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Seppelt C, Abdelwahed YS, Meteva D, Nelles G, Stähli BE, Erbay A, Kränkel N, Sieronski L, Skurk C, Haghikia A, Sinning D, Dreger H, Knebel F, Trippel TD, Krisper M, Gerhardt T, Rai H, Klotsche J, Joner M, Landmesser U, Leistner DM. Coronary microevaginations characterize culprit plaques and their inflammatory microenvironment in a subtype of acute coronary syndrome with intact fibrous cap: results from the prospective translational OPTICO-ACS study. Eur Heart J Cardiovasc Imaging 2024; 25:175-184. [PMID: 37395586 DOI: 10.1093/ehjci/jead154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023] Open
Abstract
AIMS Coronary microevaginations (CMEs) represent an outward bulge of coronary plaques and have been introduced as a sign of adverse vascular remodelling following coronary device implantation. However, their role in atherosclerosis and plaque destabilization in the absence of coronary intervention is unknown. This study aimed to investigate CME as a novel feature of plaque vulnerability and to characterize its associated inflammatory cell-vessel-wall interactions. METHODS AND RESULTS A total of 557 patients from the translational OPTICO-ACS study programme underwent optical coherence tomography imaging of the culprit vessel and simultaneous immunophenotyping of the culprit lesion (CL). Two hundred and fifty-eight CLs had a ruptured fibrous cap (RFC) and one hundred had intact fibrous cap (IFC) acute coronary syndrome (ACS) as an underlying pathophysiology. CMEs were significantly more frequent in CL when compared with non-CL (25 vs. 4%, P < 0.001) and were more frequently observed in lesions with IFC-ACS when compared with RFC-ACS (55.0 vs. 12.7%, P < 0.001). CMEs were particularly prevalent in IFC-ACS-causing CLs independent of a coronary bifurcation (IFC-ICB) when compared with IFC-ACS with an association to a coronary bifurcation (IFC-ACB, 65.4 vs. 43.7%, P = 0.030). CME emerged as the strongest independent predictor of IFC-ICB (relative risk 3.36, 95% confidence interval 1.67-6.76, P = 0.001) by multivariable regression analysis. IFC-ICB demonstrated an enrichment of monocytes in both culprit blood analysis (culprit ratio: 1.1 ± 0.2 vs. 0.9 ± 0.2, P = 0.048) and aspirated culprit thrombi (326 ± 162 vs. 96 ± 87 cells/mm2, P = 0.017), while IFC-ACB confirmed the accumulation of CD4+ T cells, as recently described. CONCLUSION This study provides novel evidence for a pathophysiological involvement of CME in the development of IFC-ACS and provides first evidence for a distinct pathophysiological pathway for IFC-ICB, driven by CME-derived flow disturbances and inflammatory activation involving the innate immune system. TRIAL REGISTRATION Registration of the study at clinicalTrials.gov (NCT03129503).
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Affiliation(s)
- Claudio Seppelt
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Youssef S Abdelwahed
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Denitsa Meteva
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Gregor Nelles
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
| | - Aslihan Erbay
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Nicolle Kränkel
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Lara Sieronski
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Arash Haghikia
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
| | - David Sinning
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Department of Cardiology Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Knebel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Department of Cardiology Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Tobias D Trippel
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin 13353, Germany
| | - Maximilian Krisper
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin 13353, Germany
| | - Teresa Gerhardt
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
| | - Himanshu Rai
- Department of Cardiology and ISAR Research Centre, German Heart Centre, Technical University Munich, Munich 80636, Germany
- Cardiovascular Research Institute Dublin, Imaging Core Lab, Mater Private Network, Dublin D07 YH66, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, and Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Charité Mitte, Berlin 10117, Germany
| | - Michael Joner
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Department of Cardiology and ISAR Research Centre, German Heart Centre, Technical University Munich, Munich 80636, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
| | - David M Leistner
- Department of Cardiology, University Heart Centre Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin (CBF), Berlin 12203, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10117 Berlin, Germany
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2
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Enrick M, Jamaiyar A, Ohanyan V, Juguilon C, Kolz C, Shi X, Janota D, Wan W, Richardson D, Stevanov K, Hakobyan T, Shockling L, Diaz A, Usip S, Dong F, Zhang P, Chilian WM, Yin L. The Roles of Bone Marrow-Derived Stem Cells in Coronary Collateral Growth Induced by Repetitive Ischemia. Cells 2023; 12:242. [PMID: 36672176 PMCID: PMC9856468 DOI: 10.3390/cells12020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Many clinical trials have attempted to use stem cells to treat ischemic heart diseases (IHD), but the benefits have been modest. Though coronary collaterals can be a "natural bypass" for IHD patients, the regulation of coronary collateral growth (CCG) and the role of endogenous stem cells in CCG are not fully understood. In this study, we used a bone marrow transplantation scheme to study the role of bone marrow stem cells (BMSCs) in a rat model of CCG. Transgenic GFP rats were used to trace BMSCs after transplantation; GFP bone marrow was harvested or sorted for bone marrow transplantation. After recovering from transplantation, the recipient rats underwent 10 days of repetitive ischemia (RI), with echocardiography before and after RI, to measure cardiac function and myocardial blood flow. At the end of RI, the rats were sacrificed for the collection of bone marrow for flow cytometry or heart tissue for imaging analysis. Our study shows that upon RI stimulation, BMSCs homed to the recipient rat hearts' collateral-dependent zone (CZ), proliferated, differentiated into endothelial cells, and engrafted in the vascular wall for collateral growth. These RI-induced collaterals improved coronary blood flow and cardiac function in the recipients' hearts during ischemia. Depletion of donor CD34+ BMSCs led to impaired CCG in the recipient rats, indicating that this cell population is essential to the process. Overall, these results show that BMSCs contribute to CCG and suggest that regulation of the function of BMSCs to promote CCG might be a potential therapeutic approach for IHD.
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Affiliation(s)
- Molly Enrick
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Anurag Jamaiyar
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Vahagn Ohanyan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Cody Juguilon
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Christopher Kolz
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Xin Shi
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Danielle Janota
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Weiguo Wan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Devan Richardson
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Kelly Stevanov
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Tatevik Hakobyan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Lindsay Shockling
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Arianna Diaz
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Sharon Usip
- Department of Anatomy and Neuroscience, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Feng Dong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Ping Zhang
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - William M. Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Liya Yin
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
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Singh MV, Dokun AO. Diabetes mellitus in peripheral artery disease: Beyond a risk factor. Front Cardiovasc Med 2023; 10:1148040. [PMID: 37139134 PMCID: PMC10149861 DOI: 10.3389/fcvm.2023.1148040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
Peripheral artery disease (PAD) is one of the major cardiovascular diseases that afflicts a large population worldwide. PAD results from occlusion of the peripheral arteries of the lower extremities. Although diabetes is a major risk factor for developing PAD, coexistence of PAD and diabetes poses significantly greater risk of developing critical limb threatening ischemia (CLTI) with poor prognosis for limb amputation and high mortality. Despite the prevalence of PAD, there are no effective therapeutic interventions as the molecular mechanism of how diabetes worsens PAD is not understood. With increasing cases of diabetes worldwide, the risk of complications in PAD have greatly increased. PAD and diabetes affect a complex web of multiple cellular, biochemical and molecular pathways. Therefore, it is important to understand the molecular components that can be targeted for therapeutic purposes. In this review, we describe some major developments in enhancing the understanding of the interactions of PAD and diabetes. We also provide results from our laboratory in this context.
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Affiliation(s)
- Madhu V. Singh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Ayotunde O. Dokun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Fraternal Order of Eagles Diabetes Research Centre, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Correspondence: Ayotunde O. Dokun
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Rocker AJ, Cavasin M, Johnson NR, Shandas R, Park D. Sulfonated Thermoresponsive Injectable Gel for Sequential Release of Therapeutic Proteins to Protect Cardiac Function after Myocardial Infarction. ACS Biomater Sci Eng 2022; 8:3883-3898. [PMID: 35950643 DOI: 10.1021/acsbiomaterials.2c00616] [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: 11/30/2022]
Abstract
Myocardial infarction causes cardiomyocyte death and persistent inflammatory responses, which generate adverse pathological remodeling. Delivering therapeutic proteins from injectable materials in a controlled-release manner may present an effective biomedical approach for treating this disease. A thermoresponsive injectable gel composed of chitosan, conjugated with poly(N-isopropylacrylamide) and sulfonate groups, was developed for spatiotemporal protein delivery to protect cardiac function after myocardial infarction. The thermoresponsive gel delivered vascular endothelial growth factor (VEGF), interleukin-10 (IL-10), and platelet-derived growth factor (PDGF) in a sequential and sustained manner in vitro. An acute myocardial infarction mouse model was used to evaluate polymer biocompatibility and to determine therapeutic effects from the delivery system on cardiac function. Immunohistochemistry showed biocompatibility of the hydrogel, while the controlled delivery of the proteins reduced macrophage infiltration and increased vascularization. Echocardiography showed an improvement in ejection fraction and fractional shortening after injecting the thermal gel and proteins. A factorial design of experimental study was implemented to optimize the delivery system for the best combination and doses of proteins for further increasing stable vascularization and reducing inflammation using a subcutaneous injection mouse model. The results showed that VEGF, IL-10, and FGF-2 demonstrated significant contributions toward promoting long-term vascularization, while PDGF's effect was minimal.
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Affiliation(s)
- Adam J Rocker
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Maria Cavasin
- Department of Medicine, Division of Cardiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Noah R Johnson
- Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Robin Shandas
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado 80045, United States
| | - Daewon Park
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado 80045, United States
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Kaloss AM, Theus MH. Leptomeningeal anastomoses: Mechanisms of pial collateral remodeling in ischemic stroke. WIREs Mech Dis 2022; 14:e1553. [PMID: 35118835 PMCID: PMC9283306 DOI: 10.1002/wsbm.1553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/13/2022]
Abstract
Arterial collateralization, as determined by leptomeningeal anastomoses or pial collateral vessels, is a well‐established vital player in cerebral blood flow restoration and neurological recovery from ischemic stroke. A secondary network of cerebral collateral circulation apart from the Circle of Willis, exist as remnants of arteriole development that connect the distal arteries in the pia mater. Recent interest lies in understanding the cellular and molecular adaptations that control the growth and remodeling, or arteriogenesis, of these pre‐existing collateral vessels. New findings from both animal models and human studies of ischemic stroke suggest a multi‐factorial and complex, temporospatial interplay of endothelium, immune and vessel‐associated cell interactions may work in concert to facilitate or thwart arteriogenesis. These valuable reports may provide critical insight into potential predictors of the pial collateral response in patients with large vessel occlusion and may aid in therapeutics to enhance collateral function and improve recovery from stroke. This article is categorized under:Neurological Diseases > Molecular and Cellular Physiology
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Affiliation(s)
- Alexandra M Kaloss
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Michelle H Theus
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA.,School of Neuroscience, Virginia Tech, Blacksburg, Virginia, USA.,Center for Regenerative Medicine, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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6
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The essential role for endothelial cell sprouting in coronary collateral growth. J Mol Cell Cardiol 2022; 165:158-171. [PMID: 35074317 PMCID: PMC8940680 DOI: 10.1016/j.yjmcc.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 12/11/2022]
Abstract
RATIONALE Coronary collateral growth is a natural bypass for ischemic heart diseases. It offers tremendous therapeutic benefit, but the process of coronary collateral growth isincompletely understood due to limited preclinical murine models that would enable interrogation of its mechanisms and processes via genetic modification and lineage tracing. Understanding the processes by which coronary collaterals develop can unlock new therapeutic strategies for ischemic heart disease. OBJECTIVE To develop a murine model of coronary collateral growth by repetitive ischemia and investigate whether capillary endothelial cells could contribute to the coronary collateral formation in an adult mouse heart after repetitive ischemia by lineage tracing. METHODS AND RESULTS A murine model of coronary collateral growth was developed using short episodes of repetitive ischemia. Repetitive ischemia stimulation resulted in robust collateral growth in adult mouse hearts, validated by high-resolution micro-computed tomography. Repetitive ischemia-induced collateral formation compensated ischemia caused by occlusion of the left anterior descending artery. Cardiac function improved during ischemia after repetitive ischemia, suggesting the improvement of coronary blood flow. A capillary-specific Cre driver (Apln-CreER) was used for lineage tracing capillary endothelial cells. ROSA mT/mG reporter mice crossed with the Apln-CreER transgene mice underwent a 17 days' repetitive ischemia protocol for coronary collateral growth. Two-photon and confocal microscopy imaging of heart slices revealed repetitive ischemia-induced coronary collateral growth initiated from sprouting Apelin+ endothelial cells. Newly formed capillaries in the collateral-dependent zone expanded in diameter upon repetitive ischemia stimulation and arterialized with smooth muscle cell recruitment, forming mature coronary arteries. Notably, pre-existing coronary arteries and arterioles were not Apelin+, and all Apelin+ collaterals arose from sprouting capillaries. Cxcr4, Vegfr2, Jag1, Mcp1, and Hif1⍺ mRNA levels in the repetitive ischemia-induced hearts were also upregulated at the early stage of coronary collateral growth, suggesting angiogenic signaling pathways are activated for coronary collaterals formation during repetitive ischemia. CONCLUSIONS We developed a murine model of coronary collateral growth induced by repetitive ischemia. Our lineage tracing study shows that sprouting endothelial cells contribute to coronary collateral growth in adult mouse hearts. For the first time, sprouting angiogenesis is shown to give rise to mature coronary arteries in response to repetitive ischemia in the adult mouse hearts.
