Barz Dagmar, Friedrich Stanley, Schuller Annette, Rummler Silke
Institute of Transfusion Medicine, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany.
Institute of Transfusion Medicine, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany.
Atheroscler Suppl. 2015 May;18:112-8. doi: 10.1016/j.atherosclerosissup.2015.02.021.
The influence of ATR-1-autoantibodies on antibody mediated rejection (AMR) is still discussed controversially. Here we demonstrate some aspects as to diagnostics, treatment, clinical relevance and graft outcome.
A total of 27 transplant recipients (6 heart, 16 kidney, 3 lung and 2 multi-organ) suffering from AMR and a control group without transplant (8 pre-Tx, 1 pregnancy and 16 autoimmune and haematological diseases) were studied. In total, 290 IA eluates and the corresponding patient serum samples before and after immunoadsorption (IA) were analysed.
ATR-1-and ETR-auto-antibodies (aAB) were found only in 4.5% of sera previous to IA treatment by using ELISA, but could be detected in 42% of IA eluates. AB with very high titres (>1:8 to 1:256) in the eluate were found more frequently in heart than in kidney recipients. These strong aAB are clinically relevant and cause dysfunction or loss of the grafts. A quick and reliable diagnosis of the aAB is essential for successful application of the therapeutic possibilities, like removal of the pathogenic autoantibodies or the blockage of their actions.
The use of eluates for antibody detection was more sensitive and more reliable than patient serum. Yet, the test results are only meaningful when AB titres are measured, as this allows for a quick statement about the actual antibody elimination. The removal of pathogenic aAB via IA is better than medication-based treatment.
ATR-1自身抗体对抗体介导的排斥反应（AMR）的影响仍存在争议。在此，我们阐述了一些关于诊断、治疗、临床相关性及移植物结局的方面。
对总共27例发生AMR的移植受者（6例心脏移植、16例肾脏移植、3例肺移植和2例多器官移植）以及一个非移植对照组（8例移植前患者、1例孕妇和16例自身免疫性及血液系统疾病患者）进行了研究。总共分析了290份免疫吸附（IA）洗脱液以及相应患者免疫吸附前后的血清样本。
通过酶联免疫吸附测定法（ELISA），仅在4.5%的IA治疗前血清中发现了ATR-1和ETR自身抗体（aAB），但在42%的IA洗脱液中能够检测到。洗脱液中具有非常高滴度（>1:8至1:256）的抗体在心脏移植受者中比在肾脏移植受者中更频繁地被发现。这些强效aAB具有临床相关性，并会导致移植物功能障碍或丧失。快速且可靠地诊断aAB对于成功应用治疗手段（如去除致病性自身抗体或阻断其作用）至关重要。
使用洗脱液检测抗体比患者血清更敏感、更可靠。然而，只有在测量抗体滴度时，检测结果才有意义，因为这能够快速说明实际的抗体清除情况。通过IA去除致病性aAB比基于药物的治疗更好。
