1
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Wang Y, Peng X. Bioinformatics analysis characterizes immune infiltration landscape and identifies potential blood biomarkers for heart transplantation. Transpl Immunol 2024; 84:102036. [PMID: 38499050 DOI: 10.1016/j.trim.2024.102036] [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: 12/04/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Cardiac allograft rejection (AR) remains a significant complication following heart transplantation. The primary objective of our study is to gain a comprehensive understanding of the fundamental mechanisms involved in AR and identify possible therapeutic targets. METHODS We acquired the GSE87301 dataset from the Gene Expression Omnibus database. In GSE87301, a comparison was conducted on blood samples from patients with and without cardiac allograft rejection (AR and NAR) to detect differentially expressed genes (DEGs). Enrichment analysis was conducted to identify the pathways that show significant enrichment during AR. Machine learning techniques, including the least absolute shrinkage and selection operator regression (LASSO) and random forest (RF) algorithms, were employed to identify potential genes for the diagnosis of AR. The diagnostic value was evaluated using a nomogram and receiver operating characteristic (ROC) curve. Additionally, immune cell infiltration was analyzed to explore any dysregulation of immune cells in AR. RESULTS A total of 114 DEGs were identified from the GSE87301 dataset. These DEGs were mainly found to be enriched in pathways related to the immune system. To identify the signature genes, the LASSO and RF algorithms were used, and four genes, namely ALAS2, HBD, EPB42, and FECH, were identified. The performance of these signature genes was evaluated using the receiver operating characteristic curve (ROC) analysis, which showed that the area under the curve (AUC) values for ALAS2, HBD, EPB42, and FECH were 0.906, 0.881, 0.900, and 0.856, respectively. These findings were further confirmed in the independent datasets and clinical samples. The selection of these specific genes was made to construct a nomogram, which demonstrated excellent diagnostic ability. Additionally, the results of the single-sample gene set enrichment analysis (ssGSEA) revealed that these genes may be involved in immune cell infiltration. CONCLUSION We identified four signature genes (ALAS2, HBD, EPB42, and FECH) as potential peripheral blood diagnostic candidates for AR diagnosis. Additionally, a nomogram was constructed to aid in the diagnosis of heart transplantation. This study offers valuable insights into the identification of candidate genes for heart transplantation using peripheral blood samples.
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Affiliation(s)
- Yujia Wang
- Queen Mary College of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiaoping Peng
- Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
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2
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Lynch CA, Guo Y, Mei A, Kreisel D, Gelman AE, Jacobsen EA, Krupnick AS. Solving the Conundrum of Eosinophils in Alloimmunity. Transplantation 2022; 106:1538-1547. [PMID: 34966103 PMCID: PMC9234098 DOI: 10.1097/tp.0000000000004030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eosinophils are bone-marrow-derived granulocytes known for their ability to facilitate clearance of parasitic infections and their association with asthma and other inflammatory diseases. The purpose of this review is to discuss the currently available human observational and animal experimental data linking eosinophils to the immunologic response in solid organ transplantation. First, we present observational human studies that demonstrate a link between transplantation and eosinophils yet were unable to define the exact role of this cell population. Next, we describe published experimental models and demonstrate a defined mechanistic role of eosinophils in downregulating the alloimmune response to murine lung transplants. The overall summary of this data suggests that further studies are needed to define the role of eosinophils in multiple solid organ allografts and points to the possibility of manipulating this cell population to improve graft survival.
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Affiliation(s)
- Cherie Alissa Lynch
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona
| | - Yizhan Guo
- Department of Surgery, University of Maryland, Baltimore Maryland
| | - Alex Mei
- Department of Surgery, University of Maryland, Baltimore Maryland
| | | | | | - Elizabeth A. Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona
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3
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Onyema OO, Guo Y, Hata A, Kreisel D, Gelman AE, Jacobsen EA, Krupnick AS. Deciphering the role of eosinophils in solid organ transplantation. Am J Transplant 2020; 20:924-930. [PMID: 31647606 PMCID: PMC7842192 DOI: 10.1111/ajt.15660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 01/25/2023]
Abstract
Eosinophils are rare granulocytes that belong to the innate arm of the immune system. This cell population is traditionally defined as a destructive and cytotoxic mediator in asthma and helminth infection. Limited data in transplantation have suggested that eosinophils play a similar role in potentiating deleterious organ inflammation and immunologic rejection. Contrary to this long-held notion, recent data have uncovered the possibility that eosinophils play an alternative role in immune homeostasis, defense against a wide range of pathogens, as well as downregulation of deleterious inflammation. Specifically, translational data from small animal models of lung transplantation have demonstrated a critical role for eosinophils in the downregulation of alloimmunity. These findings shed new light on the unique immunologic features of the lung allograft and demonstrate that environmental polarization may alter the phenotype and function of leukocyte populations previously thought to be static in nature. In this review, we provide an update on eosinophils in the homeostasis of the lung as well as other solid organs.
