title: Cells of primarily extra-valvular origin in degenerative aortic valves and bioprostheses.
abstract: OBJECTIVE
  We assessed aortic valves from patients with non-rheumatic aortic valve stenosis (AS) and with degenerative aortic valve bioprostheses (BP) for the presence of progenitor cell and leukocyte subtype-specific markers.
  
  
  RESULTS
  Diseased valve probes from a total of 87 patients (60 AS and 27 BP) were studied. We assessed presence and localization of endothelial progenitor cells (EPCs: CD34, CD133), dendritic cells (DCs: S100), T-lymphocytes (CD3), and macrophages (CD68) by immunohistochemical and morphometric analyses. In the majority of valves, we detected cell-bound signals of CD34 (48% of AS, 74% of BP, respectively), CD133 (58%/81%), S100 (58%/93%), CD3 (62%/81%), and CD68 (78%/93%). Labelled cells were predominantly localized within the valvular fibrosa. As key results, frequency of EPCs, DCs, macrophages, and lymphocytes was found significantly higher in BP when compared with AS (CD34: 19.2+/-23.2 vs. 5.7+/-13.0%; CD133: 13.7+/-12.4 vs. 5.5+/-8.3%; S100: 15.2+/-12.2 vs. 5.7+/-8.9%; CD3: 3.3+/-2.7 vs. 1.1+/-1.4%; CD68: 35.3+/-26.6 vs. 3.4+/-4.1%; each P<or=0.001).
  
  
  CONCLUSIONS
  EPCs and DCs were detected in a large collective of degenerative aortic valves, more frequently in bioprostheses than in native cusps. Aortoluminal presence of these primarily extra-valvular cells co-localized with inflammatory cells is a novel key feature involved in aortic valve degeneration.
authors.affiliation: Department of Cardiology, Heart Center University of Bonn, Bonn, Germany. dirk.skowasch@ukb.uni-bonn.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Skowasch
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schrempf
authors.forename: Nicolas
authors.initials: N
authors.lastname: Wernert
authors.forename: Martin
authors.initials: M
authors.lastname: Steinmetz
authors.forename: Alexander
authors.initials: A
authors.lastname: Jabs
authors.forename: Izabela
authors.initials: I
authors.lastname: Tuleta
authors.forename: Ulrich
authors.initials: U
authors.lastname: Welsch
authors.forename: Claus J
authors.initials: CJ
authors.lastname: Preusse
authors.forename: James A
authors.initials: JA
authors.lastname: Likungu
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.forename: Berndt
authors.initials: B
authors.lastname: Lüderitz
authors.forename: Gerhard
authors.initials: G
authors.lastname: Bauriedel
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000473:pathology* / Q000601:surgery; D001705:Bioprosthesis; D003713:Dendritic Cells / Q000473:pathology; D042783:Endothelial Cells / Q000473:pathology; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007150:Immunohistochemistry; D016131:Lymphocyte Subsets; D008264:Macrophages / Q000473:pathology; D008297:Male; D012189:Retrospective Studies; D013234:Stem Cells / Q000473:pathology*; D013601:T-Lymphocytes