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Katsimpoulas M, Morticelli L, Gontika I, Kouvaka A, Mallis P, Dipresa D, Böer U, Soudah B, Haverich A, Michalopoulos E, Korossis S. Biocompatibility and Immunogenicity of Decellularized Allogeneic Aorta in the Orthotopic Rat Model. Tissue Eng Part A 2019; 25:399-415. [PMID: 30582419 DOI: 10.1089/ten.tea.2018.0037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The generation of a small-caliber arterial graft, utilizing a large vessel of a small animal, such as the aorta of the rat or rabbit, for clinical use in the peripheral arterial tree, can widen the options for arterial prostheses. This in vivo study demonstrated the ability of the decellularization protocol that was used to produce a noncytotoxic acellular small-caliber arterial graft, with sufficient biomechanical and biological integrity to withstand the demanding flow and pressure environment of the rat aorta. This work also demonstrated the superiority of the decellularized homograft over its intact counterpart, in terms of lower immunogenicity.
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Affiliation(s)
- Michalis Katsimpoulas
- 1 Centre of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- 2 Attikon Animal Hospital, Paiania, Greece
| | - Lucrezia Morticelli
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ioanna Gontika
- 4 Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Artemis Kouvaka
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Panagiotis Mallis
- 4 Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Daniele Dipresa
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ulrike Böer
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bisharah Soudah
- 5 Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- 6 Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Sotirios Korossis
- 3 Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- 6 Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- 7 Cardiopulmonary Regenerative (CARE) Group, Centre for Biological Engineering, Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
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2
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Rey K, Manku S, Enns W, Van Rossum T, Bushell K, Morin RD, Brinkman FSL, Choy JC. Disruption of the Gut Microbiota With Antibiotics Exacerbates Acute Vascular Rejection. Transplantation 2019. [PMID: 29538261 DOI: 10.1097/tp.0000000000002169] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The gut microbiota influences many immunological processes but how its disruption affects transplant rejection is poorly understood. METHODS Interposition grafting of aortic segments was used to examine vascular rejection. The gut microbiota was disrupted in graft recipients using an antibiotic cocktail (ampicillin, vancomycin, metronidazole, neomycin sulfate) in their drinking water. RESULTS Treatment of mice with antibiotics severely reduced total bacterial content in the intestine and disrupted the bacterial composition. Short-term treatment of mice for only the first 3 weeks of life resulted in the population of the intestine in mature mice with bacterial communities that were mildly different from untreated mice, containing slightly more Clostridia and less Bacteroides. Antibiotic disruption of the gut microbiota of graft recipients, either for their entire life or only during the first 3 weeks of life, resulted in increased medial injury of allograft arteries that is reflective of acute vascular rejection but did not affect intimal thickening reflective of transplant arteriosclerosis. Exacerbated vascular rejection resulting from disruption of the gut microbiota was related to increased infiltration of allograft arteries by neutrophils. CONCLUSIONS Disruption of the gut microbiota early in life results in exacerbation of immune responses that cause acute vascular rejection.
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Affiliation(s)
- Kevin Rey
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sukhbir Manku
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Winnie Enns
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Thea Van Rossum
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kevin Bushell
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ryan D Morin
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Fiona S L Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jonathan C Choy
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
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3
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Kaminski H, Fishman JA. The Cell Biology of Cytomegalovirus: Implications for Transplantation. Am J Transplant 2016; 16:2254-69. [PMID: 26991039 DOI: 10.1111/ajt.13791] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/17/2016] [Accepted: 03/07/2016] [Indexed: 01/25/2023]
Abstract
Interpretation of clinical data regarding the impact of cytomegalovirus (CMV) infection on allograft function is complicated by the diversity of viral strains and substantial variability of cellular receptors and viral gene expression in different tissues. Variation also exists in nonspecific (monocytes and dendritic cells) and specific (NK cells, antibodies) responses that augment T cell antiviral activities. Innate immune signaling pathways and expanded pools of memory NK cells and γδ T cells also serve to amplify host responses to infection. The clinical impact of specific memory T cell anti-CMV responses that cross-react with graft antigens and alloantigens is uncertain but appears to contribute to graft injury and to the abrogation of allograft tolerance. These responses are modified by diverse immunosuppressive regimens and by underlying host immune deficits. The impact of CMV infection on the transplant recipient reflects cellular changes and corresponding host responses, the convergence of which has been termed the "indirect effects" of CMV infection. Future studies will clarify interactions between CMV infection and allograft injury and will guide interventions that may enhance clinical outcomes in transplantation.
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Affiliation(s)
- H Kaminski
- Kidney Transplant Unit, CHU Bordeaux Pellegrin, Place Raba Léon, Bordeaux, France
| | - J A Fishman
- Transplant Infectious Disease and Immunocompromised Host Program and MGH Transplant Center, Massachusetts General Hospital, Boston, MA
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4
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Abstract
The cytotoxic granzyme B (GrB)/perforin pathway has been traditionally viewed as a primary mechanism that is used by cytotoxic lymphocytes to eliminate allogeneic, virally infected and/or transformed cells. Although originally proposed to have intracellular and extracellular functions, upon the discovery that perforin, in combination with GrB, could induce apoptosis, other potential functions for this protease were, for the most part, disregarded. As there are 5 granzymes in humans and 11 granzymes in mice, many studies used perforin knockout mice as an initial screen to evaluate the role of granzymes in disease. However, in recent years, emerging clinical and biochemical evidence has shown that the latter approach may have overlooked a critical perforin-independent, pathogenic role for these proteases in disease. This review focuses on GrB, the most characterized of the granzyme family, in disease. Long known to be a pro-apoptotic protease expressed by cytotoxic lymphocytes and natural killer cells, it is now accepted that GrB can be expressed in other cell types of immune and nonimmune origin. To the latter, an emerging immune-independent role for GrB has been forwarded due to recent discoveries that GrB may be expressed in nonimmune cells such as smooth muscle cells, keratinocytes, and chondrocytes in certain disease states. Given that GrB retains its activity in the blood, can cleave extracellular matrix, and its levels are often elevated in chronic inflammatory diseases, this protease may be an important contributor to certain pathologies. The implications of sustained elevations of intracellular and extracellular GrB in chronic vascular, dermatological, and neurological diseases, among others, are developing. This review examines, for the first time, the multiple roles of GrB in disease pathogenesis.
