J Thorac Cardiovasc Surg 1998;116:532
© 1998 Mosby, Inc.
Aortic valves are antigenic but less so than myocardium
M. M. Kawauchi, MD,
J. J. Nakajima, MD,
M. M. Takeda, MD,
T. T. Oka, MD,
S. S. Takamoto, MD,
M. M. Kawauchi, MD
To the Editor
We read with interest two articles, one by Rajani, Mee, and Ratliff
1 and the other by Mitchell, Jonas, and Schoen, 2 and noted especially the difference in the results regarding immunologic reactions of the aortic valves. In our primate heterotopic heart allotransplant model, donor aortic valves were rejected more weakly than myocardium. Mononuclear cells infiltrated into 90% of the donor aortic valves. 3
Ten adult male macaque monkeys were subjected to heterotopic cardiac allotransplantation without immunosuppressive drugs. Allotransplanted hearts were rejected and stopped beating after 8 to 27 days. Pathologic examination revealed grade 3 to 4 rejection of the myocardial tissues in all the grafts. Aortic valves from six donor hearts showed subendothelial cell infiltration, and in three donor hearts there was cell infiltration into the stroma (Fig. 1), but valves from one donor showed normal structure without inflammatory cells. All animals received humane animal care in compliance with "Standards Relating to the Care and Management, Etc. of Experimental Animals (Notification No. 6, March 27, 1980, of the Prime Minister's Office, Japan)."
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Figure 1. Aortic valve with cell infiltration into the stroma. Mononuclear cells infiltrated into the stroma and normal valve structures are destroyed. The aortic valve was retrieved from the donor heart with grade 4 rejection. (Hematoxylin-eosin staining, original magnification x80).
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The antigenicity of the valves is so weak that the valves from the immunosuppressed recipient in Mitchell's studies did not show immunologic findings such as cell infiltration. In rodents, donor-specific cellular and humoral immune responses after aortic valve allografting were reported as similar in magnitude to skin allografting but somewhat slow in onset. Cyclosporine (INN: ciclosporin) arrested the homograft degeneration. 4,5 The results of these studies including ours suggest that small-dose immunosuppression may arrest homograft degeneration, especially in infants, as in Rajani's report.
Departments of Cardiothoracic Surgery and PathologyFaculty of MedicineUniversity of Tokyo,
7-3-1 Hongo, Bunkyo-ku,
Tokyo, 113, Japan
References
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Rajani B, Mee RB, Ratliff NB. Evidence for rejection of homograft cardiac valves in infants. J Thorac Cardiovasc Surg 1998;115:111-7. [Abstract/Free Full Text]
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Mitchell RN, Jonas RA, Schoen FJ. Pathology of explanted cryopreserved allograft heart valves: comparison with aortic valves from orthotopic heart transplants. J Thorac Cardiovasc Surg 1998;115:118-27.[Abstract/Free Full Text]
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Kawauchi M, Tanaka K, Nakajima J, Takeda M, Oka T, Furuse A. Antigenicity of heart valves and vessels: a primate heart transplant study. Transplant Proc 1996;28:1824-5.[Medline]
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Zhao X, Green M, Frazer IH, Hogan P, O'Brien MF. Donor-specific immune response after aortic valve allografting in the rat. Ann Thorac Surg 1994;57:1158-63.[Abstract]
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Yankah AC, Wottge Hu, Muller-Ruchholtz W. Short-course cyclosporine: a therapy for definite allograft valve survival. Ann Thorac Surg 1995;60:S146-50.
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