The goal of my proposed research is to investigate the role of dendritic cells in transplant tolerance and furthermore, to potentially modify dendritic cells for use in the induction of tolerance. I am examining the role of microRNA in the tolerogenic properties of dendritic cells in a murine model of cardiac allograft transplantation. Specifically, I study plasmacytoid dendritic cells (pDC), a subset of DC that have been identified to play a role in tolerance induction. My work expands upon the knowledge that liver allografts are well tolerated and that other solid organ allografts, when transplanted concurrently with livers, show improved allograft outcomes. However, the mechanisms underlying “hepatic tolerance” have yet to be elucidated. My clinical translational work seeks to identify biomarkers of tolerance as well as biomarkers that distinguish patients at risk for rejection or other instability of graft (i.e. infection).
- Liver Transplant
Education & Certifications
Medical Education:University of Pittsburgh School of Medicine (2008) PA
University of Pittsburgh School of Medicine (2006) PA
Fellowship:University of California, San FranciscoCA
Residency:University of California, San FranciscoCA
Internship:University of California, San FranciscoCA
Board Certification: Pediatrics, American Board of Pediatrics (2012)
Chronic high Epstein-Barr viral load carriage in pediatric small bowel transplant recipients
2010; 14 (4): 549-553
The development of EBV infection and PTLD is normally associated with a high EBV load in peripheral blood. Often, children undergoing primary or reactivation of EBV infection subsequent to ITx will have chronically elevated EBV loads. To better understand this phenomenon and its consequences, we retrospectively reviewed the records of children who underwent ITx (either isolated or part of multivisceral transplantation) at our center from 1992 to 2007, to identify chronic high EBV load carriers in this population. CHL state was defined as the presence of high load for >50% of samples for greater than or equal to six months following either asymptomatic infection or complete clinical resolution of EBV disease/PTLD. Thirty-five CHL carriers were identified from our patient population. Pretransplant serologies were available on 34 of these patients: 17 were EBV negative and 17 seropositive; one had unknown EBV serostatus prior to transplant. Seven of the 17 seronegative patients developed their CHL carrier state at the time of their primary EBV infection. Thirteen of the 35 (37%) HLC patients developed EBV disease after meeting the definition of high-load carrier states. EBV-related diseases developing in CHL carriers included EBV adenitis (n=1), EBV enteritis (n=7), PTLD (n=4), and EBV+ spindle cell tumor (n=1). Disease was seen in 7/17 of the seronegative (one PTLD) and 6/17 of the seropositive patients (three PTLD). Thirteen of 35 patients (37%) resolved their CHL state without apparent sequelae while nine remain asymptomatic CHL carriers. Three children have had more than one episode of CHL. These data provide important information about the outcome of chronic EBV high-load carriage in pediatric intestinal transplant recipients.
View details for DOI 10.1111/j.1399-3046.2009.01283.x
View details for Web of Science ID 000277528900021
View details for PubMedID 20102529
Antigen-presenting cells under the influence of alcohol
TRENDS IN IMMUNOLOGY
2009; 30 (1): 13-22
The negative influence of alcohol (ethanol) and its metabolites on innate and adaptive immunity is well-recognized. Much attention has recently been focused on the impact of acute and chronic alcohol exposure on antigen-presenting cells (APC). In particular, insights have been gained into how the properties of human blood monocytes and rodent macrophages are influenced by alcohol in vitro and in vivo. Here, we review the impact of alcohol on various aspects of APC function and the underlying mechanisms, including its effects on intracellular signaling events. We also discuss new information regarding the influence of alcohol on various APC populations in the liver, a primary site of alcohol metabolism.
View details for DOI 10.1016/j.it.2008.09.005
View details for Web of Science ID 000262970200003
View details for PubMedID 19059005
Chronic ethanol exposure affects in vivo migration of hepatic dendritic cells to secondary lymphoid tissue
2007; 68 (7): 577-585
The mechanisms by which chronic ethanol (EtOH) consumption results in an immune-compromised state have not been fully elucidated. No studies to date have ascertained whether EtOH affects the migratory capacity of dendritic cells (DC), potent immune regulators. We hypothesized that EtOH exposure might affect hepatic and splenic DC trafficking to secondary lymphoid tissues and the resulting immune response. Hepatic DC from EtOH-treated animals migrated in greater numbers to draining lymphoid tissue than controls, whereas spleen DC were unaffected. Moreover, hepatic EtOH-exposed (E) DC induced more vigorous priming of allogeneic T cells in vivo compared with splenic EDC or controls. Altered hepatic EDC migration was independent of either CCR7 or CD11a expression, with no striking changes in surface expression of other adhesion molecules analyzed. The modified trafficking to secondary lymphoid tissue observed for hepatic EDC may play a role in the altered immune response to microbial pathogens in chronic alcohol users.
