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Shaw BI, Schmitz R, Flores WJ, Magnani DM, Li J, Song M, Kirk AD. A comparative study of human-and rhesus-specific antithymocyte globulins in Rhesus macaques. Clin Transplant 2021; 35:e14369. [PMID: 34021521 DOI: 10.1111/ctr.14369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/03/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
Rabbit antithymocyte globulin (RATG) preparations are widely used in transplantation. They are developed in vivo against thymocytes and contain polyclonal antibodies specific for myriad cellular targets. The rhesus monkey is commonly used as a preclinical transplant model, but the fidelity of commercially available human-specific RATGs to anticipate the effects of RATGs in rhesus has not been established. We therefore developed two rhesus-specific ATGs (rhATG) and compared them to human-specific RATG (huATG, Thymoglobulin® ) in rhesus monkeys, assessing the magnitude and phenotype of depletion peripherally and in lymph nodes. Four primates were assigned to each group and received 20 mg/kg of drug. Depletion, repopulation, and changes in lymphocyte subsets were evaluated in peripheral blood and lymph nodes by flow cytometry over four months. We observed similar qualitative changes in lymphocyte subsets, but a generally more profound depletion with huATG compared to either rhATG. Peripheral homeostatic proliferation rather than thymic output was the major mechanism for repopulation with all RATGs. Repopulation was slower but qualitatively similar when examining RATGs in additional animals receiving concomitant chronic immunosuppression. Depletional induction is similar to human- and rhesus-specific RATGs in rhesus macaques. Both rhesus- and human-specific agents appear appropriate for preclinical modeling of clinical RATG use.
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Affiliation(s)
- Brian I Shaw
- Department of Surgery, Duke University, Durham, NC, USA
| | - Robin Schmitz
- Department of Surgery, Duke University, Durham, NC, USA
| | - Walter J Flores
- MassBiologics, University of Massachusetts Medical School, Boston, MA, USA
| | - Diogo M Magnani
- MassBiologics, University of Massachusetts Medical School, Boston, MA, USA
| | - Jie Li
- Department of Surgery, Duke University, Durham, NC, USA
| | - Mingqing Song
- Department of Surgery, Duke University, Durham, NC, USA
| | - Allan D Kirk
- Department of Surgery, Duke University, Durham, NC, USA
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2
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Snyder ME, Farber DL. Thymic-Peripheral Crosstalk in Lymphodepletion Therapy. Am J Transplant 2017; 17:1970-1971. [PMID: 28544604 DOI: 10.1111/ajt.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 01/25/2023]
Affiliation(s)
- M E Snyder
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY.,Department of Medicine, Columbia University Medical Center, New York, NY
| | - D L Farber
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY.,Department of Surgery, Columbia University Medical Center, New York, NY
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3
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Affiliation(s)
- J N Fleming
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC.
| | - D J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, SC.,Department of Pharmacy, Ralph H Johnson VAMC, Charleston, SC
| | - N A Pilch
- Transplant Center, Medical University of South Carolina, Charleston, SC
| | - T R Srinivas
- Department of Nephrology, Medical University of South Carolina, Charleston, SC
| | - K D Chavin
- Department of Surgery, Medical University of South Carolina, Charleston, SC
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4
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Cumpelik A, Gerossier E, Jin J, Tsakiris D, Dickenmann M, Sadallah S, Schifferli JA, Zecher D. Mechanism of Platelet Activation and Hypercoagulability by Antithymocyte Globulins (ATG). Am J Transplant 2015; 15:2588-601. [PMID: 25966640 DOI: 10.1111/ajt.13316] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/15/2015] [Revised: 02/23/2015] [Accepted: 03/13/2015] [Indexed: 01/25/2023]
Abstract
T cell depletion with antithymocyte globulins (ATG) can be complicated by thrombopenia and hypercoagulability. The underlying mechanism is still unclear. We found that binding of ATG to platelets caused platelet aggregation, α-granule release, membrane phosphatidylserine exposure and the rapid release of procoagulant platelet microvesicles (MV). Platelet activation and MV release were complement-dependent and required membrane insertion of C5b-8 but not stable lytic pore formation by C5b-9. ATG also activated platelets via binding to the low-affinity Fc gamma receptor FcγRII. However, only complement inhibition but not blockade of FcγRII prevented MV release and subsequent thrombin activation in plasma. In 19 hematopoietic stem cell and kidney transplant patients, ATG treatment resulted in thrombopenia and increased plasma levels of d-dimer and thrombin-antithrombin complexes. Flow cytometric analysis of complement fragments on platelet MV in patient plasma confirmed dose-dependent complement activation by ATG. However, the rapid rise in MV numbers observed in vitro was not seen during ATG treatment. In vitro experiments suggested that this was due to adherence of C3b-tagged MV to red blood cells via complement receptor CR1. These data suggest a clinically relevant link between complement activation and thrombin generation and offer a potential mechanism underlying ATG-induced hypercoagulability.
