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de Fijter J, Dreyer G, Mallat M, Budde K, Pratschke J, Klempnauer J, Zeier M, Arns W, Hugo C, Rump LC, Hauser I, Schenker P, Schiffer M, Grimm MO, Kliem V, Olbricht CJ, Pisarski P, Banas B, Suwelack B, Hakenberg O, Berlakovich G, Schneeberger S, van de Wetering J, Berger S, Bemelman F, Kuypers D, Heidt S, Rahmel A, Claas F, Peeters P, Oberbauer R, Heemann U, Krämer BK. A paired-kidney allocation study found superior survival with HLA-DR compatible kidney transplants in the Eurotransplant Senior Program. Kidney Int 2023; 104:552-561. [PMID: 37343659 DOI: 10.1016/j.kint.2023.05.025] [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: 08/18/2022] [Revised: 03/27/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023]
Abstract
The Eurotransplant Senior Program (ESP) has expedited the chance for elderly patients with kidney failure to receive a timely transplant. This current study evaluated survival parameters of kidneys donated after brain death with or without matching for HLA-DR antigens. This cohort study evaluated the period within ESP with paired allocation of 675 kidneys from donors 65 years and older to transplant candidates 65 years and older, the first kidney to 341 patients within the Eurotransplant Senior DR-compatible Program and 334 contralateral kidneys without (ESP) HLA-DR antigen matching. We used Kaplan-Meier estimates and competing risk analysis to assess all cause mortality and kidney graft failure, respectively. The log-rank test and Cox proportional hazards regression were used for comparisons. Within ESP, matching for HLA-DR antigens was associated with a significantly lower five-year risk of mortality (hazard ratio 0.71; 95% confidence interval 0.53-0.95) and significantly lower cause-specific hazards for kidney graft failure and return to dialysis at one year (0.55; 0.35-0.87) and five years (0.73; 0.53-0.99) post-transplant. Allocation based on HLA-DR matching resulted in longer cold ischemia (mean difference 1.00 hours; 95% confidence interval: 0.32-1.68) and kidney offers with a significantly shorter median dialysis vintage of 2.4 versus 4.1 yrs. in ESP without matching. Thus, our allocation based on HLA-DR matching improved five-year patient and kidney allograft survival. Hence, our paired allocation study suggests a superior outcome of HLA-DR matching in the context of old-for-old kidney transplantation.
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Affiliation(s)
- Johan de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands.
| | - Geertje Dreyer
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Marko Mallat
- Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Klemens Budde
- Department of Nephrology, Internal Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Klempnauer
- Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Arns
- Department of Nephrology and Transplantation, Cologne Merheim Medical Center, Cologne, Germany
| | - Christian Hugo
- Clinic for Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Lars-Christian Rump
- Department of Internal Medicine/Nephrology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ingeborg Hauser
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Mario Schiffer
- Department of Nephrology, Erlangen University Hospital, Erlangen, Germany
| | | | - Volker Kliem
- Department of Internal Medicine and Nephrology, Kidney Transplant Center, Nephrological Center of Lower Saxony, Klinikum Hann, Münden, Germany
| | | | - Przemyslaw Pisarski
- Department of Surgery, Section of Transplant Surgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Suwelack
- Department of Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| | | | - Gabriela Berlakovich
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Wien, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Stefan Berger
- Department of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | - Frederike Bemelman
- Department of Nephrology, Division of Internal Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Dirk Kuypers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Sebastiaan Heidt
- Eurotransplant Reference Laboratory, Leiden University Medical Center, Leiden, Netherlands
| | - Axel Rahmel
- Eurotransplant International Foundation, Leiden, Netherlands
| | - Frans Claas
- Eurotransplant Reference Laboratory, Leiden University Medical Center, Leiden, Netherlands
| | - Patrick Peeters
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard K Krämer
- V-th Department of Medicine (Nephrology), University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
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2
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Hug MN, Keller S, Marty T, Gygax D, Meinel D, Spies P, Handschin J, Kleiser M, Vazquez N, Linnik J, Buchli R, Claas F, Heidt S, Kramer CSM, Bezstarosti S, Lee JH, Schaub S, Hönger G. HLA antibody affinity determination: From HLA-specific monoclonal antibodies to donor HLA specific antibodies (DSA) in patient serum. HLA 2023. [PMID: 37191252 DOI: 10.1111/tan.15047] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023]
Abstract
Organs transplanted across donor-specific HLA antibodies (DSA) are associated with a variety of clinical outcomes, including a high risk of acute kidney graft rejection. Unfortunately, the currently available assays to determine DSA characteristics are insufficient to clearly discriminate between potentially harmless and harmful DSA. To further explore the hazard potential of DSA, their concentration and binding strength to their natural target, using soluble HLA, may be informative. There are currently a number of biophysical technologies available that allow the assessment of antibody binding strength. However, these methods require prior knowledge of antibody concentrations. Our objective within this study was to develop a novel approach that combines the determination of DSA-affinity as well as DSA-concentration for patient sample evaluation within one assay. We initially tested the reproducibility of previously reported affinities of human HLA-specific monoclonal antibodies and assessed the technology-specific precision of the obtained results on multiple platforms, including surface plasmon resonance (SPR), bio-layer interferometry (BLI), Luminex (single antigen beads; SAB), and flow-induced dispersion analysis (FIDA). While the first three (solid-phase) technologies revealed comparable high binding-strengths, suggesting measurement of avidity, the latter (in-solution) approach revealed slightly lower binding-strengths, presumably indicating measurement of affinity. We believe that our newly developed in-solution FIDA-assay is particularly suitable to provide useful clinical information by not just measuring DSA-affinities in patient serum samples but simultaneously delivering a particular DSA-concentration. Here, we investigated DSA from 20 pre-transplant patients, all of whom showed negative CDC-crossmatch results with donor cells and SAB signals ranging between 571 and 14899 mean fluorescence intensity (MFI). DSA-concentrations were found in the range between 11.2 and 1223 nM (median 81.1 nM), and their measured affinities fall between 0.055 and 24.7 nM (median 5.34 nM; 449-fold difference). In 13 of 20 sera (65%), DSA accounted for more than 0.1% of total serum antibodies, and 4/20 sera (20%) revealed a proportion of DSA even higher than 1%. To conclude, this study strengthens the presumption that pre-transplant patient DSA consists of various concentrations and different net affinities. Validation of these results in a larger patient cohort with clinical outcomes will be essential in a further step to assess the clinical relevance of DSA-concentration and DSA-affinity.
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Affiliation(s)
- Melanie N Hug
- University of Applied Sciences and Arts Northwestern Switzerland, School of Life Sciences Muttenz, Muttenz, Switzerland
| | - Sabrina Keller
- University of Applied Sciences and Arts Northwestern Switzerland, School of Life Sciences Muttenz, Muttenz, Switzerland
| | - Talea Marty
- University of Applied Sciences and Arts Northwestern Switzerland, School of Life Sciences Muttenz, Muttenz, Switzerland
| | - Daniel Gygax
- University of Applied Sciences and Arts Northwestern Switzerland, School of Life Sciences Muttenz, Muttenz, Switzerland
| | - Dominik Meinel
- University of Applied Sciences and Arts Northwestern Switzerland, School of Life Sciences Muttenz, Muttenz, Switzerland
| | - Peter Spies
- University of Applied Sciences and Arts Northwestern Switzerland, School of Life Sciences Muttenz, Muttenz, Switzerland
| | - Joëlle Handschin
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Marc Kleiser
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Noemi Vazquez
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Janina Linnik
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Rico Buchli
- Department of Research and Development, PureProtein LLC, Oklahoma City, Oklahoma, USA
| | - Frans Claas
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cynthia S M Kramer
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne Bezstarosti
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jar-How Lee
- Research Department, Terasaki Innovation Center (TIC), Glendale, California, USA
| | - Stefan Schaub
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Gideon Hönger
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
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3
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Lemieux W, Fleischer D, Yang AY, Niemann M, Oualkacha K, Klement W, Richard L, Polychronakos C, Liwski R, Claas F, Gebel HM, Keown PA, Lewin A, Sapir-Pichhadze R. Dissecting the impact of molecular T-cell HLA mismatches in kidney transplant failure: A retrospective cohort study. Front Immunol 2022; 13:1067075. [PMID: 36505483 PMCID: PMC9730505 DOI: 10.3389/fimmu.2022.1067075] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Kidney transplantation is the optimal treatment in end-stage kidney disease, but de-novo donor specific antibody development continues to negatively impact patients undergoing kidney transplantation. One of the recent advances in solid organ transplantation has been the definition of molecular mismatching between donors and recipients' Human Leukocyte Antigens (HLA). While not fully integrated in standard clinical care, cumulative molecular mismatch at the level of eplets (EMM) as well as the PIRCHE-II score have shown promise in predicting transplant outcomes. In this manuscript, we sought to study whether certain T-cell molecular mismatches (TcEMM) were highly predictive of death-censored graft failure (DCGF). Methods We studied a retrospective cohort of kidney donor:recipient pairs from the Scientific Registry of Transplant Recipients (2000-2015). Allele level HLA-A, B, C, DRB1 and DQB1 types were imputed from serologic types using the NMDP algorithm. TcEMMs were then estimated using the PIRCHE-II algorithm. Multivariable Accelerated Failure Time (AFT) models assessed the association between each TcEMM and DCGF. To discriminate between TcEMMs most predictive of DCGF, we fit multivariable Lasso penalized regression models. We identified co-expressed TcEMMs using weighted correlation network analysis (WGCNA). Finally, we conducted sensitivity analyses to address PIRCHE and IMGT/HLA version updates. Results A total of 118,309 donor:recipient pairs meeting the eligibility criteria were studied. When applying the PIRCHE-II algorithm, we identified 1,935 distinct TcEMMs at the population level. A total of 218 of the observed TcEMM were independently associated with DCGF by AFT models. The Lasso penalized regression model with post selection inference identified a smaller subset of 86 TcEMMs (56 and 30 TcEMM derived from HLA Class I and II, respectively) to be highly predictive of DCGF. Of the observed TcEMM, 38.14% appeared as profiles of highly co-expressed TcEMMs. In addition, sensitivity analyses identified that the selected TcEMM were congruent across IMGT/HLA versions. Conclusion In this study, we identified subsets of TcEMMs highly predictive of DCGF and profiles of co-expressed mismatches. Experimental verification of these TcEMMs determining immune responses and how they may interact with EMM as predictors of transplant outcomes would justify their consideration in organ allocation schemes and for modifying immunosuppression regimens.
