Background SMC migration and proliferation critically influence the clinical course of vascular disease. We tested the effect of the novel small leucine-rich repeat protein podocan on SMC migration and proliferation using a podocan deficient mouse in combination with a model of arterial injury and aortic explant SMC culture. In addition, we examined the effect of overexpression of the human form of podocan on human SMC and tested for podocan expression in human atherosclerosis. In all these conditions we evaluated concomitantly the Wnt-TCF-pathway. Methods and Results Podocan was strongly and selectively expressed in arteries of WT mice after injury. Podocan−/− mice showed increased arterial lesion formation as compared to WT littermates in response to injury (P<0.05). Also, SMC proliferation was increased in arteries of podocan −/− mice compared to WT (P<0.05). In vitro, migration and proliferation were increased in podocan−/− SMC and were normalized by transfection with the WT podocan gene (P<0.05). In addition, upregulation of the Wnt-TCF-pathway was found in SMC of podocan−/− mice both in vitro and in vivo. On the other hand, podocan overexpression in human SMC significantly reduced SMC migration and proliferation inhibiting the Wnt-TCF-pathway. Podocan and a Wnt-TCF-pathway marker were differently expressed in human coronary restenotic versus primary lesions. Conclusions Podocan appears to be a potent negative regulator of the migration and proliferation of both murine and human SMC. The lack of podocan results in excessive arterial repair and prolonged SMC proliferation, which likely is mediated by the Wnt-TCF-pathway.

Purpose of Review While a great deal of literature has been published recently on the viral kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and diagnostic testing performance for coronavirus disease 2019 (COVID-19) in the general population, a relative paucity of information has come to light regarding implications of COVID-19 diagnostics for solid organ transplantation. This review examines the current state of knowledge regarding the two principal diagnostic testing strategies for SARS-CoV-2 infection, polymerase chain reaction (PCR)–based testing and serology, and discusses COVID-19 diagnostic implications for solid organ transplantation. Recent Findings The interpretation of diagnostics for SARS-CoV-2 infection can present several challenges and raises questions regarding optimal donor and candidate screening as well as infection prevention practices in solid organ transplant recipients with SARS-CoV-2 infection. Guidance from several societies regarding donor and recipient suitability for transplantation during the COVID-19 pandemic is reviewed. Prolonged positive testing by polymerase chain reaction has been described in transplant recipients which may impact infection prevention practices. Summary The COVID-19 pandemic has put multiple aspects of solid organ transplantation at risk, with impacts on donor and recipient suitability, and mitigation of infection and transmission after transplantation. Accumulating evidence regarding diagnostic fidelity and transmissibility of SARS-CoV-2 in immunocompromised patients will continue to inform optimal practices surrounding solid organ transplantation during the COVID-19 pandemic.

Prior to the emergence of antigenically distinct SARS-CoV-2 variants, reinfections were reported infrequently - presumably due to the generation of durable and protective immune responses. However, case reports also suggested that rare, repeated infections may occur as soon as 48 days following initial disease onset. The underlying immunologic deficiencies enabling SARS-CoV-2 reinfections are currently unknown. Here we describe a renal transplant recipient who developed recurrent, symptomatic SARS-CoV-2 infection - confirmed by whole virus genome sequencing - 7 months after primary infection. To elucidate the immunological mechanisms responsible for SARS-CoV-2 reinfection, we performed longitudinal profiling of cellular and humoral responses during both primary and recurrent SARS-CoV-2 infection. We found that the patient responded to the primary infection with transient, poor-quality adaptive immune responses. The patients immune system was further compromised by intervening treatment for acute rejection of the renal allograft prior to reinfection. Importantly, we also identified the development of neutralizing antibodies and the formation of humoral memory responses prior to SARS-CoV-2 reinfection. However, these neutralizing antibodies failed to confer protection against reinfection, suggesting that additional factors are required for efficient prevention of SARS-CoV-2 reinfection. Further, we found no evidence supporting viral evasion of primary adaptive immune responses, suggesting that susceptibility to reinfection may be determined by host factors rather than pathogen adaptation in this patient. In summary, our study suggests that a low neutralizing antibody presence alone is not sufficient to confer resistance against reinfection. Thus, patients with solid organ transplantation, or patients who are otherwise immunosuppressed, who recover from infection with SARS-CoV-2 may not develop sufficient protective immunity and are at risk of reinfection.