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Karimi A, Yaghobi R, Roozbeh J, Rahimi Z, Afshari A, Akbarpoor Z, Heidari M. Study the mRNA level of IL-27/IL-27R pathway molecules in kidney transplant rejection. Arch Ital Urol Androl 2023; 95:11691. [PMID: 38193229 DOI: 10.4081/aiua.2023.11691] [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: 08/30/2023] [Accepted: 10/07/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Renal transplantation stands as the sole remedy for individuals afflicted with end-stage renal diseases, and safeguarding them from transplant rejection represents a vital, life-preserving endeavor posttransplantation. In this context, the impact of cytokines, notably IL-27, assumes a critical role in managing immune responses aimed at countering rejection. Consequently, this investigation endeavors to explore the precise function of IL-27 and its associated cytokines in the context of kidney transplant rejection. METHODS The study involved the acquisition of blood samples from a cohort of participants, consisting of 61 individuals who had undergone kidney transplantation (comprising 32 nonrejected patients and 29 rejected patients), and 33 healthy controls. The expression levels of specific genes were examined using SYBR Green Real-time PCR. Additionally, the evaluation encompassed the estimation of the ROC curve, the assessment of the relationship between certain blood factors, and the construction of protein-protein interaction networks for the genes under investigation. RESULTS Significant statistical differences in gene expression levels were observed between the rejected group and healthy controls, encompassing all the genes examined, except for TLR3 and TLR4 genes. Moreover, the analysis of the Area Under the Curve (AUC) revealed that IL-27, IL-27R, TNF-α, and TLR4 exhibited greater significance in discriminating between the two patient groups. These findings highlight the potential importance of IL-27, IL-27R, TNF-α, and TLR4 as key factors for distinguishing between individuals in the rejected group and those in the healthy control group. CONCLUSIONS In the context of kidney rejections occurring within the specific timeframe of 2 weeks to 2 months post-transplantation, it is crucial to emphasize the significance of cytokines mRNA level, including IL-27, IL-27R, TNF-α, and TLR4, in elucidating and discerning the diverse immune system responses. The comprehensive examination of these cytokines' mRNA level assumes considerable importance in understanding the intricate mechanisms underlying kidney rejection processes during this critical period.
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Affiliation(s)
- Aftab Karimi
- Zarghan branch, Islamic Azad University, Zarghan.
| | - Ramin Yaghobi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz.
| | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz.
| | - Zahra Rahimi
- Zarghan branch, Islamic Azad University, Zarghan.
| | - Afsoon Afshari
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz.
| | | | - Mojdeh Heidari
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz.
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Allred ET, Crane CR, Ingulli EG. Three-month protocol biopsies do not detect subclinical rejection in pediatric kidney transplant recipients at a single center. TRANSPLANTATION REPORTS 2021. [DOI: 10.1016/j.tpr.2021.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Chellappa S, Kushekhar K, Hagness M, Horneland R, Taskén K, Aandahl EM. The Presence of Activated T Cell Subsets prior to Transplantation Is Associated with Increased Rejection Risk in Pancreas Transplant Recipients. THE JOURNAL OF IMMUNOLOGY 2021; 207:2501-2511. [PMID: 34607938 DOI: 10.4049/jimmunol.2001103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/04/2021] [Indexed: 12/14/2022]
Abstract
Pancreas and islet transplantation (PTx) are currently the only curative treatment options for type 1 diabetes. CD4+ and CD8+ T cells play a pivotal role in graft function, rejection, and survival. However, characterization of immune cell status from patients with and without rejection of the pancreas graft is lacking. We performed multiparameter immune phenotyping of T cells from PTx patients prior to and 1 y post-PTx in nonrejectors and histologically confirmed rejectors. Our results suggest that rejection is associated with presence of elevated levels of activated CD4+ and CD8+ T cells with a gut-homing phenotype both prior to and 1 y post-PTx. The CD4+ and CD8+ T cells were highly differentiated, with elevated levels of type 1 inflammatory markers (T-bet and INF-γ) and cytotoxic components (granzyme B and perforin). Furthermore, we observed increased levels of activated FOXP3+ regulatory T cells in rejectors, which was associated with a hyporesponsive phenotype of activated effector T cells. Finally, activated T and B cell status was correlated in PTx patients, indicating a potential interplay between these cell types. In vitro treatment of healthy CD4+ and CD8+ T cells with tacrolimus abrogated the proliferation and cytokine (INF-γ, IL-2, and TNF-α) secretion associated with the type 1 inflammatory phenotype observed in pre- and post-PTx rejectors. Together, our results suggest the presence of activated CD4+ and CD8+ T cells prior to PTx confer increased risk for rejection. These findings may be used to identify patients that may benefit from more intense immunosuppressive treatment that should be monitored more closely after transplantation.
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Affiliation(s)
- Stalin Chellappa
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Centre for Cancer Immunotherapy, Institute for Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; and
| | - Kushi Kushekhar
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Centre for Cancer Immunotherapy, Institute for Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; and
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Rune Horneland
- Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kjetil Taskén
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Centre for Cancer Immunotherapy, Institute for Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; and
| | - Einar Martin Aandahl
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; .,K.G. Jebsen Centre for Cancer Immunotherapy, Institute for Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; and.,Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
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4
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Chen X, Huang Y, Wang D, Dong N, Du X. PJ34, a PARP1 inhibitor, attenuates acute allograft rejection after murine heart transplantation via regulating the CD4 + T lymphocyte response. Transpl Int 2021; 34:561-571. [PMID: 33368686 DOI: 10.1111/tri.13809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Acute allografts rejection is the most important factor causing allograft disability for many patients undergoing organ transplantation. PJ34, which is a specific inhibitor of poly(ADP-ribose) polymerase 1, is involved in immune regulation, may be effective in preventing acute cardiac rejection. We performed the models of abdominal heterotopic heart transplantation. PJ34 was injected intraperitoneally daily (20 mg/kg/day) starting the day after surgery. The severity of rejection was determined by histology. The mRNA expression levels of cytokines and transcription factors in the grafts were measured by quantitative polymerase chain reaction (qPCR). The proportion and number of T-cell subpopulations in the spleens were analyzed by flow cytometry. In vitro, the effect of PJ34 on allogeneic responses was investigated. We found treatment with PJ34 prolonged allograft survival compared with normal saline treatment. Compared with the control group, PJ34 treatment reduced the proportion of CD4+ IFN-γ+ and CD4+ IL-17A+ cells and increased the percent of CD4+ IL-4+ and CD4+ Foxp3+ cells in the spleens. In vitro, PJ34 treatment significantly inhibited the mRNA levels of IFN-γ and IL-17A and promoted the mRNA levels of TGF-β and FOXP-3 in activated CD4+ T cells. Modulating the CD4+ T lymphocyte response with PJ34 could attenuate acute allografts rejection after murine heart transplantation. These findings indicate that PARP1 may be a promising therapeutic target to attenuate acute cardiac allograft rejection.
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Affiliation(s)
- Xing Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajun Huang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dashuai Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinling Du
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
The standardization of renal allograft pathology began in 1991 at the first Banff Conference held in Banff, Alberta, Canada. The first task of transplant pathologists, clinicians, and surgeons was to establish diagnostic criteria for T-cell-mediated rejection (TCMR). The histological threshold for this diagnosis was arbitrarily set at "i2t2": a mononuclear interstitial cell infiltrate present in at least 25% of normal parenchyma and >4 mononuclear cells within the tubular basement membrane of nonatrophic tubules. TCMR was usually found in dysfunctional grafts with an elevation in the serum creatinine; however, our group and others found this extent of inflammation in "routine" or "protocol" biopsies of normally functioning grafts: "subclinical" TCMR. The prevalence of TCMR is higher in the early months posttransplant and has decreased with the increased potency of current immunosuppressive agents. However, the pathogenicity of lesser degrees of inflammation under modern immunosuppression and the relation between ongoing inflammation and development of donor-specific antibody has renewed our interest in subclinical alloreactivity. Finally, the advances in our understanding of pretransplant risk assessment, and our increasing ability to monitor patients less invasively posttransplant, promises to usher in the era of precision medicine.
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6
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Abstract
BACKGROUND T cell-mediated graft rejection is mostly correlated with potent Th1 responses. However, because IFNγ mice reject their graft as efficiently as wild-type (WT) mice, the exact contribution of IFNγ and its transcription factor T-bet remains a matter of debate. Here, we address this question in the context of pancreatic islet allograft to better inform the molecular pathways that hampers islet survival in vivo. METHODS Pancreatic islets from BALB/c mice were transplanted in WT, IFNγ, or T-bet C57BL/6 mice. Graft survival and the induction of effector and cytotoxic T-cell responses were monitored. RESULTS Rejection of fully mismatched islet allografts correlated with high expression of both IFNγ and T-bet in WT recipients. However, allogeneic islets were permanently accepted in T-bet mice, in contrast to IFNγ hosts. Long-term survival correlated with decreased CD4 and CD8 T-cell infiltrates, drastically reduced donor-specific IFNγ and tumor necrosis factor tumor necrosis factor α responses and very low expression of the cytotoxic markers granzyme B, perforin, and FasLigand. In addition, in vitro and in vivo data pointed to an increased susceptibility of T-bet CD8 T cell to apoptosis. These observations were not reported in IFNγ mice, which have set up compensatory effector mechanisms comprising an increased expression of the transcription factor Eomes and cytolytic molecules as well as tumor necrosis factor α-mediated but not IL-4 nor IL-17-mediated allogeneic responses. CONCLUSIONS Anti-islet T-cell responses require T-bet but not IFNγ-dependent programs. Our results provide new clues on the mechanisms dictating islet rejection and may help refine the therapeutic/immunosuppressive regimens applied in diabetic patients receiving islets or pancreas allografts.
