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Miyamoto E, Vosoughi D, Wang J, Al-Refaee J, Berra G, Daigneault T, Duong A, Joe B, Moshkelgosha S, Keshavjee S, Tinckam K, Hwang D, Chruscinski A, Juvet S, Martinu T. Local intragraft humoral immune responses in chronic lung allograft dysfunction. J Heart Lung Transplant 2024:S1053-2498(24)01752-2. [PMID: 39097215 DOI: 10.1016/j.healun.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 07/16/2024] [Accepted: 07/24/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Donor human leukocyte antigen (HLA)-specific antibodies (DSA) and non-HLA antibodies can cause allograft injury, possibly leading to chronic lung allograft dysfunction (CLAD) after lung transplantation. It remains unclear whether these antibodies are produced locally in the graft or derived solely from circulation. We hypothesized that DSA and non-HLA antibodies are produced in CLAD lungs. METHODS Lung tissue was prospectively collected from 15 CLAD patients undergoing retransplantation or autopsy. 0.3 g of fresh lung tissue was cultured for 4 days without or with lipopolysaccharide or CD40L: lung culture supernatant (LCS) was sampled. Protein eluate was obtained from 0.3 g of frozen lung tissue. The mean fluorescence intensity (MFI) of DSA and non-HLA antibodies was measured by Luminex and antigen microarray, respectively. RESULTS LCS from all 4 patients who had serum DSA at lung isolation were positive for DSA, with higher levels measured after CD40L stimulation (CD40L+LCS). Of these, only 2 had detectable DSA in lung eluate. MFI of non-HLA antibodies from CD40L+LCS correlated with those from lung eluate but not with those from sera. Flow cytometry showed higher frequencies of activated lung B cells in patients whose CD40L+LCS was positive for DSA (n = 4) or high non-HLA antibodies (n = 6) compared to those with low local antibodies (n = 5). Immunofluorescence staining showed CLAD lung lymphoid aggregates with local antibodies contained larger numbers of IgG+ plasma cells and greater IL-21 expression. CONCLUSIONS We show that DSA and non-HLA antibodies can be produced within activated B cell-rich lung allografts.
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Affiliation(s)
- Ei Miyamoto
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Daniel Vosoughi
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Jinguo Wang
- HLA Laboratory, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Jamal Al-Refaee
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Gregory Berra
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Tina Daigneault
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Allen Duong
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Betty Joe
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Sajad Moshkelgosha
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Tinckam
- HLA Laboratory, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Hwang
- Department of Pathology, Sunnybrook Hospital, Toronto, Ontario, Canada
| | | | - Stephen Juvet
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tereza Martinu
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Zajacova A, Mackova M, Halloran K, Gauthier P, Balko J, Guney M, Rakita D, Svorcova M, Kolarik J, Vachtenheim J, Pozniak J, Simonek J, Fila L, Lischke R, Halloran PF, Havlin J. Treatment Responses in Histologic Versus Molecular Diagnoses of Lung Rejection. Transpl Int 2024; 37:12847. [PMID: 39131792 PMCID: PMC11310027 DOI: 10.3389/ti.2024.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024]
Abstract
Histologic evaluation of allograft biopsies after lung transplantation has several limitations, suggesting that molecular assessment using tissue transcriptomics could improve biopsy interpretation. This single-center, retrospective cohort study evaluated discrepancies between the histology of transbronchial biopsies (TBBs) with no rejection (NR) and T-cell mediated rejection (TCMR) by molecular diagnosis. The accuracy of diagnosis was assessed based on response to treatment. 54 TBBs from Prague Lung Transplant Program obtained between December 2015 and January 2020 were included. Patients with acute cellular rejection (ACR) grade ≥ 1 by histology received anti-rejection treatment. Response to therapy was defined as an increase in FEV1 of ≥ 10% 4 weeks post-biopsy compared to the pre-biopsy value. Among the 54 analyzed TBBs, 25 (46%) were concordant with histology, while 29 (54%) showed discrepancies. ACR grade 0 was found in 12 TBBs (22%) and grade A1 ≥ 1 in 42 TBBs (78%). Treatment response was present in 14% in the NR group and in 50% in the TCMR group (p = 0.024). Our findings suggest that low-grade acute cellular rejection is less likely to be associated with molecular TCMR, which might better identify lung transplant recipients who benefit from therapy.
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Affiliation(s)
- A. Zajacova
- Prague Lung Transplant Program, Department of Pneumology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - M. Mackova
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada
| | - K. Halloran
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - P. Gauthier
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada
| | - J. Balko
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - M. Guney
- Second Faculty of Medicine, Charles University, Prague, Czechia
| | - D. Rakita
- Prague Lung Transplant Program, Department of Pneumology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - M. Svorcova
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - J. Kolarik
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - J. Vachtenheim
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - J. Pozniak
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - J. Simonek
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - L. Fila
- Prague Lung Transplant Program, Department of Pneumology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - R. Lischke
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
| | - P. F. Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada
| | - J. Havlin
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czechia
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Verleden GM, Hendriks JMH, Verleden SE. The diagnosis and management of chronic lung allograft dysfunction. Curr Opin Pulm Med 2024; 30:377-381. [PMID: 38305383 DOI: 10.1097/mcp.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
PURPOSE OF REVIEW Chronic lung allograft dysfunction (CLAD) remains a life-threatening complication following lung transplantation. Different CLAD phenotypes have recently been defined, based on the combination of pulmonary function testing and chest computed tomography (CT) scanning and spurred renewed interests in differential diagnosis, risk factors and management of CLAD. RECENT FINDINGS Given their crucial importance in the differential diagnosis, we will discuss the latest development in assessing the pulmonary function and chest CT scan, but also their limitations in proper CLAD phenotyping, especially with regards to patients with baseline allograft dysfunction. Since no definitive treatment exists, it remains important to timely identify clinical risk factors, but also to assess the presence of specific patterns or biomarkers in tissue or in broncho alveolar lavage in relation to CLAD (phenotypes). We will provide a comprehensive overview of the latest advances in risk factors and biomarker research in CLAD. Lastly, we will also review novel preventive and curative treatment strategies for CLAD. SUMMARY Although this knowledge has significantly advanced the field of lung transplantation, more research is warranted because CLAD remains a life-threatening complication for all lung transplant recipients.
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Affiliation(s)
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem
- Department of ASTARC, University of Antwerp, Wilrijk, Belgium
| | - Stijn E Verleden
- Department of Pneumology
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem
- Department of ASTARC, University of Antwerp, Wilrijk, Belgium
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