title: Decay-accelerating factor expression may provide immunoprotection against antibody-mediated cardiac allograft rejection.
abstract: BACKGROUND
  Not all patients with complement deposition of the heart have developed hemodynamic instability at the time of diagnosis, suggesting that immunoprotective mechanisms reside within grafts. We hypothesized that decay-accelerating factor (DAF) could provide a first-line defense against complement injury, thus explaining the discrepancy in hemodynamics. Thus, we examined the role of DAF in the clinical presentation of antibody-mediated cardiac allograft rejection.
  
  
  METHODS
  Endomyocardial biopsies from C4d(+)/C3d(+) patients were immunoflourescently stained for DAF, and its expression was compared in patients who did (n = 5) and did not (n = 4) exhibit allograft dysfunction.
  
  
  RESULTS
  Endomyocardial biopsies of patients without allograft dysfunction displayed intense staining of endothelial bound DAF expression at the time of antibody-mediated cardiac allograft rejection. Conversely, biopsies of patients with allograft dysfunction showed no evidence of DAF at that time.
  
  
  CONCLUSIONS
  Expression of DAF on cardiac allografts may provide an immunoprotective mechanism against the deleterious effects of complement deposition in patients with antibody-mediated cardiac allograft rejection.
authors: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. gonzalg@ccf.org
authors: Gonzalo V
authors: GV
authors: González-Stawinski
authors: Carmela D
authors: CD
authors: Tan
authors: Nicholas G
authors: NG
authors: Smedira
authors: Randall C
authors: RC
authors: Starling
authors: E Rene
authors: ER
authors: Rodríguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology*; D018958:CD55 Antigens / Q000378:metabolism*; D004396:Coloring Agents; D015933:Complement C3d / Q000378:metabolism; D015935:Complement C4b / Q000378:metabolism; D004699:Endocardium / Q000378:metabolism*; D004801:Eosine Yellowish-(YS); D005260:Female; D005455:Fluorescent Antibody Technique; D005456:Fluorescent Dyes; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control*; D006321:Heart / Q000503:physiopathology; D016027:Heart Transplantation / Q000276:immunology*; D006416:Hematoxylin; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism; D010865:Pilot Projects; D011184:Postoperative Period; D013194:Staining and Labeling; D014184:Transplantation, Homologous
chemical_list: D000906:Antibodies; D018958:CD55 Antigens; D004396:Coloring Agents; D005456:Fluorescent Dyes; D010446:Peptide Fragments; D015933:Complement C3d; D015935:Complement C4b; C032261:complement C4d; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin