Role of novel biomarkers in kidney transplantation

Abstract

Clinical application of biomarkers is an integral component of transplant care. Clinicians and scientists alike are in search of better biomarkers than the current serologic (serum creatinine, donor-specific antibodies), urine-derived (urinalysis, urine protein), and histologic ones we now use. The science behind recent biomarker discovery spans across multiple molecular biologic disciplines, including transcriptomics, proteomics, and metabolomics. Innovative methodology and integration of basic and clinical approaches have allowed researchers to unearth molecular phenomena preceding clinical disease. Biomarkers can be classified in several ways. In this review, we have classified them via their origin and outcome: Primarily immunologic, i.e ., representative of immune regulation and dysfunction and non-immunologic, pertaining to delayed graft function, cardiovascular events/mortality, infection, malignancy, post-transplant diabetes, graft, and patient survival. Novel biomarker uses to guide the diagnosis and management of transplant-related outcomes is a promising area of research. However, the use of biomarkers to predict outcomes after kidney transplantation is not well studied. In this review, we summarize the recent studies illustrating biomarker use and transplant outcomes.

The Role of Endothelins, IL-18, and NGAL in Kidney Hypothermic Machine Perfusion

“…On the other hand, modern biomarkers that meet the definition of the National Institutes of Health Biomarker Definition Working Group—“A characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic responses, or pharmacological responses to a therapeutic intervention”—should be detected before irreversible damage occurs. Using the WHO definition, they can be measured in the body or its products and influence, or they can predict the incidence of outcome or disease; however, despite the field of biomarker research having established their important role in detecting allograft perturbations, they also have imperfections [ 63 ]. Neither marker is connected with molecular pathophysiology.…”

Kynurenine pathway in kidney diseases

“…Another crucial problem is kidney transplant rejection because of insufficient immunosuppression, recurrent opportunistic infections and reoccurrence of primary kidney disease [ 86 ]. This highlights the need to search for novel serological, urine-derived and histological markers to predict outcomes after kidney transplantation [ 87 ]. Because KYN pathway activity is regulated by the immunological system [ 88 ], it is an interesting target to monitor kidney graft function.…”

High PIRCHE Scores May Allow Risk Stratification of Borderline Rejection in Kidney Transplant Recipients

“…In the past, there have been numerous efforts to develop new methods to diagnose potentially treatable graft injuries or predict future rejection risks. A comprehensive review of current research on immunologic and non-immunologic biomarkers was recently published by Swanson et al (7) The innovative methods span across functional cell-based immune monitoring [IFN-g-ELISPOT (8-10)], analysis of peripheral blood and urine for gene expression signatures by measuring mRNA (11)(12)(13), microRNA (14,15), and dd-cfDNA (16,17), as well as molecular phenotyping of graft biopsies [molecular microscope (MMDx)] (18), which is emerging as a promising new tool in biopsy interpretation.…”