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Calabrese DR, Tsao T, Magnen M, Valet C, Gao Y, Mallavia B, Tian JJ, Aminian EA, Wang KM, Shemesh A, Punzalan EB, Sarma A, Calfee CS, Christenson SA, Langelier CR, Hays SR, Golden JA, Leard LE, Kleinhenz ME, Kolaitis NA, Shah R, Venado A, Lanier LL, Greenland JR, Sayah DM, Ardehali A, Kukreja J, Weigt SS, Belperio JA, Singer JP, Looney MR. NKG2D receptor activation drives primary graft dysfunction severity and poor lung transplantation outcomes. JCI Insight 2022; 7:e164603. [PMID: 36346670 PMCID: PMC9869973 DOI: 10.1172/jci.insight.164603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Clinical outcomes after lung transplantation, a life-saving therapy for patients with end-stage lung diseases, are limited by primary graft dysfunction (PGD). PGD is an early form of acute lung injury with no specific pharmacologic therapies. Here, we present a large multicenter study of plasma and bronchoalveolar lavage (BAL) samples collected on the first posttransplant day, a critical time for investigations of immune pathways related to PGD. We demonstrated that ligands for NKG2D receptors were increased in the BAL from participants who developed severe PGD and were associated with increased time to extubation, prolonged intensive care unit length of stay, and poor peak lung function. Neutrophil extracellular traps (NETs) were increased in PGD and correlated with BAL TNF-α and IFN-γ cytokines. Mechanistically, we found that airway epithelial cell NKG2D ligands were increased following hypoxic challenge. NK cell killing of hypoxic airway epithelial cells was abrogated with NKG2D receptor blockade, and TNF-α and IFN-γ provoked neutrophils to release NETs in culture. These data support an aberrant NK cell/neutrophil axis in human PGD pathogenesis. Early measurement of stress ligands and blockade of the NKG2D receptor hold promise for risk stratification and management of PGD.
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Affiliation(s)
- Daniel R. Calabrese
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Tasha Tsao
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Mélia Magnen
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Colin Valet
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Ying Gao
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Beñat Mallavia
- Department of Medicine, UCSF, San Francisco, California, USA
| | | | | | - Kristin M. Wang
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Avishai Shemesh
- Department of Medicine, UCSF, San Francisco, California, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
| | | | - Aartik Sarma
- Department of Medicine, UCSF, San Francisco, California, USA
| | | | | | | | - Steven R. Hays
- Department of Medicine, UCSF, San Francisco, California, USA
| | | | | | | | | | - Rupal Shah
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Aida Venado
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Lewis L. Lanier
- Parker Institute for Cancer Immunotherapy, San Francisco, California, USA
- Department of Microbiology and Immunology and
| | - John R. Greenland
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Medicine, UCSF, San Francisco, California, USA
| | - David M. Sayah
- Department of Medicine, UCLA, Los Angeles, California, USA
| | - Abbas Ardehali
- Department of Medicine, UCLA, Los Angeles, California, USA
| | | | | | | | | | - Mark R. Looney
- Department of Medicine, UCSF, San Francisco, California, USA
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2
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Cai X, Shahandeh N, Ji J, Finn JP, Fishbein GA, Biniwale RM, Ardehali A, Sayah DM, Yang EH. Ascending Aortic Pseudoaneurysm: A Rare Complication of Transcatheter Aortic Valve Replacement and Thoracic Surgery. Circ Cardiovasc Imaging 2022; 15:e014076. [DOI: 10.1161/circimaging.122.014076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xinjiang Cai
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. (X.C., N.S., J.J., E.H.Y.)
| | - Negeen Shahandeh
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. (X.C., N.S., J.J., E.H.Y.)
| | - Jaden Ji
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. (X.C., N.S., J.J., E.H.Y.)
| | - John P. Finn
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California. (J.P.F.)
| | - Gregory A. Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. (G.A.F.)
| | - Reshma M. Biniwale
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. (R.M.B., A.A.)
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. (R.M.B., A.A.)
| | - David M. Sayah
- Division of Pulmonary, Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. (D.M.S.)
| | - Eric H. Yang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. (X.C., N.S., J.J., E.H.Y.)
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. (E.H.Y.)
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3
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Weigt SS, Kim GHJ, Jones HD, Ramsey AL, Amubieya O, Abtin F, Pourzand L, Lee J, Shino MY, DerHovanessian A, Stripp B, Noble PW, Sayah DM, Saggar R, Britton I, Lynch JP, Belperio JA, Goldin J. Quantitative Image Analysis at Chronic Lung Allograft Dysfunction Onset Predicts Mortality. Transplantation 2022; 106:1253-1261. [PMID: 34534193 PMCID: PMC8924012 DOI: 10.1097/tp.0000000000003950] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic lung allograft dysfunction (CLAD) phenotype determines prognosis and may have therapeutic implications. Despite the clarity achieved by recent consensus statement definitions, their reliance on radiologic interpretation introduces subjectivity. The Center for Computer Vision and Imaging Biomarkers at the University of California, Los Angeles (UCLA) has established protocols for chest high-resolution computed tomography (HRCT)-based computer-aided quantification of both interstitial disease and air-trapping. We applied quantitative image analysis (QIA) at CLAD onset to demonstrate radiographic phenotypes with clinical implications. METHODS We studied 47 first bilateral lung transplant recipients at UCLA with chest HRCT performed within 90 d of CLAD onset and 47 no-CLAD control HRCTs. QIA determined the proportion of lung volume affected by interstitial disease and air-trapping in total lung capacity and residual volume images, respectively. We compared QIA scores between no-CLAD and CLAD, and between phenotypes. We also assigned radiographic phenotypes based solely on QIA, and compared their survival outcomes. RESULTS CLAD onset HRCTs had more lung affected by the interstitial disease (P = 0.003) than no-CLAD controls. Bronchiolitis obliterans syndrome (BOS) cases had lower scores for interstitial disease as compared with probable restrictive allograft syndrome (RAS) (P < 0.0001) and mixed CLAD (P = 0.02) phenotypes. BOS cases had more air-trapping than probable RAS (P < 0.0001). Among phenotypes assigned by QIA, the relative risk of death was greatest for mixed (relative risk [RR] 11.81), followed by RAS (RR 6.27) and BOS (RR 3.15). CONCLUSIONS Chest HRCT QIA at CLAD onset appears promising as a method for precise determination of CLAD phenotypes with survival implications.
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Affiliation(s)
- S Samuel Weigt
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Grace-Hyun J Kim
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Heather D Jones
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA
| | - Allison L Ramsey
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Olawale Amubieya
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Fereidoun Abtin
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Lila Pourzand
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Jihey Lee
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Michael Y Shino
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | - Barry Stripp
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA
| | - Paul W Noble
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA
| | - David M Sayah
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Rajan Saggar
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Ian Britton
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Joseph P Lynch
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - John A Belperio
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jonathan Goldin
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
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Abstract
The medical care of patients awaiting lung transplantation is complex and requires the treatment of active medical conditions, including lung disease, while at the same time maintaining candidacy for transplantation. Some medications that would otherwise be considered routine may create undesirable challenges or complications in the perioperative setting. Therefore, a comprehensive assessment of the risks and benefits of these medications must take into account both their potential utility in managing a patient's current disease state, as well as the risks of compromising postlung transplant outcomes. In this review, we summarize the available data regarding several medications that are commonly used to treat patients with a variety of lung diseases, but that may impact a patient's course on the waiting list or in the posttransplant period.
