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Kip P, Tao M, Trocha KM, MacArthur MR, Peters HAB, Mitchell SJ, Mann CG, Sluiter TJ, Jung J, Patterson S, Quax PHA, de Vries MR, Mitchell JR, Keith Ozaki C. Periprocedural Hydrogen Sulfide Therapy Improves Vascular Remodeling and Attenuates Vein Graft Disease. J Am Heart Assoc 2020; 9:e016391. [PMID: 33146045 PMCID: PMC7763704 DOI: 10.1161/jaha.120.016391] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
Background Failure rates after revascularization surgery remain high, both in vein grafts (VG) and arterial interventions. One promising approach to improve outcomes is endogenous upregulation of the gaseous transmitter-molecule hydrogen sulfide, via short-term dietary restriction. However, strict patient compliance stands as a potential translational barrier in the vascular surgery patient population. Here we present a new therapeutic approach, via a locally applicable gel containing the hydrogen sulfide releasing prodrug (GYY), to both mitigate graft failure and improve arterial remodeling. Methods and Results All experiments were performed on C57BL/6 (male, 12 weeks old) mice. VG surgery was performed by grafting a donor-mouse cava vein into the right common carotid artery of a recipient via an end-to-end anastomosis. In separate experiments arterial intimal hyperplasia was assayed via a right common carotid artery focal stenosis model. All mice were harvested at postoperative day 28 and artery/graft was processed for histology. Efficacy of hydrogen sulfide was first tested via GYY supplementation of drinking water either 1 week before VG surgery (pre-GYY) or starting immediately postoperatively (post-GYY). Pre-GYY mice had a 36.5% decrease in intimal/media+adventitia area ratio compared with controls. GYY in a 40% Pluronic gel (or vehicle) locally applied to the graft/artery had decreased intimal/media area ratios (right common carotid artery) and improved vessel diameters. GYY-geltreated VG had larger diameters at both postoperative days 14 and 28, and a 56.7% reduction in intimal/media+adventitia area ratios. Intimal vascular smooth muscle cell migration was decreased 30.6% after GYY gel treatment, which was reproduced in vitro. Conclusions Local gel-based treatment with the hydrogen sulfide-donor GYY stands as a translatable therapy to improve VG durability and arterial remodeling after injury.
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Affiliation(s)
- Peter Kip
- Department of Surgery and the Heart and Vascular CenterBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMA
- Einthoven Laboratory for Experimental Vascular Medicine and Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Ming Tao
- Department of Surgery and the Heart and Vascular CenterBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
| | - Kaspar M. Trocha
- Department of Surgery and the Heart and Vascular CenterBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMA
| | - Michael R. MacArthur
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMA
| | - Hendrika A. B. Peters
- Einthoven Laboratory for Experimental Vascular Medicine and Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Sarah J. Mitchell
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMA
| | - Charlotte G. Mann
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMA
| | - Thijs J. Sluiter
- Department of Surgery and the Heart and Vascular CenterBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMA
- Einthoven Laboratory for Experimental Vascular Medicine and Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Jonathan Jung
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMA
- School of MedicineUniversity of GlasgowGlasgowUK
| | - Suzannah Patterson
- Department of Surgery and the Heart and Vascular CenterBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
| | - Paul H. A. Quax
- Einthoven Laboratory for Experimental Vascular Medicine and Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Margreet R. de Vries
- Einthoven Laboratory for Experimental Vascular Medicine and Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - James R. Mitchell
- Department of Molecular MetabolismHarvard T.H. Chan School of Public HealthBostonMA
| | - C. Keith Ozaki
- Department of Surgery and the Heart and Vascular CenterBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
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102
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Spadaccio C, Antoniades C, Nenna A, Chung C, Will R, Chello M, Gaudino MFL. Preventing treatment failures in coronary artery disease: what can we learn from the biology of in-stent restenosis, vein graft failure, and internal thoracic arteries? Cardiovasc Res 2020; 116:505-519. [PMID: 31397850 DOI: 10.1093/cvr/cvz214] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/01/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022] Open
Abstract
Coronary artery disease (CAD) remains one of the most important causes of morbidity and mortality worldwide, and the availability of percutaneous or surgical revascularization procedures significantly improves survival. However, both strategies are daunted by complications which limit long-term effectiveness. In-stent restenosis (ISR) is a major drawback for intracoronary stenting, while graft failure is the limiting factor for coronary artery bypass graft surgery (CABG), especially using veins. Conversely, internal thoracic artery (ITA) is known to maintain long-term patency in CABG. Understanding the biology and pathophysiology of ISR and vein graft failure (VGF) and mechanisms behind ITA resistance to failure is crucial to combat these complications in CAD treatment. This review intends to provide an overview of the biological mechanisms underlying stent and VGF and of the potential therapeutic strategy to prevent these complications. Interestingly, despite being different modalities of revascularization, mechanisms of failure of stent and saphenous vein grafts are very similar from the biological standpoint.
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Affiliation(s)
- Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY Glasgow, UK
| | | | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Calvin Chung
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY Glasgow, UK
| | - Ricardo Will
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY Glasgow, UK
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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103
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Zhong X, Xie F, Chen L, Liu Z, Wang Q. S100A8 and S100A9 promote endothelial cell activation through the RAGE‑mediated mammalian target of rapamycin complex 2 pathway. Mol Med Rep 2020; 22:5293-5303. [PMID: 33174028 PMCID: PMC7646991 DOI: 10.3892/mmr.2020.11595] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
S100 calcium binding protein A8 (S100A8) and A9 (S100A9) belong to the S100 family of calcium-binding proteins and have important roles in inflammation. They increase endothelial cell proliferation, thereby affecting inflammation, angiogenesis and tumorigenesis. However, the mechanism of action of S100A8/9 in endothelial cells needs further study. Therefore, the present study sought to investigate the effects of S100A8/9 on the proliferation and angiogenesis of human umbilical vein endothelial cells (HUVECs) and their mechanism of action. The viability of HUVECs was determined through a Cell Counting Kit-8 assay. The effect of S100A8/9 on the proliferation of HUVECs was detected by flow cytometry. Migration was evaluated by a Transwell migration assay. Apoptosis was evaluated by Annexin V-FITC and PI staining via flow cytometry. Western blot analysis and reverse transcription-quantitative polymerase chain reaction assays were performed to evaluate the activation of the phosphatidylinositol 3-phosphate kinase (PI3K)/Akt/mTOR pathway and mTOR complex 2 (mTORC2). We previously confirmed that S100A8/9 were consistently overexpressed at 1 and 7 days post-surgery in a rabbit vein graft model, which is the period when apoptosis changes to proliferation in neointimal hyperplasia. In the present study, proliferation, viability and migration were increased after treating HUVECs with S100A8/9. S100A8/9 stimulated the PI3K/Akt/mTOR pathway and mTORC2, which was significantly suppressed by a receptor for advanced glycation end products (RAGE)-blocking antibody. Furthermore, depleting expression of RAGE or mTORC2 protein components (rapamycin-insensitive companion of mTOR) by small interfering RNA was found to reduce the cell viability, migration and angiogenesis of S100A8/9-treated HUVECs. The development of neointimal hyperplasia is a complex process initiated by damage to endothelial cells. In conclusion, S100A8/9 has an important role in intimal hyperplasia by promoting cell growth and angiogenesis via RAGE signaling and activation of mTORC2.
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Affiliation(s)
- Xiang Zhong
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Fengwen Xie
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Li Chen
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhixing Liu
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Qun Wang
- Department of Cardiac Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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104
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All-Trans Retinoic Acid Prevented Vein Grafts Stenosis by Inhibiting Rb-E2F Mediated Cell Cycle Progression and KLF5-RARα Interaction in Human Vein Smooth Muscle Cells. Cardiovasc Drugs Ther 2020; 35:103-111. [PMID: 33044585 DOI: 10.1007/s10557-020-07089-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Vein graft failure (VGF) is an important limitation for coronary artery bypass graft (CABG) surgery. Inhibition of the excessive proliferation and migration of venous smooth muscle cells (SMCs) is an effective strategy to alleviate VGF during the CABG perioperative period. In the present study, we aimed to explore the role and potential mechanism of all-trans retinoic acid (ATRA) on preventing vein grafts stenosis. METHODS The autogenous vein grafts model was established in the right jugular artery of rabbits. Immunohistochemistry staining and western blot assays were used to detected the protein expression, while real-time PCR assay was applied for mRNAs expression detection. The interaction between proteins was identified by co-immunoprecipitation assay. The Cell Counting Kit-8 and wound-healing assays were used to investigate the role of ATRA on human umbilical vein smooth muscle cells (HUVSMCs) function. Cell cycle progression was identified by flow cytometry assay. RESULTS Vein graft stenosis and SMCs hyperproliferation were confirmed in vein grafts by histological and Ki-67 immunohistochemistry assays. Treatment of ATRA (10 mg/kg/day) significantly mitigated the stenosis extent of vein grafts, demonstrated by the decreased thickness of intima-media, and decreased Ki-67 expression. ATRA could repress the PDGF-bb-induced excessive proliferation and migration of HUVSMCs, which was mediated by Rb-E2F dependent cell cycle inhibition. Meanwhile, ATRA could reduce the interaction between KLF5 and RARα, thereby inhibiting the function of cis-elements of KLF5. KLF5-induced inducible nitric oxide synthase (iNOS) expression activation could be significantly inhibited by ATRA. CONCLUSIONS These results suggested that ATRA treatment may represent an effective prevention and therapy avenue for VGF.
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105
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Abstract
PURPOSE OF REVIEW Coronary artery bypass graft (CABG) surgery remains the gold-standard treatment for multivessel and left main coronary artery disease. Despite significant improvement in cardiovascular outcomes, patients undergoing CABG remain at risk for recurrent adverse ischemic events and other cardiovascular outcomes (coronary revascularisation, stroke, cardiac death, etc.). The purpose of this review is to summarize the most recent evidence in pharmacological preventive therapies addressing the residual cardiovascular risk in patients who have undergone CABG. RECENT FINDINGS Novel cardiovascular pharmacological preventive strategies targeting inflammatory, metabolic and prothrombotic (antiplatelet and anticoagulation) pathways have been recently assessed, with promising results for secondary prevention after CABG. SUMMARY Secondary prevention is an essential part of postoperative care after CABG. Novel lipid-lowering and glucose-controlling agents suggest a strong and consistent benefit on native coronary artery disease and overall cardiovascular outcomes. The role and the choice of enhanced antiplatelet/anticoagulation/lipid/glucose-modulating therapies following CABG should be better defined and deserves further investigation. Additional studies are required to identify new therapeutic target addressing the specific multifactorial nature of the graft CV disease and identifying the best preventive strategies for long-term graft patency.
