With an i p sensitization model, we found that mice immunized wh

With an i.p. sensitization model, we found that mice immunized when 1 week old responded differently to the immunization doses compared to the two groups immunized at older ages. This

led to the general observation that for the 0.1 μg OVA immunization dose, OVA-specific IgE, IgG1, cytokine and inflammatory CX-5461 purchase cell responses increased with age. In contrast, following immunization with 10 μg OVA, cytokine secretion and inflammatory cells responses in BALF decreased with age, while antibody production was comparable for all age groups. These observations could be explained by the fact that in 1-week-old mice, significant antibody, cytokine and inflammatory responses were only induced following immunization with the 10-μg dose. Further,

eosinophil numbers and cytokines levels were found at strikingly higher levels than in older mice, while IgE and IgG1 levels were similar this website to those in older mice. While the i.p. immunization doses differed, the airway OVA challenge dose was comparable for all groups. We observed that the antibody levels both before and after airway challenges were affected comparably by allergen dose, sex and age. The airway challenges, thus, only increased the antibody production. This suggests that the age at immunization and not the age at airway challenge determined the antibody response as observed previously also for airway hyperresponsiveness and eosinophil inflammation [21]. In adolescent and sexually mature mice, the low immunization dose stimulated stronger antibody, cytokine and eosinophil responses than the high i.p. immunization dose. Thus, a low sensitization dose may provide a better tool for modelling allergy in adult mice. These findings are in line with previous dose–response investigations showing that lower doses stimulate IgE and higher doses stimulate IgG responses [2, 22, 23]. Ohki et al. [24] observed that i.p. immunization with 10 μg compared with 1000 μg OVA resulted in higher allergen-specific IgE and inflammatory responses in both 3-day- and 8-week-old mice. Thus, one

should be aware that using a high immunization dose in adult (and possibly also young) mice may result in suboptimal IgE responses, and inflammatory cells and cytokine levels may even decrease when older mice are used. After the booster, all SPTLC1 mice in our study immunized with 1000 μg OVA suffered from severe anaphylactic shock and had to be terminated before any tissue samples could be collected (see Materials and method section). In the i.p. sensitization model, sex differences were only seen when using the ‘optimal’ 0.1-μg immunization dose; IgE production was higher in 6-week-old female mice than in male mice, and IL-5 and IL-13 secretion was generally higher in the female sex. Thus, sex differences on IgE were only found in sexually mature animals, which supports the apparent influence on allergy by sex hormones observed in previous studies [25, 26].

We report here that B lymphocytes from SLE-afflicted mice express

We report here that B lymphocytes from SLE-afflicted mice express relatively elevated levels of CD74, compared with B cells

from healthy mice. CD74 is a receptor found in complex with CD44, and it binds the pro-inflammatory cytokine MIF. The latter components were also up-regulated in B cells from the diseased mice, and treatment with hCDR1 resulted in their down-regulation and in reduced B-cell survival. Furthermore, up-regulation of CD74 and JAK inhibitor CD44 expression was detected in brain hippocampi and kidneys, two target organs in SLE. Treatment with hCDR1 diminished the expression of those molecules to the levels determined for young healthy mice. These results suggest that the CD74/MIF pathway plays an important role in lupus pathology. Systemic lupus

erythematosus (SLE) is an autoimmune disease characterized by impaired B-cell and T-cell functions and it is associated with serological and clinical manifestations that involve multiple organ systems.1 Because B and T cells play a pivotal role in SLE pathogenesis, successful treatment strategies for the disease should optimally target both cell types. For a specific treatment of SLE, a peptide designated hCDR1,2 which is based on the sequence of the complementarity-determining region (CDR) -1 of an autoantibody,3 was designed and shown to ameliorate lupus manifestations in both spontaneous and induced models of SLE.4,5 The mechanisms underlying the beneficial effects of hCDR1 are manifested through the induction of CD4+ CD25+6 see more and CD8+ CD28−7 regulatory T cells, immunomodulation of cytokines,4 Loperamide apoptosis8 and induction of regulatory molecules.9–11 Serologically, SLE is characterized by the presence of high titres of autoantibodies and abnormal B-cell activation and differentiation.12 The regulation of mature B-cell survival involves multiple mechanisms. The B-cell receptor provides survival

