Abstract
The development of accelerated coronary artery disease after heart transplantation remains the limiting factor for long-term survival. The most widely accepted hypothesis to explain the development of this vascular lesion is chronic immunologic injury to the vessel wall, which leads to recruitment of monocytes and lymphocytes into the intima and to subsequent neointimal proliferation. In this report, we describe a case of accelerated coronary artery disease that led to allograft failure and repeat heart transplantation 3 years after the initial procedure. Pathologic examination showed striking intimal proliferation with abundant expression of intercellular adhesion molecule-1 in both endothelial cells and cells deep within the intima. Cardiac myocytes also stained for intercellular adhesion molecule-1, with the most intense staining noted in intercalated disks, whereas staining for E-selectin was restricted to endothelial cells. These findings are similar to those we observed in a canine model of transplant arteriopathy and highlight the need for further studies to examine whether inhibitors of endothelial cell adhesion molecules or their leukocyte ligands can successfully ameliorate transplant vasculopathy.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Billingham M. E. Histopathology of graft coronary disease. J Heart Lung Transplant. 1992 May-Jun;11(3 Pt 2):S38–S44. [PubMed] [Google Scholar]
- Briscoe D. M., Schoen F. J., Rice G. E., Bevilacqua M. P., Ganz P., Pober J. S. Induced expression of endothelial-leukocyte adhesion molecules in human cardiac allografts. Transplantation. 1991 Feb;51(2):537–539. [PubMed] [Google Scholar]
- Deuel T. F., Senior R. M., Huang J. S., Griffin G. L. Chemotaxis of monocytes and neutrophils to platelet-derived growth factor. J Clin Invest. 1982 Apr;69(4):1046–1049. doi: 10.1172/JCI110509. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hosenpud J. D., Shipley G. D., Wagner C. R. Cardiac allograft vasculopathy: current concepts, recent developments, and future directions. J Heart Lung Transplant. 1992 Jan-Feb;11(1 Pt 1):9–23. [PubMed] [Google Scholar]
- Nelken N. A., Coughlin S. R., Gordon D., Wilcox J. N. Monocyte chemoattractant protein-1 in human atheromatous plaques. J Clin Invest. 1991 Oct;88(4):1121–1127. doi: 10.1172/JCI115411. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Qiao J. H., Ruan X. M., Trento A., Czer L. S., Blanche C., Fishbein M. C. Expression of cell adhesion molecules in human cardiac allograft rejection. J Heart Lung Transplant. 1992 Sep-Oct;11(5):920–925. [PubMed] [Google Scholar]
- Salomon R. N., Hughes C. C., Schoen F. J., Payne D. D., Pober J. S., Libby P. Human coronary transplantation-associated arteriosclerosis. Evidence for a chronic immune reaction to activated graft endothelial cells. Am J Pathol. 1991 Apr;138(4):791–798. [PMC free article] [PubMed] [Google Scholar]
- Springer T. A. Traffic signals for lymphocyte recirculation and leukocyte emigration: the multistep paradigm. Cell. 1994 Jan 28;76(2):301–314. doi: 10.1016/0092-8674(94)90337-9. [DOI] [PubMed] [Google Scholar]
- Uretsky B. F., Murali S., Reddy P. S., Rabin B., Lee A., Griffith B. P., Hardesty R. L., Trento A., Bahnson H. T. Development of coronary artery disease in cardiac transplant patients receiving immunosuppressive therapy with cyclosporine and prednisone. Circulation. 1987 Oct;76(4):827–834. doi: 10.1161/01.cir.76.4.827. [DOI] [PubMed] [Google Scholar]
- Yurochko A. D., Liu D. Y., Eierman D., Haskill S. Integrins as a primary signal transduction molecule regulating monocyte immediate-early gene induction. Proc Natl Acad Sci U S A. 1992 Oct 1;89(19):9034–9038. doi: 10.1073/pnas.89.19.9034. [DOI] [PMC free article] [PubMed] [Google Scholar]