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Schroder JN, Patel CB, DeVore AD, Casalinova S, Koomalsingh KJ, Shah AS, Anyanwu AC, D'Alessandro DA, Mudy K, Sun B, Strueber M, Khaghani A, Shudo Y, Esmailian F, Liao K, Pagani FD, Silvestry S, Wang IW, Salerno CT, Absi TS, Madsen JC, Mancini D, Fiedler AG, Milano CA, Smith JW. Increasing Utilization of Extended Criteria Donor Hearts for Transplantation: The OCS Heart EXPAND Trial. JACC Heart Fail 2024; 12:438-447. [PMID: 38276933 DOI: 10.1016/j.jchf.2023.11.015] [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] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Extended criteria donor (ECD) hearts available with donation after brain death (DBD) are underutilized for transplantation due to limitations of cold storage. OBJECTIVES This study evaluated use of an extracorporeal perfusion system on donor heart utilization and post-transplant outcomes in ECD DBD hearts. METHODS In this prospective, single-arm, multicenter study, adult heart transplant recipients received ECD hearts using an extracorporeal perfusion system if hearts met study criteria. The primary outcome was a composite of 30-day survival and absence of severe primary graft dysfunction (PGD). Secondary outcomes were donor heart utilization rate, 30-day survival, and incidence of severe PGD. The safety outcome was the mean number of heart graft-related serious adverse events within 30 days. Additional outcomes included survival through 2 years benchmarked to concurrent nonrandomized control subjects. RESULTS A total of 173 ECD DBD hearts were perfused; 150 (87%) were successfully transplanted; 23 (13%) did not meet study transplantation criteria. At 30 days, 92% of patients had survived and had no severe PGD. The 30-day survival was 97%, and the incidence of severe PGD was 6.7%. The mean number of heart graft-related serious adverse events within 30 days was 0.17 (95% CI: 0.11-0.23). Patient survival was 93%, 89%, and 86% at 6, 12, and 24 months, respectively, and was comparable with concurrent nonrandomized control subjects. CONCLUSIONS Use of an extracorporeal perfusion system resulted in successfully transplanting 87% of donor hearts with excellent patient survival to 2 years post-transplant and low rates of severe PGD. The ability to safely use ECD DBD hearts could substantially increase the number of heart transplants and expand access to patients in need. (International EXPAND Heart Pivotal Trial [EXPANDHeart]; NCT02323321; Heart EXPAND Continued Access Protocol; NCT03835754).
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Affiliation(s)
| | | | - Adam D DeVore
- Duke University Hospital, Durham, North Carolina, USA
| | | | | | - Ashish S Shah
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Karol Mudy
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Benjamin Sun
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - Yasuhiro Shudo
- Stanford University Medical Center, Stanford, California, USA
| | | | | | | | | | - I-Wen Wang
- Memorial Healthcare System, Hollywood, Florida, USA
| | | | - Tarek S Absi
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joren C Madsen
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Donna Mancini
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy G Fiedler
- University of California-San Francisco, San Francisco, California, USA
| | | | - Jason W Smith
- University of California-San Francisco, San Francisco, California, USA
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Efe O, Gassen RB, Morena L, Ganchiku Y, Al Jurdi A, Lape IT, Ventura-Aguiar P, LeGuern C, Madsen JC, Shriver Z, Babcock GJ, Borges TJ, Riella LV. A humanized IL-2 mutein expands Tregs and prolongs transplant survival in preclinical models. J Clin Invest 2024; 134:e173107. [PMID: 38426492 PMCID: PMC10904054 DOI: 10.1172/jci173107] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/05/2024] [Indexed: 03/02/2024] Open
Abstract
Long-term organ transplant survival remains suboptimal, and life-long immunosuppression predisposes transplant recipients to an increased risk of infection, malignancy, and kidney toxicity. Promoting the regulatory arm of the immune system by expanding Tregs may allow immunosuppression minimization and improve long-term graft outcomes. While low-dose IL-2 treatment can expand Tregs, it has a short half-life and off-target expansion of NK and effector T cells, limiting its clinical applicability. Here, we designed a humanized mutein IL-2 with high Treg selectivity and a prolonged half-life due to the fusion of an Fc domain, which we termed mIL-2. We showed selective and sustainable Treg expansion by mIL-2 in 2 murine models of skin transplantation. This expansion led to donor-specific tolerance through robust increases in polyclonal and antigen-specific Tregs, along with enhanced Treg-suppressive function. We also showed that Treg expansion by mIL-2 could overcome the failure of calcineurin inhibitors or costimulation blockade to prolong the survival of major-mismatched skin grafts. Validating its translational potential, mIL-2 induced a selective and sustainable in vivo Treg expansion in cynomolgus monkeys and showed selectivity for human Tregs in vitro and in a humanized mouse model. This work demonstrated that mIL-2 can enhance immune regulation and promote long-term allograft survival, potentially minimizing immunosuppression.
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Affiliation(s)
- Orhan Efe
- Center for Transplantation Sciences, Department of Surgery
- Division of Nephrology, Department of Medicine, and
| | | | - Leela Morena
- Center for Transplantation Sciences, Department of Surgery
| | | | - Ayman Al Jurdi
- Center for Transplantation Sciences, Department of Surgery
- Division of Nephrology, Department of Medicine, and
| | | | | | | | - Joren C. Madsen
- Center for Transplantation Sciences, Department of Surgery
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Leonardo V. Riella
- Center for Transplantation Sciences, Department of Surgery
- Division of Nephrology, Department of Medicine, and
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Guinn MT, Szuter ES, Yokose T, Ge J, Rosales IA, Chetal K, Sadreyev RI, Cuenca AG, Kreisel D, Sage PT, Russell PS, Madsen JC, Colvin RB, Alessandrini A. Intragraft B cell differentiation during the development of tolerance to kidney allografts is associated with a regulatory B cell signature revealed by single cell transcriptomics. Am J Transplant 2023; 23:1319-1330. [PMID: 37295719 DOI: 10.1016/j.ajt.2023.05.036] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
Mouse kidney allografts are spontaneously accepted in select, fully mismatched donor-recipient strain combinations, like DBA/2J to C57BL/6 (B6), by natural tolerance. We previously showed accepted renal grafts form aggregates containing various immune cells within 2 weeks posttransplant, referred to as regulatory T cell-rich organized lymphoid structures, which are a novel regulatory tertiary lymphoid organ. To characterize the cells within T cell-rich organized lymphoid structures, we performed single-cell RNA sequencing on CD45+ sorted cells from accepted and rejected renal grafts from 1-week to 6-months posttransplant. Analysis of single-cell RNA sequencing data revealed a shifting from a T cell-dominant to a B cell-rich population by 6 months with an increased regulatory B cell signature. Furthermore, B cells were a greater proportion of the early infiltrating cells in accepted vs rejecting grafts. Flow cytometry of B cells at 20 weeks posttransplant revealed T cell, immunoglobulin domain and mucin domain-1+ B cells, potentially implicating a regulatory role in the maintenance of allograft tolerance. Lastly, B cell trajectory analysis revealed intragraft differentiation from precursor B cells to memory B cells in accepted allografts. In summary, we show a shifting T cell- to B cell-rich environment and a differential cellular pattern among accepted vs rejecting kidney allografts, possibly implicating B cells in the maintenance of kidney allograft acceptance.
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Affiliation(s)
- Michael Tyler Guinn
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA; Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Edward S Szuter
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Takahiro Yokose
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jifu Ge
- Boston's Children Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivy A Rosales
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kashish Chetal
- Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruslan I Sadreyev
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex G Cuenca
- Boston's Children Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Kreisel
- Departments of Surgery, Pathology, and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter T Sage
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul S Russell
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joren C Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert B Colvin
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alessandro Alessandrini
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Schroder JN, Patel CB, DeVore AD, Bryner BS, Casalinova S, Shah A, Smith JW, Fiedler AG, Daneshmand M, Silvestry S, Geirsson A, Pretorius V, Joyce DL, Um JY, Esmailian F, Takeda K, Mudy K, Shudo Y, Salerno CT, Pham SM, Goldstein DJ, Philpott J, Dunning J, Lozonschi L, Couper GS, Mallidi HR, Givertz MM, Pham DT, Shaffer AW, Kai M, Quader MA, Absi T, Attia TS, Shukrallah B, Sun BC, Farr M, Mehra MR, Madsen JC, Milano CA, D'Alessandro DA. Transplantation Outcomes with Donor Hearts after Circulatory Death. N Engl J Med 2023; 388:2121-2131. [PMID: 37285526 DOI: 10.1056/nejmoa2212438] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [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] [Indexed: 06/09/2023]
Abstract
BACKGROUND Data showing the efficacy and safety of the transplantation of hearts obtained from donors after circulatory death as compared with hearts obtained from donors after brain death are limited. METHODS We conducted a randomized, noninferiority trial in which adult candidates for heart transplantation were assigned in a 3:1 ratio to receive a heart after the circulatory death of the donor or a heart from a donor after brain death if that heart was available first (circulatory-death group) or to receive only a heart that had been preserved with the use of traditional cold storage after the brain death of the donor (brain-death group). The primary end point was the risk-adjusted survival at 6 months in the as-treated circulatory-death group as compared with the brain-death group. The primary safety end point was serious adverse events associated with the heart graft at 30 days after transplantation. RESULTS A total of 180 patients underwent transplantation; 90 (assigned to the circulatory-death group) received a heart donated after circulatory death and 90 (regardless of group assignment) received a heart donated after brain death. A total of 166 transplant recipients were included in the as-treated primary analysis (80 who received a heart from a circulatory-death donor and 86 who received a heart from a brain-death donor). The risk-adjusted 6-month survival in the as-treated population was 94% (95% confidence interval [CI], 88 to 99) among recipients of a heart from a circulatory-death donor, as compared with 90% (95% CI, 84 to 97) among recipients of a heart from a brain-death donor (least-squares mean difference, -3 percentage points; 90% CI, -10 to 3; P<0.001 for noninferiority [margin, 20 percentage points]). There were no substantial between-group differences in the mean per-patient number of serious adverse events associated with the heart graft at 30 days after transplantation. CONCLUSIONS In this trial, risk-adjusted survival at 6 months after transplantation with a donor heart that had been reanimated and assessed with the use of extracorporeal nonischemic perfusion after circulatory death was not inferior to that after standard-care transplantation with a donor heart that had been preserved with the use of cold storage after brain death. (Funded by TransMedics; ClinicalTrials.gov number, NCT03831048.).
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Affiliation(s)
- Jacob N Schroder
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Chetan B Patel
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Adam D DeVore
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Benjamin S Bryner
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Sarah Casalinova
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Ashish Shah
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Jason W Smith
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Amy G Fiedler
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Mani Daneshmand
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Scott Silvestry
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Arnar Geirsson
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Victor Pretorius
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - David L Joyce
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - John Y Um
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Fardad Esmailian
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Koji Takeda
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Karol Mudy
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Yasuhiro Shudo
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Christopher T Salerno
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Si M Pham
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Daniel J Goldstein
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Jonathan Philpott
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - John Dunning
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Lucian Lozonschi
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Gregory S Couper
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Hari Reddy Mallidi
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Michael M Givertz
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Duc Thinh Pham
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Andrew W Shaffer
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Masashi Kai
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Mohammed A Quader
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Tarek Absi
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Tamer S Attia
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Bassam Shukrallah
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Ben C Sun
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Maryjane Farr
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Mandeep R Mehra
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Joren C Madsen
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - Carmelo A Milano
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
| | - David A D'Alessandro
- From Duke University Medical Center, Durham, NC (J.N.S., C.B.P., A.D.D., S.C., C.A.M.); Northwestern University (B.S.B., D.T.P.) and the University of Chicago (C.T.S.) - both in Chicago; Vanderbilt University Medical Center, Nashville (A.S., T.A.); University of Wisconsin Hospital and Clinics, Madison (J.W.S.), and the Medical College of Wisconsin, Milwaukee (D.L.J.); the University of California, San Francisco, San Francisco (A.G.F.), the University of California, San Diego, La Jolla (V.P.), Cedars-Sinai Medical Center, Los Angeles (F.E.), and Stanford University Medical Center, Stanford (Y.S.) - all in California; Emory University Hospital, Atlanta (M.D., T.S.A.); Advent Health, Orlando (S.S.), Mayo Clinic, Jacksonville (S.M.P.), and Tampa General Hospital, Tampa (J.D., L.L.) - all in Florida; Yale School of Medicine, New Haven, CT (A.G.); Nebraska Medical Center, Omaha (J.Y.U.); Columbia University Medical Center, New York (K.T.), Montefiore Medical Center, Bronx (D.J.G.), and Westchester Medical Center, Valhalla (M.K.) - all in New York; Minneapolis Heart Institute Foundation (K.M., B.S., B.C.S.) and the University of Minnesota Medical Center (A.W.S.) - both in Minneapolis; Sentara Norfolk General Hospital, Norfolk (J.P.), and Virginia Commonwealth University, Richmond (M.A.Q.) - both in Virginia; Tufts Medical Center (G.S.C.), Brigham and Women's Hospital (H.R.M., M.M.G., M.R.M.), and Massachusetts General Hospital (J.C.M., D.A.D.) - all in Boston; and the University of Texas Southwestern Medical Center, Dallas (M.F.)
