Background-Outcomes for organ transplantation are constantly improving because of advances in organ preservation, surgical techniques, immune clinical monitoring, and immunosuppressive treatment preventing acute transplant rejection. However, chronic rejection including transplant vasculopathy still limits long-term patient survival. Transplant vasculopathy is characterized by progressive neointimal hyperplasia leading to arterial stenosis and ischemic failure of the allograft. This work sought to decipher the manner in which the humoral immune response, mimicked by W6/32 anti-HLA antibody, contributes to transplant vasculopathy. Methods and Results-Studies were performed in vitro on cultured human smooth muscle cells, ex vivo on human arterial segments, and in vivo in a model consisting of human arterial segments grafted into severe combined immunodeficiency/beige mice injected weekly with anti-HLA antibodies. We report that anti-HLA antibodies are mitogenic for smooth muscle cells through a signaling mechanism implicating matrix metalloproteinases (MMPs) (membrane type 1 MMP and MMP2) and neutral sphingomyelinase-2. This mitogenic signaling and subsequent DNA synthesis are blocked in smooth muscle cells silenced for MMP2 or for neutral sphingomyelinase-2 by small interfering RNAs, in smooth muscle cells transfected with a vector coding for a dominant-negative form of membrane type 1 MMP, and after treatment by pharmacological inhibitors of MMPs (Ro28-2653) or neutral sphingomyelinase-2 (GW4869). In vivo, Ro28-2653 and GW4869 reduced the intimal thickening induced by anti-HLA antibodies in human mesenteric arteries grafted into severe combined immunodeficiency/beige mice. Key Words: anti HLA class I mAb Ⅲ metalloproteinases Ⅲ proliferation Ⅲ smooth muscle cells Ⅲ transplant vasculopathy P rogress in surgical techniques, organ preservation, and immunosuppressive drugs has improved the outcome of organ allografts. 1 However, the late outcome of organ transplants is impaired by transplant vasculopathy (also known as transplant arteriosclerosis or chronic vascular rejection), which occurs in up to 50% of heart transplant recipients within 5 years after transplantation. 2,3 Transplant vasculopathy is mediated by immune and nonimmune mechanisms (such as ischemia/reperfusion, inflammation, viral infection, and hypertension) that trigger diffuse and concentric intimal hyperplasia and lead finally to arterial stenosis, chronic ischemia, and functional loss of the grafted organ. 2,4,5
Conclusions-These
Clinical Perspective on p 2734Both cell-mediated and humoral immunologic mechanisms are thought to participate in the pathogenesis of transplant vasculopathy. [5][6][7][8] Experimental and clinical studies suggest that B cells and donor-specific alloantibodies play a role in Received January 25, 2011; accepted October 11, 2011. From INSERM UMR-1048, Toulouse, France (S.G., M. Trayssac, N.A., J.T., D.C., M. Thomsen, A.N.-S., R.S.); Faculty of Medicine, Department of Biochemistry, University of Toulouse, Toulouse, Franc...