Intragraft Regulatory T Cells in Protocol Biopsies Retain foxp3 Demethylation and Are Protective Biomarkers for Kidney Graft Outcome

Am J Transplant. 2011 Oct;11(10):2162-72. doi: 10.1111/j.1600-6143.2011.03633.x. Epub 2011 Jul 12.


Presence of subclinical rejection (SCR) with IF/TA in protocol biopsies of renal allografts has been shown to be an independent predictor factor of graft loss. Also, intragraft Foxp3+ T(reg) cells in patients with SCR has been suggested to differentiate harmful from potentially protective infiltrates. Nonetheless, whether presence of Foxp3 T(reg) cells in patients with SCR and IF/TA may potentially protect from a deleterious graft outcome has not yet been evaluated. This is a case-control study in which 37 patients with the diagnosis of SCR and 68 control patients with no cellular infiltrates at 6-month protocol biopsies matched for age and time of transplantation were evaluated. We first confirmed that numbers of intragraft Foxp3-expressing T cells in patients with SCR positively correlates with Foxp3 demethylation at the T(reg) -specific demethylation region. Patients with SCR without Foxp3+ T(reg) cells within graft infiltrates showed significantly worse 5-year graft function evolution than patients with SCR and Foxp3+ T(reg) cells and those without SCR. When presence of SCR and IF/TA were assessed together, presence of Foxp3+ T(reg) could discriminate a subgroup of patients showing the same graft outcome as patients with a normal biopsy. Thus, presence of Foxp3+ T(reg) cells in patients with SCR even with IF/TA is associated with a favorable long-term allograft outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / metabolism*
  • Biopsy
  • Case-Control Studies
  • Female
  • Forkhead Transcription Factors / metabolism*
  • Graft Rejection*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Kidney Transplantation*
  • Male
  • Methylation
  • Middle Aged
  • Retrospective Studies
  • T-Lymphocytes, Regulatory / immunology*


  • Biomarkers
  • FOXP3 protein, human
  • Forkhead Transcription Factors
  • Immunosuppressive Agents