1
|
Iglesias-Escudero M, San Segundo D, López-Hoyos M. CD4+ T cells proliferation assay to analyze Mo-MDSCs suppressive function. Methods Cell Biol 2023; 184:69-84. [PMID: 38555159 DOI: 10.1016/bs.mcb.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Among myeloid regulatory cells (MRCs), some particular subsets termed myeloid-derived suppressor cells (MDSCs) have been described. They are suppressor myeloid cells characterized by their ability to regulate innate and adaptive immune responses and known to accumulate in the context of chronic diseases and cancer. The lack of specific markers makes their classification difficult and requires functional studies to distinguish them from other myeloid cells. In this sense, the in vitro analysis of the proliferation of T lymphocytes cultured with MDSCs provides information about the regulatory function of these cells. Here, we provide a detailed protocol to assess the ability of human Mo-MDSCs to suppress T cell proliferation in vitro after obtaining Mo-MDSCs and CD4+T cell from peripheral blood.
Collapse
Affiliation(s)
| | - David San Segundo
- Transplant and Autoimmunity Group, Research Institute-IDIVAL, Santander, Spain; Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Transplant and Autoimmunity Group, Research Institute-IDIVAL, Santander, Spain; Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Molecular Biology Department, University of Cantabria, Santander, Spain.
| |
Collapse
|
2
|
González-López E, Mora-Cuesta VM, Roa-Bautista A, Comins-Boo A, Renaldo A, Irure-Ventura J, Iturbe-Fernández D, Tello-Mena S, San Segundo D, Cifrián-Martínez J, López-Hoyos M. DQA1 Eplet Mismatch Load As an Independent Risk Factor of CLAD After Lung Transplantation. Transplant Direct 2023; 9:e1513. [PMID: 37389015 PMCID: PMC10306436 DOI: 10.1097/txd.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023] Open
Abstract
Lung transplantation remains the treatment of choice for end-stage lung diseases, and recipient selection is currently based on clinical urgency, ABO compatibility, and donor size. The risk of allosensitization is classically based on HLA mismatch, but eplet mismatch load is increasingly seen to be important in long-term outcomes in solid organ transplantation. Chronic lung allograft dysfunction (CLAD) is relatively common and relevant, affecting almost 50% of patients 5 y after transplantation and being the first cause of death from the first year after transplantation. The overall class-II eplet mismatch load has been associated with CLAD development. Methods Based on clinical data, 240 lung transplant recipients were eligible for CLAD, and HLA and eplet mismatch was analyzed using the HLAMatchmaker 3.1 software. Results A total of 92 (38.3%) lung transplant recipients developed CLAD. The time free-of-CLAD was significantly decreased in patients with presence of DQA1 eplet mismatches (P = 0.015). Furthermore, when other previously described CLAD risk factors were studied in a multivariate analysis, the presence of DQA1 eplet mismatches was found to be independently associated with the early onset of CLAD. Conclusions The concept of epitope load has arisen as a new tool to better define donor-recipient immunologic compatibility. The presence of DQA1 eplet mismatches potentially would increase the likelihood of developing CLAD.
Collapse
Affiliation(s)
- Elena González-López
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - Víctor M. Mora-Cuesta
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - Adriel Roa-Bautista
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - Alejandra Comins-Boo
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - André Renaldo
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - Juan Irure-Ventura
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | | | - Sandra Tello-Mena
- Pneumology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - David San Segundo
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | | | - Marcos López-Hoyos
- Immunology Department, Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
- Molecular Biology Department, Cantabrian University, Santander, Spain
| |
Collapse
|
3
|
González-López E, Odriozola Herrán A, Renuncio García M, Roa-Bautista A, Antón Rodríguez Á, Comins-Boo A, Irure Ventura J, Puente Á, López-Hoyos M, Fortea JI, San Segundo D. CD64 expression on neutrophils as a potential biomarker for bacterial infection in ascitic fluid of cirrhotic patients. Infect Dis (Lond) 2023:1-7. [PMID: 37310691 DOI: 10.1080/23744235.2023.2223294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND CD64 expression on neutrophils surface (CD64N) by flow cytometry has been validated as a rapid biomarker for bacterial infections in both peripheral blood and other biological fluids. Ascites is a common complication in cirrhotic patients that a variety of factors can cause, including bacterial infections. Manual counting of polymorphonuclear (PMN) cells in ascitic fluid and microbiologic culture are essential for its diagnosis. We aimed to validate the determination of CD64N by flow cytometry in ascitic fluid and assess its potential usefulness in the rapid identification of bacterial infections. MATERIALS AND METHODS A prospective unicentre study was conducted. Flow cytometry was used to analyse the expression of CD64N in 77 ascitic fluid samples from the initial paracentesis of 60 cirrhotic patients in different admission episodes from November 2021 to December 2022. RESULTS Seventeen samples were diagnosed with bacterial infection based on a positive microbiologic culture or by PMN count (>250 PMN/mm3 in ascitic fluid). The median of CD64N MFI was significantly increased in the bacterial infection group (3690.5 MFI [1635.23-6521.18] vs. 1105.9 MFI [737.3-2048.2], p < 0.001). The CD64 MFI ratio of granulocytes to lymphocytes was elevated in the bacterial infection group (13.06 [6.38-24.58] vs. 5.01 [3.38-7.36], p < 0.001). A CD64N ratio higher than 9.9 identified those patients with bacterial infection with 70.6 and 86.7% sensitivity and specificity, with an area under the curve (AUC) of 79.4%. CONCLUSION The CD64N determined by flow cytometry on ascitic fluid could help quickly identify bacterial infections in ascites patients, allowing early antibiotic treatment.
Collapse
Affiliation(s)
- Elena González-López
- Immunology Department, University Hospital Marqués de Valdecilla, Santander, Spain
- Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Aitor Odriozola Herrán
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Mónica Renuncio García
- Immunology Department, University Hospital Marqués de Valdecilla, Santander, Spain
- Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Adriel Roa-Bautista
- Immunology Department, University Hospital Marqués de Valdecilla, Santander, Spain
- Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Ángela Antón Rodríguez
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Alejandra Comins-Boo
- Immunology Department, University Hospital Marqués de Valdecilla, Santander, Spain
- Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Juan Irure Ventura
- Immunology Department, University Hospital Marqués de Valdecilla, Santander, Spain
- Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Ángela Puente
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Department, University Hospital Marqués de Valdecilla, Santander, Spain
- Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - José Igancio Fortea
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Immunology Department, University Hospital Marqués de Valdecilla, Santander, Spain
- Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| |
Collapse
|
4
|
Renuncio-García M, González-López E, Carreras E, Villa J, Romón-Alonso I, Roa-Bautista A, Gutiérrez-Larrañaga M, Comins-Boo A, Irure-Ventura J, López-Hoyos M, San Segundo D. Estimation of Antibody-Verified Eplet Mismatch Load, 2-Field HLA Resolution vs Imputation in a Large Cohort of European Donors. Transplant Proc 2022; 54:2414-2418. [DOI: 10.1016/j.transproceed.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
|
5
|
Roa-Bautista A, López-Del-Moral C, González-López E, Gutiérrez-Larrañaga M, Renuncio-García M, Castro-Hernández C, Mikhalkovich-Mikhalkovich D, Comins-Boo A, Irure-Ventura J, Rodrigo E, Ruiz San Millán JC, López-Hoyos M, San Segundo D. Non-HLA Antibodies and Their Role in Highly Sensitized Patients. Transplant Proc 2022; 54:2439-2442. [PMID: 36319497 DOI: 10.1016/j.transproceed.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/20/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The role of non-HLA antibody is gaining special attention in solid-organ transplantation and in highly sensitized (HS) patients because of its potential involvement in graft loss (GL) and/or antibody-mediated rejection (ABMR). The identification of non-HLA antibodies while listed may provide deeper information about the increased immunologic risk prior to transplant. We aimed to identify non-HLA antibodies pretransplant that could involve GL in HS patients. METHODS Nineteen pretransplant samples from HS patients who underwent transplant at the Marqués de Valdecilla University Hospital were studied for both HLA antibodies and a panel of 39 non-HLA antigens analyzed based on Luminex platform. RESULTS Eleven patient (57.9%) maintained the graft (KT group), whereas 8 (42.1%) had a GL within a median of 30 days. The median fluorescent intensity (MFI) of the 39 non-HLA antigens were compared within the groups, obtaining a statistically significant differences in protein tyrosine phosphatase receptor type N (P < .04) with a MFI mean of 1408 vs 4931 for KT and GL groups, respectively. However, no significant differences were observed in non-HLA MFI between ABMR and non-ABMR KT recipients. CONCLUSIONS The presence of non-HLA antibodies in HS is high. The levels of anti-protein tyrosine phosphatase receptor type N before transplant could indicate a potential risk of GL, although longitudinal studies with large number of cases are needed to define anti-non-HLA profiles of risk of ABMR.
Collapse
Affiliation(s)
- Adriel Roa-Bautista
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | | | - Elena González-López
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - María Gutiérrez-Larrañaga
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Mónica Renuncio-García
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Carolina Castro-Hernández
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Dzmitry Mikhalkovich-Mikhalkovich
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Alejandra Comins-Boo
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Juan Irure-Ventura
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Emilio Rodrigo
- Nephrology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Marcos López-Hoyos
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - David San Segundo
- Immunology Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain; Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain.
| |
Collapse
|
6
|
Odriozola A, San Segundo D, Cuadrado A, Hernáez T, Escrich V, Fortea JI, Martínez Á, Puente Á, Lapeña B, del Barrio M, López-Hoyos M, Crespo J, Fábrega E. SARS-CoV-2 and Liver Transplant: How Has It Behaved in This Sixth Wave? Transplantation 2022; 106:1445-1449. [PMID: 35394994 PMCID: PMC9213065 DOI: 10.1097/tp.0000000000004157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Since the declaration of a new variant of concern (VOC), Omicron, by the World Health Organization in November 2021, a quick spread has been documented worldwide, being the main VOC in the sixth wave in Spain. The Omicron variant has more transmissibility, lower virulence, and less risk of severe disease than previously described VOC. Here we analyze the current wave of severe acute respiratory syndrome coronavirus 2 infection in liver transplant recipients (LTRs). METHODS A retrospective observational study of 355 LTRs was conducted in La Rioja and Cantabria regions of Spain. Epidemiological and clinical parameters were gathered on the basis of clinical records and telephone interviews. RESULTS In the current wave of infection, a higher number of LTRs have been found to be infected than the sum of the previous 5 waves (30 versus 16 LTRs). Of the 30 infected LTRs, 29 (96.6%) had received 3 vaccine doses (mRNA based), in a median of 93 d (interquartile range, 86-108) before infection. Eight of 30 LTRs (24.0%) were asymptomatic and 21 LTRs (67.8%) were with mild symptoms with a mean duration of 4.6 d (interquartile range, 2.5-7), whereas in the unvaccinated LTRs, the symptoms were fever, nausea, vomiting, and diarrhea. Moreover, in the sixth wave, intrafamiliar transmission was the main route of infection (17/30; 56.6%), and nosocomial transmission was confirmed in 2 LTRs (6.6%). CONCLUSIONS In our series, increased transmissibility of the Omicron variant was confirmed, including nosocomial infection, with a lower risk of severe disease in LTRs. These findings could be supported by the universal vaccination of LTRs and less virulence of the Omicron variant.
Collapse
Affiliation(s)
- Aitor Odriozola
- Department of Gastroenterology, Hepatology, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, University of Cantabria, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Department of Immunology, Marqués de Valdecilla University Hospital, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Antonio Cuadrado
- Department of Gastroenterology, Hepatology, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, University of Cantabria, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Tania Hernáez
- Hepatology Unit of San Pedro Hospital, Logroño, La Rioja, Spain
| | - Víctor Escrich
- Hepatology Unit of San Pedro Hospital, Logroño, La Rioja, Spain
| | - José Ignacio Fortea
- Department of Gastroenterology, Hepatology, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, University of Cantabria, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Ángela Martínez
- Hepatology Unit of San Pedro Hospital, Logroño, La Rioja, Spain
| | - Ángela Puente
- Department of Gastroenterology, Hepatology, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, University of Cantabria, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Berta Lapeña
- Hepatology Unit of San Pedro Hospital, Logroño, La Rioja, Spain
| | - María del Barrio
- Department of Gastroenterology, Hepatology, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, University of Cantabria, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Marcos López-Hoyos
- Department of Immunology, Marqués de Valdecilla University Hospital, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Javier Crespo
- Department of Gastroenterology, Hepatology, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, University of Cantabria, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Emilio Fábrega
- Department of Gastroenterology, Hepatology, Marqués de Valdecilla University Hospital, Clinical and Translational Digestive Research Group, University of Cantabria, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| |
Collapse
|
7
|
Odriozola A, Lamadrid-Perojo P, Cuadrado A, San Segundo D, del Barrio M, Fortea JI, Puente A, Amigo L, Fernández-Santiago R, Castillo F, Achalandabaso M, Andrés Echeverri J, Rodríguez-Sanjuan JC, López-Hoyos M, Crespo J, Fábrega E. Immune Response After a Third Dose of the mRNA-1273 SARS-CoV-2 Vaccine in Liver Transplant Recipients. Transplantation 2022; 106:e341-e342. [PMID: 35323163 PMCID: PMC9213066 DOI: 10.1097/tp.0000000000004147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Aitor Odriozola
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Patricia Lamadrid-Perojo
- Department of Immunology, Marqués de Valdecilla University Hospital, IDIVAL, Transplant and Autoimmunity Research Group, University of Cantabria, Santander, Spain
| | - Antonio Cuadrado
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - David San Segundo
- Department of Immunology, Marqués de Valdecilla University Hospital, IDIVAL, Transplant and Autoimmunity Research Group, University of Cantabria, Santander, Spain
| | - María del Barrio
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - José Ignacio Fortea
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Angela Puente
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Lidia Amigo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Roberto Fernández-Santiago
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Federico Castillo
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - María Achalandabaso
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Juan Andrés Echeverri
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Juan Carlos Rodríguez-Sanjuan
- Department of General Surgery, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Marcos López-Hoyos
- Department of Immunology, Marqués de Valdecilla University Hospital, IDIVAL, Transplant and Autoimmunity Research Group, University of Cantabria, Santander, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| | - Emilio Fábrega
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, IDIVAL, Clinical and Translational Digestive Research Group, University of Cantabria, Santander, Spain
| |
Collapse
|
8
|
Cuadrado A, Del Barrio M, Fortea JI, Amigo L, San Segundo D, Rodriguez-Cundin MP, Rebollo MH, Fernandez-Santiago R, Castillo F, Achalandabaso M, Echeverri J, Anderson EJ, Rodríguez-Sanjuan JC, López-Hoyos M, Crespo J, Fábrega E. Antibody response to the messenger RNA-1273 vaccine (Moderna) in liver transplant recipients. Hepatol Commun 2022; 6:1673-1679. [PMID: 35344281 PMCID: PMC9110949 DOI: 10.1002/hep4.1937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 01/05/2023] Open
Abstract
Different reports have shown the clinical and serologic response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in preventing coronavirus disease 2019 (COVID-19) in the general population, but few studies have examined these responses in transplant recipients. We assessed the vaccine immunogenicity of two doses (100 μg) of the mRNA-1273 vaccine (Moderna) administered with a 28-day interval in liver transplant recipients (LTRs) at follow-up at the Marques de Valdecilla University Hospital. LTRs without a history of COVID-19 infection were tested for SARS-CoV-2 immunoglobulin G (IgG) antibodies directed against the spike protein (S) a median of 43 days after receiving the second Moderna vaccine dose. Clinical data, including immunosuppressive regimen and routine laboratory data, were obtained from the medical record of each patient up to 3 months before the date of the first vaccination. Factors associated with serologic response were evaluated through logistic regression. In total, 129 LTRs who had anti-S results were included. Most patients were men (n = 99; 76.7%) with a median age of 63 years (interquartile range, 56-68). Alcohol (43.4%) and chronic hepatitis C (18.6%) were the most frequent causes of liver transplantation. A positive anti-S IgG response was observed in 113 LTRs (87.6%; 95% confidence interval [CI], 80.8-92.2). A strong inverse relationship between mycophenolate mofetil use and serologic response was found (odds ratio, 0.07; 95% CI, 0.02-0.26; p = 0.001). Conclusion: Most LTRs develop an immunological response to the Moderna SARS-CoV-2 mRNA-based vaccine. An immunosuppressive regimen that includes mycophenolate predicts a weak serologic response.
