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      Extracellular vesicles: a potential new player in antibody-mediated rejection in lung allograft recipients

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          Abstract

          Identification of recipients with pre-existing antibodies and cross-matching of recipient sera with donor lymphocytes have reduced the incidence of antibody-mediated rejection (AMR) after human lung transplantation. However, AMR is still common and requires not only immediate intervention but also has long-term consequences including an increased risk of chronic lung allograft dysfunction (CLAD). The mechanisms resulting in AMR remain largely unknown due to the variation in clinical and histopathological features among lung transplant recipients; however, several reports have demonstrated a strong association between the development of antibodies against mismatched donor human leucocyte antigens [donor-specific antibodies (DSAs)] and AMR. In addition, the development of antibodies against lung self-antigens (K alpha1 tubulin and collagen V) also plays a vital role in AMR pathogenesis, either alone or in combination with DSAs. In the current article, we will review the existing literature regarding the association of DSAs with AMR, along with clinical diagnostic features and current treatment options for AMR. We will also discuss the role of extracellular vesicles (EVs) in the immune-related pathogenesis of AMR, which can lead to CLAD.

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          Most cited references97

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          Minimal information for studies of extracellular vesicles 2018 (MISEV2018): a position statement of the International Society for Extracellular Vesicles and update of the MISEV2014 guidelines

          ABSTRACT The last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell-released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines based on evolution of the collective knowledge in the last four years. An important point to consider is that ascribing a specific function to EVs in general, or to subtypes of EVs, requires reporting of specific information beyond mere description of function in a crude, potentially contaminated, and heterogeneous preparation. For example, claims that exosomes are endowed with exquisite and specific activities remain difficult to support experimentally, given our still limited knowledge of their specific molecular machineries of biogenesis and release, as compared with other biophysically similar EVs. The MISEV2018 guidelines include tables and outlines of suggested protocols and steps to follow to document specific EV-associated functional activities. Finally, a checklist is provided with summaries of key points.
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            The biology, function, and biomedical applications of exosomes

            The study of extracellular vesicles (EVs) has the potential to identify unknown cellular and molecular mechanisms in intercellular communication and in organ homeostasis and disease. Exosomes, with an average diameter of ~100 nanometers, are a subset of EVs. The biogenesis of exosomes involves their origin in endosomes, and subsequent interactions with other intracellular vesicles and organelles generate the final content of the exosomes. Their diverse constituents include nucleic acids, proteins, lipids, amino acids, and metabolites, which can reflect their cell of origin. In various diseases, exosomes offer a window into altered cellular or tissue states, and their detection in biological fluids potentially offers a multicomponent diagnostic readout. The efficient exchange of cellular components through exosomes can inform their applied use in designing exosome-based therapeutics.
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              Shedding light on the cell biology of extracellular vesicles

              Extracellular vesicles are a heterogeneous group of cell-derived membranous structures comprising exosomes and microvesicles, which originate from the endosomal system or which are shed from the plasma membrane, respectively. They are present in biological fluids and are involved in multiple physiological and pathological processes. Extracellular vesicles are now considered as an additional mechanism for intercellular communication, allowing cells to exchange proteins, lipids and genetic material. Knowledge of the cellular processes that govern extracellular vesicle biology is essential to shed light on the physiological and pathological functions of these vesicles as well as on clinical applications involving their use and/or analysis. However, in this expanding field, much remains unknown regarding the origin, biogenesis, secretion, targeting and fate of these vesicles.
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                Author and article information

                Contributors
                Journal
                Front Transplant
                Front Transplant
                Front. Transplant.
                Frontiers in Transplantation
                Frontiers Media S.A.
                2813-2440
                04 September 2023
                2023
                : 2
                : 1248987
                Affiliations
                [ 1 ]Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center , Phoenix, AZ, United States
                [ 2 ]HLA Laboratory, Vitalant , Phoenix, AZ, United States
                [ 3 ]Department of Surgery, Washington University , St. Louis, MO, United States
                Author notes

                Edited by: Madhav C. Menon, Yale University, United States

                Reviewed by: Marilia Cascalho, University of Michigan, United States Andrzej Rydzewski, CSK MSWiA, Poland

                Abbreviations AMR, antibody-mediated rejection; APC, antigen presenting cell; BOS, bronchiolitis obliterative syndrome; CLAD, chronic lung allograft dysfunction; DSAs, donor-specific antibodies; EVs, extracellular vesicles; ISHLT, International Society of Heart and Lung Transplantation; IVIG, intravenous immune globulin; LTx, lung transplantation; LTxR, lung transplant recipient; PRA, panel reactive antibodies; RAS, restrictive allograft syndrome.

                Article
                10.3389/frtra.2023.1248987
                11235353
                38993876
                9a4bea8b-2445-426f-96bb-f6717a896b9c
                © 2023 Bansal, Arjuna, Franz, Guerrero-Alba, Canez, Fleming, Rahman, Hachem and Mohanakumar.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 27 June 2023
                : 22 August 2023
                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 97, Pages: 0, Words: 0
                Funding
                Funded by: National Institutes of Health
                Award ID: HL156891
                Funded by: St. Joseph′s Foundation
                Award ID:  
                Funded by: Arizona State University
                Award ID:  
                This work was supported by grants from the National Institutes of Health, HL156891 to TM, St. Joseph′s Foundation, and Seed grant from Arizona State University to (TM).
                Categories
                Transplantation
                Original Research
                Custom metadata
                Immunosuppression

                antibody mediated rejection (amr),extracellular vesicle (ev),donor specific antibodies,lung transplanation,chronic lung allograft dysfunction (clad)

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