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Christakoudi S, Runglall M, Mobillo P, Tsui TL, Duff C, Domingo-Vila C, Kamra Y, Delaney F, Montero R, Spiridou A, Kassimatis T, Phin-Kon S, Tucker B, Farmer C, Strom TB, Lord GM, Rebollo-Mesa I, Stahl D, Sacks S, Hernandez-Fuentes MP, Chowdhury P. Development of a multivariable gene-expression signature targeting T-cell-mediated rejection in peripheral blood of kidney transplant recipients validated in cross-sectional and longitudinal samples. EBioMedicine 2019; 41:571-583. [PMID: 30833191 PMCID: PMC6441872 DOI: 10.1016/j.ebiom.2019.01.060] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/29/2018] [Accepted: 01/31/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Acute T-cell mediated rejection (TCMR) is usually indicated by alteration in serum-creatinine measurements when considerable transplant damage has already occurred. There is, therefore, a need for non-invasive early detection of immune signals that would precede the onset of rejection, prior to transplant damage. METHODS We examined the RT-qPCR expression of 22 literature-based genes in peripheral blood samples from 248 patients in the Kidney Allograft Immune Biomarkers of Rejection Episodes (KALIBRE) study. To account for post-transplantation changes unrelated to rejection, we generated time-adjusted gene-expression residuals from linear mixed-effects models in stable patients. To select genes, we used penalised logistic regression based on 27 stable patients and 27 rejectors with biopsy-proven T-cell-mediated rejection, fulfilling strict inclusion/exclusion criteria. We validated this signature in i) an independent group of stable patients and patients with concomitant T-cell and antibody-mediated-rejection, ii) patients from an independent study, iii) cross-sectional pre-biopsy samples from non-rejectors and iv) longitudinal follow-up samples covering the first post-transplant year from rejectors, non-rejectors and stable patients. FINDINGS A parsimonious TCMR-signature (IFNG, IP-10, ITGA4, MARCH8, RORc, SEMA7A, WDR40A) showed cross-validated area-under-ROC curve 0.84 (0.77-0.88) (median, 2.5th-97.5th centile of fifty cross-validation cycles), sensitivity 0.67 (0.59-0.74) and specificity 0.85 (0.75-0.89). The estimated probability of TCMR increased seven weeks prior to the diagnostic biopsy and decreased after treatment. Gene expression in all patients showed pronounced variability, with up to 24% of the longitudinal samples in stable patients being TCMR-signature positive. In patients with borderline changes, up to 40% of pre-biopsy samples were TCMR-signature positive. INTERPRETATION Molecular marker alterations in blood emerge well ahead of the time of clinically overt TCMR. Monitoring a TCMR-signature in peripheral blood could unravel T-cell-related pro-inflammatory activity and hidden immunological processes. This additional information could support clinical management decisions in cases of patients with stable but poor kidney function or with inconclusive biopsy results.
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Affiliation(s)
- Sofia Christakoudi
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; Biostatistics and Health Informatics Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom; Currently at Epidemiology and Biostatistics Department, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom
| | - Manohursingh Runglall
- NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital, United Kingdom
| | - Paula Mobillo
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Tjir-Li Tsui
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital, United Kingdom; Renal Unit, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Claire Duff
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital, United Kingdom
| | - Clara Domingo-Vila
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Yogesh Kamra
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital, United Kingdom
| | - Florence Delaney
- NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital, United Kingdom
| | - Rosa Montero
- Renal Unit, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom; Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Anastasia Spiridou
- NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital, United Kingdom; Currently at Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, United Kingdom
| | - Theodoros Kassimatis
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Sui Phin-Kon
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Beatriz Tucker
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom
| | - Christopher Farmer
- Department of Renal Medicine, East Kent Hospitals University NHS Foundation Trust, Kent, United Kingdom
| | - Terry B Strom
- Department of Medicine, Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Graham M Lord
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital, United Kingdom; Renal Unit, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Irene Rebollo-Mesa
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; Biostatistics and Health Informatics Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom; Currently at UCB Celltech, Slough SL1 4NL, United Kingdom
| | - Daniel Stahl
- Biostatistics and Health Informatics Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Steven Sacks
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Maria P Hernandez-Fuentes
- MRC Centre for Transplantation, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital, United Kingdom; Currently at UCB Celltech, Slough SL1 4NL, United Kingdom.
| | - Paramit Chowdhury
- Renal Unit, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom.
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Smith RN, Matsunami M, Adam BA, Rosales IA, Oura T, Cosimi AB, Kawai T, Mengel M, Colvin RB. RNA expression profiling of nonhuman primate renal allograft rejection identifies tolerance. Am J Transplant 2018; 18:1328-1339. [PMID: 29288556 PMCID: PMC6021122 DOI: 10.1111/ajt.14637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/01/2017] [Accepted: 12/01/2017] [Indexed: 01/25/2023]
Abstract
Tolerance induction to prevent allograft rejection is a long-standing clinical goal. However, convincing and dependable tolerance identification remains elusive. Hypothesizing that intragraft RNA expression is informative in both rejection and tolerance, we profile intrarenal allograft RNA expression in a mixed chimerism renal allograft model of cynomolgus monkeys and identify biologically significant tolerance. Analysis of 67 genes identified 3 dominant factors, each with a different pattern of gene expressions, relating to T cell-mediated rejection (TCMR), chronic antibody-mediated rejection (CAMR), or Tolerance. Clustering these 3 factors created 9 groups. One of the 9 clustered groups, the Tolerance cluster, showed the lowest probability of terminal rejection, the longest duration of allograft survival, and the lowest relative risk of terminal rejection. The Tolerance factor consists of a novel set of gene expressions including cytokine and immunoregulatory genes adding mechanistic insights into tolerance. The Tolerance factor could not be identified within current pathologic diagnostic categories. The TCMR and CAMR factors are dominant to the Tolerance factor, causing rejection even if the Tolerance factor is present. These 3 factors determine the probability of terminal rejection or tolerance. This novel a posteriori approach permits identification of pathways of rejection, including tolerance.
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Affiliation(s)
- R. N. Smith
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - M. Matsunami
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - B. A. Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - I. A. Rosales
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - T. Oura
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - A. B. Cosimi
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - T. Kawai
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - M. Mengel
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - R. B. Colvin
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
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9
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Smith R, Adam B, Rosales I, Matsunami M, Oura T, Cosimi A, Kawai T, Mengel M, Colvin R. RNA expression profiling of renal allografts in a nonhuman primate identifies variation in NK and endothelial gene expression. Am J Transplant 2018; 18:1340-1350. [PMID: 29286578 PMCID: PMC5992005 DOI: 10.1111/ajt.14639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/01/2017] [Accepted: 12/12/2017] [Indexed: 01/25/2023]
Abstract
RNA transcript expression estimates are a promising method to study the mechanisms and classification of renal allograft rejections. Here we use the Nanostring platform to profile RNA expression in renal allografts in a nonhuman primate (NHP), the Cynomolgus monkey. We analyzed protocol and indication 278 archival renal allograft samples, both protocol and indication from 76 animals with diagnoses of chronic antibody-mediated rejection (CAMR), acute cellular rejection (TCMR), and MIXED (both CAMR and TCMR), plus normals and samples with no pathological rejection using a Cynomolgus-specific probe set of 67 genes. Analysis identified RNA expression heterogeneity of endothelial and NK genes within CAMR and TCMR, including the stages of CAMR. Three factors were partitioned into additional groups. One group with the longest allograft survival time is pure CAMR without NK or CD3. Three mixed groups show variation in NK and CD3. TCMR was split into 2 groups with variation in NK genes. Additional validation of the complete gene-set correlated many of the genes with diagnoses of CAMR, MIXED, and TCMR rejections and with Banff histologic criteria defined in human subjects. These NHP data demonstrate the utility of RNA expression profiling to identify additional heterogeneity of endothelial and NK RNA gene expressions.
