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Beslika E, Leite-Moreira A, De Windt LJ, da Costa Martins PA. Large animal models of pressure overload-induced cardiac left ventricular hypertrophy to study remodelling of the human heart with aortic stenosis. Cardiovasc Res 2024; 120:461-475. [PMID: 38428029 PMCID: PMC11060489 DOI: 10.1093/cvr/cvae045] [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: 04/13/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 03/03/2024] Open
Abstract
Pathologic cardiac hypertrophy is a common consequence of many cardiovascular diseases, including aortic stenosis (AS). AS is known to increase the pressure load of the left ventricle, causing a compensative response of the cardiac muscle, which progressively will lead to dilation and heart failure. At a cellular level, this corresponds to a considerable increase in the size of cardiomyocytes, known as cardiomyocyte hypertrophy, while their proliferation capacity is attenuated upon the first developmental stages. Cardiomyocytes, in order to cope with the increased workload (overload), suffer alterations in their morphology, nuclear content, energy metabolism, intracellular homeostatic mechanisms, contractile activity, and cell death mechanisms. Moreover, modifications in the cardiomyocyte niche, involving inflammation, immune infiltration, fibrosis, and angiogenesis, contribute to the subsequent events of a pathologic hypertrophic response. Considering the emerging need for a better understanding of the condition and treatment improvement, as the only available treatment option of AS consists of surgical interventions at a late stage of the disease, when the cardiac muscle state is irreversible, large animal models have been developed to mimic the human condition, to the greatest extend. Smaller animal models lack physiological, cellular and molecular mechanisms that sufficiently resemblance humans and in vitro techniques yet fail to provide adequate complexity. Animals, such as the ferret (Mustello purtorius furo), lapine (rabbit, Oryctolagus cunigulus), feline (cat, Felis catus), canine (dog, Canis lupus familiaris), ovine (sheep, Ovis aries), and porcine (pig, Sus scrofa), have contributed to research by elucidating implicated cellular and molecular mechanisms of the condition. Essential discoveries of each model are reported and discussed briefly in this review. Results of large animal experimentation could further be interpreted aiming at prevention of the disease progress or, alternatively, at regression of the implicated pathologic mechanisms to a physiologic state. This review summarizes the important aspects of the pathophysiology of LV hypertrophy and the applied surgical large animal models that currently better mimic the condition.
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Affiliation(s)
- Evangelia Beslika
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Leon J De Windt
- CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6200 MD Maastricht, Netherlands
| | - Paula A da Costa Martins
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6200 MD Maastricht, Netherlands
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Hiebing AA, Pieper RG, Witzenburg CM. A Computational Model of Ventricular Dimensions and Hemodynamics in Growing Infants. J Biomech Eng 2023; 145:101007. [PMID: 37338264 DOI: 10.1115/1.4062779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Previous computer models have successfully predicted cardiac growth and remodeling in adults with pathologies. However, applying these models to infants is complicated by the fact that they also undergo normal, somatic cardiac growth and remodeling. Therefore, we designed a computational model to predict ventricular dimensions and hemodynamics in healthy, growing infants by modifying an adult canine left ventricular growth model. The heart chambers were modeled as time-varying elastances coupled to a circuit model of the circulation. Circulation parameters were allometrically scaled and adjusted for maturation to simulate birth through 3 yrs of age. Ventricular growth was driven by perturbations in myocyte strain. The model successfully matched clinical measurements of pressures, ventricular and atrial volumes, and ventricular thicknesses within two standard deviations of multiple infant studies. To test the model, we input 10th and 90th percentile infant weights. Predicted volumes and thicknesses decreased and increased within normal ranges and pressures were unchanged. When we simulated coarctation of the aorta, systemic blood pressure, left ventricular thickness, and left ventricular volume all increased, following trends in clinical data. Our model enables a greater understanding of somatic and pathological growth in infants with congenital heart defects. Its flexibility and computational efficiency when compared to models employing more complex geometries allow for rapid analysis of pathological mechanisms affecting cardiac growth and hemodynamics.
