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Akhtar MZ, Huang H, Kaisar M, Lo Faro ML, Rebolledo R, Morten K, Heather LC, Dona A, Leuvenink HG, Fuggle SV, Kessler BM, Pugh CW, Ploeg RJ. Using an Integrated -Omics Approach to Identify Key Cellular Processes That Are Disturbed in the Kidney After Brain Death. Am J Transplant 2016; 16:1421-40. [PMID: 26602379 DOI: 10.1111/ajt.13626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/26/2015] [Accepted: 11/12/2015] [Indexed: 01/25/2023]
Abstract
In an era where we are becoming more reliant on vulnerable kidneys for transplantation from older donors, there is an urgent need to understand how brain death leads to kidney dysfunction and, hence, how this can be prevented. Using a rodent model of hemorrhagic stroke and next-generation proteomic and metabolomic technologies, we aimed to delineate which key cellular processes are perturbed in the kidney after brain death. Pathway analysis of the proteomic signature of kidneys from brain-dead donors revealed large-scale changes in mitochondrial proteins that were associated with altered mitochondrial activity and morphological evidence of mitochondrial injury. We identified an increase in a number of glycolytic proteins and lactate production, suggesting a shift toward anaerobic metabolism. Higher amounts of succinate were found in the brain death group, in conjunction with increased markers of oxidative stress. We characterized the responsiveness of hypoxia inducible factors and found this correlated with post-brain death mean arterial pressures. Brain death leads to metabolic disturbances in the kidney and alterations in mitochondrial function and reactive oxygen species generation. This metabolic disturbance and alteration in mitochondrial function may lead to further cellular injury. Conditioning the brain-dead organ donor by altering metabolism could be a novel approach to ameliorate this brain death-induced kidney injury.
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Affiliation(s)
- M Z Akhtar
- Centre for Cellular and Molecular Physiology, Oxford University, Oxford, UK.,Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK
| | - H Huang
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK.,Target Discovery Institute, Oxford University, Oxford, UK
| | - M Kaisar
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK.,Target Discovery Institute, Oxford University, Oxford, UK
| | - M L Lo Faro
- Centre for Cellular and Molecular Physiology, Oxford University, Oxford, UK.,Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK
| | - R Rebolledo
- Surgical Research Laboratory, University of Groningen, Groningen, the Netherlands
| | - K Morten
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - L C Heather
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - A Dona
- Department of Surgery, Imperial College, London, UK.,Kolling Institute for Medical Research, The University of Sydney, New South Wales, Australia
| | - H G Leuvenink
- Surgical Research Laboratory, University of Groningen, Groningen, the Netherlands
| | - S V Fuggle
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK
| | - B M Kessler
- Target Discovery Institute, Oxford University, Oxford, UK
| | - C W Pugh
- Centre for Cellular and Molecular Physiology, Oxford University, Oxford, UK
| | - R J Ploeg
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK
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2
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Duquesnoy RJ, Gebel HM, Woodle ES, Nickerson P, Baxter-Lowe LA, Bray RA, Claas FHJ, Eckels DD, Friedewald JJ, Fuggle SV, Gerlach JA, Fung JJ, Kamoun M, Middleton D, Shapiro R, Tambur AR, Taylor CJ, Tinckam K, Zeevi A. High-Resolution HLA Typing for Sensitized Patients: Advances in Medicine and Science Require Us to Challenge Existing Paradigms. Am J Transplant 2015; 15:2780-1. [PMID: 26177785 DOI: 10.1111/ajt.13376] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 04/26/2015] [Accepted: 04/26/2015] [Indexed: 01/25/2023]
Affiliation(s)
- R J Duquesnoy
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - H M Gebel
- HLA Laboratory, Emory University Hospital, Atlanta, GA
| | - E S Woodle
- University of Cincinnati, Cincinnati, OH
| | - P Nickerson
- Department of Internal Medicine and Immunology, University of Manitoba, Winnipeg, Canada
| | | | - R A Bray
- Emory University Hospital, Atlanta, GA
| | - F H J Claas
- Department of Immunohematology and Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | | | - J J Friedewald
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - S V Fuggle
- Transplant Immunology Laboratory, Oxford Transplant Centre, Oxford University Hospitals, Oxford University, Oxford, United Kingdom
| | - J A Gerlach
- Biomedical Laboratory Diagnostics Program, Michigan State University, East Lansing, MI
| | - J J Fung
- Digestive Disease Institute, Cleveland Clinic Main Campus, Cleveland, OH
| | - M Kamoun
- Immunology & Histocompatibility Testing Laboratories, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - D Middleton
- Department of Transplant Immunology, Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
| | - R Shapiro
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mt. Sinai, New York, NY
| | - A R Tambur
- Transplant Immunology Laboratory, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - C J Taylor
- Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
| | - K Tinckam
- Division of Nephrology and HLA Laboratory, University Health Network, Toronto, Canada
| | - A Zeevi
- Division of Transplant Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
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3
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Hudson A, Bradbury L, Johnson R, Fuggle SV, Shaw JAM, Casey JJ, Friend PJ, Watson CJE. The UK Pancreas Allocation Scheme for Whole Organ and Islet Transplantation. Am J Transplant 2015; 15:2443-55. [PMID: 25943412 DOI: 10.1111/ajt.13284] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 02/01/2015] [Accepted: 02/23/2015] [Indexed: 01/25/2023]
Abstract
In order to develop a national allocation scheme for donor pancreases, factors affecting waiting time and transplant outcomes in the United States (US) and United Kingdom (UK) were analyzed and compared. Blood group, sensitization, dialysis requirement, and whether the patient was waiting for a kidney and pancreas or pancreas alone affected waiting time in both countries; ethnicity and body mass index (BMI) also affected waiting time in the US. Ninety-day pancreas survival was similar in the UK and US, and was poorer for patients receiving a pancreas alone, with older donors, higher BMI and longer duration of ischemia in both countries. Factors affecting outcome, together with published data on factors affecting islet transplantation, informed the development of a points based allocation scheme for deceased donor pancreases in the UK providing equitable access for both whole organ and islet recipients through a single waiting list. Analysis of the allocation scheme 3 years after its introduction in December 2010 showed that the results were broadly as simulated, with a significant reduction in the number of long waiting patients and an increase in the number of islet transplants. There remains a surplus of highly sensitized patients in the waiting list, which the scheme should address in time.
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Affiliation(s)
- A Hudson
- Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England
| | - L Bradbury
- Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England
| | - R Johnson
- Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England
| | - S V Fuggle
- Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England.,The Oxford Transplant Center, Churchill Hospital, Headington, Oxford, England
| | - J A M Shaw
- Institute of Cellular Medicine (Diabetes), The Medical School, Newcastle-upon-Tyne, England
| | - J J Casey
- Scottish Islet Transplant Unit, The Royal Infirmary, Edinburgh, Scotland
| | - P J Friend
- The Oxford Transplant Center, Churchill Hospital, Headington, Oxford, England
| | - C J E Watson
- University Department of Surgery, Addenbrooke's Hospital, Cambridge and the NIHR Cambridge Biomedical Research Center, England
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4
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Hamilton A, Mittal S, Barnardo MCNM, Fuggle SV, Friend P, Gough SCL, Simmonds MJ. Genetic variation in caveolin-1 correlates with long-term pancreas transplant function. Am J Transplant 2015; 15:1392-9. [PMID: 25787790 DOI: 10.1111/ajt.13104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 01/25/2023]
Abstract
Pancreas transplantation is a successful treatment for a selected group of people with type 1 diabetes. Continued insulin production can decrease over time and identifying predictors of long-term graft function is key to improving survival. The aim of this study was to screen subjects for variation in the Caveolin-1 gene (Cav1), previously shown to correlate with long-term kidney transplant function. We genotyped 435 pancreas transplant donors and 431 recipients who had undergone pancreas transplantation at the Oxford Transplant Centre, UK, for all known common variation in Cav1. Death-censored cumulative events were analyzed using Kaplan-Meier and Cox regression. Unlike kidney transplantation, the rs4730751 variant in our pancreas donors or transplant recipients did not correlate with long-term graft function (p = 0.331-0.905). Presence of rs3801995 TT genotype (p = 0.009) and rs9920 CC/CT genotype (p = 0.010) in our donors did however correlate with reduced long-term graft survival. Multivariate Cox regression (adjusted for donor and recipient transplant factors) confirmed the association of rs3801995 (p = 0.009, HR = 1.83;[95% CI = 1.16-2.89]) and rs9920 (p = 0.037, HR = 1.63; [95% CI = 1.03-2.73]) with long-term graft function. This is the first study to provide evidence that donor Cav1 genotype correlates with long-term pancreas graft function. Screening Cav1 in other datasets is required to confirm these pilot results.