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Yuan Q, Hong S, Leya G, Roth E, Tsoulfas G, Williams WW, Madsen JC, Elias N. Analysis of the effects of donor and recipient hepatitis C infection on kidney transplant outcomes in the United States. World J Transplant 2023; 13:44-57. [PMID: 36908306 PMCID: PMC9993188 DOI: 10.5500/wjt.v13.i2.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 12/21/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND As Hepatitis C virus infection (HCV+) rates in kidney donors and transplant recipients rise, direct-acting antivirals (DAA) may affect outcomes.
AIM To analyze the effects of HCV+ in donors, recipients, or both, on deceased-donor (DD) kidney transplantation (KT) outcomes, and the impact of DAAs on those effects.
METHODS The Organ Procurement and Transplantation Network data of adult first solitary DD-KT recipients 1994-2019 were allocated into four groups by donor and recipient HCV+ status. We performed patient survival (PS) and death-censored graft survival (DCGS) pairwise comparisons after propensity score matching to assess the effects of HCV+ in donors and/or recipients, stratifying our study by DAA era to evaluate potential effect modification.
RESULTS Pre-DAA, for HCV+ recipients, receiving an HCV+ kidney was associated with 1.28-fold higher mortality (HR 1.151.281.42) and 1.22-fold higher death-censored graft failure (HR 1.081.221.39) compared to receiving an HCV- kidney and the absolute risk difference was 3.3% (95%CI: 1.8%-4.7%) for PS and 3.1% (95%CI: 1.2%-5%) for DCGS at 3 years. The HCV dual-infection (donor plus recipient) group had worse PS (0.56-fold) and DCGS (0.71-fold) than the dual-uninfected. Donor HCV+ derived worse post-transplant outcomes than recipient HCV+ (PS 0.36-fold, DCGS 0.34-fold). In the DAA era, the risk associated with HCV+ in donors and/or recipients was no longer statistically significant, except for impaired PS in the dual-infected vs dual-uninfected (0.43-fold).
CONCLUSION Prior to DAA introduction, donor HCV+ negatively influenced kidney transplant outcomes in all recipients, while recipient infection only relatively impaired outcomes for uninfected donors. These adverse effects disappeared with the introduction of DAA.
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Affiliation(s)
- Qing Yuan
- Department of Urology, Chinese PLA General Hospital, Beijing 100853, China
- Transplant Center and Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Shanjuan Hong
- Transplant Center and Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Gregory Leya
- Transplant Center and Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Eve Roth
- Transplant Center and Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Georgios Tsoulfas
- Department of Surgery, Aristototle University of Thessaloniki, Thessaloniki 541 24, Greece
| | - WW Williams
- Transplant Center and Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, United States
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Joren C Madsen
- Transplant Center and Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, United States
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Nahel Elias
- Transplant Center and Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, United States
- Division of Transplant Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
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6
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Abstract
Trained immunity is a functional state of the innate immune response and is characterized by long-term epigenetic reprogramming of innate immune cells. This concept originated in the field of infectious diseases - training of innate immune cells, such as monocytes, macrophages and/or natural killer cells, by infection or vaccination enhances immune responses against microbial pathogens after restimulation. Although initially reported in circulating monocytes and tissue macrophages (termed peripheral trained immunity), subsequent findings indicate that immune progenitor cells in the bone marrow can also be trained (that is, central trained immunity), which explains the long-term innate immunity-mediated protective effects of vaccination against heterologous infections. Although trained immunity is beneficial against infections, its inappropriate induction by endogenous stimuli can also lead to aberrant inflammation. For example, in systemic lupus erythematosus and systemic sclerosis, trained immunity might contribute to inflammatory activity, which promotes disease progression. In organ transplantation, trained immunity has been associated with acute rejection and suppression of trained immunity prolonged allograft survival. This novel concept provides a better understanding of the involvement of the innate immune response in different pathological conditions, and provides a new framework for the development of therapies and treatment strategies that target epigenetic and metabolic pathways of the innate immune system.
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Affiliation(s)
- Jordi Ochando
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Transplant Immunology Unit, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
| | - Willem J. M. Mulder
- grid.6852.90000 0004 0398 8763Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands ,grid.59734.3c0000 0001 0670 2351Biomedical Engineering and Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Joren C. Madsen
- grid.32224.350000 0004 0386 9924Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Mihai G. Netea
- grid.10417.330000 0004 0444 9382Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.10388.320000 0001 2240 3300Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Raphaël Duivenvoorden
- Biomedical Engineering and Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
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7
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Zhao J, Jung S, Li X, Li L, Kasinath V, Zhang H, Movahedi SN, Mardini A, Sabiu G, Hwang Y, Saxena V, Song Y, Ma B, Acton SE, Kim P, Madsen JC, Sage PT, Tullius SG, Tsokos GC, Bromberg JS, Abdi R. Delivery of costimulatory blockade to lymph nodes promotes transplant acceptance in mice. J Clin Invest 2022; 132:e159672. [PMID: 36519543 PMCID: PMC9754003 DOI: 10.1172/jci159672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/11/2022] [Indexed: 12/15/2022] Open
Abstract
The lymph node (LN) is the primary site of alloimmunity activation and regulation during transplantation. Here, we investigated how fibroblastic reticular cells (FRCs) facilitate the tolerance induced by anti-CD40L in a murine model of heart transplantation. We found that both the absence of LNs and FRC depletion abrogated the effect of anti-CD40L in prolonging murine heart allograft survival. Depletion of FRCs impaired homing of T cells across the high endothelial venules (HEVs) and promoted formation of alloreactive T cells in the LNs in heart-transplanted mice treated with anti-CD40L. Single-cell RNA sequencing of the LNs showed that anti-CD40L promotes a Madcam1+ FRC subset. FRCs also promoted the formation of regulatory T cells (Tregs) in vitro. Nanoparticles (NPs) containing anti-CD40L were selectively delivered to the LNs by coating them with MECA-79, which binds to peripheral node addressin (PNAd) glycoproteins expressed exclusively by HEVs. Treatment with these MECA-79-anti-CD40L-NPs markedly delayed the onset of heart allograft rejection and increased the presence of Tregs. Finally, combined MECA-79-anti-CD40L-NPs and rapamycin treatment resulted in markedly longer allograft survival than soluble anti-CD40L and rapamycin. These data demonstrate that FRCs are critical to facilitating costimulatory blockade. LN-targeted nanodelivery of anti-CD40L could effectively promote heart allograft acceptance.
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Affiliation(s)
- Jing Zhao
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sungwook Jung
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaofei Li
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lushen Li
- Department of Surgery and
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Vivek Kasinath
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hengcheng Zhang
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Said N. Movahedi
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad Mardini
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gianmarco Sabiu
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yoonha Hwang
- IVIM Technology, Daejeon, South Korea
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vikas Saxena
- Department of Surgery and
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Bing Ma
- Institute for Genome Sciences and
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sophie E. Acton
- Stromal Immunology Group, Laboratory for Molecular Cell Biology, University College London, London, United Kingdom
| | - Pilhan Kim
- IVIM Technology, Daejeon, South Korea
- Graduate School of Nanoscience and Technology and
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Joren C. Madsen
- Center for Transplantation Sciences, Department of Surgery
- Division of Cardiac Surgery, Department of Surgery, and
| | - Peter T. Sage
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stefan G. Tullius
- Division of Transplant Surgery and Transplant Surgery Research Laboratory, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George C. Tsokos
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan S. Bromberg
- Department of Surgery and
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Reza Abdi
- Transplantation Research Center and
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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8
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Miller CL, Madsen JC. Targeting IL-6 to prevent cardiac allograft rejection. Am J Transplant 2022; 22 Suppl 4:12-17. [PMID: 36453706 PMCID: PMC10191185 DOI: 10.1111/ajt.17206] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022]
Abstract
Outcomes following heart transplantation remain suboptimal with acute and chronic rejection being major contributors to poor long-term survival. IL-6 is increasingly recognized as a critical pro-inflammatory cytokine involved in allograft injury and has been shown to play a key role in regulating the inflammatory and alloimmune responses following heart transplantation. Therapies that inhibit IL-6 signaling have emerged as promising strategies to prevent allograft rejection. Here, we review experimental and pre-clinical evidence that supports the potential use of IL-6 signaling blockade to improve outcomes in heart transplant recipients.
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Affiliation(s)
- Cynthia L. Miller
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joren C. Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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9
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D'Alessandro DA, Wolfe SB, Osho AA, Drezek K, Prario MN, Rabi SA, Michel E, Tsao L, Coglianese E, Doucette M, Zlotoff DA, Newton-Cheh C, Thomas SS, Ton VK, Sutaria N, Schoenike MW, Christ AM, Paneitz DC, Madsen JC, Pierson R, Lewis GD. Hemodynamic and Clinical Performance of Hearts Donated After Circulatory Death. J Am Coll Cardiol 2022; 80:1314-1326. [PMID: 36175050 DOI: 10.1016/j.jacc.2022.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/27/2022] [Accepted: 07/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Donor organ demand continues to outpace supply in heart transplantation. Utilization of donation after circulatory death (DCD) hearts could significantly increase heart donor availability for patients with advanced heart failure. OBJECTIVES The purpose of this study was to describe hemodynamic and clinical profiles of DCD hearts in comparison to standard of care (SOC) hearts donated after brain death (DBD). METHODS This single-center retrospective cohort study of consecutive heart transplant recipients analyzed right heart catheterization measurements, inotrope scores, echocardiograms, and clinical outcomes between DCD and DBD heart recipients. RESULTS Between April 2016 and February 2022, 47 DCD and 166 SOC hearts were transplanted. Median time from DCD consent to transplant was significantly shorter compared with SOC waiting list time (17 days [6-28 days] vs 70 days [23-240 days]; P < 0.001). Right heart function was significantly impaired in DCD recipients compared with SOC recipients 1 week post-transplant (higher median right atrial pressure (10 mm Hg [8-13 mm Hg] vs 7 mm Hg [5-11 mm Hg]; P < 0.001), higher right atrial pressure to pulmonary capillary wedge pressure ratio (0.64 [0.54-0.82] vs 0.57 [0.43-0.73]; P = 0.016), and lower pulmonary arterial pulsatility index (1.66 [1.27-2.50] vs 2.52 [1.63-3.82]; P < 0.001), but was similar between groups by 3 weeks post-transplant. DCD and SOC recipient mortality was similar at 30 days (DCD 0 vs SOC 2%; P = 0.29) and 1 year post-transplant (DCD 3% vs SOC 8%; P = 0.16). CONCLUSIONS DCD heart utilization is associated with transient post-transplant right heart dysfunction and short-term clinical outcomes otherwise similar to transplantation using DBD hearts.
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Affiliation(s)
- David A D'Alessandro
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Stanley B Wolfe
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Asishana A Osho
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kamila Drezek
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Monica N Prario
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S Alireza Rabi
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lana Tsao
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin Coglianese
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meaghan Doucette
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel A Zlotoff
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher Newton-Cheh
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sunu S Thomas
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Van-Khue Ton
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nilay Sutaria
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark W Schoenike
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anastasia M Christ
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dane C Paneitz
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joren C Madsen
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard Pierson
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory D Lewis
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA. https://twitter.com/GLewisCardiol
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10
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Pierson RN, Allan JS, Cooper DK, D’Alessandro DA, Fishman JA, Kawai T, Lewis GD, Madsen JC, Markmann JF, Riella LV. Expert Opinion Special Feature: Patient Selection for Initial Clinical Trials of Pig Organ Transplantation. Transplantation 2022; 106:1720-1723. [PMID: 35761442 PMCID: PMC10124765 DOI: 10.1097/tp.0000000000004197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Richard N. Pierson
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - James S. Allan
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David K.C. Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David A. D’Alessandro
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jay A. Fishman
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Tatsuo Kawai
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Gregory D. Lewis
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Joren C. Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - James F. Markmann
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Leonardo V. Riella
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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11
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Abstract
Allograft failure remains a major barrier in the field of lung transplantation and results primarily from acute and chronic rejection. To date, standard-of-care immunosuppressive regimens have proven unsuccessful in achieving acceptable long-term graft and patient survival. Recent insights into the unique immunologic properties of lung allografts provide an opportunity to develop more effective immunosuppressive strategies. Here we describe advances in our understanding of the mechanisms driving lung allograft rejection and highlight recent progress in the development of novel, lung-specific strategies aimed at promoting long-term allograft survival, including tolerance.
