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Alhamdan F, Coppolino A, Sheikh A, Miele A, Lee S, Gasiewski A, Brescia P, Wood I, Venkat A, Thaniyavarn T, Jacob S, Keshk M, Meadowcroft S, Banday MM, Khan MM, Hayes D, Chandrekar A, Goldberg H, Guleria I, Sharma NS. Distinct Non-Human Leukocyte Antigen Antibody Signatures Correlate with Endothelial Crossmatch Status in Lung and Renal Transplant Recipients. Int J Mol Sci 2024; 25:10562. [PMID: 39408890 PMCID: PMC11476851 DOI: 10.3390/ijms251910562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/12/2024] [Accepted: 09/19/2024] [Indexed: 10/20/2024] Open
Abstract
Non-HLA antibodies against heterogeneous targets on endothelial cells have been associated with allograft injuries. The endothelial cell crossmatch (ECXM) is used in the detection of non-HLA antibodies but remains non-discriminatory for specific antibody identification. The primary objective of this study was to delineate the specific non-HLA antibody signatures associated with ECXM positivity and to determine the correlation of ECXM status and non-HLA antibody signatures on allograft health. Serum specimens from 25 lung transplant recipients (LTRs) and 13 renal transplant recipients (RTRs) were collected as part of clinical evaluation, and testing for angiotensin II receptor type 1 (AT1R) and donor-specific MHC class I chain-related gene A (MICA) antibodies and ECXM was performed. Remnant sera were tested for non-HLA antibodies using the LABScreen™ Autoantibody (LSAUT) Group 1, 2, and 3 kits (One Lambda, Inc., Los Angeles, CA, USA). In both cohorts, the concordance of AT1R and MICA together or individually with ECXM+ status was poor (<0.7), suggesting the presence of other unaccounted antibodies. Autoantibody profiling revealed three distinct clusters targeting fibrotic products, cytoskeletal proteins, and cell signaling molecules. A comparative analysis of ECXM+ and ECXM- specimens identified nine and five differentially expressed antibodies in the LTR and RTR cohorts, respectively. Employing machine learning techniques (variable importance, feature selection, ROC-AUC), we derived a five-antibody panel (TNFα, collagen V, CXCL11, GDNF, GAPDH) and a two-antibody panel (TNFα, CXCL9) that effectively discriminated between ECXM+ and ECXM- status in the LTR and RTR cohorts, respectively. Distinct antibody signatures were identified in LTR and RTR cohorts that correlated with ECXM+ status and were associated with allograft dysfunction.
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Affiliation(s)
- Fahd Alhamdan
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Antonio Coppolino
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Adil Sheikh
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Anna Miele
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Stefi Lee
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
- VA Boston Medical Center, Boston, MA 02130, USA
| | - Allison Gasiewski
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Peter Brescia
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Isabelle Wood
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Arvin Venkat
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Tany Thaniyavarn
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
- VA Boston Medical Center, Boston, MA 02130, USA
| | - Selvin Jacob
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Mohamed Keshk
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Stacia Meadowcroft
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Mudassir M. Banday
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Mohd Moin Khan
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Don Hayes
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Anil Chandrekar
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Hilary Goldberg
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Indira Guleria
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
| | - Nirmal S. Sharma
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (F.A.); (A.C.); (A.S.); (A.M.); (S.L.); (A.G.); (P.B.); (I.W.); (A.V.); (T.T.); (S.J.); (M.K.); (S.M.); (M.M.B.); (M.M.K.); (A.C.); (H.G.); (I.G.)
- VA Boston Medical Center, Boston, MA 02130, USA
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Panicker AJ, Prokop LJ, Hacke K, Jaramillo A, Griffiths LG. Outcome-based Risk Assessment of Non-HLA Antibodies in Heart Transplantation: A Systematic Review. J Heart Lung Transplant 2024; 43:1450-1467. [PMID: 38796046 DOI: 10.1016/j.healun.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Current monitoring after heart transplantation (HT) employs repeated invasive endomyocardial biopsies (EMB). Although positive EMB confirms rejection, EMB fails to predict impending, subclinical, or EMB-negative rejection events. While non-human leukocyte antigen (non-HLA) antibodies have emerged as important risk factors for antibody-mediated rejection after HT, their use in clinical risk stratification has been limited. A systematic review of the role of non-HLA antibodies in rejection pathologies has the potential to guide efforts to overcome deficiencies of EMB in rejection monitoring. METHODS Databases were searched to include studies on non-HLA antibodies in HT recipients. Data collected included the number of patients, type of rejection, non-HLA antigen studied, association of non-HLA antibodies with rejection, and evidence for synergistic interaction between non-HLA antibodies and donor-specific anti-human leukocyte antigen antibody (HLA-DSA) responses. RESULTS A total of 56 studies met the inclusion criteria. Strength of evidence for each non-HLA antibody was evaluated based on the number of articles and patients in support versus against their role in mediating rejection. Importantly, despite previous intense focus on the role of anti-major histocompatibility complex class I chain-related gene A (MICA) and anti-angiotensin II type I receptor antibodies (AT1R) in HT rejection, evidence for their involvement was equivocal. Conversely, the strength of evidence for other non-HLA antibodies supports that differing rejection pathologies are driven by differing non-HLA antibodies. CONCLUSIONS This systematic review underscores the importance of identifying peri-HT non-HLA antibodies. Current evidence supports the role of non-HLA antibodies in all forms of HT rejection. Further investigations are required to define the mechanisms of action of non-HLA antibodies in HT rejection.
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Affiliation(s)
- Anjali J Panicker
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota; Department of Immunology, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota
| | - Katrin Hacke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona
| | - Andrés Jaramillo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona
| | - Leigh G Griffiths
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.
