1
|
Yeung MY, Murakami N, Kafetzi ML, Simmons DP, Wood I, Macaskill P, Towle M, DellaGatta J, Stevens J, Comeau E, Baronas J, Mohsin N, Chen M, Lee JH, Lane WJ, Milford EL, Guleria I. Impact of allele-specific anti-human leukocyte antigen class I antibodies on organ allocation. Am J Transplant 2023; 23:1388-1400. [PMID: 37257653 PMCID: PMC10756661 DOI: 10.1016/j.ajt.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023]
Abstract
Technological advances in the field of histocompatibility have allowed us to define anti-human leukocyte antigen (HLA) antibody specificity at the allelic level. However, how allele-specific antibodies affect organ allocation is poorly studied. We examined allelic specificities of class I HLA antibodies in 6726 consecutive serum samples from 2953 transplant candidates and evaluated their impact on the corresponding crossmatch and organ allocation. Out of 17 class I HLA antigens represented by >1 allele in the LABScreen single antigen bead assay, 12 had potential allele-specific reactivity. Taking advantage of our unbiased cohort of deceased donor-candidate testing (123,135 complement-dependent cytotoxicity crossmatches between 2014 and 2017), we estimated that the presence of allele-specific antibody detected using a single antigen bead assay (median fluorescence intensity, >3000) against only the rare allele was a poor predictor of a positive complement-dependent cytotoxicity crossmatch, with a positive predictive value of 0% to 7%, compared with 52.5% in allele-concordant class I HLA antibodies against A or B locus antigens. Further, we confirmed allele-specific reactivity using flow crossmatch in 3 scenarios: A11:01/A11:02, A68:01/A68:02, and B44:02/B44:03. Our results suggest that allele-specific antibodies may unnecessarily exclude transplant candidates (up to 10%) from organ offers by overcalling unacceptable antigens; incorporation of selective reactivity pattern in allocation may promote precision matching and more equitable allocation.
Collapse
Affiliation(s)
- Melissa Y Yeung
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Naoka Murakami
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Maria L Kafetzi
- Biochemistry and Endocrinology Laboratory, Children's Hospital P&A Kyriakou, Athens, Greece
| | - Daimon P Simmons
- Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Isabelle Wood
- Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter Macaskill
- Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew Towle
- Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jamie DellaGatta
- Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jonathan Stevens
- Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Edward Comeau
- Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jane Baronas
- Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nabil Mohsin
- College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Mike Chen
- Division of Thermo Fisher Scientific, One Lambda Inc, West Hills, California, USA
| | - Jar-How Lee
- Division of Thermo Fisher Scientific, One Lambda Inc, West Hills, California, USA
| | - William J Lane
- Harvard Medical School, Boston, Massachusetts, USA; Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Edgar L Milford
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Indira Guleria
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| |
Collapse
|
2
|
Joseph A, Murray CJ, Novikov ND, Velliquette RW, Vege S, Halls JBL, Mah HH, Dellagatta JL, Comeau E, Aguad M, Kaufman RM, Olsson ML, Guleria I, Stowell SR, Milford EL, Hult AK, Yeung MY, Westhoff CM, Murphey CL, Lane WJ. ABO Genotyping finds more A 2 to B kidney transplant opportunities than lectin-based subtyping. Am J Transplant 2023; 23:512-519. [PMID: 36732087 DOI: 10.1016/j.ajt.2022.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023]
Abstract
ABO compatibility is important for kidney transplantation, with longer waitlist times for blood group B kidney transplant candidates. However, kidneys from non-A1 (eg, A2) subtype donors, which express less A antigen, can be safely transplanted into group B recipients. ABO subtyping is routinely performed using anti-A1 lectin, but DNA-based genotyping is also possible. Here, we compare lectin and genotyping testing. Lectin and genotype subtyping was performed on 554 group A deceased donor samples at 2 transplant laboratories. The findings were supported by 2 additional data sets of 210 group A living kidney donors and 124 samples with unclear lectin testing sent to a reference laboratory. In deceased donors, genotyping found 65% more A2 donors than lectin testing, most with weak lectin reactivity, a finding supported in living donors and samples sent for reference testing. DNA sequencing and flow cytometry showed that the discordances were because of several factors, including transfusion, small variability in A antigen levels, and rare ABO∗A2.06 and ABO∗A2.16 sequences. Although lectin testing is the current standard for transplantation subtyping, genotyping is accurate and could increase A2 kidney transplant opportunities for group B candidates, a difference that should reduce group B wait times and improve transplant equity.
Collapse
Affiliation(s)
- Abigail Joseph
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cody J Murray
- Southwest Immunodiagnostics, Inc., San Antonio, Texas, USA
| | - Natasha D Novikov
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Randall W Velliquette
- New York Blood Center Enterprises, Immunohematology and Genomics, New York, New York, USA
| | - Sunitha Vege
- New York Blood Center Enterprises, Immunohematology and Genomics, New York, New York, USA
| | - Justin B L Halls
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Helen H Mah
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jamie L Dellagatta
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Edward Comeau
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maria Aguad
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Martin L Olsson
- Clinical Immunology and Transfusion Medicine, Office of Medical Services, Region Skåne, Lund, Sweden; Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Indira Guleria
- Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sean R Stowell
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Edgar L Milford
- Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Annika K Hult
- Clinical Immunology and Transfusion Medicine, Office of Medical Services, Region Skåne, Lund, Sweden; Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Melissa Y Yeung
- Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Connie M Westhoff
- New York Blood Center Enterprises, Immunohematology and Genomics, New York, New York, USA
| | | | - William J Lane
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
3
|
Wu SC, Kamili NA, Dias-Baruffi M, Josephson CD, Rathgeber MF, Yeung MY, Lane WJ, Wang J, Jan HM, Rakoff-Nahoum S, Cummings RD, Stowell SR, Arthur CM. Innate immune Galectin-7 specifically targets microbes that decorate themselves in blood group-like antigens. iScience 2022; 25:104482. [PMID: 35754739 PMCID: PMC9218387 DOI: 10.1016/j.isci.2022.104482] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/14/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
Adaptive immunity can target a nearly infinite range of antigens, yet it is tempered by tolerogenic mechanisms that limit autoimmunity. Such immunological tolerance, however, creates a gap in adaptive immunity against microbes decorated with self-like antigens as a form of molecular mimicry. Our results demonstrate that the innate immune lectin galectin-7 (Gal-7) binds a variety of distinct microbes, all of which share features of blood group-like antigens. Gal-7 binding to each blood group expressing microbe, including strains of Escherichia coli, Klebsiella pneumoniae, Providencia alcalifaciens, and Streptococcus pneumoniae, results in loss of microbial viability. Although Gal-7 also binds red blood cells (RBCs), this interaction does not alter RBC membrane integrity. These results demonstrate that Gal-7 recognizes a diverse range of microbes, each of which use molecular mimicry while failing to induce host cell injury, and thus may provide an innate form of immunity against molecular mimicry.
