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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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von Rossum A, Enns W, Shi YP, MacEwan GE, Malekesmaeli M, Brinkman R, Choy JC. Bim regulates alloimmune-mediated vascular injury through effects on T-cell activation and death. Arterioscler Thromb Vasc Biol 2014; 34:1290-7. [PMID: 24700126 DOI: 10.1161/atvbaha.114.303649] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Bim is a proapoptotic Bcl-2 protein known to downregulate immune responses and to also be required for antigen-induced T-cell activation. However, it is not known how the effect of Bim on these offsetting processes determines the outcome of allogeneic immune responses. We have defined the role of Bim in regulating alloantigen-driven T-cell responses in a model of vascular rejection. APPROACH AND RESULTS Bim was required for proliferation of CD4 and CD8 T cells, and for interleukin-2 production, in T cells stimulated with alloantigen in vitro. Moreover, a partial reduction in Bim expression was sufficient to attenuate T-cell activation, whereas a complete elimination of Bim was required to prevent CD4 T-cell death in response to cytokine withdrawl. When alloimmune-mediated vascular rejection was examined using an aortic interposition model, there was significantly less intimal thickening in Bim(+/-), but not Bim(-/-), graft recipients. T-cell proliferation in response to allograft arteries was significantly reduced in both Bim(+/-) and Bim(-/-) mice, but cell death was attenuated only in Bim(-/-) animals. CONCLUSIONS Bim controls both T-cell activation and death in response to alloantigen stimulation. These processes act cooperatively to determine the outcome of immune responses in allograft arteries.
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Affiliation(s)
- Anna von Rossum
- From the Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada (A.v.R., W.E., Y.P.S., G.E.M., J.C.C.); and Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada (M.M., R.B.)
| | - Winnie Enns
- From the Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada (A.v.R., W.E., Y.P.S., G.E.M., J.C.C.); and Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada (M.M., R.B.)
| | - Yu P Shi
- From the Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada (A.v.R., W.E., Y.P.S., G.E.M., J.C.C.); and Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada (M.M., R.B.)
| | - Grace E MacEwan
- From the Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada (A.v.R., W.E., Y.P.S., G.E.M., J.C.C.); and Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada (M.M., R.B.)
| | - Mehrnoush Malekesmaeli
- From the Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada (A.v.R., W.E., Y.P.S., G.E.M., J.C.C.); and Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada (M.M., R.B.)
| | - Ryan Brinkman
- From the Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada (A.v.R., W.E., Y.P.S., G.E.M., J.C.C.); and Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada (M.M., R.B.)
| | - Jonathan C Choy
- From the Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada (A.v.R., W.E., Y.P.S., G.E.M., J.C.C.); and Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada (M.M., R.B.).
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Surgical angiogenesis with short-term immunosuppression maintains bone viability in rabbit allogenic knee joint transplantation. Plast Reconstr Surg 2013; 131:148e-157e. [PMID: 23358010 DOI: 10.1097/prs.0b013e3182789ad4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascularized composite allotransplantation has the potential for reconstruction of joint defects but requires lifelong immunosuppression, with substantial risks. This study evaluates an alternative, using surgical angiogenesis from implanted autogenous vessels to maintain viability without long-term immunotherapy. METHODS Vascularized knee joints were transplanted from Dutch Belted donors to New Zealand White rabbit recipients. Once positioned and revascularized microsurgically, a recipient-derived superficial inferior epigastric fascial flap and a saphenous arteriovenous bundle were placed within the transplanted femur and tibia, respectively, to develop a neoangiogenic, autogenous circulation. There were 10 transplants in group 1. Group 2 (n = 9) consisted of no-angiogenesis controls with ligated flaps and arteriovenous bundles. Group 3 rabbits (n = 10) were autotransplants with patent implants. Tacrolimus was used for 3 weeks to maintain nutrient flow during angiogenesis. At 16 weeks, the authors assessed bone healing, joint function, bone and cartilage mechanical properties, and histology. RESULTS Group 1 allotransplants had more robust angiogenesis, better healing, improved mechanical properties, and better osteocyte viability than ligated controls (group 2). All three groups developed knee joint contractures and arthritic changes. Cartilage thickness and quality were poorer in allograft groups than in autotransplant controls. CONCLUSIONS Surgical angiogenesis from implanted autogenous tissue improves bone viability, healing, and material properties in rabbit allogenic knee transplants. However, joint contractures and degenerative changes occurred in all transplants, regardless of antigenicity or blood supply. Experimental studies in a larger animal model with improved methods to maintain joint mobility are needed before the merit of living joint allotransplantation can be judged.