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Schinstock CA, Agrawal A, Valenzuela NM. The Significance of Major Histocompatibility Complex Class I Chain-related Molecule A in Solid Organ and Hematopoietic Stem Cell Transplantation: A Comprehensive Overview. Transplantation 2024; 108:115-126. [PMID: 37218026 DOI: 10.1097/tp.0000000000004643] [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: 05/24/2023]
Abstract
Improving long-term allograft survival and minimizing recipient morbidity is of key importance in all of transplantation. Improved matching of classical HLA molecules and avoiding HLA donor-specific antibody has been a major focus; however, emerging data suggest the relevance of nonclassical HLA molecules, major histocompatibility complex class I chain-related gene A (MICA) and B, in transplant outcomes. The purpose of this review is to discuss the structure, function, polymorphisms, and genetics of the MICA molecule and relates this to clinical outcomes in solid organ and hematopoietic stem cell transplantation. The tools available for genotyping and antibody detection will be reviewed combined with a discussion of their shortcomings. Although data supporting the relevance of MICA molecules have accumulated, key knowledge gaps exist and should be addressed before widespread implementation of MICA testing for recipients pre- or posttransplantation.
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Affiliation(s)
- Carrie A Schinstock
- Von Liebig Center for Transplant and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Amogh Agrawal
- Von Liebig Center for Transplant and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Nicole M Valenzuela
- UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, Los Angeles, CA
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Association of MICA and AT1R antibodies with antibody-mediated rejection and cardiac allograft vasculopathy in a pediatric heart transplant recipient. Transpl Immunol 2023; 78:101811. [PMID: 36889546 DOI: 10.1016/j.trim.2023.101811] [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: 11/30/2022] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Recipient antibodies against mismatched donor-specific human leukocyte antigens (HLA) are known to be associated with antibody-mediated rejection (AMR), posing increased risks of cardiac allograft vasculopathy (CAV), graft dysfunction, and graft loss after heart transplant (HTx). However, the impact of non-HLA antibodies on HTx outcome is not yet well defined. CASE DESCRIPTION Here we report a case of a pediatric patient, who was retransplanted after developing CAV in his first heart allograft. Five years post 2nd HTx, the patient presented with graft dysfunction and mild rejection (ACR 1R, AMR 1H, C4d Neg) in the cardiac biopsy in the absence of HLA donor-specific antibodies (DSAs). We detected strong antibodies against non-HLA antigens, including angiotensin II receptor type 1 (AT1R) and donor-specific MHC class I chain-related gene A (MICA), in the patient's serum that were implicated in the AMR and accelerated CAV of his second allograft, and likely played a role in the loss of his first allograft as well. CONCLUSION This case report underscores the clinical relevance of non-HLA antibodies in heart transplantation and highlights the value of incorporating these tests in the immunological risk assessment and post-transplant monitoring of HTx recipients.
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Has the Time Come for Widespread MHC Class I MICA Genotyping in Solid Organ Transplantation? Transplantation 2022; 106:2269-2270. [PMID: 36436096 DOI: 10.1097/tp.0000000000004338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Iacob S, Cicinnati V, Kabar I, Hüsing-Kabar A, Radtke A, Iacob R, Baba H, Schmidt HH, Paul A, Beckebaum S. Prediction of late allograft dysfunction following liver transplantation by immunological blood biomarkers. Transpl Immunol 2021; 69:101448. [PMID: 34391882 DOI: 10.1016/j.trim.2021.101448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND An accelerated course of hepatic fibrosis may occur in liver transplantation (LT) patients despite normal or slightly abnormal liver blood tests. AIM To identify screening tools based on blood biomarkers to predict late allograft dysfunction in LT recipients. METHODS 174 LT recipients were enrolled. Liver biopsy, liver functional tests, cytokine quantitation in serum, as well as soluble MHC class I polypeptide-related sequence A and B (sMICA/sMICB) and soluble UL16 binding protein 2 (sULBP2) were performed. RESULTS Patients with late graft dysfunction had a significantly higher donor age, lower albumin level, higher alanine (ALT) and aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), total bilirubin and alkaline phosphatase (ALP), higher sMICA, sULBP2, higher interleukin (IL) 6, interferon γ and lower IL10 in serum as compared to recipients without allograft dysfunction. In order to provide a better statistical accuracy for discriminating 5-year allograft dysfunction from other less progressive subtype of allograft injury, we established a predictive model, based on 7 parameters (serum ALP, ALT, AST, GGT, sMICA, IL6 and albumin) which provided an Area Under the Receiver Operating Characteristics (AUROC) curve of 0.905. CONCLUSIONS Blood-based biomarkers can significantly improve prediction of late liver allograft outcome in LT patients. The new developed score comprising serum parameters, with an excellent AUROC, can be reliably used for diagnosing late allograft dysfunction in transplanted patients.
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Affiliation(s)
- Speranta Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Vito Cicinnati
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, 48149 Muenster, Germany
| | - Iyad Kabar
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, 48149 Muenster, Germany
| | - Anna Hüsing-Kabar
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, 48149 Muenster, Germany
| | - Arnold Radtke
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, 72076 Tübingen, Germany
| | - Razvan Iacob
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Hideo Baba
- Institute for Pathology, University Hospital Essen, 45147 Essen, Germany
| | - Hartmut H Schmidt
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, 48149 Muenster, Germany
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, 45147 Essen, Germany
| | - Susanne Beckebaum
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, 48149 Muenster, Germany
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Lefaucheur C, Louis K, Philippe A, Loupy A, Coates PT. The emerging field of non-human leukocyte antigen antibodies in transplant medicine and beyond. Kidney Int 2021; 100:787-798. [PMID: 34186057 DOI: 10.1016/j.kint.2021.04.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/03/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
The major medical advances in our knowledge of the human leukocyte antigen (HLA) system have allowed us to uncover several gaps in our understanding of alloimmunity. Although the non-HLA system has long sparked the interest of the transplant community, recognition of the role of immunity to non-HLA antigenic targets has only emerged recently. In this review, we will provide a comprehensive summary of the paradigm-changing concept of immunity to the non-HLA angiotensin II type 1 receptor (AT1R), discovered by Duška Dragun et al., that began from careful bedside clinical observations, to validated detection of anti-AT1R antibodies and lead to clinical intervention. This scientific approach has also allowed the recognition of broader pathogenicity of anti-AT1R antibodies across multiple organ transplants and in other human diseases, the integration of both non-HLA and HLA systems to understand their immunologic effects on organ allografts, and the identification of future directions for therapeutic intervention to modulate immunity to AT1R. Rationally designed successful interventions to target AT1R system provide an exemplar for other non-HLA antibodies to cross borders between medical specialties, will generate new avenues in translational research beyond transplantation, and will foster the development of new and reliable tools to improve our understanding of non-HLA immunity and ultimately allow us to improve patient care.