Collapse
Affiliation(s)
- Shang-Chuen Wu
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Nourine A. Kamili
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Marcelo Dias-Baruffi
- Department of Clinical Analysis, Toxicology, and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Cassandra D. Josephson
- Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Matthew F. Rathgeber
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Melissa Y. Yeung
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - William J. Lane
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Jianmei Wang
- Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Hau-Ming Jan
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Seth Rakoff-Nahoum
- Division of Infectious Disease, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Richard D. Cummings
- Harvard Glycomics Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Sean R. Stowell
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Connie M. Arthur
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| |
Collapse
|
4
|
Yeung MY. Histocompatibility Assessment in Precision Medicine for Transplantation: Towards a Better Match. Semin Nephrol 2022; 42:44-62. [DOI: 10.1016/j.semnephrol.2022.01.004] [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: 10/18/2022]
|
5
|
Affiliation(s)
- Melissa Y Yeung
- Brigham and Women's Hospital, Department of Medicine, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
Abstract
T cells play a pivotal role in orchestrating immune responses directed against a foreign (allogeneic) graft. For T cells to become fully activated, the T-cell receptor (TCR) must interact with the major histocompatibility complex (MHC) plus peptide complex on antigen-presenting cells (APCs), followed by a second "positive" costimulatory signal. In the absence of this second signal, T cells become anergic or undergo deletion. By blocking positive costimulatory signaling, T-cell allo-responses can be aborted, thus preventing graft rejection and promoting long-term allograft survival and possibly tolerance (Alegre ML, Najafian N, Curr Mol Med 6:843-857, 2006; Li XC, Rothstein DM, Sayegh MH, Immunol Rev 229:271-293, 2009). In addition, costimulatory molecules can provide negative "coinhibitory" signals that inhibit T-cell activation and terminate immune responses; strategies to promote these pathways can also lead to graft tolerance (Boenisch O, Sayegh MH, Najafian N, Curr Opin Organ Transplant 13:373-378, 2008). However, T-cell costimulation involves an incredibly complex array of interactions that may act simultaneously or at different times in the immune response and whose relative importance varies depending on the different T-cell subsets and activation status. In transplantation, the presence of foreign alloantigen incites not only destructive T effector cells but also protective regulatory T cells, the balance of which ultimately determines the fate of the allograft (Lechler RI, Garden OA, Turka LA, Nat Rev Immunol 3:147-158, 2003). Since the processes of alloantigen-specific rejection and regulation both require activation of T cells, costimulatory interactions may have opposing or synergistic roles depending on the cell being targeted. Such complexities present both challenges and opportunities in targeting T-cell costimulatory pathways for therapeutic purposes. In this chapter, we summarize our current knowledge of the various costimulatory pathways in transplantation and review the current state and challenges of harnessing these pathways to promote graft tolerance (summarized in Table 10.1).
Collapse
Affiliation(s)
- Melissa Y Yeung
- Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Tanja Grimmig
- Department of Surgery, Molecular Oncology and Immunology, University of Wuerzburg, Wuerzburg, Germany
| | - Mohamed H Sayegh
- Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine and Immunology, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
7
|
Gordon WJ, Ainsworth L, Aronson S, Baronas J, Kaufman RM, Guleria I, Milford EL, Oates M, Paz RD, Yeung MY, Lane WJ. Development of a Calculated Panel Reactive Antibody Web Service with Local Frequencies for Platelet Transfusion Refractoriness Risk Stratification. J Pathol Inform 2019; 10:26. [PMID: 31463162 PMCID: PMC6686574 DOI: 10.4103/jpi.jpi_29_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/01/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Calculated panel reactive antibody (cPRA) scoring is used to assess whether platelet refractoriness is mediated by human leukocyte antigen (HLA) antibodies in the recipient. cPRA testing uses a national sample of US kidney donors to estimate the population frequency of HLA antigens, which may be different than HLA frequencies within local platelet inventories. We aimed to determine the impact on patient cPRA scores of using HLA frequencies derived from typing local platelet donations rather than national HLA frequencies. METHODS We built an open-source web service to calculate cPRA scores based on national frequencies or custom-derived frequencies. We calculated cPRA scores for every hematopoietic stem cell transplantation (HSCT) patient at our institution based on the United Network for Organ Sharing (UNOS) frequencies and local frequencies. We compared frequencies and correlations between the calculators, segmented by gender. Finally, we put all scores into three buckets (mild, moderate, and high sensitizations) and looked at intergroup movement. RESULTS 2531 patients that underwent HSCT at our institution had at least 1 antibody and were included in the analysis. Overall, the difference in medians between each group's UNOS cPRA and local cPRA was statistically significant, but highly correlated (UNOS vs. local total: 0.249 and 0.243, ρ = 0.994; UNOS vs. local female: 0.474 and 0.463, ρ = 0.987, UNOS vs. local male: 0.165 and 0.141, ρ = 0.996; P < 0.001 for all comparisons). The median difference between UNOS and cPRA scores for all patients was low (male: 0.014, interquartile range [IQR]: 0.004-0.029; female: 0.0013, IQR: 0.003-0.028). Placement of patients into three groups revealed little intergroup movement, with 2.96% (75/2531) of patients differentially classified. CONCLUSIONS cPRA scores using local frequencies were modestly but significantly different than those obtained using national HLA frequencies. We released our software as open source, so other groups can calculate cPRA scores from national or custom-derived frequencies. Further investigation is needed to determine whether a local-HLA frequency approach can improve outcomes in patients who are immune-refractory to platelets.
