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Obrișcă B, Leca N, Chou-Wu E, Sibulesky L, Bakthavatsalam R, Kling CE, Alawieh R, Smith KD, Ismail G, Gimferrer I. Anti-GSTT1 antibodies and Null genotype correlate with histological changes of antibody mediated rejection in kidney transplantation. Transpl Immunol 2023; 81:101943. [PMID: 37866670 DOI: 10.1016/j.trim.2023.101943] [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: 08/10/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The presence of anti-Glutathione S-transferase T1 (GSTT1) antibodies (abs) has been hypothesized as a pathogenic contributor in antibody-mediated rejection (AMR). METHODS We aimed to evaluate the relationship between genetic variants of GSTT1, anti-GSTT1 abs and AMR in a cohort of 87 kidney transplant (KTx) patients using Immucor's non-HLA Luminex assay. Patients were classified according to biopsy-proven AMR and HLA-DSA status: AMR with positive anti-HLA-DSAs (AMR/DSA+, n = 29), AMR but no detectable anti-HLA-DSAs (AMR/DSA-, n = 28) and control patients with stable allograft function and no evidence of rejection (n = 30). RESULTS At an MFI cut-off of 3000, the overall prevalence of anti-GSTT1 abs was 18.3%. The proportion of patients with anti-GSTT1 abs was higher in the AMR/DSA- group (25%), compared to the control (13.3%) and AMR/DSA+ group (3.4%) (p = 0.06). Among patients with anti-GSTT1 abs, the MFI was higher in AMR/DSA- and GSTT1-Null patients. Of 81 patients who underwent GSTT1 genotyping, 19.8% were homozygotes for the null allele (GSTT1-Null). GSTT1-Null status in the transplant recipients was associated with the development of anti-GSTT1 abs (OR, 4.49; 95%CI, 1.2-16.7). In addition, GSTT1-Null genotype (OR 26.01; 95%CI, 1.63-404) and anti-GSTT1 ab positivity (OR 14.8; 95%CI, 1.1-190) were associated with AMR. Within AMR/DSA- patients, the presence of anti-GSTT1 abs didn't confer a higher risk of failure within the study observation period. CONCLUSION The presence of anti-GSTT1 abs and GSTT1-Null genotype is associated with AMR, but do not appear to lead to accelerated graft injury in this cohort of early allograft injury changes, with a limited period of follow-up.
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Affiliation(s)
- Bogdan Obrișcă
- Fundeni Clinical Institute, Division of Nephrology, Bucharest, Romania
| | - Nicolae Leca
- University of Washington, Division of Nephrology, Seattle, WA, USA
| | - Elaine Chou-Wu
- Bloodworks Northwest, Immunogenetics/HLA Laboratory, Seattle, WA, USA
| | - Lena Sibulesky
- University of Washington, Division of Transplant Surgery, Seattle, WA, USA
| | | | - Catherine E Kling
- University of Washington, Division of Transplant Surgery, Seattle, WA, USA
| | - Rasha Alawieh
- Yale Waterbury Internal Medicine Residency Program, Waterbury, CT, USA
| | - Kelly D Smith
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Gener Ismail
- Fundeni Clinical Institute, Division of Nephrology, Bucharest, Romania
| | - Idoia Gimferrer
- Bloodworks Northwest, Immunogenetics/HLA Laboratory, Seattle, WA, USA.
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Martínez-Bravo MJ, Sánchez B, Acevedo MJ, Pérez-Simón JA, Núñez-Roldán A, Aguilera I. De novo recipient-specific Glutathione S-transferase T1 antibody development after HLA-identical hematopoietic cell transplantation. Transpl Immunol 2017; 46:36-41. [PMID: 29246878 DOI: 10.1016/j.trim.2017.12.002] [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: 07/26/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
Donor-specific antibodies against Glutathione S-transferase T1 (GSTT1) have been associated with de novo immune hepatitis after liver transplantation. These antibodies have also been found very early in allo-HCT associated with acute hepatic GvHD but in all the cases the donor cells had experienced previous priming through pregnancies. It remained to be explored whether or not primary recognition of the antigen occurs after HCT and what could be the consequences in the long term outcome. We genotyped a cohort of 68 HCT patients and found 11 with the GSTT1 null donor/positive recipient mismatch. After testing 114 serum samples, we found a unique case of a 33-year-old patient transplanted from his HLA-identical sibling donor in which IgG GSTT1 antibodies were detected for the first time on day +178. After stimulation of peripheral blood mononuclear cells with GSTT1 peptides we could demonstrate that this patient also had GSTT1-specific T lymphocytes that became activated upon exposure to the GSTT1 antigen. In this report, we describe the first case in which simultaneous T and B cell response against GSTT1 is developed in HCT although the clinical consequences in GvHD are still unclear.
