Published online before print January 30, 2003, doi: 10.1161/01.ATV.0000059337.60393.64
© 2003 American Heart Association, Inc.
ATVB In Focus |
Origin of Vascular Smooth Muscle Cells and the Role of Circulating Stem Cells in Transplant Arteriosclerosis
From the Department of Cell Biology, Section Immunology, Faculty of Medical Sciences, University of Groningen, The Netherlands.
Correspondence to J.L. Hillebrands, PhD, Department Cell Biology/Section Immunology, Faculty of Medical Sciences, University of Groningen, A. Deusinglaan 1, NL-9713 AV Groningen, The Netherlands. E-mail j.l.hillebrands{at}med.rug.nl
Abstract
To date, clinical solid-organ transplantation has not achieved its goals as a long-term treatment for patients with end-stage organ failure. Development of so-called chronic transplant dysfunction (CTD) is now recognized as the predominant cause of allograft loss long term (after the first postoperative year) after transplantation. CTD has the remarkable histological feature that the luminal areas of intragraft arteries become obliterated, predominantly with vascular smooth muscle cells (VSMCs) intermingled with some inflammatory cells (transplant arteriosclerosis, or TA). The development of TA is a multifactorial process, and many risk factors have been identified. However, the precise pathogenetic mechanisms leading to TA are largely unknown and, as a result, adequate prevention and treatment protocols are still lacking. This review discusses the origin (donor versus recipient, bone marrow versus nonbone marrow) of the VSMCs in TA lesions. Poorly controlled influx and subsequent proliferative behavior of these VSMCs are considered to be critical elements in the development of TA. Available data show heterogeneity when analyzing the origin of neointimal VSMCs in various transplant models and species, indicating the existence of multiple sites of origin. Based on these findings, a model considering plasticity of VSMC origin in TA in relation to severity and extent of graft damage is proposed.
Key Words: chronic transplant dysfunction • transplantation • transplant arteriosclerosis • origin • vascular smooth muscle cells
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