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Affiliation(s)
- Cynthia L. Miller
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - Jane M. O
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
| | - James S. Allan
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Joren C. Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, United States
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
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12
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Riella LV, Markmann JF, Madsen JC, Rosales IA, Colvin RB, Kawai T, Pierson RN. Kidney xenotransplantation in a brain-dead donor: Glass half-full or half-empty? Am J Transplant 2022; 22:1935-1936. [PMID: 35213783 PMCID: PMC10143782 DOI: 10.1111/ajt.17011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Leonardo V Riella
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James F Markmann
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joren C Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ivy A Rosales
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert B Colvin
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tatsuo Kawai
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard N Pierson
- Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Horwitz JK, Bin S, Fairchild RL, Keslar KS, Yi Z, Zhang W, Pavlov VI, Li Y, Madsen JC, Cravedi P, Heeger PS. Linking erythropoietin to regulatory T-cell-dependent allograft survival through myeloid cells. JCI Insight 2022; 7:158856. [PMID: 35389892 PMCID: PMC9220923 DOI: 10.1172/jci.insight.158856] [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: 02/01/2022] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Erythropoietin (EPO) has multiple nonerythropoietic functions, including immune modulation, but EPO’s effects in transplantation remain incompletely understood. We tested the mechanisms linking EPO administration to prolongation of murine heterotopic heart transplantation using WT and conditional EPO receptor–knockout (EPOR-knockout) mice as recipients. In WT controls, peritransplant administration of EPO synergized with CTLA4-Ig to prolong allograft survival (P < 0.001), reduce frequencies of donor-reactive effector CD8+ T cells in the spleen (P < 0.001) and in the graft (P < 0.05), and increase frequencies and total numbers of donor-reactive Tregs (P < 0.01 for each) versus CTLA4-Ig alone. Studies performed in conditional EPOR-knockout recipients showed that each of these differences required EPOR expression in myeloid cells but not in T cells. Analysis of mRNA isolated from spleen monocytes showed that EPO/EPOR ligation upregulated macrophage-expressed, antiinflammatory, regulatory, and pro-efferocytosis genes and downregulated selected proinflammatory genes. Taken together, the data support the conclusion that EPO promotes Treg-dependent murine cardiac allograft survival by crucially altering the phenotype and function of macrophages. Coupled with our previous documentation that EPO promotes Treg expansion in humans, the data support the need for testing the addition of EPO to costimulatory blockade-containing immunosuppression regimens in an effort to prolong human transplant survival.
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Affiliation(s)
- Julian K Horwitz
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Sofia Bin
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Robert L Fairchild
- Department of Immunology, Cleveland Clinic, Cleveland, United States of America
| | - Karen S Keslar
- Department of Immunology, Cleveland Clinic, Cleveland, United States of America
| | - Zhengzi Yi
- Translational Transplant Research Center, Icahn School of medicine at Mount Sinai, New York, United States of America
| | - Weijia Zhang
- Translational Transplant Research Center, Icahn school of Medicine at Mount Sinai, New York, United States of America
| | - Vasile I Pavlov
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Yansui Li
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Joren C Madsen
- Department of Surgery, Massachusetts General Hospital, Boston, United States of America
| | - Paolo Cravedi
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Peter S Heeger
- Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, United States of America
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14
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Rosales IA, Yang C, Farkash EA, Ashry T, Ge J, Aljabban I, Ayyar A, Ndishabandi D, White R, Gildner E, Gong J, Liang Y, Lakkis FG, Nickeleit V, Russell PS, Madsen JC, Alessandrini A, Colvin RB. Novel intragraft regulatory lymphoid structures in kidney allograft tolerance. Am J Transplant 2022; 22:705-716. [PMID: 34726836 DOI: 10.1111/ajt.16880] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/25/2023]
Abstract
Intragraft events thought to be relevant to the development of tolerance are here subjected to a comprehensive mechanistic study during long-term spontaneous tolerance that occurs in C57BL/6 mice that receive life sustaining DBA/2 kidneys. These allografts rapidly develop periarterial Treg-rich organized lymphoid structures (TOLS) that form in response to class II but not to class I MHC disparity and form independently of lymphotoxin α and lymphotoxin β receptor pathways. TOLS form in situ in the absence of lymph nodes, spleen, and thymus. Distinctive transcript patterns are maintained over time in TOLS including transcripts associated with Treg differentiation, T cell checkpoint signaling, and Th2 differentiation. Pathway transcripts related to inflammation are expressed in early stages of accepted grafts but diminish with time, while B cell transcripts increase. Intragraft transcript patterns at one week posttransplant distinguish those from kidneys destined to be rejected, that is, C57BL/6 allografts into DBA/2 recipients, from those that will be accepted. In contrast to inflammatory tertiary lymphoid organs (iTLOs) that form in response to chronic viral infection and transgenic Lta expression, TOLS lack high endothelial venules and germinal centers. TOLS represent a novel, pathogenetically important type of TLO that are in situ markers of regulatory tolerance.
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Affiliation(s)
- Ivy A Rosales
- Immunopathology Research Laboratory, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chao Yang
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Evan A Farkash
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Tameem Ashry
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jifu Ge
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Imad Aljabban
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Archana Ayyar
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorothy Ndishabandi
- Immunopathology Research Laboratory, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca White
- Immunopathology Research Laboratory, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elena Gildner
- Immunopathology Research Laboratory, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jingjing Gong
- NanoString Technologies, Inc., Seattle, Washington, USA
| | - Yan Liang
- NanoString Technologies, Inc., Seattle, Washington, USA
| | - Fadi G Lakkis
- Thomas E. Starzl Transplantation Institute and Departments of Surgery and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Volker Nickeleit
- Division of Nephropathology, Department of Pathology and Laboratory Medicine, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paul S Russell
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joren C Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alessandro Alessandrini
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert B Colvin
- Immunopathology Research Laboratory, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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15
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Abstract
Targeted delivery of therapeutics through the use of nanoparticles (NPs) has emerged as a promising method that increases their efficacy and reduces their side effects. NPs can be tailored to localize to selective tissues through conjugation to ligands that bind cell-specific receptors. Although the vast majority of nanodelivery platforms have focused on cancer therapy, efforts have begun to introduce nanotherapeutics to the fields of immunology as well as transplantation. In this review, we provide an overview from a clinician's perspective of current nanotherapeutic strategies to treat solid organ transplants with NPs during the time interval between organ harvest from the donor and placement into the recipient, an innovative technology that can provide major benefits to transplant patients. The use of ex vivo normothermic machine perfusion (NMP), which is associated with preserving the function of the organ following transplantation, also provides an ideal opportunity for a localized, sustained, and controlled delivery of nanotherapeutics to the organ during this critical time period. Here, we summarize previous endeavors to improve transplantation outcomes by treating the organ with NPs prior to placement in the recipient. Investigations in this burgeoning field of research are promising, but more extensive studies are needed to overcome the physiological challenges to achieving effective nanotherapeutic delivery to transplanted organs discussed in this review.
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Affiliation(s)
- Bilal Hussain
- Transplantation Research Center and Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Vivek Kasinath
- Transplantation Research Center and Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Joren C. Madsen
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jonathan Bromberg
- Departments of Surgery and Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Stefan G. Tullius
- Transplant Surgery Research Laboratory and Division of Transplant Surgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Reza Abdi
- Transplantation Research Center and Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
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16
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Pober JS, Chih S, Kobashigawa J, Madsen JC, Tellides G. Cardiac allograft vasculopathy: current review and future research directions. Cardiovasc Res 2021; 117:2624-2638. [PMID: 34343276 PMCID: PMC8783389 DOI: 10.1093/cvr/cvab259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 12/25/2022] Open
Abstract
Cardiac allograft vasculopathy (CAV) is a pathologic immune-mediated remodelling of the vasculature in transplanted hearts and, by impairing perfusion, is the major cause of late graft loss. Although best understood following cardiac transplantation, similar forms of allograft vasculopathy occur in other vascularized organ grafts and some features of CAV may be shared with other immune-mediated vasculopathies. Here, we describe the incidence and diagnosis, the nature of the vascular remodelling, immune and non-immune contributions to pathogenesis, current therapies, and future areas of research in CAV.
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MESH Headings
- Adaptive Immunity
- Animals
- Coronary Artery Disease/epidemiology
- Coronary Artery Disease/immunology
- Coronary Artery Disease/metabolism
- Coronary Artery Disease/pathology
- Coronary Vessels/immunology
- Coronary Vessels/metabolism
- Coronary Vessels/pathology
- Endothelial Cells/immunology
- Endothelial Cells/metabolism
- Endothelial Cells/pathology
- Graft Rejection/epidemiology
- Graft Rejection/immunology
- Graft Rejection/metabolism
- Graft Rejection/pathology
- Graft Survival
- Heart Transplantation/adverse effects
- Humans
- Immunity, Innate
- Muscle, Smooth, Vascular/immunology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/immunology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Risk Factors
- Signal Transduction
- Treatment Outcome
- Vascular Remodeling
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Affiliation(s)
- Jordan S Pober
- Department of Immunobiology, Pathology and Dermatology, Yale School of Medicine, 10 Amistad Street, New Haven CT 06520-8089, USA
| | - Sharon Chih
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jon Kobashigawa
- Department of Medicine, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Joren C Madsen
- Division of Cardiac Surgery and Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - George Tellides
- Department of Surgery (Cardiac Surgery), Yale School of Medicine, New Haven, CT, USA
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17
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Patel PM, Connolly MR, Coe TM, Calhoun A, Pollok F, Markmann JF, Burdorf L, Azimzadeh A, Madsen JC, Pierson RN. Minimizing Ischemia Reperfusion Injury in Xenotransplantation. Front Immunol 2021; 12:681504. [PMID: 34566955 PMCID: PMC8458821 DOI: 10.3389/fimmu.2021.681504] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/12/2021] [Indexed: 12/21/2022] Open
Abstract
The recent dramatic advances in preventing "initial xenograft dysfunction" in pig-to-non-human primate heart transplantation achieved by minimizing ischemia suggests that ischemia reperfusion injury (IRI) plays an important role in cardiac xenotransplantation. Here we review the molecular, cellular, and immune mechanisms that characterize IRI and associated "primary graft dysfunction" in allotransplantation and consider how they correspond with "xeno-associated" injury mechanisms. Based on this analysis, we describe potential genetic modifications as well as novel technical strategies that may minimize IRI for heart and other organ xenografts and which could facilitate safe and effective clinical xenotransplantation.
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Affiliation(s)
- Parth M. Patel
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Margaret R. Connolly
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Taylor M. Coe
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Anthony Calhoun
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Franziska Pollok
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - James F. Markmann
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Lars Burdorf
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Agnes Azimzadeh
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Joren C. Madsen
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Richard N. Pierson
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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18
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Zhao J, Jiang L, Uehara M, Banouni N, Al Dulaijan BS, Azzi J, Ichimura T, Li X, Jarolim P, Fiorina P, Tullius SG, Madsen JC, Kasinath V, Abdi R. ACTH treatment promotes murine cardiac allograft acceptance. JCI Insight 2021; 6:e143385. [PMID: 34236047 PMCID: PMC8410061 DOI: 10.1172/jci.insight.143385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/02/2021] [Indexed: 12/13/2022] Open
Abstract
Heart transplantation is the optimal therapy for patients with end-stage heart disease, but its long-term outcome remains inadequate. Recent studies have highlighted the importance of the melanocortin receptors (MCRs) in inflammation, but how MCRs regulate the balance between alloreactive T cells and Tregs, and whether they impact chronic heart transplant rejection, is unknown. Here, we found that Tregs express MC2R, and MC2R expression was highest among all MCRs by Tregs. Our data indicate that adrenocorticotropic hormone (ACTH), the sole ligand for MC2R, promoted the formation of Tregs by increasing the expression of IL-2Rα (CD25) in CD4+ T cells and activation of STAT5 in CD4+CD25+ T cells. ACTH treatment also improved the survival of heart allografts and increased the formation of Tregs in CD28KO mice. ACTH treatment synergized with the tolerogenic effect of CTLA-4–Ig, resulting in long-term survival of heart allografts and an increase in intragraft Tregs. ACTH administration also demonstrated higher prolongation of heart allograft survival in transgenic mouse recipients with both complete KO and conditional KO of PI3Kγ in T cells. Finally, ACTH treatment reduced chronic rejection markedly. These data demonstrate that ACTH treatment improved heart transplant outcomes, and this effect correlated with an increase in Tregs.
