Emphysema-associated autoreactive antibodies exacerbate post-lung transplant ischemia-reperfusion injury

Kunal J. Patel, Qi Cheng, Sarah Stephenson, D. Patterson Allen, Changhai Li, Jane Kilkenny, Ryan Finnegan, Valeria Montalvo-Calero, Scott Esckilsen, Chentha Vasu, Martin Goddard, Satish N. Nadig, Carl Atkinson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Chronic obstructive pulmonary disease-associated chronic inflammation has been shown to lead to an autoimmune phenotype characterized in part by the presence of lung autoreactive antibodies. We hypothesized that ischemia-reperfusion injury (IRI) liberates epitopes that would facilitate preexisting autoantibody binding, thereby exacerbating lung injury after transplant. We induced emphysema in C57BL/6 mice through 6 months of cigarette smoke (CS) exposure. Mice with CS exposure had significantly elevated serum autoantibodies compared with non-smoke-exposed agematched (NS) mice. To determine the impact of a full preexisting autoantibody repertoire on IRI, we transplanted BALB/c donor lungs into NS or CS recipients and analyzed grafts 48 hours after transplant. CS recipients had significantly increased lung injury and immune cell infiltration after transplant. Immunofluorescence staining revealed increased IgM, IgG, and C3d deposition in CS recipients. To exclude confounding alloreactivity and confirm the role of preexisting autoantibodies in IRI, syngeneic Rag12/2 (recombination-activating protein 1-knockout) transplants were performed in which recipients were reconstituted with pooled serum from CS or NS mice. Serum from CS-exposed mice significantly increased IRI compared with control mice, with trends in antibody and C3d deposition similar to those seen in allografts. These data demonstrate that pretransplant CS exposure is associated with increased IgM/IgG autoantibodies, which, upon transplant, bind to the donor lung, activate complement, and exacerbate post-transplant IRI.

Original languageEnglish (US)
Pages (from-to)678-686
Number of pages9
JournalAmerican journal of respiratory cell and molecular biology
Issue number6
StatePublished - Jun 2019
Externally publishedYes


  • Autoantibodies
  • Chronic obstructive pulmonary disease
  • Complement
  • Ischemia-reperfusion injury
  • Lung transplant

ASJC Scopus subject areas

  • Molecular Biology
  • Pulmonary and Respiratory Medicine
  • Clinical Biochemistry
  • Cell Biology


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