mTOR Inhibition Impairs the Activation and Function of Belatacept-Resistant CD4+CD57+ T Cells In Vivo and In Vitro

Calcineurin inhibitors have improved graft survival in solid-organ transplantation but their use is limited by toxicity, requiring a switch to another immunosuppressor in some cases. Belatacept is one option that has been shown to improve graft and patient survival despite being associated with a higher risk of acute cellular rejection. This risk of acute cellular rejection is correlated with the presence of belatacept-resistant T cells. We performed a transcriptomic analysis of in vitro-activated cells to identify pathways affected by belatacept in belatacept-sensitive cells (CD4⁺CD57^-) but not in belatacept-resistant CD4⁺CD57⁺ T cells. mTOR was significantly downregulated in belatacept-sensitive but not belatacept-resistant T cells. The inhibition of mTOR strongly decreases the activation and cytotoxicity of CD4⁺CD57⁺ cells. In humans, the use of a combination of mTOR inhibitor and belatacept prevents graft rejection and decreases the expression of activation markers on CD4 and CD8 T cells. mTOR inhibition decreases the functioning of belatacept-resistant CD4⁺CD57⁺ T cells in vitro and in vivo. It could potentially be used in association with belatacept to prevent acute cellular rejection in cases of calcineurin intolerance.

Impact of DSA and immunosuppression minimization on rejection, graft, and patient survival after simultaneous liver–kidney transplantation

Background

Acute rejection rate is low after simultaneous liver–kidney transplantation (SLKT), leading some groups to minimize immunosuppressive (IS) regimens. However, the impact of preformed (pDSA) or de novo donor-specific antibodies (dnDSA) on the graft remains unclear.

Methods

We performed a retrospective analysis of 102 consecutive SLKT patients to study the impact of anti-HLA antibodies.

Results

Anti-HLA antibodies were detected in 75 recipients (class I 23.8%, both classes I and II 23.8%, and class II 14.3%). In total, 42.8% of the patients had pDSA and 21.7% developed dnDSA. Overall patient survival at 1–3 and 5 years, was respectively 88, 84, and 80%. Acute rejection occurred respectively in 3 (2.9%) liver and 6 kidney (5.9%) recipients. pDSA with titers over 10,000 mean fluorescence intensity (14.3%) was associated with lower patient survival (40 vs. 82%) but not with acute rejection. In a multivariable Cox regression analysis, the risk of death was associated with maleness, the highest titer of pDSA (p < 0.0007) or the sum of pDSA >10,000. Renal function did not differ between patients with class I pDSA (p = 0.631) and those with class II pDSA (p = 0.112) or between patients with and without a positive cross-match (p = 0.842). dnDSA were not associated with acute rejection, graft dysfunction or patient survival. IS minimization was not associated with rejection, graft dysfunction or death.

Conclusion

In SLKT, high levels of pDSA >10,000 were associated with lower patient survival, but not rejection or graft survival. Minimization of maintenance immunosuppression regimen was not associated with a poorer outcome.

The proliferation of belatacept-resistant T cells requires early IFNα pathway activation

Belatacept was developed to replace calcineurin inhibitors in kidney transplantation. Its use is associated with better kidney transplant function, a lower incidence of anti-donor antibodies and higher graft survival. However, it is also associated with a higher risk of cellular rejection. We studied the activation and proliferation mechanisms of belatacept-resistant T lymphocytes (TLs), to identify new pathways for control. We performed a transcriptomic analysis on CD4⁺ CD57⁺ PD1^- memory TLs, which are responsible for a higher incidence of graft rejection, after allogeneic stimulation with activated dendritic cells (aDCs) in the presence or absence of belatacept. After six hours of contact with aDCs, the (CD4⁺ CD57⁺ PD1^- ) (CD4⁺ CD57⁺ PD1⁺ ) and (CD4⁺ CD57^- ) lymphocytes had different transcriptional profiles with or without belatacept. In the CD4⁺ CD57⁺ PD1^- population, the IFNα-dependent activation pathway was positively overrepresented, and IRF7 transcript levels were high. IRF7 was associated with IFNα/β and IL-6 regulation. The inhibition of both these cytokines in a context of belatacept treatment inhibited the proliferation of CD4⁺ CD57⁺ PD1^- T cells. Our results show that IRF7 is rapidly upregulated in belatacept-resistant CD4⁺ CD57⁺ PD1^- TLs. The inhibition of type I IFN or IL-6 in association with belatacept treatment reduces the proliferation of belatacept-resistant TLs, paving the way for new treatments for use in organ transplantation.

