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*Substance via MeSH
Medline Plus Health Information
*Heart Transplantation
*Vascular Diseases
The Journal of Immunology, 2002, 169: 1556-1560.
Copyright © 2002 by The American Association of Immunologists

Differential Expression of the IFN-{gamma}-Inducible CXCR3-Binding Chemokines, IFN-Inducible Protein 10, Monokine Induced by IFN, and IFN-Inducible T Cell {alpha} Chemoattractant in Human Cardiac Allografts: Association with Cardiac Allograft Vasculopathy and Acute Rejection1

David Xiao-Ming Zhao2,*, Yenya Hu{dagger}, Geraldine G. Miller{ddagger}, Andrew D. Luster§, Richard N. Mitchell and Peter Libby||

* Cardiovascular Medicine and Departments of {dagger} Cardiac Surgery and {ddagger} Medicine, Vanderbilt University Medical Center, Nashville, TN 37232; § Center for Immunology and Inflammatory Disease, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Departments of Pathology and || Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
CXCR3 chemokines exert potent biological effects on both immune and vascular cells. The dual targets suggest their important roles in cardiac allograft vasculopathy (CAV) and rejection. Therefore, we investigated expression of IFN-inducible protein 10 (IP-10), IFN-inducible T cell {alpha} chemoattractant (I-TAC), monokine induced by IFN (Mig), and their receptor CXCR3 in consecutive endomyocardial biopsies (n = 133) from human cardiac allografts and corresponding normal donor hearts (n = 11) before transplantation. Allografts, but not normal hearts, contained IP-10, Mig, and I-TAC mRNA. Persistent elevation of IP-10 and I-TAC was associated with CAV. Allografts with CAV had an IP-10-GAPDH ratio 3.7 ± 0.8 compared with 0.8 ± 0.2 in those without CAV (p = 0.004). Similarly, I-TAC mRNA levels were persistently elevated in allografts with CAV (6.7 ± 1.9 in allografts with vs 1.5 ± 0.3 in those without CAV, p = 0.01). In contrast, Mig mRNA was induced only during rejection (2.4 ± 0.9 with vs 0.6 ± 0.2 without rejection, p = 0.015). In addition, IP-10 mRNA increased above baseline during rejection (4.1 ± 2.3 in rejecting vs 1.8 ± 1.2 in nonrejecting biopsies, p = 0.038). I-TAC did not defer significantly with rejection. CXCR3 mRNA persistently elevated after cardiac transplantation. Double immunohistochemistry revealed differential cellular distribution of CXCR3 chemokines. Intragraft vascular cells expressed high levels of IP-10 and I-TAC, while Mig localized predominantly in infiltrating macrophages. CXCR3 was localized in vascular and infiltrating cells. CXCR3 chemokines are induced in cardiac allografts and differentially associated with CAV and rejection. Differential cellular distribution of these chemokines in allografts indicates their central roles in multiple pathways involving CAV and rejection. This chemokine pathway may serve as a monitor and target for novel therapies to prevent CAV and rejection.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Acute rejection remains a major concern in solid organ transplantation, although current immunosuppressants have significantly reduced its occurrence. Increasing evidence suggests that acute rejection, particularly untreated low grade rejection, predisposes cardiac allografts to the development of cardiac allograft vasculopathy (CAV).3 Effector T cell recruitment and retention in cardiac allografts critically participate in the development of acute rejection. Chemokines bind to CXCR3 receptors (therefore denoted as CXCR3 chemokines) and are potent chemoattractants for alloantigen-primed T cells. These CXCR3 chemokines include a trio of chemotactic polypeptides IFN-inducible protein 10 (IP-10), CXCL10; monokine induced by IFN (Mig), CXCL9; and IFN-inducible T cell {alpha} chemoattractant (I-TAC), CXCL11) typically smaller than 10 kDa and induced by IFN-{gamma}. The CXC chemokines fall into two classes based on the presence or absence of an NH2-terminal ELR sequence (ELR: Glu-Leu-Arg). The ELR-containing CXC chemokines (e.g., IL-8) attract neutrophils, while the non-ELR-containing CXC chemokines (e.g., IP-10, I-TAC, Mig) attract lymphocytes (1). IP-10, Mig, and I-TAC bind to their only receptor CXCR3. Activated T cells, NK cells, and vascular cells express CXCR3. Increased expression of IP-10, Mig, and I-TAC may contribute to the recruitment and retention of activated T lymphocytes in conventional atherosclerotic plaques (2, 3). Several studies demonstrate increased expression of various chemokines in animal transplant models and human transplanted hearts (4, 5, 6, 7, 8, 9, 10, 11). In murine cardiac transplant models, IP-10 and its receptor CXCR3 were required for development of rejection (5, 12). Recently, Miura et al. (9) demonstrated that neutralization of Mig with antiserum prolonged graft survival. These results indicate significant biological importance of CXCR3 chemokines in allograft rejection.

