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Earley J, Piletska E, Ronzitti G, Piletsky S. Evading and overcoming AAV neutralization in gene therapy. Trends Biotechnol 2022; 41:836-845. [PMID: 36503641 DOI: 10.1016/j.tibtech.2022.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022]
Abstract
Adeno-associated virus (AAV)-derived viral vectors are a promising platform for the delivery of curative, life-changing therapies to a huge number of patients with monogenic disorders. There are currently over 250 clinical trials ongoing worldwide. However, for these therapies to benefit as many patients as possible, techniques must be developed to treat those with pre-existing immunity and to potentially allow re-administration of a dose in the future, should efficacy wane over time. This review discusses the current state and prospects of technologies to evade and overcome these immune responses and allow successful treatment of the greatest number of patients possible.
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2
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Zhang H, Wang Z, Zhang J, Gui Z, Han Z, Tao J, Chen H, Sun L, Fei S, Yang H, Tan R, Chandraker A, Gu M. Combined Immunotherapy With Belatacept and BTLA Overexpression Attenuates Acute Rejection Following Kidney Transplantation. Front Immunol 2021; 12:618737. [PMID: 33732243 PMCID: PMC7959759 DOI: 10.3389/fimmu.2021.618737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/14/2021] [Indexed: 01/11/2023] Open
Abstract
Background Costimulatory blockade provides new therapeutic opportunities for ensuring the long-term survival of kidney grafts. The adoption of the novel immunosuppressant Belatacept has been limited, partly due to concerns regarding higher rates and grades of acute rejection in clinical trials. In this study, we hypothesized that a combined therapy, Belatacept combined with BTLA overexpression, may effectively attenuate acute rejection after kidney transplantation. Materials and Methods The rat kidney transplantation model was used to investigate graft rejection in single and combined therapy. Graft function was analyzed by detecting serum creatinine. Pathological staining was used to observe histological changes in grafts. The expression of T cells was observed by immunohistochemistry and flow cytometry. In vitro, we constructed an antigen-stimulated immune response by mixed lymphocyte culture, treated with or without Belatacept and BTLA-overexpression adenovirus, to observe the proliferation of receptor cells and the expression of cytokines. In addition, western blot and qRT-PCR analyses were performed to evaluate the expression of CTLA-4 and BTLA at various time points during the immune response. Results In rat models, combined therapy reduced the serum creatinine levels and prolonged graft survival compared to single therapy and control groups. Mixed acute rejection was shown in the allogeneic group and inhibited by combination treatment. Belatacept reduced the production of DSA and the deposition of C4d in grafts. Belatacept combined with BTLA overexpression downregulated the secretion of IL-2 and IFN-γ, as well as increasing IL-4 and IL-10 expression. We also found that Belatacept combined with BTLA overexpression inhibited the proliferation of spleen lymphocytes. The duration of the elevated expression levels of CTLA-4 and BTLA differentially affected the immune response. Conclusion Belatacept combined with BTLA overexpression attenuated acute rejection after kidney transplantation and prolonged kidney graft survival, which suggests a new approach for the optimization of early immunosuppression after kidney transplantation.
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Affiliation(s)
- Hengcheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Zijie Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiayi Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zeping Gui
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhijian Han
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Tao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Sun
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuang Fei
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haiwei Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruoyun Tan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Anil Chandraker
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Min Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Martin TG, Corzo K, Chiron M, van de Velde H, Abbadessa G, Campana F, Solanki M, Meng R, Lee H, Wiederschain D, Zhu C, Rak A, Anderson KC. Therapeutic Opportunities with Pharmacological Inhibition of CD38 with Isatuximab. Cells 2019; 8:E1522. [PMID: 31779273 PMCID: PMC6953105 DOI: 10.3390/cells8121522] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 12/24/2022] Open
Abstract
CD38 is a transmembrane glycoprotein with ectoenzymatic activity involved in regulation of migration, signal transduction, and receptor-mediated adhesion. CD38 is highly expressed on various malignant cells, including multiple myeloma (MM), and at relatively low levels in other tissues, making it a suitable target for therapeutic antibodies. Several anti-CD38 therapies have been, or are being, developed for the treatment of MM, including daratumumab and isatuximab (SAR650984), respectively. Studies have shown that anti-CD38 therapies are effective in the treatment of relapsed/refractory MM and are well tolerated, with infusion reactions being the most common side effects. They can be used as monotherapy or in combination with immunomodulatory agents, such as pomalidomide, or proteasome inhibitors to potentiate their activity. Here we examine isatuximab and several anti-CD38 agents in development that were generated using new antibody engineering techniques and that may lead to more effective CD38 targeting. We also summarize trials assessing these antibodies in MM, other malignancies, and solid organ transplantation. Finally, we propose that further research on the mechanisms of resistance to anti-CD38 therapy and the development of biomarkers and new backbone regimens with CD38 antibodies will be important steps in building more personalized treatment for patients with MM.
