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Sánchez-Soblechero A, López-García S, Lage C, Fernández-Matarrubia M, Irure J, López-Hoyos M, Jiménez-Bonilla J, Quirce R, de Arcocha-Torres M, Cuenca-Vera O, Martín-Arroyo J, Martínez-Dubarbie F, Pozueta A, García-Martínez M, Infante J, Sánchez-Juan P, Rodríguez-Rodríguez E. Where Should I Draw the Line: PET-Driven, Data-Driven, or Manufacturer Cut-Off? J Alzheimers Dis 2024; 98:957-967. [PMID: 38489172 DOI: 10.3233/jad-230678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background The optimal cut-off for Alzheimer's disease (AD) CSF biomarkers remains controversial. Objective To analyze the performance of cut-off points standardized by three methods: one that optimized the agreement between 11C-Pittsburgh compound B PET (a-PET) and CSF biomarkers (Aβ1-42, pTau, tTau, and Aβ1-42/Aβ1-40 ratio) in our population, called PET-driven; an unbiased cut-off using data from a healthy research cohort, called data-driven, and that provided by the manufacturer. We also compare changes in ATN classification. Methods CSF biomarkers measured by the LUMIPULSE G600II platform and qualitative visualization of amyloid positron emission tomography (a-PET) were performed in all the patients. We established a cut-off for each single biomarker and Aβ1-42/Aβ1-40 ratio that optimized their agreement with a-PET using ROC curves. Sensitivity, Specificity, and Overall Percent of Agreement are assessed using a-PET or clinical diagnosis as gold standard for every cut-off. Also, we established a data-driven cut-off from our cognitively unimpaired cohort. We then analyzed changes in ATN classification. Results One hundred and ten patients were recruited. Sixty-six (60%) were a-PET positive. PET-driven cut-offs were: pTau > 57, tTau > 362.62, Aβ1-42/Aβ1-40 < 0.069. For a single biomarker, pTau showed the highest accuracy (AUC 0.926). New PET-driven cut-offs classified patients similarly to manufacturer cut-offs (only two patients changed). However, 20 patients (18%) changed when data-driven cut-offs were used. Conclusions We established our sample's best CSF biomarkers cut-offs using a-PET as the gold standard. These cut-offs categorize better symptomatic subjects than data-driven in ATN classification, but they are very similar to the manufacturer's.
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Affiliation(s)
| | - Sara López-García
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Carmen Lage
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Marta Fernández-Matarrubia
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Irure
- Immunology Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Julio Jiménez-Bonilla
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Nuclear Medicine Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - Remedios Quirce
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Nuclear Medicine Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - María de Arcocha-Torres
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Nuclear Medicine Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - Oriana Cuenca-Vera
- Nuclear Medicine Department, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - Juan Martín-Arroyo
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
| | - Francisco Martínez-Dubarbie
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Ana Pozueta
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - María García-Martínez
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jon Infante
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Pascual Sánchez-Juan
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Alzheimer's Centre Reina Sofia-CIEN Foundation-ISCIII, Madrid, Spain
| | - Eloy Rodríguez-Rodríguez
- Neurology Department, Cognitive Impairment Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
- Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
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López-de-Eguileta A, López-García S, Lage C, Pozueta A, García-Martínez M, Kazimierczak M, Bravo M, Irure J, López-Hoyos M, Muñoz-Cacho P, Rodríguez-Perez N, Tordesillas-Gutiérrez D, Goikoetxea A, Nebot C, Rodríguez-Rodríguez E, Casado A, Sánchez-Juan P. The retinal ganglion cell layer reflects neurodegenerative changes in cognitively unimpaired individuals. Alzheimers Res Ther 2022; 14:57. [PMID: 35449033 PMCID: PMC9022357 DOI: 10.1186/s13195-022-00998-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 04/04/2022] [Indexed: 12/22/2022]
Abstract
