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Vladyka O, Zieg J, Pátek O, Bloomfield M, Paračková Z, Šedivá A, Klocperk A. Profound T Lymphocyte and DNA Repair Defect Characterizes Schimke Immuno-Osseous Dysplasia. J Clin Immunol 2024; 44:180. [PMID: 39153074 PMCID: PMC11330395 DOI: 10.1007/s10875-024-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
Schimke immuno-osseous dysplasia is a rare multisystemic disorder caused by biallelic loss of function of the SMARCAL1 gene that plays a pivotal role in replication fork stabilization and thus DNA repair. Individuals affected from this disease suffer from disproportionate growth failure, steroid resistant nephrotic syndrome leading to renal failure and primary immunodeficiency mediated by T cell lymphopenia. With infectious complications being the leading cause of death in this disease, researching the nature of the immunodeficiency is crucial, particularly as the state is exacerbated by loss of antibodies due to nephrotic syndrome or immunosuppressive treatment. Building on previous findings that identified the loss of IL-7 receptor expression as a possible cause of the immunodeficiency and increased sensitivity to radiation-induced damage, we have employed spectral cytometry and multiplex RNA-sequencing to assess the phenotype and function of T cells ex-vivo and to study changes induced by in-vitro UV irradiation and reaction of cells to the presence of IL-7. Our findings highlight the mature phenotype of T cells with proinflammatory Th1 skew and signs of exhaustion and lack of response to IL-7. UV light irradiation caused a severe increase in the apoptosis of T cells, however the expression of the genes related to immune response and regulation remained surprisingly similar to healthy cells. Due to the disease's rarity, more studies will be necessary for complete understanding of this unique immunodeficiency.
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Affiliation(s)
- Ondřej Vladyka
- Department of Immunology, 2nd Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic
| | - Jakub Zieg
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic
| | - Ondřej Pátek
- Department of Internal Medicine, 2nd Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic
| | - Markéta Bloomfield
- Department of Immunology, 2nd Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic
| | - Zuzana Paračková
- Department of Immunology, 2nd Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic
| | - Anna Šedivá
- Department of Immunology, 2nd Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic
| | - Adam Klocperk
- Department of Immunology, 2nd Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic.
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Laroche C, Lucchini G, Worth A, Marks SD. Optimal transplantation options for children with Schimke immuno-osseous dysplasia. Pediatr Transplant 2024; 28:e14616. [PMID: 37787006 DOI: 10.1111/petr.14616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Camille Laroche
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Giovanna Lucchini
- Department of Paediatric Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Austen Worth
- Department of Paediatric Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
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3
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Alotaibi M, Alahmadi Z, Desai N, Brennan DC, Kant S. Twenty years in the making: tolerance in a living-related kidney transplant recipient. J Nephrol 2024:10.1007/s40620-023-01843-1. [PMID: 38175522 DOI: 10.1007/s40620-023-01843-1] [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: 08/20/2023] [Accepted: 11/18/2023] [Indexed: 01/05/2024]
Abstract
Kidney transplant recipients require lifelong immunosuppression to prevent graft rejection. However, immunosuppression is associated with adverse effects. A minority of kidney transplant recipients can be weaned off immunosuppression and maintain their graft function, a situation referred to as "functional or operational tolerance". We describe a case of a 70-year-old man who received a haploidentical hematopoietic cell transplant for lymphoma 22 years before receiving a kidney transplant from the same donor and was weaned off all immunosuppression by four months post-transplant. Tolerance was present, and there has been no graft rejection or graft vs. host disease. This case demonstrates successful long-term hematopoietic chimerism and functional tolerance after receiving a kidney transplant from the same donor.
