The diagnostic value of transcription factors T-bet/GATA3 ratio in predicting antibody-mediated rejection.
BACKGROUND
Previous data showed that the predominance of intraglomerular T-bet or GATA3 is correlated with different mechanisms of rejection, suggesting that the ratio of T-bet/GATA3 might be used to distinguish antibody-mediated rejection (ABMR) and T-cell-mediated rejection (TCMR).


METHODS
We compared the intraglomerular T-bet/GATA3 ratio in ABMR and TCMR. The intragraft expression of T-bet and GATA3 was studied via immunohistochemistry. The correlation of the diagnosis of AMR with the ratio of T-bet/GATA3 was examined.


RESULTS
Both intraglomerular T-bet- and GATA3-expressing cells were increased during acute rejection. T-bet/GATA3>1 was strongly correlated with ABMR (93.3% versus 18.2%). The incidence of positive HLA-I/II antibodies and glomerulitis is significantly higher in T-bet/GATA3>1 group (P < 0.001, 0.013, resp.). The scores of peritubular capillary inflammation and glomerulitis were also higher in T-bet/GATA3>1 group (P = 0.052, P < 0.001, resp.). Nevertheless, T-bet/GATA3>1 is also correlated with C4d-negative ABMR and resistance to steroid treatment. Compared with C4d deposition, T-bet/GATA3>1 had a slight lower (90% versus 100%) specificity but a much higher (87.5% versus 68.8%) sensitivity.


CONCLUSIONS
Our data suggested that intraglomerular predominance of T-bet over GATA3 might be used as diagnosis maker of ABMR in addition to C4d, especially in C4d-negative cases.
Research Institute of Nephrology, Jinling Hospital, Nanjing University Clinical School of Medicine, 305 East Zhongshan Road, Nanjing 210002, China.
Xue
X
Li
Qiquan
Q
Sun
Mingchao
M
Zhang
Jinsong
J
Chen
Zhihong
Z
Liu
D000328:Adult; D064591:Allografts / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D000920:Antibody-Dependent Cell Cytotoxicity; D005260:Female; D050990:GATA3 Transcription Factor / Q000378:metabolism*; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology* / Q000378:metabolism*; D006801:Humans; D007668:Kidney / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020825:T-Box Domain Proteins / Q000378:metabolism*; D013601:T-Lymphocytes / Q000276:immunology; D014184:Transplantation, Homologous; D000098815:T-bet Transcription Factor
D050990:GATA3 Transcription Factor; D020825:T-Box Domain Proteins; D000098815:T-bet Transcription Factor