1
|
Donor-Derived Cell-Free DNA to Diagnose Graft Rejection Post-Transplant: Past, Present and Future. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2030034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Donor-derived cell-free DNA (dd-cfDNA) is a non-invasive biomarker that is more sensitive and specific towards diagnosing any graft injury or rejection. Due to its applicability over all transplanted organs irrespective of age, sex, race, ethnicity, and the non-requirement of a donor sample, it emerges as a new gold standard for graft health and rejection monitoring. Published research articles describing the role and efficiency of dd-cfDNA were identified and scrutinized to acquire a brief understanding of the history, evolution, emergence, role, efficiency, and applicability of dd-cfDNA in the field of transplantation. The dd-cfDNA can be quantified using quantitative PCR, next-generation sequencing, and droplet digital PCR, and there is a commendatory outcome in terms of diagnosing graft injury and monitoring graft health. The increased levels of dd-cfDNA can diagnose the rejection prior to any other presently used biochemistry or immunological assay methods. Biopsies are performed when these tests show any signs of injury and/or rejection. Therefore, by the time these tests predict and show any unusual or improper activity of the graft, the graft is already damaged by almost 50%. This review elucidates the evolution, physiology, techniques, limitations, and prospects of dd-cfDNA as a biomarker for post-transplant graft damage and rejection.
Collapse
|
2
|
Abstract
The liver is a unique anatomical and immunological site in which antigen-rich blood from the gastrointestinal tract is pressed through a network of sinusoids and scanned by antigen-presenting cells and lymphocytes. The liver's lymphocyte population is selectively enriched in natural killer and natural killer T cells which play critical roles in first line immune defense against invading pathogens, modulation of liver injury and recruitment of circulating lymphocytes. Circulating lymphocytes come in close contact to antigens displayed by endothelial cells, Kupffer cells and liver resident dendritic cells in the sinusoids. Circulating lymphocytes can also contact hepatocytes directly, because the sinusoidal endothelium is fenestrated and lacks a basement membrane. This unique anatomy of the liver may facilitate direct or indirect priming of lymphocytes, modulate the immune response to hepatotrophic pathogens and contribute to some of the unique immunological properties of this organ, particularly its capacity to induce antigen-specific tolerance.
Collapse
Affiliation(s)
- Vito Racanelli
- Department of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | | |
Collapse
|
3
|
Pachiadakis I, Pollara G, Chain BM, Naoumov NV. Is hepatitis C virus infection of dendritic cells a mechanism facilitating viral persistence? THE LANCET. INFECTIOUS DISEASES 2005; 5:296-304. [PMID: 15854885 DOI: 10.1016/s1473-3099(05)70114-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
More than 170 million people worldwide are chronically infected with hepatitis C virus (HCV), which is a major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Impaired T-cell reactivity to HCV, a hallmark of inefficient adaptive immunity, is believed to be responsible for the high propensity of HCV to cause chronic infection. Dendritic cells are the most potent antigen-presenting cells and many viruses affect various dendritic cell functions. Data suggest that such changes induced by HCV may have an important role in viral persistence. HCV has been shown to bind to dendritic cells, although viral replication within these cells occurs at a very low level. Dendritic cells from people with chronic HCV infection are impaired in their capacity to stimulate T cells. This impairment may be a consequence of changes in the expression of major histocompatibility complex and costimulatory molecules on its surface, as well as in the production of cytokines such as interleukin 12. In addition, hepatic dendritic cells may be affected by the tolerogenic microenvironment of the liver, possibly generating dendritic cells that promote regulatory T cells, which suppress the cellular immune response mounted against HCV.
Collapse
Affiliation(s)
- Ioannis Pachiadakis
- Institute of Hepatology, Department of Medicine, Windeyer Institute of Medical Sciences, University College London, London, UK
| | | | | | | |
Collapse
|
4
|
Abstract
Dendritic cells (DC) are rare, bone marrow-derived antigen-presenting cells that play a critical role in the induction and regulation of immune reactivity. In this article, we review the identification and characterization of liver DC, their ontogenic development, in vivo mobilization and population dynamics. In addition, we discuss the functions of DC isolated from liver tissue or celiac lymph, or propagated in vitro from liver-resident haemopoietic stem/progenitor cells. Evidence concerning the role of DC in viral hepatitis, liver tumours, autoimmune liver diseases, granulomatous inflammation and the outcome of liver transplantation is also discussed.
Collapse
Affiliation(s)
- Angus W Thomson
- Thomas E Starzl Transplantation Institute and Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | | | | | | |
Collapse
|
5
|
Jindal RM, Sahota A. The role of cell migration and microchimerism in the induction of tolerance after solid organ transplantation. Postgrad Med J 1997; 73:146-50. [PMID: 9135829 PMCID: PMC2431236 DOI: 10.1136/pgmj.73.857.146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A new hypothesis has been proposed which states that microchimerism is the basis for the clinical tolerance seen in long-term survivors of solid organ transplants. Efforts to enhance microchimerism include simultaneous infusion of bone marrow of donor origin and transplantation of a solid organ. Studies are in progress to verify the phenomenon of microchimerism and its role in clinical tolerance.
