Am J Transplant. 2026 Mar 09. pii: S1600-6135(26)00124-3. [Epub ahead of print]
Renjie Tang,
Yuan Chang,
Yuqi An,
Dan Shan,
Shen Song,
Kai Xing,
Peiyuan Li,
Hang Zhang,
Xiumeng Hua,
Xiao Chen,
Ningning Zhang,
Shengshou Hu,
Jiangping Song.
Polyamines, particularly spermidine, are well-documented for their cardiovascular protective, antitumor, and longevity-promoting properties. However, their role in heart transplantation, and specifically the contribution of T-cell polyamine metabolism to transplant acceptance, remains undefined. In this study, we integrated preclinical and clinical studies to address this gap. We found that polyamine metabolism was significantly upregulated in T cells during acute rejection (AR) in both murine allografts and human AR samples. Critically, conditional inhibition of polyamine metabolism in T cells completely prevents AR and promotes long-term graft survival. Mechanistically, we found that polyamine metabolism is crucial for the differentiation of cytotoxic CD8+ T cells. Further, this regulatory effect was mediated by polyamine-dependent hypusination of eukaryotic initiation factor 5A (eIF5A), with inhibition of T cell eIF5A hypusination recapitulating the anti-AR effects of polyamine blockade. Our study identifies T cell polyamine metabolism as a critical regulator of cytotoxic CD8+ T cell differentiation and AR in heart transplantation. Targeting this pathway holds promise as a novel therapeutic strategy for treating AR.
Keywords: Acute rejection; Heart transplantation; Odc1; Polyamine metabolism; T cell; eIF5A hypusination