Th-17, monokines, collagen type V, and primary graft dysfunction in lung transplantation.
BACKGROUND
The pathogenesis of primary graft dysfunction (PGD), a serious complication of lung transplantation, is poorly understood. Human studies and rodent models have shown that collagen type V (col[V]), stimulates IL-17-dependent cellular immunity after lung transplantation.


OBJECTIVE
To determine whether patients with end-stage lung disease develop pretransplant col(V)-specific cellular immunity, and if so, the impact of this response on PGD.


METHODS
Trans-vivo delayed-type hypersensitivity (TV-DTH) assays were used to evaluate memory T-cell responses to col(V) in 55 patients awaiting lung transplantation. Pa(O(2))/Fi(O(2)) index data were used to assess PGD. Univariate risk factor analysis was performed to identify variables associated with PGD. Rats immunized with col(V) or irrelevant antigen underwent lung isografting to determine if prior anti-col(V) immunity triggers PGD in the absence of alloreactivity.


RESULTS
We found that 58.8% (10/17) of patients with idiopathic pulmonary fibrosis, and 15.8% (6/38) of patients without idiopathic pulmonary fibrosis tested while on the wait list for a lung transplant were col(V) DTH positive. Col(V) reactivity was CD4(+) T-cell and monocyte mediated, and dependent on IL-17, IL-1beta, and tumor necrosis factor (TNF)-alpha. Pa(O(2))/Fi(O(2)) indices were impaired significantly 6-72 hours after transplantation in col(V)-reactive versus nonreactive patients. Univariate risk factor analysis identified only preoperative TV-DTH to col(V) and ischemic time as predictors of PGD. Finally, in a rat lung isograft model, col(V) sensitization resulted in significantly lower Pa(O(2))/Fi(O(2)), increased local TNF-alpha and IL-1beta production, and a moderate-to-severe bronchiolitis/vasculitis when compared with control isografts.


CONCLUSIONS
The data suggest that activation of innate immunity by col(V)-specific Th-17 memory cells represents a novel pathway to PGD after lung transplantation.
Bobadilla
Joseph L
JL
Microbiology and Immunology, Director, Center for Immunobiology, Indiana University School of Medicine, Van Nuys Medical Sciences Building MS224, 635 Barnhill Drive, Indianapolis, IN 46202-5120, USA.
Love
Robert B
RB
Jankowska-Gan
Ewa
E
Xu
Qingyong
Q
Haynes
Lynn D
LD
Braun
Ruedi K
RK
Hayney
Mary S
MS
Munoz del Rio
Alejandro
A
Meyer
Keith
K
Greenspan
Daniel S
DS
Torrealba
Jose
J
Heidler
Kathleen M
KM
Cummings
Oscar W
OW
Iwata
Takekazu
T
Brand
David
D
Presson
Robert
R
Burlingham
William J
WJ
Wilkes
David S
DS
D000328:Adult; D000818:Animals; D024062:Collagen Type V / Q000276:immunology*; D051799:Delayed Graft Function / Q000276:immunology*; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000150:complications / Q000276:immunology*; D007111:Immunity, Cellular; D020381:Interleukin-17 / Q000378:metabolism; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D051381:Rats; D011921:Rats, Inbred WKY; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D006377:T-Lymphocytes, Helper-Inducer / Q000145:classification / Q000276:immunology
D024062:Collagen Type V; D020381:Interleukin-17