1
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Relevance of Anti-HLA Antibody Strength Underestimation in Single Antigen Bead Assay for Shared Eplets. Transplantation 2022; 106:2456-2461. [PMID: 35849751 DOI: 10.1097/tp.0000000000004247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND HLAs contain combinations of multiple eplets, sometimes shared between numerous HLA alleles. Some authors suggested that single antigen bead (SAB) assays may underestimate the signal of anti-HLA antibodies (Ab) when several beads share the targeted eplet. However, this assumption has not yet been validated experimentally. METHODS We selected 5 eplets shared by 1-24 beads of the routine SAB kits: the eplet 163LS/G; the 3 eplets 127K, 62GE, and 62GRN thereafter called cross-reactive group 2C; the 82LR eplet, well-known as Bw4; the locally called QB2A5 eplet associated with the DQA1*05:01/DQB1*02:01 combination; and the 40GR DQ eplet. We selected a dozen of sera for each eplet with Ab mean fluorescence intensity (MFI) between 1000 and 15 000 for the beads carrying the targeted eplet. We tested them with the classical SAB panel (SABp), with an isolated bead carrying the eplet (isolated SAB [SABi]) and with a mixture of both (SABp+i). RESULTS No significant difference in MFI was detected among SABi, SABp, and SABp+i conditions for all the eplets. CONCLUSIONS We noticed only a nonsignificant difference in the Ab MFI signal due to eplet sharing on the SAB assay. We, therefore, conclude that this phenomenon should no longer be considered as a significant risk factor during patient follow-up pre- or posttransplantation.
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2
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Bezstarosti S, Bakker KH, Kramer CSM, de Fijter JW, Reinders MEJ, Mulder A, Claas FHJ, Heidt S. A Comprehensive Evaluation of the Antibody-Verified Status of Eplets Listed in the HLA Epitope Registry. Front Immunol 2022; 12:800946. [PMID: 35154076 PMCID: PMC8831796 DOI: 10.3389/fimmu.2021.800946] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/30/2021] [Indexed: 01/09/2023] Open
Abstract
Matching strategies based on HLA eplets instead of HLA antigens in solid organ transplantation may not only increase the donor pool for highly sensitized patients, but also decrease the incidence of de novo donor-specific antibody formation. However, since not all eplets are equally capable of inducing an immune response, antibody verification is needed to confirm their ability to be bound by antibodies, such that only clinically relevant eplets are considered. The HLA Epitope Registry has documented all theoretically defined HLA eplets along with their antibody verification status and has been the foundation for many clinical studies investigating eplet mismatch in transplantation. The verification methods for eplets in the Registry range from polyclonal sera from multi- and uni-parous women to murine and human monoclonal antibodies (mAbs), and antibodies purified by adsorption and elution from sera of HLA immunized individuals. The classification of antibody verification based on different methods for validation is problematic, since not all approaches represent the same level of evidence. In this study, we introduce a classification system to evaluate the level of evidence for the antibody-verified status of all eplets in the HLA Epitope Registry. We demonstrate that for a considerable number of eplets, the antibody-verified status is solely based on polyclonal serum reactivity of multiparous women or on reactivity of murine mAbs. Furthermore, we noted that a substantial proportion of patient sera analyses and human mAb data presented in the HLA Epitope Registry Database has never been published in a peer-reviewed journal. Therefore, we tested several unpublished human HLA-specific mAbs by luminex single antigen beads assay to analyze their HLA reactivity for eplet antibody verification. Although the majority of analyzed mAbs indeed verified their assigned eplets, this was not the case for a number of eplets. This comprehensive overview of evidence for antibody verification of eplets in the HLA Epitope Registry is instrumental for future investigations towards eplet immunogenicity and clinical studies considering antibody-verified eplet mismatch in transplantation and warrants further standardization of antibody verification using high quality data.
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Affiliation(s)
- Suzanne Bezstarosti
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands.,Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, Netherlands
| | - Kim H Bakker
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Cynthia S M Kramer
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Johan W de Fijter
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine, Erasmus Medical Center Transplantation Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Arend Mulder
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands.,Eurotransplant Reference Laboratory, Leiden, Netherlands
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands.,Eurotransplant Reference Laboratory, Leiden, Netherlands
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3
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Implementation of molecular matching in transplantation requires further characterization of both immunogenicity and antigenicity of individual HLA epitopes. Hum Immunol 2021; 83:256-263. [PMID: 34963506 DOI: 10.1016/j.humimm.2021.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 02/08/2023]
Abstract
Over the past decade, high HLA epitope mismatch scores have been associated with inferior transplant outcomes using several tools, of which HLAMatchmaker is most well-known. This software uses theoretically defined polymorphic amino acid configurations, called eplets, for HLA compatibility analysis. Although consideration of eplet mismatch loads has potential for immunological risk stratification of transplant patients, the use of eplet matching in organ allocation algorithms is hindered by lacking knowledge of the immunogenicity of individual eplets, and the possibility that single mismatched amino acids, rather than complete eplets, are responsible for HLA antibody induction. There are several approaches to define eplet immunogenicity, such as antibody verification of individual eplets, and data-driven approaches using large datasets that correlate specific eplet mismatches to donor specific antibody formation or inferior transplant outcomes. Data-driven approaches can also be used to define whether single amino acid mismatches may be more informative than eplet mismatches for predicting HLA antibody induction. When using epitope knowledge for the assignment of unacceptable antigens, it important to realize that alleles sharing an eplet to which antibodies have formed are not automatically all unacceptable since multiple contact sites determine the binding strength and thus biological function and pathogenicity of an antibody, which may differ between reactive alleles. While the future looks bright for using HLA epitopes in clinical decision making, major steps need to be taken to make this a clinical reality.
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4
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Cioni M, Comoli P, Tagliamacco A, Innocente A, Basso S, Fontana I, Magnasco A, Trivelli A, Nocco A, Macchiagodena M, Catenacci L, Klersy C, Verrina E, Garibotto G, Ghiggeri GM, Cardillo M, Ginevri F, Nocera A. Post-transplant de novo non donor-specific HLA antibodies are not associated with poor graft outcome in non-sensitized pediatric recipients of kidney transplantation. Transpl Immunol 2021; 65:101375. [PMID: 33610675 DOI: 10.1016/j.trim.2021.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
While de novo donor-specific HLA antibodies (dnDSAs) have a detrimental impact on kidney graft outcome, the clinical significance of de novo non donor-specific antibodies (dnNDSAs) is more controversial. We retrospectively evaluated for Ab development and characteristics of dnNDSAs serially collected post-transplant sera and, when available, graft biopsy eluates, from 144 non-sensitized, primary pediatric kidney recipients, consecutively transplanted at a single center between 2003 and 2017, using HLA class I and class II single-antigen flow-bead assays (SAB). The results were compared with clinical-pathologic data from HLA antibody negative and HLA dnDSA-positive patients. Forty-five out of 144 patients developed dnNDSAs (31%). Among the dnNDSA-positive patients, 86% displayed one or more class I/II antibodies recognizing antigens included in the CREG/shared epitope groups that also comprise the mismatched donor HLA antigens. Despite potential pathogenicity, as suggested by their occasional presence within the graft, dnNDSAs displayed significantly lower MFI, and limited complement binding and graft homing properties, when compared with dnDSAs. In parallel, the graft survival probability was significantly lower in patients with dnDSA than in those with dnNDSA or without HLA antibodies (p < 0.005). Indeed, the dnNDSA-positive patients remaining dnDSA-negative throughout the posttransplant period did not develop clinical antibody mediated rejection and graft loss, and maintained good graft function at a median follow-up of 9 years. The biological characteristics of dnNDSAs may account for the low graft damaging capability when compared to dnDSAs.
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Affiliation(s)
- Michela Cioni
- Laboratory of Molecular Nephrology, IRCCS Giannina Gaslini, Genova, Italy
| | - Patrizia Comoli
- Cell Factory and Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Augusto Tagliamacco
- Clinical Nephrology Unit and Transplant Coordination Unit, Policlinico San Martino, Genova, Italy
| | - Annalisa Innocente
- Transplantation Immunology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Sabrina Basso
- Cell Factory and Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Iris Fontana
- Vascular and Endovascular Unit and Kidney Transplant Surgery Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Alberto Magnasco
- Nephrology, Dialysis, Transplantation Unit, IRCCS Giannina Gaslini, Genova, Italy
| | - Antonella Trivelli
- Nephrology, Dialysis, Transplantation Unit, IRCCS Giannina Gaslini, Genova, Italy
| | - Angela Nocco
- Transplantation Immunology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Mario Macchiagodena
- Transplantation Immunology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Laura Catenacci
- Cell Factory and Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Enrico Verrina
- Nephrology, Dialysis, Transplantation Unit, IRCCS Giannina Gaslini, Genova, Italy
| | - Giacomo Garibotto
- Clinical Nephrology Unit, University of Genova and Policlinico San Martino Genova, Italy
| | - Gian Marco Ghiggeri
- Nephrology, Dialysis, Transplantation Unit, IRCCS Giannina Gaslini, Genova, Italy
| | - Massimo Cardillo
- Transplantation Immunology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Italian National Transplant Centre, Italian National Institute of Health (ISS), Rome, Italy
| | - Fabrizio Ginevri
- Nephrology, Dialysis, Transplantation Unit, IRCCS Giannina Gaslini, Genova, Italy.
