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Affiliation(s)
- Joost P G Sluijter
- From the Laboratory of Experimental Cardiology, Department of Cardiology (J.P.G.S., G.P.), UMC Utrecht Regenerative Medicine Center (J.P.G.S.), and Laboratory of Clinical Chemistry (G.P.), University Medical Center Utrecht, The Netherlands
| | - Gerard Pasterkamp
- From the Laboratory of Experimental Cardiology, Department of Cardiology (J.P.G.S., G.P.), UMC Utrecht Regenerative Medicine Center (J.P.G.S.), and Laboratory of Clinical Chemistry (G.P.), University Medical Center Utrecht, The Netherlands.
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van Ditzhuijzen NS, Kurata M, van den Heuvel M, Sorop O, van Duin RWB, Krabbendam-Peters I, Ligthart J, Witberg K, Murawska M, Bouma B, Villiger M, Garcia-Garcia HM, Serruys PW, Zijlstra F, van Soest G, Duncker DJ, Regar E, van Beusekom HMM. Neoatherosclerosis development following bioresorbable vascular scaffold implantation in diabetic and non-diabetic swine. PLoS One 2017; 12:e0183419. [PMID: 28898243 PMCID: PMC5595285 DOI: 10.1371/journal.pone.0183419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022] Open
Abstract
Background DM remains a risk factor for poor outcome after stent-implantation, but little is known if and how DM affects the vascular response to BVS. Aim The aim of our study was to examine coronary responses to bioresorbable vascular scaffolds (BVS) in swine with and without diabetes mellitus fed a ‘fast-food’ diet (FF-DM and FF-NDM, respectively) by sequential optical coherence tomography (OCT)-imaging and histology. Methods Fifteen male swine were evaluated. Eight received streptozotocin-injection to induce DM. After 9 months (M), 32 single BVS were implanted in epicardial arteries with a stent to artery (S/A)-ratio of 1.1:1 under quantitative coronary angiography (QCA) and OCT guidance. Lumen, scaffold, neointimal coverage and composition were assessed by QCA, OCT and near-infrared spectroscopy (NIRS) pre- and/or post-procedure, at 3M and 6M. Additionally, polarization-sensitive (PS)-OCT was performed in 7 swine at 6M. After sacrifice at 3M and 6M, histology and polymer degradation analysis were performed. Results Late lumen loss was high (~60%) within the first 3M after BVS-implantation (P<0.01 FF-DM vs. FF-NDM) and stabilized between 3M and 6M (<5% change in FF-DM, ~10% in FF-NDM; P>0.20). Neointimal coverage was highly heterogeneous in all swine (DM vs. NDM P>0.05), with focal lipid accumulation, irregular collagen distribution and neointimal calcification. Likewise, polymer mass loss was low (~2% at 3M, ~5% at 6M;P>0.20) and not associated with DM or inflammation. Conclusion Scaffold coverage showed signs of neo-atherosclerosis in all FF-DM and FF-NDM swine, scaffold polymer was preserved and the vascular response to BVS was not influenced by diabetes.
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Affiliation(s)
- Nienke S. van Ditzhuijzen
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mie Kurata
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mieke van den Heuvel
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard W. B. van Duin
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilona Krabbendam-Peters
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Magdalena Murawska
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Brett Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk-Jan Duncker
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
- Dept. of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Heleen M. M. van Beusekom
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
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Ruddy JM, Ikonomidis JS, Jones JA. Multidimensional Contribution of Matrix Metalloproteinases to Atherosclerotic Plaque Vulnerability: Multiple Mechanisms of Inhibition to Promote Stability. J Vasc Res 2016; 53:1-16. [PMID: 27327039 PMCID: PMC7196926 DOI: 10.1159/000446703] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/07/2016] [Indexed: 12/17/2022] Open
Abstract
The prevalence of atherosclerotic disease continues to increase, and despite significant reductions in major cardiovascular events with current medical interventions, an additional therapeutic window exists. Atherosclerotic plaque growth is a complex integration of cholesterol penetration, inflammatory cell infiltration, vascular smooth muscle cell (VSMC) migration, and neovascular invasion. A family of matrix-degrading proteases, the matrix metalloproteinases (MMPs), contributes to all phases of vascular remodeling. The contribution of specific MMPs to endothelial cell integrity and VSMC migration in atherosclerotic lesion initiation and progression has been confirmed by the increased expression of these proteases in plasma and plaque specimens. Endogenous blockade of MMPs by the tissue inhibitors of metalloproteinases (TIMPs) may attenuate proteolysis in some regions, but the progression of matrix degeneration suggests that MMPs predominate in atherosclerotic plaque, precipitating vulnerability. Plaque neovascularization also contributes to instability and, coupling the known role of MMPs in angiogenesis to that of atherosclerotic plaque growth, interest in targeting MMPs to facilitate plaque stabilization continues to accumulate. This article aims to review the contributions of MMPs and TIMPs to atherosclerotic plaque expansion, neovascularization, and rupture vulnerability with an interest in promoting targeted therapies to improve plaque stabilization and decrease the risk of major cardiovascular events.
