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Heath KE, Feduska JM, Taylor JP, Houp JA, Botta D, Lund FE, Mick GJ, McGwin G, McCormick KL, Tse HM. GABA and Combined GABA with GAD65-Alum Treatment Alters Th1 Cytokine Responses of PBMCs from Children with Recent-Onset Type 1 Diabetes. Biomedicines 2023; 11:1948. [PMID: 37509587 PMCID: PMC10377053 DOI: 10.3390/biomedicines11071948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Type 1 diabetes (T1D) is an autoimmune disease culminating in the destruction of insulin-producing pancreatic cells. There is a need for the development of novel antigen-specific strategies to delay cell destruction, including combinatorial strategies that do not elicit systemic immunosuppression. Gamma-aminobutyric acid (GABA) is expressed by immune cells, β-cells, and gut bacteria and is immunomodulatory. Glutamic-acid decarboxylase 65 (GAD65), which catalyzes GABA from glutamate, is a T1D autoantigen. To test the efficacy of combinatorial GABA treatment with or without GAD65-immunization to dampen autoimmune responses, we enrolled recent-onset children with T1D in a one-year clinical trial (ClinicalTrials.gov NCT02002130) and examined T cell responses. We isolated peripheral blood mononuclear cells and evaluated cytokine responses following polyclonal activation and GAD65 rechallenge. Both GABA alone and GABA/GAD65-alum treatment inhibited Th1 cytokine responses over the 12-month study with both polyclonal and GAD65 restimulation. We also investigated whether patients with HLA-DR3-DQ2 and HLA-DR4-DQ8, the two highest-risk human leukocyte antigen (HLA) haplotypes in T1D, exhibited differences in response to GABA alone and GABA/GAD65-alum. HLA-DR4-DQ8 patients possessed a Th1-skewed response compared to HLA-DR3-DQ2 patients. We show that GABA and GABA/GAD65-alum present an attractive immunomodulatory treatment for children with T1D and that HLA haplotypes should be considered.
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Affiliation(s)
- Katie E Heath
- Department of Microbiology, Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Joseph M Feduska
- Department of Microbiology, Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jared P Taylor
- Department of Microbiology, Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Julie A Houp
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Davide Botta
- Department of Microbiology, Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Frances E Lund
- Department of Microbiology, Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Gail J Mick
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Kenneth L McCormick
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Hubert M Tse
- Department of Microbiology, Molecular Genetics, and Immunology, University of Kansas Medical Center, Mail Stop 3029, 1012 Wahl Hall West, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
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Killian JT, King RG, Kizziah JL, Fucile CF, Diaz-Avalos R, Qiu S, Silva-Sanchez A, Mousseau BJ, Macon KJ, Callahan AR, Yang G, Hossain ME, Akther J, Houp JA, Rosenblum FD, Porrett PM, Ong SC, Kumar V, Mobley JA, Saphire EO, Kearney JF, Randall TD, Rosenberg AF, Green TJ, Lund FE. Alloreactivity and autoreactivity converge to support B cell epitope targeting in transplant rejection. bioRxiv 2023:2023.03.31.534734. [PMID: 37034637 PMCID: PMC10081326 DOI: 10.1101/2023.03.31.534734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Antibody (Ab) responses against human leukocyte antigen (HLA) proteins mismatched between donor and recipient are leading cause of allograft loss in kidney transplantation. However, therapies targeting alloreactive B cell and Ab-secreting cell (ASC) are lacking, motivating the need to understand how to prevent and abrogate these alloresponses. Using molecular, structural, and proteomic techniques, we profiled the B cell response in a kidney transplant recipient with antibody-mediated rejection and graft loss. We found that this response spanned the rejected organ and peripheral blood, stimulated the differentiation of multiple B cell subsets, and produced a high-affinity, donor-specific, anti-HLA response. We found epitopic immunodominance that relied on highly exposed, solvent-accessible mismatched HLA residues as well as structural and biomolecular evidence of autoreactivity against the recipient's self-HLA allele. These alloreactive and autoreactive signatures converged in the recipient's circulating donor-specific Ab repertoire, suggesting that rejection requires both the recognition of non-self and breaches of tolerance to lead to alloinjury and graft loss.