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Affiliation(s)
- Thomas G. Martin
- Hematology/Oncology, University of California San Francisco, San Francisco, CA 94143-0324, USA;
| | - Kathryn Corzo
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Marielle Chiron
- Translational and Experimental Medicine, Sanofi Research & Development, 94403 Vitry-sur-Seine, France;
| | - Helgi van de Velde
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Giovanni Abbadessa
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Frank Campana
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Malini Solanki
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Robin Meng
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Helen Lee
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Dmitri Wiederschain
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Chen Zhu
- Sanofi Oncology, Cambridge, MA 02142, USA; (K.C.); (H.v.d.V.); (G.A.); (F.C.); (M.S.); (R.M.); (H.L.); (D.W.); (C.Z.)
| | - Alexey Rak
- Integrated Drug Discovery, Sanofi Research & Development, 94403 Vitry-sur-Seine, France;
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4
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Leibler C, Thiolat A, Elsner RA, El Karoui K, Samson C, Grimbert P. Costimulatory blockade molecules and B-cell-mediated immune response: current knowledge and perspectives. Kidney Int 2019; 95:774-786. [PMID: 30711200 DOI: 10.1016/j.kint.2018.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Abstract
There is an urgent need for therapeutic agents that target humoral alloimmunity in solid organ transplantation. This includes sensitized patients with preformed donor-specific human leukocyte antigen antibodies and patients who develop de novo donor-specific antibodies, both of which are associated with acute and chronic antibody-mediated rejection and allograft loss. In the last decade, both experimental and clinical studies highlighted the major impact of costimulation molecules in the control of immune responses both in the field of transplantation and autoimmune disease. Although these molecules have been initially developed to control the early steps of T-cell activation, recent evidence also supports their influence at several steps of the humoral response. In this review, we aim to provide an overview of the current knowledge of the effects of costimulatory blockade agents on humoral responses in both autoimmune and allogeneic contexts. We first present the effects of costimulatory molecules on the different steps of alloantibody production. We then summarize mechanisms and clinical results observed using cytotoxic T lymphocyte antigen-4 (CTLA4)-Ig molecules both in transplantation and autoimmunity. Finally, we present the potential interest and implications of other costimulatory family members as therapeutic targets, with emphasis on combinatorial approaches, for the optimal control of the alloantigen-specific humoral response.
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Affiliation(s)
- Claire Leibler
- Service de Néphrologie et Transplantation, Pôle Cancérologie-Immunité-Transplantation-Infectiologie, Paris-Est Creteil, France; Institut National de la Santé et de la Recherch Médicale, U955, Equipe 21 and Université Paris-Est, Créteil, France; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Allan Thiolat
- Institut National de la Santé et de la Recherch Médicale, U955, Equipe 21 and Université Paris-Est, Créteil, France
| | - Rebecca A Elsner
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Khalil El Karoui
- Service de Néphrologie et Transplantation, Pôle Cancérologie-Immunité-Transplantation-Infectiologie, Paris-Est Creteil, France; Institut National de la Santé et de la Recherch Médicale, U955, Equipe 21 and Université Paris-Est, Créteil, France
| | - Chloe Samson
- Institut National de la Santé et de la Recherch Médicale, U955, Equipe 21 and Université Paris-Est, Créteil, France
| | - Philippe Grimbert
- Service de Néphrologie et Transplantation, Pôle Cancérologie-Immunité-Transplantation-Infectiologie, Paris-Est Creteil, France; Institut National de la Santé et de la Recherch Médicale, U955, Equipe 21 and Université Paris-Est, Créteil, France.