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Affiliation(s)
- María José Martínez-Bravo
- Immunology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, Seville 41013, Spain
| | - Berta Sánchez
- Immunology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, Seville 41013, Spain.
| | - María José Acevedo
- Immunology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, Seville 41013, Spain.
| | - José Antonio Pérez-Simón
- Haematology Laboratories, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
| | - Antonio Núñez-Roldán
- Immunology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, Seville 41013, Spain.
| | - Isabel Aguilera
- Immunology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, Seville 41013, Spain.
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Martínez-Bravo MJ, Sánchez B, Sousa JM, Acevedo MJ, Gómez-Bravo MA, Núñez-Roldán A, Aguilera I. T-cell allorecognition of donor glutathione S-transferase T1 in plasma cell-rich rejection. World J Hepatol 2017; 9:1115-1124. [PMID: 29026463 PMCID: PMC5620421 DOI: 10.4254/wjh.v9.i27.1115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/06/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the role of glutathione S-transferase T1 donor-specific T lymphocytes in plasma cell-rich rejection of liver allografts.
METHODS The study group included 22 liver transplant patients. Among them, 18 patients were mismatched for the glutathione S-transferase T1 (GSTT1) alleles (don+/rec-), and 4 were matched (don+/rec+). Seven of the mismatched patients produced anti-GSTT1 antibodies and developed plasma cell-rich rejection (former de novo immune hepatitis). For the detection of specific T lymphocytes, peripheral blood mononuclear cells were collected and stored in liquid nitrogen. The memory T cell response was studied by adding to the cell cultures to a mix of 39 custom-made, 15-mer overlapping peptides, which covered the entire GSTT1 amino acid sequence. The specific cellular response to peptides was analyzed by flow cytometry using the markers CD8, CD4, IL-4 and IFNγ.
RESULTS Activation of CD8+ T cells with different peptides was observed exclusively in the group of patients with plasma-cell rich rejection (3 out of 7), with production of IL-4 and/or IFNγ at a rate of 1%-4.92% depending on the peptides. The CD4+ response was most common and not exclusive for patients with the disease, where 5 out of 7 showed percentages of activated cells from 1.24% to 31.34%. Additionally, two patients without the disease but with the mismatch had cells that became stimulated with some peptides (1.45%-5.18%). Highly unexpected was the finding of a double positive CD4+CD8low T cell population that showed the highest degree of activation with some of the peptides in 7 patients with the mismatch, in 4 patients with plasma cell-rich rejection and in 3 patients without the disease. Unfortunately, CD4+CD8low cells represent 1% of the total number of lymphocytes, and stimulation could not be analyzed in 9 patients due to the low number of gated cells. Cells from the 4 patients included as controls did not show activation with any of the peptides.
CONCLUSION Patients with GSTT1 mismatch can develop a specific T-cell response, but the potential role of this response in the pathogenesis of plasma cell-rich rejection is unknown.