Collapse
Affiliation(s)
- Antonio Cuadrado
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - María Del Barrio
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - José Ignacio Fortea
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - Lidia Amigo
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - David San Segundo
- Department of ImmunologyMarqués de Valdecilla University HospitalIDIVALSantanderSpain
| | | | - María Henar Rebollo
- Department of Preventive MedicineMarqués de Valdecilla University HospitalCantabriaSpain
| | - Roberto Fernandez-Santiago
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Federico Castillo
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Maria Achalandabaso
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Juan Echeverri
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Edward J Anderson
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Juan Carlos Rodríguez-Sanjuan
- Department of General SurgeryMarqués de Valdecilla University HospitalSantanderSpain.,IDIVALSchool of MedicineUniversity of CantabriaSantanderSpain
| | - Marcos López-Hoyos
- Department of ImmunologyMarqués de Valdecilla University HospitalIDIVALSantanderSpain
| | - Javier Crespo
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - Emilio Fábrega
- Department of Gastroenterology and HepatologyMarqués de Valdecilla University HospitalSantanderSpain.,Clinical and Translational Digestive Research GroupUniversity of CantabriaInstituto de investigación sanitaria Valdecilla (IDIVAL)SantanderSpain
| |
Collapse
|
9
|
Álvarez-Reguera C, Prieto-Peña D, Herrero-Morant A, Sánchez-Bilbao L, Martín-Varillas JL, González-López E, Gutiérrez-Larrañaga M, San Segundo D, Demetrio-Pablo R, Ocejo-Vinyals G, González-Gay MA, Blanco R. Clinical and immunological study of Tofacitinib and Baricitinib in refractory Blau syndrome: case report and literature review. Ther Adv Musculoskelet Dis 2022; 14:1759720X221093211. [PMID: 35510170 PMCID: PMC9058350 DOI: 10.1177/1759720x221093211] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Blau syndrome (BS) is an autoinflammatory disorder characterized by non-caseating granulomatous dermatitis, arthritis, and uveitis. We present a case of refractory and severe BS that was treated with the Janus kinase inhibitors (JAKINIBS), Tofacitinib (TOFA) and then Baricitinib (BARI). Our aim was to describe the clinical and immunological outcomes after treatment with JAKINIBS. Blood tests and serum samples were obtained during follow-up with TOFA and BARI. We assessed their effects on clinical outcomes, acute phase reactants, absolute lymphocyte counts (ALCs), lymphocyte subset counts, immunoglobulins, and cytokine levels. A review of the literature on the use of JAKINIBS for the treatment of uveitis and sarcoidosis was also conducted. TOFA led to a rapid and maintained disease control and a steroid-sparing effect. A decrease from baseline was observed in ALC, CD3+, CD4+, CD8+, and natural killer (NK) cell counts. B-cells were stable. Serum levels of interleukin (IL)-4 and tumor necrosis factor alpha (TNF-α) increased, whereas IL-2, IL-6, IL-10, and IL-17 maintained stable. TOFA was discontinued after 19 months due to significant lymphopenia. The initiation of BARI allowed maintaining adequate control of disease activity with an adequate safety profile. The literature review showed seven patients with uveitis and five with sarcoidosis treated with JAKINIBS. No cases of BS treated with JAKINIBS were found. We report the successful use of JAKINIBS in a patient with refractory and severe BS.
Collapse
Affiliation(s)
- Carmen Álvarez-Reguera
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Diana Prieto-Peña
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Alba Herrero-Morant
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Lara Sánchez-Bilbao
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Elena González-López
- Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - David San Segundo
- Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rosalía Demetrio-Pablo
- Department of Ophthalmology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Gonzalo Ocejo-Vinyals
- Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel A. González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain
| | - Ricardo Blanco
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain
| |
Collapse
|
10
|
Iglesias-Escudero M, Segundo DS, Merino-Fernandez D, Mora-Cuesta VM, Lamadrid P, Alonso-Peña M, Raso S, Iturbe D, Fernandez-Rozas S, Cifrian J, López-Hoyos M. Myeloid-Derived Suppressor Cells Are Increased in Lung Transplant Recipients and Regulated by Immunosuppressive Therapy. Front Immunol 2022; 12:788851. [PMID: 35185863 PMCID: PMC8848105 DOI: 10.3389/fimmu.2021.788851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/17/2021] [Indexed: 12/28/2022] Open
Abstract
Lung transplantation remains as a primary treatment for end-stage lung diseases. Although remarkable improvement has been achieved due to the immunosuppressive protocols, long-term survival for lung transplant recipients (LTR) is still limited. In the last few decades, an increasing interest has grown in the study of dysregulation of immune mechanisms underlying allograft failure. In this regard, myeloid-derived suppressor cells (MDSCs) could play an important role in the promotion of graft tolerance due to their immune regulatory function. Here, we describe for the first time circulating subsets MDSCs from LTR at several time points and we evaluate the relationship of MDSCs with sort-term lung transplant outcomes. Although no effect of MDSCs subsets on short-term clinical events was observed, our results determine that Mo-MDSCs frequencies are increased after acute cellular rejection (ACR), suggesting a possible role for Mo-MDSCs in the development of chronic lung allograft dysfunction (CLAD). Therefore, whether MDSCs subsets play a role as biomarkers of chronic rejection remains unknown and requires further investigations. Also, the effects of the different immunosuppressive treatments on these subpopulations remain under research and further studies are needed to establish to what extend MDSCs immune modulation could be responsible for allograft acceptance.
Collapse
Affiliation(s)
- María Iglesias-Escudero
- Transplant and Autoimmunity group, Research Institute-IDIVAL, Santander, Spain.,Immunology Department, Universitary Hospital Germans Trias i Pujol, Badalona, Spain
| | - David San Segundo
- Transplant and Autoimmunity group, Research Institute-IDIVAL, Santander, Spain.,Immunology Department, Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Victor M Mora-Cuesta
- Pneumology Department, Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Patricia Lamadrid
- Transplant and Autoimmunity group, Research Institute-IDIVAL, Santander, Spain
| | - Marta Alonso-Peña
- Transplant and Autoimmunity group, Research Institute-IDIVAL, Santander, Spain
| | - Sandra Raso
- Transplant and Autoimmunity group, Research Institute-IDIVAL, Santander, Spain
| | - David Iturbe
- Pneumology Department, Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Sonia Fernandez-Rozas
- Pneumology Department, Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Jose Cifrian
- Pneumology Department, Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Transplant and Autoimmunity group, Research Institute-IDIVAL, Santander, Spain.,Immunology Department, Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Molecular Biology Department, Universidad Cantabria, Santander, Spain
| |
Collapse
|
11
|
Ortiz A, Roger M, Jiménez VM, Perez JCR, Furlano M, Atxer LS, Zurro DG, Casabona CMR, Zurro DG, Gómez CG, Bermúdez PP, Armisen MA, López SA, Porras IG, Ruiz JG, Orgaz JMM, Barón MM, Ortiz PDS, Fuente GDADL, Gili BQ, Fresnedo GF, Cabrera SS, Contreras JP, Pelicano MB, Blanca AM, Portillo MR, Álvarez JES, Romeo MJS, Pérez MG, Diezhandino MG, Marrero DH, Campo CF, García EM, Carmona DGC, Ramírez AT, Bellvis LM, Haym MB, Gómez MB, Martínez JMC, Garrit JMC, Garrido RSJ, Delgado JB, Marimont MB, Muñoz MOV, Villares JMP, Velázquez ÁS, Bonet LA, Bravo MÁG, Mateos FJM, Amador MM, Blanca AM, Miñano JAP, Belmonte AA, Jover AS, Rituerto DC, Sánchez FP, Arenas MD, Hernández RM, Serrano BM, Arduan AO, Sanz AB, Ramos AM, Córdoba-David G, García-Jiménez J, Fontecha-Barriuso M, Guerrero-Mauvecin J, Lopez-Díaz AM, Sánchez-Niño MD, Valiño-Rivas L, Cuarental L, Ribagorda M, Pintor-Chocano A, Favero C, Alvarez-Llamas G, Catalina MC, Fernández-Fernández B, Pérez-Gómez MV, Montaner ERAD, Prado RF, Rivera JR, Verde AMR, Luis-Lima S, Sánchez-Rodríguez J, Sánchez SP, Ortega MR, Parra EG, Mateos SR, Ortiz PJC, Expósito LM, Tejera-Muñoz A, Marchant V, Tejedor-Santamaria L, Agilar MA, Diekmann F, Genis BB, Salinas FO, Bajo MJR, Maneus EB, Guillen MA, Juárez JR, Rodríguez ML, Vicente IR, Pelicano JMB, Porras LFQ, Aguiar PVA, Font MX, Andujar AM, Cucchiari D, Marrah EM, M J, Piñeiro GJ, Salgado CM, Morales Martín AI, López Hernández FJ, Balboa NE, Vicente MP, Calvo IF, González LR, Vicente LV, Martínez SMS, Casanova Paso AG, Garriel MP, López JJV, Palacios AMC, Saénz DS, García PG, Bonilla JLA, Fernández Rodríguez MA, Galán AD, Marcos EM, Pérez-Aradros JC, José RMS, Zelaya FM, Panadés ES, Molina ÁG, Salido JA, Balcells RT, Criach EA, Encarnación MD, Perich LG, Furlano M, Girol CC, Terroba YA, Oliveras MP, Vila LE, Cabañas NS, Molas CF, Torres IS, Pelaez SL, Serra CR, Torres CC, Fajardo JPT, Lahuerta JIH, Herranz VM, Portillo MR, Malo AM, Cabrera SS, Castañeda JRM, Ortiz MER, Moreno JMM, Bermúdez AIR, Olmo RS, Pavón FG, Peregrin CM, Tejero EA, Villalba IL, Muñoz AC, Mier MVPRD, Martos CMP, Baltanas RL, Haad CR, Bartolomé MF, Valdemoros RL, Serres FEB, Díaz MN, Mariño FJJ, Sole LC, Saborido MIT, Majoral JS, Martínez ML, Calabia ER, Millán JCRS, López-Hoyos M, Benito-Hernández A, Fresnedo GF, Segundo DS, Valero R, García EC, Ona JGD, Llavona EC, Rodríguez FS, Gutiérrez RL, Peña HG, Pérez MG, Marrero DH, López V, Sola E, Cabello M, Caballero A, León M, Ruiz P, Alonso J, Navarro-González J, Mora-Fernández MDC, Donate-Correa J, Martín-Nuñez E, Delgado NP, Gigarrán-Guldris S, Pérez JCR, Teruel JLG, Castelao AM, Revilla JMV, Martínez CM, Stanojevic MB, Boque EC, Rosell MNS, Lamo VMD, Tocados JMD, Carrasco AG, López MB, Enriquez MC, Bardaji AM, Masot ND, Gómez AP, Sanjuan AE, Ortega AO, Fuentes RW, Guindo MDCDG, Fuentes MDCR, Ravassa FO, Molina MC, Tortosa CLR, Garrido RGDM, Romeo MJS, Jacobs-Cachá C, Matamoros OB, Mateos FM, Meneghini MAE, Roig JS, Betsabé IT, Larrea CL, Álvarez BS, Corte MDCD, Rodrigues-Diez RR, Vázquez AL, Rodríguez SG, Castiñeira JRV, Martín CM, Álvarez MLS, Iglesias VC, Borra JM, Rubio MAB, Gilsanz GDP, Cabrera ML, Heffernan JAJ, González MO, González OC, García MEG, Martín CJ, Correa PS, Ramos SA, Oliva ML, Becerra BR, Cabrera CV, Mateo GTG, Villanueva RS, García LÁ, Cannata Andía JB, Díaz MN, Martín JLF, López NC, García SP, Montes CA, García MR, Luengas ILM, Álvarez ES, Arias LM, Carro BM, Virgala JM, González MG, Barreiro JML, Fontan MP, González AO, Barja LMC, Barreiro AS, Arias BP, Hernández ÁA, Pérez MP, Varela JC, Lechuga JA, Rodríguez CD, Murias MG, Iglesia AMBDL, Piñeiro PB, González ÁG, Eijo AC, Cachaza NC, González MV, Garrit JMC, Blanch NL, Martínez AMS, Val MH, BordignonDraibe J, Melilli E, Montero AM, Pérez NM, Oliveras XF, Barrio MC, Santos JP, Barrera CB, Sáez MJP, Pachón MDR, Cabrales CA, Porras AB, García ER, Atxer LS, González VP, Mallol LL, Oliva MR, Puyol DR, Torres MPR, Ongil SL, Basilio LC, Centenera GO, Miguel PMD, Rodríguez LF, Nadah HB, Fernández MP, Chamond MRR, Ortiz PS, Fernández NG, Boillos AB, Cenarruzabeitia NV, Seara MAF, Moreno IDDPM, Lavilla FJ, Torres A, Miranda DM, Hernández APR, Redondo EDB, Porrini E, Caso MDLÁC, Tamajón MLP, Hernández MR, Rebollo MSG, Mallen PD, González AÁ, Rinne AMG, Rodríguez RM, Torres SE, Sosa DÁ, Cabrera BE, Rodríguez NZ, Hernández AF, Gamboa MJR, Caso C, Angeles MDL, Tamajon P, Lourdes M, Hernandez MR, Rebollo G, Sagrario M, Mallen PD, Gonzalez A, Alejandra, Rinne G, Maria A, Rodriguez RM, Torres SE, Sosa DA, Cabrera BE, Rodiguez NZ, Hernandez AF, Gamboa R, Jose M, Bermejo MLG, Lucas MF, Moreno EC, Muñoz LS, Huertas SS, Serrano EMR, Muñoz MER, Toro LC, Agudo CPB, Álvarez CG, Portoles J, Marqués M, Rubio E, Sánchez-Sobrino B, García-Menéndez E, Fernández AL, Diezhandin MG, Benítez PR, González MÁGN, Gallardo ML, Juárez GMF, Martínez EG, Terente MP, Ribera AT, Escribano TC, Fontan FC, Fernández AS, Pérez - Monteoliva NRR, Huerta EL, Rodríguez GG, Hernández SB, Zamorano SM, Gómez JML, Gallego RH. RICORS2040: the need for collaborative research in chronic kidney disease. Clin Kidney J 2021; 15:372-387. [PMID: 35211298 PMCID: PMC8862113 DOI: 10.1093/ckj/sfab170] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 01/17/2023] Open
Abstract
Abstract
Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is ‘solved’ by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020–2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true.