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Affiliation(s)
- Oscar Okwudiri Onyema
- Department of Surgery, Carter Center for Immunology, University of Virginia, Charlottesville, Virginia, USA
| | - Yizhan Guo
- Department of Surgery, Carter Center for Immunology, University of Virginia, Charlottesville, Virginia, USA
| | - Atsushi Hata
- Department of Surgery, Carter Center for Immunology, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel Kreisel
- Department of Surgery, Washington University in St Louis, Missouri, USA
| | - Andrew E. Gelman
- Department of Surgery, Washington University in St Louis, Missouri, USA
| | - Elizabeth A. Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Alexander Sasha Krupnick
- Department of Surgery, Carter Center for Immunology, University of Virginia, Charlottesville, Virginia, USA
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4
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Ryu JH, Ko HJ, Shim JR, Lee TB, Yang KH, Lee JH, Lee HJ, Kim T, Choi BH. Eosinophil-to-monocyte ratio is an excellent predictor of acute cellular rejection in pancreas transplant alone recipients. Clin Transplant 2020; 34:e13785. [PMID: 31957063 DOI: 10.1111/ctr.13785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/20/2019] [Accepted: 01/07/2020] [Indexed: 01/23/2023]
Abstract
Serum pancreatic enzymes (serum amylase and lipase) are sensitive markers for monitoring acute rejection in pancreatic transplant recipients. However, those enzymes are not specific, as their levels are elevated in other conditions. We evaluated the eosinophil-to-monocyte ratio (EMR) in peripheral blood as a biomarker of acute rejection in the clinical setting in recipients of pancreatic transplant alone. We performed 32 cases of pancreatic transplantation alone since 2015. Nine patients were diagnosed with rejection. Serum amylase and lipase levels and eosinophil and monocytes counts were analyzed and compared retrospectively between the non-rejection and rejection groups. The serum eosinophil count, eosinophil fraction of the complete blood count, and serum amylase and lipase levels were significant predictors of rejection according to the receiver operation characteristic (ROC) curve. However, the EMR was the best indicator of rejection based on the ROC curve (area under the curve 0.918, sensitivity 100%, specificity 76.2% at the cutoff value 0.80, P < .001). The combination of EMR and the lipase level had 100% sensitivity and 90.5% specificity. The EMR is a simple and excellent predictor of acute rejection in recipients of pancreatic transplant alone.
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Affiliation(s)
- Je Ho Ryu
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyo Jung Ko
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Ryong Shim
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Beom Lee
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kwang Ho Yang
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jung Hee Lee
- Department of Pathology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Ji Lee
- Department of Laboratory medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Taeun Kim
- Department of Radiology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung Hyun Choi
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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5
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Nasser NH, Simri MM, Bishara NK, Habib MG, Nasir NN. Children with heart transplants: Lessons learned from 774 visits at a primary community clinic. Pediatr Transplant 2020; 24:e13617. [PMID: 31880042 DOI: 10.1111/petr.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 10/05/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
Abstract
Aims Unexpected decompensation of PHTRs may surprise, when the patient is at home. If the PHTR lives a distance from transplant center, the task of identifying risk factors of allograft rejection/dysfunction falls primarily on the PCP in the PCC, whether or not they are knowledgeable toward pediatric heart-transplantation. Methods We reviewed the medical reports of three heart-transplanted children in our periphery clinic between the years 2005 and 2019. Results The unexpected death of one patient, hours after he left our health facility, was the impetus for writing this article. Another heart transplant child attended our periphery clinic for 774 visits. Majority of visits were casual, others were scheduled, and the rest were for administrative affairs. We referred the PHTR to the transplantation center in 9% of all visits. In remaining 91% visits, we handled problems locally. Conclusions One of the important lessons we have learned through handling the PHTR at the PCC is that, during daily workflows and dealing with the occasional visits of a heart transplant child, related critical clinical information to allograft rejection or its dysfunction can easily evade from awareness of the attending physician. Through this study, we demonstrated that a program of summoning the PHTR to "initiated monthly visits" at the PCC enables the PCP to be maximally aware of critical clinical information, in addition to limiting futile referrals of 91% of the visits to specialized centers, without adversely affecting the prognosis.
