PMID- 36688843
OWN - NLM
STAT- Publisher
LR  - 20240216
IS  - 1538-4683 (Electronic)
IS  - 1061-5377 (Print)
IS  - 1061-5377 (Linking)
DP  - 2023 Jan 23
TI  - Immunogenicity of Homologous Heart Valves: Mechanisms and Future Considerations.
LID - 10.1097/CRD.0000000000000519 [doi]
AB  - Pediatric valvar heart disease continues to be a topic of interest due to the 
      common and severe clinical manifestations. Problems with heart valve replacement, 
      including lack of adaptive valve growth and accelerated structural valve 
      degeneration, mandate morbid reoperations to serially replace valve implants. 
      Homologous or homograft heart valves are a compelling option for valve 
      replacement in the pediatric population but are susceptible to structural valve 
      degeneration. The immunogenicity of homologous heart valves is not fully 
      understood, and mechanisms explaining how implanted heart valves are attacked are 
      unclear. It has been demonstrated that preservation methods determine homograft 
      cell viability and there may be a direct correlation between increased cellular 
      viability and a higher immune response. This consists of an early increase in 
      human leukocyte antigen (HLA)-class I and II antibodies over days to months 
      posthomograft implantation, followed by the sustained increase in HLA-class II 
      antibodies for years after implantation. Cytotoxic T lymphocytes and T-helper 
      lymphocytes specific to both HLA classes can infiltrate tissue almost immediately 
      after implantation. Furthermore, increased HLA-class II mismatches result in an 
      increased cell-mediated response and an accelerated rate of structural valve 
      degeneration especially in younger patients. Further long-term clinical studies 
      should be completed investigating the immunological mechanisms of heart valve 
      rejection and their relation to structural valve degeneration as well as testing 
      of immunosuppressant therapies to determine the needed immunosuppression for 
      homologous heart valve implantation.
CI  - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Vogel, Andrew D
AU  - Vogel AD
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Medical 
      University of South Carolina, Charleston, SC.
AD  - Department of Surgery, Alabama College of Osteopathic Medicine, Dothan, AL.
FAU - Kwon, Jennie H
AU  - Kwon JH
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Medical 
      University of South Carolina, Charleston, SC.
FAU - Mitta, Alekhya
AU  - Mitta A
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Medical 
      University of South Carolina, Charleston, SC.
AD  - Department of Surgery, School of Medicine, University of South Carolina, 
      Columbia, SC.
FAU - Sherard, Curry
AU  - Sherard C
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Medical 
      University of South Carolina, Charleston, SC.
AD  - Department of Surgery, College of Medicine, Medical University of South Carolina, 
      Charleston, SC.
FAU - Brockbank, Kelvin G M
AU  - Brockbank KGM
AD  - Department of Surgery, Tissue Testing Technologies LLC, North Charleston, SC.
AD  - Department of Bioengineering, Clemson University, Charleston, SC.
FAU - Rajab, Taufiek Konrad
AU  - Rajab TK
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Medical 
      University of South Carolina, Charleston, SC.
LA  - eng
GR  - UL1 TR001450/TR/NCATS NIH HHS/United States
PT  - Journal Article
DEP - 20230123
PL  - United States
TA  - Cardiol Rev
JT  - Cardiology in review
JID - 9304686
SB  - IM
PMC - PMC10363244
MID - NIHMS1856658
COIS- Disclosure: The authors declare no conflict of interest.
EDAT- 2023/01/24 06:00
MHDA- 2023/01/24 06:00
PMCR- 2024/07/23
CRDT- 2023/01/23 10:12
PHST- 2024/07/23 00:00 [pmc-release]
PHST- 2023/01/23 10:12 [entrez]
PHST- 2023/01/24 06:00 [pubmed]
PHST- 2023/01/24 06:00 [medline]
AID - 00045415-990000000-00071 [pii]
AID - 10.1097/CRD.0000000000000519 [doi]
PST - aheadofprint
SO  - Cardiol Rev. 2023 Jan 23:10.1097/CRD.0000000000000519. doi: 
      10.1097/CRD.0000000000000519.