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Marino M, Sauty B, Vairo G. Unraveling the complexity of vascular tone regulation: a multiscale computational approach to integrating chemo-mechano-biological pathways with cardiovascular biomechanics. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01826-6. [PMID: 38507180 DOI: 10.1007/s10237-024-01826-6] [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: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 03/22/2024]
Abstract
Vascular tone regulation is a crucial aspect of cardiovascular physiology, with significant implications for overall cardiovascular health. However, the precise physiological mechanisms governing smooth muscle cell contraction and relaxation remain uncertain. The complexity of vascular tone regulation stems from its multiscale and multifactorial nature, involving global hemodynamics, local flow conditions, tissue mechanics, and biochemical pathways. Bridging this knowledge gap and translating it into clinical practice presents a challenge. In this paper, a computational model is presented to integrate chemo-mechano-biological pathways with cardiovascular biomechanics, aiming to unravel the intricacies of vascular tone regulation. The computational framework combines an algebraic description of global hemodynamics with detailed finite element analyses at the scale of vascular segments for describing their passive and active mechanical response, as well as the molecular transport problem linked with chemo-biological pathways triggered by wall shear stresses. Their coupling is accounted for by considering a two-way interaction. Specifically, the focus is on the role of nitric oxide-related molecular pathways, which play a critical role in modulating smooth muscle contraction and relaxation to maintain vascular tone. The computational framework is employed to examine the interplay between localized alterations in the biomechanical response of a specific vessel segment-such as those induced by calcifications or endothelial dysfunction-and the broader global hemodynamic conditions-both under basal and altered states. The proposed approach aims to advance our understanding of vascular tone regulation and its impact on cardiovascular health. By incorporating chemo-mechano-biological mechanisms into in silico models, this study allows us to investigate cardiovascular responses to multifactorial stimuli and incorporate the role of adaptive homeostasis in computational biomechanics frameworks.
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Affiliation(s)
- Michele Marino
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy.
| | - Bastien Sauty
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy
- Mines Saint-Etienne, Université Jean Monnet, INSERM, U1059 SAINBIOSE, F-42023, Saint-Etienne, France
| | - Giuseppe Vairo
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy
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Cornelissen A, Florescu RA, Reese S, Behr M, Ranno A, Manjunatha K, Schaaps N, Böhm C, Liehn EA, Zhao L, Nilcham P, Milzi A, Schröder J, Vogt FJ. In-vivo assessment of vascular injury for the prediction of in-stent restenosis. Int J Cardiol 2023; 388:131151. [PMID: 37423572 DOI: 10.1016/j.ijcard.2023.131151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/10/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Despite optimizations of coronary stenting technology, a residual risk of in-stent restenosis (ISR) remains. Vessel wall injury has important impact on the development of ISR. While injury can be assessed in histology, there is no injury score available to be used in clinical practice. METHODS Seven rats underwent abdominal aorta stent implantation. At 4 weeks after implantation, animals were euthanized, and strut indentation, defined as the impression of the strut into the vessel wall, as well as neointimal growth were assessed. Established histological injury scores were assessed to confirm associations between indentation and vessel wall injury. In addition, stent strut indentation was assessed by optical coherence tomography (OCT) in an exemplary clinical case. RESULTS Stent strut indentation was associated with vessel wall injury in histology. Furthermore, indentation was positively correlated with neointimal thickness, both in the per-strut analysis (r = 0.5579) and in the per-section analysis (r = 0.8620; both p ≤ 0.001). In a clinical case, indentation quantification in OCT was feasible, enabling assessment of injury in vivo. CONCLUSION Assessing stent strut indentation enables periprocedural assessment of stent-induced damage in vivo and therefore allows for optimization of stent implantation. The assessment of stent strut indentation might become a valuable tool in clinical practice.
