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Rashmi P, Sur S, Sigdel TK, Boada P, Schroeder AW, Damm I, Kretzler M, Hodgin J, Sarwal MM. Multiplexed droplet single-cell sequencing (Mux-Seq) of normal and transplant kidney. Am J Transplant 2022; 22:876-885. [PMID: 34687145 PMCID: PMC8897263 DOI: 10.1111/ajt.16871] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/06/2021] [Accepted: 10/09/2021] [Indexed: 01/25/2023]
Abstract
Maintenance of systemic homeostasis by kidney requires the coordinated response of diverse cell types. The use of single-cell RNA sequencing (scRNAseq) for patient tissue samples remains fraught with difficulties with cell isolation, purity, and experimental bias. The ability to characterize immune and parenchymal cells during transplant rejection will be invaluable in defining transplant pathology where tissue availability is restricted to needle biopsy fragments. Herein, we present feasibility data for multiplexing approach for droplet scRNAseq (Mux-Seq). Mux-Seq has the potential to minimize experimental batch bias and variation even with very small sample input. In this first proof-of-concept study for this approach, explant tissues from six normal and two transplant recipients after multiple early post-transplant rejection episodes leading to nephrectomy due to aggressive antibody mediated rejection, were pooled for Mux-Seq. A computational tool, Demuxlet was applied for demultiplexing the individual cells from the pooled experiment. Each sample was also applied individually in a single microfluidic run (singleplex) to correlate results with the pooled data from the same sample. Our applied protocol demonstrated that data from Mux-Seq correlated highly with singleplex (Pearson coefficient 0.982) sequencing results, with the ability to identify many known and novel kidney cell types including different infiltrating immune cells. Trajectory analysis of proximal tubule and endothelial cells demonstrated separation between healthy and injured kidney from transplant explant suggesting evolving stages of cell- specific differentiation in alloimmune injury. This study provides the technical groundwork for understanding the pathogenesis of alloimmune injury and host tissue response in transplant rejection and normal human kidney and provides a protocol for optimized processing precious and low input human kidney biopsy tissue for larger scale studies.
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Affiliation(s)
- Priyanka Rashmi
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Swastika Sur
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Tara K. Sigdel
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Patrick Boada
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Andrew W. Schroeder
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI
| | - Izabella Damm
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Matthias Kretzler
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI
| | - Jeff Hodgin
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI
| | - Minnie M. Sarwal
- Department of Surgery, University of California San Francisco, San Francisco, CA,Corresponding author: Minnie Sarwal, MD, PhD, MRCP, FRCP, Professor in Residence, Surgery/Medicine/Pediatrics, UCSF, Medical Director, Kidney Pancreas Transplant Program, UCSF, Co-Director, T32 Training Program, Transplant Surgery, UCSF, Director, Precision Transplant Medicine, UCSF,
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2
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Hobeika MJ, Casarin S, Saharia A, Mobley C, Yi S, McMillan R, Mark Ghobrial R, Osama Gaber A. In silico deceased donor intervention research: A potential accelerant for progress. Am J Transplant 2021; 21:2231-2239. [PMID: 33394565 DOI: 10.1111/ajt.16482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 01/25/2023]
Abstract
Progress in deceased donor intervention research has been limited. Development of an in silico model of deceased donor physiology may elucidate potential therapeutic targets and provide an efficient mechanism for testing proposed deceased donor interventions. In this study, we report a preliminary in silico model of deceased kidney donor injury built, calibrated, and validated based on data from published animal and human studies. We demonstrate that the in silico model behaves like animal studies of brain death pathophysiology with respect to upstream markers of renal injury including hemodynamics, oxygenation, cytokines expression, and inflammation. Therapeutic hypothermia, a deceased donor intervention studied in human trials, is performed to demonstrate the model's ability to mimic an established clinical trial. Finally, future directions for developing this concept into a functional, clinically applicable model are discussed.