Collapse
Affiliation(s)
- R M Jindal
- Department of Surgery, Indiana University School of Medicine, Indianapolis 46202, USA
| | | |
Collapse
|
6
|
Starzl TE, Valdivia LA, Murase N, Demetris AJ, Fontes P, Rao AS, Manez R, Marino IR, Todo S, Thomson AW. The biological basis of and strategies for clinical xenotransplantation. Immunol Rev 1994; 141:213-44. [PMID: 7868154 PMCID: PMC3005617 DOI: 10.1111/j.1600-065x.1994.tb00879.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recent discoveries have suggested that the exchange of multiple leukocyte lineages between grafts and host and subsequent long-term chimerism in both is the seminal mechanism of the acceptance of organs transplanted from the same (allografts) or different species (xenografts). This insight suggests new strategies which may allow xenotransplantation, the principal obstacle to which has been humoral rejection. We have defined humoral rejection as a family of complement activation syndromes afflicting allografts and xenografts in which there is a strong (but not invariable) association with performed antigraft antibodies, invariable evidence of complement activation, histopathologic stigmas of vascular endothelial damage, and a concomitant local or systemic coagulopathy. The generic descriptive term hyperacute rejection is a misnomer because a slow-motion version of the same "humoral" process can occur with some allografts and is the rule with the so-called concordant species xenotransplantations. The pathway of experience and discovery leading to this conclusion shows clearly that the distinction frequently made between allograft versus xenograft humoral rejection does not actually exist in principle, but only in details and intensity. Breaking down this barrier to xenotransplantation, whether or not it is associated with antibodies, is unrealistic. However, the possibility of avoiding the barrier has been exposed by showing that animal organs can be humanized, with a mixed donor and recipient cell population similar to the chimerism seen in long surviving allografts or even with complete leukocyte replacement. Pilot experiments in rodents suggest that organs from fully xenogeneic chimeras can be made into xenogeneic targets that are no more provocative of complement activation than allografts when they are transplanted into the donor bone marrow species. Although the validity of this concept of organ xenograft preparation is only at the pilot stage of verification, there is reason to suspect that the complement trigger of humoral rejection can be thereby disarmed. If this can be accomplished, independent evidence suggests that cellular rejection can be controlled with conventional T-cell directed immunosuppression, perhaps even with surprising ease. The potential subtle liability of synthetic products of xenogeneic parenchymal cells is not yet known.
Collapse
Affiliation(s)
- T E Starzl
- Pittsburgh Transplantation Institute, University of Pittsburgh Medical Center, PA 15213
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Starzl TE, Tzakis A, Fung JJ, Todo S, Demetris AJ, Manez R, Marino IR, Valdivia L, Murase N. Prospects of clinical xenotransplantation. Transplant Proc 1994; 26:1082-8. [PMID: 8029839 PMCID: PMC2976480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T E Starzl
- Pittsburgh Transplant Institute, University of Pittsburgh Medical Center, Pennsylvania 15213
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abu-Elmagd K, Todo S, Fung J, Demetris J, Rakela J, Rao AS, Iwatsuki S, Starzl T. Hepatic transplantation at the University of Pittsburgh: new horizons and paradigms after 30 years of experience. CLINICAL TRANSPLANTS 1994:133-56. [PMID: 7547533 PMCID: PMC3022492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the 1993 edition of this book, we described 4 major initiatives in liver transplantation: First, the evaluation of the new immunosuppressive drug FK506 (tacrolimus); second, the feasibility of combined liver-intestinal and multivisceral transplantation; third, 2 clinical attempts at hepatic xenotransplantation; and fourth, beginning attempts to enhance donor-specific nonreactivity with adjuvant bone marrow infusion. These and other new clinical studies during the last 12 months are the concerns of this update. The topics will be considered separately because of the unique design of each and the heterogeneity of the enrolled patient population. The patient and graft survival curves were estimated by the Kaplan-Meier method and the comparisons were done by the log-rank test. Survival time for patients was defined as the time that elapsed from the transplantation date until death, or the date of the last follow-up evaluation. For calculating graft survival, the date of graft removal was also considered. Cox’s proportional hazards model was used to analyze different causes of mortality and graft failure. Single variable comparison for qualitative data was made by chi-square analysis. The one-way analysis of variance was used for 3-way comparison.