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Affiliation(s)
- Nadim H Nasser
- Clalit Health Organization, Haifa, Israel.,Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | | | | | - Mona G Habib
- A Pediatric Neurologist at Pediatric Neurology Unit, Rambam Medical Center, Haifa, Israel
| | - Nadir N Nasir
- General Surgery Department, Ulm University Hospital, Ulm, Germany
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6
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Onyema OO, Guo Y, Mahgoub B, Wang Q, Manafi A, Mei Z, Banerjee A, Li D, Stoler MH, Zaidi MT, Schrum AG, Kreisel D, Gelman AE, Jacobsen EA, Krupnick AS. Eosinophils downregulate lung alloimmunity by decreasing TCR signal transduction. JCI Insight 2019; 4:128241. [PMID: 31167966 DOI: 10.1172/jci.insight.128241] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Despite the accepted notion that granulocytes play a universally destructive role in organ and tissue grafts, it has been recently described that eosinophils can facilitate immunosuppression-mediated acceptance of murine lung allografts. The mechanism of eosinophil-mediated tolerance, or their role in regulating alloimmune responses in the absence of immunosuppression, remains unknown. Using lung transplants in a fully MHC-mismatched BALB/c (H2d) to C57BL/6 (H2b) strain combination, we demonstrate that eosinophils downregulate T cell-mediated immune responses and play a tolerogenic role even in the absence of immunosuppression. We further show that such downregulation depends on PD-L1/PD-1-mediated synapse formation between eosinophils and T cells. We also demonstrate that eosinophils suppress T lymphocyte responses through the inhibition of T cell receptor/CD3 (TCR/CD3) subunit association and signal transduction in an inducible NOS-dependent manner. Increasing local eosinophil concentration, through administration of intratracheal eotaxin and IL-5, can ameliorate alloimmune responses in the lung allograft. Thus, our data indicate that eosinophil mobilization may be utilized as a novel means of lung allograft-specific immunosuppression.
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Affiliation(s)
| | - Yizhan Guo
- Department of Surgery, Carter Center for Immunology, and
| | - Bayan Mahgoub
- Department of Surgery, Carter Center for Immunology, and
| | - Qing Wang
- Department of Surgery, Carter Center for Immunology, and
| | - Amir Manafi
- Department of Surgery, Carter Center for Immunology, and
| | - Zhongcheng Mei
- Department of Surgery, Carter Center for Immunology, and
| | | | - Dongge Li
- Department of Surgery, Carter Center for Immunology, and
| | - Mark H Stoler
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Melissa T Zaidi
- Molecular Microbiology and Immunology, Surgery, Bioengineering, University of Missouri, Columbia, Missouri, USA
| | - Adam G Schrum
- Molecular Microbiology and Immunology, Surgery, Bioengineering, University of Missouri, Columbia, Missouri, USA
| | - Daniel Kreisel
- Department of Surgery, Washington University, St. Louis, Missouri, USA
| | - Andrew E Gelman
- Department of Surgery, Washington University, St. Louis, Missouri, USA
| | - Elizabeth A Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona, USA
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7
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López-Abente J, Bernaldo-de-Quirós E, Camino M, Gil N, Panadero E, Campos-Domínguez M, Seoane-Reula E, Gil-Jaurena JM, Pion M, Correa-Rocha R. Immune dysregulation and Th2 polarization are associated with atopic dermatitis in heart-transplant children: A delicate balance between risk of rejection or atopic symptoms. Am J Transplant 2019; 19:1536-1544. [PMID: 30614192 DOI: 10.1111/ajt.15245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/20/2018] [Accepted: 12/27/2018] [Indexed: 01/25/2023]
Abstract
Atopic dermatitis (AD) has a high incidence in heart-transplant children, and the reason why there is more AD after transplantation is still unknown. We conducted a cross-sectional study comparing 11 AD and 11 non-AD age-matched heart-transplant children, to assess which immune alterations are related to AD in these patients. AD patients had been transplanted at a younger age compared to non-AD, indicating that age at transplant may be determinant in the onset of AD. The earlier thymectomy in AD heart-transplant children favored the presence of more differentiated phenotypes in the T cell compartment. We observed a clear reduction in the T-helper 1/T-helper 2 (Th1/Th2) ratio in AD children. This Th2 polarization was related to eosinophilia and high immunoglobulin E levels, but also to an impaired regulatory T cell (Treg) suppression, which could be secondary to an exhaustion of the Treg compartment. Interestingly, AD patients were free of rejection episodes (0/11) in comparison to non-AD children (4/11). We propose that a predominant Th2 phenotype may prevent the emergence of Th1 responses associated with graft rejection. A more differentiated Treg phenotype could also play a role in preventing acute rejection in the first year posttransplant. Our findings provide useful insights and knowledge for the better understanding of atopic disorders in transplanted children.
