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Updated: Jun 13, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Donor myocardial apollon mRNA is associated with cardiac allograft rejection
Seyedhossein Aharinejad1, Olena Andrukhova, Matthias Gmeiner
1Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. seyedhossein.aharinejad@meduniwien.ac.at
Background:
Endomyocardial biopsy (EMB) is the "gold standard" in cardiac allograft acute cellular rejection (ACR) diagnosis, but it is invasive. ACR prediction at organ harvest could reduce EMB frequency in low-risk recipients. ACR is reportedly associated with apoptosis and Apollon inhibits apoptosis and promotes cell survival. It is unknown whether donor myocardial tissue Apollon mRNA could predict ACR.
Methods:
Left ventricular biopsies (LVBs) were obtained from 336 donors before and after aortic cross-clamping (ACC) and at 10, 30 and 60 minutes of reperfusion in recipients. Tissue Apollon messenger RNA (mRNA) expression was examined by real-time reverse transcript-polymerase chain reaction (RT-PCR) and correlated with ACR episodes.
Results:
Apollon LVB expression was significantly decreased before and after ACC in donors and at 10 minutes of reperfusion (p < or = 0.0233) in recipients who developed Grade 2R and 3R ACR as compared with those with Grade 1R or no ACR. In addition, Apollon myocardial expression was significantly decreased at 10 minutes of reperfusion in patients who developed Grade 3R ACR compared with all other ACR grades (p < or = 0.0425). In receiver-operating characteristic curve analysis, at a cut-off level of 75.66 arbitrary units, Apollon mRNA before ACC in donors identified combined Grade 2R and 3R ACR with a sensitivity of 94% and a specificity of 96% (p < 0.0001; area under the curve [AUC] = 0.965; odds ratio [OR] = 0.958; 95% confidence interval [CI] 0.942 to 0.974).
Conclusions:
Apollon is a sensitive and specific predictor of ACR in donated cardiac allografts and may have important implications in the choice of surveillance.
Insights
Apollon mRNA in donor hearts can accurately predict acute cellular rejection (ACR) in recipients. This finding may reduce the need for invasive endomyocardial biopsies in low-risk transplant patients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Molecular Diagnostics
Background:
- Endomyocardial biopsy (EMB) is the gold standard for diagnosing cardiac allograft acute cellular rejection (ACR) but is invasive.
- Predicting ACR at organ harvest could decrease EMB frequency in low-risk recipients.
- Apollon, an apoptosis inhibitor, is linked to cell survival, but its role in ACR prediction is unknown.
Purpose of the Study:
- To investigate whether donor myocardial Apollon mRNA expression can predict ACR in cardiac allograft recipients.
- To assess the diagnostic accuracy of Apollon mRNA levels for ACR detection.
Main Methods:
- Left ventricular biopsies (LVBs) were collected from 336 donors pre- and post-aortic cross-clamping and during reperfusion.
- Apollon mRNA expression was quantified using real-time RT-PCR.
- Apollon mRNA levels were correlated with ACR severity in recipients.
Main Results:
- Apollon mRNA levels were significantly lower in donors and recipients who developed higher grades of ACR (2R and 3R).
- Apollon mRNA expression at 10 minutes of reperfusion was particularly decreased in Grade 3R ACR cases.
- Apollon mRNA before aortic cross-clamping demonstrated high sensitivity (94%) and specificity (96%) for predicting combined Grade 2R and 3R ACR (AUC = 0.965).
Conclusions:
- Apollon mRNA is a highly sensitive and specific biomarker for predicting ACR in donated cardiac allografts.
- Measuring Apollon mRNA in donor hearts may guide surveillance strategies and reduce invasive procedures.
