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Lee S, Kim JM, Lee K, Cho H, Shin S, Kim JK. Diagnosis and classification of kidney transplant rejection using machine learning-assisted surface-enhanced Raman spectroscopy using a single drop of serum. Biosens Bioelectron 2024; 261:116523. [PMID: 38924813 DOI: 10.1016/j.bios.2024.116523] [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: 04/26/2024] [Revised: 06/13/2024] [Accepted: 06/23/2024] [Indexed: 06/28/2024]
Abstract
The quest to reduce kidney transplant rejection has emphasized the urgent requirement for the development of non-invasive, precise diagnostic technologies. These technologies aim to detect antibody-mediated rejection (ABMR) and T-cell-mediated rejection (TCMR), which are asymptomatic and pose a risk of potential kidney damage. The protocols for managing rejection caused by ABMR and TCMR differ, and diagnosis has traditionally relied on invasive biopsy procedures. Therefore, a convergence system using a nano-sensing chip, Raman spectroscopy, and AI technology was introduced to facilitate diagnosis using serum samples obtained from patients with no major abnormality, ABMR, and TCMR after kidney transplantation. Tissue biopsy and Banff score analysis were performed across the groups for validation, and 5 μL of serum obtained at the same time was added onto the Au-ZnO nanorod-based Surface-Enhanced Raman Scattering sensing chip to obtain Raman spectroscopy signals. The accuracy of machine learning algorithms for principal component-linear discriminant analysis and principal component-partial least squares discriminant analysis was 93.53% and 98.82%, respectively. The collagen (an indicative of kidney injury), creatinine, and amino acid-derived signals (markers of kidney function) contributed to this accuracy; however, the high accuracy was primarily due to the ability of the system to analyze a broad spectrum of various biomarkers.
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Affiliation(s)
- Sanghwa Lee
- Department of Convergence Medicine, Asan Institute for Life Science, Asan Medical Center, Seoul, 05505, South Korea
| | - Jin-Myung Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Kwanhee Lee
- Department of Biomedical Engineering, Brain Korea 21 Project, University of Ulsan, College of Medicine, Seoul, 05505, South Korea
| | - Haeyon Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Sung Shin
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
| | - Jun Ki Kim
- Department of Convergence Medicine, Asan Institute for Life Science, Asan Medical Center, Seoul, 05505, South Korea; Department of Biomedical Engineering, Brain Korea 21 Project, University of Ulsan, College of Medicine, Seoul, 05505, South Korea.
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Gupta S, Gea-Banacloche J, Heilman RL, Yaman RN, Me HM, Zhang N, Vikram HR, Kodali L. Impact of Early Rejection Treatment on Infection Development in Kidney Transplant Recipients: A Propensity Analysis. J Transplant 2024; 2024:6663086. [PMID: 38463548 PMCID: PMC10923621 DOI: 10.1155/2024/6663086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/24/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature. Methods We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) kidney transplant patients treated at our institution from 2014 to 2020 to understand the impact of rejection on infection development. Propensity scoring was used to match cohorts. We collected data for infections within 6 months of rejection for the cases and 18 months posttransplant for controls. Results In 370 patients, we identified 466 infections, 297 in the controls, and 169 in the cases. Urinary tract infections (38.9%) and cytomegalovirus viremia (13.7%) were most common. Cumulative incidence of infection between the case and controls was 2.17 (CI 1.54-3.05); p < 0.001. There was no difference in overall survival (HR 0.90, CI 0.49-1.66) or graft survival (HR 1.27, CI 0.74-2.20) between the groups. There was a significant difference in overall survival (HR 2.28, CI 1.14-4.55; p = 0.019) and graft survival (HR 1.98, CI 1.10-3.56; p = 0.023) when patients with infection were compared to those without. Conclusions As previously understood, rejection treatment is a risk factor for subsequent infection development. Our data have defined this relationship more clearly. This study is unique, however, in that we found that infections, but not rejection, negatively impacted both overall patient survival and allograft survival, likely due to our institution's robust post-rejection protocols. Clinicians should monitor patients closely for infections in the post-rejection period and have a low threshold to treat these infections while also restarting appropriate prophylaxis.