Collapse
Affiliation(s)
- William J. Gordon
- Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Partners HealthCare, Somerville, MA, USA
| | | | | | - Jane Baronas
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard M. Kaufman
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Indira Guleria
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edgar L. Milford
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Melissa Y. Yeung
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - William J. Lane
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
8
|
Yeung MY, Baronas J, Dellagata J, Mah H, Wood I, Guleria I, Lane W, Milford EL. P159 Evaluation of differing methods for calculating cpra for kidney allocation. Hum Immunol 2018. [DOI: 10.1016/j.humimm.2018.07.216] [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: 11/28/2022]
|
9
|
Abstract
INTRODUCTION For over thirty years, antibody (mAb)-based therapies have been a standard component of transplant immunosuppression, and yet much remains to be learned in order for us to truly harness their therapeutic capabilities. Current mAbs used in transplant directly target and destroy graft-destructive immune cells, interrupt cytokine and costimulation-dependent T and B cell activation, and prevent down-stream complement activation. Areas covered: This review summarizes our current approaches to using antibody-based therapies to prevent and treat allograft rejection. It also provides examples of promising novel mAb therapies, and discusses the potential for future mAb development in transplantation. Expert opinion: The broad capability of antibodies, in parallel with our growing ability to synthetically modulate them, offers exciting opportunities to develop better biologic therapeutics. In order to do so, we must further our understanding about the basic biology underlying allograft rejection, and gain better appreciation of how characteristics of therapeutic antibodies affect their efficacy.
Collapse
Affiliation(s)
- Melissa Y Yeung
- a Transplantation Research Center, Renal Division , Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , United States
| | - Steven Gabardi
- a Transplantation Research Center, Renal Division , Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , United States
| | - Mohamed H Sayegh
- a Transplantation Research Center, Renal Division , Brigham and Women's Hospital, Harvard Medical School , Boston , Massachusetts , United States.,b Faculty of Medicine, Professor of Medicine and Immunology , American University of Beirut , Beirut , Lebanon
| |
Collapse
|
10
|
Laws LH, Parker CE, Cherala G, Koguchi Y, Waisman A, Slifka MK, Oberbarnscheidt MH, Obhrai JS, Yeung MY, Riella LV. Inflammation Causes Resistance to Anti-CD20-Mediated B Cell Depletion. Am J Transplant 2016; 16:3139-3149. [PMID: 27265023 PMCID: PMC5334788 DOI: 10.1111/ajt.13902] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/11/2016] [Accepted: 05/23/2016] [Indexed: 01/25/2023]
Abstract
B cells play a central role in antibody-mediated rejection and certain autoimmune diseases. However, B cell-targeted therapy such as anti-CD20 B cell-depleting antibody (aCD20) has yielded mixed results in improving outcomes. In this study, we investigated whether an accelerated B cell reconstitution leading to aCD20 depletion resistance could account for these discrepancies. Using a transplantation model, we found that antigen-independent inflammation, likely through toll-like receptor (TLR) signaling, was sufficient to mitigate B cell depletion. Secondary lymphoid organs had a quicker recovery of B cells when compared to peripheral blood. Inflammation altered the pharmacokinetics (PK) and pharmacodynamics (PD) of aCD20 therapy by shortening drug half-life and accelerating the reconstitution of the peripheral B cell pool by bone marrow-derived B cell precursors. IVIG (intravenous immunoglobulin) coadministration also shortened aCD20 drug half-life and led to accelerated B cell recovery. Repeated aCD20 dosing restored B cell depletion and delayed allograft rejection, especially B cell-dependent, antibody-independent allograft rejection. These data demonstrate the importance of further clinical studies of the PK/PD of monoclonal antibody treatment in inflammatory conditions. The data also highlight the disconnect between B cell depletion on peripheral blood compared to secondary lymphoid organs, the deleterious effect of IVIG when given with aCD20 and the relevance of redosing of aCD20 for effective B cell depletion in alloimmunity.