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Affiliation(s)
- David M Sayah
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Avenue, Box 951690, Los Angeles, CA 90095-1690, USA.
| | - Joseph M Pilewski
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, NW 628 MUH, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA
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5
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Shino MY, Zhang Q, Li N, Derhovanessian A, Ramsey A, Saggar R, Britton IN, Amubieya OO, Lari SM, Hickey M, Reed EF, Noble PW, Stripp BR, Fishbein GA, Lynch JP, Ardehali A, Sayah DM, Weigt SS, Belperio JA. The allograft injury marker CXCL9 determines prognosis of anti-HLA antibodies after lung transplantation. Am J Transplant 2022; 22:565-573. [PMID: 34464505 PMCID: PMC10826889 DOI: 10.1111/ajt.16827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/01/2021] [Accepted: 08/17/2021] [Indexed: 01/25/2023]
Abstract
Despite the common detection of non-donor specific anti-HLA antibodies (non-DSAs) after lung transplantation, their clinical significance remains unclear. In this retrospective single-center cohort study of 325 lung transplant recipients, we evaluated the association between donor-specific HLA antibodies (DSAs) and non-DSAs with subsequent CLAD development. DSAs were detected in 30% of recipients and were associated with increased CLAD risk, with higher HRs for both de novo and high MFI (>5000) DSAs. Non-DSAs were detected in 56% of recipients, and 85% of DSA positive tests had concurrent non-DSAs. In general, non-DSAs did not increase CLAD risk in multivariable models accounting for DSAs. However, non-DSAs in conjunction with high BAL CXCL9 levels were associated with increased CLAD risk. Multivariable proportional hazards models demonstrate the importance of the HLA antibody-CXCL9 interaction: CLAD risk increases when HLA antibodies (both DSAs and non-DSAs) are detected in conjunction with high CXCL9. Conversely, CLAD risk is not increased when HLA antibodies are detected with low CXCL9. This study supports the potential utility of BAL CXCL9 measurement as a biomarker to risk stratify HLA antibodies for future CLAD. The ability to discriminate between high versus low-risk HLA antibodies may improve management by allowing for guided treatment decisions.
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Affiliation(s)
- Michael Y. Shino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Qiuheng Zhang
- Department of Immunogenetics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ning Li
- Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ariss Derhovanessian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Allison Ramsey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Rajan Saggar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ian N. Britton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Olawale O. Amubieya
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Shahrzad M. Lari
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michelle Hickey
- Department of Immunogenetics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Elaine F. Reed
- Department of Immunogenetics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Paul W. Noble
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Barry R. Stripp
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Gregory A. Fishbein
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joseph P. Lynch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David M. Sayah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - S. Sam Weigt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John A. Belperio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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6
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Saggar R, Giri PC, Deng C, Johnson D, McCloy MK, Liang L, Shaikh F, Hong J, Channick RN, Shapiro SS, Lynch JP, Belperio JA, Weigt SS, Ramsey AL, Ross DJ, Sayah DM, Shino MY, Derhovanessian A, Sherman AE, Saggar R. Significance of autoimmune disease in severe pulmonary hypertension complicating extensive pulmonary fibrosis: a prospective cohort study. Pulm Circ 2021; 11:20458940211011329. [PMID: 33996029 PMCID: PMC8108092 DOI: 10.1177/20458940211011329] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/23/2021] [Indexed: 12/01/2022] Open
Abstract
The association of autoimmune disease (AI) with transplant-free survival in the setting of severe Group 3 pulmonary hypertension and extensive pulmonary fibrosis remains unclear. We report cases of severe pulmonary hypertension (mean pulmonary artery pressure ≥35 mmHg and right ventricular dysfunction) and extensive pulmonary fibrosis after pulmonary arterial hypertension-specific therapy. We used multivariate regression to determine the clinical variables associated with transplant-free survival. Of 286 screened patients, 55 demonstrated severe pulmonary hypertension and extensive pulmonary fibrosis and were treated with parenteral prostacyclin therapy. The (+)AI subgroup (n = 34), when compared to the (-)AI subgroup (n = 21), was more likely to be female (77% versus 19%) and younger (58.7 ± 12.1 versus 66.0 ± 10.7 years), and revealed lower forced vital capacity (absolute) (1.9 ± 0.7 versus 2.9 ± 1.1 L), higher DLCO (% predicted) (31.1 ± 15.2 versus 23.2 ± 8.0), and increased unadjusted transplant-free survival (1 year (84.6 ± 6.3% versus 45 ± 11.1%)), 3 years (71 ± 8.2% versus 28.6 ± 11.9%), and 5 years (47.6 ± 9.6% versus 6.4 ± 8.2%); (p = 0.01)). Transplant-free survival was unchanged after adjusting for age and gender. The pulmonary hemodynamic profiles improved after parenteral prostacyclin therapy, independent of AI status. The baseline variables associated with mortality included age at pulmonary hypertension diagnosis (heart rate (HR) 1.23 (confidence interval (CI) 1.03-1.47); p = 0.02) and presence of AI (HR 0.26 (confidence interval (CI) 0.10-0.70); p < 0.01). Gas exchange was not adversely affected by parenteral prostacyclin therapy. In the setting of severe Group 3 pulmonary hypertension and extensive pulmonary fibrosis treated with pulmonary arterial hypertension-specific therapy, AI is independently associated with increased transplant-free survival. Pulmonary hypertension/pulmonary fibrosis associated with AI should be considered in future clinical trials of pulmonary arterial hypertension-specific therapy in Group 3 pulmonary hypertension.