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Affiliation(s)
- A Hamilton
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
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5
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Duquesnoy RJ, Kamoun M, Baxter-Lowe LA, Woodle ES, Bray RA, Claas FHJ, Eckels DD, Friedewald JJ, Fuggle SV, Gebel HM, Gerlach JA, Fung JJ, Middleton D, Nickerson P, Shapiro R, Tambur AR, Taylor CJ, Tinckam K, Zeevi A. Should HLA mismatch acceptability for sensitized transplant candidates be determined at the high-resolution rather than the antigen level? Am J Transplant 2015; 15:923-30. [PMID: 25778447 DOI: 10.1111/ajt.13167] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [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: 07/28/2014] [Revised: 10/19/2014] [Accepted: 11/11/2014] [Indexed: 01/25/2023]
Abstract
Defining HLA mismatch acceptability of organ transplant donors for sensitized recipients has traditionally been based on serologically defined HLA antigens. Now, however, it is well accepted that HLA antibodies specifically recognize a wide range of epitopes present on HLA antigens and that molecularly defined high resolution alleles corresponding to the same low resolution antigen can possess different epitope repertoires. Hence, determination of HLA compatibility at the allele level represents a more accurate approach to identify suitable donors for sensitized patients. This approach would offer opportunities for increased transplant rates and improved long term graft survivals.
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Affiliation(s)
- R J Duquesnoy
- Thomas E.Starzl Transplantation Institute, University of Pittsburgh, Medical Center, Pittsburgh, PA
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6
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Mittal S, Page SL, Friend PJ, Sharples EJ, Fuggle SV. De novo donor-specific HLA antibodies: biomarkers of pancreas transplant failure. Am J Transplant 2014; 14:1664-71. [PMID: 24866735 DOI: 10.1111/ajt.12750] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [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: 11/05/2013] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 01/25/2023]
Abstract
This study assesses the role of posttransplant HLA antibody monitoring in the surveillance of pancreas transplant recipients. Four hundred thirty-three pancreas transplants were performed at the Oxford Transplant Centre 2006-2011 (317 simultaneous pancreas kidney [SPK] and 116 isolated pancreas [IP]). HLA antibody monitoring was performed at 0, 6 and 12 months and annually and during clinical events. There was no association between pancreas graft failure and recipient or donor characteristics. Posttransplant antibody status, available for 354 (81.8%) of recipients, demonstrated that 141 (39.8%) developed de novo HLA antibodies, of which 52 (36.9%) were de novo donor-specific HLA antibodies (DSA) (34 SPK, 18 IP). The development of antibodies to donor HLA, but not to nondonor HLA, was significantly associated with poorer graft outcomes, with 1- and 3-year graft survival inferior in SPK recipients (85.2% vs. 93.5%; 71.8% vs. 90.3%, respectively; log-rank p = 0.002), and particularly in IP recipients (50.0% vs. 82.9%; 16.7 vs. 79.4%, respectively; log-rank p = 0.001). In a multivariate analysis, development of de novo DSA emerged as a strong independent predictor of pancreas graft failure (hazard ratio 4.66, p < 0.001). This is the largest study to examine de novo HLA antibodies following pancreas transplantation and clearly defines a high-risk group in need of specific intervention.
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Affiliation(s)
- S Mittal
- Oxford Transplant Centre, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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7
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Sutherland AI, Akhtar MZ, Zilvetti M, Brockmann J, Ruse S, Fuggle SV, Sinha S, Harden P, Friend PJ. Alemtuzumab and sirolimus in renal transplantation: six-year results of a single-arm prospective pilot study. Am J Transplant 2014; 14:677-84. [PMID: 24612687 DOI: 10.1111/ajt.12572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 01/25/2023]
Abstract
mTOR inhibitors avoid calcineurin nephrotoxicity, but sirolimus de novo is associated with unacceptable side effects and higher rejection rates. We have investigated a modified strategy: alemtuzumab induction with tacrolimus and mycophenolate maintenance, switching from tacrolimus to sirolimus at 6 months and stopping mycophenolate at 12 months. Here, we report the 6-year follow-up of 30 patients prospectively recruited to this single-arm pilot study and compare outcomes to a matched contemporaneous control group of 30 patients who received standard induction and calcineurin-inhibitor-based immunosuppression.Six-year patient and graft survival were 83% and 80%(alemtuzumab) versus 77% and 70% (control). Rejection rates in the first 6 months were similar in alemtuzumab (6.6%) and control groups (10%). A higher than expected incidence of rejection in the alemtuzumab group following cessation of mycophenolate at 1 year (17%) was mitigated in later patients by retaining low dose mycophenolate. Mean eGFR was higher in the alemtuzumab group at all time points but not significantly (p¼0.16). Tacrolimus levels in the first 6 months were significantly higher in the contemporaneous control group (p<0.001). Alemtuzumab induction with initial treatment with tacrolimus enables conversion to sirolimus without the side effects and incidence of acute rejection seen in earlier protocols.
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8
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Muthusamy ASR, Mumford L, Hudson A, Fuggle SV, Friend PJ. Pancreas transplantation from donors after circulatory death from the United Kingdom. Am J Transplant 2013; 13:824. [PMID: 23437884 DOI: 10.1111/ajt.12037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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9
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Muthusamy ASR, Mumford L, Hudson A, Fuggle SV, Friend PJ. Pancreas transplantation from donors after circulatory death from the United Kingdom. Am J Transplant 2012; 12:2150-6. [PMID: 22845910 DOI: 10.1111/j.1600-6143.2012.04075.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study reports the comparative short-term results of pancreas transplantation from donors after circulatory death (DCD) (Maastricht III & IV), and pancreases from brainstem deceased donors (DBD). Between January 2006 and December 2010, 1009 pancreas transplants were performed in the United Kingdom, with 134 grafts from DCD and 875 from DBD. DCD grafts had no premortem pharmacological interventions performed. One-year pancreas and patient survival was similar between DCD and DBD, with pancreas graft survival significantly better in the DCD cohort if performed as an SPK. Early graft loss due to thrombosis (8% vs. 4%) was mainly responsible for early graft loss in the DCD cohort. These results from donors with broader acceptance criteria in age, body mass index, premortem interventions, etc. suggest that DCD pancreas grafts may have a larger application potential than previously recognized.
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Affiliation(s)
- A S R Muthusamy
- Oxford Transplant Centre, Churchill Hospital, Roosevelt Drive, Oxford, UK
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Howell WM, Harmer A, Briggs D, Dyer P, Fuggle SV, Martin S, Sinnott P, Smith J, Taylor CJ, Vaughan R. British Society for Histocompatibility & Immunogenetics and British Transplantation Society Guidelines for the Detection and Characterisation of Clinically Relevant Antibodies in Allotransplantation. Int J Immunogenet 2010; 37:435-7. [DOI: 10.1111/j.1744-313x.2010.00955.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Quiroga I, Sweeney D, Sutton PM, Ahmad T, Walton R, Barnardo MCNM, Fuggle SV. The identification of three novel MICA alleles by sequence-based typing. ACTA ACUST UNITED AC 2006; 67:321-5. [PMID: 16634869 DOI: 10.1111/j.1399-0039.2006.00574.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During a study of MICA frequency in a healthy population and a cohort of patients suffering with inflammatory bowel disease, three DNA samples produced unusual reactivity patterns using polymerase chain reaction sequence-specific primers (PCR-SSP). These samples were subsequently characterized by sequence-based typing (SBT). Here, we report the sequence of these three novel MICA alleles.
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Affiliation(s)
- I Quiroga
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
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12
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Abstract
We have identified a novel MICA allele, MICA*051, detected by the polymerase chain reaction using sequence-specific primers and characterized by sequence-based typing. MICA*051 appears to be the result of a recombination between MICA*00801 and MICA*00701 at intron 2.
