Non-HLA antibodies to immunogenic epitopes predict the evolution of chronic renal allograft injury

J Am Soc Nephrol. 2012 Apr;23(4):750-63. doi: 10.1681/ASN.2011060596. Epub 2012 Feb 2.

Abstract

Chronic allograft injury (CAI) results from a humoral response to mismatches in immunogenic epitopes between the donor and recipient. Although alloantibodies against HLA antigens contribute to the pathogenesis of CAI, alloantibodies against non-HLA antigens likely contribute as well. Here, we used high-density protein arrays to identify non-HLA antibodies in CAI and subsequently validated a subset in a cohort of 172 serum samples collected serially post-transplantation. There were 38 de novo non-HLA antibodies that significantly associated with the development of CAI (P<0.01) on protocol post-transplant biopsies, with enrichment of their corresponding antigens in the renal cortex. Baseline levels of preformed antibodies to MIG (also called CXCL9), ITAC (also called CXCL11), IFN-γ, and glial-derived neurotrophic factor positively correlated with histologic injury at 24 months. Measuring levels of these four antibodies could help clinicians predict the development of CAI with >80% sensitivity and 100% specificity. In conclusion, pretransplant serum levels of a defined panel of alloantibodies targeting non-HLA immunogenic antigens associate with histologic CAI in the post-transplant period. Validation in a larger, prospective transplant cohort may lead to a noninvasive method to predict and monitor for CAI.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Antibody Formation / immunology
  • Biomarkers / blood
  • Biopsy, Needle
  • Chronic Disease
  • Cohort Studies
  • Epitopes / immunology*
  • Female
  • Follow-Up Studies
  • Graft Rejection / immunology*
  • HLA Antigens / immunology
  • Humans
  • Immunohistochemistry
  • Isoantibodies / blood*
  • Kidney / immunology
  • Kidney / pathology
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Assessment
  • Transplantation, Homologous / adverse effects
  • Transplantation, Homologous / immunology
  • Young Adult

Substances

  • Biomarkers
  • Epitopes
  • HLA Antigens
  • Isoantibodies