Acute lung transplant rejection is associated with localized increase in T-cell IFNgamma and TNFalpha proinflammatory cytokines in the airways

Background. Allograft rejection remains a major cause of morbidity and mortality after lung transplantation and is associated with increased gene expression for proinflammatory cytokines. T cells are a major cell type involved in graft rejection. There have been no previous studies of cytokine production by T cells from blood, bronchoalveolar lavage (BAL), and intraepithelial T cells from bronchial brushings (BB) during rejection episodes; we hypothesized that T-cell proinflammatory cytokines would be increased in the airways during rejection episodes despite standard immunosuppression regimens. Method. To investigate changes in cytokine profiles during rejection episodes, whole blood, BAL, and BB from stable lung transplant patients and those with acute rejection were stimulated in vitro and intracellular cytokine production by CD8- (CD4+) and CD8+ T-cell subsets determined using multiparameter flow cytometry. Results. Transforming growth factor (TGF)-β was significantly decreased in blood CD4+ and CD8+ T cells while interferon (IFN)-γ and tumor necrosis factor (TNF)-α were significantly increased in BAL CD4+ and CD8+ T cells in patients with evidence of rejection. There was no change in CD4:CD8, interleukin (IL)-2, or IL-4 between stable and rejecting groups. Conclusions. Acute lung transplant rejection is associated with decreased intracellular T-cell TGFβ in blood and increased intracellular IFNγ and TNFα in BAL CD4+ and CD8+ T cells. Drugs that effectively reduce airway T-cell IFNγ and TNFα proinflammatory cytokine production may improve current protocols for reducing acute graft rejection in lung transplant patients.Greg Hodge, Sandra Hodge, Daniel Chambers, Paul N. Reynolds, Mark Holme