Collapse
|
12
|
San Segundo D, Arnáiz de las Revillas F, Lamadrid-Perojo P, Comins-Boo A, González-Rico C, Alonso-Peña M, Irure-Ventura J, Olmos JM, Fariñas MC, López-Hoyos M. Innate and Adaptive Immune Assessment at Admission to Predict Clinical Outcome in COVID-19 Patients. Biomedicines 2021; 9:biomedicines9080917. [PMID: 34440121 PMCID: PMC8389676 DOI: 10.3390/biomedicines9080917] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
During the COVID-19 pandemic, many studies have been carried out to evaluate different immune system components to search for prognostic biomarkers of the disease. A broad multiparametric antibody panel of cellular and humoral components of the innate and the adaptative immune response in patients with active SARS-CoV-2 infection has been evaluated in this study. A total of 155 patients were studied at admission into our center and were categorized according to the requirement of oxygen therapy as mild or severe (the latter being those with the requirement). The patients with severe disease were older and had high ferritin, D-dimer, C-reactive protein, troponin, interleukin-6 (IL-6) levels, and neutrophilia with lymphopenia at admission. Moreover, the patients with mild symptoms had significantly increased circulating non-classical monocytes, innate lymphoid cells, and regulatory NK cells. In contrast, severe patients had a low frequency of Th1 and regulatory T cells with increased activated and exhausted CD8 phenotype (CD8+CD38+HLADR+ and CD8+CD27-CD28-, respectively). The predictive model included age, ferritin, D-dimer, lymph counts, C4, CD8+CD27-CD28-, and non-classical monocytes in the logistic regression analysis. The model predicted severity with an area under the curve of 78%. Both innate and adaptive immune parameters could be considered potential predictive biomarkers of the prognosis of COVID-19 disease.
Collapse
Affiliation(s)
- David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (D.S.S.); (A.C.-B.); (J.I.-V.)
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - Francisco Arnáiz de las Revillas
- Infectious Diseases Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (F.A.d.l.R.); (C.G.-R.); (M.C.F.)
| | - Patricia Lamadrid-Perojo
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - Alejandra Comins-Boo
- Immunology Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (D.S.S.); (A.C.-B.); (J.I.-V.)
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - Claudia González-Rico
- Infectious Diseases Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (F.A.d.l.R.); (C.G.-R.); (M.C.F.)
| | - Marta Alonso-Peña
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - Juan Irure-Ventura
- Immunology Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (D.S.S.); (A.C.-B.); (J.I.-V.)
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
| | - José Manuel Olmos
- Internal Medicine Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain;
- Faculty of Medicine, University of Cantabria, 39011 Santander, Spain
| | - María Carmen Fariñas
- Infectious Diseases Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (F.A.d.l.R.); (C.G.-R.); (M.C.F.)
- Faculty of Medicine, University of Cantabria, 39011 Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla, 39008 Santander, Spain; (D.S.S.); (A.C.-B.); (J.I.-V.)
- Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), 39011 Santander, Spain; (P.L.-P.); (M.A.-P.)
- Faculty of Medicine, University of Cantabria, 39011 Santander, Spain
- Correspondence:
| |
Collapse
|
13
|
Martín MC, Jurado A, Abad-Molina C, Orduña A, Yarce O, Navas AM, Cunill V, Escobar D, Boix F, Burillo-Sanz S, Vegas-Sánchez MC, Jiménez-de Las Pozas Y, Melero J, Aguilar M, Sobieschi OI, López-Hoyos M, Ocejo-Vinyals G, San Segundo D, Almeida D, Medina S, Fernández L, Vergara E, Quirant B, Martínez-Cáceres E, Boiges M, Alonso M, Esparcia-Pinedo L, López-Sanz C, Muñoz-Vico J, López-Palmero S, Trujillo A, Álvarez P, Prada Á, Monzón D, Ontañón J, Marco FM, Mora S, Rojo R, González-Martínez G, Martínez-Saavedra MT, Gil-Herrera J, Cantenys-Molina S, Hernández M, Perurena-Prieto J, Rodríguez-Bayona B, Martínez A, Ocaña E, Molina J. The age again in the eye of the COVID-19 storm: evidence-based decision making. Immun Ageing 2021; 18:24. [PMID: 34016150 PMCID: PMC8134808 DOI: 10.1186/s12979-021-00237-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND One hundred fifty million contagions, more than 3 million deaths and little more than 1 year of COVID-19 have changed our lives and our health management systems forever. Ageing is known to be one of the significant determinants for COVID-19 severity. Two main reasons underlie this: immunosenescence and age correlation with main COVID-19 comorbidities such as hypertension or dyslipidaemia. This study has two aims. The first is to obtain cut-off points for laboratory parameters that can help us in clinical decision-making. The second one is to analyse the effect of pandemic lockdown on epidemiological, clinical, and laboratory parameters concerning the severity of the COVID-19. For these purposes, 257 of SARSCoV2 inpatients during pandemic confinement were included in this study. Moreover, 584 case records from a previously analysed series, were compared with the present study data. RESULTS Concerning the characteristics of lockdown series, mild cases accounted for 14.4, 54.1% were moderate and 31.5%, severe. There were 32.5% of home contagions, 26.3% community transmissions, 22.5% nursing home contagions, and 8.8% corresponding to frontline worker contagions regarding epidemiological features. Age > 60 and male sex are hereby confirmed as severity determinants. Equally, higher severity was significantly associated with higher IL6, CRP, ferritin, LDH, and leukocyte counts, and a lower percentage of lymphocyte, CD4 and CD8 count. Comparing this cohort with a previous 584-cases series, mild cases were less than those analysed in the first moment of the pandemic and dyslipidaemia became more frequent than before. IL-6, CRP and LDH values above 69 pg/mL, 97 mg/L and 328 U/L respectively, as well as a CD4 T-cell count below 535 cells/μL, were the best cut-offs predicting severity since these parameters offered reliable areas under the curve. CONCLUSION Age and sex together with selected laboratory parameters on admission can help us predict COVID-19 severity and, therefore, make clinical and resource management decisions. Demographic features associated with lockdown might affect the homogeneity of the data and the robustness of the results.
Collapse
Affiliation(s)
- María C Martín
- Centro de Hemoterapia y Hemodonación de Castilla y León, Valladolid, Spain
| | - Aurora Jurado
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Cristina Abad-Molina
- Department of Microbiology and Immunology, Hospital Clínico Universitario, Valladolid, Spain
| | - Antonio Orduña
- Department of Microbiology and Immunology, Hospital Clínico Universitario, Valladolid, Spain
| | - Oscar Yarce
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Ana M Navas
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Vanesa Cunill
- Department of Immunology, Hospital Universitario Son Espases-Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Danilo Escobar
- Department of Immunology, Hospital Universitario Son Espases-Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Francisco Boix
- Department of Immunology, Hospital Clínico Universitario, Salamanca, Spain
| | | | | | | | - Josefa Melero
- Department of Immunology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Marta Aguilar
- Department of Immunology, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | - Marcos López-Hoyos
- Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Gonzalo Ocejo-Vinyals
- Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Delia Almeida
- Laboratory of Immunology, Complejo Hospitalario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Silvia Medina
- Laboratory of Immunology, Complejo Hospitalario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Luis Fernández
- Laboratoy of Immunology and Genetics, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Esther Vergara
- Laboratoy of Immunology and Genetics, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Bibiana Quirant
- Department of Immunology, Hospital Germans Trias i Pujols, Barcelona, Spain
| | | | - Marc Boiges
- Department of Immunology, Hospital Germans Trias i Pujols, Barcelona, Spain
| | - Marta Alonso
- Department of Immunology, Hospital de Cruces, Baracaldo, Spain
| | | | - Celia López-Sanz
- Department of Immunology, Hospital Universitario La Princesa, Madrid, Spain
| | | | | | - Antonio Trujillo
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Paula Álvarez
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Álvaro Prada
- Department of Immunology, Hospital de Donostia, San Sebastián, Spain
| | - David Monzón
- Department of Immunology, Hospital de Donostia, San Sebastián, Spain
| | - Jesús Ontañón
- Unit of Immunology, Hospital General Universitario, Albacete, Spain
| | | | - Sergio Mora
- Laboratory Unit, Hospital General, Alicante, Spain
| | - Ricardo Rojo
- Department of Immunology, Complejo Hospitalario, La Coruña, Spain
| | - Gema González-Martínez
- Unit of Immunology, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - María T Martínez-Saavedra
- Unit of Immunology, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Juana Gil-Herrera
- Department of Immunology, Hospital General Universitario e Instituto de Investigación Sanitaria, "Gregorio Marañón", Madrid, Spain
| | - Sergi Cantenys-Molina
- Department of Immunology, Hospital General Universitario e Instituto de Investigación Sanitaria, "Gregorio Marañón", Madrid, Spain
| | - Manuel Hernández
- Department of Immunology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | | | | | - Esther Ocaña
- Laboratory Unit, Complejo Hospitalario, Jaén, Spain
| | - Juan Molina
- Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
| |
Collapse
|
14
|
Martín-Penagos L, Fernández-Fresnedo G, Benito-Hernández A, Mazón J, de Cos M, Oviedo MV, San Segundo D, López-Hoyos M, Gómez-Román J, Ruiz JC, Rodrigo E. Measurement of galactosyl-deficient IgA1 by the monoclonal antibody KM55 contributes to predicting patients with IgA nephropathy with high risk of long-term progression. Nefrologia 2021; 41:311-320. [PMID: 36166247 DOI: 10.1016/j.nefroe.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/07/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE About 25% of patients with IgA nephropathy (IgAN) progress to stage 5 chronic kidney disease (CKD) after years of evolution. Various tools have been developed in recent years designed to predict which of the patients will had poorer outcomes. The value of circulating galactosyl-deficient IgA1 (Gd-IgA1) has been related to a worse evolution of IgAN in several studies. There are also some publications that relate higher APRIL values with a worse evolution. Recently, a new method has been developed that allows measuring the value of circulating Gd-IgA1 in a simpler way than those previously available. The objective of this study is to analyze the influence of circulating Gd-IgA1, measured by this method, on the progression of IgAN. MATERIALS AND METHODS Forty-nine patients with a diagnosis of IgAN demonstrated by renal biopsy were selected in our center, without having received prior immunosuppressive treatment, for whom frozen serum was available. The median follow-up was 4 years. Gd-IgA1 was measured by lectin-independent ELISA with the monoclonal antibody KM55 (IgA1 kit Cat. No. 30111694. IBL Int., Hamburg, Germany). Likewise, APRIL levels were also measured in these patients. RESULTS 19 (38.8%) patients reached stage 5 CKD. The fourth quartile of circulating Gd-IgA1 was related to a higher cumulative risk of reaching stage 5 CKD in the Kaplan-Meier analysis (risk at the 5th year 39.4% vs. 24.3%, log rank p=0.019). The Gd-IgA1 value was related to an increased risk of CKD stage 5 (HR 1.147, 95% CI 1.035-1.270, p=0.009), regardless of glomerular filtration rate, proteinuria, the percentage of sclerosed glomeruli and the value of segmental sclerosis. We did not find significant differences in the APRIL values. CONCLUSIONS The value of circulating Gd-IgA1 measured by the monoclonal antibody KM55 is related to a worse evolution of patients with IgAN independently of other variables, so it could be included in the study of patients to improve the prediction of the risk of disease progression.
Collapse
Affiliation(s)
- Luis Martín-Penagos
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Spain.
| | - Gema Fernández-Fresnedo
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Spain
| | - Adalberto Benito-Hernández
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Spain
| | - Jaime Mazón
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Spain
| | - Marina de Cos
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Spain
| | | | - David San Segundo
- Servicio de inmunología del Hospital Universitario Marqués de Valdecilla de SANTANDER, IDIVAL-REDINREN, Santander, Spain
| | - Marcos López-Hoyos
- Servicio de inmunología del Hospital Universitario Marqués de Valdecilla de SANTANDER, IDIVAL-REDINREN, Santander, Spain
| | - Javier Gómez-Román
- Servicio de Anatomía Patológica del Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Juan Carlos Ruiz
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Spain
| | - Emilio Rodrigo
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla, IDIVAL-REDINREN, Santander, Spain
| |
Collapse
|
15
|
Lamadrid P, Alonso-Peña M, San Segundo D, Arias-Loste M, Crespo J, Lopez-Hoyos M. Innate and Adaptive Immunity Alterations in Metabolic Associated Fatty Liver Disease and Its Implication in COVID-19 Severity. Front Immunol 2021; 12:651728. [PMID: 33859644 PMCID: PMC8042647 DOI: 10.3389/fimmu.2021.651728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
The coronavirus infectious disease 2019 (COVID-19) pandemic has hit the world, affecting health, medical care, economies and our society as a whole. Furthermore, COVID-19 pandemic joins the increasing prevalence of metabolic syndrome in western countries. Patients suffering from obesity, type II diabetes mellitus, cardiac involvement and metabolic associated fatty liver disease (MAFLD) have enhanced risk of suffering severe COVID-19 and mortality. Importantly, up to 25% of the population in western countries is susceptible of suffering from both MAFLD and COVID-19, while none approved treatment is currently available for any of them. Moreover, it is well known that exacerbated innate immune responses are key in the development of the most severe stages of MAFLD and COVID-19. In this review, we focus on the role of the immune system in the establishment and progression of MAFLD and discuss its potential implication in the development of severe COVID-19 in MAFLD patients. As a result, we hope to clarify their common pathology, but also uncover new potential therapeutic targets and prognostic biomarkers for further research.
