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Poulis N, Martin M, Hoerstrup SP, Emmert MY, Fioretta ES. Macrophage-extracellular matrix interactions: Perspectives for tissue engineered heart valve remodeling. Front Cardiovasc Med 2022; 9:952178. [PMID: 36176991 PMCID: PMC9513146 DOI: 10.3389/fcvm.2022.952178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
In situ heart valve tissue engineering approaches have been proposed as promising strategies to overcome the limitations of current heart valve replacements. Tissue engineered heart valves (TEHVs) generated from in vitro grown tissue engineered matrices (TEMs) aim at mimicking the microenvironmental cues from the extracellular matrix (ECM) to favor integration and remodeling of the implant. A key role of the ECM is to provide mechanical support to and attract host cells into the construct. Additionally, each ECM component plays a critical role in regulating cell adhesion, growth, migration, and differentiation potential. Importantly, the immune response to the implanted TEHV is also modulated biophysically via macrophage-ECM protein interactions. Therefore, the aim of this review is to summarize what is currently known about the interactions and signaling networks occurring between ECM proteins and macrophages, and how these interactions may impact the long-term in situ remodeling outcomes of TEMs. First, we provide an overview of in situ tissue engineering approaches and their clinical relevance, followed by a discussion on the fundamentals of the remodeling cascades. We then focus on the role of circulation-derived and resident tissue macrophages, with particular emphasis on the ramifications that ECM proteins and peptides may have in regulating the host immune response. Finally, the relevance of these findings for heart valve tissue engineering applications is discussed.
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Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Marcy Martin
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Simon P. Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Wyss Zurich, University and Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Wyss Zurich, University and Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- *Correspondence: Maximilian Y. Emmert, ,
| | - Emanuela S. Fioretta
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Emanuela S. Fioretta,
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Aoki T, Miyamoto T, Fukamachi N, Niimi S, Jingya Y, Wakao Y. Combination of the Modified Loop Technique and De Vega Annuloplasty in Dogs with Mitral Regurgitation. Animals (Basel) 2022; 12:ani12131653. [PMID: 35804552 PMCID: PMC9264785 DOI: 10.3390/ani12131653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/07/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Detailed surgical techniques for treating canine mitral regurgitation have not been previously reported. Method: This case series included six consecutive client-owned dogs with mitral regurgitation. All dogs underwent a combined protocol, including the modified loop technique and De Vega annuloplasty (MODEL surgery), in 2021. Artificial loops covering 80% of the length of the strut chordae tendineae were used for chordal replacement. Mitral annuloplasty was subjectively performed, targeting the circumference of the septal leaflet. Results: The breeds were Chihuahua-mixed breed, Spitz, Pomeranian, Cavalier King Charles Spaniel, and Chihuahua, with average ages and weights of 11.4 ± 2.3 years and 5.49 ± 2.98 kg, respectively. The aortic cross-clamp, pumping, and surgery times were 64.0 ± 7.5 min, 168.5 ± 39.1 min, and 321.0 ± 53.1 min, respectively. After MODEL surgery, left atrial-to-aortic ratios significantly decreased from 2.20 ± 0.18 to 1.26 ± 0.22 (p < 0.01), and left ventricular end-diastolic internal diameter normalized to body weight significantly decreased from 2.03 ± 0.26 to 1.48 ± 0.20 (p < 0.01). In all cases, the clinical signs disappeared or improved significantly. Conclusions: MODEL surgery increased mitral valve coaptation, normalized heart sizes, and significantly improved clinical signs in dogs with mitral regurgitation.
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Affiliation(s)
- Takuma Aoki
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, School of Veterinary Medicine, Azabu University, Sagamihara 252-5201, Kanagawa, Japan; (S.N.); (Y.J.); (Y.W.)
- Department of Cardiology and Respieratory Disease, Azabu University Veterinary Teaching Hospital, Azabu University, Sagamihara 252-5201, Kanagawa, Japan
- Correspondence: ; Tel.: +81-42-754-7111
| | | | | | - Seiya Niimi
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, School of Veterinary Medicine, Azabu University, Sagamihara 252-5201, Kanagawa, Japan; (S.N.); (Y.J.); (Y.W.)