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5
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Chamberlain CM, Granville DJ. The role of Granzyme B in atheromatous diseases. Can J Physiol Pharmacol 2007; 85:89-95. [PMID: 17487248 DOI: 10.1139/y06-090] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The mechanism and role of apoptotic cell death in the pathogenesis of atheromatous diseases is an area of intense research. Atherosclerosis is an inflammatory disease and as such, immune-mediated cell killing plays an important role. Recent studies have suggested that Granzyme B and perforin play an important role in atherogenesis. The current manuscript reviews our current understanding pertaining to the role of Granzyme B in cardiac allograft vasculopathy and atherosclerosis.
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Affiliation(s)
- Ciara M Chamberlain
- James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
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6
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Matia I, Lodererova A, Adamec M. Delayed administration of FK 506 is sufficient to suppress acute rejection changes after aortal transplantation in rats. Transpl Int 2007; 20:371-80. [PMID: 17326778 DOI: 10.1111/j.1432-2277.2006.00446.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Arterial allografts are used now-a-days as a modality in the treatment of vascular prosthesis infections. Prolonged administration of immunosuppressive drugs seemed to be essential for long-time patency rates of alloarterial vascular reconstructions. Nevertheless, the use of immunosuppressives if there exist an acute infection is controversial. The experimental work described herein studied effects of a delayed low-dose FK 506 administration on the development of acute rejection changes 30 days after aortal transplantation in rats. The response of the recipient's immune system to aortal wall antigens of the donor in the field of no immunosuppression resulted in an intimal proliferation and its infiltration by immunocompetent cells of the recipient, necrosis of medial smooth muscle cells, including deposition of immunoglobulins, and a massive adventitial infiltration of CD4 and CD8 positive cells. On the other hand, all the principal histological signs of rejection listed above were suppressed by FK 506 administration, no matter whether the immunosuppressive was administered on day 0 or day 7 after the transplantation.
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Affiliation(s)
- Ivan Matia
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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7
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Andriambeloson E, Cannet C, Pally C, Klanke B, Bruns C, Zerwes HG, Bigaud M. Transplantation-induced functional/morphological changes in rat aorta allografts differ from those in arteries of rat kidney allografts. Am J Transplant 2004; 4:188-95. [PMID: 14974939 DOI: 10.1046/j.1600-6143.2003.00319.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The functional/morphological changes observed in rat aorta allografts were compared with those seen in the arteries of rat kidney allografts. Untreated allografts (F344-to-LEW) were collected at various times post-transplantation (Tx). Vascular smooth muscle cell (SMC) constriction to phenylephrine (Phe) and endothelial cell (EC)-dependent relaxation to acetylcholine (Ach) were assessed. Neointima formation in graft vessels was assessed by histology. In aorta allografts, the effects of Phe and Ach were irreversibly abolished within 3-2 weeks post-Tx. Neointima formation was consistently detected between 4 and 8 weeks post-Tx. In kidney allografts, sign of vasculopathy was seen in 10, 30 and 40% of resistance arteries at 8, 16 and 33 weeks post-Tx, respectively. In the main renal artery, substantial neointima formation was not apparent before 33 weeks post-Tx, the vasoconstrictor effect of Phe was fully maintained until then, and Ach-induced vasorelaxation was irreversibly reduced by approximately 70% from week 2 post-Tx onwards. These results indicate that the post-Tx functional/morphological changes seen in aorta allografts do not reflect those seen in arteries of kidney allografts. Hence, renal arteries from rat kidney allografts can be considered as a more relevant model to study the cascade of events leading to Tx-induced CGA in solid organ allografts.
