title: Annexin-V imaging for noninvasive detection of cardiac allograft rejection.
abstract: Heart transplant rejection is characterized pathologically by myocyte necrosis and apoptosis associated with interstitial mononuclear cell infiltration. Any one of these components can be targeted for noninvasive detection of transplant rejection. During apoptotic cell death, phosphatidylserine, a phospholipid that is normally confined to the inner leaflet of cell membrane bilayer, gets exteriorized. Technetium-99m-labeled annexin-V, an endogenous protein that has high affinity for binding to phosphatidylserine, has been administered intravenously for noninvasive identification of apoptotic cell death. In the present study of 18 cardiac allograft recipients, 13 patients had negative and five had positive myocardial uptake of annexin. These latter five demonstrated at least moderate transplant rejection and caspase-3 staining, suggesting apoptosis in their biopsy specimens. This study reveals the clinical feasibility and safety of annexin-V imaging for noninvasive detection of transplant rejection by targeting cell membrane phospholipid alterations that are commonly associated with the process of apoptosis.
authors.affiliation: Hahnemann University Hospital, Philadelphia, Pennsylvania, USA. jagat.narula@drexel.edu
authors.forename: J
authors.initials: J
authors.lastname: Narula
authors.forename: E R
authors.initials: ER
authors.lastname: Acio
authors.forename: N
authors.initials: N
authors.lastname: Narula
authors.forename: L E
authors.initials: LE
authors.lastname: Samuels
authors.forename: B
authors.initials: B
authors.lastname: Fyfe
authors.forename: D
authors.initials: D
authors.lastname: Wood
authors.forename: J M
authors.initials: JM
authors.lastname: Fitzpatrick
authors.forename: P N
authors.initials: PN
authors.lastname: Raghunath
authors.forename: J E
authors.initials: JE
authors.lastname: Tomaszewski
authors.forename: C
authors.initials: C
authors.lastname: Kelly
authors.forename: N
authors.initials: N
authors.lastname: Steinmetz
authors.forename: A
authors.initials: A
authors.lastname: Green
authors.forename: J F
authors.initials: JF
authors.lastname: Tait
authors.forename: J
authors.initials: J
authors.lastname: Leppo
authors.forename: F G
authors.initials: FG
authors.lastname: Blankenberg
authors.forename: D
authors.initials: D
authors.lastname: Jain
authors.forename: H W
authors.initials: HW
authors.lastname: Strauss
mesh_terms: D000328:Adult; D000368:Aged; D017304:Annexin A5; D017209:Apoptosis; D001692:Biological Transport; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D016027:Heart Transplantation / Q000000981:diagnostic imaging* / Q000276:immunology*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging / Q000379:methods*
chemical_list: D017304:Annexin A5; D015609:Organotechnetium Compounds; C417036:technetium Tc 99m annexin V