title: Adenosine triphosphate production by peripheral blood CD4⁺T cells in clinically stable renal transplant recipients.
abstract: Previous studies have shown that intracellular adenosine triphosphate (iATP) in activated CD4 T cells in vitro may identify patients at risk of infection or rejection post-transplantation. In this study, we evaluated whether this test could identify the level of risk in 656 renal transplant recipients (RTRs) with good and stable graft function. Therefore, 1095 blood samples from RTRs and 200 from healthy blood donors (normal controls [NCs]) were collected in 2 years and analyzed using the Cylex(®) ImmuKnow™ assay (Cylex, Inc., Columbia, MD, USA). The classification of T cell responses into strong, moderate, and low revealed significant differences between patients and NCs in low and strong responses (P < .001 and P = .021, respectively). The majority of patient samples exhibited moderate immune response (72.2%) in comparison with NC (75%). One hundred twenty-eight patients had fluctuated T cell responses between the three response zones. All patients were clinically stable for at least 1 month after the test. T cell response was increased after time post-transplantation (P < .001) and was found higher in protocols using azathioprine versus other immunosuppression (P < .001) and cyclosporine instead of tacrolimus (P = .012). According to the results of this study, we are not able to support this assay as an immune monitoring test post-transplantation in clinically stable RTRs. In contrast, measuring of iATP in CD4 T cells is a valuable tool for estimating T cell activation capacity. Because T cell activation is mainly affected by immunosuppression, this test may give information regarding the strength of different immunosuppressive protocols or the strength of immunosuppression as it is associated with longer follow-up periods.
authors: National Tissue Typing Center, General Hospital of Athens "G.Gennimatas", Athens, Greece. Electronic address: a.bittoraki@gna-gennimatas.gr.
authors: A G
authors: AG
authors: Vittoraki
authors: Transplantation Unit, "Laiko Hospital", Athens, Greece.
authors: J N
authors: JN
authors: Boletis
authors: Transplantation Unit, "Laiko Hospital", Athens, Greece.
authors: M N
authors: MN
authors: Darema
authors: Biomedical Research Foundation, Academy of Athens, Athens, Greece.
authors: A J
authors: AJ
authors: Kostakis
authors: National Tissue Typing Center, General Hospital of Athens "G.Gennimatas", Athens, Greece.
authors: A G
authors: AG
authors: Iniotaki
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology* / Q000378:metabolism; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D007118:Immunoassay; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000097:blood* / Q000601:surgery*; D012306:Risk; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000255:Adenosine Triphosphate; D001379:Azathioprine