Background To evaluate a wide range of optical coherence tomography (OCT) parameters for possible application as a screening tool for cognitively healthy individuals at risk of Alzheimer’s disease (AD), assessing the potential relationship with established cerebrospinal fluid (CSF) core AD biomarkers and magnetic resonance imaging (MRI). Methods We studied 99 participants from the Valdecilla Study for Memory and Brain Aging. This is a prospective cohort for multimodal biomarker discovery and validation that includes participants older than 55 years without dementia. Participants received a comprehensive neuropsychological battery and underwent structural 3-T brain MRI, lumbar puncture for CSF biomarkers (phosphorylated-181-Tau (pTau), total Tau (tTau), beta-amyloid 1–42 (Aβ 1–42), and beta-amyloid 1–40 (Aβ 1–40)). All individuals underwent OCT to measure the retinal ganglion cell layer (GCL), the retinal nerve fiber layer (RFNL), the Bruch’s membrane opening-minimum rim width (BMO-MRW), and choroidal thickness (CT). In the first stage, we performed a univariate analysis, using Student’s t-test. In the second stage, we performed a multivariate analysis including only those OCT parameters that discriminated at a nominal level, between positive/negative biomarkers in stage 1. Results We found significant differences between the OCT measurements of pTau- and tTau-positive individuals compared with those who were negative for these markers, most notably that the GCL and the RNFL were thinner in the former. In stage 2, our dependent variables were the quantitative values of CSF markers and the hippocampal volume. The Aβ 1–42/40 ratio did not show a significant correlation with OCT measurements while the associations between pTau and tTau with GCL were statistically significant, especially in the temporal region of the macula. Besides, the multivariate analysis showed a significant correlation between hippocampal volume with GCL and RNFL. However, after false discovery rate correction, only the associations with hippocampal volume remained significant. Conclusions We found a significant correlation between Tau (pTau) and neurodegeneration biomarkers (tTau and hippocampus volume) with GCL degeneration and, to a lesser degree, with damage in RFNL. OCT analysis constitutes a non-invasive and unexpensive biomarker that allows the detection of neurodegeneration in cognitively asymptomatic individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-00998-6.
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Affiliation(s)
- Alicia López-de-Eguileta
- Department of Ophthalmology, 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' Santander, University of Cantabria, Santander, Spain.
| | - Sara López-García
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Carmen Lage
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Ana Pozueta
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - María García-Martínez
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Martha Kazimierczak
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - María Bravo
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Juan Irure
- Department of Immunology, 'Marqués de Valdecilla' University Hospital of Cantabria, Institute for Research 'Marqués de Valdecilla', Santander, Spain
| | - Marcos López-Hoyos
- Department of Immunology, 'Marqués de Valdecilla' University Hospital of Cantabria, Institute for Research 'Marqués de Valdecilla', Santander, Spain
| | - Pedro Muñoz-Cacho
- Department of Medicina Familiar y Comunitaria, IDIVAL, Santander, Spain
| | | | | | | | - Claudia Nebot
- Department of Ophthalmology, 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' Santander, University of Cantabria, Santander, Spain
| | - Eloy Rodríguez-Rodríguez
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Alfonso Casado
- Department of Ophthalmology, 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' Santander, University of Cantabria, Santander, Spain
| | - Pascual Sánchez-Juan
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
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3
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López-García S, Lage C, Pozueta A, García-Martínez M, Kazimierczak M, Fernández-Rodríguez A, Bravo M, Reyes-González L, Irure J, López-Hoyos M, Rodríguez-Rodríguez E, Sánchez-Juan P. Sleep Time Estimated by an Actigraphy Watch Correlates With CSF Tau in Cognitively Unimpaired Elders: The Modulatory Role of APOE. Front Aging Neurosci 2021; 13:663446. [PMID: 34408639 PMCID: PMC8366270 DOI: 10.3389/fnagi.2021.663446] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
There is increasing evidence of the relationship between sleep and neurodegeneration, but this knowledge is not incorporated into clinical practice yet. We aimed to test whether a basic sleep parameter, as total sleep estimated by actigraphy for 1 week, was a valid predictor of CSF Alzheimer’s Disease core biomarkers (amyloid-β-42 and –40, phosphorylated-tau-181, and total-tau) in elderly individuals, considering possible confounders and effect modifiers, particularly the APOE ε4 allele. One hundred and twenty-seven cognitively unimpaired volunteers enrolled in the Valdecilla Study for Memory and Brain Aging participated in this study. Seventy percent of the participants were women with a mean age of 65.5 years. After adjustment for covariates, reduced sleep time significantly predicted higher t-tau and p-tau. This association was mainly due to the APOE ε4 carriers. Our findings suggest that total sleep time, estimated by an actigraphy watch, is an early biomarker of tau pathology and that APOE modulates this relationship. The main limitation of this study is the limited validation of the actigraphy technology used. Sleep monitoring with wearables may be a useful and inexpensive screening test to detect early neurodegenerative changes.