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106
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Spencer HL, Sanders R, Boulberdaa M, Meloni M, Cochrane A, Spiroski AM, Mountford J, Emanueli C, Caporali A, Brittan M, Rodor J, Baker AH. The LINC00961 transcript and its encoded micropeptide, small regulatory polypeptide of amino acid response, regulate endothelial cell function. Cardiovasc Res 2020; 116:1981-1994. [PMID: 31990292 PMCID: PMC8216332 DOI: 10.1093/cvr/cvaa008] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/10/2019] [Accepted: 02/11/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Long non-coding RNAs (lncRNAs) play functional roles in physiology and disease, yet understanding of their contribution to endothelial cell (EC) function is incomplete. We identified lncRNAs regulated during EC differentiation and investigated the role of LINC00961 and its encoded micropeptide, small regulatory polypeptide of amino acid response (SPAAR), in EC function. METHODS AND RESULTS Deep sequencing of human embryonic stem cell differentiation to ECs was combined with Encyclopedia of DNA Elements (ENCODE) RNA-seq data from vascular cells, identifying 278 endothelial enriched genes, including 6 lncRNAs. Expression of LINC00961, first annotated as an lncRNA but reassigned as a protein-coding gene for the SPAAR micropeptide, was increased during the differentiation and was EC enriched. LINC00961 transcript depletion significantly reduced EC adhesion, tube formation, migration, proliferation, and barrier integrity in primary ECs. Overexpression of the SPAAR open reading frame increased tubule formation; however, overexpression of the full-length transcript did not, despite production of SPAAR. Furthermore, overexpression of an ATG mutant of the full-length transcript reduced network formation, suggesting a bona fide non-coding RNA function of the transcript with opposing effects to SPAAR. As the LINC00961 locus is conserved in mouse, we generated an LINC00961 locus knockout (KO) mouse that underwent hind limb ischaemia (HLI) to investigate the angiogenic role of this locus in vivo. In agreement with in vitro data, KO animals had a reduced capillary density in the ischaemic adductor muscle after 7 days. Finally, to characterize LINC00961 and SPAAR independent functions in ECs, we performed pull-downs of both molecules and identified protein-binding partners. LINC00961 RNA binds the G-actin sequestering protein thymosin beta-4x (Tβ4) and Tβ4 depletion phenocopied the overexpression of the ATG mutant. SPAAR binding partners included the actin-binding protein, SYNE1. CONCLUSION The LINC00961 locus regulates EC function in vitro and in vivo. The gene produces two molecules with opposing effects on angiogenesis: SPAAR and LINC00961.
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Affiliation(s)
- Helen L Spencer
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Rachel Sanders
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Mounia Boulberdaa
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Marco Meloni
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Amy Cochrane
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Ana-Mishel Spiroski
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Joanne Mountford
- Institute of Cardiovascular and Medical Sciences, University of
Glasgow, 126 University Pl, Glasgow G12 8TA, UK
| | - Costanza Emanueli
- National Heart and Lung Institute, Vascular Sciences and Cardiac Function,
Imperial Centre for Translational and Experimental Medicine, Imperial College
London, London W12 0NN, UK
| | - Andrea Caporali
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Mairi Brittan
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Julie Rodor
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Andrew H Baker
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
- Institute of Cardiovascular and Medical Sciences, University of
Glasgow, 126 University Pl, Glasgow G12 8TA, UK
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107
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Parma L, Peters HAB, Sluiter TJ, Simons KH, Lazzari P, de Vries MR, Quax PHA. bFGF blockade reduces intraplaque angiogenesis and macrophage infiltration in atherosclerotic vein graft lesions in ApoE3*Leiden mice. Sci Rep 2020; 10:15968. [PMID: 32994514 PMCID: PMC7525538 DOI: 10.1038/s41598-020-72992-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022] Open
Abstract
Intraplaque angiogenesis increases the chance of unstable atherosclerotic plaque rupture and thrombus formation leading to myocardial infarction. Basic Fibroblast Growth Factor (bFGF) plays a key role in angiogenesis and inflammation and is involved in the pathogenesis of atherosclerosis. Therefore, we aim to test K5, a small molecule bFGF-inhibitor, on remodelling of accelerated atherosclerotic vein grafts lesions in ApoE3*Leiden mice. K5-mediated bFGF-signalling blockade strongly decreased intraplaque angiogenesis and intraplaque hemorrhage. Moreover, it reduced macrophage infiltration in the lesions by modulating CCL2 and VCAM1 expression. Therefore, K5 increases plaque stability. To study the isolated effect of K5 on angiogenesis and SMCs-mediated intimal hyperplasia formation, we used an in vivo Matrigel-plug mouse model that reveals the effects on in vivo angiogenesis and femoral artery cuff model to exclusively looks at SMCs. K5 drastically reduced in vivo angiogenesis in the matrigel plug model while no effect on SMCs migration nor proliferation could be seen in the femoral artery cuff model. Moreover, in vitro K5 impaired endothelial cells functions, decreasing migration, proliferation and tube formation. Our data show that K5-mediated bFGF signalling blockade in hypercholesterolemic ApoE3*Leiden mice reduces intraplaque angiogenesis, haemorrhage and inflammation. Therefore, K5 is a promising candidate to stabilize advanced atherosclerotic plaques.
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Affiliation(s)
- Laura Parma
- Department of Vascular Surgery, D6-33, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Hendrika A B Peters
- Department of Vascular Surgery, D6-33, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Thijs J Sluiter
- Department of Vascular Surgery, D6-33, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin H Simons
- Department of Vascular Surgery, D6-33, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Paolo Lazzari
- KemoTech SrL, Build 3, Loc. Piscinamanna, 09010, Pula, Italy
| | - Margreet R de Vries
- Department of Vascular Surgery, D6-33, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul H A Quax
- Department of Vascular Surgery, D6-33, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. .,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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108
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Trocha KM, Kip P, Tao M, MacArthur MR, Treviño-Villarreal JH, Longchamp A, Toussaint W, Lambrecht BN, de Vries MR, Quax PHA, Mitchell JR, Ozaki CK. Short-term preoperative protein restriction attenuates vein graft disease via induction of cystathionine γ-lyase. Cardiovasc Res 2020; 116:416-428. [PMID: 30924866 DOI: 10.1093/cvr/cvz086] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS Therapies to prevent vein graft disease, a major problem in cardiovascular and lower extremity bypass surgeries, are currently lacking. Short-term preoperative protein restriction holds promise as an effective preconditioning method against surgical stress in rodent models, but whether it can improve vein graft patency after bypass surgery is undetermined. Here, we hypothesized that short-term protein restriction would limit vein graft disease via up-regulation of cystathionine γ-lyase and increased endogenous production of the cytoprotective gaseous signalling molecule hydrogen sulfide. METHODS AND RESULTS Low-density lipoprotein receptor knockout mice were preconditioned for 1 week on a high-fat high-cholesterol (HFHC) diet with or without protein prior to left common carotid interposition vein graft surgery with caval veins from donor mice on corresponding diets. Both groups were returned to a complete HFHC diet post-operatively, and vein grafts analysed 4 or 28 days later. A novel global transgenic cystathionine γ-lyase overexpressing mouse model was also employed to study effects of genetic overexpression on graft patency. Protein restriction decreased vein graft intimal/media+adventitia area and thickness ratios and intimal smooth muscle cell infiltration 28 days post-operatively, and neutrophil transmigration 4 days post-operatively. Protein restriction increased cystathionine γ-lyase protein expression in aortic and caval vein endothelial cells (ECs) and frequency of lung EC producing hydrogen sulfide. The cystathionine γ-lyase inhibitor propargylglycine abrogated protein restriction-mediated protection from graft failure and the increase in hydrogen sulfide-producing ECs, while cystathionine γ-lyase transgenic mice displayed increased hydrogen sulfide production capacity and were protected from vein graft disease independent of diet. CONCLUSION One week of protein restriction attenuates vein graft disease via increased cystathionine γ-lyase expression and hydrogen sulfide production, and decreased early inflammation. Dietary or pharmacological interventions to increase cystathionine γ-lyase or hydrogen sulfide may thus serve as new and practical strategies to improve vein graft durability.
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Affiliation(s)
- Kaspar M Trocha
- Department of Surgery and the Heart and Vascular Center, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Peter Kip
- Department of Surgery and the Heart and Vascular Center, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.,Einthoven Laboratory for Experimental Vascular Medicine and Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ming Tao
- Department of Surgery and the Heart and Vascular Center, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Michael R MacArthur
- Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | | | - Alban Longchamp
- Department of Surgery and the Heart and Vascular Center, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Wendy Toussaint
- VIB-UGent Center for Inflammation Research, and Department of Internal Medicine and Pediatrics, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Bart N Lambrecht
- VIB-UGent Center for Inflammation Research, and Department of Internal Medicine and Pediatrics, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Margreet R de Vries
- Einthoven Laboratory for Experimental Vascular Medicine and Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul H A Quax
- Einthoven Laboratory for Experimental Vascular Medicine and Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - James R Mitchell
- Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - C Keith Ozaki
- Department of Surgery and the Heart and Vascular Center, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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109
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Caliskan E, Pachuk CJ, Perrault LP, Emmert MY. Preservation solutions to improve graft patency: The devil is in the detail. J Cardiothorac Surg 2020; 15:228. [PMID: 32854755 PMCID: PMC7457275 DOI: 10.1186/s13019-020-01267-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/19/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Etem Caliskan
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Louis P Perrault
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany. .,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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110
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Abstract
Revascularization surgeries such as coronary artery bypass grafting (CABG) are sometimes necessary to manage coronary heart disease (CHD). However, more than half of these surgeries fail within 10 years due to the development of intimal hyperplasia (IH) among others. The cytokine transforming growth factor-beta (TGFß) and its signaling components have been found to be upregulated in diseased or injured vessels, and to promote IH after grafting. Interventions that globally inhibit TGFß in CABG have yielded contrasting outcomes in in vitro and in vivo studies including clinical trials. With advances in molecular biology, it becomes clear that TGFß exhibits both protective and damaging roles, and only specific components such as some Smad-dependent TGFß signaling mediate vascular IH. The activin receptor-like kinase (ALK)-mediated Smad-dependent TGFß signaling pathways have been found to be activated in human vascular smooth muscle cells (VSMCs) following injury and in hyperplastic preimplantation vein grafts. It appears that focused targeting of TGFß pathway constitutes a promising therapeutic target to improve the outcome of CABG. This study dissects the role of TGFß pathway in CABG failure, with particular emphasis on the therapeutic potentials of specific targeting of Smad-dependent and ALK-mediated signaling.