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Affiliation(s)
| | - Paresh C. Giri
- Division of Pulmonary and Critical Care Medicine, Loma Linda University School of Medicine, Loma Linda, USA
| | | | | | - Mary K. McCloy
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Lloyd Liang
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Faisal Shaikh
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Jason Hong
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Richard N. Channick
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Shelley S. Shapiro
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Joseph P. Lynch
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - John A. Belperio
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Samuel S. Weigt
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Allison L. Ramsey
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | | | - David M. Sayah
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Michael Y. Shino
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Ariss Derhovanessian
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Alexander E. Sherman
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Rajan Saggar
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
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7
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Mallavia B, Liu F, Lefrançais E, Cleary SJ, Kwaan N, Tian JJ, Magnen M, Sayah DM, Soong A, Chen J, Saggar R, Shino MY, Ross DJ, Derhovanessian A, Lynch JP, Ardehali A, Weigt SS, Belperio JA, Hays SR, Golden JA, Leard LE, Shah RJ, Kleinhenz ME, Venado A, Kukreja J, Singer JP, Looney MR. Mitochondrial DNA Stimulates TLR9-Dependent Neutrophil Extracellular Trap Formation in Primary Graft Dysfunction. Am J Respir Cell Mol Biol 2020; 62:364-372. [PMID: 31647878 PMCID: PMC7055700 DOI: 10.1165/rcmb.2019-0140oc] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022] Open
Abstract
The immune system is designed to robustly respond to pathogenic stimuli but to be tolerant to endogenous ligands to not trigger autoimmunity. Here, we studied an endogenous damage-associated molecular pattern, mitochondrial DNA (mtDNA), during primary graft dysfunction (PGD) after lung transplantation. We hypothesized that cell-free mtDNA released during lung ischemia-reperfusion triggers neutrophil extracellular trap (NET) formation via TLR9 signaling. We found that mtDNA increases in the BAL fluid of experimental PGD (prolonged cold ischemia followed by orthotopic lung transplantation) and not in control transplants with minimal warm ischemia. The adoptive transfer of mtDNA into the minimal warm ischemia graft immediately before lung anastomosis induces NET formation and lung injury. TLR9 deficiency in neutrophils prevents mtDNA-induced NETs, and TLR9 deficiency in either the lung donor or recipient decreases NET formation and lung injury in the PGD model. Compared with human lung transplant recipients without PGD, severe PGD was associated with high levels of BAL mtDNA and NETs, with evidence of relative deficiency in DNaseI. We conclude that mtDNA released during lung ischemia-reperfusion triggers TLR9-dependent NET formation and drives lung injury. In PGD, DNaseI therapy has a potential dual benefit of neutralizing a major NET trigger (mtDNA) in addition to dismantling pathogenic NETs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abbas Ardehali
- Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | | | | | | | | | | | | | - Mark R. Looney
- Department of Medicine
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California; and
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8
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M. Lari S, Shino MY, Derhovanessian A, Sayah DM, Lynch JP, Saggar R, Belperio J, Ardehali A, Ross DJ, Reed E, Weigt S. The impact of pre-transplant donor specific anti-HLA antibodies (DSAs) on lung transplant outcome: A single center experience. Transplantation 2019. [DOI: 10.1183/13993003.congress-2019.pa1107] [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: 11/05/2022]
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9
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Palchevskiy V, Xue YY, Kern R, Weigt SS, Gregson AL, Song SX, Fishbein MC, Hogaboam CM, Sayah DM, Lynch JP, Keane MP, Brooks DG, Belperio JA. CCR4 expression on host T cells is a driver for alloreactive responses and lung rejection. JCI Insight 2019; 5:121782. [PMID: 31085832 DOI: 10.1172/jci.insight.121782] [Citation(s) in RCA: 2] [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] [Indexed: 12/16/2022] Open
Abstract
Despite current immunosuppressive strategies, long-term lung transplant outcomes remain poor due to rapid allogenic responses. Using a stringent mouse model of allo-airway transplantation, we identify the CCR4-ligand axis as a central node driving secondary lymphoid tissue homing and activation of the allogeneic T cells that prevent long-term allograft survival. CCR4 deficiency on transplant recipient T cells diminishes allograft injury and when combined with CTLA4-Ig leads to an unprecedented long-term lung allograft accommodation. Thus, we identify CCR4-ligand interactions as a central mechanism driving allogeneic transplant rejection and suggest it as a potential target to enhance long-term lung transplant survival.
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Affiliation(s)
- Vyacheslav Palchevskiy
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Ying Ying Xue
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Rita Kern
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Stephen S Weigt
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Aric L Gregson
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Sophie X Song
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Michael C Fishbein
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Cory M Hogaboam
- Pulmonary & Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - David M Sayah
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Joseph P Lynch
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Michael P Keane
- University College Dublin School of Medicine, Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - David G Brooks
- Princess Margaret Cancer Center, University Health Network and Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - John A Belperio
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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10
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Weigt SS, Wang X, Palchevskiy V, Patel N, Derhovanessian A, Shino MY, Sayah DM, Lynch JP, Saggar R, Ross DJ, Kubak BM, Ardehali A, Palmer S, Husain S, Belperio JA. Gene Expression Profiling of Bronchoalveolar Lavage Cells During Aspergillus Colonization of the Lung Allograft. Transplantation 2019; 102:986-993. [PMID: 29256975 DOI: 10.1097/tp.0000000000002058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aspergillus colonization after lung transplant is associated with an increased risk of chronic lung allograft dysfunction (CLAD). We hypothesized that gene expression during Aspergillus colonization could provide clues to CLAD pathogenesis. METHODS We examined transcriptional profiles in 3- or 6-month surveillance bronchoalveolar lavage fluid cell pellets from recipients with Aspergillus fumigatus colonization (n = 12) and without colonization (n = 10). Among the Aspergillus colonized, we also explored profiles in those who developed CLAD (n = 6) or remained CLAD-free (n = 6). Transcription profiles were assayed with the HG-U133 Plus 2.0 microarray (Affymetrix). Differential gene expression was based on an absolute fold difference of 2.0 or greater and unadjusted P value less than 0.05. We used NIH Database for Annotation, Visualization and Integrated Discovery for functional analyses, with false discovery rates less than 5% considered significant. RESULTS Aspergillus colonization was associated with differential expression of 489 probe sets, representing 404 unique genes. "Defense response" genes and genes in the "cytokine-cytokine receptor" Kyoto Encyclopedia of Genes and Genomes pathway were notably enriched in this list. Among Aspergillus colonized patients, CLAD development was associated with differential expression of 69 probe sets, representing 64 unique genes. This list was enriched for genes involved in "immune response" and "response to wounding", among others. Notably, both chitinase 3-like-1 and chitotriosidase were associated with progression to CLAD. CONCLUSIONS Aspergillus colonization is associated with gene expression profiles related to defense responses including cytokine signaling. Epithelial wounding, as well as the innate immune response to chitin that is present in the fungal cell wall, may be key in the link between Aspergillus colonization and CLAD.
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Affiliation(s)
- S Samuel Weigt
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Xiaoyan Wang
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vyacheslav Palchevskiy
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Naman Patel
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Ariss Derhovanessian
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Michael Y Shino
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - David M Sayah
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Joseph P Lynch
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Rajan Saggar
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - David J Ross
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Bernie M Kubak
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Abbas Ardehali
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Scott Palmer
- Department of Medicine, Duke University, Durham, NC
| | - Shahid Husain
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
| | - John A Belperio
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
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11
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Shino MY, DerHovanessian A, Sayah DM, Saggar R, Ying Xue Y, Ardehali A, Stripp BR, Ross DJ, Lynch JP, Elashoff RM, Weigt SS, Belperio JA. The Impact of Allograft CXCL9 during Respiratory Infection on the Risk of Chronic Lung Allograft Dysfunction. ACTA ACUST UNITED AC 2018; 2. [PMID: 31414076 PMCID: PMC6693350 DOI: 10.21926/obm.transplant.1804029] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The long term clinical significance of respiratory infections after lung transplantation remains uncertain. Methods In this retrospective single-center cohort study of 441 lung transplant recipients, we formally evaluate the association between respiratory infection and chronic lung allograft dysfunction (CLAD). We furthermore hypothesized that bronchoalveolar lavage fluid (BALF) CXCL9 concentrations are augmented during respiratory infections, and that episodes of infection with elevated BALF CXCL9 are associated with greater CLAD risk. Results In univariable and multivariable models adjusted for other histopathologic injury patterns, respiratory infection, regardless of the causative organism, was a strong predictor of CLAD development (adjusted HR 1.8 95% CI 1.3-2.6). Elevated BALF CXCL9 concentrations during respiratory infections markedly increased CLAD risk in a dose-response manner. An episode of respiratory infection with CXCL9 concentrations greater than the 25th, 50th, and 75th percentile had adjusted HRs for CLAD of 1.8 (95% CI 1.1-2.8), 2.4 (95% CI 1.4-4.0) and 4.4 (95% CI 2.4-8.0), respectively. Conclusions Thus, we demonstrate that respiratory infections, regardless of the causative organism, are strong predictors of CLAD development. We furthermore demonstrate for the first time, the prognostic importance of BALF CXCL9 concentrations during respiratory infections on the risk of subsequent CLAD development.