Collapse
Affiliation(s)
- Patricia Lamadrid
- Transplant and Autoimmunity Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain
| | - Marta Alonso-Peña
- Clinical and Translational Research in Digestive Pathology Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain
| | - David San Segundo
- Transplant and Autoimmunity Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain.,Immunology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Mayte Arias-Loste
- Clinical and Translational Research in Digestive Pathology Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain.,Gastroenterology and Hepatology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Javier Crespo
- Clinical and Translational Research in Digestive Pathology Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain.,Gastroenterology and Hepatology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Marcos Lopez-Hoyos
- Transplant and Autoimmunity Group, Research Institute Marques de Valdecilla (IDIVAL), Santander, Spain.,Immunology Department, Marques de Valdecilla University Hospital, Santander, Spain
| |
Collapse
|
16
|
Comins-Boo A, Gutiérrez-Larrañaga M, Roa-Bautista A, Guiral Foz S, Renuncio García M, González López E, Irure Ventura J, Fariñas-Álvarez MC, San Segundo D, López Hoyos M. Validation of a Quick Flow Cytometry-Based Assay for Acute Infection Based on CD64 and CD169 Expression. New Tools for Early Diagnosis in COVID-19 Pandemic. Front Med (Lausanne) 2021; 8:655785. [PMID: 33869256 PMCID: PMC8044950 DOI: 10.3389/fmed.2021.655785] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/26/2021] [Indexed: 01/25/2023] Open
Abstract
Objectives: Several parameters aid in deciphering between viral and bacterial infections; however, new tools should be investigated in order to reduce the time to results and proceed with an early target-therapy. Validation of a biomarker study, including CD64 and CD169 expression, was conducted. Material and Methods: Patients with active SARS-CoV-2 infection (ACov-2), bacterial infection (ABI), healthy controls, and antiretroviral-controlled chronic HIV infection were assessed. Whole blood was stained and, after lysing no-wash protocol, acquired by flow cytometry. The median fluorescence intensity (MFI) of CD64 and CD169 was measured in granulocytes, monocytes, and lymphocytes. The CD64 MFI ratio granulocytes to lymphocytes (CD64N) and CD169 MFI ratio monocytes to lymphocytes (CD169Mo) were evaluated as biomarkers of acute bacterial and viral infection, respectively. Results: A CD64N ratio higher than 3.3 identified patients with ABI with 83.3 and 85.9% sensitivity and specificity, with an area under the curve (AUC) of 83.5%. In contrast, other analytic or hematological parameters used in the clinic had lower AUC compared with the CD64N ratio. Moreover, a CD169Mo ratio higher than 3.3 was able to identify ACov-2 with 91.7 and 89.8 sensitivity and specificity, with the highest AUC (92.0%). Conclusion: This work confirms the previous data of CD64N and CD169Mo ratios in an independent cohort, including controlled chronic viral HIV infection patients as biomarkers of acute bacterial and viral infections, respectively. Such an approach would benefit from quick pathogen identification for a direct-therapy with a clear application in different Health Care Units, especially during this COVID pandemic.
Collapse
Affiliation(s)
- Alejandra Comins-Boo
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Maria Gutiérrez-Larrañaga
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Adriel Roa-Bautista
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Sandra Guiral Foz
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Mónica Renuncio García
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Elena González López
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Juan Irure Ventura
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - María Carmen Fariñas-Álvarez
- Infectious Diseases Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Epidemiology and Pathogenic Mechanisms of Infectious Diseases Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - David San Segundo
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| | - Marcos López Hoyos
- Immunology Unit, Marqués de Valdecilla University Hospital, Santander, Spain.,Autoimmunity and Transplantation Research Group, Research Institute "Marqués de Valdecilla" (IDIVAL), Santander, Spain
| |
Collapse
|
17
|
Martín-Penagos L, Fernández-Fresnedo G, Benito-Hernández A, Mazón J, de Cos M, Oviedo MV, San Segundo D, López-Hoyos M, Gómez-Román J, Ruiz JC, Rodrigo E. [Measurement of galactosyl-deficient IgA1 by the monoclonal antibody KM55 contributes to predicting patients with IgA nephropathy with high risk of long-term progression]. Nefrologia 2021; 41:311-320. [PMID: 33741175 DOI: 10.1016/j.nefro.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/25/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE About 25% of patients with IgA nephropathy (IgAN) progress to stage 5 chronic kidney disease (CKD) after years of evolution. Various tools have been developed in recent years designed to predict which of the patients will had poorer outcomes. The value of circulating galactosyl-deficient IgA1 (Gd-IgA1) has been related to a worse evolution of IgAN in several studies. There are also some publications that relate higher APRIL values with a worse evolution. Recently, a new method has been developed that allows measuring the value of circulating Gd-IgA1 in a simpler way than those previously available. The objective of this study is to analyze the influence of circulating Gd-IgA1, measured by this method, on the progression of IgAN. MATERIALS AND METHODS Forty-nine patients with a diagnosis of IgAN demonstrated by renal biopsy were selected in our center, without having received prior immunosuppressive treatment, for whom frozen serum was available. The median follow-up was 4 years. Gd-IgA1 was measured by lectin-independent ELISA with the monoclonal antibody KM55 (IgA1 kit Cat. No. 30111694. IBL Int., Hamburg, Germany). Likewise, APRIL levels were also measured in these patients. RESULTS 19 (38.8%) patients reached stage 5 CKD. The fourth quartile of circulating Gd-IgA1 was related to a higher cumulative risk of reaching stage 5 CKD in the Kaplan-Meier analysis (risk at the 5th year 39.4% vs. 24.3%, log rank p=0.019). The Gd-IgA1 value was related to an increased risk of CKD stage 5 (HR 1.147, 95% CI 1.035-1.270, p=0.009), regardless of glomerular filtration rate, proteinuria, the percentage of sclerosed glomeruli and the value of segmental sclerosis. We did not find significant differences in the APRIL values. CONCLUSIONS The value of circulating Gd-IgA1 measured by the monoclonal antibody KM55 is related to a worse evolution of patients with IgAN independently of other variables, so it could be included in the study of patients to improve the prediction of the risk of disease progression.
Collapse
Affiliation(s)
- Luis Martín-Penagos
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España.
| | - Gema Fernández-Fresnedo
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España
| | - Adalberto Benito-Hernández
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España
| | - Jaime Mazón
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España
| | - Marina de Cos
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España
| | | | - David San Segundo
- Servicio de inmunología del Hospital Universitario Marqués de Valdecilla de SANTANDER. IDIVAL-REDINREN, Santander, España
| | - Marcos López-Hoyos
- Servicio de inmunología del Hospital Universitario Marqués de Valdecilla de SANTANDER. IDIVAL-REDINREN, Santander, España
| | - Javier Gómez-Román
- Servicio de Anatomía Patológica del Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Juan Carlos Ruiz
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España
| | - Emilio Rodrigo
- Servicio de Nefrología del Hospital Universitario Marqués de Valdecilla. IDIVAL-REDINREN, Santander, España
| |
Collapse
|
18
|
Arnau A, Benito-Hernández A, Ramos-Barrón MA, García-Unzueta MT, Gómez-Román JJ, Gómez-Ortega JM, López-Hoyos M, San Segundo D, Ruiz JC, Rodrigo E. Urinary C-X-C Motif Chemokine 10 Is Related to Acute Graft Lesions Secondary to T Cell- and Antibody-Mediated Damage. Ann Transplant 2021; 26:e929491. [PMID: 33686050 PMCID: PMC7955576 DOI: 10.12659/aot.929491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Non-invasive biomarkers of graft rejection are needed to optimize the management and outcomes of kidney transplant recipients. Urinary excretion of IFN-γ-related chemokine CXCL10 is clearly associated with clinical and subclinical T cell-mediated graft inflammation, but its relationship with antibody-mediated damage has not been fully addressed. Further, the variables influencing levels of urinary CXCL10 excretion are unknown. Material/Methods A total of 151 kidney graft biopsies (92 surveillance and 59 indication biopsies) and 151 matched urine samples obtained before biopsy were prospectively analyzed. T cell-mediated rejection (TCMR) and antibody-mediated rejection (AbMR) were defined according to the 2017 Banff classification criteria. Urinary CXCL10 levels were measured by ELISA and corrected by urinary creatinine. Results Banff scores ‘t’, ‘i’, ‘g’, and ‘ptc’ were significantly related to urinary CXCL10 levels. Multivariate analysis showed that ‘t’ (β=0.107, P=0.001) and ‘ptc’ (β=0.093, P=0.002) were significantly associated with urinary CXCL10. Donor-specific antibodies (DSAs) were related to the high excretion of urinary CXCL10 at 1 year after transplantation (odds ratio [OR] 17.817, P=0.003). Urinary CXCL10 showed good discrimination ability for AbMR (AUC-ROC 0.760, P=0.001). The third tertile of urinary CXCL10 remained significantly associated with AbMR (OR 4.577, 95% confidence interval 1.799–11.646, P=0.001) after multivariate regression analysis. Conclusions DSA was the only variable clearly related to high urinary CXCL10 levels. Urinary CXCL10 is a good non-invasive candidate biomarker of AbMR and TCMR, supplying information independent of renal function and other variables normally used to monitor kidney transplants.
Collapse
Affiliation(s)
- Alvaro Arnau
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Adalberto Benito-Hernández
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - María Angeles Ramos-Barrón
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - María Teresa García-Unzueta
- Department of Clinical Biochemistry, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - José Javier Gómez-Román
- Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - José María Gómez-Ortega
- Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Juan Carlos Ruiz
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| |
Collapse
|
19
|
Gutiérrez-Larrañaga M, Riesco L, Guiral S, Irure J, Rodrigo E, Ocejo-Vinyals J, Martorell J, Caro JL, López-Hoyos M, San Segundo D. Detection of antibodies to denatured human leucocyte antigen molecules by single antigen Luminex. HLA 2020; 97:52-59. [PMID: 33040479 DOI: 10.1111/tan.14098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/24/2020] [Revised: 08/04/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022]
Abstract
The anti-HLA antibody detection has been improved in sensitivity and specificity with solid-phase antigen bead (SAB) assays based on Luminex. However, false positive results due to denatured HLA (dHLA) may arise after single antigen test. The aim of this study was to compare the performance of the two Luminex technology-based anti-HLA detection kits available in the market in showing undesired anti-HLA antibody results. A prospective cohort was assessed for anti-HLA antibodies with single antigen A manufacturer (AM) kit and a comparison cohort with single antigen B manufacturer (BM) kit. A total of 11 out of 90 patients in a prospective cohort presented monospecific HLA-I antibodies with AM, and 5 out of 11 confirmed monospecific reaction with BM. Despite the confirmation of monospecific reaction with both manufacturers, 80% were assigned as dHLA reaction by specific crossmatch. Further comparative cohorts detected four out of six monospecific reactions with BM that were confirmed as possible dHLA reactions. A positive SAB test should rule out a reaction against a dHLA molecule, thus avoidance of prolonged waitlist periods or misattribution of anti-HLA reactions after transplantation.
Collapse
Affiliation(s)
- María Gutiérrez-Larrañaga
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Laura Riesco
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Sandra Guiral
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Juan Irure
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Javier Ocejo-Vinyals
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Jose L Caro
- Immunology Department, Hospital Clínic, Barcelona, Spain
| | - Marcos López-Hoyos
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| |
Collapse
|
20
|
Alvarez P, Augustín JJ, Tamayo E, Iglesias M, Acinas O, Mendiguren MA, Vázquez JA, Genre F, San Segundo D, Merino J, Merino R. Therapeutic Effects of Anti-Bone Morphogenetic Protein and Activin Membrane-Bound Inhibitor Treatment in Psoriasis and Arthritis. Arthritis Rheumatol 2020; 72:1547-1558. [PMID: 32249544 DOI: 10.1002/art.41272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The transforming growth factor β (TGFβ) inhibitor BAMBI (bone morphogenetic protein and activin membrane-bound inhibitor) has been shown to control differentiation of CD4+ T lymphocytes into either tolerogenic Treg cells or pathogenic Th17 cells, through the regulation of TGFβ and interleukin-2 (IL-2) signaling strength. The present study was undertaken to explore the potential beneficial effects of this strategy of pharmacologic inhibition using novel anti-BAMBI monoclonal antibodies (mAb) in different experimental murine models of chronic skin and joint inflammatory/autoimmune disease. METHODS Development of Saccharomyces cerevisiae mannan-induced psoriatic arthritis (MIP) (n = 18-30 mice per group), imiquimod-induced skin psoriasis (n = 20-30 mice per group), or type II collagen-induced arthritis (CIA) (n = 13-16 mice per group) was analyzed in a total of 2-5 different experiments with either wild-type (WT) or BAMBI-deficient B10.RIII mice that were left untreated or treated with mAb B101.37 (mouse IgG1 anti-BAMBI), a mouse IgG1 anti-TNP isotype control, anti-CD25, or anti-TGFβ mAb. RESULTS Treatment of normal mice with IgG1 anti-BAMBI mAb clone B101.37 led to expansion of Treg cells in vivo, and had both preventive and therapeutic effects in mice with MIP (each P < 0.05 versus controls). The conferred protection against disease progression was found to be mediated by Treg cells, which controlled the activation and expansion of pathogenic IL-17-producing cells, and was dependent on the level of TGFβ activity. Furthermore, treatment with B101.37 mAb blocked both the development of skin psoriasis induced by imiquimod and the development of CIA in mice (each P < 0.05 versus controls). Finally, pharmacologic inhibition of BAMBI with the IgM anti-BAMBI mAb B143.14 also potentiated the suppressive activity of Treg cells in vitro (P < 0.001 versus controls). CONCLUSION These results in murine models identify BAMBI as a promising new therapeutic target for chronic inflammatory diseases and other pathologic conditions modulated by Treg cells.