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Affiliation(s)
- Jing Zhao
- Transplantation Research Center.,Renal Division, and
| | - Liwei Jiang
- Transplantation Research Center.,Renal Division, and
| | - Mayuko Uehara
- Transplantation Research Center.,Renal Division, and
| | - Naima Banouni
- Transplantation Research Center.,Renal Division, and
| | | | - Jamil Azzi
- Transplantation Research Center.,Renal Division, and
| | | | - Xiaofei Li
- Transplantation Research Center.,Renal Division, and
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paolo Fiorina
- Department of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,International Center for Type 1 Diabetes, Centro di Ricerca Pediatrica Romeo ed Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università di Milano, Milan, Italy.,Endocrinology Division, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefan G Tullius
- Division of Transplant Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joren C Madsen
- Center for Transplantation Sciences, Department of Surgery, and.,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Reza Abdi
- Transplantation Research Center.,Renal Division, and
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19
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Habal MV, Miller AM, Rao S, Lin S, Obradovic A, Khosravi-Maharlooei M, See S, Roy P, Ronzon S, Ho SH, Marboe C, Naka Y, Takeda K, Restaino S, Han A, Mancini D, Givertz M, Madsen JC, Sykes M, Addonizio L, Farr M, Zorn E. T cell repertoire analysis suggests a prominent bystander response in human cardiac allograft vasculopathy. Am J Transplant 2021; 21:1465-1476. [PMID: 33021057 PMCID: PMC8672660 DOI: 10.1111/ajt.16333] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 01/25/2023]
Abstract
T cells are implicated in the pathogenesis of cardiac allograft vasculopathy (CAV), yet their clonality, specificity, and function are incompletely defined. Here we used T cell receptor β chain (TCRB) sequencing to study the T cell repertoire in the coronary artery, endomyocardium, and peripheral blood at the time of retransplant in four cases of CAV and compared it to the immunoglobulin heavy chain variable region (IGHV) repertoire from the same samples. High-dimensional flow cytometry coupled with single-cell PCR was also used to define the T cell phenotype. Extensive overlap was observed between intragraft and blood TCRBs in all cases, a finding supported by robust quantitative diversity metrics. In contrast, blood and graft IGHV repertoires from the same samples showed minimal overlap. Coronary infiltrates included CD4+ and CD8+ memory T cells expressing inflammatory (IFNγ, TNFα) and profibrotic (TGFβ) cytokines. These were distinguishable from the peripheral blood based on memory, activation, and tissue residency markers (CD45RO, CTLA-4, and CD69). Importantly, high-frequency rearrangements were traced back to endomyocardial biopsies (2-6 years prior). Comparison with four HLA-mismatched blood donors revealed a repertoire of shared TCRBs, including a subset of recently described cross-reactive sequences. These findings provide supportive evidence for an active local intragraft bystander T cell response in late-stage CAV.
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Affiliation(s)
- Marlena V. Habal
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY,Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - April M.I Miller
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Samhita Rao
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Sijie Lin
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Aleksandar Obradovic
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | | | - Sarah See
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Poulomi Roy
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Shihab Ronzon
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Siu-hong Ho
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Charles Marboe
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Susan Restaino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Arnold Han
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Donna Mancini
- Department of Medicine, Mount Sinai Hospital, Icahn School of Medicine, New York, NY
| | - Michael Givertz
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Joren C. Madsen
- Center for Transplantation Science, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan Sykes
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Linda Addonizio
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Maryjane Farr
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
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20
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van Leent MMT, Meerwaldt AE, Berchouchi A, Toner YC, Burnett ME, Klein ED, Verschuur AVD, Nauta SA, Munitz J, Prévot G, van Leeuwen EM, Ordikhani F, Mourits VP, Calcagno C, Robson PM, Soultanidis G, Reiner T, Joosten RRM, Friedrich H, Madsen JC, Kluza E, van der Meel R, Joosten LAB, Netea MG, Ochando J, Fayad ZA, Pérez-Medina C, Mulder WJM, Teunissen AJP. A modular approach toward producing nanotherapeutics targeting the innate immune system. Sci Adv 2021; 7:7/10/eabe7853. [PMID: 33674313 PMCID: PMC7935355 DOI: 10.1126/sciadv.abe7853] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/21/2021] [Indexed: 05/07/2023]
Abstract
Immunotherapies controlling the adaptive immune system are firmly established, but regulating the innate immune system remains much less explored. The intrinsic interactions between nanoparticles and phagocytic myeloid cells make these materials especially suited for engaging the innate immune system. However, developing nanotherapeutics is an elaborate process. Here, we demonstrate a modular approach that facilitates efficiently incorporating a broad variety of drugs in a nanobiologic platform. Using a microfluidic formulation strategy, we produced apolipoprotein A1-based nanobiologics with favorable innate immune system-engaging properties as evaluated by in vivo screening. Subsequently, rapamycin and three small-molecule inhibitors were derivatized with lipophilic promoieties, ensuring their seamless incorporation and efficient retention in nanobiologics. A short regimen of intravenously administered rapamycin-loaded nanobiologics (mTORi-NBs) significantly prolonged allograft survival in a heart transplantation mouse model. Last, we studied mTORi-NB biodistribution in nonhuman primates by PET/MR imaging and evaluated its safety, paving the way for clinical translation.
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Affiliation(s)
- Mandy M T van Leent
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Biochemistry, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Anu E Meerwaldt
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht/Utrecht University, Utrecht, Netherlands
| | - Alexandre Berchouchi
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yohana C Toner
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marianne E Burnett
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma D Klein
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Vera D Verschuur
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheqouia A Nauta
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jazz Munitz
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Geoffrey Prévot
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Esther M van Leeuwen
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Farideh Ordikhani
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vera P Mourits
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Claudia Calcagno
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip M Robson
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Soultanidis
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rick R M Joosten
- Center of Multiscale Electron Microscopy, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, Netherlands
| | - Heiner Friedrich
- Center of Multiscale Electron Microscopy, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Joren C Madsen
- Center for Transplantation Sciences and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ewelina Kluza
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
- Laboratory of Chemical Biology, Department of Biochemical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Roy van der Meel
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
- Laboratory of Chemical Biology, Department of Biochemical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud Center for Infectious Diseases (RCI), Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Jordi Ochando
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Willem J M Mulder
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
- Laboratory of Chemical Biology, Department of Biochemical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Abraham J P Teunissen
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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21
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Issa F, Strober S, Leventhal JR, Kawai T, Kaufman DB, Levitsky J, Sykes M, Mas V, Wood KJ, Bridges N, Welniak LA, Chandran S, Madsen JC, Nickerson P, Demetris AJ, Lakkis FG, Thomson AW. The Fourth International Workshop on Clinical Transplant Tolerance. Am J Transplant 2021; 21:21-31. [PMID: 32529725 DOI: 10.1111/ajt.16139] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 01/25/2023]
Abstract
The International Workshop on Clinical Transplant Tolerance is a biennial meeting that aims to provide an update on the progress of studies of immunosuppression minimization or withdrawal in solid organ transplantation. The Fourth International Workshop on Clinical Tolerance was held in Pittsburgh, Pennsylvania, September 5-6, 2019. This report is a summary of presentations on the status of clinical trials designed to minimize or withdraw immunosuppressive drugs in kidney, liver, and lung transplantation without subsequent evidence of rejection. All protocols had in common the use of donor or recipient cell therapy combined with organ transplantation. The workshop also included presentations of mechanistic studies designed to improve understanding of the cellular and molecular basis of tolerance and to identify potential predictors/biomarkers of tolerance. Strategies to enhance the safety of hematopoietic cell transplantation and to improve patient selection/risk stratification for clinical trials were also discussed.
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Affiliation(s)
- Fadi Issa
- Transplantation Research and Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Samuel Strober
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Joseph R Leventhal
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tatsuo Kawai
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dixon B Kaufman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Josh Levitsky
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Megan Sykes
- Columbia Center for Translational Immunology, Department of Microbiology & Immunology, Columbia University, New York, New York, USA
| | - Valeria Mas
- Transplant Research Institute, James D. Eason Transplant Institute, School of Medicine, The University of Tennessee Health Care Science, Memphis, Tennessee, USA
| | - Kathryn J Wood
- Transplantation Research and Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Nancy Bridges
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisbeth A Welniak
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sindhu Chandran
- Department of Medicine, University of California, San Francisco, California, USA
| | - Joren C Madsen
- MGH Transplant Center and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Nickerson
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony J Demetris
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fadi G Lakkis
- Department of Surgery, Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Angus W Thomson
- Department of Surgery, Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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Abstract
Consistent survival of life-supporting pig heart xenograft recipients beyond 90 days was recently reported using genetically modified pigs and a clinically applicable drug treatment regimen. If this remarkable achievement proves reproducible, published benchmarks for clinical translation of cardiac xenografts appear to be within reach. Key mechanistic insights are summarized here that informed recent pig design and therapeutic choices, which together appear likely to enable early clinical translation.
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Affiliation(s)
- Richard N Pierson
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Jay A Fishman
- Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Gregory D Lewis
- Division of Cardiology, Department of Medicine (G.D.L.), Massachusetts General Hospital and Harvard University, Boston
| | - David A D'Alessandro
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Margaret R Connolly
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Lars Burdorf
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Joren C Madsen
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
| | - Agnes M Azimzadeh
- Division of Cardiac Surgery, Department of Surgery (R.N.P., D.A.D., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston.,Center for Transplantation Sciences (R.N.P., J.A.F., M.R.C., L.B., J.C.M., A.M.A.), Massachusetts General Hospital and Harvard University, Boston
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23
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Pierson RN, Burdorf L, Madsen JC, Lewis GD, D’Alessandro DA. Pig-to-human heart transplantation: Who goes first? Am J Transplant 2020; 20:2669-2674. [PMID: 32301262 PMCID: PMC9448330 DOI: 10.1111/ajt.15916] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 03/06/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 01/25/2023]
Abstract
Cardiac xenotransplantation has recently taken an important step towards clinical reality. In anticipation of the "first-in-human" heart xenotransplantation trial, we propose a set of patient characteristics that define potential candidates. Our premise is that, to be ethically justified, the risks posed by current state-of-the-art options must outweigh the anticipated risks of a pioneering xenotransplant procedure. Suitable candidates include patients who are at high immunologic risk because of sensitization to alloantigens, including those who have exhibited early onset or accelerated cardiac allograft vasculopathy. In addition, patients should be considered (1) for whom mechanical circulatory support would be prohibitively risky due to a hypercoagulable state, a contraindication to anticoagulation, or restrictive physiology; (2) with severe biventricular dysfunction predicting unsuccessful univentricular left heart support; and (3) adults with complex congenital heart disease. In conclusion, because the published preclinical benchmark for clinical translation of heart xenotransplantation appears within reach, carefully and deliberately defining appropriate trial participants is timely as the basis for ethical clinical trial design.
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Affiliation(s)
- Richard N. Pierson
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Lars Burdorf
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Joren C. Madsen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Gregory D. Lewis
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - David A. D’Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
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24
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Yang C, Ge J, Rosales I, Yuan Q, Szuter E, Acheampong E, Russell PS, Madsen JC, Colvin RB, Alessandrini A. Kidney-induced systemic tolerance of heart allografts in mice. JCI Insight 2020; 5:139331. [PMID: 32938831 PMCID: PMC7526548 DOI: 10.1172/jci.insight.139331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/14/2020] [Indexed: 01/10/2023] Open
Abstract
In swine and nonhuman primates, kidney allografts can induce tolerance of heart allografts, leading to their long-term, immunosuppression-free survival. We refer to this phenomenon as kidney-induced cardiac allograft tolerance (KICAT). In this study, we have developed a murine model for KICAT to determine the underlining cellular/molecular mechanisms. Here, we show that spontaneously accepted DBA/2J kidneys in C57BL/6 recipients induce systemic tolerance that results in the long-term acceptance of DBA/2J heart allografts but not third-party cardiac allografts. The state of systemic tolerance of hearts was established 2 weeks after transplantation of the kidney, after which time, the kidney allograft is no longer required. Depletion of Foxp3+ T cells from these mice precipitated rejection of the heart allografts, indicating that KICAT is dependent on Treg function. Acceptance of kidney allografts and cotransplanted heart allografts did not require the thymus. In conclusion, these data show that kidney allografts induce systemic, donor-specific tolerance of cardiac allografts via Foxp3 cells, and that tolerance is independent of the thymus and continued presence of the kidney allograft. This experimental system should promote increased understanding of the tolerogenic mechanisms of the kidney. Accepted DBA/2J kidney allografts can confer acceptance of a co-transplanted DBA/2 heart allograft, which would be rejected when transplanted in the absence of the kidney graft.
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Affiliation(s)
- Chao Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Center for Transplantation Sciences, Department of Surgery, and.,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jifu Ge
- Center for Transplantation Sciences, Department of Surgery, and.,Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ivy Rosales
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Qing Yuan
- Center for Transplantation Sciences, Department of Surgery, and.,Organ Transplant Institute, 8th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Edward Szuter
- Center for Transplantation Sciences, Department of Surgery, and
| | - Ellen Acheampong
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul S Russell
- Center for Transplantation Sciences, Department of Surgery, and
| | - Joren C Madsen
- Center for Transplantation Sciences, Department of Surgery, and.,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert B Colvin
- Center for Transplantation Sciences, Department of Surgery, and.,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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25
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Knechtle SJ, Shaw JM, Hering BJ, Kraemer K, Madsen JC. Translational impact of NIH-funded nonhuman primate research in transplantation. Sci Transl Med 2020; 11:11/500/eaau0143. [PMID: 31292263 DOI: 10.1126/scitranslmed.aau0143] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022]
Abstract
The National Institutes of Health (NIH) has long supported using nonhuman primate (NHP) models for research on kidney, pancreatic islet, heart, and lung transplantation. The primary purpose of this research has been to develop new treatments for down-modulating or preventing deleterious immune responses after transplantation in human patients. Here, we discuss NIH-funded NHP studies of immune cell depletion, costimulation blockade, regulatory cell therapy, desensitization, and mixed hematopoietic chimerism that either preceded clinical trials or prevented the human application of therapies that were toxic or ineffective.
