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Gumpangseth T, Komutrattananont P, Palee P, Lekawanvijit S, Kanchai C, Prasitwattanaseree S, Mahakkanukrauh P. Collagen and elastic fibers assessment of the human heart valves for age estimation in Thais using image analysis. Forensic Sci Med Pathol 2024:10.1007/s12024-023-00775-3. [PMID: 38634992 DOI: 10.1007/s12024-023-00775-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 04/19/2024]
Abstract
The study investigated the relationship between the histological compositions of the tricuspid, pulmonary, mitral, and aortic valves, and age. All 85 fresh human hearts were obtained with an age range between 20 and 90 years. The central area of the valves was conducted to analyze the density of collagen and elastic fibers by using an image analysis program. Neural network function in MATLAB was used for classification data and accuracy test of the age predictive model. Overall, a gradual increase in the density of collagen and elastic fibers was demonstrated with age in all valve types. The pulmonary valve cusps had the least density of collagen and elastic contents, whereas the most dense of collagen was found in the mitral leaflets. A similarity was noted for the elastic fibers in the tricuspid, mitral, and aortic valves. The highest correlation between the collagen (r = 0.629) and elastic fibers (r = 0.713) and age was found in the noncoronary cusp of the aortic valve. The established predictive equations using collagen and elastic fibers in the noncoronary cusp provided the standard error of ± 14.0 and 12.5 years, respectively. A 60.9% of accuracy was found in all age groups using collagen, while accuracy in elastic fibers showed 70.0% in the classification process using the neural networks. The current study provided additional data regarding age-associated changes of collagen and elastic fibers in the human heart valves in Thais and the benefits and application in age forensic identification.
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Affiliation(s)
- Treerat Gumpangseth
- Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, 50200, Thailand
| | | | - Patison Palee
- College of Arts Media and Technology, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Suree Lekawanvijit
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaturong Kanchai
- Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Sukon Prasitwattanaseree
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pasuk Mahakkanukrauh
- Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, 50200, Thailand.
- Department of Anatomy, Faculty of Medicine and Research Cluster in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, 50200, Thailand.
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2
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Chen Q, Wang C, Wang H, Xiao J, Zhou Y, Gu S, Xu W, Yang H. Strengthened Decellularized Porcine Valves via Polyvinyl Alcohol as a Template Improving Processability. Polymers (Basel) 2023; 16:16. [PMID: 38201681 PMCID: PMC10780456 DOI: 10.3390/polym16010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
The heart valve is crucial for the human body, which directly affects the efficiency of blood transport and the normal functioning of all organs. Generally, decellularization is one method of tissue-engineered heart valve (TEHV), which can deteriorate the mechanical properties and eliminate allograft immunogenicity. In this study, removable polyvinyl alcohol (PVA) is used to encapsulate decellularized porcine heart valves (DHVs) as a dynamic template to improve the processability of DHVs, such as suturing. Mechanical tests show that the strength and elastic modulus of DHVs treated with different concentrations of PVA significantly improve. Without the PVA layer, the valve would shift during suture puncture and not achieve the desired suture result. The in vitro results indicate that decellularized valves treated with PVA can sustain the adhesion and growth of human umbilical vein endothelial cells (HUVECs). All results above show that the DHVs treated with water-soluble PVA have good mechanical properties and cytocompatibility to ensure post-treatment. On this basis, the improved processability of DHV treated with PVA enables a new paradigm for the manufacturing of scaffolds, making it easy to apply.
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Affiliation(s)
- Qingqing Chen
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430200, China; (Q.C.); (C.W.); (Y.Z.); (S.G.)
| | - Chaorong Wang
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430200, China; (Q.C.); (C.W.); (Y.Z.); (S.G.)
| | - Han Wang
- Key Laboratory of Green Processing and Functional New Textile Materials of Ministry of Education, Wuhan Textile University, Wuhan 430200, China (J.X.); (W.X.)
- Institute for Frontier Materials, Deakin University, Geelong, VIC 3216, Australia
| | - Jinfeng Xiao
- Key Laboratory of Green Processing and Functional New Textile Materials of Ministry of Education, Wuhan Textile University, Wuhan 430200, China (J.X.); (W.X.)
| | - Yingshan Zhou
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430200, China; (Q.C.); (C.W.); (Y.Z.); (S.G.)
| | - Shaojin Gu
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430200, China; (Q.C.); (C.W.); (Y.Z.); (S.G.)
| | - Weilin Xu
- Key Laboratory of Green Processing and Functional New Textile Materials of Ministry of Education, Wuhan Textile University, Wuhan 430200, China (J.X.); (W.X.)
| | - Hongjun Yang
- College of Materials Science and Engineering, Wuhan Textile University, Wuhan 430200, China; (Q.C.); (C.W.); (Y.Z.); (S.G.)
