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Ma Y, Liu C, Cao S, Chen T, Chen G. Microfluidics for diagnosis and treatment of cardiovascular disease. J Mater Chem B 2023; 11:546-559. [PMID: 36542463 DOI: 10.1039/d2tb02287g] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD), a type of circulatory system disease related to the lesions of the cardiovascular system, has become one of the main diseases that endanger human health. Currently, the clinical diagnosis of most CVDs relies on a combination of imaging technology and blood biochemical test. However, the existing technologies for diagnosis of CVDs still have limitations in terms of specificity, detection range, and cost. In order to break through the current bottleneck, microfluidic with the advantages of low cost, simple instruments and easy integration, has been developed to play an important role in the early prevention, diagnosis and treatment of CVDs. Here, we have reviewed the recent various applications of microfluidic in the clinical diagnosis and treatment of CVDs, including microfluidic devices for detecting CVD markers, the cardiovascular models based on microfluidic, and the microfluidic used for CVDs drug screening and delivery. In addition, we have briefly looked forward to the prospects and challenges of microfluidics in diagnosis and treatment of CVDs.
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Affiliation(s)
- Yonggeng Ma
- School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China.
| | - Chenbin Liu
- Department of Clinical Laboratory Medicine, Shanghai Tenth People's Hospital of Tongji University, Shanghai 200072, P. R. China
| | - Siyu Cao
- School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China.
| | - Tianshu Chen
- Department of Clinical Laboratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P. R. China.
| | - Guifang Chen
- School of Life Sciences, Shanghai University, Shanghai 200444, P. R. China.
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2
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Abela OG, Ahsan CH, Alreefi F, Salehi N, Baig I, Janoudi A, Abela GS. Plaque Rupture and Thrombosis: the Value of the Atherosclerotic Rabbit Model in Defining the Mechanism. Curr Atheroscler Rep 2016; 18:29. [PMID: 27091328 DOI: 10.1007/s11883-016-0587-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Persistent inflammation and mechanical injury associated with cholesterol crystal accretion within atherosclerotic plaques typically precedes plaque disruption (rupture and/or erosion) and thrombosis--often the terminal events of atherosclerotic cardiovascular disease. To elucidate the mechanisms of these events, the atherosclerotic rabbit model provides a unique and powerful tool that facilitates studies of atherogenesis starting with plaque buildup to eventual disruption. Examination of human coronary arteries obtained from patients who died with myocardial infarction demonstrates evidence of cholesterol crystals perforating the plaque cap and intimal surface of the arterial wall that can lead to rupture. These observations were made possible by omitting ethanol, an avid lipid solvent, from the tissue processing steps. Importantly, the atherosclerotic rabbit model exhibits a similar pathology of cholesterol crystals perforating the intimal surface as seen in ruptured human plaques. Local and systemic inflammatory responses in the model are also similar to those observed in humans. The strong parallel between the rabbit and human pathology validates the atherosclerotic rabbit model as a predictor of human pathophysiology of atherosclerosis. Thus, the atherosclerotic rabbit model can be used with confidence to evaluate diagnostic imaging and efficacy of novel anti-atherosclerotic therapy.
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Affiliation(s)
- Oliver G Abela
- Department of Medicine, Division of Cardiovascular Medicine, University of Nevada, Las Vegas, NV, USA
| | - Chowdhury H Ahsan
- Department of Medicine, Division of Cardiovascular Medicine, University of Nevada, Las Vegas, NV, USA
| | - Fadi Alreefi
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - Negar Salehi
- Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Imran Baig
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - Abed Janoudi
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - George S Abela
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA.
- Department of Physiology, Division of Pathology, Michigan State University, East Lansing, MI, USA.
- Michigan State University, B208 Clinical Center, East Lansing, MI, 48824, USA.
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3
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Robertson C, Heidari AE, Chen Z, George SC. Mechanical analysis of arterial plaques in native geometry with OCT wall motion analysis. J Biomech 2013; 47:755-8. [PMID: 24388166 DOI: 10.1016/j.jbiomech.2013.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/02/2013] [Accepted: 11/06/2013] [Indexed: 12/01/2022]
Abstract
The mechanical behavior of an atherosclerotic plaque may encode information about the type, composition, and vulnerability to rupture. Human arterial segments with varying plaque burden were analyzed ex vivo with optical coherence tomography (OCT) to determine plaque type and to determine compliance during pulsatile inflation in their native geometry. Calcifications and lipid filled plaques showed markedly different compliance when analyzed with OCT wall motion analysis. There was also a trend towards increased circumferential variation in arterial compliance with increasing plaque burden.