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Affiliation(s)
- Manal Alotaibi
- Comprehensive Transplant Center and Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Umm Al-Qura University, College of Medicine, Makkah, Saudi Arabia.
| | - Ziad Alahmadi
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Niraj Desai
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel C Brennan
- Comprehensive Transplant Center and Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sam Kant
- Comprehensive Transplant Center and Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Woo HA, Kim SH, Ahn YH, Min SI, Ha J, Ha IS, Cheong HI, Kang HG. Clinical course of post-kidney transplant Schimke immuno-osseous dysplasia. Pediatr Transplant 2023; 27:e14605. [PMID: 37691539 DOI: 10.1111/petr.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/02/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Schimke immuno-osseous dysplasia (SIOD) is a rare systemic disease characterized by short stature, proteinuria, and recurrent infections. Patients usually have spondyloepiphyseal dysplasia, and progressive steroid-resistant nephropathy that leads to kidney failure. However, their clinical course after kidney transplantation (KT) is not yet well known. Here, we present our experience with cases of SIOD treated at our institute. CASE PRESENTATION Since 2014, three children have been diagnosed with nephropathy resulting from SIOD. They presented with proteinuria in the nephrotic range at 7, 5, and 3 years of age. Focal segmental glomerulosclerosis was confirmed and progressed to kidney failure approximately 2 years after proteinuria was detected. These patients underwent living-donor KT from their parents. After KT, Case 1 lost his graft within 7 months due to multi-organ failure caused by disseminated adenovirus infection and died. Case 2 experienced graft failure 5 years after KT due to acute rejection from poor compliance. In Case 3, the allograft was still functioning 6 years after KT with low-dose tacrolimus single medication (trough level < 5 ng/mL). Extra-renal manifestations progressed regardless of KT, namely, right renal vein thrombosis and pulmonary hypertension in Case 1, severe bilateral hip dysplasia and Moyamoya syndrome in Case 2, and neutropenia and thrombocytopenia in Case 3, in addition to recurrent infection. CONCLUSION In SIOD patients, KT is complicated with recurrent infections due to their inherent immune dysfunction. Additionally, extra-renal symptoms may render the patients morbid despite the recovery of kidney function.
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Affiliation(s)
- Hyun Ah Woo
- Department of Pediatrics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Seong Heon Kim
- Department of Pediatrics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Sang Il Min
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Korea
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5
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Orozco RAP, Padilla-Guzmán A, Forero-Delgadillo JM, Jiménez VAO, Pachajoa H, Parra NJV, Restrepo JM. Schimke immuno-osseous dysplasia. A case report in Colombia. Mol Genet Metab Rep 2023; 37:100995. [PMID: 37662493 PMCID: PMC10472290 DOI: 10.1016/j.ymgmr.2023.100995] [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: 06/02/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 09/05/2023] Open
Abstract
Background Schimke immune-osseous dysplasia (SIOD) is an ultra-rare multisystemic, monogenic, and autosomal recessive inherited disease caused by biallelic mutations in the SMARCAL1 gene. Approximately 100 cases have been reported worldwide. The disease is characterized by skeletal, renal, and immunological abnormalities. Case description This is a 6-year-old female patient who debuted with nephrotic syndrome at five years of age, with a switch to corticosteroid resistance and poor response to immunosuppressive treatment received. The patient was admitted and referred to our institution due to convulsive status. During her hospitalization, thrombosis was found in the left renal vein, and a renal biopsy report of Collapsing Focal and Segmental Glomerulosclerosis (FSGS) was obtained. The patient had multiple infections during hospitalization, with T lymphocyte lymphopenia and severe IgG hypogammaglobulinemia. Additionally, given dysmorphic facies, delayed weight-height development, and spondyloepiphyseal dysplasia, exome sequencing was performed, finding an homozygous pathogenic variant c.1933C > T p.Arg645Cys in SMARCAL1, compatible with the diagnosis of SIOD. Discussion We present the case of a patient that exhibited a severe phenotype of the disease, with skeletal, renal, severe combined immunological compromise and cerebrovascular involvement during follow-up, and the available proposed mechanisms of the disease focused on the clinical manifestations of this patient. It is the first case of SIOD reported in Colombia and the first comprehensive characterization reported in the literature of a patient with homozygosity of the known variant c.1933C > T p.Arg645Cys. Conclusion A severe phenotype of the disease with cerebrovascular involvement by homozygosity of the known variant c.1933C > T p.Arg645Cys in the SMARCAL1 gene can be expected.
