Apoptosis in heart transplantation.

Apoptosis, or programmed cell death, is a mechanism of cell death that plays a major role during development, homeostasis, and in many disease states. The interaction of the cell membrance protein, Fas, with its ligand, Fas ligand, induces apoptosis in Fas-bearing cells. Several factors induce apoptosis in mammalian cardiomyocytes, including reperfusion injury, hypoxia, mechanical stretch, myocardial infarction, rapid ventricular pacing, and hypertensive heart failure. Although studies in the transplanted hearts of rodents and humans have shown the presence of Fas, Fas ligand, and apoptosis in the myocardium, there is controversy regarding which cells in the myocardium are actually undergoing apoptosis after heart transplantation. It is even less clear what type of relationship, if any, apoptosis has to allograft rejection or post-transplant graft coronary vasculopathy. This review summarizes the current knowledge regarding apoptosis in the transplanted heart and discusses some of the controversies surrounding this new and rapidly expanding area of investigation.