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Affiliation(s)
- Simran Gupta
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Juan Gea-Banacloche
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Raymond L. Heilman
- Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA
- Transplant Center, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Reena N. Yaman
- Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Hay Me Me
- Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA
- Transplant Center, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Lavanya Kodali
- Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA
- Transplant Center, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Wang Y, Lin X, Wang C, Liu X, Wu X, Qiu Y, Chen Y, Zhou Q, Zhao H, Chen J, Huang H. Identification of PDCD1 as a potential biomarker in acute rejection after kidney transplantation via comprehensive bioinformatic analysis. Front Immunol 2023; 13:1076546. [PMID: 36776400 PMCID: PMC9911868 DOI: 10.3389/fimmu.2022.1076546] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
Background Acute rejection is a determinant of prognosis following kidney transplantation. It is essential to search for novel noninvasive biomarkers for early diagnosis and prompt treatment. Methods Gene microarray data was downloaded from the Gene Expression Omnibus (GEO) expression profile database and the intersected differentially expressed genes (DEGs) was calculated. We conducted the DEGs with Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Distribution of immune cell infiltration was calculated by CIBERSORT. A hub gene marker was identified by intersecting the rejection-related genes from WGCNA and a selected KEGG pathway-T cell receptor signaling pathway (hsa04660), and building a protein-protein interaction network using the STRING database and Cytoscape software. We performed flow-cytometry analysis to validate the hub gene. Results A total of 1450 integrated DEGs were obtained from five datasets (GSE1563, GSE174020, GSE98320, GSE36059, GSE25902). The GO, KEGG and immune infiltration analysis results showed that AR was mainly associated with T cell activation and various T-cell related pathways. Other immune cells, such as B cells, Macrophage and Dendritic cells were also associated with the progress. After utilizing the WGCNA and PPI network, PDCD1 was identified as the hub gene. The flow-cytometry analysis demonstrated that both in CD4+ and CD8+ T cells, PD1+CD57-, an exhausted T cell phenotype, were downregulated in the acute rejection whole blood samples. Conclusions Our study illustrated that PDCD1 may be a candidate diagnostic biomarker for acute kidney transplant rejection via integrative bioinformatic analysis.
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Affiliation(s)
- Yucheng Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Xiaoli Lin
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Cuili Wang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Xinyu Liu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Xiaoying Wu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Yingying Qiu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Ying Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Qin Zhou
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Haige Zhao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China
| | - Hongfeng Huang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang, China,Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang, China,*Correspondence: Hongfeng Huang,
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Manook M, Kwun J, Burghuber C, Samy K, Mulvihill M, Yoon J, Xu H, MacDonald AL, Freischlag K, Curfman V, Branum E, Howell D, Farris AB, Smith RA, Sacks S, Dorling A, Mamode N, Knechtle S. Thrombalexin: Use of a Cytotopic Anticoagulant to Reduce Thrombotic Microangiopathy in a Highly Sensitized Model of Kidney Transplantation. Am J Transplant 2017; 17:2055-2064. [PMID: 28226413 PMCID: PMC5519442 DOI: 10.1111/ajt.14234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 01/04/2017] [Accepted: 01/26/2017] [Indexed: 01/25/2023]
Abstract
Early activation of coagulation is an important factor in the initiation of innate immunity, as characterized by thrombotic microangiopathy (TMA). In transplantation, systemic anticoagulation is difficult due to bleeding. A novel "cytotopic" agent, thrombalexin (TLN), combines a cell-membrane-bound (myristoyl tail) anti-thrombin (hirudin-like peptide [HLL]), which can be perfused directly to the donor organ or cells. Thromboelastography was used to measure time to clot formation (r-time) in both rhesus and human blood, comparing TLN versus HLL (without cytotopic tail) versus negative control. Both TLN- and HLL-treated rhesus or human whole blood result in significantly prolonged r-time compared to kaolin controls. Only TLN-treated human endothelial cells and neonatal porcine islets prolonged time to clot formation. Detection of membrane-bound TLN was confirmed by immunohistochemistry and fluorescence activated cell sorter. In vivo, perfusion of a nonhuman primate kidney TLN-supplemented preservation solution in a sensitized model of transplantation demonstrated no evidence of TLN systemically. Histologically, TLN was shown to be present up to 4 days after transplantation. There was no platelet deposition, and TMA severity, as well as microvascular injury scores (glomerulitis + peritubular capillaritis), were less in the TLN-treated animals. Despite promising evidence of localized efficacy, no survival benefit was demonstrated.
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Affiliation(s)
- Miriam Manook
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710,Renal and Transplant Department, Guy’s and St Thomas’ NHS Foundation Trust
| | - Jean Kwun
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Christian Burghuber
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Kannan Samy
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Michael Mulvihill
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Janghoon Yoon
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - He Xu
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Andrea L. MacDonald
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Kyle Freischlag
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Verna Curfman
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Evelyn Branum
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - David Howell
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710
| | - Alton Brad Farris
- Department of Pathology, Emory University Hospital, Atlanta GA 30322
| | | | - Stephen Sacks
- MRC Centre for Transplantation, King’s College, London, UK
| | | | - Nizam Mamode
- Renal and Transplant Department, Guy’s and St Thomas’ NHS Foundation Trust
| | - Stuart Knechtle
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710,Corresponding author: Stuart J Knechtle, MD, 330 Trent Drive, DUMC Box 3512, Durham, NC 27710, U.S.A., Phone: 919-613-9687; Fax: 919-684-8716;
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