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Affiliation(s)
- Marzuq A Ungogo
- Department of Veterinary Pharmacology and Toxicology, 58989Ahmadu Bello University, Zaria, Nigeria.,Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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111
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Akşit E, Kurt T, Büyük B, Çokkalender Ö. Drug-eluting Vein Graft with Acetylsalicylic Acid-Ticagrelor-Unfractionated Heparin Complex Inhibits Early Graft Thrombosis. Balkan Med J 2020; 37:269-275. [PMID: 32353222 PMCID: PMC7424184 DOI: 10.4274/balkanmedj.galenos.2020.2020.1.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background Bypass graft surgery remains to be an important treatment option for left main and multivessel coronary artery disease. Approximately 2% of saphenous vein grafts are lost immediately after the coronary artery bypass graft operations and 12% in the first month due to thrombosis. Aims To administer one anticoagulant and two antiplatelet agents in a way that locally affects the vein graft before the bypass operation and to thereby analyse their effects on early graft thrombosis. Study Design Animal experimentation. Methods Since ticagrelor was used locally for the first time in this study, its efficacy in combination with other drugs (acetylsalicylic acid, acetylsalicylic acid and ticagrelor, and acetylsalicylic acid + ticagrelor + unfractionated heparin) was examined on rats including control (untreated) and sham (pluronic gel) group (n=14 for each group). Before the tunica adventitia layer of the femoral veins was bypassed to the femoral artery, it was coated with the drug-eluting pluronic F-127 gel. The presence or absence of thrombus in the vein graft samples was recorded under light microscopy. In vein graft preparations where thrombus was detected, the thrombus area (μm2) was calculated using the Axiovision software. Immunohistochemical staining was performed with the anti-rat von Willebrand factor polyclonal antibody kit. Results The number of preparations containing thrombus was significantly lower in the acetylsalicylic acid + ticagrelor + unfractionated heparin group than in the acetylsalicylic acid, control, and sham groups, according to the comparisons made on the 1st and 3rd days (p=0.001 and 0.02, respectively). von Willebrand factor staining was significantly lower in the acetylsalicylic acid + ticagrelor + unfractionated heparin group than in the other groups on the 3rd day (p=0.005). Conclusion Locally effective acetylsalicylic acid-ticagrelor-unfractionated heparin complex has been shown to significantly reduce thrombus formation in vein grafts in this experimental model. Local administration of these drugs, which are routinely administered orally just before stent implantations, on the vein graft before the bypass is performed can prevent the loss of vein grafts due to thrombus, thereby reducing the mortality and morbidity of these patients.
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Affiliation(s)
- Ercan Akşit
- Department of Cardiology, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Tolga Kurt
- Department of Cardiovascular Surgery, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Başak Büyük
- Department of Histology and Embryology, İzmir Demokrasi University School of Medicine, İzmir, Turkey
| | - Ömer Çokkalender
- Clinic of Cardiovascular Surgery, 25 Aralık State Hospital, Gaziantep, Turkey
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112
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Yang Q, Lei D, Huang S, Yang Y, Jiang C, Shi H, Chen W, Zhao Q, You Z, Ye X. A novel biodegradable external stent regulates vein graft remodeling via the Hippo-YAP and mTOR signaling pathways. Biomaterials 2020; 258:120254. [PMID: 32805499 DOI: 10.1016/j.biomaterials.2020.120254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 01/10/2023]
Abstract
Coronary artery bypass graft (CABG) has been confirmed to effectively improve the prognosis of coronary artery disease, which is a major public health concern worldwide. As the most frequently used conduits in CABG, saphenous vein grafts have the disadvantage of being susceptible to restenosis due to intimal hyperplasia. To meet the urgent clinical demand, adopting external stents (eStents) and illuminating the potential mechanisms underlying their function are important for preventing vein graft failure. Here, using 4-axis printing technology, we fabricated a novel biodegradable and flexible braided eStent, which exerts excellent inhibitory effect on intimal hyperplasia. The stented grafts downregulate Yes-associated protein (YAP), indicating that the eStent regulates vein graft remodeling via the Hippo-YAP signaling pathway. Further, as a drug-delivery vehicle, a rapamycin (RM)-coated eStent was designed to amplify the inhibitory effect of eStent on intimal hyperplasia through the synergistic effects of the Hippo and mammalian target of rapamycin (mTOR) signaling pathways. Overall, this study uncovers the underlying mechanisms of eStent function and identifies a new therapeutic target for the prevention of vein graft restenosis.
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Affiliation(s)
- Qi Yang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Dong Lei
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Belt and Road Joint Laboratory of Advanced Fiber and Low-dimension Materials (Donghua University), College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China
| | - Shixing Huang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Chenyu Jiang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Hongpeng Shi
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Wenyi Chen
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Belt and Road Joint Laboratory of Advanced Fiber and Low-dimension Materials (Donghua University), College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - Zhengwei You
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Belt and Road Joint Laboratory of Advanced Fiber and Low-dimension Materials (Donghua University), College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China.
| | - Xiaofeng Ye
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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113
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Prim DA, Lane BA, Ferruzzi J, Shazly T, Eberth JF. Evaluation of the Stress-Growth Hypothesis in Saphenous Vein Perfusion Culture. Ann Biomed Eng 2020; 49:487-501. [PMID: 32728831 DOI: 10.1007/s10439-020-02582-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/22/2020] [Indexed: 01/02/2023]
Abstract
The great saphenous vein (GSV) has served as a coronary artery bypass graft (CABG) conduit for over 50 years. Despite prevalent use, first-year failure rates remain high compared to arterial autograft options. Amongst other factors, vein graft failure can be attributed to material and mechanical mismatching that lead to apoptosis, inflammation, and intimal-medial hyperplasia. Through the implementation of the continuum mechanical-based theory of "stress-mediated growth and remodeling," we hypothesize that the mechanical properties of porcine GSV grafts can be favorably tuned for CABG applications prior to implantation using a prolonged but gradual transition from venous to arterial loading conditions in an inflammatory and thrombogenic deficient environment. To test this hypothesis, we used a hemodynamic-mimetic perfusion bioreactor to guide remodeling through stepwise incremental changes in pressure and flow over the course of 21-day cultures. Biaxial mechanical testing of vessels pre- and post-remodeling was performed, with results fit to structurally-motivated constitutive models using non-parametric bootstrapping. The theory of "small-on-large" was used to describe appropriate stiffness moduli, while histology and viability assays confirmed microstructural adaptations and vessel viability. Results suggest that stepwise transition from venous-to-arterial conditions results in a partial restoration of circumferential stretch and circumferential, but not axial, stress through vessel dilation and wall thickening in a primarily outward remodeling process. These remodeled tissues also exhibited decreased mechanical isotropy and circumferential, but not axial, stiffening. In contrast, only increases in axial stiffness were observed using culture under venous perfusion conditions and those tissues experienced moderate intimal resorption.
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Affiliation(s)
- David A Prim
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Brooks A Lane
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Jacopo Ferruzzi
- Biomedical Engineering Department, Boston University, Boston, MA, USA
| | - Tarek Shazly
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA.,Mechanical Engineering Department, University of South Carolina, Columbia, SC, USA
| | - John F Eberth
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA. .,Cell Biology and Anatomy Department (CBA), SOM, University of South Carolina (USC), Bldg.1, Rm. C-36, Columbia, SC, 29208, USA.
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114
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Wen M, Yan H, Shi X, Zhao Y, Wang K, Kong D, Yuan X. Modulation of vascular endothelial cells under shear stress on electrospun membranes containing REDV and microRNA-126. INT J POLYM MATER PO 2020. [DOI: 10.1080/00914037.2020.1785452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Meiling Wen
- School of Materials Science and Engineering, and Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, China
| | - Hongyu Yan
- Key Laboratory of Bioactive Materials of Ministry of Education, College of Life Science, Nankai University, Tianjin, China
| | - Xin Shi
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, China
| | - Yunhui Zhao
- School of Materials Science and Engineering, and Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, China
| | - Kai Wang
- Key Laboratory of Bioactive Materials of Ministry of Education, College of Life Science, Nankai University, Tianjin, China
| | - Deling Kong
- Key Laboratory of Bioactive Materials of Ministry of Education, College of Life Science, Nankai University, Tianjin, China
| | - Xiaoyan Yuan
- School of Materials Science and Engineering, and Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, China
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115
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Donadoni F, Pichardo-Almarza C, Homer-Vanniasinkam S, Dardik A, Díaz-Zuccarini V. Multiscale, patient-specific computational fluid dynamics models predict formation of neointimal hyperplasia in saphenous vein grafts. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:292-306. [PMID: 32566808 PMCID: PMC7296340 DOI: 10.1016/j.jvscit.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/15/2019] [Indexed: 11/28/2022]
Abstract
Stenosis due to neointimal hyperplasia (NIH) is among the major causes of peripheral graft failure. Its link to abnormal hemodynamics in the graft is complex, and isolated use of hemodynamic markers is insufficient to fully capture its progression. Here, a computational model of NIH growth is presented, establishing a link between computational fluid dynamics simulations of flow in the lumen and a biochemical model representing NIH growth mechanisms inside the vessel wall. For all three patients analyzed, NIH at proximal and distal anastomoses was simulated by the model, with values of stenosis comparable to the computed tomography scans.
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Affiliation(s)
- Francesca Donadoni
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom
| | - Cesar Pichardo-Almarza
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Certara Quantitative Systems Pharmacology (QSP), Canterbury, United Kingdom
| | - Shervanthi Homer-Vanniasinkam
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Alan Dardik
- Yale University School of Medicine, Vascular Biology and Therapeutics, New Haven, Conn.,Department of Surgery, VA Connecticut Healthcare Systems, West Haven, Conn
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
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116
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Baganha F, de Jong A, Jukema JW, Quax PHA, de Vries MR. The Role of Immunomodulation in Vein Graft Remodeling and Failure. J Cardiovasc Transl Res 2020; 14:100-109. [PMID: 32542547 PMCID: PMC7892738 DOI: 10.1007/s12265-020-10001-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/01/2020] [Indexed: 12/18/2022]
Abstract
Obstructive arterial disease is a major cause of morbidity and mortality in the developed world. Venous bypass graft surgery is one of the most frequently used revascularization strategies despite its considerable short and long time failure rate. Due to vessel wall remodeling, inflammation, intimal hyperplasia, and accelerated atherosclerosis, vein grafts may (ultimately) fail to revascularize tissues downstream to occlusive atherosclerotic lesions. In the past decades, little has changed in the prevention of vein graft failure (VGF) although new insights in the role of innate and adaptive immunity in VGF have emerged. In this review, we discuss the pathophysiological mechanisms underlying the development of VGF, emphasizing the role of immune response and associated factors related to VG remodeling and failure. Moreover, we discuss potential therapeutic options that can improve patency based on data from both preclinical studies and the latest clinical trials. This review contributes to the insights in the role of immunomodulation in vein graft failure in humans. We describe the effects of immune cells and related factors in early (thrombosis), intermediate (inward remodeling and intimal hyperplasia), and late (intimal hyperplasia and accelerated atherosclerosis) failure based on both preclinical (mouse) models and clinical data.