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Affiliation(s)
- Emile Andriambeloson
- Novartis Pharma AG, Transplantation Research Global Business Unit, Basel, Switzerland
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8
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Hillebrands JL, Onuta G, Klatter F, Rozing J. Circulating smooth muscle cell plasticity in the development of transplant arteriosclerosis. Transplant Rev (Orlando) 2003. [DOI: 10.1016/j.trre.2003.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Karck M, Meliss R, Hestermann M, Mengel M, Pethig K, Levitzki A, Banai S, Golomb G, Fishbein I, Chorny M, Haverich A. Inhibition of aortic allograft vasculopathy by local delivery of platelet-derived growth factor receptor tyrosine-kinase blocker AG-1295. Transplantation 2002; 74:1335-41. [PMID: 12451275 DOI: 10.1097/00007890-200211150-00023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Signal transduction through the platelet-derived growth factor (PDGF)/PDGF-receptor (PDGFR) system has been linked to vascular smooth muscle cell migration and proliferation leading to allograft vasculopathy. This study describes the effect of the tyrphostin AG-1295, a specific PDGFR tyrosine-kinase inhibitor, on neointimal formation in this disease. METHODS AND RESULTS Rat aortic allografts transplanted from dark agouti (RT1 ) donors to Wistar-Furth (RT1 ) recipients were assessed in a new treatment model for local drug delivery from polymeric carrier matrices precoated with AG-1295. Matrices were wrapped around the graft immediately after transplantation. The recipients received no background immunosuppression. At day 80 posttransplantation, intimal thickness in AG-1295-treated grafts was reduced when compared to controls (11.8+/-9.1% intimal thickness vs. 23.7+/-6.4% intimal thickness; P=0.042). This finding corresponded to inhibition of intimal PDGFR-beta expression in AG-1295-treated grafts at day 20 posttransplantation (P =0.029 vs. allogeneic controls). CONCLUSIONS The tyrphostin AG-1295 reduces neointimal formation in aortic allograft vasculopathy by inhibition of PDGFR-beta-triggered tyrosine phosphorylation. Local drug release of specific tyrosine-kinase inhibitors from perivascularly co-implanted polymeric carrier matrices is effective in the prophylaxis of allograft vasculopathy under selected experimental conditions.
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Affiliation(s)
- Matthias Karck
- Department of Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany.
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10
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Satta J, Mennander A, Soini Y. Increased medial TUNEL-positive staining associated with apoptotic bodies is linked to smooth muscle cell diminution during evolution of abdominal aortic aneurysms. Ann Vasc Surg 2002; 16:462-6. [PMID: 12132024 DOI: 10.1007/s10016-001-0071-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Apoptosis has recently been identified as an important process in large vessel structural integrity. We examined whether the size of the abdominal aortic aneurysm might be associated with programmed cell death. We performed in situ labeling of the 3' ends of DNA fragments by apoptosis-associated endonucleases in 20 aneurysms, 10 controls with aortoiliac occlusive disease, and 4 controls with healthy aortas. Antibodies against a-smooth muscle actin were used to quantify smooth muscle cell alterations in the medial layer. Inflammatory cell characterization was made by using four monoclonal mouse antibodies (UCHL1, L26, PG-M1, and KP1). The results confirm the assumption that an apoptotic process may be of consequence for the loss of medial smooth muscle cells in the early evolution of an abdominal aortic aneurysm process.
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Affiliation(s)
- J Satta
- Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland.
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11
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Gomes D, Louedec L, Plissonnier D, Dauge MC, Henin D, Osborne-Pellegrin M, Michel JB. Endoluminal smooth muscle cell seeding limits intimal hyperplasia. J Vasc Surg 2001; 34:707-15. [PMID: 11668328 DOI: 10.1067/mva.2001.116802] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Intimal hyperplasia is one of the main responses of the vascular wall to injury. In the current study, we tested the hypothesis that endoluminal seeding of host syngeneic vascular cells could limit intimal hyperplasia induced by either mechanical deendothelialization or chronic allograft rejection in rat aorta. METHODS An experimental model of in situ seeding of syngeneic endothelial cells, smooth muscle cells (SMCs), and fibroblasts (FIBs) was used in mechanically deendothelialized and allografted aortas. In a preliminary study, the ability of the three cell types (n = 5 per group) to seed on the deendothelialized luminal surface of the aortic wall was evaluated after 2 days, with the use of fluorescent PKH as marker. In the first model, the abdominal aorta of Lewis rats was deendothelialized (n = 6) or deendothelialized and seeded with either SMCs (n = 6) or FIBs (n = 6) before flow was restored. In the allograft model, aortas were harvested from dark agouti rats and orthotopically grafted in Lewis receivers, directly (n = 6) or after deendothelialization. Deendothelialization was performed alone (n = 6) or associated with the seeding of similar host (Lewis) syngeneic SMCs (n = 6) or FIBs (n = 6). Results were evaluated at 2 months with histologic and morphometric methods. RESULTS SMCs and FIBs were able to adhere in situ to the deendothelialized aortic wall, whereas endothelial cells were not. In mechanically deendothelialized aortas, the seeding of syngeneic SMCs led to a significant reduction in intimal thickness compared with deendothelialized aortas or FIB-seeded aortas (26.9 +/- 1.7 microm vs 55.5 +/- 1.7 and 56.7 +/- 1.7 microm, respectively), and a lower nuclear content (382.2 +/- 35.7 microm(2) vs 779.6 +/- 65.9 and 529.6 +/- 24.3 microm(2), respectively) of neointima. After SMC seeding, intimal hyperplasia was richer in elastin, whereas after FIB seeding it was richer in collagen. In allografts, the seeding of syngeneic SMC led to a significant reduction in intimal thickness compared with control aortas, deendothelialized aortas, or FIB-seeded aortas (31.6 +/- 1.1 microm vs 88.55 +/- 2.8, 74.6 +/- 2.9, and 85.7 +/- 2.6 microm, respectively), and a reduced nuclear content of the neointima (444.9 +/- 23.4 microm(2) vs 1529.1 +/- 116, 972.3 +/- 50, and 645.2 +/- 32.4 microm(2), respectively). Differences observed in the extracellular matrix composition were equivalent to those observed in the mechanically deendothelialized model. CONCLUSIONS Our results suggest that endoluminal seeding of syngeneic SMCs can be effective in reducing intimal hyperplasia both in a deendothelialization model and in arterial allografts. SMC and FIB endoluminal seeding led to a significatively different accumulation of extracellular matrix in the intima.