View details for DOI 10.1016/j.humimm.2007.03.008
View details for Web of Science ID 000247828800003
View details for PubMedID 17584579
Ethanol affects the generation, cosignaling molecule expression, and function of plasmacytoid and myeloid dendritic cell subsets in vitro and in vivo
JOURNAL OF LEUKOCYTE BIOLOGY
2006; 79 (5): 941-953
The influence of ethanol (EtOH) on multiple dendritic cell (DC) subsets, in the steady state or following their mobilization in vivo, has not been characterized. Herein, generation of mouse bone marrow-derived DC (BMDC) in response to fms-like tyrosine kinase 3 ligand was inhibited by physiologically relevant concentrations of EtOH with selective suppression of plasmacytoid (p)DC. EtOH reduced surface expression of costimulatory molecules (CD40, CD80, CD86) but not that of coinhibitory CD274 (B7-H1) on resting or CpG-stimulated DC subsets. Interleukin (IL)-12p70 production by activated DC was impaired. Consistent with these findings, EtOH-exposed BMDC exhibited a reduced capacity to induce naïve, allogeneic T cell proliferation and impaired ability to prime T cells in vivo. DC subsets freshly isolated from EtOH-fed mice were also examined. Liver DC, inherently immature and resistant to maturation, exhibited little change in their low surface cosignaling molecule expression, whereas splenic DC showed reduced expression of surface costimulatory molecules in response to CpG stimulation in vivo. These splenic DC elicited reduced naïve, allogeneic T cell proliferation in vitro, and the stimulatory capacity of resting but not CpG-activated liver DC was reduced by chronic EtOH administration. T cells from animals primed with EtOH-exposed DC produced elevated levels of IL-10 following ex vivo challenge with donor alloantigen. Thus, EtOH impairs cytokine-driven differentiation and function of myeloid DC and pDC in vitro. Hepatic DC from chronic EtOH-fed mice are less affected than splenic DC, which exhibit impaired functional maturation following CpG stimulation. These results indicate a potential mechanism by which alcohol consumption is associated with immunosuppression.
View details for DOI 10.1189/jlb.0905517
View details for Web of Science ID 000243015200009
View details for PubMedID 16478920
Low TLR4 expression by liver dendritic cells correlates with reduced capacity to activate allogeneic T cells in response to endotoxin
JOURNAL OF IMMUNOLOGY
2005; 174 (4): 2037-2045
Signaling via TLRs results in dendritic cell (DC) activation/maturation and plays a critical role in the outcome of primary immune responses. So far, no data exist concerning TLR expression by liver DC, generally regarded as less immunostimulatory than secondary lymphoid tissue DC. Because the liver lies directly downstream from the gut, it is constantly exposed to bacterial LPS, a TLR4 ligand. We examined TLR4 expression by freshly isolated, flow-sorted C57BL/10 mouse liver DC compared with spleen DC. Real-time PCR revealed that liver CD11c+CD8alpha- (myeloid) and CD11c+CD8alpha+ ("lymphoid-related") DC expressed lower TLR4 mRNA compared with their splenic counterparts. Lower TLR4 expression correlated with reduced capacity of LPS (10 ng/ml) but not anti-CD40-stimulated liver DC to induce naive allogeneic (C3H/HeJ) T cell proliferation. By contrast to LPS-stimulated splenic DC, these LPS-activated hepatic DC induced alloantigen-specific T cell hyporesponsiveness in vitro, correlated with deficient Th1 (IFN-gamma) and Th2 (IL-4) responses. When higher LPS concentrations (> or =100 ng/ml) were tested, the capacity of liver DC to induce proliferation of T cells and Th1-type responses was enhanced, but remained inferior to that of splenic DC. Hepatic DC activated by LPS in vivo were inferior allogeneic T cell stimulators compared with splenic DC, whereas adoptive transfer of LPS-stimulated (10 ng/ml) liver DC induced skewing toward Th2 responses. These data suggest that comparatively low expression of TLR4 by liver DC may limit their response to specific ligands, resulting in reduced or altered activation of hepatic adaptive immune responses.