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Affiliation(s)
- Claire Robertson
- Department of Biomedical Engineering, University of California, Irvine, 2121 Engineering Hall, Irvine, CA 92617, USA; The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, USA
| | - Andrew E Heidari
- Department of Biomedical Engineering, University of California, Irvine, 2121 Engineering Hall, Irvine, CA 92617, USA; The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, USA; Beckman Laser Institute, University of California, Irvine, CA 92617, USA
| | - Zhongping Chen
- Department of Biomedical Engineering, University of California, Irvine, 2121 Engineering Hall, Irvine, CA 92617, USA; The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, USA; Beckman Laser Institute, University of California, Irvine, CA 92617, USA
| | - Steven C George
- Department of Biomedical Engineering, University of California, Irvine, 2121 Engineering Hall, Irvine, CA 92617, USA; The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, USA; Department of Chemical Engineering, University of California, Irvine, CA 92617, USA; Department of Medicine, University of California, Irvine, CA 92617, USA.
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4
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Michel JB, Delbosc S, Ho-Tin-Noé B, Leseche G, Nicoletti A, Meilhac O, Martin-Ventura JL. From intraplaque haemorrhages to plaque vulnerability. J Cardiovasc Med (Hagerstown) 2012; 13:628-34. [DOI: 10.2459/jcm.0b013e328357face] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Patel R, Janoudi A, Vedre A, Aziz K, Tamhane U, Rubinstein J, Abela OG, Berger K, Abela GS. Plaque Rupture and Thrombosis Are Reduced by Lowering Cholesterol Levels and Crystallization With Ezetimibe and Are Correlated With Fluorodeoxyglucose Positron Emission Tomography. Arterioscler Thromb Vasc Biol 2011; 31:2007-14. [DOI: 10.1161/atvbaha.111.226167] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective—
This study evaluated effects of lipid lowering with ezetimibe on plaque burden and associated cholesterol crystallization and inflammation in a rabbit model of plaque disruption and thrombosis.
Methods and Results—
Atherosclerotic rabbits (Group I, n=10 without; Group II, n=12 with ezetimibe, 1 mg/kg per day) were pharmacologically triggered for plaque disruption. Fluorodeoxyglucose positron emission tomography, RAM 11 macrophage staining, and serum inflammatory markers detected arterial inflammation. Serum and aortic wall cholesterol levels were measured, and thrombus area was planimetered. Cholesterol crystal density on aortic surface was scored (0 to +3) by scanning electron microscopy. Serum and aortic wall cholesterol, plaque area, and thrombosis area were significantly lower in Group II versus Group I (83.4±106.4 versus 608±386 mg/dL,
P
=0.002; 3.12±1.40 versus 9.39±5.60 mg/g,
P
=0.003; 10.84±1.6 versus 17.48±1.8 mm
2
,
P
<0.001; and 0.05±0.15 versus 0.72±0.58 mm
2
,
P
=0.01, respectively). There were significant correlations between crystal density and plaque area (
r
=0.75,
P
<0.003) and between crystal density and RAM 11 (
r
=0.82,
P
<0.001). Scanning electron microscopy demonstrated that there were fewer crystals in Group II versus Group I (+1.2±0.61 versus +2.4±0.63,
P
<0.001) and less inflammation detected by fluorodeoxyglucose positron emission tomography and RAM 11 (
P
<0.004 and
P
<0.04, respectively).
Conclusion—
Lowering cholesterol levels with ezetimibe reduced plaque burden, crystallization, and inflammation, preventing plaque disruption and thrombosis.
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Affiliation(s)
- Roshan Patel
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
| | - Abed Janoudi
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
| | - Ameeth Vedre
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
| | - Kusai Aziz
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
| | - Umesh Tamhane
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
| | - Jack Rubinstein
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
| | - Oliver G. Abela
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
| | - Kevin Berger
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
| | - George S. Abela
- From the Division of Cardiology, Department of Medicine (R.P., A.J., A.V., K.A., U.T., O.G.A., G.S.A.), Department of Radiology (K.B.), and Division of Pathology, Department of Physiology (G.S.A.), Michigan State University, East Lansing, MI; Division of Cardiology, University of Cincinnati, Cincinnati, OH (J.R.)
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Davis HR, Lowe RS, Neff DR. Effects of ezetimibe on atherosclerosis in preclinical models. Atherosclerosis 2011; 215:266-78. [DOI: 10.1016/j.atherosclerosis.2011.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 01/19/2011] [Accepted: 02/07/2011] [Indexed: 12/11/2022]
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Michel JB, Virmani R, Arbustini E, Pasterkamp G. Intraplaque haemorrhages as the trigger of plaque vulnerability. Eur Heart J 2011; 32:1977-85, 1985a, 1985b, 1985c. [PMID: 21398643 PMCID: PMC3155759 DOI: 10.1093/eurheartj/ehr054] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Atherothrombosis remains one of the main causes of morbidity and mortality in the western countries. Human atherothrombotic disease begins early in life in relation to circulating lipid retention in the inner vascular wall. Risk factors enhance the progression towards clinical expression: dyslipidaemia, diabetes, smoking, hypertension, ageing, etc. The evolution from the initial lipid retention in the arterial wall to clinical events is a continuum of increasingly complex biological processes. Current strategies to fight the consequences of atherothrombosis are orientated either towards the promotion of a healthy life style and preventive treatment of risk factors, or towards late interventional strategies. Despite this therapeutic arsenal, the incidence of clinical events remains dramatically high, dependent, at least in part, on the increasing frequency of type 2 diabetes and ageing. But some medical treatments, focusing only on prevention of the metabolic risk, have failed to reduce cardiovascular mortality, thus illustrating that our understanding of the pathophysiology of human atherothrombosis leading to clinical events remain incomplete. New paradigms are now emerging which may give rise to novel experimental strategies to improve therapeutic efficacy and prediction of disease progression. Recent studies strengthen the concept that the intraplaque neovascularization and bleeding (Figure 1, upper panel) are events that could play a major role in plaque progression and leucocyte infiltration, and may also serve as a measure of risk for the development of future events. The recent advances in our understanding of IntraPlaque Hemorrhage as a critical event in triggering acute clinical events have important implications for clinical research and possibly future clinical practice.