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Affiliation(s)
- Anne Cornelissen
- University Hospital Aachen, Department of Cardiology, Angiology, and Internal Intensive Medicine, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Roberta Andreea Florescu
- University Hospital Aachen, Department of Cardiology, Angiology, and Internal Intensive Medicine, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Stefanie Reese
- RWTH Aachen University, Institute of Applied Mechanics, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany
| | - Marek Behr
- Chair for Computational Analysis of Technical Systems (CATS), Center for Simulation and Data Science (JARA-CSD), RWTH Aachen University, 52056 Aachen, Germany
| | - Anna Ranno
- Chair for Computational Analysis of Technical Systems (CATS), Center for Simulation and Data Science (JARA-CSD), RWTH Aachen University, 52056 Aachen, Germany
| | - Kiran Manjunatha
- RWTH Aachen University, Institute of Applied Mechanics, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany
| | - Nicole Schaaps
- University Hospital Aachen, Department of Cardiology, Angiology, and Internal Intensive Medicine, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Christian Böhm
- Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical Engineering | Helmholtz Institute, RWTH Aachen University
| | - Elisa Anamaria Liehn
- University of Southern Denmark, Department of Molecular Medicine, Cardiovascular and Renal Research Unit, Campusvej 55, 5230 Odense, Denmark
| | - Liguo Zhao
- Loughborough University, School of Mechanical, Electrical and Manufacturing Engineering, Loughborough, Leicestershire LE11 3TU, United Kingdom
| | - Pakhwan Nilcham
- University Hospital Aachen, Department of Cardiology, Angiology, and Internal Intensive Medicine, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Andrea Milzi
- University Hospital Aachen, Department of Cardiology, Angiology, and Internal Intensive Medicine, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Jörg Schröder
- University Hospital Aachen, Department of Cardiology, Angiology, and Internal Intensive Medicine, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Felix Jan Vogt
- University Hospital Aachen, Department of Cardiology, Angiology, and Internal Intensive Medicine, Pauwelsstraße 30, 52074 Aachen, Germany
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Gierig M, Wriggers P, Marino M. Arterial tissues and their inflammatory response to collagen damage: A continuum in silico model coupling nonlinear mechanics, molecular pathways, and cell behavior. Comput Biol Med 2023; 158:106811. [PMID: 37011434 DOI: 10.1016/j.compbiomed.2023.106811] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/03/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Abstract
Damage in soft biological tissues causes an inflammatory reaction that initiates a chain of events to repair the tissue. This work presents a continuum model and its in silico implementation that describe the cascade of mechanisms leading to tissue healing, coupling mechanical as well as chemo-biological processes. The mechanics is described by means of a Lagrangian nonlinear continuum mechanics framework and follows the homogenized constrained mixtures theory. Plastic-like damage, growth and remodeling as well as homeostasis are taken into account. The chemo-biological pathways account for two molecular and four cellular species, and are activated by damage of collagen molecules in fibers. To consider proliferation, differentiation, diffusion and chemotaxis of species, diffusion-advection-reaction equations are employed. To the best of authors' knowledge, the proposed model combines for the first time such high number of chemo-mechano-biological mechanisms in a consistent continuum biomechanical framework. The resulting set of coupled differential equations describe balance of linear momentum, evolution of kinematic variables as well as mass balance equations. They are discretized in time according to a backward Euler finite difference scheme, and in space through a finite element Galerkin discretization. The features of the model are firstly demonstrated presenting the species dynamics and highlighting the influence of damage intensities on the growth outcome. In terms of a biaxial test, the chemo-mechano-biological coupling and the model's applicability to reproduce normal as well as pathological healing are shown. A last numerical example underlines the model's applicability to complex loading scenarios and inhomogeneous damage distributions. Concluding, the present work contributes towards comprehensive in silico models in biomechanics and mechanobiology.
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Affiliation(s)
- Meike Gierig
- Institute of Continuum Mechanics, Leibniz University of Hannover, An der Universität 1, 30823 Garbsen, Germany.
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University of Hannover, An der Universität 1, 30823 Garbsen, Germany
| | - Michele Marino
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy
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Deng Y, Wen Y, Yin J, Huang J, Zhang R, Zhang G, Qiu D. Corroded iron stent increases fibrin deposition and promotes endothelialization after stenting. Bioeng Transl Med 2023; 8:e10469. [PMID: 37206231 PMCID: PMC10189476 DOI: 10.1002/btm2.10469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/19/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Poststent restenosis is caused by insufficient endothelialization and is one of the most serious clinical complications of stenting. We observed a rapid endothelialization rate and increased fibrin deposition on the surfaces of the corroded iron stents. Thus, we hypothesized that corroded iron stents would promote endothelialization by increasing fibrin deposition on rough surfaces. To verify this hypothesis, we conducted an arteriovenous shunt experiment to analyze fibrin deposition in the corroded iron stents. We implanted a corroded iron stent in both the carotid and iliac artery bifurcations to elucidate the effects of fibrin deposition on endothelialization. Co-culture experiments were conducted under dynamic flow conditions to explore the relationship between fibrin deposition and rapid endothelialization. Our findings indicate that, from the generation of corrosion pits, the surface of the corroded iron stent was rough, and numerous fibrils were deposited in the corroded iron stent. Fibrin deposition in corroded iron stents facilitates endothelial cell adhesion and proliferation, which, in turn, promotes endothelialization after stenting. Our study is the first to elucidate the role of iron stent corrosion in endothelialization, pointing to a new direction for preventing clinical complications caused by insufficient endothelialization.