| | - Arcangelo Nocera
- Nephrology, Dialysis, Transplantation Unit, IRCCS Giannina Gaslini, Genova, Italy
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5
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Kramer CSM, Franke‐van Dijk MEI, Bakker KH, Uyar‐Mercankaya M, Karahan GE, Roelen DL, Claas FHJ, Heidt S. Generation and reactivity analysis of human recombinant monoclonal antibodies directed against epitopes on HLA-DR. Am J Transplant 2020; 20:3341-3353. [PMID: 32342632 PMCID: PMC7754395 DOI: 10.1111/ajt.15950] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Abstract
In kidney transplantation, eplet mismatches between donor and recipient have been associated with de novo donor-specific antibody development. Eplets are theoretically defined configurations of polymorphic amino acids and require experimental verification to establish whether they can be bound by alloantibodies. Human HLA-specific monoclonal antibodies (mAbs) have been instrumental for this purpose but are largely lacking for HLA class II. In this study, we isolated single HLA-DR-specific memory B cells from peripheral blood of immunized individuals (n = 3) using HLA class II tetramers to generate recombinant human HLA-DR antigen-reactive mAbs (n = 5). Comparison of the amino acid composition of the reactive HLA alleles in relation to the antibody reactivity patterns led to identification of 3 configurations, 70Q 73A, 31F 32Y 37Y, and 14K 25Q recognized, respectively, by HLA-DRB1*01:01, HLA-DRB1*04:01, and HLA-DRB1*07:01 antigen-reactive mAbs. The first 2 correspond to eplets 70QA and 31FYY and can now be considered antibody verified. The latter indicates that eplet 25Q needs to be redefined before being considered as antibody verified. Generation and reactivity analysis of human HLA-DR mAbs allowed for identification of amino acid configurations corresponding to known eplets, whereas the other patterns may be used to redefine eplets with similar, but not identical predicted amino acid composition.
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Affiliation(s)
- Cynthia S. M. Kramer
- Department of Immunohematology and Blood TransfusionLeiden University Medical CentreLeidenThe Netherlands
| | | | - Kim H. Bakker
- Department of Immunohematology and Blood TransfusionLeiden University Medical CentreLeidenThe Netherlands
| | - Merve Uyar‐Mercankaya
- Department of Immunohematology and Blood TransfusionLeiden University Medical CentreLeidenThe Netherlands
| | - Gonca E. Karahan
- Department of Immunohematology and Blood TransfusionLeiden University Medical CentreLeidenThe Netherlands
| | - Dave L. Roelen
- Department of Immunohematology and Blood TransfusionLeiden University Medical CentreLeidenThe Netherlands
| | - Frans H. J. Claas
- Department of Immunohematology and Blood TransfusionLeiden University Medical CentreLeidenThe Netherlands
| | - Sebastiaan Heidt
- Department of Immunohematology and Blood TransfusionLeiden University Medical CentreLeidenThe Netherlands
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6
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Abstract
Antibody-mediated rejection continues to hinder long-term survival of solid organ allografts. Natural antibodies (Nabs) with polyreactive and autoreactive properties have recently emerged as potential contributors to antibody-mediated graft rejection. This review discusses Nabs, their functions in health and disease, their significance in rejection following kidney, heart, and lung transplantation, and their implication in serum reactivity to key antigens associated with rejection. Finally, potential effector mechanisms of Nabs in the context of transplantation are explored.
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7
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Snanoudj R, Kamar N, Cassuto E, Caillard S, Metzger M, Merville P, Thierry A, Jollet I, Grimbert P, Anglicheau D, Hazzan M, Choukroun G, Hurault De Ligny B, Janbon B, Vuiblet V, Devys A, Le Meur Y, Delahousse M, Morelon E, Bailly E, Girerd S, Amokrane K, Legendre C, Hertig A, Rondeau E, Taupin JL. Epitope load identifies kidney transplant recipients at risk of allosensitization following minimization of immunosuppression. Kidney Int 2019; 95:1471-1485. [PMID: 30955869 DOI: 10.1016/j.kint.2018.12.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 12/01/2022]
Abstract
Human leukocyte antigen (HLA) mismatching and minimization of immunosuppression are two major risk factors for the development of de novo donor-specific antibodies, which are associated with reduced kidney graft survival. Antibodies do not recognize whole HLA antigens but rather individual epitopes, which are short sequences of amino acids in accessible positions. However, compatibility is still assessed by the simple count of mismatched HLA antigens. We hypothesized that the number of mismatched epitopes, or ("epitope load") would identify patients at the highest risk of developing donor specific antibodies following minimization of immunosuppression. We determined epitope load in 89 clinical trial participants who converted from cyclosporine to everolimus 3 months after kidney transplantation. Twenty-nine participants (32.6%) developed de novo donor specific antibodies. Compared to the number of HLA mismatches, epitope load was more strongly associated with the development of donor specific antibodies. Participants with an epitope load greater than 27 had a 12-fold relative risk of developing donor-specific antibodies compared to those with an epitope load below that threshold. Using that threshold, epitope load would have missed only one participant who subsequently developed donor specific antibodies, compared to 8 missed cases based on a 6-antigen mismatch. DQ7 was the most frequent antigenic target of donor specific antibodies in our population, and some DQ7 epitopes appeared to be more frequently involved than others. Assessing epitope load before minimizing immunosuppression may be a more efficient tool to identify patients at the highest risk of allosensitization.
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Affiliation(s)
- Renaud Snanoudj
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Hôpital Foch, Suresnes, France; CESP, INSERM, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.
| | - Nassim Kamar
- Service de Néphrologie et Transplantation d'organe, CHU Rangueil, Toulouse, France
| | | | - Sophie Caillard
- Service de Néphrologie et Transplantation, CHU de Strasbourg, Strasbourg, France
| | - Marie Metzger
- CESP, INSERM, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Pierre Merville
- Service de Néphrologie et Transplantation, Hôpital Pellegrin, Bordeaux, France
| | - Antoine Thierry
- Service de Néphrologie et Transplantation, CHU de Poitiers, Poitiers, France
| | | | - Philippe Grimbert
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Créteil, France
| | - Dany Anglicheau
- Service de Transplantation et Néphrologie, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marc Hazzan
- Service de Néphrologie, Hôpital Claude Huriez, CHRU de Lille, Lille, France
| | | | | | - Bénedicte Janbon
- Service de Néphrologie et Transplantation, CHU de Grenoble, Grenoble, France
| | - Vincent Vuiblet
- Service de Néphrologie, Hôpital Maison Blanche, Reims, France
| | - Anne Devys
- Etablissement français du sang - Centre Pays de Loire, Angers, France
| | - Yann Le Meur
- Service de Néphrologie, CHU de Brest, Brest, France
| | - Michel Delahousse
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Hôpital Foch, Suresnes, France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Elodie Bailly
- Service de Néphrologie, Hôpital Bretonneau, CHU de Tours, Tours, France
| | - Sophie Girerd
- Service de Néphrologie, CHU Nancy Brabois, Nancy, France
| | - Kahina Amokrane
- Laboratoire d'Immunologie et Histocompatibilité Hôpital Saint-Louis, Paris, France; INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
| | - Christophe Legendre
- Service de Transplantation et Néphrologie, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandre Hertig
- Service de Néphrologie et Transplantation, Hôpital Tenon, Paris, France
| | - Eric Rondeau
- Service de Néphrologie et Transplantation, Hôpital Tenon, Paris, France
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité Hôpital Saint-Louis, Paris, France; INSERM UMRs 1160, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
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8
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Zorn E. New insights on innate B-cell immunity in transplantation. Xenotransplantation 2018; 25:e12417. [PMID: 29913034 DOI: 10.1111/xen.12417] [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: 03/22/2018] [Accepted: 05/03/2018] [Indexed: 12/25/2022]
Abstract
Innate B cells and natural antibodies (Nabs) have been extensively studied in normal physiological conditions as well as in several diseases. However, their significance in the context of ABO-compatible solid organ transplantation is only emerging. This review summarizes recent studies exploring these often neglected innate immune elements in situations related to sensitization and clinical graft rejection. A focus is placed on class-switched IgG Nabs that develop amidst inflammation, rather than IgM Nabs abundant at the steady state, as new evidence point to their implication in serum reactivity to HLA and kidney graft failure. The involvement of innate B cells in the pathophysiology of CAV is also presented. Lastly, we discuss key questions that need answering to understand whether and how innate B-cell immunity contributes to the outcome of solid organ transplantation.
