Quilty effect has the features of lymphoid neogenesis and shares CXCL13-CXCR5 pathway with recurrent acute cardiac rejections.
Quilty effect (QE) is a frequent, yet enigmatic feature of cardiac allograft, since it is apparently devoid of clinical significance, though its association with acute (A) rejection (R) is strongly suspected. It was observed in 126/379 biopsies from 22 patients during the first posttransplant year. Most grade (G)2R biopsies displayed a concomitant QE. The following features typical of QE were identified: (a) focal angiogenesis and lymphangiogenesis associated with bFGF, VEGF-C and VEGF-A expression, (b) marked infiltrate of CD4(+)T and CD20(+)B followed by CD8(+)T lymphocytes arranged around PNAd(+)HEV-like vessels. Most QE appear as distinct B-T-cell-specific areas with lymphoid follicles sometimes endowed with germinal center-like structures containing VCAM-1(+)CD21(+)FDC and CD68(+)macrophages, which frequently expressed CXCL13. These cells were also found in mantle-like zones, where small lymphocytes expressed CXCR5, otherwise in the whole area of not clustered lymphoid aggregates. CXCL13 was also expressed, in association with CD20(+)B lymphocyte recruitment, in G2R biopsies obtained from patients with recurrent AR. QE has features of a tertiary lymphoid tissue suggesting an attempt, by the heart allograft, to mount a local response to a persistent alloantigen stimulation resulting in aberrant CXCL13 production, as also occurs in recurrent AR. CXCL13-CXCR5 emerge as a common molecular pathway for QE and recurrent episodes of AR.
Di Carlo
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E
Department of Oncology and Neurosciences, Anatomic Pathology Section, G. d'Annunzio University, Chieti, Italy. edicarlo@unich.it
D'Antuono
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T
Contento
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Di Nicola
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M
Ballone
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E
Sorrentino
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C
D000368:Aged; D042501:Angiogenic Proteins / Q000032:analysis; D001706:Biopsy; D002465:Cell Movement; D054382:Chemokine CXCL13; D019743:Chemokines, CXC / Q000378:metabolism*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D042583:Lymphangiogenesis; D008214:Lymphocytes; D008264:Macrophages; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009389:Neovascularization, Pathologic; D054380:Receptors, CXCR5; D019707:Receptors, Chemokine / Q000378:metabolism*; D012008:Recurrence
D042501:Angiogenic Proteins; C110663:CXCL13 protein, human; C095085:CXCR5 protein, human; D054382:Chemokine CXCL13; D019743:Chemokines, CXC; D054380:Receptors, CXCR5; D019707:Receptors, Chemokine