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Chowdhury K, Lai SL, Marín-Juez R. Modulation of VEGFA Signaling During Heart Regeneration in Zebrafish. Methods Mol Biol 2022; 2475:297-312. [PMID: 35451767 DOI: 10.1007/978-1-0716-2217-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Over the last decades, myocardial infarction and heart failure have accounted every year for millions of deaths worldwide. After a coronary occlusion, the lack of blood supply to downstream muscle leads to cell death and scarring. To date, several pro-angiogenic factors have been tested to stimulate reperfusion of the affected myocardium, VEGFA being one of the most extensively studied. Given the unsuccessful outcomes of clinical trials, understanding how cardiac revascularization takes place in models with endogenous regenerative capacity holds the key to devising more efficient therapies. Here, we summarize the main findings on VEGFA's role during cardiac repair and regeneration, with a particular focus on zebrafish as a regenerative model. Moreover, we provide a comprehensive overview of available tools to modulate Vegfa expression and action in zebrafish regeneration studies. Understanding the role of Vegfa during zebrafish heart regeneration may help devise efficient therapies and circumvent current limitations in using VEGFA for therapeutic angiogenesis approaches.
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Affiliation(s)
- Kaushik Chowdhury
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Taiwan International Graduate Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, Taiwan
| | - Shih-Lei Lai
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Taiwan International Graduate Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, Taiwan
| | - Rubén Marín-Juez
- Centre Hospitalier Universitaire Sainte-Justine Research Centre, Montreal, QC, Canada.
- Department of Pathology and Cell Biology, University of Montreal, Montreal, QC, Canada.
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8
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Hemodynamics in acute stroke: Cerebral and cardiac complications. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:295-317. [PMID: 33632449 DOI: 10.1016/b978-0-12-819814-8.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hemodynamics is the study of blood flow, where parameters have been defined to quantify blood flow and the relationship with systemic circulatory changes. Understanding these perfusion parameters, the relationship between different blood flow variables and the implications for ischemic injury are outlined in the ensuing discussion. This chapter focuses on the hemodynamic changes that occur in ischemic stroke, and their contribution to ischemic stroke pathophysiology. We discuss the interaction between cardiovascular response and hemodynamic changes in stroke. Studying hemodynamic changes has a key role in stroke prevention, therapeutic implications and prognostic importance in acute ischemic stroke: preexisting hemodynamic and autoregulatory impairments predict the occurrence of stroke. Hemodynamic failure predisposes to the formation of thromboemboli and accelerates infarction due to impairing compensatory mechanisms. In ischemic stroke involving occlusion of a large vessel, persistent collateral circulation leads to preservation of ischemic penumbra and therefore justifying endovascular thrombectomy. Following thrombectomy, impaired autoregulation may lead to reperfusion injury and hemorrhage.
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Aghajanian A, Zhang H, Buckley BK, Wittchen ES, Ma WY, Faber JE. Decreased inspired oxygen stimulates de novo formation of coronary collaterals in adult heart. J Mol Cell Cardiol 2021; 150:1-11. [PMID: 33038388 PMCID: PMC7855913 DOI: 10.1016/j.yjmcc.2020.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/13/2020] [Accepted: 09/25/2020] [Indexed: 01/18/2023]
Abstract
RATIONALE Collateral vessels lessen myocardial ischemia when acute or chronic coronary obstruction occurs. It has long been assumed that although native (pre-existing) collaterals enlarge in obstructive disease, new collaterals do not form in the adult. However, the latter was recently shown to occur after coronary artery ligation. Understanding the signals that drive this process is challenged by the difficulty in studying collateral vessels directly and the complex milieu of signaling pathways, including cell death, induced by ligation. Herein we show that hypoxemia alone is capable of inducing collateral vessels to form and that the novel gene Rabep2 is required. OBJECTIVE Hypoxia stimulates angiogenesis during embryonic development and in pathological states. We hypothesized that hypoxia also stimulates collateral formation in adult heart by a process that involves RABEP2, a recently identified protein required for formation of collateral vessels during development. METHODS AND RESULTS Exposure of mice to reduced FiO2 induced collateral formation that resulted in smaller infarctions following LAD ligation and that reversed on return to normoxia. Deletion of Rabep2 or knockdown of Vegfa inhibited formation. Hypoxia upregulated Rabep2, Vegfa and Vegfr2 in heart and brain microvascular endothelial cells (HBMVECs). Knockdown of Rabep2 impaired migration of HBMVECs. In contrast to systemic hypoxia, deletion of Rabep2 did not affect collateral formation induced by ischemic injury caused by LAD ligation. CONCLUSIONS Hypoxia induced formation of coronary collaterals by a process that required VEGFA and RABEP2, proteins also required for collateral formation during development. Knockdown of Rabep2 impaired cell migration, providing one potential mechanism for RABEP2's role in collateral formation. This appears specific to hypoxia, since formation after acute ischemic injury was unaffected in Rabep2-/- mice. These findings provide a novel model for studying coronary collateral formation, and demonstrate that hypoxia alone can induce new collaterals to form in adult heart.
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Affiliation(s)
- Amir Aghajanian
- Department of Cell Biology and Physiology and the McAllister Heart Institute, University of North Carolina at Chapel Hill, United States of America
| | - Hua Zhang
- Department of Cell Biology and Physiology and the McAllister Heart Institute, University of North Carolina at Chapel Hill, United States of America
| | - Brian K Buckley
- Department of Cell Biology and Physiology and the McAllister Heart Institute, University of North Carolina at Chapel Hill, United States of America
| | - Erika S Wittchen
- Department of Cell Biology and Physiology and the McAllister Heart Institute, University of North Carolina at Chapel Hill, United States of America
| | - Willa Y Ma
- Department of Cell Biology and Physiology and the McAllister Heart Institute, University of North Carolina at Chapel Hill, United States of America
| | - James E Faber
- Department of Cell Biology and Physiology and the McAllister Heart Institute, University of North Carolina at Chapel Hill, United States of America.
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10
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Bigler MR, Stoller M, Tschannen C, Grossenbacher R, Seiler C. Effect of permanent right internal mammary artery occlusion on right coronary artery supply: A randomized placebo-controlled clinical trial. Am Heart J 2020; 230:1-12. [PMID: 32949505 DOI: 10.1016/j.ahj.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/07/2020] [Indexed: 01/09/2023]
Abstract
Natural, nonsurgical internal mammary artery (IMA) bypasses to the coronary circulation have been shown to function as extracardiac sources of myocardial blood supply. The goal of this randomized, placebo-controlled, double-blind trial was to test the efficacy of permanent right IMA (RIMA) device occlusion on right coronary artery (RCA) occlusive blood supply and on clinical and electrocardiographic (ECG) signs of myocardial ischemia. METHODS This was a prospective superiority trial in 100 patients with chronic coronary artery disease randomly allocated (1:1) to RIMA vascular device occlusion (verum group) or to RIMA sham procedure (placebo group). The primary study end point was RCA collateral flow index (CFI) as obtained during a 1-minute ostial RCA balloon occlusion at baseline before and at follow-up examination 6 weeks after the trial intervention. CFI is the ratio between simultaneous mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure. Simultaneously obtained secondary study end points were the registration of angina pectoris and quantitative intracoronary ECG ST-segment shift. RESULTS CFI change during the follow-up period was +0.036 ± 0.068 in the verum group and -0.021 ± 0.097 in the placebo group (P = .0011). Angina pectoris during the same RCA balloon occlusions had disappeared at follow-up in 14/49 patients of the verum group and in 4/49 patients of the placebo group (P = .0091). Simultaneous intracoronary ECG ST-segment shift change revealed diminished myocardial ischemia at follow-up in the verum group and more severe ischemia in the placebo group. CONCLUSIONS Permanent RIMA device occlusion augments RCA supply to the effect of diminishing clinical and electrocardiographic signs of myocardial ischemia during a brief controlled coronary occlusion.
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11
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Zhang H, Rzechorzek W, Aghajanian A, Faber JE. Hypoxia induces de novo formation of cerebral collaterals and lessens the severity of ischemic stroke. J Cereb Blood Flow Metab 2020; 40:1806-1822. [PMID: 32423327 PMCID: PMC7430105 DOI: 10.1177/0271678x20924107] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pial collaterals provide protection in stroke. Evidence suggests their formation late during gestation (collaterogenesis) is driven by reduced oxygen levels in the cerebral watersheds. The purpose of this study was to determine if collaterogenesis can be re-activated in the adult to induce formation of additional collaterals ("neo-collateral formation", NCF). Mice were gradually acclimated to reduced inspired oxygen (FIO2) and maintained at 12, 10, 8.5 or 7% for two-to-eight weeks. Hypoxemia induced "dose"-dependent NCF and remodeling of native collaterals, and decreased infarct volume after permanent MCA occlusion. In contrast, no formation occurred of addition collateral-like intra-tree anastomoses, PComs, or branches within the MCA tree. Hypoxic NCF, remodeling and infarct protection were durable, i.e. retained for at least six weeks after return to normoxia. Hypoxia increased expression of Hif2α, Vegfa, Rabep2, Angpt2, Tie2 and Cxcr4. Neo-collateral formation was abolished in mice lacking Rabep2, a novel gene involved in VEGFA→Flk1 signaling and required for formation of collaterals during development, and inhibited by knockdown of Vegfa, Flk1 and Cxcr4. Rabep2-dependent NCF was also induced by permanent MCA occlusion. This is the first report that hypoxia induces new pial collaterals to form. Hypoxia- and occlusion-induced neo-collateral formation provide models to study collaterogenesis in the adult.
