The Quilty lesion enigma

Focal apoptosis/necrosis and lymphocyte subsets in human cardiac allografts

Shanthi Gopal, Uma Narasimhan, John D. Day, Robert Gao, Edward K. Kasper, Chi Long Chen, Steve Cina, Abel L. Robertson, Ralph H. Hruban

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Quilty lesions, as first described by Billingham in 1981, or 'Quilty Effect' (QE) are distinct endomyocardial mononuclear cell infiltrates that have been observed in human heart transplant recipients, as well as in experimental models of heart transplantation. In the present investigations, the pattern and extent of apoptosis (programmed cell death) and myocyte necrosis, as well as specific lymphocyte subsets in Quilty lesions was assessed. Endomyocardial biopsies obtained from 13 patients at 10-3362 days post-transplant were examined. Apoptosis, as identified by DNA nick end- labeling, was found in myocytes at the periphery of Quilty lesions in 11 of 13 cases (85%), and 'early' stages of myocyte necrosis, as demonstrated by specific staining with α light chain myosin monoclonal antibodies (mAb), was observed at the same sites in 10 of 13 cases (77%) of both Quilty type A and type B lesions. Apoptosis was not identified in the lymphocyte infiltrates of any of the lesions examined. Lymphocyte subsets were characterized using mAb for T cell receptor (CD3), for helper/inducer T cells (CD4), for cytotoxic/supressor T cells (CD8) and for mature B cells (CD20). Immunostaining revealed separate clusters of T lymphocytes with less prevalent B cells within the Quilty lesions. CD4+ cells were found in larger numbers than CD8+ cells in all cases. Non-B, non-T large lymphocytes were occasionally present. Except for the extent of the cellular infiltrate, no major cytochemical lymphocyte distribution differences were found between Quilty type A and B lesions. Myocyte apoptosis and early necrosis at the periphery of Quilty lesions suggest that early myocyte injury occuring in B lesions may represent initial or 'abortive stages' of cardiac allograft rejection. Why these lesions do not progress to overt rejection indeed warrant further detailed studies.

Original languageEnglish
Pages (from-to)191-198
Number of pages8
JournalPathology International
Volume48
Issue number3
Publication statusPublished - 1998
Externally publishedYes

Fingerprint

Lymphocyte Subsets
Muscle Cells
Allografts
Necrosis
Apoptosis
Lymphocytes
B-Lymphocytes
Monoclonal Antibodies
T-Lymphocytes
Single-Stranded DNA Breaks
Myosin Light Chains
Heart Transplantation
Helper-Inducer T-Lymphocytes
T-Cell Antigen Receptor
Cell Death
Theoretical Models
Cell Count
Staining and Labeling
Transplants
Biopsy

Keywords

  • Allograft rejection
  • Cardiac transplant
  • Heart disease

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Gopal, S., Narasimhan, U., Day, J. D., Gao, R., Kasper, E. K., Chen, C. L., ... Hruban, R. H. (1998). The Quilty lesion enigma: Focal apoptosis/necrosis and lymphocyte subsets in human cardiac allografts. Pathology International, 48(3), 191-198.

The Quilty lesion enigma : Focal apoptosis/necrosis and lymphocyte subsets in human cardiac allografts. / Gopal, Shanthi; Narasimhan, Uma; Day, John D.; Gao, Robert; Kasper, Edward K.; Chen, Chi Long; Cina, Steve; Robertson, Abel L.; Hruban, Ralph H.

In: Pathology International, Vol. 48, No. 3, 1998, p. 191-198.

Research output: Contribution to journalArticle

Gopal, S, Narasimhan, U, Day, JD, Gao, R, Kasper, EK, Chen, CL, Cina, S, Robertson, AL & Hruban, RH 1998, 'The Quilty lesion enigma: Focal apoptosis/necrosis and lymphocyte subsets in human cardiac allografts', Pathology International, vol. 48, no. 3, pp. 191-198.
Gopal, Shanthi ; Narasimhan, Uma ; Day, John D. ; Gao, Robert ; Kasper, Edward K. ; Chen, Chi Long ; Cina, Steve ; Robertson, Abel L. ; Hruban, Ralph H. / The Quilty lesion enigma : Focal apoptosis/necrosis and lymphocyte subsets in human cardiac allografts. In: Pathology International. 1998 ; Vol. 48, No. 3. pp. 191-198.
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