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Affiliation(s)
- A Cumpelik
- Department of Research, Basel University Hospital, Basel, Switzerland.,Department of Medicine, Basel University Hospital, Basel, Switzerland
| | - E Gerossier
- Department of Research, Basel University Hospital, Basel, Switzerland
| | - J Jin
- Department of Medicine, Basel University Hospital, Basel, Switzerland
| | - D Tsakiris
- Department of Hematology, Basel University Hospital, Basel, Switzerland.,Department of Laboratory Medicine, Basel University Hospital, Basel, Switzerland
| | - M Dickenmann
- Department of Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland
| | - S Sadallah
- Department of Research, Basel University Hospital, Basel, Switzerland
| | - J A Schifferli
- Department of Research, Basel University Hospital, Basel, Switzerland.,Department of Medicine, Basel University Hospital, Basel, Switzerland
| | - D Zecher
- Department of Research, Basel University Hospital, Basel, Switzerland.,Department of Medicine, Basel University Hospital, Basel, Switzerland.,Department of Nephrology, University Medical Center Regensburg, Regensburg, Germany
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5
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Hellemans R, Hazzan M, Durand D, Mourad G, Lang P, Kessler M, Charpentier B, Touchard G, Berthoux F, Merville P, Ouali N, Squifflet JP, Bayle F, Wissing KM, Noël C, Abramowicz D. Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study. Am J Transplant 2015; 15:1923-32. [PMID: 25707875 DOI: 10.1111/ajt.13191] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 07/07/2014] [Revised: 12/07/2014] [Accepted: 12/24/2014] [Indexed: 01/25/2023]
Abstract
We previously reported a randomized controlled trial in which 227 de novo deceased-donor kidney transplant recipients were randomized to rabbit antithymocyte (rATG, Thymoglobulin) or daclizumab if they were considered to be at high immunological risk, defined as high panel reactive antibodies (PRA), loss of a first kidney graft through rejection within 2 years of transplantation, or third or fourth transplantation. Patients treated with rATG had lower incidences of biopsy-proven acute rejection (BPAR) and steroid-resistant rejection at 1 year. Patients were followed to 5 years posttransplant in an observational study; findings are described here. Treatment with rATG was associated with a lower rate of BPAR at 5 years (14.2% vs. 26.0% with daclizumab; p = 0.035). Only one rATG-treated patient (0.9%) and one daclizumab-treated patient (1.0%) developed BPAR after 1 year. Five-year graft and patient survival rates, and renal function, were similar between the two groups. Overall graft survival at 5 years was significantly higher in patients without BPAR (81.0% vs. 54.8%; p < 0.001). In conclusion, rATG is superior to daclizumab for the prevention of BPAR among high-immunological-risk renal transplant recipients. Overall graft survival at 5 years was approximately 70% with either induction therapy, which compares favorably to low-risk cohorts.