- Key Laboratory of Green Processing and Functional New Textile Materials of Ministry of Education, Wuhan Textile University, Wuhan 430200, China (J.X.); (W.X.)
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3
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Crago M, Winlaw DS, Farajikhah S, Dehghani F, Naficy S. Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies. Bioeng Transl Med 2023; 8:e10501. [PMID: 37476058 PMCID: PMC10354783 DOI: 10.1002/btm2.10501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 03/06/2023] Open
Abstract
Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growth-accommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.
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Affiliation(s)
- Matthew Crago
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - David S. Winlaw
- Department of Cardiothoracic SurgeryHeart Institute, Cincinnati Children's HospitalCincinnatiOHUSA
| | - Syamak Farajikhah
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - Fariba Dehghani
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
| | - Sina Naficy
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyAustralia
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4
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Abstract
Patients with chronic kidney disease (CKD) exhibit tremendously elevated risk for cardiovascular disease, particularly ischemic heart disease, due to premature vascular and cardiac aging and accelerated ectopic calcification. The presence of cardiovascular calcification associates with increased risk in patients with CKD. Disturbed mineral homeostasis and diverse comorbidities in these patients drive increased systemic cardiovascular calcification in different manifestations with diverse clinical consequences, like plaque instability, vessel stiffening, and aortic stenosis. This review outlines the heterogeneity in calcification patterning, including mineral type and location and potential implications on clinical outcomes. The advent of therapeutics currently in clinical trials may reduce CKD-associated morbidity. Development of therapeutics for cardiovascular calcification begins with the premise that less mineral is better. While restoring diseased tissues to a noncalcified homeostasis remains the ultimate goal, in some cases, calcific mineral may play a protective role, such as in atherosclerotic plaques. Therefore, developing treatments for ectopic calcification may require a nuanced approach that considers individual patient risk factors. Here, we discuss the most common cardiac and vascular calcification pathologies observed in CKD, how mineral in these tissues affects function, and the potential outcomes and considerations for therapeutic strategies that seek to disrupt the nucleation and growth of mineral. Finally, we discuss future patient-specific considerations for treating cardiac and vascular calcification in patients with CKD-a population in need of anticalcification therapies.
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Affiliation(s)
- Joshua D. Hutcheson
- Department of Biomedical Engineering, Florida International University, Miami, FL (J.D.H.)
| | - Claudia Goettsch
- Department of Internal Medicine I, Division of Cardiology, Medical Faculty, RWTH Aachen University, Germany (C.G.)
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Biofabrication of Sodium Alginate Hydrogel Scaffolds for Heart Valve Tissue Engineering. Int J Mol Sci 2022; 23:ijms23158567. [PMID: 35955704 PMCID: PMC9368972 DOI: 10.3390/ijms23158567] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022] Open
Abstract
Every year, thousands of aortic valve replacements must take place due to valve diseases. Tissue-engineered heart valves represent promising valve substitutes with remodeling, regeneration, and growth capabilities. However, the accurate reproduction of the complex three-dimensional (3D) anatomy of the aortic valve remains a challenge for current biofabrication methods. We present a novel technique for rapid fabrication of native-like tricuspid aortic valve scaffolds made of an alginate-based hydrogel. Using this technique, a sodium alginate hydrogel formulation is injected into a mold produced using a custom-made sugar glass 3D printer. The mold is then dissolved using a custom-made dissolving module, revealing the aortic valve scaffold. To assess the reproducibility of the technique, three scaffolds were thoroughly compared. CT (computed tomography) scans showed that the scaffolds respect the complex native geometry with minimal variations. The scaffolds were then tested in a cardiac bioreactor specially designed to reproduce physiological flow and pressure (aortic and ventricular) conditions. The flow and pressure profiles were similar to the physiological ones for the three valve scaffolds, with small variabilities. These early results establish the functional repeatability of this new biofabrication method and suggest its application for rapid fabrication of ready-to-use cell-seeded sodium alginate scaffolds for heart valve tissue engineering.
