Journal Watch Non-HLA antibodies

The clinical impact of non-HLA specific antibodies either alone or in concert with donor HLA specific antibodies (DSA) has been an intense area of research in kidney transplantation and more recently in thoracic transplantation as well. These non-HLA antigens include receptors expressed by the vascular endothelium such as the G protein coupled receptors (GPCRs), Major Histocompatibility Complex Class I Chain-related Gene A (MICA) and antigens expressed on the surface of stressed endothelial cells such as myosin, vimentin, collagen V, and Kα1 tubulin. Of these antigens, commercially distributed reagents are only available for detection of the non-HLA specific antibodies to AT1R, ETAR, and MICA. Further, proficiency testing programs are also available for these assays making their implementation in testing for clinical transplantation more applicable. A growing body of evidence supports the role of alloimmune and autoimmune mechanisms involving antibodies directed against non-HLA antigens in transplant allograft damage. This review focuses on some of the most important studies of antibodies specific to non-HLA antigens and their impact on thoracic allograft outcome.