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Affiliation(s)
- Michael Y Shino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
| | - Ariss DerHovanessian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
| | - David M Sayah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
| | - Rajan Saggar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
| | - Ying Ying Xue
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1741, USA
| | - Barry R Stripp
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - David J Ross
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
| | - Joseph P Lynch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
| | - Robert M Elashoff
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA 90095-1652, USA
| | - S Samuel Weigt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
| | - John A Belperio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690, USA
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12
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Shino MY, Weigt SS, Li N, Derhovanessian A, Sayah DM, Saggar R, Huynh RH, Gregson AL, Ardehali A, Ross DJ, Lynch JP, Elashoff RM, Belperio JA. The Prognostic Importance of Bronchoalveolar Lavage Fluid CXCL9 During Minimal Acute Rejection on the Risk of Chronic Lung Allograft Dysfunction. Am J Transplant 2018; 18:136-144. [PMID: 28637080 PMCID: PMC5739954 DOI: 10.1111/ajt.14397] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/11/2017] [Accepted: 06/12/2017] [Indexed: 01/25/2023]
Abstract
The clinical significance and treatment strategies for minimal acute rejection (grade A1), the most common form of acute rejection (AR), remain controversial. In this retrospective single-center cohort study of 441 lung transplant recipients, we formally evaluate the association between minimal AR and chronic lung allograft dysfunction (CLAD) and test a novel hypothesis using bronchoalveolar lavage (BAL) CXCL9 concentration during minimal AR as a biomarker of subsequent CLAD development. In univariable and multivariable models adjusted for all histopathologic injury patterns, minimal AR was not associated with CLAD development. However, minimal AR with elevated BAL CXCL9 concentrations markedly increased CLAD risk in a dose-response manner. Minimal AR with CXCL9 concentrations greater than the 25th, 50th, and 75th percentile had adjusted hazard ratios (HRs) for CLAD of 1.1 (95% confidence interval [CI] 0.8-1.6), 1.6 (95% CI 1.1-2.3), and 2.2 (95% CI 1.4-3.4), respectively. Thus we demonstrate the utility of BAL CXCL9 measurement as a prognostic biomarker that allows discrimination of recipients at increased risk of CLAD development after minimal AR. BAL CXCL9 measurement during transbronchial biopsies may provide clinically useful prognostic data and guide treatment decisions for this common form of AR, as a possible strategy to minimize CLAD development.
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Affiliation(s)
- MY Shino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - SS Weigt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - N Li
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA 90095-1652
| | - A Derhovanessian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - DM Sayah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - R Saggar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - Richard H. Huynh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - AL Gregson
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1688
| | - A Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1741
| | - DJ Ross
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - JP Lynch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - RM Elashoff
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA 90095-1652
| | - JA Belperio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
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13
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Shino MY, Weigt SS, Li N, Palchevskiy V, Derhovanessian A, Saggar R, Sayah DM, Huynh RH, Gregson AL, Fishbein MC, Ardehali A, Ross DJ, Lynch JP, Elashoff RM, Belperio JA. The prognostic importance of CXCR3 chemokine during organizing pneumonia on the risk of chronic lung allograft dysfunction after lung transplantation. PLoS One 2017; 12:e0180281. [PMID: 28686641 PMCID: PMC5501470 DOI: 10.1371/journal.pone.0180281] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/13/2017] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Since the pathogenesis of chronic lung allograft dysfunction (CLAD) remains poorly defined with no known effective therapies, the identification and study of key events which increase CLAD risk is a critical step towards improving outcomes. We hypothesized that bronchoalveolar lavage fluid (BALF) CXCR3 ligand concentrations would be augmented during organizing pneumonia (OP) and that episodes of OP with marked chemokine elevations would be associated with significantly higher CLAD risk. METHODS All transbronchial biopsies (TBBX) from patients who received lung transplantation between 2000 to 2010 were reviewed. BALF concentrations of the CXCR3 ligands (CXCL9, CXCL10 and CXCL11) were compared between episodes of OP and "healthy" biopsies using linear mixed-effects models. The association between CXCR3 ligand concentrations during OP and CLAD risk was evaluated using proportional hazards models with time-dependent covariates. RESULTS There were 1894 bronchoscopies with TBBX evaluated from 441 lung transplant recipients with 169 (9%) episodes of OP and 907 (49%) non-OP histopathologic injuries. 62 (37%) episodes of OP were observed during routine surveillance bronchoscopy. Eight hundred thirty-eight (44%) TBBXs had no histopathology and were classified as "healthy" biopsies. There were marked elevations in BALF CXCR3 ligand concentrations during OP compared with "healthy" biopsies. In multivariable models adjusted for other injury patterns, OP did not significantly increase the risk of CLAD when BAL CXCR3 chemokine concentrations were not taken into account. However, OP with elevated CXCR3 ligands markedly increased CLAD risk in a dose-response manner. An episode of OP with CXCR3 concentrations greater than the 25th, 50th and 75th percentiles had HRs for CLAD of 1.5 (95% CI 1.0-2.3), 1.9 (95% CI 1.2-2.8) and 2.2 (95% CI 1.4-3.4), respectively. CONCLUSIONS This study identifies OP, a relatively uncommon histopathologic finding after lung transplantation, as a major risk factor for CLAD development when considered in the context of increased allograft expression of interferon-γ inducible ELR- CXC chemokines. We further demonstrate for the first time, the prognostic importance of BALF CXCR3 ligand concentrations during OP on subsequent CLAD risk.
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Affiliation(s)
- Michael Y. Shino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
| | - S. Samuel Weigt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Ning Li
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Vyacheslav Palchevskiy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Ariss Derhovanessian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Rajan Saggar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - David M. Sayah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Richard H. Huynh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Aric L. Gregson
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Michael C. Fishbein
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - David J. Ross
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Joseph P. Lynch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Robert M. Elashoff
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, California, United States of America
| | - John A. Belperio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, California, United States of America
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14
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Shino MY, Weigt SS, Li N, Derhovanessian A, Sayah DM, Huynh RH, Saggar R, Gregson AL, Ardehali A, Ross DJ, Lynch JP, Elashoff RM, Belperio JA. Impact of Allograft Injury Time of Onset on the Development of Chronic Lung Allograft Dysfunction After Lung Transplantation. Am J Transplant 2017; 17:1294-1303. [PMID: 27676455 PMCID: PMC5368037 DOI: 10.1111/ajt.14066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 05/19/2016] [Revised: 08/16/2016] [Accepted: 09/18/2016] [Indexed: 01/25/2023]
Abstract
The impact of allograft injury time of onset on the risk of chronic lung allograft dysfunction (CLAD) remains unknown. We hypothesized that episodes of late-onset (≥6 months) allograft injury would produce an augmented CXCR3/ligand immune response, leading to increased CLAD. In a retrospective single-center study, 1894 transbronchial biopsy samples from 441 lung transplant recipients were reviewed for the presence of acute rejection (AR), lymphocytic bronchiolitis (LB), diffuse alveolar damage (DAD), and organizing pneumonia (OP). The association between the time of onset of each injury pattern and CLAD was assessed by using multivariable Cox models with time-dependent covariates. Bronchoalveolar lavage (BAL) CXCR3 ligand concentrations were compared between early- and late-onset injury patterns using linear mixed-effects models. Late-onset DAD and OP were strongly associated with CLAD: adjusted hazard ratio 2.8 (95% confidence interval 1.5-5.3) and 2.0 (1.1-3.4), respectively. The early-onset form of these injury patterns did not increase CLAD risk. Late-onset LB and acute rejection (AR) predicted CLAD in univariable models but lost significance after multivariable adjustment for late DAD and OP. AR was the only early-onset injury pattern associated with CLAD development. Elevated BAL CXCR3 ligand concentrations during late-onset allograft injury parallel the increase in CLAD risk and support our hypothesis that late allograft injuries result in a more profound CXCR3/ligand immune response.
