Correlation between clinical outcome and tissue inflammatory response in kidney transplant recipients with cryptococcosis

ABSTRACT Cryptococcosis is the second most common invasive fungal infection reported in renal transplant recipients. Tissue granulomatous inflammation is necessary to contain Cryptococcus infection. This study aims to analyze the granuloma patterns and in situ expression of regulatory T (Treg) immun...

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Bibliographic Details
Published in:Pathogens and disease 2020-10, Vol.78 (7)
Main Authors: Nishikaku, Angela S, Soldá, Marcel V, Ricci, Giannina, Ponzio, Vinicius, Pagliari, Carla, Medina-Pestana, José O, de Franco, Marcello F, Colombo, Arnaldo Lopes
Format: Article
Language:English
Subjects:
CD4 antigen
Clinical outcomes
Cryptococcosis
Cryptococcus
Forkhead protein
Foxp3 protein
Fungal infections
Fungi
Granuloma
Granulomas
Growth factors
Histology
Immune response
Immune system
Infections
Inflammation
Inflammatory response
Interleukins
Kidney transplantation
Kidney transplants
Kidneys
Lymphocytes
Lymphocytes T
Tissues
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Summary:ABSTRACT Cryptococcosis is the second most common invasive fungal infection reported in renal transplant recipients. Tissue granulomatous inflammation is necessary to contain Cryptococcus infection. This study aims to analyze the granuloma patterns and in situ expression of regulatory T (Treg) immune response in tissue samples from 12 renal transplant recipients with cryptococcosis. Fungal isolates were molecularly identified as Cryptococcus neoformans species complex. A detailed characterization of granulomas in tissue samples from 12 kidney transplant recipients with cryptococcosis was described by checking six lung and six skin biopsies by conventional histology and for immunohistochemical detection of CD4 and Treg markers: forkhead box P3 (FoxP3), interleukin (IL)-10 and transforming-growth factor (TGF)-β. Granulomas were classified as compact, loose or mixed. Patients with mixed (n = 4) and compact (n = 3) granulomatous inflammation patterns were associated with a better prognosis and presented a higher number of CD4+FoxP3+T cells compared to the group of patients with loose granulomas. In counterpart, three out of five patients with loose granulomas died with cryptococcosis. We suggest that Treg may have a protective role in the tissue response to Cryptococcus infection given its association with compact and mixed granulomas in patients with better clinical outcomes. Tissue inflammatory host response to Cryptococcus spp. may predict outcome in kidney transplant recipients with cryptococcosis.
ISSN:2049-632X
2049-632X
DOI:10.1093/femspd/ftaa054