title: Evaluation of CXCL9 and CXCL10 as circulating biomarkers of human cardiac allograft rejection.
abstract: BACKGROUND
  Cardiac allograft rejection remains a significant clinical problem in the early phase after heart transplantation and requires frequent surveillance with endomyocardial biopsy. However, this is an invasive procedure, which is unpleasant for the patient and carries a certain risk. Therefore, a sensitive non-invasive biomarker of acute rejection would be desirable.
  
  
  METHODS
  Endomyocardial tissue samples and serum were obtained in connection with clinical biopsies from twenty consecutive heart transplant patients followed for six months. A rejection episode was observed in 14 patients (11 men and 3 women) and biopsies obtained before, during and after the episode were identified. Endomyocardial RNA, from three patients, matching these three points in time were analysed with DNA microarray. Genes showing up-regulation during rejection followed by normalization after the rejection episode were evaluated further with real-time RT-PCR. Finally, ELISA was performed to investigate whether change in gene-regulation during graft rejection was reflected in altered concentrations of the encoded protein in serum.
  
  
  RESULTS
  Three potential cardiac allograft rejection biomarker genes, chemokine (C-X-C motif) ligand 9 (CXCL9), chemokine (C-X-C motif) ligand 10 (CXCL10) and Natriuretic peptide precursor A (NPPA), from the DNA microarray analysis were selected for further evaluation. CXCL9 was significantly upregulated during rejection (p < 0.05) and CXCL10 displayed a similar pattern without reaching statistical significance. Serum levels of CXCL9 and CXCL10 were measured by ELISA in samples from 10 patients before, during and after cardiac rejection. There were no changes in CXCL9 and CXCL10 serum concentrations during cardiac rejection. Both chemokines displayed large individual variations in the selected samples, but the serum levels between the two chemokines correlated (p < 0.001).
  
  
  CONCLUSIONS
  We conclude, that despite a distinct up-regulation of CXCL9 mRNA in human hearts during cardiac allograft rejection, this was not reflected in the serum levels of the encoded protein. Thus, in contrast to previous suggestions, serum CXCL9 does not appear to be a promising serum biomarker for cardiac allograft rejection.
authors.affiliation: Department of Cardiology, The Sahlgrenska Academy, Göteborgs University, SE-413 45, Göteborg, Sweden. kristjan.karason@medfak.gu.se
authors.forename: Kristjan
authors.initials: K
authors.lastname: Karason
authors.forename: Margareta
authors.initials: M
authors.lastname: Jernås
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hägg
authors.forename: Per-Arne
authors.initials: PA
authors.lastname: Svensson
mesh_terms: D000328:Adult; D009320:Atrial Natriuretic Factor / Q000235:genetics / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D054357:Chemokine CXCL10; D054370:Chemokine CXCL9; D019743:Chemokines, CXC / Q000097:blood* / Q000235:genetics / Q000378:metabolism; D016000:Cluster Analysis; D004699:Endocardium / Q000378:metabolism; D005260:Female; D020869:Gene Expression Profiling; D006084:Graft Rejection / Q000097:blood* / Q000235:genetics / Q000378:metabolism; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D020411:Oligonucleotide Array Sequence Analysis; D012333:RNA, Messenger / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014184:Transplantation, Homologous
chemical_list: D015415:Biomarkers; C114753:CXCL10 protein, human; C080810:CXCL9 protein, human; D054357:Chemokine CXCL10; D054370:Chemokine CXCL9; D019743:Chemokines, CXC; C472955:NPPA protein, human; D012333:RNA, Messenger; D009320:Atrial Natriuretic Factor