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Published on: January 24, 2014
Patterns of myocardial endothelin-1 expression and outcome after cardiac transplantation
Claudio Ferri1, Giuliana Properzi, Gianluca Tomassoni
1University of L'Aquila, Department of Internal Medicine and Public Health, Italy.
Insights
Endothelin-1 (ET-1) in heart transplants is linked to rejection and injury. Vascular ET-1 correlates with acute rejection, while interstitial ET-1 predicts ischemic injury and vasculopathy.
Area of Science:
- Cardiology
- Immunology
- Transplantation Science
Background:
- Endothelin-1 (ET-1), a potent vasoconstrictor, is implicated in inflammatory responses post-heart transplantation.
- Understanding ET-1 expression patterns is crucial for managing transplant complications.
Purpose of the Study:
- To correlate myocardial ET-1 expression in heart biopsies with acute rejection.
- To investigate the association between ET-1 patterns and post-transplantation ischemic injury.
- To determine the relationship between ET-1 expression and the development of coronary vasculopathy.
Main Methods:
- Evaluated myocardial ET-1 expression in 47 heart transplant recipients at 3 months post-transplant.
- Assessed transplant vasculopathy via coronary angiography at 2 years.
- Correlated ET-1 expression in blood vessels and interstitium with clinical outcomes.
Main Results:
- Vascular ET-1 expression was significantly higher in patients with grade 2 rejection (41%) compared to lower grades (10%).
- Interstitial ET-1 positivity was linked to increased ischemic injury (52% vs. 9%), more vasculopathy (50% vs. 15%), and trends toward worse survival.
- Positive interstitial ET-1 correlated with fewer episodes of acute rejection in the first 3 months.
Conclusions:
- Vascular ET-1 expression is associated with acute rejection following heart transplantation.
- Interstitial ET-1 expression is linked to post-transplantation ischemic injury and the subsequent development of coronary vasculopathy.
Background:
Endothelin-1 (ET-1), a potent vasoconstrictor, is released in response to several inflammatory cytokines after heart transplantation. The present study correlated patterns of myocardial ET-1 expression in heart biopsies with acute rejection, post-transplantation ischemic injury, and subsequent development of coronary vasculopathy.
Methods And Results:
Patterns of myocardial ET-1 expression were evaluated in 47 heart transplant recipients at 3 months after transplant. Transplant vasculopathy was documented by coronary angiography at 2 years after transplant. Expression of ET-1 was tabulated for both blood vessels and the interstitium. Vascular ET-1 expression was positive in 7/17 (41%) of patients with greater than grade 2 (International Society Heart Lung Transplant) rejection compared with 3/30 (10%) of patients with grade 0 and grade 1A rejection (P=0.02). Compared with patients with negative interstitial ET-1 expression (n=22), patients with positive interstitial ET-1 expression (n=25) had higher incidence of post-transplantation ischemic injury (52% versus 9%, P=0.002), lower mean episodes of acute rejection (> or = grade 2) during the first 3 months of transplant (1.09+/-0.66 versus 1.86+/-1.6, P=0.048), and more common vasculopathy at 2 years (50% versus 15%, P=0.02), and they tended to have worse survival (83.2% versus 100%, P=0.058).
Conclusions:
Vascular ET-1 expression is likely to be associated with acute rejection. Interstitial ET-1 expression, however, is more likely to be associated with post-transplantation ischemic injury and subsequent development of coronary vasculopathy.
