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DSA Are Associated With More Graft Injury, More Fibrosis, and Upregulation of Rejection-associated Transcripts in Subclinical Rejection. Transplantation 2020; 104:551-561. [PMID: 31651790 DOI: 10.1097/tp.0000000000003034] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Subclinical T cell-mediated rejection (subTCMR) is commonly found after liver transplantation and has a good short-term prognosis, even when it is left untreated. Donor-specific antibodies (DSA) are putatively associated with a worse prognosis for recipient and graft after liver transplantation. METHODS To assess the immune regulation in subTCMR grafts, gene expression of 93 transcripts for graft injury, tolerance, and immune regulation was analyzed in 77 biopsies with "no histologic rejection" (NHR; n = 25), "clinical TCMR" (cTMCR; n = 16), and subTCMR (n = 36). In addition, all available subTCMR biopsies (n = 71) were tested for DSA with bead assays. RESULTS SubTCMR showed heterogeneous and intermediate expression profiles of transcripts that were upregulated in cTCMR. Graft gene expression suggested a lower activation of effector lymphocytes and a higher activation of regulatory T cells in grafts with subTCMR compared to cTCMR. DSA positivity in subTCMR was associated with histological evidence of more severe graft inflammation and fibrosis. This more severe DSA+ associated graft injury in subTCMR was converged with an upregulation of cTCMR-associated transcripts. In nonsupervised analysis, DSA positive subTCMR mostly clustered together with cTCMR, while DSA negative subTCMR clustered together with NHR. CONCLUSIONS T cell-mediated rejection seems to form a continuum of alloimmune activation. Although subTCMR exhibited less expression of TCMR-associated transcript, DSA positivity in subTCMR was associated with an upregulation of rejection-associated transcripts. The identification of DSA positive subclinical rejection might help to define patients with more inflammation in the graft and development of fibrosis.
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Lejnine S, Marton MJ, Wang IM, Howell BJ, Webber AL, Maxwell JW, Shire N, Malkov V, Lunceford J, Zeremski M, Sun A, Ruddy M, Talal AH. Gene expression analysis in serial liver fine needle aspirates. J Viral Hepat 2015; 22:64-76. [PMID: 24475909 PMCID: PMC4721927 DOI: 10.1111/jvh.12213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/08/2013] [Indexed: 12/21/2022]
Abstract
No method with low morbidity presently exists for obtaining serial hepatic gene expression measurements in humans. While hepatic fine needle aspiration (FNA) has lower morbidity than core needle biopsy, applicability is limited due to blood contamination, which confounds quantification of gene expression changes. The aim of this study was to validate FNA for assessment of hepatic gene expression. Liver needle biopsies and FNA procedures were simultaneously performed on 17 patients with chronic hepatitis C virus infection with an additional FNA procedure 1 week later. Nine patients had mild/moderate fibrosis and eight advanced fibrosis. Gene expression profiling was performed using Affymetrix microarrays and TaqMan qPCR; pathway analysis was performed using Ingenuity. We developed a novel strategy that applies liver-enriched normalization genes to determine the percentage of liver in the FNA sample, which enables accurate gene expression measurements overcoming biases derived from blood contamination. We obtained almost identical gene expression results (ρ = 0.99, P < 0.0001) comparing needle biopsy and FNA samples for 21 preselected genes. Gene expression results were also validated in dogs. These data suggest that liver FNA is a reliable method for serial hepatic tissue sampling with potential utility for a variety of preclinical and clinical applications.