View details for Web of Science ID 000226986700032
View details for PubMedID 15699133
Disparate ability of murine CD8 alpha(-) and CD8 alpha(+) dendritic cell subsets to traverse endothelium is not determined by differential CD11b expression
2004; 113 (3): 328-337
Upon Ag uptake and response to maturation stimuli, dendritic cells (DC) are directed through lymphatic or blood vessel endothelium to T cell areas of secondary lymphoid tissues by the constitutively expressed CC chemokines CCL19 and CCL21. We have shown that mature (m) murine CD8alpha+ DC exhibit poorer migratory ability to these chemokines than classic CD8alpha- DC by quantifying their in vitro chemotaxis through unmodified Transwell filters. We hypothesized that lower surface expression (compared to CD8alpha- mDC) of the adhesion molecule CD11b on CD8alpha+ DC might limit their ability to adhere to filter pores in vitro and/or endothelium in vitro/in vivo. To test the role of this and/or other adhesion molecules (CD11a, CD31, CD54 and CD62L) in regulating murine DC subset migration, we used specific mAbs to block their function and quantified their migration through resting or tumour necrosis factor (TNF)-alpha-activated endothelial cell (EC) layered-Transwell filters. Both CD8alpha+ and CD8alpha- subsets migrated through resting EC (albeit less than in the absence of EC) in response to CCL19 and CCL21, and migration through TNF-alpha-activated EC was enhanced. In contrast to reports concerning human DC, transendothelial migration of the murine DC subsets was not dependent on CD11b, CD31, or CD62L expression by these cells. CD54 and CD11a, however, were at least partly involved in DC/EC interactions. This is the first report to examine adhesion molecules involved in transendothelial migration of murine DC subsets.
View details for DOI 10.1111/j.1365-2567.2004.01960.x
View details for Web of Science ID 000224634000006
View details for PubMedID 15500619
Comparative evaluation of CC chemokine-induced migration of murine CD8 alpha(+) and CD8 alpha(-) dendritic cells and their in vivo trafficking
JOURNAL OF LEUKOCYTE BIOLOGY
2004; 75 (2): 275-285
Murine CD11c(+)CD8alpha(-) and CD11c(+)CD8alpha(+) dendritic cells (DCs) differentially regulate T cell responses. Although specific chemokines that recruit immature (i) or mature (m) CD8alpha(-) DCs have been identified, little is known about the influence of chemokines on CD8alpha(+) DCs. iDCs and mDCs isolated from spleens of fms-like tyrosine kinase 3 ligand-treated B10 mice were compared directly for migratory responses to a panel of CC chemokines or following local or systemic administration. In vitro assays were performed using Transwell(R) chambers. iDCs did not respond to any CC chemokines tested. Both subsets of mDCs migrated to CCL19 and CCL21, with consistently lower percentages of CD8alpha(+) DCs migrating. Chemokine receptor mRNA and protein expression were analyzed, but no correlation between expression and function was demonstrated. In vivo trafficking of fluorochrome-labeled DCs (B10; H2(b)) was assessed by immunohistochemistry and by rare-event flow cytometric analysis of allogeneic recipient (BALB/c; H2(d)) draining lymph node (DLN) and spleen cells. Twenty-four hours after intravenous injection, chloromethylfluorescein diacetate-positive CD8alpha(+) and CD8alpha(-) mDCs were detected by immunohistochemistry in spleens in similar numbers (that decreased over time). Following subcutaneous injection, both DC subsets were detected in DLN at 24 h, but only CD8alpha(-) DCs were evident by flow analysis at 48 h. Although CD8alpha(+) DCs migrate from peripheral tissues to T cell areas of (allogeneic) secondary lymphoid organs, they appear to mobilize as mDCs and less efficiently than CD8alpha(-) mDCs.
View details for DOI 10.1189/jlb.1202613
View details for Web of Science ID 000188791700016
View details for PubMedID 14597730
Liver tolerance mediated by antigen presenting cells: fact or fiction?
