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Merli P, Caruana I, De Vito R, Strocchio L, Weber G, Del Bufalo F, Buatois V, Montanari P, Cefalo MG, Pitisci A, Algeri M, Galaverna F, Quintarelli C, Cirillo V, Pagliara D, Ferlin W, Ballabio M, De Min C, Locatelli F. Role of interferon-γ in immune-mediated graft failure after allogeneic hematopoietic stem cell transplantation. Haematologica 2019; 104:2314-2323. [PMID: 30792213 PMCID: PMC6821635 DOI: 10.3324/haematol.2019.216101] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/18/2019] [Indexed: 12/26/2022] Open
Abstract
Pathophysiology of graft failure (GF) occurring after allogeneic hematopoietic stem cell transplantation (HSCT) still remains elusive. We measured serum levels of several different cytokines/chemokines in 15 children experiencing GF, comparing their values with those of 15 controls who had sustained donor cell engraftment. Already at day +3 after transplantation, patients developing GF had serum levels of interferon (IFN)-γ and CXCL9 (a chemokine specifically induced by IFNγ) significantly higher than those of controls (8859±7502 vs. 0 pg/mL, P=0.03, and 1514.0±773 vs. 233.6±50.1 pg/mlL, P=0.0006, respectively). The role played by IFNγ in HSCT-related GF was further supported by the observation that a rat anti-mouse IFNγ-neutralizing monoclonal antibody promotes donor cell engraftment in Ifngr1-/-mice receiving an allograft. In comparison to controls, analysis of bone marrow-infiltrating T lymphocytes in patients experiencing GF documented a predominance of effector memory CD8+ cells, which showed markers of activation (overexpression of CD95 and downregulation of CD127) and exhaustion (CD57, CD279, CD223 and CD366). Finally, we obtained successful donor engraftment in 2 out of 3 children with primary hemophagocytic lymphohistiocytosis who, after experiencing GF, were re-transplanted from the same HLA-haploidentical donor under the compassionate use coverage of emapalumab, an anti-IFNγ monoclonal antibody recently approved by the US Food and Drug Administration for treatment of patients with primary hemophagocytic lymphohistiocytosis. Altogether, these results suggest that the IFNγ pathway plays a major role in GF occurring after HSCT. Increased serum levels of IFNγ and CXCL9 represent potential biomarkers useful for early diagnosis of GF and provide the rationale for exploring the therapeutic/preventive role of targeted neutralization of IFNγ.
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Affiliation(s)
- Pietro Merli
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Ignazio Caruana
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Rita De Vito
- Bambino Gesù Children's Hospital, Department of Laboratories, Pathology Unit, Rome, Italy
| | - Luisa Strocchio
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Gerrit Weber
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Francesca Del Bufalo
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | | | | | - Maria Giuseppina Cefalo
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Angela Pitisci
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Mattia Algeri
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Federica Galaverna
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Concetta Quintarelli
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Valentina Cirillo
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | - Daria Pagliara
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
| | | | | | | | - Franco Locatelli
- Bambino Ges Children's Hospital, Department of Pediatric Hematology/Oncology, Cellular and Gene Therapy, Rome, Italy
- Department of Pediatrics, Sapienza, University of Rome, Rome, Italy
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Cole RT, Gandhi J, Bray RA, Gebel HM, Yin M, Shekiladze N, Young A, Grant A, Mahoney I, Laskar SR, Gupta D, Bhatt K, Book W, Smith A, Nguyen D, Vega JD, Morris AA. Racial differences in the development of de-novo donor-specific antibodies and treated antibody-mediated rejection after heart transplantation. J Heart Lung Transplant 2018; 37:503-512. [DOI: 10.1016/j.healun.2017.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022] Open
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Complement-Mediated Enhancement of Monocyte Adhesion to Endothelial Cells by HLA Antibodies, and Blockade by a Specific Inhibitor of the Classical Complement Cascade, TNT003. Transplantation 2017. [PMID: 28640789 PMCID: PMC5482566 DOI: 10.1097/tp.0000000000001486] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Antibody-mediated rejection (AMR) of most solid organs is characterized by evidence of complement activation and/or intragraft macrophages (C4d + and CD68+ biopsies). We previously demonstrated that crosslinking of HLA I by antibodies triggered endothelial activation and monocyte adhesion. We hypothesized that activation of the classical complement pathway at the endothelial cell surface by HLA antibodies would enhance monocyte adhesion through soluble split product generation, in parallel with direct endothelial activation downstream of HLA signaling. Methods Primary human aortic endothelial cells (HAEC) were stimulated with HLA class I antibodies in the presence of intact human serum complement. C3a and C5a generation, endothelial P-selectin expression, and adhesion of human primary and immortalized monocytes (Mono Mac 6) were measured. Alternatively, HAEC or monocytes were directly stimulated with purified C3a or C5a. Classical complement activation was inhibited by pretreatment of complement with an anti-C1s antibody (TNT003). Results Treatment of HAEC with HLA antibody and human complement increased the formation of C3a and C5a. Monocyte recruitment by human HLA antibodies was enhanced in the presence of intact human serum complement or purified C3a or C5a. Specific inhibition of the classical complement pathway using TNT003 or C1q-depleted serum significantly reduced adhesion of monocytes in the presence of human complement. Conclusions Despite persistent endothelial viability in the presence of HLA antibodies and complement, upstream complement anaphylatoxin production exacerbates endothelial exocytosis and leukocyte recruitment. Upstream inhibition of classical complement may be therapeutic to dampen mononuclear cell recruitment and endothelial activation characteristic of microvascular inflammation during AMR. Valenzuela et al show that HLA antibody binding to human endothelial cells in vitro, triggered complement C3a and C5a deposition that mediated monocyte recruitment, and the salutary effects of inhibiting the classical complement pathway with an anti-C1s antibody. Supplemental digital content is available in the text.
