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Mononuclear cells in acute allograft glomerulopathy
T V Tuazon1, E E Schneeberger, A K Bhan
1Department of Pathology, Massachusetts General Hospital, Boston 02114.
The American Journal of Pathology
|October 1, 1987
Summary
Acute allograft glomerulopathy (AAG) involves significant T lymphocyte infiltration, particularly CD8+ cells, within renal allografts. This distinct lesion, sometimes linked to Cytomegalovirus infection, targets glomerular endothelium.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Acute allograft glomerulopathy (AAG) is a specific glomerular injury in kidney transplants.
- AAG is characterized by hypercellularity and endothelial damage within the glomeruli.
Purpose of the Study:
- To elucidate the pathogenesis of AAG by analyzing infiltrating cells.
- To compare the cellular composition of AAG lesions with cellular rejection without AAG (non-AAG).
Main Methods:
- Light and electron microscopy with immunoperoxidase techniques and monoclonal antibodies.
- Analysis of T lymphocyte subsets (CD3+, CD4+, CD8+), HNK-1 antigen, monocyte fibronectin receptor (A6F10), interleukin-2 receptor (IL2R), and HLA antigens (Class I and II).
- Comparison of interstitial and arterial intimal infiltrates between AAG and non-AAG cases.
Main Results:
- AAG showed significantly higher intraglomerular T lymphocytes (CD3+) compared to non-AAG, predominantly CD8+ cells.
- Intraglomerular cells in AAG expressed IL2R and HLA-DR; glomeruli stained intensely for HLA Class I.
- Cytomegalovirus (CMV) infection was present in all studied AAG patients, versus 3/9 non-AAG patients.
Conclusions:
- AAG is proposed as a distinct form of T-cell-mediated allograft rejection, primarily involving CD8+ T cells targeting glomerular endothelium.
- CD8+ T cell infiltration and potential CMV association are key features of AAG.
- Specific cellular infiltrates correlate with graft survival, highlighting prognostic markers.