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Affiliation(s)
- William Lemieux
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada,Medical Affairs & Innovation, Héma-Québec, Montréal, QC, Canada
| | - David Fleischer
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Archer Yi Yang
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | | | - Karim Oualkacha
- Department of Mathematics, Université du Québec à Montreal, Montreal, QC, Canada
| | - William Klement
- Division of Organ Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Lucie Richard
- Transfusion medicine/Reference Laboratory, Héma-Québec, Montréal, QC, Canada
| | - Constantin Polychronakos
- Department of Pediatrics, The Research Institute of the McGill University Health Centre and the Montreal Children’s Hospital, Montréal, QC, Canada
| | - Robert Liwski
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Frans Claas
- Department of Immunology, Leiden University Medical Centre, Leiden, Netherlands
| | - Howard M. Gebel
- Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
| | - Paul A. Keown
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Antoine Lewin
- Medical Affairs & Innovation, Héma-Québec, Montréal, QC, Canada,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Centre, Montréal, QC, Canada,Division of Nephrology and the Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada,*Correspondence: Ruth Sapir-Pichhadze,
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4
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Mamode N, Bestard O, Claas F, Furian L, Griffin S, Legendre C, Pengel L, Naesens M. European Guideline for the Management of Kidney Transplant Patients With HLA Antibodies: By the European Society for Organ Transplantation Working Group. Transpl Int 2022; 35:10511. [PMID: 36033645 PMCID: PMC9399356 DOI: 10.3389/ti.2022.10511] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 03/16/2022] [Accepted: 06/14/2022] [Indexed: 12/12/2022]
Abstract
This guideline, from a European Society of Organ Transplantation (ESOT) working group, concerns the management of kidney transplant patients with HLA antibodies. Sensitization should be defined using a virtual parameter such as calculated Reaction Frequency (cRF), which assesses HLA antibodies derived from the actual organ donor population. Highly sensitized patients should be prioritized in kidney allocation schemes and linking allocation schemes may increase opportunities. The use of the ENGAGE 5 ((Bestard et al., Transpl Int, 2021, 34: 1005–1018) system and online calculators for assessing risk is recommended. The Eurotransplant Acceptable Mismatch program should be extended. If strategies for finding a compatible kidney are very unlikely to yield a transplant, desensitization may be considered and should be performed with plasma exchange or immunoadsorption, supplemented with IViG and/or anti-CD20 antibody. Newer therapies, such as imlifidase, may offer alternatives. Few studies compare HLA incompatible transplantation with remaining on the waiting list, and comparisons of morbidity or quality of life do not exist. Kidney paired exchange programs (KEP) should be more widely used and should include unspecified and deceased donors, as well as compatible living donor pairs. The use of a KEP is preferred to desensitization, but highly sensitized patients should not be left on a KEP list indefinitely if the option of a direct incompatible transplant exists.
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Affiliation(s)
- Nizam Mamode
- Department of Transplantation, Guys Hospital, London, United Kingdom
- *Correspondence: Nizam Mamode,
| | - Oriol Bestard
- Department of Nephrology and Kidney Transplantation, Vall d’Hebrón University Hospital, Barcelona, Spain
| | - Frans Claas
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
- Department of Immunology, University of Antwerp, Antwerp, Belgium
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical Gastroenterological and Oncological Sciences, University Hospital of Padua, Padua, Italy
| | - Siân Griffin
- Department of Nephrology, University Hospital of Wales, Cardiff, United Kingdom
| | - Christophe Legendre
- Department of Nephrology and Adult Kidney Transplantation, Hôpital Necker and Université de Paris, Paris, France
| | - Liset Pengel
- Centre for Evidence in Transplantation, University of Oxford, Oxford, United Kingdom
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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5
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Senev A, Lerut E, Coemans M, Callemeyn J, Copley HC, Claas F, Koshy P, Kosmoliaptsis V, Kuypers D, Sprangers B, Van Craenenbroeck A, Van Loon E, Van Sandt V, Emonds MP, Naesens M. Association of HLA Mismatches and Histology Suggestive of Antibody-Mediated Injury in the Absence of Donor-Specific Anti-HLA Antibodies. Clin J Am Soc Nephrol 2022; 17:1204-1215. [PMID: 35649719 PMCID: PMC9435985 DOI: 10.2215/cjn.00570122] [Citation(s) in RCA: 4] [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: 01/14/2022] [Accepted: 05/12/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES The histology of antibody-mediated rejection after kidney transplantation is observed frequently in the absence of detectable donor-specific anti-HLA antibodies. Although there is an active interest in the role of non-HLA antibodies in this phenotype, it remains unknown whether HLA mismatches play an antibody-independent role in this phenotype of microcirculation inflammation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS To study this, we used the tools HLAMatchmaker, three-dimensional electrostatic mismatch score, HLA solvent accessible amino acid mismatches, and mismatched donor HLA-derived T cell epitope targets to determine the degree of HLA molecular mismatches in 893 kidney transplant recipients with available biopsy follow-up. Multivariable Cox proportional hazards models were applied to quantify the cause-specific hazard ratios of the different types of HLA mismatch scores for developing antibody-mediated rejection or histology of antibody-mediated rejection in the absence of donor-specific anti-HLA antibodies. In all survival analyses, the patients were censored at the time of the last biopsy. RESULTS In total, 121 (14%) patients developed histology of antibody-mediated rejection in the absence of donor-specific anti-HLA antibodies, of which 44 (36%) patients had concomitant T cell-mediated rejection. In multivariable Cox analysis, all different calculations of the degree of HLA mismatch associated with developing histology of antibody-mediated rejection in the absence of donor-specific anti-HLA antibodies. This association was dependent neither on the presence of missing self (potentially related to natural killer cell activation) nor on the formation of de novo HLA antibodies. Also, glomerulitis and complement C4d deposition in peritubular capillaries associated with the degree of HLA mismatch in the absence of anti-HLA antibodies. CONCLUSIONS The histology of antibody-mediated rejection and its defining lesions are also observed in patients without circulating anti-HLA antibodies and relate to the degree of HLA mismatch.
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Affiliation(s)
- Aleksandar Senev
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium,Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross Flanders, Mechelen, Belgium
| | - Evelyne Lerut
- Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Coemans
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jasper Callemeyn
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hannah Charlotte Copley
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom,National Institute for Health and Care Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, United Kingdom,National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Frans Claas
- Department of Immunology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Priyanka Koshy
- Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom,National Institute for Health and Care Research Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, United Kingdom,National Institute for Health and Care Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Dirk Kuypers
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Ben Sprangers
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Amaryllis Van Craenenbroeck
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Elisabet Van Loon
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Vicky Van Sandt
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross Flanders, Mechelen, Belgium
| | - Marie-Paule Emonds
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium,Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross Flanders, Mechelen, Belgium
| | - Maarten Naesens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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6
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Bestard O, Thaunat O, Bellini MI, Böhmig GA, Budde K, Claas F, Couzi L, Furian L, Heemann U, Mamode N, Oberbauer R, Pengel L, Schneeberger S, Naesens M. Alloimmune Risk Stratification for Kidney Transplant Rejection. Transpl Int 2022; 35:10138. [PMID: 35669972 PMCID: PMC9163827 DOI: 10.3389/ti.2022.10138] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022]
Abstract
Different types of kidney transplantations are performed worldwide, including biologically diverse donor/recipient combinations, which entail distinct patient/graft outcomes. Thus, proper immunological and non-immunological risk stratification should be considered, especially for patients included in interventional randomized clinical trials. This paper was prepared by a working group within the European Society for Organ Transplantation, which submitted a Broad Scientific Advice request to the European Medicines Agency (EMA) relating to clinical trial endpoints in kidney transplantation. After collaborative interactions, the EMA sent its final response in December 2020, highlighting the following: 1) transplantations performed between human leukocyte antigen (HLA)-identical donors and recipients carry significantly lower immunological risk than those from HLA-mismatched donors; 2) for the same allogeneic molecular HLA mismatch load, kidney grafts from living donors carry significantly lower immunological risk because they are better preserved and therefore less immunogenic than grafts from deceased donors; 3) single-antigen bead testing is the gold standard to establish the repertoire of serological sensitization and is used to define the presence of a recipient's circulating donor-specific antibodies (HLA-DSA); 4) molecular HLA mismatch analysis should help to further improve organ allocation compatibility and stratify immunological risk for primary alloimmune activation, but without consensus regarding which algorithm and cut-off to use it is difficult to integrate information into clinical practice/study design; 5) further clinical validation of other immune assays, such as those measuring anti-donor cellular memory (T/B cell ELISpot assays) and non-HLA-DSA, is needed; 6) routine clinical tests that reliably measure innate immune alloreactivity are lacking.
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Affiliation(s)
- Oriol Bestard
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Olivier Thaunat
- Department of Transplantation, Nephrology, and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Georg A Böhmig
- Department of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Frans Claas
- Eurotransplant Reference Laboratory, Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Lionel Couzi
- Department of Nephrology, Transplantation and Dialysis, Bordeaux University Hospital, Bordeaux, France
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, University of Padua, Padua, Italy
| | - Uwe Heemann
- Department of Nephrology, Technical University of Munich, Munich, Germany
| | - Nizam Mamode
- Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Liset Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Stefan Schneeberger
- Department of General, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Maarten Naesens
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
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7
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Lim WH, Adams B, Alexander S, Bouts AHM, Claas F, Collins M, Cornelissen E, Dunckley H, de Jong H, D’Orsogna L, Francis A, Heidt S, Herman J, Holdsworth R, Kausman J, Khalid R, Kim JJ, Kim S, Knops N, Kosmoliaptsis V, Kramer C, Kuypers D, Larkins N, Palmer SC, Prestidge C, Prytula A, Sharma A, Shingde M, Taverniti A, Teixeira-Pinto A, Trnka P, Willis F, Wong D, Wong G. Improve in-depth immunological risk assessment to optimize genetic-compatibility and clinical outcomes in child and adolescent recipients of parental donor kidney transplants: protocol for the INCEPTION study. BMC Nephrol 2021; 22:416. [PMID: 34923958 PMCID: PMC8684542 DOI: 10.1186/s12882-021-02619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Parental donor kidney transplantation is the most common treatment option for children and adolescents with kidney failure. Emerging data from observational studies have reported improved short- and medium-term allograft outcomes in recipients of paternal compared to maternal donors. The INCEPTION study aims to identify potential differences in immunological compatibility between maternal and paternal donor kidneys and ascertain how this affects kidney allograft outcomes in children and adolescents with kidney failure.