signals essential for maintaining the mature B-cell pool. In addition, the B-cell activating factor (BAFF) is required for successful survival and maturation of splenic B cells.13 We demonstrated that BAFF, which was found to be elevated in sera from patients with SLE and lupus-prone mice,14,15 was down-regulated following treatment with hCDR1 in SLE-afflicted mice.16 Recently, we described an additional mechanism that regulates B-cell survival, which depends on CD74 (the cell surface form of invariant chain, li).17–19 CD74 is a type II integral membrane protein containing a transmembrane region and a luminal domain that functions as a MHC class II chaperone.20 Part of the CD74 molecule, modified by the addition of chondroitin sulphate, is expressed on antigen-presenting cells, monocytes and B cells, and interacts with CD44.21,22 Macrophage migration inhibitory factor (MIF) binds to the CD74 extracellular domain on macrophages, consequently initiating a signalling pathway.

The high affinity integrin interaction with its ligands allows fo

The high affinity integrin interaction with its ligands allows for the arrest and adhesion of the leukocyte on the endothelial cell — a process that is necessary for the subsequent transmigration into www.selleckchem.com/products/pf-06463922.html the targeted tissue. Once leukocytes gain access to the appropriate tissue, they migrate to their particular targets along chemotactic or haptotactic gradients [16]. Finally, at their target site, the retention of leukocytes

in the tissue is tightly controlled and for T cells and DCs, this process is regulated by the lysophospholipid shingosine 1-phosphate (S1P) and by the chemokine receptor CCR7 and its ligands CCL19 and CCL21 [17-20]. On T cells, the differential expression of particular combinations of selectins, chemokine receptors, and integrins on leukocytes is highly regulated and results in a directed trafficking of cellular subsets to particular organs and tissue beds. Naïve T cells, for example, largely express the chemokine receptor CCR7 and the selectin CD62L, which directs them to circulate through the SLOs where they are more likely to have a productive interaction with antigen and antigen-presenting cells [13]. Once activated FK228 purchase by antigen, the activated

effector T cells upregulate the expression of chemokine receptors that correspond and can react to the chemokine ligands produced in inflamed tissues. For CD4+ T cells, the combination of chemokine receptors that are upregulated correlates with the cell-differentiation program upon activation. Thus, CXCR3 and CCR5 are preferentially upregulated on Th1 cells while Th2 cells preferentially express CRTH2, CCR4, and CCR8 [21]. The Th17 subset preferentially expresses CCR6 [22], and Anacetrapib T follicular

helper cells express CXCR5 [23, 24]. Memory T cells can be divided into CCR7+, CD62Lhi central memory T cells that circulate in the SLOs and CCR7−, CD62Llo effector memory T cells, which traffic to peripheral tissues [25]. Interestingly, among T effector memory cells there appears to be a difference in the expression of P and E selectins by CD4 and CD8 cells, resulting in further differences of localization and migration of these lymphocyte subsets within the memory population [26]. The site where antigen is encountered by the naïve cell also affects the expression of chemokine receptors and integrins, “imprinting” them to return to particular tissue beds. This process has been best characterized for the gut and skin but also may occur in the CNS and lung [27]. In the mesenteric lymph nodes and GALT, for example, DC-produced retinoic acid induces the expression of CCR9 and the integrin α4β7 on effector memory T cells. As the ligands for CCR9 and α4β7 (CCL25 and MAdCAM-1, respectively) are mainly expressed on endothelial cells in the venules of the small intestine, these effector memory T cells then specifically home to the gut [28, 29].

Multiple clinical parameters were obtained for the long-term stab

Multiple clinical parameters were obtained for the long-term stable patients within the GenHomme project, including donor and recipient demographic characteristics, clinical history of renal graft failure, transplantation

monitoring, full blood counts and medications biochemical screening. Non-transplanted patients with “non-immune” RFA (n=8) had a creatinemia 654±193 μmol/L and proteinuria >1 g 24 h−1. The causes of RFA were polycystic kidney (4/8 patients), renal dysplasia (2/8 patients), interstitial nephropathy (1/8 patients) and malformative uropathy (1/8 patients). Finally, healthy individuals (HEI, non-transplanted individuals, n=14) with normal renal function and no known infectious pathology for at least 6 months prior to the study were enrolled. BAY 80-6946 nmr PBMC from HLA-A2 CMV+ patients were stained with PE-labeled anti-human CD8 mAb, Alexa700-labeled anti-human BAY 73-4506 cell line CD3 mAb, Alexa 647-labeled anti-human CD4 mAb and pp65-HLA-A2 APC-labeled multimer. DAPI was used to exclude dead cells. pp65-HLA-A2 APC-labeled multimer was prepared by incubating for 1h APC-streptavidin with biotinylated pp65-HLA-A2 monomer. All mAb were purchased from BD Biosciences and biotinylated pp65-HLA-A2 monomer was produced by INSERM core facility (Nantes, France). DAPI−CD3+CD4−CD8+, DAPI−CD3+CD4−CD8+pp65-HLA-A2 multimer− and DAPI−CD3+CD4−CD8+pp65-HLA-A2 multimer+