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Libby P, Roberts WC. Peter Libby, MD: a conversation with the editor. Am J Cardiol 2012; 110:741-60. [PMID: 22673635 DOI: 10.1016/j.amjcard.2012.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 04/15/2012] [Indexed: 01/10/2023]
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Susa D, De Bruin RWF, Mitchell JR, Roest HP, Hoeijmakers JHJ, Ijzermans JNM. Mechanisms of ageing in chronic allograft nephropathy. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/17471060600756058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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6
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Pratschke J, Weiss S, Neuhaus P, Pascher A. Review of nonimmunological causes for deteriorated graft function and graft loss after transplantation. Transpl Int 2008; 21:512-22. [PMID: 18266771 DOI: 10.1111/j.1432-2277.2008.00643.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Various factors determine the graft- and patient survival after transplantation. HLA-matching and immunological factors are of importance for the short- and long-term survival. Apart from these obvious determinants, nonimmunological factors play an important role in defining the baseline organ quality as well as the recipients' status. The influence of these parameters on graft- and patient survival is still underestimated and is a topic of debate. On account of the increasing acceptance of marginal-donor organs these events are of increasing importance for graft survival and long-term function. We review nonimmunological causes for deteriorated graft function and graft loss after solid organ transplantation.
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Affiliation(s)
- Johann Pratschke
- Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Berlin, Berlin, Germany.
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7
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Aoyama H, Nakagawa H, Pitha JV, Khammar GS, Chandrasekaran K, Matsudaira K, Yagi T, Yokoyama K, Lazzara R, Jackman WM. Comparison of Cryothermia and Radiofrequency Current in Safety and Efficacy of Catheter Ablation within the Canine Coronary Sinus Close to the Left Circumflex Coronary Artery. J Cardiovasc Electrophysiol 2005; 16:1218-26. [PMID: 16302908 DOI: 10.1111/j.1540-8167.2005.50126.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A canine model was used to compare cryoablation and radiofrequency ablation (RFA) within the coronary sinus (CS) in the ability to create a transmural CS myocardial (Trans-CSM) lesion and risk of coronary artery stenosis. METHODS After CS and left circumflex (LCx) coronary angiography, an intravascular ultrasound (IVUS) probe was placed in LCx in 29 dogs. An irrigated RFA catheter (8 dogs) or N(2)O cryoablation catheter (21 dogs) was inserted into the CS and positioned within 2 mm of LCx, confirmed by IVUS. RF (30-50W) was applied for 60 seconds at 10 CS sites. Cryoablation (-75 degrees C) was performed with one (n = 7) or two (n = 14) 4-minute applications. Dogs were sacrificed at 1 week (8 RFA and 13 cryoablation) or 3 months (8 cryoablation). RESULTS During RFA, IVUS showed wall thickening and LCx narrowing in 9 of 10 sites. Angiography at 5-minute post-RFA identified LCx narrowing (25-90%) at 6 of 10 sites and 25-75% narrowing at 4 of 9 sites at 1-week post-RFA. During cryoablation, IVUS showed reversible ice ball compression of LCx, and no LCx narrowing by angiography at 5 minutes, 1 week, or 3 months. Histology showed Trans-CSM lesion at 10 of 10 RFA sites and 20 of 21 cryoablation sites. RFA produced LCx medial necrosis at 7 of 10 sites, involving 20-50%(median 32.5%) of LCx circumference with loss of intima at 5 of 7 sites. Single and twice 4-minute cryoablation produced LCx medial necrosis at 2 of 7 and 8 of 14 sites (5-40%, median 25% circumference). Intima was preserved at 1 week (13/13) with minor proliferation (without narrowing) at 2 of 8 sites at 3 months. CONCLUSIONS Cryoablation in CS within 2 mm of LCx produces Trans-CSM lesions similar to RFA with lower risk of LCx stenosis than RFA.
