Shotgun proteomics identifies proteins specific for acute renal transplant rejection

Purpose: Acute rejection (AR) remains the primary risk factor for renal transplant outcome; development of non‐invasive diagnostic biomarkers for AR is an unmet need. Experimental design: We used shotgun proteomics applying LC‐MS/MS and ELISA to analyze a set of 92 urine samples, from patients with AR, stable grafts (STA), proteinuria (NS), and healthy controls. Results: A total of 1446 urinary proteins (UP) were identified along with a number of non‐specific proteinuria‐specific, renal transplantation specific and AR‐specific proteins. Relative abundance of identified UP was measured by protein‐level spectral counts adopting a weighted fold‐change statistic, assigning increased weight for more frequently observed proteins. We have identified alterations in a number of specific UP in AR, primarily relating to MHC antigens, the complement cascade and extra‐cellular matrix proteins. A subset of proteins (uromodulin, SERPINF1 and CD44), have been further cross‐validated by ELISA in an independent set of urine samples, for significant differences in the abundance of these UP in AR. Conclusions and clinical relevance: This label‐free, semi‐quantitative approach for sampling the urinary proteome in normal and disease states provides a robust and sensitive method for detection of UP for serial, non‐invasive clinical monitoring for graft rejection after kidney transplantation.