Heart transplantation: a magnified model of heart-brain interactions.

Abstract

The human heart transplant model unmasks the heart-brain link as an active process that is clinically demonstrated and confirmed at the tissue level. Further studies are needed to elucidate the relative contribution of each of these isolated observations to the pathogenesis of coronary allograft vasculopathy, which remains enigmatic. Recent studies have suggested that mTOR inhibitors may have the ability to attenuate this lethal process that limits the long-term survival of cardiac transplant recipients. The observations we have discussed here suggest that other targeted therapies, including glycoprotein IIb/IIIa inhibitors, tissue metalloproteinase inhibitors, and angiotensin receptor blockers, may facilitate the attenuation of cardiac transplant vasculopathy, but clinical trials are difficult to conduct in this relatively small population of patients. These observations may shed insight, however, into the pathophysiology of hypertension and its impact on the vascular system, as cardiac transplantation provides a setting in which heart-brain interactions are magnified and the pathophysiology occurs over years rather than decades.