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Affiliation(s)
- D Gomes
- U460 Inserm, CHU Xavier Bichat, Paris, France
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12
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Chen W, Thoburn CJ, Miura Y, Sommer M, Hruban R, Qian Z, Baldwin W, Hess AD. Autoimmune-mediated vasculopathy. Clin Immunol 2001; 100:57-70. [PMID: 11414746 DOI: 10.1006/clim.2001.5038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The use of the immunosuppressive drug cyclosporine A (CsA) in solid organ transplantation can be associated with the development of vasculopathy as part of the complex immune response involved in chronic rejection, including autoimmune recognition. Although CsA can directly affect endothelial cells, this drug alters the T cell repertoire promoting autoimmune recognition. The present studies evaluated the ability of CsA-induced autoreactive T cells to mediate vascular lesions in syngeneic heart grafts. Graft vasculopathy developed in syngeneic heart grafts following either the primary induction of autoimmunity with CsA or the adoptive transfer of CsA-induced autoreactive T cells. Initially, an inflammatory response occurred in the medial wall of the small arterial vessels, accompanied by a perivascular lymphocytic infiltrate (including a lymphocytic infiltrate into the myocardium), followed by progression of vascular disease with endothelial cell proliferation. The development and progression of vascular disease correlated with the cytokine profile of the infiltrating lymphocytes with type 1 cytokines detected early and type 2 cytokines detected as the disease progressed. Initiation of this response correlated with upregulation of the target antigen recognized by the CsA-induced autoreactive T cells, the MHC class II-invariant chain peptide complex. This antigen complex, when upregulated on endothelial cells by interferon, allowed effective targeting by the autoreactive T lymphocytes. Strategies to inhibit the upregulation of MHC class II antigens by treatment of the recipients with chloroquine truncated the disease process. The results of these studies suggest that CsA-induced autoreactive mechanisms can contribute to the development of graft vasculopathy.
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Affiliation(s)
- W Chen
- Department of Oncology, The Johns Hopkins University, Baltimore, Maryland 21231, USA
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13
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Osterholm C, Qi Z, Ekberg J, Veress B, Pyke C, Hedner U, Ekberg H. Initial inhibition of tissue factor signalling reduces chronic vascular changes in isogenic rat aortic transplants. Am J Transplant 2001; 1:29-37. [PMID: 12095034 DOI: 10.1034/j.1600-6143.2001.010107.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Vascular changes are considered the major histopathological indicator of chronic allograft dysfunction. These changes are characterized by intimal thickening caused by accumulation of primarily smooth muscle cells. Contributing factors may be of both immunological and nonimmunological origin. Cold ischemia has been shown to trigger intimal proliferation in the absence of alloantigen in an isogenic rat aortic transplant model. We have used this model to investigate the impact of inhibition of tissue factor (TF) signalling on the progression of intimal thickening. Group 1 was treated with recombinant FVIIa inhibited in its active site (rFVIIai), and group 2 served as untreated controls. At 8 weeks the intimal area was measured with image analysis. Medial areas and the proportion of medial necrosis were determined. Animals treated with rFVIIai showed significantly less intimal thickening compared with controls: median 0.147 vs. 0.256 mm2, respectively (p = 0.008). A positive correlation between intimal hyperplasia and medial necrosis (r(s) = 0.79, p = 0.01), as well as adventitial inflammation (r(s) = 0.83, p = 0.009), was found. TF mRNA was not detected in the neointima at 8 weeks, as determined by in situ hybridization. We conclude that active site inhibited FVIIa (rFVIIai) given prior to and directly after implantation of aortic transplants significantly reduces intimal hyperplasia caused by nonimmunological factors in this model.
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Affiliation(s)
- C Osterholm
- Department of Nephrology and Transplantation, Lund University, University Hospital, Malmö, Sweden
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14
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Légaré JF, Issekutz T, Lee TD, Hirsch G. CD8+ T lymphocytes mediate destruction of the vascular media in a model of chronic rejection. THE AMERICAN JOURNAL OF PATHOLOGY 2000; 157:859-65. [PMID: 10980125 PMCID: PMC1885687 DOI: 10.1016/s0002-9440(10)64599-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2000] [Indexed: 11/18/2022]
Abstract
Allograft arteriosclerosis is an important characteristic of chronic graft rejection. In allograft arteriosclerosis there is a striking loss of medial smooth muscle cells (SMCs) before the development of a concentric intimal proliferative response. In this study we evaluated the role of CD8+ T lymphocytes in this medial SMC loss. Brown Norway aortic segments were transplanted into Lewis animals for 60 days (long allo-exposure) or 20 days (short allo-exposure). After 20 days allogeneic exposure aortic segments were transplanted back into syngeneic (Brown Norway) animals for 40 days. Experimental animals were treated with mAb to CD8. Apoptosis was measured by terminal dUTP nick-end labeling at 20 days and morphometry analyzed at 60 days to evaluate medial and intimal changes. Anti-CD8 treatment significantly lowered CD8+ T cell counts in peripheral blood, reduced medial SMC apoptosis at 20 days, and increased medial SMC counts at 60 days. Both short- and long-allogeneic exposure groups confirmed these findings and demonstrated that medial SMC loss is proportional to the length of allogeneic exposure. Antibody depletion of CD8+ T cells results in reduced medial SMC apoptosis and better medial SMC preservation. This supports the hypothesis that medial SMC loss occurs by apoptotic death and is driven by CD8+ T lymphocytes.