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Affiliation(s)
- Emmanuel Zorn
- Columbia Center for Translational Immunology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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9
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Michielsen LA, Wisse BW, Kamburova EG, Verhaar MC, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas MC, Spierings E, Hack CE, van Reekum FE, Bots ML, Drop ACAD, Plaisier L, Seelen MAJ, Sanders JSF, Hepkema BG, Lambeck AJ, Bungener LB, Roozendaal C, Tilanus MGJ, Voorter CE, Wieten L, van Duijnhoven EM, Gelens M, Christiaans MHL, van Ittersum FJ, Nurmohamed SA, Lardy NM, Swelsen W, van der Pant KA, van der Weerd NC, ten Berge IJM, Bemelman FJ, Hoitsma A, van der Boog PJM, de Fijter JW, Betjes MGH, Heidt S, Roelen DL, Claas FH, Otten HG, van Zuilen AD. A paired kidney analysis on the impact of pre-transplant anti-HLA antibodies on graft survival. Nephrol Dial Transplant 2018; 34:1056-1063. [DOI: 10.1093/ndt/gfy316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Laura A Michielsen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bram W Wisse
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elena G Kamburova
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Irma Joosten
- Laboratory Medicine, Lab Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wil A Allebes
- Laboratory Medicine, Lab Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnold van der Meer
- Laboratory Medicine, Lab Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marije C Baas
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Eric Spierings
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis E Hack
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Franka E van Reekum
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan C A D Drop
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Loes Plaisier
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marc A J Seelen
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Stephan F Sanders
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bouke G Hepkema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annechien J Lambeck
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura B Bungener
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Caroline Roozendaal
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel G J Tilanus
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christien E Voorter
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lotte Wieten
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elizabeth M van Duijnhoven
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mariëlle Gelens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maarten H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Shaikh A Nurmohamed
- Department of Nephrology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Neubury M Lardy
- Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands
| | - Wendy Swelsen
- Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands
| | - Karlijn A van der Pant
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Neelke C van der Weerd
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Ineke J M ten Berge
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Andries Hoitsma
- Dutch Organ Transplant Registry (NOTR), Dutch Transplant Foundation (NTS), Leiden, The Netherlands
| | | | - Johan W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Sebastiaan Heidt
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave L Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans H Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Henderikus G Otten
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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10
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Ravindranath MH. HLA Class Ia and Ib Polyreactive Anti-HLA-E IgG2a Monoclonal Antibodies (TFL-006 and TFL-007) Suppress Anti-HLA IgG Production by CD19+ B Cells and Proliferation of CD4+ T Cells While Upregulating Tregs. J Immunol Res 2017; 2017:3475926. [PMID: 28634589 PMCID: PMC5467321 DOI: 10.1155/2017/3475926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/18/2017] [Accepted: 03/23/2017] [Indexed: 12/20/2022] Open
Abstract
The anti-HLA-E IgG2a mAbs, TFL-006 and TFL-007, reacted with all HLA-I antigens, similar to the therapeutic preparations of IVIg. Indeed, IVIg lost its HLA reactivity, when its HLA-E reactivity was adsorbed out. US-FDA approved IVIg to reduce antibodies in autoimmune diseases. But the mechanism underlying IVIg-mediated antibody reduction could not be ascertained due to the presence of other polyclonal antibodies. In spite of it, the cost prohibitive high or low IVIg is administered to patients waiting for donor organ and for allograft recipients for lowering antiallograft antibodies. A mAb that could mimic IVIg in lowering Abs, with defined mechanism of action, would be highly beneficial for patients. Demonstrably, the anti-HLA-E mAbs mimicked several functions of IVIg relevant to suppressing the antiallograft Abs. The mAbs suppressed activated T cells and anti-HLA antibody production by activated B cells, which were dose-wise superior to IVIg. The anti-HLA-E mAb expanded CD4+, CD25+, and Foxp3+ Tregs, which are known to suppress T and B cells involved in antibody production. These defined functions of the anti-HLA-E IgG2a mAbs at a level superior to IVIg encourage developing their humanized version to lower antibodies in allograft recipients, to promote graft survival, and to control autoimmune diseases.
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11
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Kramer CSM, Roelen DL, Heidt S, Claas FHJ. Defining the immunogenicity and antigenicity of HLA epitopes is crucial for optimal epitope matching in clinical renal transplantation. HLA 2017; 90:5-16. [DOI: 10.1111/tan.13038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 12/25/2022]
Affiliation(s)
- C. S. M. Kramer
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
| | - D. L. Roelen
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
| | - S. Heidt
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
| | - F. H. J. Claas
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Centre; Leiden the Netherlands
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12
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Kauke T, Oberhauser C, Lin V, Coenen M, Fischereder M, Dick A, Schoenermarck U, Guba M, Andrassy J, Werner J, Meiser B, Angele M, Stangl M, Habicht A. De novo donor-specific anti-HLA antibodies after kidney transplantation are associated with impaired graft outcome independently of their C1q-binding ability. Transpl Int 2017; 30:360-370. [PMID: 27862352 DOI: 10.1111/tri.12887] [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: 07/05/2016] [Revised: 07/28/2016] [Accepted: 11/09/2016] [Indexed: 12/16/2022]
Abstract
Many aspects of post-transplant monitoring of donor-specific (DSA) and non-donor-specific (nDSA) anti-HLA antibodies on renal allograft survival are still unclear. Differentiating them by their ability to bind C1q may offer a better risk assessment. We retrospectively investigated the clinical relevance of de novo C1q-binding anti-HLA antibodies on graft outcome in 611 renal transplant recipients. Acute rejection (AR), renal function, and graft survival were assessed within a mean follow-up of 6.66 years. Post-transplant 6.5% patients developed de novo DSA and 11.5% de novo nDSA. DSA (60.0%; P < 0.0001) but not nDSA (34.1%, P = 0.4788) increased rate of AR as compared with controls (27.4%). C1q-binding anti-HLA antibodies did not alter rate of AR in both groups. Renal function was only significantly diminished in patients with DSAC1q+ . However, DSA significantly impaired 5-year graft survival (65.2%; P < 0.0001) in comparison with nDSA (86.7%; P = 0.0054) and controls (90.7%). While graft survival did not differ between DSAC1q- and DSAC1q+ recipients, 5-year allograft survival was reduced in nDSAC1q+ (80.9%) versus nDSAC1q- (90.7%, P = 0.0251). De novo DSA independently of their ability to bind C1q are associated with diminished graft survival.
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Affiliation(s)
- Teresa Kauke
- Laboratory of Immunogenetics, University Hospital Munich, Munich, Germany.,Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Cornelia Oberhauser
- Department of Medical Informatics, Biometry and Epidemiology - IBE, Chair for Public Health and Health Services Research, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Viviane Lin
- Laboratory of Immunogenetics, University Hospital Munich, Munich, Germany.,Transplant Center, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michaela Coenen
- Department of Medical Informatics, Biometry and Epidemiology - IBE, Chair for Public Health and Health Services Research, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michael Fischereder
- Renal Division, Department of Internal Medicine IV, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Andrea Dick
- Laboratory of Immunogenetics, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Ulf Schoenermarck
- Renal Division, Department of Internal Medicine IV, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Markus Guba
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Joachim Andrassy
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jens Werner
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Bruno Meiser
- Transplant Center, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Martin Angele
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Manfred Stangl
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Antje Habicht
- Transplant Center, University Hospital Munich, Munich, Germany.,Ludwig-Maximilians-University (LMU), Munich, Germany
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13
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Verghese PS, Reed RC, Lihong B, Matas AJ, Kim Y. The clinical implications of the unique glomerular complement deposition pattern in transplant glomerulopathy. J Nephrol 2016; 31:157-164. [PMID: 27848227 DOI: 10.1007/s40620-016-0365-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022]
Abstract
The etiology and treatment of transplant glomerulopathy (TG) is not clear. TG is associated with donor-specific antibodies but the lack of C4d deposition in the peritubular capillaries (ptc-C4d) in some cases has caused the role of complement in the pathogenesis of TG to be debated. There is however, little information on C4d deposition in the glomerulus itself. We retrieved random frozen sections from 25 cases with well-established TG by light microscopy (LM) and 25 cases without TG as controls and reviewed the LM and immunofluorescence (nine biopsies were excluded due to inadequate samples). Glomerular complement deposition was assessed in all included biopsies. Glomerular C3d and C4d deposition occurred in a distinct pattern in all TG biopsies: segmental or global double linear staining of the glomerular capillary wall in 23 (100%). This pattern was not present in any NON-TG biopsies. The distinct glomerular complement deposition patterns in all TG cases are suggestive that TG is a proximal complement-mediated process and therapies should focus on proximal complement inhibition.
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Affiliation(s)
- Priya S Verghese
- Division of Pediatric Nephrology, University of Minnesota, Minneapolis, USA.
| | - Robin C Reed
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, USA
| | - Bu Lihong
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, USA
| | - Arthur J Matas
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Youngki Kim
- Division of Pediatric Nephrology, University of Minnesota, Minneapolis, USA
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14
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Hörmann M, Dieplinger G, Rebellato LM, Briley KP, Bolin P, Morgan C, Haisch CE, Everly MJ. Incidence and impact of anti-HLA-DP antibodies in renal transplantation. Clin Transplant 2016; 30:1108-14. [DOI: 10.1111/ctr.12794] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Lorita M. Rebellato
- Department of Pathology; Brody School of Medicine at East Carolina University; Greenville NC USA
| | - Kimberly P. Briley
- Department of Pathology; Brody School of Medicine at East Carolina University; Greenville NC USA
| | - Paul Bolin
- Department of Medicine; Brody School of Medicine at East Carolina University; Greenville NC USA
| | - Claire Morgan
- Department of Medicine; Brody School of Medicine at East Carolina University; Greenville NC USA
| | - Carl E. Haisch
- Department of Surgery; Brody School of Medicine at East Carolina University; Greenville NC USA
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15
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Evidence to Support a Contribution of Polyreactive Antibodies to HLA Serum Reactivity. Transplantation 2016; 100:217-26. [PMID: 26285015 DOI: 10.1097/tp.0000000000000840] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assessing the serum reactivity to HLA is essential for the evaluation of transplant candidates and the follow-up of allograft recipients. In this study, we look for evidence at the clonal level that polyreactive antibodies cross-reactive to apoptotic cells and multiple autoantigens can also react to HLA and contribute to the overall serum reactivity. METHODS We immortalized B cell clones from the blood of 2 kidney transplant recipients and characterized their reactivity to self-antigens, apoptotic cells as well as native, denatured, and cryptic HLA determinants using enzyme-linked immunosorbent assay (ELISA), immunofluorescence, flow cytometry and Luminex assays. We also assessed the reactivity of 300 pretransplant serum specimens to HLA and apoptotic cells. RESULTS We report here 4 distinct B cell clones cross-reactive to self and HLA class I. All 4 clones reacted to numerous HLA class I alleles but did not appear to target canonical "shared" epitopes. In parallel experiments, we observed a strong correlation between IgG reactivity to HLA and apoptotic cells in pretransplant serum samples collected from 300 kidney transplant recipients. Further analysis revealed that samples with higher reactivity to apoptotic cells displayed significantly higher class I percent panel-reactive antibodies compared to samples with low reactivity to apoptotic cells. CONCLUSIONS We provide here (1) proof of principle at the clonal level that human polyreactive antibodies can cross-react to HLA, multiple self-antigens and apoptotic cells and (2) supportive evidence that polyreactive antibodies contribute to overall HLA reactivity in the serum of patients awaiting kidney transplant.