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Affiliation(s)
- R.N. Smith
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - B.A. Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - I.A. Rosales
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - M. Matsunami
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - T. Oura
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - A.B. Cosimi
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - T. Kawai
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - M. Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - R.B. Colvin
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, USA
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10
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Adam B, Smith R, Rosales I, Matsunami M, Afzali B, Oura T, Cosimi A, Kawai T, Colvin R, Mengel M. Chronic Antibody-Mediated Rejection in Nonhuman Primate Renal Allografts: Validation of Human Histological and Molecular Phenotypes. Am J Transplant 2017; 17:2841-2850. [PMID: 28444814 PMCID: PMC5658276 DOI: 10.1111/ajt.14327] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/19/2017] [Accepted: 04/19/2017] [Indexed: 01/25/2023]
Abstract
Molecular testing represents a promising adjunct for the diagnosis of antibody-mediated rejection (AMR). Here, we apply a novel gene expression platform in sequential formalin-fixed paraffin-embedded samples from nonhuman primate (NHP) renal transplants. We analyzed 34 previously described gene transcripts related to AMR in humans in 197 archival NHP samples, including 102 from recipients that developed chronic AMR, 80 from recipients without AMR, and 15 normal native nephrectomies. Three endothelial genes (VWF, DARC, and CAV1), derived from 10-fold cross-validation receiver operating characteristic curve analysis, demonstrated excellent discrimination between AMR and non-AMR samples (area under the curve = 0.92). This three-gene set correlated with classic features of AMR, including glomerulitis, capillaritis, glomerulopathy, C4d deposition, and DSAs (r = 0.39-0.63, p < 0.001). Principal component analysis confirmed the association between three-gene set expression and AMR and highlighted the ambiguity of v lesions and ptc lesions between AMR and T cell-mediated rejection (TCMR). Elevated three-gene set expression corresponded with the development of immunopathological evidence of rejection and often preceded it. Many recipients demonstrated mixed AMR and TCMR, suggesting that this represents the natural pattern of rejection. These data provide NHP animal model validation of recent updates to the Banff classification including the assessment of molecular markers for diagnosing AMR.
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Affiliation(s)
- B.A. Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - R.N. Smith
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - I.A. Rosales
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - M. Matsunami
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - B. Afzali
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - T. Oura
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - A.B. Cosimi
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - T. Kawai
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - R.B. Colvin
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - M. Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
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11
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Chandran S, Tang Q, Sarwal M, Laszik ZG, Putnam AL, Lee K, Leung J, Nguyen V, Sigdel T, Tavares EC, Yang JY, Hellerstein M, Fitch M, Bluestone JA, Vincenti F. Polyclonal Regulatory T Cell Therapy for Control of Inflammation in Kidney Transplants. Am J Transplant 2017; 17:2945-2954. [PMID: 28675676 PMCID: PMC5662482 DOI: 10.1111/ajt.14415] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 01/25/2023]
Abstract
Early subclinical inflammation in kidney transplants is associated with later graft fibrosis and dysfunction. Regulatory T cells (Tregs) can reverse established inflammation in animal models. We conducted a pilot safety and feasibility trial of autologous Treg cell therapy in three kidney transplant recipients with subclinical inflammation noted on 6-month surveillance biopsies. Tregs were purified from peripheral blood and polyclonally expanded ex vivo using medium containing deuterated glucose to label the cells. All patients received a single infusion of ~320 × 106 (319, 321, and 363.8 × 106 ) expanded Tregs. Persistence of the infused Tregs was tracked. Graft inflammation was monitored with follow-up biopsies and urinary biomarkers. Nearly 1 × 109 (0.932, 0.956, 1.565 × 109 ) Tregs were successfully manufactured for each patient. There were no infusion reactions or serious therapy-related adverse events. The infused cells demonstrated patterns of persistence and stability similar to those observed in non-immunosuppressed subjects receiving the same dose of Tregs. Isolation and expansion of Tregs is feasible in kidney transplant patients on immunosuppression. Infusion of these cells was safe and well tolerated. Future trials will test the efficacy of polyclonal and donor alloantigen-reactive Tregs for the treatment of inflammation in kidney transplants.
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Affiliation(s)
- Sindhu Chandran
- Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Qizhi Tang
- Department of Surgery, University of California, San Francisco, CA 94143, USA,Diabetes Center, University of California, San Francisco, CA 94143, USA
| | - Minnie Sarwal
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Zoltan G. Laszik
- Department of Pathology, University of California, San Francisco, CA 94143, USA
| | - Amy L. Putnam
- Diabetes Center, University of California, San Francisco, CA 94143, USA
| | - Karim Lee
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Joey Leung
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Vinh Nguyen
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Tara Sigdel
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Erica C. Tavares
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Joshua Y.C. Yang
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Mark Fitch
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | | | - Flavio Vincenti
- Department of Medicine, University of California, San Francisco, CA 94143, USA,Department of Surgery, University of California, San Francisco, CA 94143, USA
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12
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High expression of TIM-3 and KIM-1 in blood and urine of renal allograft rejection patients. Transpl Immunol 2017; 43-44:11-20. [PMID: 28757398 DOI: 10.1016/j.trim.2017.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND T cell immunoglobulin and mucin domain 3 (TIM-3) is involved in alloimmune and autoimmune responses, as well as tolerance induction in kidney transplantation. Kidney injury molecule-1 (KIM-1) is highly expressed in epithelial cells of the injured proximal tubule. In this study, we have investigated both urinary and blood TIM-3 mRNA expressions, urinary KIM-1 mRNA expression, and urinary and serum KIM-1 proteins in renal allograft recipients diagnosed with acute allograft rejection (AR) and chronic allograft dysfunction (CAD), as well as those with well-functioning transplants (WFG). METHODS We divided 85 patients into the following groups: AR (n=24), CAD (n=19), and WFG (n=42). TIM-3 and KIM-1 mRNA expressions were quantified using real-time reverse-transcription TaqMan probe polymerase chain reaction (RT-PCR). An ELISA test was used to measure the amount of KIM-1 protein in serum and urine samples. RESULTS AR and CAD patients had significantly greater urinary and blood TIM-3 mRNA expressions, urinary KIM-1 mRNA expression, and urinary and serum KIM-1 proteins compared to WFG patients. Receiver operating characteristic (ROC) analysis showed that these molecules discriminated Allograft rejections from WFG. CONCLUSION Quantification of TIM-3 and KIM-1 mRNA expressions, along with KIM-1 protein measurements in urine and blood could be employed as promising tools for noninvasive diagnosis of allograft dysfunction.
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13
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Jacquemont L, Soulillou JP, Degauque N. Blood biomarkers of kidney transplant rejection, an endless search? Expert Rev Mol Diagn 2017; 17:687-697. [PMID: 28571481 DOI: 10.1080/14737159.2017.1337512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The tailoring of immunosuppressive treatment is recognized as a promising strategy to improve long-term kidney graft outcome. To guide the standard care of transplant recipients, physicians need objective biomarkers that can identify an ongoing pathology with the graft or low intensity signals that will be later evolved to accelerated transplant rejection. The early identification of 'high-risk /low-risk' patients enables the adjustment of standard of caring, including managing the frequency of clinical visits and the immunosuppression dosing. Given their ease of availability and the compatibility with a large technical array, blood-based biomarkers have been widely scrutinized for use as potential predictive and diagnostic biomarkers. Areas covered: Here, the authors report on non-invasive biomarkers, such as modification of immune cell subsets and mRNA and miRNA profiles, identified in the blood of kidney transplant recipients collected before or after transplantation. Expert commentary: Combined with functional tests, the identification of biomarkers will improve our understanding of pathological processes and will contribute to a global improvement in clinical management.
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Affiliation(s)
- Lola Jacquemont
- a Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM , Université de Nantes , Nantes , France.,b Institut de Transplantation Urologie Néphrologie (ITUN) , CHU Nantes , Nantes , France
| | - Jean-Paul Soulillou
- a Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM , Université de Nantes , Nantes , France.,b Institut de Transplantation Urologie Néphrologie (ITUN) , CHU Nantes , Nantes , France
| | - Nicolas Degauque
- a Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM , Université de Nantes , Nantes , France.,b Institut de Transplantation Urologie Néphrologie (ITUN) , CHU Nantes , Nantes , France.,c LabEx IGO , "Immunotherapy, Graft, Oncology" , Nantes , France
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14
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Erol A, Arpali E, Murat Yelken B, Kocak B, Calıskan YK, Nane I, Turkmen A, Savran Oguz F. Evaluation of T H17 and T H1 Immune Response Profile in Patients After Renal Transplant. Transplant Proc 2017; 49:467-471. [PMID: 28340814 DOI: 10.1016/j.transproceed.2017.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Renal transplantation (RT) is the best treatment option for patients with end-stage renal disease (ESRD) because it improves both quality of life and survival. However, allograft rejection remains the most important barrier to successful transplantation. Underlying immunologic mechanisms should be understood to develop appropriate treatment strategies. METHODS In this prospective study, we followed renal transplant recipients for 6 months. The study population comprised 50 recipients of renal transplants, and these were divided into 2 groups: 44 patients with stable graft function (SGF) and 6 patients with rejection (RX). Peripheral blood samples were drawn from patients on the pre-RT day, at post-RT day 7, month 1, and month 6, and on the day of rejection for analysis of the percentages of cytokines interleukin (IL) 17 and interferon (IFN) γ with the use of flow cytometry and enzyme-linked immunosorbent assay. RESULTS The percentages of intracellular IFN-γ were not significant in the group with RX compared with SGF. Levels of intracellular IL-17 obtained at the 6th month after RT were significantly higher in the RX group than in the SGF group. Plasma levels of pre-RT IL-17 were also higher in the RX group; therefore, it may be a predictive biomarker of acute rejection of renal transplants. CONCLUSIONS The present study provides information about pre-RT and post-RT cytokine profiles of Turkish patients with ESRD. We consider cytokine analysis to be a valuable biomarker panel in the prevention of rejection and in assisting with new treatment strategies for patients undergoing renal transplant.
