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J Autoimmun. 2018 Dec 7. pii: S0896-8411(18)30453-0. doi: 10.1016/j.jaut.2018.11.006. [Epub ahead of print]

Germinal center humoral autoimmunity independently mediates progression of allograft vasculopathy.

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University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ, UK.
Department of Pathology, Papworth Hospital, Papworth Everard, CB23 3RE, UK.
Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, CB22 3AT, UK.
Division of Surgery and Interventional Sciences, Faculty of Medical Sciences, University College London, London, NW3 2QG, UK; Centre for Transplantation, Department of Renal Medicine, University College London, London, NW3 2QG, UK; Institute of Immunity and Transplantation, University College London, London, NW3 2QG, UK.
University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ, UK. Electronic address:


The development of humoral autoimmunity following organ transplantation is increasingly recognised, but of uncertain significance. We examine whether autoimmunity contributes independently to allograft rejection. In a MHC class II-mismatched murine model of chronic humoral rejection, we report that effector antinuclear autoantibody responses were initiated upon graft-versus-host allorecognition of recipient B cells by donor CD4 T-cells transferred within heart allografts. Consequently, grafts were rejected more rapidly, and with markedly augmented autoantibody responses, upon transplantation of hearts from donors previously primed against recipient. Nevertheless, rejection was dependent upon recipient T follicular helper (TFH) cell differentiation and provision of cognate (peptide-specific) help for maintenance as long-lived GC reactions, which diversified to encompass responses against vimentin autoantigen. Heart grafts transplanted into stable donor/recipient mixed haematopoietic chimeras, or from parental strain donors into F1 recipients (neither of which can trigger host adaptive alloimmune responses), nevertheless provoked GC autoimmunity and were rejected chronically, with rejection similarly dependent upon host TFH cell differentiation. Thus, autoantibody responses contribute independently of host adaptive alloimmunity to graft rejection, but require host TFH cell differentiation to maintain long-lived GC responses. The demonstration that one population of helper CD4 T-cells initiates humoral autoimmunity, but that a second population of TFH cells is required for its maintenance as a GC reaction, has important implications for how autoimmune-related phenomena manifest.


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