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Affiliation(s)
- Jean-Baptiste Michel
- UMR 698 Inserm, Paris 7-Denis Diderot University, Xavier Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France.
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Abela GS, Aziz K, Vedre A, Pathak DR, Talbott JD, DeJong J. Effect of cholesterol crystals on plaques and intima in arteries of patients with acute coronary and cerebrovascular syndromes. Am J Cardiol 2009; 103:959-68. [PMID: 19327423 DOI: 10.1016/j.amjcard.2008.12.019] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 11/26/2022]
Abstract
Plaque disruption (PD) causes most acute cardiovascular events. Although cholesterol crystals (CCs) have been observed in plaques, their role in PD was unknown. However, cholesterol expands with crystallization tearing and perforating fibrous tissues. This study tested the hypothesis that CCs can damage plaques and intima, triggering PD, as observed in tissues prepared without ethanol solvents that dissolve CCs. Coronary arteries of patients who died of acute coronary syndrome (n = 19) and non-acute coronary syndrome causes (n = 12) and carotid plaques from patients with (n = 51) and without (n = 19) neurologic symptoms were studied. Samples were examined for CCs perforating the intima using light and scanning electron microscopy (SEM) with ethanol or vacuum dehydration. In addition, fresh unfixed carotid plaques were examined at 37 degrees C using confocal microscopy. Crystal content using SEM was scored from 0 to +3. SEM using vacuum dehydration had significantly higher crystal content compared with SEM using ethanol dehydration (+2.5 +/- 0.53 vs +0.25 +/- 0.46; p <0.0003), with enhanced detection of CC perforations. The presence of CCs using SEM and confocal microscopy was similar, suggesting that CC perforation can occur in vivo at 37 degrees C. All patients with acute coronary syndrome had perforating CCs, but none was present in patients without acute coronary syndrome (p = 0.0001). For all plaques, there were strong associations of CCs with PD, thrombus, symptoms (p <0.0001), and plaque size (p <0.02). Crystal content was an independent predictor of thrombus and symptoms. In conclusion, by avoiding ethanol in tissue preparation, CCs perforating the intima were shown to be associated with PD. Crystal content was significantly associated with clinical events, suggesting that cholesterol crystallization may have a role in PD.
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Vedre A, Pathak DR, Crimp M, Lum C, Koochesfahani M, Abela GS. Physical factors that trigger cholesterol crystallization leading to plaque rupture. Atherosclerosis 2009; 203:89-96. [DOI: 10.1016/j.atherosclerosis.2008.06.027] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 05/24/2008] [Accepted: 06/17/2008] [Indexed: 11/29/2022]
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10
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Phinikaridou A, Hallock KJ, Qiao Y, Hamilton JA. A robust rabbit model of human atherosclerosis and atherothrombosis. J Lipid Res 2009; 50:787-97. [PMID: 19141434 DOI: 10.1194/jlr.m800460-jlr200] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Disruption and thrombosis of atherosclerotic plaques cause most acute cardiovascular events, but their systematic study has been hampered by the lack of suitable animal models. To assess the value of a modified rabbit model of atherothrombosis, we performed detailed histology of rabbit aortic plaques. Atherosclerosis was induced with a high cholesterol diet fed 2 weeks prior to and 6 weeks after balloon injury of the aorta, followed by 4 weeks of normal diet. We found six out of eight types of plaques cataloged by the American Heart Association in the rabbit aorta. Vulnerable plaques were defined as those with attached platelet and fibrin-rich thrombi after pharmacological triggering with Russell's viper venom and histamine. Ruptured plaques had, as also described for human plaques: i) marked medial and adventitial changes, including neovascularization and inflammation; ii) cholesterol monohydrate crystals and liquid crystalline cholesterol esters in the intima and the fibrous cap; and iii) inflamed, thin fibrous caps. Increased cholesterol monohydrate area, internal elastic lamina area, positive remodeling, fibrous cap inflammation, adventitia breakdown, and inflammation were independent predictors of plaque disruption. Our findings reveal novel insights into plaque vulnerability and could guide the design of noninvasive imaging approaches for detecting and treating high-risk plaques.
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Affiliation(s)
- Alkystis Phinikaridou
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA, USA
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