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16
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Cai J, Terasaki PI, Zhu D, Lachmann N, Schönemann C, Everly MJ, Qing X. Complement-fixing antibodies against denatured HLA and MICA antigens are associated with antibody mediated rejection. Exp Mol Pathol 2016; 100:45-50. [DOI: 10.1016/j.yexmp.2015.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 12/01/2022]
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17
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Association of Kidney Graft Loss With De Novo Produced Donor-Specific and Non-Donor-Specific HLA Antibodies Detected by Single Antigen Testing. Transplantation 2015; 99:1976-80. [PMID: 25769065 DOI: 10.1097/tp.0000000000000672] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association of donor-specific HLA antibodies (DSA) with kidney graft failure has been addressed previously; however, the majority of studies were based on small numbers of patients with graft failure. METHODS We investigated 83 patients with failed kidney transplants for a possible association of de novo development and persistence or loss of pre-existing DSA with graft failure. Single Antigen Bead assay-detected DSA and non-DSA antibodies were compared between patients with graft loss and matched controls with functioning grafts. RESULTS The incidence of weak de novo DSA or non-DSA at a mean fluorescence intensity of 500 or higher was higher in the graft loss than in the nonrejector group (76% vs 40%, P < 0.001). Because of the low number of patients developing de novo DSA, the DSA results did not reach statistical significance (only 22% of patients with graft loss developed de novo DSA). However, at all cutoffs, there was a significantly higher rate of graft loss in patients with de novo non-DSA. The incidence of strong pretransplant DSA that persist after transplantation was higher in the graft loss group (10% vs 1%, P = 0.034). When C1q-binding ability in sera of rejectors and nonrejectors with posttransplant de novo or persistent DSA was compared, none of the nonrejectors demonstrated C1q positivity, whereas 43% of patients with graft loss showed C1q-positive antibodies, although not necessarily donor-specific (P < 0.001). CONCLUSIONS Our data show that the posttransplant presence of persisting or de novo HLA antibodies, especially if C1q binding, is associated with graft loss, even if the antibodies are not specific for mismatched donor HLA.
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18
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New insights regarding chronic antibody-mediated rejection and its progression to transplant glomerulopathy. Curr Opin Nephrol Hypertens 2015; 23:611-8. [PMID: 25295960 DOI: 10.1097/mnh.0000000000000070] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF THIS REVIEW To discuss new insights regarding chronic antibody-mediated rejection (CAMR) and its progression to transplant glomerulopathy. We will describe the progression to transplant glomerulopathy from a histologic perspective and provide updates on what is known about its pathophysiology, prognosis, and potential therapy. RECENT FINDINGS Transplant glomerulopathy is a major contributor to long-term renal allograft loss and is most often associated with CAMR. On the basis of protocol biopsies, we have found that 3.5% of conventional transplants and 27.5% of positive crossmatch kidney transplants have transplant glomerulopathy at 1 year. The pathophysiology of the process is largely unknown, but complement activation was previously thought to be essential. However, CAMR appears to develop despite terminal complement blockade and many C4d negative cases of CAMR have been identified. Thus, complement independent mechanisms, such as direct endothelial cell activation and the infiltration of natural killer cells and monocytes, are likely key to the development of transplant glomerulopathy. SUMMARY Transplant glomerulopathy is often the result of CAMR and leads to allograft loss. It is characterized by distinctive histologic changes, and its pathophysiology is a multifaceted process involving both innate and adaptive immunity. Despite advances in the understanding of this condition, no effective therapy exists.
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19
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Tambur AR, Claas FHJ. HLA epitopes as viewed by antibodies: what is it all about? Am J Transplant 2015; 15:1148-54. [PMID: 25708017 DOI: 10.1111/ajt.13192] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 01/25/2023]
Abstract
The need for new approaches to define HLA antibodies, in the context of organ transplantation, is intensely debated among HLA professionals. In this review, we sought to provide background and perspective to current understanding of the immunogenicity of HLA mismatches with respect to the humoral alloimmune response and the definition of B cell epitopes. Initial data suggest that epitope matching not only assists in defining better matches for the current transplant, but also minimizes the risk of developing de novo HLA-donor-specific-antibodies posttransplant. In other words, other than lowering the risk of current graft rejection, epitope matching is likely to lower overall future sensitization levels and thus increases the likelihood of finding a compatible donor when the need for a retransplantation arises. More detailed knowledge of epitopes makes it possible to investigate what constitutes permissible versus non-permissible HLA mismatches. The currently available evidence suggest that epitope matching is the most rational way to decrease the risk of HLA-linked transplant rejection. This review is aimed at stimulating further and more intense collaborative effort in this field.
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Affiliation(s)
- A R Tambur
- Transplant Immunology Laboratory, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
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20
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Shimizu T, Ishida H, Toki D, Nozaki T, Omoto K, Tanabe K, Honda K, Koike J. Clinical and pathological analyses of transplant glomerulopathy cases. Nephrology (Carlton) 2015; 19 Suppl 3:21-6. [PMID: 24842817 DOI: 10.1111/nep.12243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2014] [Indexed: 11/29/2022]
Abstract
AIM Transplant glomerulopathy (TG) is included as one of the criteria of chronic active antibody-mediated rejection (c-AMR) in Banff 09 classification. In this report, we discuss the clinical and pathological analyses of cases of TG after renal transplantation. PATIENTS TG was diagnosed in 86 renal allograft biopsy specimens (BS) obtained from 50 renal transplant patients followed up at our institute between January 2006 and October 2012. We retrospectively reviewed the data of these 86 BS and 50 patients. RESULTS Among the 50 patients, 42 (84%) had a history of acute rejection (AR); of these, 30 (60%) had acute antibody-mediated rejection (a-AMR). Among the 86 BS of TG, the TG was mild in 35 cases (cg1 in Banff classification), moderate in 28 cases (cg2) and severe in 23 cases (cg3). Peritubular capillaritis was present in 74 BS (86%), transplant glomerulitis in 65 (76%), interstitial fibrosis and tubular atrophy (IF/TA) in 71 (83%), thickening of the peritubular capillary (PTC) basement membrane in 72 (84%), and interstitial inflammation in 40 (47%). C4d deposition in the PTC was present in 49 BS (57%); 39 of these 49 BS showed diffuse C4d deposits in the PTC (C4d3), while the remaining 10 BS showed focal deposits (C4d2). Diffuse C4d deposition in the glomerular capillaries (GC) was seen in 70 BS (81%), while focal C4d deposition in the GC was seen in 9 (11%). In the assay using plastic beads coated with HLA antigen performed in 67 serum samples obtained in the peri-biopsy period, circulating ant-HLA alloantibody was detected in 55 (82%); in 33 of the 55 (49%) samples, donor-specific antibodies (DSA) were detected. Among our study, the findings in 22 BS (26%) fully met the criteria for c-AMR in Banff '09 classification, including TG, C4d deposition in the PTC and presence of DSA, while those in 27 BS were suspicious of c-AMR. Deterioration of the renal allograft function after the biopsies was seen in 31 patients (62%), of which 11 lost their graft. CONCLUSIONS We suggest that histopathological changes of transplant glomerulopathy might be accompanied by inflammation of the microvasculature, such as transplant glomerulitis and peritubular capillaritis, thickening of the peritubular capillary basement membrane, and circulating anti-HLA antibodies. C4d deposition in the PTC is not always present in biopsy specimens of TG. We speculated that C4d deposition in the GC, rather than that in the PTC might be a more characteristic manifestation of TG. Many of the patients with TG had a history of AR. Anti-HLA antibody Class II, particularly when the antibody was DSA Class II, appeared to be associated with the development of TG. The prognosis of grafts exhibiting TG was not too good even under the currently used immunosuppressive protocol.
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Affiliation(s)
- Tomokazu Shimizu
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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21
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Posttransplant Soluble B-Cell Activating Factor Kinetics in Pediatric Recipients of First Kidney Allograft. Transplantation 2015; 99:243-9. [DOI: 10.1097/tp.0000000000000276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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22
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Duquesnoy RJ, Marrari M, Tambur AR, Mulder A, da Mata Sousa LCD, da Silva AS, do Monte SJ. First report on the antibody verification of HLA-DR, HLA-DQ and HLA-DP epitopes recorded in the HLA Epitope Registry. Hum Immunol 2014; 75:1097-103. [DOI: 10.1016/j.humimm.2014.09.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 01/07/2023]
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23
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Abstract
BACKGROUND Human leukocyte antigen (HLA)-DQ has emerged as the alloantibody most frequently associated with the generation of de novo donor-specific antibody (DSA), antibody-mediated-rejection, and unfavorable transplantation outcome. METHODS The generation of HLA-DQ de novo DSA was interrogated in 40 transplant recipients who were immunologically naive before their failed transplantation. Eplet and epitope analyses were performed using HLAMatchmaker and Cn3D software. RESULTS Ten DQA and thirteen DQB eplets or eplet combinations were identified. All but one revealed an epitope footprint that includes both the DQα and DQβ chains. Four examples are illustrated in detail, representing a range of different epitope landscapes. A disparity between antigen density and mean fluorescence intensity values for some alleles within an eplet group was noted, with mean fluorescence intensity values of the lowest fluorescence bead being one tenth of the highest fluorescence bead, despite the fact that the amount of antigen on these beads were not significantly different. CONCLUSION Our data support the need for changing the manner in which HLA-DQ antigens and antibodies are evaluated for organ transplantation. The current nomenclature system does not reflect the true nature of HLA-DQ polymorphism. Moreover, epitope immunogenicity likely involves more than the mere presence of a specific eplet. Because our field contemplates the use of epitope matching as an approach to improve organ allocation and overall outcomes, it is imperative to have accurate characterization of the immunogenicity of each epitope. This will pave the way to identifying acceptable mismatches and will allow risk stratification for generating de novo HLA-DSA after transplantation.
