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Kisserli A, Schneider N, Audonnet S, Tabary T, Goury A, Cousson J, Mahmoudi R, Bani-Sadr F, Kanagaratnam L, Jolly D, Cohen JH. Acquired decrease of the C3b/C4b receptor (CR1, CD35) and increased C4d deposits on erythrocytes from ICU COVID-19 patients. Immunobiology 2021; 226:152093. [PMID: 34022670 PMCID: PMC8106962 DOI: 10.1016/j.imbio.2021.152093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 12/30/2022]
Abstract
In order to study the mechanisms of COVID-19 damage following the complement activation phase occurring during the innate immune response to SARS-CoV-2, CR1 (the regulating complement activation factor, CD35, the C3b/C4b receptor), C4d deposits on Erythrocytes (E), and the products of complement activation C3b/C3bi, were assessed in 52 COVID-19 patients undergoing O2 therapy or assisted ventilation in ICU units in Rheims France. An acquired decrease of CR1 density on E from COVID-19 patients was observed (Mean = 418, SD = 162, N = 52) versus healthy individuals (Mean = 592, SD = 287, N = 400), Student’s t-test p < 10−6, particularly among fatal cases, and in parallel with several parameters of clinical severity. Large deposits of C4d on E in patients were well above values observed in normal individuals, mostly without concomitant C3 deposits, in more than 80% of the patients. This finding is reminiscent of the increased C4d deposits on E previously observed to correlate with sub endothelial pericapillary deposits in organ transplant rejection, and with clinical SLE flares. Conversely, significant C3 deposits on E were only observed among ¼ of the patients. The decrease of CR1/E density, deposits of C4 fragments on E and previously reported detection of virus spikes or C3 on E among COVID-19 patients, suggest that the handling and clearance of immune complex or complement fragment coated cell debris may play an important role in the pathophysiology of SARS-CoV-2. Measurement of C4d deposits on E might represent a surrogate marker for assessing inflammation and complement activation occurring in organ capillaries and CR1/E decrease might represent a cumulative index of complement activation in COVID-19 patients. Taken together, these original findings highlight the participation of complement regulatory proteins and indicate that E are important in immune pathophysiology of COVID-19 patients. Besides a potential role for monitoring the course of disease, these observations suggest that novel therapies such as the use of CR1, or CR1-like molecules, in order to down regulate complement activation and inflammation, should be considered.
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Affiliation(s)
- Aymric Kisserli
- Oncogeriatric Coordination Unit, Rheims University Hospital, Rheims, France; Nanosciences Research Laboratory LRN EA 4682, University of Rheims Champagne-Ardenne, Rheims, France
| | - Nathalie Schneider
- Biochemistry, Pharmacology and Toxicology Unit, Rheims University Hospital, Rheims, France
| | - Sandra Audonnet
- URCACyt, Flow Cytometry Technical Platform, University of Rheims Champagne-Ardenne, Rheims, France
| | - Thierry Tabary
- Nanosciences Research Laboratory LRN EA 4682, University of Rheims Champagne-Ardenne, Rheims, France; Immunology Laboratory, Rheims University Hospital, Rheims, France
| | - Antoine Goury
- Medical-Surgical ICU, Rheims University Hospital, Rheims, France
| | - Joel Cousson
- Medical-Surgical ICU, Rheims University Hospital, Rheims, France
| | - Rachid Mahmoudi
- Department of Internal Medicine and Geriatrics, Rheims University Hospital, Rheims, France; Aging and Fragility Unit EA 3797, University of Rheims Champagne-Ardenne, Rheims, France
| | | | - Lukshe Kanagaratnam
- Aging and Fragility Unit EA 3797, University of Rheims Champagne-Ardenne, Rheims, France; Research Promotion and Support Unit, Rheims University Hospital, Rheims, France
| | - Damien Jolly
- Aging and Fragility Unit EA 3797, University of Rheims Champagne-Ardenne, Rheims, France; Research Promotion and Support Unit, Rheims University Hospital, Rheims, France
| | - Jacques Hm Cohen
- Nanosciences Research Laboratory LRN EA 4682, University of Rheims Champagne-Ardenne, Rheims, France.
