Jorge Neumann

Acute humoral rejection in a lung recipient: reversion with bortezomib.

on treatment, the poorly functioning area signifying the abscess cavity showed a reduction in size with alteration of shape and a decline in R2* value within, whereas T1-weighted and T2-weighted images showed only minimal changes (Fig. 1). Functional changes preceded morphologic changes as the abscess became gradually enclosed by normal functioning renal tissue. Prednisolone perhaps reduced the surrounding fibrosis as described by Haramaki et al. (4) No hypermetabolizing tissue was seen around the abscess as might be expected in a pyogenic abscess with surrounding inflammation. Using its ability to estimate tissue oxygen bioavailability, BOLD MRI can distinguish between acute rejection and acute tubular necrosis in a setting of early renal allograft dysfunction (5, 6). Although this technique cannot quantify absolute tissue oxygen levels because of the nonlinear relationship between R2* values and the partial pressure of oxygen, it could be used in various clinical situations to monitor renal oxygenation. This is the first report of the use of BOLD MRI to demonstrate the functional changes associated with a healing tuberculous abscess in a renal allograft. More studies may be required to obtain any further conclusion. This ability to combine functional with morphologic imaging heralds a new horizon and could emerge as a useful tool for vascular and functional assessment of the kidneys.

Immunological tolerance in human transplantation. The possible existence of a maternal effect.

We analyzed data from 93 patients who received a kidney graft from their parents: 55 were transplanted with a kidney from their mothers (Mat.) and thirty-eight from their fathers (Pat.) The Pat. group has shown a better graft and patient survival as well as long-term renal function when compared with the Mat. group. This pattern was more evident with time. Long-term graft function assessed by creatinine levels also showed differences between the groups, favoring that Pat. group. The results are interesting since recent reports have claimed a tolerance developed by the individual to noninherited HLA antigens of their mother.

HLA-A, -B, and -DRB1 allelic and haplotypic diversity in a sample of bone marrow volunteer donors from Rio Grande do Sul State, Brazil

The HLA A, B, and DRB1 allele, phenotype, and haplotype frequencies were studied in a sample of 5,000 volunteer bone marrow donors registered at the Brazilian Volunteer Bone Marrow Donor Registry. The participants live in the state of Rio Grande do Sul and were classified according to ethnic group (4,428 Caucasians, 324 mestizos [mixed race], and 248 blacks). Typing was performed using the polymerase chain reaction sequence-specific oligonucleotide method combined with Luminex technology. Twenty-one HLA-A, 33 HLA-B, and 13 HLA-DRB1 allele groups were identified. The most frequent allele groups for each locus were A*02, B*35, and DRB1*13. The most frequent haplotypes were A*01 B*08 DRB1*03 in Caucasians and mestizos and A*02 B*15 and DRB1*04 in blacks. The allele frequencies were compared with samples from different Brazilian regions. In most comparisons no significant differences were found. The most significant differences were observed in the comparison of the groups of our sample, indicating that human leukocyte antigen (HLA) is a good marker to distinguish among people from different ethnic groups. The data provide insight on the knowledge of HLA diversity in the population of Rio Grande do Sul and in the search for a better match for transplant.

Analysis of HLA-G Polymorphisms in Couples with Implantation Failure

HLA‐G expression is related as an immune modulator of fetal–maternal tolerance, and its levels was correlated with pregnancy outcome. In a case–control study, we investigate the association between the genetic variability of the HLA‐G gene and serum levels of soluble HLA‐G in cases of embryo implantation failure.

High Amounts of Total and Extracellular Vesicle-Derived Soluble HLA-G are Associated with HLA-G 14-bp Deletion Variant in Women with Embryo Implantation Failure.

Human leukocyte antigen‐G (HLA‐G) expression is related to 14‐bp insertion/deletion polymorphism at the 3′UTR of the HLA‐G gene. Soluble forms of HLA‐G are released as free molecules or via extracellular vesicles (EVs). Due to the crucial role of HLA‐G during pregnancy, we analyzed the 14‐bp polymorphism and the two secreted forms in implantation failure women (IF) and in fertile women (FW).

Comparative study of adenoviruses with monoclonal antibodies

The obtainment of monoclonal antibodies for adenovirus species 4(Ad4) is described. The specificities of selected monoclonal antibodies were determined by means of viral neutralization test in cell culture, immunofluorescence and Enzyme-Linked Immunosorbent Assay (ELISA), in the presence of the following species of human adenovirus: 1, 2, 5 (subgenus C), 4 (subgenus E), 7 and 16 (subgenus B) and 9 (subgenus D). Two monoclonal antibodies species specific to adenovirus 4 (1CIII and 3DIII) and one monoclonal antibody that cross reacted with adenovirus species 4 and 7 (2HIII) were obtained.