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Ruiz San Millán JC, López-Hoyos M, Segundo DS, Quintela E, Rodrigo E, Gómez-Alamillo C, Romón I, Arias M. Predictive factors of allosensitization in renal transplant patients switched from calcineurin to mTOR inhibitors. Transpl Int 2014; 27:847-56. [PMID: 24707885 DOI: 10.1111/tri.12334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/18/2013] [Accepted: 04/04/2014] [Indexed: 11/30/2022]
Abstract
Conversion of kidney-transplant recipients from calcineurin inhibitors to mTOR inhibitors has been suggested to be a risk factor for increased alloimmune response. We have analyzed the development of new HLA-antibodies (HLA-Abs) early after conversion in 184 patients converted in stable phase at our hospital and compared with a control group of nonconverted comparable 63 transplants. Using single-antigen solid-phase immunoassay analysis, a preconversion and a 3-6 months postconversion sera were prospectively analyzed in every patient for the appearance of new HLA-Abs. Renal function at 2 years postconversion and cumulative graft survival were compared between groups. In 16 patients, new HLA-Abs (3-DSA and 13-NonDSA), not present at the moment of conversion, were detected (8.7% vs. 3.1% in the control group). The type of mTORi used, type of CNI preconversion, the presence of steroids, time of conversion, or indication for conversion did not have influence on this effect but the presence of HLA-Abs before conversion highly correlated with the appearance of new specificities. Patients with de novo HLA-Abs showed a trend to worst graft function and survival. In conclusion, conversion to mTORi can be followed by early appearance of de novo HLA-Abs, especially in patients with HLA-Abs preconversion, and this complication should be screened early after conversion.
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Affiliation(s)
- Juan Carlos Ruiz San Millán
- Nephrology Department, Hospital Universitario Marqués de Valdecilla-IFIMAV, Universidad de Cantabria, Santander, Spain
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25
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Jiang X, Sung YK, Tian W, Qian J, Semenza GL, Nicolls MR. Graft microvascular disease in solid organ transplantation. J Mol Med (Berl) 2014; 92:797-810. [PMID: 24880953 PMCID: PMC4118041 DOI: 10.1007/s00109-014-1173-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/29/2014] [Accepted: 05/14/2014] [Indexed: 02/07/2023]
Abstract
Alloimmune inflammation damages the microvasculature of solid organ transplants during acute rejection. Although immunosuppressive drugs diminish the inflammatory response, they do not directly promote vascular repair. Repetitive microvascular injury with insufficient regeneration results in prolonged tissue hypoxia and fibrotic remodeling. While clinical studies show that a loss of the microvascular circulation precedes and may act as an initiating factor for the development of chronic rejection, preclinical studies demonstrate that improved microvascular perfusion during acute rejection delays and attenuates tissue fibrosis. Therefore, preservation of a functional microvasculature may represent an effective therapeutic strategy for preventing chronic rejection. Here, we review recent advances in our understanding of the role of the microvasculature in the long-term survival of transplanted solid organs. We also highlight microvessel-centered therapeutic strategies for prolonging the survival of solid organ transplants.
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Affiliation(s)
- Xinguo Jiang
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA,
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26
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Ansari M, Uppugunduri CRS, Ferrari-Lacraz S, Bittencourt H, Gumy-Pause F, Chalandon Y, Tiercy JM, Schechter T, Gassas A, Doyle JD, Dupuis L, Duval M, Krajinovic M, Villard J. The clinical relevance of pre-formed anti-HLA and anti-MICA antibodies after cord blood transplantation in children. PLoS One 2013; 8:e72141. [PMID: 23977232 PMCID: PMC3747133 DOI: 10.1371/journal.pone.0072141] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 07/06/2013] [Indexed: 11/22/2022] Open
Abstract
Preformed anti-HLA antibodies (AHA) are known to be associated with delayed engraftment and reduced overall survival after adult hematopoietic stem cell transplantation. However, limited data is available in pediatric patients. In this study, we explored the role of AHA on clinical outcomes in 70 pediatric patients who received a single unit of HLA mismatch cord blood for hematologic malignancies, immunodeficiencies or metabolic diseases. The presence of AHA was detected in 44% (31/70) of the patients. Preformed class I AHA was associated with an increased occurrence of grade 1–4 acute graft-versus host disease (p<0.05). The presence of anti- major-histocompatibility-complex class I–related chain A antigens (MICA) antibodies was significantly associated with a reduced platelet recovery after transplantation (p<0.05). AHA of class II with the strength of antibody titer measured as the mean fluorescence intensity above 2000 was associated with reduced event-free survival (p<0.05). A reduction of high titer of AHA and anti-MICA antibodies might have to be considered before cord blood transplantation in pediatric patients for better outcomes.
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Affiliation(s)
- Marc Ansari
- Onco-Hematology Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland
- CANSEARCH Research Center, Geneva Medical University, Geneva, Switzerland
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, Canada
| | - Chakradhara Rao S. Uppugunduri
- Onco-Hematology Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland
- CANSEARCH Research Center, Geneva Medical University, Geneva, Switzerland
| | - Sylvie Ferrari-Lacraz
- Transplantation Immunology Unit and Swiss National Laboratory for Histocompatibility, Division of Immunology and Allergy, Division of Laboratory Medicine, Geneva University Hospital and Medical School, Switzerland
| | - Henrique Bittencourt
- Oncology and Hematology Unit, Department of Pediatrics, CHU Ste Justine, Montreal, Canada
| | - Fabienne Gumy-Pause
- Onco-Hematology Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland
- CANSEARCH Research Center, Geneva Medical University, Geneva, Switzerland
| | - Yves Chalandon
- Onco-Hematology Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland
| | - Jean-Marie Tiercy
- Transplantation Immunology Unit and Swiss National Laboratory for Histocompatibility, Division of Immunology and Allergy, Division of Laboratory Medicine, Geneva University Hospital and Medical School, Switzerland
| | - Tal Schechter
- Canada Department of Pharmacy, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Adam Gassas
- Canada Department of Pharmacy, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - John D. Doyle
- Canada Department of Pharmacy, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lee Dupuis
- Canada Department of Pharmacy, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Michel Duval
- Oncology and Hematology Unit, Department of Pediatrics, CHU Ste Justine, Montreal, Canada
| | - Maja Krajinovic
- Charles-Bruneau Cancer Center, CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Jean Villard
- Transplantation Immunology Unit and Swiss National Laboratory for Histocompatibility, Division of Immunology and Allergy, Division of Laboratory Medicine, Geneva University Hospital and Medical School, Switzerland
- * E-mail:
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Neither pre-transplant rituximab nor splenectomy affects de novo HLA antibody production after renal transplantation. Kidney Int 2013; 85:425-30. [PMID: 23945498 DOI: 10.1038/ki.2013.291] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/01/2013] [Accepted: 06/06/2013] [Indexed: 02/07/2023]
Abstract
The long-term effect of rituximab and splenectomy on de novo HLA antibody production and chronic antibody-mediated rejection after renal transplantation is uncertain. In order to gain insight on this, we studied 92 ABO-incompatible and 228 ABO-identical/compatible consecutive renal transplant patients and determined their de novo HLA antibody production and graft outcome. Patients with pretransplant donor-specific antibodies had been excluded. ABO-incompatible transplants included 30 recipients treated with rituximab, 51 by splenectomy, or 11 with neither, due to low anti-A or -B antibody titer. Graft survival in ABO-identical/compatible patients (97.7% at 5 years) was significantly higher than in ABO-incompatible (87.0% at 5 years), rituximab (96.7% at 3 years), or splenectomy (85.7% at 5 years) patients. Only four patients had clinical chronic antibody-mediated rejection (two each identical/compatible and incompatible). There was no significant difference in prevalence of de novo HLA antibody, including donor-specific and nondonor-specific antibodies among ABO-identical/compatible patients (13.9%), patients receiving rituximab (14.3%) or splenectomy (13.2%), or among those receiving cyclosporine, tacrolimus, mycophenolate mofetil, mizoribine, and everolimus. Renal function remained stable in most recipients with de novo HLA antibody. Thus, neither pretransplant splenectomy nor rituximab treatment has an inhibitory effect on de novo HLA antibody production during medium-term follow-up. Further study on long-term effects is needed.
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Wu P, Jin J, Everly MJ, Lin C, Terasaki PI, Chen J. Impact of alloantibody strength in crossmatch negative DSA positive kidney transplantation. Clin Biochem 2013; 46:1389-93. [PMID: 23726814 DOI: 10.1016/j.clinbiochem.2013.05.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The clinical relevance of pre-transplant "low-level" donor specific anti-HLA antibodies (DSAs) in crossmatch negative kidney transplant recipients remains unclear. To determine what level of DSA associates with antibody mediated rejection (AMR) could be the way to measure the clinical relevance of pre-transplant "low-level" donor specific anti-HLA antibodies (DSAs) in crossmatch negative kidney transplant recipients. DESIGN AND METHODS A retrospective analysis of 221 patients from October 2008 to December 2009 was included in this study. Sera were obtained pre-transplant and two weeks post-transplant and tested for DSA using LABScreen single antigen beads. RESULTS Among the 221 patients, 11 experienced AMR within 200days after transplant (5%). Pre-transplant DSA was associated with AMR at multiple mean fluorescence intensity (MFI) cutoffs (500, 1000, 2000, 3000, 5000; p=0.003, 0.001, 0.007, 0.003, and 0.003, respectively). No correlation was seen between acute T-cell mediated rejection (CMR) and pre-transplant DSA at any of the same MFI cutoffs. There was an increased risk of AMR with higher levels of pre-transplant DSA. Finally, an increase in DSA MFI from pre- to two weeks post-transplant was indicative of a higher probability of AMR. CONCLUSION Overall, this data supports using the single antigen bead to detect "low-level" DSA both pre- and post- as having a positive and persistent DSA may be predictive of higher AMR rates and poorer graft survival.
