Abstract
Background
B-cells are increasingly recognized as important players in alloimmunity. B cell-activating factor (BAFF) and its receptor BAFF-R are essential for B-cell differentiation and survival. Data on BAFF levels in pediatric renal transplant (RT) patients are scarce.
Objective
It is known from adult data that elevated BAFF levels correlate with an unfavorable outcome in bone marrow and kidney recipients. To analyze this hypothesis in pediatric renal transplant patients we performed a cross-sectional analysis of serum BAFF levels, lymphocyte surface BAFF-R expression, and clinical variables in a cohort of 43 pediatric renal transplant patients.
Methods
We studied serum BAFF, CD19+ B-, and FoxP3+ regulatory T-cells (Tregs) and BAFF-R expression in 43 children 2.9 (0.1–12.4) years after RT on maintenance immunosuppression. Twenty-two healthy children and 19 children with chronic kidney disease stage 5 (CKD5) served as controls.
Results
BAFF levels were significantly higher in RT patients than in healthy children (1,435±574 vs 894±189 pg/mL; p<0.0001) whereas numbers of B-cells and Tregs were significantly lower. BAFF-R expression on B-cells was decreased after RT (531±334 vs 707±257 MFI; p<0.005), BAFF inversely correlated with BAFF-R (r=-0.5022, p<0.006), but not with B-cell count. BAFF was elevated in CKD5 patients (1,276±294 pg/mL). In RT patients BAFF was significantly higher in those with eGFR <60 ml/min/1.73m2 (1,553±447 vs 1,234±323 pg/mL; p=0.02). BAFF levels and BAFF-R expression did not correlate with HLA antibody status, time after transplantation, age or gender of the patients.
Conclusion
Serum BAFF concentrations were significantly elevated in pediatric RT patients. They correlated with decreased BAFF-R expression on CD19+ B-cells and impaired allograft function. Our findings of a dysregulated BAFF/BAFF-R axis may be of clinical relevance after renal transplantation and therefore underline the importance of further research into BAFF-dependent mechanisms.
Similar content being viewed by others
References
Kirk AD, Turgeon NA, Iwakoshi NN (2010) B cells and transplantation tolerance. Nat Rev Nephrol 6:584–593
Muorah MR, Brogan PA, Sebire NJ, Trompeter RS, Marks SD (2009) Dense B cell infiltrates in paediatric renal transplant biopsies are predictive of allograft loss. Pediatr Transplant 13:217–222
Lehnhardt A, Mengel M, Pape L, Ehrich JH, Offner G, Strehlau J (2006) Nodular B-cell aggregates associated with treatment refractory renal transplant rejection resolved by rituximab. Am J Transplant 6:847–851
Zarkhin V, Li L, Kambham N, Sigdel T, Salvatierra O, Sarwal MM (2008) A randomized, prospective trial of rituximab for acute rejection in pediatric renal transplantation. Am J Transplant 8:2607–2617
Kohei N, Hirai T, Omoto K, Ishida H, Tanabe K (2012) Chronic antibody-mediated rejection is reduced by targeting B-cell immunity during an introductory period. Am J Transplant 12:469–476
Moore PA, Belvedere O, Orr A, Pieri K, LaFleur DW, Feng P, Soppet D, Charters M, Gentz R, Parmelee D, Li Y, Galperina O, Giri J, Roschke V, Nardelli B, Carrell J, Sosnovtseva S, Greenfield W, Ruben SM, Olsen HS, Fikes J, Hilbert DM (1999) BLyS: member of the tumor necrosis factor family and B lymphocyte stimulator. Science 285:260–263
Mackay F, Browning JL (2002) BAFF: a fundamental survival factor for B cells. Nat Rev Immunol 2:465–475
Rodig SJ, Shahsafaei A, Li B, Mackay CR, Dorfman DM (2005) BAFF-R, the major B cell-activating factor receptor, is expressed on most mature B cells and B-cell lymphoproliferative disorders. Hum Pathol 36:1113–1119
Mackay F, Leung H (2006) The role of the BAFF/APRIL system on T cell function. Semin Immunol 18:284–289
Cheema GS, Roschke V, Hilbert DM, Stohl W (2001) Elevated serum B lymphocyte stimulator levels in patients with systemic immune-based rheumatic diseases. Arthritis Rheum 44:1313–1319
Mackay F, Schneider P (2009) Cracking the BAFF code. Nat Rev Immunol 9:491–502
Vallerskog T, Heimburger M, Gunnarsson I, Zhou W, Wahren-Herlenius M, Trollmo C, Malmstrom V (2006) Differential effects on BAFF and APRIL levels in rituximab-treated patients with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Res Ther 8:R167
Ansell SM, Novak AJ, Ziesmer S, Price-Troska T, LaPlant B, Dillon SR, Witzig TE (2009) Serum BLyS levels increase after rituximab as initial therapy in patients with follicular Grade 1 non-Hodgkin lymphoma. Am J Hematol 84:71–73
Zarkhin V, Li L, Sarwal MM (2009) BAFF may modulate the rate of B-cell repopulation after rituximab therapy for acute renal transplant rejection. Transplantation 88:1229–1230
Bloom D, Chang Z, Pauly K, Kwun J, Fechner J, Hayes C, Samaniego M, Knechtle S (2009) BAFF is increased in renal transplant patients following treatment with alemtuzumab. Am J Transplant 9:1835–1845
