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Shazly T, Uline M, Webb C, Pederson B, Eberth JF, Kolachalama VB. Novel Payloads to Mitigate Maladaptive Inward Arterial Remodeling in Drug-Coated Balloon Therapy. J Biomech Eng 2023; 145:121004. [PMID: 37542712 PMCID: PMC10578076 DOI: 10.1115/1.4063122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
Drug-coated balloon therapy is a minimally invasive endovascular approach to treat obstructive arterial disease, with increasing utilization in the peripheral circulation due to improved outcomes as compared to alternative interventional modalities. Broader clinical use of drug-coated balloons is limited by an incomplete understanding of device- and patient-specific determinants of treatment efficacy, including late outcomes that are mediated by postinterventional maladaptive inward arterial remodeling. To address this knowledge gap, we propose a predictive mathematical model of pressure-mediated femoral artery remodeling following drug-coated balloon deployment, with account of drug-based modulation of resident vascular cell phenotype and common patient comorbidities, namely, hypertension and endothelial cell dysfunction. Our results elucidate how postinterventional arterial remodeling outcomes are altered by the delivery of a traditional anti-proliferative drug, as well as by codelivery with an anti-contractile drug. Our findings suggest that codelivery of anti-proliferative and anti-contractile drugs could improve patient outcomes following drug-coated balloon therapy, motivating further consideration of novel payloads in next-generation devices.
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Affiliation(s)
- Tarek Shazly
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Mechanical Engineering, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208
| | - Mark Uline
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Chemical Engineering, University of South Carolina, Columbia, SC 29208
| | - Clinton Webb
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; School of Medicine, Department of Cell Biology and Anatomy, University of South Carolina, Columbia, SC 29208
| | - Breanna Pederson
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208
| | - John F. Eberth
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118; Department of Computer Science and Faculty of Computing and Data Sciences, Boston University, Boston, MA 02115
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Kostelnik CJ, Gale MK, Crouse KJ, Shazly T, Eberth JF. Acute Mechanical Consequences of Vessel-Specific Coronary Bypass Combinations. Cardiovasc Eng Technol 2023; 14:404-418. [PMID: 36828977 DOI: 10.1007/s13239-023-00661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Premature coronary artery bypass graft (CABG) failure has been linked to geometric, mechanical, and compositional discrepancies between host and graft tissues. Acute hemodynamic disturbances and the introduction of wall stress gradients trigger a myriad of mechanobiological processes at the anastomosis that can be associated with restenosis and graft failure. Although the origins of coronary artery disease dictate the anastomotic target, an opportunity exists for graft-vessel optimization through rationale graft selection. METHODS Here we explored the four distinct regions of the left (L) and right (R) ITA (1 = proximal, 2 = submuscular, 3 = middle, 4 = distal), and four common target vessels in the coronary circulation including the proximal and distal left anterior descending (PLAD & DLAD), right coronary (RCA), and left circumflex (LCX) arteries. Benchtop biaxial mechanical data was used to acquire constitutive model parameters of these tissues and enable vessel-specific computational models to elucidate the mechanical consequences of 32 unique graft-target combinations. RESULTS Simulations revealed the maximum principal wall stresses for the PLAD, RCA, and LCX occurred when anastomosed with LITA1, and the maximum flow-induced shear stress occurred with LITA4. The DLAD, on the other hand, reached stress maximums when anastomosed to LITA4. Using a normalized objective function of simulation output variables, we found LITA2 to be the best graft choice for both LADs, RITA3 for the RCA, and LITA3 for the LCX. CONCLUSION Although mechanical compatibility is just one of many factors determining bypass graft outcomes, our data suggests improvements can be made to the grafting process through vessel-specific regional optimization.
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Affiliation(s)
- Colton J Kostelnik
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Mary K Gale
- Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, GA, USA
| | - Kiersten J Crouse
- Mechanical Engineering Department, University of South Carolina, Columbia, SC, 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.