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Sazzad F, Hon JKF, Ramanathan K, Nah JH, Ong ZX, Ti LK, Foo R, Tay E, Kofidis T. Design Variation, Implantation, and Outcome of Transcatheter Mitral Valve Prosthesis: A Comprehensive Review. Front Cardiovasc Med 2022; 8:782278. [PMID: 35284498 PMCID: PMC8907442 DOI: 10.3389/fcvm.2021.782278] [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: 09/24/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
The transcatheter mitral valve prosthesis is ideally suited for patients with inoperable mitral etiology. The transcatheter mitral valve implantation (TMVI) procedure has closely followed the evolution of transcatheter aortic procedures. There are considerable design variations amongst the limited TMVI prostheses currently available, and the implantation profiles of the devices are notably different. This comprehensive review will provide an overview of the current clinically tried TMVI devices with a focused outcome analysis. In addition, we have discussed the various design characteristics of TMVI and its associated failure mode, implantation technology, delivery methods, first-in-man trials, and pivotal trial summary for the synthesis of recent evidence. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255241, identifier: CRD42021255241.
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Affiliation(s)
- Faizus Sazzad
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
- Cardiovascular Disease Translational Research Programme, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
| | - Jimmy Kim Fatt Hon
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Jie Hui Nah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhi Xian Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lian Kah Ti
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiovascular Disease Translational Research Programme, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Edgar Tay
- National University Heart Centre, National University Health System, Singapore, Singapore
- Asian Heart & Vascular Centre (AHVC), Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Theo Kofidis
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
- Cardiovascular Disease Translational Research Programme, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
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7
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Manduteanu I, Simionescu D, Simionescu A, Simionescu M. Aortic valve disease in diabetes: Molecular mechanisms and novel therapies. J Cell Mol Med 2021; 25:9483-9495. [PMID: 34561944 PMCID: PMC8505854 DOI: 10.1111/jcmm.16937] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022] Open
Abstract
Valve disease and particularly calcific aortic valve disease (CAVD) and diabetes (DM) are progressive diseases constituting a global health burden for all aging societies (Progress in Cardiovascular Diseases. 2014;56(6):565: Circulation Research. 2021;128(9):1344). Compared to non‐diabetic individuals (The Lancet. 2008;371(9626):1800: The American Journal of Cardiology. 1983;51(3):403: Journal of the American College of Cardiology. 2017;69(12):1523), the diabetic patients have a significantly greater propensity for cardiovascular disorders and faster degeneration of implanted bioprosthetic aortic valves. Previously, using an original experimental model, the diabetic‐hyperlipemic hamsters, we have shown that the earliest alterations induced by these conditions occur at the level of the aortic valves and, with time these changes lead to calcifications and CAVD. However, there are no pharmacological treatments available to reverse or retard the progression of aortic valve disease in diabetes, despite the significant advances in the field. Therefore, it is critical to uncover the mechanisms of valve disease progression, find biomarkers for diagnosis and new targets for therapies. This review aims at presenting an update on the basic research in CAVD in the context of diabetes. We provide an insight into the accumulated data including our results on diabetes‐induced progressive cell and molecular alterations in the aortic valve, new potential biomarkers to assess the evolution and therapy of the disease, advancement in targeted nanotherapies, tissue engineering and the potential use of circulating endothelial progenitor cells in CAVD.
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Affiliation(s)
- Ileana Manduteanu
- Institute of Cellular Biology and Pathology "Nicolae Simionescu" of the Romanian Academy, Bucharest, Romania
| | - Dan Simionescu
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Agneta Simionescu
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Maya Simionescu
- Institute of Cellular Biology and Pathology "Nicolae Simionescu" of the Romanian Academy, Bucharest, Romania
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8
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Wu S, Kumar V, Xiao P, Kuss M, Lim JY, Guda C, Butcher J, Duan B. Age related extracellular matrix and interstitial cell phenotype in pulmonary valves. Sci Rep 2020; 10:21338. [PMID: 33288823 PMCID: PMC7721746 DOI: 10.1038/s41598-020-78507-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
Heart valve disease is a common manifestation of cardiovascular disease and is a significant cause of cardiovascular morbidity and mortality worldwide. The pulmonary valve (PV) is of primary concern because of its involvement in common congenital heart defects, and the PV is usually the site for prosthetic replacement following a Ross operation. Although effects of age on valve matrix components and mechanical properties for aortic and mitral valves have been studied, very little is known about the age-related alterations that occur in the PV. In this study, we isolated PV leaflets from porcine hearts in different age groups (~ 4-6 months, denoted as young versus ~ 2 years, denoted as adult) and studied the effects of age on PV leaflet thickness, extracellular matrix components, and mechanical properties. We also conducted proteomics and RNA sequencing to investigate the global changes of PV leaflets and passage zero PV interstitial cells in their protein and gene levels. We found that the size, thickness, elastic modulus, and ultimate stress in both the radial and circumferential directions and the collagen of PV leaflets increased from young to adult age, while the ultimate strain and amount of glycosaminoglycans decreased when age increased. Young and adult PV had both similar and distinct protein and gene expression patterns that are related to their inherent physiological properties. These findings are important for us to better understand the physiological microenvironments of PV leaflet and valve cells for correctively engineering age-specific heart valve tissues.
