Autoantibody appearance in cytomegalovirus‐infected liver transplant recipients: Correlation with antigenemia

Abstract

The presence of anti-endothelial cells (AECA), smooth muscle (SMA), antinuclear (ANA) and antimitochondrial (AMA) autoantibodies, and liver/kidney microsomal antibody type 1 (LKM1) was investigated retrospectively in sera of liver transplant patients and correlated with cytomegalovirus (CMV) infection as determined by the antigenemia test and with the appearance of acute or chronic allograft rejection. Indirect immunofluorescence analysis was carried out in sequential sera from 40 liver transplant patients. Ten out of 23 antigenemia-positive and none of the antigenemia-negative patients developed serum autoantibodies (P = 0.002, Fisher's exact test). Anti-endothelial cell autoantibodies were found in nine cases and SMA in four patients. Antinuclear antibodies were detected in one otherwise autoantibody-negative patient. All but one case of autoantibody positivity were observed in the high antigenemia group (P < 0.0001, Fisher's exact test). In all but one case, autoantibodies were detected in blood during the antigenemia phase and in most cases in coincidence with or after the antigenemia peak. Even though a statistically significant correlation was not found between autoantibody production and the development of acute or chronic allograft rejection, proportionally more acute rejection cases were observed in the autoantibody-positive than in the autoantibody-negative group. It has been speculated that CMV-induced endothelial damage may be a potent antigenic stimulus, which leads to the production of anti-endothelial cells autoantibodies. Anti-endothelial cell autoantibodies may represent not only a marker of cell injury but also contribute to the progression of the inflammatory response leading to the exposure of tissue-privileged self antigens and the induction of other autoantibodies such as SMA.

Autoimmune hemolytic anemia following allogeneic hematopoietic stem cell transplantation in adult patients

“…33 This association could not be confirmed in the present study. Patients who developed AIHA after HSCT showed a poor outcome.…”

Human Cytomegalovirus Differentially Controls B Cell and T Cell Responses through Effects on Plasmacytoid Dendritic Cells

“…For example, natural and anti-CD13-specific autoantibodies have been found in bone marrow transplant patients undergoing HCMV infection, and anti-CD13 Abs have been associated with the development of chronic graft-vs-host disease (4,5). Nonorganspecific autoantibodies associated with HCMV infection have also been detected in solid organ transplant recipients and may contribute to the development of acute and chronic allograft rejection (6,7). In addition, hypergammaglobulinemia, cryoglobulinemia, and autoantibody production are features of HCMV-induced mononucleosis and postperfusion syndrome (8,9).…”

Liver biopsy interpretation for causes of late liver allograft dysfunction

“…Recipient dendritic cell antigen uptake and self-reactive T and/or B lymphocyte priming 10 triggers "autoantibody" production and immunity directed against non-major histocompatibility complex determinants. Some non-major histocompatibility complex cytoplasmic, nuclear, and matrix protein antigens [11][12][13][14] (reviewed in Graft [15][16][17][18] ) are shared by the donor and recipient, whereas others may be donor-specific.…”