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Affiliation(s)
- Hua Zhang
- Department of Cell Biology and Physiology, McAllister Heart Institute, Curriculum in Neurobiology, University of North Carolina at Chapel Hill, NC, USA
| | - Wojciech Rzechorzek
- Department of Cell Biology and Physiology, McAllister Heart Institute, Curriculum in Neurobiology, University of North Carolina at Chapel Hill, NC, USA
| | - Amir Aghajanian
- Department of Cell Biology and Physiology, McAllister Heart Institute, Curriculum in Neurobiology, University of North Carolina at Chapel Hill, NC, USA
| | - James E Faber
- Department of Cell Biology and Physiology, McAllister Heart Institute, Curriculum in Neurobiology, University of North Carolina at Chapel Hill, NC, USA
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12
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Gao Y, Aravind S, Patel NS, Fuglestad M, Ungar JS, Mietus CJ, Li S, Casale GP, Pipinos II, Carlson MA. Collateral Development and Arteriogenesis in Hindlimbs of Swine After Ligation of Arterial Inflow. J Surg Res 2020; 249:168-179. [PMID: 31986359 PMCID: PMC7218255 DOI: 10.1016/j.jss.2019.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/04/2019] [Accepted: 12/03/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Development of collateral vasculature is key in compensating for arterial occlusions in patients with peripheral artery disease (PAD). We aimed to examine the development of collateral pathways after ligation of native vessels in a porcine model of PAD. METHODS Right hindlimb ischemia was induced in domestic swine (n = 11) using two versions of arterial ligation. Version 1 (n = 6) consisted of ligation with division of the right external iliac, profunda femoral, and superficial femoral arteries. Version 2 (n = 5) consisted of the ligation of version 1 with additional ligation with division of the right internal iliac artery. Development of collateral pathways was evaluated with standard angiography before arterial ligation and at termination (30 days later). Relative luminal diameter of the arteries supplying the ischemic right hind limb were determined by two-dimensional angiography. RESULTS The dominant collateral pathway that developed after version 1 ligation connected the right internal iliac artery to the right profunda femoral and then to the right superficial femoral and popliteal artery. Mean luminal diameter of the right internal iliac artery at termination increased by 38% compared with baseline. Two codominant collateral pathways developed in version 2 ligation: (i) from the left profunda femoral artery to the reconstituted right profunda femoral artery and (ii) from the common internal iliac trunk and the left internal iliac artery to the reconstituted right internal iliac artery, which then supplied the right profunda femoral and then the right superficial femoral and popliteal artery. The mean diameter of the left profunda and the left internal iliac artery increased at termination by 26% and 21%, respectively (P < 0.05). CONCLUSIONS Two versions of hindlimb ischemia induction (right ilio-femoral artery ligation with and without right internal iliac artery ligation) in swine produced differing collateral pathways, along with changes to the diameter of the inflow vessels (i.e., arteriogenesis).
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Affiliation(s)
- Y Gao
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska,Department of Surgery and VA Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE
| | - S Aravind
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska,Department of Surgery and VA Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE
| | - NS Patel
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska,Department of Surgery and VA Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE
| | - M Fuglestad
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - JS Ungar
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - CJ Mietus
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - S Li
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - GP Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - II Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska,Department of Surgery and VA Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE,Corresponding authors: Iraklis I. Pipinos, MD (), Mark A. Carlson, MD (), Department of Surgery, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, Tel.: 402-559-9549 (IIP); 402-995-5371 (MAC), Fax: 402-559-6749
| | - MA Carlson
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska,Department of Surgery and VA Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE,Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska,Corresponding authors: Iraklis I. Pipinos, MD (), Mark A. Carlson, MD (), Department of Surgery, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, Tel.: 402-559-9549 (IIP); 402-995-5371 (MAC), Fax: 402-559-6749
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13
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de Waard GA, Hollander MR, Ruiter D, Ten Bokkel Huinink T, Meer R, van der Hoeven NW, Meinster E, Beliën JAM, Niessen HW, van Royen N. Downstream Influence of Coronary Stenoses on Microcirculatory Remodeling: A Histopathology Study. Arterioscler Thromb Vasc Biol 2019; 40:230-238. [PMID: 31665906 DOI: 10.1161/atvbaha.119.313462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Inducible myocardial ischemia is influenced by contributions of both the epicardial artery and the coronary microcirculation. Experimental studies have found adverse microcirculatory remodeling to occur downstream of severe coronary stenoses. Coronary physiology studies in patients contradict the experimental findings, as the minimal microvascular resistance is not modified by stenoses. The objective was to determine whether microcirculatory remodeling occurs downstream of coronary stenoses in the human coronary circulation. Approach and Results: Myocardium corresponding to 115 coronary arteries of 55 deceased patients was investigated. Histopathologic staining of the microcirculation was performed using antibodies against SMA-α (smooth muscle actin-α) and CD31, to stain arterioles and capillaries, respectively. The following parameters were analyzed: ratio between lumen and vesel area, ratio between lumen and vessel diameter (both ratios for arterioles of <40, 40-100, and 100-200 µm diameter), arteriolar density, and capillary density. From the 55 patients, 32 pairs of an unobstructed coronary artery and a coronary artery with a stenosis were formed. No statistically significant differences between any of the microcirculatory parameters were found. A confirmatory unpaired analysis compared 3 groups: (1) coronary arteries in patients without coronary artery disease (n=53), (2) unobstructed coronary arteries in patients with a stenosis in one of the other coronary arteries (n=23), and (3) coronary stenoses (n=39). No statistically significant differences were observed between the groups. CONCLUSIONS The microcirculation distal to noncritical stenoses does not undergo structural remodeling in the human coronary circulation.
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Affiliation(s)
- Guus A de Waard
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, The Netherlands (G.A.d.W., M.R.H., N.W.v.d.H., H.W.N.)
| | - Maurits R Hollander
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, The Netherlands (G.A.d.W., M.R.H., N.W.v.d.H., H.W.N.)
| | - Danique Ruiter
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas Ten Bokkel Huinink
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands
| | - Romain Meer
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands
| | - Nina W van der Hoeven
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, The Netherlands (G.A.d.W., M.R.H., N.W.v.d.H., H.W.N.)
| | - Elisa Meinster
- Department of Pathology and Cardiac Surgery (E.M., J.A.M.B., H.W.N.), VU University Medical Center, Amsterdam, The Netherlands
| | - Jeroen A M Beliën
- Department of Pathology and Cardiac Surgery (E.M., J.A.M.B., H.W.N.), VU University Medical Center, Amsterdam, The Netherlands
| | - Hans W Niessen
- Department of Pathology and Cardiac Surgery (E.M., J.A.M.B., H.W.N.), VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, The Netherlands (G.A.d.W., M.R.H., N.W.v.d.H., H.W.N.)
| | - Niels van Royen
- From the Department of Cardiology (G.A.d.W., M.R.H., D.R., T.t.B.H., R.M., N.W.v.d.H., N.v.R.), VU University Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
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14
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Al-Rifai R, Nguyen P, Bouland N, Terryn C, Kanagaratnam L, Poitevin G, François C, Boisson-Vidal C, Sevestre MA, Tournois C. In vivo efficacy of endothelial growth medium stimulated mesenchymal stem cells derived from patients with critical limb ischemia. J Transl Med 2019; 17:261. [PMID: 31399109 PMCID: PMC6688282 DOI: 10.1186/s12967-019-2003-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 07/27/2019] [Indexed: 12/24/2022] Open
Abstract
Background Cell therapy has been proposed for patients with critical limb ischemia (CLI). Autologous bone marrow derived cells (BMCs) have been mostly used, mesenchymal stem cells (MSCs) being an alternative. The aim of this study was to characterize two types of MSCs and evaluate their efficacy. Methods MSCs were obtained from CLI-patients BMCs. Stimulated- (S-) MSCs were cultured in endothelial growth medium. Cells were characterized by the expression of cell surface markers, the relative expression of 6 genes, the secretion of 10 cytokines and the ability to form vessel-like structures. The cell proangiogenic properties was analysed in vivo, in a hindlimb ischemia model. Perfusion of lower limbs and functional tests were assessed for 28 days after cell infusion. Muscle histological analysis (neoangiogenesis, arteriogenesis and muscle repair) was performed. Results S-MSCs can be obtained from CLI-patients BMCs. They do not express endothelial specific markers but can be distinguished from MSCs by their secretome. S-MSCs have the ability to form tube-like structures and, in vivo, to induce blood flow recovery. No amputation was observed in S-MSCs treated mice. Functional tests showed improvement in treated groups with a superiority of MSCs and S-MSCs. In muscles, CD31+ and αSMA+ labelling were the highest in S-MSCs treated mice. S-MSCs induced the highest muscle repair. Conclusions S-MSCs exert angiogenic potential probably mediated by a paracrine mechanism. Their administration is associated with flow recovery, limb salvage and muscle repair. The secretome from S-MSCs or secretome-derived products may have a strong potential in vessel regeneration and muscle repair. Trial registration NCT00533104 Electronic supplementary material The online version of this article (10.1186/s12967-019-2003-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rida Al-Rifai
- EA-3801, SFR CAP-santé, Université de Reims Champagne-Ardenne, 51092, Reims Cedex, France
| | - Philippe Nguyen
- EA-3801, SFR CAP-santé, Université de Reims Champagne-Ardenne, 51092, Reims Cedex, France.,Laboratoire d'Hématologie, CHU Robert Debré, Reims, France
| | - Nicole Bouland
- Laboratoire d'Anatomie Pathologique, Université de Reims Champagne-Ardenne, Reims, France
| | - Christine Terryn
- Plateforme PICT, Université de Reims Champagne Ardenne, Reims, France
| | | | - Gaël Poitevin
- EA-3801, SFR CAP-santé, Université de Reims Champagne-Ardenne, 51092, Reims Cedex, France
| | - Caroline François
- EA-3801, SFR CAP-santé, Université de Reims Champagne-Ardenne, 51092, Reims Cedex, France
| | - Catherine Boisson-Vidal
- Inserm UMR S1140, Faculté de Pharmacie de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Claire Tournois
- EA-3801, SFR CAP-santé, Université de Reims Champagne-Ardenne, 51092, Reims Cedex, France. .,Laboratoire d'Hématologie, CHU Robert Debré, Reims, France.
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15
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Allahwala UK, Brilakis ES, Byrne J, Davies JE, Ward MR, Weaver JC, Bhindi R. Applicability and Interpretation of Coronary Physiology in the Setting of a Chronic Total Occlusion. Circ Cardiovasc Interv 2019; 12:e007813. [PMID: 31272226 DOI: 10.1161/circinterventions.119.007813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Concurrent coronary artery disease in a vessel remote from a chronic total occlusion (CTO) is common and presents a management dilemma. While the use of adjunctive coronary physiology to guide revascularization is now commonplace in the catheterization laboratory, the presence of a CTO provides a unique and specific situation whereby the physiological assessment is more complex and relies on theoretical assumptions. Broadly, the physiological assessment of a CTO relies on assessing the function and regression of collaterals, the assessment of the microcirculation, the impact of collateral steal as well as assessing the severity of a lesion in the donor vessel (the vessel supplying the majority of collaterals to the CTO). Recent studies have shown that physiological assessment of the donor vessel in the setting of a CTO may overestimate the severity of stenosis, and that after revascularization of a CTO, the index of ischemia may increase, potentially altering the need for revascularization. In this review article, we present the current literature on physiological assessment of patients with a CTO, management recommendations and identify areas for ongoing research.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (U.K.A., M.R.W., R.B.).,Sydney Medical School, University of Sydney, NSW, Australia (U.K.A., R.B.)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (E.S.B.).,Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas (E.S.B.)
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, London, United Kingdom (J.B.)
| | - Justin E Davies
- Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom (J.E.D.)
| | - Michael R Ward
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (U.K.A., M.R.W., R.B.)
| | - James C Weaver
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (J.C.W.).,School of Medicine, University of New South Wales, Sydney, Australia (J.C.W.)
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (U.K.A., M.R.W., R.B.).,Sydney Medical School, University of Sydney, NSW, Australia (U.K.A., R.B.)