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Affiliation(s)
- Jean Marie Ruddy
- Division of Vascular Surgery, Department of Surgery, Medical University of South Carolina, Charleston, S.C., USA
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Goyal SN, Bharti S, Krishnamurthy B, Agrawal Y, Ojha SK, Arya DS. Impact of metabolic syndrome on re-stenosis development: role of drug-eluting stents. Diab Vasc Dis Res 2012; 9:177-88. [PMID: 22219135 DOI: 10.1177/1479164111430336] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Metabolic syndrome (MetS) is defined as a cluster of numerous cardiovascular risk factors, which encompasses obesity, dyslipidaemia, insulin resistance and hypertension. Patients with MetS are more prone to developing cardiovascular events than other patients. To date, several approaches such as physical exercise, dietary control and invasive and non-invasive therapeutic interventions for dyslipidaemia, hypertension and insulin resistance have been used to manage MetS. However, there is a progressive elevation in the incidence of fatal and non-fatal cardiovascular events due to the increased prevalence of obesity and diabetes. Percutaneous coronary intervention has emerged over the last few years as an effective revascularisation strategy for those with coronary artery disease, in parallel with the development of effective anti-platelet medications and newer drug-eluting stents. In recent years, considerable research efforts have been undertaken to elucidate the pathophysiology of re-stenosis and develop strategies to prevent re-stenosis following percutaneous transluminal coronary angioplasty and stent implantation. Although the rate of stent re-stenosis and target-lesion revascularisation has been reduced, there is little information in the literature on the outcome of MetS in the pathophysiology of re-stenosis. In this review article, we summarise the recent development and progress on re-stenosis and the role of drug-eluting stents, particularly in MetS.
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Affiliation(s)
- S N Goyal
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Osherov AB, Gotha L, Cheema AN, Qiang B, Strauss BH. Proteins mediating collagen biosynthesis and accumulation in arterial repair: novel targets for anti-restenosis therapy. Cardiovasc Res 2011; 91:16-26. [PMID: 21245059 DOI: 10.1093/cvr/cvr012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Events contributing to restenosis after coronary interventions include platelet aggregation, inflammatory cell infiltration, growth factor release, and accumulation of smooth muscle cells (SMCs) and extracellular matrix (ECM). The ECM is composed of various collagen subtypes and proteoglycans and over time constitutes the major component of the mature restenotic plaque. The pathophysiology of collagen accumulation in the ECM during arterial restenosis is reviewed. Factors regulating collagen synthesis and degradation, including various cytokines and growth factors involved in the process, may be targets for therapies aimed at prevention of in-stent restenosis.
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Affiliation(s)
- Azriel B Osherov
- Schulich Heart Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room A-253, Toronto, Ontario, Canada M4N 3M5
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Dormán G, Cseh S, Hajdú I, Barna L, Kónya D, Kupai K, Kovács L, Ferdinandy P. Matrix metalloproteinase inhibitors: a critical appraisal of design principles and proposed therapeutic utility. Drugs 2010; 70:949-64. [PMID: 20481653 DOI: 10.2165/11318390-000000000-00000] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Matrix metalloproteinases (MMPs) play an important role in tissue remodelling associated with various physiological and pathological processes, such as morphogenesis, angiogenesis, tissue repair, arthritis, chronic heart failure, chronic obstructive pulmonary disease, chronic inflammation and cancer metastasis. As a result, MMPs are considered to be viable drug targets in the therapy of these diseases. Despite the high therapeutic potential of MMP inhibitors (MMPIs), all clinical trials have failed to date, except for doxycycline for periodontal disease. This can be attributed to (i) poor selectivity of the MMPIs, (ii) poor target validation for the targeted therapy and (iii) poorly defined predictive preclinical animal models for safety and efficacy. Lessons from previous failures, such as recent discoveries of oxidative/nitrosative activation and phosphorylation of MMPs, as well as novel non-matrix related intra- and extracellular targets of MMP, give new hope for MMPI development for both chronic and acute diseases. In this article we critically review the major structural determinants of the selectivity and the milestones of past design efforts of MMPIs where 2-/3-dimensional structure-based methods were intensively applied. We also analyse the in vitro screening and preclinical/clinical pharmacology approaches, with particular emphasis on drawing conclusions on how to overcome efficacy and safety problems through better target validation and design of preclinical studies.
