Urinary miR-155-5p and CXCL10 as prognostic and predictive biomarkers of rejection, graft outcome and treatment response in kidney transplantation

Abstract

Background and Purpose

MicroRNAs (miRNAs) may be useful biomarkers of rejection and allograft outcome in kidney transplantation. Elevated urinary CXCL10 levels have been associated with acute rejection (AR) and may predict allograft failure. We examined the correlation of miRNA, CXCL10 levels and immunosuppressive drug exposure with AR and graft function in kidney transplant recipients.

Experimental Approach

Eighty de novo kidney transplant recipients were recruited from four European centres. All patients received tacrolimus, mycophenolate mofetil, and methylprednisolone. Urinary pellet expression of miR-142-3p, miR-210-3p, and miR-155-5p was assessed by qPCR and urinary CXCL10 levels by ELISA at the 1^st week and the 1^st, 2^nd, 3^rd and 6^th month post-transplantation.

Key Results

Eight patients experienced AR. Before and during AR, patients showed a significant increase of urinary miR-142-3p, miR-155-5p, and CXCL10 levels and a decrease of miR-210-3p levels. Receiver Operating Characteristic curve analysis showed that miR-155-5p (AUC=0.875; P=0.046) and CXCL10 (AUC=0.865; P=0.029) had excellent capacity to discriminate between rejectors and non-rejectors. The optimal cut-off values for the prognosis of AR were 0.51, with 85% sensitivity and 86% specificity for miR-155-5p and 84.73 pg/ml, with 84% sensitivity and 80% specificity for CXCL10. miR-155-5p and CXCL10 levels correlated with glomerular filtration rate. Levels of both biomarkers normalised after recovery of graft function.

Conclusions and Implications

The regular early post-transplantation monitoring of urinary miR-155-5p and CXCL10 can help in the prognosis of AR and graft dysfunction. Large prospective randomised multicentre trials are warranted to refine our cut-off values and validate the clinical usefulness of these biomarkers.

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