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Herrera-Gómez F, Del Aguila W, Tejero-Pedregosa A, Adler M, Padilla-Berdugo R, Maurtua-Briseño-Meiggs Á, Pascual J, Pascual M, San Segundo D, Heidt S, Álvarez FJ, Ochoa-Sangrador C, Lambert C. The number of FoxP3 regulatory T cells in the circulation may be a predictive biomarker for kidney transplant recipients: A multistage systematic review. Int Immunopharmacol 2018; 65:483-492. [PMID: 30390595 DOI: 10.1016/j.intimp.2018.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/10/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The kinetics of the FoxP3 regulatory T-cell (Treg) population in kidney transplant recipients (KTR) are related to the clinical effect of immunosuppression based on mammalian Target Of Rapamycin inhibitors (mTORi) with/without belatacept (predictive biomarker). METHODS A multistage systematic review of published and unpublished literature is presented [registration IDs in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42017057570, CRD42018085019, CRD42018084941, CRD42018085186]. A multidisciplinary supervision mechanism for contextualizing of search findings was required. The peripheral blood immune cell phenotypes encompassing all regulatory cells in KTRs were assessed in order to suggest new markers of acute rejection-associated acute allograft dysfunction (AR/AAD) events in KTRs treated with mTORi alone or combined to belatacept. Quantitative estimates and evaluation of the body of evidence are provided. RESULTS An increase in Tregs and other regulatory cell types in the circulation in KTRs under mTORi with/without belatacept were observed. Patients with increased Tregs presented a low frequency of AR/AAD events compared to those in which the number of Tregs remained unchanged or even diminished [Odds Ratio (OR)/95% confidence interval (95% CI)/I2/number of studies (n): 0.31/0.10-0.93/0%/6]. Nevertheless, there are too few trials to consider Tregs in the circulation as a predictive biomarker. Inadequate reporting prevents appreciating clinical relevance in such studies. CONCLUSIONS Despite advances, clinical qualification of potential predictive biomarkers continues to be difficult. Clinical evidence on Tregs in KTRs needs to be enlarged. Biomarkers should be able to evaluate the effect of medicines targeted to specific patient populations.
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Affiliation(s)
- Francisco Herrera-Gómez
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain; Department of Nephrology, Hospital Virgen de la Concha, Sanidad de Castilla y León, Zamora, Spain.
| | | | - Armando Tejero-Pedregosa
- Intensive Care Medicine, Hospital Virgen de la Concha, Sanidad de Castilla y León, Zamora, Spain
| | - Marcel Adler
- Hematology, University Hospital of Basel, Basel, Switzerland
| | - Rosario Padilla-Berdugo
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | | | | | - Manuel Pascual
- Centre de Transplantation d'Organes, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - David San Segundo
- Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Sebastiaan Heidt
- Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.
| | - F Javier Álvarez
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain; CEIm Área de Salud Valladolid Este, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | | | - Claude Lambert
- Immunology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest-en-Jarez, France
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