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Affiliation(s)
- Hiroshi Aoyama
- Cardiac Arrhythmia Research Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Choy JC, Kerjner A, Wong BW, McManus BM, Granville DJ. Perforin mediates endothelial cell death and resultant transplant vascular disease in cardiac allografts. THE AMERICAN JOURNAL OF PATHOLOGY 2004; 165:127-33. [PMID: 15215168 PMCID: PMC1618552 DOI: 10.1016/s0002-9440(10)63281-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
T cell-induced endothelial injury is an important event in the development of transplant vascular disease (TVD), the leading expression of chronic rejection of vascularized organ transplants. However, the precise contribution of perforin to vascular damage in allografts and resultant TVD has not been addressed in vivo. Minor histocompatability antigen mismatched mouse heterotopic cardiac transplants were performed from 129J donors into C57Bl/6 (wild-type (WT)) or perforin knockout (PKO) recipients. Perforin was abundant in immune infiltrates in the myocardium and vasculature of transplanted hearts in WT mice. Allograft coronary arteries in both WT and PKO mice had considerable vasculitis. There was also marked endothelial disruption, as well as TUNEL-positivity in the endothelial region, in coronary arteries of hearts transplanted into WT mice that was not evident in PKO recipients (P = 0.05). At 30 days post-transplantation, intimal thickening was assessed on elastic Van Gieson-stained ventricular sections. There was an average of 54.2 +/- 6.7% luminal narrowing of coronary arteries in allografts from WT mice as compared to 13.4 +/- 5.1% luminal narrowing in PKO counterparts (P < 0.00002). In summary, perforin plays a primary role in endothelial damage and the resultant onset and progression of TVD.
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Affiliation(s)
- Jonathan C Choy
- James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital/University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
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Densem CG, Hutchinson IV, Yonan N, Brooks NH. Influence of IFN-γ polymorphism on the development of coronary vasculopathy after cardiac transplantation. Ann Thorac Surg 2004; 77:875-80. [PMID: 14992891 DOI: 10.1016/j.athoracsur.2003.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2003] [Indexed: 11/20/2022]
Abstract
BACKGROUND The development of coronary vasculopathy (CV) limits survival after cardiac transplantation. Interferon (IFN)-gamma is an important immunomodulator affecting the growth and function of T cells and macrophages, free radical formation, adhesion molecule, and MHC class I and II expression, which are important processes for CV formation. IFN-gamma is expressed early after transplantation and neutralization or genetic absence of the cytokine can abrogate CV development. The expression of IFN-gamma is influenced by a dinucleotide repeat in the first intron of the IFN-gamma gene. We investigated the effect of this polymorphism on the development of CV. METHODS Using sequence specific primers to the IFN-gamma polymorphic region, polymerase chain reaction (PCR) and gel electrophoresis identified the genotype in 144 cardiac transplant recipients and 134 donors. An association was sought between the presence of a high, intermediate or low IFN-gamma producing genotype and the development of CV diagnosed by routine surveillance posttransplant angiography. RESULTS High, intermediate, and low IFN-gamma producers made up 29.2%, 44.4%, 26.4% and 24.6%, 40.3%, 35.1% of recipients and donors respectively (p = NS). IFN-gamma polymorphism in cardiac graft recipients had no impact on the time to first diagnosis of CV; high producers 4.03 years (+/- 129.9 days), intermediate producers 3.40 years (+/- 79.7 days), low producers 4.01 years (+/- 102.9 days); p = 0.16. Similar results were found on investigating donor polymorphism; high producers (3.68 years +/- 120.1 days), intermediate producers (3.83 years +/- 105.9 days), low producers (3.3 years +/- 77.7 days); p = 0.35. Multivariate analysis identified the number of rejection episodes of ISHLT grade 3 or greater and increasing donor age to be independent risk factors for CV development. CONCLUSIONS Dinucleotide repeat polymorphism in the first intron of the human IFN-gamma gene does not influence CV development and cannot be used as a genetic risk marker.