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Affiliation(s)
- Shaohua Wu
- College of Textiles & Clothing, Qingdao University, Qingdao, People's Republic of China
- Mary & Dick Holland Regenerative Medicine Program and Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vikas Kumar
- Mass Spectrometry and Proteomics Core Facility, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peng Xiao
- Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mitchell Kuss
- Mary & Dick Holland Regenerative Medicine Program and Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jung Yul Lim
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Chittibabu Guda
- Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jonathan Butcher
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program and Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA.
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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9
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Gumpangseth T, Lekawanvijit S, Mahakkanukrauh P. Histological assessment of the human heart valves and its relationship with age. Anat Cell Biol 2020; 53:261-271. [PMID: 32727956 PMCID: PMC7527117 DOI: 10.5115/acb.20.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022] Open
Abstract
The human heart valves are complex anatomical structures consisting of leaflets with many supporting structures. With advancing age, the microstructure of the components of the valves can change. Knowledge and understanding of the anatomical relationships between the different components of the heart valve structures and their relationship with age is crucial for the development and progression of treatment of valvular disease. The purpose of this study was to determine histological changes of the components of the heart valves and their relationship with age. Fifty hearts taken from cadavers were included to examine the histology of the tricuspid, mitral, pulmonary, and aortic valves. All specimens were stained with Elastic Van Gieson, and picrosirius red to enable the evaluation of elastic and collagen fibers, respectively. There was a gradual increase in elastic and collagen fibers with advancing age, particularly over 40 years, in all valve types. In the case of tricuspid and mitral valves increases in collagen and elastic fibers were observed starting in the fifth decade. Elastic fiber fragmentation was observed in specimens over 50 years. In the case of the pulmonary and the aortic valves, collagen fibers were denser and more irregular in the sixth to seventh decades when compared to younger ages while elastic fibers were significantly increased in the sixth decade. In addition, an increase in fat deposition had an association with aging. These findings provide additional basic knowledge in age-related morphological changes of the heart valves and will increase understanding concerning valvular heart diseases and treatment options.
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Affiliation(s)
- Treerat Gumpangseth
- PhD Degree Program in Anatomy, Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suree Lekawanvijit
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, Thailand
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Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY. Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments. Expert Rev Cardiovasc Ther 2020; 18:681-696. [DOI: 10.1080/14779072.2020.1792777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Polina Zaytseva
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Eric K. N. Gähwiler
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Sarah E. Motta
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | | | - Nikola Cesarovic
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center of Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Simon P. Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and 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
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11
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Next-generation tissue-engineered heart valves with repair, remodelling and regeneration capacity. Nat Rev Cardiol 2020; 18:92-116. [PMID: 32908285 DOI: 10.1038/s41569-020-0422-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Valvular heart disease is a major cause of morbidity and mortality worldwide. Surgical valve repair or replacement has been the standard of care for patients with valvular heart disease for many decades, but transcatheter heart valve therapy has revolutionized the field in the past 15 years. However, despite the tremendous technical evolution of transcatheter heart valves, to date, the clinically available heart valve prostheses for surgical and transcatheter replacement have considerable limitations. The design of next-generation tissue-engineered heart valves (TEHVs) with repair, remodelling and regenerative capacity can address these limitations, and TEHVs could become a promising therapeutic alternative for patients with valvular disease. In this Review, we present a comprehensive overview of current clinically adopted heart valve replacement options, with a focus on transcatheter prostheses. We discuss the various concepts of heart valve tissue engineering underlying the design of next-generation TEHVs, focusing on off-the-shelf technologies. We also summarize the latest preclinical and clinical evidence for the use of these TEHVs and describe the current scientific, regulatory and clinical challenges associated with the safe and broad clinical translation of this technology.
