Fredrich R, Toyoda M, Czer L S, Galfayan K, Galera O, Trento A, Freimark D, Young S, Jordan S C
Department of Pediatrics, Cedars-Sinai Medical Center/UCLA School of Medicine, Los Angeles, California 90048, USA.
Transplantation. 1999 Feb 15;67(3):385-91. doi: 10.1097/00007890-199902150-00008.
Vascular endothelial cells are primary targets for injury during both cellular and humoral allograft rejection (AR). In cardiac transplantation, the role of humoral immunity in mediating AR has not been extensively characterized.
Antibodies against human vascular endothelial cells (AECA) were measured using a cellular ELISA developed from human umbilical vein endothelial cells in 80 consecutive patients after cardiac transplantation. The aim was to determine the incidence of AECA formation after transplantation and their association with different types of AR, graft survival, and development of cardiac allograft vasculopathy (CAV). At least eight serum samples obtained from each patient were examined for AECA and an endomyocardial biopsy was performed at regular intervals during the first year after transplantation.
Of the 80 patients examined, 31 were AECA (+) and 49 patients were AECA (-). There were no significant differences between the AECA (+) and (-) groups when examined for age, sex, and pretransplantation ischemia time. A significant correlation was found between the presence of AECA and humoral AR (P<0.015). AECA positivity did not correlate with the presence of cellular AR or the number of rejection episodes. In addition, allograft survival at 2 years after transplantation was significantly better in the AECA (-) group compared with that in the AECA (+) group (89.8% vs. 71.0%, P<0.0004). The persistence of AECA positivity during the first year after transplantation was also associated with a significantly greater incidence of CAV when compared with the patients who were AECA (-) (25.8% vs. 14.3%, P<0.004).
AECA may be important in the mediation of humoral AR, may decrease allograft survival, and may identify a high-risk group for CAV.
在细胞和体液性同种异体移植排斥反应（AR）过程中，血管内皮细胞都是损伤的主要靶点。在心脏移植中，体液免疫在介导AR中的作用尚未得到充分表征。
采用从人脐静脉内皮细胞开发的细胞酶联免疫吸附测定法（ELISA），对80例心脏移植术后连续患者的抗人血管内皮细胞抗体（AECA）进行检测。目的是确定移植后AECA形成的发生率及其与不同类型AR、移植物存活以及心脏移植血管病变（CAV）发生的关联。对每位患者至少采集8份血清样本检测AECA，并在移植后第一年定期进行心内膜心肌活检。
在检查的80例患者中，31例AECA阳性（AECA(+)），49例AECA阴性（AECA(-)）。在年龄、性别和移植前缺血时间方面，AECA(+)组和(-)组之间无显著差异。发现AECA的存在与体液性AR之间存在显著相关性（P<0.015）。AECA阳性与细胞性AR的存在或排斥发作次数无关。此外，移植后2年时，AECA(-)组的移植物存活率显著高于AECA(+)组（89.8%对71.0%，P<0.0004）。与AECA(-)患者相比，移植后第一年AECA持续阳性也与CAV的发生率显著更高相关（25.8%对14.3%，P<0.004）。
AECA可能在体液性AR的介导中起重要作用，可能降低移植物存活率，并可能识别出CAV的高危组。
