Journal Article

Cold ischaemia, innate immunity and deterioration of the glomerular filtration barrier in antibody-mediated acute rejection

Èlia Ripoll, Víctor Nacher, August Vidal, Esther Herrero, Núria Bolaños, Juan Torras, Josep M. Grinyó, Jesús Ruberte and Immaculada Herrero-Fresneda

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 8, pages 3296-3305
Published in print August 2012 | ISSN: 0931-0509
Published online May 2012 | e-ISSN: 1460-2385 | DOI:
Cold ischaemia, innate immunity and deterioration of the glomerular filtration barrier in antibody-mediated acute rejection

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In renal transplantation, cold ischaemia (CI) determines acute rejection through innate immunity among others. Acute rejection episodes are a risk factor for late allograft dysfunction and proteinuria. This implies some alteration of the glomerular filtration barrier (GFB). Besides its effects on acute rejection, we hypothesized that CI might somehow damage the GFB being directly responsible for late proteinuria.


On rat kidney allografts suffering from antibody-mediated acute rejection with or without CI and compared with syngeneic grafts, we quantified the gene expression of innate and adaptive immune mediators and assessed the capillary glomerular basement membranes (CapBM) by immunostaining collagen-IV (ColIV). ColIV was also assessed in equivalent groups from a previous chronic study followed up for 24 weeks.


CI up-regulated enzymes critical in the stabilization of collagen chains, increasing ColIV deposition and thickening the CapBM. CI increased the C4d and IgG deposits within grafts, amplified innate immunity (heat shock protein 70, fibronectin, Toll-like-receptor-4 and MyD88) and synergized with alloreactivity in triggering adaptive response through CD40.


Initial CI increased the ColIV deposition in CapBM, damaging the GFB and being responsible for part of the proteinuria associated with late allograft dysfunction. This deterioration of the GFB is related to the early innate immunity activation and subsequent up-regulation of CD40 in acute rejected grafts. In chronic rejected allografts, thickened CapBM may be a consequence of an unresolved immune–inflammatory response worsened by CI.

Keywords: AbAR CD40; cold ischaemia; collagen-IV; GFB; TLR4

Journal Article.  5275 words.  Illustrated.

Subjects: Nephrology

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