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Affiliation(s)
- MY Shino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - SS Weigt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - N Li
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA 90095-1652
| | - A Derhovanessian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - DM Sayah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - RH Huynh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - R Saggar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - AL Gregson
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1688
| | - A Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1741
| | - DJ Ross
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - JP Lynch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - RM Elashoff
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA 90095-1652
| | - JA Belperio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
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15
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Lefrançais E, Ortiz-Muñoz G, Caudrillier A, Mallavia B, Liu F, Sayah DM, Thornton EE, Headley MB, David T, Coughlin SR, Krummel MF, Leavitt AD, Passegué E, Looney MR. The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors. Nature 2017; 544:105-109. [PMID: 28329764 PMCID: PMC5663284 DOI: 10.1038/nature21706] [Citation(s) in RCA: 684] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 02/14/2017] [Indexed: 12/13/2022]
Abstract
Platelets are critical for haemostasis, thrombosis, and inflammatory responses, but the events that lead to mature platelet production remain incompletely understood. The bone marrow has been proposed to be a major site of platelet production, although there is indirect evidence that the lungs might also contribute to platelet biogenesis. Here, by directly imaging the lung microcirculation in mice, we show that a large number of megakaryocytes circulate through the lungs, where they dynamically release platelets. Megakaryocytes that release platelets in the lungs originate from extrapulmonary sites such as the bone marrow; we observed large megakaryocytes migrating out of the bone marrow space. The contribution of the lungs to platelet biogenesis is substantial, accounting for approximately 50% of total platelet production or 10 million platelets per hour. Furthermore, we identified populations of mature and immature megakaryocytes along with haematopoietic progenitors in the extravascular spaces of the lungs. Under conditions of thrombocytopenia and relative stem cell deficiency in the bone marrow, these progenitors can migrate out of the lungs, repopulate the bone marrow, completely reconstitute blood platelet counts, and contribute to multiple haematopoietic lineages. These results identify the lungs as a primary site of terminal platelet production and an organ with considerable haematopoietic potential.
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Affiliation(s)
- Emma Lefrançais
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Guadalupe Ortiz-Muñoz
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Axelle Caudrillier
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Beñat Mallavia
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Fengchun Liu
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - David M. Sayah
- Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California 90095, USA
| | - Emily E. Thornton
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Mark B. Headley
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Tovo David
- Cardiovascular Research Institute, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Shaun R. Coughlin
- Cardiovascular Research Institute, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Matthew F. Krummel
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Andrew D. Leavitt
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Emmanuelle Passegué
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
| | - Mark R. Looney
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
- Department of Laboratory Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143, USA
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16
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Weigt SS, Wang X, Palchevskiy V, Gregson AL, Patel N, DerHovanessian A, Shino MY, Sayah DM, Birjandi S, Lynch JP, Saggar R, Ardehali A, Ross DJ, Palmer SM, Elashoff D, Belperio JA. Gene Expression Profiling of Bronchoalveolar Lavage Cells Preceding a Clinical Diagnosis of Chronic Lung Allograft Dysfunction. PLoS One 2017; 12:e0169894. [PMID: 28103284 PMCID: PMC5245825 DOI: 10.1371/journal.pone.0169894] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 12/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background Chronic Lung Allograft Dysfunction (CLAD) is the main limitation to long-term survival after lung transplantation. Although CLAD is usually not responsive to treatment, earlier identification may improve treatment prospects. Methods In a nested case control study, 1-year post transplant surveillance bronchoalveolar lavage (BAL) fluid samples were obtained from incipient CLAD (n = 9) and CLAD free (n = 8) lung transplant recipients. Incipient CLAD cases were diagnosed with CLAD within 2 years, while controls were free from CLAD for at least 4 years following bronchoscopy. Transcription profiles in the BAL cell pellets were assayed with the HG-U133 Plus 2.0 microarray (Affymetrix). Differential gene expression analysis, based on an absolute fold change (incipient CLAD vs no CLAD) >2.0 and an unadjusted p-value ≤0.05, generated a candidate list containing 55 differentially expressed probe sets (51 up-regulated, 4 down-regulated). Results The cell pellets in incipient CLAD cases were skewed toward immune response pathways, dominated by genes related to recruitment, retention, activation and proliferation of cytotoxic lymphocytes (CD8+ T-cells and natural killer cells). Both hierarchical clustering and a supervised machine learning tool were able to correctly categorize most samples (82.3% and 94.1% respectively) into incipient CLAD and CLAD-free categories. Conclusions These findings suggest that a pathobiology, similar to AR, precedes a clinical diagnosis of CLAD. A larger prospective investigation of the BAL cell pellet transcriptome as a biomarker for CLAD risk stratification is warranted.
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Affiliation(s)
- S. Samuel Weigt
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- * E-mail:
| | - Xiaoyan Wang
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Vyacheslav Palchevskiy
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Aric L. Gregson
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Naman Patel
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Ariss DerHovanessian
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Michael Y. Shino
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - David M. Sayah
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Shirin Birjandi
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Joseph P. Lynch
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Rajan Saggar
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Abbas Ardehali
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - David J. Ross
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Scott M. Palmer
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - John A. Belperio
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
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17
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Kolaitis NA, Duffy E, Zhang A, Lo M, Barba DT, Chen M, Soriano T, Hu J, Nabili V, Saggar R, Sayah DM, DerHovanessian A, Shino MY, Lynch JP, Kubak BM, Ardehali A, Ross DJ, Belperio JA, Elashoff D, Saggar R, Weigt SS. Voriconazole increases the risk for cutaneous squamous cell carcinoma after lung transplantation. Transpl Int 2016; 30:41-48. [PMID: 27678492 DOI: 10.1111/tri.12865] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 03/13/2016] [Revised: 05/04/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Abstract
Lung transplant recipients (LTR) are at high risk of cutaneous squamous cell carcinoma (SCC). Voriconazole exposure after lung transplant has recently been reported as a risk factor for SCC. We sought to study the relationship between fungal prophylaxis with voriconazole and the risk of SCC in sequential cohorts from a single center. We evaluated 400 adult LTR at UCLA between 7/1/2005 and 12/22/2012. On 7/1/2009, our center instituted a protocol switch from targeted to universal antifungal prophylaxis for at least 6 months post-transplant. Using Cox proportional hazards models, time to SCC was compared between targeted (N = 199) and universal (N = 201) prophylaxis cohorts. Cox models were also used to assess SCC risk as a function of time-dependent cumulative exposure to voriconazole and other antifungal agents. The risk of SCC was greater in the universal prophylaxis cohort (HR 2.02, P < 0.01). Voriconazole exposure was greater in the universal prophylaxis cohort, and the cumulative exposure to voriconazole was associated with SCC (HR 1.75, P < 0.01), even after adjustment for other important SCC risk factors. Voriconazole did not increase the risk of advanced tumors. Exposure to other antifungal agents was not associated with SCC. Voriconazole should be used cautiously in this population.
