Noninvasive diagnosis of acute rejection of renal allografts.
OBJECTIVE
Acute rejection is an immune process that begins with the recognition of the allograft as nonself and ends in graft destruction. Histological features of the allograft biopsy are currently used for the differential diagnosis of allograft dysfunction. In view of the safety and the opportunity for repetitive sampling, development of noninvasive biomarkers of allograft status is an important objective in transplantation. Herein, we review some of the progress towards the development of noninvasive biomarkers of human allograft status.


RESULTS
Urinary cell and peripheral blood cell mRNA profiles have been associated with acute rejection of human renal allografts. Emerging data support the idea that development of noninvasive biomarkers predictive of antibody-mediated rejection is feasible. The demonstration that intragraft microRNA expression predicts renal allograft status suggests that noninvasively ascertained microRNA profiles may be of value.


CONCLUSIONS
We are pleased with the progress to date, and anticipate clinical trials investigating the hypotheses that noninvasively ascertained mRNA profiles will minimize the need for invasive biopsy procedures, predict the development of acute rejection and chronic allograft nephropathy, facilitate preemptive therapy capable of preserving graft function, and facilitate personalization of immunosuppressive therapy for the allograft recipient.
Hartono
Choli
C
Division of Nephrology and Hypertension, Departments of Medicine and Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York 10065, USA.
Muthukumar
Thangamani
T
Suthanthiran
Manikkam
M
D000208:Acute Disease; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001706:Biopsy; D005819:Genetic Markers; D005820:Genetic Testing; D006084:Graft Rejection / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D006085:Graft Survival / Q000235:genetics*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D035683:MicroRNAs / Q000097:blood / Q000652:urine; D011237:Predictive Value of Tests; D012333:RNA, Messenger / Q000097:blood / Q000652:urine; D015203:Reproducibility of Results; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D015415:Biomarkers; D005819:Genetic Markers; D035683:MicroRNAs; D012333:RNA, Messenger