The long-term survival of transplanted hearts is limited by CAV. Increasing evidence supports an immune-mediated and growth factor-driven mechanism for CAV (13, 14, 15, 16). We and others have shown that IFN-{gamma} plays an essential role in the pathogenesis of CAV (14). Absence or neutralization of IFN-{gamma} markedly reduces CAV in mice. IFN-{gamma} alone sufficed to induce transplantation arteriosclerosis in SCID mice (17). IFN-{gamma} modulates the immune response by stimulating the production of adhesion molecules, MHC class II expression, and cytokines including CXCR3 chemokines. In addition to their potent effects on immune system (1), CXCR3 chemokines potently alter vascular cell functions (3, 18). The dual targets of these molecules suggest a critical role for these mediators in the pathogenesis of CAV, a disease characterized by immune-mediated vascular SMC proliferation.

Members of the CXC chemokine family can display disparate angiogenic activity depending upon the presence or absence of the ELR motif. ELR-containing CXC chemokines (e.g., IL-8) stimulate angiogenesis. In contrast, non-ELR-containing CXC chemokines (e.g., platelet factor 4, IP-10, Mig, and I-TAC) are angiostatic (19). Non-ELR-containing CXC chemokines can potentiate growth factor-induced SMC mitogenesis. Cardiac allografts exhibit augmented expression of several growth factors, including acidic fibroblast growth factor, platelet-derived growth factor (20, 21), and vascular endothelial growth factor (22). Increased expression of those growth factors correlates with the development of CAV (15, 16). In contrast, transplanted hearts generally do not develop abundant collateral vessels, despite high levels of angiogenic growth factors (23, 24). Therefore, angiostatic factors such as non-ELR-containing CXCR3 chemokines expressed in the transplanted hearts may antagonize neovessel formation, but promote SMC proliferation. Accordingly, this study tested the hypothesis that expression of CXCR3 chemokines increases in human cardiac allografts and may participate in the pathogenesis of CAV and rejection.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Myocardial biopsies from cardiac allografts and normal hearts

A total of 133 sequential endomyocardial biopsies from 11 cardiac allografts and biopsies from their corresponding normal donor hearts before the transplantation were analyzed for expression of IP-10, I-TAC, Mig, and CXCR3 mRNA by quantitative RT-PCR. Myocardium from normal donor hearts was obtained before transplantation. Allograft myocardial biopsies were obtained at routine follow-up biopsy after transplantation or when clinically indicated. At each cardiac catheterization, four biopsies were obtained for histology to monitor allograft rejection, and one was obtained and frozen for RNA extraction. Acute allograft rejection was graded according to the criteria established by International Society of Heart Lung Transplantation.

Annual coronary angiography was used to assess CAV. Coronary angiograms were reviewed and compared with baseline angiograms independently by two cardiologists who were unaware of the results of current study. CAV was assessed according to the criteria established by Gao et al. (23).

Isolation of RNA from myocardial biopsies and RT-PCR

Total RNA was isolated from myocardial biopsies using RNAzol B (Tel-Test, Friendswood, TX) and was used as template for cDNA synthesis. Primers used in PCR are IP-10 (5'-agaatgctgtcctcg-3' and 5'-tttcttgcaggctttggtct-3'), Mig (5'-aaatgtaacccaggacgctg-3' and 5'-gccttggatggaagaacaaa-3'), I-TAC (5'-ccactgtccccactgacttt-3' and 5'-ggcaatgacgaaggaggtta-3'), CXCR3 (5'-agctttgaccgctacctgaa-3' and 5'-ctcacaagcccgagtaggag-3'), and GAPDH (24). Techniques of quantitative RT-PCR have been described previously (16, 24). Standard curves within the exponential range of amplification for each gene were generated with known amount of cDNA template. The concentration of cDNA in each sample was calculated from the standards run at the same time. RNA from myocardial biopsies could not be quantitated because of the small size of the biopsies. Therefore, the amount of cDNA for each gene was normalized to the amount of cDNA for GAPDH in each sample. The ratio (x1000) between each gene of interest and GAPDH is used for comparison.