CASK, the Soluble Glomerular Permeability Factor, Is Secreted by Macrophages in Patients With Recurrent Focal and Segmental Glomerulo-Sclerosis

Introduction: Focal and segmental glomerulosclerosis (FSGS) is a frequent form of glomerulonephritis that may be caused by a soluble permeability factor and regulated by the immune system. We previously described a soluble form of calcium/calmodulin-dependent serine/threonine kinase (CASK) acting as a permeability factor in patients with recurrent FSGS (rFSGS). Here, we aimed to identify the immune cells associated with CASK secretion in patients with rFSGS. Methods: FACS, western blotting and immunoprecipitation were performed to detect CASK in peripheral blood mononuclear cells, including CD3⁺, CD20⁺, and CD14⁺subsets, from patients with rFSGS, healthy donors, transplant patients and patients with nephrotic syndrome due to diabetes mellitus, and in KHM2 cells. Results: CASK was produced mostly by monocytes in patients with rFSGS but not by T or B lymphocytes. It was not detectein cells from control patients. CASK was also produced and secreted by M2 polarized macrophages and KMH2 cells, but not by M1 polarized macrophages. CASK secretion was not not inhibited by brefeldin A, suggesting an absence of classical secretion pathway involvement. Within cells, CASK was partly colocalized with ALIX, a molecule involved in exosome development, and these two molecules were coprecipitated from M2 macrophages. Moreover, exosomes derived from M2 macrophages induced podocyte cytoskeleton alterations and increased podocyte motility. Conclusion: These results suggest that the soluble permeability factor CASK is secreted by monocytes and M2 macrophages, via exosomes, to alter the glomerular filtration barrier in rFSGS.

Human Fetal Liver Mesenchymal Stem Cell-Derived Exosomes Impair Natural Killer Cell Function

Mesenchymal stem cells (MSCs) are powerful immunomodulators that regulate the diverse functions of immune cells involved in allogeneic reactions, such as T cells and natural killer (NK) cells, through cell-cell contact or secreted factors. Exosomes secreted by MSCs may be involved in their regulatory functions, providing new therapeutic tools. Here, we showed that fetal liver (FL) MSC-derived exosomes inhibit proliferation, activation, and cytotoxicity of NK cells. Exosomes bearing latency associated peptide (LAP), TGFβ, and thrombospondin 1 (TSP1), a regulatory molecule for TGFβ, induced downstream TGFβ/Smad2/3 signaling in NK cells. The inhibition of TGFβ, using a neutralizing anti-TGFβ antibody, restored NK proliferation, differentiation, and cytotoxicity, demonstrating that FL-MSC-derived exosomes exert their inhibition on NK cell function via TGFβ. These results suggest that FL-MSC-derived exosomes regulate NK cell functions through exosome-associated TGFβ.

Circulating CASK is associated with recurrent focal segmental glomerulosclerosis after transplantation

Introduction

Focal and Segmental GlomeruloSclerosis (FSGS) can cause nephrotic syndrome with a risk of progression to end-stage renal disease. The idiopathic form has a high rate of recurrence after transplantation, suggesting the presence of a systemic circulating factor that causes glomerular permeability and can be removed by plasmapheresis or protein-A immunoadsorption.

Results

To identify this circulating factor, the eluate proteins bound on therapeutic immunoadsorption with protein-A columns were analyzed by comparative electrophoresis and mass spectrometry. A soluble form of calcium/calmodulin-dependent serine protein kinase (CASK) was identified. CASK was immunoprecipitated only in the sera of patients with recurrent FSGS after transplantation and not in control patients. Recombinant-CASK (rCASK) induced the reorganization of the actin cytoskeleton in immortalized podocytes, a redistribution of synaptopodin, ZO-1,vinculin and ENA. rCASK also induced alterations in the permeability of a monolayer of podocytes and increased the motility of pdodocytes in vitro. The extracellular domain of CD98, a transmembrane receptor expressed on renal epithelial cells, has been found to co-immunoprecipitated with rCASK. The invalidation of CD98 with siRNA avoided the structural changes of rCask treated cells suggesting its involvement in physiopathology of the disease. In mice, recombinant CASK induced proteinuria and foot process effacement in podocytes.