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Affiliation(s)
- Stuart J Knechtle
- Duke Transplant Center, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Julia M Shaw
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA
| | - Bernhard J Hering
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kristy Kraemer
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA
| | - Joren C Madsen
- Center for Transplantation Sciences and Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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26
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Moore C, Gao B, Roskin KM, Vasilescu ERM, Addonizio L, Givertz MM, Madsen JC, Zorn E. B cell clonal expansion within immune infiltrates in human cardiac allograft vasculopathy. Am J Transplant 2020; 20:1431-1438. [PMID: 31811777 PMCID: PMC7238293 DOI: 10.1111/ajt.15737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 01/25/2023]
Abstract
Cardiac allograft vasculopathy (CAV) is associated with intragraft B cell infiltrates. Here, we studied the clonal composition of B cell infiltrates using 4 graft specimens with CAV. Using deep sequencing, we analyzed the immunoglobulin heavy chain variable region repertoire in both graft and blood. Results showed robust B cell clonal expansion in the graft but not in the blood for all cases. Several expanded B cell clones, characterized by their uniquely rearranged complementarity-determining region 3, were detected in different locations in the graft. Sequences from intragraft B cells also showed elevated levels of mutated rearrangements in the graft compared to blood B cells. The number of somatic mutations per rearrangement was also higher in the graft than in the blood, suggesting that B cells continued maturing in situ. Overall, our studies demonstrated B cell clonal expansion in human cardiac allografts with CAV. This local B cell response may contribute to the pathophysiology of CAV through a mechanism that needs to be identified.
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Affiliation(s)
- Carolina Moore
- Center for Transplantation Science, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Baoshan Gao
- Center for Transplantation Science, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Transplant Center, The First Hospital of Jilin University, Changchun, China
| | - Krishna M. Roskin
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | | | - Linda Addonizio
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Michael M. Givertz
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joren C. Madsen
- Center for Transplantation Science, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emmanuel Zorn
- Center for Transplantation Science, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
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27
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Benichou G, Wang M, Ahrens K, Madsen JC. Extracellular vesicles in allograft rejection and tolerance. Cell Immunol 2020; 349:104063. [PMID: 32087929 DOI: 10.1016/j.cellimm.2020.104063] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 01/19/2023]
Abstract
Extracellular vesicles (EVs), including exosomes, ectosomes and apoptotic vesicles, play an essential role in communication between cells of the innate and adaptive immune systems. Recent studies showed that EVs released after transplantation of allogeneic tissues and organs are involved in the immune recognition and response leading to rejection or tolerance in mice. After skin, pancreatic islet, and solid organ transplantation, donor-derived EVs were shown to initiate direct inflammatory alloresponses by T cells leading to acute rejection. This occurred through presentation of intact allogeneic MHC molecules on recipient antigen presenting cells (MHC cross-dressing) and subsequent activation of T cells via semi-direct allorecognition. On the other hand, some studies have documented the role of EVs in maternal tolerance of fetal alloantigens during pregnancy and immune privilege associated with spontaneous tolerance of liver allografts in laboratory rodents. The precise nature of the EVs, which are involved in rejection or tolerance, and the cells which produce them, is still unclear. Nevertheless, several reports showed that EVs released in the blood and urine by allografts can be used as biomarkers of rejection. This article reviews current knowledge on the contribution of EVs in allorecognition by T cells and discusses some mechanisms underlying their influence on T cell alloimmunity in allograft rejection or tolerance.
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Affiliation(s)
- Gilles Benichou
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Mengchuan Wang
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Kaitlan Ahrens
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Joren C Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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28
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Yuan Q, Hong S, Perez-Ortiz A, Roth E, Chang DC, Madsen JC, Elias N. Effect of Recipient Hepatitis C Status on Outcomes of Deceased Donor Kidney Transplantation. J Am Coll Surg 2020; 230:853-861.e3. [PMID: 32035979 DOI: 10.1016/j.jamcollsurg.2019.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection has been deemed detrimental to kidney transplantation (KT) outcomes. Breakthrough HCV treatment with direct-acting antiviral (DAA) medications improved the probability of HCV+ kidney use for KT even in noninfected (HCV-) recipients. We hypothesized that recipient HCV infection influences deceased donor KT outcomes, and this effect could be modified by donor HCV status and use of DAAs. STUDY DESIGN We conducted a retrospective cohort study based on data from the Organ Procurement and Transplantation Network as of September 2018. A mate kidneys analysis was performed with HCV+ and HCV- recipients of solitary adult KT from ABO-compatible deceased donor between January 1994 and June 2018. We selected donors where 1 KT recipient was HCV+ and the mate kidney recipient was HCV-. Both HCV- and HCV+ donors were identified and analyzed separately. Outcomes, including survival of patients, grafts, and death-censored grafts, were compared between the groups. RESULTS Four-hundred and twenty-five HCV+ and 5,575 HCV- donor mate kidneys were transplanted in HCV-discrepant recipients. HCV+ recipients of HCV- donor had worse patient and graft survival (adjusted hazard ratio 1.28; 95% CI, 1.19 to 1.37 and adjusted hazard ratio 1.26; 95% CI 1.18 to 1.34, respectively) and death-censored grafts (adjusted hazard ratio 1.24; 95% CI, 1.15 to 1.34) compared with HCV- recipients. Comparable patient and graft survival and death-censored grafts were found in recipients of HCV+ donors, regardless of recipient HCV status. The risk associated with HCV positivity in donors or recipients in the pre-DAA era (before December 2013) was no longer statistically significant in the post-DAA era. CONCLUSIONS Given comparable outcomes between HCV+ and HCV- recipients in post-DAA era or when receiving HCV+ donor kidneys, broader use of HCV+ kidneys regardless of the recipient's HCV status should be advocated, and allocation algorithm for HCV+ kidneys should be revised.
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Affiliation(s)
- Qing Yuan
- Transplant Center, Massachusetts General Hospital, Boston, MA; Organ Transplant Institute, 8th Medical Center, Chinese PLA General Hospital, Beijing, China; Harvard Medical School, Boston, MA
| | - Shanjuan Hong
- Transplant Center, Massachusetts General Hospital, Boston, MA
| | | | - Eve Roth
- Transplant Center, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - David C Chang
- Harvard Medical School, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Joren C Madsen
- Transplant Center, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Nahel Elias
- Transplant Center, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA; Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA.
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29
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Ochando J, Fayad ZA, Madsen JC, Netea MG, Mulder WJM. Trained immunity in organ transplantation. Am J Transplant 2020; 20:10-18. [PMID: 31561273 PMCID: PMC6940521 DOI: 10.1111/ajt.15620] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 07/15/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 01/25/2023]
Abstract
Consistent induction of donor-specific unresponsiveness in the absence of continuous immunosuppressive therapy and toxic effects remains a difficult task in clinical organ transplantation. Transplant immunologists have developed numerous experimental treatments that target antigen-presentation (signal 1), costimulation (signal 2), and cytokine production (signal 3) to establish transplantation tolerance. While promising results have been obtained using therapeutic approaches that predominantly target the adaptive immune response, the long-term graft survival rates remain suboptimal. This suggests the existence of unrecognized allograft rejection mechanisms that contribute to organ failure. We postulate that trained immunity stimulatory pathways are critical to the immune response that mediates graft loss. Trained immunity is a recently discovered functional program of the innate immune system, which is characterized by nonpermanent epigenetic and metabolic reprogramming of macrophages. Since trained macrophages upregulate costimulatory molecules (signal 2) and produce pro-inflammatory cytokines (signal 3), they contribute to potent graft reactive immune responses and organ transplant rejection. In this review, we summarize the detrimental effects of trained immunity in the context of organ transplantation and describe pathways that induce macrophage training associated with graft rejection.
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Affiliation(s)
- Jordi Ochando
- Department of Oncological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew York,Transplant Immunology UnitNational Center of MicrobiologyInstituto de Salud Carlos IIIMadridSpain
| | - Zahi A. Fayad
- Department of RadiologyTranslational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkNew York
| | - Joren C. Madsen
- Center for Transplantation Sciences and Division of Cardiac SurgeryDepartment of SurgeryMassachusetts General HospitalBostonMassachusetts
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands,Department for Genomics & ImmunoregulationLife and Medical Sciences Institute (LIMES)University of BonnBonnGermany
| | - Willem J. M. Mulder
- Department of Oncological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew York,Department of RadiologyTranslational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkNew York,Laboratory of Chemical BiologyDepartment of Biomedical EngineeringInstitute for Complex Molecular SystemsEindhoven University of TechnologyEindhovenThe Netherlands
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30
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Loor G, Warnecke G, Villavicencio MA, Smith MA, Kukreja J, Ardehali A, Hartwig M, Daneshmand MA, Hertz MI, Huddleston S, Haverich A, Madsen JC, Van Raemdonck D. Portable normothermic ex-vivo lung perfusion, ventilation, and functional assessment with the Organ Care System on donor lung use for transplantation from extended-criteria donors (EXPAND): a single-arm, pivotal trial. Lancet Respir Med 2019; 7:975-984. [PMID: 31378427 DOI: 10.1016/s2213-2600(19)30200-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Donor lung use for transplantation is the lowest among solid organ tranplants because of several complex and multifactorial reasons; one area that could have a substantial role is the limited capabilities of cold ischaemic storage. The aim of the EXPAND trial was to evaluate the efficacy of normothermic portable Organ Care System (OCS) Lung perfusion and ventilation on donor lung use from extended-criteria donors and donors after circulatory death, which are rarely used. METHODS In this single-arm, pivotal trial done in eight institutions across the USA, Germany, and Belgium, lungs from extended-criteria donors were included if fulfilling one or more of the following criteria: a ratio of partial pressure of arterial oxygen (PaO2) to fractional concentration of oxygen inspired air (FiO2) in the donor lung of 300 mm Hg or less; expected ischaemic time longer than 6 h; donor age 55 years or older; or lungs from donors after circulatory death that were recruited and assessed using OCS Lung. Lungs were transplanted if they showed stability of OCS Lung variables, PaO2:FiO2 was more than 300 mm Hg, and they were accepted by the transplanting surgeon. Patients were adult bilateral lung transplant recipients. The primary efficacy endpoint was a composite of patient survival at day 30 post-transplant and absence of The International Society for Heart & Lung Tranplantation primary-graft dysfunction grade 3 (PGD3) within 72 h post-transplantation, with a prespecified objective performance goal of 65%. The primary analysis population was all transplanted recipients. This trial is registered with ClinicalTrials.gov, number NCT01963780, and is now complete. FINDINGS Between Jan 23, 2014, and Oct 23, 2016, 93 lung pairs were perfused, ventilated, and assessed on the OCS Lung. 12 lungs did not meet OCS transplantation criteria so 81 lungs were suitable for transplantation. Two lungs were excluded for logistical reasons, hence 79 (87%) of eligible lungs were transplanted. The primary endpoint was achieved in 43 (54%) of 79 patients and did not meet the objective performance goal. 35 (44%) of 79 patients had PGD3 within the initial 72 h. 78 (99%) of 79 patients had survived at 30 days post-transplant. The mean number of lung graft-related serious adverse events (respiratory failure and major pulmonary-related infection) was 0·3 events per patient (SD 0·5). INTERPRETATION Despite missing the objective primary endpoint, the portable OCS Lung resulted in 87% donor lung use for transplantation with excellent clinical outcomes. Many lungs declined by other transplant centres were successfully transplanted using this new technology, which implies its use has the potential to increase the number of lung transplants performed worldwide. Whether similar outcomes could be obtained if these lungs were preserved on ice is unknown and remains an area for future research. FUNDING TransMedics Inc.
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Affiliation(s)
- Gabriel Loor
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA; Baylor College of Medicine, Baylor St Luke's Medical Center, Houston, TX, USA.
| | - Gregor Warnecke
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mauricio A Villavicencio
- Massachusetts General Transplant Center and Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michael A Smith
- Department of General Thoracic Surgery, St Joseph's Medical Center, Phoenix, AZ, USA
| | - Jasleen Kukreja
- Department of Thoracic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Abbas Ardehali
- Department of Surgery, Division of Cardiothoracic Surgery, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Matthew Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mani A Daneshmand
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Marshall I Hertz
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Stephen Huddleston
- Department of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Joren C Madsen
- Massachusetts General Transplant Center and Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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31
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Stehlik J, Armstrong B, Baran DA, Bridges ND, Chandraker A, Gordon R, De Marco T, Givertz MM, Heroux A, Iklé D, Hunt J, Kfoury AG, Madsen JC, Morrison Y, Feller E, Pinney S, Tripathi S, Heeger PS, Starling RC. Early immune biomarkers and intermediate-term outcomes after heart transplantation: Results of Clinical Trials in Organ Transplantation-18. Am J Transplant 2019; 19:1518-1528. [PMID: 30549425 PMCID: PMC6482086 DOI: 10.1111/ajt.15218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/03/2018] [Revised: 11/07/2018] [Accepted: 11/28/2018] [Indexed: 01/25/2023]
Abstract
Clinical Trials in Organ Transplantation-18 (CTOT-18) is a follow-up analysis of the 200-subject multicenter heart transplant CTOT-05 cohort. CTOT-18 aimed to identify clinical, epidemiologic, and biologic markers associated with adverse clinical events past 1 year posttransplantation. We examined various candidate biomarkers including serum antibodies, angiogenic proteins, blood gene expression profiles, and T cell alloreactivity. The composite endpoint (CE) included death, retransplantation, coronary stent, myocardial infarction, and cardiac allograft vasculopathy. The mean follow-up was 4.5 ± SD 1.1 years. Subjects with serum anti-cardiac myosin (CM) antibody detected at transplantation and at 12 months had a higher risk of meeting the CE compared to those without anti-CM antibody (hazard ratio [HR] = 2.9, P = .046). Plasma VEGF-A and VEGF-C levels pretransplant were associated with CE (odds ratio [OR] = 13.24, P = .029; and OR = 0.13, P = .037, respectively). Early intravascular ultrasound findings or other candidate biomarkers were not associated with the study outcomes. In conclusion, anti-CM antibody and plasma levels of VEGF-A and VEGF-C were associated with an increased risk of adverse events. Although this multicenter report supports further evaluation of the mechanisms through which anti-CM antibody and plasma angiogenesis proteins lead to allograft injury, we could not identify additional markers of adverse events or potential novel therapeutic targets.