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Affiliation(s)
- Fabiana Baganha
- Department of Vascular Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, Aberdeen University, Aberdeen, UK
| | - Alwin de Jong
- Department of Vascular Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul H A Quax
- Department of Vascular Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Margreet R de Vries
- Department of Vascular Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. .,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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117
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Ragnarsson S, Janiec M, Modrau IS, Dreifaldt M, Ericsson A, Holmgren A, Hultkvist H, Jeppsson A, Sartipy U, Ternström L, Per Vikholm M, de Souza D, James S, Thelin S. No-touch saphenous vein grafts in coronary artery surgery (SWEDEGRAFT): Rationale and design of a multicenter, prospective, registry-based randomized clinical trial. Am Heart J 2020; 224:17-24. [PMID: 32272256 DOI: 10.1016/j.ahj.2020.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
The SWEDEGRAFT study (ClinicalTrials.gov Identifier: NCT03501303) tests the hypothesis that saphenous vein grafts (SVGs) harvested with the "no-touch" technique improves patency of coronary artery bypass grafts compared with the conventional open skeletonized technique. This article describes the rationale and design of the randomized trial and baseline characteristics of the population enrolled during the first 9 months of enrollment. The SWEDEGRAFT study is a prospective, binational multicenter, open-label, registry-based trial in patients undergoing first isolated nonemergent coronary artery bypass grafting (CABG), randomized 1:1 to no-touch or conventional open skeletonized vein harvesting technique, with a planned enrollment of 900 patients. The primary end point is the proportion of patients with graft failure defined as SVGs occluded or stenosed >50% on coronary computed tomography angiography at 2 years after CABG, earlier clinically driven coronary angiography demonstrating an occluded or stenosed >50% vein graft, or death within 2 years. High-quality health registries and coronary computed tomography angiography are used to assess the primary end point. The secondary end points include wound healing in the vein graft sites and the composite outcome of major adverse cardiac events during the first 2 years based on registry data. Demographics of the first 200 patients enrolled in the trial and other CABG patients operated in Sweden during the same time period are comparable when the exclusion criteria are taken into consideration. RCT# NCT03501303.
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118
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Goldstein RL, McCormack MC, Mallidi S, Runyan G, Randolph MA, Austen WG, Redmond RW. Photochemical Tissue Passivation of Arteriovenous Grafts Prevents Long-Term Development of Intimal Hyperplasia in a Swine Model. J Surg Res 2020; 253:280-287. [PMID: 32402853 DOI: 10.1016/j.jss.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/27/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The autologous vein remains the standard conduit for lower extremity and coronary artery bypass grafting despite a 30%-50% 5-y failure rate, primarily attributable to intimal hyperplasia (IH) that develops in the midterm period (3-24 mo) of graft maturation. Our group discovered that externally strengthening vein grafts by cross-linking the adventitial collagen with photochemical tissue passivation (PTP) mitigates IH in an arteriovenous model at 4 wk. We now investigate whether this effect is retained in the midterm period follow-up. METHODS Six Hanford miniature pigs received bilateral carotid artery interposition vein grafts. In each animal, the external surface of one graft was treated with PTP before grafting, whereas the opposite side served as the untreated control. The grafts were harvested after 3 mo. Ultrasound evaluation of all vein grafts was performed at the time of grafting and harvest. The grafts were also evaluated histomorphometrically and immunohistologically for markers of IH. RESULTS All vein grafts were patent at 3 mo except one graft in the PTP-treated group because of early technical failure. The control vein grafts had significantly greater IH than PTP-treated grafts at 3 mo, as evidenced by the intimal area (2.6 ± 1.0 mm2versus 1.4 ± 1.5 mm2, respectively, P = 0.045) and medial area (5.1 ± 1.9 mm2versus 2.7 ± 2.4 mm2, respectively, P = 0.048). The control grafts had an increased presence and proliferation of mural myofibroblasts with greater smooth muscle actin and proliferating cell nuclear antigen staining. CONCLUSIONS PTP treatment to the external surface of the vein grafts decreases IH at 3 mo after arteriovenous grafting and may prevent future graft failure.
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Affiliation(s)
- Rachel L Goldstein
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts; Plastic Surgery Research Laboratory, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael C McCormack
- Plastic Surgery Research Laboratory, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Srivalleesha Mallidi
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Gem Runyan
- Plastic Surgery Research Laboratory, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark A Randolph
- Plastic Surgery Research Laboratory, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - William G Austen
- Plastic Surgery Research Laboratory, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert W Redmond
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
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119
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Sandner SE, Pachuk CJ, Aschacher T, Milojevic M, Caliskan E, Emmert MY. Endothelial damage inhibitors for improvement of saphenous vein graft patency in coronary artery bypass grafting. Minerva Cardioangiol 2020; 68:480-488. [PMID: 32326681 DOI: 10.23736/s0026-4725.20.05234-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The saphenous vein graft (SVG) remains the most commonly used conduit in coronary artery bypass grafting (CABG). In light of this further research must be aimed at the development of strategies to optimize SVG patency and thereby improve both short- and long-term outcomes of CABG surgery. SVG patency in large part depends on the protection of the structural and functional integrity of the vascular endothelium at the time of conduit harvesting, including optimal storage conditions to prevent endothelial damage. This review provides an overview of currently available storage and preservation solutions, including novel endothelial damage inhibitors, and their role in mitigating endothelial damage and vein graft failure.
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Affiliation(s)
- Sigrid E Sandner
- Division of Cardiac Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria -
| | | | - Thomas Aschacher
- Division of Cardiac Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Etem Caliskan
- Department of Cardiovascular Surgery, Charite University of Medicine, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charite University of Medicine, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
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120
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Jiang Q, Yang Y, Sun H, Tang Y, Lv F, Hu S. Stable Hemodynamics within "No-Touch" Saphenous Vein Graft. Ann Thorac Cardiovasc Surg 2020; 26:88-94. [PMID: 31611499 PMCID: PMC7184034 DOI: 10.5761/atcs.oa.19-00156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To investigate the hemodynamics characteristics of the "no-touch" saphenous vein graft (SVG) conduits by nicardipine intraluminal administration in vivo experiment. METHODS A total of 59 consecutive patients were enrolled and underwent a sequential SVG to three non-left anterior descending (LAD) targets with the average runoff ≤2 mm, 30 with "no-touch" harvest technique (group A) and 29 with conventional preparation (group B). The patients were subject to nicardipine intraluminal injection during off-pump coronary artery bypass grafting (CABG) procedure. The intraoperative flow was measured with the ultrasonic transit time flow meter (TTFM), and the graft patency testified by multi-detector computed tomography (MDCT) angiography, respectively. RESULTS The baseline blood flow was higher in group A than that in group B (p <0.05). However, the increases in blood flow of SVG conduits in group A were lower than those in group B with 19.7 ± 5.9 vs. 35.4 ± 9.2 mL/min, 14.8 ± 5.6 vs. 23.1 ± 6.8 mL/min, 6.6 ± 2.1 vs. 11.2 ± 4.3 mL/min before the first, second, and third anastomose after nicardipine intraluminal administration, respectively (all p <0.01). CONCLUSIONS No-touch SVGs were associated with higher baseline blood flow and less rises after nicardipine intraluminal administration during off-pump CABG procedure compared with conventional preparation. The no-touch SVGs seemed to be less spastic and well-tolerated on flow dilatation.
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Affiliation(s)
- Qin Jiang
- Department of Cardiac Surgery, Sichuan Provincial People's Hospital; Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China.,Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yang
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hansong Sun
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Tang
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Lv
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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121
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Qu Q, Pang Y, Zhang C, Liu L, Bi Y. Exosomes derived from human umbilical cord mesenchymal stem cells inhibit vein graft intimal hyperplasia and accelerate reendothelialization by enhancing endothelial function. Stem Cell Res Ther 2020; 11:133. [PMID: 32293542 PMCID: PMC7092460 DOI: 10.1186/s13287-020-01639-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 01/05/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background In our previous research, we found that mesenchymal stem cell (MSC) transplantation therapy can inhibit intimal hyperplasia and enhance endothelial function in arterialized vein grafts in rats. However, whether MSC-derived exosomes (MSC-exosomes) can reduce neointimal formation and its possible mechanism is still unclear. Methods The primary human umbilical cord MSCs (hucMSCs) and human umbilical vein endothelial cells (HUVECs) were isolated and characterized by flow cytometry and immunofluorescence. The exosomes derived from hucMSCs (hucMSC-exosomes) were identified by transmission electron microscopy and western blots. hucMSC-exosomes were intravenously injected into a rat model of vein grafting, and its effect on vein grafts reendothelialization and intimal hyperplasia was assessed by physical, histological, immunohistochemistry, and immunofluorescence examinations. The effects of hucMSC-exosomes on endothelial cells were evaluated by integrated experiment, EdU staining, scratch assay, and Transwell assay. The expression levels of key gene and pathways associated with the biological activity of vascular endothelial cells were evaluated following the stimulation of hucMSC-exosomes. Results We successfully isolated and characterized primary hucMSCs and hucMSC-exosomes and primary HUVECs. We verified that the systemic administration of hucMSC-exosomes accelerates reendothelialization and decreases intimal hyperplasia of autologous vein graft in a rat model. We also identified that hucMSC-exosomes can be uptaken by endothelial cells to stimulate cell proliferative and migratory activity in vitro. Furthermore, we detected that vascular endothelial growth factor (VEGF) plays an important part in hucMSC-exosome-mediated proliferation and migration in HUVECs. In addition, we also provided evidence that the signalling pathways of PI3K/AKT and MAPK/ERK1/2 take part in hucMSC-exosome-induced VEGF regulation. Conclusion Our data suggest that hucMSC-exosomes exert a vasculoprotective role in the setting of vein graft disease, which may provide a new clue to protect against vein graft failure in the future.
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Affiliation(s)
- Qingxi Qu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Yingxin Pang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Chunmei Zhang
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Linghong Liu
- Research Center of Stem Cell and Regenerative Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China. .,Laboratory of Cryomedicine, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China.
| | - Yanwen Bi
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China.
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122
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Jovin DG, Katlaps GJ, Sumption KF. Coronary artery bypass graft markers: history, usage, and effects. Gen Thorac Cardiovasc Surg 2020; 68:453-458. [DOI: 10.1007/s11748-020-01325-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/21/2020] [Indexed: 01/09/2023]
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Di Mauro M, Di Baldassarre A. Commentary: Born vein, you cannot die artery! JTCVS Tech 2020; 1:53-54. [PMID: 34317712 PMCID: PMC8288623 DOI: 10.1016/j.xjtc.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Michele Di Mauro
- Department of Heart Disease, SS Annunziata Hospital, Chieti, Italy
- Address for reprints: Michele Di Mauro, MD, PhD, MSc Biostat, Heart Disease Department, SS Annunziata Hospital, Via dei Vestini, 66100, Chieti, Italy.