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16
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Ono K, Yanishi K, Ariyoshi M, Kaimoto S, Uchihashi M, Shoji K, Matoba S. First-in-Man Clinical Pilot Study Showing the Safety and Efficacy of Intramuscular Injection of Basic Fibroblast Growth Factor With Atelocollagen Solution for Critical Limb Ischemia. Circ J 2018; 83:217-223. [PMID: 30416190 DOI: 10.1253/circj.cj-18-0815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Therapeutic angiogenesis with basic fibroblast growth factor (bFGF) with atelocollagen was confirmed in a study using a limb ischemia mouse model. Because the number of elderly patients with critical limb ischemia (CLI) is increasing, particularly that caused by arteriosclerosis obliterans (ASO), the development of less invasive angiogenesis therapies desired. Methods and Results: This first-in-man clinical study was designed to assess the safety and efficacy of i.m. injection of bFGF with atelocollagen. Human recombinant bFGF (200 μg), combined with 4.8 mL 3% atelocollagen solution, was prepared and injected into the gastrocnemius muscle of the ischemic leg. The primary endpoint was safety, evaluated on all adverse events over 48 weeks after this treatment. The secondary endpoint was efficacy, evaluated by improvement of ischemic symptoms. No serious procedure-related adverse events were observed during the follow-up period. Visual analogue scale (VAS) score was significantly improved at 4, 24 and 48 weeks compared with baseline (P<0.05), and 7 patients became pain free during the follow-up period. Fontaine classification was improved in 4 of 10 patients at 48 weeks. Cyanotic lesions disappeared in 2 patients at 4 weeks. CONCLUSIONS I.m. injection of bFGF with atelocollagen is safe and feasible in patients with CLI. Randomized controlled trials are therefore needed to confirm these results.
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Affiliation(s)
- Kazunori Ono
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Makoto Ariyoshi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Satoshi Kaimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Motoki Uchihashi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Keisuke Shoji
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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17
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Jamaiyar A, Juguilon C, Dong F, Cumpston D, Enrick M, Chilian WM, Yin L. Cardioprotection during ischemia by coronary collateral growth. Am J Physiol Heart Circ Physiol 2018; 316:H1-H9. [PMID: 30379567 DOI: 10.1152/ajpheart.00145.2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ischemic heart diseases (IHD) cause millions of deaths around the world annually. While surgical and pharmacological interventions are commonly used to treat patients with IHD, their efficacy varies from patient to patient and is limited by the severity of the disease. One promising, at least theoretically, approach for treating IHD is induction of coronary collateral growth (CCG). Coronary collaterals are arteriole-to-arteriole anastomoses that can undergo expansion and remodeling in the setting of coronary disease when the disease elicits myocardial ischemia and creates a pressure difference across the collateral vessel that creates unidirectional flow. Well-developed collaterals can restore blood flow in the ischemic area of the myocardium and protect the myocardium at risk. Moreover, such collaterals are correlated to reduced mortality and infarct size and better cardiac function during occlusion of coronary arteries. Therefore, understanding the process of CCG is highly important as a potentially viable treatment of IHD. While there are several excellent review articles on this topic, this review will provide a unified overview of the various aspects related to CCG as well as an update of the advancements in the field. We also call for more detailed studies with an interdisciplinary approach to advance our knowledge of CCG. In this review, we will describe growth of coronary collaterals, the various factors that contribute to CCG, animal models used to study CCG, and the cardioprotective effects of coronary collaterals during ischemia. We will also discuss the impairment of CCG in metabolic syndrome and the therapeutic potentials of CCG in IHD.
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Affiliation(s)
- Anurag Jamaiyar
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio.,School of Biomedical Sciences, Kent State University , Kent, Ohio
| | - Cody Juguilon
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Feng Dong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Devan Cumpston
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Molly Enrick
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - William M Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Liya Yin
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
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18
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Baeyens N. Fluid shear stress sensing in vascular homeostasis and remodeling: Towards the development of innovative pharmacological approaches to treat vascular dysfunction. Biochem Pharmacol 2018; 158:185-191. [PMID: 30365948 DOI: 10.1016/j.bcp.2018.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
Abstract
Blood circulation, facilitating gas exchange and nutrient transportation, is a quintessential feature of life in vertebrates. Any disruption to blood flow, may it be by blockade or traumatic rupture, irrevocably leads to tissue infarction or death. Therefore, it is not surprising that hemostasis and vascular adaptation measures have been evolutionarily selected to mitigate the adverse consequences of altered circulation. Blood vessels can be broadly categorized as arteries, veins, or capillaries, based on their structure, hemodynamics, and gas exchange. However, all of them share one property: they are lined with an epithelial sheet called the endothelium, which typically lies on a basement membrane. This endothelium is the primary interface between the flowing blood and the rest of the body, and it has highly specialized molecular mechanisms to detect and respond to changes in blood perfusion. The purpose of this commentary will be to highlight some of the recent developments in the research on blood flow sensing, vascular remodeling, and homeostasis and to discuss the development of innovative pharmaceutical approaches targeting mechanosensing mechanisms to prolong patient survival and improve quality of life.
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Affiliation(s)
- Nicolas Baeyens
- Laboratoire de physiologie et pharmacologie, Faculté de Médecine, Université libre de Bruxelles, ULB, Belgium.
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19
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Jurić I, Fazlibegović E, Pravdić D, Starčević B, Punda A, Huić D, Hadžiomerović M, Rozić D, Martinac M, Markota D, Vasilj M, Vasilj I, Saxena A. The Significance of Thallium-201-Chloride SPECT Myocardial Perfusion Imaging in the Management of Patients With Stable Chronic Coronary Artery Disease. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818790562. [PMID: 30046258 PMCID: PMC6056776 DOI: 10.1177/1179546818790562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/28/2018] [Indexed: 11/15/2022]
Abstract
Background: Patients with stable coronary artery disease (CAD) can be evaluated for
myocardial viability by examining reverse redistribution of Thallium-201
(201TI) through cardiac scintigraphy. There is limited
knowledge about association of a reverse redistribution with favorable
cardiac outcomes. In this study, we hypothesized that higher left
ventricular ejection fraction (LVEF), lower myocardial necrosis, fewer
ischemic events, and less angina will be associated with reverse
redistribution of 201TI imaging. Methods: Adult patients with stable CAD included in this study underwent
exercise-redistribution Thallium single-photon emission computed tomography
(SPECT) and were followed for one year. LVEF and regional wall motion
abnormalities were evaluated with echocardiography, exercise duration by
bicycle testing, and myocardial ischemia and viability by Thallium
SPECT. Results: We studied 159 patients (87 men, 72 women, median age 60 years, range: 38-84)
with well-developed collaterals. Those with reverse redistribution on SPECT
(n = 61, 38.3%) had significantly better exercise tolerance (⩾85%;
P < .001). Subjects with reverse redistribution had
better LVEF (P < .001), wall motion parameters
(P < .001), a lower degree of myocardial necrosis
(P < .05), less angina during follow-up
(P = .02), and fewer ischemic events whether treated
with OMT or PCI (P < .001). Conclusions: Reverse redistribution of 201Tl on scintigraphic images is a
predictor of myocardial viability. Evidence from our study suggests that
optimally treated chronic CAD patients with reverse redistribution may have
lower likelihood of future adverse cardiovascular events and better
prognosis.
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Affiliation(s)
- Ivan Jurić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | - Danijel Pravdić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | - Ante Punda
- Clinical Department for Nuclear Medicine, Split, Croatia
| | - Dražen Huić
- Clinical Department for Nuclear Medicine and Radiation Protection, Zagreb, Croatia
| | | | - Damir Rozić
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | - Darko Markota
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Mirjana Vasilj
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ivan Vasilj
- Faculty of Health Studies, Mostar, Bosnia and Herzegovina
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20
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Stuijfzand WJ, Driessen RS, Raijmakers PG, Rijnierse MT, Maeremans J, Hollander MR, Lammertsma AA, van Rossum AC, Dens J, Nap A, van Royen N, Knaapen P. Prevalence of ischaemia in patients with a chronic total occlusion and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2018; 18:1025-1033. [PMID: 27585716 DOI: 10.1093/ehjci/jew188] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/11/2016] [Indexed: 01/21/2023] Open
Abstract
Aims Previous studies on invasive assessment of collateral function in patients with a chronic total occlusion (CTO) have displayed only a limited increase in collateral flow and high occurrence of coronary steal during pharmacological stress. This could question the necessity for ischaemia testing prior to revascularization of CTOs in the presence of myocardial viability. The purpose of the present study was to determine the prevalence of perfusion impairments in patients with a CTO as assessed by [15O]H2O positron emission tomography (PET). Methods and results Seventy-six consecutive patients (60 men, 62 ± 10 years) with a documented CTO and preserved left ventricular ejection fraction (LVEF) were included. All patients underwent PET to assess (hyperaemic) myocardial blood flow (MBF) and coronary flow reserve (CFR). Collateral connection score was 0 in 7 (9%), 1 in 13 (17%), and 2 in 56 (74%) of the cases, with predominantly a high Rentrop grade (96% ≥2). MBF of the target area during hyperaemia was significantly lower when compared with the remote area (1.37 ± 0.37 vs. 2.63 ± 0.71 mL min-1 g-1, P < 0.001). Target to remote ratio during hyperaemia was on average 0.54 ± 0.13, and 73 (96%) patients demonstrated a significantly impaired target to remote ratio (≤0.75). Only 7 (9%) patients displayed a preserved CFR of ≥2.50, whereas coronary steal (CFR <1.0) was observed in 10 (13%) patients. Conclusions Even in the presence of angiographically well-developed collateral arteries, the vast majority of CTO patients with a preserved LVEF showed significantly impaired perfusion. These results suggest that collateral function during increased blood flow demand in viable myocardium is predominantly insufficient.
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Affiliation(s)
- Wijnand J Stuijfzand
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Mischa T Rijnierse
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Maurits R Hollander
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jo Dens
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Alexander Nap
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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21
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Whayne TF, Wells G, Messerli A. Prognostic Implications of Coronary Collaterals in Transmural Infarct-Related Percutaneous Coronary Interventions. Angiology 2018; 70:193-196. [PMID: 29747518 DOI: 10.1177/0003319718775843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Thomas F Whayne
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Gretchen Wells
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Adrian Messerli
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
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22
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Ramai D, Lai J, Monzidelis C, Reddy S. Coronary Artery Development: Origin, Malformations, and Translational Vascular Reparative Therapy. J Cardiovasc Pharmacol Ther 2018; 23:292-300. [PMID: 29642708 DOI: 10.1177/1074248418769633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
After thickening of the cardiac chamber walls during embryogenesis, oxygen and nutrients can no longer be adequately supplied to cardiac cells via passive diffusion; therefore, a primitive vascular network develops to supply these vital structures. This plexus further matures into coronary arteries and veins, which ensures continued development of the heart. Various models have been proposed to account for the growth of the coronary arteries. However, lineage-tracing studies in the last decade have identified 3 major sources, namely, the proepicardium, the sinus venosus, and endocardium. Although the exact contribution of each source remains unknown, the emerging model depicts alternative pathways and progenitor cells, which ensure successful coronary angiogenesis. We aim to explore the current trends in coronary artery development, the cellular and molecular signals regulating heart vascularization, and its implications for heart disease and vascular regeneration.
