Hepatitis C Virus Infection and Mixed Cryoglobulinemia

Figure 4

Schematic representation of chronic inflammation and organization of secondary lymphoid follicles in HCV chronic infection. The ability of HCV to chronically persist in the host may represent a continuous stimulus for the immune system resulting in B-cell oligo/monoclonal expansions with selective advantage to clones depending on antigen stimulation. Some chemokines may play a crucial role in the establishment of an adequate microenvironment for activation and expansion of B-lymphocytes in response to signals provided by antigen-presenting cells. Among them, CXC motif chemokine ligand 13 (CXCL13) and its chemokine receptor 5 (CXCR5) are important for secondary lymphoid tissue development and distribution of lymphocytes within microenvironments. CXCL13 is released by endothelial and stromal cells mediated by lymphotoxin-β receptor (LTβR) signaling and contributes to lymphoid homing in the liver by the creation of a favourable microenvironment sustaining focal B-cell aggregation similar to lymphoid follicles.