"Using Molecular Phenotyping to Guide Improvements in the Histologic Diagnosis of T Cell–Mediated Rejection"

Originally aired on April 26, 2016 • 4:00 pm EDT • Hosted by the AST Education Committee

"Using Molecular Phenotyping to Guide Improvements in the Histologic Diagnosis of T Cell–Mediated Rejection" (AJT, April 2016)
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Jeff Reeve, PhD • University of Alberta
Philip Halloran, MD, PhD 
• University of Alberta

Leo Riella, MD, PhD • Harvard Medical School

Written response to a question we did not have time for in the live session:
Q: Are there any genes in the array specifically correlated with BKV infection? Could the TCMR score be "qualified" or modified somehow with the expression of those?

A: There are no genes we have found so far that specifically indicate PVN, although we may have missed something.  However, we are planning a new array that will have virus-associated RNAs.   Then we can relate viral activity (mRNA) to other aspects of the molecular phenotype.
Our experience with PVN, like the experience of some others who have written about this, indicates that there are three main types of cases:
1. PVN with little inflammation;
2. PVN with inflammation and injury but no molecular TCMR;
3. PVN with molecular TCMR.
We will need more cases to get higher resolution.  The question that cannot be answered in biopsies is: is the TCMR in PVN biopsies alloantigen specific or viral peptide specific?  We hope that the labs working on PVN will answer this.

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