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Affiliation(s)
| | | | - Jessica María Forero-Delgadillo
- Servicio de nefrología pediátrica, Departamento de salud maternoinfantil, Fundación Valle del Lili, Cali, Colombia
- Facultad de ciencias de la salud, Universidad Icesi, Cali, Colombia
| | - Vanessa Amparo Ochoa Jiménez
- Servicio de nefrología pediátrica, Departamento de salud maternoinfantil, Fundación Valle del Lili, Cali, Colombia
- Facultad de ciencias de la salud, Universidad Icesi, Cali, Colombia
| | - Harry Pachajoa
- Servicio de genética, Fundación Valle del Lili, Cali, Colombia
- Facultad de ciencias de la salud, Universidad Icesi, Cali, Colombia
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
| | | | - Jaime M. Restrepo
- Servicio de nefrología pediátrica, Departamento de salud maternoinfantil, Fundación Valle del Lili, Cali, Colombia
- Facultad de ciencias de la salud, Universidad Icesi, Cali, Colombia
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DeZern AE, Brodsky RA. Combining PTCy and ATG for GvHD prophylaxis in non-malignant diseases. Blood Rev 2023; 62:101016. [PMID: 36244884 DOI: 10.1016/j.blre.2022.101016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022]
Abstract
Bone marrow transplantation for non-malignant diseases such as aplastic anemia and hemoglobinopathies is a burgeoning clinical area. The goal of these transplants is to correct the hematopoietic defect with as little toxicity as possible. This requires mitigation of transplant-specific toxicities such as graft versus host disease, given this is not needed in non-malignant disorders. This review details current clinical outcomes in the field with a focus on post-transplantation cyclophosphamide and anti-thymoglobulin as intensive graft versus host disease prophylaxis to achieve that goal.
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Affiliation(s)
- Amy E DeZern
- Division of Hematologic Malignancies, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRBI Room 3M87, Baltimore, MD 21287-0013, United States of America.
| | - Robert A Brodsky
- Division of Hematology, The Johns Hopkins University School of Medicine, 720 Rutland Avenue | Ross 1025, Baltimore, MD 21205, United States of America.
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Goggin KP, Londeree J, Freeman AF, Garro R, George RP. Successful Use of Fosmanogepix for Treatment of Rare Highly Resistant Cutaneous Fusariosis in a Pediatric Patient With STAT3 Hyper-Immunoglobulin E Syndrome and End-Stage Kidney Disease. Open Forum Infect Dis 2023; 10:ofad285. [PMID: 37305844 PMCID: PMC10249262 DOI: 10.1093/ofid/ofad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/19/2023] [Indexed: 06/13/2023] Open
Abstract
We describe the successful use of the novel antifungal drug fosmanogepix to treat a chronic case of multidrug-resistant cutaneous Fusarium suttonianum infection in a pediatric patient with STAT3 hyper-IgE syndrome and end-stage kidney disease on peritoneal dialysis.
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Affiliation(s)
- Kathryn P Goggin
- Correspondence: Kathryn P. Goggin, MD, MSc, Infectious Diseases Division Emory Department of Pediatrics 2015 Uppergate Drive, Suite 534 Atlanta, GA 30322 ()
| | - Jackson Londeree
- Division of Nephrology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rouba Garro
- Division of Nephrology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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Sobrino S, Abdo C, Neven B, Denis A, Gouge-Biebuyck N, Clave E, Charbonnier S, Blein T, Kergaravat C, Alcantara M, Villarese P, Berthaud R, Dehoux L, Albinni S, Karkeni E, Lagresle-Peyrou C, Cavazzana M, Salomon R, André I, Toubert A, Asnafi V, Picard C, Blanche S, Macintyre E, Boyer O, Six E, Zuber J. Human kidney-derived hematopoietic stem cells can support long-term multilineage hematopoiesis. Kidney Int 2023; 103:70-76. [PMID: 36108807 DOI: 10.1016/j.kint.2022.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/23/2022] [Accepted: 08/12/2022] [Indexed: 01/10/2023]
Abstract
Long-term multilineage hematopoietic donor chimerism occurs sporadically in patients who receive a transplanted solid organ enriched in lymphoid tissues such as the intestine or liver. There is currently no evidence for the presence of kidney-resident hematopoietic stem cells in any mammal species. Graft-versus-host-reactive donor T cells promote engraftment of graft-derived hematopoietic stem cells by making space in the bone marrow. Here, we report full (over 99%) multilineage, donor-derived hematopoietic chimerism in a pediatric kidney transplant recipient with syndromic combined immune deficiency that leads to transplant tolerance. Interestingly, we found that the human kidney-derived hematopoietic stem cells took up long-term residence in the recipient's bone marrow and gradually replaced their host counterparts, leading to blood type conversion and full donor chimerism of both lymphoid and myeloid lineages. Thus, our findings highlight the existence of human kidney-derived hematopoietic stem cells with a self-renewal ability able to support multilineage hematopoiesis.
