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Kessler Iglesias C, Bloom JE, Xiao X, Moskovitch J, Eckford H, Offen S, Kotlyar E, Keogh A, Jabbour A, Bergin P, Leet A, Hare JL, Taylor AJ, Hayward CS, Jansz P, Kaye DM, Macdonald PS, Muthiah K. Early Use of Aspirin for Coronary Allograft Prophylaxis in Heart Transplant Recipients. Transplantation 2024:00007890-990000000-00814. [PMID: 39020464 DOI: 10.1097/tp.0000000000005131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
BACKGROUND Coronary allograft vasculopathy (CAV) remains a significant cause of morbidity and mortality after heart transplantation. The use of aspirin for CAV prophylaxis has recently garnered interest as a possible therapeutic adjunct in this setting. METHODS This 2-center retrospective cohort study included 372 patients who underwent heart transplantation between January 2009 and March 2018 and were stratified according to the commencement of aspirin during their index transplant admission. The primary outcome was the development of moderate or severe CAV (International Society for Heart and Lung Transplantation grade ≥2) at surveillance coronary angiography. Secondary endpoints included mortality at follow-up. RESULTS There were no differences in age, sex, and cause of heart failure. In the early aspirin group, the preponderant risk factors included use of ventricular assist devices, pretransplant smoking, and mild or moderate rejection. Multivariable analyses to assess for independent predictors of CAV development and mortality demonstrated that aspirin was associated with reduced mortality (adjusted hazard ratio = 0.19; 95% confidence interval, 0.08-0.47, P < 0.01) and a trend toward a protective effect against the development of moderate or severe CAV (adjusted hazard ratio = 0.24; 95% confidence interval, 0.54-1.19; P = 0.08). CONCLUSIONS In this retrospective risk-adjusted 2-center cohort study, early aspirin administration was associated with reduced risk of death and a trend toward a protective effect against CAV development. These findings warrant validation in prospective randomized trials.
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Affiliation(s)
- Cassia Kessler Iglesias
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Xiaoman Xiao
- Department of Cardiology, Alfred Health, Melbourne, VIC, Australia
| | | | - Hunter Eckford
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Sophie Offen
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Eugene Kotlyar
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Anne Keogh
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Andrew Jabbour
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Peter Bergin
- Department of Cardiology, Alfred Health, Melbourne, VIC, Australia
| | - Angeline Leet
- Department of Cardiology, Alfred Health, Melbourne, VIC, Australia
| | - James L Hare
- Department of Cardiology, Alfred Health, Melbourne, VIC, Australia
| | - Andrew J Taylor
- Department of Cardiology, Alfred Health, Melbourne, VIC, Australia
| | - Christopher S Hayward
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Paul Jansz
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Peter S Macdonald
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Kavitha Muthiah
- Heart Failure and Transplant Unit, Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Chang A, Martin KA, Colvin M, Bellumkonda L. Role of ascorbic acid in cardiac allograft vasculopathy. Clin Transplant 2023; 37:e15153. [PMID: 37792313 DOI: 10.1111/ctr.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/04/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF THE REVIEW Cardiac allograft vasculopathy (CAV) is a progressive fibroproliferative disease which occurs after heart transplantation and is associated with significant long-term morbidity and mortality. Currently available strategies including statins, mammalian target of rapamycin (mTOR) inhibitors, and revascularization, have limited overall effectiveness in treating this pathology once the disease process is established. mTOR inhibitors, while effective when used early in the disease process, are not well tolerated, and hence not routinely used in post-transplant care. RECENT DATA Recent work on rodent models have given us a novel mechanistic understanding of effects of ascorbic acid in preventing CAV. TET methyl cytosine dioxygenase2 (TET2) reduces vascular smooth muscle cell (VSMC) apoptosis and intimal thickening. TET2 is repressed by interferon γ (IFNγ) in the setting of CAV. Ascorbic acid has been shown to promote TET2 activity and attenuate allograft vasculopathy in animal models and CAV progression in a small clinical trial. SUMMARY CAV remains a challenging disease process and needs better preventative strategies. Ascorbic acid improves endothelial dysfunction, reduces reactive oxygen species, and prevents development of intimal hyperplasia by preventing smooth muscle cell apoptosis and hyperproliferation. Further large-scale randomized control studies of ascorbic acid are needed to establish the role in routine post-transplant management.
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Affiliation(s)
- Alyssa Chang
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathleen A Martin
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Monica Colvin
- Division of Cardiology, Department of Medicine, Yale University, New Haven, Connecticut, USA
| | - Lavanya Bellumkonda
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Xing K, Che Y, Wang Z, Yuan S, Wu Q, Shi F, Chen Y, Shen X, Zhong X, Xie X, Zhu Q, Li X. Chitosan nanoparticles encapsulated with BEZ235 prevent acute rejection in mouse heart transplantation. Int Immunopharmacol 2023; 124:110922. [PMID: 37699303 DOI: 10.1016/j.intimp.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023]
Abstract
Acute rejection may manifest following heart transplantation, despite the implementation of relatively well-established immunosuppression protocols. The significance of the mTOR signaling pathway in rejection is widely acknowledged. BEZ235, a second-generation mTOR inhibitor with dual inhibitory effects on PI3K and mTOR, holds promise for clinical applications. This study developed a nanodelivery system, BEZ235@NP, to facilitate the intracellular delivery of BEZ235, which enhances efficacy and reduces adverse effects by improving the poor solubility of BEZ235. In the complete MHCII-mismatched model, BEZ235@NP significantly prolonged cardiac allografts survival compared to free BEZ235, which was attributed to more effective suppression of effector T cell activation and promotion of greater expansion of Tregs. These nanoparticles demonstrated excellent biosafety and exhibited no short-term biotoxicity upon investigation. To elucidate the mechanism, primary T cells were isolated from the spleen and it was observed that BEZ235@NP treatment resulted in the arrest of these cells in the G0/G1 phase. As indicated by Western blot analysis, BEZ235@NP substantially reduced mTOR phosphorylation. This, in turn, suppressed downstream pathways and ultimately exerted an anti-proliferative and anti-activating effect on cells. Furthermore, it was observed that inhibition of the mTOR pathway stimulated T-cell autophagy. In conclusion, the strategy of intracellular delivery of BEZ235 presents promising applications for the treatment of acute rejection.
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Affiliation(s)
- Kai Xing
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Yanjia Che
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Zhiwei Wang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China.
| | - Shun Yuan
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Qi Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Feng Shi
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Yuanyang Chen
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Xiaoyan Shen
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Xiaohan Zhong
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Xiaoping Xie
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Qingyi Zhu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
| | - Xu Li
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China; Central Laboratory, Renmin Hospital of Wuhan University. District No. 99, Zhang Road, Wuhan 430060, Hubei, PR China
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