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Killian JT, Houp JA, Burkholder GA, Roman Soto SA, Killian AC, Ong SC, Erdmann NB, Goepfert PA, Hauptfeld-Dolejsek V, Leal SM, Zumaquero E, Nellore A, Agarwal G, Kew CE, Orandi BJ, Locke JE, Porrett PM, Levitan EB, Kumar V, Lund FE. COVID-19 Vaccination and Remdesivir are Associated With Protection From New or Increased Levels of Donor-Specific Antibodies Among Kidney Transplant Recipients Hospitalized With COVID-19. Transpl Int 2022; 35:10626. [PMID: 35928347 PMCID: PMC9343962 DOI: 10.3389/ti.2022.10626] [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: 05/08/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023]
Abstract
Alloimmune responses in kidney transplant (KT) patients previously hospitalized with COVID-19 are understudied. We analyzed a cohort of 112 kidney transplant recipients who were hospitalized following a positive SARS-CoV-2 test result during the first 20 months of the COVID-19 pandemic. We found a cumulative incidence of 17% for the development of new donor-specific antibodies (DSA) or increased levels of pre-existing DSA in hospitalized SARS-CoV-2-infected KT patients. This risk extended 8 months post-infection. These changes in DSA status were associated with late allograft dysfunction. Risk factors for new or increased DSA responses in this KT patient cohort included the presence of circulating DSA pre-COVID-19 diagnosis and time post-transplantation. COVID-19 vaccination prior to infection and remdesivir administration during infection were each associated with decreased likelihood of developing a new or increased DSA response. These data show that new or enhanced DSA responses frequently occur among KT patients requiring admission with COVID-19 and suggest that surveillance, vaccination, and antiviral therapies may be important tools to prevent alloimmunity in these individuals.
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Affiliation(s)
- John T. Killian
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Julie A. Houp
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Greer A. Burkholder
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Salomon A. Roman Soto
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - A. Cozette Killian
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Song C. Ong
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nathaniel B. Erdmann
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul A. Goepfert
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vera Hauptfeld-Dolejsek
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sixto M. Leal
- Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Esther Zumaquero
- Department of Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anoma Nellore
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gaurav Agarwal
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Clifton E. Kew
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Babak J. Orandi
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jayme E. Locke
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paige M. Porrett
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emily B. Levitan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vineeta Kumar
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Frances E. Lund
- Department of Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,*Correspondence: Frances E. Lund,
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Houp JA, Turner C, Smail AK, Hauptfeld-Dolejsek V. P085 Pre-treatment of patient sera with melon™ gel spin column yields better results in solid phase immunoassays. Hum Immunol 2019. [DOI: 10.1016/j.humimm.2019.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Houp JA, Desai NM, Kraus ES, Alachkar N, Jackson AM. P141Kas three years later: life after the bolus effect. Hum Immunol 2018. [DOI: 10.1016/j.humimm.2018.07.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Houp JA, Schillinger KP, Eckstein AJ, Vega RM, Desai NM, Lonze BE, Jackson AM. Casting a smaller net into a bigger donor pool: A single center's experience with the new kidney allocation system. Hum Immunol 2016; 78:49-53. [PMID: 27890719 DOI: 10.1016/j.humimm.2016.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 12/27/2022]
Abstract
The new kidney allocation system (KAS) provides additional allocation points for candidates with broad HLA sensitization in an effort to increase transplant rates for this underserved population. Following the implementation of KAS, our center lowered the HLA antibody threshold for listing unacceptable antigens from a cytotoxicity crossmatch level to a flow cytometric crossmatch level increasing Calculated Panel Reactive Antibody (CPRA) values and allocation points, yet restricting acceptable donor HLA phenotypes. As a result, many sensitized candidates were transitioned from 50% to 98% CPRA categories into the 99% CPRA regional share and 100% CPRA national share categories. Exposure to these larger donor pools significantly increased transplantation with compatible donors for 100% CPRA candidates, but regional sharing was not sufficient to increase transplantation rates for our 99% CPRA candidates. Competition within the 100% CPRA cohort identified inequities for 99.99-100.0% CPRA candidates and highlighted the continued need for desensitization therapies to reduce immunological barriers and provide transplant opportunities for the most highly sensitized candidates.