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Affiliation(s)
- Mark J Hobeika
- J.C. Walter, Jr. Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas.,Department of Surgery, Weill Cornell Medical College, New York, New York.,Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Center for Outcomes Research, Houston Methodist, Houston, Texas.,Houston Methodist Academic Institute, Houston, Texas
| | - Stefano Casarin
- Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Center for Computational Surgery, Houston Methodist Research Institute, Houston, Texas.,Houston Methodist Academic Institute, Houston, Texas
| | - Ashish Saharia
- J.C. Walter, Jr. Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas.,Department of Surgery, Weill Cornell Medical College, New York, New York.,Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Houston Methodist Academic Institute, Houston, Texas
| | - Constance Mobley
- J.C. Walter, Jr. Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas.,Department of Surgery, Weill Cornell Medical College, New York, New York.,Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Houston Methodist Academic Institute, Houston, Texas
| | - Stephanie Yi
- J.C. Walter, Jr. Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas.,Department of Surgery, Weill Cornell Medical College, New York, New York.,Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Center for Outcomes Research, Houston Methodist, Houston, Texas.,Houston Methodist Academic Institute, Houston, Texas
| | - Robert McMillan
- J.C. Walter, Jr. Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas.,Department of Surgery, Weill Cornell Medical College, New York, New York.,Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Houston Methodist Academic Institute, Houston, Texas
| | - Rafik Mark Ghobrial
- J.C. Walter, Jr. Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas.,Department of Surgery, Weill Cornell Medical College, New York, New York.,Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Houston Methodist Academic Institute, Houston, Texas
| | - Ahmed Osama Gaber
- J.C. Walter, Jr. Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas.,Department of Surgery, Weill Cornell Medical College, New York, New York.,Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Houston Methodist Academic Institute, Houston, Texas
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3
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Weissenbacher A, Huang H, Surik T, Lo Faro ML, Ploeg RJ, Coussios CC, Friend PJ, Kessler BM. Urine recirculation prolongs normothermic kidney perfusion via more optimal metabolic homeostasis-a proteomics study. Am J Transplant 2021; 21:1740-1753. [PMID: 33021021 PMCID: PMC8246941 DOI: 10.1111/ajt.16334] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/27/2020] [Accepted: 09/20/2020] [Indexed: 01/25/2023]
Abstract
We describe a proteomics analysis to determine the molecular differences between normothermically perfused (normothermic machine perfusion, NMP) human kidneys with urine recirculation (URC) and urine replacement (UR). Proteins were extracted from 16 kidney biopsies with URC (n = 8 donors after brain death [DBD], n = 8 donors after circulatory death [DCD]) and three with UR (n = 2 DBD, n = 1 DCD), followed by quantitative analysis by mass spectrometry. Damage-associated molecular patterns (DAMPs) were decreased in kidney tissue after 6 hours NMP with URC, suggesting reduced inflammation. Vasoconstriction was also attenuated in kidneys with URC as angiotensinogen levels were reduced. Strikingly, kidneys became metabolically active during NMP, which could be enhanced and prolonged by URC. For instance, mitochondrial succinate dehydrogenase enzyme levels as well as carbonic anhydrase were enhanced with URC, contributing to pH stabilization. Levels of cytosolic and the mitochondrial phosphoenolpyruvate carboxykinase were elevated after 24 hours of NMP, more prevalent in DCD than DBD tissue. Key enzymes involved in glucose metabolism were also increased after 12 and 24 hours of NMP with URC, including mitochondrial malate dehydrogenase and glutamic-oxaloacetic transaminase, predominantly in DCD tissue. We conclude that NMP with URC permits prolonged preservation and revitalizes metabolism to possibly better cope with ischemia reperfusion injury in discarded kidneys.
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Affiliation(s)
- Annemarie Weissenbacher
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Present address:
Annemarie WeissenbacherDepartment of Visceral, Transplant and Thoracic SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Honglei Huang
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Target Discovery InstituteNuffield Department of MedicineUniversity of OxfordOxfordUK
- Present address:
Honglei HuangOxford BioMedica PlcOxfordUK
| | - Tomas Surik
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Maria L. Lo Faro
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Rutger J. Ploeg
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Constantin C. Coussios
- Institute of Biomedical EngineeringDepartment of Engineering ScienceUniversity of OxfordOxfordUK
| | - Peter J. Friend
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Benedikt M. Kessler
- Target Discovery InstituteNuffield Department of MedicineUniversity of OxfordOxfordUK
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4
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Yang Y, Nankivell BJ, Hua W, Rao P, Ren X, Yu H, Chen T, Cao Q, Wang Y, Wang YM, Lee VW, Alexander SI, P'Ng CH, Rogers N, Zheng G, Harris DC. Renal tubular cell binding of β-catenin to TCF1 versus FoxO1 is associated with chronic interstitial fibrosis in transplanted kidneys. Am J Transplant 2021; 21:727-739. [PMID: 32870598 DOI: 10.1111/ajt.16287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/25/2023]
Abstract
β-Catenin is an important co-factor which binds multiple transcriptional molecules and mediates fibrogenic signaling pathways. Its role in kidney transplantation is unknown. We quantified binding of β-catenin within renal tubular epithelial cells to transcription factors, TCF1 and FoxO1, using a proximity ligation assay in 240 transplanted kidneys, and evaluated their pathological and clinical outcomes. β-Catenin/FoxO1 binding in 1-month protocol biopsies inversely correlated with contemporaneous chronic fibrosis, subsequent inflammation. and inflammatory fibrosis (P < .001). The relative binding of β-catenin/TCF1 versus β-catenin/FoxO1 (TF ratio) was the optimal biomarker, and abnormal in diverse fibrotic transplant diseases. A high 1-month TF ratio was followed by greater tubular atrophy and interstitial fibrosis scores, cortical inflammation, renal impairment, and proteinuria at 1 year (n = 131, all P < .001). The TF ratio was associated with reduced eGFR (AUC 0.817), mild fibrosis (AUC 0.717), and moderate fibrosis (AUC 0.769) using receiver operating characteristic analysis. An independent validation cohort (n = 76) confirmed 1-month TF was associated with 12-month moderate fibrosis (15.8% vs. 2.6%, P = .047), however, not with other outcomes or 10-year graft survival, which limits generalizabilty of these findings. In summary, differential binding of β-catenin to TCF1 rather than FoxO1 in renal tubular cells was associated with the fibrogenic response in transplanted kidneys.