Collapse
Affiliation(s)
| | | | - Ganesh Cherala
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University
| | - Yoshinobu Koguchi
- Molecular Microbiology & Immunology, Oregon Health & Science University
| | - Ari Waisman
- Institute for Molecular Medicine, Johannes Gutenberg University Mainz
| | - Mark K. Slifka
- Oregon National Primate Research Center, Oregon Health & Science University
| | | | | | - Melissa Y. Yeung
- Schuster Transplant Research Center, Renal Division, Brigham & Women's Hospital, Harvard Medical School
| | - Leonardo V. Riella
- Schuster Transplant Research Center, Renal Division, Brigham & Women's Hospital, Harvard Medical School
| |
Collapse
|
11
|
Ueno T, Kim P, McGrath MM, Yeung MY, Shimizu T, Jung K, Sayegh MH, Chandraker AK, Abdi R, Yun SH. Live Images of Donor Dendritic Cells Trafficking via CX3CR1 Pathway. Front Immunol 2016; 7:412. [PMID: 27790214 PMCID: PMC5063889 DOI: 10.3389/fimmu.2016.00412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/23/2016] [Indexed: 01/22/2023] Open
Abstract
Background A number of studies have demonstrated the role of CX3CR1 in regulating the migration of monocytes into peripheral tissue and their transformation into dendritic cell (DC). No data are yet available on the importance of chemokine pathways in regulating homeostasis of DC in heart transplants. Recently, we showed that recipients of heart allografts from CX3CR1−/− donors show longer survival. To assess the trafficking of dDC, we have developed and tested a novel in vivo imaging tool in CX3CR1GFP/+ DC (B6 background) heart graft into BALB/c recipient model. Results Majority of GFP+ cells were noted in the middle of cardiac myocyte. However few hours post transplant, they experienced morphological changes including stretching their extensions (3 and 24 h). However, images from 72 h at cardiac graft showed many of GFP+ cells moved to vessel areas. GFP+ cells were detected in near vessel wall. Only one GFP+ cell was observed in three lymph nodes (two mesenteric and one inguinal) (72 h). Conclusion Our data indicate that immediately post transplant dDC undergo morphological changes and traffic out of the organs via systemic circulation. While, we still noted presence of dDC in the transplanted organs, their trafficking to lymphoid tissue remains to be fully explored.
Collapse
Affiliation(s)
- Takuya Ueno
- Renal Division, Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Pilhan Kim
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Martina M McGrath
- Renal Division, Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Melissa Y Yeung
- Renal Division, Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Tetsunosuke Shimizu
- Renal Division, Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Keehoon Jung
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Mohamed H Sayegh
- Renal Division, Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Anil K Chandraker
- Renal Division, Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Reza Abdi
- Renal Division, Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Seok H Yun
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| |
Collapse
|
12
|
Ueno T, Jung K, Yeung MY, McGrath MM, Shimizu T, Kim P, Sayegh MH, Chandraker A, Yun SH. Imaging cell biology in transplantation. Transpl Int 2016; 29:1349-1351. [DOI: 10.1111/tri.12852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Takuya Ueno
- Transplantation Research Center; Renal Division; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Keehoon Jung
- Department of Dermatology; Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Melissa Y Yeung
- Transplantation Research Center; Renal Division; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Martina M McGrath
- Transplantation Research Center; Renal Division; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Tetsunosuke Shimizu
- Transplantation Research Center; Renal Division; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Pilhan Kim
- Department of Dermatology; Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Mohamed H Sayegh
- Transplantation Research Center; Renal Division; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Anil Chandraker
- Transplantation Research Center; Renal Division; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Seok H Yun
- Department of Dermatology; Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| |
Collapse
|
13
|
Ito T, Yamada A, Batal I, Yeung MY, McGrath MM, Sayegh MH, Chandraker A, Ueno T. The Limits of Linked Suppression for Regulatory T Cells. Front Immunol 2016; 7:82. [PMID: 27014262 PMCID: PMC4783400 DOI: 10.3389/fimmu.2016.00082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/22/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We have previously found that CD4(+)CD25(+) regulatory T cells (Tregs) can adoptively transfer tolerance after its induction with costimulatory blockade in a mouse model of murine cardiac allograft transplantation. In these experiments, we tested an hypothesis with three components: (1) the Tregs that transfer tolerance have the capacity for linked suppression, (2) the determinants that stimulate the Tregs are expressed by the indirect pathway, and (3) the donor peptides contributing to these indirect determinants are derived from donor major histocompatibility complex (MHC) antigens (Ags). METHODS First heart transplants were performed from the indicated donor strain to B10.D2 recipients along with costimulatory blockade treatment (250 μg i.p. injection of MR1 on day 0 and 250 μg i.p. injection of CTLA-4 Ig on day 2). At least 8 weeks later, a second heart transplant was performed to a new B10.D2 recipient who had been irradiated with 450 cGy. This recipient was given 40 × 106 naive B10.D2 spleen cells + 40 × 106 B10.D2 spleen cells from the first (tolerant) recipient. We performed three different types of heart transplants using various donors. RESULTS (1) Tregs suppress the graft rejection in an Ag-specific manner. (2) Tregs generated in the face of MHC disparities suppress the rejection of grafts expressing third party MHC along with tolerant MHC. CONCLUSION The limits of linkage appear to be quantitative and not universally determined by either the indirect pathway or by peptides of donor MHC Ags.
Collapse
Affiliation(s)
- Toshiro Ito
- Transplantation Unit, Surgical Services, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Akira Yamada
- Transplantation Unit, Surgical Services, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Ibrahim Batal
- Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Melissa Y Yeung
- Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Martina M McGrath
- Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Mohamed H Sayegh
- Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Anil Chandraker
- Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital, Harvard Medical School , Boston, MA , USA
| | - Takuya Ueno
- Transplantation Unit, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
14
|
Brooks CR, Yeung MY, Brooks YS, Chen H, Ichimura T, Henderson JM, Bonventre JV. KIM-1-/TIM-1-mediated phagocytosis links ATG5-/ULK1-dependent clearance of apoptotic cells to antigen presentation. EMBO J 2015; 34:2441-64. [PMID: 26282792 DOI: 10.15252/embj.201489838] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 07/01/2015] [Indexed: 12/14/2022] Open
Abstract
Phagocytosis of apoptotic cells by both professional and semi-professional phagocytes is required for resolution of organ damage and maintenance of immune tolerance. KIM-1/TIM-1 is a phosphatidylserine receptor that is expressed on epithelial cells and can transform the cells into phagocytes. Here, we demonstrate that KIM-1 phosphorylation and association with p85 results in encapsulation of phagosomes by lipidated LC3 in multi-membrane organelles. KIM-1-mediated phagocytosis is not associated with increased ROS production, and NOX inhibition does not block LC3 lipidation. Autophagy gene expression is required for efficient clearance of apoptotic cells and phagosome maturation. KIM-1-mediated phagocytosis leads to pro-tolerogenic antigen presentation, which suppresses CD4 T-cell proliferation and increases the percentage of regulatory T cells in an autophagy gene-dependent manner. Taken together, these data reveal a novel mechanism of epithelial biology linking phagocytosis, autophagy and antigen presentation to regulation of the inflammatory response.
