COVID‐19 in a lung transplant recipient: Exploring the diagnostic role of circulating exosomes and the clinical impact of advanced immunosuppression. Issue 2 (13th October 2020)

• Record Type: Journal Article
• Authors: Goodlet, Kellie J.; Bansal, Sandhya; Arjuna, Ashwini; Nailor, Michael D.; Buddhdev, Bhuvin; Abdelrazek, Hesham; Mohamed, Hesham; Omar, Ashraf; Walia, Rajat; Mohanakumar, Thalachallour; Tokman, Sofya
• Is Part Of: Transplant infectious disease. Volume 23:Issue 2(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-10-13
• Subjects: allograft dysfunction -- COVID‐19 -- exosomes -- lung self antigens -- lung transplant -- rejection; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13480
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Exosomes isolated from plasma of lung transplant recipients with allograft injury contain donor‐derived lung self‐antigens (collagen V and Kα1 tubulin) and human leukocyte antigen (HLA) molecules. We present a case of a 76‐year‐old, female lung transplant recipient treated for acute cellular rejection with methylprednisolone and anti‐thymocyte globulin, who subsequently contracted SARS‐CoV‐2 and developed a sharp increase in the mean fluorescent intensity of anti‐HLA antibodies. Analysis of circulating exosomes during rejection, but before SARS‐CoV‐2 infection, revealed the presence of lung self‐antigens and HLA class II molecules. After the patient contracted SARS‐CoV‐2, exosomes with the SARS‐CoV‐2 spike protein were also found. After resolution of infectious symptoms, exosomes with SARS‐CoV‐2 spike protein were no longer detected; however, exosomes with lung self‐antigens and HLA class II molecules persisted, which coincided with a progressive decline in spirometric flows, suggesting chronic lung allograft dysfunction. We propose that the analysis of circulating exosomes may be used to detect allograft injury mediated by both rejection and infection. Furthermore, the detection of exosomes containing viral proteins may be helpful in identifying allograft injury driven by viral pathogens.