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5
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Leibler C, Thiolat A, Hénique C, Samson C, Pilon C, Tamagne M, Pirenne F, Vingert B, Cohen JL, Grimbert P. Control of Humoral Response in Renal Transplantation by Belatacept Depends on a Direct Effect on B Cells and Impaired T Follicular Helper-B Cell Crosstalk. J Am Soc Nephrol 2018; 29:1049-1062. [PMID: 29321143 DOI: 10.1681/asn.2017060679] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/15/2017] [Indexed: 12/14/2022] Open
Abstract
Generation of de novo donor-specific antibodies (dnDSAs) after renal transplant is recognized as the leading cause of late transplant failure. Hence, the optimal immunosuppressive strategies to limit dnDSA development need to be defined. Recent clinical trials using the novel costimulatory blockade agent CTLA4-Ig (Belatacept) have shown that kidney transplant recipients (KTRs) treated with Belatacept have better graft survival and function and a lower proportion of dnDSAs than control-treated KTRs. Mechanisms involved in the control of humoral responses by Belatacept remain to be investigated. Here, we analyzed the effect of Belatacept on different steps of the B cell-mediated response in humans. In vitro, Belatacept reduced plasmablast differentiation, Ig production, and the expression of the major transcription factor involved in plasma cell function, Blimp-1, in a T cell-independent manner. Moreover, Belatacept induced activation of the STAT3 transcription factor in stimulated B cells and reduced the expression of CD86. Additionally, Belatacept blocked CD28-mediated activation of T follicular helper cells (Tfhs) in an autologous Tfh-memory B cells model. We then validated these observations in KTRs treated with Belatacept, who had a reduced proportion of blood effector B cells and activated Tfh (PD1+ICOS+) compared with control-treated KTRs. Our in vitro and in vivo results suggest that Belatacept modulates B cell function directly and at the level of B cell-Tfh interaction. These mechanisms likely account for the optimal control of humoral responses observed in KTRs treated with Belatacept.
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Affiliation(s)
- Claire Leibler
- Université Paris-Est, Unité Mixte de Recherche 955, Université Paris-Est-Créteil, Creteil, France.,U955, Team 21, Institut National de la Santé et de la Recherche Médicale, Creteil, France.,Hopital Henri-Mondor-A. Chenevier, CIC-BT-504, Assistance Publique-Hôpitaux de Paris, Creteil, France; and
| | - Allan Thiolat
- Université Paris-Est, Unité Mixte de Recherche 955, Université Paris-Est-Créteil, Creteil, France.,U955, Team 21, Institut National de la Santé et de la Recherche Médicale, Creteil, France
| | - Carole Hénique
- Université Paris-Est, Unité Mixte de Recherche 955, Université Paris-Est-Créteil, Creteil, France.,U955, Team 21, Institut National de la Santé et de la Recherche Médicale, Creteil, France
| | - Chloé Samson
- Université Paris-Est, Unité Mixte de Recherche 955, Université Paris-Est-Créteil, Creteil, France.,U955, Team 21, Institut National de la Santé et de la Recherche Médicale, Creteil, France
| | - Caroline Pilon
- Université Paris-Est, Unité Mixte de Recherche 955, Université Paris-Est-Créteil, Creteil, France.,U955, Team 21, Institut National de la Santé et de la Recherche Médicale, Creteil, France
| | - Marie Tamagne
- U955, Team 2, Institut National de la Santé et de la Recherche Médicale, Creteil, France
| | - France Pirenne
- U955, Team 2, Institut National de la Santé et de la Recherche Médicale, Creteil, France
| | - Benoit Vingert
- U955, Team 2, Institut National de la Santé et de la Recherche Médicale, Creteil, France
| | - José L Cohen
- Université Paris-Est, Unité Mixte de Recherche 955, Université Paris-Est-Créteil, Creteil, France.,U955, Team 21, Institut National de la Santé et de la Recherche Médicale, Creteil, France.,Hopital Henri-Mondor-A. Chenevier, CIC-BT-504, Assistance Publique-Hôpitaux de Paris, Creteil, France; and