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Affiliation(s)
- S. Lejnine
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - M. J. Marton
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - I.-M. Wang
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - B. J. Howell
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - A. L. Webber
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - J. W. Maxwell
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - N. Shire
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - V. Malkov
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - J. Lunceford
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - M. Zeremski
- Division of Gastroenterology and Hepatology and Center for the Study of Hepatitis C, Weill Cornell Medical College, New York, NY, USA
| | - A. Sun
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - M. Ruddy
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - A. H. Talal
- Division of Gastroenterology and Hepatology and Center for the Study of Hepatitis C, Weill Cornell Medical College, New York, NY, USA
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Cheng L, Tian F, Tang L, Wang S, Chen G, Duan G, Yan X. Local distribution analysis of cytotoxic molecules in liver allograft is helpful for the diagnosis of acute cellular rejection after orthotopic liver transplantation. Diagn Pathol 2012; 7:148. [PMID: 23111143 PMCID: PMC3523046 DOI: 10.1186/1746-1596-7-148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/24/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As it is often difficult for a transplant pathologist to make a definite diagnosis of acute cellular rejection (ACR) by routine morphological analysis of liver allograft biopsy, supplementary methods and objective markers are needed to facilitate this determination. METHODS To evaluate the diagnostic value of cytotoxic molecules in ACR episodes, immunohistochemical staining for perforin, granzyme B and T-cell intracellular antigen-1 (TIA-1) were performed in liver allograft biopsies. The positive cells in the portal tract area and lobules were counted separately to investigate the distribution of the cytotoxic molecules. RESULTS The immunohistochemical study showed that the overall positive rates for the three markers were not significantly different between the ACR and non-ACR groups. However, in the portal tract area, perforin-, granzyme B- and TIA-1-positive cells in the ACR group were significantly more than those in the non-ACR groups. In the lobules, perforin- and granzyme B-positive cells in the ACR group were significantly more than those in the biliary complication and opportunistic infection groups, while TIA-1-positive cells was significantly fewer than those in non-ACR groups. The numbers of positive cells in the portal tract area correlated with the rejection activity index of ACR. CONCLUSIONS These results indicate that, though the overall positive rates have nonsense in ACR diagnosis, the quantification and local distribution analysis of cytotoxic molecule positive cells in liver tissue is helpful for differential diagnosis and severity evaluation of ACR following liver transplantation. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2292255038100487.
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Affiliation(s)
- Long Cheng
- Institute of Pathology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
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4
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Organ transplantation. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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5
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Øzbay A, Tørring C, Olsen R, Carstens J. Transcriptional Profiles in Urine During Acute Rejection, Bacteriuria, CMV Infection and Stable Graft Function After Renal Transplantation. Scand J Immunol 2009; 69:357-65. [DOI: 10.1111/j.1365-3083.2009.02226.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Truong DQ, Cornet A, Wieërs G, Robert A, Reding R, Latinne D. Pre- and post-transplant monitoring of granzyme B enzyme-linked immunosorbent spot assay in pediatric liver recipients. Transpl Immunol 2008; 19:215-9. [PMID: 18602007 DOI: 10.1016/j.trim.2008.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 06/03/2008] [Accepted: 06/09/2008] [Indexed: 01/12/2023]
Abstract
UNLABELLED This study aims to investigate potential role of granzyme B enzyme-linked immunosorbent spot (GrB ELISPOT) for immunological monitoring in pediatric liver transplantation. PATIENTS AND METHODS Peripheral blood mononuclear cells from 28 pediatric recipients were serially tested for GrB-producing donor-reactive cells at day 0 pre-transplantation (baseline) and days 7, 14, and 28 post-transplantation. RESULTS At baseline, no difference of GrB value was found in acute rejection (14/28) compared to normal graft function patients (day 0: 4(3.9) spots versus 5(2.9) spots, respectively: p=0.65). At day 7 post-transplantation, acute rejection patients showed frequencies of GrB ELISPOT higher than those with normal graft function, but the differences observed were not statistically significant (day 7: 15(4.9) spots versus 10(4.0) spots, respectively: p=0.55). GrB increased significantly at day 7 from baseline in the rejection group (15(4.9) spots versus 4(3.9), respectively p=0.04), whereas corresponding changes were not significant in the group without rejection (10(4.0) versus 5(2.9), respectively: p=0.15). CONCLUSION GrB ELISPOT pre-transplantation could not predict the occurrence of early post-transplant acute rejection; similarly frequencies at days 7, 14 and 28 could not be correlated with acute rejection in pediatric liver recipients. However, a kinetic study of GrB ELISPOT could be helpful to predict or confirm early rejection in the small group of liver allograft recipients analyzed in this study.
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Affiliation(s)
- Dinh Quang Truong
- Pediatric Liver Transplant Program, Saint-Luc University Clinics, Université catholique de Louvain, Brussels, Belgium
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Rosen HR. Transplantation immunology: what the clinician needs to know for immunotherapy. Gastroenterology 2008; 134:1789-801. [PMID: 18471555 DOI: 10.1053/j.gastro.2008.02.062] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 01/23/2008] [Accepted: 02/12/2008] [Indexed: 12/15/2022]
Abstract
The liver is unique among transplanted organs with respect to its interaction with the host immune system. There is evidence, both anecdotal and documented, that some liver recipients who cease taking immunosuppressive drugs maintain allograft function, suggesting robust tolerance is in place. Moreover, recipients of human liver allografts require less immunosuppression than do other organ recipients, and liver transplants confer protection on other organ grafts from the same donor. Hence, the liver shows features of immune privilege. Still, the liver can display destructive immunologic processes such as rejection in approximately one quarter of patients. The understanding of the cellular and molecular mechanisms operant in tolerance vs allograft rejection is important for developing new agents to improve long-term outcome, minimize infectious complications (including recurrence of hepatotropic viruses), and deliver immunosuppression without long-term toxicity. This review describes the unique aspects of the hepatic immune response, the pathways involved in T-cell activation and alloantigen recognition, effector cells and pathways mediating liver allograft rejection, the role of regulatory T cells, and targets of current and future immunosuppressive agents.
