Th-17, monokines, collagen type V, and primary graft dysfunction in lung transplantation

Joseph L. Bobadilla, Robert B. Love, Ewa Jankowska-Gan, Qingyong Xu, Lynn D. Haynes, Ruedi K. Braun, Mary S. Hayney, Alejandro Munoz Del Rio, Keith Meyer, Daniel S. Greenspan, Jose Torrealba, Kathleen M. Heidler, Oscar W. Cummings, Takekazu Iwata, David Brand, Robert Presson, William J. Burlingham, David S. Wilkes

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


Rationale: 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. Objectives: 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. PaO2/FIO2 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. Measurements and Main 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-1β, and tumor necrosis factor (TNF)-α. PaO2/FIO2 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 PaO2/FIO2, increased local TNF-α and IL-1β production, and amoderate-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.

Original languageEnglish (US)
Pages (from-to)660-668
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Issue number6
StatePublished - Mar 15 2008


  • Autoimmunity
  • Collagen type V
  • Lung transplantation
  • Memory T cell
  • Primary graft dysfunction

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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