1
|
Than NN, Hodson J, Schmidt-Martin D, Taubert R, Wawman RE, Botter M, Gautam N, Bock K, Jones R, Appanna GD, Godkin A, Montano-Loza AJ, Lammert F, Schramm C, Manns MP, Swain M, Burak KW, Adams DH, Hirschfield GM, Oo YH. Efficacy of rituximab in difficult-to-manage autoimmune hepatitis: Results from the International Autoimmune Hepatitis Group. JHEP Rep 2019; 1:437-445. [PMID: 32039395 PMCID: PMC7005655 DOI: 10.1016/j.jhepr.2019.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
Treatment options remain limited for patients with autoimmune hepatitis (AIH), while there are still concerns over the consequences of long-term corticosteroid use. A few studies have suggested a role for B cell-driven autoimmune liver injury in AIH. This multicentre, international retrospective cohort study from the International Autoimmune Hepatitis Group aims to evaluate the clinical efficacy and safety of rituximab in difficult-to-manage AIH. Methods Clinical data from 22 patients who received rituximab between 2007 and 2017 were collected from centres in the United Kingdom, Germany and Canada. Clinical response was assessed using changes in biochemical and immunological parameters up to 24 months post-rituximab infusion. In addition, we compared the doses of prednisolone used 3 months before and 12 months after treatment, and assessed freedom from AIH flares over the post-treatment period. Results Twenty-two patients with type-1 AIH were included, with a median age of 40 years at diagnosis (range 19–79); 15/22 (68%) were female and 18/22 (82%) were Caucasian. The median period from diagnosis to the end of follow-up in these patients was 11 years (range 3–28). Values of alanine aminotransferase, aspartate aminotransferase and albumin improved significantly following rituximab therapy, and were sustained for up to 2 years (all p ≪0.001). Prednisolone doses were significantly reduced by 12 months post-treatment (p = 0.003), with 13/21 (62%) patients having a dose reduction. Over a median post-treatment follow-up period of 6 years (range 1–10), 5 patients developed AIH flares at a median of 22 months post-treatment, giving an estimated 71% freedom from AIH flare at 2 years. Four of these patients received a second course of treatment, of whom 2 had subsequent further flares. No serious adverse events attributable to rituximab were recorded. Conclusion In patients with difficult-to-manage AIH, rituximab appears to be clinically effective and well tolerated. Rituximab was associated with sustained improvements in serum liver tests, an absence of clinical disease flares, and a reduction in prednisolone dose. Controlled trials are warranted to further evaluate B cell-targeting therapies in patients with AIH. Lay summary Autoimmune hepatitis is an autoimmune condition of the liver, usually treated with medications that suppress the immune system, such as steroids. However, some patients do not respond to this treatment. We analysed the safety and efficacy of rituximab in patients who were not responding to first- or second-line therapies. Rituximab was safe and improved liver blood tests in 70% of patients over a 2-year follow-up period, while enabling steroid doses to be reduced in two-thirds of patients, which is a very positive clinical outcome. Study of rituximab therapy in 22 patients with autoimmune hepatitis over a follow-up period of 24 months. No serious adverse events were noted during follow-up in patients treated with rituximab. Rituximab therapy improved liver enzymes significantly during the 2 years of follow-up. Prednisolone dose reductions were seen in 62% of patients at 12-month follow-up. A total of 71% of patients were free of AIH flares during the 24 months of follow-up.