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Affiliation(s)
- I Quiroga
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
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13
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Quiroga I, Sweeney D, Sutton PM, Chapple SDJ, Souto-Grando JP, Barnardo MCNM, Fuggle SV. A novel major histocompatibility complex class I-related chain allele. ACTA ACUST UNITED AC 2004; 64:74-7. [PMID: 15191526 DOI: 10.1111/j.1399-0039.2004.00242.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the identification of a novel major histocompatibility complex class I-related chain (MICB) allele, provisionally designated as MICB-0114 pending the WHO Nomenclature Classification for the MICB locus. This new allele is identical to MICB-0103101v except for a single mutation of G to A in exon 4 that translates into an amino acid substitution from glutamic acid to lysine.
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Affiliation(s)
- I Quiroga
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
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Abstract
Alloimmunization to human platelet alloantigens (HPAs) is responsible for neonatal alloimmune thrombocytopenia (NAIT), post-transfusional purpura (PTP) and platelet transfusion refractoriness. HPAs may also have a role as histocompatibility antigens in transplantation as well as associations with cardiac disease. We have developed a polymerase chain reaction-sequence-specific primer (PCR-SSP) assay capable of detecting 15 HPA allelic variants. As part of the validation of the assay, 134 UK renal donors were genotyped to determine HPA allele frequencies in the UK population. The HPA allele frequencies obtained are consistent with those of the other European studies: GP1A*1 (HPA-5a) and GP1A*2 (HPA-5b), 0.914 and 0.086, respectively; GP1BA*1 (HPA-2a) and GP1BA*2 (HPA-2b), 0.925 and 0.075; GP2B*1 (HPA-3a) and GP2B*2 (HPA-3b), 0.627 and 0.373; GP3A*1 (HPA-1a) and GP3A*2 (HPA-1b), 0.840 and 0.161. The rare alleles GP2B*3 (HPA-9bw) and GP3A*3 to *8 (HPA-4b, -6b, -7bw, -8bw, -10bw and -11bw, respectively) were all absent. This comprehensive HPA genotyping assay allows rapid, accurate and reproducible results at low cost.
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Affiliation(s)
- D C Jones
- Department of Pathology, Cambridge University, UK.
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Affiliation(s)
- R H Chen
- Nuffield Department of Surgery, John Radcliffe Hospital, Headington, UK
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16
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Abstract
Hereditary hemochromatosis (HH) is an iron-overload disease common in populations of Northern European origin. Patients display increased iron absorption leading to excessive iron deposition and potential multiorgan failure. Using polymerase chain reaction sequence-specific primer (PCR-SSP) technology, we have developed an HH diagnosis assay capable of detecting 19 non-synonymous HFE mutations (including a previously unreported mutation, V295A) and several TFR2, SLC11A3 and H ferritin alleles implicated in HH. As part of the validation process, 159 UK renal donors were genotyped to determine HH allele frequencies in the UK population. The alleles nominally identified as HFE*01 (C282Y), HFE*02 (H63D) and HFE*03 (S65C) were found at frequencies of 0.085, 0.173 and 0.009, respectively. All other potential HH-associated alleles were absent, confirming their low prevalence in this population. This assay enables comprehensive routine HH genotyping, producing rapid, accurate and reproducible results at low cost.
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Affiliation(s)
- D C Jones
- Transplantation Imunology, Oxford Transplant Center, Churchill Hospital, Oxford, UK.
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Chapple SDJ, Agudelo JD, Barnardo MCNM, Vargas-Cuero AL, Fuggle SV. Characterization of a novel HLA-C allele, Cw*0315. Tissue Antigens 2002; 60:404-6. [PMID: 12492817 DOI: 10.1034/j.1399-0039.2002.600508.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The presence of an unusual HLA class I reactivity pattern was detected in a Caucasoid-Asian individual by PCR-sequence specific primer (PCR-SSP) typing. Exons 2 and 3 were characterized using PCR-sequence-based typing (PCR-SBT) and were found to contain a novel Cw*03 sequence, Cw*0315. In the region studied, Cw*0315 was comprised mainly of the Cw*0302 sequence, but at four positions it contained nucleotides normally only found in other HLA Cw locus alleles. These positions each resulted in an amino acid substitution.
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Affiliation(s)
- S D J Chapple
- Transplant Immunology, Oxford Transplant Center, Churchill Hospital, Oxford, UK
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18
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Johnson RJ, Belger MA, Briggs JD, Fuggle SV, Morris PJ. Renal transplantation in the UK and Republic of Ireland. Clin Transpl 2001:105-13. [PMID: 11512304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
RENAL TRANSPLANT OUTCOME: Analysis of 5-year transplant survival in the UK showed a number of significant factors influencing outcome of adult cadaveric renal transplantation. Data from 5,963 first grafts and 1,078 regrafts carried out between 1990-1997 showed year of graft, recipient age and diabetes, donor age, kidney exchange between centres and HLA matching to influence 5-year outcome. The most important prognostic factor was donor age: the risk of transplant failure within 5 years for grafts using kidneys from donors aged 60 years and over was double that of grafts using donors aged 18-34 years. Unlike the effect of donor age, the influence of HLA matching would appear to be diminishing with time. In contrast to transplants in the 1980's, the difference in 5-year transplant survival between 000 mismatched and favourably matched (100, 010 or 110 mismatched) transplants is no longer significant. An analysis of posttransplant survival for first grafts in different epochs (0-3 months, 3 months to 3 years and beyond 3 years) showed that one factor affected short-term outcome (exchange of kidneys between centres), whereas others affected outcome throughout the epochs (most notably donor age, recipient age and recipient diabetes). RECIPIENT AND DONOR AGE MATCHING: The mean recipient age in the UK and Republic of Ireland increased by 5 years between 1981-1990 but has remained at approximately 45 years since then. The mean donor age increased by 7 years to 42.5 years (s.e. 0.5) between 1981-1991 and since then has increased at a slower rate to 43.4 years (s.e. 0.5) in 1998. The mean donor-recipient age difference for more than 15,000 transplants carried out between 1990-1998 has decreased, primarily due to increasing donor age over this time. However, the introduction of a new Kidney Allocation Scheme in the UK in July 1998, part of which is aimed at minimising age differences, has increased the likelihood that recipients aged over 60 years will be allocated grafts from donors closer to their own age than previously. The new UK Kidney Allocation Scheme also gave children increased access to well-matched adult organs leading to an increased mean age difference for this group between July-December 1998. DONOR AND RECIPIENT HLA MATCHING: Modifications to the Kidney Allocation Scheme introduced in January 1997 with the aim of increasing the number of well-matched transplants has led to a rise in 000 mismatched grafts from 5% to 7% and favourably matched (100/010/110 mismatches) from 29% to 36% between 1990-1992 and 1996-1998. Over this same time the proportion of 2 DR-mismatched grafts has decreased from 10% to 4%. The revised Kidney Allocation Scheme implemented in July 1998 gave a further increase in priority to 000 mismatches, increasing the proportion of these transplants to 12% for the last half of 1998, a level which has been maintained since then.
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Koo DD, Welsh KI, West NE, Channon KM, Penington AJ, Roake JA, Morris PJ, Fuggle SV. Endothelial cell protection against ischemia/reperfusion injury by lecithinized superoxide dismutase. Kidney Int 2001; 60:786-96. [PMID: 11473663 DOI: 10.1046/j.1523-1755.2001.060002786.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Organs used for transplantation may experience long periods of cold ischemic preservation and consequently oxygen free radical-mediated damage following reperfusion. Lecithinized superoxide dismutase (lec-SOD) is a novel free radical scavenger that has been shown to bind with high affinity to cell membranes. The aim of this study was to determine whether lec-SOD bound to endothelial cells under organ preservation conditions to mediate direct antioxidant activity at the endothelial cell surface and thus offer protection against the harmful effects of ischemia/reperfusion injury. METHODS An in vitro study was performed on large vessel endothelial cells (HUVEC) and a human microvascular endothelial cell line HMEC-1, to investigate the potential therapeutic benefits of incorporating lec-SOD into organ preservation solution. A cold hypoxia/reoxygenation system was developed to examine lec-SOD binding affinity to endothelial cells, protection against hypoxia/reoxygenation-induced cell death, and neutrophil adhesion. RESULTS Lec-SOD bound to endothelial cells with higher affinity than unmodified recombinant human superoxide dismutase (rhSOD) and significantly protected both HUVEC and HMEC-1 from cell death following 27 hours of cold hypoxia (P < 0.01). Furthermore, neutrophil adhesion to the endothelium stimulated by hypoxia and reoxygenation was significantly inhibited by treatment with lec-SOD but not by lecithin or rhSOD (P < 0.01). Analysis by flow cytometry demonstrated that E-selectin and ICAM-1 were up-regulated by hypoxia/reoxygenation that was inhibited in part by lec-SOD. CONCLUSIONS The results from this study suggest that incorporation of lec-SOD into organ preservation solutions provides effective protection to endothelial cells against cold ischemia and reperfusion injury following transplantation.