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Affiliation(s)
- Ying Yang
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia.,Department of Nephrology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Brian J Nankivell
- Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Winston Hua
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia
| | - Padmashree Rao
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia
| | - Xiaojun Ren
- Department of Nephrology, Shanxi Bethune Hospital, Taiyuan, China
| | - Hong Yu
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia
| | - Titi Chen
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia
| | - Qi Cao
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia
| | - Yiping Wang
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia
| | - Yuan M Wang
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | - Vincent W Lee
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | - Chow H P'Ng
- Tissue Pathology and Diagnostic Oncology ICPMR, Sydney, Australia
| | - Natasha Rogers
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Guoping Zheng
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia
| | - David C Harris
- Centre for Transplant and Renal Research, University of Sydney at Westmead Institute for Medical Research, Westmead, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, Australia
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5
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DiRito JR, Hosgood SA, Reschke M, Albert C, Bracaglia LG, Ferdinand JR, Stewart BJ, Edwards CM, Vaish AG, Thiru S, Mulligan DC, Haakinson DJ, Clatworthy MR, Saltzman WM, Pober JS, Nicholson ML, Tietjen GT. Lysis of cold-storage-induced microvascular obstructions for ex vivo revitalization of marginal human kidneys. Am J Transplant 2020; 21:161-173. [PMID: 32627324 PMCID: PMC7775334 DOI: 10.1111/ajt.16148] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 01/25/2023]
Abstract
Thousands of kidneys from higher-risk donors are discarded annually because of the increased likelihood of complications posttransplant. Given the severe organ shortage, there is a critical need to improve utilization of these organs. To this end, normothermic machine perfusion (NMP) has emerged as a platform for ex vivo assessment and potential repair of marginal organs. In a recent study of 8 transplant-declined human kidneys on NMP, we discovered microvascular obstructions that impaired microvascular blood flow. However, the nature and physiologic impact of these lesions were unknown. Here, in a study of 39 human kidneys, we have identified that prolonged cold storage of human kidneys induces accumulation of fibrinogen within tubular epithelium. Restoration of normoxic conditions-either ex vivo during NMP or in vivo following transplant-triggered intravascular release of fibrinogen correlating with red blood cell aggregation and microvascular plugging. Combined delivery of plasminogen and tissue plasminogen activator during NMP lysed the plugs leading to a significant reduction in markers of renal injury, improvement in indicators of renal function, and improved delivery of vascular-targeted nanoparticles. Our study suggests a new mechanism of cold storage injury in marginal organs and provides a simple treatment with immediate translational potential.