Collapse
Affiliation(s)
- Nwe Ni Than
- Liver Transplant and Hepatobiliary Unit, University Hospital Birmingham NHS Foundation Trust, United Kingdom
- Centre for Liver and Gastroenterology Research & National Institute of Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - James Hodson
- Liver Transplant and Hepatobiliary Unit, University Hospital Birmingham NHS Foundation Trust, United Kingdom
| | - Daniel Schmidt-Martin
- Liver Transplant and Hepatobiliary Unit, University Hospital Birmingham NHS Foundation Trust, United Kingdom
| | - Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- European Reference Network (ERN) Rare Liver
| | - Rebecca E. Wawman
- Centre for Liver and Gastroenterology Research & National Institute of Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
- Imperial College, London
| | - Meemee Botter
- Centre for Liver and Gastroenterology Research & National Institute of Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
- University of Amsterdam, Netherland
| | - Nishant Gautam
- Liver Transplant and Hepatobiliary Unit, University Hospital Birmingham NHS Foundation Trust, United Kingdom
| | - Kilian Bock
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- European Reference Network (ERN) Rare Liver
| | - Rebecca Jones
- Leeds Liver Transplant Unit, St James University Hospital, Leeds, United Kingdom
| | | | - Andrew Godkin
- University Hospital of Wales, Cardiff, United Kingdom
| | | | - Frank Lammert
- Department of Medicine II, Saarland University Medical Centre, Homburg
| | - Christoph Schramm
- University Medical Centre Hamburg-Eppendorf, Hamburg, I. Department of Medicine and Martin Zeitz Centre for Rare Diseases, Germany
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany; Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- European Reference Network (ERN) Rare Liver
| | - Mark Swain
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Canada
| | - Kelly W. Burak
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Canada
| | - David H. Adams
- Liver Transplant and Hepatobiliary Unit, University Hospital Birmingham NHS Foundation Trust, United Kingdom
- Centre for Liver and Gastroenterology Research & National Institute of Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
- Autoimmune Liver Diseases Clinic, Centre for Rare Diseases, Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Gideon M Hirschfield
- University of Toronto, Canada
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Ye Htun Oo
- Liver Transplant and Hepatobiliary Unit, University Hospital Birmingham NHS Foundation Trust, United Kingdom
- Centre for Liver and Gastroenterology Research & National Institute of Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
- Autoimmune Liver Diseases Clinic, Centre for Rare Diseases, Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
- European Reference Network (ERN) Rare Liver
- Corresponding author. Address: Liver Transplant and Hepatobiliary Unit, University Hospital Birmingham NHS Foundation Trust, Vincent Drive, B15 2TT, Birmingham, United Kingdom. Tel: +44 121 415 8700, fax: +44 121 415 8701.
| |
Collapse
|
2
|
Oo YH, Ackrill S, Cole R, Jenkins L, Anderson P, Jeffery HC, Jones N, Jeffery LE, Lutz P, Wawman RE, Athwal AK, Thompson J, Gray J, Guo K, Barton D, Hirschfield GM, Wong T, Guest P, Adams DH. Liver homing of clinical grade Tregs after therapeutic infusion in patients with autoimmune hepatitis. JHEP Rep 2019; 1:286-296. [PMID: 32039380 PMCID: PMC7001578 DOI: 10.1016/j.jhepr.2019.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/04/2019] [Accepted: 08/09/2019] [Indexed: 01/09/2023] Open
Abstract
Autoimmune hepatitis (AIH) is an immune-mediated disease with no curative treatment. Regulatory T cell (Treg) therapy is potentially curative in AIH given the critical role of Tregs in preventing autoimmunity. To work effectively, adoptively transferred Tregs must migrate to and survive within the inflamed liver. We conducted a proof-of-concept study aiming to assess the safety and liver-homing properties of good manufacturing practice (GMP)-grade autologous Tregs in patients with AIH. METHODS Autologous polyclonal GMP-grade Tregs were isolated using leukapheresis and CliniMACS, labelled with indium tropolonate and re-infused intravenously to 4 patients with AIH. GMP-Treg homing to the liver was investigated with longitudinal gamma camera and SPECT-CT scanning. GMP-Treg immunophenotype, function and immunometabolic state were assessed during the study. RESULTS We observed that the isolated Tregs were suppressive and expressed CXCR3, a chemokine receptor involved in recruitment into the inflamed liver, as well as Treg functional markers CD39, CTLA-4 and the transcription factor Foxp3. Serial gamma camera and SPECT-CT imaging demonstrated that 22-44% of infused Tregs homed to and were retained in the livers of patients with autoimmune hepatitis for up to 72 h. The infused cells did not localise to any off-target organs other than the spleen and bone marrow. GMP-Tregs were metabolically competent and there were no infusion reactions or high-grade adverse effects after Treg infusion. CONCLUSION Our novel findings suggest that the liver is a good target organ for Treg cellular therapy, supporting the development of clinical trials to test efficacy in autoimmune hepatitis and other autoimmune liver diseases. LAY SUMMARY Autoimmune liver diseases occur when the body's immune cells target their own liver cells. Regulatory T cells (Tregs) prevent autoimmunity, thus they are a potential therapy for autoimmune liver diseases. In patients with autoimmune hepatitis, Treg infusion is safe, with nearly a quarter of infused Tregs homing to the liver and suppressing tissue-damaging effector T cells. Thus, Tregs are a potentially curative immune cell therapy for early autoimmune liver diseases.
