The suppressive effect on CD4 T cell alloresponse against endothelial HLA-DR via PD-L1 induced by anti-A/B ligation.

While donor-specific human leukocyte antigen (HLA) antibodies are a frequent cause for chronic antibody-mediated rejection in organ transplantation, this is not the case for antibodies targeting blood group antigens, as ABO-incompatible (ABO-I) organ transplantation has been associated with a favorable graft outcome. Here, we explored the role of CD4 T cell-mediated alloresponses against endothelial HLA-D-related (DR) in the presence of anti-HLA class I or anti-A/B antibodies. CD4 T cells, notably CD45RA-memory CD4 T cells, undergo extensive proliferation in response to endothelial HLA-DR. The CD4 T cell proliferative response was enhanced in the presence of anti-HLA class I, but attenuated in the presence of anti-A/B antibodies. Microarray analysis and molecular profiling demonstrated that the expression of CD274 programmed cell death ligand 1 (PD-L1) increased in response to anti-A/B ligation-mediated extracellular signal-regulated kinase (ERK) inactivation in endothelial cells that were detected even in the presence of interferon-γ stimulation. Anti-PD-1 antibody enhanced CD4 T cell proliferation, and blocked the suppressive effect of the anti-A/B antibodies. Educated CD25+ CD127- regulatory T cells (edu.Tregs ) were more effective at preventing CD4 T cell alloresponses to endothelial cells compared with naive Treg ; anti-A/B antibodies were not involved in the Treg -mediated events. Finally, amplified expression of transcript encoding PD-L1 was observed in biopsy samples from ABO-I renal transplants when compared with those from ABO-identical/compatible transplants. Taken together, our findings identified a possible factor that might prevent graft rejection and thus contribute to a favorable outcome in ABO-I renal transplantation.

Fetal glioblastoma: rapid growth during the third trimester.

We present a case of fetal glioblastoma which appeared after 28 weeks' gestation. The first ultrasonographic finding was an enlarged fetal head with right shifted falx cerebri at 31 weeks' gestation. At 33 weeks, a large and high echogenic mass in the left hemisphere and right enlarged ventricle was identified. Magnetic resonance imaging showed that the tumor was localized in the left hemisphere and a margin of the tumor was defined. Because fetal well-being judging from biophysical parameters was good and we considered that the tumor was resectable, a male fetus weighing 2,670 g was delivered at 34 weeks' gestation by cesarean section. However, he was inoperable due to consumptive coagulopathy and rapid growth of the tumor, and died on the 41st day of life.

Preoperative localization of brain lesions by magnetic resonance imaging with a marking device. Technical note.

A new technique for preoperative localization of brain lesions using magnetic resonance imaging and a marking device is described. The projection of lesions, especially superficial brain tumors, is demonstrated on the scalp, with an acceptable tolerance for open procedures. This simple and inexpensive method, which was use in a group of 34 patients, can assist surgeons in planning an operative approach to intracranial lesions.

[A case of clival chordoma without bone destruction].

A case of clival chordoma without bone destruction is reported. A 28-year-old man was admitted to Kagoshima University Hospital on April 8, 1983 with the complaints of headache, displopia and gait disturbance. Neurological examination revealed the right eighth, ninth, tenth nerve palsy and gait disturbance. Plain skull firms showed no abnormality and left vertebral arteriography revealed a displacement of basilar artery to the left side. The CT scanning showed a low density area at the retroclival region, and enhancement was acquired slightly. Metrizamide cisternography, CT cisternography showed retroclival round tumor and no destruction of the bone. The tumor which invaded intradurally was removed totally. Histological examination confilmed the chordoma. In this report, it will be stressed that when clival chordoma invades intradually, subtemporal approach will be most favorable, and metrizamide CT cisternography is one of the useful diagnostic procedures of retroclival mass.