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Augusto JF, Benden C, Diekmann F, Zuckermann A. The value of extracorporeal photopheresis as an immunosuppression-modifying approach in solid organ transplantation: a potential solution to an unmet medical need. Front Immunol 2024; 15:1371554. [PMID: 38846942 PMCID: PMC11154098 DOI: 10.3389/fimmu.2024.1371554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Allograft rejection is a critical issue following solid organ transplantation (SOT). Immunosuppressive therapies are crucial in reducing risk of rejection yet are accompanied by several significant side effects, including infection, malignancy, cardiovascular diseases, and nephrotoxicity. There is a current unmet medical need with a lack of effective minimization strategies for these side effects. Extracorporeal photopheresis (ECP) has shown potential as an immunosuppression (IS)-modifying technique in several SOT types, with improvements seen in acute and recurrent rejection, allograft survival, and associated side effects, and could fulfil this unmet need. Through a review of the available literature detailing key areas in which ECP may benefit patients, this review highlights the IS-modifying potential of ECP in the four most common SOT procedures (heart, lung, kidney, and liver transplantation) and highlights existing gaps in data. Current evidence supports the use of ECP for IS modification following SOT, however there is a need for further high-quality research, in particular randomized control trials, in this area.
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Affiliation(s)
- Jean-François Augusto
- Department of Nephrology-Dialysis-Transplantation, University Hospital of Angers, Angers, France
| | | | - Fritz Diekmann
- Renal Transplantation Unit, Department of Nephrology and Kidney Transplantation, Hospital Clinic, Barcelona, Spain
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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2
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Jung R, Ly K, Taniguchi M, Arriola AG, Gravante C, Shinn D, Mathew L, Hamad E, Geier S, Liacini A. Improved Graft Function following Desensitization of Anti-AT 1R and Autoantibodies in a Heart Transplant Recipient Negative for Donor-Specific Antibodies with Antibody-Mediated Rejection: A Case Report. Int J Mol Sci 2024; 25:2218. [PMID: 38396895 PMCID: PMC10888554 DOI: 10.3390/ijms25042218] [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: 01/07/2024] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
HLA donor-specific antibodies (DSAs) pre and post transplant increase the risk of antibody-mediated rejection (AMR) and lead to poor graft survival. Increasing data exist to support the involvement of non-HLA antibodies in triggering an immunological response. The development of non-HLA antibodies specific for AT1R is associated with poor clinical outcomes in orthotopic heart transplant recipients. This case presents an investigation of non-HLA antibodies in a 56-year-old female heart transplant recipient diagnosed with AMR in the absence of DSAs.
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Affiliation(s)
- Regina Jung
- Department of Pharmacy, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Kevin Ly
- Department of Pharmacy, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Michiko Taniguchi
- Immunogenetics Laboratory, Temple University Hospital, Philadelphia, PA 19140, USA
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA 19140, USA
| | - Aileen Grace Arriola
- Immunogenetics Laboratory, Temple University Hospital, Philadelphia, PA 19140, USA
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA 19140, USA
| | - Christopher Gravante
- Immunogenetics Laboratory, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Derek Shinn
- Immunogenetics Laboratory, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Leena Mathew
- Immunogenetics Laboratory, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Eman Hamad
- Heart and Vascular Institute, Section of Cardiology, Lewis Katz School of Medicine, Philadelphia, PA 19140, USA
| | - Steven Geier
- Immunogenetics Laboratory, Temple University Hospital, Philadelphia, PA 19140, USA
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA 19140, USA
| | - Abdelhamid Liacini
- Immunogenetics Laboratory, Temple University Hospital, Philadelphia, PA 19140, USA
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Philadelphia, PA 19140, USA
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3
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Teszak T, Assabiny A, Kiraly A, Tarjanyi Z, Parazs N, Szakal-Toth Z, Hartyanszky I, Szabolcs Z, Racz K, Reti M, Merkely B, Sax B. Extracorporeal photopheresis in the treatment of cardiac allograft rejection: A single-centre experience. Transpl Immunol 2023; 79:101853. [PMID: 37196865 DOI: 10.1016/j.trim.2023.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/19/2023]
