Tertiary lymphoid structures: autoimmunity goes local

Detection of germinal center-like structures within tertiary lymphoid organs (TLS) in the salivary glands of patients with Sjogren’s syndrome (SS) is associated with increased risk of lymphoma. Moreover, histological analysis of salivary glands is currently used as a prognostic tool in clinical practice and the disaggregation of TLOs in post-treatment biopsies is considered a valid measure of positive outcome in ongoing clinical trials. Nonetheless, the biological role of TLS in inflammation remains unclear. How do these structures form and how do they differ from a physiological secondary lymphoid organ? Are those differences at the core of the autoimmune process in SS?
During her undergraduate course in Italy, Francesca developed a strong interest in research and, after obtaining her degree, decided to suspend her clinical training to undertake a PhD. She relocated to London to investigate the mechanisms that regulate the acquisition of lymphoid organ features in salivary gland inflammatory infiltrates of Sjogren’s Syndrome patients, with particular focus on the factors that regulate lymphocyte organization and survival within the gland.
She obtained her Specialization as a rheumatologist in 2007 followed by her PhD in 2008. At Kings College London, she embarked on a period of post-doctoral studies examining the physiological biology of mucosal B cells, whilst also working as an honorary rheumatology consultant at Guy’s Hospital.
In 2010 Francesca moved to Birmingham to study the mechanisms regulating leukocyte/stromal cell interaction in humans and animal models of inflammatory diseases. She obtained a Wellcome Trust Clinician Scientist fellowship in July 2010 to develop her research interest and start her own independent group.
Francesca currently works as a consultant rheumatologist in both the University Hospitals Birmingham (UHB) and also the Sandwell and West Birmingham Trusts, with a main clinical interest in inflammatory arthritis and Sjogren’s syndrome. Since 2014 she has been the Head of the eSSential – EULAR Sjogren’s Syndrome Experimental aNd Translational Investigative Alliance (EULAR) study group.
In 2016 Francesca obtained a Senior Research Fellowship from ARUK (now Versus Arthritis) to exploit the mechanisms enabling the persistence of tertiary lymphoid structures (TLS) in inflamed tissue and to investigate the pathogenicity of stromal cells in TLS-associated diseases.