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Affiliation(s)
- D D Koo
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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20
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Abstract
OBJECTIVE To identify potential risk factors for the development of chronic renal allograft failure. SUMMARY BACKGROUND DATA Chronic allograft failure (CAF) is the leading cause of late graft loss in renal transplantation. The authors studied the risk factors for the development of CAF in a single center during a period in which a consistent baseline immunosuppression regimen (cyclosporine, azathioprine, and prednisolone) was used. METHODS Data from the Oxford Transplant Center Database were assessed on 862 renal allografts during a 10-year period. Risk factors were identified using multivariate logistic regression analysis. RESULTS Biopsy-proven CAF occurred in 77 patients (9.2%) in the entire group. Multivariate risk factor analysis revealed that early and late acute rejection episodes, proteinuria, and serum triglycerides were significant factors. Acute rejection after 3 months was more important than early acute rejection. Serum triglyceride level and proteinuria at 1 year were both elevated in the CAF group. Male sex provided a protective effect. Serum creatinine levels at 6 months after the transplant were not predictive of the risk of developing CAF. CONCLUSIONS These results from the largest single-center review to date suggest that both antigen-dependent and -independent factors are involved in the pathogenesis of CAF. Acute rejection at all time points has a significant impact on the development of CAF.
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Affiliation(s)
- A J McLaren
- Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
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Dunn PP, Carter V, Dunn A, Day S, Fuggle SV, Ross J, Cavanagh G. Identification of an HLA-B7 serological variant and its characterization by sequencing based typing. Tissue Antigens 2000; 55:71-3. [PMID: 10703614 DOI: 10.1034/j.1399-0039.2000.550114.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We have identified an HLA-B*07 variant allele, B*0716, in a Caucasoid cadaver kidney donor. The HLA class I type by polymerase chain reaction using sequence-specific primers (PCR-SSP) was A*01, 32; B*07, 08; Cw*07. Serological typing, using monoclonal and polyclonal anti-HLA antisera, gave disparate results for the B antigens. Monoclonal antibodies identified B7 and B8 antigens but polyclonal antisera recognised only the B8 antigen. PCR using sequencing based typing (PCR-SBT) confirmed the presence of both B*0703 and B*0801 alleles but with a mutation in one of the alleles. The HLA-B*07 allele was isolated by allele-specific PCR and was shown to have a mutation, G-->T, at 292 in exon 2. This mutation changes codon 74, which encodes aspartic acid (GAC) present in all previously identified B*07 alleles, to tyrosine (TAC) in the variant. The serological results suggest that codon 74 is a crucial part of a B7 antigen-specific epitope recognised by tissue typing polyclonal antisera.
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Affiliation(s)
- P P Dunn
- UKTSSA, Stoke Gifford, Bristol, United Kingdom
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22
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Morris PJ, Johnson RJ, Fuggle SV, Belger MA, Briggs JD. Analysis of factors that affect outcome of primary cadaveric renal transplantation in the UK. HLA Task Force of the Kidney Advisory Group of the United Kingdom Transplant Support Service Authority (UKTSSA). Lancet 1999; 354:1147-52. [PMID: 10513707 DOI: 10.1016/s0140-6736(99)01104-6] [Citation(s) in RCA: 192] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the UK, kidneys are exchanged between centres on the basis of matching for HLA. We analysed various factors that might affect graft outcome to establish whether exchange of kidneys on this basis remains valid. METHODS 6363 primary cadaveric renal transplants carried out in 23 centres in the UK between 1986 and 1993 were used in the analysis. 6338 (99.6%) patients who underwent transplantation were followed up at 1 year. 5-year follow-up data were available for 2907 (97.8%) of the 2972 patients who survived to 5 years. We made random checks to validate the data. A multifactorial analysis with Cox's proportional hazards models was used to analyse factors that had a possible effect on graft outcome. To ensure that the analysis of matching was constant during the 8-year study, our analysis was based on the HLA antigens used for organ exchange (11 A locus antigens, 27 B locus antigens, and 12 DR locus antigens). We assessed overall outcome at 5 years and during three periods after transplantation at: 0-3 months, 3-36 months, and after 36 months. FINDINGS The following factors were significantly associated with graft outcome in the multifactorial analysis: year of graft, age of donor, age of recipient, whether the recipient had diabetes, cause of donor's death, cold ischaemic time, transport of kidneys, transplant centre, and matching for HLA. The best outcome was achieved with kidneys that had no mismatches at HLA-A, HLA-B, and HLA-DR loci (000 mismatches). The next most favourable outcome was achieved with one mismatch at either A or B loci or one mismatch at both the A and B , but no mismatch at the DR locus (100, 010, or 110 mismatches). Age of the donor and recipient had a significant effect on transplant outcome: older age was associated with increased risk of graft failure. INTERPRETATION Various factors affect the outcome of primary cadaveric renal transplantation, particularly the age of the donor and the recipient. However, the effect of matching for HLA remains a strong one and fully justifies the continuing policy in the UK of exchanging kidneys on the basis of HLA matching, especially to recipients when there is a 000 mismatch for HLA between donor and recipient. On the basis of this analysis, a new allocation scheme for kidneys was introduced in the UK in 1998. During the first 9 months of the scheme, there has been a doubling of the number of HLA-000 mismatched kidneys transplanted.
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Affiliation(s)
- P J Morris
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, UK
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23
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Koo DD, Welsh KI, McLaren AJ, Roake JA, Morris PJ, Fuggle SV. Cadaver versus living donor kidneys: impact of donor factors on antigen induction before transplantation. Kidney Int 1999; 56:1551-9. [PMID: 10504507 DOI: 10.1046/j.1523-1755.1999.00657.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND It is widely recognized that living-related donor (LRD) renal allografts have a higher overall graft survival than cadaver donor transplants. We tested the hypothesis that part of this is attributable to LRD kidneys being obtained under optimal conditions from healthy donors, whereas cadaveric kidneys may have experienced injury as a result of inflammatory events around the time of brain death. METHODS We have performed a comparative immunohistochemical analysis of pretransplant donor biopsies from cadaveric (N = 65) and LRD (N = 29) kidneys to determine any differences that may predispose them to subsequent damage. Cryostat sections were stained with antibodies to leukocytes, adhesion molecules, and human leukocyte antigen (HLA)-DR antigens, and the expression was assessed semiquantitatively. RESULTS High levels of endothelial E-selectin and proximal tubular expression of HLA-DR antigens, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1 were detected in biopsies from cadaveric kidneys, whereas expression of these markers was markedly reduced in LRD kidneys. High levels of tubular antigen expression were significantly associated with traumatic death, prolonged ventilation, and episodes of infection in cadaver donors. Furthermore, the expression of pretransplant tubular antigens in cadaver donor kidneys was significantly associated with early acute rejection following transplantation, suggesting that such kidneys are predisposed to subsequent immune-mediated attack following transplantation. CONCLUSIONS These results may explain, in part, the superior outcome of LRD allografts compared with cadaver renal allografts.