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Affiliation(s)
- Hugo R Rosen
- Division of Gastroenterology & Hepatology, Liver Transplantation, Hepatitis C Center, Department of Medicine, University of Colorado Health Sciences Center, Aurora, Colorado 80045, USA.
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Demirkiran A, Baan CC, Kok A, Metselaar HJ, Tilanus HW, van der Laan LJW. Intrahepatic Detection of FOXP3 Gene Expression After Liver Transplantation Using Minimally Invasive Aspiration Biopsy. Transplantation 2007; 83:819-23. [PMID: 17414718 DOI: 10.1097/01.tp.0000258597.97468.88] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intragraft accumulation of Forkhead box P3 (FOXP3)-positive regulatory T cells (Treg) is associated with local suppression of alloresponses in transplantation models. In the current study, the utility of the minimally invasive fine needle aspiration biopsy for the intragraft detection of FOXP3 and interferon (IFN)-gamma mRNA expression was investigated in clinical liver transplantation (LTx). Intragraft FOXP3 increased within the first year after LTx, but not in blood. Elevated FOXP3, but not IFN-gamma expression, in the liver was observed after hepatitis C virus (HCV) reinfection and after a previous episode of acute rejection. These data show the feasibility of aspiration biopsy for intragraft monitoring of gene expression. Intrahepatic FOXP3 levels are associated with HCV reinfection, a history of acute rejection, and increased within the first year after LTx. Differences in gene expression between the graft and blood underline the importance of local immune monitoring.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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van der Laan LJW, Taimr P, Kok A, Sprengers D, Zondervan PE, Tilanus HW, Janssen HLA. Flowcytometric quantitation of hepatitis B viral antigens in hepatocytes from regular and fine-needle biopsies. J Virol Methods 2007; 142:189-97. [PMID: 17328969 DOI: 10.1016/j.jviromet.2007.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 01/17/2007] [Accepted: 01/25/2007] [Indexed: 12/27/2022]
Abstract
The aim of the study was to investigate the use of flow cytometry, as an alternative for immunohistochemistry, for the detection of viral antigens in the liver of patients with chronic hepatitis B virus (HBV) infection. Hepatocytes were obtained from regular- and fine-needle biopsy from HBV positive (n=17) and negative (n=7) patients and quantified by flow cytometry for intracellular hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg). Number of HBsAg positive hepatocytes ranged from 0 to 83%. A significant correlation was found between the percentage of infected hepatocytes and the intracellular expression level of HBsAg (R=0.841, p<0.001). The specificity and sensitivity of flow cytometry was similar to immunohistochemistry. Of the patients on anti-viral treatment with undetectable serum HBV DNA (<400 copies/ml), two had high HBsAg expression in the liver. HBcAg staining was found in 3 out of 15 patients, with 2-3% positive hepatocytes. The results obtained with fine-needle aspiration biopsy (n=12) were comparable to regular biopsy. In conclusion, flowcytometric quantitation of HBV antigens is sensitive and provides relevant information on the course of infection. The minimally invasive fine-needle biopsy provides a useful alternative for regular-needle biopsy for monitoring intrahepatic antiviral responses during therapy.