Methods
This longitudinal observational study will recruit kidney transplant recipients aged ≤18 years who have received a parental donor kidney transplant across 4 countries (Australia, New Zealand, United Kingdom and the Netherlands) between 1990 and 2020. High resolution human leukocyte antigen (HLA) typing of both recipients and corresponding parental donors will be undertaken, to provide an in-depth assessment of immunological compatibility. The primary outcome is a composite of de novo donor-specific anti-HLA antibody (DSA), biopsy-proven acute rejection or allograft loss up to 60-months post-transplantation. Secondary outcomes are de novo DSA, biopsy-proven acute rejection, acute or chronic antibody mediated rejection or Chronic Allograft Damage Index (CADI) score of > 1 on allograft biopsy post-transplant, allograft function, proteinuria and allograft loss. Using principal component analysis and Cox proportional hazards regression modelling, we will determine the associations between defined sets of immunological and clinical parameters that may identify risk stratification for the primary and secondary outcome measures among young people accepting a parental donor kidney for transplantation. This study design will allow us to specifically investigate the relative importance of accepting a maternal compared to paternal donor, for families deciding on the best option for donation.
Discussion
The INCEPTION study findings will explore potentially differential immunological risks of maternal and paternal donor kidneys for transplantation among children and adolescents. Our study will provide the evidence base underpinning the selection of parental donor in order to achieve the best projected long-term kidney transplant and overall health outcomes for children and adolescents, a recognized vulnerable population.
Trial registration
The INCEPTION study has been registered with the Australian New Zealand Clinical Trials Registry, with the trial registration number of ACTRN12620000911998 (14th September 2020).
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8
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Hof LV', Schotvanger N, Haasnoot G, van der Keur C, Roelen D, Lashley L, Claas F, Eikmans M, Hoorn MLVD. Maternal-fetal HLA compatibility in uncomplicated and preeclamptic naturally conceived pregnancies. Placenta 2021. [DOI: 10.1016/j.placenta.2021.07.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Tran JN, Günther OP, Sherwood KR, Fenninger F, Allan LL, Lan J, Sapir-Pichhadze R, Duquesnoy R, Claas F, Marsh SGE, McMaster WR, Keown PA. High-throughput sequencing defines donor and recipient HLA B-cell epitope frequencies for prospective matching in transplantation. Commun Biol 2021; 4:583. [PMID: 33990681 PMCID: PMC8121953 DOI: 10.1038/s42003-021-01989-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/18/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
Compatibility for human leukocyte antigen (HLA) genes between transplant donors and recipients improves graft survival but prospective matching is rarely performed due to the vast heterogeneity of this gene complex. To reduce complexity, we have combined next-generation sequencing and in silico mapping to determine transplant population frequencies and matching probabilities of 150 antibody-binding eplets across all 11 classical HLA genes in 2000 ethnically heterogeneous renal patients and donors. We show that eplets are more common and uniformly distributed between donors and recipients than the respective HLA isoforms. Simulations of targeted eplet matching shows that a high degree of overall compatibility, and perfect identity at the clinically important HLA class II loci, can be obtained within a patient waiting list of approximately 250 subjects. Internal epitope-based allocation is thus feasible for most major renal transplant programs, while regional or national sharing may be required for other solid organs. Tran et al. combine high throughput sequencing, structural biology and computational simulation to determine the HLA allele and antibody-defined epitope frequencies in renal transplant patients and donors. These results demonstrate the feasibility of HLA epitope matching using data from a national transplantation program.
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Affiliation(s)
- Jenny N Tran
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Karen R Sherwood
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Franz Fenninger
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lenka L Allan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James Lan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Rene Duquesnoy
- Department of Pathology, University of Pittsburgh, Pennsylvania, PA, USA
| | - Frans Claas
- Department of Immunohematology and Blood Transfusion, University of Leiden, Leiden, Netherlands
| | - Steven G E Marsh
- Anthony Nolan Research Institute and UCL Cancer Institute, Royal Free Campus, London, UK
| | - W Robert McMaster
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,Infection and Immunity Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Paul A Keown
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada. .,Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Infection and Immunity Research Centre, University of British Columbia, Vancouver, BC, Canada.
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10
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Senev A, Coemans M, Lerut E, Van Sandt V, Kerkhofs J, Daniëls L, Driessche MV, Compernolle V, Sprangers B, Van Loon E, Callemeyn J, Claas F, Tambur AR, Verbeke G, Kuypers D, Emonds MP, Naesens M. Eplet Mismatch Load and De Novo Occurrence of Donor-Specific Anti-HLA Antibodies, Rejection, and Graft Failure after Kidney Transplantation: An Observational Cohort Study. J Am Soc Nephrol 2020; 31:2193-2204. [PMID: 32764139 DOI: 10.1681/asn.2020010019] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [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: 01/06/2020] [Accepted: 05/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In kidney transplantation, evaluating mismatches of HLA eplets-small patches of surface-exposed amino acids of the HLA molecule-instead of antigen mismatches might offer a better approach to assessing donor-recipient HLA incompatibility and improve risk assessment and prediction of transplant outcomes. METHODS To evaluate the effect of number of eplet mismatches (mismatch load) on de novo formation of donor-specific HLA antibodies (DSAs) and transplant outcomes, we conducted a cohort study that included consecutive adult kidney recipients transplanted at a single center from March 2004 to February 2013. We performed retrospective high-resolution genotyping of HLA loci of 926 transplant pairs and used the HLAMatchmaker computer algorithm to count HLA eplet mismatches. RESULTS De novo DSAs occurred in 43 (4.6%) patients. Multivariable analysis showed a significant independent association between antibody-verified eplet mismatch load and de novo DSA occurrence and graft failure, mainly explained by DQ antibody-verified eplet effects. The association with DQ antibody-verified eplet mismatches was linear, without a safe threshold at which de novo DSA did not occur. Odds for T cell- or antibody-mediated rejection increased by 5% and 12%, respectively, per antibody-verified DQ eplet mismatch. CONCLUSIONS Eplet mismatches in HLA-DQ confer substantial risk for de novo DSA formation, graft rejection, and graft failure after kidney transplantation. Mismatches in other loci seem to have less effect. The results suggest that antibody-verified HLA-DQ eplet mismatch load could be used to guide personalized post-transplant immunosuppression. Adoption of molecular matching for DQA1 and DQB1 alleles could also help to minimize de novo DSA formation and potentially improve transplant outcomes.
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Affiliation(s)
- Aleksandar Senev
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium.,Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Maarten Coemans
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, University of Leuven, Leuven, Belgium
| | - Evelyne Lerut
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Vicky Van Sandt
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Johan Kerkhofs
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Liesbeth Daniëls
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium
| | | | - Veerle Compernolle
- Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Ben Sprangers
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Elisabet Van Loon
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Jasper Callemeyn
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Frans Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anat R Tambur
- Transplant Immunology Laboratory, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Geert Verbeke
- Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, University of Leuven, Leuven, Belgium
| | - Dirk Kuypers
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Paule Emonds
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium.,Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium .,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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11
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Carapito R, Aouadi I, Pichot A, Spinnhirny P, Morlon A, Kotova I, Macquin C, Rolli V, Cesbron A, Gagne K, Oudshoorn M, van der Holt B, Labalette M, Spierings E, Picard C, Loiseau P, Tamouza R, Toubert A, Parissiadis A, Dubois V, Paillard C, Maumy-Bertrand M, Bertrand F, von dem Borne PA, Kuball JHE, Michallet M, Lioure B, Peffault de Latour R, Blaise D, Cornelissen JJ, Yakoub-Agha I, Claas F, Moreau P, Charron D, Mohty M, Morishima Y, Socié G, Bahram S. Compatibility at amino acid position 98 of MICB reduces the incidence of graft-versus-host disease in conjunction with the CMV status. Bone Marrow Transplant 2020; 55:1367-1378. [PMID: 32286503 DOI: 10.1038/s41409-020-0886-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 11/10/2022]
Abstract
Graft-versus-host disease (GVHD) and cytomegalovirus (CMV)-related complications are leading causes of mortality after unrelated-donor hematopoietic cell transplantation (UD-HCT). The non-conventional MHC class I gene MICB, alike MICA, encodes a stress-induced polymorphic NKG2D ligand. However, unlike MICA, MICB interacts with the CMV-encoded UL16, which sequestrates MICB intracellularly, leading to immune evasion. Here, we retrospectively analyzed the impact of mismatches in MICB amino acid position 98 (MICB98), a key polymorphic residue involved in UL16 binding, in 943 UD-HCT pairs who were allele-matched at HLA-A, -B, -C, -DRB1, -DQB1 and MICA loci. HLA-DP typing was further available. MICB98 mismatches were significantly associated with an increased incidence of acute (grade II-IV: HR, 1.20; 95% CI, 1.15 to 1.24; P < 0.001; grade III-IV: HR, 2.28; 95% CI, 1.56 to 3.34; P < 0.001) and chronic GVHD (HR, 1.21; 95% CI, 1.10 to 1.33; P < 0.001). MICB98 matching significantly reduced the effect of CMV status on overall mortality from a hazard ratio of 1.77 to 1.16. MICB98 mismatches showed a GVHD-independent association with a higher incidence of CMV infection/reactivation (HR, 1.84; 95% CI, 1.34 to 2.51; P < 0.001). Hence selecting a MICB98-matched donor significantly reduces the GVHD incidence and lowers the impact of CMV status on overall survival.
