Immunological and fibrotic mechanisms in cardiac allograft vasculopathy

Cardiac allograft vasculopathy (CAV) has a high prevalence among patients who received heart transplantation (HTx). CAV is a multiple factorial process in which the immune system plays a large role. In this thesis, the data on the immunological and fibrotic processes that are involved in the development of CAV are summarized. During the pathogenesis of CAV, cells from the innate and the adaptive immune system cooperate to reject the foreign organ that is transplanted. The inflammatory response results in dysfunction of the endothelium and migration and proliferation of smooth muscle cells (SMCs). Apoptosis and factors secreted by both the endothelium as the SMCs lead to fibrosis. The migration of SMCs together with fibrosis provoke concentric intimal thickening of the coronary arteries, which is the main characteristic of CAV.