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Bansal S, Rahman M, Ravichandran R, Canez J, Fleming T, Mohanakumar T. Extracellular Vesicles in Transplantation: Friend or Foe. Transplantation 2024; 108:374-385. [PMID: 37482627 DOI: 10.1097/tp.0000000000004693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
The long-term function of transplanted organs, even under immunosuppression, is hindered by rejection, especially chronic rejection. Chronic rejection occurs more frequently after lung transplantation, termed chronic lung allograft dysfunction (CLAD), than after transplantation of other solid organs. Pulmonary infection is a known risk factor for CLAD, as transplanted lungs are constantly exposed to the external environment; however, the mechanisms by which respiratory infections lead to CLAD are poorly understood. The role of extracellular vesicles (EVs) in transplantation remains largely unknown. Current evidence suggests that EVs released from transplanted organs can serve as friend and foe. EVs carry not only major histocompatibility complex antigens but also tissue-restricted self-antigens and various transcription factors, costimulatory molecules, and microRNAs capable of regulating alloimmune responses. EVs play an important role in antigen presentation by direct, indirect, and semidirect pathways in which CD8 and CD4 cells can be activated. During viral infections, exosomes (small EVs <200 nm in diameter) can express viral antigens and regulate immune responses. Circulating exosomes may also be a viable biomarker for other diseases and rejection after organ transplantation. Bioengineering the surface of exosomes has been proposed as a tool for targeted delivery of drugs and personalized medicine. This review focuses on recent studies demonstrating the role of EVs with a focus on exosomes and their dual role (immune activation or tolerance induction) after organ transplantation, more specifically, lung transplantation.
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Affiliation(s)
- Sandhya Bansal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
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Joo S, Dhaygude K, Westerberg S, Krebs R, Puhka M, Holmström E, Syrjälä S, Nykänen AI, Lemström K. Transcriptomic Landscape of Circulating Extracellular Vesicles in Heart Transplant Ischemia-Reperfusion. Genes (Basel) 2023; 14:2101. [PMID: 38003044 PMCID: PMC10671425 DOI: 10.3390/genes14112101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
Ischemia-reperfusion injury (IRI) is an inevitable event during heart transplantation, which is known to exacerbate damage to the allograft. However, the precise mechanisms underlying IRI remain incompletely understood. Here, we profiled the whole transcriptome of plasma extracellular vesicles (EVs) by RNA sequencing from 41 heart transplant recipients immediately before and at 12 h after transplant reperfusion. We found that the expression of 1317 protein-coding genes in plasma EVs was changed at 12 h after reperfusion. Upregulated genes of plasma EVs were related to metabolism and immune activation, while downregulated genes were related to cell survival and extracellular matrix organization. In addition, we performed correlation analyses between EV transcriptome and intensity of graft IRI (i.e., cardiomyocyte injury), as well as EV transcriptome and primary graft dysfunction, as well as any biopsy-proven acute rejection after heart transplantation. We ultimately revealed that at 12 h after reperfusion, 4 plasma EV genes (ITPKA, DDIT4L, CD19, and CYP4A11) correlated with both cardiomyocyte injury and primary graft dysfunction, suggesting that EVs are sensitive indicators of reperfusion injury reflecting lipid metabolism-induced stress and imbalance in calcium homeostasis. In conclusion, we show that profiling plasma EV gene expression may enlighten the mechanisms of heart transplant IRI.
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Affiliation(s)
- SeoJeong Joo
- Translational Immunology Research Program, Transplantation Laboratory, University of Helsinki, 00014 Helsinki, Finland; (S.J.); (K.D.); (S.W.); (R.K.); (E.H.); (S.S.); (A.I.N.)
| | - Kishor Dhaygude
- Translational Immunology Research Program, Transplantation Laboratory, University of Helsinki, 00014 Helsinki, Finland; (S.J.); (K.D.); (S.W.); (R.K.); (E.H.); (S.S.); (A.I.N.)
| | - Sofie Westerberg
- Translational Immunology Research Program, Transplantation Laboratory, University of Helsinki, 00014 Helsinki, Finland; (S.J.); (K.D.); (S.W.); (R.K.); (E.H.); (S.S.); (A.I.N.)
| | - Rainer Krebs
- Translational Immunology Research Program, Transplantation Laboratory, University of Helsinki, 00014 Helsinki, Finland; (S.J.); (K.D.); (S.W.); (R.K.); (E.H.); (S.S.); (A.I.N.)
| | - Maija Puhka
- Institute for Molecular Medicine Finland FIMM, EV and HiPREP Core, University of Helsinki, 00014 Helsinki, Finland;
| | - Emil Holmström
- Translational Immunology Research Program, Transplantation Laboratory, University of Helsinki, 00014 Helsinki, Finland; (S.J.); (K.D.); (S.W.); (R.K.); (E.H.); (S.S.); (A.I.N.)
| | - Simo Syrjälä
- Translational Immunology Research Program, Transplantation Laboratory, University of Helsinki, 00014 Helsinki, Finland; (S.J.); (K.D.); (S.W.); (R.K.); (E.H.); (S.S.); (A.I.N.)
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | - Antti I. Nykänen
- Translational Immunology Research Program, Transplantation Laboratory, University of Helsinki, 00014 Helsinki, Finland; (S.J.); (K.D.); (S.W.); (R.K.); (E.H.); (S.S.); (A.I.N.)
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | - Karl Lemström
- Translational Immunology Research Program, Transplantation Laboratory, University of Helsinki, 00014 Helsinki, Finland; (S.J.); (K.D.); (S.W.); (R.K.); (E.H.); (S.S.); (A.I.N.)
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
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Halverson LP, Hachem RR. Antibody-Mediated Rejection: Diagnosis and Treatment. Clin Chest Med 2023; 44:95-103. [PMID: 36774172 PMCID: PMC10148231 DOI: 10.1016/j.ccm.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Antibody-mediated rejection (AMR) is a form of lung allograft rejection that is emerging as an important risk factor for chronic lung allograft dysfunction and decreased long-term survival. In this review, we provide a brief overview of our current understanding of its pathophysiology with an emphasis on donor-specific antibodies before moving on to focus on the current diagnostic criteria and treatment strategies. Our goal is to discuss the limitations of our current knowledge and explore how novel diagnostic and therapeutic options aim to improve outcomes through earlier definitive diagnosis and preemptive targeted treatment.
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Affiliation(s)
- Laura P Halverson
- Division of Pulmonary & Critical Care, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, Saint Louis, MO 63108, USA.
| | - Ramsey R Hachem
- Division of Pulmonary & Critical Care, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, Saint Louis, MO 63108, USA
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