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Affiliation(s)
- Jenna R. DiRito
- Department of Surgery, University of Cambridge, Cambridge, UK,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Melanie Reschke
- Department of Molecular Biophysics & Biochemistry, Yale University, New Haven, Connecticut
| | - Claire Albert
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Laura G. Bracaglia
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - John R. Ferdinand
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Benjamin J. Stewart
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Anand G. Vaish
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sathia Thiru
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - David C. Mulligan
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Menna R. Clatworthy
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - W. Mark Saltzman
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Jordan S. Pober
- Department of Immunobiology, Yale University, New Haven, Connecticut
| | | | - Gregory T. Tietjen
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut,Department of Biomedical Engineering, Yale University, New Haven, Connecticut
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6
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Louis K, Hertig A, Taupin JL, Buob D, Jamme M, Brocheriou I, Luque Y, Jouanneau C, Ouali N, Audouin M, Rondeau E, Xu-Dubois YC. Markers of graft microvascular endothelial injury may identify harmful donor-specific anti-HLA antibodies and predict kidney allograft loss. Am J Transplant 2019; 19:2434-2445. [PMID: 30836425 DOI: 10.1111/ajt.15340] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/02/2018] [Revised: 01/29/2019] [Accepted: 02/22/2019] [Indexed: 01/25/2023]
Abstract
Graft microvasculature is a major target of donor-specific antibodies (DSA) and endothelial damage is direct evidence of antibody-mediated rejection (ABMR). Using immunohistochemistry, we analyzed the expression of three microvascular endothelial activation markers (fascin, vimentin, and hsp47), suggestive of endothelial-to-mesenchymal transition (EndMT) in 351 graft biopsies from 248 kidney recipients, with concomitant screening of circulating antihuman leukocyte antigen (HLA) DSA at the time of the biopsy. The factors associated with EndMT marker expression were DSA and the presence of microvascular inflammation (MI). EndMT expressing grafts had significantly more allograft loss compared to EndMT negative grafts (P < .0001). The expression of EndMT markers positively correlated with anti-HLA DSA class II mean fluorescence intensity (MFI) levels and especially identified DQ and DR antibodies as being more closely associated with microvascular injury. Moreover, only DSA linked to positive EndMT score affected allograft survival, regardless of DSA MFI levels or presence of C4d deposition. Thus, EndMT markers could represent a clinically relevant tool for early identification of ongoing endothelial injury, harmful DSA, and patients at high risk for allograft failure.
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Affiliation(s)
- Kevin Louis
- Sorbonne University, Inserm UMR_S1155, AP-HP, Hôpital Tenon, F-75020, Paris, France
| | - Alexandre Hertig
- Sorbonne University, Inserm UMR_S1155, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, UMR S 1155, Paris, France
| | - Jean-Luc Taupin
- AP-HP, Hôpital Saint Louis, Laboratoire d'immunologie et d'histocompatibilité, Paris, France
| | - David Buob
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1155, Paris, France.,AP-HP, Hôpital Tenon, Service d'Anatomo-Pathologie, Paris, France
| | - Matthieu Jamme
- Sorbonne University, Inserm UMR_S1155, AP-HP, Hôpital Tenon, F-75020, Paris, France
| | - Isabelle Brocheriou
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1155, Paris, France.,AP-HP, Hôpital Pitié-Salpétrière, Service d'Anatomo-Pathologie, Paris, France
| | - Yosu Luque
- Sorbonne University, Inserm UMR_S1155, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, UMR S 1155, Paris, France
| | - Chantal Jouanneau
- Sorbonne University, Inserm UMR_S1155, AP-HP, Hôpital Tenon, F-75020, Paris, France
| | - Nacera Ouali
- Sorbonne University, Inserm UMR_S1155, AP-HP, Hôpital Tenon, F-75020, Paris, France
| | - Marie Audouin
- APHP, Hôpital Tenon, Service d'urologie, Paris, France
| | - Eric Rondeau
- Sorbonne University, Inserm UMR_S1155, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, UMR S 1155, Paris, France
| | - Yi-Chun Xu-Dubois
- Sorbonne University, Inserm UMR_S1155, AP-HP, Hôpital Tenon, F-75020, Paris, France.,APHP, Hôpital Tenon, Service de Santé publique, Paris, France
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7
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Madill-Thomsen KS, Wiggins RC, Eskandary F, Böhmig GA, Halloran PF. The Effect of Cortex/Medulla Proportions on Molecular Diagnoses in Kidney Transplant Biopsies: Rejection and Injury Can Be Assessed in Medulla. Am J Transplant 2017; 17:2117-2128. [PMID: 28226404 PMCID: PMC5550741 DOI: 10.1111/ajt.14233] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 01/25/2023]
Abstract
Histologic assessment of kidney transplant biopsies relies on cortex rather than medulla, but for microarray studies, the proportion cortex in a biopsy is typically unknown and could affect the molecular readings. The present study aimed to develop a molecular estimate of proportion cortex in biopsies and examine its effect on molecular diagnoses. Microarrays from 26 kidney transplant biopsies divided into cortex and medulla components and processed separately showed that many of the most significant differences were in glomerular genes (e.g. NPHS2, NPHS1, CLIC5, PTPRO, PLA2R1, PLCE1, PODXL, and REN). Using NPHS2 (podocin) to estimate proportion cortex, we examined whether proportion cortex influenced molecular assessment in the molecular microscope diagnostic system. In 1190 unselected kidney transplant indication biopsies (Clinicaltrials.govNCT01299168), only 11% had <50% cortex. Molecular scores for antibody-mediated rejection, T cell-mediated rejection, and injury were independent of proportion cortex. Rejection was diagnosed in many biopsies that were mostly or all medulla. Agreement in molecular diagnoses in paired cortex/medulla samples (23/26) was similar to biological replicates (32/37). We conclude that NPHS2 expression can estimate proportion cortex; that proportion cortex has little influence on molecular diagnosis of rejection; and that, although histology cannot assess medulla, rejection does occur in medulla as well as cortex.