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Affiliation(s)
- Ashley A Hiebing
- Cardiovascular Biomechanics Laboratory, Department of Biomedical Engineering, University of Wisconsin-Madison, Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706-1609
| | - Riley G Pieper
- Cardiovascular Biomechanics Laboratory, Department of Biomedical Engineering, University of Wisconsin-Madison, Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706-1609
| | - Colleen M Witzenburg
- Cardiovascular Biomechanics Laboratory, Department of Biomedical Engineering, University of Wisconsin-Madison, Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706-1609
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Scott AK, Rafuse M, Neu CP. Mechanically induced alterations in chromatin architecture guide the balance between cell plasticity and mechanical memory. Front Cell Dev Biol 2023; 11:1084759. [PMID: 37143893 PMCID: PMC10151697 DOI: 10.3389/fcell.2023.1084759] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/07/2023] [Indexed: 05/06/2023] Open
Abstract
Phenotypic plasticity, or adaptability, of a cell determines its ability to survive and function within changing cellular environments. Changes in the mechanical environment, ranging from stiffness of the extracellular matrix (ECM) to physical stress such as tension, compression, and shear, are critical environmental cues that influence phenotypic plasticity and stability. Furthermore, an exposure to a prior mechanical signal has been demonstrated to play a fundamental role in modulating phenotypic changes that persist even after the mechanical stimulus is removed, creating stable mechanical memories. In this mini review, our objective is to highlight how the mechanical environment alters both phenotypic plasticity and stable memories through changes in chromatin architecture, mainly focusing on examples in cardiac tissue. We first explore how cell phenotypic plasticity is modulated in response to changes in the mechanical environment, and then connect the changes in phenotypic plasticity to changes in chromatin architecture that reflect short-term and long-term memories. Finally, we discuss how elucidating the mechanisms behind mechanically induced chromatin architecture that lead to cell adaptations and retention of stable mechanical memories could uncover treatment methods to prevent mal-adaptive permanent disease states.
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Affiliation(s)
- Adrienne K. Scott
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States
| | - Michael Rafuse
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States
| | - Corey P. Neu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, United States
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, United States
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Yoshida K, McCulloch AD, Omens JH, Holmes JW. Predictions of hypertrophy and its regression in response to pressure overload. Biomech Model Mechanobiol 2019; 19:1079-1089. [PMID: 31813071 DOI: 10.1007/s10237-019-01271-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022]
Abstract
Mechanics-based cardiac growth models can now predict changes in mass, chamber size, and wall thickness in response to perturbations such as pressure overload (PO), volume overload, and myocardial infarction with a single set of growth parameters. As these models move toward clinical applications, many of the most interesting applications involve predictions of whether or how a patient's heart will reverse its growth after an intervention. In the case of PO, significant regression in wall thickness is observed both experimentally and clinically following relief of overload, for example following replacement of a stenotic aortic valve. Therefore, the objective of this work was to evaluate the ability of a published cardiac growth model that captures forward growth in multiple situations to predict growth reversal following relief of PO. Using a finite element model of a beating canine heart coupled to a circuit model of the circulation, we quantitatively matched hemodynamic data from a canine study of aortic banding followed by unbanding. Surprisingly, although the growth model correctly predicted the time course of PO-induced hypertrophy, it predicted only limited growth reversal given the measured unbanding hemodynamics, contradicting experimental and clinical observations. We were able to resolve this discrepancy only by incorporating an evolving homeostatic setpoint for the governing growth equations. Furthermore, our analysis suggests that many strain- and stress-based growth laws using the traditional volumetric growth framework will have similar difficulties capturing regression following the relief of PO unless growth setpoints are allowed to evolve.
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Affiliation(s)
- Kyoko Yoshida
- Department of Biomedical Engineering, University of Virginia, Box 800759, Health System, Charlottesville, VA, 22903, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia, Box 800759, Health System, Charlottesville, VA, 22903, USA. .,Department of Medicine, University of Virginia, Charlottesville, VA, USA. .,Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA. .,The Center for Engineering in Medicine, University of Virginia, Box 800759, Health System, Charlottesville, VA, 22903, USA.
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Oglesby M, Escobedo D, Escobar GP, Fatemifar F, Sako EY, Bailey SR, Han HC, Feldman MD. Trabecular cutting: a novel surgical therapy to increase diastolic compliance. J Appl Physiol (1985) 2019; 127:457-463. [PMID: 31219774 DOI: 10.1152/japplphysiol.00087.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a common cause of hospital admission in patients over 65 yr old and has high mortality. HFpEF is characterized by left ventricular (LV) hypertrophy that reduces compliance. Current HFpEF therapies control symptoms, but no existing medications or therapies can sustainably increase LV compliance. LV trabeculae develop hypertrophy and fibrosis that contribute to reduced LV compliance. This study expands our previous results in ex vivo human hearts to show that severing LV trabeculae increases diastolic compliance in an ex vivo working rabbit heart model. Trabecular cutting was performed in ex vivo rabbit hearts set up in a working heart perfusion system perfused with oxygenated Krebs-Henseleit buffer. A hook was inserted in the LV to cut trabeculae. End-systolic and end-diastolic pressure-volume relationships during transient preload reduction were recorded using an admittance catheter in the following three groups: control (no cutting; n = 9), mild cutting (15 cuts; n = 5), and aggressive cutting (30 cuts; n = 5). In a second experiment, each heart served as its own control. Hemodynamic data were recorded before and after trabecular cutting (n = 10) or sham cutting (n = 5) within the same heart. In the first experiments, trabecular cutting did not affect systolic function (P > 0.05) but significantly increased overall diastolic compliance (P = 0.009). Greater compliance was seen as trabecular cutting increased (P = 0.002, r2 = 0.435). In the second experiment, significant increases in systolic function (P = 0.048) and diastolic compliance (P = 0.002) were seen after trabecular cutting compared with baseline. In conclusion, trabecular cutting significantly increases diastolic compliance without reducing systolic function.NEW & NOTEWORTHY We postulate that, in mammalian hearts, free-running trabeculae carneae exist to provide tensile support to the left ventricle and minimize diastolic wall stress. Because of hypertrophy and fibrosis of trabeculae in patients with left ventricular hypertrophy, this supportive role can become pathologic, worsening diastolic compliance. We demonstrate a novel operation involving cutting trabeculae as a method to acutely increase diastolic compliance in patients presenting with heart failure and diastolic dysfunction to improve their left ventricle compliance.
