title: VEGF-C, VEGF-A and related angiogenesis factors as biomarkers of allograft vasculopathy in cardiac transplant recipients.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV), the major cause of late allograft loss after cardiac transplantation, results from donor-directed cellular and humoral alloimmune responses. Graft vascular endothelial cells (EC) are primary targets of these destructive responses, suggesting that factors associated with endothelial injury and repair could serve as biomarkers of CAV.
  
  
  METHODS
  Using a protein profiler array platform, we measured the levels of 55 angiogenesis-related proteins in sera from 33 adult heart transplant recipients, including 17 with angiographically documented CAV and 16 age- and gender-matched controls without CAV. All patients were >2 years after heart transplant.
  
  
  RESULTS
  The study population was 75% male with a mean age of 62 ± 11 years. On average, patients were 12 ± 5 years after heart transplantation. We found that vascular endothelial growth factor (VEGF)-C, VEGF-A, angiopoietin-2, artemin, urokinase-type plasminogen activator and vasohibin were strongly associated with established CAV (all p < 0.01). Multivariable modeling identified VEGF-C, VEGF-A and platelet factor-4 (PF-4) as significant independent biomarkers of CAV. Furthermore, receiver-operating characteristic curve analysis demonstrated that the combination of all 3 molecules provided outstanding performance for the diagnosis of CAV (area under the curve [AUC] = 0.98; p < 0.001).
  
  
  CONCLUSIONS
  Serum levels of VEGF-C, VEGF-A and PF-4 demonstrate strong associations with established CAV and, together with related angiogenesis factors, may serve as a reliable, non-invasive diagnostic test for CAV in cardiac transplant recipients.
authors.affiliation: Transplantation Research Center, Division of Nephrology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Daly
authors.forename: Michael E
authors.initials: ME
authors.lastname: Seifert
authors.forename: Anil
authors.initials: A
authors.lastname: Chandraker
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Anju
authors.initials: A
authors.lastname: Nohria
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
authors.forename: David M
authors.initials: DM
authors.lastname: Briscoe
mesh_terms: D043925:Angiogenesis Inducing Agents / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D011446:Prospective Studies; D014652:Vascular Diseases / Q000097:blood*; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*; D042582:Vascular Endothelial Growth Factor C / Q000097:blood*
chemical_list: D043925:Angiogenesis Inducing Agents; D015415:Biomarkers; D042461:Vascular Endothelial Growth Factor A; D042582:Vascular Endothelial Growth Factor C