title: Donor-Specific Antibodies Are Produced Locally in Ectopic Lymphoid Structures in Cardiac Allografts.
abstract: Cardiac allograft vasculopathy (CAV) is a transplant pathology, limiting graft survival after heart transplantation. CAV arteries are surrounded by ectopic lymphoid structures (ELS) containing B cells and plasma cells. The aim of this study was to characterize the antigenic targets of antibodies produced in ELS. Coronary arteries and surrounding epicardial tissue from 56 transplant recipients were collected during autopsy. Immunofluorescence was used to identify antibody-producing plasma cells. Immunoglobulin levels in tissue lysates were measured by enzyme-linked immunosorbent assay and analyzed for donor-specific HLA antibodies by Luminex assay. Cytokine and receptor expression levels were quantified using quantitative polymerase chain reaction. Plasma cells in ELS were polyclonal and produced IgG and/or IgM antibodies. In epicardial tissue, IgG (p < 0.05) and IgM levels were higher in transplant patients with larger ELS than smaller ELS. In 4 of 21 (19%) patients with ELS, donor-specific HLA type II antibodies were detected locally. Cytokine and receptor expression (CXCR3, interferon γ and TGF-β) was higher in large ELS in the epicardial tissue than in other vessel wall layers, suggesting active recruitment and proliferation of T and B lymphocytes. ELS exhibited active plasma cells producing locally manufactured antibodies that, in some cases, were directed against the donor HLA, potentially mediating rejection with major consequences for the graft.
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: M M H
authors.initials: MM
authors.lastname: Huibers
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: A J
authors.initials: AJ
authors.lastname: Gareau
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: J M T
authors.initials: JM
authors.lastname: Beerthuijzen
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Siera-de Koning
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Kuik
authors.affiliation: Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: E G
authors.initials: EG
authors.lastname: Kamburova
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Vink
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: de Jonge
authors.affiliation: Department of Pathology, Dalhousie University, Halifax, Canada.|Department of Surgery, Dalhousie University, Halifax, Canada.|Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada.
authors.forename: T D G
authors.initials: TD
authors.lastname: Lee
authors.affiliation: Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: H G
authors.initials: HG
authors.lastname: Otten
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: de Weger
mesh_terms: D064591:Allografts; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006085:Graft Survival / Q000276:immunology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology*; D008221:Lymphoid Tissue / Q000276:immunology*; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D014019:Tissue Donors
chemical_list: D007518:Isoantibodies
keywords: B cell biology; alloantibody; heart transplantation/cardiology; molecular biology; pathology/histopathology; rejection: antibody-mediated (ABMR); rejection: chronic; translational research/science; vasculopathy