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J Thorac Cardiovasc Surg 2001;121:401
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Raymond H. Chen, MD, PhD, R. Saeid Farivar, MD, PhD, David H. Adams, MD

Division of Cardiac Surgery
Brigham and Women's Hospital Boston, MA 02115

Reply to the Editor:

We read with interest the letter from Beranek regarding our previously published articles on pig-to-primate cardiac xenograft rejection,Go Go 1,2 and we appreciate his identification of myocardial apoptosis in our figures.

An important mechanism in hyperacute rejection involves the binding of porcine galactose {alpha}-1,3 ({alpha}-Gal) by primate immunoglobulin M antibodies, which activate the complement membrane attack complex (MAC) and induces microvascular thrombosis and graft loss. Beranek has previously commented that apoptosis-induced cardiomyocyte damage may be another potential mechanism of xenograft rejectionGo Go 3-6: vascular leakage during hyperacute rejection allows immunoglobulin M and MAC to attack bystander cardiomyocytes, inducing apoptosis and myocardial defects.

Although we agree that apoptosis may play a role in xenograft rejection, we are uncertain whether this phenomenon is the result of vascular leakage of immunoglobulin M and MAC. Ischemia and reperfusion alone can induce apoptosis.Go 7 In the setting of hyperacute rejection where the graft is rejected minutes after implantation, the contribution of ischemia/reperfusion versus immunoglobulin M/MAC in the induction of cardiomyocyte apoptosis remains unclear. Although we agree that apoptosis may occur after transplantation, we do not necessarily agree that vascular leakage of immunologic proteins is the mechanism.

12/8/111201

doi:10.1067/mtc.2001.111201

References

  1. Chen RH, Kadner A, Mitchell RN, Adams DH. Mechanism of delayed rejection in transgenic pig-to-primate cardiac xenotransplantation. J Surg Res 2000;90:119-25.[Medline]
  2. Chen RH, Kadner A, Mitchell RN, Adams DH. Fresh porcine cardiac valves are not rejected in primates. J Thorac Cardiovasc Surg 2000;119:1216-20.[Abstract/Free Full Text]
  3. Beranek JT. Myocardial pseudovascular tubes are present in the delayed rejection of pig-to-baboon orthotopic cardiac xenografts [letter comment]. J Thorac Cardiovasc Surg 1999;117:1233-4.[Free Full Text]
  4. Beranek JT. Apoptosis is the main mechanism of cardiomyocyte death in the hyperacute rejection of heart xeno- and allografts [letter] [see comments]. Transplantation 1997;64:1632-3.[Medline]
  5. Beranek JT. Myocardial pseudovascular tubes are present in the delayed rejection of heart xenografts [letter comment]. Transplantation 1997;63:486-7.[Medline]
  6. Beranek JT. Eosinophilic droplets similar to red cells are present in the hyperacute rejection of heart xenografts [letter; comment]. J Intern Med 1997;241:89-90.[Medline]
  7. Kang PM, Haunstetter A, Aoki H. Usheva A, Izumo S. Morphological and molecular characterization of adult cardiomyocyte apoptosis during hypoxia and reoxygenation. Circ Res 2000;87:118-25.[Abstract/Free Full Text]




This Article
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Right arrow Mediastinum
Right arrow Transplantation - heart
Right arrow Esophagus - cancer

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