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Affiliation(s)
- A Erol
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - E Arpali
- Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
| | - B Murat Yelken
- Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
| | - B Kocak
- Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
| | - Y K Calıskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - I Nane
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - F Savran Oguz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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15
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Vanhove T, Goldschmeding R, Kuypers D. Kidney Fibrosis: Origins and Interventions. Transplantation 2017; 101:713-726. [PMID: 27941433 PMCID: PMC7228593 DOI: 10.1097/tp.0000000000001608] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/24/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023]
Abstract
All causes of renal allograft injury, when severe and/or sustained, can result in chronic histological damage of which interstitial fibrosis and tubular atrophy are dominant features. Unless a specific disease process can be identified, what drives interstitial fibrosis and tubular atrophy progression in individual patients is often unclear. In general, clinicopathological factors known to predict and drive allograft fibrosis include graft quality, inflammation (whether "nonspecific" or related to a specific diagnosis), infections, such as polyomavirus-associated nephropathy, calcineurin inhibitors (CNI), and genetic factors. The incidence and severity of chronic histological damage have decreased substantially over the last 3 decades, but it is difficult to disentangle what effects individual innovations (eg, better matching and preservation techniques, lower CNI dosing, BK viremia screening) may have had. There is little evidence that CNI-sparing/minimization strategies, steroid minimization or renin-angiotensin-aldosterone system blockade result in better preservation of intermediate-term histology. Treatment of subclinical rejections has only proven beneficial to histological and functional outcome in studies in which the rate of subclinical rejection in the first 3 months was greater than 10% to 15%. Potential novel antifibrotic strategies include antagonists of transforming growth factor-β, connective tissue growth factor, several tyrosine kinase ligands (epidermal growth factor, platelet-derived growth factor, vascular endothelial growth factor), endothelin and inhibitors of chemotaxis. Although many of these drugs are mainly being developed and marketed for oncological indications and diseases, such as idiopathic pulmonary fibrosis, a number may hold promise in the treatment of diabetic nephropathy, which could eventually lead to applications in renal transplantation.
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Affiliation(s)
- Thomas Vanhove
- 1 Department of Microbiology and Immunology, KU Leuven-University of Leuven, Leuven, Belgium. 2 Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium. 3 Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
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16
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A Meta-analysis of the Significance of Granzyme B and Perforin in Noninvasive Diagnosis of Acute Rejection After Kidney Transplantation. Transplantation 2016; 99:1477-86. [PMID: 25643139 DOI: 10.1097/tp.0000000000000567] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies have reported that granzyme B (GZMB) and perforin (PRF) could serve as noninvasive biomarkers in the diagnosis of acute rejection (AR) after kidney transplant. Yet, their noninvasive diagnostic value in clinical practice is still unknown. METHODS To assess the noninvasive diagnostic performance of GZMB and PRF for AR, we performed a systematic search. After reviewing published studies in which both GZMB and PRF were detected, data on the diagnostic accuracy of separate and combined evaluation of GZMB and PRF were pooled. RESULTS Across 16 studies (680 subjects), summary sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios with 95% confidence intervals were calculated. For overall GZMB analysis, the indices were 0.76 (0.71-0.81), 0.86 (0.82-0.89), 4.58 (3.36-6.25), and 0.32 (0.22-0.47), respectively. For overall PRF analysis, the indices were 0.83 (0.78-0.88), 0.86 (0.82-0.89), 4.82 (3.66-6.35), and 0.26 (0.18-0.37), respectively. Subgroup analyses showed similar results compared to overall study analyses. In analyses of combined evaluation of GZMB and PRF, the above indices were 0.65 (0.53-0.76), 0.96 (0.91-0.98), 12.66 (5.83-27.50), and 0.40 (0.23-0.69), respectively, when both markers were positive. The probability of developing AR in kidney transplant recipients increased from 15% to 73% when both GZMB and PRF tests were positive and was reduced to 2% if that were negative. CONCLUSIONS Currently, neither GZMB nor PRF, if evaluated alone, could be a convincing noninvasive diagnostic marker for AR in clinical practice. Combined use of PRF and GZMB post-kidney transplant may be a better choice in AR evaluation to direct allograft biopsy execution and earlier therapeutic intervention.
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Schneider M, Cardones ARG, Selim MA, Cendales LC. Vascularized composite allotransplantation: a closer look at the banff working classification. Transpl Int 2016; 29:663-71. [DOI: 10.1111/tri.12750] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/15/2015] [Accepted: 01/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - M. Angelica Selim
- Pathology and Dermatology; Department of Pathology; Duke University Medical Center; Durham NC USA
| | - Linda C. Cendales
- Department of Surgery; Duke University Medical Center; Durham NC USA
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18
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Adam B, Afzali B, Dominy KM, Chapman E, Gill R, Hidalgo LG, Roufosse C, Sis B, Mengel M. Multiplexed color-coded probe-based gene expression assessment for clinical molecular diagnostics in formalin-fixed paraffin-embedded human renal allograft tissue. Clin Transplant 2016; 30:295-305. [DOI: 10.1111/ctr.12689] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin Adam
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Bahman Afzali
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
- Institute of Pathology; University of Duisburg−Essen; Essen Germany
| | - Katherine M. Dominy
- Division of Immunology and Inflammation; Department of Medicine; Centre for Complement and Inflammation Research; Imperial College; London UK
| | - Erin Chapman
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Reeda Gill
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Luis G. Hidalgo
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Candice Roufosse
- Division of Immunology and Inflammation; Department of Medicine; Centre for Complement and Inflammation Research; Imperial College; London UK
- Department of Cellular Pathology; Hammersmith Hospital; London UK
| | - Banu Sis
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
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19
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Merhi B, Bayliss G, Gohh RY. Role for urinary biomarkers in diagnosis of acute rejection in the transplanted kidney. World J Transplant 2015; 5:251-260. [PMID: 26722652 PMCID: PMC4689935 DOI: 10.5500/wjt.v5.i4.251] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/04/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023] Open
Abstract
Despite the introduction of potent immunosuppressive medications within recent decades, acute rejection still accounts for up to 12% of all graft losses, and is generally associated with an increased risk of late graft failure. Current detection of acute rejection relies on frequent monitoring of the serum creatinine followed by a diagnostic renal biopsy. This strategy is flawed since an alteration in the serum creatinine is a late clinical event and significant irreversible histologic damage has often already occurred. Furthermore, biopsies are invasive procedures that carry their own inherent risk. The discovery of non-invasive urinary biomarkers to help diagnose acute rejection has been the subject of a significant amount of investigation. We review the literature on urinary biomarkers here, focusing on specific markers perforin and granzyme B mRNAs, FOXP3 mRNA, CXCL9/CXCL10 and miRNAs. These and other biomarkers are not yet widely used in clinical settings, but our review of the literature suggests that biomarkers may correlate with biopsy findings and provide an important early indicator of rejection, allowing more rapid treatment and better graft survival.
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20
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Cho JH, Yoon YD, Jang HM, Kwon E, Jung HY, Choi JY, Park SH, Kim YL, Kim HK, Huh S, Won DI, Kim CD. Immunologic Monitoring of T-Lymphocyte Subsets and Hla-Dr-Positive Monocytes in Kidney Transplant Recipients: A Prospective, Observational Cohort Study. Medicine (Baltimore) 2015; 94:e1902. [PMID: 26554788 PMCID: PMC4915889 DOI: 10.1097/md.0000000000001902] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The clinical significance of circulating T-lymphocyte subsets and human leukocyte antigen (HLA)-DR-positive monocytes in the peripheral blood of kidney transplant recipients (KTRs) remains unclear. We examined the efficacy of enumerating these cells for the immunologic monitoring of KTRs.Blood samples were obtained before transplantation, 2 weeks after transplantation and at diagnosis, and 2 weeks after treating biopsy-proven acute cellular rejection and cytomegalovirus (CMV) infection. Serial flow cytometric analysis was performed using peripheral blood obtained from 123 patients to identify the frequencies of HLA-DR, CD3, CD4, CD8, and CD25 T-lymphocytes and HLA-DR-positive monocytes.Frequencies of CD4CD25/CD4 T cells, CD8CD25/CD8 T cells, and HLA-DR-positive monocytes were significantly lower at 2 weeks after transplantation than before transplantation (all P < 0.001). This decrease was not correlated with clinical parameters. The frequency of CD4CD25/CD4 T cells was significantly higher in KTRs with acute rejection than in KTRs at 2 weeks after transplantation (9.10% [range 4.30-25.6%] vs 5.10% [range 0.10-33.3%]; P = 0.024). However, no significant differences were observed between stable KTRs and KTRs with CMV infection. Analysis of the receiver operating characteristic curve adjusted by covariates showed that acute rejection could be predicted with 75.0% sensitivity and 68.4% specificity by setting the cutoff value of CD4CD25/CD4 T cell frequency as 5.8%.Circulating T-lymphocyte and monocyte subsets showed significant and consistent changes in their frequencies after immunosuppression. Of the various immune cells examined, circulating levels of CD4CD25 T cells might be a useful noninvasive immunologic indicator for detecting acute rejection.
