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Bronchiolitis After Lung Transplantation Lymphoid Tissue In The Role of Intrapulmonary De Novo Lymphoid Tissue in Obliterative Bronchiolitis after Lung Transplantation This information is current as Masaaki Sato, Shin Hirayama, David M. Hwang, Humberto of September 25, 2021. Lara-Guerra, Dirk Wagnetz, Thomas K. Waddell, Mingyao Liu and Shaf Keshavjee J Immunol 2009; 182:7307-7316; ; doi: 10.4049/jimmunol.0803606 http://www.jimmunol.org/content/182/11/7307 Downloaded from References This article cites 46 articles, 4 of which you can access for free at: http://www.jimmunol.org/content/182/11/7307.full#ref-list-1 http://www.jimmunol.org/ Why The JI? Submit online. • Rapid Reviews! 30 days* from submission to initial decision • No Triage! Every submission reviewed by practicing scientists • Fast Publication! 4 weeks from acceptance to publication by guest on September 25, 2021 *average Subscription Information about subscribing to The Journal of Immunology is online at: http://jimmunol.org/subscription Permissions Submit copyright permission requests at: http://www.aai.org/About/Publications/JI/copyright.html Email Alerts Receive free email-alerts when new articles cite this article. Sign up at: http://jimmunol.org/alerts The Journal of Immunology is published twice each month by The American Association of Immunologists, Inc., 1451 Rockville Pike, Suite 650, Rockville, MD 20852 Copyright © 2009 by The American Association of Immunologists, Inc. All rights reserved. Print ISSN: 0022-1767 Online ISSN: 1550-6606. The Journal of Immunology The Role of Intrapulmonary De Novo Lymphoid Tissue in Obliterative Bronchiolitis after Lung Transplantation1 Masaaki Sato,* Shin Hirayama,* David M. Hwang,*† Humberto Lara-Guerra,* Dirk Wagnetz,* Thomas K. Waddell,* Mingyao Liu,* and Shaf Keshavjee2* Chronic rejection after lung transplantation is manifested as obliterative bronchiolitis (OB). The development of de novo lymphoid tissue (lymphoid neogenesis) may contribute to local immune responses in small airways. Compared with normal lungs, the lung tissue of 13 lung transplant recipients who developed OB demonstrated a significantly larger number of small, airway-associated, peripheral node addressin-positive (PNAd؉) high endothelial venules (HEVs) unique to lymphoid tissue (p < 0.001). HEVs were most abundant in lesions of lymphocytic bronchiolitis and “active” OB infiltrated by lymphocytes compared with those of “in- active” OB. T cells in lymphocytic bronchiolitis and active OB were predominantly of the CD45RO؉CCR7؊ effector memory phenotype. Similar lymphoid tissue was also observed in the rat lung after intrapulmonary transplantation of allograft trachea Downloaded from (Brown Norway (BN) to Lewis), but not after isograft transplantation. Subsequent orthotopic transplantation of the recipient ؋ Lewis lung containing a BN trachea into an F1 (Lewis BN) rat demonstrated stable homing of Lewis-derived T cells in the lung and their Ag-specific effector function against the secondary intrapulmonary BN trachea. In conclusion, we found de novo lymphoid tissue in the lung composed of effector memory T cells and HEVs but lacking delineated T cell and B cell zones. This de novo lymphoid tissue may play a critical role in chronic local immune responses after lung transplantation. The Journal of Immunology, 2009, 182: 7307–7316. http://www.jimmunol.org/ e novo lymphoid tissue formation or lymphoid neogen- However, formation of TLO after lung transplantation has not esis has recently been recognized as a potentially im- been reported and is controversial. Chronic rejection after lung D portant mechanism that supports chronic inflammation transplantation is manifested by obliterative bronchiolitis (OB), a in peripheral tissue (1). The best characterized de novo lymphoid chronic inflammatory and fibroproliferative condition in small air- tissue is the tertiary lymphoid organ (TLO),3 a structure resem- ways, and its clinical correlate, bronchiolitis obliterans syndrome bling a lymph node that includes high endothelial venules (HEVs), (BOS) (10). In the lung, TLO is considered to be represented by an well-defined T cell and B cell zones, and a germinal center ac- inducible form of bronchus-associated lymphoid tissue (BALT), by guest on September 25, 2021 companying follicular dendritic cells (2). TLO has been reported in namely iBALT (1, 11). Formation of iBALT has been reported in various chronic inflammatory conditions such as autoimmune (3, various chronic inflammatory lung diseases such as emphysema 4) and chronic infectious diseases (5, 6). (12), pulmonary fibrosis (13), and chronic hypersensitive pneumo- Chronic rejection after organ transplantation is a condition in nitis (14). In contrast, Hasegawa et al. demonstrated a negative which alloantigen persists and chronic inflammation occurs. In- result regarding the relationship