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MESH Headings
- Animals
- Antibodies, Blocking/pharmacology
- Antibodies, Monoclonal/pharmacology
- Aorta, Abdominal/pathology
- Aorta, Abdominal/transplantation
- Apoptosis
- CD8 Antigens/immunology
- CD8-Positive T-Lymphocytes/physiology
- Chronic Disease
- Disease Models, Animal
- Flow Cytometry
- Graft Rejection/pathology
- Immunoenzyme Techniques
- In Situ Nick-End Labeling
- Lymphocyte Count
- Male
- Muscle, Smooth, Vascular/pathology
- Rats
- Rats, Inbred BN
- Rats, Inbred Lew
- Transplantation, Homologous
- Tunica Media/pathology
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Affiliation(s)
- J F Légaré
- Department of Surgery, Victoria General Hospital, Halifax, Nova Scotia, Canada
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15
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Yin M, Rusyn I, Schoonhoven R, Graves LM, Rusyn EV, Li X, Li F, Cox AD, Harding TW, Bunzendahl H, Swenberg JA, Thurman RG. Inhibition of chronic rejection of aortic allografts by dietary glycine. Transplantation 2000; 69:773-80. [PMID: 10755525 DOI: 10.1097/00007890-200003150-00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic rejection is influenced by a variety of risk factors, including histoincompatibility and ischemia. Glycine, a cytoprotective agent, has been shown to protect against ischemia-reperfusion injury in the liver, inactivate hepatic resident macrophages, minimize cyclosporin A-induced nephrotoxicity, and exhibit immunosuppressive properties in vitro. The aim of this study was to investigate whether dietary glycine could reduce development of chronic rejection. METHODS Lewis recipients of Fisher-344 abdominal aortic allografts received diets that contained either 5% glycine plus 15% casein or 20% casein as control for 10 weeks. Vascular lesions of aortic isografts and allografts were evaluated quantitatively with image analysis and cell counting. RESULTS No significant vascular changes were observed in isografts (mean medial areas of 3.3 +/- 0.3x0(5) microm2). However, dramatic intimal thickening (neointimal area 2.1+/-0.3) and medial thinning (1.5+/-0.3) were observed in allografts from rats fed control diet. In contrast, glycine significantly reduced the neointima by 45% (1.2+/-0.3) and protected the media (3.5+/-0.2). This led to intima to media area ratios almost twice as large in the control group as in glycine-fed rats (2.2+/-0.4 vs. 1.1+/-0.3, P<0.05). Moreover, infiltrating leukocytes, especially macrophages, were reduced significantly in the adventitia by glycine. In addition, glycine inhibited proliferation and migration of rat aortic smooth muscle cells in culture by 45 and 60%, respectively. CONCLUSION These results indicate that dietary glycine minimizes histopathological changes of chronic rejection by reducing the immune response and, in part, by minimizing proliferation and migration of smooth muscle cells.
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MESH Headings
- Animals
- Aorta/surgery
- Aorta, Abdominal/drug effects
- Aorta, Abdominal/pathology
- Aorta, Abdominal/transplantation
- Cell Count/drug effects
- Cell Division/drug effects
- Cell Movement/drug effects
- Cells, Cultured
- Chronic Disease
- Diet
- Female
- Glycine/administration & dosage
- Glycine/blood
- Glycine/therapeutic use
- Graft Rejection/prevention & control
- Leukocytes/pathology
- Male
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Proliferating Cell Nuclear Antigen/metabolism
- Rats
- Rats, Inbred F344
- Rats, Inbred Lew
- Transplantation, Homologous
- Transplantation, Isogeneic
- Tunica Intima/metabolism
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Affiliation(s)
- M Yin
- Department of Pharmacology, University of North Carolina, Chapel Hill 27599-7365, USA
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16
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Bigaud M, Schraa EO, Andriambeloson E, Lobstein V, Pally C, Kobel T, Bruns C, Zerwes HG. Complete loss of functional smooth muscle cells precedes vascular remodeling in rat aorta allografts. Transplantation 1999; 68:1701-7. [PMID: 10609946 DOI: 10.1097/00007890-199912150-00013] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The functional consequences of vascular remodeling in rat aorta allografts were studied at different times after transplantation (Tx). METHODS At days 1, 3, 7, 14, 28, and 56 after Tx, rat aorta allografts (Dark Agouti [DA]-to-Lewis) were mounted as isolated organs, and their contractile properties tested with phenylephrine, KCl, or endothelin-1. Controls were native DA-aortae and DA-syngeneic grafts. Changes in alpha smooth muscle actin and morphology were assessed by immunoblotting and histology. RESULTS PostTx syngeneic grafts presented similar functional and morphological properties to native aortae. In allografts, no morphological changes was detected at day 7 after Tx, but phenylephrine-induced vasoconstriction was reduced by 60%. Signs of medial smooth muscle cell (SMC) loss and adventitial inflammation were observed at day 14 after Tx, without neointima formation. A complete loss of contractile property was observed at day 28 after Tx in association with a 75% decrease in alpha-SMC actin, severe adventitial inflammation, and reduced medial cellularity. At this time, neointima was restricted to both edges of allografts. At day 56 after Tx, allografts were also not functional and exhibited neointima on their entire length. All these changes were prevented by treating recipients with cyclosporine (7.5 mg/kg/day). CONCLUSION These results indicate that, after Tx, the contractile property of rat aorta allografts is altered before manifest vascular remodeling. Because this can be prevented by cyclosporine, it most likely reflects an acute rejection of SMC. These results also show that vascular graft dysfunction can be used to monitor the development of rejection in the rat aorta allograft model.