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Affiliation(s)
- Sara López-García
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Carmen Lage
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Ana Pozueta
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - María García-Martínez
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Martha Kazimierczak
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Andrea Fernández-Rodríguez
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - María Bravo
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | | | - Juan Irure
- Department of Immunology, 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Marcos López-Hoyos
- Department of Immunology, 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), Santander, Spain
| | - Eloy Rodríguez-Rodríguez
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
| | - Pascual Sánchez-Juan
- Cognitive Impairment Unit, Neurology Service and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 'Marqués de Valdecilla' University Hospital, Institute for Research 'Marqués de Valdecilla' (IDIVAL), University of Cantabria, Santander, Spain
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4
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Bestard O, Meneghini M, Crespo E, Bemelman F, Koch M, Volk HD, Viklicky O, Giral M, Banas B, Ruiz JC, Melilli E, Hu L, van Duivenvoorden R, Nashan B, Thaiss F, Otto NM, Bold G, Stein M, Sefrin A, Lachmann N, Hruba P, Stranavova L, Brouard S, Braudeau C, Blancho G, Banas M, Irure J, Christakoudi S, Sanchez-Fueyo A, Wood KJ, Reinke P, Grinyó JM. Preformed T cell alloimmunity and HLA eplet mismatch to guide immunosuppression minimization with tacrolimus monotherapy in kidney transplantation: Results of the CELLIMIN trial. Am J Transplant 2021; 21:2833-2845. [PMID: 33725408 DOI: 10.1111/ajt.16563] [Citation(s) in RCA: 16] [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: 01/04/2021] [Revised: 02/08/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023]
Abstract
Personalizing immunosuppression is a major objective in transplantation. Transplant recipients are heterogeneous regarding their immunological memory and primary alloimmune susceptibility. This biomarker-guided trial investigated whether in low immunological-risk kidney transplants without pretransplant DSA and donor-specific T cells assessed by a standardized IFN-γ ELISPOT, low immunosuppression (LI) with tacrolimus monotherapy would be non-inferior regarding 6-month BPAR than tacrolimus-based standard of care (SOC). Due to low recruitment rates, the trial was terminated when 167 patients were enrolled. ELISPOT negatives (E-) were randomized to LI (n = 48) or SOC (n = 53), E+ received the same SOC. Six- and 12-month BPAR rates were higher among LI than SOC/E- (4/35 [13%] vs. 1/43 [2%], p = .15 and 12/48 [25%] vs. 6/53 [11.3%], p = .073, respectively). E+ patients showed similarly high BPAR rates than LI at 6 and 12 months (12/55 [22%] and 13/66 [20%], respectively). These differences were stronger in per-protocol analyses. Post-hoc analysis revealed that poor class-II eplet matching, especially DQ, discriminated E- patients, notably E-/LI, developing BPAR (4/28 [14%] low risk vs. 8/20 [40%] high risk, p = .043). Eplet mismatch also predicted anti-class-I (p = .05) and anti-DQ (p < .001) de novo DSA. Adverse events were similar, but E-/LI developed fewer viral infections, particularly polyoma-virus-associated nephropathy (p = .021). Preformed T cell alloreactivity and HLA eplet mismatch assessment may refine current baseline immune-risk stratification and guide immunosuppression decision-making in kidney transplantation.