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Affiliation(s)
| | - Erin Duffy
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Alice Zhang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Michelle Lo
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - David T Barba
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Meng Chen
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Teresa Soriano
- Division of Dermatology, University of California, Los Angeles, CA, USA
| | - Jenny Hu
- Division of Dermatology, University of California, Los Angeles, CA, USA
| | - Vishad Nabili
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Rajeev Saggar
- Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - David M Sayah
- Department of Medicine, University of California, Los Angeles, CA, USA
| | | | - Michael Y Shino
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Joseph P Lynch
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Bernie M Kubak
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Abbas Ardehali
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - David J Ross
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - John A Belperio
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Rajan Saggar
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - S Samuel Weigt
- Department of Medicine, University of California, Los Angeles, CA, USA
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DerHovanessian A, Weigt SS, Palchevskiy V, Shino MY, Sayah DM, Gregson AL, Noble PW, Palmer SM, Fishbein MC, Kubak BM, Ardehali A, Ross DJ, Saggar R, Lynch JP, Elashoff RM, Belperio JA. The Role of TGF-β in the Association Between Primary Graft Dysfunction and Bronchiolitis Obliterans Syndrome. Am J Transplant 2016; 16:640-9. [PMID: 26461171 PMCID: PMC4946573 DOI: 10.1111/ajt.13475] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/09/2015] [Accepted: 07/03/2015] [Indexed: 01/25/2023]
Abstract
Primary graft dysfunction (PGD) is a possible risk factor for bronchiolitis obliterans syndrome (BOS) following lung transplantation; however, the mechanism for any such association is poorly understood. Based on the association of TGF-β with acute and chronic inflammatory disorders, we hypothesized that it might play a role in the continuum between PGD and BOS. Thus, the association between PGD and BOS was assessed in a single-center cohort of lung transplant recipients. Bronchoalveolar lavage fluid concentrations of TGF-β and procollagen collected within 24 h of transplantation were compared across the spectrum of PGD, and incorporated into Cox models of BOS. Immunohistochemistry localized expression of TGF-β and its receptor in early lung biopsies posttransplant. We found an association between PGD and BOS in both bilateral and single lung recipients with a hazard ratio of 3.07 (95% CI 1.76-5.38) for the most severe form of PGD. TGF-β and procollagen concentrations were elevated during PGD (p < 0.01), and associated with increased rates of BOS. Expression of TGF-β and its receptor localized to allograft infiltrating mononuclear and stromal cells, and the airway epithelium. These findings validate the association between PGD and the subsequent development of BOS, and suggest that this association may be mediated by receptor/TGF-β biology.
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Affiliation(s)
- Ariss DerHovanessian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
| | - S. Samuel Weigt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Vyacheslav Palchevskiy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Michael Y. Shino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
| | - David M. Sayah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Aric L. Gregson
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, California
| | - Paul W. Noble
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles California
| | - Scott M. Palmer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Michael C. Fishbein
- Depatment of Pathology and Laboratory Medicine, University of California, Los Angeles, California
| | - Bernard M. Kubak
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, California
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, Los Angeles, California
| | - David J. Ross
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Rajan Saggar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Joseph P. Lynch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Robert M. Elashoff
- Department of Biomathematics, University of California, Los Angeles, California
| | - John A. Belperio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, California
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19
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Sayah DM, Mallavia B, Looney MR. Reply: neutrophil extracellular traps in primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med 2015; 191:1089. [PMID: 25932769 DOI: 10.1164/rccm.201501-0177le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- David M Sayah
- 1 University of California, Los Angeles Los Angeles, California
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20
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Sayah DM, Mallavia B, Liu F, Ortiz-Muñoz G, Caudrillier A, DerHovanessian A, Ross DJ, Lynch JP, Saggar R, Ardehali A, Ware LB, Christie JD, Belperio JA, Looney MR. Neutrophil extracellular traps are pathogenic in primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med 2015; 191:455-63. [PMID: 25485813 DOI: 10.1164/rccm.201406-1086oc] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Primary graft dysfunction (PGD) causes early mortality after lung transplantation and may contribute to late graft failure. No effective treatments exist. The pathogenesis of PGD is unclear, although both neutrophils and activated platelets have been implicated. We hypothesized that neutrophil extracellular traps (NETs) contribute to lung injury in PGD in a platelet-dependent manner. OBJECTIVES To study NETs in experimental models of PGD and in lung transplant patients. METHODS Two experimental murine PGD models were studied: hilar clamp and orthotopic lung transplantation after prolonged cold ischemia (OLT-PCI). NETs were assessed by immunofluorescence microscopy and ELISA. Platelet activation was inhibited with aspirin, and NETs were disrupted with DNaseI. NETs were also measured in bronchoalveolar lavage fluid and plasma from lung transplant patients with and without PGD. MEASUREMENTS AND MAIN RESULTS NETs were increased after either hilar clamp or OLT-PCI compared with surgical control subjects. Activation and intrapulmonary accumulation of platelets were increased in OLT-PCI, and platelet inhibition reduced NETs and lung injury, and improved oxygenation. Disruption of NETs by intrabronchial administration of DNaseI also reduced lung injury and improved oxygenation. In bronchoalveolar lavage fluid from human lung transplant recipients, NETs were more abundant in patients with PGD. CONCLUSIONS NETs accumulate in the lung in both experimental and clinical PGD. In experimental PGD, NET formation is platelet-dependent, and disruption of NETs with DNaseI reduces lung injury. These data are the first description of a pathogenic role for NETs in solid organ transplantation and suggest that NETs are a promising therapeutic target in PGD.
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Affiliation(s)
- David M Sayah
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
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21
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Lynch JP, Sayah DM, Belperio JA, Weigt SS. Lung transplantation for cystic fibrosis: results, indications, complications, and controversies. Semin Respir Crit Care Med 2015; 36:299-320. [PMID: 25826595 DOI: 10.1055/s-0035-1547347] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Survival in patients with cystic fibrosis (CF) has improved dramatically over the past 30 to 40 years, with mean survival now approximately 40 years. Nonetheless, progressive respiratory insufficiency remains the major cause of mortality in CF patients, and lung transplantation (LT) is eventually required. Timing of listing for LT is critical, because up to 25 to 41% of CF patients have died while awaiting LT. Globally, approximately 16.4% of lung transplants are performed in adults with CF. Survival rates for LT recipients with CF are superior to other indications, yet LT is associated with substantial morbidity and mortality (∼50% at 5-year survival rates). Myriad complications of LT include allograft failure (acute or chronic), opportunistic infections, and complications of chronic immunosuppressive medications (including malignancy). Determining which patients are candidates for LT is difficult, and survival benefit remains uncertain. In this review, we discuss when LT should be considered, criteria for identifying candidates, contraindications to LT, results post-LT, and specific complications that may be associated with LT. Infectious complications that may complicate CF (particularly Burkholderia cepacia spp., opportunistic fungi, and nontuberculous mycobacteria) are discussed.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David M Sayah
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John A Belperio
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - S Sam Weigt
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
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22
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Greenland JR, Xu X, Sayah DM, Liu FC, Jones KD, Looney MR, Caughey GH. Mast cells in a murine lung ischemia-reperfusion model of primary graft dysfunction. Respir Res 2014; 15:95. [PMID: 25115556 PMCID: PMC4151192 DOI: 10.1186/s12931-014-0095-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/04/2014] [Indexed: 01/21/2023] Open
Abstract
Primary graft dysfunction (PGD), as characterized by pulmonary infiltrates and high oxygen requirements shortly after reperfusion, is the major cause of early morbidity and mortality after lung transplantation. Donor, recipient and allograft-handling factors are thought to contribute, although new insights regarding pathogenesis are needed to guide approaches to prevention and therapy. Mast cells have been implicated in ischemic tissue injury in other model systems and in allograft rejection, leading to the hypothesis that mast cell degranulation contributes to lung injury following reperfusion injury. We tested this hypothesis in a mouse model of PGD involving reversible disruption of blood flow to one lung. Metrics of injury included albumin permeability, plasma extravasation, lung histopathology, and mast cell degranulation. Responses were assessed in wild-type (Kit+/+) and mast cell-deficient (KitW-sh/W-sh) mice. Because mouse lungs have few mast cells compared with human lungs, we also tested responses in mice with lung mastocytosis generated by injecting bone marrow-derived cultured mast cells (BMCMC). We found that ischemic lung responses of mast cell-deficient KitW-sh/W-sh mice did not differ from those of Kit+/+ mice, even after priming for injury using LPS. Degranulated mast cells were more abundant in ischemic than in non-ischemic BMCMC-injected KitW-sh/W-sh lungs. However, lung injury in BMCMC-injected KitW-sh/W-sh and Kit+/+ mice did not differ in globally mast cell-deficient, uninjected KitW-sh/W-sh mice or in wild-type Kit+/+ mice relatively deficient in lung mast cells. These findings predict that mast cells, although activated in lungs injured by ischemia and reperfusion, are not necessary for the development of PGD.
