Absence of IL-6 Receptor Blockade Effect on the Outcomes of Transplant Glomerulopathy in the Absence of Anti-HLA Donor-specific Antibodies
| Autor: | Alberto Mella, MD, PhD, Antonio Lavacca, MD, Diana Teodora Dodoi, MD, Roberto Presta, MD, Fabrizio Fop, MSc, Marco Campagna, MD, Ana Maria Manzione, MD, Caterina Dolla, MD, PhD, Ester Gallo, MD, Isabella Abbasciano, MD, Chiara Gai, PhD, Giovanni Camussi, MD, Antonella Barreca, MD, PhD, Cristiana Caorsi, PhD, Gloria Giovinazzo, MD, Luigi Biancone, MD, PhD |
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| Jazyk: | angličtina |
| Rok vydání: | 2024 |
| Předmět: | |
| Zdroj: | Transplantation Direct, Vol 10, Iss 6, p e1638 (2024) |
| Druh dokumentu: | article |
| ISSN: | 2373-8731 00000000 |
| DOI: | 10.1097/TXD.0000000000001638 |
| Popis: | Background. Transplant glomerulopathy (TG) is the hallmark of chronic antibody-mediated rejection but often occurs without anti-HLA donor-specific antibodies (DSAs) in the assumption that other DSAs may be the effectors of the tissue injury. Recently, we reported a positive effect of interleukin-6 (IL-6) receptor blocker tocilizumab (TCZ) in TG/DSA+. In the present study, we investigate the effect of TCZ in a cohort of TG cases without detectable anti-HLA DSAs. Methods. Single-center retrospective analysis of TG cases without anti-HLA DSAs (TG/DSA) treated with TCZ for chronic antibody-mediated rejection as first-line therapy evaluated through clinical, protocol biopsies, and gene expression analyses was included. Results. Differently from TG/DSA+, TG/DSA– showed a progressive reduction in the estimated glomerular filtration rate at 12 mo and after that with no significant modification in microvascular inflammation or C4d+. No upregulation in tight junction protein-1, aldo-keto reductase family 1 member C3, and calcium/calmodulin-dependent serine protein kinase, documented in TG/DSA+, was noted in post-TCZ biopsies. The reduction of microvascular inflammation was associated with natural killer-cell reduction in TG/DSA+, whereas TG/DSA– tends to maintain or increase periglomerular/interstitial infiltration. Conclusions. In the absence of anti-HLA DSAs, TG behavior seems not to be modified by IL-6 receptor blockade. These results are at variance with observational studies and previous trials with IL-6 inhibitors in TG associated with anti-HLA DSAs. These data may fuel the hypothesis of different mechanisms underlying TGs (including the potentially different roles of natural killer cells) and suggest carefully selecting patients with TG for clinical trials or off-label treatment based on their antidonor serologic status. |
| Databáze: | Directory of Open Access Journals |
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