title: Analysis of the IgVH genes in T cell-mediated and antibody-mediated rejection of the kidney graft.
abstract: OBJECTIVE
  Grafts have been shown to be sites where the alloimmune response develops in a direct interaction between the targeted tissue and the immune effectors. An important issue in renal rejection is B cell infiltrate that may contribute to the development or persistence of rejection. Analysis of gene-expression patterns also provides a window on the biology and pathogenesis of renal allograft rejection.
  
  
  METHODS
  To better understand the role exerted by B cells in a renal acute rejection, the authors analysed the IgVH gene repertoire in six cases of transplanted kidneys with acute T cell-mediated rejection (TCMR), three of which were associated with antibody-mediated rejection (ABMR).
  
  
  RESULTS
  The authors found mutated and unmutated sequences, without any evidence of clonal relationships, in all patients with TCMR alone and in two of the three cases with both acute TCMR and ABMR. The remaining patient showed glomerular inflammation and thrombosis, with diffuse C4d glomerular and peritubular capillary deposition, and hypermutated V region genes.
  
  
  CONCLUSIONS
  These results suggest that there is more than one pathway to the onset and perpetuation of CD20 (+) B cells infiltration in acute rejection; furthermore, the CD20 (+) B cells' clonal expansion may be responsible for a more severe pattern of ABMR, through immune-mediated tissue damage.
authors.affiliation: Section of Pathological Anatomy, Department of Human Pathology and Oncology, University of Siena, Siena, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Bellan
authors.forename: Teresa
authors.initials: T
authors.lastname: Amato
authors.forename: Mario
authors.initials: M
authors.lastname: Carmellini
authors.forename: Monica
authors.initials: M
authors.lastname: Onorati
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Amuri
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Leoncini
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: del Vecchio
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D018951:Antigens, CD20 / Q000032:analysis; D016175:B-Lymphocyte Subsets / Q000276:immunology*; D005260:Female; D015321:Gene Rearrangement; D050438:Genes, Immunoglobulin Heavy Chain / Q000276:immunology*; D020022:Genetic Predisposition to Disease; D006084:Graft Rejection / Q000235:genetics* / Q000276:immunology; D006801:Humans; D007135:Immunoglobulin Variable Region / Q000235:genetics; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D055815:Young Adult
chemical_list: D018951:Antigens, CD20; D007135:Immunoglobulin Variable Region