Background
Chemokines and their receptors play a critical role in leukocyte trafficking, and inhibition of select chemokines has been shown to attenuate kidney disease and allograft rejection in animal models. We therefore evaluated chemokine and chemokine receptor transcripts in human renal allograft biopsies, correlating transcript levels with clinical course and immunohistochemical analysis to relate chemokine expression to relevant clinical human disease phenotypes.
Methods
Renal biopsies were grouped as post-reperfusion (n=10), stable function (n=10), subclinical (n=10) or acute rejection (n=17), or calcineurin inhibitor nephrotoxicity (n=9) based on clinical presentation and histopathological assessment. Using quantitative real-time polymerase chain reaction analysis, chemokine transcripts were assessed relative to transcript levels in pre-procurement biopsies from live donor kidneys (n=15).
Results
Transcripts from several inflammatory chemokines (CCL3, CCL5, CXCL9, CXCL10 and CXCL11) and chemokine receptors (CCR5, CCR7 and CXCR3) were significantly elevated in allografts with subclinical and clinical acute rejection, indicating a strong polarization toward a TH1 effector phenotype during rejection. These transcripts also distinguished acutely rejecting allografts from allografts with non-rejection causes of renal dysfunction. Biopsies from patients with stable function without histological evidence of rejection had increased chemokine transcript levels that were qualitatively similar but quantitatively reduced compared to rejecting allografts.
Conclusions
This comprehensive evaluation of chemokines and their receptors in human renal transplantation defines associations between chemokine expression and clinical phenotypes, may have diagnostic utility, and highlights relevant pathways for therapeutic intervention.