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Affiliation(s)
- Josef Stehlik
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | - Nancy D Bridges
- Transplantation Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | | | | | - Teresa De Marco
- University of California at San Francisco, San Francisco CA, USA
| | | | - Alain Heroux
- Loyola University Medical Center, Maywood, IL, USA
| | | | - Judson Hunt
- Medical City Dallas Hospital, Dallas TX, USA
| | | | | | - Yvonne Morrison
- Transplantation Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | | | - Sean Pinney
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Peter S Heeger
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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32
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Donadei C, Angeletti A, Cantarelli C, D'Agati VD, La Manna G, Fiaccadori E, Horwitz JK, Xiong H, Guglielmo C, Hartzell S, Madsen JC, Maggiore U, Heeger PS, Cravedi P. Erythropoietin inhibits SGK1-dependent TH17 induction and TH17-dependent kidney disease. JCI Insight 2019; 5:127428. [PMID: 31013255 DOI: 10.1172/jci.insight.127428] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/20/2022] Open
Abstract
IL-17-producing CD4+ cells (TH17) are pathogenically linked to autoimmunity including to autoimmune kidney disease. Erythropoietin's (EPO) newly recognized immunoregulatory functions and its predominant intra-renal source suggested that EPO physiologically regulates TH17 differentiation, thereby serving as a barrier to the development of autoimmune kidney disease. Using in vitro studies of human and murine cells and in vivo models, we show that EPO ligation of its receptor (EPO-R) on CD4+ T cells directly inhibits TH17 generation and promotes trans-differentiation of TH17 into IL-17-FOXP3+CD4+ T cells. Mechanistically, EPO/EPO-R ligation abrogates upregulation of SGK1 gene expression and blocks p38 activity to prevent SGK1 phosphorylation, thereby inhibiting RORC-mediated transcription of IL-17 and IL-23 receptor genes. In a murine model of TH17-dependent aristolochic acid (ArA)-induced, interstitial kidney disease associated with reduced renal EPO production, we demonstrate that transgenic EPO overexpression or recombinant EPO (rEPO) administration limits TH17 formation and clinical/histological disease expression. EPO/EPO-R ligations on CD4+ T cells abrogate, while absence of T cell-expressed EPO-R augments, TH17 induction and clinical/histological expression of pristane-induced glomerulonephritis (associated with decreased intrarenal EPO). rEPO prevents spontaneous glomerulonephritis and TH17 generation in MRL-lpr mice. Together, our findings indicate that EPO physiologically and therapeutically modulate TH17 cells to limit expression of TH17-associated autoimmune kidney disease.
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Affiliation(s)
- Chiara Donadei
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy
| | - Andrea Angeletti
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy
| | - Chiara Cantarelli
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Dipartimento di Medicina e Chirurgia (Università di Parma), UO Nefrologia (Azienda Ospedaliera-Universitaria Parma), Parma, Italy
| | - Vivette D D'Agati
- Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, New York, USA
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy
| | - Enrico Fiaccadori
- Dipartimento di Medicina e Chirurgia (Università di Parma), UO Nefrologia (Azienda Ospedaliera-Universitaria Parma), Parma, Italy
| | - Julian K Horwitz
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Huabao Xiong
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chiara Guglielmo
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan Hartzell
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joren C Madsen
- Center for Transplantation Sciences and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia (Università di Parma), UO Nefrologia (Azienda Ospedaliera-Universitaria Parma), Parma, Italy
| | - Peter S Heeger
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paolo Cravedi
- Department of Medicine, Translational Transplant Research Center, Precision Institute of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Robinson KA, Orent W, Madsen JC, Benichou G. Maintaining T cell tolerance of alloantigens: Lessons from animal studies. Am J Transplant 2018; 18:1843-1856. [PMID: 29939471 PMCID: PMC6352985 DOI: 10.1111/ajt.14984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 01/25/2023]
Abstract
Achieving host immune tolerance of allogeneic transplants represents the ultimate challenge in clinical transplantation. It has become clear that different cells and mechanisms participate in acquisition versus maintenance of allograft tolerance. Indeed, manipulations which prevent tolerance induction often fail to abrogate tolerance once it has been established. Hence, elucidation of the immunological mechanisms underlying maintenance of T cell tolerance to alloantigens is essential for the development of novel interventions that preserve a robust and long lasting state of allograft tolerance that relies on T cell deletion in addition to intra-graft suppression of inflammatory immune responses. In this review, we discuss some essential elements of the mechanisms involved in the maintenance of naturally occurring or experimentally induced allograft tolerance, including the newly described role of antigen cross-dressing mediated by extracellular vesicles.
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Affiliation(s)
- Kortney A. Robinson
- Center for Transplant Sciences, Massachusetts General
Hospital and Harvard Medical School, Boston, MA
| | - William Orent
- Center for Transplant Sciences, Massachusetts General
Hospital and Harvard Medical School, Boston, MA
| | - Joren C. Madsen
- Center for Transplant Sciences, Massachusetts General
Hospital and Harvard Medical School, Boston, MA.,Division of Cardiac Surgery, Department of Surgery,
Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Gilles Benichou
- Center for Transplant Sciences, Massachusetts General
Hospital and Harvard Medical School, Boston, MA
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34
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Wang Z, Louras NJ, Lellouch AG, Pratts SG, Zhang H, Wang H, Huang CA, Cetrulo CL, Madsen JC, Sachs DH, Wang Z. Dosing optimization of CCR4 immunotoxin for improved depletion of CCR4 + Treg in nonhuman primates. Mol Oncol 2018; 12:1374-1382. [PMID: 29873181 PMCID: PMC6068354 DOI: 10.1002/1878-0261.12331] [Citation(s) in RCA: 5] [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: 02/14/2018] [Revised: 05/07/2018] [Accepted: 05/19/2018] [Indexed: 12/15/2022] Open
Abstract
Recently, we have developed a diphtheria toxin‐based recombinant anti‐human CCR4 immunotoxin for targeting CCR4+ tumors and Tregs. In this study, we further optimized the dosing schedule for improved CCR4+ Treg depletion. We have demonstrated that up to a 90% depletion was achieved and the depletion extended to approximately 2 weeks in the peripheral blood and more than 48 days in the lymph node at 25 μg·kg−1, BID for 8 consecutive days in cynomolgus monkeys. Expansion was observed including monocytes and NK cells. Antibody against the CCR4 immunotoxin was detected after approximately 2 weeks, affecting further depletion efficacy for multiple course treatment.
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Affiliation(s)
- Zhaohui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nathan J Louras
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandre G Lellouch
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shannon G Pratts
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Huiping Zhang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Haoyu Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christene A Huang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Curtis L Cetrulo
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joren C Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David H Sachs
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,TBRC Laboratories, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhirui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Sasaki H, Oura T, Spitzer TR, Chen YB, Madsen JC, Allan J, Sachs DH, Cosimi AB, Kawai T. Preclinical and clinical studies for transplant tolerance via the mixed chimerism approach. Hum Immunol 2018; 79:258-265. [PMID: 29175110 PMCID: PMC5963722 DOI: 10.1016/j.humimm.2017.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/02/2017] [Accepted: 11/20/2017] [Indexed: 01/22/2023]
Abstract
Based upon observations in murine models, we have developed protocols to induce renal allograft tolerance by combined kidney and bone marrow transplantation (CKBMT) in non-human primates (NHP) and in humans. Induction of persistent mixed chimerism has proved to be extremely difficult in major histocompatibility complex (MHC)-mismatched primates, with detectable chimerism typically disappearing within 30-60 days. Nevertheless, in MHC mismatched NHP, long-term immunosuppression-free renal allograft survival has been achieved reproducibly, using a non-myeloablative conditioning approach that has also been successfully extended to human kidney transplant recipients. CKBMT has also been applied to the patients with end stage renal disease with hematologic malignancies. Renal allograft tolerance and long-term remission of myeloma have been achieved by transient mixed or persistent full chimerism. This review summarizes the current status of preclinical and clinical studies for renal and non-renal allograft tolerance induction by CKBMT. Improving the consistency of tolerance induction with less morbidity, extending this approach to deceased donor transplantation and inducing tolerance of non-renal transplants, are critical next steps for bringing this strategy to a wider range of clinical applications.
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Affiliation(s)
- Hajime Sasaki
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tetsu Oura
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas R Spitzer
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yi-Bin Chen
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joren C Madsen
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James Allan
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David H Sachs
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A B Cosimi
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tatsuo Kawai
- Department of surgery, Center for transplant science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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36
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Michel SG, Madariaga MLL, LaMuraglia GMII, Villani V, Sekijima M, Farkash EA, Colvin RB, Sachs DH, Yamada K, Rosengard BR, Allan JS, Madsen JC. The effects of brain death and ischemia on tolerance induction are organ-specific. Am J Transplant 2018; 18:1262-1269. [PMID: 29377632 PMCID: PMC5910264 DOI: 10.1111/ajt.14674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/29/2017] [Accepted: 01/18/2018] [Indexed: 01/25/2023]
Abstract
We have previously shown that 12 days of high-dose calcineurin inhibition induced tolerance in MHC inbred miniature swine receiving MHC-mismatched lung, kidney, or co-transplanted heart/kidney allografts. However, if lung grafts were procured from donation after brain death (DBD), and transplanted alone, they were rejected within 19-45 days. Here, we investigated whether donor brain death with or without allograft ischemia would also prevent tolerance induction in kidney or heart/kidney recipients. Four kidney recipients treated with 12 days of calcineurin inhibition received organs from donors rendered brain dead for 4 hours. Six heart/kidney recipients also treated with calcineurin inhibition received organs from donors rendered brain dead for 4 hours, 8 hours, or 4 hours with 4 additional hours of cold storage. In contrast to lung allograft recipients, all isolated kidney or heart/kidney recipients that received organs from DBD donors achieved long-term survival (>100 days) without histologic evidence of rejection. Proinflammatory cytokine gene expression was upregulated in lungs and hearts, but not kidney allografts, after brain death. These data suggest that the deleterious effects of brain death and ischemia on tolerance induction are organ-specific, which has implications for the application of tolerance to clinical transplantation.
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Affiliation(s)
- SG Michel
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Clinic of Cardiac Surgery, Ludwig-Maximilians-University Munich, Germany
| | - MLL Madariaga
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - GMII LaMuraglia
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - V Villani
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - M Sekijima
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Organ Replacement and Xenotransplantation Surgery, Kagoshima University, Japan
| | - EA Farkash
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA,University of Michigan Health System Department of Pathology, Ann Arbor, MI, USA
| | - RB Colvin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - DH Sachs
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Center for Translational Immunology, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - K Yamada
- Center for Translational Immunology, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | | | - JS Allan
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - JC Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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37
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Affiliation(s)
- Joren C Madsen
- Center for Transplantation Sciences and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
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38
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Purroy C, Fairchild RL, Tanaka T, Baldwin WM, Manrique J, Madsen JC, Colvin RB, Alessandrini A, Blazar BR, Fribourg M, Donadei C, Maggiore U, Heeger PS, Cravedi P. Erythropoietin Receptor-Mediated Molecular Crosstalk Promotes T Cell Immunoregulation and Transplant Survival. J Am Soc Nephrol 2017; 28:2377-2392. [PMID: 28302753 PMCID: PMC5533236 DOI: 10.1681/asn.2016101100] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/30/2017] [Indexed: 01/14/2023] Open
Abstract
Although spontaneous kidney transplant acceptance/tolerance occurs in mice and occasionally in humans, mechanisms remain unclear. Herein we test the hypothesis that EPO, a hormone predominantly produced by the adult kidney, has immunomodulating properties that are required for spontaneous kidney graft acceptance. In vitro, in a manner dependent on the EPO receptor and CD131 on antigen-presenting cells, EPO induced the secretion of active TGFβ by antigen-presenting cells, which in turn converted naïve CD4+ T cells into functional Foxp3+ regulatory T cells (Treg). In murine transplant models, pharmacologic downregulation of kidney-derived EPO prevented spontaneous Treg generation. In a controlled, prospective cohort clinical study, EPO administration at doses used to correct anemia augmented the frequency of peripheral CD4+CD25+CD127lo T cells in humans with CKD. Furthermore, EPO directly inhibited conventional T cell proliferation in vitro via tyrosine phosphatase SHP-1-dependent uncoupling of IL-2Rβ signaling. Conversely, EPO-initiated signals facilitated Treg proliferation by augmenting IL-2Rγ signaling and maintaining constitutively quenched IL-2Rβ signaling. In additional murine transplant models, recombinant EPO administration prolonged heart allograft survival, whereas pharmacologic downregulation of kidney-derived EPO reduced the expression of TGFβ mRNA and abrogated kidney allograft acceptance. Together, our findings delineate the protolerogenic properties of EPO in inhibiting conventional T cells while simultaneously promoting Treg induction, and suggest that manipulating the EPO/EPO receptor signaling axis could be exploited to prevent and/or treat T cell-mediated pathologies, including transplant rejection.
