A common rejection module (CRM) for acute rejection across multiple organs identifies novel therapeutics for organ transplantation.

A common rejection module (CRM) for acute rejection across multiple organs identifies novel therapeutics for organ transplantation.
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DOI:
10.1084/jem.20122709
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发表时间:
2013-10-21
期刊:
The Journal of experimental medicine
影响因子:
--
通讯作者:
Sarwal MM
Sarwal MM
中科院分区:
其他
文献类型:
--
作者:
Khatri P;Roedder S;Kimura N;De Vusser K;Morgan AA;Gong Y;Fischbein MP;Robbins RC;Naesens M;Butte AJ;Sarwal MM

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一组由11个基因组成的基因,称为共同排斥模块,可以预测实体器官移植患者的急性移植排斥反应,并可能有助于识别移植中的新型药物靶点。使用来自四个器官的八个独立移植数据集(236个移植物活检样本)的荟萃分析,我们确定了一个共同的排斥模块(CRM),由11个基因组成,这些基因在所有移植器官的急性排斥反应(AR)中显著过表达。CRM基因可以在另外三个独立队列(794个样本)中以高特异性和灵敏度诊断AR。在另外两个独立的队列(151例肾移植活检)中,CRM基因与移植物损伤程度相关,并使用协议活检预测移植物的未来损伤。从文献中推断的药物机制表明,两种FDA批准的药物(阿托伐他汀和达沙替尼),批准用于非移植适应症,可以调节特定的CRM基因,减少AR期间移植物浸润细胞的数量。我们用阿托伐他汀和达沙替尼治疗HLA不匹配的小鼠心脏移植小鼠,结果显示CRM基因减少,移植物浸润细胞显著减少,移植物存活延长。我们通过回顾性分析2,515例单中心队列肾移植患者的电子病历,进一步验证了阿托伐他汀对移植物存活的有益作用,随访时间长达22年。总之,我们确定了移植中的CRM,为诊断、药物重新定位和合理药物设计提供了新的机会。
A set of 11 genes, termed the common rejection module, predicts acute graft rejection in solid organ transplant patients and may help to identify novel drug targets in transplantation. Using meta-analysis of eight independent transplant datasets (236 graft biopsy samples) from four organs, we identified a common rejection module (CRM) consisting of 11 genes that were significantly overexpressed in acute rejection (AR) across all transplanted organs. The CRM genes could diagnose AR with high specificity and sensitivity in three additional independent cohorts (794 samples). In another two independent cohorts (151 renal transplant biopsies), the CRM genes correlated with the extent of graft injury and predicted future injury to a graft using protocol biopsies. Inferred drug mechanisms from the literature suggested that two FDA-approved drugs (atorvastatin and dasatinib), approved for nontransplant indications, could regulate specific CRM genes and reduce the number of graft-infiltrating cells during AR. We treated mice with HLA-mismatched mouse cardiac transplant with atorvastatin and dasatinib and showed reduction of the CRM genes, significant reduction of graft-infiltrating cells, and extended graft survival. We further validated the beneficial effect of atorvastatin on graft survival by retrospective analysis of electronic medical records of a single-center cohort of 2,515 renal transplant patients followed for up to 22 yr. In conclusion, we identified a CRM in transplantation that provides new opportunities for diagnosis, drug repositioning, and rational drug design.
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