were separated from PBMC using a high-speed cell sorter (FACSAria, BD Biosciences). Purity was greater than 98%. Blood, collected in EDTA tubes, was obtained Selleckchem Fluorouracil from a peripheral vein or arteriovenous fistula. PBMC were separated

on an MSL layer (Eurobio) and frozen in TRIzol® reagent (Invitrogen) for RNA extraction. Total RNA was reverse-transcribed using a classical MMLV cDNA synthesis (Invitrogen). Complementary DNA was amplified by PCR using pairs of primers specific of each Vβ gene 10, elongated and electrophorezed using a gel sequencer (ABI Prism 377 DNA sequencer – Applied Biosystems) 35. The CDR3 profiles obtained were transformed into mathematical distributions and normalized so that the total area was equal to one. In parallel, the level of Vβ family transcripts was measured by real-time quantitative PCR and normalized by a housekeeping gene (HPRT). The CDR3-LD was then combined with each normalized Vβ transcript amounts to obtain the TcL data as described previously 15, 36, 37. Several parameters or metrics can be used to describe, and summarize with one value, the shape of the Vβ CDR3-LD. Indeed, the distribution of 13 lengths of Vβ CDR3 reflects different immunological situations which can be analyzed 12. Kurtosis, a mathematical index, has been chosen to quantify the CDR3-LD diversity 17. The Kurtosis reflects the degree of “peakedness” of a distribution 38 and is perfectly suitable for describing CDR3-LD with expansions.

This means that minor details on the surface of objects are not s

This means that minor details on the surface of objects are not something that infants at 12 months may reliably

use to individuate objects. Nevertheless, if a feature is pointed to them, then it helps them keep track of the referent across multiple contexts and time periods. In conclusion, this study demonstrates that infants’ understanding of an object’s identity as they encounter it in multiple contexts affects their comprehension of references to that object when absent. When infants saw an object in two different locations providing them with identifying information, but not other kind of information, helped them respond to absent reference by locating the object. This finding highlights the relationship between early cognitive and language development: The way infants perceive and conceptualize objects and space affects their Olaparib concentration comprehension of speech about the absent. We thank all families who participated. We also thank Amy Needham and Daniel Levin

for helpful advice. We thank Maria Vázquez, Hannah Suchy, Michelle Doscas, and Bronwyn Backstrom for their help with data collection and coding. “
“It is well attested that 14-month-olds have difficulty learning similar sounding words (e.g., bih/dih), despite their excellent phonetic discrimination abilities. By contrast, Rost Apitolisib molecular weight and McMurray (2009) recently demonstrated that 14-month-olds’ minimal-pair learning can be improved by the presentation of words by multiple talkers. This study investigates which components of the variability found in multitalker input improved infants’ processing, assessing

both the phonologically contrastive aspects of the for speech stream and phonologically irrelevant indexical and suprasegmental aspects. In the first two experiments, speaker was held constant while cues to word-initial voicing were systematically manipulated. Infants failed in both cases. The third experiment introduced variability in speaker, but voicing cues were invariant within each category. Infants in this condition learned the words. We conclude that aspects of the speech signal that have been typically thought of as noise are in fact valuable information—signal—for the young word learner. Research in early language acquisition has been peppered with findings that very young infants have excellent abilities to discriminate speech categories (e.g., Eimas, Siqueland, Jusczyk, & Vigorito, 1971; Werker & Tees, 1984; for a review, see Werker & Curtin, 2005). However, Stager and Werker (1997) (for a review, see Werker & Fennell, 2006) reported that for somewhat older infants (14-month-olds), some of these abilities appear to be ineffective when applied to word learning.