- Department of Cardiology and Respieratory Disease, Azabu University Veterinary Teaching Hospital, Azabu University, Sagamihara 252-5201, Kanagawa, Japan
| | - Yao Jingya
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, School of Veterinary Medicine, Azabu University, Sagamihara 252-5201, Kanagawa, Japan; (S.N.); (Y.J.); (Y.W.)
- Department of Cardiology and Respieratory Disease, Azabu University Veterinary Teaching Hospital, Azabu University, Sagamihara 252-5201, Kanagawa, Japan
| | - Yoshito Wakao
- Laboratory of Small Animal Surgery, Department of Veterinary Medicine, School of Veterinary Medicine, Azabu University, Sagamihara 252-5201, Kanagawa, Japan; (S.N.); (Y.J.); (Y.W.)
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Stephens EH, Nguyen TC, Blazejewski JG, Vekilov DP, Connell JP, Itoh A, Ingels NB, Miller DC, Grande-Allen KJ. Extracellular matrix remodeling in wound healing of critical size defects in the mitral valve leaflet. Heart Vessels 2016; 31:1186-95. [PMID: 26563105 PMCID: PMC10578972 DOI: 10.1007/s00380-015-0768-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
The details of valvular leaflet healing following valvuloplasty and leaflet perforation from endocarditis are poorly understood. In this study, the synthesis and turnover of valvular extracellular matrix due to healing of a critical sized wound was investigated. Twenty-nine sheep were randomized to either CTRL (n = 11) or HOLE (n = 18), in which a 2.8-4.8 mm diameter hole was punched in the posterior mitral leaflet. After 12 weeks, posterior leaflets were harvested and histologically stained to localize extracellular matrix components. Immunohistochemistry was also performed to assess matrix components and markers of matrix turnover. A semi-quantitative grading scale was used to quantify differences between HOLE and CTRL. After 12 weeks, the hole diameter was reduced by 71.3 ± 1.4 % (p < 0.001). Areas of remodeling surrounding the hole contained more activated cells, greater expression of proteoglycans, and markers of matrix turnover (prolyl 4-hydroxylase, metalloproteases, and lysyl oxidase, each p ≤ 0.025), along with fibrin accumulation. Two distinct remodeling regions were evident surrounding the hole, one directly bordering the hole rich in versican and hyaluronan and a second adjacent region with abundant collagen and elastic fiber turnover. The remodeling also caused reduced delineation between valve layers (p = 0.002), more diffuse staining of matrix components and markers of matrix turnover (p < 0.001), and disruption of the collagenous fibrosa. In conclusion, acute valve injury elicited distinct, heterogeneous alterations in valvular matrix composition and structure, resulting in partial wound closure. Because these changes could also affect leaflet mechanics and valve function, it will be important to determine their impact on healing wounds.
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Affiliation(s)
- Elizabeth H Stephens
- Department of Bioengineering, Rice University, PO Box 1892, MS142, Houston, TX, 77251-1892, USA
- Department of Cardiothoracic Surgery, Columbia University School of Medicine, New York, NY, USA
| | - Tom C Nguyen
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center, Houston, TX, USA
| | - Jack G Blazejewski
- Department of Bioengineering, Rice University, PO Box 1892, MS142, Houston, TX, 77251-1892, USA
| | - Dragoslava P Vekilov
- Department of Bioengineering, Rice University, PO Box 1892, MS142, Houston, TX, 77251-1892, USA
| | - Jennifer P Connell
- Department of Bioengineering, Rice University, PO Box 1892, MS142, Houston, TX, 77251-1892, USA
| | - Akinobu Itoh
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Neil B Ingels
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Laboratory of Cardiovascular Physiology and Biophysics, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - K Jane Grande-Allen
- Department of Bioengineering, Rice University, PO Box 1892, MS142, Houston, TX, 77251-1892, USA.
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