title: Apoptosis and increased expression of inducible nitric oxide synthase in human allograft rejection.
abstract: BACKGROUND
  The mechanisms of myocyte death during cardiac allograft rejection are incompletely understood. In a previous study using a rat heterotopic cardiac allograft model, we showed that cardiac myocyte apoptosis, inducible nitric oxide synthase (iNOS) mRNA, protein and enzyme activity, and nitrotyrosine increased simultaneously during cardiac allograft rejection. This study was designed to investigate whether apoptosis and expression of iNOS occur in human cardiac allograft rejection.
  
  
  METHODS
  Right ventricular endomyocardial biopsies from 30 cases of allograft rejection (International Society of Heart and Lung Transplantation grade 3A/B) were compared with 12 biopsies with no rejection (International Society of Heart and Lung Transplantation grade 0). Samples were co-labeled for apoptosis and muscle actin. Serial sections were stained for iNOS, nitrotyrosine, and the leukocyte markers CD3, CD4, CD8, and CD68 to identify T-cell subpopulations and macrophages.
  
  
  RESULTS
  Biopsies with cardiac allograft rejection showed a 30-fold increase of apoptotic cells when compared with controls. Most apoptotic cardiac myocytes were found in proximity to macrophage (CD68+)-rich inflammatory infiltrates. iNOS immunoreactivity was strongest in macrophages and adjacent myocytes, which also showed high levels of nitrotyrosine, representing damage by peroxynitrite.
  
  
  CONCLUSIONS
  Apoptosis is a major form of myocyte death during human cardiac allograft rejection. Cardiac myocyte apoptosis is closely associated with expression of iNOS in macrophages and myocytes and with nitration of myocyte proteins by peroxynitrite.
authors.affiliation: Department of Pathology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Szabolcs
authors.forename: S
authors.initials: S
authors.lastname: Ravalli
authors.forename: O
authors.initials: O
authors.lastname: Minanov
authors.forename: R R
authors.initials: RR
authors.lastname: Sciacca
authors.forename: R E
authors.initials: RE
authors.lastname: Michler
authors.forename: P J
authors.initials: PJ
authors.lastname: Cannon
mesh_terms: D000208:Acute Disease; D017209:Apoptosis; D001706:Biopsy; D006084:Graft Rejection; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000473:pathology; D009206:Myocardium / Q000201:enzymology / Q000473:pathology; D019001:Nitric Oxide Synthase / Q000378:metabolism*; D052247:Nitric Oxide Synthase Type II
chemical_list: C496319:NOS2 protein, human; D019001:Nitric Oxide Synthase; D052247:Nitric Oxide Synthase Type II