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Affiliation(s)
- Oriol Bestard
- Kidney Transplant Unit, Nephrology department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain.,Nephrology and Transplantation Laboratory, IDIBELL, Barcelona University, Barcelona, Spain
| | - Maria Meneghini
- Kidney Transplant Unit, Nephrology department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain.,Nephrology and Transplantation Laboratory, IDIBELL, Barcelona University, Barcelona, Spain
| | - Elena Crespo
- Nephrology and Transplantation Laboratory, IDIBELL, Barcelona University, Barcelona, Spain
| | - Frederike Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Martina Koch
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans D Volk
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ondrej Viklicky
- Transplant Laboratory, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Magali Giral
- Nantes Université, Inserm, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France
| | - Bernhard Banas
- Department of Nephrology, University Medical Center Regensburg, Regensburg, Germany
| | - Juan C Ruiz
- Department of Nephrology, Hospital Universitario "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL, Santander, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain
| | - Liu Hu
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Raphael van Duivenvoorden
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedrich Thaiss
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Natalie M Otto
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Gantuja Bold
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Maik Stein
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Anett Sefrin
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Nils Lachmann
- HLA-Laboratory, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Lucia Stranavova
- Transplant Laboratory, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Sophie Brouard
- Nantes Université, Inserm, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France
| | - Cécile Braudeau
- Nantes Université, Inserm, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France.,CHU Nantes, Laboratoire d'immunologie, CIMNA, Nantes, France
| | - Gilles Blancho
- Nantes Université, Inserm, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, ITUN, Nantes, France
| | - Miriam Banas
- Department of Nephrology, University Medical Center Regensburg, Regensburg, Germany
| | - Juan Irure
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Sophia Christakoudi
- Institute of Liver Studies, MRC Centre for Transplantation, Department of Inflammation Biology, Faculty of Sciences & Medicine, King's College London, London, UK
| | - Alberto Sanchez-Fueyo
- Institute of Liver Studies, MRC Centre for Transplantation, Department of Inflammation Biology, Faculty of Sciences & Medicine, King's College London, London, UK
| | - Kathryn J Wood
- Transplantation Research and Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Petra Reinke
- BeCAT, BCRT, and Department of Nephrology & Intensive Care, Charité Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - Josep M Grinyó
- Kidney Transplant Unit, Nephrology department, Bellvitge University Hospital, IDIBELL, Barcelona University, Barcelona, Spain.,Nephrology and Transplantation Laboratory, IDIBELL, Barcelona University, Barcelona, Spain
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5
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Gutiérrez-Larrañaga M, Riesco L, Guiral S, Irure J, Rodrigo E, Ocejo-Vinyals J, Martorell J, Caro JL, López-Hoyos M, San Segundo D. Detection of antibodies to denatured human leucocyte antigen molecules by single antigen Luminex. HLA 2020; 97:52-59. [PMID: 33040479 DOI: 10.1111/tan.14098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/04/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022]
Abstract
The anti-HLA antibody detection has been improved in sensitivity and specificity with solid-phase antigen bead (SAB) assays based on Luminex. However, false positive results due to denatured HLA (dHLA) may arise after single antigen test. The aim of this study was to compare the performance of the two Luminex technology-based anti-HLA detection kits available in the market in showing undesired anti-HLA antibody results. A prospective cohort was assessed for anti-HLA antibodies with single antigen A manufacturer (AM) kit and a comparison cohort with single antigen B manufacturer (BM) kit. A total of 11 out of 90 patients in a prospective cohort presented monospecific HLA-I antibodies with AM, and 5 out of 11 confirmed monospecific reaction with BM. Despite the confirmation of monospecific reaction with both manufacturers, 80% were assigned as dHLA reaction by specific crossmatch. Further comparative cohorts detected four out of six monospecific reactions with BM that were confirmed as possible dHLA reactions. A positive SAB test should rule out a reaction against a dHLA molecule, thus avoidance of prolonged waitlist periods or misattribution of anti-HLA reactions after transplantation.
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Affiliation(s)
- María Gutiérrez-Larrañaga
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Laura Riesco
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Sandra Guiral
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Juan Irure
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Javier Ocejo-Vinyals
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Jose L Caro
- Immunology Department, Hospital Clínic, Barcelona, Spain
| | - Marcos López-Hoyos
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Immunology Department, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
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Irure J, Sango C, San Segundo D, Fernández-Fresnedo G, Ruiz JC, Benito-Hernández A, Asensio E, López-Hoyos M, Rodrigo E. Late Plasma Cell Depletion After Thymoglobulin Induction in Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2019; 17:732-738. [DOI: 10.6002/ect.2018.0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Riesco L, Irure J, Rodrigo E, Guiral S, Ruiz JC, Gómez J, López-Hoyos M, San Segundo D. Anti-perlecan antibodies and acute humoral rejection in hypersensitized patients without forbidden HLA specificities after kidney transplantation. Transpl Immunol 2018; 52:53-56. [PMID: 30458294 DOI: 10.1016/j.trim.2018.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The improvement in the definition of serum anti-HLA antibodies (HLA-Abs) profiles after Luminex-assay implementation in transplant patients follow-up is clear. This success has permitted the development of hypersensitized-recipient allocation and donor-paired exchange programs improving the access to transplantation. However, non-HLA Abs have been described in transplanted patients but their effect in hypersensitized transplanted recipients is unclear. METHODS Twenty-seven HLA hypersensitized patients awaiting for kidney transplantation (KT) were studied and 11 of them were followed after KT. The HLA Abs profile was confirmed in serum by Single Antigen Luminex assay and panel reactive of antigens >98% was achieved in all patients. Subsequently, the ability to fix complement by C1q test was also assessed. Serum non-HLA Abs before and 1 month after transplantation were measured in the 11 hypersensitized recipients. RESULTS 95.2% of the hypersensitized on waiting list had concomitant serum anti-HLA and non-HLA Abs. The more frequent specificity in non-HLA Abs were found against Glutathione S-transferase theta-1 (GSST-1) (in 62%) and C-terminal fragment of perlecan (LG3) (in 52%). Four out of 11 transplanted patients presented early antibody-mediated rejection (ABMR) confirmed by biopsy and had serum anti-LG3 antibodies, two of them with concomitant anti-anti-angiotensin II type I receptor. Only one patient developed de novo-donor specific HLA antibodies. CONCLUSIONS The incidence of non-HLA antibodies in patients in the waiting list is largely underestimated. The concomitance anti-HLA and non-HLA Abs in hypersensitized patients is very common and the detection of non-HLA Abs in this population could allow to identify patients with an increased risk of humoral rejection.