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Affiliation(s)
- Yalan Deng
- NHC Key Laboratory of Cancer Proteomics & Laboratory of Structural Biology, Xiangya HospitalCentral South UniversityChangshaHunanPeople's Republic of China
| | - Yanbin Wen
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanPeople's Republic of China
| | - Jun Yin
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanPeople's Republic of China
| | - Jiabing Huang
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiPeople's Republic of China
| | - Rongsen Zhang
- Department of Ultrasonography, Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Gui Zhang
- R&D Center, Lifetech Scientific (Shenzhen) Co LtdShenzhenPeople's Republic of China
| | - Dongxu Qiu
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanPeople's Republic of China
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Agrafiotis E, Mayer C, Grabenwöger M, Zimpfer D, Regitnig P, Mächler H, Holzapfel GA. Global and local stiffening of ex vivo-perfused stented human thoracic aortas: A mock circulation study. Acta Biomater 2023; 161:170-183. [PMID: 36849029 DOI: 10.1016/j.actbio.2023.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/25/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
The effects of thoracic endovascular repair (TEVAR) on the biomechanical properties of aortic tissue have not been adequately studied. Understanding these features is important for the management of endograft-triggered complications of a biomechanical nature. This study aims to examine how stent-graft implantation affects the elastomechanical behavior of the aorta. Non-pathological human thoracic aortas (n=10) were subjected to long-standing perfusion (8h) within a mock circulation loop under physiological conditions. To quantify compliance and its mismatch in the test periods without and with a stent, the aortic pressure and the proximal cyclic circumferential displacement were measured. After perfusion, biaxial tension tests (stress-stretch) were carried out to examine the stiffness profiles between non-stented and stented tissue, followed by a histological assessment. Experimental evidence shows: (i) a significant reduction in aortic distensibility after TEVAR, indicating aortic stiffening and compliance mismatch, (ii) a stiffer behavior of the stented samples compared to the non-stented samples with an earlier entry into the nonlinear part of the stress-stretch curve and (iii) strut-induced histological remodeling of the aortic wall. The biomechanical and histological comparison of the non-stented and stented aortas provides new insights into the interaction between the stent-graft and the aortic wall. The knowledge gained could refine the stent-graft design to minimize the stent-induced impacts on the aortic wall and the resulting complications. STATEMENT OF SIGNIFICANCE: Stent-related cardiovascular complications occur the moment the stent-graft expands on the human aortic wall. Clinicians base their diagnosis on the anatomical morphology of CT scans while neglecting the endograft-triggered biomechanical events that compromise aortic compliance and wall mechanotransduction. Experimental replication of endovascular repair in cadaver aortas within a mock circulation loop may have a catalytic effect on biomechanical and histological findings without an ethical barrier. Demonstrating interactions between the stent and the wall can help clinicians make a broader diagnosis such as ECG-triggered oversizing and stent-graft characteristics based on patient-specific anatomical location and age. In addition, the results can be used to optimize towards more aortophilic stent grafts.
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Affiliation(s)
| | - Christian Mayer
- Department of Cardiac Surgery, Medical University of Graz, Austria
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Graz, Austria
| | - Peter Regitnig
- Institute of Pathology, Medical University of Graz, Austria
| | - Heinrich Mächler
- Department of Cardiac Surgery, Medical University of Graz, Austria
| | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria; Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Left main bifurcation stenting: the impact of strut thickness on long-term outcomes. J Geriatr Cardiol 2021; 18:91-93. [PMID: 33747057 PMCID: PMC7940968 DOI: 10.11909/j.issn.1671-5411.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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