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Affiliation(s)
- Raphael Carapito
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France. .,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France. .,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France. .,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan. .,Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, Strasbourg, France.
| | - Ismail Aouadi
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Angélique Pichot
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Perrine Spinnhirny
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Aurore Morlon
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,BIOMICA SAS, Strasbourg, France
| | - Irina Kotova
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,BIOMICA SAS, Strasbourg, France
| | - Cécile Macquin
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Véronique Rolli
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Anne Cesbron
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Etablissement Français du Sang (EFS) Centre-Pays de la Loire, Laboratoire HLA, Nantes, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Société Francophone d'Histocompatibilité et d'Immunogénétique (SFHI), Paris, France
| | - Katia Gagne
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Etablissement Français du Sang (EFS) Centre-Pays de la Loire, Laboratoire HLA, Nantes, France.,INSERM 1232, CRCINA, Université Nantes-Angers, Nantes, France
| | - Machteld Oudshoorn
- Europdonor operated by Matchis Foundation, Leiden, The Netherlands.,Department of Immunohematology and Blood transfusion, LUMC, Leiden, The Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Myriam Labalette
- Laboratoire d'Immunologie, CHRU de Lille, Lille, France.,LIRIC INSERM U995, Université Lille 2, Lille, France
| | - Eric Spierings
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christophe Picard
- CNRS, EFS-PACA, ADES UMR 7268, Aix-Marseille Université, Marseille, France
| | - Pascale Loiseau
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Laboratoire Jean Dausset, INSERM UMR_S 1160, Hôpital Saint-Louis, Paris, France
| | - Ryad Tamouza
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Laboratoire Jean Dausset, INSERM UMR_S 1160, Hôpital Saint-Louis, Paris, France
| | - Antoine Toubert
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Laboratoire Jean Dausset, INSERM UMR_S 1160, Hôpital Saint-Louis, Paris, France
| | - Anne Parissiadis
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Etablissement Français du Sang (EFS) Grand-Est, Laboratoire HLA, Strasbourg, France
| | - Valérie Dubois
- Etablissement Français du Sang (EFS) Rhône-Alpes, Laboratoire HLA, Lyon, France
| | - Catherine Paillard
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie et d'Oncologie pédiatrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Myriam Maumy-Bertrand
- Institut de Recherche Mathématique Avancée, CNRS UMR 7501, LabEx Institut de Recherche en Mathématiques, ses Interactions et Applications, Université de Strasbourg, Strasbourg, France
| | - Frédéric Bertrand
- Institut de Recherche Mathématique Avancée, CNRS UMR 7501, LabEx Institut de Recherche en Mathématiques, ses Interactions et Applications, Université de Strasbourg, Strasbourg, France
| | | | - Jürgen H E Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mauricette Michallet
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Centre Hospitalier Lyon Sud, Hématologie 1G, Hospices Civils de Lyon, Pierre Bénite, Lyon, France
| | - Bruno Lioure
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie Adulte, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Régis Peffault de Latour
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie - Greffe, Hôpital Saint-Louis, APHP, Paris, France
| | - Didier Blaise
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Department of Hematology and ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ibrahim Yakoub-Agha
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,LIRIC INSERM U995, Université Lille 2, Lille, France
| | - Frans Claas
- Department of Immunohematology and Blood transfusion, LUMC, Leiden, The Netherlands
| | - Philippe Moreau
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie Clinique, CHU Hôtel Dieu, Nantes, France
| | - Dominique Charron
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Laboratoire Jean Dausset, INSERM UMR_S 1160, Hôpital Saint-Louis, Paris, France
| | - Mohamad Mohty
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Département d'Hématologie, Hôpital Saint Antoine, Paris, France.,Université Pierre & Marie Curie, Paris, France.,Centre de Recherche Saint-Antoine, INSERM UMR_S 938, Paris, France
| | - Yasuo Morishima
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Gérard Socié
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie Adulte, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Seiamak Bahram
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France. .,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France. .,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France. .,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan. .,Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, Strasbourg, France.
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12
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Schinkelshoek M, Fronczek R, Verduijn W, Haasnoot G, Overeem S, Donjacour C, van der Heide A, Roelen D, Claas F, Lammers GJ. HLA associations in narcolepsy type 1 persist after the 2009 H1N1 pandemic. J Neuroimmunol 2020; 342:577210. [PMID: 32179327 DOI: 10.1016/j.jneuroim.2020.577210] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
We aimed to compare HLA-DQB1-associations in narcolepsy type 1 (NT1) patients with disease onset before and after the 2009 H1N1 pandemic in a large Dutch cohort. 525 NT1 patients and 1272 HLA-DQB1*06:02-positive healthy controls were included. Because of the discussion that has arisen on the existence of sporadic and post-H1N1 NT1, HLA-DQB1-associations in pre- and post-H1N1 NT1 patients were compared. The associations between HLA-DQB1 alleles and NT1 were not significantly different between pre- and post-H1N1 NT1 patients. Both HLA-DQB1-associations with pre- and -post H1N1 NT1 reported in recent smaller studies were replicated. Our findings combine the results of studies in pre- and post-H1N1 NT1 and argue against considering post-H1N1 NT1 as a different entity.
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Affiliation(s)
- Mink Schinkelshoek
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands; Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103, SW, Heemstede, The Netherlands.
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands; Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103, SW, Heemstede, The Netherlands
| | - Willem Verduijn
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Geert Haasnoot
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, PO Box 61, 5590, AB, Heeze, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
| | - Claire Donjacour
- Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Dokter Denekampweg 20, 8025, BV, Zwolle, The Netherlands
| | - Astrid van der Heide
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584, CG, Utrecht, The Netherlands
| | - Dave Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Frans Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands; Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103, SW, Heemstede, The Netherlands
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van Bentem K, Lashley E, Bos M, Eikmans M, Heidt S, Claas F, le Cessie S, van der Hoorn ML. Relating the number of human leucocytes antigen mismatches to pregnancy complications in oocyte donation pregnancies: study protocol for a prospective multicentre cohort study (DONOR study). BMJ Open 2019; 9:e027469. [PMID: 31345965 PMCID: PMC6661658 DOI: 10.1136/bmjopen-2018-027469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/05/2019] [Accepted: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Oocyte donation (OD) enables women with reproductive failure to conceive. Compared with naturally conceived (NC) and in vitrofertilisation (IVF) pregnancies, OD pregnancies are associated with a higher risk of pregnancy complications. The allogeneic nature of the fetus in OD pregnancies possibly plays a role in the development of these complications. The objective of the current study is therefore to study the number and nature of human leucocyte antigen (HLA) mismatches between fetus and mother and its association with the development of hypertensive pregnancy complications. METHODS AND ANALYSIS In this prospective multicentre cohort study, 200 patients visiting one of the 11 participating fertility centres in the Netherlands to perform OD or embryo donation or surrogacy will be invited to participate. These patients will be included as the exposed group. In addition, 146 patients with a NC pregnancy and 146 patients who applied for non-donor IVF are included as non-exposed subjects. These groups are frequency matched on age and ethnicity and only singleton pregnancies will be included. The primary clinical outcome of the study is the development of hypertensive disease during pregnancy. Secondary outcomes are the severity of the pre-eclampsia, time to development of pre-eclampsia and development of other pregnancy complications. The association of high number of HLA mismatches (>5) between mother and fetus will be determined and related to clinical outcome and pregnancy complication. ETHICS AND DISSEMINATION This study received ethical approval from the medical ethics committee in the Leiden University Medical Centre, the Netherlands (P16.048, ABR NL56308.058.16). Study findings will be presented at (inter) national conferences and published in peer-reviewed journals.
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Affiliation(s)
- Kim van Bentem
- Department of Gynaecology and Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Eileen Lashley
- Department of Gynaecology and Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Manon Bos
- Department of Gynaecology and Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Michael Eikmans
- Department of Immunohematology and Bloodtransfusion, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Sebastiaan Heidt
- Department of Immunohematology and Bloodtransfusion, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Frans Claas
- Department of Immunohematology and Bloodtransfusion, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
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Chen M, Zoet Y, Roelen D, Martorell J, Middleton D, Slavcev A, Iniotaki A, Claas F, Fuggle S. Towards uniformity in the definition of acceptable mismatches for highly sensitized patients. HLA 2019; 94:147-153. [PMID: 31177642 PMCID: PMC6771471 DOI: 10.1111/tan.13607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/22/2019] [Revised: 05/16/2019] [Accepted: 06/05/2019] [Indexed: 12/04/2022]
Abstract
The Eurotransplant (The Eurotransplant International Foundation) acceptable mismatch programme has been shown to be a successful tool to enhance transplantation of highly sensitized patients(HSPs). However, patients with rare HLA phenotypes in relation to the Eurotransplant donor population remain on the waiting list. EUROSTAM is an European Union funded project to explore the feasibility of a Europe‐wide acceptable mismatch programme enabling transplantation of HSPs with rare HLA phenotypes within their own organ exchange organization. The present study, which forms part of the EUROSTAM project, assesses the differences in the practices of the laboratories in different countries with respect to their HLA antibody profiling and risk adverseness. In the serum exchange exercises of 18 samples, a high level of variability has been shown in both assays and interpretation of results. In the data exchange exercise when all participants were given the same Luminex raw data for analysis, a high degree of consensus was reached where the median fluorescent intensity values of beads were <500 and >2000 for standard single antigen bead assays, or <500 and >5000 for assignment of acceptable mismatches. The risk adverseness analysis has showed distinct patterns of attitudes towards the perceived risks based on HLA antibody assay results, most probably influenced by the local protocols of the clinical transplant programme of each laboratory. In order to ensure fairness and maintain consistencies of organ exchange among partner transplant centres, a centralized facility will be instrumental for a uniform definition of acceptable mismatches.
