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Chen Z, Mondal NK, Zheng S, Koenig SC, Slaughter MS, Griffith BP, Wu ZJ. High shear induces platelet dysfunction leading to enhanced thrombotic propensity and diminished hemostatic capacity. Platelets 2017; 30:112-119. [PMID: 29182470 DOI: 10.1080/09537104.2017.1384542] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Thrombosis and bleeding are devastating adverse events in patients supported with blood-contacting medical devices (BCMDs). In this study, we delineated that high non-physiological shear stress (NPSS) caused platelet dysfunction that may contribute to both thrombosis and bleeding. Human blood was subjected to NPSS with short exposure time. Levels of platelet surface GPIbα and GPVI receptors as well as activation level of GPIIb/IIIa in NPSS-sheared blood were examined with flow cytometry. Adhesion of sheared platelets on fibrinogen, von Willibrand factor (VWF), and collagen was quantified with fluorescent microscopy. Ristocetin- and collagen-induced platelet aggregation was characterized by aggregometry. NPSS activated platelets in a shear and exposure time-dependent manner. The number of activated platelets increased with increasing levels of NPSS and exposure time, which corresponded well with increased adhesion of sheared platelets on fibrinogen. Concurrently, NPSS caused shedding of GPIbα and GPVI in a manner dependent on shear and exposure time. The loss of intact GPIbα and GPVI increased with increasing levels of NPSS and exposure time. The number of platelets adhered on VWF and collagen decreased with increasing levels of NPSS and exposure time, respectively. The decrease in the number of platelets adhered on VWF and collagen corresponded well with the loss in GPIbα and GPVI on platelet surface. Both ristocetin- and collagen-induced platelet aggregation in sheared blood decreased with increasing levels of NPSS and exposure time. The study clearly demonstrated that high NPSS causes simultaneous platelet activation and receptor shedding, resulting in a paradoxical effect on platelet function via two distinct mechanisms. The results from the study suggested that the NPSS could induce the concurrent propensity for both thrombosis and bleeding in patients.
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Affiliation(s)
- Zengsheng Chen
- a Department of Surgery , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Nandan K Mondal
- b Department of Cardiovascular and Thoracic Surgery , School of Medicine, University of Louisville , Louisville , KY , USA
| | - Shirong Zheng
- b Department of Cardiovascular and Thoracic Surgery , School of Medicine, University of Louisville , Louisville , KY , USA
| | - Steven C Koenig
- b Department of Cardiovascular and Thoracic Surgery , School of Medicine, University of Louisville , Louisville , KY , USA.,c Department of Bioengineering , Speed School of Engineering, University of Louisville , Louisville , KY , USA
| | - Mark S Slaughter
- b Department of Cardiovascular and Thoracic Surgery , School of Medicine, University of Louisville , Louisville , KY , USA
| | - Bartley P Griffith
- a Department of Surgery , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Zhongjun J Wu
- a Department of Surgery , University of Maryland School of Medicine , Baltimore , MD , USA.,d Fischell Department of Bioengineering , A. James Clark School of Engineering, University of Maryland , College Park , MD , USA
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Early Bioprosthetic Valve Failure: Mechanistic Insights via Correlation between Echocardiographic and Operative Findings. J Am Soc Echocardiogr 2015; 28:1131-48. [DOI: 10.1016/j.echo.2015.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 11/22/2022]
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Thrombogenicity and biocompatibility studies of reduced graphene oxide modified acellular pulmonary valve tissue. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 53:310-21. [DOI: 10.1016/j.msec.2015.04.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/31/2015] [Accepted: 04/24/2015] [Indexed: 12/12/2022]
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Abstract
BACKGROUND Patient-prosthesis mismatch is a known and severe complication after aortic valve repair in the general population. There is a paucity of literature regarding this condition in pregnancy. CASE We present the clinical course of a pregnant woman with severe patient-prosthesis mismatch after aortic valve replacement. After extensive workup, the patient underwent aortic valve replacement, enlargement of the aortic root, and placement of a larger prosthetic valve at 21 weeks of gestation. Her postoperative course was complicated by fetal death. CONCLUSION Cardiopulmonary bypass and aortic valve replacement present a multitude of risks to maternal and fetal health. The obstetrician managing pregnant women with prosthetic heart valves should be aware of the complications that may arise, including patient-prosthesis mismatch.
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Off-the-shelf human decellularized tissue-engineered heart valves in a non-human primate model. Biomaterials 2013; 34:7269-80. [PMID: 23810254 DOI: 10.1016/j.biomaterials.2013.04.059] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/27/2013] [Indexed: 11/27/2022]
Abstract
Heart valve tissue engineering based on decellularized xenogenic or allogenic starter matrices has shown promising first clinical results. However, the availability of healthy homologous donor valves is limited and xenogenic materials are associated with infectious and immunologic risks. To address such limitations, biodegradable synthetic materials have been successfully used for the creation of living autologous tissue-engineered heart valves (TEHVs) in vitro. Since these classical tissue engineering technologies necessitate substantial infrastructure and logistics, we recently introduced decellularized TEHVs (dTEHVs), based on biodegradable synthetic materials and vascular-derived cells, and successfully created a potential off-the-shelf starter matrix for guided tissue regeneration. Here, we investigate the host repopulation capacity of such dTEHVs in a non-human primate model with up to 8 weeks follow-up. After minimally invasive delivery into the orthotopic pulmonary position, dTEHVs revealed mobile and thin leaflets after 8 weeks of follow-up. Furthermore, mild-moderate valvular insufficiency and relative leaflet shortening were detected. However, in comparison to the decellularized human native heart valve control - representing currently used homografts - dTEHVs showed remarkable rapid cellular repopulation. Given this substantial in situ remodeling capacity, these results suggest that human cell-derived bioengineered decellularized materials represent a promising and clinically relevant starter matrix for heart valve tissue engineering. These biomaterials may ultimately overcome the limitations of currently used valve replacements by providing homologous, non-immunogenic, off-the-shelf replacement constructs.
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