Immunological monitoring of extracorporeal photopheresis after heart transplantation. (April 2014)

• Record Type: Journal Article
• Authors: Dieterlen, M.‐T.; Bittner, H. B.; Pierzchalski, A.; Dhein, S.; Mohr, F. W.; Barten, M. J.
• Is Part Of: Clinical and experimental immunology. Volume 176:Number 1(2014:Apr.)
• Page Start: 120
• Page End: 128
• Publication Date: 2014-04
• Subjects: Immunopathology -- Periodicals; 616.079
• DOI: 10.1111/cei.12254
• Languages: English
• ISSNs: 0009-9104

Abstract

<abstract abstract-type="main"> <title>Summary</title> <p>Extracorporeal photopheresis (ECP) has been used as a prophylactic and therapeutic option to avoid and treat rejection after heart transplantation (HTx). Tolerance‐inducing effects of ECP such as up‐regulation of regulatory T cells (T<sub>regs</sub>) are known, but specific effects of ECP on regulatory T cell (T<sub>reg</sub>) subsets and dendritic cells (DCs) are lacking. We analysed different subsets of T<sub>regs</sub> and DCs as well as the immune balance status during ECP treatment after HTx. Blood samples were collected from HTx patients treated with ECP for prophylaxis (<italic>n</italic> = 9) or from patients with histologically proven acute cellular rejection (ACR) of grade ≥ 1B (<italic>n</italic> = 9), as well as from control HTx patients without ECP (HTxC; <italic>n</italic> = 7). Subsets of T<sub>regs</sub> and DCs as well as different cytokine levels were analysed. Almost 80% of the HTx patients showed an effect to ECP treatment with an increase of T<sub>regs</sub> and plasmacytoid DCs (pDCs). The percentage of pDCs before ECP treatment was significantly higher in patients with no ECP effect (26·3% ± 5·6%) compared to patients who showed an effect to ECP (9·8% ± 10·2%; <italic>P</italic> = 0·011). Analysis of functional subsets of CD4<sup>+</sup>CD25<sup>high</sup>CD127<sup>low</sup> T<sub>regs</sub> showed that CD62L‐, CD120b‐ and CD147‐positive T<sub>regs</sub> did not differ between the groups. CD39‐positive T<sub>regs</sub> increased during ECP treatment compared to HTxC. ECP‐treated patients showed higher levels for T helper type 1 (Th1), Th2 and Th17 cytokines. Cytokine levels were higher in HTx patients with rejection before ECP treatment compared to patients with prophylactic ECP treatment. We recommend a monitoring strategy that includes the quantification and analysis of T<sub>regs</sub>, pDCs and the immune balance status before and up to 12 months after starting ECP.</p> </abstract>