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
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Eberth J, Humphrey J. Reduced Smooth Muscle Contractile Capacity Facilitates Maladaptive Arterial Remodeling. J Biomech Eng 2021; 144:1122986. [PMID: 34729580 DOI: 10.1115/1.4052888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/08/2022]
Abstract
Albeit seldom considered explicitly, the vasoactive state of a central artery can contribute significantly to the in vivo values of flow-induced wall shear stress and pressure-induced wall stress, which in turn are strong determinants of wall growth and remodeling. In this technical brief, we test the hypothesis that diminished vasoactive capacity compromises effective mechano-adaptations of central arteries. Toward this end, we use consistent methods to re-interpret previously published data on carotid artery remodeling in a common mouse model of induced hypertension and a separate model of connective tissue disease that results in Marfan syndrome. Animals have identical backgrounds and in both cases, the data are consistent with the hypothesis considered. In particular, individual carotid arteries with strong (normal) vasoactive capacity tend to maintain wall thickness and in vivo axial stress closer to homeostatic, thus resulting in passive circumferential wall stress and energy storage closer to normal values. We conclude, therefore, that effective vasoactivity helps to control the biomechanical state in which cells and matrix turnover, thus helping to delineate mechano-adaptive from maladaptive remodeling. Future analyses of experimental data and computational models of growth and remodeling should account for this strong coupling between smooth muscle contractile capacity and central arterial remodeling.
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Affiliation(s)
- JohnF Eberth
- Department of Cell Biology and Anatomy, Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Jay Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
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Lane BA, Chakrabarti M, Ferruzzi J, Azhar M, Eberth JF. Mechanics of ascending aortas from TGFβ-1, -2, -3 haploinsufficient mice and elastase-induced aortopathy. J Biomech 2021; 125:110543. [PMID: 34174532 DOI: 10.1016/j.jbiomech.2021.110543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Transforming growth factor-beta (TGFβ-1, -2, -3) ligands act through a common receptor complex yet each is expressed in a unique and overlapping fashion throughout development. TGFβ plays a role in extra-cellular matrix composition with mutations to genes encoding TGFβ and TGFβ signaling molecules contributing to diverse and deadly thoracic aortopathies common in Loeys-Dietz syndrome (LDS). In this investigation, we studied the TGFβ ligand-specific mechanical phenotype of ascending thoracic aortas (ATA) taken from 4-to-6 months-old Tgfb1+/-, Tgfb2+/-, and Tgfb3+/- mice, their wild-type (WT) controls, and an elastase infusion model representative of severe elastolysis. Heterozygous mice were studied at an age without dilation to elucidate potential pre-aortopathic mechanical cues. Our findings indicate that ATAs from Tgfb2+/- mice demonstrated significant wall thickening, a corresponding decrease in biaxial stress, decreased biaxial stiffness, and a decrease in stored energy. These results were unlike the pathological elastase model where decreases in biaxial stretch were found along with increases in diameter, biaxial stress, and biaxial stiffness. ATAs from Tgfb1+/- and Tgfb3+/-, on the other hand, had few mechanical differences when compared to wild-type controls. Although aortopathy generally occurs later in development, our findings reveal that in 4-to-6 month-old animals, only Tgfb2+/- mice demonstrate a significant phenotype that fails to model ubiquitous elastolysis.
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Affiliation(s)
- Brooks A Lane
- Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208 USA
| | - Mrinmay Chakrabarti
- Cell Biology and Anatomy Department, University of South Carolina School of Medicine, Columbia, SC 29208, USA
| | - Jacopo Ferruzzi
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Mohamad Azhar
- Cell Biology and Anatomy Department, University of South Carolina School of Medicine, Columbia, SC 29208, USA; William Jennings Bryan Dorn VA Medical Center, Columbia, SC 29209, USA
| | - John F Eberth
- Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208 USA; Cell Biology and Anatomy Department, University of South Carolina School of Medicine, Columbia, SC 29208, USA.