Collapse
Affiliation(s)
- Pilar Alvarez
- Instituto de Biomedicina y Biotecnología de Cantabria, CSIC-Universidad de Cantabria-SODERCAN, Santander, Spain
| | | | - Esther Tamayo
- IDIVAL and Universidad de Cantabria, Santander, Spain
| | | | - Olga Acinas
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | - Jesús Merino
- IDIVAL and Universidad de Cantabria, Santander, Spain
| | - Ramón Merino
- IDIVAL and Instituto de Biomedicina y Biotecnología de Cantabria, CSIC-Universidad de Cantabria-SODERCAN, Santander, Spain
| |
Collapse
|
21
|
Rodrigo E, Chedid MF, Segundo DS, Millán JCRS, López-Hoyos M. Acute Rejection Following Kidney Transplantation: State-of-the-Art and Future Perspectives. Curr Pharm Des 2020; 26:3468-3496. [PMID: 32520680 DOI: 10.2174/1381612826666200610184433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/02/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022]
Abstract
Although acute renal graft rejection rate has declined in the last years, and because an adequate therapy can improve graft outcome, its therapy remains as one of the most significant challenges for pharmacists and physicians taking care of transplant patients. Due to the lack of evidence highlighted by the available metaanalyses, we performed a narrative review focused on the basic mechanisms and current and future therapies of acute rejection in kidney transplantation. According to Kidney Disease/Improving Global Outcomes (KDIGO) guidelines, both clinical and subclinical acute rejection episodes should be treated. Usually, high dose steroids and basal immunosuppression optimization are the first line of therapy in treating acute cellular rejection. Rabbit antithymocytic polyclonal globulins are used as rescue therapy for recurrent or steroid-resistant cellular rejection episodes. Current standard-of-care (SOC) therapy for acute antibody-mediated rejection (AbMR) is the combination of plasma exchange with intravenous immunoglobulin (IVIG). Since a significant rate of AbMR does not respond to SOC, different studies have analyzed the role of new drugs such as Rituximab, Bortezomib, Eculizumab and C1 inhibitors. Lack of randomized controlled trials and heterogenicity among performed studies limit obtaining definite conclusions. Data about new direct and indirect B cell and plasma cell depleting agents, proximal and terminal complement blockers, IL-6/IL-6R pathway inhibitors and antibody removal agents, among other promising drugs, are reviewed.
Collapse
Affiliation(s)
- Emilio Rodrigo
- Nephrology Service, University Hospital Marques de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Marcio F Chedid
- Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clinicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - David San Segundo
- Immunology Service, University Hospital Marques de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Juan C R San Millán
- Nephrology Service, University Hospital Marques de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marques de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| |
Collapse
|
22
|
Irure-Ventura J, San Segundo D, Rodrigo E, Merino D, Belmar-Vega L, Ruiz San Millán JC, Valero R, Benito A, López-Hoyos M. High Pretransplant BAFF Levels and B-cell Subset Polarized towards a Memory Phenotype as Predictive Biomarkers for Antibody-Mediated Rejection. Int J Mol Sci 2020; 21:ijms21030779. [PMID: 31991734 PMCID: PMC7037386 DOI: 10.3390/ijms21030779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 01/05/2023] Open
Abstract
Antibody-mediated rejection (AbMR) is one of the leading causes of graft loss in kidney transplantation and B cells play an important role in the development of it. A B-cell activating factor (BAFF) is a cytokine involved in B cell ontogeny. Here, we analyzed whether B cell maturation and the effect of B cell soluble factors, such as BAFF could be involved in AbMR. Serum BAFF levels and B and T cell subpopulations were analyzed 109 kidney transplant patients before transplantation and at 6 and 12 months after kidney transplantation. Pretransplant serum BAFF levels as well as memory B cell subpopulations were significantly higher in those patients who suffered clinical AbMR during the first 12 months after kidney transplantation. Similar results were observed in the prospective analysis of patients with subclinical antibody-mediated rejection detected in the surveillance biopsy performed at 12 months after kidney transplantation. A multivariate analysis confirmed the independent role of BAFF in the development of AbMR, irrespective of other classical variables. Pretransplant serum BAFF levels could be an important non-invasive biomarker for the prediction of the development of AbMR and posttransplant increased serum BAFF levels contribute to AbMR.
Collapse
Affiliation(s)
- Juan Irure-Ventura
- Immunology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain; (J.I.-V.); (D.S.S.)
| | - David San Segundo
- Immunology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain; (J.I.-V.); (D.S.S.)
| | - Emilio Rodrigo
- Nephrology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain, (L.B.-V.); (J.C.R.S.M.); (R.V.)
| | - David Merino
- Health Research Institute-IDIVAL, 39011 Santander, Spain; (D.M.); (A.B.)
| | - Lara Belmar-Vega
- Nephrology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain, (L.B.-V.); (J.C.R.S.M.); (R.V.)
| | - Juan Carlos Ruiz San Millán
- Nephrology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain, (L.B.-V.); (J.C.R.S.M.); (R.V.)
| | - Rosalía Valero
- Nephrology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain, (L.B.-V.); (J.C.R.S.M.); (R.V.)
| | - Adalberto Benito
- Health Research Institute-IDIVAL, 39011 Santander, Spain; (D.M.); (A.B.)
| | - Marcos López-Hoyos
- Immunology Department. University Hospital Marqués de Valdecilla-IDIVAL, 39008 Santander, Spain; (J.I.-V.); (D.S.S.)
- Correspondence: (M.L.-H.); Tel.: +34-942-202520 (ext. 73225)
| |
Collapse
|
23
|
Irure J, Sango C, San Segundo D, Fernández-Fresnedo G, Ruiz JC, Benito-Hernández A, Asensio E, López-Hoyos M, Rodrigo E. Late Plasma Cell Depletion After Thymoglobulin Induction in Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2019; 17:732-738. [DOI: 10.6002/ect.2018.0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
24
|
Martín‐Penagos L, Benito‐Hernández A, San Segundo D, Sango C, Azueta A, Gómez‐Román J, Fernández‐Fresnedo G, López‐Hoyos M, Ruiz JC, Rodrigo E. A proliferation‐inducing ligand increase precedes IgA nephropathy recurrence in kidney transplant recipients. Clin Transplant 2019; 33:e13502. [DOI: 10.1111/ctr.13502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Luis Martín‐Penagos
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Adalberto Benito‐Hernández
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - David San Segundo
- Immunology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Cristina Sango
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Ainara Azueta
- Pathology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Javier Gómez‐Román
- Pathology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Gema Fernández‐Fresnedo
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Marcos López‐Hoyos
- Immunology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Juan C. Ruiz
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| | - Emilio Rodrigo
- Nephrology Service University Hospital Marqués de Valdecilla‐IDIVAL, University of Cantabria Santander Spain
| |
Collapse
|
25
|
Riesco L, Irure J, Rodrigo E, Guiral S, Ruiz JC, Gómez J, López-Hoyos M, San Segundo D. Anti-perlecan antibodies and acute humoral rejection in hypersensitized patients without forbidden HLA specificities after kidney transplantation. Transpl Immunol 2018; 52:53-56. [PMID: 30458294 DOI: 10.1016/j.trim.2018.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 07/26/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The improvement in the definition of serum anti-HLA antibodies (HLA-Abs) profiles after Luminex-assay implementation in transplant patients follow-up is clear. This success has permitted the development of hypersensitized-recipient allocation and donor-paired exchange programs improving the access to transplantation. However, non-HLA Abs have been described in transplanted patients but their effect in hypersensitized transplanted recipients is unclear. METHODS Twenty-seven HLA hypersensitized patients awaiting for kidney transplantation (KT) were studied and 11 of them were followed after KT. The HLA Abs profile was confirmed in serum by Single Antigen Luminex assay and panel reactive of antigens >98% was achieved in all patients. Subsequently, the ability to fix complement by C1q test was also assessed. Serum non-HLA Abs before and 1 month after transplantation were measured in the 11 hypersensitized recipients. RESULTS 95.2% of the hypersensitized on waiting list had concomitant serum anti-HLA and non-HLA Abs. The more frequent specificity in non-HLA Abs were found against Glutathione S-transferase theta-1 (GSST-1) (in 62%) and C-terminal fragment of perlecan (LG3) (in 52%). Four out of 11 transplanted patients presented early antibody-mediated rejection (ABMR) confirmed by biopsy and had serum anti-LG3 antibodies, two of them with concomitant anti-anti-angiotensin II type I receptor. Only one patient developed de novo-donor specific HLA antibodies. CONCLUSIONS The incidence of non-HLA antibodies in patients in the waiting list is largely underestimated. The concomitance anti-HLA and non-HLA Abs in hypersensitized patients is very common and the detection of non-HLA Abs in this population could allow to identify patients with an increased risk of humoral rejection.
Collapse
Affiliation(s)
- Laura Riesco
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| | - Juan Irure
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - Sandra Guiral
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| | - Juan Carlos Ruiz
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - Javier Gómez
- Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| | - David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| |
Collapse
|
26
|
Villarrubia N, Rodríguez-Martín E, Alari-Pahissa E, Aragón L, Castillo-Triviño T, Eixarch H, Ferrer JM, Martínez-Rodríguez JE, Massot M, Pinto-Medel MJ, Prada Á, Rodríguez-Acevedo B, Urbaneja P, Gascón-Gimenez F, Herrera G, Hernández-Clares R, Salgado MG, Oterino A, San Segundo D, Cuello JP, Gil-Herrera J, Cámara C, Gómez-Gutiérrez M, Martínez-Hernández E, Meca-Lallana V, Moga E, Muñoz-Calleja C, Querol L, Presas-Rodríguez S, Teniente-Serra A, Vlagea A, Muriel A, Roldán E, Villar LM. Multi-centre validation of a flow cytometry method to identify optimal responders to interferon-beta in multiple sclerosis. Clin Chim Acta 2018; 488:135-142. [PMID: 30408481 DOI: 10.1016/j.cca.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/23/2018] [Revised: 10/23/2018] [Accepted: 11/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Percentages of blood CD19+CD5+ B cells and CD8+perforin+ T lymphocytes can predict response to Interferon (IFN)-beta treatment in relapsing-remitting multiple sclerosis (RRMS) patients. We aimed to standardize their detection in a multicenter study, prior to their implementation in clinical practice. METHODS Fourteen hospitals participated in the study. A reference centre was established for comparison studies. Peripheral blood cells of 105 untreated RRMS patients were studied. Every sample was analyzed in duplicate in the participating centre and in the reference one by flow cytometry. When needed, participating centres corrected fluorescence compensations and negative cut-off position following reference centre suggestions. Concordance between results obtained by participating centres and by reference one was evaluated by intraclass correlation coefficients (ICC) and Spearman correlation test. Centre performance was measured by using z-scores values. RESULTS After results review and corrective actions implementation, overall ICC was 0.86 (CI: 0.81-0.91) for CD19+CD5+ B cell and 0.89 (CI: 0.85-0.93) for CD8+ perforin+ T cell quantification; Spearman r was 0.92 (0.89-0.95; p <0.0001) and 0.92 (0.88-0.95; p <0.0001) respectively. All centres obtained z-scores≤0.5 for both biomarkers. CONCLUSION Homogenous percentages of CD19+CD5+ B cells and CD8 perforin+ T lymphocytes can be obtained if suitable compensation values and negative cut-off are pre-established.
Collapse
Affiliation(s)
- Noelia Villarrubia
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Eulalia Rodríguez-Martín
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Elisenda Alari-Pahissa
- Immunology and Neurology Dpt., Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Carrer del Dr. Aiguader 88, 08003 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Larraitz Aragón
- Immunology and Neurology Dpt., Hospital Universitario de Donostia, Biodonostia, P° Dr. Beguiristain 107-111, 20014 San Sebastián, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Tamara Castillo-Triviño
- Immunology and Neurology Dpt., Hospital Universitario de Donostia, Biodonostia, P° Dr. Beguiristain 107-111, 20014 San Sebastián, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Herena Eixarch
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Joana María Ferrer
- Immunology and Neurology Dpt., Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears, IdISBa, Ctra. Valldemossa 79, Palma 07010, Spain
| | - José Enrique Martínez-Rodríguez
- Immunology and Neurology Dpt., Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Carrer del Dr. Aiguader 88, 08003 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Margarita Massot
- Immunology and Neurology Dpt., Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears, IdISBa, Ctra. Valldemossa 79, Palma 07010, Spain.
| | - María Jesús Pinto-Medel
- Clinical Management Unit of Neurosciences, Instituto de Biomedicina de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Plaza del Hospital Civil s/n., Málaga, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Álvaro Prada
- Immunology and Neurology Dpt., Hospital Universitario de Donostia, Biodonostia, P° Dr. Beguiristain 107-111, 20014 San Sebastián, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Cemcat, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Patricia Urbaneja
- Clinical Management Unit of Neurosciences, Instituto de Biomedicina de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Plaza del Hospital Civil s/n., Málaga, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - Francisco Gascón-Gimenez
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Av. de Blasco Ibáñez 17, 46010 València, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - Guadalupe Herrera
- Flow Cytometry Unit, UCIM, INCLIVA-Universidad de Valencia, Avda Blasco Ibañez 13, 46010 València, Spain
| | - Rocío Hernández-Clares
- Immunology and Neurology Dpt., Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - María Gema Salgado
- Immunology and Neurology Dpt., Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Agustín Oterino
- Immunology and Neurology Dpt., IDIVAL, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla 25, 39008 Santander, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - David San Segundo
- Immunology and Neurology Dpt., IDIVAL, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla 25, 39008 Santander, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Juan Pablo Cuello
- Immunology and Neurology Dpt., Hospital General Universitario and Instituto de Investigación Sanitaria "Gregorio Marañón", C/ Dr Esquerdo 46, 28007 Madrid, Spain.
| | - Juana Gil-Herrera
- Immunology and Neurology Dpt., Hospital General Universitario and Instituto de Investigación Sanitaria "Gregorio Marañón", C/ Dr Esquerdo 46, 28007 Madrid, Spain.
| | - Carmen Cámara
- Immunology and Neurology Dpt., Hospital San Pedro de Alcántara, Avda. Pablo Naranjo s/n, 10003 Cáceres, Spain.