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Affiliation(s)
- Pingping Wu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China; Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of the People's Republic of China, PR China; Key Laboratory of Zhejiang Province, PR China
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29
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Predicting operational tolerance in pediatric living-donor liver transplantation by absence of HLA antibodies. Transplantation 2013; 95:177-83. [PMID: 23232368 DOI: 10.1097/tp.0b013e3182782fef] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of anti-human leukocyte antigen (HLA) antibodies in operational tolerance (OT) after pediatric living-donor liver transplantation (LDLT) remains inconclusive. We investigated whether the presence of HLA antibodies impeded the development of OT. METHODS We retrospectively examined the prevalence of anti-HLA antibodies in pediatric LDLT recipients before transplantation and at 3 weeks after transplantation and analyzed the significance of those antibodies in relation to later OT. Forty pediatric LDLTs were performed between April 1996 and December 2000 and followed up through July 2011, with sera available for measurement of HLA antibodies. Seventeen patients achieved OT (mean follow-up, 4571.9±544.7 days) and 23 patients did not achieve OT (mean follow-up, 4532.0±425.4 days). Protocol liver biopsy was done for 14 OT patients and 16 non-OT patients. Their sera were tested for anti-HLA class I and II antibodies using the LABScreen single antigen beads test, in which a 1000 mean fluorescence value was considered positive. RESULTS The prevalence of antibodies after transplantation in non-OT patients was higher than in OT patients (95.2% vs. 73.3%; P<0.001). The highest mean fluorescence intensity of antibodies was significantly higher in non-OT patients than in OT patients. The prevalence of HLA-B, HLA-C, HLA-DQ, and HLA-DR antibodies was significantly higher in non-OT patients than in OT patients. The highest mean fluorescence intensity of HLA-A, HLA-B, and HLA-DQ observed in non-OT patients was significantly higher than those in OT patients. CONCLUSIONS In our study, posttransplantation HLA antibodies were associated with the future absence of OT. A prospective study with more patients is necessary to confirm the predictive value of HLA antibodies for OT.
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Ginevri F, Nocera A, Comoli P, Innocente A, Cioni M, Parodi A, Fontana I, Magnasco A, Nocco A, Tagliamacco A, Sementa A, Ceriolo P, Ghio L, Zecca M, Cardillo M, Garibotto G, Ghiggeri GM, Poli F. Posttransplant de novo donor-specific hla antibodies identify pediatric kidney recipients at risk for late antibody-mediated rejection. Am J Transplant 2012; 12:3355-62. [PMID: 22959074 DOI: 10.1111/j.1600-6143.2012.04251.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The emerging role of humoral immunity in the pathogenesis of chronic allograft damage has prompted research aimed at assessing the role of anti-HLA antibody (Ab) monitoring as a tool to predict allograft outcome. Data on the natural history of allografts in children developing de novo Ab after transplantation are limited. Utilizing sera collected pretransplant, and serially posttransplant, we retrospectively evaluated 82 consecutive primary pediatric kidney recipients, without pretransplant donor-specific antibodies (DSA), for de novo Ab occurrence, and compared results with clinical-pathologic data. At 4.3-year follow up, 19 patients (23%) developed de novo DSA whereas 24 had de novo non-DSA (NDSA, 29%). DSA appeared at a median time of 24 months after transplantation and were mostly directed to HLA-DQ antigens. Among the 82 patients, eight developed late/chronic active C4d+ antibody-mediated rejection (AMR), and four C4d-negative AMR. Late AMR correlated with DSA (p < 0.01), whose development preceded AMR by 1-year median time. Patients with DSA had a median serum creatinine of 1.44 mg/dL at follow up, significantly higher than NDSA and Ab-negative patients (p < 0.005). In our pediatric cohort, DSA identify patients at risk of renal dysfunction, AMR and graft loss; treatment started at Ab emergence might prevent AMR occurrence and/or progression to graft failure.
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Affiliation(s)
- F Ginevri
- Pediatric Nephrology, Istituto G. Gaslini, Genova, Italy.
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Porcheray F, DeVito J, Helou Y, Dargon I, Fraser JW, Nobecourt P, Ferdman J, Germana S, Girouard TC, Kawai T, Saidman SL, Wong W, Colvin RB, Leguern C, Zorn E. Expansion of polyreactive B cells cross-reactive to HLA and self in the blood of a patient with kidney graft rejection. Am J Transplant 2012; 12:2088-97. [PMID: 22510337 PMCID: PMC3402627 DOI: 10.1111/j.1600-6143.2012.04053.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Antibody rejection is often accompanied by nondonor HLA specific antibodies (NDSA) and self-reactive antibodies that develop alongside donor-specific antibodies (DSA). To determine the source of these antibodies, we immortalized 107 B-cell clones from a kidney transplant recipient with humoral rejection. Two of these clones reacted to HLA class I or MICA. Both clones were also reactive to self-antigens and a lysate of a kidney cell line, hence revealing a pattern of polyreactivity. Monoclonality was verified by the identification of a single rearranged immunoglobulin heavy chain variable region (VH) sequence for each clone. By tracking their unique CDR3 sequence, we found that one such polyreactive clone was highly expanded in the patient blood, representing ~0.2% of circulating B cells. The VH sequence of this clone showed evidence of somatic mutations that were consistent with its memory phenotype and its expansion. Lastly, the reactivity of the expanded polyreactive B-cell clone was found in the patient serum at time of rejection. In conclusion, we provide here proof of principle at the clonal level that human antibodies can cross-react to HLA and self. Our findings strongly suggest that polyreactive antibodies contribute to DSA, NDSA as well as autoantibodies, in transplant recipients.
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Affiliation(s)
- Fabrice Porcheray
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Julie DeVito
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Ynes Helou
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Ian Dargon
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - James W. Fraser
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Priscilla Nobecourt
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Jack Ferdman
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Sharon Germana
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Timothy C. Girouard
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Tatsuo Kawai
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Susan L. Saidman
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Waichi Wong
- Renal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Robert B. Colvin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Christian Leguern
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Emmanuel Zorn
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
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Hopkins RA, Bert AA, Hilbert SL, Quinn RW, Brasky KM, Drake WB, Lofland GK. Bioengineered human and allogeneic pulmonary valve conduits chronically implanted orthotopically in baboons: hemodynamic performance and immunologic consequences. J Thorac Cardiovasc Surg 2012; 145:1098-1107.e3. [PMID: 22841171 DOI: 10.1016/j.jtcvs.2012.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/10/2012] [Accepted: 06/12/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study assesses in a baboon model the hemodynamics and human leukocyte antigen immunogenicity of chronically implanted bioengineered (decellularized with collagen conditioning treatments) human and baboon heart valve scaffolds. METHODS Fourteen baboons underwent pulmonary valve replacement, 8 with decellularized and conditioned (bioengineered) pulmonary valves derived from allogeneic (N = 3) or xenogeneic (human) (N = 5) hearts; for comparison, 6 baboons received clinically relevant reference cryopreserved or porcine valved conduits. Panel-reactive serum antibodies (human leukocyte antigen class I and II), complement fixing antibodies (C1q binding), and C-reactive protein titers were measured serially until elective sacrifice at 10 or 26 weeks. Serial transesophageal echocardiograms measured valve function and geometry. Differences were analyzed with Kruskal-Wallis and Wilcoxon rank-sum tests. RESULTS All animals survived and thrived, exhibiting excellent immediate implanted valve function by transesophageal echocardiograms. Over time, reference valves developed a smaller effective orifice area index (median, 0.84 cm(2)/m(2); range, 1.22 cm(2)/m(2)), whereas all bioengineered valves remained normal (effective orifice area index median, 2.45 cm(2)/m(2); range, 1.35 cm(2)/m(2); P = .005). None of the bioengineered valves developed elevated peak transvalvular gradients: 5.5 (6.0) mm Hg versus 12.5 (23.0) mm Hg (P = .003). Cryopreserved valves provoked the most intense antibody responses. Two of 5 human bioengineered and 2 of 3 baboon bioengineered valves did not provoke any class I antibodies. Bioengineered human (but not baboon) scaffolds provoked class II antibodies. C1q(+) antibodies developed in 4 recipients. CONCLUSIONS Valve dysfunction correlated with markers for more intense inflammatory provocation. The tested bioengineering methods reduced antigenicity of both human and baboon valves. Bioengineered replacement valves from both species were hemodynamically equivalent to native valves.