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Affiliation(s)
- Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale UMR-S970, Université de Paris, Paris, France; Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Kevin Louis
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Human Immunology and Immunopathology, Institut National de la santé et de la recherche médicale UMR-976, Université de Paris, Paris, France
| | - Aurélie Philippe
- Department of Nephrology and Critical Care Medicine, Campus Virchow Klinikum, Berlin, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale UMR-S970, Université de Paris, Paris, France; Department of Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P Toby Coates
- Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia; Central Northern Adelaide Renal and Transplantation Service (CNARTS), The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Donor specific anti-HLA antibodies and cardiac allograft vasculopathy: A prospective study using highly automated 3-D optical coherence tomography analysis. Transpl Immunol 2020; 65:101340. [PMID: 33069814 DOI: 10.1016/j.trim.2020.101340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Recent studies suggested potential positive correlations between HLA-specific antibodies and development of cardiac allograft vasculopathy (CAV). METHODS This prospective two-center study investigated early progression of CAV by coronary optical coherence tomography in 1 month and 12 months after heart transplantation (HTx) in 104 patients. Detection and characterization of donor specific (DSA) and MHC class-I polypeptide-related sequence A (MICA) antibodies were performed before, 1, 6 and 12 months after transplantation. RESULTS During the first post-HTx year, we observed a significant reduction in the mean coronary luminal area (P < .001), and progression in mean intimal thickness (IT) (P < .001). DSA and anti-MICA occurred in 17% of all patients, but no significant relationship was observed between presence of DSA/anti-MICA and IT progression within 12 months after HTx. In contrast, we observed significant association between presence of DSA (p=0.031), de-novo DSA (p=0.031), HLA Class II DSA (p=0.017) and media thickness (MT) progression. CONCLUSION Results of our study did not identify a direct association between presence of DSA/anti-MICA and intimal thickness progression in an early period after HTx. However, we found significant relationships between DSA and media thickness progression that may identify a newly recognized immune-pathological aspect of CAV.
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Butler CL, Hickey MJ, Jiang N, Zheng Y, Gjertson D, Zhang Q, Rao P, Fishbein GA, Cadeiras M, Deng MC, Banchs HL, Torre G, DeNofrio D, Eisen HJ, Kobashigawa J, Starling RC, Kfoury A, Van Bakel A, Ewald G, Balazs I, Baas AS, Cruz D, Ardehali R, Biniwale R, Kwon M, Ardehali A, Nsair A, Ray B, Reed EF. Discovery of non-HLA antibodies associated with cardiac allograft rejection and development and validation of a non-HLA antigen multiplex panel: From bench to bedside. Am J Transplant 2020; 20:2768-2780. [PMID: 32185871 PMCID: PMC7494540 DOI: 10.1111/ajt.15863] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 01/25/2023]
Abstract
We analyzed humoral immune responses to nonhuman leukocyte antigen (HLA) after cardiac transplantation to identify antibodies associated with allograft rejection. Protein microarray identified 366 non-HLA antibodies (>1.5 fold, P < .5) from a discovery cohort of HLA antibody-negative, endothelial cell crossmatch-positive sera obtained from 12 cardiac allograft recipients at the time of biopsy-proven rejection. From these, 19 plasma membrane proteins and 10 autoantigens identified from gene ontology analysis were combined with 48 proteins identified through literature search to generate a multiplex bead array. Longitudinal sera from a multicenter cohort of adult cardiac allograft recipients (samples: n = 477 no rejection; n = 69 rejection) identified 18 non-HLA antibodies associated with rejection (P < .1) including 4 newly identified non-HLA antigenic targets (DEXI, EMCN, LPHN1, and SSB). CART analysis showed 5/18 non-HLA antibodies distinguished rejection vs nonrejection. Antibodies to 4/18 non-HLA antigens synergize with HLA donor-specific antibodies and significantly increase the odds of rejection (P < .1). The non-HLA panel was validated using an independent adult cardiac transplant cohort (n = 21 no rejection; n = 42 rejection, >1R) with an area under the curve of 0.87 (P < .05) with 92.86% sensitivity and 66.67% specificity. We conclude that multiplex bead array assessment of non-HLA antibodies identifies cardiac transplant recipients at risk of rejection.
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Affiliation(s)
- Carrie L. Butler
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Michelle J. Hickey
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Ying Zheng
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - David Gjertson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Qiuheng Zhang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ping Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Gregory A. Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Martin Cadeiras
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mario C. Deng
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Hector L. Banchs
- Cardiovascular Center of Puerto Rico and the Caribbean Transplant Program, Carolina, Puerto Rico
| | - Guillermo Torre
- Houston Methodist Hospital Research Institution, Houston, Texas
| | | | - Howard J. Eisen
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Adrian Van Bakel
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Gregory Ewald
- Department of Medicine, Washington University, St. Louis, Missouri
| | | | - Arnold S. Baas
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Daniel Cruz
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Reza Ardehali
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Reshma Biniwale
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Murray Kwon
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Abbas Ardehali
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Ali Nsair
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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10
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Abstract
Purpose of review Since the discovery of human leukocyte antigen (HLA) in the 1950s, there has been great interest in the role of antibodies in posttransplant rejection. The development of the lymphocyte toxicity test by Terasaki et al. in the 1960s was the first step toward understanding the role of antibodies in posttransplant rejection. Recent findings Subsequently, various organs have been transplanted and improving posttransplant outcomes have become a focus of research. In particular, methods to measure antibodies that affect posttransplant outcomes, including anti-HLA antibodies, and methods to desensitize patients from specific antibodies have been explored. One recent method for measuring antibodies is called the solid-phase assay, which uses purified HLA fixed to microbeads. This assay does not use donor lymphocytes and allows clinicians to test the reactivity of patient serum against a panel of antibodies. It has also enabled the identification of specific anti-HLA antibodies using a single HLA. Summary In addition to advances in methods to measure and analyze anti-HLA antibodies, the clinical impact of non-HLA antibodies has also received much attention recently.