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Affiliation(s)
- D D Koo
- Nuffield Department of Surgery and Oxford Transplant Center, University of Oxford, John Radcliffe Hospital, England, United Kingdom
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24
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Bates WD, Davies DR, Welsh K, Gray DW, Fuggle SV, Morris PJ. An evaluation of the Banff classification of early renal allograft biopsies and correlation with outcome. Nephrol Dial Transplant 1999; 14:2364-9. [PMID: 10528659 DOI: 10.1093/ndt/14.10.2364] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Banff classification for assessment of renal allograft biopsies was introduced as a standardized international classification of renal allograft pathology and acute rejection. Subsequent debate and evaluation studies have attempted to develop and refine the classification. A recent alternative classification, known as the National Institutes of Health Collaborative Clinical Trials in Transplantation (NIH-CCTT) classification, proposed three distinct types of acute rejection. The 1997 Fourth Banff meeting appeared to move towards a consensus for describing transplant biopsies, which incorporated both approaches. Patients who received a renal allograft at the Oxford Transplant Centre were managed by a combination of protocol and clinically indicated biopsies. We have undertaken a retrospective analysis of the biopsies correlated with the clinical outcome to test the prognostic value of the original Banff (Banff 93-95) and NIH-CCTT classifications. METHODS Three hundred and eighty-two patients received renal allografts between May 1985 and December 1989, and were immunosuppressed using a standard protocol of cyclosporine, azathioprine and steroid. Adequate 5-year follow-up data were available on 351 patients, and of these, 293 had at least one satisfactory biopsy taken between days 2 and 35 after transplantation, the latter patients forming the study group. The D2-35 biopsies taken from these patients, which were not originally reported according to the Banff classification, were re-examined and classified according to the Banff 93-95 protocols. For each patient the biopsy found to be the most severely abnormal was selected, and the Banff and NIH-CCTT grading compared with the clinical outcome. RESULTS Seven hundred and forty-three biopsies taken from 293 patients between days 2 and 35 after transplantation were examined and the patients categorized on the basis of the 'worst' Banff grading as follows. Normal or non-rejection, 20%; borderline, 34%; acute rejection grade I (AR I), 18%; AR IIA, 6%; AR IIB, 14%; AR III, 1%; AR IIIC, 3%; widespread necrosis 3%. The clinical outcome for the last two groups combined was very poor with 18% of grafts functioning at 3 months and 6% at 5 years. The other groups with vascular rejection (AR IIB and AR III) had an intermediate outcome, graft survival being 78% at 3 months and 61% at 5 years. The remaining four groups (normal, borderline, cellular AR I and AR IIA) had the best outcome: graft survival 95% at 3 months and 78% at 5 years with virtually no difference between the four groups. Three forms of acute rejection, namely tubulo-interstitial, vascular and transmural vascular, were identified, but only the latter two categories were associated with a poor outcome. CONCLUSIONS The eight sub-categories of the Banff classification of renal allograft biopsies are associated with three different prognoses with respect to graft survival in the medium term. These three prognostic groups correspond to the three NIH-CCTT types. The data provide support for the consensus developed at Banff 97 separating tubulo-interstitial, vascular and transmural vascular rejection (types I, II and III acute rejection).
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Affiliation(s)
- W D Bates
- Department of Cellular Pathology, Oxford Transplant Centre, Oxford Radcliffe Hospital, University of Oxford, UK
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Fuggle SV, Belger MA, Johnson RJ, Ray TC, Morris PJ. A new national allocation scheme for adult kidneys in the United Kingdom. United Kingdom Transplant Support Service Authority (UKTSSA) Users' Kidney Advisory Group and its Task Forces. Clin Transpl 1999:107-13. [PMID: 10503089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A new allocation scheme for kidneys from adult cadaver donors was introduced in the UK on July 1st, 1998. The new scheme is based on data from an analysis of factors influencing transplant survival instigated by the Kidney Advisory Group (KAG) of the UKTSSA. A cohort of 6,363 first cadaver allografts performed in the UK between 1986-1993 was used for the analysis with 99.6% one-year follow-up and 97.8% 5-year follow-up. HLA matching was one of a number of factors that were found to influence transplant survival, thus supporting the policy of exchange of kidneys based on matching. The new allocation scheme is based on 3 tiers in which cadaver organs are offered first in Tier 1 to patients with zero HLA antigen mismatches (000 matchgrade), in Tier 2 to favorably matched patients, (matched for HLA-DR and mismatched for a maximum of one HLA-A and one-B locus antigen -100, 010, 110 matchgrades) and remaining kidneys in Tier 3 to non-favorably matched patients. A points score devised by a subgroup of the KAG to reflect natural justice and common sense is used as a discriminator between equally matched patients. The points are based on recipient age, donor-recipient age difference, waiting time, matchability for HLA antigens, sensitization to HLA antigens and the transplant unit balance of organ exchange. The performance of the scheme will be closely monitored, but computer simulations predict that there will be an overall improvement in transplant survival as a result of an increase in well matched transplants.
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26
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Carter AS, Cerundolo L, Bunce M, Koo DD, Welsh KI, Morris PJ, Fuggle SV. Nested polymerase chain reaction with sequence-specific primers typing for HLA-A, -B, and -C alleles: detection of microchimerism in DR-matched individuals. Blood 1999; 94:1471-7. [PMID: 10438736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
It is widely accepted that donor leukocytes survive within the recipient periphery after blood transfusion or solid organ transplantation. The significance of this microchimerism remains unclear, partially because of the insecurity of assays used to detect the donor-derived material. The techniques used to detect donor-derived DNA within recipient peripheral blood rely largely on major histocompatibility complex class II polymorphism. We and others have shown that the sensitivity of polymerase chain reaction with sequence-specific primers (PCR-SSP) typing for HLA class II alleles can be increased 100-fold by the addition of a primary amplification step (nested PCR-SSP). We have now extended this technique to encompass typing for HLA class I alleles, thereby adding flexibility to microchimerism testing by enabling testing of recipients HLA-DR matched with their donors. However, the high level of sensitivity achieved with the technique (1:100,000) leads to a concomitant decrease in the specificity that results in the amplification of unexpected products, a phenomenon we encountered in the development of our nested PCR-SSP typing system for HLA class II alleles. We describe here how it is possible to compensate for these anomalies by including multiple testing of a pretransfusion sample that acts as a specificity control, establishing a rigorous baseline for subsequent analysis.
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Affiliation(s)
- A S Carter
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
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27
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Morrell G, Whalley J, Stewart A, Day S, Lewis L, Makar Y, Fuggle SV, Ross J, Dunn PP. Identification of an HLA-A11 serological variant and its characterization by sequencing based typing. Tissue Antigens 1999; 53:591-4. [PMID: 10395112 DOI: 10.1034/j.1399-0039.1999.530612.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We have identified an HLA-A11 variant allele, A*1105, segregating in a Caucasoid family. The variant antigen expressed by this allele failed to cross-react with most Caucasoid anti-HLA-A11 antisera tested. Sequencing based typing has been used to characterize this new allele and this showed that it has a novel mutation at a polymorphic position (502) in exon 3. In comparison with A*1101, the mutation (A-->G) results in an amino acid change from positively-charged lysine to negative glutamate and this may explain the altered HLA-A11 serological profile exhibited by this antigen. The new allele was found in a patient with acute lymphoid leukaemia (ALL), her father and two siblings.
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Affiliation(s)
- G Morrell
- Tissue Typing Laboratory, Manchester Blood Centre, Plymouth Grove, UK
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28
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McLaren AJ, Jassem W, Gray DW, Fuggle SV, Welsh KI, Morris PJ. Delayed graft function: risk factors and the relative effects of early function and acute rejection on long-term survival in cadaveric renal transplantation. Clin Transplant 1999; 13:266-72. [PMID: 10383108 DOI: 10.1034/j.1399-0012.1999.130308.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Delayed graft function (DGF) and acute rejection have both been associated with reduced renal allograft survival. In some studies, they have been shown to have an interactive effect. We studied the risk factors for DGF and the relative impact of DGF and rejection on both short- and long-term survival in recipients of cadaveric renal transplants. Data from the Oxford Transplant Centre Database were assessed on 710 cadaver allografts over a 10-yr period, during which time all recipients received cyclosporin-based immunosuppressive protocols. The interaction between DGF and acute rejection was examined using logistic and Cox multivariate regression. Long cold ischaemia time (CIT), sensitisation and older donor age were found to be independent predictors of DGF. The occurrence of DGF resulted in a reduced 5-yr survival (56 vs. 75%). However, the effect of DGF was confined to the first year post-transplant, as there was no significant difference in survival, as measured by half-life (t1/2) of grafts functioning at 1 yr, with DGF alone and a group with good early function (t1/2 = 21.3 vs. 20.0 yr). There was no increase in acute rejection in grafts with DGF. However, the combination of DGF and acute rejection resulted in the worst short-term graft survival (68% at 1 yr, compared to 92.3% in those grafts with no DGF or acute rejection) and this continued over the long term (t1/2 = 10.5 yr). These data suggest that early function is critical to the success of renal transplantation. The effects of DGF are limited to the first year post-transplant. Long-term graft survival may be improved by efforts to limit CITs, particularly for grafts from older donors and sensitised recipients.