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Affiliation(s)
- Richard A Hopkins
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo.
| | - Arthur A Bert
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo; Department of Surgery (Division of Cardiac Anesthesiology), Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Stephen L Hilbert
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo
| | - Rachael W Quinn
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo
| | - Kathleen M Brasky
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Tex
| | - William B Drake
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo
| | - Gary K Lofland
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo
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Montgomery RA, Zachary AA. All for one and one for all—alloimmunization and polyreactivity. Nat Rev Nephrol 2012; 8:442-3. [DOI: 10.1038/nrneph.2012.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Shimizu T, Tanabe T, Shirakawa H, Omoto K, Ishida H, Tanabe K. Clinical and pathological analysis of transplant glomerulopathy cases. Clin Transplant 2012; 26 Suppl 24:37-42. [DOI: 10.1111/j.1399-0012.2012.01639.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tomokazu Shimizu
- Department of Urology; Tokyo Women's Medical University; Tokyo; Japan
| | - Tatsu Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo; Japan
| | - Hiroki Shirakawa
- Department of Urology; Tokyo Women's Medical University; Tokyo; Japan
| | - Kazuya Omoto
- Department of Urology; Tokyo Women's Medical University; Tokyo; Japan
| | - Hideki Ishida
- Department of Urology; Tokyo Women's Medical University; Tokyo; Japan
| | - Kazunari Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo; Japan
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Li Z, Luo M, Qiu J, Liu Y, Fan Y, Jahr FM, Cai J, Terasaki PI. Detection of Antibodies Against Major Histocompatibility Complex Class I-Related Chain A in Long-term Renal Graft Recipients. EXP CLIN TRANSPLANT 2012; 10:239-42. [DOI: 10.6002/ect.2011.0103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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36
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Yoshihara S, Taniguchi K, Ogawa H, Saji H. The role of HLA antibodies in allogeneic SCT: is the 'type-and-screen' strategy necessary not only for blood type but also for HLA? Bone Marrow Transplant 2012; 47:1499-506. [PMID: 22231464 DOI: 10.1038/bmt.2011.249] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of HLA antibodies in SCT has drawn increasing attention because of the significantly increased number of patients who receive HLA-mismatched SCT, including cord blood transplantation, haploidentical SCT and unrelated SCT. Technical advancements in the methods of HLA Ab testing have realized rapid, accurate and objective identification, as well as quantification of specific HLA antibodies. Recent clinical studies have suggested that the presence of donor-specific HLA antibodies (DSA) in patients is associated with graft failure in HLA-mismatched SCT when the above-listed stem cell sources are used and results in different impacts. Of note, most of the 'HLA-matched' unrelated SCT actually involve HLA mismatches in HLA-DP and the presence of antibodies against this locus has been reported to be associated with graft failure. Thus, HLA Ab should be examined as a work-up for all patients who undergo SCT from 'alternative donors.' The simplest route for preventing HLA Ab-mediated graft failure in Ab-positive patients is to avoid donors who possess the target Ag of HLA antibodies. If SCT from such donors must be performed, treatment for DSA before SCT may improve the chances of successful donor engraftment.
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Affiliation(s)
- S Yoshihara
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
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37
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Ntokou ISA, Iniotaki AG, Kontou EN, Darema MN, Apostolaki MD, Kostakis AG, Boletis JN. Long-term follow up for anti-HLA donor specific antibodies postrenal transplantation: high immunogenicity of HLA class II graft molecules. Transpl Int 2011; 24:1084-93. [PMID: 21848902 DOI: 10.1111/j.1432-2277.2011.01312.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Τhe clinical significance of de novo post-transplant anti-HLA donor-specific antibodies (DSA) was evaluated using 4241 serum samples collected between 2000 and 2007 from 597 renal transplant recipients. Patients transplanted before December 1996 (n = 77) were included in the historic group and those transplanted thereafter (n = 520) were included in the study group. All recipients were negative for DSA before transplantation (Tx). Post-Tx, de novo DSA were detected in 92/597 (15.4%) patients, while 196 had third party anti-HLA antibodies (DSA-negative). DSA were more frequent in the historic group (33.8%) compared with the study group (12.7%) (P < 0.001). Anti-HLA class-II DSA predominated in both groups (84.6% vs. 69.7%). Recipients of HLA class II-incompatible grafts developed DSA more frequently than those receiving HLA class II-compatible grafts (17.9% vs.7.9%, P = 0.003), directed mainly against HLA-DQ graft molecules (64/446, 14.4%). DSA production was not different between presensitized and nonsensitized patients (P = 0.842). Graft survival was higher in patients without antibodies compared with DSA-positive (log-rank test, P = 0.002) and DSA-negative patients (log-rank test, P = 0.002). Univariate and multivariate analysis showed independent association for DSA class I (HR = 31.78), DSA class II (HR = 20.92) and non-DSA (HR = 5.94) and graft failure. We conclude that HLA class II incompatible graft transplantations need careful monitoring and should be avoided in high immunological risk cases.
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Affiliation(s)
- Irma-Sofia A Ntokou
- National Tissue Typing Center, General State Hospital of Athens, Athens, Greece.
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Duquesnoy RJ. Antibody-reactive epitope determination with HLAMatchmaker and its clinical applications. ACTA ACUST UNITED AC 2011; 77:525-34. [PMID: 21410655 DOI: 10.1111/j.1399-0039.2011.01646.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Antibodies against allogeneic human leukocyte antigen (HLA) molecules are important impediments to the success of different clinical procedures including transplantation and platelet transfusion. In these settings, characterization of the repertoire of immunogenic epitopes is important for permissible mismatch determination and the identification of acceptable mismatches for sensitized patients. HLAMatchmaker is a computer algorithm that considers small configurations of polymorphic residues referred to as eplets as essential components of HLA epitopes. This review critically elaborates the concepts underlying the HLAMatchmaker and describes the usefulness of HLAMatchmaker in the clinical setting. Recent developments have increased our understanding of structural basis of HLA antigenicity (i.e. reactivity with specific antibody) and immunogenicity (i.e. its ability to induce an antibody response).
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Affiliation(s)
- R J Duquesnoy
- Division of Transplantation Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Ishida H, Hirai T, Kohei N, Yamaguchi Y, Tanabe K. Significance of qualitative and quantitative evaluations of anti-HLA antibodies in kidney transplantation. Transpl Int 2010; 24:150-7. [DOI: 10.1111/j.1432-2277.2010.01166.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Virtual crossmatch by identification of donor-specific anti-human leukocyte antigen antibodies by solid-phase immunoassay: a 30-month analysis in living donor kidney transplantation. Hum Immunol 2010; 71:268-73. [PMID: 20074605 DOI: 10.1016/j.humimm.2010.01.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/18/2009] [Accepted: 01/06/2010] [Indexed: 01/08/2023]
Abstract
Selection of donors for kidney transplantation depends on accurate prediction of risk factors for immunologic rejection. Historically, cytotoxicity crossmatch (CXM) examining lysis of donor cells by preformed anti-human leukocyte antigen (HLA) antibodies (Abs) has been considered the best predictor of immunologic rejection. However, there is much interest in defining anti-HLA Ab specificity in recipient sera by immunoassay to predict crossmatch results and aid in donor selection. Current immunoassays for anti-HLA Abs are highly sensitive, though correlation between Abs detected by immunoassay and their functional relevance in CXM and subsequent transplantation is not well defined. In this study, we retrospectively examined the predictive value of detection of donor-specific anti-HLA Abs (DSA) by Luminex Single Antigen assay from 149 consecutive living donor kidney transplant recipients. We demonstrate that detection of DSA by immunoassay accurately predicted negative crossmatch and graft survival. However, this approach had limited sensitivity for predicting positive crossmatch, attributable to either limited typing of donor HLA-DQ and -DP alleles or due to non-HLA Abs. False-positive prediction of CXM correlated with detection of "weak" Abs with low mean fluorescence intensity (MFI < 2000). Furthermore, we found that a ratio of the MFI of the DSA bead to the MFI of the positive control bead was a better method for identifying weak DSA that did not result in CXM-positive reactions. Interestingly, patients with weak DSA and negative CXM had equivalent graft survival over an 18 month follow-up period, suggesting that weak DSA may not preclude transplantation.
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Haririan A, Kiangkitiwan B, Kukuruga D, Cooper M, Hurley H, Drachenberg C, Klassen D. The impact of c4d pattern and donor-specific antibody on graft survival in recipients requiring indication renal allograft biopsy. Am J Transplant 2009; 9:2758-67. [PMID: 19845596 DOI: 10.1111/j.1600-6143.2009.02836.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We examined the pattern of PTC C4d by immunohistochemistry and DSA in 297 kidney recipients with indication biopsies, and evaluated their predictive value for graft survival. Median biopsy time was 5.1 months posttransplant. Patients were followed for 17.9 +/- 9.4 months postbiopsy. An 18.5% had focal and 15.2% had diffuse C4d, with comparable graft survival (adjusted graft failure HR: 2.3, p = 0.001; HR:1.9, p < 0.02, respectively). 31.3% were DSA+, 19.5% class I and 22.9% class II DSA. Only those with class II DSA had worse outcome (adjusted HR:2.5, p = 0.001 for class II only; HR:2.7, p < 0.001 for class I/II DSA). Among patients with <10%C4d, 23.9% had DSA, compared to 68.9% with diffuse staining. For patients biopsied in first-year posttransplant presence of DSA, regardless of C4d positivity in biopsy, was a poor prognostic factor (adjusted graft failure HR: 4.2, p < 0.02 for C4d-/DSA+; HR:4.9, p = 0.001 for C4d+/DSA+), unlike those biopsied later. We have shown that focal C4d had similar impact on graft survival as diffuse pattern. During the first-year posttransplant either class I or II DSA, and afterward only class II DSA were associated with worse graft survival. DSA was predictive of worse outcome regardless of C4d for patients biopsied in first year and only with C4d positivity afterward, supporting the importance of assessment of both DSA and C4d pattern in biopsy.
