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Patwardhan S, Gunes ME, Manell E, Hong J, Jordache P, Chauhan I, Almesallmy A, Mulder H, Ekanayake-Alper D, Hajosi D, Ko HM, Sanmugarajah K, Cetrulo CL, Nowak G, Sachs DH, Sykes M, Weiner J. Durable Mixed Chimerism May Permit Subsequent Immunosuppression-Free Intestinal Transplantation - a Proof-of-Principle Study. Am J Transplant 2024:S1600-6135(24)00674-9. [PMID: 39442670 DOI: 10.1016/j.ajt.2024.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/18/2024] [Accepted: 10/17/2024] [Indexed: 10/25/2024]
Abstract
Intestinal transplantation (ITx) is the definitive treatment for intestinal failure but has the highest rejection rate among solid organ transplants, requiring high doses of immunosuppression with high rates of infection, graft-versus-host disease, and malignancy. Transplant tolerance would overcome the need for long-term immunosuppression. Using non-myeloablative conditioning, our laboratory has developed a novel swine model of hematopoietic stem cell transplantation (HSCT) that produces durable mixed chimerism (MC) and immune tolerance without toxicity. We investigated whether durable MC would promote tolerance of subsequently transplanted donor-matched intestinal allografts without immunosuppression. Using miniature swine with defined MHC, we performed HSCT across an MHC-Class-I haplotype mismatch. Immunosuppression was stopped by day 45. MC was evaluated by flow cytometry, and mixed lymphocyte reaction (MLR) assays were used to evaluate cellular responses. Subsequently, orthotopic ITx was performed without immunosuppression using a donor that was MHC-matched to the HSCT donor. Recipients were observed for four weeks and euthanized for tissue collection and mechanistic assays. After HSCT, the recipients developed durable multilineage MC and apparent deletional tolerance. After ITx, recipients showed no clinical or histological signs of rejection, and chimerism was unchanged. These results demonstrate the potential value of generating durable MC to achieve transplant tolerance.
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Affiliation(s)
- Satyajit Patwardhan
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - M Esad Gunes
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Elin Manell
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA; Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Julie Hong
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Philip Jordache
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Ishit Chauhan
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Ahmed Almesallmy
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Harko Mulder
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA
| | - Dilrukshi Ekanayake-Alper
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA; Department of Comparative Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Dominik Hajosi
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA; Institute of Comparative Medicine, Columbia University, New York, NY, USA
| | - Huaibin Mabel Ko
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA; Department of Pathology, Columbia University, New York, NY, USA
| | | | - Curtis L Cetrulo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Greg Nowak
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA; Division of Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - David H Sachs
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Columbia University/New York-Presbyterian Hospital, New York, NY, USA
| | - Megan Sykes
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA; Department of Surgery, Columbia University/New York-Presbyterian Hospital, New York, NY, USA; Department of Medicine, Columbia University/New York-Presbyterian Hospital, New York, NY, USA; Department of Microbiology & Immunology, Columbia University/New York-Presbyterian Hospital, New York, NY, USA
| | - Joshua Weiner
- Columbia Center of Translational Immunology, Department of Medicine, Columbia University, New York, NY, USA; Department of Surgery, Columbia University/New York-Presbyterian Hospital, New York, NY, USA.
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Ying WZ, Li X, Rangarajan S, Feng W, Curtis LM, Sanders PW. Immunoglobulin light chains generate proinflammatory and profibrotic kidney injury. J Clin Invest 2019; 129:2792-2806. [PMID: 31205024 DOI: 10.1172/jci125517] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/09/2019] [Indexed: 12/30/2022] Open
Abstract
Because of the less-than-robust response to therapy and impact on choice of optimal chemotherapy and prognosis, chronic kidney disease has drawn attention in the treatment of multiple myeloma, a malignant hematologic disorder that can produce significant amounts of monoclonal immunoglobulin free light chains (FLCs). These low-molecular-weight proteins are relatively freely filtered through the glomerulus and are reabsorbed by the proximal tubule. The present study demonstrated that during the process of metabolism of immunoglobulin FLCs, ROS activated the STAT1 pathway in proximal tubule epithelium. STAT1 activation served as the seminal signaling molecule that produced the proinflammatory molecule IL-1β, as well as the profibrotic agent TGF-β by this portion of the nephron. These effects occurred in vivo and were produced specifically by the generation of hydrogen peroxide by the VL domain of the light chain. To the extent that the experiments reflect the human condition, these studies offer insights into the pathogenesis of progressive kidney failure in the setting of lymphoproliferative disorders, such as multiple myeloma, that feature increased circulating levels of monoclonal immunoglobulin fragments that require metabolism by the kidney.
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Affiliation(s)
| | | | | | | | - Lisa M Curtis
- Department of Medicine and.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Paul W Sanders
- Department of Medicine and.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
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