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11
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Kobashigawa J, Colvin M, Potena L, Dragun D, Crespo-Leiro MG, Delgado JF, Olymbios M, Parameshwar J, Patel J, Reed E, Reinsmoen N, Rodriguez ER, Ross H, Starling RC, Tyan D, Urschel S, Zuckermann A. The management of antibodies in heart transplantation: An ISHLT consensus document. J Heart Lung Transplant 2018; 37:537-547. [PMID: 29452978 DOI: 10.1016/j.healun.2018.01.1291] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 01/18/2018] [Indexed: 12/19/2022] Open
Abstract
Despite the successes from refined peri-operative management techniques and immunosuppressive therapies, antibodies remain a serious cause of morbidity and mortality for patients both before and after heart transplantation. Patients awaiting transplant who possess antibodies against human leukocyte antigen are disadvantaged by having to wait longer to receive an organ from a suitably matched donor. The number of pre-sensitized patients has been increasing, a trend that is likely due to the increased use of mechanical circulatory support devices. Even patients who are not pre-sensitized can go on to produce donor-specific antibodies after transplant, which are associated with worse outcomes. The difficulty in managing antibodies is uncertainty over which antibodies are of clinical relevance, which patients to treat, and which treatments are most effective and safe. There is a distinct lack of data from prospective trials. An international consensus conference was organized and attended by 103 participants from 75 centers to debate contentious issues, determine the best practices, and formulate ideas for future research on antibodies. Prominent experts presented state-of-the-art talks on antibodies, which were followed by group discussions, and then, finally, a reconvened session to establish consensus where possible. Herein we address the discussion, consensus points, and research ideas.
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Affiliation(s)
- Jon Kobashigawa
- Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
| | - Monica Colvin
- Cardiovascular Division, University of Michigan, Ann Arbor, Michigan, USA
| | - Luciano Potena
- Department of Specialist, Diagnostic, and Experimental Medicine, Bologna University Hospital, Bologna, Italy
| | - Duska Dragun
- Center for Cardiovascular Research, Charité Universtätsmedizin, Berlin, Germany
| | - Maria G Crespo-Leiro
- Heart Failure and Heart Transplant Program, Hospital Universitario A Coruña, Coruña, Spain
| | - Juan F Delgado
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Michael Olymbios
- Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | - Jignesh Patel
- Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Elaine Reed
- UCLA Immunogenetics Center, Los Angeles, California, USA
| | - Nancy Reinsmoen
- Department of Immunology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - E Rene Rodriguez
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Heather Ross
- Ted Rogers Centre of Excellence in Heart Function, University of Toronto, Toronto, Ontario, Canada
| | - Randall C Starling
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dolly Tyan
- Department of Clinical Pathology, Stanford University Medical Center, Palo Alto, California, USA
| | - Simon Urschel
- Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Andreas Zuckermann
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
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12
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Chang DH, Kobashigawa JA. Current diagnostic and treatment strategies for cardiac allograft vasculopathy. Expert Rev Cardiovasc Ther 2016; 13:1147-54. [PMID: 26401922 DOI: 10.1586/14779072.2015.1087312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Heart transplantation remains the most durable treatment for end-stage heart disease that is not amenable to coronary revascularization or anti-arrhythmic therapies. Cardiac allograft vasculopathy (CAV) remains one of the main contributors to morbidity and mortality post heart transplant. Nonimmune and immune factors that influence CAV can be modified after a heart transplant. Given the potential silent nature of CAV in the denervated heart, early diagnosis of CAV is critical. Diagnosis and treatment of CAV remain key areas of investigation to improve patient care and quality of life post heart transplant. While repeat heart transplantation is an option in the treatment of significant CAV, outcomes following retransplantation are inferior to outcomes following first heart transplant. Repeat heart transplantation is limited to a select group of patients after index heart transplant.
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Affiliation(s)
- David H Chang
- a Cedars- Sinai Heart Institute, Los Angeles 90211, USA
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13
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sMICA as novel and early predictors for acute myocardial infarction. Eur J Med Res 2016; 21:25. [PMID: 27306684 PMCID: PMC4910230 DOI: 10.1186/s40001-016-0220-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS MHC class I polypeptide-related chain A (MICA) molecule is induced in response to viral infection, various types of stress, such as endoplasmic reticulum stress, and ischemia or/and reperfusion, by which MICA was shed from the cell surface into the extracellular domain, generating a soluble form (sMICA). In the present study, we designed to investigate the serum sMICA level in patients with AMI and determine whether sMICA could be an early biomarker for diagnosis of AMI. METHODS There were 103 patients who presented with first-time AMI that was assessed after the incident. The control group consisted of 103 healthy volunteers. Serum levels of sMICA and Troponin T were detected by the specific ELISA kits. RESULTS Serum levels of sMICA reach the peaks [(1.34 ± .18 and 1.72 ± .20)n/l] at 6-12 h and serum levels of cTnT reach the peaks [(1.16 ± .28 and 1.14 ± .34)n/l] at 12-24 h. Both of them were significantly higher than the healthy controls [(.168 ± .014) n/l, p = .000] for sMICA and [(.13 ± .06) n/l, p = .000] for Troponin T (cTnT). sMICA is more sensitive in the early diagnosis of AMI than cTnT. The combined ROC analysis revealed an AUC value of .78 (95 % CI .69-.83) in discriminating AMI patients from healthy controls. CONCLUSIONS We have detected high levels of sMICA in patients with AMI. Elevated serum sMICA may be a novel biomarker for the early detection of myocardial injury in humans.