Conclusion

Our results suggest that CASK can induce the recurrence of FSGS after renal transplantation.

SYK Inhibition Induces Apoptosis in Germinal Center-Like B Cells by Modulating the Antiapoptotic Protein Myeloid Cell Leukemia-1, Affecting B-Cell Activation and Antibody Production

B cells play a major role in the antibody-mediated rejection (AMR) of solid organ transplants, a major public health concern. The germinal center (GC) is involved in the generation of donor-specific antibody-producing plasma cells and memory B cells, which are often poorly controlled by current treatments. Myeloid cell leukemia-1 (Mcl-1), an antiapoptotic member of the B-cell lymphoma-2 family, is essential for maintenance of the GC reaction and B-cell differentiation. During chronic AMR (cAMR), tertiary lymphoid structures resembling GCs appear in the rejected organ, suggesting local lymphoid neogenesis. We report the infiltration of the kidneys with B cells expressing Mcl-1 in patients with cAMR. We modulated GC viability by impairing B-cell receptor signaling, by spleen tyrosine kinase (SYK) inhibition. SYK inhibition lowers viability and Mcl-1 protein levels in Burkitt's lymphoma cell lines. This downregulation of Mcl-1 is coordinated at the transcriptional level, possibly by signal transducer and activator of transcription 3 (STAT3), as shown by (1) the impaired translocation of STAT3 to the nucleus following SYK inhibition, and (2) the lower levels of Mcl-1 transcription upon STAT3 inhibition. Mcl-1 overproduction prevented cells from entering apoptosis following SYK inhibition. In vitro studies with primary tonsillar B cells confirmed that SYK inhibition impaired cell survival and decreased Mcl-1 protein levels. It also impaired B-cell activation and immunoglobulin G secretion by tonsillar B cells. These findings suggest that the SYK-Mcl-1 pathway could be targeted, to improve graft survival by manipulating the humoral immune response.

CD57(+) CD4 T Cells Underlie Belatacept-Resistant Allograft Rejection

Belatacept is a B7-specific fusion protein used to prevent allograft rejection by blocking T cell costimulation. Generally efficacious, it fails to prevent acute rejection in a sizable minority of patients. In experimental models, memory T cells mediate costimulation blockade-resistant rejection (CoBRR), but this remains undefined in humans. To explore relationships between individual patients' immune cell phenotypes and CoBRR, we studied patients receiving belatacept or conventional calcineurin inhibitor-based immunosuppression. We identified a population of CD57(+) PD1(-) CD4 T cells present prior to transplantation that correlated with CoBRR. Contrary to data recognizing CD57 as a marker of senescence on CD8 T cells, we discovered a nonsenescent, cytolytic phenotype associated with CD57 on CD4 T cells. Moreover, CD57(+) CD4 T cells expressed high levels of adhesion molecules implicated in experimental CoBRR, were CD28(-) , expressed a transcriptional phenotype broadly defining allograft rejection and were shown to be present in rejecting human kidney allografts. These data implicate CD57(+) CD4 T cells in clinical CoBRR. If prospectively validated, this characteristic could identify patients at higher risk for acute rejection on belatacept-based therapy.

Immature human dendritic cells enhance their migration through KCa3.1 channel activation

Migration capacity is essential for dendritic cells (DCs) to present antigen to T cells for the induction of immune response. The DC migration is supposed to be a calcium-dependent process, while not fully understood. Here, we report a role of the KCa3.1/IK1/SK4 channels in the migration capacity of both immature (iDC) and mature (mDC) human CD14(+)-derived DCs. KCa3.1 channels were shown to control the membrane potential of human DC and the Ca(2+) entry, which is directly related to migration capacities. The expression of migration marker such as CCR5 and CCR7 was modified in both types of DCs by TRAM-34 (100nM). But, only the migration of iDC was decreased by use of both TRAM-34 and KCa3.1 siRNA. Confocal analyses showed a close localization of CCR5 with KCa3.1 in the steady state of iDC. Finally, the implication of KCa3.1 seems to be limited to the migration capacities as T cell activation of DCs appeared unchanged. Altogether, these results demonstrated that KCa3.1 channels have a pro-migratory effect on iDC migration. Our findings suggest that KCa3.1 in human iDC play a major role in their migration and constitute an attractive target for the cell therapy optimization.

