Università degli Studi di Brescia is part of the international research group led by scientists from the prestigious Columbia University in New York who conducted the study with which “the gene of rejection” was identified. A real breakthrough in the world of kidney transplantation.
Among the names of the study, published in the New England Journal of Medicine, there is also that of Francesco Scolari, associate professor of Nephrology at the University of Brescia.
This is a discovery that will help improve the choice of donors, that is their compatibility with the person waiting for an organ, but also the anti-rejection therapies, significantly reducing the number of transplants with ominous results. Scientists examined the genetic characteristics of 2,700 pairs of donors and recipients, all of whom have undergone kidney transplantation. A third of the couples was followed by Città della Salute and the University of Turin in collaboration with Professor Scolari. Investigating the thousands of genetic features, the researchers identified a new genomic region on chromosome 2, close to the Lims1 gene, associated with kidney transplant rejection. The study showed that 60% of the subjects have a genetic variant that allows the expression of the Lims1 protein, present in many tissues, including the kidney; on the contrary, 40% have genetic variants that do not allow it to be expressed. Why rejection. In the case of kidney transplantation that comes from a donor with the protein-expressing variant, recipients that genetically do not produce it can recognize it as a foreigner and direct an immune response against it to reject the entire transplant. Indeed, it has been shown that recipients negative for the protein, when transplanted with positive kidneys, develop anti-Lims1 antibodies. In kidney transplantation, the genetic characteristics of the tissues, especially those of the major histocompatibility system (called Hla) play the most important role in determining the appearance of rejection and therefore the survival of the organ in the long term. However, even in the most favorable conditions a certain amount of transplants is rejected, suggesting the existence of incompatibilities linked to genetic characteristics. What happen. There are two important implications of this study. Professor Scolari explains to her. «The first concerns the phase that precedes the renal transplant, that is the choice of the donor-recipient couple. In perspective, this new genetic knowledge could be used to identify the most compatible combinations between donor and recipient to be initiated in kidney transplantation. In addition to traditional tissue typing (Hla), it could be advantageous to add the analysis of this new genetic characteristic in the pre-transplant phase; improving donor / recipient combinations could result in a lower incidence of rejection and therefore an improvement in the outcome of transplants ». “The second relapse, in fact, is relative to the aftermath. The researchers developed specific laboratory tests to identify the presence of antibodies against the Lims1 protein during post-transplantation. Identifying them could allow transplants to be monitored over time; their appearance after transplantation and their early identification, before the clinical signs of rejection, could allow a more effective modulation of anti-rejection therapy”.