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MESH Headings
- Actins/metabolism
- Animals
- Aorta, Abdominal/drug effects
- Aorta, Abdominal/physiology
- Aorta, Abdominal/physiopathology
- Aorta, Abdominal/transplantation
- Endothelin-1/pharmacology
- Immunosuppression Therapy
- In Vitro Techniques
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Phenylephrine/pharmacology
- Postoperative Period
- Potassium/pharmacology
- Rats
- Rats, Inbred Lew
- Rats, Inbred Strains
- Transplantation, Isogeneic
- Vasoconstrictor Agents/pharmacology
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Affiliation(s)
- M Bigaud
- Novartis Pharma AG, Transplantation Research, Basel, Switzerland.
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17
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McDonald PC, Wong D, Granville DJ, McManus BM. Emerging roles of endothelial cells and smooth muscle cells in transplant vascular disease. Transplant Rev (Orlando) 1999. [DOI: 10.1016/s0955-470x(99)80070-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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18
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Higuchi ML, Benvenuti LA, Demarchi LM, Libby P. Histological evidence of concomitant intramyocardial and epicardial vasculitis in necropsied heart allografts: a possible relationship with graft coronary arteriosclerosis. Transplantation 1999; 67:1569-76. [PMID: 10401764 DOI: 10.1097/00007890-199906270-00011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The significance of medial lymphocytic vasculitis in intramural coronary vessels in heart transplantation is very poorly understood. This study was designed to identify histological evidence of an association between the presence of epicardial coronary lesions and the occurrence of intramyocardial vasculitis and/or myocardial ischemia. METHODS We analyzed the frequency of medial vasculitis and other myocardial histological alterations in a retrospective study of 24 human cardiac allografts from patients who died of ischemic heart disease and/or myocardial rejection. RESULTS Medial lymphocytic vasculitis in the myocardium was associated with vasculitis in the vasa vasorum of the epicardial coronary arteries and the presence of microfoci of acute myocardial infarction but was independent of the occurrence of myocardial fiber rejection. Chronic graft epicardial arteriopathy revealed two patterns of lesions. One pattern was similar to that of usual atherosclerosis, compromising mainly the proximal segments of the coronary artery, and was not associated with intramural vasculitis. The other pattern demonstrated diffuse involvement of the epicardial artery associated with vasculitis of its vasa vasorum and lymphocytic vasculitis of the intramural vessels. This second type of epicardial coronary lesion seemed to evolve to fibrotic arteries with thinned walls, frequently demonstrating aneurysmal dilatation with severe fibrosis of the adventitia and poor vasa vasorum. CONCLUSION Medial vasculitis affecting intramyocardial vessels is associated with adventitial epicardial coronary vasculitis in the transplanted heart. The process of vasculitis may be involved in the development of chronic graft arteriosclerosis and is associated with ischemic myocardial lesions, but seems independent of myocardial fiber rejection.
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Affiliation(s)
- M L Higuchi
- InCor (Heart Institute), São Paulo University Medical School, Brazil
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19
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Marois Y, Wagner E, Pâris E, Roy R, Douville Y, Guidoin R. Comparison of healing in fresh and preserved arterial allografts in the dog. Ann Vasc Surg 1999; 13:130-40. [PMID: 10072451 DOI: 10.1007/s100169900231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The use of aortic allografts for the management of vascular prosthetic infections has recently been reintroduced. Impressive results have been obtained; however, the possibility of late degeneration remains a major concern. The healing behavior of aortic allografts, either fresh or preserved, in antibiotic-supplemented nutrient medium at 4 degrees C for 1 week and used as thoracic aorta substitutes in dogs was investigated after 6 months of implantation. Four dogs received a fresh aortic allograft from four different donors, and four dogs received a preserved allograft from two different donors. Autografts in two dogs were performed as controls. The in vivo investigation was conducted to describe (1) the histological characteristics of the arterial wall, (2) the macroscopic and thrombogenic aspect of the luminal surface, (3) the integrity of the endothelial lining by scanning electron microscopy, and (4) its biochemical function by prostacyclin (PGI2) and thromboxane A2 (TXA2) secretion. Immune-mediated reactions directed toward the grafts were measured by sequential screening of donor-specific serum antibody development. All donor-recipient pairs of dogs were major histocompatibility complex (MHC)-incompatible according to a mixed lymphocyte reaction (MLR) assay. From the results of this study we concluded that although preserved arterial allografts exhibited similar surface characteristics as those of fresh allografts in terms of re-endothelialization and long-term graft function, an elicited immune response, a degenerative process in the media, and a hyperplasic reaction in the intima could not be prevented using this method of preservation.
