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El Fekih R, Hurley J, Tadigotla V, Alghamdi A, Srivastava A, Coticchia C, Choi J, Allos H, Yatim K, Alhaddad J, Eskandari S, Chu P, Mihali AB, Lape IT, Lima Filho MP, Aoyama BT, Chandraker A, Safa K, Markmann JF, Riella LV, Formica RN, Skog J, Azzi JR. Discovery and Validation of a Urinary Exosome mRNA Signature for the Diagnosis of Human Kidney Transplant Rejection. J Am Soc Nephrol 2021; 32:994-1004. [PMID: 33658284 PMCID: PMC8017553 DOI: 10.1681/asn.2020060850] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/26/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Developing a noninvasive clinical test to accurately diagnose kidney allograft rejection is critical to improve allograft outcomes. Urinary exosomes, tiny vesicles released into the urine that carry parent cells' proteins and nucleic acids, reflect the biologic function of the parent cells within the kidney, including immune cells. Their stability in urine makes them a potentially powerful tool for liquid biopsy and a noninvasive diagnostic biomarker for kidney-transplant rejection. METHODS Using 192 of 220 urine samples with matched biopsy samples from 175 patients who underwent a clinically indicated kidney-transplant biopsy, we isolated urinary exosomal mRNAs and developed rejection signatures on the basis of differential gene expression. We used crossvalidation to assess the performance of the signatures on multiple data subsets. RESULTS An exosomal mRNA signature discriminated between biopsy samples from patients with all-cause rejection and those with no rejection, yielding an area under the curve (AUC) of 0.93 (95% CI, 0.87 to 0.98), which is significantly better than the current standard of care (increase in eGFR AUC of 0.57; 95% CI, 0.49 to 0.65). The exosome-based signature's negative predictive value was 93.3% and its positive predictive value was 86.2%. Using the same approach, we identified an additional gene signature that discriminated patients with T cell-mediated rejection from those with antibody-mediated rejection (with an AUC of 0.87; 95% CI, 0.76 to 0.97). This signature's negative predictive value was 90.6% and its positive predictive value was 77.8%. CONCLUSIONS Our findings show that mRNA signatures derived from urinary exosomes represent a powerful and noninvasive tool to screen for kidney allograft rejection. This finding has the potential to assist clinicians in therapeutic decision making.
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Affiliation(s)
- Rania El Fekih
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Hurley
- Exosome Diagnostics, a Bio-Techne brand, Waltham, Massachusetts
| | | | - Areej Alghamdi
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand Srivastava
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - John Choi
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hazim Allos
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karim Yatim
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Juliano Alhaddad
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Siawosh Eskandari
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philip Chu
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Albana B. Mihali
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Isadora T. Lape
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mauricio P. Lima Filho
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bruno T. Aoyama
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anil Chandraker
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kassem Safa
- Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James F. Markmann
- Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leonardo V. Riella
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Johan Skog
- Exosome Diagnostics, a Bio-Techne brand, Waltham, Massachusetts
| | - Jamil R. Azzi
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Sula Karreci E, Eskandari SK, Dotiwala F, Routray SK, Kurdi AT, Assaker JP, Luckyanchykov P, Mihali AB, Maarouf O, Borges TJ, Alkhudhayri A, Patel KR, Radwan A, Ghobrial I, McGrath M, Chandraker A, Riella LV, Elyaman W, Abdi R, Lieberman J, Azzi J. Human regulatory T cells undergo self-inflicted damage via granzyme pathways upon activation. JCI Insight 2017; 2:91599. [PMID: 29093262 DOI: 10.1172/jci.insight.91599] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 09/25/2017] [Indexed: 12/13/2022] Open
Abstract
Tregs hold great promise as a cellular therapy for multiple immunologically mediated diseases, given their ability to control immune responses. The success of such strategies depends on the expansion of healthy, suppressive Tregs ex vivo and in vivo following the transfer. In clinical studies, levels of transferred Tregs decline sharply in the blood within a few days of the transfer. Tregs have a high rate of apoptosis. Here, we describe a new mechanism of Treg self-inflicted damage. We show that granzymes A and -B (GrA and GrB), which are highly upregulated in human Tregs upon stimulation, leak out of cytotoxic granules to induce cleavage of cytoplasmic and nuclear substrates, precipitating apoptosis in target cells. GrA and GrB substrates were protected from cleavage by inhibiting granzyme activity in vitro. Additionally, we show - by using cytometry by time of flight (CYTOF) - an increase in GrB-expressing Tregs in the peripheral blood and renal allografts of transplant recipients undergoing rejection. These GrB-expressing Tregs showed an activated phenotype but were significantly more apoptotic than non-GrB expressing Tregs. This potentially novel finding improves our understanding of Treg survival and suggests that manipulating Gr expression or activity might be useful for designing more effective Treg therapies.
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Affiliation(s)
- Esilida Sula Karreci
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Siawosh K Eskandari
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Farokh Dotiwala
- Program in Cellular and Molecular Medicine, Boston Children's Hospital
| | - Sujit K Routray
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Ahmed T Kurdi
- Department of Medical Oncology, Dana-Farber Cancer Institute, and
| | - Jean Pierre Assaker
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Pavlo Luckyanchykov
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Albana B Mihali
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Omar Maarouf
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Thiago J Borges
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Abdullah Alkhudhayri
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Kruti R Patel
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA
| | - Amr Radwan
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Irene Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, and
| | - Martina McGrath
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Anil Chandraker
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Leonardo V Riella
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Wassim Elyaman
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA
| | - Reza Abdi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
| | - Judy Lieberman
- Program in Cellular and Molecular Medicine, Boston Children's Hospital
| | - Jamil Azzi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital
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