How Reliable is the Management of Cytomegalovirus by Preemptive Therapy after Renal Transplantation

Introduction Cytomegalovirus (CMV) is the most frequent opportunistic infection in the first six months after kidney transplantation (Tx). There are two major strategies used for CMV prevention: preemptive therapy and universal prophylaxis. The objective of this study is to evaluate the results of the preemptive therapy in our service through the incidence of CMV infection and disease at 3 and 6 months after transplantation, the number of treatments and the interval between the antigenemia collection and the beginning of treatment. Materials and Methods A retrospective cohort study analyzing 221 adult renal transplant recipients performed between May 2015 and June 2016 and followed up at our service. Data collection was performed by review of medical records and results of pp65 antigenemia from the immunology laboratory. Antigenemia is performed on weekly bases from 30-90 days and fortnightly from 91-180 days after Tx. Cumulative Incidences of CMV infection and disease were analyzed by the Kaplan-Meyer method. Results From 221 recipients, 45.2% were female, mean age of 49 years (SD±14.11), deceased-donor in 90.5%. Induction therapy was used in 216 patients, thymoglobulin in 41.2%, and basiliximab in 58.8%. Maintenance therapy was tacrolimus, mycophenolate and prednisone in 94.1%. All recipients with negative CMV serology (R-), who received the kidney from a donor positive serology (D+), and all patients receiving thymoglobulin induction received intravenous ganciclovir prophylaxis during hospitalization. The cumulative incidence of CMV infection (any positive antigenemia) was 76% at 3 months and 72%, at 6 months, the first infection being 22 days post-Tx. Considering significant viral replication above 10/200.00 polymorphonuclear cells, the incidence was 42% at 3 months and 48% at 6 months. The cumulative incidence of disease was 21% at 3 months and 25% at 6 months. No disease was seen in the first month after transplantation. Gastrointestinal symptoms were the main manifestation. The mean time between the antigenemia collection and the beginning of the treatment was 4 days (CI 95% 3.60-5.07), regardless of the form of communication between the laboratory and the Tx staff. 111 (50.2%) patients were treated with IV ganciclovir. 25 patients presented one relapse and 8 two relapses. From 11 CMV IgG negative serology (R-) patients, only 2 (18.2%) had no viral replication, 3 (27.3%) had 1-10 +cells, 1 (9.1%) had 11-40 +cells and 5 (45.5%) had more than 40 +cells. From 210 recipients with CMV IgG positive serology (R+) pre-transplant, 60 (28.6%) had no viral replication, 34.3% had 1-10 +cells, 20.5% had 11-40 +cells and 16.7% had more than 40 +cells. Conclusion The incidence of CMV disease at 6 months post-transplantation was one-quarter of the sample. We consider that the preemptive therapy was properly performed, with a short time between diagnosis and treatment, avoiding CMV disease in most part of our patients and treatment by half of them.

Cytogenetic abnormalities in couples with a history of primary and secondary recurrent miscarriage: a Brazilian Multicentric Study

Abstract Objective: To evaluate the difference between chromosomal abnormalities between the gender of couples affected by Recurrent miscarriage (RM) and if there is an association between previous obstetric history and chromosomal abnormalities of the parents. Methods: Multicenter, retrospective, observational study from seven different RM clinics between 2006 and 2016. We enrolled 707 couples (1014 participants) with a history of RM. We compared the frequency of chromosomal abnormalities between groups of couples with primary and secondary RM and separated between women and their partners. Furthermore, we compared the prevalence of chromosomal abnormalities between groups based on the number of previous spontaneous abortions. Results: The overall prevalence of all cytogenetic abnormalities was 5.59% (n = 1414, women and their partners). Excluding cases of polymorphism and inversion of chromosome 9, which are considered variants of normality, the prevalence in all individuals was 2.26% (n = 32/1414). The comparative analysis of cases of chromosomal abnormalities among couples with primary and secondary RM based on the number of previous miscarriages (PM) revealed a similar frequency between groups. The statistical analysis of the total cases (primary PM + secondary PM) in these three groups were as follows: (a) couple, 2 pm versus 3 pm vs. ≥4 PM, p = .514; (b) women, 2 pm versus 3 pm vs. ≥4 PM, p = .347; and (3) partner, 2 pm versus 3 pm vs. ≥4 PM, p = .959. Chromosomal abnormalities were significantly more prevalent among women than among their partners (6.9 versus 4.2%; p = .027). Moreover, the distribution of leading chromosomal abnormalities among women was different compared with their partners. Among women, we observed these abnormalities in the following frequency order: mosaicism (38.8%), polymorphism (32.6%), translocation (16.3%), and inversion (12.3%). Among their partners, these abnormalities were polymorphism (73.3%), inversion (13.3%), mosaicism (6.7%), and translocation (6.7%). Conclusion: The number of PM and the history of full-term pregnancy does not correlate with an increase or decrease in the prevalence of cytogenetic abnormalities in couples with RM.

Lymphocyte immunotherapy for recurrent miscarriages: Predictors of therapeutic success

To evaluate the predictors of successful pregnancies in women with a history of recurrent miscarriages (RMs) having undergone lymphocyte immunotherapy (LIT).

Reactivity of renal transplant sera against a 17 kD mononuclear cell antigen.

In recent years, studies have shown that non-HLA antigens can be involved in renal graft rejection. The so called minor antigens have been found to be expressed on a variety of cells, including endothelial cells. With the aim of understanding better the role of minor antigens in graft rejection, we undertook a Western blot screening of sera from patients waiting for or having received grafts from living-related or cadaveric donors. In this study we described the reactivity of these sera against a 17 kD antigen with expression in many different cell types.