Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.
Am J Transplant. 2016 Dec;16(12):3416-3429. doi: 10.1111/ajt.13866. Epub 2016 Jun 23.
Pretransplant autoantibodies to LG3 and angiotensin II type 1 receptors (AT1R) are associated with acute rejection in kidney transplant recipients, whereas antivimentin autoantibodies participate in heart transplant rejection. Ischemia-reperfusion injury (IRI) can modify self-antigenic targets. We hypothesized that ischemia-reperfusion creates permissive conditions for autoantibodies to interact with their antigenic targets and leads to enhanced renal damage and dysfunction. In 172 kidney transplant recipients, we found that pretransplant anti-LG3 antibodies were associated with an increased risk of delayed graft function (DGF). Pretransplant anti-LG3 antibodies are inversely associated with graft function at 1 year after transplantation in patients who experienced DGF, independent of rejection. Pretransplant anti-AT1R and antivimentin were not associated with DGF or its functional outcome. In a model of renal IRI in mice, passive transfer of anti-LG3 IgG led to enhanced dysfunction and microvascular injury compared with passive transfer with control IgG. Passive transfer of anti-LG3 antibodies also favored intrarenal microvascular complement activation, microvascular rarefaction and fibrosis after IRI. Our results suggest that anti-LG3 antibodies are novel aggravating factors for renal IRI. These results provide novel insights into the pathways that modulate the severity of renal injury at the time of transplantation and their impact on long-term outcomes.
移植前针对 LG3 和血管紧张素 II 型 1 型受体 (AT1R) 的自身抗体与肾移植受者的急性排斥反应有关,而抗波形蛋白自身抗体则参与心脏移植排斥反应。缺血再灌注损伤 (IRI) 可改变自身抗原靶标。我们假设缺血再灌注为自身抗体与其抗原靶标相互作用创造了许可条件,并导致肾损伤和功能障碍加重。在 172 名肾移植受者中,我们发现移植前抗 LG3 抗体与延迟移植物功能 (DGF) 的风险增加有关。在经历 DGF 的患者中,移植前抗 LG3 抗体与移植后 1 年的移植物功能呈负相关,与排斥无关。移植前抗 AT1R 和抗波形蛋白与 DGF 或其功能结果无关。在小鼠肾 IRI 模型中,与被动转移对照 IgG 相比,被动转移抗 LG3 IgG 导致肾功能障碍和微血管损伤加重。被动转移抗 LG3 抗体也有利于 IRI 后肾内微血管补体激活、微血管稀疏和纤维化。我们的研究结果表明,抗 LG3 抗体是肾 IRI 的新型加重因素。这些结果为调节移植时肾损伤严重程度的途径及其对长期结果的影响提供了新的见解。