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Affiliation(s)
- Daryl Ramai
- Department of Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
- Department of Anatomical Sciences, School of Medicine, St George’s University, Grenada, West Indies
| | - Jonathan Lai
- Department of Anatomical Sciences, School of Medicine, St George’s University, Grenada, West Indies
| | - Constantine Monzidelis
- Department of Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Sarath Reddy
- Division of Cardiology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
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23
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de Waard GA, Cook CM, van Royen N, Davies JE. Coronary autoregulation and assessment of stenosis severity without pharmacological vasodilation. Eur Heart J 2017; 39:4062-4071. [DOI: 10.1093/eurheartj/ehx669] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/20/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Guus A de Waard
- Department of Cardiology, VU University Medical Center, de Boelelaan 1117, HV Amsterdam, The Netherlands
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
| | - Christopher M Cook
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, de Boelelaan 1117, HV Amsterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA, Nijmegen, The Netherlands
| | - Justin E Davies
- National Heart and Lung Institute - Cardiovascular Science, Imperial College London, The Hammersmith Hospital, Du Cane Road, London, UK
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24
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Tong LS, Guo ZN, Ou YB, Yu YN, Zhang XC, Tang J, Zhang JH, Lou M. Cerebral venous collaterals: A new fort for fighting ischemic stroke? Prog Neurobiol 2017; 163-164:172-193. [PMID: 29199136 DOI: 10.1016/j.pneurobio.2017.11.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/03/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
Stroke therapy has entered a new era highlighted by the use of endovascular therapy in addition to intravenous thrombolysis. However, the efficacy of current therapeutic regimens might be reduced by their associated adverse events. For example, over-reperfusion and futile recanalization may lead to large infarct, brain swelling, hemorrhagic complication and neurological deterioration. The traditional pathophysiological understanding on ischemic stroke can hardly address these occurrences. Accumulating evidence suggests that a functional cerebral venous drainage, the major blood reservoir and drainage system in brain, may be as critical as arterial infusion for stroke evolution and clinical sequelae. Further exploration of the multi-faceted function of cerebral venous system may add new implications for stroke outcome prediction and future therapeutic decision-making. In this review, we emphasize the anatomical and functional characteristics of the cerebral venous system and illustrate its necessity in facilitating the arterial infusion and maintaining the cerebral perfusion in the pathological stroke content. We then summarize the recent critical clinical studies that underscore the associations between cerebral venous collateral and outcome of ischemic stroke with advanced imaging techniques. A novel three-level venous system classification is proposed to demonstrate the distinct characteristics of venous collaterals in the setting of ischemic stroke. Finally, we discuss the current directions for assessment of cerebral venous collaterals and provide future challenges and opportunities for therapeutic strategies in the light of these new concepts.
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Affiliation(s)
- Lu-Sha Tong
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Zhen-Ni Guo
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Yi-Bo Ou
- Department of Neurosurgery, Tong-ji Hospital, Wuhan, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Yan-Nan Yu
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiao-Cheng Zhang
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiping Tang
- Department of Anesthesiology, Loma Linda University, School of Medicine, CA, USA
| | - John H Zhang
- Departments of Physiology, Loma Linda University, School of Medicine, CA, USA.
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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25
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Harnoss JM, Krackhardt F, Ritter Z, Granzow S, Felsenberg D, Neumann K, Lerman LO, Riediger F, Hillmeister P, Bramlage P, Buschmann IR. Porcine arteriogenesis based on vasa vasorum in a novel semi-acute occlusion model using high-resolution imaging. Heart Vessels 2017; 32:1400-1409. [PMID: 28776069 DOI: 10.1007/s00380-017-1028-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/28/2017] [Indexed: 11/29/2022]
Abstract
Bridging collaterals (BC) develop in several chronic total artery occlusion diseases, and can prevent extensive myocardial necrosis. Yet, their origin, growth process, and histo-morphology are still unclear. Since vasa vasorum (VV) may take part in collateralization, we hypothesized that VV are the basis for BCs. To comprehensively investigate this arteriogenesis process, we used high-resolution imaging, including corrosion casts, post-mortem angiography with stereoscopy, micro-CT, and immunohistology, in combination with a novel semi-acute vessel occlusion model. This porcine model was produced by implanting a copper stent minimally invasively into the left anterior descending coronary artery. To define the kinetics of arteriogenesis, pigs (n = 11) were assigned to one of the five euthanasia timepoints: day 0.5 (D0.5, n = 2), D3 (n = 2), D5 (n = 1), D7 (n = 3), or D12 (n = 3) after stent implantation. We found that (1) BCs originate from longitudinally running type 1 VV, mainly VV interna, partially also from VV externa; (2) the growth of VV to BC is rapid, occurring within 7 days; and (3) porcine BCs are likely functionally relevant, considering an observed 102% increase in the number of smooth muscle cell layers in their vascular wall. High-resolution imaging in a minimally invasive non-acute vessel occlusion model is an innovative technique that allowed us to provide direct evidence that porcine BCs develop from the VV. These data may be crucial for further studies on the treatment of angina pectoris and thromboangiitis obliterans through therapeutic stimulation of BC development.
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Affiliation(s)
- Jonathan M Harnoss
- Department for Angiology, Center for Internal Medicine I, Medizinische Hochschule Brandenburg (MHB), Brandenburg Medical School, Hochstr. 29, 14770, Brandenburg, Germany.,Department of Cardiology, Charité University Hospital, Campus Virchow, Berlin, Germany
| | - Florian Krackhardt
- Department for Angiology, Center for Internal Medicine I, Medizinische Hochschule Brandenburg (MHB), Brandenburg Medical School, Hochstr. 29, 14770, Brandenburg, Germany.,Department of Cardiology, Charité University Hospital, Campus Virchow, Berlin, Germany
| | - Zully Ritter
- Center for Muscle and Bone Research (ZMK), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Granzow
- Department of Cardiology, Charité University Hospital, Campus Virchow, Berlin, Germany
| | - Dieter Felsenberg
- Center for Muscle and Bone Research (ZMK), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Konrad Neumann
- Institute for Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fabian Riediger
- Department for Angiology, Center for Internal Medicine I, Medizinische Hochschule Brandenburg (MHB), Brandenburg Medical School, Hochstr. 29, 14770, Brandenburg, Germany
| | - Philipp Hillmeister
- Department for Angiology, Center for Internal Medicine I, Medizinische Hochschule Brandenburg (MHB), Brandenburg Medical School, Hochstr. 29, 14770, Brandenburg, Germany.,Department of Cardiology, Charité University Hospital, Campus Virchow, Berlin, Germany
| | - Peter Bramlage
- Department for Angiology, Center for Internal Medicine I, Medizinische Hochschule Brandenburg (MHB), Brandenburg Medical School, Hochstr. 29, 14770, Brandenburg, Germany.,Institute for Pharmacology and Preventive Medicine, Mahlow, Germany
| | - Ivo R Buschmann
- Department for Angiology, Center for Internal Medicine I, Medizinische Hochschule Brandenburg (MHB), Brandenburg Medical School, Hochstr. 29, 14770, Brandenburg, Germany. .,Department of Cardiology, Charité University Hospital, Campus Virchow, Berlin, Germany.
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26
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The relationship between fasting blood glucose variability and coronary artery collateral formation in type 2 diabetes patients with coronary artery disease. Coron Artery Dis 2017. [PMID: 28644211 DOI: 10.1097/mca.0000000000000520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Coronary collaterals are an alternative source of blood supply to ischemic myocardium. Well-developed coronary collateral arteries in patients with coronary artery disease (CAD) limit the size of acute myocardial infarction and improves survival. The aim of this study was to investigate the relationship between glycemic variability and coronary collateral formation in patients with type 2 diabetes mellitus and CAD. METHODS Consecutive patients undergoing percutaneous coronary intervention or coronary artery bypass grafting procedures were studied. Multivariate logistic regression models were used to examine the association between coronary artery collateral formation graded by Rentrope classification and glycemic variability, measured by coefficient variation of fasting blood glucose. RESULTS In our study, we retrospectively enrolled 300 patients, of whom 239 were diabetic (age: 70.1±11.9, 56% men) and 61 were nondiabetic (age: 71.5±11.5, 72% men). Diabetic patients were further stratified as follows: those with poor coronary collateral artery development (n=171, age: 69.7±12.4, 55% men) and those with good coronary collateral artery development (n=68, age 71.1±10.8, 59% men) according to the Rentrope classification. Our findings did not show association between glycemic variability and coronary collateral vessels development after controlling for potential confounders (odds ratio: 2.51; 95% confidence interval: 0.57-11.03; P=0.22). The culprit lesion (≥75% stenosis) in the left anterior descending artery and the right coronary artery was more frequent in the good collateral group compared with the poor collateral group (66 vs. 50%, P=0.02; 63 vs. 45%, P=0.01 respectively). CONCLUSION Glycemic variability is not associated with coronary collateral artery formation in patients with type 2 diabetes mellitus and CAD.
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27
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van Diemen PA, Stuijfzand WJ, Biesbroek SP, Raijmakers PG, Driessen RS, Schumacher SP, Nap A, van Rossum AC, van Royen N, Nijveldt R, Knaapen P. Impact of right ventricular side branch occlusion during percutaneous coronary intervention of chronic total occlusions on right ventricular function. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:405-410. [PMID: 28432004 DOI: 10.1016/j.carrev.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the impact of right ventricular side branch (RVB) occlusion, during percutaneous coronary interventions (PCIs) of chronic total occlusions (CTOs) of the right coronary artery (RCA), on right ventricular (RV) function. BACKGROUND Developments in PCI techniques have expanded PCI CTO feasibility. However, the utilization of dissection and reentry techniques and extensive stent implantation increases the risk of coronary side branch occlusion. METHODS Fifty-four patients (80% male, 63±10years) evaluated with cardiac magnetic resonance imaging (CMR) prior and three months after successful PCI CTO RCA (median: 99days, IQR: 92-105days) were included. Right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), and ejection fraction (RVEF) were quantified on CMR images. Occurrence of RVB occlusion and/or RVB recruitment was assessed using procedural angiograms. RESULTS RVB occlusion was observed in 12 patients (22%), while RVB recruitment occurred in seven patients (13%). Overall, RVEF was comparable between baseline and follow-up (53.8±5.8 vs. 53.9±5.8%, p=0.95). RVB occlusion was not associated with a significant change in RVEDV or RVEF (156.9±36.3 vs. 162.1±35.5mL, p=0.30 and 54.2±3.9 vs. 52.7±4.4%, p=0.19, respectively); however a trend was observed for an increase of RVESV (72.5±20.0 vs. 77.4±20.7mL, p=0.05) at follow-up. RVB recruitment did not result in a significant improvement of RVEF (55.4±4.6 vs. 56.1±5.3%, p=0.75). CONCLUSION RVB occlusion was not associated with a significant decreased RVEF at follow-up, although the results suggested a limited increase of RVESV.
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Affiliation(s)
- Pepijn A van Diemen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Wynand J Stuijfzand
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Stefan P Biesbroek
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexander Nap
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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28
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Abstract
The heart is uniquely responsible for providing its own blood supply through the coronary circulation. Regulation of coronary blood flow is quite complex and, after over 100 years of dedicated research, is understood to be dictated through multiple mechanisms that include extravascular compressive forces (tissue pressure), coronary perfusion pressure, myogenic, local metabolic, endothelial as well as neural and hormonal influences. While each of these determinants can have profound influence over myocardial perfusion, largely through effects on end-effector ion channels, these mechanisms collectively modulate coronary vascular resistance and act to ensure that the myocardial requirements for oxygen and substrates are adequately provided by the coronary circulation. The purpose of this series of Comprehensive Physiology is to highlight current knowledge regarding the physiologic regulation of coronary blood flow, with emphasis on functional anatomy and the interplay between the physical and biological determinants of myocardial oxygen delivery. © 2017 American Physiological Society. Compr Physiol 7:321-382, 2017.
