Successful desensitization with proteasome inhibition and costimulation blockade in sensitized nonhuman primates

Jean Kwun, Christopher Burghuber, Miriam Manook, Brian Ezekian, Jaeberm Park, Janghoon Yoon, John S. Yi, Neal Iwakoshi, Adriana Gibby, Jung Joo Hong, Alton B. Farris, Allan D. Kirk, Stuart J. Knechtle*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

The detrimental effects of donor-directed antibodies in sensitized transplant patients remain a difficult immunologic barrier to successful organ transplantation. Antibody removal is often followed by rebound. Proteasome inhibitors (PIs) deplete antibodyproducing plasma cells (PCs) but have shown marginal benefit for desensitization. In an allosensitized nonhuman primate (NHP) model, we observed increased germinal center (GC) formation after PI monotherapy, suggesting a compensatory PC repopulationmediated via GCactivation.Herewe showthat costimulation blockade (CoB) targetsGCfollicularhelperT(Tfh) cells in allosensitized NHPs. Combined PI and CoB significantly reduces bone marrow PCs (CD19+CD202CD38+), Tfh cells (CD4+ICOS+PD-1hi), and GC B cells (BCL-61CD201); controls the homeostatic GC response to PC depletion; and sustains alloantibody decline. Importantly, dual PC and CoB therapy prolongs rejection-free graft survival in major histocompatibility complex incompatible kidney transplantation without alloantibody rebound. Our study illustrates a translatable desensitization method and provides mechanistic insight into maintenance of alloantibody sensitization.

Original languageEnglish
Pages (from-to)2115-2119
Number of pages5
JournalBlood Advances
Volume1
Issue number24
DOIs
StatePublished - 14 Nov 2017
Externally publishedYes

Fingerprint

Dive into the research topics of 'Successful desensitization with proteasome inhibition and costimulation blockade in sensitized nonhuman primates'. Together they form a unique fingerprint.

Cite this