Twelve patients were identified on the basis of p-ANCA reactivity

Twelve patients were identified on the basis of p-ANCA reactivity, detectable anti-MPO antibodies (>20 units of reactivity) and serum availability for fine specificity analysis. Of these patients, 58% were male and the average age of individuals within the cohort was 60·5 (±15·6 years of age). All patients were referred for serological evaluation of a clinical systemic vasculitis, with all but one having evidence of significant renal involvement. Healthy

control sera displayed no significant binding when tested by anti-MPO ELISA. Overlapping decapeptides representing the MPO protein were tested against the 12 patient samples and frequency matched control samples. The patients displayed significant reactivity to multiple sections of the protein, SRT1720 chemical structure including seven major significant epitopes (Fig. 1). Significant epitopes are defined as being those sequences for which at least 33% of patients exhibited an average reactivity ≥3 standard deviations (s.d.) above the normal mean. These major significant epitopes include epitope 1: GSASPMELLS (aa 91–100); epitope 2: WTPGVKRNGF (aa 213–222); epitope

3: SARIPCFLAG (aa 393–402); epitope 4: WDGERLYQEA (aa 437–446); epitope 5: YRSYNDSVDP (aa 479–488); epitope 6: RLDNRYQPMEPN (aa 511–522); and epitope 7: IFMSNSYPRD (aa 717–726) (Table 2). Epitopes 2 and 6 were bound by the highest percentage of patients, having been bound by 41·7% Selleckchem MLN2238 and 58·3% of tested patient sera, respectively. Epitopes 1, 3, 4, 5 and 7 were all bound by 33·3% of patients. While these epitopes were found to be most common among the patients, the overall response was highly variable (Table 1). An example of this in Fig. 1 Grape seed extract shows binding patterns from two patients (Fig. 1a,b) that exhibit a response against various MPO decapeptides, with the only similarity found at decapeptides 256–257 (epitope 6). Males displayed a more diverse repertoire of antibody specificities than females, on average targeting 3·7 specificities

compared with 1·2 in females. None of the defined epitope sequences displayed significant binding by control samples. The RLDNRYQPMEPN (aa 511–522) sequence representing epitope 6, which is the most common antigen target with the highest intensity of binding compared to the other defined epitopes, was used for confirmatory analysis of the solid-phase peptide results. The samples were screened using a peptide ELISA format with the peptide constructed on a polylysine (MAP) backbone. Of the 12 samples (excluding one with insufficient sera), six patients displayed significant levels of this antibody specificity (Table 1), providing 100% concordance with the solid phase epitope mapping.

In DC-based immunotherapy, it is occasionally difficult to obtain

In DC-based immunotherapy, it is occasionally difficult to obtain a sufficient number of quality-guaranteed DC for some patient groups, such as: (1) paediatric cancer patients, who are too

small to receive leukapheresis for DC preparation [20], (2) cancer patients with pancytopaenia owing to cachexia or basal disease-related factors such as liver cirrhosis or (3) patients with haematological malignancy, in whom peripheral blood may be contaminated with a large number of viable malignant cells. In such patients, allogeneic DC may be an alternative source. It has been suggested that the host alloresponse to the injected DC may actually facilitate the antitumour response CH5424802 datasheet and that their alloantigens may work as helper antigens [21]. However, this theory is controversial [22, 23]. Moreover, EMD 1214063 chemical structure some preclinical studies using murine s.c. tumour models have shown that s.c. immunization using fully allogeneic DC failed to induce antitumour effects [14, 24]; thus, the use of allogeneic DC in DC-based immunotherapy may be limited. When allogeneic DC are used for cancer immunotherapy, three important factors must be considered. First,

the major histocompatibility complex (MHC) incompatibility of the DC used may be the most important factor for priming the MHC-restricted TAA-specific CD8+ T cells [25, 26] because during T-cell development, the host T cells acquire MHC restriction because of positive selection [27] by somatic cells (cortical thymic epithelial cells (cTECs), which are the crucial APC for expressing the MHC), rather than

haematopoietic cells [27]. Second, the survival of injected allogeneic DC may be shortened by T-cell-mediated rejection, and this may have an effect on the resulting antitumour response because DC survival is an important factor in priming antigen-specific T-cell responses. Third, it is not known whether host-derived pAPC can function in an antitumour capacity in DC-based immunotherapy, especially via the i.t. injection route. Until www.selleck.co.jp/products/Adrucil(Fluorouracil).html now, no experimental model has been developed that assesses these factors individually, and it is unclear which of the factors, and to what degree, will affect the antitumour responses of allogeneic DC. It is also unclear which injection route is most preferable when using allogeneic DC. Here, we aimed at evaluating the availability of allogeneic DC for DC-based immunotherapy and to elucidate the mechanism for the antitumour effect, focusing on the three important factors related to allogeneic DC. We demonstrate that s.c. immunization using semi- or fully allogeneic DC pulsed with tumour lysate has a limited antitumour effect and does not induce a significant number of IFN-γ-producing tumour-specific CD8+ T cells. When semi-allogeneic DC were injected via an i.t. injection route, we observed the induction of an efficient antitumour response and a significant tumour-specific CD8+ T-cell response.