Abstract
Despite novel immunosuppressive (IS) protocols, adverse effects of IS drugs continue to have notable negative impact on patient and cardiac allograft survival after heart transplantation (HTx). Therefore, IS regimens with less toxic side effects are sorely needed. We aimed to evaluate the efficacy of extracorporeal photopheresis (ECP) in combination with tacrolimus-based maintenance IS therapy in the treatment of allograft rejection in adult HTx recipients. Indications for ECP included acute moderate-to-severe or persistent mild cellular rejection, or mixed rejection. Twenty-two patients underwent a median of 22(2-44) ECP treatments after HTx. Median duration of ECP course was 173.5(2-466) days. No relevant adverse effects of ECP were noted. Reduction of methylprednisolone doses was safe throughout the ECP course. ECP, used in conjunction with pharmacological anti-rejection therapy, had a successful reversal of cardiac allograft rejection, decreased the rates of subsequential rejection episodes and normalized the allograft function in patients completing the ECP course. Short- and long-term survivals were excellent (91% at 1 and 5 years post-ECP) and comparable to International Society for Heart and Lung Transplantation registry data on HTx recipient overall survival. In conclusion, ECP can be safely used for the treatment and prevention of cardiac allograft rejection in conjunction with traditional IS regimen.
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Affiliation(s)
- Timea Teszak
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary.
| | - Alexandra Assabiny
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Akos Kiraly
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Zoltan Tarjanyi
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Nora Parazs
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Zsofia Szakal-Toth
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Istvan Hartyanszky
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Zoltan Szabolcs
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Kristof Racz
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Marienn Reti
- Department of Apheresis, National Institute for Haematology and Infectious Diseases, 5-7 Albert Florian Road, Budapest, 1097 - Hungary
| | - Bela Merkely
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
| | - Balazs Sax
- Heart and Vascular Centre, Semmelweis University, 68 Varosmajor Street, Budapest, 1122 - Hungary
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Barten MJ, Sax B, Schopka S, Amarelli C, Epailly E, Natali B, Teszák T, Gökler J, Borchert K, Theil J, Ingram A, Zuckermann A. European multicenter study on the real-world use and clinical impact of extracorporeal photopheresis after heart transplantation. J Heart Lung Transplant 2023; 42:1131-1139. [PMID: 37037751 DOI: 10.1016/j.healun.2023.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Aim of this study was to describe the real-world use of extracorporeal photopheresis (ECP) and assess its impact on clinical outcomes in the modern era of heart transplantation. METHODS Seven transplant centers from 5 European countries participated in this retrospective, observational, single-arm chart review study. All patients received ECP after heart transplantation in 2015 or later. Data were extracted from medical records between November 2020 and December 2021. RESULTS Overall, 105 patients were enrolled and followed for an average of 2 years after initiation of ECP. Reasons to start ECP were acute cellular rejection (35.2%), rejection prevention (32.4%), mixed rejection (18.1%), and antibody-mediated rejection (14.3%). Rejection ISHLT grades improved from start to end of ECP treatment in 92% of patients treated with ECP for rejection. Of patients who started ECP to prevent rejection, 88% remained free from any rejection despite a reduction of calcineurin inhibitors. Overall survival was 95%, and no deaths were related to ECP. Safety events occurred in 18 patients, of which 13 experienced complications with venous access. CONCLUSIONS This study, the largest European ECP study in heart transplantation, demonstrates that ECP can effectively be used to treat different rejection types and to prevent rejection in the modern era of immunosuppression. Patients with rejections who have received ECP have shown high response as measured by histological improvements in ISHLT classification. A high percentage of patients in the prevention group remained free from rejection despite reduction in immunosuppression, in particular calcineurin inhibitors.