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Affiliation(s)
- Mian Chen
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Oxford University Hospitals, Churchill Hospital, Oxford, UK
| | - Yvonne Zoet
- Eurotransplant Reference Laboratory, Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Dave Roelen
- Department of Immunohematology and Blood transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Derek Middleton
- Transplant Immunology Laboratory, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Antonij Slavcev
- Department of Immunogenetics, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Aliki Iniotaki
- National Tissue Typing Center, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Frans Claas
- Eurotransplant Reference Laboratory, Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.,Department of Immunohematology and Blood transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Susan Fuggle
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Oxford University Hospitals, Churchill Hospital, Oxford, UK.,Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK
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Visentin J, Leu DL, Mulder A, Jambon F, Badier L, Lee JH, Guidicelli G, Bouthemy C, Ralazamahaleo M, Claas F, Di Primo C, Taupin JL. Measuring anti-HLA antibody active concentration and affinity by surface plasmon resonance: Comparison with the luminex single antigen flow beads and T-cell flow cytometry crossmatch results. Mol Immunol 2019; 108:34-44. [DOI: 10.1016/j.molimm.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
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Reindl-Schwaighofer R, Heinzel A, Kainz A, van Setten J, Jelencsics K, Hu K, Loza BL, Kammer M, Heinze G, Hruba P, Koňaříková A, Viklicky O, Boehmig GA, Eskandary F, Fischer G, Claas F, Tan JC, Albert TJ, Patel J, Keating B, Oberbauer R. Contribution of non-HLA incompatibility between donor and recipient to kidney allograft survival: genome-wide analysis in a prospective cohort. Lancet 2019; 393:910-917. [PMID: 30773281 DOI: 10.1016/s0140-6736(18)32473-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/18/2018] [Accepted: 09/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The introduction of HLA matching of donors and recipients was a breakthrough in kidney transplantation. However, half of all transplanted kidneys still fail within 15 years after transplantation. Epidemiological data suggest a fundamental role of non-HLA alloimmunity. METHODS We genotyped 477 pairs of deceased donors and first kidney transplant recipients with stable graft function at three months that were transplanted between Dec 1, 2005, and April 30, 2015. Genome-wide genetic mismatches in non-synonymous single nucleotide polymorphisms (nsSNPs) were calculated to identify incompatibilities in transmembrane and secreted proteins. We estimated the association between nsSNP mismatch and graft loss in a Cox proportional hazard model, adjusting for HLA mismatch and clinical covariates. Customised peptide arrays were generated to screen for antibodies against genotype-derived mismatched epitopes in 25 patients with biopsy-confirmed chronic antibody-mediated rejection. FINDINGS 59 268 nsSNPs affecting a transmembrane or secreted protein were analysed. The median number of nsSNP mismatches in immune-accessible transmembrane and secreted proteins between donors and recipients was 1892 (IQR 1850-1936). The degree of nsSNP mismatch was independently associated with graft loss in a multivariable model adjusted for HLA eplet mismatch (HLA-A, HLA-B, HLA-C, HLA-DP, HLA-DQ, and HLA-DR). Each increase by a unit of one IQR had an HR of 1·68 (95% CI 1·17-2·41, p=0·005). 5-year death censored graft survival was 98% in the quartile with the lowest mismatch, 91% in the second quartile, 89% in the third quartile, and 82% in the highest quartile (p=0·003, log-rank test). Customised peptide arrays verified a donor-specific alloimmune response to genetically predicted mismatched epitopes. INTERPRETATION Genetic mismatch of non-HLA haplotypes coding for transmembrane or secreted proteins is associated with an increased risk of functional graft loss independently of HLA incompatibility. As in HLA alloimmunity, donor-specific alloantibodies can be identified against genotype derived non-HLA epitopes. FUNDING Austrian Science Fund, WWTF (Vienna Science and Technology Fund), and Ministry of Health of the Czech Republic.
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Affiliation(s)
| | - Andreas Heinzel
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Alexander Kainz
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Jessica van Setten
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Kira Jelencsics
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Karin Hu
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Bao-Li Loza
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Kammer
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Georg Heinze
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Alena Koňaříková
- Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ondrej Viklicky
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Georg A Boehmig
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Farsad Eskandary
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Gottfried Fischer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Frans Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | | | - Brendan Keating
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria.
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van Bentem K, Bos M, van der Keur C, Eikmans M, Heidt S, Claas F, Lashley L, van der Hoorn ML. 245. The development of pre-eclampsia in oocyte donation pregnancies is related to the number of HLA class II mismatches. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.08.322] [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: 11/29/2022]
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Romee R, Rosario M, Berrien-Elliott MM, Wagner JA, Jewell BA, Schappe T, Leong JW, Abdel-Latif S, Schneider SE, Willey S, Neal CC, Yu L, Oh ST, Lee YS, Mulder A, Claas F, Cooper MA, Fehniger TA. Cytokine-induced memory-like natural killer cells exhibit enhanced responses against myeloid leukemia. Sci Transl Med 2017; 8:357ra123. [PMID: 27655849 DOI: 10.1126/scitranslmed.aaf2341] [Citation(s) in RCA: 554] [Impact Index Per Article: 79.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/04/2016] [Indexed: 12/14/2022]
Abstract
Natural killer (NK) cells are an emerging cellular immunotherapy for patients with acute myeloid leukemia (AML); however, the best approach to maximize NK cell antileukemia potential is unclear. Cytokine-induced memory-like NK cells differentiate after a brief preactivation with interleukin-12 (IL-12), IL-15, and IL-18 and exhibit enhanced responses to cytokine or activating receptor restimulation for weeks to months after preactivation. We hypothesized that memory-like NK cells exhibit enhanced antileukemia functionality. We demonstrated that human memory-like NK cells have enhanced interferon-γ production and cytotoxicity against leukemia cell lines or primary human AML blasts in vitro. Using mass cytometry, we found that memory-like NK cell functional responses were triggered against primary AML blasts, regardless of killer cell immunoglobulin-like receptor (KIR) to KIR-ligand interactions. In addition, multidimensional analyses identified distinct phenotypes of control and memory-like NK cells from the same individuals. Human memory-like NK cells xenografted into mice substantially reduced AML burden in vivo and improved overall survival. In the context of a first-in-human phase 1 clinical trial, adoptively transferred memory-like NK cells proliferated and expanded in AML patients and demonstrated robust responses against leukemia targets. Clinical responses were observed in five of nine evaluable patients, including four complete remissions. Thus, harnessing cytokine-induced memory-like NK cell responses represents a promising translational immunotherapy approach for patients with AML.
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Affiliation(s)
- Rizwan Romee
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Maximillian Rosario
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA. Department of Pathology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Melissa M Berrien-Elliott
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Julia A Wagner
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Brea A Jewell
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Timothy Schappe
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jeffrey W Leong
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sara Abdel-Latif
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Stephanie E Schneider
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sarah Willey
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Carly C Neal
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Liyang Yu
- Division of Hematology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Stephen T Oh
- Division of Hematology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yi-Shan Lee
- Department of Pathology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Arend Mulder
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, 2333 ZC Leiden, Netherlands
| | - Frans Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, 2333 ZC Leiden, Netherlands
| | - Megan A Cooper
- Division of Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Todd A Fehniger
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
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van der Zwan A, Li N, van der Keur C, Koning F, Heidt S, Claas F, van Unen V. Visualizing the players of the maternal immune response at the maternal-fetal interface by high-dimensional mass cytometry. Placenta 2017. [DOI: 10.1016/j.placenta.2017.07.080] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Geneugelijk K, Niemann M, Drylewicz J, van Zuilen A, Joosten I, Allebes W, van der Meer A, Hilbrands L, Baas M, Hack E, van Reekum F, Verhaar M, Kamburova E, Bots M, Seelen M, Sanders JS, Hepkema B, Lambeck A, Bungener L, Tilanus M, Voorter C, Vanderlocht J, Wieten L, Duijnhoven E, Gelens M, Christiaans M, van Ittersum F, Nurmohamed A, Lardy N, Swelsen W, van der Pant K, van der Weerd N, Berge IT, Bemelman F, Hoitsma A, van der Boog P, de Fijter J, Betjes M, Heidt S, Roelen D, Claas F, Otten H, Spierings E. OR41 PIRCHE-II: A novel tool to identify permissible HLA mismatches in kidney transplantation. Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.06.047] [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: 10/18/2022]
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Bontrop R, Brand A, Claas F. Prof Dr. Johannes Joseph (Jon) van Rood (1926–2017). Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.08.001] [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: 11/26/2022]
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Gielis E, Anholts J, de Fijter J, Claas F, Eikmans M. MP790MICRORNAS IN URINE HELP TO IDENTIFY ACUTE REJECTION AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx182.mp790] [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: 11/13/2022] Open
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Karahan GE, Vaal Y, Krop J, Roelen D, Claas F, Heidt S. OR26 Taking the hla-specific memory b cell elispot to the next level: assaying the full donor hla repertoire. Hum Immunol 2016. [DOI: 10.1016/j.humimm.2016.07.038] [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: 10/21/2022]
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Yang J, Kemps-Mols B, Spruyt-Gerritse M, Anholts J, Claas F, Eikmans M. The source of SYBR green master mix determines outcome of nucleic acid amplification reactions. BMC Res Notes 2016; 9:292. [PMID: 27259280 PMCID: PMC4893258 DOI: 10.1186/s13104-016-2093-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantitative (q) PCR by amplification of nucleic acid with a fluorescent dye is widely used. Selection of adequate PCR reagents and devices is relevant to achieve reliable and consistent data. Our main objective was to test the robustness of different commercial SYBR green PCR mixes with respect to specificity and sensitivity of the PCR assay, across various PCR machines (Light Cycler 96, ViiA7) and amplification protocols. Herein, we applied PCR protocols for determining mRNA transcript levels, DNA copy numbers, and DNA genotype. RESULTS First, we set up 70 primer-based assays that targeted immune-related mRNA transcripts. Of the 70 assays 66 (94.3 %) resulted in a single melting curve peak, indicating specificity of the amplification, with PCR mixes from large vendors (Roche, ABI, Bio-Rad). But this was only seen when the PCR protocol that was indicated in the vendor's guidelines for each particular mix was applied. When deviating from the prescribed protocol, suboptimal melting curves were most often seen when using Roche SYBR green. With respect to PCR yields, the use of ABI mix more often led to lower Cq values. Second, we set up 20 primer-selective PCR assays to target different insertion-deletion and single nucleotide polymorphism regions throughout the genome. The variation in delta Cq between positive and negative DNA samples among the PCR assays was the lowest when using ABI master mix. Finally, the quality of high resolution melting (HRM) assays for DNA genotyping was compared between four commercial HRM PCR mixes (Roche, Bioline, PCR Biosystems, ABI). Only Roche and ABI mixes produced optimal clusters of melting profiles that clearly distinguished genotype variants. CONCLUSIONS The current results show a preference for the use of ABI mix when it comes to obtaining higher sensitivity in cDNA analysis and a higher consistency among assays in distinguishing DNA genotypes among different individuals. For HRM assays, it is advisable to use master mix from a relatively large vendor.