Collapse
Affiliation(s)
- Ye Htun Oo
- Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham
- National Institute of Health Research Birmingham Biomedical Research Centre
- Liver Transplant and Hepato-biliary Unit, Queen Elizabeth Hospital, University Hospital Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Susan Ackrill
- Clinical Radiopharmacy, Imaging and Nuclear Medicine Department, University Hospital of Birmingham National Health Service Foundation Trust; Birmingham
| | - Richard Cole
- Clinical Radiopharmacy, Imaging and Nuclear Medicine Department, University Hospital of Birmingham National Health Service Foundation Trust; Birmingham
| | - Lee Jenkins
- Clinical Radiopharmacy, Imaging and Nuclear Medicine Department, University Hospital of Birmingham National Health Service Foundation Trust; Birmingham
| | - Philip Anderson
- Clinical Radiopharmacy, Imaging and Nuclear Medicine Department, University Hospital of Birmingham National Health Service Foundation Trust; Birmingham
| | - Hannah C. Jeffery
- Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham
| | - Nicholas Jones
- Institute of Life Science, Swansea University Medical School, Singleton Park, Swansea
| | - Louisa E. Jeffery
- Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham
| | - Philipp Lutz
- Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham
| | - Rebecca E. Wawman
- Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham
| | | | | | - Joanna Gray
- National Institute of Health Research Wellcome Trust Clinical Research Facility, Birmingham
| | - Kathy Guo
- National Institute of Health Research Birmingham Biomedical Research Centre
- Department of Haematology, University Hospital Birmingham National Health Service Foundation Trust
| | - Darren Barton
- Cancer Research Clinical Trial Unit, University of Birmingham
| | - Gideon M Hirschfield
- Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham
- National Institute of Health Research Birmingham Biomedical Research Centre
| | - Timothy Wong
- Department of Haematology, University Hospital Birmingham National Health Service Foundation Trust
| | - Peter Guest
- Clinical Radiopharmacy, Imaging and Nuclear Medicine Department, University Hospital of Birmingham National Health Service Foundation Trust; Birmingham
| | - David H. Adams
- Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham
- National Institute of Health Research Birmingham Biomedical Research Centre
- Liver Transplant and Hepato-biliary Unit, Queen Elizabeth Hospital, University Hospital Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
3
|
Jeffery HC, Hunter S, Humphreys EH, Bhogal R, Wawman RE, Birtwistle J, Atif M, Bagnal CJ, Rodriguez Blanco G, Richardson N, Warner S, Dunn WB, Afford SC, Adams DH, Oo YH. Bidirectional Cross-Talk between Biliary Epithelium and Th17 Cells Promotes Local Th17 Expansion and Bile Duct Proliferation in Biliary Liver Diseases. J Immunol 2019; 203:1151-1159. [PMID: 31391236 PMCID: PMC6697739 DOI: 10.4049/jimmunol.1800455] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/01/2019] [Indexed: 12/17/2022]
Abstract
There is no effective treatment for autoimmune biliary diseases. Therefore, understanding their immunopathology is crucial. The biliary epithelial cells (BEC), expressing TLR-4, are constantly exposed to gut microbes and bacterial wall LPS, and in settings of inflammation, the immune infiltrate is dense within the peribiliary region of human liver. By dual immunohistochemistry, we affirm human intrahepatic T cell infiltrate includes CCR6+CD4+ and AhR+CD4+ T cells with potential for plasticity to Th17 phenotype. Mechanistically, we demonstrate that Th1 and Th17 inflammatory cytokines and LPS enhance human primary BEC release of the CCR6 ligand CCL20 and BEC secretion of Th17-polarizing cytokines IL-6 and IL-1β. Cell culture assays with human BEC secretome showed that secretome polarizes CD4 T cells toward a Th17 phenotype and supports the survival of Th17 cells. BEC