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14
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Abstract
Human and mouse NKG2D ligands (NKG2DLs) are absent or only poorly expressed by most normal cells but are upregulated by cell stress, hence, alerting the immune system in case of malignancy or infection. Although these ligands are numerous and highly variable (at genetic, genomic, structural, and biochemical levels), they all belong to the major histocompatibility complex class I gene superfamily and bind to a single, invariant, receptor: NKG2D. NKG2D (CD314) is an activating receptor expressed on NK cells and subsets of T cells that have a key role in the recognition and lysis of infected and tumor cells. Here, we review the molecular diversity of NKG2DLs, discuss the increasing appreciation of their roles in a variety of medical conditions, and propose several explanations for the evolutionary force(s) that seem to drive the multiplicity and diversity of NKG2DLs while maintaining their interaction with a single invariant receptor.
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Affiliation(s)
- Raphael Carapito
- ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire International Associé (LIA) INSERM, Strasbourg (France) - Nagano (Japan), Strasbourg, France.,Fédération Hospitalo-Universitaire (FHU) OMICARE, Strasbourg, France
| | - Seiamak Bahram
- ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Laboratoire International Associé (LIA) INSERM, Strasbourg (France) - Nagano (Japan), Strasbourg, France.,Fédération Hospitalo-Universitaire (FHU) OMICARE, Strasbourg, France.,Laboratoire Central d'Immunologie, Pôle de Biologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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15
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Crespo-Leiro MG, Barge-Caballero E, Paniagua-Martin MJ, Barge-Caballero G, Suarez-Fuentetaja N. Update on Immune Monitoring in Heart Transplantation. CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-015-0081-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Svobodova E, Gazdic T, Kubanek M, Vymetalova J, Voska L, Kment M, Lanska V, Kolesar L, Urban M, Netuka I, Pirk J, Melenovsky V, Kautzner J, Slavcev A, Malek I. Novel insights into pretransplant allosensitization in heart transplant recipients in the contemporary era of immunosuppression and rejection surveillance. Transpl Int 2015; 29:63-72. [DOI: 10.1111/tri.12684] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/03/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Eva Svobodova
- Department of Immunogenetics; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Tomas Gazdic
- Department of Cardiac Surgery; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Milos Kubanek
- Department of Cardiology; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Jevgenija Vymetalova
- Department of Cardiology; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Ludek Voska
- Department of Pathology; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Martin Kment
- Department of Pathology; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Vera Lanska
- Department of Biostatistics; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Libor Kolesar
- Department of Immunogenetics; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Marian Urban
- Department of Cardiac Surgery; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Ivan Netuka
- Department of Cardiac Surgery; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Jan Pirk
- Department of Cardiac Surgery; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Josef Kautzner
- Department of Cardiology; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Antonij Slavcev
- Department of Immunogenetics; Institute for Clinical and Experimental Medicine; Prague Czech Republic
| | - Ivan Malek
- Department of Cardiology; Institute for Clinical and Experimental Medicine; Prague Czech Republic
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17
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Chang DH, Kittleson MM, Kobashigawa JA. Immunosuppression following heart transplantation: prospects and challenges. Immunotherapy 2014; 6:181-94. [PMID: 24491091 DOI: 10.2217/imt.13.163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Immunosuppression after heart transplantation has significantly reduced the incidence of cellular rejection and improved patient outcomes with the routine use of calcineurin inhibitors. Antimetabolites and proliferation signal inhibitors add to the improvement in patient outcomes, particularly with respect to the reduced burden of cardiac allograft vasculopathy. Patients with antibody sensitization are potentially at higher risk of postoperative complications. Sensitized patients are undergoing heart transplantation with increased frequency, in part due to the emergence of ventricular assist device use as a bridge to heart transplantation. Despite improvements in immunosuppressive therapies, many challenges face physicians and patients, which will further refine and improve care of the post-heart transplant patient.
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Affiliation(s)
- David H Chang
- Cedars Sinai Heart Institute, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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18
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Deutsch MA, Lange R, Hagl C, Kaczmarek I. Ethnic diversity and immunological barriers in heart transplantation. J Am Coll Cardiol 2014; 63:2171. [PMID: 24657692 DOI: 10.1016/j.jacc.2013.10.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/01/2013] [Indexed: 11/17/2022]
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19
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Abstract
Although great progress has been achieved in thoracic organ transplantation through the development of effective immunosuppression, there is still significant risk of rejection during the early post-transplant period, creating a need for routine monitoring for both acute antibody and cellular mediated rejection. The currently available multiplexed, microbead assays utilizing solubilized HLA antigens afford the capability of sensitive detection and identification of HLA and non-HLA specific antibodies. These assays are being used to assess the relative strength of donor specific antibodies; to permit performance of virtual crossmatches which can reduce the waiting time to transplantation; to monitor antibody levels during desensitization; and for heart transplants to monitor antibodies post-transplant. For cell mediated immune responses, the recent development of gene expression profiling has allowed noninvasive monitoring of heart transplant recipients yielding predictive values for acute cellular rejection. T cell immune monitoring in heart and lung transplant recipients has allowed individual tailoring of immunosuppression, particularly to minimize risk of infection. While the current antibody and cellular laboratory techniques have enhanced the ability to manage thoracic organ transplant recipients, future developments from improved understanding of microchimerism and graft tolerance may allow more refined allograft monitoring techniques.
