Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated Rejection
Objective: Chronic renal antibody-mediated rejection (ABMR) is a common cause of allograft failure, but an effective therapy is not available. Extracorporeal photopheresis (ECP) has been proven successful in chronic lung and heart rejection, and graft versus host disease. The aim of this study was t...
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MDPI AG
2021-06-01
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| author | Marilena Gregorini Claudia Del Fante Eleonora Francesca Pattonieri Maria Antonietta Avanzini Maria Antonietta Grignano Irene Cassaniti Fausto Baldanti Giuditta Comolli Angela Nocco Miriam Ramondetta Gianluca Viarengo Vincenzo Sepe Carmelo Libetta Catherine Klersy Cesare Perotti Teresa Rampino |
| author_facet | Marilena Gregorini Claudia Del Fante Eleonora Francesca Pattonieri Maria Antonietta Avanzini Maria Antonietta Grignano Irene Cassaniti Fausto Baldanti Giuditta Comolli Angela Nocco Miriam Ramondetta Gianluca Viarengo Vincenzo Sepe Carmelo Libetta Catherine Klersy Cesare Perotti Teresa Rampino |
| author_sort | Marilena Gregorini |
| collection | DOAJ |
| description | Objective: Chronic renal antibody-mediated rejection (ABMR) is a common cause of allograft failure, but an effective therapy is not available. Extracorporeal photopheresis (ECP) has been proven successful in chronic lung and heart rejection, and graft versus host disease. The aim of this study was to evaluate the effectiveness of ECP in chronic ABMR patients. Patients and Methods: We investigated ECP treatment in 14 patients with biopsy-proven chronic ABMR and stage 2–3 chronic renal failure. The primary aim was to e valuate the eGFR lowering after 1 year of ECP therapy. The ECP responders (R) showed eGFR reduction greater than 20% vs the basal levels. We also evaluated the effectiveness of ECP on proteinuria, anti-HLA antibodies (HLAab), interleukin 6 (IL-6) serum levels, and CD3, CD4, CD8, CD19, NK, Treg and T helper 17 (Th17) circulating cells. Results: Three patients dropped out of the study. The R patients were eight (72.7%) out of the 11 remaining patients. Because ECP was not associated with any adverse reaction, the R patients continued such treatment for up to 3 years, showing a persisting eGFR stabilization. Twenty four hour proteinuria did not increase in the R patients over the follow-up when compared to the non-responder patients (NR). In the R patients, the HLAab levels were reduced and completely cleared in six out of eight patients when compared with the NR patients. The NR HLAab levels also increased after the discontinuation of the ECP. The ECP in the R patients showed a decrease in CD3, CD4, CD8, CD19, and NK circulating cells. The ECP treatment in the R patients also induced Tregs and Th17 cell increases, and a decrease of the IL-6 serum levels. Conclusions: ECP abates the HLAab titer and renal failure progression in patients with chronic renal ABMR, modulating the immune cellular and humoral responses. |
| first_indexed | 2024-03-10T10:17:52Z |
| format | Article |
| id | doaj.art-b9deca2848954dd9ac57ac5c2585a2ca |
| institution | Directory Open Access Journal |
| issn | 2079-7737 |
| language | English |
| last_indexed | 2024-03-10T10:17:52Z |
| publishDate | 2021-06-01 |
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| series | Biology |
| spelling | doaj.art-b9deca2848954dd9ac57ac5c2585a2ca2023-11-22T00:42:12ZengMDPI AGBiology2079-77372021-06-0110654710.3390/biology10060547Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated RejectionMarilena Gregorini0Claudia Del Fante1Eleonora Francesca Pattonieri2Maria Antonietta Avanzini3Maria Antonietta Grignano4Irene Cassaniti5Fausto Baldanti6Giuditta Comolli7Angela Nocco8Miriam Ramondetta9Gianluca Viarengo10Vincenzo Sepe11Carmelo Libetta12Catherine Klersy13Cesare Perotti14Teresa Rampino15Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, ItalyImmunohematology and Transfusion Service, IRCCS Policlinico San Matteo, 27100 Pavia, ItalyUnit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyImmunology and Transplantation Laboratory, Cell Factory, Pediatric Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, ItalyUnit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyMolecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyMolecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyMolecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyLaboratory of Transplant Immunology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milano, 20122 Milano, ItalyLaboratory of Transplant Immunology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milano, 20122 Milano, ItalyImmunohematology and Transfusion Service, IRCCS Policlinico San Matteo, 27100 Pavia, ItalyUnit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyDepartment of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, ItalyClinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyImmunohematology and Transfusion Service, IRCCS Policlinico San Matteo, 27100 Pavia, ItalyUnit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, ItalyObjective: Chronic renal antibody-mediated rejection (ABMR) is a common cause of allograft failure, but an effective therapy is not available. Extracorporeal photopheresis (ECP) has been proven successful in chronic lung and heart rejection, and graft versus host disease. The aim of this study was to evaluate the effectiveness of ECP in chronic ABMR patients. Patients and Methods: We investigated ECP treatment in 14 patients with biopsy-proven chronic ABMR and stage 2–3 chronic renal failure. The primary aim was to e valuate the eGFR lowering after 1 year of ECP therapy. The ECP responders (R) showed eGFR reduction greater than 20% vs the basal levels. We also evaluated the effectiveness of ECP on proteinuria, anti-HLA antibodies (HLAab), interleukin 6 (IL-6) serum levels, and CD3, CD4, CD8, CD19, NK, Treg and T helper 17 (Th17) circulating cells. Results: Three patients dropped out of the study. The R patients were eight (72.7%) out of the 11 remaining patients. Because ECP was not associated with any adverse reaction, the R patients continued such treatment for up to 3 years, showing a persisting eGFR stabilization. Twenty four hour proteinuria did not increase in the R patients over the follow-up when compared to the non-responder patients (NR). In the R patients, the HLAab levels were reduced and completely cleared in six out of eight patients when compared with the NR patients. The NR HLAab levels also increased after the discontinuation of the ECP. The ECP in the R patients showed a decrease in CD3, CD4, CD8, CD19, and NK circulating cells. The ECP treatment in the R patients also induced Tregs and Th17 cell increases, and a decrease of the IL-6 serum levels. Conclusions: ECP abates the HLAab titer and renal failure progression in patients with chronic renal ABMR, modulating the immune cellular and humoral responses.https://www.mdpi.com/2079-7737/10/6/547lymphocytes subsetchronic allograft rejectionkidney transplantationextracorporeal photopheresisproteinuria, Donor-Specific-Antibody |
| spellingShingle | Marilena Gregorini Claudia Del Fante Eleonora Francesca Pattonieri Maria Antonietta Avanzini Maria Antonietta Grignano Irene Cassaniti Fausto Baldanti Giuditta Comolli Angela Nocco Miriam Ramondetta Gianluca Viarengo Vincenzo Sepe Carmelo Libetta Catherine Klersy Cesare Perotti Teresa Rampino Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated Rejection Biology lymphocytes subset chronic allograft rejection kidney transplantation extracorporeal photopheresis proteinuria, Donor-Specific-Antibody |
| title | Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated Rejection |
| title_full | Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated Rejection |
| title_fullStr | Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated Rejection |
| title_full_unstemmed | Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated Rejection |
| title_short | Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated Rejection |
| title_sort | photopheresis abates the anti hla antibody titer and renal failure progression in chronic antibody mediated rejection |
| topic | lymphocytes subset chronic allograft rejection kidney transplantation extracorporeal photopheresis proteinuria, Donor-Specific-Antibody |
| url | https://www.mdpi.com/2079-7737/10/6/547 |
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