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Affiliation(s)
- Y Marois
- Department of Surgery, Laval University, Quebec City, Quebec, Canada
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20
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Mirelli M, Nanni-Costa A, Scolari MP, Iannelli S, Buscaroli A, Ridolfi L, Petrini F, Stella A, DeSanctis L, Borgnino LC, Stefoni S, D'Addato M, Bonomini V. Mismatch-specific anti-HLA antibody production following aorta transplants. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb01177.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Subbotin V, Sun H, Aitouche A, Valdivia LA, Fung JJ, Starzl TE, Rao AS. Abrogation of chronic rejection in a murine model of aortic allotransplantation by prior induction of donor-specific tolerance. Transplantation 1997; 64:690-5. [PMID: 9311704 PMCID: PMC2957293 DOI: 10.1097/00007890-199709150-00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aortic allotransplantation in mice has been well established as a model of choice to study the evolvement of chronic rejection, the etiopathology of which is believed to be that of immune origin. This has prompted the postulation that prior induction of donor-specific tolerance would attenuate or abrogate the underlying events that culminate in posttransplant arteriosclerosis. To study the effects of donor-specific tolerance on chronic rejection, we performed orthotopic liver transplantation without immunosuppression in mice 30 days before aortic allotransplantation across C57Bl/ 10J (H2b)-->C3H (H2k) strain combinations (group III). Aortic allografting in syngeneic (group I; C3H-->C3H) and allogeneic (group II, C57Bl/10J-->C3H) animals served as controls. No morphological changes were evidenced in the transplanted aortas in group I animals. Contrarily, aortic allografts in group II animals underwent a self-limiting acute cellular rejection, which resolved completely and was succeeded by day 30 after transplantation by histopathological changes pathognomonic of chronic rejection. There was evidence for diffuse myointimal thickening, progressive concentric luminal narrowing, and patchy destruction of internal elastic membranes resulting in massive vascular obliteration by day 120 after transplantation. It was of interest that no arteriosclerotic changes were observed for the duration of follow-up (up to 120 days after transplantation) in transplanted aortas (liver donor-type) harvested from animals in group III. However, vasculopathy was prominent in third-party aortic grafts transplanted into tolerant recipients. Taken together, these data suggest that prior induction of tolerance abrogates the development of chronic rejection; this protection seems to be donor specific.
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Affiliation(s)
- V Subbotin
- Thomas E. Starzl Transplantation Institute and the Department of Surgery, University of Pittsburgh Medical Center, Pennsylvania 15261, USA
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22
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Wehr S, Rudin M, Joergensen J, Hof A, Hof RP. Allo- and autotransplantation of carotid artery--a new model of chronic graft vessel disease: evaluation by magnetic resonance imaging and histology. Transplantation 1997; 64:20-7. [PMID: 9233695 DOI: 10.1097/00007890-199707150-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Graft vessel disease is a special form of accelerated arteriosclerosis. Because immunological and nonimmunological factors can contribute to graft vessel disease, we developed a model that enables the study of both factors simultaneously. METHODS A carotid artery was allografted from DA to Lewis rats, with the excised native artery autografted on the contralateral side. Five groups of six to seven rats were treated for 8 weeks with vehicle (placebo) or cyclosporine (CsA) (0.3, 1, 3, and 10 mg x kg(-1) x day(-1)), which was administered using subcutaneous osmotic minipumps. The carotid lumen area was estimated in vivo at 2, 4, and 8 weeks by magnetic resonance imaging (MRI); CsA blood levels were determined twice. Carotid neointimal thickening and medial and luminal area were measured with histological techniques. RESULTS MRI showed bulging of the allografts but not autografts. Bulging disappeared over time with narrowing of the allograft lumina estimated by both MRI and histology. Histologically, vehicle-treated animals developed a massive neointima, which was inhibited in a dose-dependent manner by CsA. Autografts remained normal except for minimal subintimal thickening of two of four arteries in the group given the highest dose of CsA. Cellular rejection was detected in the allografts of all but the highest-dose group. The CsA blood levels were similar to those used in man at the two lower doses and about 10-fold higher at the highest dose. CONCLUSIONS Subintimal thickening did not correlate with in vivo lumen size, a phenomenon that we have previously described for balloon catheter-induced lesions. CsA blood concentrations similar to those used in patients suppressed neointima formation in part, and 10-fold higher concentrations almost completely suppressed neointima formation.
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Affiliation(s)
- S Wehr
- Transplantation Department, Sandoz Pharma Ltd., Basel, Switzerland
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23
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Mennander A, Häyry P. Reversibility of allograft arteriosclerosis after retransplantation to donor strain. Transplantation 1996; 62:526-9. [PMID: 8781620 DOI: 10.1097/00007890-199608270-00016] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The rat aortic transplant model was modified to investigate whether the vascular wall changes on chronic rejection are reversible. DA (RT1a) aortas were first transplanted to WF (RT1a) recipients. The first transplantation was accompanied, as described earlier, by an increase in intimal cellularity and thickness and typical arteriosclerotic changes of chronic rejection in the allograft intima. A second transplantation was made to DA, WF or to (DAxWF)F1 recipients 10 days-2 months after the first transplantation. In all retransplantations performed at any one of the indicated timepoints, the thickness and number of nuclei of the intima continued to increase. These observations demonstrate that, after an initial trigger, allograft arteriosclerosis proceeds and is irreversible despite elimination of histoincompatibility.