Collapse
Affiliation(s)
- Craig R Brooks
- Department of Medicine, Renal Division, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
| | - Melissa Y Yeung
- Department of Medicine, Renal Division, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA Transplantation Research Center, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
| | - Yang S Brooks
- Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, MA, USA Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Hui Chen
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Takaharu Ichimura
- Department of Medicine, Renal Division, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
| | - Joel M Henderson
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Joseph V Bonventre
- Department of Medicine, Renal Division, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA Harvard Stem Cell Institute, Cambridge, MA, USA
| |
Collapse
|
15
|
Yeung MY, Ding Q, Brooks CR, Xiao S, Workman CJ, Vignali DA, Ueno T, Padera RF, Kuchroo VK, Najafian N, Rothstein DM. TIM-1 signaling is required for maintenance and induction of regulatory B cells. Am J Transplant 2015; 15:942-53. [PMID: 25645598 PMCID: PMC4530122 DOI: 10.1111/ajt.13087] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/09/2014] [Accepted: 10/28/2014] [Indexed: 01/25/2023]
Abstract
Apart from their role in humoral immunity, B cells can exhibit IL-10-dependent regulatory activity (Bregs). These regulatory subpopulations have been shown to inhibit inflammation and allograft rejection. However, our understanding of Bregs has been hampered by their rarity, lack of a specific marker, and poor insight into their induction and maintenance. We previously demonstrated that T cell immunoglobulin mucin domain-1 (TIM-1) identifies over 70% of IL-10-producing B cells, irrespective of other markers. We now show that TIM-1 is the primary receptor responsible for Breg induction by apoptotic cells (ACs). However, B cells that express a mutant form of TIM-1 lacking the mucin domain (TIM-1(Δmucin) ) exhibit decreased phosphatidylserine binding and are unable to produce IL-10 in response to ACs or by specific ligation with anti-TIM-1. TIM-1(Δmucin) mice also exhibit accelerated allograft rejection, which appears to be due in part to their defect in both baseline and induced IL-10(+) Bregs, since a single transfer of WT TIM-1(+) B cells can restore long-term graft survival. These data suggest that TIM-1 signaling plays a direct role in Breg maintenance and induction both under physiological conditions (in response to ACs) and in response to therapy through TIM-1 ligation. Moreover, they directly demonstrate that the mucin domain regulates TIM-1 signaling.
Collapse
Affiliation(s)
- Melissa Y. Yeung
- Transplantation Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Qing Ding
- Thomas E. Starzl Transplantation Institute, Departments of Surgery and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Craig R. Brooks
- Renal Division, Harvard Medical School, Boston, Massachusetts, USA
| | - Sheng Xiao
- Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, USA
| | - Creg J. Workman
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Department of Immunology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Dario A.A. Vignali
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Department of Immunology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Takuya Ueno
- Transplantation Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert F. Padera
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vijay K. Kuchroo
- Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, USA
| | - Nader Najafian
- Transplantation Research Center, Harvard Medical School, Boston, Massachusetts, USA,Department of Nephrology, Cleveland Clinic Florida, Weston, FL, USA
| | - David M. Rothstein
- Thomas E. Starzl Transplantation Institute, Departments of Surgery and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
16
|
Yang L, Brooks CR, Xiao S, Sabbisetti V, Yeung MY, Hsiao LL, Ichimura T, Kuchroo V, Bonventre JV. KIM-1-mediated phagocytosis reduces acute injury to the kidney. J Clin Invest 2015; 125:1620-36. [PMID: 25751064 DOI: 10.1172/jci75417] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/22/2015] [Indexed: 12/13/2022] Open
Abstract
Kidney injury molecule 1 (KIM-1, also known as TIM-1) is markedly upregulated in the proximal tubule after injury and is maladaptive when chronically expressed. Here, we determined that early in the injury process, however, KIM-1 expression is antiinflammatory due to its mediation of phagocytic processes in tubule cells. Using various models of acute kidney injury (AKI) and mice expressing mutant forms of KIM-1, we demonstrated a mucin domain-dependent protective effect of epithelial KIM-1 expression that involves downregulation of innate immunity. Deletion of the mucin domain markedly impaired KIM-1-mediated phagocytic function, resulting in increased proinflammatory cytokine production, decreased antiinflammatory growth factor secretion by proximal epithelial cells, and a subsequent increase in tissue macrophages. Mice expressing KIM-1Δmucin had greater functional impairment, inflammatory responses, and mortality in response to ischemia- and cisplatin-induced AKI. Compared with primary renal proximal tubule cells isolated from KIM-1Δmucin mice, those from WT mice had reduced proinflammatory cytokine secretion and impaired macrophage activation. The antiinflammatory effect of KIM-1 expression was due to the interaction of KIM-1 with p85 and subsequent PI3K-dependent downmodulation of NF-κB. Hence, KIM-1-mediated epithelial cell phagocytosis of apoptotic cells protects the kidney after acute injury by downregulating innate immunity and inflammation.