| | - Montserrat Gómez-Gutiérrez
- Immunology and Neurology Dpt., Hospital San Pedro de Alcántara, Avda. Pablo Naranjo s/n, 10003 Cáceres, Spain
| | - Eugenia Martínez-Hernández
- Immunology and Neurology Dpt., Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Virginia Meca-Lallana
- Immunology and Neurology Dpt., Instituto de Investigación Sanitaria La Princesa, IIS-IP, Demyelinating Diseases Unit, Hospital Universitario de La Princesa, C/ Diego de León 62, 28006 Madrid, Spain
| | - Esther Moga
- Immunology and Neurology Dpt., Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Sant Antoni Maria Claret 167, 08025 Barcelona, Ciberer, Madrid, Spain.
| | - Cecilia Muñoz-Calleja
- Immunology and Neurology Dpt., Instituto de Investigación Sanitaria La Princesa, IIS-IP, Demyelinating Diseases Unit, Hospital Universitario de La Princesa, C/ Diego de León 62, 28006 Madrid, Spain.
| | - Luis Querol
- Immunology and Neurology Dpt., Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Sant Antoni Maria Claret 167, 08025 Barcelona, Ciberer, Madrid, Spain.
| | - Silvia Presas-Rodríguez
- Immunology and Neurology Dpt., Multiple Sclerosis Unit, Hospital Universitario e Instituto de Investigación Germans Trias i Pujol, Campus Can Ruti, 08916 Badalona, Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - Aina Teniente-Serra
- Immunology and Neurology Dpt., Multiple Sclerosis Unit, Hospital Universitario e Instituto de Investigación Germans Trias i Pujol, Campus Can Ruti, 08916 Badalona, Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Alexandru Vlagea
- Immunology and Neurology Dpt., Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.
| | - Alfonso Muriel
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain.
| | - Ernesto Roldán
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| | - Luisa María Villar
- Immunology Dpt. and Biostatistic Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km 9.100, 28034 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
| |
Collapse
|
27
|
Herrera-Gómez F, Del Aguila W, Tejero-Pedregosa A, Adler M, Padilla-Berdugo R, Maurtua-Briseño-Meiggs Á, Pascual J, Pascual M, San Segundo D, Heidt S, Álvarez FJ, Ochoa-Sangrador C, Lambert C. The number of FoxP3 regulatory T cells in the circulation may be a predictive biomarker for kidney transplant recipients: A multistage systematic review. Int Immunopharmacol 2018; 65:483-492. [PMID: 30390595 DOI: 10.1016/j.intimp.2018.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 09/08/2018] [Revised: 10/10/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The kinetics of the FoxP3 regulatory T-cell (Treg) population in kidney transplant recipients (KTR) are related to the clinical effect of immunosuppression based on mammalian Target Of Rapamycin inhibitors (mTORi) with/without belatacept (predictive biomarker). METHODS A multistage systematic review of published and unpublished literature is presented [registration IDs in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42017057570, CRD42018085019, CRD42018084941, CRD42018085186]. A multidisciplinary supervision mechanism for contextualizing of search findings was required. The peripheral blood immune cell phenotypes encompassing all regulatory cells in KTRs were assessed in order to suggest new markers of acute rejection-associated acute allograft dysfunction (AR/AAD) events in KTRs treated with mTORi alone or combined to belatacept. Quantitative estimates and evaluation of the body of evidence are provided. RESULTS An increase in Tregs and other regulatory cell types in the circulation in KTRs under mTORi with/without belatacept were observed. Patients with increased Tregs presented a low frequency of AR/AAD events compared to those in which the number of Tregs remained unchanged or even diminished [Odds Ratio (OR)/95% confidence interval (95% CI)/I2/number of studies (n): 0.31/0.10-0.93/0%/6]. Nevertheless, there are too few trials to consider Tregs in the circulation as a predictive biomarker. Inadequate reporting prevents appreciating clinical relevance in such studies. CONCLUSIONS Despite advances, clinical qualification of potential predictive biomarkers continues to be difficult. Clinical evidence on Tregs in KTRs needs to be enlarged. Biomarkers should be able to evaluate the effect of medicines targeted to specific patient populations.
Collapse
Affiliation(s)
- Francisco Herrera-Gómez
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain; Department of Nephrology, Hospital Virgen de la Concha, Sanidad de Castilla y León, Zamora, Spain.
| | | | - Armando Tejero-Pedregosa
- Intensive Care Medicine, Hospital Virgen de la Concha, Sanidad de Castilla y León, Zamora, Spain
| | - Marcel Adler
- Hematology, University Hospital of Basel, Basel, Switzerland
| | - Rosario Padilla-Berdugo
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | | | | | - Manuel Pascual
- Centre de Transplantation d'Organes, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - David San Segundo
- Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Sebastiaan Heidt
- Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.
| | - F Javier Álvarez
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain; CEIm Área de Salud Valladolid Este, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | | | - Claude Lambert
- Immunology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest-en-Jarez, France
| |
Collapse
|
28
|
Riesco L, Irure J, Palomar R, Piñera C, Rodrigo E, López-Hoyos M, Segundo DS. Unmasking Uncertain Results after Anti-HLA Antibody Screening in Patients on Waiting List. Transplantation 2018. [DOI: 10.1097/01.tp.0000542871.84644.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Lázaro-Díez M, Chapartegui-González I, Redondo-Salvo S, Leigh C, Merino D, Segundo DS, Fernández A, Navas J, Icardo JM, Acosta F, Ocampo-Sosa A, Martínez-Martínez L, Ramos-Vivas J. Human neutrophils phagocytose and kill Acinetobacter baumannii and A. pittii. Sci Rep 2017; 7:4571. [PMID: 28676640 PMCID: PMC5496873 DOI: 10.1038/s41598-017-04870-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/22/2017] [Indexed: 12/23/2022] Open
Abstract
Acinetobacter baumannii is a common cause of health care associated infections worldwide. A. pittii is an opportunistic pathogen also frequently isolated from Acinetobacter infections other than those from A. baumannii. Knowledge of Acinetobacter virulence factors and their role in pathogenesis is scarce. Also, there are no detailed published reports on the interactions between A. pittii and human phagocytic cells. Using confocal laser and scanning electron microscopy, immunofluorescence, and live-cell imaging, our study shows that immediately after bacteria-cell contact, neutrophils rapidly and continuously engulf and kill bacteria during at least 4 hours of infection in vitro. After 3 h of infection, neutrophils start to release neutrophil extracellular traps (NETs) against Acinetobacter. DNA in NETs colocalizes well with human histone H3 and with the specific neutrophil elastase. We have observed that human neutrophils use large filopodia as cellular tentacles to sense local environment but also to detect and retain bacteria during phagocytosis. Furthermore, co-cultivation of neutrophils with human differentiated macrophages before infections shows that human neutrophils, but not macrophages, are key immune cells to control Acinetobacter. Although macrophages were largely activated by both bacterial species, they lack the phagocytic activity demonstrated by neutrophils.
Collapse
Affiliation(s)
- María Lázaro-Díez
- Instituto de Investigación Valdecilla IDIVAL, Santander, 39011, Spain
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, 39008, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Itziar Chapartegui-González
- Instituto de Investigación Valdecilla IDIVAL, Santander, 39011, Spain
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, 39008, Spain
| | | | - Chike Leigh
- New York University School of Medicine, New York, 10003, USA
| | - David Merino
- Instituto de Investigación Valdecilla IDIVAL, Santander, 39011, Spain
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, 39008, Spain
| | - David San Segundo
- Instituto de Investigación Valdecilla IDIVAL, Santander, 39011, Spain
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, 39008, Spain
| | - Adrián Fernández
- Instituto de Investigación Valdecilla IDIVAL, Santander, 39011, Spain
| | - Jesús Navas
- Instituto de Investigación Valdecilla IDIVAL, Santander, 39011, Spain
- Departamento de Biología Molecular, Universidad de Cantabria, Santander, 39011, Spain
| | - José Manuel Icardo
- Departamento de Anatomía y Biología Celular, Universidad de Cantabria, Santander, 39011, Spain
| | - Félix Acosta
- Grupo de Investigación en Acuicultura, Universidad de Las Palmas de Gran Canaria, Gran Canaria, 35214, Spain
| | - Alain Ocampo-Sosa
- Instituto de Investigación Valdecilla IDIVAL, Santander, 39011, Spain
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, 39008, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Luis Martínez-Martínez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, Córdoba, 14004, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, 14004, Spain
| | - José Ramos-Vivas
- Instituto de Investigación Valdecilla IDIVAL, Santander, 39011, Spain.
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, 39008, Spain.
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, 28029, Spain.
| |
Collapse
|
30
|
Asensio E, López-Hoyos M, Romón Í, Ontañón J, San Segundo D. Assessment of Spanish Panel Reactive Antibody Calculator and Potential Usefulness. Front Immunol 2017; 8:540. [PMID: 28553286 PMCID: PMC5425465 DOI: 10.3389/fimmu.2017.00540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background and objectives The calculated panel reactive of antibodies (cPRAs) necessary for kidney donor-pair exchange and highly sensitized programs are estimated using different panel reactive antibody (PRA) calculators based on big enough samples in Eurotransplant (EUTR), United Network for Organ Sharing (UNOS), and Canadian Transplant Registry (CTR) websites. However, those calculators can vary depending on the ethnic they are applied. Here, we develop a PRA calculator used in the Spanish Program of Transplant Access for Highly Sensitized patients (PATHI) and validate it with EUTR, UNOS, and CTR calculators. Methods The anti-human leukocyte antigen (HLA) antibody profile of 42 sensitized patients on waiting list was defined, and cPRA was calculated with different PRA calculators. Results Despite different allelic frequencies derived from population differences in donor panel from each calculator, no differences in cPRA between the four calculators were observed. The PATHI calculator includes anti-DQA1 antibody profiles in cPRA calculation; however, no improvement in total cPRA calculation of highly sensitized patients was demonstrated. Interpretation and conclusion The PATHI calculator provides cPRA results comparable with those from EUTR, UNOS, and CTR calculators and serves as a tool to develop valid calculators in geographical and ethnic areas different from Europe, USA, and Canada.
Collapse
Affiliation(s)
- Esther Asensio
- Immunology Service, Marqués de Valdecilla Universitary Hospital-IDIVAL, Santander, Cantabria, Spain.,Tissue Typing Laboratory, Marqués de Valdecilla Universitary Hospital-IDIVAL, Santander, Cantabria, Spain
| | - Marcos López-Hoyos
- Immunology Service, Marqués de Valdecilla Universitary Hospital-IDIVAL, Santander, Cantabria, Spain.,Tissue Typing Laboratory, Marqués de Valdecilla Universitary Hospital-IDIVAL, Santander, Cantabria, Spain
| | - Íñigo Romón
- Tissue Typing Laboratory, Marqués de Valdecilla Universitary Hospital-IDIVAL, Santander, Cantabria, Spain
| | - Jesús Ontañón
- Immunology, Universitary Hospital of Albacete, Castilla la Mancha, Spain
| | - David San Segundo
- Immunology Service, Marqués de Valdecilla Universitary Hospital-IDIVAL, Santander, Cantabria, Spain.,Tissue Typing Laboratory, Marqués de Valdecilla Universitary Hospital-IDIVAL, Santander, Cantabria, Spain
| |
Collapse
|
31
|
Irure J, Asensio E, Rodrigo E, Romón Í, Gómez J, Arias M, López-Hoyos M, San Segundo D. Improvement in the definition of anti-HLA antibody profile in highly sensitized patients. PLoS One 2017; 12:e0171463. [PMID: 28158255 PMCID: PMC5291387 DOI: 10.1371/journal.pone.0171463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/20/2017] [Indexed: 11/20/2022] Open
Abstract
The definition of anti-HLA antibody profile in highly sensitized patients on a waiting list is crucial when virtual crossmatch is used in organ allocation systems, but also when used to identify the true deleterious anti-HLA antibodies. Here we propose different levels of risk based on the results of anti-HLA antibody testing in neat serum (N) and after sera dilution (DIL) and C1q test in 18 highly sensitized patients. This group was heterogeneous in terms of anti-HLA antibody titers and their ability to fix complement. After dilution, 15 out of 18 patients (83.3%) showed a reduction of positive bead counts whereas 4 patients showed a prozone effect and complement fixation was demonstrated. The high dilution of sera and ascertaining the complement fixation allow the accurate definition of risk anti-HLA antibody profiles in highly sensitized patients, as demonstrated in 5 of the sensitized patients who were transplanted.
Collapse
Affiliation(s)
- Juan Irure
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Esther Asensio
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Íñigo Romón
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Javier Gómez
- Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Manuel Arias
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
- * E-mail:
| |
Collapse
|
32
|
Arias-Loste MT, Iruzubieta P, Puente Á, Ramos D, Santa Cruz C, Estébanez Á, Llerena S, Alonso-Martín C, San Segundo D, Álvarez L, López Useros A, Fábrega E, López-Hoyos M, Crespo J. Increased Expression Profile and Functionality of TLR6 in Peripheral Blood Mononuclear Cells and Hepatocytes of Morbidly Obese Patients with Non-Alcoholic Fatty Liver Disease. Int J Mol Sci 2016; 17:ijms17111878. [PMID: 27834919 PMCID: PMC5133878 DOI: 10.3390/ijms17111878] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 01/21/2023] Open
Abstract
Current evidence suggests that gut dysbiosis drives obesity and non-alcoholic fatty liver disease (NAFLD) pathogenesis. Toll-like receptor 2 (TLR2) and TLR6 specifically recognize components of Gram-positive bacteria. Despite the potential implications of TLR2 in NAFLD pathogenesis, the role of TLR6 has not been addressed. Our aim is to study a potential role of TLR6 in obesity-related NAFLD. Forty morbidly obese patients undergoing bariatric surgery were prospectively studied. Cell surface expression of TLR2 and TLR6 was assessed on peripheral blood mononuclear cells (PBMCs) by flow cytometry. Freshly isolated monocytes were cultured with specific TLR2/TLR6 agonists and intracellular production of cytokines was determined by flow-cytometry. In liver biopsies, the expression of TLR2 and TLR6 was analyzed by immunohistochemistry and cytokine gene expression using RT-qPCR. TLR6 expression in PBMCs from non-alcoholic steatohepatitis (NASH) patients was significantly higher when compared to those from simple steatosis. The production of pro-inflammatory cytokines in response to TLR2/TLR6 stimulation was also significantly higher in patients with lobular inflammation. Hepatocyte expression of TLR6 but not that of TLR2 was increased in NAFLD patients compared to normal liver histology. Deregulated expression and activity of peripheral TLR6 in morbidly obese patients can mirror the liver inflammatory events that are well known drivers of obesity-related NASH pathogenesis. Moreover, TLR6 is also significantly overexpressed in the hepatocytes of NAFLD patients compared to their normal counterparts. Thus, deregulated TLR6 expression may potentiate TLR2-mediated liver inflammation in NAFLD pathogenesis, and also serve as a potential peripheral biomarker of obesity-related NASH.
