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The impact of belatacept on the phenotypic heterogeneity of renal T cell–mediated alloimmune response: The critical role of maintenance treatment and inflammatory load
Author(s) -
Dobi Dejan,
Vincenti Flavio,
Chandran Sindhu,
Greenland John R.,
Bowman Christopher,
Chen Adeline,
Junger Henrik,
Laszik Zoltan G.
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14084
Subject(s) - belatacept , medicine , immunosuppression , calcineurin , immunology , immune system , t cell , abatacept , transplantation , kidney transplantation , antibody , rituximab , kidney transplant
Abstract Belatacept offers superior long‐term outcome relative to calcineurin inhibitor (CNI)‐based immunosuppression. However, the higher frequency of early T cell–mediated rejection (TCMR) in belatacept‐treated patients hampered the widespread adoption of costimulation blockade. Here, we applied gene expression analysis and whole‐slide inflammatory cell quantification to assess the impact of belatacept on intragraft immune signature. We studied formalin‐fixed, paraffin‐embedded renal biopsies from 92 patients stratified by histopathologic diagnosis (TCMR, borderline changes, or normal) and immunosuppression regimen (belatacept, CNI). An interaction model was built to explore maintenance treatment‐dependent expression level changes of immune response‐related genes across diagnostic categories of normal, borderline changes, and TCMR. Ninety‐one percent of genes overexpressed in TCMR showed significant correlation with whole section inflammatory load. There were 27 genes that had a positive association with belatacept treatment. These were mostly related to myeloid cells and innate immunity. Genes negatively associated with costimulation blockade (n = 14) could be linked to B‐cell differentiation and proliferation. We concluded that expression levels of genes characteristic of TCMR are strongly interconnected with quantitative changes of the biopsy inflammatory load. Our results might suggest differential involvement of the innate immune system, and an altered B‐cell engagement during TCMR in belatacept‐treated patients relative to CNI‐treated referents.