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Affiliation(s)
- Adam G Goodwill
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
| | - Gregory M Dick
- California Medical Innovations Institute, 872 Towne Center Drive, Pomona, CA
| | - Alexander M Kiel
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Drive, Lafayette, IN
| | - Johnathan D Tune
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
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29
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Hillmeister P, Buschmann E, Persson PB, Bondke Persson A. Exercise for healthy flow. Acta Physiol (Oxf) 2017; 219:3-8. [PMID: 27863044 DOI: 10.1111/apha.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P. Hillmeister
- Department for Angiology; Center for Internal Medicine I; Clinic Brandenburg, Medical University Brandenburg (MHB); Brandenburg an der Havel Germany
- Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - E. Buschmann
- Department for Angiology; Center for Internal Medicine I; Clinic Brandenburg, Medical University Brandenburg (MHB); Brandenburg an der Havel Germany
- Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - P. B. Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
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30
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Lucitti JL, Sealock R, Buckley BK, Zhang H, Xiao L, Dudley AC, Faber JE. Variants of Rab GTPase-Effector Binding Protein-2 Cause Variation in the Collateral Circulation and Severity of Stroke. Stroke 2016; 47:3022-3031. [PMID: 27811335 DOI: 10.1161/strokeaha.116.014160] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/23/2016] [Accepted: 09/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE The extent (number and diameter) of collateral vessels varies widely and is a major determinant, along with arteriogenesis (collateral remodeling), of variation in severity of tissue injury after large artery occlusion. Differences in genetic background underlie the majority of the variation in collateral extent in mice, through alterations in collaterogenesis (embryonic collateral formation). In brain and other tissues, ≈80% of the variation in collateral extent among different mouse strains has been linked to a region on chromosome 7. We recently used congenic (CNG) fine mapping of C57BL/6 (B6, high extent) and BALB/cByJ (BC, low extent) mice to narrow the region to a 737 Kb locus, Dce1. Herein, we report the causal gene. METHODS We used additional CNG mapping and knockout mice to narrow the number of candidate genes. Subsequent inspection identified a nonsynonymous single nucleotide polymorphism between B6 and BC within Rabep2 (rs33080487). We then created B6 mice with the BC single nucleotide polymorphism at this locus plus 3 other lines for predicted alteration or knockout of Rabep2 using gene editing. RESULTS The single amino acid change caused by rs33080487 accounted for the difference in collateral extent and infarct volume between B6 and BC mice attributable to Dce1. Mechanistically, variants of Rabep2 altered collaterogenesis during embryogenesis but had no effect on angiogenesis examined in vivo and in vitro. Rabep2 deficiency altered endosome trafficking known to be involved in VEGF-A→VEGFR2 signaling required for collaterogenesis. CONCLUSIONS Naturally occurring variants of Rabep2 are major determinants of variation in collateral extent and stroke severity in mice.
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Affiliation(s)
- Jennifer L Lucitti
- From the Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill
| | - Robert Sealock
- From the Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill
| | - Brian K Buckley
- From the Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill
| | - Hua Zhang
- From the Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill
| | - Lin Xiao
- From the Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill
| | - Andrew C Dudley
- From the Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill
| | - James E Faber
- From the Department of Cell Biology and Physiology, The McAllister Heart Institute, University of North Carolina, Chapel Hill.
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31
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SPECT and PET imaging of angiogenesis and arteriogenesis in pre-clinical models of myocardial ischemia and peripheral vascular disease. Eur J Nucl Med Mol Imaging 2016; 43:2433-2447. [PMID: 27517840 PMCID: PMC5095166 DOI: 10.1007/s00259-016-3480-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/28/2016] [Indexed: 01/03/2023]
Abstract
Purpose The extent of neovascularization determines the clinical outcome of coronary artery disease and other occlusive cardiovascular disorders. Monitoring of neovascularization is therefore highly important. This review article will elaborately discuss preclinical studies aimed at validating new nuclear angiogenesis and arteriogenesis tracers. Additionally, we will briefly address possible obstacles that should be considered when designing an arteriogenesis radiotracer. Methods A structured medline search was the base of this review, which gives an overview on different radiopharmaceuticals that have been evaluated in preclinical models. Results Neovascularization is a collective term used to indicate different processes such as angiogenesis and arteriogenesis. However, while it is assumed that sensitive detection through nuclear imaging will facilitate translation of successful therapeutic interventions in preclinical models to the bedside, we still lack specific tracers for neovascularization imaging. Most nuclear imaging research to date has focused on angiogenesis, leaving nuclear arteriogenesis imaging largely overlooked. Conclusion Although angiogenesis is the process which is best understood, there is no scarcity in theoretical targets for arteriogenesis imaging.
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32
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Ramo K, Sugamura K, Craige S, Keaney JF, Davis RJ. Suppression of ischemia in arterial occlusive disease by JNK-promoted native collateral artery development. eLife 2016; 5:e18414. [PMID: 27504807 PMCID: PMC4999312 DOI: 10.7554/elife.18414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/08/2016] [Indexed: 12/29/2022] Open
Abstract
Arterial occlusive diseases are major causes of morbidity and mortality. Blood flow to the affected tissue must be restored quickly if viability and function are to be preserved. We report that disruption of the mixed-lineage protein kinase (MLK) - cJun NH2-terminal kinase (JNK) signaling pathway in endothelial cells causes severe blockade of blood flow and failure to recover in the murine femoral artery ligation model of hindlimb ischemia. We show that the MLK-JNK pathway is required for the formation of native collateral arteries that can restore circulation following arterial occlusion. Disruption of the MLK-JNK pathway causes decreased Dll4/Notch signaling, excessive sprouting angiogenesis, and defects in developmental vascular morphogenesis. Our analysis demonstrates that the MLK-JNK signaling pathway is a key regulatory mechanism that protects against ischemia in arterial occlusive disease.
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Affiliation(s)
- Kasmir Ramo
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, United States
| | - Koichi Sugamura
- Cardiovascular Medicine Division, University of Massachusetts Medical School, Worcester, United States
- Department of Medicine, University of Massachusetts Medical School, Worcester, United States
| | - Siobhan Craige
- Cardiovascular Medicine Division, University of Massachusetts Medical School, Worcester, United States
- Department of Medicine, University of Massachusetts Medical School, Worcester, United States
| | - John F Keaney
- Cardiovascular Medicine Division, University of Massachusetts Medical School, Worcester, United States
- Department of Medicine, University of Massachusetts Medical School, Worcester, United States
| | - Roger J Davis
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, United States
- Howard Hughes Medical Institute, Worcester, United States
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Zhu H, Zhang M, Liu Z, Xing J, Moriasi C, Dai X, Zou MH. AMP-Activated Protein Kinase α1 in Macrophages Promotes Collateral Remodeling and Arteriogenesis in Mice In Vivo. Arterioscler Thromb Vasc Biol 2016; 36:1868-78. [PMID: 27444205 DOI: 10.1161/atvbaha.116.307743] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/27/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE AMP-activated protein kinase (AMPK), an energy and redox sensor, is activated in response to various cellular stresses, including hypoxia, nutrient deprivation, oxidative stress, and fluid shear stress at the site of vessel blockade. The activation of AMPK is involved in angiogenesis. However, it is unknown whether AMPK can influence arteriogenesis. Here, we demonstrate the contribution of macrophage AMPK to arteriogenesis and collateral remodeling and their underlying mechanisms in well-characterized in vivo and in vitro models. APPROACH AND RESULTS AMPKα1, AMPKα2 knockout and wild-type littermates underwent femoral artery ligation. Collateral arteriogenesis was monitored in wild-type, global AMPKα1 knockout, or macrophage-specific AMPKα1 knockout mice, with or without hindlimb ligation. Compared with wild-type mice with ligation, global AMPKα1 knockout mice displayed significant reduction in blood flow recovery and impaired remodeling of collateral arterioles. Similar impairments were observed in macrophage-specific AMPK α1 knockout mice after hindlimb ligation. Mechanistically, we found that AMPKα1 promotes the production of growth factors, such as transforming growth factor β, by directly phosphorylating the inhibitor of nuclear factor κB kinase alpha, resulting in an nuclear factor κB-dependent production of growth factors CONCLUSIONS Our findings suggest a novel role for macrophage AMPKα1 in arteriogenesis and collateral remodeling and indicate that AMPKα1 activation might be beneficial for recovery from occlusive vascular disorders.
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Affiliation(s)
- Huaiping Zhu
- From the Center for Molecular and Translational Medicine, Georgia State University, Atlanta (H.Z., Z.L., C.M., X.D., M.-H.Z.); and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (M.Z., J.X.)
| | - Miao Zhang
- From the Center for Molecular and Translational Medicine, Georgia State University, Atlanta (H.Z., Z.L., C.M., X.D., M.-H.Z.); and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (M.Z., J.X.)
| | - Zhaoyu Liu
- From the Center for Molecular and Translational Medicine, Georgia State University, Atlanta (H.Z., Z.L., C.M., X.D., M.-H.Z.); and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (M.Z., J.X.)
| | - Junjie Xing
- From the Center for Molecular and Translational Medicine, Georgia State University, Atlanta (H.Z., Z.L., C.M., X.D., M.-H.Z.); and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (M.Z., J.X.)
| | - Cate Moriasi
- From the Center for Molecular and Translational Medicine, Georgia State University, Atlanta (H.Z., Z.L., C.M., X.D., M.-H.Z.); and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (M.Z., J.X.)
| | - Xiaoyan Dai
- From the Center for Molecular and Translational Medicine, Georgia State University, Atlanta (H.Z., Z.L., C.M., X.D., M.-H.Z.); and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (M.Z., J.X.)
| | - Ming-Hui Zou
- From the Center for Molecular and Translational Medicine, Georgia State University, Atlanta (H.Z., Z.L., C.M., X.D., M.-H.Z.); and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (M.Z., J.X.).
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Xu YY, Li ML, Gao S, Hou B, Sun ZY, Zhou HL, Feng F, Xu WH. Non-moyamoya vessel network formation along steno-occlusive middle cerebral artery. Neurology 2016; 86:1957-63. [PMID: 27164677 DOI: 10.1212/wnl.0000000000002698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/29/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In this study, we sought to examine the prevalence and clinical relevance of deep tiny flow voids (DTFV) in patients with steno-occlusive middle cerebral artery (MCA) disease on high-resolution MRI (HRMRI). METHODS We retrospectively reviewed the HRMRI and clinical data of 477 patients with MCA steno-occlusive disease. The presence and distribution of DTFV, defined as 3 or more flow voids along the affected MCA on at least 2 consecutive T2-weighted image slices on HRMRI, were observed. The relationships among DTFV, the degree of stenosis (mild <50%, moderate 50%-70%, severe 70%-99%, and occlusion), and infarctions were analyzed. To clarify the difference between DTFV and moyamoya collaterals, we compared the HRMRI findings of the patients with DTFV and 102 patients with moyamoya disease. RESULTS The prevalence of DTFV was 1.4% in mild stenosis, 12.8% in moderate stenosis, 40.6% in severe stenosis, and 50.7% in MCA occlusions. Of the 112 patients with DTFV, 57 (50.9%) had all 4 quadrants (superior, inferior, dorsal, and ventral sides) of the MCA involved. DTFV were more common in asymptomatic patients than in symptomatic patients with severe stenosis (49.3% vs 30.9%, p = 0.025) and occlusions (68.0% vs 41.7%, p = 0.033). Obvious flow voids in the basal ganglia region were observed in 58 patients (56.9%) with moyamoya disease but in none of the patients with DTFV (p < 0.001). CONCLUSIONS DTFV are common in patients with severe steno-occlusive MCA disease, especially in asymptomatic patients. We hypothesize that DTFV originate from new vessel network formation in response to chronic cerebral ischemia.