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Affiliation(s)
- R Hellemans
- Dienst Néphrologie, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - M Hazzan
- Service de N, é, phrologie, Hôpital, Lille, France
| | - D Durand
- Service de Néphrologie-HTA-Dialyse-Transplantation, CHU-Toulouse Rangueil, Toulouse, France
| | - G Mourad
- Département de Néphrologie et Transplantation, CHRU-Hôpital Lapeyronie, Montpellier, France
| | - P Lang
- Service de Néphrologie, Hôpital Henri Mondor, Créteil, France
| | - M Kessler
- Département de Néphrologie, Hôpital Universitaire de Nancy, Nancy, France
| | - B Charpentier
- Service de Néphrologie, CHRU de Bicêtre, Bicêtre, France
| | - G Touchard
- Service de Néphrologie-Transplantation, CHU de Poitiers, Hôpital Jean-Bernard, Poitiers, France
| | - F Berthoux
- Service de Néphrologie, CHRU-Hôpital Nord, Saint-Etienne, France
| | - P Merville
- Service de Néphrologie, Hôpital Pellegrin, Bordeaux, France
| | - N Ouali
- Service de Néphrologie A, Hôpital Tenon, Paris, France
| | - J-P Squifflet
- Cliniques Universitaires St Luc, Brussels, and Department of Abdominal Transplantation, CHU Sart Tilman, Liege, Belgium
| | - F Bayle
- Service de Néphrologie, CHU de Grenoble, Grenoble, France
| | - K M Wissing
- Dienst Nefrologie, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - C Noël
- Service de N, é, phrologie, Hôpital, Lille, France
| | - D Abramowicz
- Dienst Néphrologie, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
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6
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Zhang H, Guo H, Lu L, Zahorchak AF, Wiseman RW, Raimondi G, Cooper DKC, Ezzelarab MB, Thomson AW. Sequential monitoring and stability of ex vivo-expanded autologous and nonautologous regulatory T cells following infusion in nonhuman primates. Am J Transplant 2015; 15:1253-66. [PMID: 25783759 PMCID: PMC4773915 DOI: 10.1111/ajt.13113] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 04/18/2014] [Revised: 10/24/2014] [Accepted: 11/17/2014] [Indexed: 01/25/2023]
Abstract
Ex vivo-expanded cynomolgus monkey CD4(+)CD25(+)CD127(-) regulatory T cells (Treg) maintained Foxp3 demethylation status at the Treg-specific demethylation region, and potently suppressed T cell proliferation through three rounds of expansion. When carboxyfluorescein succinimidyl ester- or violet proliferation dye 450-labeled autologous (auto) and nonautologous (non-auto)-expanded Treg were infused into monkeys, the number of labeled auto-Treg in peripheral blood declined rapidly during the first week, but persisted at low levels in both normal and anti-thymocyte globulin plus rapamycin-treated (immunosuppressed; IS) animals for at least 3 weeks. By contrast, MHC-mismatched non-auto-Treg could not be detected in normal monkey blood or in blood of two out of the three IS monkeys by day 6 postinfusion. They were also more difficult to detect than auto-Treg in peripheral lymphoid tissue. Both auto- and non-auto-Treg maintained Ki67 expression early after infusion. Sequential monitoring revealed that adoptively transferred auto-Treg maintained similarly high levels of Foxp3 and CD25 and low CD127 compared with endogenous Treg, although Foxp3 staining diminished over time in these nontransplanted recipients. Thus, infused ex vivo-expanded auto-Treg persist longer than MHC-mismatched non-auto-Treg in blood of nonhuman primates and can be detected in secondary lymphoid tissue. Host lymphodepletion and rapamycin administration did not consistently prolong the persistence of non-auto-Treg in these sites.