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Affiliation(s)
- Cameron G Densem
- Cardiothoracic Transplant Unit, Wythenshawe Hospital, United Kingdom.
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10
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Abstract
Allograft arteriopathy is a vascular intimal proliferative process that occurs in all solid organ transplants and stands as the single most significant obstacle to successful long-term solid organ transplantation; it shares a number of pathologic features with restenosis lesions and atherosclerosis. This article will review some of the newer developments in our understanding of the immunological and vascular biology underpinnings of the disease, including the roles played by cytokine and chemokine mediators in recruiting and activating both inflammatory cells, as well as smooth muscle cell precursors.
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Affiliation(s)
- Richard N Mitchell
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 77 Avenue Louis Pasteur/NRB 730D, Boston, MA 02115, USA.
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11
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Pietra B, Boucek M. Coronary artery vasculopathy in pediatric cardiac transplant patients: the therapeutic potential of immunomodulators. Paediatr Drugs 2003; 5:513-24. [PMID: 12895134 DOI: 10.2165/00148581-200305080-00002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The single largest cause of late graft loss in pediatric cardiac transplantation is transplant coronary artery vasculopathy (CAV). The mechanism of CAV remains unknown; it appears to have both immune and non-immune causes. The final common pathway of these mechanisms is endothelial activation, a prothrombotic environment, and endothelial damage with subsequent diffuse intimal proliferation. The disease process has largely been thought to be progressive and unresponsive to treatment. Re-transplantation has been advocated as the only definitive treatment. The appropriate management is largely unknown; intervention or surgical management has had limited utility, while medical management appears to have the most promise. Improvement in outcome can be achieved by optimizing non-immune factors and aggressive management of the immune mechanisms. Long-term survival of transplant patients after diagnosis with CAV is now being reported.
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Affiliation(s)
- Biagio Pietra
- Department of Pediatrics, The Children's Hospital, Denver, Colorado 80212, USA.
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12
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Klingenberg R, Koch A, Schnabel PA, Zimmermann R, Sack FU, Haass M, Dengler TJ. Allograft rejection of ISHLT grade >/=3A occurring late after heart transplantation--a distinct entity? J Heart Lung Transplant 2003; 22:1005-13. [PMID: 12957610 DOI: 10.1016/s1053-2498(02)01154-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The significance of International Society of Heart and Lung Transplantation (ISHLT) grade >/=3A rejection detected by routine endomyocardial biopsies beyond 2 years post-transplant remains uncertain. METHODS We performed a retrospective analysis of our single-institution database consisting of 4,041 biopsies (188 patients) from 1986 to 2001. Incidence, clinical correlates and outcome of ISHLT grade >/=3A rejection beyond 2 years post-transplant were analyzed. RESULTS A total of 307 ISHLT grade >/=3A rejection episodes was diagnosed up to 10 years after transplantation, 69 of which occurred later than 2 years post-transplant in 33 of 139 patients ("late rejection") at therapeutic levels of immunosuppression. Late rejection was only marginally correlated with the incidence of moderate rejection within the first 2 post-transplant years (p = 0.09). The incidence of moderate rejection per patient-year decreased from 1.05 in Year 1 over 0.11 in Year 5 to 0.04 in Year 10. The technical failure rate of biopsies remained low throughout the post-transplant period (range 0.7% to 2.4%). Spontaneous resolution of ISHLT grade >/=3A rejection beyond 2 years post-transplant occurred in all 17 patients in whom specific anti-rejection therapy had been electively withheld. Mortality beyond 2 years post-transplant was lower (p = 0.033) in the "late rejecting" group (n = 33) than in the control group (n = 106). CONCLUSIONS Endomyocardial biopsy continues to detect episodes of moderate rejection even very late after heart transplantation, without a close correlation with the rejection frequency in the early post-transplant period. Even without specific treatment, late rejection carries a benign clinical prognosis and may represent a separate biologic entity. Potential long-term effects-for instance, on the pathogenesis of transplant vasculopathy-need further elucidation.