Collapse
|
17
|
Allegretti AS, Yeung MY, Riella LV. Counseling potential donors to the risk of ESRD after kidney donation: glass half-full or half-empty? Am J Transplant 2014; 14:2434-5. [PMID: 25167951 DOI: 10.1111/ajt.12861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 01/25/2023]
Affiliation(s)
- A S Allegretti
- Schuster Transplant Research Center, Brigham and Women's, Harvard Medical School, Boston, MA
| | | | | |
Collapse
|
18
|
Abstract
INTRODUCTION The pivotal role of costimulatory pathways in regulating T-cell activation versus tolerance has stimulated tremendous interest in their manipulation for therapeutic purposes. Of these, the CD28-B7 pathway is arguably the most important and best studied. Therapeutic targets of CD28 are currently used in the treatment of melanoma, autoimmune diseases and in transplantation. AREAS COVERED In this review, we summarize our current knowledge of CD28 and cytotoxic T-lymphocyte antigen-4 (CTLA-4) signaling, and review the current state and challenges of harnessing them to promote transplant tolerance. EXPERT OPINION Despite the success of belatacept, a first-in-class CTLA-4 fusion protein now clinically used in transplantation, it is apparent that we have only scratched the surface in understanding the complexities of how costimulatory pathways modulate the immune system. Our initial assumption that positive costimulators activate effector T cells and prevent tolerance, while negative costimulators inhibit effector T cells and promote tolerance, is clearly an oversimplified view. Indeed, belatacept is not only capable of blocking deleterious CD28-B7 interactions that promote effector T-cell responses but can also have undesired effects on tolerogenic regulatory T-cell populations.
Collapse
Affiliation(s)
- Melissa Y Yeung
- Brigham and Women's Hospital, Transplantation Research Center, Harvard Medical School, Renal Division , Boston, MA , USA +1 617 525 8005 ; +1 617 732 5254 ;
| | | | | |
Collapse
|
19
|
Yeung MY, McGrath MM, Nakayama M, Shimizu T, Boenisch O, Magee CN, Abdoli R, Akiba H, Ueno T, Turka LA, Najafian N. Interruption of dendritic cell-mediated TIM-4 signaling induces regulatory T cells and promotes skin allograft survival. J Immunol 2013; 191:4447-55. [PMID: 24038092 DOI: 10.4049/jimmunol.1300992] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Dendritic cells (DCs) are the central architects of the immune response, inducing inflammatory or tolerogenic immunity, dependent on their activation status. As such, DCs are highly attractive therapeutic targets and may hold the potential to control detrimental immune responses. TIM-4, expressed on APCs, has complex functions in vivo, acting both as a costimulatory molecule and a phosphatidylserine receptor. The effect of TIM-4 costimulation on T cell activation remains unclear. In this study, we demonstrate that Ab blockade of DC-expressed TIM-4 leads to increased induction of induced regulatory T cells (iTregs) from naive CD4(+) T cells, both in vitro and in vivo. iTreg induction occurs through suppression of IL-4/STAT6/Gata3-induced Th2 differentiation. In addition, blockade of TIM-4 on previously activated DCs still leads to increased iTreg induction. iTregs induced under TIM-4 blockade have equivalent potency to control and, upon adoptive transfer, significantly prolong skin allograft survival in vivo. In RAG(-/-) recipients of skin allografts adoptively transferred with CD4(+) T cells, we show that TIM-4 blockade in vivo is associated with a 3-fold prolongation in allograft survival. Furthermore, in this mouse model of skin transplantation, increased induction of allospecific iTregs and a reduction in T effector responses were observed, with decreased Th1 and Th2 responses. This enhanced allograft survival and protolerogenic skewing of the alloresponse is critically dependent on conversion of naive CD4(+) to Tregs in vivo. Collectively, these studies identify blockade of DC-expressed TIM-4 as a novel strategy that holds the capacity to induce regulatory immunity in vivo.
Collapse
Affiliation(s)
- Melissa Y Yeung
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02445
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Ueno T, Yeung MY, McGrath M, Yang S, Zaman N, Snawder B, Padera RF, Magee CN, Gorbatov R, Hashiguchi M, Azuma M, Freeman GJ, Sayegh MH, Najafian N. Intact B7-H3 signaling promotes allograft prolongation through preferential suppression of Th1 effector responses. Eur J Immunol 2013; 42:2343-53. [PMID: 22733595 DOI: 10.1002/eji.201242501] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Ligands of the B7 family provide both positive and negative costimulatory signals to the CD28 family of receptors on T lymphocytes, the balance of which determines the immune response. B7-H3 is a member of the B7 family whose function in T-cell activation has been the subject of some controversy: in autoimmunity and tumor immunity, it has been described as both costimulatory and coinhibitory, while in transplantation, B7-H3 signaling is thought to contribute to graft rejection. However, we now demonstrate results to the contrary. Signaling through a putative B7-H3 receptor prolonged allograft survival in a fully MHC-mismatched cardiac model and promoted a shift toward a Th2 milieu; conversely, B7-H3 blockade, achieved by use of a blocking antibody, resulted in accelerated rejection, an effect associated with enhanced IFN-γ production. Finally, graft prolongation achieved by CTLA4 Ig was shortened both by B7-H3 blockade and the absence of recipient B7-H3. These findings suggest a coinhibitory role for B7-H3. However, experience with other CD28/B7 family members suggests that immune redundancy plays a crucial role in determining the functions of various pathways. Given the abundance of conflicting data, it is plausible that, under differing conditions, B7-H3 may have both positive and negative costimulatory functions.