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Affiliation(s)
- Yu-Yuan Xu
- From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming-Li Li
- From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shan Gao
- From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Hou
- From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao-Yong Sun
- From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hai-Long Zhou
- From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Feng
- From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei-Hai Xu
- From the Departments of Neurology (Y.-Y.X., S.G., W.-H.X.) and Radiology (M.-L.L., B.H., Z.-Y.S., H.-L.Z., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Miquerol L. [Revascularization of the heart after infarct: lessons from embryonic development]. Med Sci (Paris) 2016; 32:158-62. [PMID: 26936172 DOI: 10.1051/medsci/20163202008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucile Miquerol
- Aix-Marseille université, institut de biologie du développement de Marseille, CNRS UMR 7288, campus de Luminy, case 907, 13288 Marseille Cedex 9, France
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36
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Better Blood Flow Delivered. JACC Basic Transl Sci 2016; 1:45-48. [PMID: 30167505 PMCID: PMC6113172 DOI: 10.1016/j.jacbts.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Anderson ME. Oxidant stress promotes disease by activating CaMKII. J Mol Cell Cardiol 2015; 89:160-7. [PMID: 26475411 PMCID: PMC5075238 DOI: 10.1016/j.yjmcc.2015.10.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/09/2015] [Accepted: 10/10/2015] [Indexed: 12/31/2022]
Abstract
CaMKII is activated by oxidation of methionine residues residing in the regulatory domain. Oxidized CaMKII (ox-CaMKII) is now thought to participate in cardiovascular and pulmonary diseases and cancer. This invited review summarizes current evidence for the role of ox-CaMKII in disease, considers critical knowledge gaps and suggests new areas for inquiry.
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Affiliation(s)
- Mark E Anderson
- Johns Hopkins Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, United States.
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Choo GH. Collateral Circulation in Chronic Total Occlusions – an interventional perspective. Curr Cardiol Rev 2015; 11:277-284. [PMID: 26354508 PMCID: PMC4774630 DOI: 10.2174/1573403x11666150909112548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/04/2015] [Indexed: 11/22/2022] Open
Abstract
Human coronary collaterals are inter-coronary communications that are believed to be present from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be assessed by various methods. These coronary collateral channels have been used successfully as a retrograde access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target in patients with no suitable revascularization option is an exciting proposal.
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Affiliation(s)
- Gim-Hooi Choo
- Ramsay Sime Darby Health Care Subang Jaya Medical Centre
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Heuslein JL, Meisner JK, Li X, Song J, Vincentelli H, Leiphart RJ, Ames EG, Blackman BR, Blackman BR, Price RJ. Mechanisms of Amplified Arteriogenesis in Collateral Artery Segments Exposed to Reversed Flow Direction. Arterioscler Thromb Vasc Biol 2015; 35:2354-65. [PMID: 26338297 PMCID: PMC4618717 DOI: 10.1161/atvbaha.115.305775] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/14/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Collateral arteriogenesis, the growth of existing arterial vessels to a larger diameter, is a fundamental adaptive response that is often critical for the perfusion and survival of tissues downstream of chronic arterial occlusion(s). Shear stress regulates arteriogenesis; however, the arteriogenic significance of reversed flow direction, occurring in numerous collateral artery segments after femoral artery ligation, is unknown. Our objective was to determine if reversed flow direction in collateral artery segments differentially regulates endothelial cell signaling and arteriogenesis. APPROACH AND RESULTS Collateral segments experiencing reversed flow direction after femoral artery ligation in C57BL/6 mice exhibit increased pericollateral macrophage recruitment, amplified arteriogenesis (30% diameter and 2.8-fold conductance increases), and remarkably permanent (12 weeks post femoral artery ligation) remodeling. Genome-wide transcriptional analyses on human umbilical vein endothelial cells exposed to reversed flow conditions mimicking those occurring in vivo yielded 10-fold more significantly regulated transcripts, as well as enhanced activation of upstream regulators (nuclear factor κB [NFκB], vascular endothelial growth factor, fibroblast growth factor-2, and transforming growth factor-β) and arteriogenic canonical pathways (protein kinase A, phosphodiesterase, and mitogen-activated protein kinase). Augmented expression of key proarteriogenic molecules (Kruppel-like factor 2 [KLF2], intercellular adhesion molecule 1, and endothelial nitric oxide synthase) was also verified by quantitative real-time polymerase chain reaction, leading us to test whether intercellular adhesion molecule 1 or endothelial nitric oxide synthase regulate amplified arteriogenesis in flow-reversed collateral segments in vivo. Interestingly, enhanced pericollateral macrophage recruitment and amplified arteriogenesis was attenuated in flow-reversed collateral segments after femoral artery ligation in intercellular adhesion molecule 1(-/-) mice; however, endothelial nitric oxide synthase(-/-) mice showed no such differences. CONCLUSIONS Reversed flow leads to a broad amplification of proarteriogenic endothelial signaling and a sustained intercellular adhesion molecule 1-dependent augmentation of arteriogenesis. Further investigation of the endothelial mechanotransduction pathways activated by reversed flow may lead to more effective and durable therapeutic options for arterial occlusive diseases.
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Affiliation(s)
- Joshua L Heuslein
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.)
| | - Joshua K Meisner
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.)
| | - Xuanyue Li
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.)
| | - Ji Song
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.)
| | - Helena Vincentelli
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.)
| | - Ryan J Leiphart
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.)
| | - Elizabeth G Ames
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.)
| | - Brett R Blackman
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.)
| | | | - Richard J Price
- From the Departments of Biomedical Engineering (J.L.H., J.K.M., X.L., J.S., H.V., R.J.L., E.G.A., R.J.P.), Molecular Physiology and Biological Physics (E.G.A.), Radiology (R.J.P.), and Radiation Oncology (R.J.P.), University of Virginia, Charlottesville; and HemoShear Therapeutics LLC, Charlottesville, VA (B.R.B.).
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Avolio E, Spinetti G, Madeddu P. Training monocytes by physical exercise: good practice for improving collateral artery development and postischemic outcomes. Arterioscler Thromb Vasc Biol 2015. [PMID: 26203159 DOI: 10.1161/atvbaha.115.306034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Elisa Avolio
- From the Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom (E.A., P.M.); and MultiMedica Research Institute, Milan, Italy (G.S.)
| | - Gaia Spinetti
- From the Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom (E.A., P.M.); and MultiMedica Research Institute, Milan, Italy (G.S.)
| | - Paolo Madeddu
- From the Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom (E.A., P.M.); and MultiMedica Research Institute, Milan, Italy (G.S.).
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41
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Zhang H, Faber JE. De-novo collateral formation following acute myocardial infarction: Dependence on CCR2⁺ bone marrow cells. J Mol Cell Cardiol 2015; 87:4-16. [PMID: 26254180 DOI: 10.1016/j.yjmcc.2015.07.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/02/2015] [Accepted: 07/24/2015] [Indexed: 12/21/2022]
Abstract
Wide variation exists in the extent (number and diameter) of native pre-existing collaterals in tissues of different strains of mice, with supportive indirect evidence recently appearing for humans. This variation is a major determinant of the wide variation in severity of tissue injury in occlusive vascular disease. Whether such genetic-dependent variation also exists in the heart is unknown because no model exists for study of mouse coronary collaterals. Also owing to methodological limitations, it is not known if ischemia can induce new coronary collaterals to form ("neo-collaterals") versus remodeling of pre-existing ones. The present study sought to develop a model to study coronary collaterals in mice, determine whether neo-collateral formation occurs, and investigate the responsible mechanisms. Four strains with known rank-ordered differences in collateral extent in brain and skeletal muscle were studied: C57BLKS>C57BL/6>A/J>BALB/c. Unexpectedly, these and 5 additional strains lacked native coronary collaterals. However after ligation, neo-collaterals formed rapidly within 1-to-2 days, reaching their maximum extent in ≤7 days. Rank-order for neo-collateral formation differed from the above: C57BL/6>BALB/c>C57BLKS>A/J. Collateral network conductance, infarct volume(-1), and contractile function followed this same rank-order. Neo-collateral formation and collateral conductance were reduced and infarct volume increased in MCP1(-/-) and CCR2(-/-) mice. Bone-marrow transplant rescued collateral formation in CCR2(-/-) mice. Involvement of fractalkine➔CX3CR1 signaling and endothelial cell proliferation were also identified. This study introduces a model for investigating the coronary collateral circulation in mice, demonstrates that neo-collaterals form rapidly after coronary occlusion, and finds that MCP➔CCR2-mediated recruitment of myeloid cells is required for this process.
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Affiliation(s)
- Hua Zhang
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, USA; McAllister Heart Institute, University of North Carolina at Chapel Hill, USA
| | - James E Faber
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, USA; McAllister Heart Institute, University of North Carolina at Chapel Hill, USA.
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Yıldırım C, Nieuwenhuis S, Teunissen PF, Horrevoets AJ, van Royen N, van der Pouw Kraan TC. Interferon-Beta, a Decisive Factor in Angiogenesis and Arteriogenesis. J Interferon Cytokine Res 2015; 35:411-20. [DOI: 10.1089/jir.2014.0184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Cansu Yıldırım
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sylvia Nieuwenhuis
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul F. Teunissen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Anton J.G. Horrevoets
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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Miquerol L, Thireau J, Bideaux P, Sturny R, Richard S, Kelly RG. Endothelial plasticity drives arterial remodeling within the endocardium after myocardial infarction. Circ Res 2015; 116:1765-71. [PMID: 25834185 DOI: 10.1161/circresaha.116.306476] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
RATIONALE Revascularization of injured, ischemic, and regenerating organs is essential to restore organ function. In the postinfarct heart, however, the mechanisms underlying the formation of new coronary arteries are poorly understood. OBJECTIVE To study vascular remodeling of coronary arteries after infarction. METHODS AND RESULTS We performed permanent left coronary ligation on Connexin40-GFP mice expressing green fluorescent protein (GFP) in endothelial cells of coronary arteries but not veins, capillaries, or endocardium. GFP(+) endothelial foci were identified within the endocardium in the infarct zone. These previously undescribed structures, termed endocardial flowers, have a distinct endothelial phenotype (Cx40(+), VEGFR2(+), and endoglin(-)) to the surrounding endocardium (Cx40(-), VEGFR2(-), and endoglin(+)). Endocardial flowers are contiguous with coronary vessels and associated with subendocardial smooth muscle cell accumulation. Genetic lineage tracing reveals extensive endothelial plasticity in the postinfarct heart, showing that endocardial flowers develop by arteriogenesis of Cx40(-) cells and by outgrowth of pre-existing coronary arteries. Finally, endocardial flowers exhibit angiogenic features, including early VEGFR2 expression and active proliferation of adjacent endocardial and smooth muscle cells. CONCLUSIONS Arterial endothelial foci within the endocardium reveal extensive endothelial cell plasticity in the infarct zone and identify the endocardium as a site of endogenous arteriogenesis and source of endothelial cells to promote vascularization in regenerative strategies.
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Affiliation(s)
- Lucile Miquerol
- From Aix Marseille Université, CNRS, IBDM UMR 7288, Marseille, France (L.M., R.S., R.G.K.); and PHYMEDEXP, Physiologie et Médecine Expérimentale Cœur et Muscles, INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier, France (J.T., P.B, S.R.).
| | - Jérome Thireau
- From Aix Marseille Université, CNRS, IBDM UMR 7288, Marseille, France (L.M., R.S., R.G.K.); and PHYMEDEXP, Physiologie et Médecine Expérimentale Cœur et Muscles, INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier, France (J.T., P.B, S.R.)
| | - Patrice Bideaux
- From Aix Marseille Université, CNRS, IBDM UMR 7288, Marseille, France (L.M., R.S., R.G.K.); and PHYMEDEXP, Physiologie et Médecine Expérimentale Cœur et Muscles, INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier, France (J.T., P.B, S.R.)
| | - Rachel Sturny
- From Aix Marseille Université, CNRS, IBDM UMR 7288, Marseille, France (L.M., R.S., R.G.K.); and PHYMEDEXP, Physiologie et Médecine Expérimentale Cœur et Muscles, INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier, France (J.T., P.B, S.R.)
| | - Sylvain Richard
- From Aix Marseille Université, CNRS, IBDM UMR 7288, Marseille, France (L.M., R.S., R.G.K.); and PHYMEDEXP, Physiologie et Médecine Expérimentale Cœur et Muscles, INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier, France (J.T., P.B, S.R.)
| | - Robert G Kelly
- From Aix Marseille Université, CNRS, IBDM UMR 7288, Marseille, France (L.M., R.S., R.G.K.); and PHYMEDEXP, Physiologie et Médecine Expérimentale Cœur et Muscles, INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier, France (J.T., P.B, S.R.)