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Affiliation(s)
- Markus J Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Balázs Sax
- Heart and Vascular Center, Semmelweis University Budapest, Budapest, Hungary
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Cristiano Amarelli
- Department of Cardiovascular Surgery and Transplant, Azienda dei Colli, Monaldi Hospital, Naples, Italy
| | - Eric Epailly
- Department of Cardiovascular Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Benedetta Natali
- Department of Cardiac Surgery, Siena University Hospital, Siena, Italy
| | - Tímea Teszák
- Heart and Vascular Center, Semmelweis University Budapest, Budapest, Hungary
| | - Johannes Gökler
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Andy Ingram
- Mallinckrodt Pharmaceuticals, Staines-Upon-Thames, UK
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Xipell M, Molina-Andújar A, Cid J, Piñeiro GJ, Montagud-Marrahi E, Cofan F, Oppenheimer F, Rovira J, Diekmann F, Lozano M. Immunogenic and immunotolerogenic effects of extracorporeal photopheresis in high immunological risk kidney recipients. A single center case series. J Clin Apher 2021; 37:197-205. [PMID: 34936110 DOI: 10.1002/jca.21958] [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: 10/11/2021] [Revised: 11/25/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022]
Abstract
The immunomodulatory effects of extracorporeal photopheresis (ECP) have been used for the treatment of T-cell mediated disorders, such as rejection in organ transplantation. Currently, it is an established therapy for heart and lung rejection, but not for kidney transplantation (KT), where experience is limited. In addition, some data suggest that ECP could generate an immune response against infections, thus being an alternative for the treatment of rejection in case of active or high-risk of infection. In the present study, we analyze four cases of use of ECP as concomitant therapy in patients with KT and high risk of opportunistic infections due to the high burden of immunosuppression throughout their renal diseases. Two patients had concomitant viral infection (cytomegalovirus and BK virus, respectively) and three patients were on treatment for graft rejection. In the two patients with active viral infection, the infection was successfully controlled during ECP treatment. In all cases, ECP has been shown to be a safe procedure, without complications.
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Affiliation(s)
- Marc Xipell
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Alícia Molina-Andújar
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Joan Cid
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Gastón J Piñeiro
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Enrique Montagud-Marrahi
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Frederic Cofan
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Frederic Oppenheimer
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Rovira
- Laboratori Experimental de Nefrologia I Trasplantament, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Fritz Diekmann
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Miquel Lozano
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Hospital Clinic de Barcelona, Barcelona, Spain
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Slomovich S, Bell J, Clerkin KJ, Habal MV, Griffin JM, Raikhelkar JK, Fried JA, Vossoughi SR, Finnigan K, Latif F, Farr MA, Sayer GT, Uriel N. Extracorporeal photopheresis and its role in heart transplant rejection: prophylaxis and treatment. Clin Transplant 2021; 35:e14333. [PMID: 33914369 DOI: 10.1111/ctr.14333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 01/30/2023]
Abstract
Heart transplantation is the gold standard therapeutic option for select patients with end-stage heart failure. Unfortunately, successful long-term outcomes of heart transplantation can be hindered by immune-mediated rejection of the cardiac allograft, specifically acute cellular rejection, antibody-mediated rejection, and cardiac allograft vasculopathy. Extracorporeal photopheresis is a cellular immunotherapy that involves the collection and treatment of white blood cells contained in the buffy coat with a photoactive psoralen compound, 8-methoxy psoralen, and subsequent irradiation with ultraviolet A light. This process is thought to cause DNA and RNA crosslinking, ultimately leading to cell destruction. The true mechanism of therapeutic action remains unknown. In the last three decades, extracorporeal photopheresis has shown promising results and is indicated for a variety of conditions. The American Society for Apheresis currently recommends the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma, scleroderma, psoriasis, pemphigus vulgaris, atopic dermatitis, graft-versus-host disease, Crohn's disease, nephrogenic systemic fibrosis, and solid organ rejection in heart, lung, and liver transplantation. In this review, we aim to explore the proposed effects of extracorporeal photopheresis and to summarize published data on its use as a prophylactic and therapy in heart transplant rejection.
