Current advances and remaining challenges in human transplant immunology

Aims: To determine the number of CD4⁺CD25^-Foxp3⁺, CD4⁺CD25⁺Foxp3⁺ and CD4⁺CXCR5⁺Foxp3⁺ T cells in renal transplant recipients that are transplanted stable (TS), or experiencing accelerated rejection (ALR), or acute rejection (AR). Methods: Renal transplantation was conducted in 28 patients with end-stage renal failure (ESRF). The number of peripheral CD4⁺CD25^-Foxp3⁺, CD4⁺CD25⁺Foxp3⁺, or CD4⁺CXCR5⁺Foxp3⁺ T cells and the serum levels of interleukin-10 (IL-10) were measured in pre- and post-transplant patients and these results were compared to 10 healthy controls (HC). Correlation between CD4⁺CD25⁺Foxp3⁺ and estimated glomerular filtration rate (eGFR), CD4⁺CD25^-Foxp3⁺ and serum creatinine (Cr) levels, or Cr and IL-10 levels in TS patients was also determined. Results: The number of CD4⁺CD25^-Foxp3⁺ T cells was significantly increased in patients with ESRF, as compared to HC. Stratification analysis demonstrated that TS patients contained greater numbers of CD4⁺CD25⁺Foxp3⁺ and CD4⁺CXCR5⁺Foxp3⁺ T cells, higher levels of serum IL-10, and fewer numbers of CD4⁺CD25^-Foxp3⁺ T cells than ESRF patients. In contrast, ALR and AR patients contained fewer numbers of CD4⁺CD25⁺Foxp3⁺ and CD4⁺CXCR5⁺Foxp3⁺ T cells, greater numbers of CD4⁺CD25^-Foxp3⁺ T cells, and lower levels of serum IL-10 than ESRF patients. In TS patients, the numbers of CD4⁺CD25⁺Foxp3⁺ and CD4⁺CD25^-Foxp3⁺ T cells were positively correlated with eGFR and serum Cr levels, respectively. Conclusion: An imbalance of different types of CD4⁺Foxp3⁺ T cells might be involved in renal transplant rejection.