present, sensitization can limit a transplantation candidate’s access to organs, prolong wait time, and, in some cases, exclude the candidate from heart transplantation altogether. The management of sensitization is not yet standardized, and current therapies have not yielded consistent results. Although current strategies involve antibody suppression and removal with intravenous immunoglobulin, plasmapheresis, and antibody therapy, newer strategies with more specific targets are being investigated.
Collapse
|
5
|
Apithy MJ, Desoutter J, Gicquel A, Guiheneuf E, Westeel PF, Lesage A, Piot V, Choukroun G, Guillaume N. Pronase treatment improves flow cytometry crossmatching results. HLA 2017; 90:157-164. [DOI: 10.1111/tan.13073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/03/2017] [Accepted: 06/07/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M.-J. Apithy
- Department of Histocompatibility; Amiens University Medical Center; Amiens France
- Department of Hematology; Amiens University Medical Center; Amiens France
| | - J. Desoutter
- Department of Histocompatibility; Amiens University Medical Center; Amiens France
- Department of Hematology; Amiens University Medical Center; Amiens France
| | - A. Gicquel
- Department of Histocompatibility; Amiens University Medical Center; Amiens France
- Department of Hematology; Amiens University Medical Center; Amiens France
| | - E. Guiheneuf
- Department of Hematology; Amiens University Medical Center; Amiens France
| | - P.-F. Westeel
- Department of Nephrology and Transplantation; Amiens University Medical Center; Amiens France
| | - A. Lesage
- Department of Histocompatibility; Amiens University Medical Center; Amiens France
| | - V. Piot
- Department of Histocompatibility; Amiens University Medical Center; Amiens France
| | - G. Choukroun
- Department of Nephrology and Transplantation; Amiens University Medical Center; Amiens France
| | - N. Guillaume
- Department of Histocompatibility; Amiens University Medical Center; Amiens France
- Department of Hematology; Amiens University Medical Center; Amiens France
- EA466; University of Picardie; Amiens France
| |
Collapse
|
6
|
Desoutter J, Apithy MJ, Guillaume N. Unexpected Positive Prospective Crossmatches in Organ Transplant. EXP CLIN TRANSPLANT 2017; 15:253-259. [PMID: 28447927 DOI: 10.6002/ect.2016.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Preformed donor-specific antibodies against human leukocyte antigen can induce antibody-mediated rejection after organ transplant. Hence, future transplant recipients undergo pretransplant screening for preformed antibodies (ie, virtual crossmatch). Subsequently, prospective (analytic) crossmatching is performed using conventional, complement-dependent cytotoxicity assays and/or flow cytometry-based methods. The present article reviews factors that must be considered when unexpected, positive, prospective crossmatches are observed. First, the prozone effect caused by the interference of complement or immunoglobulin M must be abrogated by treating the serum with moderate heat, dilution, hypotonic dialysis, EDTA, or dithiothreitol. Second, the physician must check for the presence of potentially interfering autoantibodies (in a context of autoimmune disease or human immunodeficiency virus infection) or therapeutic antibodies (such as rituximab and antithymocyte globulin). In conclusion, knowledge of each assay's technical characteristics will enable the physician to reliably interpret any discrepancies. The reasons for an unexpected, positive, prospective crossmatch must be elucidated before transplant to ensure efficient organ allocation and optimize patient outcomes.
Collapse
Affiliation(s)
- Judith Desoutter
- From the Department of Histocompatibility, Amiens University Medical Center, Amiens, France
| | | | | |
Collapse
|
7
|
Hurh S, Kang B, Choi I, Cho B, Lee EM, Kim H, Kim YJ, Chung YS, Jeong JC, Hwang JI, Kim JY, Lee BC, Surh CD, Yang J, Ahn C. Human antibody reactivity against xenogeneic N-glycolylneuraminic acid and galactose-α-1,3-galactose antigen. Xenotransplantation 2016; 23:279-92. [PMID: 27373998 DOI: 10.1111/xen.12239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/07/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite the development of α1,3-galactosyl transferase-knockout (GTKO) pigs, acute humoral xenograft rejection caused by antibodies against non-Gal antigens, along with complement activation, are hurdles that need to be overcome. Among non-Gal antigens, N-glycolylneuraminic acid (Neu5Gc) is considered to play an important role in xenograft rejection in human. METHODS We generated human embryonic kidney 293 (HEK293) cells that expressed xenogeneic Neu5Gc (HEK293-pCMAH) or α1,3Gal (HEK293-pGT) antigen and investigated the degree of human antibody binding and complement-dependent cytotoxicity (CDC) against these antigens using 100 individual human sera. RESULTS Both IgM and IgG bound to α1,3Gal, while only IgG bound to Neu5Gc. Of the ABO blood groups, the degree of IgG binding to α1,3Gal was highest for blood group A. The degree of CDC against HEK293-pCMAH cells was significantly lower than that against HEK293-pGT cells. However, CDC against HEK293-pCMAH cells was significantly higher than that against control HEK293 cells. In addition, the severity of CDC against HEK293-pCMAH cells positively correlated with that against GTKO pig aortic endothelial cells (PAECs), suggesting that Neu5Gc is the main antigen in GTKO PAECs. Similar to antibody-binding activity, only IgG binding correlated with CDC against HEK293-pCMAH cells. The most common subclass of IgGs against Neu5Gc was IgG1, which typically induces strong complement activation. CONCLUSIONS We showed that IgG-mediated CDC was detected in Neu5Gc-overexpressed HEK293 cells incubated with human sera; however, this antibody reactivity to Neu5Gc was highly variable among individuals. Our results suggest that additional modifications to the CMAH gene should be considered for widespread use of pig organs for human transplants.
Collapse
Affiliation(s)
- Sunghoon Hurh
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Graduate School of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bohae Kang
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Graduate School of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Choi
- Department of Pharmaceutical Engineering, College of Life and Health Sciences, Hoseo University, Asan, Chungcheongnam-do, Korea
| | - Bumrae Cho
- Designed Animal & Transplantation Research Institute, Institute of Green Bio Science & Technology, Seoul National University, Pyeongchang, Gangwon-do, Korea
| | - Eun Mi Lee
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Graduate School of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hwajung Kim
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young June Kim
- Designed Animal & Transplantation Research Institute, Institute of Green Bio Science & Technology, Seoul National University, Pyeongchang, Gangwon-do, Korea
| | - Yun Shin Chung
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Cheol Jeong
- Department of Nephrology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Jong-Ik Hwang
- Graduate School of Medicine, Korea University, Seoul, Korea
| | - Jae Young Kim
- Department of Life Science, Gachon University, Seongnam, Korea
| | - Byeong Chun Lee
- Designed Animal & Transplantation Research Institute, Institute of Green Bio Science & Technology, Seoul National University, Pyeongchang, Gangwon-do, Korea.,Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Seoul National University, Seoul, Korea.,Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - Charles D Surh
- Academy of Immunology and Microbiology, Institute for Basic Science, Pohang, Korea.,Department of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Korea.,Division of Developmental Immunology, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - Jaeseok Yang
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Curie Ahn
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Designed Animal & Transplantation Research Institute, Institute of Green Bio Science & Technology, Seoul National University, Pyeongchang, Gangwon-do, Korea.,Transplantation Center, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|