| | - Philippe Grimbert
- Université Paris-Est, Unité Mixte de Recherche 955, Université Paris-Est-Créteil, Creteil, France; .,U955, Team 21, Institut National de la Santé et de la Recherche Médicale, Creteil, France.,Hopital Henri-Mondor-A. Chenevier, CIC-BT-504, Assistance Publique-Hôpitaux de Paris, Creteil, France; and
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6
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Treatment of Antibody-Mediated Renal Allograft Rejection: Improving Step by Step. J Immunol Res 2017; 2017:6872046. [PMID: 28255562 PMCID: PMC5306998 DOI: 10.1155/2017/6872046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/17/2016] [Accepted: 01/15/2017] [Indexed: 11/18/2022] Open
Abstract
Throughout the past years we stepwise modified our immunosuppressive treatment regimen for patients with antibody-mediated rejection (ABMR). Here, we describe three consecutive groups treated with different regimens. From 2005 until 2008, we treated all patients with biopsy-proven ABMR with rituximab (500 mg), low-dose (30 g) intravenous immunoglobulins (IVIG), and plasmapheresis (PPH, 6x) (group RLP, n = 12). Between 2009 and June 2010, patients received bortezomib (1.3 mg/m2, 4x) together with low-dose IVIG and PPH (group BLP, n = 11). In July 2010, we increased the IVIG dose and treated all subsequent patients with bortezomib, high-dose IVIG (1.5 g/kg), and PPH (group BHP, n = 11). Graft survival at three years after treatment was 73% in group BHP as compared to 45% in group BLP and 25% in group RLP. At six months after treatment median serum creatinine was 2.1 mg/dL, 2.9 mg/dL, and 4.2 mg/dL in groups BHP, BLP, and RLP, respectively (p = 0.02). Following treatment, a significant decrease of donor-specific HLA antibody (DSA) mean fluorescence intensity from 8467 ± 6876 to 5221 ± 4711 (p = 0.01) was observed in group BHP, but not in the other groups. Our results indicate that graft survival, graft function, and DSA levels could be improved along with stepwise modifications to our treatment regimen, that is, the introduction of bortezomib and high-dose IVIG treatment.
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7
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Kim EJ, Kwun J, Gibby AC, Hong JJ, Farris AB, Iwakoshi NN, Villinger F, Kirk AD, Knechtle SJ. Costimulation blockade alters germinal center responses and prevents antibody-mediated rejection. Am J Transplant 2014; 14:59-69. [PMID: 24354871 PMCID: PMC3985346 DOI: 10.1111/ajt.12526] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/13/2013] [Accepted: 10/01/2013] [Indexed: 01/25/2023]
Abstract
De novo donor-specific antibody (DSA) after organ transplantation promotes antibody-mediated rejection (AMR) and causes late graft loss. Previously, we demonstrated that depletion using anti-CD3 immunotoxin combined with tacrolimus and alefacept (AMR regimen) reliably induced early DSA production with AMR in a nonhuman primate kidney transplant model. Five animals were assigned as positive AMR controls, four received additional belatacept and four received additional anti-CD40 mAb (2C10R4). Notably, production of early de novo DSA was completely attenuated with additional belatacept or 2C10R4 treatment. In accordance with this, while positive controls experienced a decrease in peripheral IgM(+) B cells, bela- and 2C10R4-added groups maintained a predominant population of IgM(+) B cells, potentially indicating decreased isotype switching. Central memory T cells (CD4(+) CD28(+) CD95(+)) as well as PD-1(hi) CD4(+) T cells were decreased in both bela-added and 2C10R4-added groups. In analyzing germinal center (GC) reactions in situ, lymph nodes further revealed a reduction of B cell clonal expansion, GC-follicular helper T (Tfh) cells, and IL-21 production inside GCs with additional belatacept or 2C10R4 treatment. Here we provide evidence that belatacept and 2C10R4 selectively suppresses the humoral response via regulating Tfh cells and prevents AMR in this nonhuman primate model.