Collapse
Affiliation(s)
- K Abu-Elmagd
- Pittsburgh Transplant Institute, Department of Surgery, University of Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Starzl TE, Demetris AJ, Trucco M, Murase N, Ricordi C, Ildstad S, Ramos H, Todo S, Tzakis A, Fung JJ. Cell migration and chimerism after whole-organ transplantation: the basis of graft acceptance. Hepatology 1993; 17:1127-52. [PMID: 8514264 PMCID: PMC2964270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Improvements in the prevention or control of rejection of the kidney and liver have been largely interchangeable (1 , 2 ) and then applicable, with very little modification, to thoracic and other organs. However, the mechanism by which anti rejection treatment permits any of these grafts to be “accepted” has been an immunological enigma (3 , 4 ). We have proposed recently that the exchange of migratory leukocytes between the transplant and the recipient with consequent long-term cellular chimerism in both is the basis for acceptance of all whole-organ allografts and xenografts (5 ). Although such chimerism was demonstrated only a few months ago, the observations have increased our insight into transplantation immunology and have encouraged the development of alternative therapeutic strategies (6 ).
Collapse
Affiliation(s)
- T E Starzl
- Department of Surgery, University of Pittsburgh Health Science Center, Pennsylvania 15213
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Starzl TE, Demetris AJ, Trucco M, Murase N, Ricordi C, Ildstad S, Ramos H, Todo S, Tzakis A, Fung JJ, Nalesnik M, Zeevi A, Rudert WA, Kocova M. Cell migration and chimerism after whole-organ transplantation: the basis of graft acceptance. Hepatology 1993. [PMID: 8514264 DOI: 10.1002/hep.1840170629] [Citation(s) in RCA: 495] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Improvements in the prevention or control of rejection of the kidney and liver have been largely interchangeable (1, 2) and then applicable, with very little modification, to thoracic and other organs. However, the mechanism by which anti rejection treatment permits any of these grafts to be “accepted” has been an immunological enigma (3, 4). We have proposed recently that the exchange of migratory leukocytes between the transplant and the recipient with consequent long-term cellular chimerism in both is the basis for acceptance of all whole-organ allografts and xenografts (5). Although such chimerism was demonstrated only a few months ago, the observations have increased our insight into transplantation immunology and have encouraged the development of alternative therapeutic strategies (6).
Collapse
Affiliation(s)
- T E Starzl
- Department of Surgery, University of Pittsburgh Health Science Center, Pennsylvania 15213
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Murase N, Starzl TE, Demetris AJ, Valdivia L, Tanabe M, Cramer D, Makowka L. Hamster-to-rat heart and liver xenotransplantation with FK506 plus antiproliferative drugs. Transplantation 1993; 55:701-7; discussion 707-8. [PMID: 7682735 PMCID: PMC2957097 DOI: 10.1097/00007890-199304000-00003] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Heterotopic hamster hearts transplanted to unmodified LEW rats underwent humoral rejection in 3 days. Survival was prolonged to a median of 4 days with 2 mg/kg/day FK506. As monotherapy, 15 mg/kg/day cyclophosphamide greatly prolonged graft survival--far more than could be accomplished with RS-61443, brequinar (BQR), mizoribine, methotrexate, or deoxyspergualin. However, when FK506 treatment, which was ineffective alone, was combined with a short induction course (14 or 30 days) of subtherapeutic BQR, RS-61443, or cyclophosphamide, routine survival of heart xenografts was possible for as long as the daily FK506 was continued. In addition, a single large dose of 80 mg/kg cyclophosphamide 10 days preoperatively allowed routine cardiac xenograft survival under FK506. The ability of these antimetabolites to unmask the therapeutic potential of FK506 correlated, although imperfectly, with the prevention of rises of preformed heterospecific cytotoxic antibodies immediately postoperatively. As an adjunct to FK506, azathioprine was of marginal value, whereas mizoribine, methotrexate, and deoxyspergualin (DSPG) were of intermediate efficacy. After orthotopic hepatic xenotransplantation, the perioperative survival of the liver with its well-known resistance to antibodies was less dependent than the heart on the antimetabolite component of the combined drug therapy, but the unsatisfactory results with monotherapy of FK506, BQR, RS-61443, or cyclophosphamide were changed to routine success by combining continuous FK506 with a short course of any of the other drugs. Thus, by breaking down the antibody barrier to xenotransplantation with these so-called antiproliferative drugs, it has been possible with FK506 to transplant heart and liver xenografts with consistent long-term survival of healthy recipients.
Collapse
Affiliation(s)
- N Murase
- Pittsburgh Transplant Institute, University of Pittsburgh Health Science Center, Pennsylvania 15213
| | | | | | | | | | | | | |
Collapse
|
12
|
Valdivia LA, Demetris AJ, Fung JJ, Celli S, Murase N, Starzl TE. Successful hamster-to-rat liver xenotransplantation under FK506 immunosuppression induces unresponsiveness to hamster heart and skin. Transplantation 1993; 55:659-61. [PMID: 7681230 PMCID: PMC2976608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- L A Valdivia
- Department of Surgery, Pittsburgh Transplant Institute, University of Pittsburgh Health Science Center, Pennsylvania 15213
| | | | | | | | | | | |
Collapse
|
13
|
Starzl TE. The Future of Xenotransplantation. Ann Surg 1992; 216:3-10. [PMID: 25006273 PMCID: PMC4082968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Thomas E Starzl
- Director of the Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|