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Alba AC, Foroutan F, Ng Fat Hing NKV, Fan CPS, Manlhiot C, Ross HJ. Incidence and predictors of sudden cardiac death after heart transplantation: A systematic review and meta-analysis. Clin Transplant 2018; 32:e13206. [DOI: 10.1111/ctr.13206] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ana C. Alba
- Heart Failure and Transplantation Program; Toronto General Hospital; University Health Network; Toronto ON Canada
| | - Farid Foroutan
- Heart Failure and Transplantation Program; Toronto General Hospital; University Health Network; Toronto ON Canada
| | | | - Chun-Po S. Fan
- The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Cedric Manlhiot
- The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Heather J. Ross
- Heart Failure and Transplantation Program; Toronto General Hospital; University Health Network; Toronto ON Canada
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Haidar F, Kisserli A, Tabary T, McGregor B, Noel LH, Réveil B, Toupance O, Rieu P, Thervet E, Legendre C, Morelon E, Issa N, Cohen JHM. Comparison of C4d detection on erythrocytes and PTC-C4d to histological signs of antibody-mediated rejection in kidney transplantation. Am J Transplant 2012; 12:1564-75. [PMID: 22420823 DOI: 10.1111/j.1600-6143.2012.04003.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
C4d on erythrocytes (EC4d), C4d peritubular capillary deposition (PTC-C4d) staining and histology were compared in a cross-sectional cohort of 146 renal allograft biopsies (132 patients). EC4d levels paralleled PTC-C4d staining, but were more predictive of peritubular capillaritis (PTC). Donor-specific antibodies (DSA), PTC-C4d, EC4d and PTC were analyzed in an independent longitudinal follow-up cohort (96 biopsies, 76 patients). Seventy-six samples were PTC and EC4d concordant, 11 positive and 65 negative, 7 PTC-EC4d+ and 13 PTC+EC4d-. EC4d levels were related to DSA occurrence. With ABMR defined by PTC and DSA, all apparently discordant patients, EC4d negative, were correctly reassigned comparing EC4d level curves with rejection kinetics, with positive EC4d samples predating biopsy or late biopsies compared with ABMR flare-ups. All EC4d-positive patients without PTC or DSA had permanent high EC4d levels unrelated to rejection. EC4d was more abundant in PTC-positive (mean = 108.5%± 3.4; n = 50) than PTC-negative samples (mean = 88.1%± 1.3; n= 96; p < 0.0001). Sensitivity, specificity, positive predictive value and negative predictive value of PTC-C4d and EC4d for PTC were, respectively, 75%, 79%; 64%, 76% (p < 0.05); 28%, 46% (p < 0.05) and 93%, 94%. Values were similar for DSA. A noninvasive blood test, EC4d, and particularly longitudinally monitoring EC4d levels, may increase surrogate ABMR testing options.
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Affiliation(s)
- F Haidar
- Laboratoire d'Immunologie, CHU Reims, Reims, France.