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Affiliation(s)
- Sharon Slomovich
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Jennifer Bell
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Kevin J Clerkin
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Marlena V Habal
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Jan M Griffin
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Jayant K Raikhelkar
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Justin A Fried
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Sarah R Vossoughi
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Katie Finnigan
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
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7
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Knobler R, Arenberger P, Arun A, Assaf C, Bagot M, Berlin G, Bohbot A, Calzavara-Pinton P, Child F, Cho A, French LE, Gennery AR, Gniadecki R, Gollnick HPM, Guenova E, Jaksch P, Jantschitsch C, Klemke C, Ludvigsson J, Papadavid E, Scarisbrick J, Schwarz T, Stadler R, Wolf P, Zic J, Zouboulis C, Zuckermann A, Greinix H. European dermatology forum: Updated guidelines on the use of extracorporeal photopheresis 2020 - Part 2. J Eur Acad Dermatol Venereol 2020; 35:27-49. [PMID: 32964529 PMCID: PMC7821314 DOI: 10.1111/jdv.16889] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
Background Following the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T‐cell lymphoma published in 1983, this technology has received continued use and further recognition for additional earlier as well as refractory forms. After the publication of the first guidelines for this technology in the JEADV in 2014, this technology has maintained additional promise in the treatment of other severe and refractory conditions in a multidisciplinary setting. It has confirmed recognition in well‐known documented conditions such as graft‐vs.‐host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection including lung, heart and liver and to a lesser extent inflammatory bowel disease. Materials and methods In order to further provide recognized expert practical guidelines for the use of this technology for all indications, the European Dermatology Forum (EDF) again proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. All authors had the opportunity to review each contribution as it was added. Results and conclusion These updated 2020 guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. The guidelines were divided into two parts: PART I covers Cutaneous T‐cell lymphoma, chronic graft‐vs.‐host disease and acute graft‐vs.‐host disease, while PART II will cover scleroderma, solid organ transplantation, Crohn’s disease, use of ECP in paediatric patients, atopic dermatitis, type 1 diabetes, pemphigus, epidermolysis bullosa acquisita and erosive oral lichen planus.
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Affiliation(s)
- R Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - P Arenberger
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Arun
- FRCPath, The Rotherham NHA Foundation Trust, Rotherham, United Kingdom
| | - C Assaf
- Department of Dermatology and Venerology, Helios Klinikum Krefeld, Krefeld, Germany
| | - M Bagot
- Hospital Saint Louis, Université de Paris, Paris, France
| | - G Berlin
- Department of Clinical Immunology and Transfusion Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A Bohbot
- Onco-Hematology Department, Hautepierre Hospital, Strasbourg, France
| | | | - F Child
- FRCP, St John's Institution of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Cho
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - L E French
- Department of Dermatology, University Hospital, München, Germany
| | - A R Gennery
- Translational and Clinical Research Institute Newcastle University Great North Children's Hospital Newcastle upon Tyne, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - R Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Canada
| | - H P M Gollnick
- Department Dermatology & Venereology Otto-von-Guericke University, Magdeburg, Germany
| | - E Guenova
- Faculty of Biology and Medicine, University of Lausanne and Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - P Jaksch
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - C Jantschitsch
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Klemke
- Hautklinik Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - J Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - E Papadavid
- National and Kapodistrian University of Athens, Athens, Greece
| | - J Scarisbrick
- University Hospital Birmingham, Birmingham, United Kingdom
| | - T Schwarz
- Department of Dermatology, University Clinics Schleswig-Holstein, Kiel, Germany
| | - R Stadler
- University Clinic for Dermatology Johannes Wesling Medical Centre, UKRUB, University of Bochum, Minden, Germany
| | - P Wolf
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - J Zic
- Vanderbilt University Medical Center Department of Dermatology, Nashville, Tennessee, USA
| | - C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - A Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - H Greinix
- LKH-Univ. Klinikum Graz, Division of Haematology, Medical University of Graz, Graz, Austria
