Postoperative cellular stress in the kidney is associated with an early systemic [gamma][delta] T-cell immune cell response

Background Basic science data suggest that acute kidney injury (AKI) induced by ischemia-reperfusion injury (IRI) is an inflammatory process involving the adaptive immune response. Little is known about the T-cell contribution in the very early phase, so we investigated if tubular cellular stress expressed by elevated cell cycle biomarkers is associated with early changes in circulating T-cell subsets, applying a bedside-to-bench approach. Methods Our observational pilot study included 20 consecutive patients undergoing endovascular aortic repair for aortic aneurysms affecting the renal arteries, thereby requiring brief kidney hypoperfusion and reperfusion. Clinical-grade flow cytometry-based immune monitoring of peripheral immune cell populations was conducted perioperatively and linked to tubular cell stress biomarkers ([TIMP-2]*[IGFBP7]) immediately after surgery. To confirm clinical results and prove T-cell infiltration in the kidney, we simulated tubular cellular injury in an established mouse model of mild renal IRI. Results A significant correlation between tubular cell injury and a peripheral decline of [gamma][delta] T cells, but no other T-cell subpopulation, was discovered within the first 24 hours (r = 0.53; p = 0.022). Turning to a mouse model of kidney warm IRI, a similar decrease in circulating [gamma][delta] T cells was found and concomitantly was associated with a 6.65-fold increase in [gamma][delta] T cells (p = 0.002) in the kidney tissue without alterations in other T-cell subsets, consistent with our human data. In search of a mechanistic driver of IRI, we found that the damage-associated molecule high-mobility group box 1 protein HMGB1 was significantly elevated in the peripheral blood of clinical study subjects after tubular cell injury (p = 0.019). Correspondingly, HMGB1 RNA content was significantly elevated in the murine kidney. Conclusions Our investigation supports a hypothesis that [gamma][delta] T cells are important in the very early phase of human AKI and should be considered when designing clinical trials aimed at preventing kidney damage. Trial registration ClinicalTrials.gov, NCT01915446. Registered on 5 Aug 2013. Keywords: Tubular cell stress, Aortic surgery, Immunosurveillance, [gamma][delta] T cells, Ischemia-reperfusion injury