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Affiliation(s)
- Jacobo López-Abente
- Laboratory of Immune-regulation, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Esther Bernaldo-de-Quirós
- Laboratory of Immune-regulation, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Manuela Camino
- Pediatric-Cardiology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nuria Gil
- Pediatric-Cardiology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esther Panadero
- Pediatric-Cardiology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Minia Campos-Domínguez
- Laboratory of Immune-regulation, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Dermatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Seoane-Reula
- Laboratory of Immune-regulation, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Pediatric Immunology Unit of the Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan M Gil-Jaurena
- Pediatric Cardiac Surgery Unit of the Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marjorie Pion
- Laboratory of Immune-regulation, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rafael Correa-Rocha
- Laboratory of Immune-regulation, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Canadian National Transplant Research Program, Canada
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8
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Woulfe KC, Bruns DR. From pediatrics to geriatrics: Mechanisms of heart failure across the life-course. J Mol Cell Cardiol 2018; 126:70-76. [PMID: 30458169 DOI: 10.1016/j.yjmcc.2018.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/29/2018] [Accepted: 11/14/2018] [Indexed: 01/08/2023]
Abstract
Heart failure (HF) is a significant public health problem and a disease with high 5-year mortality. Although age is the primary risk factor for development of HF, it is a disease which impacts patients of all ages. Historically, HF has been studied as a one-size fits all strategy- with the majority of both clinical and basic science investigations employing adult male subjects or adult male pre-clinical animal models. We postulate that inclusion of biological variables in HF studies is necessary to improve our understanding of mechanisms of HF and improve outcomes. In this review, we will discuss age-specific differences in HF patients, particularly focusing on the pediatric and geriatric age groups. In addition, we will also discuss the biological variable of sex. Characterizing and understanding the mechanistic differences in these distinct HF populations can provide insights that will benefit and personalize therapeutic interventions. Further, we propose that future investigations into the cellular mechanisms involved in the developing and juvenile heart may provide valuable insights for targets that would be beneficial in aging patients.
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Affiliation(s)
- Kathleen C Woulfe
- University of Colorado-Denver; Department of Medicine, Division of Cardiology, 12700 E 19th Ave Aurora, CO, USA.
| | - Danielle R Bruns
- University of Wyoming, Division of Kinesiology & Health, Laramie, WY, USA
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9
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McEachern W, Godown J, Dodd DA, Dipchand AI, Conway JL, Wilson GJ, Hoffman RD. Sudden death in a pediatric heart transplant recipient with peripheral eosinophilia and eosinophilic myocardial infiltrates. Pediatr Transplant 2017; 21. [PMID: 28504342 DOI: 10.1111/petr.12937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
Abstract
Eosinophilia has been rarely reported in pediatric heart transplant recipients and has been suggested to play a role in graft rejection. We report a case of a young female patient with peripheral blood eosinophilia who died suddenly 2 years following ABO-incompatible heart transplantation. She was found at autopsy to have myocardial infiltration of not only T-lymphocytes and macrophages expected in acute cellular rejection but also of eosinophils, B-lymphocytes, and plasma cells indicating myocarditis.