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20
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Sigdel TK, Gao X, Sarwal MM. Protein and peptide biomarkers in organ transplantation. Biomark Med 2012; 6:259-71. [PMID: 22731899 DOI: 10.2217/bmm.12.29] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Organ transplantation is the optimal treatment choice for end-stage organ failure in pediatric patients. The ideal maintenance of a transplanted organ requires efficient monitoring tools and an effective individualized post-transplant treatment plan. Currently available post-transplant monitoring options are not ideal because of their invasiveness or their lack of sensitivity and specificity when providing an accurate assessment of transplant injury. Current research on proteins and peptides, including mass spectrometry-based proteomics, can identify novel surrogate protein and peptide biomarkers that can assist in monitoring the graft in order to correctly assess the status of the transplanted organ. In this article, we have critically reviewed current relevant literature to highlight the importance of protein and peptide biomarkers in the field of pediatric organ transplantation, the status of research findings in the field of protein and peptide biomarkers in different organ transplantation and factors that impact and inhibit the progression of protein biomarker discovery in the field of solid-organ transplantation in pediatrics.
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Affiliation(s)
- Tara K Sigdel
- California Pacific Medical Center - Research Institute, San Francisco, USA.
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21
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Detrait M, Dubois V, Sobh M, Morisset S, Tedone N, Labussière H, Gillis L, Barraco F, Cannas G, Ducastelle S, Fatoum J, Thomas X, Chelgoum Y, Nicolini FE, Michallet M. Impact of anti-HLA antibodies on allogeneic hematopoietic stem cell transplantation outcomes after reduced-intensity conditioning regimens. Exp Hematol 2012; 40:792-9. [PMID: 22705505 DOI: 10.1016/j.exphem.2012.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/04/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Abstract
Anti-human leukocyte antigen (HLA) antibodies are associated with several complications in solid organ transplantations, but their impact after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not yet well defined. To evaluate the relevance of anti-HLA antibodies, we have retrospectively analyzed 107 peripheral blood allo-HSCTs after reduced-intensity conditioning regimen between 2005 and 2010. Acute myeloid leukemia and multiple myeloma were the most frequent malignancies in the cohort. The detection of anti-HLA antibodies was systematically performed in all patients before transplantation. Anti-HLA antibodies were present in 24 patients (22%). There was no significant impact of anti-HLA antibodies on engraftment, incidence of relapse, and incidence of acute graft-vs-host disease. The presence of anti-HLA antibodies was associated with significantly worse overall survival (p = 0.006) and event-free survival (p = 0.024) after stratification on sex. The 3-year probability of overall survival was 34% without anti-HLA antibodies and 16% in their presence. Patients with anti-HLA antibodies had a higher transplant-related mortality associated with life-threatening vascular complications. Our study supports that anti-HLA antibodies should be tested and considered as an important impacting factor for transplantation outcomes after reduced-intensity conditioning allo-HSCT. We recommend its consideration before allo-HSCT in the donor-recipient selection parameters.
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Affiliation(s)
- Marie Detrait
- Blood and Marrow Transplant Unit, Department of Hematology, Centre Hospitalier Lyon Sud, University of Lyon, Lyon, France
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22
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Braga JR, Santos ISO, McDonald M, Shah PS, Ross HJ. Factors associated with the development of cardiac allograft vasculopathy - a systematic review of observational studies. Clin Transplant 2011; 26:E111-24. [DOI: 10.1111/j.1399-0012.2011.01565.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Acevedo MJ, Caro-Oleas JL, Álvarez-Márquez AJ, Sobrino JM, Lage-Gallé E, Aguilera I, Núñez-Roldán A. Antibodies against heterogeneous nuclear ribonucleoprotein K in patients with cardiac allograft vasculopathy. J Heart Lung Transplant 2011; 30:1051-9. [DOI: 10.1016/j.healun.2011.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/14/2010] [Accepted: 02/11/2011] [Indexed: 11/28/2022] Open
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24
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Naemi FMA, Ali S, Kirby JA. Antibody-mediated allograft rejection: the emerging role of endothelial cell signalling and transcription factors. Transpl Immunol 2011; 25:96-103. [PMID: 21782944 DOI: 10.1016/j.trim.2011.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/08/2011] [Accepted: 07/08/2011] [Indexed: 10/18/2022]
Abstract
The presence of antibodies against class I human leukocyte antigens (HLA) can cause the development of chronic allograft rejection. Although endothelial cell activation has been identified as a main effector, the mechanisms mediating this process are not fully understood. Exposure of endothelium to antibodies against HLA antigens induces cell activation which promotes rejection. This activation process can be divided into two phases: an early response in which intracellular signalling proteins and transcription factors are activated, and a later change in protein expression and cell function. In this review, antibody-mediated endothelial signalling and the role of transcription factors in organ transplantation will be described with a particular focus on their potential to mediate some of the graft-damaging effects of anti-HLA class I antibodies.
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Affiliation(s)
- Fatmah M A Naemi
- Applied Immunobiology and Transplantation Research Group, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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25
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A role for antibodies to human leukocyte antigens, collagen-V, and K-α1-Tubulin in antibody-mediated rejection and cardiac allograft vasculopathy. Transplantation 2011; 91:1036-43. [PMID: 21383658 DOI: 10.1097/tp.0b013e318211d2f4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We determined the role of donor-specific antibodies (DSA) and antibodies (Abs) to self-antigens, collagen-V (Col-V), and K-α1-Tubulin (KAT) in pathogenesis of acute antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV) after human heart transplantation (HTx). METHODS One hundred thirty-seven HTx recipients, with 60 early period (≤ 12 months) and 77 late period (>12 months), were enrolled in this study. Circulating DSA was determined using LUMINEX. Abs against Col-I, II, IV, V, and KAT were measured using ELISA. Frequency of CD4+T helper cells (CD4+Th) secreting interferon (IFN)-γ, interleukin (IL)-5, -10, or -17 specific to self-antigens were determined using Enzyme Linked Immunosorbent Spot assay. RESULTS A significant association between AMR and DSA was demonstrated. Development of DSA in AMR patients correlated well with the development of auto-Abs to Col-V (AMR[+]: 383 ± 72 μg/mL, AMR[-]: 172 ± 49 μg/mL, P=0.033) and KAT (AMR[+]: 252 ± 49 μg/mL, AMR[-]: 61 ± 21 μg/mL, P=0.014). Patients who developed AMR demonstrated increased frequencies of CD4+Th secreting IFN-γ and IL-5 with reduction in IL-10 specific for Col-V/KAT. Patients diagnosed with CAV also developed DSA and auto-Abs to Col-V (CAV[+]: 835 ± 142 μg/mL, CAV[-]: 242 ± 68 μg/mL, P=0.025) and KAT (CAV[+]: 768 ± 206 μg/mL, CAV[-]: 196 ± 72 μg/mL, P=0.001) with increased frequencies of CD4+Th secreting IL-17 with reduction in IL-10 specific for Col-V/KAT. CONCLUSIONS.: Development of Abs to human leukocyte antigens and self-antigens are associated with increases in CD4+Th secreting IFN-γ and IL-5 in AMR and IL-17 in CAV, with reduction in CD4+Th secreting IL-10 in both AMR and CAV.