3A), and a dramatic reduction of blood flow (Fig  3B) Brain edem

3A), and a dramatic reduction of blood flow (Fig. 3B). Brain edema/swelling was documented in infected WT mice during acute ECM by measuring three distances (Fig. 3A), namely line 1 from the pituitary gland to Sylvius aqueduct, line 2 crossing the medial cerebellar nucleus and line 3 stemming from the cerebellar obex [30]. PbA-infected WT mice showed increased distance 1, indicative of brain stem swelling, and cerebellum compression documented by distance 2 reduction and distance 3 increase, as compared with noninfected mice (Fig. 3D–F), in agreement with the data from Penet et al. [30]. We document

buy AUY-922 here, for the first time, that IFN-γR1−/− mice present unaltered MRI/MRA signals upon PbA infection, with no change in cerebral vasculature nor significant alteration of the metric parameters, as compared with noninfected WT mice (Fig. 3B–F), in line with their ECM-resistant phenotype. IFNAR1−/− mice presented a intermediate phenotype, with hyper-intense signal corresponding to some swelling at the corpus callosum, modest alterations of cerebellar structure, and lower brain stem swelling that were not significantly different from PbA-infected WT mice, while the blood

flow reduction was more heterogeneous, affecting only limited areas of the brain in these mice (Fig. 3B–F). Therefore, IFN-γR1−/− mice present no MRI/MRA detectable brain alteration, confirming that type II IFN-γ signaling is critically involved in microvascular obstruction development and Midostaurin supplier ischemic brain damage consecutive to PbA infection, while the contribution of the type I IFN-α/β pathway is of lesser importance. In order

to validate the functional data obtained by MRI/MRA, we further investigated the brain microvascular lesions on day 7 after blood-stage PbA infection. Microscopically, the brain vascular blood flow perturbation in PbA-infected WT mice was associated to microvascular lesions, with perivascular hemorrhage and intravascular accumulation of mononuclear cells and erythrocytes (Fig. 4A). many These parameters were reduced in PbA-infected IFNAR1−/− mice and absent in IFN-γR1−/− mice (Fig. 4A). The brain microvascular obstruction severity and local hemorrhage was assessed semiquantitatively and a significant reduction of brain pathology was documented in IFNAR1−/− mice, with an absence of pathology in IFN-γR1−/− mice (Fig. 4B). Thus, brain microscopic examination was in agreement with MRI results. Similarly, the perivascular hemorrhage and mononuclear cells and erythrocytes sequestration seen in WT mice after PbA sporozoite-initiated infection were reduced in IFNAR1−/− mice and furthermore in IFN-γR1−/− mice (data not shown). In mice, as in human, severe malaria can be associated with respiratory distress characterized by inflammatory-mediated increased capillary permeability or endothelial damage [34-37].

Using TEM, the number of neutrophils and MCs were counted on two

Using TEM, the number of neutrophils and MCs were counted on two intestinal grids for each infected fish. The number of each type of granulocyte was determined in an area measuring 1800 μm2 in close proximity to the point of cestode attachment (i.e. the interface region) and in a second area measuring 1800 μm2 at a distance of approximately 200 μm from the site of cestode attachment. Prior to analysis, the Gaussian distributions (i.e. normality) Nivolumab purchase and the homogeneity of variances of the data were assessed; the data were subsequently square

root transformed to meet these assumptions. Using the software package Statistica 7, anovas (Statistica 7, Praha, Cech Republic) were performed to detect significant differences in the number of granulocytes determined from the uninfected and infected tench and in the abundance of neutrophils and MCs at the point of cestode attachment and then at a distance of 200 μm away. Bonferroni post hoc tests and a P < 0·01 level of

