title: Mechanistic differences between phenotypes of chronic lung allograft dysfunction after lung transplantation.
abstract: Distinct phenotypes of chronic lung allograft dysfunction (CLAD) after lung transplantation are emerging with lymphocytic bronchiolitis (LB)/azithromycin reversible allograft dysfunction (ARAD), classical or fibrotic bronchiolitis obliterans syndrome (BOS), and restrictive allograft syndrome (RAS) proposed as separate entities. We have additionally identified lung transplant recipients with prior LB, demonstrating persistent airway neutrophilia (PAN) despite azithromycin treatment. The aim of this study was to evaluate differences in the airway microenvironment in different phenotypes of CLAD. Bronchoalveolar lavage (BAL) from recipients identified as stable (control), LB/ARAD, PAN, BOS, and RAS were evaluated for differential cell counts and concentrations of IL-1α, IL-1β, IL-6, IL-8, and TNF-α. Primary human bronchial epithelial cells were exposed to BAL supernatants from different phenotypes and their viability measured. BOS and RAS showed increased BAL neutrophilia but no change in cytokine concentrations compared with prediagnosis. In both LB/ARAD and PAN, significant increases in IL-1α, IL-1β, and IL-8 were present. BAL IL-6 and TNF-α concentrations were increased in PAN and only this phenotype demonstrated decreased epithelial cell viability after exposure to BAL fluid. This study demonstrates clear differences in the airway microenvironment between different CLAD phenotypes. Systematic phenotyping of CLAD may help the development of more personalized approaches to treatment.
authors.affiliation: Fibrosis Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Monika I
authors.initials: MI
authors.lastname: Suwara
authors.forename: Bart M
authors.initials: BM
authors.lastname: Vanaudenaerde
authors.forename: Stijn E
authors.initials: SE
authors.lastname: Verleden
authors.forename: Robin
authors.initials: R
authors.lastname: Vos
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Green
authors.forename: Chris
authors.initials: C
authors.lastname: Ward
authors.forename: Lee A
authors.initials: LA
authors.lastname: Borthwick
authors.forename: Elly
authors.initials: E
authors.lastname: Vandermeulen
authors.forename: Jim
authors.initials: J
authors.lastname: Lordan
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.forename: Paul A
authors.initials: PA
authors.lastname: Corris
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Fisher
mesh_terms: D000328:Adult; D064591:Allografts; D001989:Bronchiolitis Obliterans / Q000209:etiology*; D002478:Cells, Cultured; D002908:Chronic Disease; D016207:Cytokines / Q000032:analysis; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010641:Phenotype
chemical_list: D016207:Cytokines
keywords: epithelial cell damage; inflammation; lung transplantation; neutrophil; phenotyping; rejection
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