secretome did not promote Th1 cell generation. Additionally, we give evidence for a mutually beneficial feedback of the type 17 cell infiltrate on BEC, showing that treatment with type 17 cytokines increases BEC proliferation, as monitored by Ki67 and activation of JAK2-STAT3 signaling. This study identifies human BEC as active players in determining the nature of the intrahepatic immune microenvironment. In settings of inflammation and/or infection, biliary epithelium establishes a prominent peribiliary type 17 infiltrate via recruitment and retention and enhances polarization of intrahepatic CD4 cells toward Th17 cells via type 17 cytokines, and, reciprocally, Th17 cells promote BEC proliferation for biliary regeneration. Altogether, we provide new insight into cross-talk between Th17 lymphocytes and human primary biliary epithelium in biliary regenerative pathologies.
Collapse
Affiliation(s)
- Hannah C Jeffery
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Stuart Hunter
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Elizabeth H Humphreys
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Ricky Bhogal
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Rebecca E Wawman
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
- Department of Medicine, Imperial College London, London SW7 2BX, United Kingdom
| | - Jane Birtwistle
- Clinical Immunology Department, University of Birmingham National Health Service Foundation Trust, Birmingham, Edgbaston B15 2GW, United Kingdom
| | - Muhammad Atif
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Christopher J Bagnal
- Human Biomaterial Resource Centre, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Giovanny Rodriguez Blanco
- Phenome Centre Birmingham, School of Biosciences, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Naomi Richardson
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Suz Warner
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
- Liver Unit, Birmingham Children's Hospital, Birmingham B4 6NH, United Kingdom; and
| | - Warwick B Dunn
- Phenome Centre Birmingham, School of Biosciences, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Simon C Afford
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
| | - David H Adams
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom
- Liver Transplant and Hepatobiliary Unit, Queen Elizabeth Hospital, University Hospital Birmingham National Health Service Foundation Trust, Birmingham, Edgbaston B15 2GW, United Kingdom
| | - Ye Htun Oo
- Centre for Liver and Gastrointestinal Research, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, Edgbaston B15 2TT, United Kingdom;
- Liver Transplant and Hepatobiliary Unit, Queen Elizabeth Hospital, University Hospital Birmingham National Health Service Foundation Trust, Birmingham, Edgbaston B15 2GW, United Kingdom
| |
Collapse
|
4
|
Jeffery HC, Braitch MK, Bagnall C, Hodson J, Jeffery LE, Wawman RE, Wong LL, Birtwistle J, Bartlett H, Lohse AW, Hirschfield GM, Dyson J, Jones D, Hubscher SG, Klenerman P, Adams DH, Oo YH. Changes in natural killer cells and exhausted memory regulatory T Cells with corticosteroid therapy in acute autoimmune hepatitis. Hepatol Commun 2018; 2:421-436. [PMID: 29619420 PMCID: PMC5880196 DOI: 10.1002/hep4.1163] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 12/24/2022] Open
Abstract
Autoimmune hepatitis (AIH) is an immune-mediated liver disease currently treated by immunosuppressive medications with significant side effects. Thus, novel mechanistic treatments are greatly needed. We performed prospective deep immunophenotyping of blood immune cells in patients with acute AIH before and after corticosteroid therapy. Blood samples from 26 patients with acute AIH (United Kingdom-AIH Consortium) were phenotyped by flow cytometry at baseline and 4 months after starting corticosteroids. Pretreatment liver tissues were stained for forkhead box P3-positive (FOXP3POS) regulatory T cells (Tregs), clusters of differentiation (CD)56POS natural killer (NK) cells, and chemokine (C-X-C motif) ligand 10. Chemokine secretion by cultured primary hepatocyte and biliary epithelial cells was measured by enzyme-linked immunosorbent assay. Functional coculture assays with stimulated NK cells and Tregs were performed. CD161 ligand, lectin-like transcript-1 expression by intrahepatic immune cells was demonstrated with flow cytometry. Frequencies of NKbright cells declined with therapy (P < 0.001) and correlated with levels of alanine aminotransferase (P = 0.023). The Treg:NKbright ratio was lower pretreatment, and Tregs had an activated memory phenotype with high levels of CD39, cytotoxic T lymphocyte antigen 4, and FOXP3 but also high programmed death ligand 1, indicating exhaustion. Coculture experiments suggested the Tregs could not efficiently suppress interferon-γ secretion by NK cells. Both Tregs and NK cells had high expression of liver infiltration and T helper 17 plasticity-associated marker CD161 (P = 0.04). Pretreatment and CD161pos NK cells expressed high levels of perforin and granzyme B, consistent with an activated effector phenotype (P < 0.05). Lectin-like transcript 1, a ligand for CD161, is expressed on intrahepatic B cells, monocytes, and neutrophils. Conclusion: Activated effector NK cells, which correlate with biochemical measurements of hepatitis, and exhausted memory Tregs are increased in the blood of patients with treatment-naive AIH and decline with corticosteroid therapy. Inadequate regulation of NK cells by exhausted FOXP3pos Tregs may play a role in AIH pathogenesis and contribute to liver injury. (Hepatology Communications 2018;2:421-436).
Collapse
Affiliation(s)
- Hannah C. Jeffery
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
| | - Manjit K. Braitch
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
| | - Chris Bagnall
- Human Biomaterials Resource CentreUniversity of BirminghamUnited Kingdom
| | - James Hodson
- Institute of Translational MedicineUniversity Hospitals Birmingham National Health Services Foundation Trust, University of BirminghamBirminghamUnited Kingdom
| | - Louisa E. Jeffery
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
| | - Rebecca E. Wawman
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
- School of Life Sciences, Faculty of Health and Life SciencesCoventry UniversityCoventryUnited Kingdom
| | - Lin Lee Wong
- Newcastle Biomedical Research Centre and Newcastle UniversityNewcastleUnited Kingdom
| | - Jane Birtwistle
- Clinical Immunology DepartmentUniversity of BirminghamBirminghamUnited Kingdom
| | - Helen Bartlett
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
| | | | - Gideon M. Hirschfield
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
- Liver Transplantation and Hepatobiliary Unit, Queen Elizabeth HospitalUniversity Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
| | - Jessica Dyson
- Newcastle Biomedical Research Centre and Newcastle UniversityNewcastleUnited Kingdom
| | - David Jones
- Newcastle Biomedical Research Centre and Newcastle UniversityNewcastleUnited Kingdom
| | - Stefan G. Hubscher
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
- Department of Histopathology, Queen Elizabeth HospitalUniversity Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
| | - Paul Klenerman
- Peter Medawar Building of Pathogen ResearchUniversity of OxfordOxfordUnited Kingdom
| | - David H. Adams
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
- Liver Transplantation and Hepatobiliary Unit, Queen Elizabeth HospitalUniversity Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
| | - Ye H. Oo
- Centre for Liver Research, Institute of Immunology and Immunotherapy and National Institute of Health Research Inflammation Biomedical Research Centre BirminghamUniversity of BirminghamBirminghamUnited Kingdom
- Liver Transplantation and Hepatobiliary Unit, Queen Elizabeth HospitalUniversity Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
| |
Collapse
|