IL-2 phosphorylates STAT5 to drive IFN-γ production and activation of human dendritic cells

Human dendritic cells (hDCs) produce IL-2 and express IL-2R α-chain (CD25), but the role of IL-2 in DC functions is not well defined. A recent study suggested that the main function of CD25 on hDCs was to transpresent IL-2 to activate T lymphocytes. Our results demonstrate the expression of the three chains of the IL-2R on hDCs and that IL-2 induces STAT5 phosphorylation. Interestingly, use of inhibitors of p-STAT5 revealed that IL-2 increases LPS-induced IFN-γ through STAT5 phosphorylation. Finally, we report that IL-2 increases the ability of hDCs to activate helpless CD8(+) T cells, most likely because of IL-2-triggered IFN-γ synthesis, as we previously described. For the first time, to our knowledge, we disclose that IL-2 induces monocyte-derived hDC's functional maturation and activation through IL-2R binding. Interestingly, our study suggests a direct effect of anti-CD25 mAbs on hDCs that may contribute to their clinical efficacy.

Direct CD4 help provision following interaction of memory CD4 and CD8 T cells with distinct antigen-presenting dendritic cells

Accumulating evidence suggests that CD4 help is needed at the memory stage to mount effective secondary CD8 T cell responses. In this paper, we report that memory CD4 T cells can provide efficient help to memory CD8 T cells after interaction of the two lymphocytes with distinct dendritic cells. Provision of help to CD8 T cells required direct cell-cell contact and involved both IL-2 and CD40 ligation, within a CD4-CD8 T cell synapse. Thus, following antigenic interaction with APCs, activated memory CD4 and CD8 T cells appear to separate from their respective APCs before meeting each other for help provision, regardless of their Ag specificity. CD4 help for memory CD8 T cells therefore appears to be conditioned primarily not by Ag specificity but by activation status.

hCG in the Regulation of Placental Angiogenesis. Results of an In Vitro Study

Placental vascular development is essential for fetal growth and development. Inadequate placental vascular development is associated with early pregnancy losses and other pregnancy related pathologies. In addition to the ubiquitous, well-characterized angiogenic factors like vascular endothelial growth factor (VEGF) or basic fibroblast growth factor (bFGF), some pregnancy-specific factors (e.g. human chorionic gonadotropin (hCG), insulin-like growth factor-II (IGF-II) or alpha fetoprotein (AFP) were recently described to play a possible regulatory role in this process. In the present study we described an improved separation method for human placental microvascular endothelial cells (HPMVEC) and their functional characterization. Using the combination of enzymatic digestion and multistep immunomagnetic sorting with CD31 antibodies a model for villous vascularization was established. Isolated cells took up ac-dil-LDL, spontaneously formed capillary-like structures, and expressed common endothelial markers such as vascular endothelial growth factor receptor-2 (VEGFR-2), angiopoetin-1 and -2, Tie-2, CD144, thrombomodulin, and von Willebrand factor (vWF) as shown by RT-PCR, flow cytometry and Western blot analysis. The expression of the hCG/LH receptor in the placental vascular tree was verified both in vitro and in vivo. hCG stimulated proliferation of HPMVEC in a dose specific manner. While hCG alone had no significant effect on endothelial cell apoptosis, the combination of VEGF-A and hCG protected HPMVEC from staurosporine-induced apoptosis. hCG significantly stimulated sprout formation when compared to controls in a spheroid angiogenesis assay. Our results demonstrate a modified and reproducible method allowing studies of placental vascular development and provide new insights into the possible role of trophoblastic factors in this process.

