Hyperexpression of the granzyme B inhibitor PI-9 in human renal allografts: a potential mechanism for stable renal function in patients with subclinical rejection

Kidney Int. 2004 Oct;66(4):1417-22. doi: 10.1111/j.1523-1755.2004.00903.x.


Background: Granzyme B-positive T lymphocytes infiltrate renal allografts during acute cellular rejection and cause graft injury by inducing apoptosis of tubular cells. Protease inhibitor 9 (PI-9), an intracellular serpin that inhibits granzyme B, is known to protect cells from the action of cytotoxic T lymphocytes.

Methods: Expression of granzyme B and PI-9 in transplant biopsies from patients with acute cellular rejection (N= 18), subclinical rejection showing a mononuclear cell infiltrate without deterioration of renal function (N= 15), or stable transplant function (N= 13) were studied. Immunohistochemical stainings were analyzed and scored semiquantitatively by two independent observers who were not aware of clinical results.

Results: Granzyme B was expressed by mononuclear cells in all biopsies with cellular infiltrates. PI-9 was diffusely expressed by tubular cells in the allografts of all patients with subclinical rejection. In contrast, PI-9 expression was only focally in the patients with clinical rejection or without rejection. Although no difference was observed in granzyme B levels between acute and subclinical rejection, in subclinical rejection tubular epithelial cells showed significantly stronger expression of PI-9 than in acute rejection (P= 0.011).

Conclusion: These data suggest that a high expression of PI-9 by tubular epithelial cells can serve as one of the factors protecting renal allografts from rejection in spite of the presence of inflammatory cell infiltrates.

MeSH terms

  • Acute Disease
  • Chronic Disease
  • Epithelial Cells / enzymology
  • Epithelial Cells / immunology
  • Graft Rejection / immunology
  • Graft Rejection / metabolism*
  • Graft Rejection / physiopathology*
  • Granzymes
  • Humans
  • Kidney Transplantation*
  • Kidney Tubules / cytology
  • Kidney Tubules / enzymology
  • Kidney Tubules / immunology
  • Lymphocytes / enzymology
  • Serine Endopeptidases / metabolism*
  • Serpins / genetics*
  • Serpins / metabolism
  • Transplantation, Homologous


  • SERPINB9 protein, human
  • Serpins
  • GZMB protein, human
  • Granzymes
  • Serine Endopeptidases