HLA antibodies present in the sera of sensitized patients awaiting renal transplant are also reactive to swine leukocyte antigens.

BACKGROUND: To determine whether preformed HLA alloantibodies present in the sera of patients awaiting kidney transplantation will be detrimental to a potential porcine xenograft, we tested their cross-reactivity to swine leukocyte antigens (SLA). METHODS: Sera obtained from patients with varying levels of HLA sensitization (high panel-reactive antibodies > 70%, n= 7; moderate panel-reactive antibodies 30-40%, n=2) were analyzed. Pooled normal human AB sera and sera from nonsensitized patients (n=3) served as negative control. IgG was purified by protein-G chromatography, and xenoreactive natural antibodies (XNA) were depleted by passing the IgG through a series of melibiose and thyroglobulin-agarose columns. The elimination of XNA from HLA IgG preparations was confirmed by GS-IB4 lectin blocking assay and by an ELISA. RESULTS: IgG isolated from normal AB serum and three nonsensitized patients, which was depleted of XNA (HLA-IgG), did not react to human or porcine lymphocytes (peripheral blood mononuclear cells; PBMC) either by flow cytometry or by complement-dependent microcytotoxicity assays. However, HLA-IgG isolated from nine sensitized patients were reactive to a panel of porcine peripheral blood lymphocytes (n=6) by flow cytometry (>50 mean channel shift) and in complement-dependent microcytotoxicity assays in addition to their reactivity to human PBMC. The binding of HLA-IgG to porcine PBMC was significantly reduced by preabsorption with pooled human platelet concentrate. Further, the HLA IgG showed recognition of 45-kDa affinity-purified SLA class I on Western blots. CONCLUSIONS: This study demonstrates that HLA antibodies present in the sera of sensitized individuals can cross-react with SLA. Thus, xenotransplantation of porcine organs into HLA-sensitized patients has the potential to be rejected by humoral mechanisms. Testing to avoid such cross-reactive antibodies should be considered.

Increased expression of the HDJ-2 heat shock protein in biopsies of human rejected kidney.

The presence of donor-specific alloreactive helper and cytotoxic T cells has been described in allograft biopsies obtained from individuals undergoing acute allograft rejection of various solid organs. However, not all of these lymphocytes demonstrated specificity to mismatched donor HLA antigens. The identity of the antigens to which these T cells are directed to is still unknown at present. The possibility that heat shock proteins (Hsp) could serve as antigenic determinants to which these T cells respond has been raised. We have recently cloned and characterized a novel Hsp of 45Kd molecular weight. In the present study we show that the synthesis of this Hsp (HDJ-2) as well as Hsp60 is significantly elevated in kidney biopsies from individuals undergoing acute and chronic rejection. No message was detected either for HDJ-2 or Hsp60 in biopsies obtained from normal pretransplant kidneys or posttransplant kidneys with no rejection. However, there was some increase in Hsp in miscellaneous causes of allograft dysfunction such as infection and drug allergy. But, this was not as consistent as that noted for allograft rejection. This marked increase in Hsp expression during allograft rejection suggests Hsps as potential candidates for antigenic determinants contributing to kidney rejection.