Collapse
Affiliation(s)
- Takuya Ueno
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
D’Addio F, Boenisch O, Magee CN, Yeung MY, Yuan X, Mfarrej B, Vergani A, Ansari MJ, Fiorina P, Najafian N. Prolonged, low-dose anti-thymocyte globulin, combined with CTLA4-Ig, promotes engraftment in a stringent transplant model. PLoS One 2013; 8:e53797. [PMID: 23326509 PMCID: PMC3542267 DOI: 10.1371/journal.pone.0053797] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 10/09/2012] [Accepted: 12/03/2012] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite significant nephrotoxicity, calcineurin inhibitors (CNIs) remain the cornerstone of immunosuppression in solid organ transplantation. We, along with others, have reported tolerogenic properties of anti-thymocyte globulin (ATG, Thymoglobulin®), evinced by its ability both to spare Tregs from depletion in vivo and, when administered at low, non-depleting doses, to expand Tregs ex vivo. Clinical trials investigating B7/CD28 blockade (LEA29Y, Belatacept) in kidney transplant recipients have proven that the replacement of toxic CNI use is feasible in selected populations. METHODS Rabbit polyclonal anti-murine thymocyte globulin (mATG) was administered as induction and/or prolonged, low-dose therapy, in combination with CTLA4-Ig, in a stringent, fully MHC-mismatched murine skin transplant model to assess graft survival and mechanisms of action. RESULTS Prolonged, low-dose mATG, combined with CTLA4-Ig, effectively promotes engraftment in a stringent transplant model. Our data demonstrate that mATG achieves graft acceptance primarily by promoting Tregs, while CTLA4-Ig enhances mATG function by limiting activation of the effector T cell pool in the early stages of treatment, and by inhibiting production of anti-rabbit antibodies in the maintenance phase, thereby promoting regulation of alloreactivity. CONCLUSION These data provide the rationale for development of novel, CNI-free clinical protocols in human transplant recipients.
Collapse
Affiliation(s)
- Francesca D’Addio
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
- Transplantation Medicine Division, San Raffaele Hospital, Milan, Italy
| | - Olaf Boenisch
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ciara N. Magee
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Melissa Y. Yeung
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xueli Yuan
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bechara Mfarrej
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andrea Vergani
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
- Transplantation Medicine Division, San Raffaele Hospital, Milan, Italy
| | - Mohammed Javeed Ansari
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
- Divisions of Nephrology and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Paolo Fiorina
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
- Transplantation Medicine Division, San Raffaele Hospital, Milan, Italy
| | - Nader Najafian
- Renal Division, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
22
|
De Serres SA, Mfarrej BG, Grafals M, Riella LV, Magee CN, Yeung MY, Dyer C, Ahmad U, Chandraker A, Najafian N. Derivation and validation of a cytokine-based assay to screen for acute rejection in renal transplant recipients. Clin J Am Soc Nephrol 2012; 7:1018-25. [PMID: 22498498 DOI: 10.2215/cjn.11051011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Acute rejection remains a problem in renal transplantation. This study sought to determine the utility of a noninvasive cytokine assay in screening of acute rejection. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this observational cross-sectional study, 64 patients from two centers were recruited upon admission for allograft biopsy to investigate acute graft dysfunction. Blood was collected before biopsy and assayed for a panel of 21 cytokines secreted by PBMCs. Patients were classified as acute rejectors or nonrejectors according to a classification rule derived from an initial set of 32 patients (training cohort) and subsequently validated in the remaining patients (validation cohort). RESULTS Although six cytokines (IL-1β, IL-6, TNF-α, IL-4, GM-CSF, and monocyte chemoattractant protein-1) distinguished acute rejectors in the training cohort, logistic regression modeling identified a single cytokine, IL-6, as the best predictor. In the validation cohort, IL-6 was consistently the most accurate cytokine (area under the receiver-operating characteristic curve, 0.85; P=0.006), whereas the application of a prespecified cutoff level, as determined from the training cohort, resulted in a sensitivity and specificity of 92% and 63%, respectively. Secondary analyses revealed a strong association between IL-6 levels and acute rejection after multivariate adjustment for clinical characteristics (P<0.001). CONCLUSIONS In this pilot study, the measurement of a single cytokine can exclude acute rejection with a sensitivity of 92% in renal transplant recipients presenting with acute graft dysfunction. Prospective studies are needed to determine the utility of this simple assay, particularly for low-risk or remote patients.
Collapse
Affiliation(s)
- Sacha A De Serres
- Schuster Family Transplantation Research Center, Renal Division, Brigham and Women's Hospital & Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Ueno T, Ikeda T, Ikeda K, Taniuchi H, Suda S, Yeung MY, Matsuno N. HMGB-1 as a Useful Prognostic Biomarker in Sepsis-Induced Organ Failure in Patients Undergoing PMX-DHP. J Surg Res 2011; 171:183-90. [DOI: 10.1016/j.jss.2009.11.708] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 10/27/2009] [Accepted: 11/12/2009] [Indexed: 10/20/2022]
|
24
|
Ueno T, Yamada A, Ito T, Yeung MY, Gorbatov R, Shimizu T, Abdi R, Sayegh MH, Auchincloss H, Najafian N. Role of nuclear factor of activated T cell (NFAT) transcription factors in skin and vascularized cardiac allograft rejection. Transplantation 2011; 92:e26-7. [PMID: 21866037 DOI: 10.1097/tp.0b013e318228061c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Takuya Ueno
- Transplantation Unit, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Since their discovery in 2001, the T-cell immunoglobulin mucin (TIM) family members have been shown to play important roles in the regulation of immune responses. The TIM family comprises of eight genes in the mouse, three of which are conserved in humans (TIM-1, TIM-3 and TIM-4). Initially, TIM-1 and TIM-3 were thought to be expressed solely on T cells. However, emerging data suggest a much broader expression pattern where their presence on APCs confers differing functions, including the ability to mediate phagocytosis. In contrast, TIM-4 is exclusively expressed on APCs. Together, the TIM molecules provide a functional repertoire for determining the fate of T-cell activation and differentiation. To date, much of the knowledge about the TIM family members has been garnered from the models of asthma, allergy and autoimmunity. More recently, data from experimental models of transplantation demonstrate that TIM family members also have a key role in alloimmunity. This review will serve to highlight the emerging data regarding this unique family of molecules and to identify their potential in transplantation tolerance.