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Affiliation(s)
- Julie A Houp
- Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Karl P Schillinger
- Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Andrew J Eckstein
- Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Renato M Vega
- Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Niraj M Desai
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Bonnie E Lonze
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Annette M Jackson
- Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA.
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Eckstein AJ, Schillinger KP, Houp JA, Jackson AM. P112 Analysis of KAS impact on a single center. Hum Immunol 2016. [DOI: 10.1016/j.humimm.2016.07.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Houp JA, Schillinger KP, Kaplan I, Leffell MS, Zachary AA. Impact of DP in CPRA Calculation. Hum Immunol 2015. [DOI: 10.1016/j.humimm.2015.07.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Berger SA, Rossiter ND, Vega RM, Houp JA, Leffell MS. 141-P HLA-DP: Its relevance for broadly sensitized hematopoetic stem cell recipients. Hum Immunol 2011. [DOI: 10.1016/j.humimm.2011.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Houp JA, Iglehart B, Avergas C, Zachary AA, Leffell MS. 260-P: The production of Bw6-specific antibody by individuals with an HLA-B46 phenotype. Hum Immunol 2009. [DOI: 10.1016/j.humimm.2009.09.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Locke JE, Zachary AA, Warren DS, Segev DL, Houp JA, Montgomery RA, Leffell MS. Proinflammatory events are associated with significant increases in breadth and strength of HLA-specific antibody. Am J Transplant 2009; 9:2136-9. [PMID: 19663896 DOI: 10.1111/j.1600-6143.2009.02764.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Identification of factors responsible for an increase in the breadth or strength of HLA-specific antibody (HSA) is critical to the continued successful management and transplantation of sensitized patients. A retrospective review of our HLA registry identified 107 patients with known HSA and sufficient information in their electronic patient record to determine the presence or absence of a proinflammatory event. The patients were stratified according to transplant status [sensitized and on the transplant waitlist (n = 65); immunosuppressed recipients of a positive crossmatch (+XM) transplant (n = 42)]. Eighty-three percent of waitlist candidates and 55% of sensitized kidney transplant recipients with a documented proinflammatory event had an associated increase in HSA. Interestingly, among patients with a culture-proven infection, 97% of the waitlist patients and 54.8% of +XM recipients had an associated rise in HSA. Overall, proinflammatory events were associated with a greater increase among waitlist patients than +XM recipients, 5.3-fold [IRR 5.25, (95% CI 4.03-6.85), p < 0.001] versus 2.5-fold [IRR 2.54, (95% CI 1.64-3.95), p < 0.001] increase in HSA. Therefore, sensitized patients known to have an infection or undergoing surgery should be monitored for expansion of HSA.
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Affiliation(s)
- J E Locke
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Zachary AA, Sholander JT, Houp JA, Leffell MS. Using real data for a virtual crossmatch. Hum Immunol 2009; 70:574-9. [DOI: 10.1016/j.humimm.2009.06.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 05/28/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
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Houp JA, Martin LS, Melancon JK, Montgomery RA, Leffell MS, Zachary AA. 51-W: Transplant outcome in patients with low level donor specific antibody. Hum Immunol 2007. [DOI: 10.1016/j.humimm.2007.08.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Houp JA, Sholander JT, Kopchaliska D, Leffell MS, Zachary AA. 199-P. Hum Immunol 2006. [DOI: 10.1016/j.humimm.2006.08.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The number of renal transplants can be increased by implementing an exchange program involving donor-recipient pairs for whom the donors are each incompatible with their original patient but compatible with each other's patient. The number can be further increased if the exchanges are not limited to ABO incompatible pairs or combinations of two donor-recipient pairs. However, as the number of donor-recipient pairs willing to participate in such a program increases, there is a substantial increase in both the time taken to identify such matches and the potential for error. We have developed a computer program that accounts for ABO and HLA compatibility and is not limited to two-way exchanges. With our database of 60 patients and 83 donors, we have been able to identify 122 two-way and 1230 three-way exchanges with an average run time of 30 s.
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Affiliation(s)
- Inessa Kaplan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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