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Affiliation(s)
- Steicy Sobrino
- INSERM UMR_S1163, Institut IMAGINE, Paris, France; Université Paris Cité, Paris, France
| | - Chrystelle Abdo
- Université Paris Cité, Paris, France; Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Bénédicte Neven
- Université Paris Cité, Paris, France; Service d'Immuno-Hématologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | | | - Nathalie Gouge-Biebuyck
- Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Emmanuel Clave
- INSERM UMR_S1160, Institut de Recherche Saint Louis, Paris, France
| | | | | | | | - Marion Alcantara
- Université Paris Cité, Paris, France; Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Patrick Villarese
- Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Romain Berthaud
- Université Paris Cité, Paris, France; Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Laurène Dehoux
- Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Souha Albinni
- Etablissement Français du Sang Ile-de-France, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Esma Karkeni
- Cytometry and Biomarkers UTechS, Center for Translational Science, Institut Pasteur, Paris, France
| | | | - Marina Cavazzana
- INSERM UMR_S1163, Institut IMAGINE, Paris, France; Université Paris Cité, Paris, France
| | - Rémi Salomon
- Université Paris Cité, Paris, France; Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | | | - Antoine Toubert
- Université Paris Cité, Paris, France; INSERM UMR_S1160, Institut de Recherche Saint Louis, Paris, France
| | - Vahid Asnafi
- Université Paris Cité, Paris, France; Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Capucine Picard
- INSERM UMR_S1163, Institut IMAGINE, Paris, France; Université Paris Cité, Paris, France; CEDI, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Stéphane Blanche
- Université Paris Cité, Paris, France; Service d'Immuno-Hématologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Elizabeth Macintyre
- Université Paris Cité, Paris, France; Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Olivia Boyer
- Université Paris Cité, Paris, France; Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | | | - Julien Zuber
- INSERM UMR_S1163, Institut IMAGINE, Paris, France; Université Paris Cité, Paris, France; Service des Maladies du Rein et Métabolisme, Transplantation et Immunologie Clinique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France.
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Cheng P, Jian Q, Fu Z, Deng R, Ma Y. Inhibition of DAI refrains dendritic cells from maturation and prolongs murine islet and skin allograft survival. Front Immunol 2023; 14:1182851. [PMID: 37197662 PMCID: PMC10183602 DOI: 10.3389/fimmu.2023.1182851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
Introduction Central to allograft rejection is the T cell-mediated adaptive immune response initiated by activated dendritic cells (DCs). Previous studies have shown that the DNA-dependent activator of IFN regulatory factors (DAI) is involved in the maturation and activation of DCs. Therefore, we hypothesized that inhibition of DAI could prevent DCs from maturation and prolong murine allograft survival. Methods Donor mouse bone marrow-derived dendritic cells (BMDCs) were transduced with the recombinant adenovirus vector (AdV-DAI-RNAi-GFP) to inhibit DAI expression (DC-DAI-RNAi), and the immune cell phenotype and function of DC-DAI-RNAi upon lipopolysaccharide (LPS) stimulation were evaluated. Then DC-DAI-RNAi was injected into recipient mice before islet transplantation and skin transplantation. The survival times of islet and skin allograft were recorded and the proportions of T cell subsets in spleen and secretion levels of cytokines in serum were measured. Results We identified that DC-DAI-RNAi inhibited the expression of main co-stimulatory molecules and MHC-II, exhibited strong phagocytic ability, and secreted high levels of immunosuppressive cytokines and low levels of immunostimulating cytokines. Recipient mice treated with DC-DAI-RNAi had longer islet and skin allograft survival times. In the murine islet transplantation model, we observed an increase in Treg cells proportion, a reduction in Th1 and Th17 cells proportions in spleen, and similar trends in their secreted cytokines in serum in the DC-DAI-RNAi group. Conclusion Inhibition of DAI by adenovirus transduction inhibits the maturation and activation of DCs, affects the differentiation of T cell subsets as well as their secreted cytokines, and prolongs allograft survival.