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Affiliation(s)
- A J McLaren
- Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, UK.
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Abstract
The continuing shortage of organs available for transplantation limits the number of patients able to benefit from this highly successful form of therapy. Interest in alternative sources of organs has now turned towards the pig because of its physiological similarity to human. There is a requirement therefore for reagents not only for research purposes but possibly for studying xenotransplants in the clinical situation in the future. In this study, we have concentrated on determining the cross-species reactivity of a large panel of antibodies directed against human leukocyte markers, testing peripheral blood leukocytes and also including renal tissue to determine non-leukocyte cross-reactivity. A total of 63 out of 127 antibodies cross-reacted with cynomolgus monkey cells. Twenty of these antibodies stained similar populations of leukocytes to human, whereas the remaining 43 reacted with clearly different populations. The majority of antibodies (108/127) were unreactive with porcine leukocytes, reflecting the evolutionary differences between pig and man. Of the 19 antibodies cross-reactive with porcine cells, seven reacted with similar proportions of leukocytes to human, whereas the remaining 12 antibodies stained entirely different populations. The most interesting, and potentially most useful, antibodies were four that reacted with human, cynomolgus monkey and porcine tissue in a similar manner, suggesting that the epitopes recognized are present on similar molecules. These antibodies were directed against CD29 (MEM1O1A, K20) and CD18 (BU87, 7E4), the common beta1- and beta2-integrin subunits respectively. This study demonstrates that there are antigens common to cynomolgus monkey, pig and man that react with currently available antibodies. Nevertheless, when determining cross-species reactivity of human antibodies, it is important to consider the possibility that there may be additional non-leukocyte reactivity in other tissues.
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Affiliation(s)
- A S Carter
- Nuffield Department of Surgery, University of Oxford, UK
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30
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Abstract
BACKGROUND Chronic allograft failure (CAF) is a major cause of late graft loss in renal transplantation. Up-regulation of adhesion molecules has been demonstrated in renal allograft biopsies during both acute and chronic rejection, and these molecules are known to regulate leukocyte migration into the graft. METHODS A single-center retrospective study was performed between 1985 and 1996 on renal transplant recipients who developed CAF. Genotyping was performed for five polymorphisms in intercellular adhesion molecule-1 (ICAM-1), E-selectin, and L-selectin. Frequency data for the polymorphisms in the CAF group (N = 62) and their matched donors, where available (N = 33), were compared with a group of recipients with graft survival of more than 10 years (N = 110) and a group of United Kingdom (UK) controls (N = 101). RESULTS A variant allele in exon 4 of ICAM-1 (R241) was more common in the CAF recipients compared with both long-term survivors and UK controls (19.4 vs. 10.0 and 9.4%, P = 0.015 and 0.025). In addition, stratification by time to graft failure caused by CAF revealed more rapid failure in the presence of another ICAM-1 variant in the recipient (E469) in exon 6 (P = 0.033). CONCLUSIONS ICAM-1 polymorphisms may represent a predetermined genetic risk factor for CAF. The polymorphism in exon 4 is in the Mac-1 binding site, and that in exon 6 is in the fifth immunoglobulin-like domain. Potential mechanisms of action of ICAM-1 variants in CAF include an alteration of activity as an adhesion molecule, altered costimulation, or a minor histocompatibility antigen.
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Affiliation(s)
- A J McLaren
- Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, England, United Kingdom.
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31
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Abstract
We have identified a variant HLA-C allele, Cw*0805, in DNA isolated from a blood sample used in the UK National External Quality Assessment Scheme for Histocompatibility and Immunogenetics. The DNA was initially typed by PCR-SSP and PCR-SBT as Cw*0802, 1602 with a single mismatch in exon 2 of one of the alleles. The two HLA-C alleles were separated by locus- and allele-specific PCRs and sequencing analysis showed that the Cw*0802 allele was variant in this sample, with a single mismatch in exon 2 at position 289.
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Affiliation(s)
- P P Dunn
- UK Transplant Support Service Authority, Gifford, Bristol.
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32
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Abstract
BACKGROUND Ischemia/reperfusion injury of human renal allografts has a number of clinically significant consequences. A number of mechanisms of ischemia/ reperfusion injury have been elucidated, and there is evidence that apoptosis may be a contributing factor. METHODS To examine immediate posttransplant events, fixed tissue sections from paraffin-embedded wedge biopsy specimens taken before and after reperfusion of human renal allografts were stained using terminal deoxytransferase-mediated dUTP nick-end labeling to detect the DNA fragmentation characteristic of apoptosis. Thirty-six pairs of pre- and postreperfusion biopsy specimens were examined, 11 from living-related donor renal transplants and 25 from cadaveric donor transplants. RESULTS Quantitation of the terminal deoxytransferase-mediated dUTP nick-end labeling signal showed that significantly more apoptosis occurred in postreperfusion compared with prereperfusion biopsy specimens from cadaveric donor transplants, but a similar difference was not observed in living-related donor renal transplants. Furthermore, significantly more apoptosis was observed in postreperfusion biopsy specimens from cadaveric compared with living-related renal transplants. Postreperfusion biopsy specimens from kidneys that were cold preserved longer than 30 hr had a higher mean apoptosis score than those stored for less than 24 hr, but the result was not statistically significant. CONCLUSIONS Thus, apoptosis occurs predominantly as a result of reperfusion after cold preservation of cadaveric donor renal allografts and provides additional information regarding the extent of ischemia/ reperfusion injury in an organ. The clinical value of this information remains to be determined.
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Affiliation(s)
- A T Burns
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, United Kingdom
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33
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Koo DD, Welsh KI, Roake JA, Morris PJ, Fuggle SV. Ischemia/reperfusion injury in human kidney transplantation: an immunohistochemical analysis of changes after reperfusion. Am J Pathol 1998; 153:557-66. [PMID: 9708815 PMCID: PMC1852972 DOI: 10.1016/s0002-9440(10)65598-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Organs used for transplantation undergo varying degrees of cold ischemia and reperfusion injury after transplantation. In renal transplantation, prolonged cold ischemia is strongly associated with delayed graft function, an event that contributes to inferior graft survival. At present, the pathophysiological changes associated with ischemia/reperfusion injury in clinical renal transplantation are poorly understood. We have performed an immunohistochemical analysis of pre- and postreperfusion biopsies obtained from cadaver (n = 55) and living/related donor (LRD) (n = 11) renal allografts using antibodies to adhesion molecules and leukocyte markers to investigate the intragraft changes after cold preservation and reperfusion. Neutrophil infiltration and P-selectin expression were detected after reperfusion in 29 of 55 (53%) and 24 of 55 (44%) cadaver renal allografts, respectively. In marked contrast, neutrophil infiltration was not observed in LRD allografts, and only 1 of 11 (9%) had an increased level of P-selectin after reperfusion. Immunofluorescent double-staining demonstrated that P-selectin expression resulted from platelet deposition and not from endothelial activation. No statistically significant association was observed between neutrophil infiltration and P-selectin expression in the glomeruli or intertubular capillaries despite the large number of cadaver renal allografts with postreperfusion changes. Neutrophil infiltration into the glomeruli was significantly associated with long cold ischemia times and delayed graft function. Elevated serum creatinine levels at 3 and 6 months after transplantation were also associated with the presence of neutrophils and platelets after reperfusion. Our results suggest that graft function may be influenced by early inflammatory events after reperfusion, which can be targeted for future therapeutic intervention.