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Affiliation(s)
- Roland Klingenberg
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
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Chemokine-mediated recruitment of inflammatory and smooth muscle cells in transplant-associated arteriosclerosis. Curr Opin Organ Transplant 2003. [DOI: 10.1097/00075200-200303000-00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Osako M, Otani H, Yamamura T, Nakao Y, Hattori R, Omiya H, Fujii H, Tanaka K, Imamura H. Alloimmune response may be involved in neointimal hyperplasia in cryopreserved aortic allografts. Transplant Proc 2001; 33:2566-70. [PMID: 11406250 DOI: 10.1016/s0041-1345(01)02100-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Osako
- Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Moriguchi, Japan
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15
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Demers P, Elkouri S, Sirois MG, Cartier R. Coronary artery endothelial dysfunction after ischemia-reperfusion and acute untreated rejection in a canine heterotopic heart transplantation model. Transplantation 2001; 71:26-32. [PMID: 11211191 DOI: 10.1097/00007890-200101150-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute rejection is a common problem in heart transplantation and may contribute to the development of cardiac allograft vasculopathy. This study was designed to evaluate the mechanisms of coronary endothelial dysfunction associated with ischemia-reperfusion and acute untreated rejection. METHODS Two groups of mongrel dogs (n=7 per group) underwent heterotopic cervical heart transplantation without immunosuppression. Allografts were harvested on posttransplant day 1 (group 1) and day 5 (group 2). A third group of unoperated dogs served as control (group 3). After harvesting, epicardial coronary arteries were studied in organ chamber for endothelium-dependent and independent reactivity. RESULTS Group 1 displayed multifocal ischemic damage without any rejection while hearts from group 2 reached grade IV rejection. Immunohistochemical studies for von Willebrand factor showed expression on coronary endothelial cells in all animals with scattered areas of denudation in transplanted groups. Endothelium-dependent responses to acetylcholine, calcium ionophore A23147, and bradykinin were unaffected in groups 1 and 2. Endothelial relaxations to sodium fluoride (Gi-protein activator) was significantly reduced in group 1 and significantly increased in group 2 compared with control. Responses to serotonin and UK14304 (receptors linked to Gi-protein) were significantly increased in group 2. Responses to thrombin were decreased in both groups. Endothelium-independent responses were unaffected. CONCLUSIONS In the canine model of heterotopic heart transplantation, the early (24 hr) endothelial dysfunction seen after transplantation is specific to the thrombin receptor and the Gi-protein signaling pathway. Acute untreated rejection did not modify the alteration in endothelial reactivity to thrombin but enhanced the sensibility of the Gi-protein signaling pathways.