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12
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Boll LFC, Rodrigues GO, Rodrigues CG, Bertollo FL, Irigoyen MC, Goldmeier S. Using a 3D printer in cardiac valve surgery: a systematic review. ACTA ACUST UNITED AC 2019; 65:818-824. [PMID: 31340310 DOI: 10.1590/1806-9282.65.6.818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/10/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The use of the 3D printer in complex cardiac surgery planning. OBJECTIVES To analyze the use and benefits of 3D printing in heart valve surgery through a systematic review of the literature. METHODS This systematic review was reported following the Preferred Reporting Items for Systematic Review and registered in the Prospero (International Prospective Register of Systematic Reviews) database under the number CRD42017059034. We used the following databases: PubMed, EMBASE, Scopus, Web of Science and Lilacs. We included articles about the keywords "Heart Valves", "Heart Valve Prosthesis Implantation", "Heart Valve Prosthesis", "Printing, Three-Dimensional", and related entry terms. Two reviewers independently conducted data extraction and a third reviewer solved disagreements. All tables used for data extraction are available at a separate website. We used the Cochrane Collaboration tool to assess the risk of bias of the studies included. RESULTS We identified 301 articles and 13 case reports and case series that met the inclusion criteria. Our studies included 34 patients aged from 3 months to 94 years. CONCLUSIONS Up to the present time, there are no studies including a considerable number of patients. A 3D-printed model produced based on the patient enables the surgeon to plan the surgical procedure and choose the best material, size, format, and thickness to be used. This planning leads to reduced surgery time, exposure, and consequently, lower risk of infection.
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Affiliation(s)
| | | | - Clarissa Garcia Rodrigues
- Institute of Cardiology / University Foundation of Cardiology; Av. Princesa Isabel, 370 - Porto Alegre, RS, Brasil
| | - Felipe Luiz Bertollo
- Institute of Cardiology / University Foundation of Cardiology; Av. Princesa Isabel, 370 - Porto Alegre, RS, Brasil
| | | | - Silvia Goldmeier
- Institute of Cardiology / University Foundation of Cardiology; Av. Princesa Isabel, 370 - Porto Alegre, RS, Brasil
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13
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Simmons CA, Jo H. Editorial: Special Issue on Heart Valve Mechanobiology : New Insights into Mechanical Regulation of Valve Disease and Regeneration. Cardiovasc Eng Technol 2019; 9:121-125. [PMID: 29761407 DOI: 10.1007/s13239-018-0360-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Craig A Simmons
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON, Canada. .,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada. .,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.
| | - Hanjoong Jo
- Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA. .,Department of Cardiology, Emory University, Atlanta, GA, USA.
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14
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Gumpangseth T, Mahakkanukrauh P, Das S. Gross age-related changes and diseases in human heart valves. Anat Cell Biol 2019; 52:25-33. [PMID: 30984448 PMCID: PMC6449582 DOI: 10.5115/acb.2019.52.1.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Abstract
Cardiac valves are highly complex structures optimizing their function during the cardiac cycle. They open and close directed by blood flow under different pressure conditions in the dynamic environment in the heart. It is acknowledged that the aging process affects the structure and functions of the heart valves. With regard to morphometry, age-related changes of the heart valve can be found in valve circumference, thickness of the leaflet, luminal area at the sinotubular junction, valve diameter, orifice area, and leaflet size in circumferential and radial direction. In addition, there are differences between male and female hearts in some features. Moreover, there are studies the qualitative and quantitative assessment of histological compositions, echocardiography study to investigate the annular circumference and diameter in the human heart valves related with age. Studies into the detailed anatomy of the changes in heart valves with age are important and the correlation between valve morphology and age may be used as an age indicator. This study reviews the basic anatomical structure of the heart valves, age-related changes of valve morphometry, heart valve diseases, and general treatment of valvular diseases in humans. Detailed knowledge of the anatomical features of the morphology of the human heart valve is useful for any treatments of valve pathology.