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23
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Shino MY, Weigt SS, Li N, Palchevskiy V, Derhovanessian A, Saggar R, Sayah DM, Gregson AL, Fishbein MC, Ardehali A, Ross DJ, Lynch JP, Elashoff RM, Belperio JA. CXCR3 ligands are associated with the continuum of diffuse alveolar damage to chronic lung allograft dysfunction. Am J Respir Crit Care Med 2013; 188:1117-25. [PMID: 24063316 DOI: 10.1164/rccm.201305-0861oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
RATIONALE After lung transplantation, insults to the allograft generally result in one of four histopathologic patterns of injury: (1) acute rejection, (2) lymphocytic bronchiolitis, (3) organizing pneumonia, and (4) diffuse alveolar damage (DAD). We hypothesized that DAD, the most severe form of acute lung injury, would lead to the highest risk of chronic lung allograft dysfunction (CLAD) and that a type I immune response would mediate this process. OBJECTIVES Determine whether DAD is associated with CLAD and explore the potential role of CXCR3/ligand biology. METHODS Transbronchial biopsies from all lung transplant recipients were reviewed. The association between the four injury patterns and subsequent outcomes were evaluated using proportional hazards models with time-dependent covariates. Bronchoalveolar lavage (BAL) concentrations of the CXCR3 ligands (CXCL9/MIG, CXCL10/IP10, and CXCL11/ITAC) were compared between allograft injury patterns and "healthy" biopsies using linear mixed-effects models. The effect of these chemokine alterations on CLAD risk was assessed using Cox models with serial BAL measurements as time-dependent covariates. MEASUREMENTS AND MAIN RESULTS There were 1,585 biopsies from 441 recipients with 62 episodes of DAD. An episode of DAD was associated with increased risk of CLAD (hazard ratio, 3.0; 95% confidence interval, 1.9-4.7) and death (hazard ratio, 2.3; 95% confidence interval, 1.7-3.0). There were marked elevations in BAL CXCR3 ligand concentrations during DAD. Furthermore, prolonged elevation of these chemokines in serial BAL fluid measurements predicted the development of CLAD. CONCLUSIONS DAD is associated with marked increases in the risk of CLAD and death after lung transplantation. This association may be mediated in part by an aberrant type I immune response involving CXCR3/ligands.
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Affiliation(s)
- Michael Y Shino
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
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24
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Sayah DM, Schwartz BS, Kukreja J, Singer JP, Golden JA, Leard LE. Scedosporium prolificans pericarditis and mycotic aortic aneurysm in a lung transplant recipient receiving voriconazole prophylaxis. Transpl Infect Dis 2013; 15:E70-4. [PMID: 23387799 DOI: 10.1111/tid.12056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/13/2012] [Accepted: 11/23/2012] [Indexed: 11/28/2022]
Abstract
Despite the adoption of antifungal prophylaxis, fungal infections remain a significant concern in lung transplant recipients. Indeed, some concern exists that such prophylaxis may increase the risk of infection with drug-resistant fungal organisms. Here, we describe a case of disseminated Scedosporium prolificans infection, presenting as pericarditis, which developed in a lung transplant patient receiving prophylactic voriconazole for 8 months. The epidemiology and clinical presentation of S. prolificans infections are reviewed, and controversies surrounding antifungal prophylaxis and the development of resistant infections are discussed.
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Affiliation(s)
- D M Sayah
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, California, USA.
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25
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Sayah DM, Koff JL, Leard LE, Hays SR, Golden JA, Singer JP. Rhinovirus and other respiratory viruses exert different effects on lung allograft function that are not mediated through acute rejection. Clin Transplant 2012; 27:E64-71. [PMID: 23278569 DOI: 10.1111/ctr.12054] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Community acquired respiratory virus (CARV) infections in lung transplant recipients (LTR) have been associated with adverse outcomes, including acute rejection (AR) and decline in allograft function, in some but not in all studies. METHODS Spirometry and transbronchial biopsy results of LTR diagnosed with CARV infection over a two-yr period were extracted from clinical records. Primary outcomes, studied at 1-2.5 months postinfection, were as follows: (i) incidence of biopsy-proven AR (grade >A0) and (ii) allograft function, defined by forced expiratory volume in one s (FEV(1)). A reference group of biopsies (n = 526) collected during the study period established the baseline incidence of AR. Rhinovirus (RV) and non-rhinovirus (non-RV) infections were analyzed as subgroups. RESULTS Eighty-seven cases of CARV infection were identified in 59 subjects. Incidences of AR were similar in the post-CARV and reference groups and did not differ significantly after RV vs. non-RV infection. Allograft function declined significantly after non-RV infection, but not after RV infection. CONCLUSIONS In LTR, CARV infections other than RV are associated with allograft dysfunction at 1-2.5 months after infection. However, CARVs do not appear associated with AR at this time point. The impact of specific CARVs on lung allografts, including the development of chronic allograft rejection, merits further study.
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Affiliation(s)
- David M Sayah
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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26
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Sayah DM, Looney MR, Toy P. Transfusion reactions: newer concepts on the pathophysiology, incidence, treatment, and prevention of transfusion-related acute lung injury. Crit Care Clin 2012; 28:363-72, v. [PMID: 22713611 DOI: 10.1016/j.ccc.2012.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. TRALI presents as acute lung injury (ALI) within 6 hours after blood product transfusion. Diagnosing TRALI requires a high index of suspicion, and the exclusion of circulatory overload or other causes of ALI. The pathophysiology of TRALI is incompletely understood, but in part involves transfusion of certain anti-neutrophil antibodies, anti-HLA antibodies, or other bioactive substances, into susceptible recipients. Recent studies have identified both recipient and transfusion risk factors for the development of TRALI. This article describes these TRALI risk factors, as well as diagnosis, treatment and prevention strategies.
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Affiliation(s)
- David M Sayah
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0130, USA.
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27
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Berthoux L, Sebastian S, Sayah DM, Luban J. Disruption of human TRIM5alpha antiviral activity by nonhuman primate orthologues. J Virol 2005; 79:7883-8. [PMID: 15919943 PMCID: PMC1143641 DOI: 10.1128/jvi.79.12.7883-7888.2005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 02/15/2005] [Indexed: 11/20/2022] Open
Abstract
TRIM5 is a determinant of species-specific differences in susceptibility to infection by retroviruses bearing particular capsids. Human immunodeficiency virus type 1 (HIV-1) infection is blocked by the alpha isoform of macaque TRIM5 (TRIM5alpha(rh)) or by the product of the owl monkey TRIM5-cyclophilin A gene fusion (TRIMCyp). Human TRIM5alpha potently restricts specific strains of murine leukemia virus (N-MLV) but has only a modest effect on HIV-1. The amino termini of TRIM5 orthologues are highly conserved and possess a coiled-coil domain that promotes homomultimerization. Here we show that heterologous expression of TRIM5alpha(rh) or TRIMCyp in human cells interferes with the anti-N-MLV activity of endogenous human TRIM5alpha (TRIM5alpha(hu)). Deletion of the cyclophilin domain from TRIMCyp has no effect on heteromultimerization or colocalization with TRIM5alpha(hu) but prevents interference with anti-N-MLV activity. These data demonstrate that TRIM5 orthologues form heteromultimers and indicate that C-terminal extensions alter virus recognition by multimers of these proteins.