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, University “G. D'Annunzio,” Chieti-Pescara, Chieti, Italy
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Sterpetti AV, Sapienza P, Borrelli V, Di Marzo L. Inflammatory cytokines and experimental arterial and vein grafts. JTCVS Tech 2020; 1:48-50. [PMID: 34317710 PMCID: PMC8289074 DOI: 10.1016/j.xjtc.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/05/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022] Open
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Garoffolo G, Ruiter MS, Piola M, Brioschi M, Thomas AC, Agrifoglio M, Polvani G, Coppadoro L, Zoli S, Saccu C, Spinetti G, Banfi C, Fiore GB, Madeddu P, Soncini M, Pesce M. Coronary artery mechanics induces human saphenous vein remodelling via recruitment of adventitial myofibroblast-like cells mediated by Thrombospondin-1. Am J Cancer Res 2020; 10:2597-2611. [PMID: 32194822 PMCID: PMC7052885 DOI: 10.7150/thno.40595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022] Open
Abstract
Rationale: Despite the preferred application of arterial conduits, the greater saphenous vein (SV) remains indispensable for coronary bypass grafting (CABG), especially in multi-vessel coronary artery disease (CAD). The objective of the present work was to address the role of mechanical forces in the activation of maladaptive vein bypass remodeling, a process determining progressive occlusion and recurrence of ischemic heart disease. Methods: We employed a custom bioreactor to mimic the coronary shear and wall mechanics in human SV vascular conduits and reproduce experimentally the biomechanical conditions of coronary grafting and analyzed vein remodeling process by histology, histochemistry and immunofluorescence. We also subjected vein-derived cells to cyclic uniaxial mechanical stimulation in culture, followed by phenotypic and molecular characterization using RNA and proteomic methods. We finally validated our results in vitro and using a model of SV carotid interposition in pigs. Results: Exposure to pulsatile flow determined a remodeling process of the vascular wall involving reduction in media thickness. Smooth muscle cells (SMCs) underwent conversion from contractile to synthetic phenotype. A time-dependent increase in proliferating cells expressing mesenchymal (CD44) and early SMC (SM22α) markers, apparently recruited from the SV adventitia, was observed especially in CABG-stimulated vessels. Mechanically stimulated SMCs underwent transition from contractile to synthetic phenotype. MALDI-TOF-based secretome analysis revealed a consistent release of Thrombospondin-1 (TSP-1), a matricellular protein involved in TGF-β-dependent signaling. TSP-1 had a direct chemotactic effect on SV adventitia resident progenitors (SVPs); this effects was inhibited by blocking TSP-1 receptor CD47. The involvement of TSP-1 in adventitial progenitor cells differentiation and graft intima hyperplasia was finally contextualized in the TGF-β-dependent pathway, and validated in a saphenous vein into carotid interposition pig model. Conclusions: Our results provide the evidence of a matricellular mechanism involved in the human vein arterialization process controlled by alterations in tissue mechanics, and open the way to novel potential strategies to block VGD progression based on targeting cell mechanosensing-related effectors.
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Wang Z, Liu C, Zhu D, Gu X, Xu Y, Qin Q, Dong N, Zhang S, Wang J. Untangling the co-effects of oriented nanotopography and sustained anticoagulation in a biomimetic intima on neovessel remodeling. Biomaterials 2020; 231:119654. [DOI: 10.1016/j.biomaterials.2019.119654] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/31/2022]
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Prolonged Hyperoxygenation Treatment Improves Vein Graft Patency and Decreases Macrophage Content in Atherosclerotic Lesions in ApoE3*Leiden Mice. Cells 2020; 9:cells9020336. [PMID: 32024075 PMCID: PMC7072413 DOI: 10.3390/cells9020336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 12/14/2022] Open
Abstract
Unstable atherosclerotic plaques frequently show plaque angiogenesis which increases the chance of rupture and thrombus formation leading to infarctions. Hypoxia plays a role in angiogenesis and inflammation, two processes involved in the pathogenesis of atherosclerosis. We aim to study the effect of resolution of hypoxia using carbogen gas (95% O2, 5% CO2) on the remodeling of vein graft accelerated atherosclerotic lesions in ApoE3*Leiden mice which harbor plaque angiogenesis. Single treatment resulted in a drastic decrease of intraplaque hypoxia, without affecting plaque composition. Daily treatment for three weeks resulted in 34.5% increase in vein graft patency and increased lumen size. However, after three weeks intraplaque hypoxia was comparable to the controls, as were the number of neovessels and the degree of intraplaque hemorrhage. To our surprise we found that three weeks of treatment triggered ROS accumulation and subsequent Hif1a induction, paralleled with a reduction in the macrophage content, pointing to an increase in lesion stability. Similar to what we observed in vivo, in vitro induction of ROS in bone marrow derived macrophages lead to increased Hif1a expression and extensive DNA damage and apoptosis. Our study demonstrates that carbogen treatment did improve vein graft patency and plaque stability and reduced intraplaque macrophage accumulation via ROS mediated DNA damage and apoptosis but failed to have long term effects on hypoxia and intraplaque angiogenesis.
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Lopera Higuita M, Griffiths LG. Small Diameter Xenogeneic Extracellular Matrix Scaffolds for Vascular Applications. TISSUE ENGINEERING PART B-REVIEWS 2019; 26:26-45. [PMID: 31663438 DOI: 10.1089/ten.teb.2019.0229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Currently, despite the success of percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) remains among the most commonly performed cardiac surgical procedures in the United States. Unfortunately, the use of autologous grafts in CABG presents a major clinical challenge as complications due to autologous vessel harvest and limited vessel availability pose a significant setback in the success rate of CABG surgeries. Acellular extracellular matrix (ECM) scaffolds derived from xenogeneic vascular tissues have the potential to overcome these challenges, as they offer unlimited availability and sufficient length to serve as "off-the-shelf" CABGs. Unfortunately, regardless of numerous efforts to produce a fully functional small diameter xenogeneic ECM scaffold, the combination of factors required to overcome all failure mechanisms in a single graft remains elusive. This article covers the major failure mechanisms of current xenogeneic small diameter vessel ECM scaffolds, and reviews the recent advances in the field to overcome these failure mechanisms and ultimately develop a small diameter ECM xenogeneic scaffold for CABG. Impact Statement Currently, the use of autologous vessel in coronary artery bypass graft (CABG) is common practice. However, the use of autologous tissue poses significant complications due to tissue harvest and limited availability. Developing an alternative vessel for use in CABG can potentially increase the success rate of CABG surgery by eliminating complications related to the use of autologous vessel. However, this development has been hindered by an array of failure mechanisms that currently have not been overcome. This article describes the currently identified failure mechanisms of small diameter vascular xenogeneic extracellular matrix scaffolds and reviews current research targeted to overcoming these failure mechanisms toward ensuring long-term graft patency.
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Affiliation(s)
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Sequential multidetector computed tomography assessments after venous graft treatment solution in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2019; 161:96-106.e2. [PMID: 31866081 DOI: 10.1016/j.jtcvs.2019.10.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the effect of DuraGraft (Somahlution Inc, Jupiter, Fla), an intraoperative graft treatment, on saphenous vein grafts in patients undergoing isolated coronary artery bypass grafting. METHODS Within patients, 2 saphenous vein grafts were randomized to DuraGraft or heparinized saline. Multidetector computed tomography angiography at 1, 3, and 12 months assessed change in wall thickness (primary end point at 3 months), lumen diameter, and maximum narrowing for the whole graft and the proximal 5-cm segment. Safety end points included graft occlusion, death, myocardial infarction, and repeat revascularization. RESULTS At 3 months, no significant changes were observed between DuraGraft- and saline-treated grafts (125 each) for wall thickness, lumen diameter, and maximum narrowing. At 12 months, DuraGraft-treated grafts demonstrated smaller mean wall thickness, overall (0.12 ± 0.06 vs 0.20 ± 0.31 mm; P = .02) and in the proximal segment (0.11 ± 0.03 vs 0.21 ± 0.33 mm; P = .01). Changes in wall thickness were greater in the proximal segment of saline-treated grafts (0.09 ± 0.29 vs 0.00 ± 0.03 mm; P = .04). Increase in maximum graft narrowing was larger in the proximal segment in the saline-treated grafts (4.7% ± 12.7% vs 0.2% ± 3.8%; P = .01). Nine DuraGraft and 11 saline grafts had occluded or thrombosed. One myocardial infarction was associated with a saline graft occlusion. No deaths or revascularizations were observed. CONCLUSIONS DuraGraft demonstrated a favorable effect on wall thickness at 12 months, particularly in the proximal segment. Longer-term follow-up in larger studies is needed to evaluate the effect on clinical outcomes.
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Wu BJ, Li Y, Ong KL, Sun Y, Johns D, Barter PJ, Rye KA. The Cholesteryl Ester Transfer Protein Inhibitor, des-Fluoro-Anacetrapib, Prevents Vein Bypass-induced Neointimal Hyperplasia in New Zealand White Rabbits. Sci Rep 2019; 9:16183. [PMID: 31700015 PMCID: PMC6838195 DOI: 10.1038/s41598-019-52510-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/18/2019] [Indexed: 11/25/2022] Open
Abstract
Coronary artery bypass grafting is among the most commonly performed of all cardiovascular surgical procedures. However, graft failure due to stenosis reduces the long-term benefit of the intervention. This study asks if elevating plasma high density lipoprotein cholesterol (HDL-C) levels by inhibition of cholesteryl ester transfer protein (CETP) activity with des-fluoro-anacetrapib, an analog of the CETP inhibitor anacetrapib, prevents vein bypass-induced neointimal hyperplasia. NZW rabbits were placed on a normal chow diet or chow containing 0.14% (wt/wt) des-fluoro-anacetrapib for 6 weeks. Bypass grafting of the jugular vein to the common carotid artery was performed 2 weeks after starting dietary des-fluoro-anacetrapib supplementation. The animals were euthanised 4 weeks post-bypass grafting. Relative to control, dietary supplementation with des-fluoro-anacetrapib reduced plasma CETP activity by 89 ± 6.9%, increased plasma apolipoprotein A-I levels by 24 ± 5.5%, increased plasma HDL-C levels by 93 ± 26% and reduced intimal hyperplasia in the grafted vein by 38 ± 6.2%. Des-fluoro-anacetrapib treatment was also associated with decreased bypass grafting-induced endothelial expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1), endothelial dysfunction, and smooth muscle cell (SMC) proliferation in the grafted vein. In conclusion, increasing HDL-C levels by inhibiting CETP activity is associated with inhibition of intimal hyperplasia in grafted veins, reduced inflammatory responses, improved endothelial function, and decreased SMC proliferation.
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Affiliation(s)
- Ben J Wu
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia.
| | - Yue Li
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia
| | - Kwok-Leung Ong
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia
| | - Yidan Sun
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Immunology and Pathophysiology, Medical University of Graz, Graz, Austria
| | | | - Philip J Barter
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia.
