title: Bronchopulmonary lymph nodes and large airway cell trafficking in patients with fatal asthma.
abstract: BACKGROUND
  Immune responses in asthmatic patients involve coordinated cellular responses in the airways and lymph nodes (LNs). However, no studies have described the composition of different cell populations in the bronchopulmonary LNs of asthmatic patients.
  
  
  OBJECTIVE
  We sought to investigate the expression of dendritic cells (DCs) and costimulatory molecules, B cells, T cells, TH2-related cytokines, eosinophils, and vascular cell adhesion molecule in the bronchopulmonary LNs and large airways of asthmatic patients.
  
  
  METHODS
  Using histochemistry, immunohistochemistry, and image analysis, we investigated the expression of Factor XIIIa(+), CD1a(+), CD83(+), and CD207(+) DCs; CD4(+) and CD8(+) T cells; CD20(+) B cells; CD23(+) (FcεRII) cells; IL-4; IL-5; eosinophils, and vascular cell adhesion molecule 1 in the large airways and bronchopulmonary LNs of 11 nonsmokers who died from an asthma exacerbation (fatal asthma [FA]) in comparison with 8 nonasthmatic control subjects. In selected cases of FA, we analyzed the coexpression of HLA-DR, CD40, and CD80 in lung and LN eosinophils.
  
  
  RESULTS
  The LNs of asthmatic patients exhibited increased density of eosinophils. No other cells were expressed differently in the LNs of patients with FA. The large airways of patients with FA had increased expression of eosinophils in all layers and increased expression of Factor XIIIa(+) cells, CD4(+) and CD8(+) T cells, CD20(+) B cells, and CD23(+) cells in the outer layer. There was colocalization of HLA-DR, CD40, and CD80 in the eosinophils at both sites.
  
  
  CONCLUSIONS
  FA is associated with the increased presence of eosinophils in the LNs and large airways, which express HLA-DR and costimulatory molecules. The expression of Factor XIIIa(+) monocyte-derived DCs, CD4(+) and CD8(+) T cells, CD20(+) B cells, and CD23(+) cells was increased in the large airways without a corresponding increase in the expression of these cells in the bronchopulmonary LNs. These findings support the concept that eosinophils might act as antigen-presenting cells in patients with FA.
authors.affiliation: Department of Pathology, São Paulo University Medical School, São Paulo, Brazil. Electronic address: erikafeltrini@yahoo.com.br.
authors.forename: Erika Feltrini
authors.initials: EF
authors.lastname: Cagnoni
authors.affiliation: Department of Pathology, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Diogenes Seraphim
authors.initials: DS
authors.lastname: Ferreira
authors.affiliation: Department of Pathology, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Ferraz da Silva
authors.affiliation: Department of Pathology, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Ana Laura
authors.initials: AL
authors.lastname: Nicoletti Carvalho Petry
authors.affiliation: Department of Pathology, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Angela Batista
authors.initials: AB
authors.lastname: Gomes dos Santos
authors.affiliation: Department of Pathology, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Rodrigues Medeiros
authors.affiliation: Department of Pathology, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Marisa
authors.initials: M
authors.lastname: Dolhnikoff
authors.affiliation: LungenClinic Grosshansdorf, Grosshansdorf, Germany.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Rabe
authors.affiliation: Department of Pathology, São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Thais
authors.initials: T
authors.lastname: Mauad
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D016022:Case-Control Studies; D002423:Cause of Death; D002465:Cell Movement / Q000276:immunology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000276:immunology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012137:Respiratory System / Q000276:immunology* / Q000473:pathology*
keywords: Asthma; antigen presenting cell; bronchopulmonary lymph nodes; dendritic cells; eosinophils