ABSTRACT
Women are often subjected to serum human chorionic gonadotropin (HCG) testing prior to diagnostic and therapeutic interventions. A positive result leads to further testing to rule out pregnancy and avoid possible fetal teratogenicity. The impact of chronic kidney disease (CKD) on HCG testing has not been studied. We report a series of 5 women out of 62 with CKD, who had a positive HCG test on routine pre-transplant screening at a single transplant center. We analyzed their case records retrospectively. Despite aggressive investigation, their elevated HCG levels remained unexplained. The positive test contributed to delays in transplantation and increased overall cost of treatment.
ABSTRACT
Myeloid-derived suppressor cells (MDSC) are negative regulators of the immune response and are in part responsible for the inhibition of the T cell-mediated immune responses. While MDSC have been demonstrated to participate in the induction of prolonged allograft survival in animal models of transplantation, little is known about their immune regulatory function in human transplant recipients. Here, we report that two subsets of human MDSC expressing CD11b(+), CD33(+) and HLA-DR(-) develop in renal patients posttransplantation. We found that CD14(+) expressing monocytic MDSC isolated from transplant recipients were highly efficient in suppressing the proliferation of CD4(+) T cells in mixed leukocyte reactions. In addition, we observed that CD11b(+) CD33(+) HLA-DR(-) MDSC are capable of expanding Treg in vitro, and their accumulation overtime after transplantation linearly correlated with an increase in Treg in vivo. This is the first study to link the presence of MDSC with the emergence of Treg in vivo in transplant recipients, and to define the subpopulation of MDSC derived from transplant recipients responsible for generation of Treg. Further studies are necessary to determine the alloimmune regulatory function of MDSC in human transplant recipients.
Subject(s)
Forkhead Transcription Factors/metabolism , Kidney Transplantation , Monocytes/cytology , Renal Insufficiency/therapy , T-Lymphocytes, Regulatory/cytology , CD11b Antigen/metabolism , Female , HLA-DR Antigens/metabolism , Humans , Immunophenotyping , Lipopolysaccharide Receptors/metabolism , Lymphocyte Culture Test, Mixed , Male , Myeloid Cells/cytology , Prospective Studies , Sialic Acid Binding Ig-like Lectin 3/metabolism , Treatment OutcomeABSTRACT
Cytomegalovirus (CMV) is an important cause of morbidity and mortality in immunosuppressed patients. Though acute lymphoblastic leukemia (ALL) is an immunosuppressed state, CMV disease has been reported infrequently. We present a patient of adult B lineage ALL who was on maintenance chemotherapy and developed CMV pneumonia. Patient was managed with intravenous ganciclovir and had successful outcome. However, three weeks later patient had a relapse of ALL and died shortly after high dose chemotherapy.