HCG increases trophoblast migration in vitro via the insulin-like growth factor-II/mannose-6 phosphate receptor

We have previously shown that both HCG and insulin-like growth factor-II (IGF-II) stimulate trophoblastic invasion. Furthermore, the invasion-promoting function of IGF-II resulted from IGF-II mannose 6-phosphate receptor (IGF-II/M6PR) activation. Since HCG and IGF-II did not have an additive effect on cell migration of extravillous trophoblast (EVT) cell line, HTR-8 SVneo, we hypothesized that HCG actions are mediated via alterations in the expression and/or function of IGF-II axis. HCG treatment (50-50,000 mU/ml) of the HTR-8/SVneo cells did not alter the expression of either insulin-like growth factor-I or IGF-II mRNA or peptide synthesis, but caused (i) an increase in the (125)I-IGF-II binding to EVT cells, and (ii) an increase in the externalization rate of the IGF-II binding sites without affecting their internalization. This effect was due to the increase in the number of IGF-II binding sites in the plasma membrane without any change in the IGF-II binding affinity. Although HCG did not influence the abundance of IGF-II/M6PR mRNA or protein, anti-IGF-II/M6PR antibody decreased HCG-induced migration of EVT, supporting the hypothesis that HCG might stimulate EVT migration by increasing IGF-II binding to the plasma membrane and subsequently by increasing the IGF-II effect probably mediated via the IGF-II/M6PR.

A case of intracranial dural arteriovenous fistula draining into the spinal medullary veins

Intracranial dural arteriovenous fistulas draining into the spinal medullary veins (ICDAVFMs) are exceedingly rare lesions. Their diagnosis is difficult and is often made late. About twenty well documented cases have been published. We report a case in a 55-year-old woman who presented with persistent interscapular pain and neurological evidence of ascending myelopathy after therapy for cervicobrachial neuralgia. ICDAVFM should be considered by rheumatologists in patients with clinical and radiological findings suggestive of spinal cord disease, particularly if these findings indicate involvement of the medulla oblongata or cervical spinal cord.

The behavioral pharmacology of butaclamol hydrochloride (AY-23,028), a new potent neuroleptic drug

Butaclamol hydrochloride (AY-23,028) is a member of a new chemical class for which antipsychotic activity in humans has recently been demonstrated. The compound antagonized amphetamine-induced stereotyped behavior in rats, amphetamine toxicity in aggregated mice and apomorphine-induced emesis in dogs. It depressed both discriminated avoidance and continuous lever-pressing behavior in rats and inhibited ambulation and rearing in the open field. At higher doses, AY-23,028 induced catalepsy. Adrenergic blocking activity, measured by the antagonism of epinephrine-induced mortality, was weak. These pharmacological actions are characteristic of neuroleptic drugs. In the dose range where the aforementioned effects were observed AY-23,028 did not antagonize either the tetrabenazine-induced ptosis or the tremorine syndrome and did not cause either hypothermia or ataxia. The potency and onset of action of AY-23,028 were comparable to those of fluphenazine but AY-23,028 was of longer duration. The results are discussed in relation to current concepts of neuroleptic mechanisms.

Determination of the therapeutic mean effective doses of several anti-inflammatory agents in adjuvant arthritic rats

The large variation in the severity of the arthritic response of the adjuvant-injected rat often makes it impossible to obtain statistically manageable dose–response curves with anti-inflammatory drugs. Consequently, the relative potency of anti-inflammatory drugs generally was not established. In the present study, with a modification of the therapeutic test, reliable dose–response curves were obtained with seven anti-inflammatory drugs. With this method the "therapeutic" mean effective dose (ED50) and relative potency were calculated by probit analysis. Charles River rats were injected in the left hind paw with adjuvant. On day 14, rats with an injected paw volume of 4–6 ml that increased by at least 0.5 ml between days 10 and 14 were selected for drug treatment. Groups of 6–12 rats with a mean injected paw volume of 5–5.5 ml were formed. Dosing with compounds was started on day 14 and continued daily until day 22 (nine injections). Ninety-four percent of the arthritic control rats showed a further increase in injected paw size between days 14 and 22 (mean, 1.06 ± 0.12 ml) whereas rats dosed with anti-inflammatory compounds showed a dose-related decrease in paw size during the same period. A decrease of 0.5 ml or more between days 14 and 22 was considered to be a therapeutic effect, smaller decreases were taken as no effect. The oral ED50's in milligrams per kilogram were indomethacin, 0.22 ± 0.05; prednisolone, 3.49 ± 1.0; hydrocortisone, 12.4 ± 3.0; phenylbutazone, 13.27 ± 2.7; mefenamic acid 20.10 ± 5.8; aminopyrine, 129.95 ± 25.3; and aspirin, 279.0 ± 24.6. Except for aspirin, the relative potency of the compounds studied by this therapeutic test (chronic) was comparable to that reported for the acute carrageenin assay. Aspirin appears to be markedly less active in chronic inflammation than in acute. This finding is consistent with both experimental and clinical observations.