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Affiliation(s)
- Luc J W van der Laan
- Department of Surgery, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
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10
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Sprengers D, van der Molen RG, Kusters JG, Kwekkeboom J, van der Laan LJW, Niesters HGM, Kuipers EJ, De Man RA, Schalm SW, Janssen HLA. Flow cytometry of fine-needle-aspiration biopsies: a new method to monitor the intrahepatic immunological environment in chronic viral hepatitis. J Viral Hepat 2005; 12:507-12. [PMID: 16108766 DOI: 10.1111/j.1365-2893.2005.00626.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Information about the character and grade of the intrahepatic immune response in viral hepatitis is important for the evaluation of disease stage and effect of therapy. Complications like haemorrhage limit the frequent performance of tissue-needle biopsies (TB), and the cells of peripheral blood have to be used as surrogate markers instead. Fine-needle-aspiration biopsy (FNAB) of the liver represents a safe and atraumatic method that allows frequent cytological sampling. Our aim was to investigate whether flow cytometry of FNAB specimens allows co-analysis of phenotype, function and specificity of key populations of liver-infiltrating lymphocytes (LIL). In 20 consecutive patients with chronic viral hepatitis [10 hepatitis B virus (HBV), 10 hepatitis C virus (HCV)], flow cytometry was performed on FNAB cytology, and simultaneously on lymphocytes isolated from a TB and peripheral blood mononuclear cells (PBMC). The ratio of CD8+/CD4+ lymphocytes in FNAB correlated well with LIL from TB (r =0.78, P < 0.05) but differed from PBMC (mean ratio: 2.6, 2.1 and 0.7, respectively). Similarly, a correlation was observed for percentage CD56+ natural killer (NK) cells (mean %: 29.9, 32.3 and 14.5, respectively; r = 0.69, P < 0.05). The percentage of interferon (IFN)-gamma-producing CD3+ lymphocytes in both FNAB and TB was higher than in PBMC (mean %: 41, 44 and 22, respectively; P < 0.05). Furthermore, tetrameric complexes allowed analysis of HBV-specific T cells in FNAB specimens. In conclusion, flow cytometry of FNAB allows easy, atraumatic and reliable analysis of lymphocytes obtained from the intrahepatic compartment. Therefore, the FNAB is a valuable tool in the study of the immunopathology of viral hepatitis, and it may contribute to the improved clinical evaluation of chronic viral liver disease.
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Affiliation(s)
- D Sprengers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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11
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Tang TJ, Kwekkeboom J, Mancham S, Binda RS, de Man RA, Schalm SW, Kusters JG, Janssen HLA. Intrahepatic CD8+ T-lymphocyte response is important for therapy-induced viral clearance in chronic hepatitis B infection. J Hepatol 2005; 43:45-52. [PMID: 15893402 DOI: 10.1016/j.jhep.2005.01.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 01/17/2005] [Accepted: 01/26/2005] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS To determine which immune cells contribute to HBV-clearance during antiviral therapy, we performed a longitudinal analysis of intrahepatic immune cells during interferon-alpha therapy of chronic HBV-patients using the FNAB technique. METHODS Twenty chronic HBeAg+-patients were treated with pegylated alpha-interferon combined with lamivudine or placebo for 52 weeks. FNAB and blood specimens were obtained at week 0, 2, 8 and 52. CD4+- and CD8+ T-lymphocytes, CD56+ cells, IFNgamma and granzyme B (GrB) were immunocytochemically quantified. RESULTS The relative numbers of CD56+ cells and CD8+ T-lymphocytes were significantly higher in FNAB compared to blood at all time-points. Responders (n=9) exhibited significant increases in intrahepatic CD8+ and CD8+GrB+ lymphocytes, a small elevation in CD8+IFNgamma+ T-lymphocytes, no change in CD4+ T-lymphocytes, and a decrease in intrahepatic CD56+ cells during the first weeks of therapy. In non-responders (n=11) no significant changes in CD4+- and CD8+ T-lymphocytes and an increase in intrahepatic and CD56+ cells were observed during therapy. CONCLUSIONS The intrahepatic CD8+ T-lymphocyte, but not the CD4+ T-lymphocyte or NK/NKT-cell response, is important for HBV clearance during interferon-alpha therapy, and the antiviral effect may be mediated by both cytolytic and non-cytolytic mechanisms.
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Affiliation(s)
- Thjon J Tang
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Room L-455, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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12
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Kircher B, Hack CE, Dickinson AM, Wang XN, Oudshoorn M, Sachs A, Wolbink A, Niederwieser D, Eibl GJ, van Houwelingen HC, Goulmy E. Towards functional transplant donor matching by measurement of granzyme A and granzyme B production levels. J Immunol Methods 2004; 293:51-9. [PMID: 15541276 DOI: 10.1016/j.jim.2004.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2003] [Revised: 06/29/2004] [Accepted: 06/30/2004] [Indexed: 11/25/2022]
Abstract
Graft-versus-host disease (GvHD) can be a major complication after allogeneic stem cell transplantation (SCT) especially when donor and recipient are unrelated. The latter serious complication, together with the growing number of available unrelated stem cell donors, demand a simple in vitro assay for functional stem cell donor selection. Activated donor cytotoxic T lymphocytes (CTLs) and natural killer cells produce granzymes (Gr) that are involved in the pathogenesis of GvHD. We measured granzymes A and B (GrA and GrB) production levels in the supernatants of 96 h pretransplant mixed lymphocyte cultures (MLC) of 26 sibling and 31 unrelated patient/donor pairs by enzyme-linked immunosorbent assay (ELISA). In detail, the GrA and GrB production levels from a selected cohort of 37 potential patient/donor pairs were correlated with relative responses (RR) of MLC and with human leukocyte antigen (HLA) class II mismatches and with the development of acute GvHD in a second, consecutive cohort of 20 sibling SCT recipients. In vitro measurement of GrA and GrB production levels significantly correlated with the RR of pretransplant MLC (r=0.492, p< or =0.01 and r=0.853, p< or =0.01, respectively) and increased with the number of HLA class II mismatches between patient and donor. Pretransplant GrA production levels were significantly associated with the in vivo development of acute GvHD grades II-IV in patients transplanted with an HLA-identical sibling donor (p< or =0.001). In conclusion, in vitro GrA and GrB production levels can be measured by a quantitative and sensitive ELISA. This novel and simple method may be used for functional selection of unrelated stem cell donors and for the identification of patients who are at risk for acute GvHD grades II-IV.