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Affiliation(s)
- Jianxin Yang
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Bldg 1, E3-Q, Albinusdreef 2, 2333, Leiden, The Netherlands
| | - Berit Kemps-Mols
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Bldg 1, E3-Q, Albinusdreef 2, 2333, Leiden, The Netherlands
| | - Marijke Spruyt-Gerritse
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Bldg 1, E3-Q, Albinusdreef 2, 2333, Leiden, The Netherlands
| | - Jacqueline Anholts
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Bldg 1, E3-Q, Albinusdreef 2, 2333, Leiden, The Netherlands
| | - Frans Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Bldg 1, E3-Q, Albinusdreef 2, 2333, Leiden, The Netherlands
| | - Michael Eikmans
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Bldg 1, E3-Q, Albinusdreef 2, 2333, Leiden, The Netherlands.
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Johnsen GM, Størvold GL, Drabbels JJ, Haasnoot GW, Eikmans M, Alnæs-Katjavivi P, Scherjon S, Redman CW, Claas F, Staff AC. Maternal KIR-B haplotype in combination with fetal HLA-C2 is associated with pregnancy acute atherosis in the decidua basalis. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.030] [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: 10/21/2022]
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Johnsen GM, Størvold GL, Drabbels JJ, Haasnoot GW, Eikmans M, Alnæs-Katjavivi P, Scherjon S, Redman CW, Claas F, Staff AC. Maternal KIR-B haplotype in combination with fetal HLA-C2 is associated with pregnancy acute atherosis in the decidua basalis. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.198] [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: 11/16/2022]
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Roelen D, Brand-Schaaf S, Stein S, Claas F. P027. Hum Immunol 2014. [DOI: 10.1016/j.humimm.2014.08.089] [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: 10/24/2022]
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Pascual J, Abramowicz D, Cochat P, Claas F, Dudley C, Harden P, Heeman U, Hourmant M, Maggiore U, Salvadori M, Spasovski G, Squif JP, Steiger J, Torres A, Vanholder R, Van Biesen W, Viklicky O, Zeier M, Nagler E. European renal best practice guideline on the management and evaluation of the kidney donor and recipient. Nefrologia 2014; 34:293-301. [PMID: 24798566 DOI: 10.3265/nefrologia.pre2014.feb.12490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2014] [Indexed: 06/03/2023] Open
Abstract
The purpose of this Clinical Practice Guideline is to provide guidance on evaluation of the kidney donor and transplant recipient as well as on the management of the recipient in the perioperative period. It is designed to provide information and aid decision-making. It is not intended to define a standard of care, and should neither be construed as one nor should it be interpreted as prescribing an exclusive course of management. The original version of this guideline was published in Nephrology, Dialysis and Transplantation and this current version is a reduced article aiming to disseminate the guideline into Spanish-speaking countries and transplant communities.
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Fast L, Reagan J, Nevola M, Mulder A, Claas F, Quesenberry P. Induction of anti-leukemic responses using cellular immunotherapy (TUM2P.921). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.71.45] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Previous work has shown that blood cancers can be treated through stimulation of the cancer patient’s immune system. In initial studies, it was observed that 14/26 patients with refractory hematological malignancies responded (9 major) to the infusion of large numbers (1 -2 x 108 CD3+ cells/kg) of haploidentical white blood cells following low levels of total body irradiation (100cGy). A cytokine storm quickly developed with a median time of 14 hours and resulted in high fevers that were allowed to persist for 48 hours, if possible, and then controlled with corticosteroids if needed. However the potential role of anti-leukemic effector cells in these responses was not determined. Three patients have been enrolled into a re-opened cellular immunotherapy clinical trial in which haploidentical white blood cells are infused with no prior chemotherapy or radiation. Blood samples were obtained from the recipient approximately 1, 24, 48, 72 and 168 hours after infusion and analyzed for the persistence and activity of donor/recipient cells as well as levels of cytokines and other factors in the plasma. Thus far, the results demonstrate elimination of donor cells by day 7, rapid upregulation of PD-1 ligands on leukemic cells and prolonged plasma levels of IL-10. Evaluation of the trends obtained with increased number of patients enrolled in the clinical trials will provide insights into new approaches to enhance the anti-leukemic responses in these patients.
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Affiliation(s)
- Loren Fast
- 1Medicine, Rhode Island Hospital, Providence, RI
| | - John Reagan
- 1Medicine, Rhode Island Hospital, Providence, RI
| | | | - Arend Mulder
- 2Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - F. Claas
- 2Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
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Benítez C, Londoño MC, Miquel R, Manzia TM, Abraldes JG, Lozano JJ, Martínez-Llordella M, López M, Angelico R, Bohne F, Sese P, Daoud F, Larcier P, Roelen DL, Claas F, Whitehouse G, Lerut J, Pirenne J, Rimola A, Tisone G, Sánchez-Fueyo A. Prospective multicenter clinical trial of immunosuppressive drug withdrawal in stable adult liver transplant recipients. Hepatology 2013; 58:1824-35. [PMID: 23532679 DOI: 10.1002/hep.26426] [Citation(s) in RCA: 229] [Impact Index Per Article: 20.8] [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] [Received: 07/12/2012] [Accepted: 03/22/2013] [Indexed: 12/12/2022]
Abstract
UNLABELLED Lifelong immunosuppression increases morbidity and mortality in liver transplantation. Discontinuation of immunosuppressive drugs could lessen this burden, but the safety, applicability, and clinical outcomes of this strategy need to be carefully defined. We enrolled 102 stable liver recipients at least 3 years after transplantation in a single-arm multicenter immunosuppression withdrawal trial. Drugs were gradually discontinued over a 6 to 9-month period. The primary endpoint was the development of operational tolerance, defined as successful immunosuppressive drug cessation maintained for at least 12 months with stable graft function and no histopathologic evidence of rejection. Out of the 98 recipients evaluated, 57 rejected and 41 successfully discontinued all immunosuppressive drugs. In nontolerant recipients rejection episodes were mild and resolved over 5.6 months (two nontolerant patients still exhibited mild gradually improving cholestasis at the end of follow-up). In tolerant recipients no progressive clinically significant histological damage was apparent in follow-up protocol biopsies performed up to 3 years following drug withdrawal. Tolerance was independently associated with time since transplantation (odds ratio [OR] 1.353; P = 0.0001), recipient age (OR 1.073; P = 0.009), and male gender (OR 4.657; P = 0.016). A predictive model incorporating the first two clinical variables identified subgroups of recipients with very high (79%), intermediate (30%-38%), and very low (0%) likelihood of successful withdrawal. CONCLUSION When conducted at late timepoints after transplantation, immunosuppression withdrawal is successful in a high proportion of carefully selected liver recipients. A combination of clinical parameters could be useful to predict the success of this strategy. Additional prospective studies are now needed to confirm these results and to validate clinically applicable diagnostic biomarkers.
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Affiliation(s)
- Carlos Benítez
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
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32
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Roelen D, de Vaal Y, Vierra-Green C, Waldvogel S, Spellman S, Claas F, Oudshoorn M. 13-OR. Hum Immunol 2013. [DOI: 10.1016/j.humimm.2013.08.024] [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: 10/26/2022]
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33
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Dierselhuis MP, Spierings E, Drabbels J, Hendriks M, Alaez C, Alberú J, Alvarez MB, Burlingham W, Campos E, Christiaans M, Claas F, Fasano ME, Gerbase-DeLima M, Gervais T, Gorodezky C, Larriba J, Lardy NM, Latinne D, Morales-Buenrostro LE, Moreno MJ, Oguz F, Opelz G, Sergeant R, Tambutti M, Teper S, Tilanus M, Turkmen A, Warrens AN, Weimar W, Goulmy E. Minor H antigen matches and mismatches are equally distributed among recipients with or without complications after HLA identical sibling renal transplantation. ACTA ACUST UNITED AC 2013; 82:312-6. [DOI: 10.1111/tan.12209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/31/2013] [Accepted: 09/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M. P. Dierselhuis
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden; The Netherlands
| | - E. Spierings
- Department of Immunology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - J. Drabbels
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden; The Netherlands
| | - M. Hendriks
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden; The Netherlands
| | - C. Alaez
- Department of Immunology & Immunogenetics; Instituto de Diagnostico y Referencia Epidemiologicos; Mexico City; Mexico
| | - J. Alberú
- Department of Transplantation; Instituto Nacional de Ciencias, Médicas y de la Nutrición; Mexico City; Mexico
| | - M. B. Alvarez
- Centro de Inmunología y Genética molecular; Buenos Aires; Argentina
| | - W. Burlingham
- Department of Surgery; University of Wisconsin; Madison; WI; USA
| | - E. Campos
- Universidade Federal de São Paulo and Associação Fundo de Incentivo à Pesquisa; São Paulo; Brazil
| | - M. Christiaans
- Department of Nephrology; Maastricht University Medical Center; Maastricht; The Netherlands
| | - F. Claas
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden; The Netherlands
| | - M. E. Fasano
- Immunologia Trapianti c/o Genetica; Turin; Italy
| | - M. Gerbase-DeLima
- Universidade Federal de São Paulo and Associação Fundo de Incentivo à Pesquisa; São Paulo; Brazil
| | - T. Gervais
- Immunohaematology, Cliniques St. Luc; Université Catholique de Louvain; Brussels; Belgium
| | - C. Gorodezky
- Department of Immunology & Immunogenetics; Instituto de Diagnostico y Referencia Epidemiologicos; Mexico City; Mexico
| | - J. Larriba
- Histocompatibility and Immunogenetics-ICBME; Hospital Italiano de Buenos Aires; Buenos Aires; Argentina
| | - N. M. Lardy
- Sanquin-Diagnostic Services; Amsterdam; The Netherlands
| | - D. Latinne
- Immunohaematology, Cliniques St. Luc; Université Catholique de Louvain; Brussels; Belgium
| | - L.-E. Morales-Buenrostro
- Department of Nephrology and Mineral Metabolism; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran; México City; Mexico
| | - M. J. Moreno
- Histocompatibility Laboratory; CEMIC-Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; Buenos Aires; Argentina
| | - F. Oguz
- Department of Medical Biology, Medical Faculty of Istanbul; Istanbul University; Istanbul; Turkey
| | - G. Opelz
- Institute of Immunology; University of Heidelberg; Heidelberg; Germany
| | - R. Sergeant
- Immunology; Imperial College Healthcare NHS Trust; London; UK
| | - M. Tambutti
- Histocompatibility and Immunogenetics-ICBME; Hospital Italiano de Buenos Aires; Buenos Aires; Argentina
| | - S. Teper
- Histocompatibility Laboratory; CEMIC-Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; Buenos Aires; Argentina
| | - M. Tilanus
- Transplantation Immunology, Tissue Typing Laboratory; Maastricht University Medical Center; Maastricht; The Netherlands
| | - A. Turkmen
- Department of Medical Biology, Medical Faculty of Istanbul; Istanbul University; Istanbul; Turkey
| | - A. N. Warrens
- Immunology; Imperial College Healthcare NHS Trust; London; UK
| | - W. Weimar
- Internal medicine; Erasmus Medical Center; Rotterdam; The Netherlands
| | - E. Goulmy
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden; The Netherlands
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Askar M, Daghstani J, Thomas D, Leahy N, Dunn P, Claas F, Doran S, Saji H, Kanangat S, Karoichane M, Tambur A, Monos D, El-Khalifa M, Turner V, Kamoun M, Mustafa M, Ramon D, Gandhi M, Vernaza A, Gorodezky C, Wagenknecht D, Gautreaux M, Hajeer A, Kashi Z, Fernandez-Vina M. 16(th) IHIW: global distribution of extended HLA haplotypes. Int J Immunogenet 2013; 40:31-8. [PMID: 23302097 DOI: 10.1111/iji.12029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 11/09/2012] [Accepted: 11/12/2012] [Indexed: 01/02/2023]
Abstract
This report describes the project to identify the global distribution of extended HLA haplotypes, a component of 16th International HLA and Immunogenetics Workshop (IHIW), and summarizes the initial analyses of data collected. The project aims to investigate extended HLA haplotypes, compare their distribution among different populations, assess their frequency in hematopoietic stem cell unrelated donor registries and initiate an international family studies database and DNA repository to be made publicly available. HLA haplotypes compiled in immunogenetics laboratories during the evaluation of transplant candidates and related potential donors were analysed. Haplotypes were determined using the pedigree analysis tool publicly available from the National Marrow Donor Program (NMDP) website. Nineteen laboratories from 10 countries (11 laboratories from North America, five from Asia, two from Latin America and one from Australia) contributed data on a total of 1719 families comprised of 7474 individuals. We identified 10393 HLA haplotypes, of which 1682 haplotypes included high-resolution typing at HLA-A, B, C, DRB1 and DQB1 loci. We also present haplotypes containing MICA and other HLA loci and haplotypes containing rare alleles seen in these families. The project will be extended through the 17th IHIW, and investigators interested in joining the project may communicate with the first author.