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Affiliation(s)
- Pengrui Cheng
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Jian
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zongli Fu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Ronghai Deng, ; Yi Ma,
| | - Yi Ma
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Ronghai Deng, ; Yi Ma,
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Pilat N. Inadvertent stem cell transfer demonstrating a way for tolerance induction. Kidney Int 2023; 103:21-22. [PMID: 36603970 DOI: 10.1016/j.kint.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 01/04/2023]
Abstract
In this issue, Sobrino et al. present a case of hematopoietic chimerism and subsequent tolerance after isolated kidney transplantation in a pediatric patient with syndromic combined immune deficiency. This report not only highlights the chimerism approach for tolerance induction in transplantation, but it is also the first evidence of hematopoietic stem cells in human kidneys. This commentary discusses the potency and risks of the chimerism approach for tolerance induction after solid organ transplantation, especially in (pediatric) patients with immune deficiencies.
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Affiliation(s)
- Nina Pilat
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.
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11
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Handgretinger R, Arendt AM, Maier CP, Lang P. Ex vivo and in vivo T-cell depletion in allogeneic transplantation: towards less or non-cytotoxic conditioning regimens. Expert Rev Clin Immunol 2022; 18:1285-1296. [PMID: 36220154 DOI: 10.1080/1744666x.2022.2134857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Although tremendous progress has been made since the introduction of allogeneic hematopoietic stem cell transplantation (HSCT) decades ago, there are still many obstacles to overcome. A major obstacle is the presence of T-lymphocytes in the recipient and in the donor. Recipient-derived T-lymphocytes not eliminated by the conditioning regimen are a major barrier and can lead to mixed chimerism or to complete rejection of the graft. Donor-derived T-lymphocytes can induce severe acute and chronic Graft-versus-Host Disease (GvHD). AREAS COVERED Currently published strategies for in vivo depletion of recipient-derived T-lymphocytes are discussed including the increase of the intensity of the conditioning regimen, the addition of anti-thymocyte globulin (ATG) or the anti-CD52 monoclonal antibody Campath. For the depletion or tolerization of the donor-derived T-lymphocytes, ex vivo-T-cell depletion methods, such as positive selection of CD34+ stem cells, negative depletion of CD3+ or TcRαβ+ T-lymphocytes or the use of post-transplant cyclophosphamide (PTCy) have been developed. EXPERT COMMENTARY All these currently used approaches have their disadvantages and new approaches should be investigated. In this review, we discuss current and propose new possible strategies to overcome the HLA barrier by using more specific T-cell directed therapies and/or by the combinations of current methods.
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Affiliation(s)
- Rupert Handgretinger
- Department of Hematology/Oncology. Children's University Hospital, University of Tuebingen, Germany.,Abu Dhabi Stem Cells Center, Abu Dhabi, UAE
| | - Anne-Marie Arendt
- Department of Hematology/Oncology. Children's University Hospital, University of Tuebingen, Germany
| | - Claus-Philipp Maier
- Department of Hematology/Oncology. Children's University Hospital, University of Tuebingen, Germany.,Department of Hematology, Oncology, Clinical Immunology and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Department of Hematology/Oncology. Children's University Hospital, University of Tuebingen, Germany
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Merli P, Guzzo I, Locatelli F. Sequential Stem Cell-Kidney Transplantation in Schimke Immuno-osseous Dysplasia. N Engl J Med 2022; 387:860. [PMID: 36053525 DOI: 10.1056/nejmc2209527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Pietro Merli
- IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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Allison SJ. Stem cell-kidney transplantation in Schimke immuno-osseous dysplasia. Nat Rev Nephrol 2022; 18:543. [PMID: 35879532 DOI: 10.1038/s41581-022-00613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- Thomas R Spitzer
- From the Departments of Medicine (T.R.S.) and Surgery (D.H.S.), Massachusetts General Hospital, Boston; and the Departments of Medicine and Surgery, Columbia University, New York (D.H.S.)
| | - David H Sachs
- From the Departments of Medicine (T.R.S.) and Surgery (D.H.S.), Massachusetts General Hospital, Boston; and the Departments of Medicine and Surgery, Columbia University, New York (D.H.S.)
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