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Affiliation(s)
- Brigitte Kircher
- Laboratory for Tumor and Immunobiology, Department of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
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Vrolijk JM, Tang TJ, Kwekkeboom J, Haagmans BL, Herscheid AJ, Kusters JG, Janssen HLA, Brouwer JT, Schalm SW. Monitoring intrahepatic CD8+ T cells by fine-needle aspiration cytology in chronic hepatitis C infection. J Viral Hepat 2004; 11:342-8. [PMID: 15230857 DOI: 10.1111/j.1365-2893.2004.00526.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Infection of the liver with hepatitis C virus (HCV) causes compartmentalization of CD8+ cytotoxic T cells to the site of disease. These cells are thought to be involved in viral clearance during interferon therapy. The repetitive analysis of the intrahepatic immune response is hampered by the difficulty to obtain the intrahepatic T cells. The fine-needle aspiration biopsy (FNAB) technique was evaluated for its use to obtain liver-derived CD8+ T cells in a minimally invasive way. In 26 chronic HCV patients who were evaluated for Peg-interferon and ribavirin combination therapy, pre-treatment FNABs and peripheral blood specimens were obtained simultaneously with liver tissue biopsies, and CD3+ and CD8+ T cells were quantified by immunocytochemistry. The CD8+/CD3+ ratio was significantly higher in the FNABs than in peripheral blood (P < 0.01), and similar to those in portal areas in the tissue biopsies. A significant correlation was observed between numbers of CD3+CD8+ T lymphocytes in the FNABs and the numbers of CD8+ cells in the lobular fields or in the portal tracts of the liver tissue biopsies, but not with CD3+CD8+ T lymphocytes in peripheral blood. Finally, the ratio of CD8+/CD3+ T lymphocytes in FNABs was significantly higher in those patients who responded rapidly to therapy when compared with slow responders at 4 weeks of treatment (P = 0.02). These findings demonstrate that the intrahepatic T-cell composition is reflected in FNABs, and that the FNAB technique can be used for predicting early virological response to therapy of patients chronically infected with HCV.
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Affiliation(s)
- J M Vrolijk
- Department of Gastroenterology and Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Tang TJ, Janssen HLA, Kusters JG, de Man RA, Schalm SW, Kwekkeboom J. The intrahepatic immune response during chronic hepatitis B infection can be monitored by the fine-needle aspiration biopsy technique. ACTA ACUST UNITED AC 2003; 39:69-72. [PMID: 14556998 DOI: 10.1016/s0928-8244(03)00206-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Frequent analysis of the intrahepatic cellular immune response during chronic hepatitis B infection is not feasible with the liver tissue biopsy technique, due to its risk profile and patient discomfort. We investigated whether the relatively safe and patient-friendly cytological fine-needle aspiration biopsy (FNAB) technique is suited for this purpose. FNABs taken during hepatitis flares in three chronic hepatitis B patients treated with interferon-alpha, showed significant increments of CD8(+)-lymphocytes compared with the FNABs taken before and after the flares. No increments were observed in peripheral blood. The increments of intrahepatic CD8+ lymphocytes detected by the FNAB were related to anti-viral immune reactivity, since they coincided with significant serum hepatitis B virus DNA level reductions and in two of three patients with HBeAg seroconversion. In conclusion, the FNAB technique is suited to investigate the intrahepatic immune response during chronic hepatitis B infection on a frequent basis.
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Affiliation(s)
- Thjon J Tang
- Department of Gastroenterology and Hepatology, Room L-455, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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