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Affiliation(s)
- María José Martínez-Bravo
- Immunology Service, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | - Berta Sánchez
- Immunology Service, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | - José Manuel Sousa
- Digestive Diseases Service, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - María José Acevedo
- Immunology Service, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | | | - Antonio Núñez-Roldán
- Immunology Service, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | - Isabel Aguilera
- Immunology Service, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
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Aguilera I, Sousa JM, Núñez-Roldán A. Clinical relevance of GSTT1 mismatch in solid organ and hematopoietic stem cell transplantation. Hum Immunol 2013; 74:1470-3. [DOI: 10.1016/j.humimm.2013.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/04/2013] [Accepted: 06/07/2013] [Indexed: 12/11/2022]
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Akgul S, Oguz F, Çalişkan Y, Kekik C, Gürkan H, Türkmen A, Nane I, Aydin F. The Effect of Glutathion S-Transferase Polymoprhisms and Anti-GSST1 Antibodies on Allograft Functions in Recipients of Renal Transplant. Transplant Proc 2012; 44:1679-84. [DOI: 10.1016/j.transproceed.2012.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Donor-specific antibodies against HLA, MICA, and GSTT1 in patients with allograft rejection and C4d deposition in renal biopsies. Transplantation 2009; 87:94-9. [PMID: 19136897 DOI: 10.1097/tp.0b013e31818bd790] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Production of antibodies against donor-specific antigens is one of the central mechanisms of allograft rejection. This antibody-mediated rejection (AMR) is evidenced by the presence of circulating donor-specific antibodies and deposition of complement component C4d on renal endothelium. Although anti-human leukocyte antigen (HLA) antibodies account for a high proportion of AMR, in many cases anti-HLA antibodies cannot be demonstrated. In liver transplant, antibodies against glutathione-S-transferase T1 (GSTT1) expressed on the graft may induce an antibody response leading to a severe graft dysfunction. In addition, presence of antibodies against major-histocompatibility-complex class I chain-related gene A (MICA) has been associated with a poor graft survival in kidney transplantation. METHODS Pre- and posttransplantation sera from 19 patients fulfilling the criteria for AMR including C4d deposition in renal biopsies were included. Donor-specific antibodies against HLA-I and -II and MICA were studied using Luminex. Anti-GSTT1 antibodies were analyzed by indirect immunofluorescence and by an ELISA method. A control group of 39 patients with graft dysfunction negative for C4d was also included. RESULTS At the time of the biopsy, 4 (21%) patients had only anti-HLA class I antibodies; 3 (15.8%) had anti-GSTT1, 2 (10.5%) had anti-HLA-class II, and 2 (10.5%) had anti-MICA; four patients had combination of antibodies: HLA-I + MICA (n=1), HLA-I + GSTT1 (n=2), and GSTT1+MICA (n=1). No antibodies were found in 4 (21%) patients. In total, 6 (31.6%) C4d+ patients had anti-GSTT1 antibodies, whereas, among the 39 C4d-negative patients, only 3 (7.7%) had anti-GSTT1 antibodies (P=0.027). CONCLUSION Besides anti-HLA antibodies, donor-specific antibodies against MICA and GSTT1 antigens could be responsible for the occurrence of antibody-mediated kidney graft rejection.
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Aguilera I, Alvarez-Marquez A, Gentil MA, Fernandez-Alonso J, Fijo J, Saez C, Wichmann I, Nuñez-Roldan A. Anti-glutathione S-transferase T1 antibody-mediated rejection in C4d-positive renal allograft recipients. Nephrol Dial Transplant 2008; 23:2393-8. [PMID: 18308775 DOI: 10.1093/ndt/gfm955] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic humoral rejection is a progressive form of graft injury, with defined diagnostic criteria, the crucial one being the evidence of circulating anti-donor antibodies. These antibodies are mainly directed against human leucocyte antigens (HLA), but other targets have also been described. We previously reported that antibodies against the Glutathione S-transferase T1 (GSTT1) enzyme appear in recipients without the GSTT1 gene who receive a graft from a GSTT1-positive donor. The primary aim of this study was to analyse the role of GSTT1 in cases of antibody-mediated rejection (AMR) in the absence of anti-HLA antibodies. A second objective was to describe the distribution of the GSTT1 enzyme in the human kidney. METHODS Four renal biopsies from four renal transplanted patients with declined renal function and circulating anti-donor GSTT1 antibodies were studied for C4d deposits in sections of paraffin-embedded tissue samples. Anti-donor-specific HLA and MICA antibody detection was done with the Luminex platform and anti-GSTT1 antibodies were tested by indirect immunofluorescence on rat tissues and ELISA assay. DNA of the patients was extracted for GSTT1 genotyping. RESULTS Four patients with the GSTT1 donor/recipient mismatch developed anti-GSTT1 antibodies 32, 42, 48 and 60 months after the transplant. One patient also had donor-specific anti-HLA antibodies. Their biopsies showed pathologic lesions compatible with chronic antibody-mediated rejection (CAMR), along with positive C4d deposition in peritubular capillaries in three of them, being no valuable in the other case. CONCLUSION This is the first study reporting an association between the appearance of chronic antibody-mediated renal allograft rejection and the occurrence of de novo production of anti-GSTT1 antibodies, in the absence of anti-HLA donor-specific antibodies. This fact suggests a potential role of the GSTT1 system in anti-graft immune response.