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Affiliation(s)
- Eugenia J Kim
- Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322
| | - Jean Kwun
- Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322
| | - Adriana C Gibby
- Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322
| | - Jung Joo Hong
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30322
| | - Alton B Farris
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322
| | - Neal N Iwakoshi
- Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322
| | - Francois Villinger
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30322
| | - Allan D Kirk
- Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322
| | - Stuart J Knechtle
- Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322
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Li ZW, Wen XF, Wang Y, Luo M, Qiu JX. Effect of Mycophenolic Acid and Bortezomib on Purified Human B Cells: An In Vitro Study of Long-Term Functionally Stable MICA-Sensitized Renal Recipients. EXP CLIN TRANSPLANT 2013; 11:482-8. [DOI: 10.6002/ect.2012.0281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Tanabe K, Inui M. Desensitization for prevention of chronic antibody-mediated rejection after kidney transplantation. Clin Transplant 2013; 27 Suppl 26:2-8. [DOI: 10.1111/ctr.12260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Kazunari Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Masashi Inui
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
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Hara H, Bentall A, Long C, Fang J, Andreyev O, Lunz J, Ezzelarab M, Abu-Elmagd KM, Shapiro R, Ayares D, Stegall M, Cooper DKC. Minimal effect of bortezomib in reducing anti-pig antibodies in human leukocyte antigen-sensitized patients: a pilot study. Xenotransplantation 2013; 20:429-37. [PMID: 23998233 DOI: 10.1111/xen.12052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/31/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bortezomib, a proteasome inhibitor used to treat multiple myeloma, has been administered (± plasma exchange ± intravenous immunoglobulin [IVIg]) in attempts to reduce antibodies against human leukocyte antigens (HLA) in sensitized patients undergoing organ transplantation. To our knowledge, bortezomib has not been investigated for its effect on natural anti-pig antibodies. If bortezomib could reduce the production of anti-pig antibodies, this would likely be beneficial to the outcome of pig organ grafts in primates. METHODS Nine patients received bortezomib either to reduce anti-HLA antibody levels before organ allotransplantation or to treat antibody-mediated rejection. Patients at the Mayo Clinic (Group 1; n = 4) received bortezomib alone, whereas at the UPMC (Group 2; n = 5), this was combined with plasmaphereses ± IVIg in some cases. Anti-pig IgM and IgG levels against wild-type (WT) and α1,3-galactosyltransferase gene knockout (GTKO) pig aortic endothelial cells (flow cytometry-relative mean fluorescence intensity) and anti-Gal IgM and IgG (ELISA-OD480 nm ) were measured pre- and post-bortezomib therapy. RESULTS Mean anti-pig IgM levels were 11.2 (WT) and 1.9 (GTKO) pre-bortezomib treatment and 9.4 (WT: P = 0.02) and 1.7 (GTKO: P = 0.33) post-bortezomib treatment, respectively. Mean anti-pig IgG levels were 4.3 (WT) and 1.5 (GTKO) pre-bortezomib treatment and 3.6 (WT: P = 0.21) and 1.4 (GTKO: P = 0.20) post-bortezomib treatment, respectively. Mean anti-Gal IgM and IgG levels were 0.7 and 1.1, respectively, pre-treatment, and 0.6 (P = 0.03) and 1.1 (NS), respectively, post-treatment. When the data were analyzed in Groups 1 and 2 separately, there were no significant differences between the pre- and post-bortezomib levels of anti-pig, anti-non-Gal, or anti-Gal IgM or IgG. CONCLUSIONS From this limited study, we conclude that bortezomib might reduce anti-Gal IgM levels in primates, but, in this respect alone, is unlikely to have any significant effect on the outcome of GTKO pig organ transplantation.
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Affiliation(s)
- Hidetaka Hara
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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11
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Clatworthy MR. B-cell regulation and its application to transplantation. Transpl Int 2013; 27:117-28. [PMID: 23909582 DOI: 10.1111/tri.12160] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/08/2013] [Accepted: 07/08/2013] [Indexed: 12/22/2022]
Abstract
There has been increasing interest in the role played by B cells and their associated antibody in the immune response to an allograft, driven by the need to undertake antibody-incompatible transplantation and evidence suggesting that B cells play a role in acute T-cell-mediated rejection and in acute and chronic antibody-mediated rejection. This review focuses on the molecular events, both activating and inhibitory, which control B-cell activation, and considers how this information might inform therapeutic strategies. Potential targets include the BAFF (B-cell-activating factor belonging to the tumour necrosis factor family) and CD40-CD40L pathways and inhibitory molecules, such as CD22 and FcγRIIB. B cells can also play an immunomodulatory role via interleukin (IL)10 production and may contribute to transplant tolerance. The expansion of allograft-specific IL10-producing B cells may be an additional therapeutic goal. Thus, the treatment paradigm required in transplantation has shifted from that of simple B-cell depletion, to that of a more subtle, differential manipulation of different B-cell subsets.