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Affiliation(s)
- Carolina Purroy
- Department of Medicine, Translational Transplant Research Center, Recanati Miller Transplant Institute and
- Nephrology Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Toshiaki Tanaka
- Department of Immunology, The Cleveland Clinic, Cleveland, Ohio
| | | | - Joaquin Manrique
- Nephrology Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Joren C Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert B Colvin
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alessandro Alessandrini
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bruce R Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota; and
| | - Miguel Fribourg
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chiara Donadei
- Department of Medicine, Translational Transplant Research Center, Recanati Miller Transplant Institute and
| | - Umberto Maggiore
- Kidney and Pancreas Transplantation Unit, University Hospital of Parma, Parma, Italy
| | - Peter S Heeger
- Department of Medicine, Translational Transplant Research Center, Recanati Miller Transplant Institute and
| | - Paolo Cravedi
- Department of Medicine, Translational Transplant Research Center, Recanati Miller Transplant Institute and
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39
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Wang Z, Zheng Q, Zhang H, Bronson RT, Madsen JC, Sachs DH, Huang CA, Wang Z. Ontak-like human IL-2 fusion toxin. J Immunol Methods 2017; 448:51-58. [PMID: 28551309 DOI: 10.1016/j.jim.2017.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/18/2022]
Abstract
Ontak® is a FDA-approved diphtheria toxin-based recombinant fusion toxin for treatment of human CD25+ cutaneous T cell lymphoma (CTCL). However, it has been discontinued clinically due to the production issue related to the bacterial expression system with difficult purification. Recently we have developed monovalent and bivalent human IL-2 fusion toxins targeting human CD25+ cells using advanced unique diphtheria toxin resistant yeast Pichia Pastoris expression system. In vitro efficacy characterization using human CD25+ HUT102/6TG cells demonstrated that both monovalent and bivalent isoforms are potent and the bivalent isoform is approximately two logs more potent than the monovalent isoform. In this study, we further assessed the in vivo efficacy of the human IL-2 fusion toxins using human CD25+ HUT102/6TG tumor-bearing NSG mouse model. The data demonstrated that both monovalent and bivalent human IL-2 fusion toxins significantly prolonged the survival of the human CD25+ tumor-bearing NSG mice in a dose-dependent manner. Then we further assessed the residual tumor cells from the HUT102/6TG tumor-bearing NSG mice using the residual tumor cell bearing NSG mouse model. The results demonstrated that the residual tumor cells were still sensitive to the continual treatment with the human IL-2 fusion toxin. This yeast-expressed human IL-2 fusion toxin will be a promising candidate to replace the clinically discontinued Ontak®.
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MESH Headings
- Animals
- Antineoplastic Agents/metabolism
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/toxicity
- Cell Line, Tumor
- Diphtheria Toxin/pharmacology
- Diphtheria Toxin/toxicity
- Dose-Response Relationship, Drug
- Humans
- Immunoconjugates/genetics
- Immunoconjugates/metabolism
- Immunoconjugates/pharmacology
- Immunoconjugates/toxicity
- Interleukin-2/biosynthesis
- Interleukin-2/genetics
- Interleukin-2/pharmacology
- Interleukin-2/toxicity
- Interleukin-2 Receptor alpha Subunit/immunology
- Interleukin-2 Receptor alpha Subunit/metabolism
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Mice, Inbred NOD
- Mice, Knockout
- Mice, SCID
- Pichia/genetics
- Pichia/metabolism
- Recombinant Fusion Proteins/pharmacology
- Recombinant Fusion Proteins/toxicity
- Safety-Based Drug Withdrawals
- Skin Neoplasms/drug therapy
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- Time Factors
- Tumor Burden/drug effects
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Zhaohui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Qian Zheng
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Huiping Zhang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Joren C Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David H Sachs
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; TBRC Laboratories, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christene A Huang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhirui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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40
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Zheng Q, Wang Z, Zhang H, Huang Q, Madsen JC, Sachs DH, Huang CA, Wang Z. Diphtheria toxin-based anti-human CD19 immunotoxin for targeting human CD19 + tumors. Mol Oncol 2017; 11:584-594. [PMID: 28306193 PMCID: PMC5527461 DOI: 10.1002/1878-0261.12056] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/07/2017] [Indexed: 02/04/2023] Open
Abstract
CD19 is expressed on normal and neoplastic B cells and is a promising target for immunotherapy. However, there is still an unmet need to further develop novel therapeutic drugs for the treatment of the refractory/relapsing human CD19+ tumors. We have developed a diphtheria toxin‐based anti‐human CD19 immunotoxin for targeting human CD19+ tumors. We have constructed three isoforms of the CD19 immunotoxin: monovalent, bivalent, and foldback diabody. In vitro binding affinity and efficacy analysis demonstrated that the bivalent isoform had the highest binding affinity and in vitro efficacy. The in vivo efficacy of the CD19 immunotoxins was assessed using human CD19+ JeKo‐1 tumor‐bearing NOD/SCID IL‐2 receptor γ−/− (NSG) mouse model. In these animals, CD19 immunotoxins significantly prolonged the median survival from 31 days in controls to 34, 36, and 40 days in animals receiving the monovalent isoform, foldback diabody isoform, and bivalent isoform, respectively. The bivalent CD19 immunotoxin is a promising therapeutic drug candidate for targeting relapsing/refractory human CD19+ tumors.
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Affiliation(s)
- Qian Zheng
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhaohui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Huiping Zhang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Qi Huang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joren C Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David H Sachs
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,TBRC Laboratories, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christene A Huang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhirui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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41
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Nuñez S, Moore C, Gao B, Rogers K, Hidalgo Y, Del Nido PJ, Restaino S, Naka Y, Bhagat G, Madsen JC, Bono MR, Zorn E. The human thymus perivascular space is a functional niche for viral-specific plasma cells. Sci Immunol 2016; 1. [PMID: 28459117 DOI: 10.1126/sciimmunol.aah4447] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The human thymus is susceptible to viral infections that can severely alter thymopoiesis and compromise the mechanisms of acquired tolerance to self-antigens. In humans, plasma cells residing primarily in the bone marrow confer long-lasting protection to common viruses by secreting antigen-specific antibodies. Since the thymus also houses B cells, we examined the phenotypic complexity of these thymic resident cells and their possible protective role against viral infections. Using tissue specimens collected from subjects ranging in age from 5 days to 71 years, we found that starting during the first year of life, CD138+ plasma cells (PC) begin accumulating in the thymic perivascular space (PVS) where they constitutively produce IgG without the need for additional stimulation. These, thymic PC secrete almost exclusively IgG1 and IgG3, the two main complement-fixing effector IgG subclasses. Moreover, using antigen-specific ELISpot assays, we demonstrated that thymic PC include a high frequency of cells reactive to common viral proteins. Our study reveals an unrecognized role of the PVS as a functional niche for viral-specific PCs. The PVS is located between the thymic epithelial areas and the circulation. PCs located in this compartment may therefore provide internal protection against pathogen infections and preserve the integrity and function of the organ.
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Affiliation(s)
- Sarah Nuñez
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Biology, University of Chile, Santiago, Chile
| | - Carolina Moore
- MGH Transplant Center and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Baoshan Gao
- MGH Transplant Center and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kortney Rogers
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Yessia Hidalgo
- Department of Biology, University of Chile, Santiago, Chile
| | - Pedro J Del Nido
- Department of Surgery, Boston Children Hospital, Boston, MA, USA
| | - Susan Restaino
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Joren C Madsen
- MGH Transplant Center and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Wang Z, Navarro-Alvarez N, Shah JA, Zhang H, Huang Q, Zheng Q, Madsen JC, Sachs DH, Huang CA, Wang Z. Porcine Treg depletion with a novel diphtheria toxin-based anti-human CCR4 immunotoxin. Vet Immunol Immunopathol 2016; 182:150-158. [PMID: 27863545 DOI: 10.1016/j.vetimm.2016.10.014] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 01/11/2023]
Abstract
Regulatory T cells (Tregs) are known to play an important role in immunoregulation and have been shown to facilitate induction of transplantation tolerance. Chemokine (C-C motif) receptor 4 (CCR4) is expressed on the surface of effector Tregs involved in controlling alloimmune and autoimmune responses. Recently we have developed a novel diphtheria-toxin based anti-human CCR4 immunotoxin for depleting CCR4+ cells in vivo. In this study, we have demonstrated that the anti-human CCR4 immunotoxin bound to porcine lymphocytes including CD4+FoxP3+ Tregs. Anti-human CCR4 immunotoxin effectively depleted CCR4+ Foxp3+ porcine Tregs in vivo. We observed depletion of up to 70-85% of the CCR4+Foxp3+ porcine Tregs in the peripheral blood and 85-91% in the lymph nodes following the anti-human CCR4 immunotoxin treatment in Massachusetts General Hospital (MGH) miniature swine. The depletion lasted for about one week with no significant reduction observed within CCR4- cell populations including CD8α+ T cells, CCR4-CD4+ T cells and B cells. In summary, anti-human CCR4 immunotoxin effectively depleted CCR4+Foxp3+ porcine Tregs in both peripheral blood and lymph nodes.
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Affiliation(s)
- Zhaohui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nalu Navarro-Alvarez
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jigesh A Shah
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Huiping Zhang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Qi Huang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Qian Zheng
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joren C Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David H Sachs
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; TBRC Laboratories, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christene A Huang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Zhirui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Sihag S, Haas MS, Kim KM, Guerrero JL, Beaudoin J, Alicot EM, Schuerpf F, Gottschall JD, Puro RJ, Madsen JC, Sachs DH, Newman W, Carroll MC, Allan JS. Natural IgM Blockade Limits Infarct Expansion and Left Ventricular Dysfunction in a Swine Myocardial Infarct Model. Circ Cardiovasc Interv 2016; 9:e002547. [PMID: 26671971 DOI: 10.1161/circinterventions.115.002547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute coronary syndrome is the leading cause of mortality worldwide. However, treatment of acute coronary occlusion inevitably results in ischemia-reperfusion injury. Circulating natural IgM has been shown to play a significant role in mouse models of ischemia-reperfusion injury. A highly conserved self-antigen, nonmuscle myosin heavy chain II, has been identified as a target of pathogenic IgM. We hypothesized that a monoclonal antibody (m21G6) directed against nonmuscle myosin heavy chain II may inhibit IgM binding and reduce injury in a preclinical model of myocardial infarction. Thus, our objective was to evaluate the efficacy of intravenous m21G6 treatment in limiting infarct expansion, troponin release, and left ventricular dysfunction in a swine myocardial infarction model. METHODS AND RESULTS Massachusetts General Hospital miniature swine underwent occlusion of the midleft anterior descending coronary artery for 60 minutes, followed by 1 hour, 5-day, or 21-day reperfusion. Specificity and localization of m21G6 to injured myocardium were confirmed using fluorescently labeled m21G6. Treatment with m21G6 before reperfusion resulted in a 49% reduction in infarct size (P<0.005) and a 61% reduction in troponin-T levels (P<0.05) in comparison with saline controls at 5-day reperfusion. Furthermore, m21G6-treated animals recovered 85.4% of their baseline left ventricular function as measured by 2-dimensional transthoracic echocardiography in contrast to 67.1% in controls at 21-day reperfusion (P<0.05). CONCLUSIONS Treatment with m21G6 significantly reduced infarct size and troponin-T release, and led to marked preservation of cardiac function in our study. Overall, these findings suggest that pathogenic IgM blockade represents a valid therapeutic strategy in mitigating myocardial ischemia-reperfusion injury.