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Pachuk CJ, Rushton-Smith SK, Emmert MY. Intraoperative storage of saphenous vein grafts in coronary artery bypass grafting. Expert Rev Med Devices 2019; 16:989-997. [DOI: 10.1080/17434440.2019.1682996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Maximilian Y. Emmert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Caliskan E, Sandner S, Misfeld M, Aramendi J, Salzberg SP, Choi YH, Satishchandran V, Iyer G, Perrault LP, Böning A, Emmert MY. A novel endothelial damage inhibitor for the treatment of vascular conduits in coronary artery bypass grafting: protocol and rationale for the European, multicentre, prospective, observational DuraGraft registry. J Cardiothorac Surg 2019; 14:174. [PMID: 31615560 PMCID: PMC6794868 DOI: 10.1186/s13019-019-1010-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background Vein graft disease (VGD) impairs graft patency rates and long-term outcomes after coronary artery bypass grafting (CABG). DuraGraft is a novel endothelial-damage inhibitor developed to efficiently protect the structural and functional integrity of the vascular endothelium. The DuraGraft registry will evaluate the long-term clinical outcomes of DuraGraft in patients undergoing CABG procedures. Methods This ongoing multicentre, prospective observational registry will enrol 3000 patients undergoing an isolated CABG procedure or a combined procedure (ie, CABG plus valve surgery or other surgery) with at least one saphenous vein grafts or one free arterial graft (ie, radial artery or mammary artery). If a patient is enrolled, all free grafts (SVG and arterial will be treated with DuraGraft. Data on baseline, clinical, and angiographic characteristics as well as procedural and clinical events will be collected. The primary outcome measure is the occurrence of a major adverse cardiac event (MACE; defined as death, non-fatal myocardial-infarction, or need for repeat-revascularisation). Secondary outcome measures are the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as death, non-fatal myocardial-infarction, repeat-revascularisation, or stroke), patient-reported quality of life, and health-economic data. Patient assessments will be performed during hospitalisation, at 1-month, 1-year, and annually thereafter to 5 years post-CABG. Events will be adjudicated by an independent clinical events committee. This European, multi-institutional registry will provide detailed insights into clinical outcome associated with DuraGraft. Discussion This European, multi-institutional registry will provide detailed insights into clinical outcome associated with the use of DuraGraft. Beyond that, and given the comprehensive data sets comprising of patient, procedural, and graft parameters that are being collected, the registry will enable for multiple subgroup analyses targeting focus groups or specific clinical questions. These may include analysis of subpopulations such as patients with diabetes or multimorbid high-risk patients (patient level), evaluation of relevance of harvesting technique including endoscopic versus open conduit harvesting (procedural level), or particular graft-specific aspects (conduit level). Trial registration ClinicalTrials.gov NCT02922088. Registered October 3, 2016. Ethics and dissemination The regional ethics committees have approved the registry. Results will be submitted for publication.
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Affiliation(s)
- Etem Caliskan
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Sigrid Sandner
- Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Martin Misfeld
- University Clinic of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Jose Aramendi
- Division of Cardiac Surgery, Hospital de Cruces, Barakaldo, Spain
| | | | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | | | | | - Louis P Perrault
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Andreas Böning
- Department of Cardiovascular Surgery, Justus-Liebig University Gießen, Gießen, Germany
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany. .,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
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Solo K, Lavi S, Kabali C, Levine GN, Kulik A, John-Baptiste AA, Fremes SE, Martin J, Eikelboom JW, Ruel M, Huitema AA, Choudhury T, Bhatt DL, Tzemos N, Mamas MA, Bagur R. Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis. BMJ 2019; 367:l5476. [PMID: 31601578 PMCID: PMC6785742 DOI: 10.1136/bmj.l5476] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019. ELIGIBILITY CRITERIA: for selecting studies Randomised controlled trials of participants (aged ≥18) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery. MAIN OUTCOME MEASURES The primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death. RESULTS This review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates. CONCLUSIONS The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes. STUDY REGISTRATION PROSPERO registration number CRD42017065678.
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Affiliation(s)
- Karla Solo
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Cochrane Canada Center, MacGRADE Center and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Shahar Lavi
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Conrad Kabali
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Glenn N Levine
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexander Kulik
- Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ava A John-Baptiste
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Anesthesia & Perioperative Medicine and Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, ON, Canada
- Interfaculty Program in Public Health, Western University, London, ON, Canada
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Janet Martin
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Anesthesia & Perioperative Medicine and Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, ON, Canada
| | - John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ashlay A Huitema
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Tawfiq Choudhury
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikolaos Tzemos
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke on Trent, UK
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El-Kurdi M, Soletti L, McGrath J, Linhares S, Rousselle S, Greisler H, Edelman E, Schoen FJ. Functional remodeling of an electrospun polydimethylsiloxane-based polyether urethane external vein graft support device in an ovine model. J Biomed Mater Res A 2019; 107:2135-2149. [PMID: 31094084 PMCID: PMC6689261 DOI: 10.1002/jbm.a.36724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/13/2019] [Accepted: 05/07/2019] [Indexed: 11/07/2022]
Abstract
Saphenous vein graft (SVG) failure rates are unacceptably high, and external mechanical support may improve patency. We studied the histologic remodeling of a conformal, electrospun, polydimethylsiloxane-based polyether urethane external support device for SVGs and evaluated graft structural evolution in adult sheep to 2 years. All sheep (N = 19) survived to their intended timepoints, and angiography showed device-treated SVG geometric stability over time (30, 90, 180, 365, or 730 days), with an aggregated graft patency rate of 92%. There was minimal inflammation associated with the device material at all timepoints. By 180 days, treated SVG remodeling was characterized by minimal/nonprogressive intimal hyperplasia; polymer fragmentation and integration; as well as the development of a neointima, and a confluent endothelium. By 1-year, the graft developed a media-like layer by remodeling the neointima, and elastic fibers formed well-defined structures that subtended the neo-medial layer of the remodeled SVG. Immunohistochemistry showed that this neo-media was populated with smooth muscle cells, and the intima was lined with endothelial cells. These data suggest that treated SVGs were structurally remodeled by 180 days, and developed arterial-like features by 1 year, which continued to mature to 2 years. Device-treated SVGs remodeled into arterial-like conduits with stable long-term performance as arterial grafts in adult sheep.
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Affiliation(s)
| | | | | | | | | | - Howard Greisler
- Loyola University, Maywood, IL and Hines VA Hospital, Hines, IL
| | - Elazer Edelman
- Massachusetts Institute of Technology, Cambridge, MA, Harvard Medical School, Boston, MA, Brigham and Women’s Hospital, Boston, MA
| | - Frederick J. Schoen
- Brigham and Women’s Hospital, Boston, MA, and Harvard Medical School, Boston, MA
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Royse AG, Brennan AP, Ou-Young J, Pawanis Z, Canty DJ, Royse CF. 21-Year Survival of Left Internal Mammary Artery-Radial Artery-Y Graft. J Am Coll Cardiol 2019; 72:1332-1340. [PMID: 30213324 DOI: 10.1016/j.jacc.2018.06.064] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 1999, Royse et al. reported on the left internal mammary artery, radial artery, Y-graft technique (LIMA-RA-Y), which achieves total arterial revascularization (TAR). However, the most common coronary reconstruction remains LIMA and supplementary saphenous vein grafts (LIMA + SVG). OBJECTIVES The goal of this study was to conduct a survival comparison of LIMA-RA-Y versus the conventional LIMA + SVG. METHODS Of the original 464 LIMA-RA-Y patients reported (1996 to 1998), 346 were from the Royal Melbourne Hospital. Survival at June 2017 was compared with a group of 534 patients from 1996 to 2003 from the same institution who received LIMA + SVG, or 5,800 patients who received TAR with different grafting configurations. Propensity score matching (PSM) was performed with 1:1 matching using 26 variables. Comparisons used Kaplan-Meier (KM) and Cox proportional hazards methods. LIMA-RA-Y was compared with LIMA + SVG in which all non-left anterior descending artery grafts were performed with either composite RA or aorta-coronary SVG with no use of right internal mammary artery. We also conducted a comparison of LIMA-RA-Y versus TAR. RESULTS Baseline characteristics of the LIMA-RA-Y group (n = 346) compared with LIMA + SVG (n = 534) after PSM (n = 232 pairs) did not differ (3.3 ± 0.8 grafts per patient). Survival was worse for LIMA + SVG in the unmatched groups (KM, p < 0.001) and for PSM groups (KM, p = 0.043; Cox proportional hazards ratio: 1.3; 95% confidence interval: 1.0 to 1.6; p = 0.038). Survival did not differ between LIMA-RA-Y and other TAR (n = 5,800) patients before, or after, PSM (n = 332 pairs). CONCLUSIONS Use of LIMA + SVG has worse survival than LIMA-RA-Y in achieving total arterial revascularization.
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Affiliation(s)
- Alistair G Royse
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia; Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | | | | | - Zulfayandi Pawanis
- Universitas Airlangga Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - David J Canty
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia; Department of Anaesthesia and Pain Management, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Colin F Royse
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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136
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Effectiveness and safety of using a novel endothelial damage inhibitor in arteriovenous fistula formation. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.788906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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137
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A bioink blend for rotary 3D bioprinting tissue engineered small-diameter vascular constructs. Acta Biomater 2019; 95:152-164. [PMID: 31271883 DOI: 10.1016/j.actbio.2019.06.052] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 01/12/2023]
Abstract
3D bioprinted vascular constructs have gained increased interest due to their significant potential for creating customizable alternatives to autologous vessel grafts. In this study, we developed a new approach for biofabricating fibrin-based vascular constructs using a novel rotary 3D bioprinter developed in our lab. We formulated a new bioink by incorporating fibrinogen with gelatin to achieve a desired shear-thinning property for rotary bioprinting. The blending of heat-treated gelatin with fibrinogen turned unprintable fibrinogen into a printable biomaterial for vessel bioprinting by leveraging the favorable rheological properties of gelatin. We discovered that the heat-treatment of gelatin remarkably affects the rheological properties of a gelatin-fibrinogen blended bioink, which in turn influences the printability of the ink. Further characterizations revealed that not only concentration of the gelatin but the heat treatment also affects cell viability during printing. Notably, the density of cells included in the bioinks also influenced printability and tissue volumetric changes of the printed vessel constructs during cultures. We observed increased collagen deposition and construct mechanical strength during two months of the cultures. The burst pressure of the vessel constructs reached 1110 mmHg, which is about 52% of the value of the human saphenous vein. An analysis of the tensile mechanical properties of the printed vessel constructs unveiled an increase in both the circumferential and axial elastic moduli during cultures. This study highlights important considerations for bioink formulation when bioprinting vessel constructs. STATEMENT OF SIGNIFICANCE: There has been an increased demand for small-diameter tissue-engineered vascular grafts. Vascular 3D bioprinting holds the potential to create equivalent vascular grafts but with the ability to tailor them to meet patient's needs. Here, we presented a new and innovative 3D rotary bioprinter and a new bioink formulation for printing vascular constructs using fibrinogen, a favorable biomaterial for vascular tissue engineering. The bioink was formulated by blending fibrinogen with a more printable biomaterial, gelatin. The systematic characterization of the effects of heat treatment and gelatin concentration as well as bioink cell concentration on the printability of the bioink offers new insight into the development of printable biomaterials for tissue biofabrication.
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138
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Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol 2019; 17:155-169. [DOI: 10.1038/s41569-019-0249-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
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139
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A mathematical model to evaluate hemodynamic effects of the graft anastomosis in coronary surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:106-108. [PMID: 31410101 PMCID: PMC6690154 DOI: 10.5114/kitp.2019.86366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/30/2019] [Indexed: 11/17/2022]
Abstract
The durability and patency of a coronary graft can be negatively affected by technical factors that induce thrombosis of the graft and poor prognosis of patients undergoing coronary artery bypass grafting. Technical factors include the inclination angle of the coronary anastomosis and the alignment between the main vessel and the inserted vessel as graft. We have studied a mathematical model aimed to assess the best angulation of the anastomosis and the influence of a correct alignment in order to prevent the risk of early graft occlusion. From data obtained from the mathematical model, in our opinion an inclination of the anastomotic angle of at least 30° seems to be a right choice when performing a coronary artery bypass graft. In addition, the incision of the coronary vessel should be done perfectly on the same axis as that performed on the graft, since even a deviation of the axis of the anastomosis of only 10° can create turbulence of the flow in the anastomosis site, which is accentuated when the deviation reaches 20°.