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Affiliation(s)
- Treerat Gumpangseth
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Excellence in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, Thailand
| | - Srijit Das
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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15
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Esmerats JF, Villa-Roel N, Kumar S, Gu L, Salim MT, Ohh M, Taylor WR, Nerem RM, Yoganathan AP, Jo H. Disturbed Flow Increases UBE2C (Ubiquitin E2 Ligase C) via Loss of miR-483-3p, Inducing Aortic Valve Calcification by the pVHL (von Hippel-Lindau Protein) and HIF-1α (Hypoxia-Inducible Factor-1α) Pathway in Endothelial Cells. Arterioscler Thromb Vasc Biol 2019; 39:467-481. [PMID: 30602302 PMCID: PMC6393167 DOI: 10.1161/atvbaha.118.312233] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/18/2018] [Indexed: 12/28/2022]
Abstract
Objective- Calcific aortic valve (AV) disease, characterized by AV sclerosis and calcification, is a major cause of death in the aging population; however, there are no effective medical therapies other than valve replacement. AV calcification preferentially occurs on the fibrosa side, exposed to disturbed flow (d-flow), whereas the ventricularis side exposed to predominantly stable flow remains protected by unclear mechanisms. Here, we tested the role of novel flow-sensitive UBE2C (ubiquitin E2 ligase C) and microRNA-483-3p (miR-483) in flow-dependent AV endothelial function and AV calcification. Approach and Results- Human AV endothelial cells and fresh porcine AV leaflets were exposed to stable flow or d-flow. We found that UBE2C was upregulated by d-flow in human AV endothelial cells in the miR-483-dependent manner. UBE2C mediated OS-induced endothelial inflammation and endothelial-mesenchymal transition by increasing the HIF-1α (hypoxia-inducible factor-1α) level. UBE2C increased HIF-1α by ubiquitinating and degrading its upstream regulator pVHL (von Hippel-Lindau protein). These in vitro findings were corroborated by immunostaining studies using diseased human AV leaflets. In addition, we found that reduction of miR-483 by d-flow led to increased UBE2C expression in human AV endothelial cells. The miR-483 mimic protected against endothelial inflammation and endothelial-mesenchymal transition in human AV endothelial cells and calcification of porcine AV leaflets by downregulating UBE2C. Moreover, treatment with the HIF-1α inhibitor (PX478) significantly reduced porcine AV calcification in static and d-flow conditions. Conclusions- These results suggest that miR-483 and UBE2C and pVHL are novel flow-sensitive anti- and pro-calcific AV disease molecules, respectively, that regulate the HIF-1α pathway in AV. The miR-483 mimic and HIF-1α pathway inhibitors may serve as potential therapeutics of calcific AV disease.
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Affiliation(s)
- Joan Fernandez Esmerats
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University
| | - Nicolas Villa-Roel
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University
| | - Sandeep Kumar
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University
| | - Lina Gu
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University
| | - Md Tausif Salim
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology
| | - Michael Ohh
- Department of Biochemistry, Faculty of Medicine, University of Toronto, Toronto, CA
| | - W. Robert Taylor
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University
- Division of Cardiology, Department of Medicine, Emory University
| | - Robert M. Nerem
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology. Atlanta, GA, USA
| | - Ajit P. Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology
| | - Hanjoong Jo
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University
- Division of Cardiology, Department of Medicine, Emory University
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16
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Jover E, Fagnano M, Angelini G, Madeddu P. Cell Sources for Tissue Engineering Strategies to Treat Calcific Valve Disease. Front Cardiovasc Med 2018; 5:155. [PMID: 30460245 PMCID: PMC6232262 DOI: 10.3389/fcvm.2018.00155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular calcification is an independent risk factor and an established predictor of adverse cardiovascular events. Despite concomitant factors leading to atherosclerosis and heart valve disease (VHD), the latter has been identified as an independent pathological entity. Calcific aortic valve stenosis is the most common form of VDH resulting of either congenital malformations or senile “degeneration.” About 2% of the population over 65 years is affected by aortic valve stenosis which represents a major cause of morbidity and mortality in the elderly. A multifactorial, complex and active heterotopic bone-like formation process, including extracellular matrix remodeling, osteogenesis and angiogenesis, drives heart valve “degeneration” and calcification, finally causing left ventricle outflow obstruction. Surgical heart valve replacement is the current therapeutic option for those patients diagnosed with severe VHD representing more than 20% of all cardiac surgeries nowadays. Tissue Engineering of Heart Valves (TEHV) is emerging as a valuable alternative for definitive treatment of VHD and promises to overcome either the chronic oral anticoagulation or the time-dependent deterioration and reintervention of current mechanical or biological prosthesis, respectively. Among the plethora of approaches and stablished techniques for TEHV, utilization of different cell sources may confer of additional properties, desirable and not, which need to be considered before moving from the bench to the bedside. This review aims to provide a critical appraisal of current knowledge about calcific VHD and to discuss the pros and cons of the main cell sources tested in studies addressing in vitro TEHV.
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Affiliation(s)
- Eva Jover
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Marco Fagnano
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni Angelini
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Paolo Madeddu
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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