Quilty lesions are associated with increased expression of vitronectin receptor (alphavbeta3) and subsequent development of coronary vasculopathy.
BACKGROUND
Quilty lesions are common after heart transplantation; however, their relationship to vasculopathy has not been described. We tested the hypothesis that Quilty lesions are associated with increased expression of vitronectin receptor (alphavbeta3) and the subsequent development of coronary vasculopathy.


METHODS
A total of 140 heart transplant recipients underwent coronary intravascular ultrasound at baseline and at 1 year after transplantation, and we measured the change in coronary maximal intimal thickness. Endomyocardial biopsy specimens taken within 8 weeks after transplantation showed Quilty lesions in 54 of 140 (39%) patients (Quilty group). We compared these results with the remaining 86 of 140 patients (61%) who had no evidence of Quilty lesions during the same period (control group). We evaluated 10 endomyocardial biopsy specimens from each group for alphavbeta3, using immunohistochemistry staining and immunoblotting.


RESULTS
Quilty lesions stained positive for alphavbeta3, and Western blot analysis showed a 1.3-fold (p = 0.004) increase in expression of alphavbeta3. Compared with control, the Quilty group tended to have a greater incidence of post-transplant ischemic injury complicated by fibrosis (54% vs 38%, p = 0.08) and a greater reported incidence of "previous biopsy site" during the first 4 weeks after transplantation (48% vs 32%, p = 0.06). At 1 year, the Quilty group had a significant increase in the change in coronary maximal intimal thickness seen with intravascular ultrasound (0.54 +/- 0.34 vs 0.42 +/- 0.28 mm, p = 0.038).


CONCLUSIONS
This is the first report to describe the association of Quilty lesions with coronary vasculopathy and its association with increased alphavbeta3 expression.
Yamani
Mohamad H
MH
Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. yamanim@ccf.org
Ratliff
Norman B
NB
Starling
Randall C
RC
Tuzcu
E Murat
EM
Yu
Yang
Y
Cook
Daniel J
DJ
Crow
Timothy
T
Hobbs
Robert
R
Rincon
Gustavo
G
Bott-Silverman
Corinne
C
McCarthy
Patrick M
PM
Young
James B
JB
D000328:Adult; D015153:Blotting, Western; D003327:Coronary Disease / Q000378:metabolism* / Q000601:surgery; D003331:Coronary Vessels / Q000378:metabolism* / Q000473:pathology* / Q000601:surgery; D004719:Endomyocardial Fibrosis / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D005434:Flow Cytometry; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D015994:Incidence; D039302:Integrin alphaVbeta3 / Q000096:biosynthesis*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D013223:Statistics as Topic; D013601:T-Lymphocytes / Q000378:metabolism; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D039302:Integrin alphaVbeta3