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Affiliation(s)
- D D Koo
- Nuffield Department of Surgery and Oxford Transplant Centre, University of Oxford, John Radcliffe Hospital, Headington, United Kingdom
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34
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Carter AS, Bunce M, Cerundolo L, Welsh KI, Morris PJ, Fuggle SV. Detection of microchimerism after allogeneic blood transfusion using nested polymerase chain reaction amplification with sequence-specific primers (PCR-SSP): a cautionary tale. Blood 1998; 92:683-9. [PMID: 9657771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In bone marrow transplantation, the detection of chimerism is an important adjunct to the repertoire of tests available for determining acceptance of the graft. In solid organ transplantation, there is currently intense interest in the role that chimerism plays in both short- and long-term host reactivity to the graft. Allogeneic blood transfusion has been associated with a subtle immunosuppressive effect in renal transplantation and chimerism is implicated as a possible mechanism for this effect. To assess the survival of allogeneic cells after blood transfusion or transplantation, we have developed a technique based on molecular typing for HLA class II alleles, which enables the detection of donor-derived cells in patients receiving blood transfusions. While developing this technology, we investigated why we and others observe false amplification. Sequencing of false products has shown that they arise from amplification of both pseudogenes and non-pseudogenes present in the DNA under test. Elucidation of this phenomenon allows the amplification of these false products to be predicted in any given combination and hence avoided by the judicious selection of primers. Validation has been achieved by following donor alleles after transfusion of blood containing defined numbers of leukocytes expressing selected mismatched antigens.
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Affiliation(s)
- A S Carter
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK.
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35
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Abstract
Leukocyte adhesion molecules are critically involved at a number of stages in immune and inflammatory responses, and their importance in the response to a renal allograft has been recognized for some years. They are involved in antigen presentation, in the cascade of events leading to extravasation of leukocytes into the allograft, in the subsequent migration of leukocytes through the extracellular matrix, and in the interactions between effector and target cells. Thus the adhesion molecules are highly attractive targets for therapeutic intervention in organ transplantation. Strategies have been explored to exploit the involvement of adhesion molecules in ischemia/reperfusion injury, allograft rejection, and the induction of immunological tolerance. Furthermore, the expression of a number of adhesion molecules is regulated by cytokines, and elevated levels may be detected both in transplant biopsies and as soluble forms measured in serum and urine. It has been proposed that these changes in levels might provide useful information in the diagnosis of allograft rejection and differentiation from other causes of graft dysfunction.
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Affiliation(s)
- S V Fuggle
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, England, UK
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36
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McLean AG, Hughes D, Welsh KI, Gray DW, Roake J, Fuggle SV, Morris PJ, Dallman MJ. Patterns of graft infiltration and cytokine gene expression during the first 10 days of kidney transplantation. Transplantation 1997; 63:374-80. [PMID: 9039926 DOI: 10.1097/00007890-199702150-00008] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Understanding of the events preceding acute cellular rejection of kidney transplants would be useful in the development of immunosuppressive strategies to prevent rejection. Information about these events in humans has been scarce, because of the lack of early, serial, biopsy samples. We took daily fine needle aspirates from kidney allografts for the first 10 days after transplant. Samples were analyzed by morphological cytology of graft-infiltrating cells, and reverse transcriptase-polymerase chain reaction for detection of interleukin (IL)-2, IL-4, IL-6, IL-10, and gamma-interferon gene expression. During the first 4 days, all of the grafts developed a low-grade monocyte-rich mononuclear cell infiltrate, accompanied by IL-10 gene expression. Thereafter, the infiltrates either remained stable or intensified. Of the 13 grafts with dense infiltrates, seven developed graft dysfunction. The remaining six did not, despite significant interstitial infiltrates. Both rejecting and nonrejecting dense infiltrates were associated with a biphasic pattern of IL-2 and gamma-interferon gene expression, preceding and accompanying lymphocytic graft infiltration. Grafts that did not develop dense infiltrates had no detectable IL-2 or gamma-interferon gene expression and did not suffer cellular rejection during the study period. The development of both rejecting and nonrejecting infiltrates was strongly associated with DR mismatches between donor and recipient. IL-2 and gamma-interferon gene expression are necessary, but not sufficient, for the development of acute cellular rejection in the first 10 days of kidney transplantation, and are more closely associated with the period leading up to rejection than with the period of graft dysfunction.
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Affiliation(s)
- A G McLean
- Nuffield Department of Surgery, Oxford University John Radcliffe Hospital, Headington, United Kingdom
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37
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Roake JA, Fawcett J, Koo DD, Fuggle SV, Gray DW, Morris PJ. Late reflush in clinical renal transplantation. Protection against delayed graft function not observed. Transplantation 1996; 62:114-6. [PMID: 8693524 DOI: 10.1097/00007890-199607150-00021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Mechanical flushing of cadaveric kidneys with organ preservation fluid immediately before transplantation has been reported to be associated with improved early graft function. We report here the results of a prospective randomized controlled study of cadaveric renal transplantation after late reflush with organ preservation fluid in which no benefit with respect to delayed graft function was observed and, indeed, the protocol may have been harmful. The study was terminated after recruitment of only 18 patients (9 to each arm) because postreperfusion biopsies of reflushed kidneys contained unusual features, including abnormal cellular debris within the tubules or eosinophilic proteinaceous material within Bowman's capsule. These features were not present in the control kidneys. Acute tubular necrosis and biopsy-proven acute rejection episodes were more frequently seen in the reflushed kidneys, but at 1 year there was no significant difference in the function of the surviving grafts.
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Affiliation(s)
- J A Roake
- Oxford Transplant Centre, Nuffield Department of Surgery, University of Oxford, Churchill Hospital, Headington, United Kingdom
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38
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Chen RH, Bushell A, Fuggle SV, Wood KJ, Morris PJ. Expression of granzyme A and perforin in mouse heart transplants immunosuppressed with donor-specific transfusion and anti-CD4 monoclonal antibody. Transplantation 1996; 61:625-9. [PMID: 8610391 DOI: 10.1097/00007890-199602270-00018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Granzyme A and perforin are produced by activated cytotoxic T lymphocytes and their expression correlates with the appearance of cytotoxicity. Using in situ hybridization and immunohistochemistry, we examined the phenotype of cellular infiltration and the appearance of granzyme A+ and perforin+ cells in a mouse cardiac transplant model where the recipients were pretreated with donor-specific transfusion, anti-CD4 monoclonal antibody, or both. While the profiles of cellular infiltration failed to correlate with graft survival, tolerized grafts, as compared with untreated allografts, showed a decreased frequency of granzyme A and perforin expression. These functional markers of cytotoxic T lymphocytes can differentiate between rejecting and indefinitely surviving grafts and may be of value in dissecting the immunological events involved in tolerance induction.
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Affiliation(s)
- R H Chen
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, United Kingdom
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39
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Chen RH, Fuggle SV. In situ cDNA polymerase chain reaction. A novel technique for detecting mRNA expression. Am J Pathol 1993; 143:1527-34. [PMID: 8256845 PMCID: PMC1887277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report a novel method for detecting intracellular messenger RNA by combining the techniques of in situ hybridization and polymerase chain reaction (PCR) (in situ cDNA PCR). The technique could detect low abundancy signals and distinguish different levels of gene expression. We examined the expression of the functional markers of activated cytotoxic T lymphocytes, granzyme A, and perforin in human lymphocytes from in vitro cultures. The amplification products were found in the cells and the supernatants, with the distribution critically affected by the protease digestion conditions. The specificity of amplification was confirmed by electrophoretic analysis and Southern blotting. We conclude that the in situ cDNA PCR technique offers a sensitive method of measuring the frequency of signal-expressing cells and has significant research and clinical applications.