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26
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Eng HS, Leffell MS. Histocompatibility testing after fifty years of transplantation. J Immunol Methods 2011; 369:1-21. [DOI: 10.1016/j.jim.2011.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 03/31/2011] [Accepted: 04/11/2011] [Indexed: 01/02/2023]
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27
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Lu J, Luo L, Guo Y, Long D, Wei L, Shan J, Feng L, Li S, Yang X, Lu Y, Krams S, Li Y. The effect of MICA antigens on transplant outcomes: a systematic review. J Evid Based Med 2011; 4:106-21. [PMID: 23672701 DOI: 10.1111/j.1756-5391.2011.01125.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Human major histocompatibility complex class I-related gene A (MICA) is reportedly associated with poor transplant outcomes and a high risk of acute and chronic rejection in solid organ transplantation. However, studies on these risks have found conflicting results. In order to identify areas in which additional research is needed, we have undertaken the first systematic review of evidence concerning the risk of anti-MICA antibodies in recipients' sera. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for original reports of clinical studies involving detection of MICA abs in transplant recipients' sera which used survival rate, acute rejection, and/or chronic rejection as outcome measures. RevMan 5.0.15 was used to calculate relative risk (RR), odds ratios (ORs), and 95% confidence intervals (95%CIs). RESULTS We found 18 relevant articles, with a total of 6,607 recipients. Follow-up duration ranged from 1 to 15 years. In studies with more than 2 years of follow-up, anti-MICA abs positive in kidney recipients' post-transplant sera was associated with a lower graft survival rate (4 years: RR = 2.04, 95%CI 1.30 to 3.22; 3 years: OR = 3.56, 95%CI 1.47 to 8.62; 2 years: RR = 2.17, 95%CI 1.09 to 4.31) and a higher acute rejection rate (RR = 1.92, 95%CI 1.27 to 2.91), but there was no clear association with chronic rejection. Similar conclusions could not be drawn for heart or liver transplantation due to possible confounding by anti-HLA abs and the small sample sizes of the available studies. CONCLUSION Anti-MICA antibodies in recipients' sera may associated with poor graft survival rates and high risk of acute and chronic rejection in solid organ transplantation, but more rigorous studies are needed to confirm or refute this relationship. Current immunosuppressive therapy may fail to suppress the harmful effect of MICA antigens.
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Affiliation(s)
- Jun Lu
- Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
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28
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Joshi M, Dindelegan G, Olausson M, Oltean M. Natural killer group 2 member D cell recruitment driven by major histocompatibility complex class I chain-related antigens A and B: a possible mechanism during acute intestinal allograft rejection in the mouse. Transplant Proc 2011; 42:4467-9. [PMID: 21168719 DOI: 10.1016/j.transproceed.2010.09.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intestinal allograft rejection occurs frequently despite potent T-cell depletion protocols. We investigated the interaction of major histocompatibility complex class I chain-related antigens A and B (MICA/B; a ligand for natural killer [NK] cells) and NK group 2 member D (NKG2D) cells as an alternative mechanism for acute rejection (AR) of the intestinal graft. Heterotopic intestinal allotransplantation was performed from BalbC to C57Bl mice. Samples of grafted and native intestine were obtained at days 1, 3, 6, and 8 after transplantation (n = 4-6). We performed immunostaining for MICA/B and NKG2D. Moderate AR with increased crypt apoptosis was observed at day 6 and advanced AR with crypt destruction and mucosal sloughing was present by day 8. Low MICA/B levels were observed in grafted and native intestines on day 1. MICA/B expression gradually increased in the grafts during AR but not in the native intestines. The up-regulation was found mostly in the crypts. NKG2D+ cell counts that increased in the graft colocalized with MICA/B. The increase was most prominent in the crypt and villus. Together, these results suggest that MICA/B up-regulation and its subsequent interaction with the NK cells may represent an important link between innate and adaptive immune responses early after intestinal transplantation.
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Affiliation(s)
- M Joshi
- Department of Surgery, Transplantation Biology Laboratory, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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Abstract
PURPOSE OF REVIEW The proportion of heart transplant candidates who are allosensitized has increased over time. Advances in tissue typing and immunosuppression have improved the rate of successful transplant in this challenging population. Recently published data regarding contemporary approaches to desensitization prior to and immunosuppression following transplant are summarized. RECENT FINDINGS Continued progress in measurement and characterization of antibodies and strategies to abrogate antibody production both prior to and following heart transplant have been encouraging. Updates on the role of non-human leukocyte antigen antibodies and the impact of mechanical circulatory support on allosensitization are provided. Data on current desensitization strategies, including the increasing use of monoclonal antibodies, are provided and the potential role of complement inhibitors will be reviewed. Increasing experience with potent novel agents is likely to provide the opportunity to improve transplant outcomes for highly sensitized patients. SUMMARY Although allosensitized heart transplant candidates remain a management challenge, excellent outcomes can be achieved with contemporary approaches. Advances in the understanding of B-cell biology are anticipated to further broaden options and improve outcomes.