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140
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Application of virtual histological intravascular ultrasound in plaque composition assessment of saphenous vein graft diseases. Chin Med J (Engl) 2019; 132:957-962. [PMID: 30958438 PMCID: PMC6595773 DOI: 10.1097/cm9.0000000000000183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Saphenous vein grafts disease (SVGD) is a common complication after coronary artery bypass graft (CABG) and normally treated by percutaneous coronary intervention (PCI). The most common complication after SVG-PCI is slow or no-reflow. It is known that the no-reflow phenomenon occurs in up to 15% of the SVG-PCI and is associated with high risk of major adverse cardiac events (MACEs) and mortality, therefore, it is important to investigate the factors that could predict the clinical outcome of PCI for risk stratification and guiding interventions. In recent years, the spectral analysis of intravascular ultrasound (IVUS) radiofrequency data (virtual histology-IVUS [VH-IVUS]) has been used to provide quantitative assessment on both plaque compositions and morphologic characteristics. DATA SOURCES The PubMed, Embase, and Central databases were searched for possible relevant studies published from 1997 to 2018 using the following index keywords: "Coronary artery bypass grafting," "Saphenous venous graft disease," "Virtual histology-intravascular ultrasound," "Virtual histology-intravascular ultrasound," and "Percutaneous coronary intervention." STUDY SELECTION The primary references were Chinese and English articles including original studies and literature reviews, were identified and reviewed to summarize the advances in the application of VH-IVUS techniques in situ vascular and venous graft vascular lesions. RESULTS With different plaque components exhibiting a defined spectrum, VH-IVUS can classify atherosclerotic plaque into four types: fibrous tissue (FT), fibro fatty (FF), necrotic core (NC), and dense calcium (DC). The radiofrequency signal is mathematically transformed into a color-coded representation, including lipid, fibrous tissue, calcification, and necrotic core. Several studies have demonstrated the independent relationship between VH-IVUS-defined plaque classification or plaque composition and MACEs, but a significant association between plaque components and no-reflow after PCI in acute coronary syndrome. In recent years, VH-IVUS are applied to assess the plaque composition of SVGD, based on the similarity of pathophysiological mechanisms between coronary artery disease (CAD) and SVGD, further studies with the larger sample size, the long-term follow-up, multicenter clinical trials may be warranted to investigate the relationship between plaque composition of saphenous vein graft (SVG) by VH-IVUS and clinical outcomes in patients with SVGD undergoing PCI. CONCLUSIONS In degenerative SVG lesions, VH-IVUS found that plaque composition was associated with clinical features, future studies need to explore the relationship between VH-IVUS defined atherosclerotic plaque components and clinical outcomes in SVGD patients undergoing PCI, an innovative prediction tool of clinical outcomes can be created.
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141
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Simons KH, de Vries MR, Peters HAB, Jukema JW, Quax PHA, Arens R. CD8+ T Cells Protect During Vein Graft Disease Development. Front Cardiovasc Med 2019; 6:77. [PMID: 31263704 PMCID: PMC6584838 DOI: 10.3389/fcvm.2019.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/28/2019] [Indexed: 12/18/2022] Open
Abstract
Aims: Vein grafts are frequently used conduits for arterial reconstruction in patients with cardiovascular disease. Unfortunately, vein graft disease (VGD) causes diminished patency rates. Innate immune system components are known to contribute to VGD. However, the role of T cells has yet to be established. The purpose of this study was to investigate the role of T cells and T cell activation pathways via the T cell receptor (TCR), co-stimulation and bystander effect in VGD. Methods and results: Here, we show upon vein graft surgery in mice depleted of CD4+ T cells or CD8+ T cells, that CD8+ T cells are locally activated and have a major protective role for vein graft patency. In presence of CD8+ T cells vein grafts appear patent while CD8+ T cell depletion results in occluded vein grafts with increases apoptosis. Importantly, the protective effect of CD8+ T cells in VGD development was TCR and co-stimulation independent. This was demonstrated in vein grafts of OT-I mice, CD70−/−, CD80/86−/−, and CD70/80/86−/− mice compared to C57BL/6 mice. Interestingly, cytokines including IL-15, IL-18, IL-33, and TNF are up-regulated in vein grafts. These cytokines are co-operatively capable to activate CD8+ T cells in a bystander-mediated fashion, in contrast to CD4+ T cells. Conclusions: T cells are modulators of VGD with a specific protective role of CD8+ T cells, which are locally activated in vein grafts. CD8+ T cells may protect against occlusive lesions by providing survival signals, and concert their protection independent of TCR and co-stimulation signaling.
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Affiliation(s)
- Karin H Simons
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Margreet R de Vries
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Hendrika A B Peters
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - J Wouter Jukema
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Paul H A Quax
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Ramon Arens
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
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142
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Zhang X, Fernández-Hernando C. MiR-33 regulation of stretch-induced intimal hyperplasia in vein grafts. Cardiovasc Res 2019; 113:434-436. [PMID: 28339676 DOI: 10.1093/cvr/cvx038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Xinbo Zhang
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, 10 Amistad Street, New Haven, CT 06520, USA.,Integrative Cell Signaling and Neurobiology of Metabolism Program, Department of Comparative Medicine and Department of Pathology, Yale University School of Medicine, 10 Amistad Street, New Haven, CT 06520, USA
| | - Carlos Fernández-Hernando
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, 10 Amistad Street, New Haven, CT 06520, USA.,Integrative Cell Signaling and Neurobiology of Metabolism Program, Department of Comparative Medicine and Department of Pathology, Yale University School of Medicine, 10 Amistad Street, New Haven, CT 06520, USA
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143
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Mylonaki I, Allain E, Strano F, Allémann E, Corpataux JM, Meda P, Jordan O, Delie F, Rougemont AL, Haefliger JA, Saucy F. Evaluating intimal hyperplasia under clinical conditions. Interact Cardiovasc Thorac Surg 2019; 27:427-436. [PMID: 29617792 DOI: 10.1093/icvts/ivy101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/04/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Open arterial revascularization using venous segments is frequently associated with the development of intimal hyperplasia (IH), leading to severe restenosis and graft failure. The lack of treatment to prevent this pathology is a major problem. Therefore, we generated a new porcine model, which closely mimics the clinical development of human IH, to test the therapeutic potential of candidate drugs. METHODS A patch of jugular vein was sutured to the right common carotid artery of pigs, to expose the vein to haemodynamic conditions of the arterial bed. Four weeks after surgery, the operated vessels which received no further treatment (the control group) were compared with (i) contralateral, non-operated vessels (the healthy group); (ii) vessels of pigs that received a perivascular application of a drug-free microparticle gel (the placebo group) and (iii) vessels of pigs that perioperatively received the same gel loaded with 10-mg atorvastatin (the atorvastatin group). RESULTS When compared with non-operated vessels, all operated segments displayed a sizable IH which was thicker in the venous patch than in the host artery. These alterations were associated with a thickening of the intima layer of both vessels in the absence of inflammation. The intima/media ratio has been significantly increased by 2000-fold in the vein patches. Perivascular application of atorvastatin did not prevent IH formation. However, the drug increased the adventitial neovascularization in the operated vessels. CONCLUSIONS The novel porcine model allows for monitoring IH formation under haemodynamic conditions which mimic clinical situations. It should facilitate the screening of innovative treatments to prevent restenosis.
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Affiliation(s)
- Ioanna Mylonaki
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Elisabeth Allain
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesco Strano
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Jean-Marc Corpataux
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Paolo Meda
- Department of Cell Physiology and Metabolism, University of Geneva, Medical Center, Geneva, Switzerland
| | - Olivier Jordan
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Florence Delie
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Anne-Laure Rougemont
- Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland
| | | | - François Saucy
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
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144
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Zhang J, McIntosh BE, Wang B, Brown ME, Probasco MD, Webster S, Duffin B, Zhou Y, Guo LW, Burlingham WJ, Kent C, Ferris M, Thomson JA. A Human Pluripotent Stem Cell-Based Screen for Smooth Muscle Cell Differentiation and Maturation Identifies Inhibitors of Intimal Hyperplasia. Stem Cell Reports 2019; 12:1269-1281. [PMID: 31080110 PMCID: PMC6565755 DOI: 10.1016/j.stemcr.2019.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 02/04/2023] Open
Abstract
Contractile to synthetic phenotypic switching of smooth muscle cells (SMCs) contributes to stenosis in vascular disease and vascular transplants. To generate more contractile SMCs, we performed a high-throughput differentiation screen using a MYH11-NLuc-tdTomato human embryonic stem cell reporter cell line. We identified RepSox as a factor that promotes differentiation of MYH11-positive cells by promoting NOTCH signaling. RepSox induces SMCs to exhibit a more contractile phenotype than SMCs generated using PDGF-BB and TGF-β1, two factors previously used for SMC differentiation but which also cause intimal hyperplasia. In addition, RepSox inhibited intimal hyperplasia caused by contractile to synthetic phenotypic switching of SMCs in a rat balloon injury model. Thus, in addition to providing more contractile SMCs that could prove useful for constructing artificial blood vessels, this study suggests a strategy for identifying drugs for inhibiting intimal hyperplasia that act by driving contractile differentiation rather than inhibiting proliferation non-specifically. Fully defined differentiation of contractile (95% MYH11+) smooth muscle cells (SMCs) RepSox-NOTCH signal promotes SMC differentiation and inhibits intimal hyperplasia RepSox-SMCs could reduce the risk of intimal hyperplasia compared with PDGF/TGF-SMCs Applying SMC differentiation for high-throughput screening of anti-restenosis drugs
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Affiliation(s)
- Jue Zhang
- Regenerative Biology, Morgridge Institute for Research, 330 North Orchard Street, Madison, WI 53715, USA.
| | - Brian E McIntosh
- Regenerative Biology, Morgridge Institute for Research, 330 North Orchard Street, Madison, WI 53715, USA
| | - Bowen Wang
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Matthew E Brown
- Regenerative Biology, Morgridge Institute for Research, 330 North Orchard Street, Madison, WI 53715, USA; Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Mitchell D Probasco
- Regenerative Biology, Morgridge Institute for Research, 330 North Orchard Street, Madison, WI 53715, USA
| | - Sarah Webster
- Regenerative Biology, Morgridge Institute for Research, 330 North Orchard Street, Madison, WI 53715, USA
| | - Bret Duffin
- Regenerative Biology, Morgridge Institute for Research, 330 North Orchard Street, Madison, WI 53715, USA
| | - Ying Zhou
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Lian-Wang Guo
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | | | - Craig Kent
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA; College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Michael Ferris
- College of Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA; Computer Sciences, Industrial & Systems Engineering, Mathematics, Optimization, Wisconsin Institute for Discovery, Madison, WI 53715, USA
| | - James A Thomson
- Regenerative Biology, Morgridge Institute for Research, 330 North Orchard Street, Madison, WI 53715, USA; Department of Cell & Regenerative Biology, University of Wisconsin-Madison, Madison, WI 53706, USA; Department of Molecular, Cellular, & Developmental Biology, University of California, Santa Barbara, CA 93117, USA.
