Molecular assessment of renal allografts has already been suggested in antibody-mediated rejection (ABMR), but little is known about the gene transcript patterns in particular renal compartments. We used laser capture microdissection coupled with quantitative RT-PCR to distinguish the transcript patterns in the glomeruli and tubulointerstitium of kidney allografts in sensitized retransplant recipients at high risk of ABMR. The expressions of 13 genes were quantified in biopsies with acute active ABMR, chronic active ABMR, acute tubular necrosis (ATN), and normal findings. The transcripts were either compartment specific (TGFB1 in the glomeruli and HAVCR1 and IGHG1 in the tubulointerstitium), ABMR specific (GNLY), or follow-up specific (CXCL10 and CX3CR1). The transcriptional profiles of early acute ABMR shared similarities with ATN. The transcripts of CXCL10 and TGFB1 increased in the glomeruli in both acute ABMR and chronic active ABMR. Chronic active ABMR was associated with the upregulation of most genes (SH2D1B, CX3CR1, IGHG1, MS4A1, C5, CD46, and TGFB1) in the tubulointerstitium. In this study, we show distinct gene expression patterns in specific renal compartments reflecting cellular infiltration observed by conventional histology. In comparison with active ABMR, chronic active ABMR is associated with increased transcripts of tubulointerstitial origin.

• Klíčová slova
• antibody-mediated rejection, gene expression, kidney transplantation, laser capture microdissection, renal compartments,
• MeSH
• biopsie MeSH
• chronická nemoc MeSH
• dospělí MeSH
• glomerulus imunologie   metabolismus   patologie   MeSH
• HLA antigeny imunologie   MeSH
• isoprotilátky imunologie   MeSH
• kvantitativní polymerázová řetězová reakce MeSH
• laserová záchytná mikrodisekce MeSH
• ledviny imunologie   metabolismus   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polymerázová řetězová reakce s reverzní transkripcí MeSH
• rejekce štěpu genetika   imunologie   metabolismus   patologie   MeSH
• senioři MeSH
• stanovení celkové genové exprese MeSH
• studie případů a kontrol MeSH
• transkriptom * MeSH
• transplantace ledvin škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• HLA antigeny MeSH
• isoprotilátky MeSH

Prevention of cytomegalovirus (CMV) is essential in organ transplantation. The two main strategies are pre-emptive therapy, in which one screens for and treats asymptomatic CMV viremia, and universal antiviral prophylaxis. We compared these strategies and examined long-term outcomes in a randomized, open-label, single-center trial. We randomly assigned 70 renal transplant recipients (CMV-seropositive recipient or donor) to 3-month prophylaxis with valacyclovir (n=34) or pre-emptive valganciclovir for significant CMV viremia detected at predefined assessments through month 12 (n=36). Among the 55 patients who had a protocol biopsy specimen available at 3 years to allow assessment of the primary outcome, 9 (38%) of 24 patients in the prophylaxis group and 6 (19%) of 31 patients in the pre-emptive therapy group had moderate to severe interstitial fibrosis and tubular atrophy (odds ratio, 2.50; 95% confidence interval, 0.74-8.43; P=0.22). The prophylaxis group had significantly higher intrarenal mRNA expression of genes involved in fibrogenesis. The occurrence of CMV disease was similar in both groups, but pre-emptive therapy improved 4-year graft survival (92% versus 74%; P=0.049) as a result of worse outcomes in patients with late-onset CMV viremia. In conclusion, compared with valacyclovir prophylaxis, pre-emptive valganciclovir therapy may lead to less severe interstitial fibrosis and tubular atrophy and to significantly better graft survival.

• MeSH
• acyklovir analogy a deriváty   terapeutické užití   MeSH
• antivirové látky terapeutické užití   MeSH
• atrofie MeSH
• biopsie MeSH
• cytomegalovirové infekce mortalita   prevence a kontrola   MeSH
• Cytomegalovirus izolace a purifikace   MeSH
• dospělí MeSH
• fibróza MeSH
• ganciklovir analogy a deriváty   terapeutické užití   MeSH
• Kaplanův-Meierův odhad MeSH
• ledviny patologie   virologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• následné studie MeSH
• přežívání štěpu MeSH
• transplantace ledvin * mortalita   MeSH
• valaciclovir MeSH
• valganciklovir MeSH
• valin analogy a deriváty   terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• acyklovir MeSH
• antivirové látky MeSH
• ganciklovir MeSH
• valaciclovir MeSH
• valganciklovir MeSH
• valin MeSH

Earlier detection of antibody-mediated rejection of kidney allografts may improve graft outcomes. Profiling of gene expression holds promise for the diagnosis and prognosis of antibody-mediated rejection. Here, we identified 730 patients who received kidney transplants during 2002-2005, including 21 patients (2.9%) who experienced early acute antibody-mediated rejection. We also identified a matched group of 43 patients with early acute T cell-mediated rejection to serve as controls. Compared with patients with T cell-mediated rejection, those with antibody-mediated rejection had significantly higher intrarenal mRNA expression of the cytoprotective heme oxygenase-1 but had lower expression of the regulatory T cell marker forkhead box P3 (FoxP3), the B cell marker CD20, and the chemokine regulated upon activation, normal T cell expressed and secreted (RANTES). T cell infiltration was similar in both groups of patients. Compared with grafts that had a favorable course, those that failed as a result of antibody-mediated rejection had expression profiles suggesting a lack of regulation (less FoxP3, TGF-beta1, RANTES, and CD20). Grafts that failed as a result of T cell-mediated rejection only revealed lower expression of CD20 mRNA. In summary, these data suggest that severe antibody-mediated rejection and T cell-mediated rejection result in graft loss by distinct mechanisms. Molecular phenotypes of early acute rejection might help to identify grafts with poor prognosis, allowing earlier application of additional therapies.

• MeSH
• antigeny CD20 genetika   metabolismus   MeSH
• chemokin CCL5 genetika   metabolismus   MeSH
• dospělí MeSH
• fenotyp * MeSH
• forkhead transkripční faktory genetika   metabolismus   MeSH
• Kaplanův-Meierův odhad MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• protilátky imunologie   MeSH
• rejekce štěpu genetika   imunologie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• stanovení celkové genové exprese * MeSH
• studie případů a kontrol MeSH
• T-lymfocyty imunologie   MeSH
• transformující růstový faktor beta1 genetika   metabolismus   MeSH
• transplantace ledvin imunologie   fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antigeny CD20 MeSH
• chemokin CCL5 MeSH
• forkhead transkripční faktory MeSH
• FOXP3 protein, human MeSH Prohlížeč
• protilátky MeSH
• transformující růstový faktor beta1 MeSH