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Affiliation(s)
- Jang-Hee Cho
- From the Department of Internal Medicine (J-HC, Y-DY, EK, H-YJ, J-YC, S-HP, Y-LK, C-DK); Department of Statistics (HMJ); Department of Surgery (H-KK, SH); and Department of Clinical Pathology, Kyungpook National University Hospital, Daegu, Korea (D-IW)
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21
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Abstract
Despite its long-standing status as the diagnostic "gold standard", the renal transplant biopsy is limited by a fundamental dependence on descriptive, empirically-derived consensus classification. The recent shift towards personalized medicine has resulted in an increased demand for precise, mechanism-based diagnoses, which is not fully met by the contemporary transplantation pathology standard of care. The expectation is that molecular techniques will provide novel pathogenetic insights that will allow for the identification of more accurate diagnostic, prognostic, and therapeutic targets. Here we review the current state of molecular renal transplantation pathology. Despite significant research activity and progress within the field, routine adoption of clinical molecular testing has not yet been achieved. The recent development of novel molecular platforms suitable for use with formalin-fixed paraffin-embedded tissue will offer potential solution for the major barriers to implementation. The recent incorporation of molecular diagnostic criteria into the 2013 Banff classification is a reflection of progress made and future directions in the area of molecular transplantation pathology. Transcripts related to endothelial injury and NK cell activation have consistently been shown to be associated with antibody-mediated rejection. Prospective multicenter validation and implementation of molecular diagnostics for major entities remains an unmet clinical need in transplantation. It is expected that an integrated system of transplantation pathology diagnosis comprising molecular, morphological, serological, and clinical variables will ultimately provide the greatest diagnostic precision.
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22
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Elevated urinary CXCL10-to-creatinine ratio is associated with subclinical and clinical rejection in pediatric renal transplantation. Transplantation 2015; 99:797-804. [PMID: 25222013 DOI: 10.1097/tp.0000000000000419] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Subclinical and clinical T cell-mediated rejection (TCMR) has significant prognostic implications in pediatric renal transplantation. The goal of this study was to independently validate urinary CXCL10 as a noninvasive biomarker for detecting acute rejection in children and to extend these findings to subclinical rejection. METHODS Urines (n = 140) from 51 patients with surveillance or indication biopsies were assayed for urinary CXCL10 using enzyme-linked immunosorbent assay and corrected with urinary creatinine. RESULTS Median urinary CXCL10-to-creatinine (Cr) ratio (ng/mmol) was significantly elevated in subclinical TCMR (4.4 [2.6, 25.4], P < 0.001, n = 17); clinical TCMR (24.3 [11.2, 44.8], P < 0.001, n = 9); and antibody-mediated rejection (6.0 [3.3, 13.7], P = 0.002, n = 9) compared to noninflamed histology (1.4 [0.4, 4.2], normal and interstitial fibrosis and tubular atrophy, n = 52), and borderline tubulitis (3.3, [1.3, 4.9], n = 36). Elevated urinary CXCL10:Cr was independently associated with t scores (P < 0.001) and g scores (P = 0.006) on multivariate analysis. The area under receiver operating curve for subclinical and clinical TCMR was 0.81 (P = 0.045) and 0.88 (P = 0.019), respectively. This corresponded to a sensitivity-specificity of 0.59-0.67 and 0.77-0.60 for subclinical and clinical TCMR at cutoffs of 4.82 and 4.72 ng/mmol, respectively. CONCLUSION This study demonstrates that urinary CXCL10:Cr corresponds with microvascular inflammation and is a sensitive and specific biomarker for subclinical and clinical TCMR in children. This may provide a noninvasive monitoring tool for posttransplant immune surveillance for pediatric renal transplant recipients.
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Adam B, Mengel M. Molecular nephropathology: ready for prime time? Am J Physiol Renal Physiol 2015; 309:F185-8. [PMID: 26017976 DOI: 10.1152/ajprenal.00153.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/20/2015] [Indexed: 11/22/2022] Open
Abstract
In the current era of precision medicine, the existing nephropathology paradigm of light microscopy, immunofluorescence, and electron microscopy will become increasingly insufficient. There will be an expectation to supplement these traditional diagnostic tools with patient-specific information related to a growing understanding of molecular pathophysiology. Next generation sequencing technologies are expected to play a key role in the future of nephropathology, but transcriptomics is poised to represent the first major foray into routine molecular testing. The introduction of molecular techniques into clinical nephropathology has been hindered in part by the reliance of existing platforms on fresh tissue samples. The NanoString gene expression system works with formalin-fixed paraffin-embedded tissue and thus represents a promising solution to this technical barrier that may finally allow for the translation of recent transcriptomics discoveries into the enhancement of patient care. Widespread adoption of this new diagnostic dimension will require ongoing multidisciplinary cooperation between pathologists and clinicians, including molecular testing consensus generation and rigorous multicenter validation.
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Affiliation(s)
- Benjamin Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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24
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The Transcription Factor, T-bet, Primes Intestine Transplantation Rejection and Is Associated With Disrupted Mucosal Homeostasis. Transplantation 2015; 99:890-4. [DOI: 10.1097/tp.0000000000000445] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Béland S, Désy O, Vallin P, Basoni C, De Serres SA. Innate immunity in solid organ transplantation: an update and therapeutic opportunities. Expert Rev Clin Immunol 2015; 11:377-89. [PMID: 25644774 DOI: 10.1586/1744666x.2015.1008453] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Innate immunity is increasingly recognized as a major player in transplantation. In addition to its role in inflammation in the early post-transplant period, innate immunity shapes the differentiation of cells of adaptive immunity, with a capacity to promote either rejection or tolerance. Emerging data indicate that innate allorecognition, a characteristic previously limited to lymphocytes, is involved in allograft rejection. This review briefly summarizes the physiology of each component of the innate immune system in the context of transplantation and presents the current or promising therapeutic applications, such as cellular, anticomplement and anticytokine therapies.
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Affiliation(s)
- Stéphanie Béland
- Transplantation Unit, Renal Division, Department of Medicine, CHU de Québec Research Center, Faculty of Medicine, Laval University, 11 Côte du Palais, Québec, QC, Canada
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Girmanova E, Hruba P, Viklicky O. Circulating biomarkers of tolerance. Transplant Rev (Orlando) 2015; 29:68-72. [PMID: 25636718 DOI: 10.1016/j.trre.2015.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/09/2015] [Accepted: 01/11/2015] [Indexed: 02/01/2023]
Abstract
On the basis of reviewed literature here we describe models of tolerance and summarize the evidence of circulating biomarkers suitable for the assessment of immunological risk in organ transplantation. We focused on results of evaluation of specific peripheral immune cell populations and transcripts in peripheral blood of operationally tolerant liver and kidney transplant recipients. Validation of described markers to define potentially tolerant patients before their use in clinical trials is critical.
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Affiliation(s)
- Eva Girmanova
- Transplant Laboratory, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petra Hruba
- Transplant Laboratory, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ondrej Viklicky
- Department of Nephrology, Transplant Laboratory, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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27
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Venner JM, Famulski KS, Badr D, Hidalgo LG, Chang J, Halloran PF. Molecular landscape of T cell-mediated rejection in human kidney transplants: prominence of CTLA4 and PD ligands. Am J Transplant 2014; 14:2565-76. [PMID: 25219326 DOI: 10.1111/ajt.12946] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/11/2014] [Accepted: 07/22/2014] [Indexed: 01/25/2023]
Abstract
We used expression microarrays to characterize the changes most specific for pure T cell-mediated rejection (TCMR) compared to other diseases including antibody-mediated rejection in 703 human kidney transplant biopsies, using a Discovery Set-Validation Set approach. The expression of thousands of transcripts--fold change and association strength--changed in a pattern that was highly conserved between the Discovery and Validation sets, reflecting a hierarchy of T cell signaling, costimulation, antigen-presenting cell (APC) activation and interferon-gamma (IFNG) expression and effects, with weaker associations for inflammasome activation, innate immunity, cytotoxic molecules and parenchymal injury. In cell lines, the transcripts most specific for TCMR were expressed most strongly in effector T cells (e.g. CTLA4, CD28, IFNG), macrophages (e.g. PDL1, CD86, SLAMF8, ADAMDEC1), B cells (e.g. CD72, BTLA) and IFNG-treated macrophages (e.g. ANKRD22, AIM2). In pathway analysis, the top pathways included T cell receptor signaling and CTLA4 costimulation. These results suggest a model in which TCMR creates an inflammatory compartment with a rigorous hierarchy dominated by the proximal aspects of cognate engagement of effector T cell receptor and costimulator triggering by APCs. The prominence of inhibitors like CTLA4 and PDL1 raises the possibility of active negative controls within the rejecting tissue.
