Allograft heart valves: The role of apoptosis-mediated cell loss

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Presentation transcript:

Allograft heart valves: The role of apoptosis-mediated cell loss Stephen L. Hilbert, MD, PhD, Rafael E. Luna, BS, Jun Zhang, MD, Yining Wang, MD, Richard A. Hopkins, MD, Zu-Xi Yu, MD, PhD, Victor J. Ferrans, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 117, Issue 3, Pages 454-462 (March 1999) DOI: 10.1016/S0022-5223(99)70324-7 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig 1 A, Characteristic histologic appearance of a native aortic valve. Three distinct regions are present: the ventricularis (v), the spongiosa (s), and the fibrosa (f). (Hematoxylin and eosin stain; original magnification, ×100.) B, Histologic section of a cryopreserved aortic allograft valve depicts the loss of the trilaminar structure of the cusp after 30 days of implantation. Loss of endothelial cells and a marked reduction in cusp cellularity are apparent. (Hematoxylin and eosin stain; original magnification, ×100.) C, Cryopreserved allograft valve 30 days after implantation. Light micrograph shows pyknotic nuclei and apoptotic bodies in cells having increased cytoplasmic eosinophilia (arrowhead). (Hematoxylin and eosin stain; original magnification, ×900.) D, Light micrograph of a fresh allograft valve implanted for 20 weeks demonstrates a marked loss of cusp cellularity. The cusp is completely encased by a thick fibrous sheath. (Movat pentachrome stain: elastic fibers, black; cellular components, red; proteoglycans, blue; collagen, yellow; mixture of proteoglycans and collagen, blue-green. Original magnification, ×100.) E, Native aortic valve. Confocal image shows PCNA-positive nuclei (green fluorescence) in myofibroblasts and endothelial cells. (Original magnification, ×400.) F, Native aortic valve. High magnification confocal image depicts factor VIII-positive endothelial cells (red cytoplasmic fluorescence) lining the surface of the fibrosa. Note the PCNA-positive nuclei (green fluorescence). (Original magnification, ×1000.) The Journal of Thoracic and Cardiovascular Surgery 1999 117, 454-462DOI: (10.1016/S0022-5223(99)70324-7) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig 2 A, Cryopreserved allograft valve after 2 days of implantation. Confocal image demonstrates a marked reduction in the number of PCNA-positive nuclei (green fluorescence) in the spongiosa and ventricularis. (Original magnification, ×1000.) B, Cryopreserved allograft valve implanted for 30 days. Confocal image demonstrates the absence of PCNA-positive nuclei (green fluorescence) and endothelial cells lining the surface of the fibrosa. Note the low level of autofluorescence in the extracellular matrix of the cusp. Compare with Fig 1, E and F. (Original magnification, ×400.) C, Cryopreserved allograft valve 2 days after implantation. Confocal image shows an apoptotic nucleus (nick end labeling; green fluorescence). Cusp cellularity within the fibrosa is normal, and nonapoptotic nuclei are demonstrated by staining with DAPI (blue fluorescence). (Original magnification, ×400.) D, Fresh allograft valve 14 days after implantation. Nick end labeling demonstrates apoptotic nuclei (black; peroxidase-labeling) in the spongiosa. Nonapoptotic nuclei have been counterstained with hematoxylin stain. (Original magnification, ×630.) E, Cryopreserved allograft valve 30 days after implantation. High magnification view of apoptotic nuclei and apoptotic bodies stained black by the peroxidase method for nick end labeling. (Original magnification, ×1000.) F, Cryopreserved allograft valve implanted for 30 days. Apoptotic, pyknotic nuclei (nick end labeling; green fluorescence) and intracellular apoptotic bodies (arrowhead) are present in the ventricularis. Cusp cellularity is decreased, as demonstrated by nuclear counterstaining with DAPI (blue fluorescence). Elastic fibers in the ventricularis show moderate yellow autofluorescence. (Original magnification, ×400.) The Journal of Thoracic and Cardiovascular Surgery 1999 117, 454-462DOI: (10.1016/S0022-5223(99)70324-7) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig 3 A, Cryopreserved allograft valve implanted for 30 days. Ultrastructural appearance of pyknotic endothelial cell lining the fibrosa. Note marked condensation of the nuclear chromatin and contraction of the cytoplasm. Compare with the normal chromatin of adjacent fibroblasts. (Uranyl acetate/lead citrate stain; original magnification, ×4800.) B, Cryopreserved allograft valve implanted for 30 days. Transmission electron micrograph of a macrophage contains a phagocytosed apoptotic body composed of fragmented nuclear chromatin. (Uranyl acetate/lead citrate stain; original magnification, ×10,000.) Transmission electron micrographs depict changes in the crimping of collagen in the cusps of (C) cryopreserved allograft valves after 30 days of implantation and (D) fresh allograft valves after 20 weeks of implantation. Collagen crimp is preserved at 30 days, although prominent regions of collagen straightening are noted at 20 weeks. (Uranyl acetate/lead citrate stain; original magnification, [C] ×3500 and [D] ×2900.) The Journal of Thoracic and Cardiovascular Surgery 1999 117, 454-462DOI: (10.1016/S0022-5223(99)70324-7) Copyright © 1999 Mosby, Inc. Terms and Conditions