title: Serial peripheral blood cytotoxic lymphocyte gene expression measurements for prediction of pancreas transplant rejection.
abstract: Acute rejection after pancreas transplantation remains a significant problem and contributes to immunological graft loss. No clinical markers of pancreas rejection have been universally accepted. The purpose of this study was to investigate the use of genetic markers; granzyme B, perforin, and HLA-DRA in the peripheral blood of pancreas transplant recipients. These genes have been identified in renal and islet cell transplant recipients as noninvasive tools to predict acute rejection. Blood samples were collected weekly for up to 1 year posttransplant. Surveillance biopsies of the pancreas were scheduled at weeks 2, 4, 8, and 12 as part of the typical posttransplant protocol for patients with pancreas alone or pancreas after kidney transplantation. Exclusion criteria included a diagnosis of biopsy-proven chronic rejection alone, pancreatitis, or kidney rejection within 2 months after pancreas biopsy. Gene expression levels of granzyme B, perforin, and HLA-DRA were compared in patients with (n = 7) and without biopsy proven acute rejection (n = 7). Recipients with acute rejection showed increased expression of granzyme B, HLA-DRA, as well as perforin genes compared to patients without biopsy-proven rejection. In addition, we observed that elevation of these genes occurred as early as 4 weeks before the traditional biopsy diagnosis, while the recipients with no rejection showed no change in gene expression. Our data indicated that serial measurements of peripheral blood granzyme B, perforin, and HLA-DRA gene expression can be a useful tool to predict pancreas rejection in its earliest stage.
authors.affiliation: Department of Surgery, University of Tennesee, memphis, Tennessee 38163, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Cashion
authors.forename: O M
authors.initials: OM
authors.lastname: Sabek
authors.forename: C J
authors.initials: CJ
authors.lastname: Driscoll
authors.forename: L W
authors.initials: LW
authors.lastname: Gaber
authors.forename: A O
authors.initials: AO
authors.lastname: Gaber
mesh_terms: D000961:Antilymphocyte Serum / Q000627:therapeutic use; D005786:Gene Expression Regulation / Q000276:immunology*; D006084:Graft Rejection / Q000235:genetics* / Q000276:immunology*; D053804:Granzymes / Q000235:genetics; D006684:HLA-DR Antigens / Q000235:genetics; D059805:HLA-DR alpha-Chains; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008562:Membrane Glycoproteins / Q000235:genetics; D016035:Pancreas Transplantation / Q000276:immunology*; D054353:Perforin; D052899:Pore Forming Cytotoxic Proteins / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*
chemical_list: D000961:Antilymphocyte Serum; D006684:HLA-DR Antigens; D059805:HLA-DR alpha-Chains; D007166:Immunosuppressive Agents; D008562:Membrane Glycoproteins; D052899:Pore Forming Cytotoxic Proteins; D054353:Perforin; D053804:Granzymes