In 1990, an international grading system for cardiac allograft biopsies was adopted by the International Society for Heart Transplantation. This system has served the heart transplant community well, facilitating communication between transplant centers, especially with regard to patient management and research. In 2004, under the direction of the International Society for Heart and Lung Transplantation (ISHLT), a multidisciplinary review of the cardiac biopsy grading system was undertaken to address challenges and inconsistencies in its use and to address recent advances in the knowledge of antibody-mediated rejection. This article summarizes the revised consensus classification for cardiac allograft rejection. In brief, the revised (R) categories of cellular rejection are as follows: Grade 0 R--no rejection (no change from 1990); Grade 1 R--mild rejection (1990 Grades 1A, 1B and 2); Grade 2 R--moderate rejection (1990 Grade 3A); and Grade 3 R--severe rejection (1990 Grades 3B and 4). Because the histologic sub-types of Quilty A and Quilty B have never been shown to have clinical significance, the "A" and "B" designations have been eliminated. Recommendations are also made for the histologic recognition and immunohistologic investigation of acute antibody-mediated rejection (AMR) with the expectation that greater standardization of the assessment of this controversial entity will clarify its clinical significance. Technical considerations in biopsy processing are also addressed. This consensus revision of the Working Formulation was approved by the ISHLT Board of Directors in December 2004.

Continuing improvements in analytical technology along with an increased interest in performing comprehensive, quantitative metabolic profiling, is leading to increased interest pressures within the metabolomics community to develop centralized metabolite reference resources for certain clinically important biofluids, such as cerebrospinal fluid, urine and blood. As part of an ongoing effort to systematically characterize the human metabolome through the Human Metabolome Project, we have undertaken the task of characterizing the human serum metabolome. In doing so, we have combined targeted and non-targeted NMR, GC-MS and LC-MS methods with computer-aided literature mining to identify and quantify a comprehensive, if not absolutely complete, set of metabolites commonly detected and quantified (with today's technology) in the human serum metabolome. Our use of multiple metabolomics platforms and technologies allowed us to substantially enhance the level of metabolome coverage while critically assessing the relative strengths and weaknesses of these platforms or technologies. Tables containing the complete set of 4229 confirmed and highly probable human serum compounds, their concentrations, related literature references and links to their known disease associations are freely available at http://www.serummetabolome.ca.

Our results do not support routine treatment of myocarditis with immunosuppressive drugs. Ventricular function improved regardless of whether patients received immunosuppressive therapy, but long-term mortality was high. Patients with a vigorous inflammatory response had less severe disease.

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Recent studies suggest a possible takeover of host antimicrobial autophagy machinery by positive-stranded RNA viruses to facilitate their own replication. In the present study, we investigated the role of autophagy in coxsackievirus replication. Coxsackievirus B3 (CVB3), a picornavirus associated with viral myocarditis, causes pronounced intracellular membrane reorganization after infection. We demonstrate that CVB3 infection induces an increased number of double-membrane vesicles, accompanied by an increase of the LC3-II/LC3-I ratio and an accumulation of punctate GFP-LC3-expressing cells, two hallmarks of cellular autophagosome formation. However, protein expression analysis of p62, a marker for autophagy-mediated protein degradation, showed no apparent changes after CVB3 infection. These results suggest that CVB3 infection triggers autophagosome formation without promoting protein degradation by the lysosome. We further examined the role of the autophagosome in CVB3 replication. We demonstrated that inhibition of autophagosome formation by 3-methyladenine or small interfering RNAs targeting the genes critical for autophagosome formation (ATG7, Beclin-1, and VPS34 genes) significantly reduced viral replication. Conversely, induction of autophagy by rapamycin or nutrient deprivation resulted in increased viral replication. Finally, we examined the role of autophagosome-lysosome fusion in viral replication. We showed that blockage of the fusion by gene silencing of the lysosomal protein LAMP2 significantly promoted viral replication. Taken together, our results suggest that the host's autophagy machinery is activated during CVB3 infection to enhance the efficiency of viral replication.

Purpose: Patients with neurofibromatosis 1 (NF1) are at increased risk for a variety of cardiovascular disorders, but the natural history and pathogenesis of these abnormalities are poorly understood. Methods: The National Neurofibromatosis Foundation convened an expert task force to review current knowledge about cardiovascular manifestations of NF1 and to make recommendations regarding clinical management and research priorities related to these features of the disease. Results: This report summarizes the NF1 Cardiovascular Task Force's current understanding of vasculopathy, hypertension, and congenital heart defects that occur in association with Key Words: neurofibromatosis 1, vasculopathy, hypertension, congenital heart defects Neurofibromatosis 1 (NF1), an autosomal dominant disease, is one of the most common mendelian disorders. 1 It is characterized by extremely variable expressivity, but most patients have café-au-lait spots, intertriginous freckling, dermal and plexiform neurofibromas, and learning disabilities. 2 People with NF1 may also develop cardiac and vascular disease, but the frequency, natural history, and pathogenesis of these abnormalities are uncertain. The National Neurofibromatosis Foundation convened an expert panel, the NF1 Cardiovascular Task Force, to review current knowledge about the cardiovascular manifestations of NF1 and to make recommendations regarding clinical management and research priorities. This is the report of that Task Force.Neurofibromas, the characteristic tumors of NF1, can develop within the heart, obstruct blood flow in the heart or major vessels by compression or invasion, or erode a vessel and cause hemorrhage. Fortunately, these are rare complications. This report will concentrate on the three most common cardiovascular manifestations of NF1, viz., vasculopathy, hypertension, and congenital heart defects.People with NF1 constitute a substantial fraction of all patients with dysplastic renal artery stenosis, 3 early-onset cerebrovascular disease, 4 or pheochromocytomas, 5 and cardiovascular disease is a frequent cause of premature death in individuals with NF1. Sørensen and associates 6 found that myocardial infarction and cerebrovascular accidents often occurred at a younger than expected age among NF1 patients. Zöller et al. 7 reported that cardiovascular disease, hemorrhage, and embolism were frequent causes of death in 70 adult NF1 patients who were followed for 12 years. Hypertension was significantly associated with mortality, and the mean age at death among the NF1 patients was approximately 14 years younger than expected. The median age of death reported on death certificates of 3,253 individuals with probable NF1 was approximately 15 years less than expected in another study. 8 Diagnoses suggestive of NF1 vasculopathy were listed 7.2 times more often than expected among NF1 patients Ͻ 30 years old and 2.2 times more often than expected among those who were 30 to 40 years old at the time of death. NF1 VASCULOPATHY Epidemiology and clinical featuresNF1 c...

use of traditional and emerging techniques to identifying suspected myocarditis patients. Consolidating our understanding of myocarditis may aid in new research that can spearhead challenging questions and overcome obstacles in the field, especially in better defining the wide range of causative agents and clinical presentations of myocarditis.

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