Anita S. Chong

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Exonic variants in Apolipoprotein-L1 (G1 and G2) are linked to increased risk of kidney disease as well as kidney transplant rejection. Outside of the association of these prevalent variants with African ancestry, underpinning causal mechanisms for rejection are unknown. We investigated T-cell function using transgenic mice with physiologic expression of wild type (G0-), G1-APOL1 (G1), or G2-APOL1 (G2). Mice with either variant showed greater CD8+T-cell activation with expansion of a central memory (TCM) subset. Stimulated G1-CD8+T-cells showed enhanced proliferation and cytokine production, which reversed with APOL1 inhibition. In MHC-mismatched cardiac transplants, G1-mice demonstrated greater CD8+T-cell infiltration and reduced survival. Bulk transcriptome of G1-CD8+T-cells, and single-cell transcriptome of graft infiltrating TCMs, showed enrichment of canonical T-cell receptor (TCR) pathways including Ca ²⁺ -signaling. G1-CD8+T-cells demonstrated baseline ER-Ca ²⁺ depletion followed by sustained increases in cytosolic-Ca ²⁺ upon TCR stimulation. G1-CD8+T-cells were more sensitive to Ca ²⁺ chelation, or store-operated Ca ²⁺ entry inhibition, and were relatively resistant to calcineurin antagonism compared to G0-CD8+T-cells. Analogously, in a kidney transplant cohort, APOL1-variant recipients that had elevated peripheral TCMs before transplantation, developed rejection despite significantly higher tacrolimus levels vs G0/G0 recipients. In summary, we unravel an excitatory mechanism for APOL1 variants in T-cells that causally links them to kidney rejection.

Respiratory pathogens pose significant global health challenges, with current vaccines often failing to prevent viral replication at mucosal entry points.

Lupus nephritis (LuN) and renal allograft rejection (RAR) manifest inflammation and fibrosis that ultimately lead to kidney failure. To quantitatively assess spatial injury patterns, we collected high dimensional spatial proteomics data from 23 LuN, 33 RAR, and 8 kidney control (KC) biopsies. We developed a computational pipeline to segment and classify tubules, capillaries, and glomeruli in whole-slide images using three trained neural networks (Renal Damage diagnosis, RDDx). RDDx achieved high accuracy and generalizability, reliably identifying small capillaries and differentiating tubular and vascular inflammation in kidney tissues. Both LuN and RAR showed reduced tubular and capillary areas with expanded interstitial space. LuN displayed patchy clusters of stressed and inflamed tubules, whereas RAR exhibited diffuse injury. Within RAR, T cell–mediated rejection (TCMR) showed intense tubulitis while antibody-mediated rejection (ABMR) featured proliferating and inflamed capillaries near atrophic tubules. RDDx quantitative metric outputs correlated with histopathological scores, highlighting their reproducibility and clinical relevance. Stressed tubules in mildly inflamed LuN biopsies suggested they were a sensitive injury marker, while proliferating capillaries revealed microvascular remodeling in ABMR. These findings indicated RDDx can identify and quantify damage mechanisms specific to each renal disease thus facilitating future mechanistic studies and therapeutic target discovery.

Organ shortage remains a major challenge in transplantation, and gene-edited pig organs offer a promising solution^1–3. Despite gene-editing, the immune reactions following xenotransplantation can still cause transplant failure⁴. To understand the immunological response of a pig-to-human kidney xenotransplantation, we conducted large-scale multi-omics profiling of the xenograft and the host’s blood over a 61-day procedure in a brain-dead human (decedent) recipient. Blood plasmablasts, natural killer (NK) cells, and dendritic cells increased between postoperative day (POD)10 and 28, concordant with expansion of IgG/IgA B-cell clonotypes, and subsequent biopsy-confirmed antibody-mediated rejection (AbMR) at POD33. Human T-cell frequencies increased from POD21 and peaked between POD33-49 in the blood and xenograft, coinciding with T-cell receptor diversification, expansion of a restricted TRBV2/J1 clonotype and histological evidence of a combined AbMR and cell-mediated rejection at POD49. At POD33, the most abundant human immune population in the graft was CXCL9+ macrophages, aligning with IFN-γ-driven inflammation and a Type I immune response. In addition, we see evidence of interactions between activated pig-resident macrophages and infiltrating human immune cells. Xenograft tissue showed pro-fibrotic tubular and interstitial injury, marked by S100A6⁵, SPP1⁶ (Osteopontin), and COLEC11⁷, at POD21–POD33. Proteomics profiling revealed human and pig complement activation, with decreased human component after AbMR therapy with complement inhibition. Collectively, these data delineate the molecular orchestration of human immune responses to a porcine kidney, revealing potential immunomodulatory targets for improving xenograft survival.