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Affiliation(s)
- William McEachern
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Debra A Dodd
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Anne I Dipchand
- Department of Pediatrics, Labatt Family Heart Centre, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer L Conway
- University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Gregory J Wilson
- Division of Pathology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert D Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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10
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Wisotzkey BL, Jorgensen NW, Albers EL, Kemna MS, Boucek RJ, Kronmal RA, Law YM, Bhat AH. Feasibility and interpretation of global longitudinal strain imaging in pediatric heart transplant recipients. Pediatr Transplant 2017; 21. [PMID: 28295946 DOI: 10.1111/petr.12909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 01/07/2023]
Abstract
Evaluation of myocardial mechanics after heart transplant is important in monitoring allograft function and identifying rejection. Speckle tracking global longitudinal strain (GLS) may be more sensitive to early regional changes from rejection. This study aimed to determine feasibility of GLS in pediatric hearts during surveillance echocardiograms, compare their GLS to published norms (-18% to -22%), and assess association of GLS with other indices of graft function. Retrospective review of transplant echocardiograms from 2013 to 2014. Philips QLAB was used for post-acquisition GLS analysis. Multiple linear regression was used to assess the association of GLS with echocardiographic/catheterization indices, and B-type natriuretic peptide (BNP). Forty-seven patients (84 studies) were included. Calculation of GLS was feasible in 82 studies (97%) with inter- and intra-observer variability of 0.71 and 0.69. Patients (n=9) with rejection had GLS of -16.4% (SD=3.5%) compared to those without [-16.8% (SD=3.7%)]. GLS worsened linearly with increasing Ln(BNP) (P=<.001), left ventricular volume in diastole (P=<.001), septal a' wave (P=<.001), and pulmonary capillary wedge pressure (P=<.001). Speckle tracking-based GLS is feasible and reproducible in pediatric heart recipients and is reduced at baseline. The role of GLS and BNP in detecting early systolic dysfunction warrants further investigation.
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Affiliation(s)
- Bethany L Wisotzkey
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Neal W Jorgensen
- Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Erin L Albers
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Mariska S Kemna
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Robert J Boucek
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Richard A Kronmal
- Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Yuk M Law
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Aarti H Bhat
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
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11
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Bush JW, Mohammad S, Melin-Aldana H, Kagalwalla AF, Arva NC. Eosinophilic density in graft biopsies positive for rejection and blood eosinophil count can predict development of post-transplant digestive tract eosinophilia. Pediatr Transplant 2016; 20:540-51. [PMID: 26917244 DOI: 10.1111/petr.12693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 01/07/2023]
Abstract
EGID is a known post-transplant complication. Its etiology has been related to antirejection medication, but other factors may also play a role as only few transplant recipients develop EGID despite standardized treatment. This study aimed to determine whether EGID is associated with rejection events and with a specific phenotype of the rejection-positive graft biopsies in children with solid organ transplant. All patients with liver, heart, and kidney transplant followed at our institution were included in the study. Digestive tract eosinophilia was more common in heart and liver recipients and was a rare event after renal transplantation. Subjects with EGID had higher incidence of rejection and elevated peripheral blood AEC. The first rejection event and high AEC values preceded EGID diagnosis in the majority of patients. Histologically, the initial rejection-positive graft biopsy revealed accentuated eosinophilia in EGID patients compared with non-EGID cohort, which correlated with higher blood eosinophil counts at the time of first rejection episode. Prominent graft tissue and peripheral blood eosinophilia prior to EGID diagnosis suggests a predisposition for eosinophil activation in patients with post-transplant digestive eosinophilic disorder. These parameters can be used as markers for subsequent development of EGID.
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Affiliation(s)
- Jonathan W Bush
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Saeed Mohammad
- Department of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Hector Melin-Aldana
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amir F Kagalwalla
- Department of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nicoleta C Arva
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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12
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Long H, Liao W, Wang L, Lu Q. A Player and Coordinator: The Versatile Roles of Eosinophils in the Immune System. Transfus Med Hemother 2016; 43:96-108. [PMID: 27226792 PMCID: PMC4872051 DOI: 10.1159/000445215] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/04/2016] [Indexed: 12/18/2022] Open
Abstract
Eosinophils have traditionally been associated with allergic diseases and parasite infection. Research advances in the recent decades have brought evolutionary changes in our understanding of eosinophil biology and its roles in immunity. It is currently recognized that eosinophils play multiple roles in both innate and adaptive immunity. As effector cells in innate immunity, eosinophils exert a pro-inflammatory and destructive role in the Th2 immune response associated with allergic inflammation or parasite infection. Eosinophils can also be recruited by danger signals released by pathogen infections or tissue injury, inducing host defense against parasitic, fungal, bacterial or viral infection or promoting tissue repair and remodeling. Eosinophils also serve as nonprofessional antigen-presenting cells in response to allergen challenge or helminth infection, and, meanwhile, are known to function as a versatile coordinator that actively regulates or interacts with various immune cells including T lymphocytes and dendritic cells. More roles of eosinophils implicated in immunity have been proposed including in immune homeostasis, allograft rejection, and anti-tumor immunity. Eosinophil interactions with structural cells are also implicated in the mechanisms in allergic inflammation and in Helicobacter pylori gastritis. These multifaceted roles of eosinophils as both players and coordinators in immune system are discussed in this review.
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Affiliation(s)
- Hai Long
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Wei Liao
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Ling Wang
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qianjin Lu
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
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