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Kfoury AG, Miller DV, Snow GL, Afshar K, Stehlik J, Drakos SG, Budge D, Fang JC, Revelo MP, Alharethi RA, Gilbert EM, Caine WT, McKellar S, Molina KM, Hammond MEH. Mixed cellular and antibody-mediated rejection in heart transplantation: In-depth pathologic and clinical observations. J Heart Lung Transplant 2016; 35:335-341. [DOI: 10.1016/j.healun.2015.10.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/01/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022] Open
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Mohamedali B, Pyle J, Bhat G. Acute Cellular Rejection and C4d Positivity in Heart Transplantation : A Manifestation of Asymptomatic Antibody-Mediated Rejection? Am J Clin Pathol 2016; 145:238-43. [PMID: 26767383 DOI: 10.1093/ajcp/aqv026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES The role of routine C4d staining in endomyocardial biopsy specimens is uncertain. The implications of a diagnosis of acute cellular rejection (ACR) with a positive C4d with or without any evidence of antibody-mediated rejection (AMR) are unclear. This study sought to evaluate a distinct phenotype of ACR+/C4d+ in AMR- patients. METHODS Data on C4d, ACR, and AMR were collected. Donor-specific antibody (DSA), panel-reactive antibody (PRA), flow crossmatch, and data on ACR and AMR episodes were also reviewed. RESULTS Thirty-five patients were followed. Group I with C4d+ biopsy specimens was compared with group II with C4d- biopsy specimens. ACR greater than 1R was higher in group I compared with group II (50% vs 7.4%; P = .01). Clinical suspicion of AMR, positive retrospective crossmatches, and detection of de novo DSA were also higher in group I. CONCLUSIONS Our result indicate that C4d and ACR positivity in posttransplant patients may be a harbinger of a subclinical form of asymptomatic AMR.
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Affiliation(s)
- Burhan Mohamedali
- From the Division of Cardiology and Pathology, Rush University, Advocate Christ Medical Center, Chicago and Oak Lawn, IL.
| | - Joseph Pyle
- From the Division of Cardiology and Pathology, Rush University, Advocate Christ Medical Center, Chicago and Oak Lawn, IL
| | - Geetha Bhat
- From the Division of Cardiology and Pathology, Rush University, Advocate Christ Medical Center, Chicago and Oak Lawn, IL
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Lanio N, Sarmiento E, Gallego A, Calahorra L, Jaramillo M, Navarro J, Palomo J, Fernandez-Yañez J, Ruiz M, Fernandez-Cruz E, Carbone J. Alterations of naïve and memory B-cell subsets are associated with risk of rejection and infection in heart recipients. Transpl Int 2013; 26:800-12. [DOI: 10.1111/tri.12131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 02/07/2013] [Accepted: 05/13/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Nallibe Lanio
- Transplant Immunology Group; Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - Elizabeth Sarmiento
- Transplant Immunology Group; Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - Antonio Gallego
- Transplant Immunology Group; Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - Leticia Calahorra
- Transplant Immunology Group; Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - María Jaramillo
- Transplant Immunology Group; Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - Joaquin Navarro
- Transplant Immunology Group; Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - Jesus Palomo
- Cardiology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | | | - Manuel Ruiz
- Cardiovascular Surgery Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - Eduardo Fernandez-Cruz
- Transplant Immunology Group; Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - Javier Carbone
- Transplant Immunology Group; Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
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