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Affiliation(s)
- Laura Riesco
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| | - Juan Irure
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - Sandra Guiral
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| | - Juan Carlos Ruiz
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - Javier Gómez
- Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
| | - David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain.
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Riesco L, Irure J, Palomar R, Piñera C, Rodrigo E, López-Hoyos M, Segundo DS. Unmasking Uncertain Results after Anti-HLA Antibody Screening in Patients on Waiting List. Transplantation 2018. [DOI: 10.1097/01.tp.0000542871.84644.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Irure J, Ballesteros M, Merino D, Iturbe D, Mora V, Fernández-Rozas S, Mons R, Asensio E, Gómez-Román J, Cifrián J, López-Hoyos M, San Segundo D. CD8 T Effector Memory T Cells asPredictive Biomarker of Severe Acute Rejection in Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Irure J, López-Hoyos M, Rodrigo E, Gómez-Román J, Ruiz JC, Arias M, San Segundo D. Antibody-Mediated Rejection in Kidney Transplantation Without Evidence of Anti-HLA Antibodies? Transplant Proc 2017; 48:2888-2890. [PMID: 27932099 DOI: 10.1016/j.transproceed.2016.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/13/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The definition of antibody-mediated rejection (AMR) is based on serologic (presence and/or development of donor-specific anti-HLA antibodies [DSAs]) and histologic (C4d deposition and endothelial damage) criteria. However, several cases of AMR have been described without C4d deposition, and other cases of histologic AMR without DSAs, which could be driven by other non-HLA alloantibodies such as anti-MICA or anti-angiotensin II type I receptor (AT1R). Here we studied clinical and histologic humoral rejection in kidney transplant recipients without evidence of anti-HLA antibodies. MATERIALS AND METHODS Fifteen kidney transplant recipients with AMR defined as C4d+ and/or histologic g+ptc without anti-HLA antibodies in screening test were studied. Sera at the moment of biopsy and 2 months earlier were studied for anti-HLA antibodies by Luminex, in neat, diluted 1/160, and sera after treatment with dithiothreitol (DTT) and confirmed by single-antigen test. The anti-AT1R was measured by enzyme-linked immunosorbent assay. RESULTS A lack of anti-HLA and MICA antibodies was confirmed after anti-HLA screening test in all conditions (neat, diluted, and DTT-treated) and de novo development of AT1R antibodies was ruled out. Nevertheless, after single-antigen test, 3 patients were identified with a weak reaction against class I antigen and another 4 patients against class II antigen. Due to the lack of locus-C typing in the donors, the DSA assignment cannot be confirmed, whereas anti-HLA class II antigens were DSA. CONCLUSIONS A low sensitivity in the screening of anti-HLA antibody testing was observed. Our results suggest performing single-antigen test in seronegative patients with clinical humoral rejection after screening to confirm the presence of DSA.