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12
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Hansen PJ. Physiology and Endocrinology Symposium: maternal immunological adjustments to pregnancy and parturition in ruminants and possible implications for postpartum uterine health: is there a prepartum-postpartum nexus? J Anim Sci 2013; 91:1639-49. [PMID: 23307838 DOI: 10.2527/jas.2012-5934] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Establishment of microbial infections in the reproductive tract can have negative consequences for reproductive function of the postpartum female. Most periparturient cows experience bacterial contamination of the uterus after parturition, but only a fraction of these develop subclinical or clinical disease. It is not well understood why one female resolves uterine infections after parturition while another develops disease. Perhaps those that develop metritis or endometritis are exposed to a greater bacterial load at parturition than those that successfully restore the uterus to a healthy condition. A second possibility is that females that develop bacterial disease have compromised immune function, either systemically or in the reproductive tract and associated lymph nodes. Here, the possibility is raised that maternal immunological adjustments to the presence of the allogeneic conceptus may predispose some females to metritis or endometritis. Several regulatory processes ensure that adaptive immune responses against paternal antigens on the conceptus are downregulated during pregnancy. Among these are immunosuppressive effects of progesterone, local accumulation of immune cells that can inhibit inflammation and T cell responses, including M2 macrophages and γδ T cells, and differentiation of regulatory T cells to inhibit alloreactive lymphocytes. Some immunological adjustments to the conceptus also make the uterus more susceptible to bacterial infection. For example, progesterone not only depresses skin graft rejection but also reduces uterine capacity to eliminate bacterial infections. Macrophages of M2 phenotype can inhibit inflammation and facilitate persistence of some microbial infections. At parturition, immune defenses in the uterus may be further weakened by loss of the luminal epithelium of the endometrium, which is part of the innate immune system, as well as by disappearance of intraepithelial γδ T cells that produce the antibacterial proteins granulysin and perforin. It is currently not known whether molecules and cells that inhibit immune responses during pregnancy persist after parturition but, if so, they could contribute to compromised immune function in the uterus. It is hypothesized that individual variation in immune adjustments to pregnancy and parturition and the reversal of these changes in the postpartum period are important determinants of susceptibility of the uterus to infection.
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Affiliation(s)
- P J Hansen
- Department of Animal Sciences, D. H. Barron Reproductive and Perinatal Biology Research Program, and Genetics Institute, University of Florida, Gainesville 32611-0910, USA.
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Prevalence and pharmacological modulation of humoral immunity to AAV vectors in gene transfer to synovial tissue. Gene Ther 2012; 20:417-24. [PMID: 22786533 PMCID: PMC3473155 DOI: 10.1038/gt.2012.55] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Antibodies against adeno-associated viral (AAV) vectors are highly prevalent in humans. Both preclinical and clinical studies showed that antibodies against AAV block transduction even at low titers, particularly when the vector is introduced into the bloodstream. Here we measured the neutralizing antibody (NAb) titer against AAV serotypes 2, 5, 6 and 8 in the serum and matched synovial fluid (SF) from rheumatoid arthritis patients. The titer in the SF was lower than that in the matched plasma samples, indicating a difference in distribution of NAb to AAV depending on the body fluid compartment. This difference was more evident for AAV2, against which higher titers were measured. Of all serotypes, anti-AAV5 antibodies were the least prevalent in both the serum and SF. We next evaluated the impact of B-cell depletion on anti-AAV antibodies in rheumatoid arthritis patients who received one or two courses of the anti-CD20 antibody rituximab as part of their disease management. A drop of NAb titer was observed in a subset of those subjects carrying NAb titers ≤1:1000; however, only in a minority of subjects titers dropped below 1:5. This work provides insights into strategies to overcome the limitation of pre-existing humoral immunity to AAV vectors.
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