significance were used throughout. Fourteen (60·9%) of the 23 tench were parasitized with M. wageneri; identity of the cestodes was confirmed using morphology and standard taxonomic keys. The intensity of infection ranged from 3 to 130 worms per host (39·5 ± 47·7, mean ± SD). The anterior part of the intestine bore the heaviest infections with the vast majority of tapeworms still attached with their scolices embedded within the intestinal wall (Figure 1a). Upon dissection in situ, M. wageneri were noticed in groups of variable numbers and in some portion of the host intestine the presence of more than one foci was frequent (Figure 1a). In tench gut wall, at the site Cediranib (AZD2171) of M. wageneri attachment, selleck chemical a raised plaque-like formation or round nodule encircled the firmly attached scolex (Figure 1b). Histological sections revealed that specimen of M. wageneri had penetrated by means

of bluntly truncated scolex deep into the mucosa and submucosa (Figure 2a, b) and in some instances into the muscularis layer (Figure 2c). This parasite anchoring system provided a secure attachment to the tench intestine (Figures 1a, b and 2b). At the site of attachment, the tapeworms induced necrosis, degeneration and/or loss of the epithelium (Figure 2a). M. wageneri elicited intense immune cells and fibroblasts proliferation within the thickness of the tench gut wall (Figure 2b, c). Diffuse hyperplastic inflammation was noticed in tench with few M. wageneri as well as in those harbouring numerous tapeworms (Figure 2a–c). Within the submucosa layer, beneath the point of M. wageneri scolex insertion, numerous granulocytes (e.g. neutrophils, MCs) (Figure 2d), rodlet cells (Figure 2e) and collagenous fibres were observed. Degranulation of the granulocytes, which was visible by light microscopy (Figure 2d), was common in the submucosa. Parasitized intestines were determined to have a significantly higher number of granulocytes than those that were uninfected (Table 1; anova, P < 0·01).

The perinephric haematoma seen on ultrasound underscores the risk

The perinephric haematoma seen on ultrasound underscores the risk of anticoagulation in the early post-transplant period. Evidence for treatment of APS-related renal TMA is limited to case reports and retrospective series.[8, 72] In APS-related allograft TMA (Table 4) plasma exchange has been associated with a good response in two cases,[39,

73] and may have contributed to partial renal recovery in a further two cases.[34, 38] However, a patient in the HCV/aCL transplant series died of multiorgan infarction despite plasmapheresis.[42] In the current case, TMA resolved following prompt intervention with daily plasma exchange, Navitoclax clinical trial IVIg and high dose steroids, before eventual reinstitution of warfarin. In CAPS, it is postulated that plasma exchange removes pathogenic aPL antibodies and other prothrombotic

factors.[74, 75] Plasma is generally recommended as replacement fluid,[75] although the potential for procoagulant factors in plasma to learn more exacerbate CAPS has led some to suggest albumin as the replacement fluid.[72, 76] FFP was predominantly used in this case in order to minimize the risk of bleeding from concomitant anticoagulation. In a previous case report, perioperative unfractionated heparin and plasmapheresis was associated with supratherapeutic anticoagulation and retroperitoneal haemorrhage.[77] Evidence from animal models suggests a role for complement inhibition at the C5 level in the treatment of APS.[6] Eculizumab is a monoclonal antibody blocking C5 activation approved for use in aHUS (including in transplantation[31, 32, 78]). Eculizumab has been associated with successful prevention and treatment of AbMR[28, 29] and post-transplant APS-related TMA;[33, 34, 71, 79, 80] the latter includes cases where APS-related allograft TMA was unresponsive to anticoagulation and plasma exchange, but resolved after the addition of eculizumab.[33, 71] A phase 2 clinical

trial is investigating whether eculizumab administered in the course of renal transplantation is beneficial in recipients with a pre-transplant history of CAPS (NCT01029587). Cyclin-dependent kinase 3 Finally, successful use of rituximab has been reported in conjunction with other therapies in patients with APS and renal-limited TMA,[81, 82] CAPS with renal involvement[83-85] and previous CAPS undergoing renal transplantation.[34] Renal transplantation in patients with APS may be associated with macrovascular thrombosis or TMA. Consideration should be given to the range of available therapies to address both the large vessel occlusive and microangiopathic manifestations. Based on current evidence, this includes anticoagulation in conjunction with plasma exchange (with or without use of IVIg) and/or eculizumab. Results of ongoing studies are awaited with interest. Dr Barbour is a Kidney Research UK (KRUK) Clinical Research Fellow (TF12/2011). The authors wish to thank Dr Anna Richards for some very helpful suggestions.