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Khand A, Patel B, Palmer N, Jones J, Andron M, Perry R, Mehrotra S, Mitsudo K. Retrograde Wiring of Collateral Channels of the Heart in Chronic Total Occlusions. Angiology 2015; 66:925-32. [DOI: 10.1177/0003319715573902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To conduct a systematic review and meta-analysis on retrograde wiring in chronic total occlusions (CTOs) with focus on its safety and feasibility. Methods and Results: We searched publications from 1990 to December 2013 in PubMed, Ovid, EMBASE, and the Cochrane database inserting a number of terms relating to the collateral circulation of the heart in CTOs. A total of 18 case series (n range17-462) with a total of 2280 CTO revascularization attempts fulfilled criteria for a study of retrograde wiring of collateral channels in CTOs. There were no randomized studies comparing a primary antegrade with a primary retrograde approach. Procedural CTO revascularization rates ranged from 67% to 90.6% with a large proportion having previously failed an “antegrade” approach. The septal perforator collaterals and epicardial channels were used in 73.2% (n = 1670) and 21.7% (n = 495) of cases. Although collateral/coronary perforation was not infrequent (n = 90, 5%), serious acute complications were uncommon; in the combined population 18 cases of cardiac tamponade (0.8%) and 3 deaths (0.1%). Septal perforating wiring (79.3%) was significantly more likely to be successful compared to epicardial coronary artery wiring (72.5%) when chosen by the operator as a route of retrograde access to the CTO body (relative risk 1.11 [95% confidence interval: 1.02-1.20; P = .013]). Conclusion: Successful retrograde wiring of collateral channels in selected patients undertaken by “CTO dedicated” operators can significantly enhance the chances of revascularization of complex CTOs with a low risk of acute serious complications. Septal perforator channels are significantly more likely to be successfully retrogradely wired compared to epicardial vessels when either is selected, by reference to their anatomical suitability by the operator, as a route of access.
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Affiliation(s)
- Aleem Khand
- Department of Cardiology, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- School of Ageing and Chronic Diseases, University of Liverpool, Liverpool, United Kingdom
| | - Bilal Patel
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Nicholas Palmer
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Julia Jones
- Department of Cardiology, University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom
| | - Mohammed Andron
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Raph Perry
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Sanjay Mehrotra
- Department of Cardiology, Narayana Hrudayalaya, Bangalore, India
| | - Kazuaki Mitsudo
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
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Wagner M, Koester H, Deffge C, Weinert S, Lauf J, Francke A, Lee J, Braun-Dullaeus RC, Herold J. Isolation and intravenous injection of murine bone marrow derived monocytes. J Vis Exp 2014. [PMID: 25591000 DOI: 10.3791/52347] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
As a subtype of leukocytes and progenitors of macrophages, monocytes are involved in many important processes of organisms and are often the subject of various fields in biomedical science. The method described below is a simple and effective way to isolate murine monocytes from heterogeneous bone marrow. Bone marrow from the femur and tibia of Balb/c mice is harvested by flushing with phosphate buffered saline (PBS). Cell suspension is supplemented with macrophage-colony stimulating factor (M-CSF) and cultured on ultra-low attachment surfaces to avoid adhesion-triggered differentiation of monocytes. The properties and differentiation of monocytes are characterized at various intervals. Fluorescence activated cell sorting (FACS), with markers like CD11b, CD115, and F4/80, is used for phenotyping. At the end of cultivation, the suspension consists of 45%± 12% monocytes. By removing adhesive macrophages, the purity can be raised up to 86%± 6%. After the isolation, monocytes can be utilized in various ways, and one of the most effective and common methods for in vivo delivery is intravenous tail vein injection. This technique of isolation and application is important for mouse model studies, especially in the fields of inflammation or immunology. Monocytes can also be used therapeutically in mouse disease models.
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Affiliation(s)
- Martin Wagner
- Department for Cardiology, Angiology and Pneumology, Otto von Guericke University Magdeburg
| | - Helen Koester
- Department for Cardiology, Angiology and Pneumology, Otto von Guericke University Magdeburg
| | - Christian Deffge
- Department for Cardiology, Angiology and Pneumology, Otto von Guericke University Magdeburg
| | - Soenke Weinert
- Department for Cardiology, Angiology and Pneumology, Otto von Guericke University Magdeburg
| | - Johannes Lauf
- Department for Cardiology, Angiology and Pneumology, Otto von Guericke University Magdeburg
| | - Alexander Francke
- Herzzentrum Dresden, Universitätsklinikum an der Technischen Universität Dresden, Technische Universität Dresden
| | - Jerry Lee
- Department of Public Health and Primary Care, University of Cambridge
| | - R C Braun-Dullaeus
- Department for Cardiology, Angiology and Pneumology, Otto von Guericke University Magdeburg
| | - Joerg Herold
- Department for Cardiology, Angiology and Pneumology, Otto von Guericke University Magdeburg;
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Faber JE, Chilian WM, Deindl E, van Royen N, Simons M. A brief etymology of the collateral circulation. Arterioscler Thromb Vasc Biol 2014; 34:1854-9. [PMID: 25012127 DOI: 10.1161/atvbaha.114.303929] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It is well known that the protective capacity of the collateral circulation falls short in many individuals with ischemic disease of the heart, brain, and lower extremities. In the past 15 years, opportunities created by molecular and genetic tools, together with disappointing outcomes in many angiogenic trials, have led to a significant increase in the number of studies that focus on: understanding the basic biology of the collateral circulation; identifying the mechanisms that limit the collateral circulation's capacity in many individuals; devising methods to measure collateral extent, which has been found to vary widely among individuals; and developing treatments to increase collateral blood flow in obstructive disease. Unfortunately, accompanying this increase in reports has been a proliferation of vague terms used to describe the disposition and behavior of this unique circulation, as well as the increasing misuse of well-ensconced ones by new (and old) students of collateral circulation. With this in mind, we provide a brief glossary of readily understandable terms to denote the formation, adaptive growth, and maladaptive rarefaction of collateral circulation. We also propose terminology for several newly discovered processes that occur in the collateral circulation. Finally, we include terms used to describe vessels that are sometimes confused with collaterals, as well as terms describing processes active in the general arterial-venous circulation when ischemic conditions engage the collateral circulation. We hope this brief review will help unify the terminology used in collateral research.
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Affiliation(s)
- James E Faber
- From the Departments of Cell Biology and Physiology, University of North Carolina, Chapel Hill (J.E.F.); Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown (W.M.C.), Walter-Brendel-Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany (E.D.); Division of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (N.V.R.); and Departments of Internal Medicine and Cell Biology, Yale Cardiovascular Research Center, New Haven, CT (M.S.).
| | - William M Chilian
- From the Departments of Cell Biology and Physiology, University of North Carolina, Chapel Hill (J.E.F.); Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown (W.M.C.), Walter-Brendel-Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany (E.D.); Division of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (N.V.R.); and Departments of Internal Medicine and Cell Biology, Yale Cardiovascular Research Center, New Haven, CT (M.S.)
| | - Elisabeth Deindl
- From the Departments of Cell Biology and Physiology, University of North Carolina, Chapel Hill (J.E.F.); Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown (W.M.C.), Walter-Brendel-Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany (E.D.); Division of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (N.V.R.); and Departments of Internal Medicine and Cell Biology, Yale Cardiovascular Research Center, New Haven, CT (M.S.)
| | - Niels van Royen
- From the Departments of Cell Biology and Physiology, University of North Carolina, Chapel Hill (J.E.F.); Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown (W.M.C.), Walter-Brendel-Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany (E.D.); Division of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (N.V.R.); and Departments of Internal Medicine and Cell Biology, Yale Cardiovascular Research Center, New Haven, CT (M.S.)
| | - Michael Simons
- From the Departments of Cell Biology and Physiology, University of North Carolina, Chapel Hill (J.E.F.); Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown (W.M.C.), Walter-Brendel-Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany (E.D.); Division of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (N.V.R.); and Departments of Internal Medicine and Cell Biology, Yale Cardiovascular Research Center, New Haven, CT (M.S.)
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El polimorfismo de un solo nucleótido PLAU P141L se asocia con el grado de circulación colateral en pacientes con enfermedad arterial coronaria. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Chronic total occlusions (CTOs) are often detected on diagnostic coronary angiograms, but percutaneous coronary intervention (PCI) for CTO is currently infrequently performed owing to high technical difficulty, perceived risk of complications, and a lack of randomized data. However, successful CTO-PCI can significantly increase a patient's quality of life, improve left ventricular function, reduce the need for subsequent CABG surgery, and possibly improve long-term survival. A number of factors must be taken into account for the selection of patients for CTO-PCI, including the extent of ischaemia surrounding the occlusion, the level of myocardial viability, coronary location of the CTO, and probability of procedural success. Moreover, in patients with ST-segment elevation myocardial infarction, a CTO in a noninfarct-related artery might lead to an increase in infarct area, increased end-diastolic left ventricular pressure, and decreased left ventricular function, which are all associated with poor clinical outcomes. In this Review, we provide an overview of the anatomy and histopathology of CTOs, perceived benefits of CTO-PCI, considerations for patient selection for this procedure, and a summary of emerging techniques for CTO-PCI.
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Pacini S, Petrini I. Are MSCs angiogenic cells? New insights on human nestin-positive bone marrow-derived multipotent cells. Front Cell Dev Biol 2014; 2:20. [PMID: 25364727 PMCID: PMC4207020 DOI: 10.3389/fcell.2014.00020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/30/2014] [Indexed: 01/09/2023] Open
Abstract
Recent investigations have made considerable progress in the understanding of tissue regeneration driven by mesenchymal stromal cells (MSCs). Data indicate the anatomical location of MSC as residing in the “perivascular” space of blood vessels dispersed across the whole body. This histological localization suggests that MSCs contribute to the formation of new blood vessels in vivo. Indeed, MSCs can release angiogenic factors and protease to facilitate blood vessel formation and in vitro are able to promote/support angiogenesis. However, the direct differentiation of MCSs into endothelial cells is still matter of debate. Most of the conflicting data might arise from the presence of multiple subtypes of cells with heterogeneous morpho functional features within the MSC cultures. According to this scenario, we hypothesize that the presence of the recently described Mesodermal Progenitor Cells (MPCs) within the MSCs cultures is responsible for their variable angiogenic potential. Indeed, MPCs are Nestin-positive CD31-positive cells exhibiting angiogenic potential that differentiate in MSC upon proper stimuli. The ISCT criteria do not account for the presence of MPC within MSC culture generating confusion in the interpretation of MSC angiogenic potential. In conclusion, the discovery of MPC gives new insight in defining MSC ancestors in human bone marrow, and indicates the tunica intima as a further, and previously overlooked, possible additional source of MSC.
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Affiliation(s)
- Simone Pacini
- Department of Clinical and Experimental Medicine, University of Pisa Pisa, Italy
| | - Iacopo Petrini
- Department of Clinical and Experimental Medicine, University of Pisa Pisa, Italy
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