Posttransplant bronchiolitis obliterans syndrome is associated with bronchial epithelial to mesenchymal transition

Am J Transplant. 2009 Apr;9(4):727-33. doi: 10.1111/j.1600-6143.2009.02558.x.


Bronchiolitis obliterans syndrome (BOS) compromises lung transplant outcomes and is characterised by airway epithelial damage and fibrosis. The process whereby the normal epithelial configuration is replaced by fibroblastic scar tissue is poorly understood, but recent studies have implicated epithelial mesenchymal transition (EMT). The primary aim of this study was to assess the utility of flow cytometry in detecting and quantifying EMT in bronchial epithelial cells. Large airway brushings were obtained at 33 bronchoscopies in 16 BOS-free and 6 BOS grade 1-3 patients at 2-120 months posttransplant. Flow cytometry was used to assess expression of the mesenchymal markers alphaSMA, S100A4 and ED-A FN and HLA-DR. TGF beta 1 and HGF were measured in Bronchoalveolar lavage (BAL). Expression of all three mesenchymal markers was increased in BOS, as was HLA-DR. BAL HGF, but not TGF beta 1 was increased in BOS. Longitudinal investigation of one patient revealed a 100% increase in EMT markers concurrent with a 6-fold increase in BAL TGF beta 1 and the diagnosis of BOS at 17 months posttransplant. Flow cytometric evaluation of bronchial epithelium may provide a novel and rapid means to assess lung allografts at risk of BOS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antigens, CD / analysis
  • Bronchi / cytology
  • Bronchi / pathology
  • Bronchi / physiology
  • Bronchi / physiopathology
  • Bronchiolitis Obliterans / epidemiology*
  • Bronchoalveolar Lavage Fluid
  • Bronchoscopy
  • Epithelial Cells / cytology*
  • Epithelial Cells / immunology
  • Epithelial Cells / physiology
  • Female
  • Flow Cytometry
  • HLA-DR Antigens / genetics
  • Hepatocyte Growth Factor / analysis
  • Hepatocyte Growth Factor / genetics
  • Humans
  • Immunoglobulin G / analysis
  • Leukocyte Common Antigens / analysis
  • Lung Transplantation / adverse effects*
  • Lung Transplantation / statistics & numerical data
  • Male
  • Mesoderm / cytology*
  • Mesoderm / physiology
  • Middle Aged
  • Risk Assessment
  • Transforming Growth Factor beta1 / analysis
  • Transforming Growth Factor beta1 / genetics
  • Transplantation, Homologous / pathology
  • Transplantation, Homologous / physiology


  • Antigens, CD
  • HLA-DR Antigens
  • Immunoglobulin G
  • Transforming Growth Factor beta1
  • Hepatocyte Growth Factor
  • Leukocyte Common Antigens