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Diagnosis of antibody-mediated rejection in cardiac transplantation: a call for standardization. Curr Opin Organ Transplant 2010; 15:769-73. [DOI: 10.1097/mot.0b013e32834016e4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Donor-specific antibodies to human leukocyte antigens are associated with and precede antibodies to major histocompatibility complex class I-related chain A in antibody-mediated rejection and cardiac allograft vasculopathy after human cardiac transplantation. Hum Immunol 2010; 71:1191-6. [PMID: 20868717 DOI: 10.1016/j.humimm.2010.09.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/17/2010] [Accepted: 09/16/2010] [Indexed: 11/24/2022]
Abstract
Humoral immune responses to mismatched donor human leukocyte antigen (HLA) and major histocompatibility complex (MHC) class I-related chain A (MICA) have been reported to contribute to immunopathogenesis of antibody-mediated rejection (AMR) in the early period and cardiac allograft vasculopathy (CAV) in the late period after cardiac transplantation (HTx). The goal of this study is to define the roles of donor-specific antibodies (DSA) and anti-MICA in AMR and CAV. A total of 95 post-HTx recipients were enrolled; 43 patients in the early period (≤ 12 months post-HTx) and 52 patients in the late period (>12 months post-HTx). Development of DSA and anti-MICA were serially monitored using Luminex. Development of DSA (AMR+: n = 6/8.75%, AMR-: n = 4/35.11%, p = 0.009) and anti-MICA (AMR+: n = 5/8.63%, AMR-: n = 4/35.11%, p = 0.002) was significantly associated with AMR. AMR+DSA+ patients demonstrated increased anti-MICA levels compared with AMR+DSA- patients (p=0.01). Serial monitoring revealed DSA (2.7 ± 1.4 months) preceded development of anti-MICA (6.5 ± 2.1 months) in recipients diagnosed with AMR at 8.3 ± 2.5 months post-HTx. Development of DSA (CAV+: n = 8/12.67%, CAV-: n = 5/40.13%, p = 0.004) and anti-MICA (CAV+: n = 9/12.75%, CAV-: n = 5/40.13%, p = 0.001) was significantly associated with CAV. CAV+DSA+ patients demonstrated increased anti-MICA levels compared with CAV+DSA- patients (p = 0.01). Antibodies to HLA are associated with and precede development of anti-MICA in AMR and CAV. Therefore, DSA and anti-MICA can be used as noninvasive markers for monitoring AMR and CAV.
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Pavlova YA, Malek I, Honsova E, Netuka I, Sochman J, Lodererova A, Kolesar L, Striz I, Skibova J, Slavcev A. Hepatocyte growth factor and antibodies to HLA and MICA antigens in heart transplant recipients. ACTA ACUST UNITED AC 2010; 76:380-6. [DOI: 10.1111/j.1399-0039.2010.01523.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Angaswamy N, Saini D, Ramachandran S, Nath DS, Phelan D, Hachem R, Trulock E, Patterson GA, Mohanakumar T. Development of antibodies to human leukocyte antigen precedes development of antibodies to major histocompatibility class I-related chain A and are significantly associated with development of chronic rejection after human lung transplantation. Hum Immunol 2010; 71:560-5. [PMID: 20211214 DOI: 10.1016/j.humimm.2010.02.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 02/09/2010] [Accepted: 02/18/2010] [Indexed: 01/06/2023]
Abstract
The development of antibodies (Abs) to major histocompatibility (MHC) class I-related chain A (MICA) and human leukocyte antigen (HLA) and their role in the immunopathogenesis of chronic rejection (bronchiolitis obliterans syndrome [BOS]) after human lung transplantation (LTx) was analyzed. Sera from 80 LTx recipients were analyzed for anti-MICA and anti-HLA Abs using Luminex and flow PRA (panel reactive assay). Development of Abs either to MICA alone or MICA and HLA together significantly correlated (p < 0.01) with development of BOS. Kinetic analysis in the post-LTx period revealed that development of anti-HLA Abs (7.6 +/- 4.7 months) preceded the development of anti-MICA Abs (10.0 +/- 3.5 months). Abs to MICA alleles (*001 and *009) developed approximately 6 months after LTx and peak titers were present at the time of clinical diagnosis of BOS (16.3 +/- 2.7 months). The development of Abs to both MICA and HLA was strongly associated with the development of BOS thereby suggesting a synergistic effect. Furthermore, immune response to mismatched HLA can lead to development of Abs to other MHC related antigens expressed on the airway epithelial cells. Cumulatively, these immune responses contribute to the pathogenesis of chronic rejection following human LTx.
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Affiliation(s)
- Nataraju Angaswamy
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Antihuman leukocyte antigen antibody-induced autoimmunity: role in chronic rejection. Curr Opin Organ Transplant 2010; 15:16-20. [PMID: 19898237 DOI: 10.1097/mot.0b013e3283342780] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW We provide evidence for the role of de-novo development of immune responses to self-antigens in the posttransplant period and its possible induction by alloimmunity in the pathogenesis of chronic rejection following lung, heart and kidney transplantation. The present review details recent findings for the two distinct yet interdependent immune processes in the immunopathogenesis of chronic rejection. RECENT FINDINGS The contribution of both humoral and cell-mediated alloimmune responses against mismatched donor histocompatibility antigens (HLA) in the pathogenesis of chronic rejection is well established. Recent studies have focused on development of immune responses to self-antigens during the posttransplant period and its correlation with chronic rejection. These self-antigens include myosin and vimentin in cardiac, K-alpha-1-tubulin and collagen-V in lung and angiotensin II type 1 receptor, collagen-IV and VI in kidney transplants. During the posttransplant period, the development of immune responses to self-antigens is facilitated by induction of a distinct subset of autoreactive T-helper cells referred to as Th17 cells. SUMMARY Following organ transplantation, tissue injury and remodeling inflicted by antibodies (Abs) to HLA antigens is conducive to develop autoimmunity. Abs to HLA and self-antigens are detectable in the serum of transplant recipients who develop chronic rejection. Anti-HLA Abs are often present transiently but precede the development of Abs to self-antigens.
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