Dorner T, Radbruch A, Burmester GR (2009) B-cell-directed therapies for autoimmune disease. Nat Rev Rheumatol 5:433–441
Sarantopoulos S, Stevenson KE, Kim HT, Cutler CS, Bhuiya NS, Schowalter M, Ho VT, Alyea EP, Koreth J, Blazar BR, Soiffer RJ, Antin JH, Ritz J (2009) Altered B-cell homeostasis and excess BAFF in human chronic graft-versus-host disease. Blood 113:3865–3874
Xu H, He X, Liu Q, Shi D, Chen Y, Zhu Y, Zhang X (2009) Abnormal high expression of B-cell activating factor belonging to the TNF superfamily (BAFF) associated with long-term outcome in kidney transplant recipients. Transplant Proc 41:1552–1556
Filler G, Lepage N (2003) Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 18:981–985
White C, Akbari A, Hussain N, Dinh L, Filler G, Lepage N, Knoll GA (2007) Chronic kidney disease stage in renal transplantation classification using cystatin C and creatinine-based equations. Nephrol Dial Transplant 22:3013–3020
Wolpl A, Halder T, Kalbacher H, Neumeyer H, Siemoneit K, Goldmann SF, Eiermann TH (1998) Human monoclonal antibody with T-cell-like specificity recognizes MHC class I self-peptide presented by HLA-DR1 on activated cells. Tissue Antigens 51:258–269
Shearer WT, Rosenblatt HM, Gelman RS, Oyomopito R, Plaeger S, Stiehm ER, Wara DW, Douglas SD, Luzuriaga K, McFarland EJ, Yogev R, Rathore MH, Levy W, Graham BL, Spector SA (2003) Lymphocyte subsets in healthy children from birth through 18 years of age: the Pediatric AIDS Clinical Trials Group P1009 study. J Allergy Clin Immunol 112:973–980
Pranzatelli MR, Tate ED, Hoefgen ER, Swan JA, Colliver JA (2008) Therapeutic down-regulation of central and peripheral B-cell-activating factor (BAFF) production in pediatric opsoclonus-myoclonus syndrome. Cytokine 44:26–32
Zarkhin V, Lovelace PA, Li L, Hsieh SC, Sarwal MM (2011) Phenotypic evaluation of B-cell subsets after rituximab for treatment of acute renal allograft rejection in pediatric recipients. Transplantation 91:1010–1018
Kreuzaler M, Rauch M, Salzer U, Birmelin J, Rizzi M, Grimbacher B, Plebani A, Lougaris V, Quinti I, Thon V, Litzman J, Schlesier M, Warnatz K, Thiel J, Rolink AG, Eibel H (2012) Soluble BAFF levels inversely correlate with peripheral B cell numbers and the expression of BAFF receptors. J Immunol 188:497–503
Demirkiran A, Hendrikx TK, Baan CC, van der Laan LJ (2008) Impact of immunosuppressive drugs on CD4 + CD25 + FOXP3+ regulatory T cells: does in vitro evidence translate to the clinical setting? Transplantation 85:783–789
Ng LG, Sutherland AP, Newton R, Qian F, Cachero TG, Scott ML, Thompson JS, Wheway J, Chtanova T, Groom J, Sutton IJ, Xin C, Tangye SG, Kalled SL, Mackay F, Mackay CR (2004) B cell-activating factor belonging to the TNF family (BAFF)-R is the principal BAFF receptor facilitating BAFF costimulation of circulating T and B cells. J Immunol 173:807–817
Pahl MV, Gollapudi S, Sepassi L, Gollapudi P, Elahimehr R, Vaziri ND (2009) Effect of end-stage renal disease on B-lymphocyte subpopulations, IL-7, BAFF and BAFF receptor expression. Nephrol Dial Transplant 25:205–212
Riccobene TA, Miceli RC, Lincoln C, Knight Y, Meadows J, Stabin MG, Sung C (2003) Rapid and specific targeting of 125I-labeled B lymphocyte stimulator to lymphoid tissues and B cell tumors in mice. J Nucl Med 44:422–433
Bouts AH, Out TA, Schroder CH, Monnens LA, Nauta J, Krediet RT, Davin JC (2000) Characteristics of peripheral and peritoneal white blood cells in children with chronic renal failure, dialyzed or not. Perit Dial Int 20:748–756
Thorn M, Lewis RH, Mumbey-Wafula A, Kantrowitz S, Spatz LA (2009) BAFF overexpression promotes anti-dsDNA B-cell maturation and antibody secretion. Cell Immunol 261:9–22
Thaunat O, Patey N, Gautreau C, Lechaton S, Fremeaux-Bacchi V, Dieu-Nosjean MC, Cassuto-Viguier E, Legendre C, Delahousse M, Lang P, Michel JB, Nicoletti A (2008) B cell survival in intragraft tertiary lymphoid organs after rituximab therapy. Transplantation 85:1648–1653
Stohl W, Hiepe F, Latinis KM, Thomas M, Scheinberg MA, Clarke A, Aranow C, Wellborne FR, Abud-Mendoza C, Hough DR, Pineda L, Migone TS, Zhong ZJ, Freimuth WW, Chatham WW (2012) Belimumab reduces autoantibodies, normalizes low complement, and reduces select B-cell populations in patients with systemic lupus erythematosus. Arthritis Rheum doi: 10.1002/art.34400
Acknowledgement
This work was supported in part by a grant from the charity organization “Hamburg macht Kinder gesund.”
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lehnhardt, A., Dunst, F., van Husen, M. et al. Elevated serum levels of B-cell activating factor in pediatric renal transplant patients. Pediatr Nephrol 27, 1389–1395 (2012). https://doi.org/10.1007/s00467-012-2142-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-012-2142-8