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Iasella CJ, Hoji A, Popescu I, Wei J, Snyder ME, Zhang Y, Xu W, Iouchmanov V, Koshy R, Brown M, Fung M, Langelier C, Lendermon EA, Dugger D, Shah R, Lee J, Johnson B, Golden J, Leard LE, Kleinhenz ME, Kilaru S, Hays SR, Singer JP, Sanchez PG, Morrell MR, Pilewski JM, Greenland JR, Chen K, McDyer JF. Type-1 immunity and endogenous immune regulators predominate in the airway transcriptome during chronic lung allograft dysfunction. Am J Transplant 2021; 21:2145-2160. [PMID: 33078555 PMCID: PMC8607839 DOI: 10.1111/ajt.16360] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 06/17/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) remains the major complication limiting long-term survival among lung transplant recipients (LTRs). Limited understanding of CLAD immunopathogenesis and a paucity of biomarkers remain substantial barriers for earlier detection and therapeutic interventions for CLAD. We hypothesized the airway transcriptome would reflect key immunologic changes in disease. We compared airway brush-derived transcriptomic signatures in CLAD (n = 24) versus non-CLAD (n = 21) LTRs. A targeted assessment of the proteome using concomitant bronchoalveolar lavage (BAL) fluid for 24 cytokines/chemokines and alloimmune T cell responses was performed to validate the airway transcriptome. We observed an airway transcriptomic signature of differential genes expressed (DGEs) in CLAD marked by Type-1 immunity and striking upregulation of two endogenous immune regulators: indoleamine 2, 3 dioxygenase 1 (IDO-1) and tumor necrosis factor receptor superfamily 6B (TNFRSF6B). Advanced CLAD staging was associated with a more intense airway transcriptome signature. In a validation cohort using the identified signature, we found an area under the curve (AUC) of 0.77 for CLAD LTRs. Targeted proteomic analyses revealed a predominant Type-1 profile with detection of IFN-γ, TNF-α, and IL-1β as dominant CLAD cytokines, correlating with the airway transcriptome. The airway transcriptome provides novel insights into CLAD immunopathogenesis and biomarkers that may impact diagnosis of CLAD.
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Affiliation(s)
- Carlo J. Iasella
- Department of Pharmacy and Therapeutics, University of
Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Aki Hoji
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Iulia Popescu
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Jianxin Wei
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Mark E. Snyder
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Wei Xu
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Vera Iouchmanov
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Ritchie Koshy
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Mark Brown
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Monica Fung
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Charles Langelier
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Elizabeth A. Lendermon
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Daniel Dugger
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Rupal Shah
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Joyce Lee
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Bruce Johnson
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Jeffrey Golden
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Lorriana E. Leard
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Mary Ellen Kleinhenz
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Silpa Kilaru
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Steven R. Hays
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Jonathan P. Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Pablo G. Sanchez
- Department of Cardiothoracic Surgery, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew R. Morrell
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - Joseph M. Pilewski
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - John R. Greenland
- Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California San Francisco, San Francisco, California
| | - Kong Chen
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
| | - John F. McDyer
- Division of Pulmonary, Allergy, and Critical Care Medicine,
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania
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Heilman RL, Smith ML, Kurian SM, Huskey J, Batra RK, Chakkera HA, Katariya NN, Khamash H, Moss A, Salomon DR, Reddy KS. Transplanting Kidneys from Deceased Donors With Severe Acute Kidney Injury. Am J Transplant 2015; 15:2143-51. [PMID: 25808278 DOI: 10.1111/ajt.13260] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 01/25/2023]
Abstract
Our aim was to determine outcomes with transplanting kidneys from deceased donors with acute kidney injury, defined as a donor with terminal serum creatinine ≥2.0 mg/dL, or a donor requiring acute renal replacement therapy. We included all patients who received deceased donor kidney transplant from June 2004 to October 2013. There were 162 AKI donor transplant recipients (21% of deceased donor transplants): 139 in the standard criteria donor (SCD) and 23 in the expanded criteria donor (ECD) cohort. 71% of the AKI donors had stage 3 (severe AKI), based on acute kidney injury network (AKIN) staging. Protocol biopsies were done at 1, 4, and 12 months posttransplant. One and four month formalin-fixed paraffin embedded (FFPE) biopsies from 48 patients (24 AKI donors, 24 non-AKI) underwent global gene expression profiling using DNA microarrays (96 arrays). DGF was more common in the AKI group but eGFR, graft survival at 1 year and proportion with IF/TA>2 at 1 year were similar for the two groups. At 1 month, there were 898 differentially expressed genes in the AKI group (p-value <0.005; FDR <10%), but by 4 months there were no differences. Transplanting selected kidneys from deceased donors with AKI is safe and has excellent outcomes.
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Affiliation(s)
- R L Heilman
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - M L Smith
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - S M Kurian
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA
| | - J Huskey
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - R K Batra
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - H A Chakkera
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | | | - H Khamash
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - A Moss
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - D R Salomon
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA
| | - K S Reddy
- Department of Surgery, Mayo Clinic, Phoenix, AZ
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