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Affiliation(s)
- A Mennander
- Transplantation Laboratory, University of Helsiniki, Finland
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24
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Akyürek M, Wanders A, Aurivillius M, Larsson E, Funa K, Fellström B. Effects of angiopeptin on transplant arteriosclerosis in the rat. Transpl Int 1995. [DOI: 10.1111/j.1432-2277.1995.tb01484.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Akyürek ML, Wanders A, Aurivillius M, Larsson E, Funa K, Fellström BC. Effects of angiopeptin on transplant arteriosclerosis in the rat. Transpl Int 1995; 8:103-10. [PMID: 7766291 PMCID: PMC7087531 DOI: 10.1007/bf00344419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The influence of the somatostatin analogue angiopeptin on transplant arteriosclerosis was investigated using two aortic transplantation rat models. One was characterized by ischemia/reperfusion-induced changes in syngeneic transplants while immunologically induced changes dominated in the other allogeneic model. Angiopeptin, 100 micrograms/kg per day, was administered continuously until the sacrifice of the rats after 8 weeks. No additional immunosuppression was used in either model. An image analysis system was used to quantify the intimal and medial thicknesses of the grafts. In the syngeneic grafts, the intimal thickness was less than 50% of that of control grafts (P < 0.05), but no difference was seen in the allogeneic model. The expression of selected cells, TGF-beta s, and PDGF and PDGF alpha-receptors was detected immunohistochemically and displayed a similar picture in control and angiopeptin-treated grafts in both models. We conclude that angiopeptin has no clear immunosuppressive properties but may counteract ischemia-induced transplant arteriosclerosis.
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Affiliation(s)
- M L Akyürek
- Department of Pathology, University Hospital, Uppsala, Sweden
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26
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Wanders A, Akyürek M, Waltenberger J, Ren Z, Stafberg C, Funa K, Larsson E, Fellström B. Ischemia-Induced Transplant Arteriosclerosis in the Rat. Arterioscler Thromb Vasc Biol 1995. [DOI: 10.1161/atvb.15v01.0145] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of cold graft ischemia time on the development of transplant arteriosclerosis was investigated. Aorta grafts from DA or PVG rats were stored in a cold perfusion solution for 1, 4, or 24 hours before being orthotopically transplanted to PVG recipients. After observation times ranging from 2 to 8 weeks, the grafts were examined for various cell populations. Regional changes in the intima and media layers were measured by using an image analysis system. The arteriosclerosis-like changes seen in syngeneic grafts with the longest ischemia time could be almost as prominent as those seen in the al-logeneic transplants. The magnitude of the regional intima changes in the syngeneic group correlated well with the ischemia time and in the allogeneic group with the observation time. The cell composition found in the intima and media of the allogeneic vessels consisted of macrophages, T-lymphocytes, MHC class II-expressing cells, and smooth muscle cells, whereas the syngeneic grafts contained almost exclusively smooth muscle cells and macro-phages. We therefore conclude that the damage due to prolonged cold ischemia time is sufficient to cause pronounced graft arteriosclerosis. The patho-physiological mechanism leading to ischemia-induced arteriosclerosis is different from the one seen in the allogeneic situation.
(Arterio-scler Throtnb Vase Biol
. 1995;15:145-155.)
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Affiliation(s)
- A. Wanders
- From the Departments of Medicine (A.W., C.S., B.F.) and Pathology (M.L.A., Z.P.R., E.L.), University Hospital, Uppsala, Sweden; the Department of Medicine (J.W.), University Hospital, Ulm, FRG; and the Ludwig Institute for Cancer Research (K.F.), Uppsala, Sweden
| | - M.L. Akyürek
- From the Departments of Medicine (A.W., C.S., B.F.) and Pathology (M.L.A., Z.P.R., E.L.), University Hospital, Uppsala, Sweden; the Department of Medicine (J.W.), University Hospital, Ulm, FRG; and the Ludwig Institute for Cancer Research (K.F.), Uppsala, Sweden
| | - J. Waltenberger
- From the Departments of Medicine (A.W., C.S., B.F.) and Pathology (M.L.A., Z.P.R., E.L.), University Hospital, Uppsala, Sweden; the Department of Medicine (J.W.), University Hospital, Ulm, FRG; and the Ludwig Institute for Cancer Research (K.F.), Uppsala, Sweden
| | - Z.P. Ren
- From the Departments of Medicine (A.W., C.S., B.F.) and Pathology (M.L.A., Z.P.R., E.L.), University Hospital, Uppsala, Sweden; the Department of Medicine (J.W.), University Hospital, Ulm, FRG; and the Ludwig Institute for Cancer Research (K.F.), Uppsala, Sweden
| | - C. Stafberg
- From the Departments of Medicine (A.W., C.S., B.F.) and Pathology (M.L.A., Z.P.R., E.L.), University Hospital, Uppsala, Sweden; the Department of Medicine (J.W.), University Hospital, Ulm, FRG; and the Ludwig Institute for Cancer Research (K.F.), Uppsala, Sweden
| | - K. Funa
- From the Departments of Medicine (A.W., C.S., B.F.) and Pathology (M.L.A., Z.P.R., E.L.), University Hospital, Uppsala, Sweden; the Department of Medicine (J.W.), University Hospital, Ulm, FRG; and the Ludwig Institute for Cancer Research (K.F.), Uppsala, Sweden
| | - E. Larsson
- From the Departments of Medicine (A.W., C.S., B.F.) and Pathology (M.L.A., Z.P.R., E.L.), University Hospital, Uppsala, Sweden; the Department of Medicine (J.W.), University Hospital, Ulm, FRG; and the Ludwig Institute for Cancer Research (K.F.), Uppsala, Sweden
| | - B. Fellström
- From the Departments of Medicine (A.W., C.S., B.F.) and Pathology (M.L.A., Z.P.R., E.L.), University Hospital, Uppsala, Sweden; the Department of Medicine (J.W.), University Hospital, Ulm, FRG; and the Ludwig Institute for Cancer Research (K.F.), Uppsala, Sweden
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