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Affiliation(s)
| | - R. C. Wiggins
- Nephrology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - F. Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - G. A. Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - P. F. Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada,Department of Medicine, University of Alberta, Edmonton, AB, Canada,Corresponding author: Philip F. Halloran,
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8
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Chang NK, Gu J, Gu S, Osorio RW, Concepcion W, Gu E. Arterial flow regulator enables transplantation and growth of human fetal kidneys in rats. Am J Transplant 2015; 15:1692-700. [PMID: 25645705 DOI: 10.1111/ajt.13149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 12/01/2014] [Accepted: 12/06/2014] [Indexed: 01/25/2023]
Abstract
Here we introduce a novel method of transplanting human fetal kidneys into adult rats. To overcome the technical challenges of fetal-to-adult organ transplantation, we devised an arterial flow regulator (AFR), consisting of a volume adjustable saline-filled cuff, which enables low-pressure human fetal kidneys to be transplanted into high-pressure adult rat hosts. By incrementally withdrawing saline from the AFR over time, blood flow entering the human fetal kidney was gradually increased until full blood flow was restored 30 days after transplantation. Human fetal kidneys were shown to dramatically increase in size and function. Moreover, rats which had all native renal mass removed 30 days after successful transplantation of the human fetal kidney were shown to have a mean survival time of 122 days compared to 3 days for control rats that underwent bilateral nephrectomy without a prior human fetal kidney transplant. These in vivo human fetal kidney models may serve as powerful platforms for drug testing and discovery.
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Affiliation(s)
- N K Chang
- Department of Microsurgery, Ganogen, Inc., Redwood City, CA.,Duke University School of Medicine, Durham, NC
| | - J Gu
- Department of Microsurgery, Ganogen, Inc., Redwood City, CA
| | - S Gu
- Department of Microsurgery, Ganogen, Inc., Redwood City, CA
| | - R W Osorio
- Department of Transplantation, California Pacific Medical Center, San Francisco, CA
| | - W Concepcion
- Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA
| | - E Gu
- Department of Microsurgery, Ganogen, Inc., Redwood City, CA.,Duke University School of Medicine, Durham, NC
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9
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Chen T, Yuan J, Duncanson S, Hibert ML, Kodish BC, Mylavaganam G, Maker M, Li H, Sremac M, Santosuosso M, Forbes B, Kashiwagi S, Cao J, Lei J, Thomas M, Hartono C, Sachs D, Markmann J, Sambanis A, Poznansky MC. Alginate encapsulant incorporating CXCL12 supports long-term allo- and xenoislet transplantation without systemic immune suppression. Am J Transplant 2015; 15:618-27. [PMID: 25693473 DOI: 10.1111/ajt.13049] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [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: 02/24/2014] [Revised: 10/03/2014] [Accepted: 10/04/2014] [Indexed: 01/25/2023]
Abstract
Islet transplantation represents a potentially curative approach for individuals with Type I Diabetes. The requirement for systemic immune suppression to control immune-mediated rejection of transplanted islets and the limited human islet supply represent significant roadblocks to progress for this approach. Islet microencapsulation in alginate offers limited protection in the absence of systemic immunosuppression, but does not support long-term islet survival. The chemokine, CXCL12, can repel effector T cells while recruiting immune-suppressive regulatory T cells (Tregs) to an anatomic site while providing a prosurvival signal for beta-cells. We proposed that coating or encapsulating donor islets with CXCL12 would induce local immune-isolation and protect and support the function of an allo- or xenograft without systemic immune suppression. This study investigated the effect of alginate microcapsules incorporating CXCL12 on islet function. Islet transplantation was performed in murine models of insulin-dependent diabetes. Coating of islets with CXCL12 or microencapsulation of islets with alginate incorporating the chemokine, resulted in long-term allo- and xenoislet survival and function, as well as a selective increase in intragraft Tregs. These data support the use of CXCL12 as a coating or a component of an alginate encapsulant to induce sustained local immune-isolation for allo- or xenoislet transplantation without systemic immunosuppression.
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Affiliation(s)
- T Chen
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Charlestown, MA
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