The Regulatory/Cytotoxic T Cell Profiles in Blood of Pediatric Kidney-Transplant Recipients with Acute Rejection

Background: The equilibrium between regulatory cells and cytotoxic cells may define graft consequence. We investigated the relationship between the expression of main regulatory and cytotoxic markers (i.e., FOXP3 and granzyme B (GZM-B), respectively) and acute rejection (AR) in the peripheral blood of pediatric renal transplant recipients. Methods: In this retrospective study, FOXP3 mRNA expression and serum GZM-B levels in peripheral blood samples from 47 first-time pediatric kidney-transplant recipients were measured, with 17 children classified as possessing AR; whereas the remaining 30 children had functionally stabilized allografts. Results: Levels of the FOXP3 mRNA vs. the expression levels GADPH mRNA (FOXP3 mRNA/GADPH mRNA) were significantly elevated in children with AR than those with stabilized renal allograft (0.48 ± 0.26 vs.0.23 ± 0.18, respectively, P=0.002) Also, serum GZM-B levels in the AR group were elevated than those in the functionally stabilized children (120.07 ± 91.42p g/ml and, 60.16 ± 46.29 pg/ml respectively, P=0.01). ROC curve evidenced that measuring FOXP3 mRNA may have a scope as a decision-taking agent in clinical proceedings to diagnose AR. Measuring peripheral blood FOXP3 mRNA elucidated scope to help in the noninvasive diagnosis of AR. Conclusions: Our results emphasize FOXP3 mRNA as a biomarker for AR in pediatrics. Assessment of regulatory/cytotoxic profiles in the peripheral blood of pediatric renal transplant recipients is a potentially useful tool for patient selection and early detection of rejection. Depending on many variables, such as the method of sample normalization, the technique used, the extent of graft inflammation, the immunosuppression regimen, depletion/ repletion of T-lymphocyte component, the importance of FOXP3 may differ.