Bcl-2-mediated inhibition of apoptosis in rat cardiac allografts worsens development of graft coronary artery disease

Background: We hypothesized that adenovirally mediated Bcl-2 transfection of donor hearts would reduce the apoptosis that occurs during acute rejection while worsening the development of chronic graft coronary artery disease (GCAD). Methods: PVG donor hearts were treated with either AdvBcl-2 or AdvNull virus before heterotopic transplantation into ACI rats. Bcl-2 expression was assessed on post-operative day 4 (POD) 4 by western blot. Apoptosis was measured using ^99mTechnetium-bound-annexin V imaging and caspase 3 activity assay. Allograft survival was determined in a separate cohort of animals. Long-term-treated animals were then assessed for measures of GCAD on POD 90. Results: Western blot analysis showed upregulation of Bcl-2 expression in AdvBcl-2-treated hearts. ^99mTc-annexin V images demonstrated decreased uptake in the AdvBcl-2 group (1.41 ± 0.33% vs 1.94 ± 0.37%, p = 0.026). Caspase 3 activity was also significantly lower in this treatment group (0.112 ± 0.032 vs 0.204 ± 0.096, p = 0.049). Allograft survival was similar in both groups, respectively (7.7 ± 1.2 vs 6.8 ± 1.5 days, p = 0.340). GCAD, as determined by percent luminal narrowing (5.9 ± 6.1% vs 1.6 ± 1.5%, p = 0.039), intima-to-media ratio (5.1 ± 5.1% vs 1.5 ± 1.7%, p = 0.040) and percent of affected vessels (15.1 ± 9.9% vs 5.3 ± 4.4%, p = 0.009), was higher for the AdvBcl-2 group. Conclusion: Treatment of cardiac allografts with AdvBcl-2 resulted in a reduction of apoptosis that did not significantly improve short-term graft survival, but worsened chronic GCAD.