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Affiliation(s)
- Meagan Oglesby
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Danny Escobedo
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Gladys Patricia Escobar
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Fatemeh Fatemifar
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Edward Y Sako
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Steven R Bailey
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Hai-Chao Han
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Marc D Feldman
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Al‐Shafei AIM, El‐Gendy OAA. Regular consumption of green tea improves pulse pressure and induces regression of left ventricular hypertrophy in hypertensive patients. Physiol Rep 2019; 7:e14030. [PMID: 30912296 PMCID: PMC6434072 DOI: 10.14814/phy2.14030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/14/2019] [Accepted: 02/17/2019] [Indexed: 12/21/2022] Open
Abstract
This study characterized the effects of regular green tea (GT) and hot water (HW) ingestion on systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and left ventricular hypertrophy (LVH) in two equal, sex- and age-matched groups; Grp1 and Grp2 (n = 100 each; age 53 ± 4 years) of hypertensive patients. Grp1 had regular GT treatment, followed by HW ingestion, whereas Grp2 had HW ingestion followed by GT treatment for periods of 4 months each. Electrocardiographic (ECG) and echocardiographic assessments of LVH were made before and at the end of both periods. SBP was lowered significantly by 6.6%; DBP by 5.1%, and PP by 9.1% by the end of month 4 of GT treatment in Grp1. Upon GT cessation and HW ingestion, SBP, DBP, and PP returned to pretreatment levels over 4 months. In Grp2, SBP, DBP, and PP were reduced insignificantly by 1.5%, 1.0%, and 2.3% by the end of the 4th month of HW ingestion. Conversely, over 4 months of GT treatment, SBP, DBP, and PP were significantly lowered by 5.4%, 4.1%, and 7.7% from the baseline values, respectively. ECG and echocardiographic evidence of LVH was shown in 20% of Grp1 and 24% of Grp2 patients before intervention. This was significantly lowered to 8% and 10% in Grp1 and Grp2 by GT treatment. However, this increased to 16% following HW ingestion in Grp1. HW ingestion did mot induce regression of LVH in Grp2. Thus, regular GT ingestion has cardiovascular protective effects.
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Affiliation(s)
- Ahmad I. M. Al‐Shafei
- Istanbul Medipol UniversityIstanbulTurkey
- Bahrain UniversitySouthern GovernorateBahrain
- Qassim UniversityQassimSaudi Arabia
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Ronzhina M, Olejnickova V, Stracina T, Novakova M, Janousek O, Hejc J, Kolarova J, Hlavacova M, Paulova H. Effect of increased left ventricle mass on ischemia assessment in electrocardiographic signals: rabbit isolated heart study. BMC Cardiovasc Disord 2017; 17:216. [PMID: 28778146 PMCID: PMC5544990 DOI: 10.1186/s12872-017-0652-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/28/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Detailed quantitative analysis of the effect of left ventricle (LV) hypertrophy on myocardial ischemia manifestation in ECG is still missing. The associations between both phenomena can be studied in animal models. In this study, rabbit isolated hearts with spontaneously increased LV mass were used to evaluate the effect of such LV alteration on ischemia detection criteria and performance. METHODS Electrophysiological effects of increased LV mass were evaluated on sixteen New Zealand rabbit isolated hearts under non-ischemic and ischemic conditions by analysis of various electrogram (EG) parameters. To reveal hearts with increased LV mass, LV weight/heart weight ratio was proposed. Standard paired and unpaired statistical tests and receiver operating characteristics analysis were used to compare data derived from different groups of animals, monitor EG parameters during global ischemia and evaluate their ability to discriminate between unchanged and increased LV as well as non-ischemic and ischemic state. RESULTS Successful evaluation of both increased LV mass and ischemia is lead-dependent. Particularly, maximal deviation of QRS and area under QRS associated with anterolateral heart wall respond significantly to even early phase (the 1st-3rd min) of ischemia. Besides ischemia, these parameters reflect increased LV mass as well (with sensitivity reaching approx. 80%). However, the sensitivity of the parameters to both phenomena may lead to misinterpretations, when inappropriate criteria for ischemia detection are selected. Particularly, use of cut-off-based criteria defined from control group for ischemia detection in hearts with increased LV mass may result in dramatic reduction (approx. 15%) of detection specificity due to increased number of false positives. Nevertheless, criteria adjusted to particular experimental group allow achieving ischemia detection sensitivity of 89-100% and specificity of 94-100%, respectively. CONCLUSIONS It was shown that response of the heart to myocardial ischemia can be successfully evaluated only when taking into account heart-related factors (such as LV mass) and other methodological aspects (such as recording electrodes position, selected EG parameters, cut-off criteria, etc.). Results of this study might be helpful for developing new clinical diagnostic strategies in order to improve myocardial ischemia detection in patients with LV hypertrophy.