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Affiliation(s)
- Lionel Berthoux
- Department of Microbiology, Columbia University College of Physicians and Surgeons, 701 West 168th St., New York, NY 10032, USA
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28
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Sokolskaja E, Sayah DM, Luban J. Target cell cyclophilin A modulates human immunodeficiency virus type 1 infectivity. J Virol 2004; 78:12800-8. [PMID: 15542632 PMCID: PMC524981 DOI: 10.1128/jvi.78.23.12800-12808.2004] [Citation(s) in RCA: 183] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Accepted: 07/22/2004] [Indexed: 11/20/2022] Open
Abstract
The peptidyl-prolyl isomerase cyclophilin A (CypA) increases the kinetics by which human immunodeficiency virus type 1 (HIV-1) spreads in tissue culture. This was conclusively demonstrated by gene targeting in human CD4(+) T cells, but the role of CypA in HIV-1 replication remains unknown. Though CypA binds to mature HIV-1 capsid protein (CA), it is also incorporated into nascent HIV-1 virions via interaction with the CA domain of the Gag polyprotein. These findings raised the possibility that CypA might act at multiple steps of the retroviral life cycle. Disruption of the CA-CypA interaction, either by the competitive inhibitor cyclosporine (CsA) or by mutation of CA residue G89 or P90, suggested that producer cell CypA was required for full virion infectivity. However, recent studies indicate that CypA within the target cell regulates HIV-1 infectivity by modulating Ref1- or Lv1-mediated restriction. To examine the relative contribution to HIV-1 replication of producer cell CypA and target cell CypA, we exploited multiple tools that disrupt the HIV-1 CA-CypA interaction. These tools included the drugs CsA, MeIle(4)-CsA, and Sanglifehrin; CA mutants exhibiting decreased affinity for CypA or altered CypA dependence; HeLa cells with CypA knockdown by RNA interference; and Jurkat T cells homozygous for a deletion of the gene encoding CypA. Our results clearly demonstrate that target cell CypA, and not producer cell CypA, is important for HIV-1 CA-mediated function. Inhibition of HIV-1 infectivity resulting from virion production in the presence of CsA occurs independently of the CA-CypA interaction or even of CypA.
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Affiliation(s)
- Elena Sokolskaja
- Department of Microbiology, Columbia University, 701 W. 168th St., New York, NY 10032, USA
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29
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Sayah DM, Luban J. Selection for loss of Ref1 activity in human cells releases human immunodeficiency virus type 1 from cyclophilin A dependence during infection. J Virol 2004; 78:12066-70. [PMID: 15479848 PMCID: PMC523284 DOI: 10.1128/jvi.78.21.12066-12070.2004] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2004] [Accepted: 06/21/2004] [Indexed: 11/20/2022] Open
Abstract
Capsid (CA)-specific restrictions are determinants of retroviral tropism in mammalian cells. One such restriction, human Ref1, targets strains of murine leukemia virus bearing an arginine at CA residue 110 (N-MLV), resulting in decreased accumulation of viral cDNA. The cellular factors accounting for Ref1 activity are unknown. As(2)O(3) increases N-MLV titer in Ref1-positive cells, possibly by counteracting Ref1. Restriction factor saturation experiments suggest that Ref1 may also target human immunodeficiency virus type 1 (HIV-1), but only if its CA is not bound to the cellular protein cyclophilin A (CypA). As a step towards understanding the genetic determinants of Ref1, we subjected Ref1-positive TE671 cells to three sequential rounds of selection with N-MLV reporter viruses. We isolated a subclone, 17H1, that was permissive for N-MLV infection and therefore deficient in Ref1 activity. Stimulation of N-MLV replication by As(2)O(3) was attenuated in 17H1, confirming that the drug acts by overcoming Ref1 activity. HIV-1 infection of 17H1 cells was resistant to disruption of the CA-CypA interaction, demonstrating that Ref1 restricts CypA-free HIV-1. Our results suggest that interaction with CypA evolved to protect HIV-1 from this human antiviral activity.
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Affiliation(s)
- David M Sayah
- Departmetn of Microbiology, Columbia University College of Physicians and Surgeons, 701 W. 168th St., New York, NY 10032, USA
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30
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Sayah DM, Sokolskaja E, Berthoux L, Luban J. Cyclophilin A retrotransposition into TRIM5 explains owl monkey resistance to HIV-1. Nature 2004; 430:569-73. [PMID: 15243629 DOI: 10.1038/nature02777] [Citation(s) in RCA: 529] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 06/22/2004] [Indexed: 01/03/2023]
Abstract
In Old World primates, TRIM5-alpha confers a potent block to human immunodeficiency virus type 1 (HIV-1) infection that acts after virus entry into cells. Cyclophilin A (CypA) binding to viral capsid protects HIV-1 from a similar activity in human cells. Among New World primates, only owl monkeys exhibit post-entry restriction of HIV-1 (ref. 1). Paradoxically, the barrier to HIV-1 in owl monkey cells is released by capsid mutants or drugs that disrupt capsid interaction with CypA. Here we show that knockdown of owl monkey CypA by RNA interference (RNAi) correlates with suppression of anti-HIV-1 activity. However, reintroduction of CypA protein to RNAi-treated cells did not restore antiviral activity. A search for additional RNAi targets unearthed TRIMCyp, an RNAi-responsive messenger RNA encoding a TRIM5-CypA fusion protein. TRIMCyp accounts for post-entry restriction of HIV-1 in owl monkeys and blocks HIV-1 infection when transferred to otherwise infectable human or rat cells. It seems that TRIMCyp arose after the divergence of New and Old World primates when a LINE-1 retrotransposon catalysed the insertion of a CypA complementary DNA into the TRIM5 locus. This is the first vertebrate example of a chimaeric gene generated by this mechanism of exon shuffling.
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Affiliation(s)
- David M Sayah
- Department of Microbiology, Columbia University, College of Physicians and Surgeons, 701 West 168th Street, HHSC 1502 New York, New York 10032, USA
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Abstract
A genetic screen using mice was performed to identify dominant loci affecting behavior. Mice were mutagenized with ENU, then bred to examine their G1 offspring for behavioral abnormalities. Potentially mutant G1 pups were screened through a variety of behavioral assays, including tests of learning and memory, sensorimotor gating, fear and anxiety, nociception (pain perception) and locomotor activity. Mice falling outside the normal performance distribution in these tests were considered potential behavioral mutants and were bred for further analysis. Outliers included both animals with very discrete defects and animals with abnormal performance across a range of tests. To date, we have identified two confirmed mutants affecting sensorimotor gating. These results provide further impetus for the use of random mutagenesis screens as a tool for dissecting the genetic basis of brain and behavior.
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Affiliation(s)
- D M Sayah
- Department of Molecular and Medical Pharmacology, UCLA School of Medicine, 23-120 CHS, Box 951735, Los Angeles, CA 90095-1735, USA
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