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Affiliation(s)
- Smita Sihag
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Michael S Haas
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Karen M Kim
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - J Luis Guerrero
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Jonathan Beaudoin
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Elisabeth M Alicot
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Franziska Schuerpf
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - James D Gottschall
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Robyn J Puro
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Joren C Madsen
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - David H Sachs
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Walter Newman
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Michael C Carroll
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - James S Allan
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
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Hotta K, Aoyama A, Oura T, Yamada Y, Tonsho M, Huh KH, Kawai K, Schoenfeld D, Allan JS, Madsen JC, Benichou G, Smith RN, Colvin RB, Sachs DH, Cosimi AB, Kawai T. Induced regulatory T cells in allograft tolerance via transient mixed chimerism. JCI Insight 2016; 1. [PMID: 27446989 DOI: 10.1172/jci.insight.86419] [Citation(s) in RCA: 30] [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: 01/27/2023] Open
Abstract
Successful induction of allograft tolerance has been achieved in nonhuman primates (NHPs) and humans via induction of transient hematopoietic chimerism. Since allograft tolerance was achieved in these recipients without durable chimerism, peripheral mechanisms are postulated to play a major role. Here, we report our studies of T cell immunity in NHP recipients that achieved long-term tolerance versus those that rejected the allograft (AR). All kidney, heart, and lung transplant recipients underwent simultaneous or delayed donor bone marrow transplantation (DBMT) following conditioning with a nonmyeloablative regimen. After DBMT, mixed lymphocyte culture with CFSE consistently revealed donor-specific loss of CD8+ T cell responses in tolerant (TOL) recipients, while marked CD4+ T cell proliferation in response to donor antigens was found to persist. Interestingly, a significant proportion of the proliferated CD4+ cells were FOXP3+ in TOL recipients, but not in AR or naive NHPs. In TOL recipients, CD4+FOXP3+ cell proliferation against donor antigens was greater than that observed against third-party antigens. Finally, the expanded Tregs appeared to be induced Tregs (iTregs) that were converted from non-Tregs. These data provide support for the hypothesis that specific induction of iTregs by donor antigens is key to long-term allograft tolerance induced by transient mixed chimerism.
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Affiliation(s)
- Kiyohiko Hotta
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Akihiro Aoyama
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tetsu Oura
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yohei Yamada
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Makoto Tonsho
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kyu Ha Huh
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kento Kawai
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David Schoenfeld
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James S Allan
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joren C Madsen
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gilles Benichou
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rex-Neal Smith
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert B Colvin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David H Sachs
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - A Benedict Cosimi
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tatsuo Kawai
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Alexander SI, Madsen JC. Organ Transplant Tolerance for Children; in Sight for Some. J Pediatr 2016; 168:232-235. [PMID: 26581495 DOI: 10.1016/j.jpeds.2015.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 09/25/2015] [Accepted: 10/09/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Stephen I Alexander
- Center for Kidney Research, University of Sydney, Sydney, Australia; Department of Nephrology, Children's Hospital at Westmead, Westmead, Australia.
| | - Joren C Madsen
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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46
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Wang Z, Pratts SG, Zhang H, Spencer PJ, Yu R, Tonsho M, Shah JA, Tanabe T, Powell HR, Huang CA, Madsen JC, Sachs DH, Wang Z. Treg depletion in non-human primates using a novel diphtheria toxin-based anti-human CCR4 immunotoxin. Mol Oncol 2015; 10:553-65. [PMID: 26643572 DOI: 10.1016/j.molonc.2015.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/05/2015] [Accepted: 11/08/2015] [Indexed: 12/15/2022] Open
Abstract
Regulatory T cells (Treg) play an important role in modulating the immune response and has attracted increasing attention in diverse fields such as cancer treatment, transplantation and autoimmune diseases. CC chemokine receptor 4 (CCR4) is expressed on the majority of Tregs, especially on effector Tregs. Recently we have developed a diphtheria-toxin based anti-human CCR4 immunotoxin for depleting CCR4(+) cells in vivo. In this study, we demonstrated that the anti-human CCR4 immunotoxin bound and depleted monkey CCR4(+) cells in vitro. We also demonstrated that the immunotoxin bound to the CCR4(+)Foxp3(+) monkey Tregs in vitro. In vivo studies performed in two naive cynomolgus monkeys revealed 78-89% CCR4(+)Foxp3(+) Treg depletion in peripheral blood lasting approximately 10 days. In lymph nodes, 89-96% CCR4(+)Foxp3(+) Tregs were depleted. No effect was observed in other cell populations including CD8(+) T cells, other CD4(+) T cells, B cells and NK cells. To our knowledge, this is the first agent that effectively depleted non-human primate (NHP) Tregs. This immunotoxin has potential to deplete effector Tregs for combined cancer treatment.
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Affiliation(s)
- Zhaohui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shannon G Pratts
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Huiping Zhang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Philip J Spencer
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ruichao Yu
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Makoto Tonsho
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jigesh A Shah
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tatsu Tanabe
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Harrison R Powell
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christene A Huang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joren C Madsen
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David H Sachs
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; TBRC Laboratories, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhirui Wang
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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47
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La Muraglia GM, O'Neil MJ, Madariaga ML, Michel SG, Mordecai KS, Allan JS, Madsen JC, Hanekamp IM, Preffer FI. A novel approach to measuring cell-mediated lympholysis using quantitative flow and imaging cytometry. J Immunol Methods 2015; 427:85-93. [PMID: 26516062 DOI: 10.1016/j.jim.2015.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/05/2015] [Accepted: 10/21/2015] [Indexed: 11/30/2022]
Abstract
In this study, we established a novel isotope-free approach for the detection of cell-mediated lympholysis (CML) in MHC defined peripheral blood mononuclear cells (PBMCs) using multiparameter flow and imaging cytometry. CML is an established in vitro assay to detect the presence of cytotoxic effector T-lymphocytes precursors (CTLp). Current methods employed in the identification of CTLp in the context of transplantation are based upon the quantification of chromium ((51)Cr) released from target cells. In order to adapt the assay to flow cytometry, primary porcine PBMC targets were labeled with eFluor670 and incubated with major histocompatibility complex (MHC) mismatched effector cytotoxic lymphocytes (CTLs). With this method, we were able to detect target-specific lysis that was comparable to that observed with the (51)Cr-based assay. In addition, the use of quantitative cell imaging demonstrates the presence of accessory cells involved in the cytotoxic pathway. This innovative technique improves upon the standard (51)Cr release assay by eliminating the need for radioisotopes and provides enhanced characterization of the interactions between effector and target cells. This technique has wide applicability to numerous experimental and clinical models involved with effector-cell interactions.
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Affiliation(s)
- G M La Muraglia
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - M J O'Neil
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - M L Madariaga
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - S G Michel
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - K S Mordecai
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - J S Allan
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - J C Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - I M Hanekamp
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - F I Preffer
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
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48
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Michel SG, La Muraglia GM, Madariaga MLL, Titus JS, Selig MK, Farkash EA, Allan JS, Anderson LM, Madsen JC. Twelve-Hour Hypothermic Machine Perfusion for Donor Heart Preservation Leads to Improved Ultrastructural Characteristics Compared to Conventional Cold Storage. Ann Transplant 2015; 20:461-8. [PMID: 26259549 DOI: 10.12659/aot.893784] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hypothermic machine perfusion of donor hearts has the theoretical advantage of continuous aerobic metabolism and washes out toxic metabolic byproducts. Here, we studied the effect of hypothermic machine perfusion on cardiac myocyte integrity when hearts are preserved for longer ischemic times (12 hours). MATERIAL AND METHODS Pig hearts were harvested and stored in Celsior® solution for 12 hours using either conventional cold storage on ice (12 h CS, n=3) or pulsatile perfusion with the Paragonix Sherpa Perfusion™ Cardiac Transport System at different flow rates (12 h PP, n=3 or 12 h PP low flow, n=2). After cold preservation, hearts were reperfused using an LV isovolumic Langendorff system. Controls (n=3) were reperfused immediately after organ harvest. Biopsies were taken from the apex of the left ventricle before storage, after storage and after reperfusion to measure ATP and endothelin-1 content in the tissue. TUNEL staining for signs of apoptosis and electron microscopy of the donor hearts were performed. RESULTS 12 h PP hearts showed significantly more weight gain than 12 h CS and controls after preservation. Pulsatile perfused hearts showed less ATP depletion, lower endothelin-1 levels and less apoptosis after preservation compared to CS. Electron microscopy showed damaged muscle fibers, endothelial cell rupture, and injury of mitochondria in the 12 h CS group, while machine perfusion could preserve the cell structures. CONCLUSIONS Hypothermic machine perfusion of donor hearts can preserve the cell structures better than conventional cold storage in prolonged ischemic times. Hypothermic pulsatile perfusion may therefore enable longer preservation times of donor hearts. Whether this method is able to avoid primary graft failure after orthotopic heart transplantation remains to be evaluated in further studies.
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Affiliation(s)
- Sebastian G Michel
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Glenn M La Muraglia
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Maria Lucia L Madariaga
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James S Titus
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Martin K Selig
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Evan A Farkash
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - James S Allan
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Joren C Madsen
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Matthews KA, Tonsho M, Madsen JC. New-Onset Diabetes Mellitus After Transplantation in a Cynomolgus Macaque (Macaca fasicularis). Comp Med 2015; 65:352-356. [PMID: 26310466 PMCID: PMC4549682] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/12/2014] [Accepted: 02/19/2015] [Indexed: 06/04/2023]
Abstract
A 5.5-y-old intact male cynomolgus macaque (Macaca fasicularis) presented with inappetence and weight loss 57 d after heterotopic heart and thymus transplantation while receiving an immunosuppressant regimen consisting of tacrolimus, mycophenolate mofetil, and methylprednisolone to prevent graft rejection. A serum chemistry panel, a glycated hemoglobin test, and urinalysis performed at presentation revealed elevated blood glucose and glycated hemoglobin (HbA1c) levels (727 mg/dL and 10.1%, respectively), glucosuria, and ketonuria. Diabetes mellitus was diagnosed, and insulin therapy was initiated immediately. The macaque was weaned off the immunosuppressive therapy as his clinical condition improved and stabilized. Approximately 74 d after discontinuation of the immunosuppressants, the blood glucose normalized, and the insulin therapy was stopped. The animal's blood glucose and HbA1c values have remained within normal limits since this time. We suspect that our macaque experienced new-onset diabetes mellitus after transplantation, a condition that is commonly observed in human transplant patients but not well described in NHP. To our knowledge, this report represents the first documented case of new-onset diabetes mellitus after transplantation in a cynomolgus macaque.
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Affiliation(s)
- Kristin A Matthews
- Center for Comparative Medicine, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Makoto Tonsho
- Transplant Center, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joren C Madsen
- Transplant Center, Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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50
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Wei M, Marino J, Trowell A, Zhang H, Stromp Peraino J, Rajasekera PV, Madsen JC, Sachs DH, Huang CA, Benichou G, Wang Z. Diphtheria toxin-based recombinant murine IL-2 fusion toxin for depleting murine regulatory T cells in vivo. Protein Eng Des Sel 2015; 27:289-95. [PMID: 25147093 DOI: 10.1093/protein/gzu034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Regulatory T cells (Tregs) are a subpopulation of CD4(+) T cells which suppress immune responses of effector cells and are known to play a very important role in protection against autoimmune disease development, induction of transplantation tolerance and suppression of effective immune response against tumor cells. An effective in vivo Treg depletion agent would facilitate Treg-associated studies across many research areas. In this study, we have developed diphtheria toxin-based monovalent and bivalent murine IL-2 fusion toxins for depleting murine IL-2 receptor positive cells including CD25(+) Treg in vivo. Their potencies were assessed by in vitro protein synthesis inhibition and cell proliferation inhibition assays using a murine CD25(+) CTLL-2 cell line. Surprisingly, in contrast to our previously developed recombinant fusion toxins, the monovalent isoform (DT390-mIL-2) was approximately 4-fold more potent than its bivalent counterpart (DT390-bi-mIL-2). Binding analysis by flow cytometry demonstrated that the monovalent isoform bound stronger than the bivalent version. In vivo Treg depletion with the monovalent murine IL-2 fusion toxin was performed using C57BL/6J (B6) mice. Spleen Treg were significantly depleted with a maximum reduction of ∼70% and detectable as early as 12 h after the last injection. The spleen Treg numbers were reduced until Day 3 and returned to control levels by Day 7. We believe that this monovalent murine IL-2 fusion toxin will be an effective in vivo murine Treg depleter.
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Affiliation(s)
- Min Wei
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA MGH-DF/HCC Recombinant Protein Expression and Purification Core, Boston, MA, USA
| | - Jose Marino
- Transplant Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aaron Trowell
- Transplant Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Huiping Zhang
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA MGH-DF/HCC Recombinant Protein Expression and Purification Core, Boston, MA, USA
| | - Jaclyn Stromp Peraino
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA MGH-DF/HCC Recombinant Protein Expression and Purification Core, Boston, MA, USA
| | - Priyani V Rajasekera
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA MGH-DF/HCC Recombinant Protein Expression and Purification Core, Boston, MA, USA
| | - Joren C Madsen
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Transplant Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David H Sachs
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA MGH-DF/HCC Recombinant Protein Expression and Purification Core, Boston, MA, USA
| | - Christene A Huang
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA MGH-DF/HCC Recombinant Protein Expression and Purification Core, Boston, MA, USA
| | - Gilles Benichou
- Transplant Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhirui Wang
- Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA MGH-DF/HCC Recombinant Protein Expression and Purification Core, Boston, MA, USA
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