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Affiliation(s)
- J M Venner
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada; Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
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28
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Whitehouse G, Sanchez-Fueyo A. Postoperative Monitoring: Biomarkers and Alloimmune Responses and Their Relevance to Vascularized Composite Allotransplantation. CURRENT TRANSPLANTATION REPORTS 2014. [DOI: 10.1007/s40472-014-0022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Mengel M. Renalomics: Molecular Pathology in Kidney Biopsies. Surg Pathol Clin 2014; 7:443-55. [PMID: 26837449 DOI: 10.1016/j.path.2014.04.005] [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: 11/24/2022]
Abstract
In this article, various omics technologies and their applications in renal pathology (native and transplant biopsies) are reviewed and discussed. Despite significant progress and novel insights derived from these applications, extensive adoption of molecular diagnostics in renal pathology has not been accomplished. Further validation of specific applications leading to increased diagnostic precision in a clinically relevant way is ongoing.
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Affiliation(s)
- Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, 4B1.18 Walter Mackenzie Center, 8440-112 Street, Edmonton T6G2S2, Canada.
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Cravedi P, Mannon RB. Noninvasive methods to assess the risk of kidney transplant rejection. Expert Rev Clin Immunol 2014; 5:535-546. [PMID: 20161000 DOI: 10.1586/eci.09.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In current clinical practice, immune reactivity of kidney transplant recipients is estimated by monitoring the levels of immunosuppressive drugs, and by functional and/or histological evaluation of the allograft. The availability of assays that could directly quantify the extent of the recipient's immune response towards the allograft would help clinicians to customize the prescription of immunosuppressive drugs to individual patients. Importantly, these assays might provide a more in-depth understanding of the complex mechanisms of acute rejection, chronic injury, and tolerance in organ transplantation, allowing the design of new and potentially more effective strategies for the minimization of immunosuppression, or even for the induction of immunological tolerance. The purpose of this review is to summarize results from recent studies in this field.
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Affiliation(s)
- Paolo Cravedi
- Mario Negri Institute for Pharmacological Research, Bergamo, Italy, Tel.: +39 035 453 5405, ,
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31
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Zhang Q, Reed EF. Array-based methods for diagnosis and prevention of transplant rejection. Expert Rev Mol Diagn 2014; 6:165-78. [PMID: 16512777 DOI: 10.1586/14737159.6.2.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
DNA microarray is a microhybridization-based assay that is used to simultaneously study the expression of thousands of genes, thus providing a global view of gene expression in a tissue sample. This powerful technique has been adopted by many biomedical disciplines and will likely have a profound impact on the diagnosis, treatment and prognosis of human diseases. This review article presents an overview of the application of microarray technology to the field of solid-organ transplantation.
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Affiliation(s)
- Qiuheng Zhang
- Immunogenetics Center, Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.
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Abstract
During the course of an immune response in kidney transplantation, distinct functional subsets of effector and regulatory T cells are generated in the lymphoid compartment following the differentiation of T cells under the influence of specific cytokines. In addition to effector cells inflammation in a CXCR3-independent manner, a CXCR3-chemokine dependent pathway exacerbates these inflammatory processes in this scenario. Indeed, the upregulation of CXCR3 ligands mediates the mobilization of effector CTLs to the peripheral site of infection. The immediate upregulation of CXCR3 on CD4+ CTLs and CD8+ CTL following DC activation makes this an interesting proposal, as activated T cells are recruited into lymphoid and noncanonical lymphoid compartments. The importance of tissue in vivo characterization is emerged as a central topic in kidney transplantation. In the following method we describe a protocol based on immunohistochemistry (IHC) and immunofluorescence/confocal microscopy along with strategies of overall signals quantification and positive cells quantification (Aperio, Adobe Photoshop). Through an in vivo approach, we focus on those changes that result relevant during immune response in transplantation. Although less quantitative than other methods, the information gained from IHC combined with microscopy provides a "picture" that can help to address our subsequent experiments. The advantage of this protocol consists in the possibility to evidence CTLs tissue accumulation and to investigate the different areas (tubular, glomerular, and interstitial) of the graft directly affected by CTLs-specific activity.
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Viklicky O, Hribova P, Brabcova I. Molecular markers of rejection and tolerance: lessons from clinical research. Nephrol Dial Transplant 2013; 28:2701-8. [PMID: 23739154 DOI: 10.1093/ndt/gft102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In terms of finding specific molecular markers associated with graft outcome, attempts have been made to study whole genome transcripts using microarray assays or to study the effect of number of genes of interest using quantitative real-time polymerase chain reaction. Using these techniques, molecular phenotypes of rejection have been characterized, and the variability of the clinical outcome besides similar morphology explained in part. Recently, several specific transcripts including naïve B cell regulation have been identified in the peripheral blood of operationally tolerant kidney transplant recipients. The decrease in immature B cell-related transcripts in the peripheral blood in patients with immunosuppression was shown to be associated with acute rejection. Similarly, tolerance-associated antigen 1 transcripts were identified in biopsies and regulatory T cell transcripts in urine and biopsies in patients without rejection. Better understanding of molecular processes associated with allograft rejection or alloantigen hyporesponsiveness/tolerance may help to improve our knowledge about graft pathology and identify novel markers suitable for future monitoring and guided therapy and finally improve the outcome of kidney transplantation.
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Affiliation(s)
- Ondrej Viklicky
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Differential effects of activated human renal epithelial cells on T-cell migration. PLoS One 2013; 8:e64916. [PMID: 23717673 PMCID: PMC3661561 DOI: 10.1371/journal.pone.0064916] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Renal tubular epithelial cells (TECs) are one of the main targets of inflammatory insults during interstitial nephritis and kidney transplant rejection. While Th1 cells are know to be essential in the pathogenesis of rejection, the role of Th17 is still under debate. We hypothesize that TECs modulate the outcome of rejection process by production of distinct chemokines and cytokines that determine the attraction of different T-cell subsets. Therefore, we studied differential effects of activated human renal epithelial cells on T-cell migration. METHODS Human primary TECs were stimulated by IFN-γ and TNF-α in vitro. Chemokines and cytokines produced by activated TECs were measured using Luminex or ELISA. Chemotaxis assay was performed using activated peripheral blood mononuclear cells composed of CD4+CXCR3+ and CD4+CCR6+ T cells migrating towards stimulated and unstimulated TECs. RESULTS While activated TECs secreted abundant amounts of the pro-inflammatory cytokines IL-6 and IL-8, the T helper cell differentiation cytokines IL-1β, IL-12p70, IL-23 or TGF-β1 were not produced. The production of Th1 chemokines CXCL9, CXCL10 and CCL5 were significantly upregulated after TEC stimulation. In contrast, Th17 chemokine CCL20 could not be detected. Finally, activated TECs attracted significantly higher numbers of CD4+CXCR3+ T cells as compared to unstimulated TECs. No migration of CD4+CCR6+ T cells could be observed. CONCLUSION Activated primary renal tubular epithelial cells do not attract Th17 cells nor produce cytokines promoting Th17 cell differentiation in our experimental system mimicking the proinflammatory microenvironment of rejection.
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The effects of in vivo B-cell depleting therapy on ex-vivo cytokine production. Transpl Immunol 2013; 28:183-8. [PMID: 23651756 DOI: 10.1016/j.trim.2013.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 11/23/2022]
Abstract
In renal transplantation, IL-17 production by T-cells might be dependent on the presence of B-cells. Therefore, the effect of in vivo B-cell depletion on ex-vivo IL-17 production was investigated. Twenty patients undergoing living-donor renal transplantation were recruited from a larger cohort of patients participating in a randomized, double-blind trial. All patients were allocated to a single intra-operative dose of either placebo or rituximab (375 mg/m(2)) added to the standard immunosuppressive therapy. Blood was collected at baseline, at one day, and at one month after surgery. The healthy kidney donors also gave blood at baseline. Peripheral blood mononuclear cells were stimulated ex-vivo in different manners (heat killed Candida albicans yeast, heat killed Staphylococcus aureus, or αCD3αCD28 coated beads), to address the role of B-cells in ex-vivo cytokine responses. The concentration of monocyte- and T-cell-derived cytokines (IL-1β, IL-6, TNF-α, IFN-γ, IL-17 and IL-22) was measured in supernatants. Of the 20 recruited patients, 13 received treatment with rituximab and 7 received placebo. In all patients, IL-17 was produced by CD4-positive, γδTCR-negative cells. After stimulation, there was no difference between patients and healthy controls in ex-vivo production of IL-17 or other cytokines. In all patients there was a general decrease of monocyte- and T-cell-derived cytokines after transplantation, except for IL-17. There was no difference between patients who received rituximab and patients who received placebo. A single dose of rituximab treatment added to standard immunosuppressive therapy in renal transplant patients did not influence the production of IL-17 or other monocyte- or T-cell derived cytokines after ex-vivo stimulation.