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Affiliation(s)
- P Demers
- Department of Surgery and the Research Center, Montreal Heart Institute, Quebec, Canada
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Kouwenhoven EA, IJzermans JNM, Bruin RWF. Etiology and pathophysiology of chronic transplant dysfunction. Transpl Int 2000. [DOI: 10.1111/j.1432-2277.2000.tb01017.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ikonen TS, Briffa N, Gummert JF, Honda Y, Hayase M, Hausen B, Billingham ME, Yock PG, Robbins RC, Morris RE. Multidimensional assessment of graft vascular disease (GVD) in aortic grafts by serial intravascular ultrasound in rhesus monkeys. Transplantation 2000; 70:420-9. [PMID: 10949182 DOI: 10.1097/00007890-200008150-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Graft vascular disease (GVD) is an incompletely understood process and the primary cause of late allograft failure. A nonhuman primate model was established to study the progression of GVD by using serial intravascular ultrasound (IVUS). METHODS Aortic allografts were transplanted below the inferior mesenteric arteries (IMA) into 6 rhesus monkeys. Removed and re-implanted aortic segments between renal arteries, and the inferior mesenteric arteries served as autografts. IVUS was performed at days 0, 24, 52, 80, and 98 after transplantation. Vessel area (VA) and lumen area (LA) were measured from each cross-section at 0.5 mm intervals. Intimal index (II=100x (VA-LA/VA)) and corresponding vessel volumes were calculated for the whole grafts. Histologic features were assessed from autopsy samples using computerized morphometric method and a score from 0 to 3 for GVD (0=none, 3=severe). RESULTS In allografts, vessel volume and luminal volume decreased significantly (P<0.05 for both) and the intimal index increased from 12% to 59% by day 98. These parameters remained unchanged in autografts. Histologic analysis of allografts showed concentric intimal hyperplasia and scattered mononuclear cell accumulations, whereas the autografts had only occasional eccentric intimal changes. The GVD-scores were significantly higher in allografts than in autografts (median 3 vs. 1, P=0.042). CONCLUSIONS We introduce a nonhuman primate model of GVD that enables serial IVUS assessments of multiple parameters of GVD. Concentric intimal proliferation and decrease of vessel dimensions was observed in allografts as a consequence of alloimmunity. This is a potential new model for studying new therapies to prevent GVD or halt its progression.
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Affiliation(s)
- T S Ikonen
- Department of Cardiothoracic Surgery, Transplantation Immunology, Stanford University Medical School, California, USA
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Hosenpud JD, Boyle TM, Hensler H, Sanford G, Khanna AK. The relationship between acute rejection and chronic rejection is highly dependent on specific MHC matching: a multi-strain rat heterotopic heart transplant study. Transplantation 2000; 69:2173-8. [PMID: 10852619 DOI: 10.1097/00007890-200005270-00037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The impact of acute rejection, immunosuppression, and infection, specifically cytomegalovirus infection, on the development of chronic rejection in the cardiac allograft, has been the subject of a large number of investigations. One of the difficulties in finding associations has been the marked immunologic heterogeneity of the patient population coupled with the lack of the ability to HLA match. Furthermore, the ideal animal model, which duplicates as well as controls for this immunologic heterogeneity, is lacking. METHODS To try to simulate differences in HLA matching, immunosuppression regiments and cytomegalovirus infection, heterotopic heart transplantation was performed in two separate, complete MHC mismatch, rat strain combinations (WF-LEW, BN-LEW) requiring chronic immunosuppression and employing four separate immunosuppression/infection protocols. Animals were followed for 6 months, killed, and rejection and vascular changes were scored blinded to the group. RESULTS The mean vascular and acute rejection scores were not significantly different between treatment regiments for either specific strain combination. There was a trend for the subtherapeutic groups to have higher vascular scores. Overall, there were no significant differences in vascular scores between the WF-LEW and BN-LEW groups (1.25+/-0.18 vs. 1.13+/-0.20, P=NS). Similar numbers of WF-LEW and BN-LEW exhibited cellular infiltration and necrosis of the allograft, but the intensity of the response (rejection score) was more severe in the WF-LEW combination (4.54+/-0.22 vs. 3.92+/-0.21, P=0.052) when limiting the analysis to those with myocyte necrosis. There was no significant correlation between acute rejection and vascular lesion severity in the WF-LEW combination (r=0.22, P=NS) but a high correlation between these parameters in the BN-LEW combination (r=0.74, P<0.0001). CONCLUSIONS These data suggest that, although acute rejection and chronic rejection are related, MHC matching may influence their interdependence. These data also may explain why the clinical association between acute and chronic rejection is difficult to demonstrate.
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Affiliation(s)
- J D Hosenpud
- Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee 53226, USA.