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Affiliation(s)
- A Haririan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Shimizu T, Ishida H, Shirakawa H, Omoto K, Tsunoyama K, Iida S, Tanabe K, Yamaguchi Y. Clinicopathological analysis of transplant glomerulopathy cases. Clin Transplant 2009; 23 Suppl 20:39-43. [DOI: 10.1111/j.1399-0012.2009.01008.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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HLAMatchmaker-based definition of structural human leukocyte antigen epitopes detected by alloantibodies. Curr Opin Organ Transplant 2009; 14:403-9. [DOI: 10.1097/mot.0b013e32832ca2b8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anti-human leukocyte antigen and donor-specific antibodies detected by luminex posttransplant serve as biomarkers for chronic rejection of renal allografts. Transplantation 2009; 87:1505-13. [PMID: 19461487 DOI: 10.1097/tp.0b013e3181a44206] [Citation(s) in RCA: 290] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the incidence of early acute rejection could have been diminished in the past, the long-term renal allograft survival could not benefit from the introduction of more effective immunosuppressive regimens mainly aiming at cellular rejection mechanisms. The cause of chronic rejection is still discussed controversially. Here, we demonstrate to what extent human leukocyte antigen (HLA) antibodies (HLAab) posttransplant contribute to late graft outcome. METHODS A total of 1014 deceased kidney transplant recipients transplanted at the Charité hospital were monitored in a cross-sectional manner for the development of HLAab using Luminex Single Antigen beads. Patients with stable kidney function at a median of 5-years posttransplant were tested once for HLAab and monitored for 5.5 years after testing. RESULTS Thirty percent of recipients showed HLAab. Donor-specific antibodies (DSA) were found in 31% of antibody positive patients. The presence of DSA was associated with a significantly lower graft survival of 49% vs. 83% in the HLAab negative group (P< or =0.0001). Non-DSAs also had an adverse effect on graft survival (70% vs. 83%; P=0.0001). In a prospective analysis of 195 patients with repeatedly no detectable HLAab, the survival probability was 94% as opposed to 79% survival among patients who developed HLAab de novo after the first testing (P=0.05). CONCLUSIONS We confirmed that HLAab produced even late after transplantation are detrimental to graft outcome. DSA were proven to have a strong adverse impact on graft survival. The results indicate that a posttransplant HLAab monitoring routine could be appropriate to improve long-term results.
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Marrari M, Duquesnoy RJ. Correlations between Terasaki's HLA class II epitopes and HLAMatchmaker-defined eplets on HLA-DR and -DQ antigens. ACTA ACUST UNITED AC 2009; 74:134-46. [PMID: 19497040 DOI: 10.1111/j.1399-0039.2009.01272.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Human leukocyte antigen (HLA) class II-specific antibodies increase the risk of transplant failure, and their characterization must consider epitopes rather than antigens. There are two strategies to determine HLA epitope structure. Terasaki's group has analyzed antibody reactivity patterns with single antigen panels with a computer program based on shared amino acid residues of reactive alleles. HLAMatchmaker is a theoretical algorithm that predicts HLA epitopes on the HLA molecular surface from stereochemical modeling of epitope-paratope interfaces of antigen-antibody complexes. Our epitope repertoire is based on so-called 'eplets' representing 3-A patches of at least one polymorphic residue on the molecular surface. This report describes how 49 of 53 Terasaki's HLA-DR epitopes correspond to HLAMatchmaker-defined eplets. Most of them are equivalent to single eplets (n = 33) or two or more possible eplets (n = 10), but six had corresponding eplet pairs. There were 10 cases whereby eplets have permissible residue combinations, and in 5 cases, we found that eplet specificity might be influenced by nearby hidden residues. We could assign corresponding eplets to 17 of 18 Terasaki's HLA-DQ epitopes. This study demonstrates how the HLAMatchmaker interpretation of amino acid residues shared between antibody-reactive antigens can increase our understanding of the structural basis of HLA epitopes.
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Affiliation(s)
- M Marrari
- Division of Transplantation Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
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Duquesnoy RJ, Marrari M. Correlations between Terasaki's HLA class I epitopes and HLAMatchmaker-defined eplets on HLA-A, -B and -C antigens. ACTA ACUST UNITED AC 2009; 74:117-33. [PMID: 19497041 DOI: 10.1111/j.1399-0039.2009.01271.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although the determination of human leukocyte antigen (HLA) antibody specificity has traditionally been directed toward HLA antigens, there is now increasing attention to structurally defined HLA epitopes. An understanding of the HLA epitope repertoire is important to acceptable mismatching for sensitized patients and to a new epitope-based matching algorithm aimed to reduce antibody-mediated rejection. There are two strategies to determine the HLA epitope repertoire. Terasaki's group has used an empirical method to analyze the reactivity of single allele Luminex panels with mouse monoclonal antibodies (mAbs) and absorbed/eluted alloantibodies with a computer program based on shared residues in the amino acid sequences of reactive alleles. HLAMatchmaker is a theoretical algorithm that predicts HLA epitopes on the HLA molecular surface from stereochemical modeling of epitope-paratope interfaces of antigen-antibody complexes. Our epitope repertoire is based on so-called 'eplets' representing 3-A patches of at least one polymorphic residue on the molecular surface. A comparative analysis has shown that 81/103 Terasaki's HLA class I epitopes are equivalent to individual eplets (n = 50) or pairs of eplets (n = 31) separated far enough to serve as potential contact sites for two complementarity-determining regions of antibody. An additional 12 Terasaki's epitopes (TerEps) correspond to eplets with permissible residue combinations that do not seem to affect epitope specificity. We could not identify corresponding eplets for the remaining 10 TerEps, including 8 that might be considered xeno-epitopes defined by mouse mAbs. Conversely, HLAMatchmaker has 38 additional eplets in well-exposed surface positions that do not have equivalent TerEps, and for many of them, we have found specific antibodies. These findings strengthen the concept that eplets are essential basic units of HLA epitopes and that they provide a better understanding of HLA immunogenicity (i.e. ability to induce an antibody response) and antigenicity (i.e. reactivity with specific antibody).
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Affiliation(s)
- R J Duquesnoy
- Division of Transplantation Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
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Proust B, Kennel A, Ladrière M, Kessler M, Perrier P. Unexpected anti-HLA-DR and -DQ alloantibodies after nephrectomy of an HLA-DR and -DQ identical first renal transplant. Transpl Immunol 2009; 21:166-8. [PMID: 19341797 DOI: 10.1016/j.trim.2009.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 03/20/2009] [Accepted: 03/24/2009] [Indexed: 11/30/2022]
Abstract
The development of the single antigen beads assay by Luminex technology enables accurate identification of allele-specific antibodies. Herein, we report the identification of donor-specific HLA-DR and -DQ antibodies in a first kidney transplant recipient who received a DR and DQ identical kidney transplant. The recipient was a non-sensitized, non-transfused male patient suffering from an end-stage renal failure due to focal and segmental glomerulosclerosis. Two weeks after graft nephrectomy, anti-class I (donor-specific and non-donor specific) and class II antibodies were detected. The single antigen beads technique identified class II antibodies directed against DRB3*0202 and HLA-DQB1*0603 alleles. High-resolution class II typing revealed five allelic incompatibilities between donor and recipient. Amino-acid sequence alignment showed why this post-transplant highly immunized patient developed only these two allele-specific antibodies. Minimizing HLA mismatches between donor and recipient is important, but it is also useful to consider the combination of all HLA molecules present in the donor and recipient in order to define the antibody epitopes responsible for alloantibody responses.
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Affiliation(s)
- Barbara Proust
- Histocompatibility Laboratory, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
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Transplant glomerulopathy: risk and prognosis related to anti-human leukocyte antigen class II antibody levels. Transplantation 2008; 86:681-5. [PMID: 18791449 DOI: 10.1097/tp.0b013e3181837626] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Transplant glomerulopathy (TG) is a histopathologic entity of kidney allografts related to anti-human leukocyte antigen (HLA) antibodies. The goal of this study was to determine the relationships among antibody characteristics (level and specificity), risk for TG, and graft survival. METHODS The presence and characteristics of anti-HLA antibody were assessed by single antigen beads assays in stored pretransplant sera from 598 kidney recipients with negative T-cell crossmatch. Transplant glomerulopathy was diagnosed by surveillance and clinical biopsies. RESULTS Thirty-nine percent of patients presented with anti-HLA antibodies pretransplant. Transplant glomerulopathy was diagnosed in 73 patients (12%) during 54+/-19 months of follow-up. The risk of TG increased with higher anti-HLA-II antibody levels (HR=1.890, 95% CI 1.42-2.52; P<0.0001), donor specificity of the antibodies (3.524 [1.67-7.44]; P=0.001), and in patients with history of antibody-mediated rejection (4.985 [2.77-8.97]; P<0.0001, multivariate Cox). Graft survival during the follow-up period was 95% without TG and 62% with TG (P<0.0001). The presence of C4d in peritubular capillaries was an independent risk factor for graft failure after TG diagnosis. Thus, 25% of TG/C4d and 80% of TG/C4d+ grafts failed (P<0.0001). Of interest, higher anti-HLA-II levels were related to the presence of C4d (3.216 [1.376-7.517]; P=0.007). CONCLUSIONS In T-cell negative crossmatch patients, higher anti-HLA-II antibody levels are related to the increase in the risk of developing TG. Higher antibody levels are also related to the presence of C4d in peritubular capillaries in TG biopsies. Furthermore, the presence of C4d in TG is related to the reduced graft survival.
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Duquesnoy RJ. Clinical usefulness of HLAMatchmaker in HLA epitope matching for organ transplantation. Curr Opin Immunol 2008; 20:594-601. [DOI: 10.1016/j.coi.2008.06.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 06/26/2008] [Indexed: 11/26/2022]
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Cai J, Terasaki PI. Post-transplantation antibody monitoring and HLA antibody epitope identification. Curr Opin Immunol 2008; 20:602-6. [DOI: 10.1016/j.coi.2008.07.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/08/2008] [Accepted: 07/09/2008] [Indexed: 02/06/2023]
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