2003; 52 (8): 1075-1078
Possible mechanisms by which liver antigen presenting cells (APC) may facilitate tolerance induction are discussed. Tolerance may be facilitated by a distinctive combination of factors, linked to the unique anatomical and microenvironmental features of the liver.
View details for Web of Science ID 000184182300001
View details for PubMedID 12865260
Effects of docosapentaenoic acid on neuronal apoptosis
2003; 38 (4): 453-457
We previously established that n-3 FA status in membrane phospholipids influences the biosynthesis and accumulation of PS in neuronal tissues. We also demonstrated that neuronal apoptosis under adverse conditions is prevented by DHA enrichment in a PS-dependent manner. In this study, we examined the effect of a structural analog of DHA, docosapentaenoic acid (22:5n-6, DPA), which accumulates in neuronal membranes during n-3 FA deficiency. We observed that enrichment of neuronal cells with DPA increased the total PS content in comparison to nonenriched control. However, the increase was significantly less than that observed in DHA-enriched cells, primarily due to the fact that the 18:0,22:5n-6 species was not accumulated as effectively as 18:0,22:6n-3 in PS. As was the case with DHA, DPA enrichment also protected against cell death induced by staurosporine treatment in Neuro 2A cells, but to a lesser extent. These data indicate that provision of DPA in place of DHA is sufficient neither for fully supporting PS accumulation nor for cell survival. The in vitro interaction between Raf-1 and membrane was affected not only by the PS content but also by the fatty acyl composition in PS. The reduction of PS concentration as well as the substitution of 18:0,22:6 with 16:0,18:1 in the liposome considerably reduced the interaction with Raf-1. These data suggest that depletion of DHA from neuronal tissues may have a compounding effect on Raf-1 translocation in growth factor signaling. The fact that DPA cannot fully support the protective role played by DHA may provide a basis for the adverse effect of n-3 FA deficiency on neuronal development and function.
View details for Web of Science ID 000183577400021
View details for PubMedID 12848293
Dendritic cells and immune regulation in the liver
2003; 52 (2): 307-314
Hepatic dendritic cells (DC) unquestionably play important roles in the induction and regulation of immune responses. Due to their paucity, functional characterisation of these important antigen presenting cells has been slow but use of DC growth factors (in particular GM-CSF and Flt3L) that markedly enhance their numbers has proved helpful in furnishing adequate study material. While there is growing evidence that DC function is affected in the pathogenesis of liver disease, most work to date has been performed on non-hepatic DC. Increasing knowledge of hepatic DC biology is likely to improve our understanding of disease pathogenesis and resistance to and therapy of liver disease.
View details for Web of Science ID 000180534200032
View details for PubMedID 12524419
Inhibition of neuronal apoptosis by docosahexaenoic acid (22 : 6n-3) - Role of phosphatidylserine in antiapoptotic effect
JOURNAL OF BIOLOGICAL CHEMISTRY
2000; 275 (45): 35215-35223
Enrichment of Neuro 2A cells with docosahexaenoic acid (22:6n-3) decreased apoptotic cell death induced by serum starvation as evidenced by the reduced DNA fragmentation and caspase-3 activity. The protective effect of 22:6n-3 became evident only after at least 24 h of enrichment before serum starvation and was potentiated as a function of the enrichment period. During enrichment 22:6n-3 incorporated into phosphatidylserine (PS) steadily, resulting in a significant increase in the total PS content. Similar treatment with oleic acid (18:1n-9) neither altered PS content nor resulted in protective effect. Hindering PS accumulation by enriching cells in a serine-free medium diminished the protective effect of 22:6n-3. Membrane translocation of Raf-1 was significantly enhanced by 22:6n-3 enrichment in Neuro 2A cells. Consistently, in vitro biomolecular interaction between PS/phosphatidylethanolamine /phosphatidylcholine liposomes, and Raf-1 increased in a PS concentration-dependent manner. Collectively, enrichment of neuronal cells with 22:6n-3 increases the PS content and Raf-1 translocation, down-regulates caspase-3 activity, and prevents apoptotic cell death. Both the antiapoptotic effect of 22:6n-3 and Raf-1 translocation are sensitive to 22:6n-3 enrichment-induced PS accumulation, strongly suggesting that the protective effect of 22:6n-3 may be mediated at least in part through the promoted accumulation of PS in neuronal membranes.
View details for Web of Science ID 000165422800053
View details for PubMedID 10903316