Researchers
at the Charité (Mitte), the Franz Volhard Clinic, Helios Klinikum-Berlin, and
the Max Delbrück Center
for Molecular Medicine (MDC) Berlin-Buch have discovered that kidney transplant
patients with humoral rejection commonly make antibodies directed against the
angiotensin (AT1) receptor. Humoral rejection accounts for about 10 per cent of
all graft losses. The autoantibodies activate the receptor and may cause severe
hypertension and organ damage. The report appeared in the New England
Journal of Medicine (online; Vol. 352 No. 6, pp 558-69, 2005)* accompanied
by an editorial. The work follows earlier studies from the Franz Volhard Clinic
and the MDC suggesting that similar antibodies are involved in preeclampsia, a
life-threatening hypertension crisis during pregnancy. The investigators were
able to develop a relatively specific therapy, such as Angiotensin 1 receptor
blockers in combination with the removal of the antibodies for their kidney
transplant patients. They also transferred the condition to an animal model.
However, much work remains to be done. Eighteen investigators participated in
the work. The study is an example of close cooperation between clinicians and
MDC investigators. The first author is Duska Dragun (now Charité Mitte,
erstwhile Franz Volhard Clinic) and the last author is Gerd Wallukat (MDC).
*Angiotensin II Type
1-Receptor-Activating Antibodies in Renal-Allograft Rejection
Duska Dragun, M.D., Dominik N. Müller,
Ph.D., Jan Hinrich Bräsen, M.D., Lutz Fritsche, M.D., Melina Nieminen-Kelhä,
B.S., Ralf Dechend, M.D., Ulrich Kintscher, M.D., Birgit Rudolph, M.D., Johan
Hoebeke, Ph.D., Diana Eckert, M.D., Istvan Mazak, M.D., Ralph Plehm, Ph.D.,
Constanze Schönemann, Ph.D., Thomas Unger, M.D., Klemens Budde, M.D.,
Hans-Hellmut Neumayer, M.D., Friedrich C. Luft, M.D., and Gerd Wallukat, Ph.D.
From the Departments of Nephrology (D.D.,
L.F., M.N.-K., D.E., K.B., H.-H.N.) and Pathology (B.R.), and the Center for
Cardiovascular Research (D.D., M.N.-K.,
U.K., T.U.).
Charité University Hospital; the Franz Volhard Clinic and HELIOS Klinikum
(D.N.M., J.H.B., R.D., I.M., F.C.L.); the Max Delbrück Center for Molecular
Medicine (R.P., G.W.); and the HLA Laboratory (C.S.) – all in Berlin; an the
Institut de Biologie Molêculaire et Cellulaire, Centre National de la Recherche
Scientifique, Strasbourg, France (J.H.). Address reprint requests to Dr. Dragun
at the Department of Nephrology and Transplantation, Charité University
Hospital, Campus Mitte,
Schumannstr. 20-21, 10117 Berlin,
Germany, or at
duska.dragun.@charite.de.
N Engl J Med 2005; 352: 558-69
Copyright © 2005 Massachusetts Medical Society
Barbara
Bachtler
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and Public Affairs
Max Delbrück
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