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145
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Wang Z, Liu M, Liu X, Sun A, Fan Y, Deng X. Hydraulic conductivity and low-density lipoprotein transport of the venous graft wall in an arterial bypass. Biomed Eng Online 2019; 18:50. [PMID: 31023303 PMCID: PMC6482508 DOI: 10.1186/s12938-019-0669-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Blood flow condition may have influence upon the hydraulic conductivity of venous graft (Lp,vein) in an arterial bypass, then affecting the accumulation of low-density lipoproteins (LDLs) within the graft wall. To probe this possibility, we first measured in vitro the filtration rates of swine lateral saphenous vein segments under different flow rates, and the correlation of Lp,vein with wall shear stress (WSS) was then obtained. Results The experimental results showed that when WSS was very low, Lp,vein would increase drastically with WSS from 1.16 ± 0.15 × 10−11 m/s Pa at 0 dyn/cm2 to 2.17 ± 0.20 × 10−11 m/s Pa at 0.7 dyn/cm2, then became constant of approximately 2.33 × 10−11 m/s Pa as the WSS increased further. Based on the experimental results, we assumed three different cases of Lp,vein and numerically simulated the LDLs transport in an arterial bypass model with venous graft. Case A: Lp,vein = 2.33 × 10−11 m/s Pa; Case B: Lp,vein = 1.16 × 10−11 m/s Pa (static condition with WSS of 0); Case C: Lp,vein was shear dependent. The simulation showed that the deposition/accumulation of LDLs within the venous graft wall in Case A was greatly enhanced when compared with that in Case B. However, the LDL accumulation in the graft wall was similar for Case A and Case C. Conclusions Our study, therefore, indicates that when the venous graft was implanted as a bypass graft, the Lp,vein might remain nearly constant along its whole length except for very few areas where the value of WSS was extremely low (less than 0.7 dyn/cm2) and the effects of Lp,vein modulated by blood flow on LDL transport may be neglected.
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Affiliation(s)
- Zhenze Wang
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Technical Aids Analysis and Identification Key Laboratory of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Ming Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Xiao Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China. .,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China.
| | - Yubo Fan
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Technical Aids Analysis and Identification Key Laboratory of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China. .,Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China. .,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China.
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100083, China
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146
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Skovrind I, Harvald EB, Juul Belling H, Jørgensen CD, Lindholt JS, Andersen DC. Concise Review: Patency of Small-Diameter Tissue-Engineered Vascular Grafts: A Meta-Analysis of Preclinical Trials. Stem Cells Transl Med 2019; 8:671-680. [PMID: 30920771 PMCID: PMC6591545 DOI: 10.1002/sctm.18-0287] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
Several patient groups undergoing small‐diameter (<6 mm) vessel bypass surgery have limited autologous vessels for use as grafts. Tissue‐engineered vascular grafts (TEVG) have been suggested as an alternative, but the ideal TEVG remains to be generated, and a systematic overview and meta‐analysis of clinically relevant studies is lacking. We systematically searched PubMed and Embase databases for (pre)clinical trials and identified three clinical and 68 preclinical trials ([>rabbit]; 873 TEVGs) meeting the inclusion criteria. Preclinical trials represented low to medium risk of bias, and binary logistic regression revealed that patency was significantly affected by recellularization, TEVG length, TEVG diameter, surface modification, and preconditioning. In contrast, scaffold types were less important. The patency was 63.5%, 89%, and 100% for TEVGs with a median diameter of 3 mm, 4 mm, and 5 mm, respectively. In the group of recellularized TEVGs, patency was not improved by using smooth muscle cells in addition to endothelial cells nor affected by the endothelial origin, but seems to benefit from a long‐term (46–240 hours) recellularization time. Finally, data showed that median TEVG length (5 cm) and median follow‐up (56 days) used in preclinical settings are relatively inadequate for direct clinical translation. In conclusion, our data imply that future studies should consider a TEVG design that at least includes endothelial recellularization and bioreactor preconditioning, and we suggest that more standard guidelines for testing and reporting TEVGs in large animals should be considered to enable interstudy comparisons and favor a robust and reproducible outcome as well as clinical translation.
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Affiliation(s)
- Ida Skovrind
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark.,Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense C, Denmark
| | - Eva Bang Harvald
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark.,Center for Vascular Regeneration, Odense University Hospital, Odense C, Denmark.,Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense C, Denmark
| | - Helene Juul Belling
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark.,Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense C, Denmark
| | | | - Jes Sanddal Lindholt
- Department of Cardiac, Thoracic, and Vascular Surgery, Odense University Hospital, Odense C, Denmark
| | - Ditte Caroline Andersen
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark.,Center for Vascular Regeneration, Odense University Hospital, Odense C, Denmark.,Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense C, Denmark.,Clinical Institute, University of Southern Denmark, Odense C, Denmark
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147
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Daban G, Bayram C, Bozdoğan B, Denkbaş EB. Porous polyurethane film fabricated via the breath figure approach for sustained drug release. J Appl Polym Sci 2019. [DOI: 10.1002/app.47658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Gizem Daban
- Bioengineering Division, Graduate School of Science and EngineeringHacettepe University, 06800 Ankara Turkey
| | - Cem Bayram
- Advanced Technologies Application and Research CenterHacettepe University, 06800 Ankara Turkey
| | - Betül Bozdoğan
- Chemistry Department, Faculty of Science and LettersAksaray University, 68100 Aksaray Turkey
| | - Emir Baki Denkbaş
- Bioengineering Division, Graduate School of Science and EngineeringHacettepe University, 06800 Ankara Turkey
- Biomedical Engineering Department, Faculty of EngineeringBaşkent University, 06530 Bağlıca, Ankara Turkey
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148
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Therapeutic Targeting of the Proinflammatory IL-6-JAK/STAT Signalling Pathways Responsible for Vascular Restenosis in Type 2 Diabetes Mellitus. Cardiol Res Pract 2019; 2019:9846312. [PMID: 30719343 PMCID: PMC6334365 DOI: 10.1155/2019/9846312] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is increasing worldwide, and it is associated with increased risk of coronary artery disease (CAD). For T2DM patients, the main surgical intervention for CAD is autologous saphenous vein grafting. However, T2DM patients have increased risk of saphenous vein graft failure (SVGF). While the mechanisms underlying increased risk of vascular disease in T2DM are not fully understood, hyperglycaemia, insulin resistance, and hyperinsulinaemia have been shown to contribute to microvascular damage, whereas clinical trials have reported limited effects of intensive glycaemic control in the management of macrovascular complications. This suggests that factors other than glucose exposure may be responsible for the macrovascular complications observed in T2DM. SVGF is characterised by neointimal hyperplasia (NIH) arising from endothelial cell (EC) dysfunction and uncontrolled migration and proliferation of vascular smooth muscle cells (SMCs). This is driven in part by proinflammatory cytokines released from the activated ECs and SMCs, particularly interleukin 6 (IL-6). IL-6 stimulation of the Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT) pathway is a key mechanism through which EC inflammation, SMC migration, and proliferation are controlled and whose activation might therefore be enhanced in patients with T2DM. In this review, we investigate how proinflammatory cytokines, particularly IL-6, contribute to vascular damage resulting in SVGF and how suppression of proinflammatory cytokine responses via targeting the JAK/STAT pathway could be exploited as a potential therapeutic strategy. These include the targeting of suppressor of cytokine signalling (SOCS3), which appears to play a key role in suppressing unwanted vascular inflammation, SMC migration, and proliferation.
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149
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de Vries MR, Parma L, Peters HAB, Schepers A, Hamming JF, Jukema JW, Goumans MJTH, Guo L, Finn AV, Virmani R, Ozaki CK, Quax PHA. Blockade of vascular endothelial growth factor receptor 2 inhibits intraplaque haemorrhage by normalization of plaque neovessels. J Intern Med 2019; 285:59-74. [PMID: 30102798 PMCID: PMC6334526 DOI: 10.1111/joim.12821] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Plaque angiogenesis is associated with atherosclerotic lesion growth, plaque instability and negative clinical outcome. Plaque angiogenesis is a natural occurring process to fulfil the increasing demand of oxygen and nourishment of the vessel wall. However, inadequate formed, immature plaque neovessels are leaky and cause intraplaque haemorrhage. OBJECTIVE Blockade of VEGFR2 normalizes the unbridled process of plaque neovessel formation and induces maturation of nascent vessels resulting in prevention of intraplaque haemorrhage and influx of inflammatory cells into the plaque and subsequently increases plaque stability. METHODS AND RESULTS In human carotid and vein graft atherosclerotic lesions, leaky plaque neovessels and intraplaque haemorrhage co-localize with VEGF/VEGFR2 and angiopoietins. Using hypercholesterolaemic ApoE3*Leiden mice that received a donor caval vein interposition in the carotid artery, we demonstrate that atherosclerotic vein graft lesions at t28 are associated with hypoxia, Hif1α and Sdf1 up-regulation. Local VEGF administration results in increased plaque angiogenesis. VEGFR2 blockade in this model results in a significant 44% decrease in intraplaque haemorrhage and 80% less extravasated erythrocytes compared to controls. VEGFR2 blockade in vivo results in a 32% of reduction in vein graft size and more stable lesions with significantly reduced macrophage content (30%), and increased collagen (54%) and smooth muscle cell content (123%). Significant decreased VEGF, angiopoietin-2 and increased Connexin 40 expression levels demonstrate increased plaque neovessel maturation in the vein grafts. VEGFR2 blockade in an aortic ring assay showed increased pericyte coverage of the capillary sprouts. CONCLUSION Inhibition of intraplaque haemorrhage by controlling neovessels maturation holds promise to improve plaque stability.
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Affiliation(s)
- M. R. de Vries
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - L. Parma
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - H. A. B. Peters
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - A. Schepers
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - J. F. Hamming
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - J. W. Jukema
- Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - M. J. T. H. Goumans
- Department of Cell and Chemical BiologyLeiden University Medical CenterLeidenThe Netherlands
| | - L. Guo
- CVPath Institute Inc.GaithersburgMDUSA
| | | | | | - C. K. Ozaki
- Department of SurgeryDivision of Vascular and Endovascular SurgeryBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - P. H. A. Quax
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenThe Netherlands
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Zhang Y, Fang Q, Niu K, Gan Z, Yu Q, Gu T. Time-dependently slow-released multiple-drug eluting external sheath for efficient long-term inhibition of saphenous vein graft failure. J Control Release 2019; 293:172-182. [DOI: 10.1016/j.jconrel.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/19/2018] [Accepted: 12/01/2018] [Indexed: 12/22/2022]
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