between OB/BOS and BALT, deed, development of TLO has been reported in various tissues and which should theoretically include iBALT (15). Although the organs after transplantation, including human cardiac and renal study using transbronchial biopsies was limited in its sensitivity to allografts (7) and animal models of cardiac (8), skin (9), and vas- detect OB lesions and (i)BALT, it is possible that de novo lym- cular (7) allografts. phoid tissue after lung transplantation does not form the conven- tional structure of TLO with HEVs, T and B cell zones, and ger- minal center formation. *Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute Interestingly, an evolving concept proposed by van Panhuys † and Department of Pathology, University Health Network, University of Toronto, et al. indicates the existence of “effector lymphoid tissue” (ELT) Toronto, Ontario, Canada that exerts effector function by collecting effector and effector Received for publication October 27, 2008. Accepted for publication March 31, 2009. memory T cells but does not necessarily take the conventional The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance anatomical form of TLO or iBALT (16). Increasing evidence sug- with 18 U.S.C. Section 1734 solely to indicate this fact. gests that the lung might be an important reservoir of effector and 1 This work was supported by the Canadian Cystic Fibrosis Foundation. M.S. is a effector memory T cells (17, 18). In a s.c. tracheal transplant model recipient of Wyeth/Canadian Institutes of Health Research Rx&D Industrial Partner of OB, preferential localization of effector memory CD4ϩ and Program Fellowship (2005–2007) and Canadian Cystic Fibrosis Foundation Postdoc- ϩ toral Fellowship (2007–2009). CD8 T cells to the lung parenchyma and airways has been dem- 2 Address correspondence and reprint requests to Dr. Shaf Keshavjee, Toronto Lung onstrated (19). Transplant Program, Toronto General Hospital, 200 Elizabeth Street 9N947, Toronto, Thus, we hypothesized that lymphoid neogenesis plays an im- Ontario, Canada M5G 2C4. E-mail address: [email protected] portant role in chronic rejection after lung transplantation. To ad- 3 Abbreviations used in this paper: TLO, tertiary lymphoid organ; BALT, bronchus- dress the hypothesis, we conducted careful histological and immu- associated lymphoid tissue; BN, Brown Norway; BOS, bronchiolitis obliterans; ELT, effector lymphoid tissue; HEV, high endothelial venule; iBALT, inducible BALT; nohistochemical analyses of the lungs that were explanted at the MAdCAM, mucosal addressin cell adhesion molecule; OB, obliterative bronchiolitis; time of retransplantation due to OB/BOS after the initial lung PNAd, peripheral node addressin. transplantation. Furthermore, we have devised an animal model Copyright © 2009 by The American Association of Immunologists, Inc. 0022-1767/09/$2.00 that combines a rat intrapulmonary tracheal transplant model of www.jimmunol.org/cgi/doi/10.4049/jimmunol.0803606 7308 LYMPHOID NEOGENESIS AFTER LUNG TRANSPLANTATION Table I. Demographics of lung transplant recipients who were diagnosed with OB/BOSa Age at Time from 1st Primary Examined Lung No. of Lymphocytic No. of Active OB No. of Inactive OB Sex 2nd Tx Tx (mo) Diagnosis Area (cm2) Bronchiolitis (area in cm2) (area in cm2) (area in cm2) Male 20 10.4 CF 4.30 3 (2.6) 2 (0.5) 2 (0.5) Female 36 10.7 CF 5.91 3 (2.0) 6 (1.0) 0 (0) Female 20 21.5 CF 1.15 0 (0) 1 (0.9) 0 (0) Male 36 34.2 BE 1.93 2 (0.4) 3 (1.6) 7 (3.6) Female 26 35.0 IPF 8.62 7 (4.0) 7 (0.8) 12 (1.4) Male 57 40.6 COPD 12.82 5 (5.8) 4 (0.3) 10 (0.8) Female 60 52.2 IPF 12.08 0 (0) 0 (0) 23 (1.9) Male 23 69.3 OB 3.85 6 (3.3) 2 (0.5) 0 (0) Female 40 82.2 IPF 3.76 4 (2.1) 2 (0.5) 4 (1.1) Female 53 88.2 OB 17.67 0 (0) 1 (0.1) 0 (0) Female 48 92.2 BE 3.90 6 (2.1) 5 (1.3) 0 (0) Female 35 132.1 OB 6.37 7 (2.2) 9 (1.4) 11 (1.7) Female 39b 18.6b BE 3.32 0 (0) 1 (1.2) 7 (2.1) Average Ϯ SEM 38.0 Ϯ 3.8 52.9 Ϯ 10.4 6.59 Ϯ 1.4 3.31 Ϯ 0.8 (1.89 Ϯ 0.5) 3.31 Ϯ 0.8 (0.77 Ϯ 0.1) 5.85 Ϯ 1.9 (1.00 Ϯ 0.3) a Tx, Transplantation; BE, bronchiectasis; CF, cystic fibrosis; COPD, chronic obstructive pulmonary disorder; IPF, idiopathic pulmonary fibrosis; OB, obliterative bronchi- olitis (idiopathic or secondary to hematopoietic stem cell transplantation). b This patient underwent open lung biopsy. The age at 2nd Tx indicates the age at the time of open lung biopsy. The other 12 patients underwent retransplantation for diagnosed OB/BOS after the initial lung transplantation. Downloaded from OB (20) and orthotopic lung transplantation to examine the effec- Histology and immunofluorescence labeling tor function of intrapulmonary de novo lymphoid tissue after Formalin-fixed, paraffin-embedded tissues cut into 5-␮m-thick sections transplantation. were used for standard H&E stain, elastic trichrome stain, and all human immunofluorescence labeling studies.
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