Manipulation of miRNAs can be a possible cure for CAV in heart transplant patients
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Organ transplantation needs to be considered as an acute life saver in patients suffering from organ failure. After organ transplantation there is a chance that the transplanted organ might be rejected. After transplantation patients are required to use large amounts of immunosuppressive drugs, to suppress the organ rejection. Unfortunately even these high amounts of drugs are sometimes not able to fully repress organ rejection. In patients with heart transplantations, a disease, related to organ rejection, called cardiac allograft vasculopathy might arise. Cardiac allograft vasculopathy is characterized by vascular remodelling. The remodelling starts with intima thickening and at a later stage the disease progresses with luminal stenosis of the epicardial vessels. The cellular immune response is considered to be the most important factor in cardiac allograft vasculopathy. The T-helper 1 response presumably plays an important role. T-helper 1 release interferon-γ, resulting in the activation of the immune response. Macrophages are activated thru the T-helper 1 response and start to infiltrate the transplanted heart and start releasing transforming growth factor-β. The release of transforming growth factor-β results in the infiltration and activation of fibroblasts. These fibroblasts deposit collagen, which is the cause of the luminal stenosis as seen in cardiac allograft vasculopathy. So far no cure is available, but a topic of interest to which scientists have become much more aware of and which might be a possible cure to this disease, are microRNAs. MicroRNAs are small untranslated genomic clusters, which have the ability to silence their mRNA targets. This review focuses on miRNAs that play a role in the processes of the cellular immune response to give an insight into the possibility of using miRNAs to cure cardiac allograft vasculopathy.