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Kushak RI, Boyle DC, Rosales IA, Ingelfinger JR, Stahl GL, Ozaki M, Colvin RB, Grabowski EF. Platelet thrombus formation in eHUS is prevented by anti-MBL2. PLoS One 2019; 14:e0220483. [PMID: 31881024 PMCID: PMC6934323 DOI: 10.1371/journal.pone.0220483] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/05/2019] [Indexed: 11/29/2022] Open
Abstract
E. coli associated Hemolytic Uremic Syndrome (epidemic hemolytic uremic syndrome, eHUS) caused by Shiga toxin-producing bacteria is characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury that cause acute renal failure in up to 65% of affected patients. We hypothesized that the mannose-binding lectin (MBL) pathway of complement activation plays an important role in human eHUS, as we previously demonstrated that injection of Shiga Toxin-2 (Stx-2) led to fibrin deposition in mouse glomeruli that was blocked by co-injection of the anti-MBL-2 antibody 3F8. However, the markers of platelet thrombosis in affected mouse glomeruli were not delineated. To investigate the effect of 3F8 on markers of platelet thrombosis, we used kidney sections from our mouse model (MBL-2+/+ Mbl-A/C-/-; MBL2 KI mouse). Mice in the control group received PBS, while mice in a second group received Stx-2, and those in a third group received 3F8 and Stx-2. Using double immunofluorescence (IF) followed by digital image analysis, kidney sections were stained for fibrin(ogen) and CD41 (marker for platelets), von-Willebrand factor (marker for endothelial cells and platelets), and podocin (marker for podocytes). Electron microscopy (EM) was performed on ultrathin sections from mice and human with HUS. Injection of Stx-2 resulted in an increase of both fibrin and platelets in glomeruli, while administration of 3F8 with Stx-2 reduced both platelet and fibrin to control levels. EM studies confirmed that CD41-positive objects observed by IF were platelets. The increases in platelet number and fibrin levels by injection of Stx-2 are consistent with the generation of platelet-fibrin thrombi that were prevented by 3F8.
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Affiliation(s)
- R. I. Kushak
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - D. C. Boyle
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - I. A. Rosales
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - J. R. Ingelfinger
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - G. L. Stahl
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - M. Ozaki
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - R. B. Colvin
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - E. F. Grabowski
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Smith RN, Matsunami M, Adam BA, Rosales IA, Oura T, Cosimi AB, Kawai T, Mengel M, Colvin RB. RNA expression profiling of nonhuman primate renal allograft rejection identifies tolerance. Am J Transplant 2018; 18:1328-1339. [PMID: 29288556 PMCID: PMC6021122 DOI: 10.1111/ajt.14637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/01/2017] [Accepted: 12/01/2017] [Indexed: 01/25/2023]
Abstract
Tolerance induction to prevent allograft rejection is a long-standing clinical goal. However, convincing and dependable tolerance identification remains elusive. Hypothesizing that intragraft RNA expression is informative in both rejection and tolerance, we profile intrarenal allograft RNA expression in a mixed chimerism renal allograft model of cynomolgus monkeys and identify biologically significant tolerance. Analysis of 67 genes identified 3 dominant factors, each with a different pattern of gene expressions, relating to T cell-mediated rejection (TCMR), chronic antibody-mediated rejection (CAMR), or Tolerance. Clustering these 3 factors created 9 groups. One of the 9 clustered groups, the Tolerance cluster, showed the lowest probability of terminal rejection, the longest duration of allograft survival, and the lowest relative risk of terminal rejection. The Tolerance factor consists of a novel set of gene expressions including cytokine and immunoregulatory genes adding mechanistic insights into tolerance. The Tolerance factor could not be identified within current pathologic diagnostic categories. The TCMR and CAMR factors are dominant to the Tolerance factor, causing rejection even if the Tolerance factor is present. These 3 factors determine the probability of terminal rejection or tolerance. This novel a posteriori approach permits identification of pathways of rejection, including tolerance.