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Wang X, Parasaram V, Dhital S, Nosoudi N, Hasanain S, Lane BA, Lessner SM, Eberth JF, Vyavahare NR. Systemic delivery of targeted nanotherapeutic reverses angiotensin II-induced abdominal aortic aneurysms in mice. Sci Rep 2021; 11:8584. [PMID: 33883612 PMCID: PMC8060294 DOI: 10.1038/s41598-021-88017-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) disease causes dilation of the aorta, leading to aortic rupture and death if not treated early. It is the 14th leading cause of death in the U.S. and 10th leading cause of death in men over age 55, affecting thousands of patients. Despite the prevalence of AAA, no safe and efficient pharmacotherapies exist for patients. The deterioration of the elastic lamina in the aneurysmal wall is a consistent feature of AAAs, making it an ideal target for delivering drugs to the AAA site. In this research, we conjugated nanoparticles with an elastin antibody that only targets degraded elastin while sparing healthy elastin. After induction of aneurysm by 4-week infusion of angiotensin II (Ang II), two biweekly intravenous injections of pentagalloyl glucose (PGG)-loaded nanoparticles conjugated with elastin antibody delivered the drug to the aneurysm site. We show that targeted delivery of PGG could reverse the aortic dilation, ameliorate the inflammation, restore the elastic lamina, and improve the mechanical properties of the aorta at the AAA site. Therefore, simple iv therapy of PGG loaded nanoparticles can be an effective treatment option for early to middle stage aneurysms to reverse disease progression and return the aorta to normal homeostasis.
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Affiliation(s)
- Xiaoying Wang
- Department of Bioengineering, Clemson University, 501 Rhodes Engineering Research Center, Clemson, SC, 29634, USA
| | - Vaideesh Parasaram
- Department of Bioengineering, Clemson University, 501 Rhodes Engineering Research Center, Clemson, SC, 29634, USA
| | - Saphala Dhital
- Department of Bioengineering, Clemson University, 501 Rhodes Engineering Research Center, Clemson, SC, 29634, USA
| | - Nasim Nosoudi
- Department of Bioengineering, Clemson University, 501 Rhodes Engineering Research Center, Clemson, SC, 29634, USA.,Biomedical Engineering, College of Engineering & Computer Sciences, Marshall University, Huntington, WV, USA
| | - Shahd Hasanain
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, USA
| | - Brooks A Lane
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, USA
| | - Susan M Lessner
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, USA
| | - John F Eberth
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, USA
| | - Naren R Vyavahare
- Department of Bioengineering, Clemson University, 501 Rhodes Engineering Research Center, Clemson, SC, 29634, USA.
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Kostelnik CJ, Crouse KJ, Carver W, Eberth JF. Longitudinal histomechanical heterogeneity of the internal thoracic artery. J Mech Behav Biomed Mater 2021; 116:104314. [PMID: 33476887 DOI: 10.1016/j.jmbbm.2021.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/10/2020] [Accepted: 01/03/2021] [Indexed: 11/16/2022]
Abstract
The internal thoracic artery (ITA) is the principal choice for coronary artery bypass grafting (CABG) due to its mechanical compatibility, histological composition, anti-thrombogenic lumen, and single anastomotic junction. Originating at the subclavian artery, traversing the thoracic cavity, and terminating at the superior epigastric and musculophrenic bifurcation, bilateral ITAs follow a protracted circuitous pathway. The physiological hemodynamics, anatomical configuration, and perivascular changes that occur throughout this length influence the tissue's microstructure and gross mechanical properties. Since histomechanics play a major role in premature graft failure we used inflation-extension testing to quantify the regional material and biaxial mechanical properties at four distinct locations along the left (L) and right (R) ITA and fit the results to a structurally-motivated constitutive model. Our comparative analysis of 44 vessel segments revealed a significant increase in the amount of collagen but not smooth muscle and a significant decrease in elastin and elastic lamellae present with distance from the heart. A subsequent decrease in the total deformation energy and isotropic contribution to the strain energy was present in the LITA but not RITA. Circumferential stress and compliance generally decreased along the length of the LITA while axial stress increased in the RITA. When comparing RITAs to LITAs, some morphological and histological differences were found in proximal sections while distal sections revealed differences predominantly in compliance and axial stress. Overall, this information can be used to better guide graft selection, graft preparation, and xenograft-based tissue-engineering strategies for CABG.
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Affiliation(s)
- Colton J Kostelnik
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Kiersten J Crouse
- Mechanical Engineering Department, University of South Carolina, Columbia, SC, USA
| | - Wayne Carver
- Cell Biology and Anatomy 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, University of South Carolina, Columbia, SC, USA.
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