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Eur J Cardiothorac Surg 2003;23:620-625
© 2003 Elsevier Science NL
a Department of Thoracic and Cardiovascular Surgery, Johannes Gutenberg University, Mainz, Germany
b Department of Internal Medicine, Johannes Gutenberg University, Mainz, Germany
c Department of Thoracic and Cardiovascular Surgery, University Regensburg, Regensburg, Germany
d Department of Pathology, Johannes Gutenberg University, Mainz, Germany
Received 22 May 2002; received in revised form 21 December 2002; accepted 7 January 2003.
* Corresponding author. Tel.: +49-6131-172106; fax: +49-6131-470193
e-mail: hilker{at}mail.uni-mainz.de
Objective: Aorto-coronary bypass graft disease with its increasing clinical signification represents an unsolved problem in cardiological and heart surgery practice. Late occlusion of autologous saphenous vein grafts is due to medial and neointimal thickening secondary to migration and proliferation of smooth muscle cells (SMCs) and the subsequent formation of atherosclerotic plaques. This study is aimed at identifying differentially expressed genes in human stenotic bypass grafts to detect unknown pathomechanism and to identify novel targets for prophylactic treatment options. Methods: Stenotic saphenous aorto-coronary bypass grafts (n=5) were retrieved during re-do aorto-coronary bypass surgery. Ungrafted saphenous vein segments (n=5) were taken from the same group of patients and served as internal controls. cDNA samples were prepared and hybridized to cDNA arrays. Results: Some of the differentially expressed genes complied with expected gene expression including upregulation of c-jun and CDK10. In addition, previously unidentified gene expression patterns were detected such as upregulation of HSP70, fibronectin1, erbB3 proto-oncogene and c-myc. To confirm the latter finding, upregulation of c-myc in neointimal and medial SMCs of stenotic graft segments was confirmed by in situ hybridization studies and by immunhistochemistry. Conclusion: Gene expression patterns of human stenotic bypass grafts retrieved by re-do operations can be reliably analyzed by cDNA array technology. With this technique, new therapeutic targets in patients could be identified as shown by the findings regarding c-myc. c-myc is a proto-oncogene acting as a transcription factor and blocking c-myc has shown a reduction of neointima formation in animal models. Our study yields a rational for the use of antisense c-myc oligonucleotides to reduce neointima formation and to avoid stenosis in patients.
Key Words: Bypass graft disease • cDNA array • c-myc • In situ hybridization
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