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Affiliation(s)
- R. N. Smith
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - M. Matsunami
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - B. A. Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - I. A. Rosales
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - T. Oura
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - A. B. Cosimi
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - T. Kawai
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - M. Mengel
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - R. B. Colvin
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
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Madariaga MLL, Spencer PJ, Michel SG, La Muraglia GM, O’Neil MJ, Mannon EC, Leblang C, Rosales IA, Colvin RB, Sachs DH, Allan JS, Madsen JC. Effects of Lung Cotransplantation on Cardiac Allograft Tolerance Across a Full Major Histocompatibility Complex Barrier in Miniature Swine. Am J Transplant 2016; 16:979-86. [PMID: 26469344 PMCID: PMC5010442 DOI: 10.1111/ajt.13489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/10/2015] [Accepted: 08/09/2015] [Indexed: 01/25/2023]
Abstract
A 12-day course of high-dose tacrolimus induces tolerance of major histocompatibility complex-mismatched lung allografts in miniature swine but does not induce tolerance of heart allografts unless a kidney is cotransplanted. To determine whether lungs share with kidneys the ability to induce cardiac allograft tolerance, we investigated heart-lung cotransplantation using the same induction protocol. Hearts (n = 3), heart-kidneys (n = 3), lungs (n = 6), and hearts-lungs (n = 3) were transplanted into fully major histocompatibility complex-mismatched recipients treated with high-dose tacrolimus for 12 days. Serial biopsy samples were used to evaluate rejection, and in vitro assays were used to detect donor responsiveness. All heart-kidney recipients and five of six lung recipients demonstrated long-term graft survival for longer than 272 days, while all heart recipients rejected their allografts within 35 days. Tolerant recipients remained free of alloantibody and showed persistent donor-specific unresponsiveness by cell-mediated lympholysis/mixed-lymphocyte reaction. In contrast, heart-lung recipients demonstrated rejection of both allografts (days 47, 55, and 202) and antidonor responsiveness in vitro. In contrast to kidneys, lung cotransplantation leads to rejection of both heart and lung allografts, indicating that lungs do not have the same tolerogenic capacity as kidneys. We conclude that cells or cell products present in kidney, but not heart or lung allografts, have a unique capacity to confer unresponsiveness on cotransplanted organs, most likely by amplifying host regulatory mechanisms.
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Lei J, Kim JI, Shi S, Zhang X, Machaidze Z, Lee S, Schuetz C, Martins PN, Oura T, Farkash EA, Rosales IA, Smith RN, Stott R, Lee KM, Soohoo J, Boskovic S, Cappetta K, Nadazdin OM, Yamada Y, Yeh H, Kawai T, Sachs DH, Benichou G, Markmann JF. Pilot Study Evaluating Regulatory T Cell-Promoting Immunosuppression and Nonimmunogenic Donor Antigen Delivery in a Nonhuman Primate Islet Allotransplantation Model. Am J Transplant 2015; 15:2739-49. [PMID: 26014796 DOI: 10.1111/ajt.13329] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/01/2015] [Accepted: 03/20/2015] [Indexed: 01/25/2023]
Abstract
The full potential of islet transplantation will only be realized through the development of tolerogenic regimens that obviate the need for maintenance immunosuppression. Here, we report an immunotherapy regimen that combines 1-ethyl-3-(3'-dimethylaminopropyl)-carbodiimide (ECDI)-treated donor lymphoid cell infusion (ECDI-DLI) with thymoglobulin, anti-interleukin-6 receptor antibody and rapamycin to achieve prolonged allogeneic islet graft survival in a nonhuman primate (NHP) model. Prolonged graft survival is associated with Treg expansion, donor-specific T cell hyporesponsiveness and a transient absence of donor-specific alloantibody production during the period of graft survival. This regimen shows promise for clinical translation.
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Affiliation(s)
- J Lei
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J I Kim
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - S Shi
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - X Zhang
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Z Machaidze
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - S Lee
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - C Schuetz
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - P N Martins
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - T Oura
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - E A Farkash
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - I A Rosales
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - R N Smith
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - R Stott
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - K M Lee
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J Soohoo
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - S Boskovic
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - K Cappetta
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - O M Nadazdin
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Y Yamada
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - H Yeh
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - T Kawai
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - D H Sachs
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - G Benichou
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J F Markmann
- Center for Transplantation Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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