Collapse
Affiliation(s)
- María Teresa Arias-Loste
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| | - Paula Iruzubieta
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| | - Ángela Puente
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| | - David Ramos
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| | - Carolina Santa Cruz
- Transplant and Autoimmunity Group, Research Institute Marqués de Valdecilla (IDIVAL), 39008 Santander, Spain.
| | - Ángel Estébanez
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| | - Susana Llerena
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| | - Carmen Alonso-Martín
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| | - David San Segundo
- Transplant and Autoimmunity Group, Research Institute Marqués de Valdecilla (IDIVAL), 39008 Santander, Spain.
- Immunology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
| | - Lorena Álvarez
- Transplant and Autoimmunity Group, Research Institute Marqués de Valdecilla (IDIVAL), 39008 Santander, Spain.
| | - Antonio López Useros
- General Surgery Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
| | - Emilio Fábrega
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| | - Marcos López-Hoyos
- Transplant and Autoimmunity Group, Research Institute Marqués de Valdecilla (IDIVAL), 39008 Santander, Spain.
- Immunology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain.
- Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), 390008 Santander, Spain.
| |
Collapse
|
33
|
Merino D, San Segundo D, Medina JM, Rodrigo E, Asensio E, Irure J, Fernández-Fresnedo G, Arias MA, López-Hoyos M. Different in vitro proliferation and cytokine-production inhibition of memory T-cell subsets after calcineurin and mammalian target of rapamycin inhibitors treatment. Immunology 2016; 148:206-15. [PMID: 26931075 DOI: 10.1111/imm.12603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 07/09/2015] [Revised: 02/10/2016] [Accepted: 02/24/2016] [Indexed: 12/14/2022] Open
Abstract
Calcineurin inhibitors (CNI) and mammalian target of rapamycin inhibitors (mTORi) are the main immunosuppressants used for long-term maintenance therapy in transplant recipients to avoid acute rejection episodes. Both groups of immunosuppressants have wide effects and are focused against the T cells, although different impacts on specific T-cell subsets, such as regulatory T cells, have been demonstrated. A greater knowledge of the impact of immunosuppression on the cellular components involved in allograft rejection could facilitate decisions for individualized immunosuppression when an acute rejection event is suspected. Memory T cells have recently gained focus because they might induce a more potent response compared with naive cells. The impact of immunosuppressants on different memory T-cell subsets remains unclear. In the present study, we have studied the specific impact of CNI (tacrolimus) and mTORi (rapamycin and everolimus) over memory and naive CD4(+) T cells. To do so, we have analysed the proliferation, phenotypic changes and cytokine synthesis in vitro in the presence of these immunosuppressants. The present work shows a more potent effect of CNI on proliferation and cytokine production in naive and memory T cells. However, the mTORi permit the differentiation of naive T cells to the memory phenotype and allow the production of interleukin-2. Taken together, our data show evidence to support the combined use of CNI and mTORi in transplant immunosuppression.
Collapse
Affiliation(s)
- David Merino
- Autoimmunity and Transplant Group-IDIVAL, Santander, Spain
| | - David San Segundo
- Immunology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Juan M Medina
- Autoimmunity and Transplant Group-IDIVAL, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Esther Asensio
- Immunology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Juan Irure
- Immunology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Manuel A Arias
- Nephrology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| |
Collapse
|
34
|
Boix F, Millan O, San Segundo D, Mancebo E, Rimola A, Fabrega E, Fortuna V, Mrowiec A, Castro-Panete MJ, Peña JDL, Llorente S, Minguela A, Bolarin JM, Paz-Artal E, Lopez-Hoyos M, Brunet M, Muro M. High expression of CD38, CD69, CD95 and CD154 biomarkers in cultured peripheral T lymphocytes correlates with an increased risk of acute rejection in liver allograft recipients. Immunobiology 2016; 221:595-603. [PMID: 26850323 DOI: 10.1016/j.imbio.2016.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023]
Abstract
The mayor goal still outstanding into the solid organ transplantation field involves the search of surrogate biomarkers able to predict several clinical events, such as acute rejection (AR) or opportunistic infection. In the present multicenter study, a series of interesting surface antigens with important activator or inhibitory immune functions on cultured peripheral T cells were monitored in liver transplant recipients drawn at baseline and up to one year after transplantation. Sixty-four patients were included in the multicenter study during 3 years. Pre- and post-transplantation surface antigens levels displayed significant differences between AR and non acute rejection (NAR) groups, and also this differential expression was used to construct a risk predictive model based on a composite panel of outcome biomarkers (CD38, CD69, CD95 and CD154). The model was able to stratify these patients at high risk of AR. These preliminary results could provide basic information to improve the immunosuppressive treatment and it might better help to predict AR episodes.
Collapse
Affiliation(s)
- Francisco Boix
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain
| | - Olga Millan
- Pharmacology and Toxicology, Biomedical Diagnostic Center, IDIBAPS, Clinic Hospital, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - David San Segundo
- Immunology Service, University Hospital ́Marques Valdecillá-IDIVAL, Santander, Spain
| | - Esther Mancebo
- Investigation Institute ́12 de Octubré, Immunology Service, Hospital ́12 de Octubré, Medicine Faculty, Complutense University, Madrid, Spain
| | - Antoni Rimola
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Liver Unit, Biomedical Diagnostic Center, IDIBAPS, Clinic Hospital, Barcelona, Spain
| | - Emilio Fabrega
- Digestive Medicine, University Hospital ́Marques de Valdecillá-IDIVAL, Santander, Spain
| | - Virginia Fortuna
- Pharmacology and Toxicology, Biomedical Diagnostic Center, IDIBAPS, Clinic Hospital, Barcelona, Spain
| | - Anna Mrowiec
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain
| | - Maria J Castro-Panete
- Investigation Institute ́12 de Octubré, Immunology Service, Hospital ́12 de Octubré, Medicine Faculty, Complutense University, Madrid, Spain
| | - Jesus de la Peña
- Pathology Service, Clinical University Hospital ́Virgen de la Arrixacá, Murcia, Spain
| | - Santiago Llorente
- Nephrology Service, Clinical University Hospital ́Virgen de la Arrixacá, Murcia, Spain
| | - Alfredo Minguela
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Jose M Bolarin
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain
| | - Estela Paz-Artal
- Investigation Institute ́12 de Octubré, Immunology Service, Hospital ́12 de Octubré, Medicine Faculty, Complutense University, Madrid, Spain
| | - Marcos Lopez-Hoyos
- Immunology Service, University Hospital ́Marques Valdecillá-IDIVAL, Santander, Spain
| | - Mercé Brunet
- Pharmacology and Toxicology, Biomedical Diagnostic Center, IDIBAPS, Clinic Hospital, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Manuel Muro
- Immunology Service, Clinical University Hospital ́Virgen de la Arrixacá-IMIB (Murcian Institute of Biomedical Investigation), Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
| |
Collapse
|
35
|
Mancebo E, Castro MJ, Allende LM, Talayero P, Brunet M, Millán O, Guirado L, López-Hoyos M, San Segundo D, Rodrigo E, Muñoz P, Boix Giner F, Llorente Viñas S, Muro-Amador M, Paz-Artal E. High proportion of CD95(+) and CD38(+) in cultured CD8(+) T cells predicts acute rejection and infection, respectively, in kidney recipients. Transpl Immunol 2016; 34:33-41. [PMID: 26773856 DOI: 10.1016/j.trim.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 10/13/2015] [Revised: 12/14/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to find noninvasive T-cell markers able to predict rejection or infection risk after kidney transplantation. We prospectively examined T-lymphocyte subsets after cell culture stimulation (according to CD38, CD69, CD95, CD40L, and CD25 expression) in 79 first graft recipients from four centers, before and after transplantation. Patients were followed up for one year. Patients who rejected within month-1 (n=10) showed high pre-transplantation and week-1 post-transplantation percentages of CD95(+), in CD4(+) and CD8(+) T-cells (P<0.001 for all comparisons). These biomarkers conferred independent risk for early rejection (HR:5.05, P=0.061 and HR:75.31, P=0.004; respectively). The cut-off values were able to accurately discriminate between rejectors and non-rejectors and Kaplan-Meier curves showed significantly different free-of-rejection time rates (P<0.005). Patients who rejected after the month-1 (n=4) had a higher percentage of post-transplantation CD69(+) in CD8(+) T-cells than non-rejectors (P=0.002). Finally, patients with infection (n=41) previously showed higher percentage of CD38(+) in CD8(+) T-cells at all post-transplantation times evaluated, being this increase more marked in viral infections. A cut-off of 59% CD38(+) in CD8(+) T-cells at week-1, week-2 and month-2 reached 100% sensitivity for the detection of subsequent viral infections. In conclusion, predictive biomarkers of rejection and infection risk after transplantation were detected that could be useful for the personalized care of kidney recipients.
Collapse
Affiliation(s)
- Esther Mancebo
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - María José Castro
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luís M Allende
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Paloma Talayero
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mercè Brunet
- Farmacología y Toxicología, Centro de Diagnóstico Biomédico, IDIBAPS, Hospital Clínico, Universidad de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Olga Millán
- Farmacología y Toxicología, Centro de Diagnóstico Biomédico, IDIBAPS, Hospital Clínico, Universidad de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Luís Guirado
- Unidad de Trasplante Renal, Servicio de Nefrología, Fundación Puigvert, Barcelona, Spain
| | - Marcos López-Hoyos
- Inmunología, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain. REDINREN-ISCIII (RD12/0021/007)
| | - David San Segundo
- Inmunología, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain. REDINREN-ISCIII (RD12/0021/007)
| | - Emilio Rodrigo
- Nefrología, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain. REDINREN-ISCIII (RD12/0021/007)
| | - Pedro Muñoz
- Gerencia de Atención Primaria. Servicio Cántabro de Salud, Santander, Spain
| | - Francisco Boix Giner
- Servicio de Inmunología, Hospital Clínico Universitario Virgen Arrixaca-IMIB, Murcia, Spain
| | | | - Manuel Muro-Amador
- Servicio de Inmunología, Hospital Clínico Universitario Virgen Arrixaca-IMIB, Murcia, Spain
| | - Estela Paz-Artal
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
36
|
Cuadrado A, San Segundo D, López-Hoyos M, Crespo J, Fábrega E. Clinical significance of donor-specific human leukocyte antigen antibodies in liver transplantation. World J Gastroenterol 2015; 21:11016-11026. [PMID: 26494958 PMCID: PMC4607901 DOI: 10.3748/wjg.v21.i39.11016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/29/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Antibody-mediated rejection (AMR) caused by donor-specific anti-human leukocyte antigen antibodies (DSA) is widely accepted to be a risk factor for decreased graft survival after kidney transplantation. This entity also plays a pathogenic role in other solid organ transplants as it appears to be an increasingly common cause of heart graft dysfunction and an emerging issue in lung transplantation. In contrast, the liver appears relatively resistant to DSA-mediated injury. This “immune-tolerance” liver property has been sustained by a low rate of liver graft loss in patients with preformed DSA and by the intrinsic liver characteristics that favor the absorption and elimination of DSA; however, alloantibody-mediated adverse consequences are increasingly being recognized, and several cases of acute AMR after ABO-compatible liver transplant (LT) have been reported. Furthermore, the availability of new solid-phase assays, allowing the detection of low titers of DSA and the refinement of objective diagnostic criteria for AMR in solid organ transplants and particularly in LT, have improved the recognition and management of this entity. A cost-effective strategy of DSA monitoring, avoidance of class II human leukocyte antigen mismatching, judicious immunosuppression attached to a higher level of clinical suspicion of AMR, particularly in cases unresponsive to conventional anti-rejection therapy, can allow a rational approach to this threat.
Collapse
|
37
|
Boix-Giner F, Millan O, San Segundo D, Muñoz-Cacho P, Mancebo E, Llorente S, Rafael-Valdivia L, Rimola A, Fábrega E, Mrowiec A, Allende L, Minguela A, Bolarín JM, Paz-Artal E, López-Hoyos M, Brunet M, Muro M. High frequency of central memory regulatory T cells allows detection of liver recipients at risk of early acute rejection within the first month after transplantation. Int Immunol 2015; 28:55-64. [PMID: 26270267 DOI: 10.1093/intimm/dxv048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 05/28/2015] [Accepted: 08/06/2015] [Indexed: 02/06/2023] Open
Abstract
Several studies have analyzed the potential of T regulatory cells (Treg cells) as biomarkers of acute rejection (AR). The aim of the present multicenter study was to correlate the percentage of peripheral Treg cells in liver graft recipients drawn at baseline up to 12 months after transplantation with the presence of AR. The percentage of central memory (cm) Treg cells (CD4(+)CD25(high)CD45RO(+)CD62L(+)) was monitored at pre-transplant and at 1 and 2 weeks, and 1, 2, 3 and 6 months and 1 year post-transplantation. The same validation standard operating procedures were used in all participating centers. Fifteen patients developed AR (23.4%). Hepatitis C virus recurrence was observed in 16 recipients, who displayed low peripheral blood cmTreg levels compared with patients who did not. A steady increase of cmTregs was observed during the first month after transplantation with statistically significant differences between AR and non-AR patients. The high frequency of memory Treg cells allowed us to monitor rejection episodes during the first month post-transplantation. On the basis of these data, we developed a prediction model for assessing risk of AR that can provide clinicians with useful information for managing patients individually and customizing immunosuppressive therapies.