Immunohistochemistry

Biopsies from nine allografts and five normal hearts were analyzed using immunohistochemical staining. Serial cryostat sections (5 µm) were incubated sequentially in 0.3% H2O2/PBS, 5% horse serum/PBS, and first Abs in 5% horse serum/PBS. The primary Abs used were rabbit anti-human IP-10 (1:100), I-TAC (1:50), Mig (1:50) (2, 25, 26), and monoclonal anti-human CXCR3 (R&D Systems, Minneapolis, MN). Rabbit or mouse IgG was used as primary Ab in negative controls at different dilutions (1/30, 1/50, and 1/100), respectively. After wash in PBS, slides were incubated with biotinylated horse anti-rabbit or mouse secondary Ab (Vector Laboratories, Burlingame, CA) and developed using a Vectastain ABC kit (Vector Laboratories) and 3-amino-9-ethyl carbazole substrate kit (Vector Laboratories). For immunofluorescent staining, slides were incubated with streptavidin-conjugated Texas Red (1:100; Amersham, Piscataway, NJ) following secondary Ab. Cell types were determined by double immunofluorescence staining using FITC-labeled cell-specific mAbs, including anti-actin for SMC (DAKO, Carpinteria, CA), anti-CD31 for endothelial cells (EC; DAKO), and anti-CD68 for macrophages (DAKO).

Data analysis

Differences in levels of IP-10, I-TAC, Mig, and CXCR3 mRNA in transplanted hearts were compared in allografts with and without severe CAV, biopsies with and without acute rejection, and normal hearts. Statistical significance was determined by Student’s t test. A value of <0.05 was considered statistically significant.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Human cardiac allografts contain IP-10, I-TAC, Mig, and their receptor CXCR3

We investigated the expression of IP-10, I-TAC, Mig, and CXCR3 in 133 consecutive biopsies from 11 human cardiac allografts (15–17 biopsies for each allograft in a 2-year follow-up) and myocardium collected from corresponding donor hearts before the transplantation. Cardiac allografts had high levels of IP-10, I-TAC, and Mig mRNA. However, none of the 11 normal hearts contained these transcripts before transplantation (Fig. 1Go and Tables IGo and IIGo). IP-10 mRNA levels correlated well with the development of CAV (Fig. 2GoA and Table IGo). Cardiac allografts with CAV had persistently elevated baseline IP-10 mRNA levels. The mean IP-10-GAPDH ratio (over 2 years) was 3.7 ± 0.8 in patients with CAV (77 sequential biopsies from six allografts) compared with 0.8 ± 0.2 in those without CAV (56 sequential biopsies from five allografts, p = 0.004). Moreover, IP-10 mRNA further increased above baseline levels in both CAV and non-CAV groups during the acute rejection. Of 28 biopsies with rejection, 11 had grade I (International Society of Heart Lung Transplantation criteria), 17 had grade II, and 3 had severe rejection (>grade III). The mean IP-10-GAPDH ratio was 4.1 ± 2.3 in rejecting biopsies (all grades, n = 28) compared with 1.8 ± 1.2 in nonrejecting biopsies (n = 105; p = 0.038, Table IIGo). There were insufficient numbers of biopsies in each grade to permit a meaningful statistical analysis of the association between the IP-10 mRNA levels and the severity of acute rejection. However, accumulation of IP-10 mRNA increased in both low grade (grade I and II) and high grade (>grade III) rejection. Fig. 3Go shows changes of IP-10 mRNA levels in a representative patient during rejection episodes.



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FIGURE 1. Cardiac allografts had elevated CXCR3 chemokine mRNA determined by quantitative RT-PCR. PCR analysis of RNA extracted from a representative allograft and its corresponding donor heart before transplantation. NH, Normal heart before transplantation; Tx, transplantation; Neg, negative controls (without templates).

 

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Table I. Association of CXCR3 chemokines with CAV1

 

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Table II. Association of CXCR3 chemokines with cardiac allograft rejection1

 


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FIGURE 2. Association of IP-10, Mig, and I-TAC mRNA with CAV (A) and acute rejection (B). Levels of CXCR3 chemokine mRNA in biopsies were expressed as IP-10, Mig, or I-TAC-GAPDH ratio (x1000).

 


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FIGURE 3. Changes of chemokine mRNA levels in sequential biopsies from a representative patient. *, Rejection episode.

 
Patterns of I-TAC and Mig mRNA elevation differed from IP-10. Similar to IP-10, I-TAC mRNA levels were persistently elevated in cardiac allografts with CAV (I-TAC-GAPDH ratio = 6.7 ± 1.9) compared with those without CAV (I-TAC-GAPDH ratio = 1.5 ± 0.3, p = 0.01, Fig. 2GoA and Table IGo). However, I-TAC levels did not vary substantially during rejection in either the CAV or the non-CAV group (Figs. 2GoB and 3 and Table IIGo). Mean I-TAC-GAPDH ratio was 5.6 ± 1.3 in biopsies with and 4.2 ± 1.2 in those without rejection (p = NS).