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Affiliation(s)
- R H Chen
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom
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40
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Fuggle SV, Sanderson JB, Gray DW, Richardson A, Morris PJ. Variation in expression of endothelial adhesion molecules in pretransplant and transplanted kidneys--correlation with intragraft events. Transplantation 1993; 55:117-23. [PMID: 7678354 DOI: 10.1097/00007890-199301000-00022] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Endothelial adhesion molecules are directly involved in the localization and migration of leukocytes from the circulation into tissues at sites of inflammation. We have compared the expression of PECAM-1 (CD31), ELAM-1, ICAM-1 (CD54), and VCAM-1 in pretransplant (n = 20) and needle-core biopsies from renal transplants obtained during different clinical circumstances (n = 42). PECAM-1 was consistently expressed on all endothelium in both pretransplant and transplant biopsies. In contrast, there was variation in endothelial expression of ELAM-1 and in proximal tubular expression of ICAM-1 and VCAM-1 between pretransplant biopsies. After transplantation induced expression of endothelial ELAM-1 and VCAM-1 and tubular induction of ICAM-1 and VCAM-1 was detected. Induced adhesion molecule expression was frequently associated with focal leukocyte infiltration, and there was a significantly higher level of CD45 and CD25 positive cell infiltration in biopsies with induced adhesion molecule expression. The induction of adhesion molecule expression is evidence of endothelial activation in these transplant biopsies. Comparison of adhesion molecule expression and HLA-class II antigen expression revealed that induced tubular class II antigens may be detected in the absence of induced adhesion molecule expression.
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Affiliation(s)
- S V Fuggle
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, United Kingdom
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41
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Abstract
Immunohistological analyses of transplant biopsy material can provide valuable insight into the intragraft events following transplantation. The magnitude, composition and phenotype of the leukocyte infiltration and up-regulation of parenchymal antigen expression within the renal allograft have been major areas of interest. Immunohistological analyses have demonstrated the presence of leukocyte infiltration not only during clinical rejection episodes, but also during periods of stable graft function. Nevertheless the infiltration is significantly increased during clinical rejection. Indeed, quantitation of the leukocyte infiltration using a morphometric point counting technique or image analysis can be used prospectively to diagnose rejection in the renal transplant recipient. Macrophages and T lymphocytes (both of the CD4 and CD8 phenotype) are the major infiltrating cells, B lymphocytes and NK cells being present, but in the minority. Activated and proliferating cells have been demonstrated during allograft rejection and may provide a means of identifying a functionally active infiltrate.
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Affiliation(s)
- S V Fuggle
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, U.K
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42
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Fuggle SV, McWhinnie DL, Morris PJ. Immunohistological analysis of renal allograft biopsies from cyclosporin-treated patients. Transpl Int 1989. [DOI: 10.1007/bf02414597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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43
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Fuggle SV, McWhinnie DL, Morris PJ. Immunohistological analysis of renal allograft biopsies from cyclosporin-treated patients. Induced HLA-class II antigen expression does not exclude a diagnosis of cyclosporin nephrotoxicity. Transpl Int 1989; 2:123-8. [PMID: 2679626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Differentiation of cyclosporin nephrotoxicity from renal allograft rejection is often difficult. Induction of tubular HLA-class II antigens and elevated levels of leucocyte infiltration are associated with allograft rejection but their association with cyclosporin nephrotoxicity is unclear. In order to determine these relationships, transplant biopsies (n = 32) from patients considered to have cyclosporin nephrotoxicity, allograft rejection or stable graft function were stained with monoclonal antibodies specific for HLA-class II antigens and infiltrating leucocytes. Leucocyte infiltration was elevated during rejection but not in cyclosporin nephrotoxicity or stable graft function. While HLA-class II antigen expression was induced in 71% of the biopsies obtained during clinical rejection, no increased expression was found in the other 29%. Induced antigens were detected in five of the nine biopsies obtained in the presence of cyclosporin nephrotoxicity 90 days after transplantation. In four of these, induction was attributed to prolongation of increased class II expression following previous rejection episodes. Thus, the presence of induced class II antigens in the renal allograft does not exclude a diagnosis of cyclosporin nephrotoxicity.
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Affiliation(s)
- S V Fuggle
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, UK
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44
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Abstract
Monoclonal antibodies are powerful tools for analyzing HLA antigen polymorphism. We have investigated the serological and biochemical nature of the DRw52-related antigen defined by the monoclonal antibody NDS10. A detailed analysis of the population distribution of NDS10 reactivity revealed that the epitope was present on a subpopulation of DRw52 positive cells. A distinct pattern of reactivity was found within DR3 individuals: all of the B18,DR3 cells were NDS10 positive, whereas the A1,B8,DR3 cells were negative. All of the DR5(w11) cells and two of three DRw12 cells reacted with NDS10. NDS10 reactivity with DRw6 was not restricted to either of the serologically defined subtypes; three of 17 DRw13 and nine of 10 DRw14 cells were NDS10 positive. NDS10 was unreactive with all of the DRw8 cells tested. Two-dimensional gel analyses revealed that the NDS10 molecule precipitated from DR3, DR5(w11) and DRw6(w14) cell lines had an identical beta chain profile. These data indicate that NDS10 recognises the Dw25 allele of the DRw52 complex.
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Affiliation(s)
- S V Fuggle
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, U.K
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45
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Brown AE, Chandanayingyong D, Fuggle SV, Webster HK. Immune responses to the circumsporozoite protein of Plasmodium falciparum in relation to HLA-DR type. Tissue Antigens 1989; 34:200-4. [PMID: 2688192 DOI: 10.1111/j.1399-0039.1989.tb01737.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Associations between HLA-DR/DQ phenotypes and immune responses to the circumsporozoite (CS) protein of the human malaria parasite, Plasmodium falciparum, were investigated in Thai adults. The frequency of DR and DQ types did not differ between 15 high antibody responders and 16 antibody non-responders. Initial results which suggested that lymphocyte responses to a CS-derived peptide (R32tet32) might be HLA-DR associated were not confirmed by subsequent extension of the study. Thus, MHC restriction appears not to be a major factor in the frequently observed unresponsiveness of the immune system to the P. falciparum sporozoite. Based on these results, it is expected that MHC restriction will not be a major obstacle to the application of a malaria vaccine in outbred human populations.
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Affiliation(s)
- A E Brown
- Department of Immunology, U.S. Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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46
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Fuggle SV, McWhinnie DL, Morris PJ. HLA-class II antigen induction does not exclude a diagnosis of cyclosporine nephrotoxicity. Transplant Proc 1989; 21:1525-6. [PMID: 2652491] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- S V Fuggle
- Nuffield Dept of Surgery, University of Oxford, John Radcliffe Hospital, England
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47
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McWhinnie DL, Hughes D, Fuggle SV, Dunnill MS, Carter NP, Morris PJ. Immunohistology or conventional histology for the diagnosis of renal allograft rejection? Transplant Proc 1989; 21:1888-9. [PMID: 2652613] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- D L McWhinnie
- Nuffield Dept Surgery, University of Oxford, John Radcliffe Hospital, U.K
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48
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Foot RA, Fuggle SV, McWhinnie DL, Carter NP, Morris PJ. The diagnosis of renal allograft rejection: an improved assessment of graft infiltration using image analysis. Transplant Proc 1989; 21:1905-6. [PMID: 2652621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
These results show that image analysis is an accurate alternative to point counting in the assessment of infiltration in renal allograft biopsies and can provide an efficient and rapid diagnosis of cellular rejection in the transplanted patient.
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Affiliation(s)
- R A Foot
- Nuffield Department Surgery, University of Oxford, John Radcliffe Hospital, U.K
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49
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Carter C, Fuggle SV, Ting A, Morris PJ. Biochemically detected HLA-DQ polymorphism in DR-matched donors and recipients of renal allografts. Transplant Proc 1989; 21:639-40. [PMID: 2650208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We performed a retrospective biochemical analysis of HLA-D-region antigens of serologically DR-compatible donors and recipients of renal allografts. No incompatible D-region antigens were detected in grafts with a stable clinical course--i.e., there were no rejection episodes--whereas incompatibility for one or more D-region antigens was found in all 13 grafts with rejection. Thus, mismatched D-region antigens may provide a stimulus for early rejection in these grafts.
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Affiliation(s)
- C Carter
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom
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50
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McWhinnie DL, Fuggle SV, Azevedo LS, Carter NP, Morris PJ. Correlation of HLA class II antigen induction and cellular infiltration in renal allograft rejection. Transplant Proc 1989; 21:320-1. [PMID: 2650134] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- D L McWhinnie
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom
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