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Affiliation(s)
- H. Zhang
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - H. Guo
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - L. Lu
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - A. F. Zahorchak
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - R. W. Wiseman
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - G. Raimondi
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - D. K. C. Cooper
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - M. B. Ezzelarab
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - A. W. Thomson
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA,Corresponding author: Angus W. Thomson,
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Khan T. Delayed graft function in laparoscopic kidney transplantation: the importance of prolonged cold and warm ischemia. Am J Transplant 2015; 15:1444. [PMID: 25809841 DOI: 10.1111/ajt.13229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 01/25/2023]
Affiliation(s)
- T Khan
- Department of Surgery, Prince Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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8
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Crepin T, Carron C, Roubiou C, Gaugler B, Gaiffe E, Simula-Faivre D, Ferrand C, Tiberghien P, Chalopin JM, Moulin B, Frimat L, Rieu P, Saas P, Ducloux D, Bamoulid J. ATG-induced accelerated immune senescence: clinical implications in renal transplant recipients. Am J Transplant 2015; 15:1028-38. [PMID: 25758660 DOI: 10.1111/ajt.13092] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/16/2014] [Accepted: 11/01/2014] [Indexed: 01/25/2023]
Abstract
Persistent ATG-induced CD4(+) T cell lymphopenia is associated with serious clinical complications. We tested the hypothesis that ATG induces accelerated immune senescence in renal transplant recipients (RTR). Immune senescence biomarkers were analyzed at transplant and one-year later in 97 incident RTR -62 patients receiving ATG and 35 receiving anti-CD25 mAb (α-CD25). This consisted in: (i) thymic output; (ii) bone marrow renewal of CD34(+) hematopoietic progenitor cells (CD34(+) HPC) and lymphoid (l-HPC) and myeloid (m-HPC) progenitor ratio; (iii) T cell phenotype; and (iv) measurement of T cell relative telomere length (RTL) and telomerase activity (RTA). Clinical correlates were analyzed with a 3 year follow-up. Thymic output significantly decreased one-year posttransplant in ATG-treated patients. ATG was associated with a significant decrease in l-HPC/m-HPC ratio. Late stage differentiated CD57(+) /CD28(-) T cells increased in ATG-treated patients. One-year posttransplant T cell RTL and RTA were consequently lower in ATG-treated patients. ATG is associated with accelerated immune senescence. Increased frequency of late differentiated CD4(+) T cell frequency at transplantation tended to be predictive of a higher risk of subsequent opportunistic infections and of acute rejection only in ATG-treated patients but this needs confirmation. Considering pretransplant immune profile may help to select those patients who may benefit from ATG to prevent severe infections and acute rejection.
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Affiliation(s)
- T Crepin
- INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France; Université de Franche-Comté, Faculté de Médecine et de Pharmacie, Besançon, France; Structure Fédérative de Recherche, SFR FED4234, Besançon, France; CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
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Halldorson JB, Bakthavatsalam R, Montenovo M, Dick A, Rayhill S, Perkins J, Reyes J. Differential rates of ischemic cholangiopathy and graft survival associated with induction therapy in DCD liver transplantation. Am J Transplant 2015; 15:251-8. [PMID: 25534449 DOI: 10.1111/ajt.12962] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/08/2014] [Revised: 07/09/2014] [Accepted: 08/04/2014] [Indexed: 01/25/2023]
Abstract
Transplantation utilizing donation after circulatory death (DCD) donors is associated with ischemic cholangiopathy (IC) and graft loss. The University of Washington (UW) DCD experience totals 89 DCD liver transplants performed between 2003 and 2011. Overall outcome after DCD liver transplantation at UW demonstrates Kaplan-Meier estimated 5-year patient and graft survival rates of 81.6% and 75.6%, respectively, with the great majority of patient and graft losses occurring in the first-year posttransplant from IC. Our program has almost exclusively utilized either anti-thymocyte globulin (ATG) or basiliximab induction (86/89) for DCD liver transplantations. Analysis of the differential effect of induction agent on graft survival demonstrated graft survival of 96.9% at 1 year for ATG versus 75.9% for basiliximab (p = 0.013). The improved survival did not appear to be from a lower rate of rejection (21.9% vs. 22.2%) but rather a differential rate of IC, 35.2% for basiliximab versus 12.5% for ATG (p = 0.011). Multivariable analysis demonstrated induction agent to be independently associated with graft survival and IC free graft survival when analyzed against variables including donor age, fWIT, donor cold ischemia time and transplant era.
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Affiliation(s)
- J B Halldorson
- Division of Transplantation, University of California, San Diego, CA
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