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Eur J Cardiothorac Surg 2007;31:222-228. doi:10.1016/j.ejcts.2006.10.042
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Gene transfer of a soluble IL-1 type 2 receptor-Ig fusion protein improves cardiac allograft survival in rats

^a Department of Cardiology, University of Lausanne Medical School, Lausanne, Switzerland
^b Department of Experimental Surgery, University of Lausanne Medical School, Lausanne, Switzerland
^c Department of Rheumatology, University of Lausanne Medical School, Lausanne, Switzerland
^d Department of Cardiovascular Surgery, University of Lausanne Medical School, Lausanne, Switzerland
^e Department of Microbiology, University of Lausanne Medical School, Lausanne, Switzerland
^f Center for Organ Transplantation, University of Lausanne Medical School, Lausanne, Switzerland
^g Transplant Laboratories, Novartis Pharma, Basel, Switzerland

Received 27 March 2006; received in revised form 11 October 2006; accepted 23 October 2006.

^_* Corresponding author. Address: CHUV-BH10, 1011 Lausanne, Switzerland. Tel.: +41 21 3140076; fax: +41 21 3140013. (Email: giuseppe.vassalli{at}chuv.hospvd.ch).

Objective: Interleukin-1 (IL-1) mediates ischemia–reperfusion injury and graft inflammation after heart transplantation. IL-1 affects target cells through two distinct types of transmembrane receptors, type-1 receptor (IL-1R1), which transduces the signal, and the non-signaling type-2 receptor (IL-1R2), which acts as a ligand sink that subtracts IL-1ß from IL-1R1. We analyzed the efficacy of adenovirus (Ad)-mediated gene transfer of a soluble IL-1R2-Ig fusion protein in delaying cardiac allograft rejection and the mechanisms underlying the protective effect. Methods: IL-1 inhibition by IL-1R2-Ig was tested using an in vitro functional assay whereby endothelial cells preincubated with AdIL-1R2-Ig or control virus were stimulated with recombinant IL-1ß or tumor necrosis factor- (TNF-), and urokinase-type plasminogen activator (u-PA) induction was measured by zymography. AdIL-1R2-Ig was delivered to F344 rat donor hearts ex vivo, which were placed in the abdominal position in LEW hosts. Intragraft inflammatory cell infiltrates and proinflammatory cytokine expression were analyzed by immunohistochemistry and real-time reverse transcriptase-polymerase chain reaction (RT-PCR), respectively. Results: IL-1R2-Ig specifically inhibited IL-1ß-induced u-PA responses in vitro. IL-1R2-Ig gene transfer reduced intragraft monocytes/macrophages and CD4⁺ cell infiltrates (p < 0.05), TNF- and transforming growth factor-ß (TGF-ß) expression (p < 0.05), and prolonged graft survival (15.6 ± 5.7 vs 10.3 ± 2.5 days with control vector and 10.1 ± 2.1 days with buffer alone; p < 0.01). AdIL-1R2-Ig combined with a subtherapeutic regimen of cyclosporin A (CsA) was superior to CsA alone (19.4 ± 3.0 vs 15.9 ± 1.8 days; p < 0.05). Conclusions: Soluble IL-1 type-2 receptor gene transfer attenuates cardiac allograft rejection in a rat model. IL-1 inhibition may be useful as an adjuvant therapy in heart transplantation.

Key Words: Heart transplantation • Acute rejection • IL-1 • Gene therapy