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8
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Effect of miR-744 on Ameliorating Heart Allograft Rejection in BALB/c Mice Via Regulation of TNFRSF4 Expression in Regulatory T Cells. Transplant Proc 2020; 52:398-405. [PMID: 31928781 DOI: 10.1016/j.transproceed.2019.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022]
Abstract
CD134 (TNFRSF4) is a member of the TNFR superfamily, which is specifically expressed on T cells. Previous studies have shown that blocking of CD134L-CD134 interaction reduces the percentage of activated T cells and prevents effector T cell-mediated graft rejection in heart transplantation. However, the role of microRNA-regulated inhibition of the CD134 signal in cardiac transplantation of T-regulatory (Treg) cells is not clear. In this study, we found microRNA 744 (miR-744) agomir administration enhanced the expression levels of miR-744 in CD4+CD25+ Treg cells from heart transplantation mice. Moreover, miR-744 agomir administration significantly enhanced the expression levels of CD62L and Ki67 in CD4+CD25+ Treg cells from heart transplantation mice and further enhanced immunosuppressive function of Treg cells following coculture with CD4+CD25- T cells for different ratios. In addition, miR-744 agomir treatment significantly prolonged survival time and reduced rejection response of heart allografts in vivo, which are involved in downregulation of TNFRSF4 expression. These results provided a novel molecular mechanism of ameliorating heart allograft rejection in Treg cells, which could be used in the treatment of heart allograft rejection clinically.
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9
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Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34:171-354. [PMID: 31180581 DOI: 10.1002/jca.21705] [Citation(s) in RCA: 757] [Impact Index Per Article: 151.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
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Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute & Blood Research Institute, Versiti & Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany & First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erin Meyer
- Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks NW & Department of Laboratory Medicine, University of Washington, Seattle, Washington, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Cho A, Jantschitsch C, Knobler R. Extracorporeal Photopheresis-An Overview. Front Med (Lausanne) 2018; 5:236. [PMID: 30211164 PMCID: PMC6119964 DOI: 10.3389/fmed.2018.00236] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/03/2018] [Indexed: 12/23/2022] Open
Abstract
Extracorporeal photopheresis (ECP) has been in clinical use for over three decades after receiving FDA approval for the palliative treatment of the Sézary Syndrome variant of cutaneous T-cell lymphoma (CTCL) in 1988. After the first positive experiences with CTCL, additional indications have been successfully explored including areas such as graft-vs.-host disease (GVHD), scleroderma, and solid organ transplantation. The mechanism of action is still not fully resolved, but important steps in understanding ECP in recent years have been very informative. Originally, the primary hypothesis stated that psoralen and ultraviolet A (UVA) in combination induce apoptosis in the treated immune cells. This view shifted in favor of dendritic cell initiation, modification of the cytokine profile and stimulation of several T-cell lineages, in particular regulatory T-cells. A number of ECP guidelines have been produced to optimize treatment regimens in the clinical context. In CTCL, enough evidence is available for the use of ECP as a first line treatment for Sézary Syndrome (SS), but also as a second line or rescue treatment in therapy-refractory forms of mycosis fungoides (MF). ECP in the treatment of acute and chronic GVHD has shown promising results as second line therapy in steroid-refractory presentations. In solid organ transplantation, ECP has been used to increase tissue tolerance and decrease infections with opportunistic pathogens, attributed to the use of high doses of immunosuppressive medication. Infection with cytomegalovirus (CMV) remains a limiting factor affecting survival in solid organ transplantation and the role of ECP will be discussed in this review. A trend toward prophylactic use of ECP can be observed and may further contribute to improve the outcome in many patients. To further deepen our knowledge of ECP and thus facilitate its use in patients that potentially benefit most from it, future prospective randomized trials are urgently needed in this rapidly growing field. The aim of this review is to (1) introduce the method, (2) give an overview where ECP has shown promising effects and has become an essential part of treatment protocols, and (3) to give recommendations on how to proceed in numerous indications.
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Affiliation(s)
| | | | - Robert Knobler
- Department of Dermatology, Medizinische Universität Wien, Vienna, Austria
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