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França LHG, Pereira AH. Atualização sobre endopróteses vasculares (stents): dos estudos experimentais à prática clínica. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000400010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Atualmente, o tratamento das doenças vasculares periféricas é uma das áreas da medicina de maior expansão. O número de intervenções vasculares aumenta e os resultados das novas técnicas endovasculares estão muito próximos aos das tradicionais cirurgias vasculares. Embora a angioplastia ofereça bons resultados em curto prazo, o implante de stents procura melhorar o sucesso do procedimento e estender o seu uso a um número maior de pacientes com doença vascular periférica. Entretanto, a sua utilização ainda é controversa. O implante de stents no sistema aorto-ilíaco tem bons resultados; porém, a sua indicação para as lesões femoro-poplíteas ainda é discutida. Além disso, o rápido desenvolvimento de stents e sua escolha para uso no sistema vascular periférico têm sido uma difícil tarefa para o cirurgião endovascular. Muitos fatores influenciam a escolha do stent, e um amplo conhecimento desse material é essencial. Tal escolha depende da avaliação pré-operatória, da localização e das características da lesão e também do uso do stent primário ou seletivo. Nesse trabalho, são realizadas revisão do histórico do desenvolvimento dos stents, desde os estudos experimentais até os ensaios clínicos e também discussão sobre a sua aplicação no tratamento das doenças vasculares periféricas.
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Cena J, Lalu MM, Rosenfelt C, Schulz R. Endothelial dependence of matrix metalloproteinase-mediated vascular hyporeactivity caused by lipopolysaccharide. Eur J Pharmacol 2007; 582:116-22. [PMID: 18242597 DOI: 10.1016/j.ejphar.2007.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 12/03/2007] [Accepted: 12/16/2007] [Indexed: 11/29/2022]
Abstract
Septic shock remains the leading cause of death in intensive care units in North America. Recent evidence implicates matrix metalloproteinases (MMP) in the pathogenesis of sepsis. MMP activity is upregulated in blood vessels exposed to bacterial lipopolysaccharide (LPS) or pro-inflammatory cytokines and contributes to vascular hyporeactivity to vasoconstrictors. The exact mechanism of MMP-mediated vascular hyporeactivity is unknown. We investigated the contribution of the endothelium in the MMP response to LPS-mediated vascular hyporeactivity in vitro. Tone induced by phenylephrine in isolated rat aortic rings with either intact or denuded endothelium was measured in the presence of LPS for 6 h. These rings were incubated with the nitric oxide (NO) synthase inhibitor, N(G)-nitro-l-arginine methyl ester (l-NAME), to determine whether NO synthase was involved in the response, or the MMP inhibitors, doxycycline or GM6001. MMP activity was measured after 6 h. LPS caused a greater reduction of phenylephrine-induced tone in endothelium-intact rings versus endothelium-denuded rings, indicating both endothelium-independent and -dependent mechanisms for LPS-induced vascular hyporeactivity. l-NAME abolished the response to LPS in both endothelium-intact and endothelium-denuded rings. MMP inhibitors prevented the LPS-induced loss of tone in endothelium-intact but not endothelium-denuded rings. LPS caused significantly greater MMP-2 activity in endothelium-intact aortae which was attenuated by doxycycline. MMP-2 activity in endothelium-denuded aortae was unchanged by LPS. The vascular endothelium contributes to MMP-mediated vascular dysfunction induced by LPS. The protective effect of MMP inhibition is endothelium-dependent and is a novel mechanism by which MMPs contribute to vascular dysfunction.
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Affiliation(s)
- Jonathan Cena
- Department of Pharmacology, Cardiovascular Research Group, University of Alberta, Edmonton, Alberta, Canada
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