Collapse
Affiliation(s)
- Francisco Boix-Giner
- Servicio de Inmunología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Olga Millan
- Farmacología y Toxicología, Centro de Diagnóstico Biomédico, IDIBAPS, Hospital Clínico, Universidad de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - David San Segundo
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Pedro Muñoz-Cacho
- Servicio de Epidemiologia, Gerencia de Atención Primaria-IFIMAV, Santander, Spain
| | - Esther Mancebo
- Servicio de Inmunología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Santiago Llorente
- Servicio de Nefrologia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Antoni Rimola
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain Unidad de Hígado, Hospital Clínico, IDIBAPS, Barcelona, Spain
| | - Emilio Fábrega
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Anna Mrowiec
- Servicio de Inmunología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Luis Allende
- Servicio de Inmunología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alfredo Minguela
- Servicio de Inmunología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Jose M Bolarín
- Servicio de Inmunología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Estela Paz-Artal
- Servicio de Inmunología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marcos López-Hoyos
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Mercé Brunet
- Farmacología y Toxicología, Centro de Diagnóstico Biomédico, IDIBAPS, Hospital Clínico, Universidad de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Manuel Muro
- Servicio de Inmunología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| |
Collapse
|
38
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Juan Carlos Ruiz San Millán
- Nephrology Department, Hospital Universitario Marqués de Valdecilla-IFIMAV, Universidad de Cantabria, Santander, Spain
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Rodrigo E, López-Hoyos M, Corral M, Fábrega E, Fernández-Fresnedo G, San Segundo D, Piñera C, Arias M. ImmuKnow as a diagnostic tool for predicting infection and acute rejection in adult liver transplant recipients: a systematic review and meta-analysis. Liver Transpl 2012; 18:1245-53. [PMID: 22740321 DOI: 10.1002/lt.23497] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Immune status monitoring of transplant recipients could identify patients at risk of acute rejection, infection, and cancer, which are important sources of morbidity and mortality in these patients. The ImmuKnow assay provides an objective assessment of the cellular immune function of immunosuppressed patients. Inconclusive results concerning the ability of the ImmuKnow test to predict acute rejection and infection have raised concerns about the predictive value of ImmuKnow in liver transplant recipients. We conducted a systematic literature review to identify studies published up to March 2012 that documented the use of ImmuKnow for monitoring immune function in liver transplant recipients. The study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 score. We identified 5 studies analyzing ImmuKnow performance for infection and 5 studies analyzing ImmuKnow performance for acute rejection. The pooled sensitivity, specificity, positive likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve were 83.8% [95% confidence interval (CI) = 78.5%-88.3%], 75.3% (95% CI = 70.9%-79.4%), 3.3 (95% CI = 2.8-4.0), 14.6 (95% CI = 9.6-22.3), and 0.824 ± 0.034, respectively, for infection and 65.6% (95% CI = 55.0%-75.1%), 80.4% (95% CI = 76.4%-83.9%), 3.4 (95% CI = 2.4-4.7), 8.8 (95% CI = 3.1-24.8), and 0.835 ± 0.060, respectively, for acute rejection. Heterogeneity was low for infection studies and high for acute rejection studies. In conclusion, the ImmuKnow test is a valid tool for determining the risk of further infection in adult liver transplant recipients. Significant heterogeneity across studies precludes the conclusion that ImmuKnow identifies liver transplant patients at risk for rejection.
Collapse
Affiliation(s)
- Emilio Rodrigo
- Nephrology Service, Marqués de Valdecilla University Hospital, University of Cantabria, Institute for Training and Research of the Marqués de Valdecilla Foundation, Santander, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Heidt S, San Segundo D, Shankar S, Mittal S, Muthusamy ASR, Friend PJ, Fuggle SV, Wood KJ. Peripheral blood sampling for the detection of allograft rejection: biomarker identification and validation. Transplantation 2011; 92:1-9. [PMID: 21494177 DOI: 10.1097/tp.0b013e318218e978] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Currently, acute allograft rejection can only be detected reliably by deterioration of graft function confirmed by allograft biopsy. A huge drawback of this method of diagnosis is that substantial organ damage has already taken place at the time that rejection is diagnosed. Discovering and validating noninvasive biomarkers that predict acute rejection, and chronic allograft dysfunction, is of great importance. Many studies have investigated changes in the peripheral blood in an attempt to find biomarkers that reflect changes in the graft directly or indirectly. Herein, we will review the promises and limitations of the peripheral blood biomarkers that have been described in the literature so far.
Collapse
Affiliation(s)
- Sebastiaan Heidt
- Transplant Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Heidt S, Shankar S, Muthusamy ASR, San Segundo D, Wood KJ. Pretransplant serum CXCL9 and CXCL10 levels fail to predict acute rejection in kidney transplant recipients receiving induction therapy. Transplantation 2011; 91:e59-61. [PMID: 21475065 DOI: 10.1097/tp.0b013e318210de6b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
42
|
Segundo DS, Fernández-Fresnedo G, Gago M, Beares I, Ruiz-Criado J, González M, Ruiz JC, Gómez-Alamillo C, López-Hoyos M, Arias M. Kidney transplant recipients show an increase in the ratio of T-cell effector memory/central memory as compared to nontransplant recipients on the waiting list. Transplant Proc 2011; 42:2877-9. [PMID: 20970557 DOI: 10.1016/j.transproceed.2010.07.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Studies of allotolerance in animal models do not usually consider the presence of preexisting memory T cells and activated immune status. However, humans are exposed throughout life to a multitude of external agents that enhance the immune memory. In this article, we consider the effect that a previous kidney transplant has on the number of regulatory T cells (Tregs), effector memory T cells (TEM), and central memory T cells (TCM). Sixty-three patients with end-stage renal disease were studied just before being transplanted (51 first transplants and 12 retransplants). The numbers of Tregs (CD4+ CD25highCD127lowCD27+CD62L+CD45RO+FOXP3+), TEM (CD3+CD45RO+CD62L+), and TCM (CD3+CD45RO+CD62L-) cell subsets were quantified in peripheral blood by flow cytometry. The absolute number of Tregs was slightly lower in patients with previous allografts (median, 95% confidence interval [CI]: 16.7 cells/mm3, 12-20.5) than in those who received their first transplants (median, 95% CI: 19.6 cells/mm3, 19.3-29.6; P-NS). Clearer differences were found with the number of CD3+ TCM, since the transplanted patients had lower numbers (238 cells/mm3, 153-323) than those who had not yet received transplants (378 cells/mm3, 317-439; P=.029). As a result, the TEM/TCM ratios of both CD4+ and CD8+ T cells in patients with previous allografts were higher than in those who received first transplants. In conclusion, the assessment of just the number of Tregs in renal transplant patients is not enough and must be read together with the number of TEM and TCM. The TEM:TCM ratio increases in patients with previous allografts, probably due to activation of the immune response in renal transplantation.
Collapse
Affiliation(s)
- D S Segundo
- Servicio Inmunología, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Carroll RP, Segundo DS, Hollowood K, Marafioti T, Clark TG, Harden PN, Wood KJ. Immune phenotype predicts risk for posttransplantation squamous cell carcinoma. J Am Soc Nephrol 2010; 21:713-22. [PMID: 20110382 DOI: 10.1681/asn.2009060669] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cutaneous squamous cell cancer (SCC) affects up to 30% of kidney transplant recipients (KTRs) within 10 years of transplantation. There are no reliable clinical tests that predict those who will develop multiple skin cancers. High numbers of regulatory T cells associate with poor prognosis for patients with cancer in the general population, suggesting their potential as a predictive marker of cutaneous SCC in KTRs. We matched KTRs with (n = 65) and without (n = 51) cutaneous SCC for gender, age, and duration of immunosuppression and assessed several risk factors for incident SCC during a median follow-up of 340 days. Greater than 35 peripheral FOXP3(+)CD4(+)CD127(low) regulatory T cells/microl, <100 natural killer cells/microl, and previous SCC each significantly associated with increased risk for new cutaneous SCC development (hazard ratio [HR] 2.48 [95% confidence interval (CI) 1.04 to 5.98], HR 5.6 [95% CI 1.31 to 24], and HR 1.33 [95% CI 1.15 to 1.53], respectively). In addition, the ratio of CD8/FOXP3 expression was significantly lower in cutaneous SCC excised from KTRs (n = 25) compared with matched SCC from non-KTRs (n = 25) and associated with development of new cutaneous SCCs. In summary, monitoring components of the immune system can predict development of cutaneous SCC among KTRs.
Collapse
Affiliation(s)
- Robert P Carroll
- Transplantation Research Immunology Group, Nuffield Department of Surgery, Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, Oxford, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
44
|
San Segundo D, Fernández-Fresnedo G, Ruiz JC, Rodrigo E, Benito MJ, Arias M, López-Hoyos M. Two-year follow-up of a prospective study of circulating regulatory T cells in renal transplant patients. Clin Transplant 2009; 24:386-93. [PMID: 19744094 DOI: 10.1111/j.1399-0012.2009.01086.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CD4(+)CD25(high)FOXP3(+) regulatory T cells (Tregs) are involved in alloreactivity and may be associated with protection from rejection. Their quantification in peripheral blood could guide clinicians in the management of renal transplant patients. Thus, we prospectively monitored the levels and in vitro suppression of circulating Tregs in 33 renal transplant patients from deceased donors within the first two yr of transplantation. Patients received maintenance immunosuppression with tacrolimus, mofetil mycophenolate and prednisolone. Results showed that peripheral blood Tregs were significantly lower six months after transplantation and recovered to almost basal levels at first post-transplant year. The number of circulating Tregs increased significantly over basal levels afterwards. The decrease in circulating Tregs at six months may be explained by the high load of tacrolimus, as demonstrated by the inverse correlation between the blood concentration of Tregs and tacrolimus. Likewise, nine patients treated with anti-CD25 antibodies showed higher numbers of Tregs at six months than those that did not, although differences were not observed later. In conclusion, circulating Tregs decrease in the first six months but recover thereafter up to two yr after kidney transplantation. Such a decrease is favored by high levels of tacrolimus but not by induction protocols with anti-CD25.
Collapse
Affiliation(s)
- David San Segundo
- Immunology, Hospital Universitario Marques de Valdecilla-IFIMAV, 39008 Santander, Spain
| | | | | | | | | | | | | |
Collapse
|
45
|
Fábrega E, López-Hoyos M, San Segundo D, Casafont F, Pons-Romero F. Changes in the serum levels of interleukin-17/interleukin-23 during acute rejection in liver transplantation. Liver Transpl 2009; 15:629-33. [PMID: 19479806 DOI: 10.1002/lt.21724] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Interleukin-23 (IL-23) and T helper 17 (Th17) cells have been cast as major players in autoimmunity, but their role in transplantation immunity remains to be specified. The aim of our study was to investigate the time course of serum levels of IL-23 and IL-17 during hepatic allograft rejection. Serum levels of IL-23 and IL-17 were determined in 20 healthy subjects and 50 hepatic transplant recipients. These patients were divided into 2 groups: group I was composed of 15 patients with acute rejection, and group II was composed of 35 patients without acute rejection. Samples were collected on days 1 and 7 after liver transplantation and on the day of liver biopsy. The concentrations of IL-23 were similar for the rejection group and nonrejection group at early postoperative times. We observed a significant increase in serum IL-23 levels in the rejection group when a diagnosis of acute rejection had been established. Similarly to IL-23, at the diagnosis of acute rejection, the concentration of IL-17 was significantly higher in the rejection group versus the nonrejection group. The whole transplant group, including those with stable graft function, had higher serum levels of IL-23 and IL-17 than the controls during the entire postoperative period. In conclusion, IL-23 and IL-17 are up-regulated during acute hepatic rejection. These findings suggest a role for Th17 cells in human liver allograft rejection.
Collapse
Affiliation(s)
- Emilio Fábrega
- Gastroenterology and Hepatology Unit, Faculty of Medicine, Marqués de Valdecilla University Hospital, Santander, Spain.
| | | | | | | | | |
Collapse
|
46
|
Fernández-Fresnedo G, López-Hoyos M, San Segundo D, Crespo J, Ruiz JC, De Francisco ALM, Arias M. Antiphospholipid antibodies after renal transplantation and cardiovascular disease. Clin Transplant 2008; 22:567-71. [PMID: 18492073 DOI: 10.1111/j.1399-0012.2008.00825.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim was to assess the presence of pre- or post-transplant serum antiphospholipid antibodies (APA) and its association with the development of cardiovascular disease (CVD) in renal transplantation. METHODS We studied 138 patients transplanted with a cadaver kidney graft between 1990 and 1998 and with a graft functioning for longer than one yr. One pre-transplant sample and another obtained after transplantation from our serum bank were analyzed. The ELISA used were set up in our laboratory, following established international guidelines, and results were confirmed in three different runs. RESULTS 23.9% and 31.2% of patients had pre- and post-transplant positive titers of APA, respectively. 16% developed those antibodies de novo after transplantation. Post-transplant CVD was observed in 20.3% of patients but they were not associated with the production of APA in the whole population studied. However, multivariate analysis demonstrated an increased risk (RR 2.27; p = 0.02) for CVD when APA were produced after acute rejection. CONCLUSIONS The presence of serum APA alone was not an independent risk factor for CVD after kidney transplantation. Nonetheless, in kidney recipients who produced APA de novo after acute rejection, the control of cardiovascular risk factors must be intensified.
Collapse
|
47
|
Segundo DS, Ruiz JC, Izquierdo M, Fernández-Fresnedo G, Gómez-Alamillo C, Merino R, Benito MJ, Cacho E, Rodrigo E, Palomar R, López-Hoyos M, Arias M. Calcineurin inhibitors, but not rapamycin, reduce percentages of CD4+CD25+FOXP3+ regulatory T cells in renal transplant recipients. Transplantation 2006; 82:550-7. [PMID: 16926600 DOI: 10.1097/01.tp.0000229473.95202.50] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Immunosuppression in renal transplantation, although manageable in the short-term, is a major hurdle for long-term graft survival. Recently, increased frequencies of CD4CD25 regulatory T cells (Tregs) have been described as an additional mechanism that induces alloimmune tolerance. METHODS We assessed 64 renal transplant recipients with stable renal function for at least one year. Patients were divided into two groups according to the immunosuppression they were receiving at the moment of the study: one consisted of patients receiving rapamycin (Rapa) but not calcineurin inhibitors (CNI), and the other group received CNI but not Rapa. The Rapa group was further divided into three subgroups according to their previous experience with CNI: CNI-free, CNI withdrawal, and CNI conversion. Frequencies of blood Tregs were studied by flow cytometry after staining with monoclonal antibodies specific for different markers of Tregs. RESULTS Frequencies of CD4 T cells with regulatory phenotype and function were significantly decreased in peripheral blood of renal transplant patients receiving CNI compared with those receiving Rapa. This effect was independent of an early exposure to CNI because the CNI-free patients in the Rapa group showed similar frequencies of Tregs to the CNI withdrawal and CNI conversion groups. CONCLUSIONS CNI, but not Rapa, induce a decrease of circulating Tregs in stable renal transplant recipients. Thus, Rapa might be further explored in strategies using preservation of Tregs for transplant tolerance. Furthermore, quantification of blood Tregs may be a suitable tool to identify renal transplant recipients who may be candidates for reduced immunosuppression.
Collapse
Affiliation(s)
- David San Segundo
- Servicios Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|