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Tugay C, Ayhan S, Carnevale K, Siemionow M. Inflammatory vascular response and microcirculatory hemodynamics during acute rejection phase in composite tissue allografts. Transplant Proc 2000; 32:576-7. [PMID: 10812119 DOI: 10.1016/s0041-1345(00)00896-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- C Tugay
- Departments of Plastic and Reconstructive Surgery, and Cell Biology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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20
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Abstract
More than 30 years have passed since the first human heart transplantation was performed. Since then, short-term survival after heart transplantation has been markedly improved, but this development has not been paralleled with a similar improvement in long-term survival. One of the major reasons for this is the subsequent development of heart allograft vascular disease, an obliterative disease in the coronary arteries of the transplanted heart. The dubious effect of re-vascularization in this disease, the less favorable outcome after repeat heart transplantation, and the low donor supply have called for intensified research for new and efficient prophylactic therapies against heart allograft vascular disease. This research has lead to improved knowledge about diagnosis, etiology, pathogenesis, prophylaxis, and treatment possibilities. The most important among these seem to be: (i) the introduction of intravascular ultrasound for early detection of the disease; (ii) evidence to suggest that hyperlipidemia, insufficient immunosuppressive therapy, human leukocyte antigen (HLA)-mismatch, and infection with cytomegalovirus (CMV) all may promote allografts vascular disease; and (iii) the introduction of at least two promising prophylactic therapies in humans namely 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors and calcium entry blockers, and others potentially promising e.g. angiotensin-converting enzyme-inhibitors, angiopeptin, mycophenolate mofetil and rapamycin. This review summarizes present knowledge on the possibilities of inhibiting or treating heart allograft vascular disease incorporating evidence from both human and experimental studies.
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Affiliation(s)
- H Orbaek Andersen
- Department of Cardio-Thoracic Surgery, R. Gentofte University Hospital, Hellerup, Denmark
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Wilhelm MJ, Kusaka M, Pratschke J, Tilney NL. Chronic rejection: increasing evidence for the importance of allogen-independent factors. Transplant Proc 1998; 30:2402-6. [PMID: 9723519 DOI: 10.1016/s0041-1345(98)00669-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic rejection is a process caused by an interplay of different risk factors. Early injury regardless of type, seems to be an important prognostic event. Later insults appear to contribute. As the individual components of the process are increasingly dissected and understood, means to modulate or normalize them will be forthcoming.
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Affiliation(s)
- M J Wilhelm
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02150, USA
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Andersen HO, Qvortrup K, Rostgaard J, Nordestgaard BG. Effect of cyclosporine during initiation of transplant arteriosclerosis. An ultrastructural study in the aorta-transplanted rabbit. Atherosclerosis 1997; 133:171-81. [PMID: 9298677 DOI: 10.1016/s0021-9150(97)00123-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The immunosuppressant cyclosporine protects against the development of experimental transplant arteriosclerosis. To investigate the mechanism underlying this effect, aorta-allografted rabbits were randomly assigned to cyclosporine (n = 6) in the human therapeutic range or to its vehicle (n = 5). Perfusion fixation was performed 2 weeks after the transplantation, followed by light, scanning and transmission electron microscopy examination. Intimal proliferation was absent in native aortas, present in all grafts from vehicle-treated animals, and either absent or sparse in grafts from cyclosporine-treated rabbits. The endothelium of native aortas from both vehicle- and cyclosporine-treated rabbits was normal. Aortic allografts from cyclosporine-treated rabbits exhibited a normal endothelium with only a few adhering mononuclear cells, whereas aortic allografts from vehicle-treated rabbits exhibited an endothelial surface ranging from near-normal with only few adhering platelets and mononuclear cells, to an almost destroyed endothelium, lined with lymphocyte-like cells, monocytes/macrophages, platelets, erythrocytes and fibrin; in the subendothelial layer, mononuclear cells and smooth muscle cells were abundant. These results suggest that damage to the endothelial cells as well as invasion of lymphocytes, monocytes/macrophages and smooth muscle cells into the subendothelial space are important events during initiation of transplant arteriosclerosis, and that cyclosporine largely attenuates these early pathological changes.
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Affiliation(s)
- H O Andersen
- Department of Thoracic Surgery RT, Rigshospitalet, University of Copenhagen, Denmark
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