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Affiliation(s)
- Zhongmin Liu
- Department of Cardiovascular and Thoracic Surgery; Shanghai East Hospital of Tongji University; Shanghai; China
| | - Huimin Fan
- Department of Cardiovascular and Thoracic Surgery; Shanghai East Hospital of Tongji University; Shanghai; China
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37
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Molecular networks involved in the immune control of BK polyomavirus. Clin Dev Immunol 2012; 2012:972102. [PMID: 23251224 PMCID: PMC3521483 DOI: 10.1155/2012/972102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/05/2012] [Indexed: 01/22/2023]
Abstract
BK polyomavirus infection is the important cause of virus-related nephropathy following kidney transplantation. BK virus reactivates in 30%–80% of kidney transplant recipients resulting in BK virus-related nephropathy in 1%–10% of cases. Currently, the molecular processes associated with asymptomatic infections in transplant patients infected with BK virus remain unclear.
In this study we evaluate intrarenal molecular processes during different stages of BKV infection.
The gene expression profiles of 90 target genes known to be associated with immune response were evaluated in kidney graft biopsy material using TaqMan low density array. Three patient groups were examined: control patients with no evidence of BK virus reactivation (n = 11), infected asymptomatic patients (n = 9), and patients with BK virus nephropathy (n = 10). Analysis of biopsies from asymptomatic viruria patients resulted in the identification of 5 differentially expressed genes (CD3E, CD68, CCR2, ICAM-1, and SKI) (P < 0.05), and functional analysis showed a significantly heightened presence of costimulatory signals (e.g., CD40/CD40L; P < 0.05). Gene ontology analysis revealed several biological networks associated with BKV immune control in comparison to the control group.
This study demonstrated that asymptomatic BK viruria is associated with a different intrarenal regulation of several genes implicating in antiviral immune response.
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38
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An effective immune-monitoring protocol based on gene expression profiles in the peripheral T-cell fraction reactive to graft antigens. Transplantation 2012; 94:802-8. [PMID: 22992770 DOI: 10.1097/tp.0b013e3182696a5b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ability to induce tolerance, or at least minimize the need for immunosuppressive therapy, is a high priority in organ transplantation. Accomplishing this goal requires a novel method for determining when a patient has become tolerant to or is rejecting their graft. Here, we sought to develop an efficient monitoring protocol based on gene expression profiles of recipient T cells in murine skin and islet allograft models. METHODS Unlike previous studies, here, gene expression analysis was focused on donor antigen-reactive T cells, which were prepared by collecting CD69(+) T cells from cocultures of recipient peripheral T cells and donor antigen-presenting cells. Candidate tolerance and rejection biomarker genes were selected from a CD69(+) T-cell microarray analysis, and their expression levels were measured in the recipient CD69(+) T-cell fraction using quantitative reverse transcription polymerase chain reaction. RESULTS Our new monitoring protocol was capable of precisely detecting the immune status of recipients relative to their graft regardless of the organ received, whether they were taking immunosuppressive drugs, or different strains of origin. CONCLUSIONS Gene expression analysis focusing on recipient CD69(+) T cells as the donor antigen-reactive T-cell population could be used as an effective and sensitive method for monitoring transplant patients.
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Li L, Khatri P, Sigdel TK, Tran T, Ying L, Vitalone M, Chen A, Hsieh SC, Dai H, Zhang M, Naesens M, Zarkhin V, Sansanwal P, Chen R, Mindrinos M, Xiao W, Benfield M, Ettenger R, Dharnidharka V, Mathias R, Portale A, McDonald R, Harmon W, Kershaw D, Vehaskari VM, Kamil E, Baluarte HJ, Warady B, Davis R, Butte AJ, Salvatierra O, Sarwal M. A peripheral blood diagnostic test for acute rejection in renal transplantation. Am J Transplant 2012; 12:2710-8. [PMID: 23009139 PMCID: PMC4148014 DOI: 10.1111/j.1600-6143.2012.04253.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Monitoring of renal graft status through peripheral blood (PB) rather than invasive biopsy is important as it will lessen the risk of infection and other stresses, while reducing the costs of rejection diagnosis. Blood gene biomarker panels were discovered by microarrays at a single center and subsequently validated and cross-validated by QPCR in the NIH SNSO1 randomized study from 12 US pediatric transplant programs. A total of 367 unique human PB samples, each paired with a graft biopsy for centralized, blinded phenotype classification, were analyzed (115 acute rejection (AR), 180 stable and 72 other causes of graft injury). Of the differentially expressed genes by microarray, Q-PCR analysis of a five gene-set (DUSP1, PBEF1, PSEN1, MAPK9 and NKTR) classified AR with high accuracy. A logistic regression model was built on independent training-set (n = 47) and validated on independent test-set (n = 198)samples, discriminating AR from STA with 91% sensitivity and 94% specificity and AR from all other non-AR phenotypes with 91% sensitivity and 90% specificity. The 5-gene set can diagnose AR potentially avoiding the need for invasive renal biopsy. These data support the conduct of a prospective study to validate the clinical predictive utility of this diagnostic tool.
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Affiliation(s)
- Li Li
- California Pacific Medical Center - Research Institute, San Francisco, CA, USA
- Department of Pediatrics, Stanford University, CA, USA
| | | | - Tara K. Sigdel
- California Pacific Medical Center - Research Institute, San Francisco, CA, USA
- Department of Pediatrics, Stanford University, CA, USA
| | - Tim Tran
- California Pacific Medical Center - Research Institute, San Francisco, CA, USA
- Department of Pediatrics, Stanford University, CA, USA
| | - Lihua Ying
- Department of Pediatrics, Stanford University, CA, USA
| | - Matthew Vitalone
- California Pacific Medical Center - Research Institute, San Francisco, CA, USA
- Department of Pediatrics, Stanford University, CA, USA
| | - Amery Chen
- Department of Pediatrics, Stanford University, CA, USA
| | - Szu-chuan Hsieh
- California Pacific Medical Center - Research Institute, San Francisco, CA, USA
- Department of Pediatrics, Stanford University, CA, USA
| | - Hong Dai
- California Pacific Medical Center - Research Institute, San Francisco, CA, USA
- Department of Pediatrics, Stanford University, CA, USA
| | - Meixia Zhang
- Department of Pediatrics, Stanford University, CA, USA
| | | | | | - Poonam Sansanwal
- California Pacific Medical Center - Research Institute, San Francisco, CA, USA
| | - Rong Chen
- Department of Pediatrics, Stanford University, CA, USA
| | | | - Wenzhong Xiao
- Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Mark Benfield
- Pediatric Nephrology, University of Alabama at Birmingham, AL, USA
| | - Robert Ettenger
- Division of Nephrology, Department of Pediatrics, David Geffen School of Medicine at UCLA, UCLA Children’s Health Center, University of California Los Angeles, CA, USA
| | - Vikas Dharnidharka
- Department of Pediatrics Nephrology, University of Florida College of Medicine & Shands Children’s Hospital, Gainesville FL USA
| | - Robert Mathias
- Pediatric Nephrology, Nemours Children’s Clinic Orlando, FL, USA
| | - Anthony Portale
- Department of Pediatrics, University of California San Francisco, CA, USA
| | - Ruth McDonald
- Children’s Hospital & Regional Medical Center Seattle, WA, USA
| | | | - David Kershaw
- Department of Pediatrics, University of Michigan, MI, USA
| | - V. Matti Vehaskari
- Department of Pediatrics, University of Louisiana Health Sciences Center, LA, USA
| | - Elaine Kamil
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Brad Warady
- Children’s Mercy Hospital, Kansas City, MO, USA
| | - Ron Davis
- Department of Biochemistry, Stanford University, CA, USA
| | - Atul J. Butte
- Department of Pediatrics, Stanford University, CA, USA
| | - Oscar Salvatierra
- Department of Pediatrics, Stanford University, CA, USA
- Department of Surgery, Stanford University, CA, USA
| | - Minnie Sarwal
- California Pacific Medical Center - Research Institute, San Francisco, CA, USA
- Department of Pediatrics, Stanford University, CA, USA
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Xu X, Huang H, Cai M, Qian Y, Li Z, Bai H, Han Y, Xiao L, Zhou W, Wang X, Shi B. Combination of IL-1 Receptor Antagonist, IL-20 and CD40 Ligand for the Prediction of Acute Cellular Renal Allograft Rejection. J Clin Immunol 2012; 33:280-7. [DOI: 10.1007/s10875-012-9777-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
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Sun Q, Zhang M, Xie K, Li X, Zeng C, Zhou M, Liu Z. Endothelial injury in transplant glomerulopathy is correlated with transcription factor T-bet expression. Kidney Int 2012; 82:321-9. [DOI: 10.1038/ki.2012.112] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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42
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Surveillance biopsies in children post-kidney transplant. Pediatr Nephrol 2012; 27:753-60. [PMID: 21792611 PMCID: PMC3315641 DOI: 10.1007/s00467-011-1969-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 06/29/2011] [Accepted: 07/05/2011] [Indexed: 01/05/2023]
Abstract
Surveillance biopsies are increasingly used in the post-transplant monitoring of pediatric renal allograft recipients. The main justification for this procedure is to diagnose early and presumably modifiable acute and chronic renal allograft injury. Pediatric recipients are theoretically at increased risk for subclinical renal allograft injury due to their relatively large adult-sized kidneys and their higher degree of immunological responsiveness. The safety profile of this procedure has been well investigated. Patient morbidity is low, with macroscopic hematuria being the most common adverse event. No patient deaths have been attributed to this procedure. Longitudinal surveillance biopsy studies have revealed a substantial burden of subclinical immunological and non-immunological injury, including acute cellular rejection, interstitial fibrosis and tubular atrophy, microvascular lesions and transplant glomerulopathy. The main impediment to the implementation of surveillance biopsies as the standard of care is the lack of demonstrable benefit of early histological detection on long-term outcome. The considerable debate surrounding this issue highlights the need for multicenter, prospective, and randomized studies.