Collapse
Affiliation(s)
- Melissa Y. Yeung
- Transplantation Research Center, Brigham and Women’s Hospital & Children’s Hospital, Harvard Medical School, Boston, MA
| | - Martina McGrath
- Transplantation Research Center, Brigham and Women’s Hospital & Children’s Hospital, Harvard Medical School, Boston, MA
| | - Nader Najafian
- Transplantation Research Center, Brigham and Women’s Hospital & Children’s Hospital, Harvard Medical School, Boston, MA,Address correspondence and reprint requests to: Nader Najafian, M.D., Transplantation Research Center, Brigham and Women’s Hospital & Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA, Phone: (617) 732-5259, FAX: (617) 732-5254,
| |
Collapse
|
26
|
De Serres SA, Yeung MY, Mfarrej BG, Najafian N. Effect of biologic agents on regulatory T cells. Transplant Rev (Orlando) 2011; 25:110-6. [DOI: 10.1016/j.trre.2010.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 11/26/2010] [Indexed: 02/07/2023]
|
27
|
Boenisch O, D'Addio F, Watanabe T, Elyaman W, Magee CN, Yeung MY, Padera RF, Rodig SJ, Murayama T, Tanaka K, Yuan X, Ueno T, Jurisch A, Mfarrej B, Akiba H, Yagita H, Najafian N. TIM-3: a novel regulatory molecule of alloimmune activation. J Immunol 2010; 185:5806-19. [PMID: 20956339 DOI: 10.4049/jimmunol.0903435] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
T cell Ig domain and mucin domain (TIM)-3 has previously been established as a central regulator of Th1 responses and immune tolerance. In this study, we examined its functions in allograft rejection in a murine model of vascularized cardiac transplantation. TIM-3 was constitutively expressed on dendritic cells and natural regulatory T cells (Tregs) but only detected on CD4(+)FoxP3(-) and CD8(+) T cells in acutely rejecting graft recipients. A blocking anti-TIM-3 mAb accelerated allograft rejection only in the presence of host CD4(+) T cells. Accelerated rejection was accompanied by increased frequencies of alloreactive IFN-γ-, IL-6-, and IL-17-producing splenocytes, enhanced CD8(+) cytotoxicity against alloantigen, increased alloantibody production, and a decline in peripheral and intragraft Treg/effector T cell ratio. Enhanced IL-6 production by CD4(+) T cells after TIM-3 blockade plays a central role in acceleration of rejection. Using an established alloreactivity TCR transgenic model, blockade of TIM-3 increased allospecific effector T cells, enhanced Th1 and Th17 polarization, and resulted in a decreased frequency of overall number of allospecific Tregs. The latter is due to inhibition in induction of adaptive Tregs rather than prevention of expansion of allospecific natural Tregs. In vitro, targeting TIM-3 did not inhibit nTreg-mediated suppression of Th1 alloreactive cells but increased IL-17 production by effector T cells. In summary, TIM-3 is a key regulatory molecule of alloimmunity through its ability to broadly modulate CD4(+) T cell differentiation, thus recalibrating the effector and regulatory arms of the alloimmune response.
Collapse
Affiliation(s)
- Olaf Boenisch
- Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Yeung MY, Ueno T, Akiba H, Yagita H, Najafian N, Sayegh M. 326: Novel Role of the Tim-4 Molecule in Alloimmunity. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.333] [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: 11/11/2022]
|
29
|
Yeung MY, Smyth JP, Maheshwari R, Shah S. Evaluation of standardized versus individualized total parenteral nutrition regime for neonates less than 33 weeks gestation. J Paediatr Child Health 2003; 39:613-7. [PMID: 14629529 DOI: 10.1046/j.1440-1754.2003.00246.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the difference in nutrient intakes and biochemical responses in newborn infants <33 weeks gestation who received standardized versus individualized total parenteral nutrition (TPN) regimes. METHOD Comparison of nutrient intakes and daily biochemical responses in newborn infants <33 weeks gestation who received standardized regime versus those who received individualized TPN regimes from day 2 to day 7 of life. RESULTS Twenty-seven infants in the standardized TPN group and 31 infants in the individualized TPN group were compared. There were no statistically significant differences (P > 0.05) between the two groups in gestation, birthweight, Clinical Risk Index for Babies scores, daily TPN volume intake and biochemical responses. Infants in the standardized TPN group received less sodium (P < 0.01) and no potassium on day 2 as required, more protein (P < 0.02) every day, and more calcium and phosphate (P < 0.02 from day 4). CONCLUSION There were no significant clinical and statistical differences in biochemical responses in newborn infants <33 weeks gestation who received standardized versus individualized TPN regimes during the first week of life. The economic cost of TPN provision using standardized TPN formulation was approximately 30% lower.
Collapse
Affiliation(s)
- M Y Yeung
- Neonatal Intensive Care Unit, Nepean Hospital, New South Wales, Australia.
| | | | | | | |
Collapse
|
30
|
Yeung MY. Transient leukopenia/neutropenia associated with stat doses of frusemide in a preterm infant. J Paediatr Child Health 1999; 35:591-2. [PMID: 10633309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
|
31
|
Affiliation(s)
- M Y Yeung
- Nepean Hospital Penrith, NSW Australia
| | - L M Downe
- Nepean Hospital Penrith, NSW Australia
| | | |
Collapse
|
32
|
Kessler R, Tavernier L, Yeung MY, Weitzenblum E. A brachiocephalic vein abnormality causing a 'twisted' central venous catheter. Eur J Radiol 1995; 20:105-7. [PMID: 7588862 DOI: 10.1016/0720-048x(95)00630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R Kessler
- Service de Pneumologie, University Hospital of Strasbourg, France
| | | | | | | |
Collapse
|