Induction of ovulation in progestin-treated adult rats

The ovulation was blocked in a strain of 4 day cyclic rats by a single intramuscular injection of different doses of medroxyprogesterone acetate (MPA). The MPA was given one day before the expected day of prooestrus. The ovulation-blocking effect of smaller doses of MPA (0.01 and 0.1 mg/rat) was reversed by two orally active oestrogens, namely, ethynyl oestradiol and a new oestrogen, AY-11,483. The anti-ovulatory effect of 1.0 mg MPA could not be reversed by smaller or bigger doses of any one of the oestrogens. These oestrogens were given orally also on the day before prooestrus. Evidence of ovulation was obtained by counting freshlyshed ova microscopically from the fallopian tubes on the expected day of the following oestrus. Both of these oestrogens were active in reversing the ovulation-blocking effect of smaller doses of MPA. It has been suggested that a bigger dose of MPA, in addition to blocking the release of pituitary-LH, also suppressed the ovarian response to exogenous gonadotrophin.

The effect of some CNS depressants on the hypermotility and anorexia induced by amphetamine in rats

This study examines the effects of chlorpromazine, tetrabenazine, and chlordiazepoxide on the hypermotility and anorexia caused by amphetamine 11.5 mg/kg per os in rats. Each CNS depressant was used at three dose levels and was administered simultaneously with amphetamine. Chlorpromazine, 2 mg/kg, potentiated the hypermotility caused by amphetamine as measured in jiggle cages. Higher doses antagonized amphetamine stimulation. In rats which were trained to eat during a 5-h period, all doses of chlorpromazine potentiated amphetamine anorexia. Tetrabenazine antagonized amphetamine stimulation but did not affect its anorexic effect. Chlordiazepoxide antagonized both effects of amphetamine.

Effects of medroxyprogesterone acetate and chlorpromazine on ovulation and vaginal cytology in a strain of 4-day cyclic rats

A correlation observed between the vaginal cornification and the presence of freshly shed ova in the fallopian tube in a strain of 4-day cyclic rats was altered by administering medroxyprogesterone acetate (MPA) and chlorpromazine (CPZ). MPA, given 1 day before proestrus, blocked vaginal cornification, uterine fluid imbibition, and ovulation. A single injection of human chorionic gonadotropin (HCG), given on the expected day of proestrus, induced ovulation in all MPA-treated rats, but did not induce estrogenic parameters. CPZ, given at noon on the day of proestrus, also blocked ovulation, but did not alter the estrogenic effects. Again, HCG induced ovulation in CPZ-treated rats. These data indicate that MPA and CPZ have a similar pharmacologic effect at the hypothalamus–pituitary axis, while acting differently at the estrogenic receptor sites.

Prolongation of certain effects of amphetamine by chlorpromazine

This study examines the effect of chlorpromazine on the hypermotility and hyperthermia induced by amphetamine in rats and correlates the effects observed with brain levels of the stimulant. Chlorpromazine antagonized these effects of amphetamine initially, and there was a dose–effect relationship in this antagonism. On the other hand, a combination of 7.2 mg/kg chlorpromazine and 8.5 mg/kg dl-amphetamine caused a delayed excitation and hyperthermia. The excitatory effect of this dose of amphetamine was prolonged by doses of chlorpromazine ranging from 1.9 to 7.2 mg/kg. Chlorpromazine modified the disposition of amphetamine as evidenced by considerably higher and more sustained brain levels of the stimulant in rats which received the combined treatment. The significance of these findings and the similarity of the interaction of chlorpromazine and imipramine with amphetamine are discussed.