Circulating delta‐like Notch ligand 1 is correlated with cardiac allograft vasculopathy and suppressed in heart transplant recipients on everolimus‐based immunosuppression. Issue 4 (5th November 2018)

• Record Type: Journal Article
• Authors: Norum, Hilde M.; Michelsen, Annika E.; Lekva, Tove; Arora, Satish; Otterdal, Kari; Olsen, Maria Belland; Kong, Xiang Yi; Gude, Einar; Andreassen, Arne K.; Solbu, Dag; Karason, Kristjan; Dellgren, Göran; Gullestad, Lars; Aukrust, Pål; Ueland, Thor
• Is Part Of: American journal of transplantation. Volume 19:Issue 4(2019)
• Page Start: 1050
• Page End: 1060
• Publication Date: 2018-11-05
• Subjects: clinical research/practice -- everolimus -- heart transplantation/cardiology -- immunosuppressant ‐ mechanistic target of rapamycin -- immunosuppression/immune modulation -- signaling/signaling pathways -- translational research/science -- vasculopathy; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15141
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Cardiac allograft vasculopathy (CAV) causes heart failure after heart transplantation (HTx), but its pathogenesis is incompletely understood. Notch signaling, possibly modulated by everolimus (EVR), is essential for processes involved in CAV. We hypothesized that circulating Notch ligands would be dysregulated after HTx. We studied circulating delta‐like Notch ligand 1 (DLL1) and periostin (POSTN) and CAV in de novo HTx recipients (n = 70) randomized to standard or EVR‐based, calcineurin inhibitor‐free immunosuppression and in maintenance HTx recipients (n = 41). Compared to healthy controls, plasma DLL1 and POSTN were elevated in de novo ( P < .01; P < .001) and maintenance HTx recipients ( P < .001; P < .01). Use of EVR was associated with a treatment effect for DLL1. For de novo HTx recipients, a change in DLL1 correlated with a change in CAV at 1 ( P = .021) and 3 years ( P = .005). In vitro, activation of T cells increased DLL1 secretion, attenuated by EVR. In vitro data suggest that also endothelial cells and vascular smooth muscle cells (VSMCs) could contribute to circulating DLL1. Immunostaining of myocardial specimens showed colocalization of DLL1 with T cells, endothelial cells, and VSMCs. Our findings suggest a role of DLL1 in CAV progression, and that the beneficial effect of EVR on CAV could reflect a suppressive effect on DLL1. Trial registration numbers— SCHEDULE trial: ClinicalTrials.gov NCT01266148; NOCTET trial: ClinicalTrials.gov NCT00377962. Abstract : Delta‐like Notch ligand 1 is expressed in the myocardium and elevated in the plasma after heart transplantation, reduced by everolimus, and associated with cardiac allograft vasculopathy.