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Affiliation(s)
- M Askar
- Allogen Laboratories, Cleveland Clinic, Cleveland, OH 44195, USA.
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35
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Süsal C, Roelen DL, Fischer G, Campos EF, Gerbase-DeLima M, Hönger G, Schaub S, Lachmann N, Martorell J, Claas F. Algorithms for the determination of unacceptable HLA antigen mismatches in kidney transplant recipients. ACTA ACUST UNITED AC 2013; 82:83-92. [PMID: 23718733 DOI: 10.1111/tan.12137] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
One of the major tasks of human leukocyte antigen (HLA) laboratories is the pretransplant determination of unacceptable HLA antigen mismatches (UAM) in organ transplant recipients. HLA antigen specificities are determined against which the patient has circulating alloantibodies that are expected to harm the transplanted organ. Using the information on UAM, negative crossmatch (XM) prediction or 'virtual XM' is possible when a potential donor's complete HLA typing is available. Before the introduction of solid-phase antibody detection assays, UAM were determined using the complement-dependent cytotoxicity methodology. After the introduction of the single antigen bead technique, however, various UAM determination algorithms have emerged. In this report, six different laboratories worldwide present how they determine UAM in their collective of kidney transplant recipients in the pretransplant phase and proceed thereafter to transplantation.
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Affiliation(s)
- C Süsal
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
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36
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Roelen D, Rowshani A, Brand-Schaaf S, Wetering JV, Roodnat J, Stein S, Weimar W, Claas F. 46-P. Hum Immunol 2012. [DOI: 10.1016/j.humimm.2012.07.172] [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: 11/24/2022]
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38
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Duquesnoy RJ, Marrari M, Mulder A, Claas F. 15-OR. Hum Immunol 2012. [DOI: 10.1016/j.humimm.2012.07.047] [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: 10/27/2022]
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39
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van der Hoorn ML, van Lochem A, Swings G, van Beelen E, van der Keur C, Blois S, Tirado-Gonzales I, Karumanchi A, Bianchi D, Claas F, Scherjon S. Differential immunoregulation in successful oocyte donation pregnancies compared with naturally conceived pregnancies. J Reprod Immunol 2012. [DOI: 10.1016/j.jri.2012.03.324] [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: 11/27/2022]
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40
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van Lochem A, van Beelen E, van der Keur C, Swings G, van Zijl L, Claas F, Scherjon S. Preservation of human placenta is feasible and facilitates studies on the local immune regulation in normal and aberrant pregnancies. J Reprod Immunol 2012. [DOI: 10.1016/j.jri.2012.03.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Schonkeren D, Swings G, Roberts D, Claas F, de Heer E, Scherjon S. Pregnancy close to the edge: an immunosuppressive infiltrate in the chorionic plate of placentas from uncomplicated egg cell donation. PLoS One 2012; 7:e32347. [PMID: 22479322 PMCID: PMC3314004 DOI: 10.1371/journal.pone.0032347] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [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: 08/18/2011] [Accepted: 01/27/2012] [Indexed: 11/19/2022] Open
Abstract
In pregnancies achieved after egg donation (ED) tolerance towards a completely allogeneic fetus is mediated by several complex immunoregulatory mechanisms, of which numerous aspects are still unknown. A distinct lesion not described previously in the literature, was repeatedly found in the chorionic plate in a substantial portion of placentas from ED pregnancies, but never in placentas from normal term pregnancies. The aim of this study was to assess its origin and its cellular composition. The relation between the lesion, the clinical and histological parameters were assessed. In addition we investigated the relation with the number of HLA-mismatches and KIR genotype of mother and child.In ten out of twenty-six (38.5%) placentas from ED pregnancies an inflammatory lesion was present in the chorionic plate. A significantly lower incidence of pre-eclampsia was found in the group with the lesion; 0% versus 45.5%. A significant relation was found between this lesion and the presence of intervillositis, chronic deciduitis, presence of plasma cells and fibrin deposition in the decidua. Fluorescent in situ hybridisation with X/Y-chromosome probes showed that the majority of cells present in the lesion are of maternal origin. The expression of the macrophage marker CD14+ and of the type 2 macrophage (M2) marker CD163+ was significantly higher in the lesion. The incidence of a fetal HLA-C2 genotype was significantly higher in cases with a lesion compared to the group without the lesion. In conclusion, a striking relationship was observed between the presence of a not previously described inflammatory lesion in the chorionic plate and the absence of pre-eclampsia in ED pregnancies. The lesion consists of mainly maternal cells with a higher expression of the macrophage marker CD14+ and the M2 marker CD163+. These findings suggest a protective immune mechanism which might contribute to the prevention of severe clinical complications like pre-eclampsia.
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MESH Headings
- Adult
- Antigens, CD/immunology
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/immunology
- Antigens, Differentiation, Myelomonocytic/metabolism
- Chorion/immunology
- Chorion/metabolism
- Chorion/pathology
- Decidua/immunology
- Decidua/metabolism
- Decidua/pathology
- Female
- Fetus/immunology
- Fetus/metabolism
- Genotype
- HLA-C Antigens/genetics
- HLA-C Antigens/immunology
- Humans
- Immune Tolerance/immunology
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Infant, Newborn
- Inflammation/immunology
- Inflammation/metabolism
- Inflammation/pathology
- Lipopolysaccharide Receptors/immunology
- Lipopolysaccharide Receptors/metabolism
- Macrophages/immunology
- Macrophages/metabolism
- Male
- Middle Aged
- Oocyte Donation
- Placenta/immunology
- Placenta/metabolism
- Placenta/pathology
- Pregnancy
- Pregnancy Complications/immunology
- Pregnancy Complications/metabolism
- Pregnancy Complications/pathology
- Receptors, Cell Surface/immunology
- Receptors, Cell Surface/metabolism
- Receptors, KIR/genetics
- Receptors, KIR/immunology
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Affiliation(s)
- Dorrith Schonkeren
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
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42
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Cohen D, Visser J, Claas F, Bruijn J, Bajema I, Bloemenkamp K. Placental C4d and anti-HLA antibodies in patients with recurrent miscarriage of unknown etiology: humoral rejection of the fetal allograft? J Reprod Immunol 2011. [DOI: 10.1016/j.jri.2011.06.039] [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: 10/18/2022]
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43
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Schonkeren D, van der Hoorn ML, Khedoe P, Swings G, van Beelen E, Claas F, van Kooten C, de Heer E, Scherjon S. Differential distribution and phenotype of decidual macrophages in preeclamptic versus control pregnancies. Am J Pathol 2011; 178:709-17. [PMID: 21281803 DOI: 10.1016/j.ajpath.2010.10.011] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/08/2010] [Accepted: 10/01/2010] [Indexed: 01/11/2023]
Abstract
Maternal immune tolerance of the semiallogeneic fetus is a complex phenomenon. Macrophages are an abundant cell population in the human decidua, and changes in distribution or phenotype may be involved in the development of preeclampsia. The aim of this study was to assess the distribution and phenotype of macrophages in preterm preeclamptic, preterm control, and term control placentas. Placentas of preterm preeclamptic (n = 6), preterm control (n = 5), and term control pregnancies (n = 6) were sequentially immunohistochemically stained for CD14, CD163, DC SIGN, and IL-10. The distributions of CD14(+), CD163(+), DC SIGN(+), IL-10(+), CD163(+)/CD14(+), DC SIGN(+)/CD14(+), and Flt-1/CD14(+) cells were determined by double staining and by digital image analysis of sequential photomicrographs. CD14 and CD163 expression increased significantly in preterm preeclamptic decidua basalis compared with preterm control pregnancies (P = 0.0006 and P = 0.034, respectively). IL-10 expression was significantly lower in the decidua parietalis of preterm preeclamptic pregnancies compared with preterm control pregnancies (P = 0.03). The CD163/CD14 ratio was significantly lower in the decidua basalis (P = 0.0293) and the DC SIGN/CD14 ratio was significantly higher in the decidua basalis (P < 0.0001) and parietalis (P < 0.0001) of preterm preeclamptic pregnancies compared with preterm control pregnancies. CD14(+) macrophages did express Flt-1. Alterations in distribution and phenotype of macrophages in the decidua of preterm preeclamptic pregnancies compared with control pregnancies may contribute to the pathogenesis of preeclampsia.
