Leukotriene B4 Contributes to Development of Cardiac Allograft Vasculopathy

Abstract

Purpose Cardiac allograft vasculopathy (CAV) is a highly prevalent vaso-occlusive disease that is a leading cause of graft failure and mortality after heart transplantation. While the pathogenesis of CAV remains incompletely understood, histologic evidence suggests that macrophages, which constitute an important part of the innate immune response, may play an important role. Prior studies in pulmonary hypertension have shown that macrophage-derived leukotriene B4 (LTB4) induces proliferation and hypertrophy of human pulmonary artery smooth muscle cells. We hypothesized that LTB4 plays a similar role in the development of CAV. Methods Human studies: We performed immunofluorescence staining of sections from human CAV+ and CAV- coronary arteries with CD68 (macrophage marker) and 5-LO (5-lipoxygenase, LTB4-producing enzyme), and measured serial LTB4 plasma levels in 14 patients with angiographic CAV and 14 matched CAV- controls. Rat model: We performed aortic transplants in a rat CAV model (Fischer into Lewis orthotopic aortic transplants, n=11) with allogeneic transplants as controls (n=6), and performed CD68 and 5-LO staining of aortic cross-sections of mice with and without aortic intimal hyperplasia. We then treated rat allogeneic transplants with bestatin (protease inhibitor that blocks LTB4 production) to determine whether LTB4 inhibition can prevent the intimal proliferation seen in this rat CAV model. Results Immunofluorescence staining showed that 5-LO co-localized with CD68+ macrophages in the intimal layer of CAV+ human arterioles and in allogeneic rat aortic transplant models. Plasma LTB4 levels were higher in CAV+ cases compared to CAV- controls (n=14 per group, p Conclusion Macrophage-derived leukotriene B4 may contribute to development of CAV. Blockade of LTB4 synthesis has the potential to prevent CAV development after heart transplantation.