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Massoud O, Heimbach J, Viker K, Krishnan A, Poterucha J, Sanchez W, Watt K, Wiesner R, Charlton M. Noninvasive diagnosis of acute cellular rejection in liver transplant recipients: a proteomic signature validated by enzyme-linked immunosorbent assay. Liver Transpl 2011; 17:723-32. [PMID: 21618694 PMCID: PMC3293624 DOI: 10.1002/lt.22266] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The diagnosis of acute cellular rejection (ACR) requires liver biopsy with its attendant expense and risk. Our first aim was to prospectively determine in an exploratory analysis whether there is a serum proteome signature associated with histologically confirmed ACR. Our second aim was to use simpler and faster enzyme-linked immunosorbent assay (ELISA)-based assays for proteins identified as differentially abundant in the proteomic analysis to identify patients with ACR in a separate validation cohort. We used sequential high-abundance protein depletion and isobaric tag for relative and absolute quantitation liquid chromatography-tandem mass spectrometry to characterize the serum proteome in serum samples of patients with or without ACR. Seven of the 41 proteins identified as differentially abundant [serum amyloid A, complement component 4 (C4), fibrinogen, complement component 1q (C1q), complement component 3, heat shock protein 60 (HSP60), and HSP70] could be measured with ELISA-based assays in a validation cohort consisting of patients with ACR (n = 25) and patients without ACR (n = 21). The mean alanine aminotransferase (ALT) levels in patients with ACR and in patients without ACR were 198 ± 27 and 153 ± 34 U/L, respectively. Among the 7 proteins for which ELISA assays were available, C4 and C1q were both independent predictors of ACR. C4 had the greatest predictivity for differentiating patients with or without ACR. A C4 level ≤ 0.31 g/L had a sensitivity of 97%, a specificity of 62%, a positive predictive value of 74%, and a negative predictive value of 94%. A C4 level ≤ 0.31 g/L and an ALT level ≥ 70 IU/mL together had a sensitivity of 96%, a specificity of 81%, a positive predictive value of 86%, and a negative predictive value of 94%. In summary, in this exploratory analysis, serum C4 and ALT levels were highly predictive of ACR in liver transplant recipients. Confirmation in a prospective, larger, and diverse population is needed.
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Affiliation(s)
- Omar Massoud
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julie Heimbach
- Division of Transplant Surgery, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Kimberly Viker
- Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Anuradha Krishnan
- Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - John Poterucha
- Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - William Sanchez
- Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Kymberly Watt
- Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Russell Wiesner
- Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | - Michael Charlton
- Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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Golocheikine A, Nath DS, Basha HI, Saini D, Phelan D, Aloush A, Trulock EP, Hachem RR, Patterson GA, Ahearn JM, Mohanakumar T. Increased erythrocyte C4D is associated with known alloantibody and autoantibody markers of antibody-mediated rejection in human lung transplant recipients. J Heart Lung Transplant 2010; 29:410-6. [PMID: 20022265 DOI: 10.1016/j.healun.2009.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 10/09/2009] [Accepted: 10/11/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Immune responses to mismatched donor human leukocyte antigens (HLA) are important in the pathogenesis of chronic rejection. This study evaluated whether erythrocyte-bound C4d (E-C4d) is associated with known alloimmune and autoimmune markers of antibody-mediated rejection after human lung transplantation (LTx). METHODS Flow cytometry was used to analyze 22 LTx recipients and 15 healthy individuals for E-C4d. Development of antibodies to donor-mismatched HLA (donor-specific antibody [DSA]) and antibodies to HLA were determined using the solid-phase method by Luminex. Development of antibodies to self-antigens, K-alpha-1-tubulin (KA1T) and collagen V (Col-V), were measured by enzyme-linked immunosorbent assay. C3d deposition in lung biopsy specimens was determined by immunohistochemical staining. RESULTS Percent E-C4d (%E-C4d) levels were 19.9% in LTx patients vs 3.7% in healthy individuals (p = 0.02). DSA+ patients had higher E-C4d levels than DSA- patients (34.1% vs 16.7%, p = 0.02). In 5 patients with preformed anti-HLA, E-C4d levels were not significantly different vs 13 patients without detectable anti-HLA (p = 0.1). E-C4d levels were higher in patients who developed antibodies to KA1T (p = 0.02) and Col-V (p = 0.03). Recipients with C3d-positive tissue deposition had higher E-C4d levels than patients with C3d-negative biopsy results (p = 0.01). CONCLUSIONS Increased %E-C4d levels are found in patients with positive DSA, high antibody titers to KA1T and Col-V, and have C3d+ lung biopsy findings. Therefore, %E-C4d can serve as a potential marker for antibody-mediated rejection after LTx.
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Affiliation(s)
- Angali Golocheikine
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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