European Heart Journal Advance Access originally published online on August 22, 2005
European Heart Journal 2005 26(23):2576-2580; doi:10.1093/eurheartj/ehi458
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Cells of primarily extravalvular origin in degenerative aortic valves and bioprostheses
1Department of Cardiology, Heart Center University of Bonn, Bonn, Germany
2Institute of Pathology, University of Bonn, Bonn, Germany
3Institute of Anatomy II, University of Munich, Munich, Germany
4Department of Heart Surgery, Heart Center University of Bonn, Bonn, Germany
Received 29 March 2005; revised 20 July 2005; accepted 22 July 2005; online publish-ahead-of-print 22 August 2005.
* Corresponding author. Tel: +49 228 287 6670; fax: +49 228 287 4983. E-mail address: dirk.skowasch{at}ukb.uni-bonn.de
Aims We assessed aortic valves from patients with non-rheumatic aortic valve stenosis (AS) and with degenerative aortic valve bioprostheses (BP) for the presence of progenitor cell and leukocyte subtype-specific markers.
Methods and results Diseased valve probes from a total of 87 patients (60 AS and 27 BP) were studied. We assessed presence and localization of endothelial progenitor cells (EPCs: CD34, CD133), dendritic cells (DCs: S100), T-lymphocytes (CD3), and macrophages (CD68) by immunohistochemical and morphometric analyses. In the majority of valves, we detected cell-bound signals of CD34 (48% of AS, 74% of BP, respectively), CD133 (58%/81%), S100 (58%/93%), CD3 (62%/81%), and CD68 (78%/93%). Labelled cells were predominantly localized within the valvular fibrosa. As key results, frequency of EPCs, DCs, macrophages, and lymphocytes was found significantly higher in BP when compared with AS (CD34: 19.2±23.2 vs. 5.7±13.0%; CD133: 13.7±12.4 vs. 5.5±8.3%; S100: 15.2±12.2 vs. 5.7±8.9%; CD3: 3.3±2.7 vs. 1.1±1.4%; CD68: 35.3±26.6 vs. 3.4±4.1%; each P
0.001).
Conclusion EPCs and DCs were detected in a large collective of degenerative aortic valves, more frequently in bioprostheses than in native cusps. Aortoluminal presence of these primarily extravalvular cells co-localized with inflammatory cells is a novel key feature involved in aortic valve degeneration.
Key Words: Aortic valve prostheses • Degenerative aortic stenosis • Dendritic cells • Endothelial progenitor cells • Inflammation
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