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Libraty DH, Mäkelä S, Vlk J, Hurme M, Vaheri A, Ennis FA, Mustonen J. The degree of leukocytosis and urine GATA-3 mRNA levels are risk factors for severe acute kidney injury in Puumala virus nephropathia epidemica. PLoS One 2012; 7:e35402. [PMID: 22523590 PMCID: PMC3327672 DOI: 10.1371/journal.pone.0035402] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/16/2012] [Indexed: 11/29/2022] Open
Abstract
Puumala hantavirus (PUUV) infection, also known as nephropathia epidemica, is the most common cause of hemorrhagic fever with renal syndrome (HFRS) in Europe. The pathogenesis of PUUV nephropathia epidemica is complex and multifactorial, and the risk factors for severe acute kidney injury (AKI) during acute PUUV infection are not well defined. We conducted a prospective study of hospitalized patients with PUUV infection in Tampere, Finland to identify acute illness risk factors for HFRS severity. Serial daily blood and urine samples were collected throughout acute illness and at 2 week and 6 month convalescent visits. By univariate analyses, the maximum white blood cell count during acute illness was a risk factor for severe AKI. There were no significant associations between PUUV-induced AKI severity and platelet counts, C-reactive protein, or alanine aminotransferase levels. Maximum plasma interleukin (IL)-6, urine IL-6, and urine IL-8 concentrations were positively associated with PUUV-induced AKI. Finally, the maximum urinary sediment GATA-3 mRNA level was positively correlated with the peak fold-change in serum creatinine, regardless of AKI severity classification. By multivariate analyses, we found that the maximum levels of leukocytes and urinary sediment GATA-3 mRNA during acute illness were independent risk factors for severe PUUV-induced AKI. We have identified novel acute illness risk factors for severe PUUV-induced AKI.
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Affiliation(s)
- Daniel H Libraty
- Department of Medicine, Medical School, University of Massachusetts, Worcester, Massachusetts, United States of America.
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44
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Xu X, Huang H, Cai M, Qian Y, Han Y, Xiao L, Zhou W, Wang X, Shi B. Serum hematopoietic growth factors as diagnostic and prognostic markers of acute renal allograft rejection: A potential role for serum stem cell factor. Cytokine 2011; 56:779-85. [DOI: 10.1016/j.cyto.2011.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/31/2011] [Accepted: 09/19/2011] [Indexed: 12/23/2022]
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45
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Jackson JA, Kim EJ, Begley B, Cheeseman J, Harden T, Perez SD, Thomas S, Warshaw B, Kirk AD. Urinary chemokines CXCL9 and CXCL10 are noninvasive markers of renal allograft rejection and BK viral infection. Am J Transplant 2011; 11:2228-34. [PMID: 21812928 PMCID: PMC3184377 DOI: 10.1111/j.1600-6143.2011.03680.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Renal transplant recipients require periodic surveillance for immune-based complications such as rejection and infection. Noninvasive monitoring methods are preferred, particularly for children, for whom invasive testing is problematic. We performed a cross-sectional analysis of adult and pediatric transplant recipients to determine whether a urine-based chemokine assay could noninvasively identify patients with rejection among other common clinical diagnoses. Urine was collected from 110 adults and 46 children with defined clinical conditions: healthy volunteers, stable renal transplant recipients, and recipients with clinical or subclinical acute rejection (AR) or BK infection (BKI), calcineurin inhibitor (CNI) toxicity or interstitial fibrosis (IFTA). Urine was analyzed using a solid-phase bead-array assay for the interferon gamma-induced chemokines CXCL9 and CXCL10. We found that urine CXCL9 and CXCL10 were markedly elevated in adults and children experiencing either AR or BKI (p = 0.0002), but not in stable allograft recipients or recipients with CNI toxicity or IFTA. The sensitivity and specificity of these chemokine assays exceeded that of serum creatinine. Neither chemokine distinguished between AR and BKI. These data show that urine chemokine monitoring identifies patients with renal allograft inflammation. This assay may be useful for noninvasively distinguishing those allograft recipients requiring more intensive surveillance from those with benign clinical courses.
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Affiliation(s)
- J A Jackson
- Children's Healthcare of Atlanta, Atlanta, Georgia The Emory Transplant Center, Emory University, Atlanta, Georgia, USA
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46
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Intrarenal IFN-γ mRNA Expression Differentiates Clinical and Subclinical Glomerulitis in Renal Transplant Recipients. Transplantation 2011; 92:170-5. [DOI: 10.1097/tp.0b013e31821eab65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Pomahac B, Nowinski D, Diaz-Siso JR, Bueno EM, Talbot SG, Sinha I, Westvik TS, Vyas R, Singhal D. Face Transplantation. Curr Probl Surg 2011; 48:293-357. [DOI: 10.1067/j.cpsurg.2011.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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48
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Sun Q, Cheng D, Zhang M, He Q, Chen Z, Liu Z. Predominance of intraglomerular T-bet or GATA3 may determine mechanism of transplant rejection. J Am Soc Nephrol 2011; 22:246-52. [PMID: 21289214 DOI: 10.1681/asn.2010050471] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The transcription factors T-bet and GATA3 determine the differentiation of helper T cells into Th1 or Th2 cells, respectively. An altered ratio of their relative expression promotes the pathogenesis of certain immunological diseases, but whether this may also contribute to the pathogenesis of antibody-mediated rejection (ABMR) versus T cell-mediated rejection (TCMR) is unknown. Here, we characterized the intragraft expression of T-bet and GATA3 and determined the correlation of their levels with the presence of typical lesions of ABMR and TCMR. We found a predominant intraglomerular expression of T-bet in patients with ABMR, which was distinct from that in patients with TCMR. In ABMR, interstitial T-bet expression was typically located in peritubular capillaries, although the overall quantity of interstitial T-bet was less than that observed in TCMR. The expression of intraglomerular T-bet correlated with infiltration of CD4+ and CD8+ lymphocytes, which express T-bet, as well as intraglomerular CD68+ monocyte/macrophages, which do not express T-bet. The predominance of intraglomerular T-bet expression relative to GATA3 expression associated with poor response to treatment with bolus steroid. In summary, predominance of intraglomerular T-bet expression correlates with antibody-mediated rejection and resistance to steroid treatment.
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Affiliation(s)
- Qiquan Sun
- Research Institute of Nephrology, Jinling Hospital, 305 East Zhong Shan Road, Nanjing 210002, China
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49
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Abstract
Solid organ transplantation is the standard treatment to improve both the quality of life and survival in patients with various end-stage organ diseases. The primary barrier against successful transplantation is recipient alloimmunity and the need to be maintained on immunosuppressive therapies with associated side effects. Despite such treatments in renal transplantation, after death with a functioning graft, chronic allograft dysfunction (CAD) is the most common cause of late allograft loss. Recipient recognition of donor histocompatibility antigens, via direct, indirect, and semidirect pathways, is critically dependent on the antigen-presenting cell (APC) and elicits effector responses dominated by recipient T cells. In allograft rejection, the engagement of recipient and donor cells results in recruitment of T-helper (Th) cells of the Th1 and Th17 lineage to the graft. In cases in which the alloresponse is dominated by regulatory T cells (Tregs), rejection can be prevented and the allograft tolerated with minimum or no immunosuppression. Here, we review the pathways of allorecognition that underlie CAD and the T-cell effector phenotypes elicited as part of the alloresponse. Future therapies including depletion of donor-reactive lymphocytes, costimulation blockade, negative vaccination using dendritic cell subtypes, and Treg therapy are inferred from an understanding of these mechanisms of allograft rejection.
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Abstract
Late failure of a kidney transplant continues to be a major problem after transplantation, in spite of more potent immunosuppressive strategies and the focus of clinical management shifting toward prolonging long-term graft survival. It is now recognized that graft failure occurs because of two major complications: death with a functioning graft and intrinsic allograft failure. Recent studies of late kidney graft loss have indicated a complexity of findings, including etiologies that are both immune and non-immune. These studies suggest that late graft failure is not an inevitable fact and that further investigation into the etiology of transplant graft failure may lead to a new understanding of the biology that will provide novel therapeutic strategies and biomarkers. In this review, we will focus on late allograft failure due to intrinsic injury to the transplant. The role of immune monitoring will be discussed in the context of monitoring for ongoing injury or for identifying late injury. A variety of methodologies have been used, including genomics, proteomics, and metabolomics, not only for monitoring allograft injury but also for identifying markers of graft failure that are more sensitive than serum creatinine. The available studies, as they relate to late or chronic graft injury, will also be reviewed.
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