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Summary: Diagnostic Uses
Summary: Diagnostic Uses J. Harold Helderman, MD
M
ONOCLONAL ANTIBODIES have advanced the clinical utility of various forms of renal transplant biopsies. With respect to core needle biopsies of the renal transplant, immunoperoxidase studies using monoclonal antibodies to specific cell markers have to date been adjunctive. Standard histochemical and pathologic analysis of the core biopsy permits an accurate clinical diagnosis to be made based on the architecture of the tissue and the presence, position, and nature of immunocompetent cell infiltrates. The role of monoclonal antibodies has been able to delineate the pedigree of the infiltrating lymphocyte responsible for rejection that may be discerned. Because rejection is a heterogenous entity, cells from a wide range of different pedigrees participate in the phenomenon. Little additional diagnostic information has so far been gained by analysis of these markers by monoclonal antibodies. In contrast, the presence of activation markers, such as the interleukin 2 (IL-2) receptor, the transferrin receptor, or the appearance of class II antigens on tubular cells has been instructive as it may confirm the presence of rejection diagnosed by standard technique. Dual markers will in the future improve the role that the surface structures playas diagnostic elements. The most important role for the panel of described monoclonal antibodies at present may be prognosis. In terms of the fine needle aspiration biopsy, monoclonal antibodies may play a greater diagnostic role. The goal of this form of biopsy is to aspirate out of the allograft an array of cells including immunocompetent cells and isolated tu-
134
bular structures. Morphologic analysis by standard histochemical techniques permits one to appreciate the stage of maturation of the immunocompetent cells, but monoclonal antibodies to cell surface markers can help delineate carefully the role that a given pedigree of lymphocyte may play in rejection on the one hand, and the state of antigen activation on the other. It has been very instructive to analyze class II molecule appearance on aspirated tubular structures as corroborative of acute allograft rejection. Activation markers on the cell surface of lymphocytes serves an equal role. For both varieties of biopsy the greatest function of monoclonal antibodies presently is at the level of research increasing the capacity of the investigator to begin to parse out the role that the wide variety of immunocompetent cells may play in the rejection process. The investigative use of the monoclonal antibody in the renal transplant biopsy will be as great as the imagination of the investigator. From the Renal Immunology Laboratory. Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas. Consensus Conference on Monoclonal Antibodies in Transplantation sponsored by the National Kidney Foundation, Scottsdale, AZ, June 26-27, 1987. Address reprint requests to J. Harold Helderman, MD, Renal Immunology Laboratory, Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 752359030. © 1988 by the National Kidney Foundation, Inc. 0272-6386/88// 102-00/3$3.00/0
American Journal of Kidney Diseases, Vol XI, No 2 (February), 1988: p 134
M
ONOCLONAL ANTIBODIES have advanced the clinical utility of various forms of renal transplant biopsies. With respect to core needle biopsies of the renal transplant, immunoperoxidase studies using monoclonal antibodies to specific cell markers have to date been adjunctive. Standard histochemical and pathologic analysis of the core biopsy permits an accurate clinical diagnosis to be made based on the architecture of the tissue and the presence, position, and nature of immunocompetent cell infiltrates. The role of monoclonal antibodies has been able to delineate the pedigree of the infiltrating lymphocyte responsible for rejection that may be discerned. Because rejection is a heterogenous entity, cells from a wide range of different pedigrees participate in the phenomenon. Little additional diagnostic information has so far been gained by analysis of these markers by monoclonal antibodies. In contrast, the presence of activation markers, such as the interleukin 2 (IL-2) receptor, the transferrin receptor, or the appearance of class II antigens on tubular cells has been instructive as it may confirm the presence of rejection diagnosed by standard technique. Dual markers will in the future improve the role that the surface structures playas diagnostic elements. The most important role for the panel of described monoclonal antibodies at present may be prognosis. In terms of the fine needle aspiration biopsy, monoclonal antibodies may play a greater diagnostic role. The goal of this form of biopsy is to aspirate out of the allograft an array of cells including immunocompetent cells and isolated tu-
134
bular structures. Morphologic analysis by standard histochemical techniques permits one to appreciate the stage of maturation of the immunocompetent cells, but monoclonal antibodies to cell surface markers can help delineate carefully the role that a given pedigree of lymphocyte may play in rejection on the one hand, and the state of antigen activation on the other. It has been very instructive to analyze class II molecule appearance on aspirated tubular structures as corroborative of acute allograft rejection. Activation markers on the cell surface of lymphocytes serves an equal role. For both varieties of biopsy the greatest function of monoclonal antibodies presently is at the level of research increasing the capacity of the investigator to begin to parse out the role that the wide variety of immunocompetent cells may play in the rejection process. The investigative use of the monoclonal antibody in the renal transplant biopsy will be as great as the imagination of the investigator. From the Renal Immunology Laboratory. Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas. Consensus Conference on Monoclonal Antibodies in Transplantation sponsored by the National Kidney Foundation, Scottsdale, AZ, June 26-27, 1987. Address reprint requests to J. Harold Helderman, MD, Renal Immunology Laboratory, Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 752359030. © 1988 by the National Kidney Foundation, Inc. 0272-6386/88// 102-00/3$3.00/0
American Journal of Kidney Diseases, Vol XI, No 2 (February), 1988: p 134