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Affiliation(s)
- Marina Ronzhina
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Technická 12, 616 00 Brno, Czech Republic
| | - Veronika Olejnickova
- Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University in Prague, U Nemocnice 3, 128 00 Prague, Czech Republic
- Institute of Physiology, Czech Academy of Sciences, Vídeňská 1083, 142 20 Praque, Czech Republic
| | - Tibor Stracina
- Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Marie Novakova
- Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Pekářská 53, 656 91 Brno, Czech Republic
| | - Oto Janousek
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Technická 12, 616 00 Brno, Czech Republic
| | - Jakub Hejc
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Technická 12, 616 00 Brno, Czech Republic
| | - Jana Kolarova
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Technická 12, 616 00 Brno, Czech Republic
| | - Miroslava Hlavacova
- Department of Biochemistry, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Hana Paulova
- Department of Biochemistry, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
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Archer CR, Robinson EL, Drawnel FM, Roderick HL. Endothelin-1 promotes hypertrophic remodelling of cardiac myocytes by activating sustained signalling and transcription downstream of endothelin type A receptors. Cell Signal 2017; 36:240-254. [PMID: 28412414 PMCID: PMC5486433 DOI: 10.1016/j.cellsig.2017.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/21/2017] [Accepted: 04/12/2017] [Indexed: 02/07/2023]
Abstract
G-protein coupled receptor (GPCR) mediated activation of the MAPK signalling cascade is a key pathway in the induction of hypertrophic remodelling of the heart – a response to pathological cues including hypertension and myocardial infarction. While levels of pro-hypertrophic hormone agonists of GPCRs increase during periods of greater workload to enhance cardiac output, hypertrophy does not necessarily result. Here we investigated the relationship between the duration of exposure to the pro-hypertrophic GPCR agonist endothelin-1 (ET-1) and the induction of hypertrophic remodelling in neonatal rat ventricular myocytes (NRVM) and in the adult rat heart in vivo. Notably, a 15 min pulse of ET-1 was sufficient to induce markers of hypertrophy that were present when measured at 24 h in vivo and 48 h in vitro. The persistence of ET-1 action was insensitive to ET type A receptor (ETA receptor) antagonism with BQ123. The extended effects of ET-1 were dependent upon sustained MAPK signalling and involved persistent transcription. Inhibitors of endocytosis however conferred sensitivity upon the hypertrophic response to BQ123, suggesting that endocytosis of ETA receptors following ligand binding preserves their active state by protection against antagonist. Contrastingly, α1 adrenergic-induced hypertrophic responses required the continued presence of agonist and were sensitive to antagonist. These studies shed new light on strategies to pharmacologically intervene in the action of different pro-hypertrophic mediators. Acute ET-1 exposure elicits a long-lasting cardiac myocyte hypertrophic response. ET-1 effects depend on persistent MAPK signalling and active transcription. ET-1 elicited hypertrophy is insensitive to subsequent ETA receptor antagonism. Endocytosis inhibition potentiates ET-1-induction of hypertrophy markers. Endocytosis inhibition sensitises effects of ET-1 to ETA receptor antagonist.
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Affiliation(s)
| | - Emma L Robinson
- Laboratory of Experimental Cardiology, Dept. of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium
| | - Faye M Drawnel
- The Babraham Institute, Babraham, Cambridge, CB22 3AT, UK
| | - H Llewelyn Roderick
- Laboratory of Experimental Cardiology, Dept. of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
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