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Published on: May 14, 2013
Cardiac allograft vasculopathy: a donor or recipient induced pathology?
Patricia van den Hoogen1, Manon M H Huibers, Joost P G Sluijter
1Department of Cardiology, Experimental Cardiology laboratory, University Medical Centre Utrecht, Utrecht, The Netherlands.
Insights
Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant failure. This review explores the roles of both donor and recipient cells in CAV pathogenesis, highlighting their complex interactions.
Area of Science:
- Cardiology
- Immunology
- Transplantation Science
Background:
- Cardiac allograft vasculopathy (CAV) is a leading cause of late-stage heart failure post-heart transplantation.
- CAV pathogenesis involves concentric luminal narrowing of coronary arteries, but remains incompletely understood.
- Existing research presents conflicting evidence regarding the roles of recipient immune responses versus donor-derived cell-induced immunity.
Purpose of the Study:
- To review and synthesize current knowledge on the pathogenesis of cardiac allograft vasculopathy (CAV).
- To elucidate the contributions of both donor and recipient cells in CAV development.
- To provide insights into the complex immune and fibrotic processes underlying CAV.
Main Methods:
- This study is a comprehensive literature review.
- It synthesizes findings from research investigating donor-derived and recipient-derived cellular contributions to CAV.
- The review analyzes evidence related to immune responses and neo-intima fibrosis in CAV.
Main Results:
- Conflicting evidence exists regarding whether recipient immunity or donor cells initiate the immune response in CAV.
- Both recipient-derived and donor-derived circulating cells can induce neo-intima fibrosis.
- Dual outcomes are observed concerning the specific roles of donor and recipient cells in CAV initiation and fibrosis.
Conclusions:
- The pathogenesis of CAV is complex, involving contributions from both donor and recipient cells.
- Understanding the interplay between donor and recipient cells is crucial for insights into CAV.
- Future research should investigate potential synergistic interactions between donor and recipient cells in CAV development.
Abstract:
Cardiac allograft vasculopathy (CAV) is one of the main causes of late-stage heart failure after heart transplantation. CAV is characterized by concentric luminal narrowing of the coronary arteries, but the exact pathogenesis of CAV is still not unraveled. Many researchers show evidence of an allogeneic immune response of the recipient, whereas others show contrasting results in which donor-derived cells induce an immune response against the graft. In addition, fibrosis of the neo-intima can be induced by recipient-derived circulating cells or donor-derived cells. In this review, both donor and recipient sides of the story are described to obtain better insight in the pathogenesis of CAV. Dual outcomes were found regarding the contribution of donor and recipient cells in the initiation of the immune response and the development of fibrosis during CAV. Future research could focus more on the potential synergistic interaction of donor and recipient cells leading to CAV.