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Affiliation(s)
- Dorrith Schonkeren
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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44
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Nielsen HS, Witvliet MD, Steffensen R, Haasnoot GW, Goulmy E, Christiansen OB, Claas F. The presence of HLA-antibodies in recurrent miscarriage patients is associated with a reduced chance of a live birth. J Reprod Immunol 2011; 87:67-73. [PMID: 20605049 DOI: 10.1016/j.jri.2010.05.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 05/21/2010] [Accepted: 05/23/2010] [Indexed: 10/19/2022]
Abstract
Anti-paternal HLA-antibodies are considered a harmless phenomenon during most pregnancies, whereas their role in recurrent miscarriage (RM) patients is disputed. In contrast to primary RM, patients with secondary RM have carried a fetus to term pregnancy prior to a series of miscarriages, which increases the chance that allogeneic fetal cells appear in the maternal circulation. This study investigates the frequency of HLA-antibodies in secondary RM, primary RM patients and parous controls and analyzes whether the presence of HLA-antibodies in early pregnancy is associated with pregnancy outcome. Sera from women with secondary RM (n=56), primary RM (n=13) and parous controls (n=24) were tested for HLA-antibodies using an ELISA assay and complement dependent cytotoxicity. Samples were taken at gestational week 4-5 in 62 (90%) of the patients. HLA-antibodies were significantly more frequent in secondary RM patients with a boy prior to the miscarriages (62%) compared to secondary RM patients with a firstborn girl (29%, p=0.03), primary RM patients (23%, p=0.02) and parous controls (25%, p=0.005). Forty-one percent of HLA-antibody positive pregnant RM patients had a live birth compared to 76% of HLA-antibody negative RM patients, p=0.006 (adjusted OR: 0.22 (0.07-0.68), p=0.008). In conclusion, HLA-antibodies are significantly more frequent in secondary RM patients with a firstborn boy than in other RM patients and controls. The presence of these antibodies in early pregnancy is associated with a reduced chance of a live birth. Further exploring this association may increase our understanding of maternal acceptance of the fetal allograft.
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Affiliation(s)
- Henriette Svarre Nielsen
- The Fertility Clinic, University Hospital Copenhagen, Rigshospitalet, Fertility Clinic 4071, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Scherjon S, Lashley L, van der Hoorn ML, Claas F. Fetus specific T cell modulation during fertilization, implantation and pregnancy. Placenta 2011; 32 Suppl 4:S291-7. [PMID: 21592567 DOI: 10.1016/j.placenta.2011.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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] [Received: 02/16/2011] [Accepted: 03/28/2011] [Indexed: 02/07/2023]
Abstract
Recently there is an increasing interest in aspects of a more specific immunoregulation during pregnancy. Understanding these mechanism might have a broader application not only for reproductive immunology but also in general for biology and medicine. Especially the induction, already before conception, of feto-specific T cells with a possibly regulatory function gives a biological explanation of local immunotolerance at the maternal fetal interface, supporting the epidemiological evidence of a feto/paternal-specific immuneregulation. Understanding the expression of specific HLA-classes on trophoblast and the crosstalk of these antigens with various cell types, specifically modulated in the decidua, resulting in the secretion of cytokines and (angiogenic) chemokines has given us a more and more detailed understanding of this regulation. This regulation could be induced by fetal cells circulating in the mother (microchimerism) and from the interaction with fetal subcellular fractions as exosomes, but also from paternal antigens present in seminal fluid. Molecular interaction between paternal and fetal antigens and receptors in endometrium and the decidua are discussed. This review highlights besides uNK cells, especially the function of CD4+ and CD8+ T cells with a regulatory function in the context of recurrent miscarriage and pre-eclampsia. Besides HLA, also male-specific minor histocompatibility antigens and the genetic background for these pregnancy complications are discussed.
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Affiliation(s)
- S Scherjon
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
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46
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Nielsen HS, Witvliet MD, Steffensen R, Haasnoot GW, Goulmy E, Christiansen OB, Claas F. Corrigendum to “The presence of HLA-antibodies in recurrent miscarriage patients is associated with a reduced chance of a live birth” [J. Reprod. Immunol. 87 (2010) 67–73]. J Reprod Immunol 2011. [DOI: 10.1016/j.jri.2011.04.002] [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: 11/26/2022]
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Marrari M, Mostecki J, Mulder A, Claas F, Balazs I, Duquesnoy RJ. Human monoclonal antibody reactivity with human leukocyte antigen class I epitopes defined by pairs of mismatched eplets and self-eplets. Transplantation 2011; 90:1468-72. [PMID: 21063243 DOI: 10.1097/tp.0b013e3182007b74] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM Humoral sensitization affects transplant outcome, and it is now apparent that human leukocyte antigen (HLA) antibodies are specific for epitopes rather than antigens. Such epitopes can be structurally defined by HLAMatchmaker, an algorithm that considers eplets as critical elements of epitopes recognized by alloantibodies. This study addressed the question how mismatched HLA antigens induce specific antibodies in context with eplet differences with the antibody producer. METHODS HLA class I-specific human monoclonal antibodies derived from women sensitized during pregnancy were tested in Luminex assays with single allele panels. Their epitope specificity was determined from reactivity patterns and eplet differences between immunizing antigen and the antibody producer. RESULTS This study focuses on the reactivity patterns of 10 monoclonal antibodies specific for epitopes defined by a mismatched eplet paired with a self-eplet shared between immunizing HLA antigens and HLA antigens of the antibody producer. The eplets in these pairs are between 7 and 16 Å apart, a sufficient distance for contact by two separate complementarity-determining regions of antibody. CONCLUSIONS These findings demonstrate that immunizing antigens have mismatched eplets that can form antibody-reactive epitopes with self-configurations on the molecular surface. They seem to suggest that HLA antibodies can be produced by autoreactive B cells that have undergone receptor editing to accommodate the recognition of nonself-eplets, the driving force of the humoral alloresponse. This concept enhances our understanding of structural epitope immunogenicity and the interpretation of antibody reactivity patterns with HLA panels.
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Affiliation(s)
- Marilyn Marrari
- Division of Transplantation Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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48
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van der Hoorn ML, Helmerhorst F, Claas F, Scherjon S. Dizygotic twin pregnancy after transfer of one embryo. Fertil Steril 2010; 95:805.e1-3. [PMID: 20850717 DOI: 10.1016/j.fertnstert.2010.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 07/21/2010] [Accepted: 08/13/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To consider the risk of intercourse without contraception during infertility treatment. DESIGN Case report. SETTING Leiden University Medical Center. PATIENT(S) An infertile couple underwent IVF for tubal pathology. INTERVENTION(S) Transfer of one embryo during a natural cycle. MAIN OUTCOME MEASURE(S) Human leukocyte antigen typing, histochemical analysis of the fetal membranes, neonatal and maternal clinical outcomes. RESULT(S) A dizygotic twin pregnancy was confirmed after birth by human leukocyte antigen typing of both fetuses and mother and by histochemical analysis of the dividing fetal membranes. This suggests a pregnancy of concurrent IVF and spontaneous conception. Pregnancy was complicated by preeclampsia and intrauterine growth retardation of both fetuses. CONCLUSION(S) We state that couples should abstain from intercourse without contraception during infertility treatment to prevent multiple gestation and its related complications for mother and fetuses.
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49
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DʼOrsogna LJ, van der Meer-Prins E, van der Pol P, Franke-van Dijk M, Zoet Y, Eikmans M, Anholts J, Mulder A, van Kooten C, Rossjohn J, McCluskey J, Roelen D, Doxiadis I, Claas F. ORGAN SPECIFICITY OF CROSS-REACTIVE ALLOGENEIC RESPONSES BY VIRAL SPECIFIC MEMORY T-CELLS. Transplantation 2010. [DOI: 10.1097/00007890-201007272-00454] [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]
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50
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Tilburgs T, Schonkeren D, Eikmans M, Strominger J, Roelen D, Scherjon S, Claas F. Human decidual tissue contains disarmed CD8+ Effector-Memory T cells (48.2). The Journal of Immunology 2010. [DOI: 10.4049/jimmunol.184.supp.48.2] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
During pregnancy maternal lymphocytes at the fetal-maternal interface play a key role in the immune acceptance of the allogeneic fetus. Recently, CD4+CD25bright regulatory T cells have shown to be concentrated in decidual tissue where they are able to suppress fetus-specific immune responses. Decidual CD8+ T cells form the largest fraction of T cells at the fetal-maternal interface but limited data is present on the characteristics of these cells. In this study we examined decidual and peripheral CD8+ T cells for CD45RA, CCR7, CD28 and CD27 expression using nine-colour flowcytometry. Our data demonstrate that decidual CD8+ T cells mainly consist of differentiated CD45RA-CCR7- effector-memory (EM) cells while unprimed CD45RA+CCR7+ naïve cells are absent. Unlike peripheral blood EM T cells, the decidual EM T cells do not express perforin and have a reduced expression of granzyme B, which was confirmed by immunohistochemistry of decidual tissue sections. Interestingly, quantitative PCR shows an increased perforin and granzyme B mRNA content in decidual EM T cells in comparison to peripheral blood. The presence of high levels of perforin and granzyme B mRNA in decidual EM T cells suggests that decidual CD8+ T cells pursue alternative means of EM cell differentiation that may include a blockade of perforin and granzyme B mRNA translation into functional proteins. Regulation of decidual CD8+ T cell differentiation may play a crucial role in maternal immune tolerance to the fetus.
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Affiliation(s)
- Tamara Tilburgs
- 1Molecular and Cellular Biology, Harvard University, Cambridge, MA
- 2Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Jack Strominger
- 1Molecular and Cellular Biology, Harvard University, Cambridge, MA
| | - Dave Roelen
- 2Leiden University Medical Center, Leiden, Netherlands
| | | | - Frans Claas
- 2Leiden University Medical Center, Leiden, Netherlands
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