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Affiliation(s)
- Isabel Aguilera
- Immunology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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Rodriguez-Mahou M, Salcedo M, Fernandez-Cruz E, Tiscar JLR, Bañares R, Clemente G, Vicario JL, Alvarez E, Rodriguez-Sainz C. Antibodies against glutathione S-transferase T1 (GSTT1) in patients with GSTT1 null genotype as prognostic marker: long-term follow-up after liver transplantation. Transplantation 2007; 83:1126-9. [PMID: 17452905 DOI: 10.1097/01.tp.0000259963.47350.da] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
An objective to improve the evolution of transplants is to identify risk biomarkers of morbidity and loss of allograft. In liver transplant (LTX) recipients, an association has been demonstrated between the presence of mismatch for glutathione S-transferase T1 (GSTT1) and the development of de novo immune hepatitis (IH). In 419 LTX patients we analyzed, for a period of 1 to 14 years, the development of "atypical" autoantibodies directed against GSTT1 and their relationship with the mismatch for GSTT1 genotype and with the risk for developing de novo IH. A total of 6.9% LTX recipients had "atypical" autoantibodies and 24 showed mismatch (recipient/donor) for GSTT1 genotype. From this last group, up to 70% developed de novo IH and graft dysfunction after LTX (95% confidence interval: 17.4-37.5 months). In LTX recipients with a GSTT1 null genotype, the evaluation of "atypical" autoantibodies is useful for monitoring the development of de novo IH.
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Affiliation(s)
- Margarita Rodriguez-Mahou
- Autoimmunity Laboratory and ImmunoGenetics and Molecular Immunology Laboratory, Immunology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Wichmann I, Aguilera I, Sousa JM, Bernardos A, García Núñez EJ, Vigil E, Magariño R, Magariño I, Torres A, Núñez-Roldán A. Antibodies against glutathione S-transferase T1 in non-solid organ transplanted patients. Transfusion 2006; 46:1505-9. [PMID: 16965576 DOI: 10.1111/j.1537-2995.2006.00938.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND This article describes the presence of antibodies against glutathione S-transferase T1 (GSTT1) in a group of patients who never received a solid organ graft. These antibodies have been previously detected in liver and kidney transplant subjects with donor-recipient mismatch for this enzyme at the genetic level. In liver-grafted subjects, the appearance of these antibodies correlated with de novo immune hepatitis. STUDY DESIGN AND METHODS To obtain some insights in this phenomenon, the clinical records of these patients were reviewed, and the possible causes leading to the production of these antibodies and possible clinical consequences were analyzed. RESULTS The clinical situation of these patients was very heterogeneous, but they had in common the need for transfusions or a previous pregnancy. GSTT1 antigen is present in red blood cells, liver, kidney, and other tissues. Because the presence of the GSTT1-null allele in seven of these patients has been demonstrated, it can be hypothesized that both GSTT1-positive transfusions or pregnancy of a GSTT1-positive fetus could induce these antibodies. Because the recipient is allele-null, no adverse effects in the host are expected to occur. The longest follow-up (5 years) shows no antibody-derived diseases. CONCLUSION It is concluded that anti-GSTT1 can appear in a context different from the previously published alloreactivity after liver and kidney transplantation, as a consequence of transfusions and pregnancies. So far, no adverse clinical outcomes in our patients have been observed.
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Affiliation(s)
- Ingeborg Wichmann
- Department of Immunology, Virgen del Rocío University Hospital, Andalusian Service of Health, Seville, Spain.
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