Mig mRNA levels did not elevate persistently and only increased during acute rejection. Mean Mig/GAPDH levels were 2.4 ± 0.9 in biopsies with compared with 0.9 ± 0.2 in those without rejection (p = 0.015, Figs. 2GoB and 3 and Table IIGo). Levels of Mig mRNA did not differ significantly between CAV vs non-CAV groups (2.0 ± 1.1 vs 0.98 ± 0.56; p = NS, Fig. 2GoA and Table IGo).

CXCR3 is the common receptor for IP-10, I-TAC, and Mig. CXCR3 mRNA expressed in normal donor hearts at low levels and increased immediately after transplantation. All first biopsies from allografts analyzed in this study contained 3- to 5-folds higher levels of CXCR3 mRNA compared with their corresponding donor hearts before the transplantation. Mean CXCR3-GAPDH ratio was 1.3 ± 1.0 in first biopsies after transplantation vs 0.2 ± 0.1 in normal donor hearts (p < 0.043). CXCR3 mRNA levels remained persistently elevated in cardiac allografts (Fig. 3Go). Mean CXCR3-GAPDH ratio was 0.9 ± 0.7 in all allograft biopsies (2 year follow-up) vs 0.2 ± 0.1 in normal donor hearts (p < 0.05). CXCR3 levels did not defer significantly during rejection (Table IIGo).

Cellular distribution of IP-10, I-TAC, Mig, and their receptor CXCR3 in human cardiac allografts

We next localized IP-10, I-TAC, Mig, and CXCR3 protein in human cardiac allografts by immunohistochemical staining of biopsies from cardiac allografts and normal hearts. In accordance with the mRNA results, cardiac allografts demonstrated intense expression of IP-10, I-TAC, and Mig proteins (Fig. 4Go, A–C), while normal hearts had negligible levels of those chemokines (Fig. 4Go, EG). Double immunostaining revealed that vascular SMC contained substantial IP-10 and I-TAC in cardiac allografts, while vascular EC predominantly expressed I-TAC. Macrophages expressed all three chemokines. Mig localized predominantly in macrophages, but not in vascular wall cells (Fig. 5Go). The receptor CXCR3 primarily localized in vascular wall cells in cardiac allografts (Fig. 4GoD).



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FIGURE 4. Human cardiac allografts exhibit elevated CXCR3 and CXCR3 chemokines compared with normal hearts. Upper left panels, Representative biopsies (small vessel) from an allograft (day 203 posttransplantation with mild CAV; nonrejecting biopsy) stained with Abs to IP-10 (A), I-TAC (B), Mig (C), and CXCR3 (D), respectively. Lower left panels, Samples (small vessel) from a representative normal heart stained with Abs to IP-10 (E), I-TAC (F), Mig (G), and CXCR3 (H). Right panels, Negative controls: allograft biopsies stained with mouse (I) or rabbit IgG (J) as primary Abs (1:50).

 


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FIGURE 5. Cellular distribution of CXCR3 chemokines in biopsies from a representative allograft. Photofluorescence shows small vessels in biopsies. Samples were double stained with cell-specific Abs and Abs to IP-10 (A), Mig (B), or I-TAC (C). Top panels, Cell markers including EC, SMC, and M{phi} (macrophages), respectively. The green color indicates positive staining for cell markers indicated. Middle panels, Staining for chemokines. The red color indicates positive staining for the respective chemokines. Bottom panels, Composite double staining with cell markers and chemokines. The yellow/orange color indicates positive staining for both cell markers and chemokines.

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Acute allograft rejection remains a major concern after cardiac transplantation. CXCR3 chemokines are important cytokines in leukocyte recruitment and retention that critically participate in allograft rejection. Several studies demonstrate increased expression of various chemokines in animal transplant models and human transplanted hearts (4, 5, 6, 7, 8, 9, 10, 11). In the current study, we provide direct evidence in human cardiac allografts for substantially increased expression of IP-10 and Mig during acute allograft rejection. Furthermore, we demonstrate differential localization of IP-10 and Mig in cardiac allografts. Donor vascular cells are the primary cells expressing IP-10, while Mig is predominantly present in infiltrating macrophages. This observation may represent complex synergistic interaction between donor and recipient mechanisms in directing alloantigen-primed T cells into cardiac allografts. Experiments in IP-10 knockout mice demonstrate that donor-derived IP-10 initiates development of acute rejection (12). The intense expression of IP-10 by donor vascular cells in human cardiac allografts provides new evidence to support the hypothesis that induction of T cell chemoattractants in donor cells plays an important role in the pathogenesis of allograft rejection. In contrast to IP-10, Mig is predominantly present in infiltrating macrophages. This result parallels to the observation from animal models that recipient-derived macrophages are primary cells of Mig in cardiac allografts (9). Together, these results indicate a novel role for recipient-derived infiltrating macrophages in effector T cell recruitment during the development of rejection. Combined donor and recipient production of several T cell chemoattractants may provide multiple pathways to ensure T cell recruitment and retention in cardiac allografts.