BACKGROUND: In human lupus nephritis (LuN), tubulointerstitial inflammation (TII) is prognostically more important than glomerular inflammation. However, a comprehensive understanding of both TII complexity and heterogeneity is lacking. METHODS: Herein, we used high-dimensional confocal microscopy, spatial transcriptomics, and specialized computer vision techniques to quantify immune cell populations and localize these within normal and diseased renal cortex structures. With these tools, we compared LuN to renal allograft rejection (RAR) and normal kidney tissues on 54 deidentified biopsies. RESULTS: In both LuN and RAR, the 33 characterized immune cell populations formed discrete subgroups whose constituents covaried in prevalence across biopsies. In both diseases, these covariant immune cell subgroups organized into the same unique niches. Therefore, inflammation could be resolved into trajectories representing the relative prevalence and density of cardinal immune cell members of each covariant subgroup. Indeed, in any one biopsy, the inflammatory state could be characterized by quantifying constituent immune cell trajectories. Remarkably, LuN heterogeneity could be captured by quantifying a few myeloid immune cell trajectories, while RAR was more complex with additional T cell trajectories. CONCLUSIONS: Our studies identify rules governing renal inflammation and thus provide an approach for resolving LuN into discrete mechanistic categories. FUNDING: NIH (U19 AI 082724 [MRC], R01 AI148705 [MRC and ASC]), Chan Zuckerberg Biohub (MRC), and Lupus Research Alliance (MRC).

Pregnancy acts as both a tolerogenic and sensitizing event, inducing T cell hypofunction and humoral sensitization. Mouse studies reported that T cell hypofunction is a key mechanism in preserving fetal viability, but this phenomenon remains uncharacterized in humans. In this study, we developed an assay to specifically assess fetal-specific T cell tolerance in uncomplicated, full-term human pregnancies. The majority of maternal PBMCs stimulated with matured fetus-matched dendritic cells (CBDCs) exhibited low IFNγ responses that were significantly lower than third-party fetus-unmatched CBDCs. This hyporesponsiveness to matched CBDCs extended to the production of a range of Th1 and Th2 cytokines, and was not associated with increased immunoregulatory cytokines, IL-10 or IL-1RA. Unexpectedly, a small number of grand multiparous individuals displayed heightened IFNγ responses to fetus-matched CBDCs; these individuals also exhibited heightened Th1 and Th2 cytokine responses. Together, our study introduces a novel assay to measure fetal antigen-specific T cell responses that confirmed T cell hypofunction as an immunological mechanism enabling successful pregnancy in humans in addition to mouse. It also implicates alternative tolerance mechanisms that allow successful pregnancies to proceed even in the presence of fetus-specific T effector cell reactivity. These findings have implications for understanding immune dysregulation in pregnancy complications and for improving transplantation outcomes in multiparous women.

Pathogenic antibodies produced by alloreactive B cells mediate antibody-mediated rejection after kidney transplantation, but the mechanisms remain poorly understood. Follicular regulatory T (Tfr) cells modulate follicular helper T cell-mediated B cell responses, but the functions of Tfr in controlling alloreactive antibody are unknown. Here we study the developmental signals and functions of Tfr cells in mouse allogeneic kidney transplantation models, and show that costimulatory blockade alters the development of Tfr cells disproportionately by decreasing germinal center (GC)-like Tfr cells but increasing follicular-like Tfr cells. Functionally, global Tfr cell deletion results in accelerated graft rejection and increases in donor-specific B cells in both draining lymph nodes and kidney allografts. Mechanistically, Tfr cell deletion increases GC B cell expression of pro-inflammatory cytokines such as IL-15, while neutralization of IL-15 compensates for the loss of Tfr cells and prolongs the survival of mice receiving kidney transplants. Together our preclinical mouse data demonstrate how Tfr restrains kidney allograft rejection by limiting alloreactive B cell responses.

Successful allograft-specific tolerance induction would eliminate the need for daily immunosuppression and improve posttransplant quality of life. Adoptive cell therapy with regulatory T cells expressing donor-specific chimeric antigen receptors (CAR Tregs) is a promising strategy but, as monotherapy, cannot prolong survival with allografts with multiple MHC mismatches. Using an HLA-A2–transgenic haplo-mismatched heart transplantation model in immunocompetent C57BL/6 recipients, we showed that HLA-A2–specific CAR (A2.CAR) Tregs were able to synergize with a low dose of anti-CD154 to enhance graft survival. Using haplo-mismatched grafts expressing the 2W-OVA transgene and tetramer-based tracking of 2W- and OVA-specific T cells, we showed that in mice with accepted grafts, A2.CAR Tregs inhibited donor-specific T cell, B cell, and antibody responses and promoted a substantial increase in endogenous FOXP3 ⁺ Tregs with indirect donor specificity. By contrast, in mice where A2.CAR Tregs failed to prolong graft survival, FOXP3 ^– A2.CAR T cells preferentially accumulated in rejecting allografts, and endogenous donor-specific responses were not controlled. This study therefore provides evidence for synergy between A2.CAR Tregs and CD154 blockade to promote infectious tolerance in immunocompetent recipients of haplo-mismatched heart grafts and defines features of A2.CAR Tregs when they fail to reshape host immunity toward allograft tolerance.