Alloimmunity and nonimmunologic risk factors in cardiac allograft vasculopathy.

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Serval ID
serval:BIB_4D701B8CF37E
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Alloimmunity and nonimmunologic risk factors in cardiac allograft vasculopathy.
Journal
European heart journal
Author(s)
Vassalli G., Gallino A., Weis M., von Scheidt W., Kappenberger L., von Segesser L.K., Goy J.J.
ISSN
0195-668X
Publication state
Published
Issued date
2003
Peer-reviewed
Oui
Volume
24
Number
13
Pages
1180-8
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; Review - Publication Status: ppublish
Abstract
Graft vasculopathy is an accelerated form of coronary artery disease that occurs in transplanted hearts. Despite major advances in immunosuppression, the prevalence of the disease has remained substantially unchanged during the last two decades. According to the 'response to injury' paradigm, graft vasculopathy is the result of a continuous inflammatory response to tissue injury initiated by both alloantigen-dependent and independent stress responses. Experimental evidence suggests that these responses may become self-sustaining, as allograft re-transplantation into the donor strain at a later stage fails to prevent disease progression. Histological evidence of endothelitis and arteritis, in association with intima fibrosis and atherosclerosis, reflects the central role of alloimmunity and inflammation in the development of arterial lesions. Experimental results in gene-targeted mouse models indicate that cellular and humoral immune responses are both involved in the pathogenesis of graft vasculopathy. Circulating antibodies against donor endothelium are found in a significant number of patients, but their pathogenic role is still controversial. Alloantigen-independent factors include donor-transmitted coronary artery disease, surgical trauma, ischaemia-reperfusion injury, viral infections, hyperlipidaemia, hypertension, and glucose intolerance. Recent therapeutic advances include the use of novel immunosuppressive agents such as sirolimus (rapamycin), HMG-CoA reductase inhibitors, calcium channel blockers, and angiotensin converting enzyme inhibitors. Optimal treatment of cardiovascular risk factors remains of paramount importance.
Keywords
Antibody Formation, Coronary Angiography, Coronary Disease, Endothelium, Vascular, Heart Transplantation, Humans, Isoantibodies, Isoantigens, Postoperative Complications, Risk Factors, Transplantation Immunology, Transplantation Tolerance, Transplantation, Homologous
Pubmed
Web of science
Open Access
Yes
Create date
15/02/2008 12:28
Last modification date
25/09/2019 7:09
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