Although current immunosuppressive regimens have substantially reduced the incidence of acute allograft rejection, these immunosuppressants do not prevent CAV. Increasing evidence shows that allograft rejection, particularly low grade untreated rejection, predisposes cardiac allografts to CAV (15, 27). CXCR3 chemokines not only attract leukocytes, but also alter functions of vascular wall cells. The dual targets of CXCR3 chemokines on immune and vascular cells suggest an important role for this group of cytokines in CAV, a disease characterized by immune-mediated vascular smooth muscle cell proliferation. Current study provides first direct evidence in human cardiac allografts that persistent elevation of IP-10 and I-TAC is associated with the development of CAV. Members of the CXC chemokine family can display disparate angiogenic activity depending upon the presence or absence of the ELR motif. ELR-containing CXC chemokines (e.g., IL-8) stimulate angiogenesis. In contrast, non-ELR-containing CXC chemokines (e.g., platelet factor 4, IP-10, Mig, and I-TAC) are angiostatic (19). In addition, non-ELR-containing CXC chemokines can potentiate growth factor-induced SMC mitogenesis. Transplanted hearts have elevated levels of several growth factors, which associate with the development of CAV (16, 20, 21, 22). In contrast, transplanted hearts show scant angiogenesis, despite high levels of angiogenic growth factors (23, 24). We originally proposed that mediators produced in transplanted hearts altered vascular responses to growth factors by inhibiting angiogenesis and facilitating intimal SMC proliferation (24). Induction of IP-10, I-TAC, and their receptor CXCR3 in human cardiac allografts, particularly in vascular SMC, suggests their role in control of SMC proliferation. Persistent elevation of IP-10 and I-TAC in grafts with CAV is consistent with the chronic nature of this disease. Moreover, the presence of non-ELR-containing chemokines (IP-10, I-TAC) may provide angiostatic effects in transplanted hearts and account for the absence of angiogenesis in those allografts. Interestingly, Mig only expresses during rejection and does not elevate persistently as IP-10 and I-TAC do in human cardiac allografts. In addition, Mig is predominantly expressed in macrophages, but not in donor vascular cells. The absence of persistent elevation and vascular distribution of Mig may represent the biological bases for the lack of correlation between Mig and CAV. Although IP-10, I-TAC, and Mig are IFN-{gamma} inducible and share a common receptor (CXCR3), increasing evidence suggests that their biological functions may differ. Our study provides new evidence that these CXCR3 chemokines may also be regulated differently. However, precise mechanisms of differential regulation of these three CXCR3 chemokines and their biological importance require further studies.

The development of CAV requires IFN-{gamma} (14, 17). In this study, we elucidate the involvement of one set of downstream mediators of IFN-{gamma} in CAV and rejection. Thus, the IFN-{gamma}-inducible CXCR3 chemokines most likely recruit T cells to transplanted hearts, and also alter vascular EC and SMC functions in transplanted hearts. Both processes can promote the development of CAV. The dual functions of CXCR3 chemokines in immune and vascular cells make them novel therapeutic targets for promoting angiogenesis and reducing neointimal SMC proliferation and rejection in cardiac allografts.


    Footnotes
 
1 This work was supported in part by Grants T32HL07604, HL 43364, HL53771, and CA69212 from the National Institutes of Health. Back

2 Address correspondence and reprint requests to Dr. David Xiao-Ming Zhao, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt Medical Center, 2311 Pierce Avenue, PCHI Room 2229, Nashville, TN 37232. E-mail address: david.zhao{at}vanderbilt.edu Back

3 Abbreviations used in this paper: CAV, cardiac allograft vasculopathy; EC, endothelial cell; I-TAC, IFN-inducible T cell {alpha} chemoattractant; IP-10, IFN-inducible protein 10; Mig, monokine induced by IFN; SMC, smooth muscle cell. Back

Received for publication February 22, 2002. Accepted for publication May 20, 2002.


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 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

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