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Affiliation(s)
- J Irure
- Immunology Service, Marqués de Valdecilla Hospital-IDIVAL, Santander, Spain
| | - M López-Hoyos
- Immunology Service, Marqués de Valdecilla Hospital-IDIVAL, Santander, Spain
| | - E Rodrigo
- Nephrology Service, Marqués de Valdecilla Hospital-IDIVAL, Santander, Spain
| | - J Gómez-Román
- Pathology Service, Marqués de Valdecilla Hospital-IDIVAL, Santander, Spain
| | - J C Ruiz
- Nephrology Service, Marqués de Valdecilla Hospital-IDIVAL, Santander, Spain
| | - M Arias
- Nephrology Service, Marqués de Valdecilla Hospital-IDIVAL, Santander, Spain
| | - D San Segundo
- Immunology Service, Marqués de Valdecilla Hospital-IDIVAL, Santander, Spain.
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11
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Irure J, Asensio E, Rodrigo E, Romón Í, Gómez J, Arias M, López-Hoyos M, San Segundo D. Improvement in the definition of anti-HLA antibody profile in highly sensitized patients. PLoS One 2017; 12:e0171463. [PMID: 28158255 PMCID: PMC5291387 DOI: 10.1371/journal.pone.0171463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/20/2017] [Indexed: 11/20/2022] Open
Abstract
The definition of anti-HLA antibody profile in highly sensitized patients on a waiting list is crucial when virtual crossmatch is used in organ allocation systems, but also when used to identify the true deleterious anti-HLA antibodies. Here we propose different levels of risk based on the results of anti-HLA antibody testing in neat serum (N) and after sera dilution (DIL) and C1q test in 18 highly sensitized patients. This group was heterogeneous in terms of anti-HLA antibody titers and their ability to fix complement. After dilution, 15 out of 18 patients (83.3%) showed a reduction of positive bead counts whereas 4 patients showed a prozone effect and complement fixation was demonstrated. The high dilution of sera and ascertaining the complement fixation allow the accurate definition of risk anti-HLA antibody profiles in highly sensitized patients, as demonstrated in 5 of the sensitized patients who were transplanted.
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Affiliation(s)
- Juan Irure
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Esther Asensio
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Íñigo Romón
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Javier Gómez
- Pathology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Manuel Arias
- Nephrology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
| | - David San Segundo
- Immunology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Tissue Typing Laboratory, University Hospital Marqués de Valdecilla, Santander, Spain
- * E-mail:
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12
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Merino D, San Segundo D, Medina JM, Rodrigo E, Asensio E, Irure J, Fernández-Fresnedo G, Arias MA, López-Hoyos M. Different in vitro proliferation and cytokine-production inhibition of memory T-cell subsets after calcineurin and mammalian target of rapamycin inhibitors treatment. Immunology 2016; 148:206-15. [PMID: 26931075 DOI: 10.1111/imm.12603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/10/2016] [Accepted: 02/24/2016] [Indexed: 12/14/2022] Open
Abstract
Calcineurin inhibitors (CNI) and mammalian target of rapamycin inhibitors (mTORi) are the main immunosuppressants used for long-term maintenance therapy in transplant recipients to avoid acute rejection episodes. Both groups of immunosuppressants have wide effects and are focused against the T cells, although different impacts on specific T-cell subsets, such as regulatory T cells, have been demonstrated. A greater knowledge of the impact of immunosuppression on the cellular components involved in allograft rejection could facilitate decisions for individualized immunosuppression when an acute rejection event is suspected. Memory T cells have recently gained focus because they might induce a more potent response compared with naive cells. The impact of immunosuppressants on different memory T-cell subsets remains unclear. In the present study, we have studied the specific impact of CNI (tacrolimus) and mTORi (rapamycin and everolimus) over memory and naive CD4(+) T cells. To do so, we have analysed the proliferation, phenotypic changes and cytokine synthesis in vitro in the presence of these immunosuppressants. The present work shows a more potent effect of CNI on proliferation and cytokine production in naive and memory T cells. However, the mTORi permit the differentiation of naive T cells to the memory phenotype and allow the production of interleukin-2. Taken together, our data show evidence to support the combined use of CNI and mTORi in transplant immunosuppression.
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Affiliation(s)
- David Merino
- Autoimmunity and Transplant Group-IDIVAL, Santander, Spain
| | - David San Segundo
- Immunology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Juan M Medina
- Autoimmunity and Transplant Group-IDIVAL, Santander, Spain
| | - Emilio Rodrigo
- Nephrology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Esther Asensio
- Immunology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Juan Irure
- Immunology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Manuel A Arias
- Nephrology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Immunology Service Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
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