Key result
Low glutaraldehyde crosslinking fails to mask immunogenicity, promoting humoral response and bioprosthetic valve degeneration.
Why the study?
The immunogenicity of bioprosthetic heart-valve tissue prepared with low concentrations of crosslinking reagent is not sufficiently masked, contributing to tissue degeneration processes.
Immunogenicity persists despite low-glutaraldehyde valve preparation; hypothesis-generating for durability concerns and should not yet change practice.
In an attempt to avoid the destructive process of bioprosthetic heart-valve calcification associated with the use of glutaraldehyde, valves are today prepared using low concentrations of the crosslinking reagent. In this review, we summarize our findings and those of others that confirm that the immunogenicity of such tissue is not sufficiently masked and that a defined humoral response is indeed mounted against a repertoire of antigens unrelated to those associated with vascularized and non—cross-linked xenograft organs. We demonstrate the need for increased cross-linking of tissue to satisfactorily mitigate that response; furthermore, we examine the impact of increased cross-link density on the macrophage as antigen presenting cell with respect to its involvement in both tissue erosion and pannus overgrowth. Finally we present evidence for a role of circulating antibodies in bioprosthesis calcification.
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Human et al. (2001) conducted a review in Bioprosthetic heart-valve calcification. Low concentration of crosslinking reagent vs. Increased cross-linking density was evaluated on Immunogenicity, humoral response, and bioprosthesis calcification. Low concentrations of glutaraldehyde crosslinking fail to mask bioprosthetic tissue immunogenicity, resulting in a humoral response that contributes to valve calcification and degeneration.
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