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Ganes A, Henderson J, Samuel R, Segan L, Hiew C, Hutchison A. Early coronary angiography in NSTEMI: a regional Victorian perspective. Intern Med J 2024. [PMID: 38958050 DOI: 10.1111/imj.16465] [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: 03/07/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Current guidelines highlight a paucity of evidence guiding optimal timing for non-ST-elevation myocardial infarction (NSTEMI) in high-risk and non-high-risk cases. AIM We assessed long-term major adverse cardiovascular events (MACEs) in NSTEMI patients undergoing early (<24 h) versus delayed (>24 h) coronary angiography at 6 years. Secondary end-points included all-cause mortality and cumulative MACE outcomes. METHODS Baseline characteristics and clinical outcomes were assessed among 355 patients presenting to a tertiary regional hospital between 2017 and 2018. Cox proportional hazard models were generated for MACE and all-cause mortality outcomes, adjusting for the Global Registry of Acute Coronary Events (GRACE) score, patient demographics, biomarkers and comorbidities. RESULTS Two hundred and seventy patients were included; 147 (54.4%) and 123 (45.6%) underwent early and delayed coronary angiography respectively. Median time to coronary angiography was 13.3 and 45.4 h respectively. At 6 years, 103 patients (38.1%) experienced MACE; 41 in the early group and 62 in the delayed group (hazard ratio (HR) = 2.23; 95% confidence interval (CI) = 1.50-3.31). After multivariable adjustment, the delayed group had higher rates of MACE (HR = 1.79; 95% CI = 1.19-2.70), all-cause mortality (HR = 2.76; 95% CI = 1.36-5.63) and cumulative MACE (incidence rate ratio = 1.54; 95% CI = 1.12-2.11). Subgroup analysis of MACE outcomes in rural and weekend NSTEMI presentations was not significant between early and delayed coronary angiography (HR = 1.49; 95% CI = 0.83-2.62). CONCLUSION Higher MACE rates in the delayed intervention group suggest further investigation is needed. Randomised control trials would be well suited to assess the role of early invasive intervention across all NSTEMI risk groups.
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Affiliation(s)
- Anand Ganes
- Department of Cardiology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - James Henderson
- Department of Cardiology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | | | | | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Adam Hutchison
- Department of Cardiology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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2
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Suh JW, Memtsas V, Gue YX, Cho HW, Lee W, Kang SH, Gorog DA. Ethnic Differences in Thrombotic Profiles of Acute Coronary Syndrome Patients and Relationship to Cardiovascular Outcomes: A Comparison of East Asian and White subjects. Thromb Haemost 2024; 124:501-516. [PMID: 38158199 PMCID: PMC11126334 DOI: 10.1055/s-0043-1777794] [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] [Received: 05/26/2023] [Accepted: 10/27/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND East Asians (EAs), compared to white Caucasians (W), have a lower risk of ischemic heart disease and a higher risk of bleeding with antithrombotic medications. The underlying mechanisms are incompletely understood. OBJECTIVES We sought to compare thrombotic profiles of EA and W patients with myocardial infarction (MI) and relate these to cardiovascular outcomes. METHODS In a prospective study in the United Kingdom and Korea, blood samples from patients (n = 515) with ST- or non-ST-elevation MI (STEMI and NSTEMI) were assessed using the Global Thrombosis Test, measuring thrombotic occlusion (OT) and endogenous fibrinolysis (lysis time [LT]). Patients were followed for 1 year for major adverse cardiovascular events (MACE) and bleeding. RESULTS EA patients showed reduced OT (longer OT) compared to W (646 seconds [470-818] vs. 436 seconds [320-580], p < 0.001), with similar LT. In STEMI, OT (588 seconds [440-759] vs. 361 seconds [274-462], p < 0.001) and LT (1,854 seconds [1,389-2,729] vs. 1,338 seconds [1,104-1,788], p < 0.001) were longer in EA than W. In NSTEMI, OT was longer (OT: 734 seconds [541-866] vs. 580 seconds [474-712], p < 0.001) and LT shorter (1519 seconds [1,058-2,508] vs. 1,898 seconds [1,614-2,806], p = 0.004) in EA than W patients. MACE was more frequent in W than EA (6.3 vs. 1.9%, p = 0.014) and bleeding infrequent. While OT was unrelated, LT was a strong independent predictor of MACE event after adjustment for risk factors (hazard ratio: 3.70, 95% confidence interval: 1.43-9.57, p = 0.007), predominantly in W patients, and more so in STEMI than NSTEMI patients. CONCLUSION EA patients exhibit different global thrombotic profiles to W, associated with a lower rate of cardiovascular events.
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Affiliation(s)
- Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Vassilios Memtsas
- Cardiovascular Division, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ying X Gue
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Hyoung-Won Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Wonjae Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Diana A. Gorog
- Cardiovascular Division, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
- Centre for Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom
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3
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Frol S, Pretnar Oblak J, Šabovič M, Ntaios G, Kermer P. Idarucizumab in dabigatran-treated patients with acute stroke: a review and clinical update. Front Neurol 2024; 15:1389283. [PMID: 38817549 PMCID: PMC11137220 DOI: 10.3389/fneur.2024.1389283] [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: 02/21/2024] [Accepted: 04/19/2024] [Indexed: 06/01/2024] Open
Abstract
Idarucizumab is an antibody fragment specific for the immediate reversal of dabigatran anticoagulation effects. The use of idarucizumab is approved for dabigatran-treated patients suffering from life-threatening or uncontrolled bleeding and those in need of urgent surgery or invasive procedures. Data from randomized controlled clinical trials and real-world experience provide reassuring evidence about the efficacy and safety of idarucizmab use in patients with acute stroke. In this narrative review, we summarize the available real-world evidence and discuss the relevance and importance of idarucizumab treatment in acute stroke patients in everyday clinical practice. In addition, we also discuss special issues like prothrombin complex concentrate application as an alternative to idarucizumab, its application before endovascular therapy, sensitivity of thrombi to lysis, and necessary laboratory examinations.
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Affiliation(s)
- Senta Frol
- Department of Vascular Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Janja Pretnar Oblak
- Department of Vascular Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mišo Šabovič
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Disorders, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - George Ntaios
- Faculty of Medicine, Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Pawel Kermer
- Department of Neurology, Nordwest-Krankenhaus Sanderbusch, Friesland Kliniken GmbH, Sande, Germany
- University Medical Center Göttingen, Göttingen, Germany
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4
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Wu H, Yang L, Luo R, Li L, Zheng T, Huang K, Qin Y, Yang X, Zhang X, Wang Y. A drug-free cardiovascular stent functionalized with tailored collagen supports in-situ healing of vascular tissues. Nat Commun 2024; 15:735. [PMID: 38272886 PMCID: PMC10810808 DOI: 10.1038/s41467-024-44902-2] [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] [Received: 07/04/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
Drug-eluting stent implantation suppresses the excessive proliferation of smooth muscle cells to reduce in-stent restenosis. However, the efficacy of drug-eluting stents remains limited due to delayed reendothelialization, impaired intimal remodeling, and potentially increased late restenosis. Here, we show that a drug-free coating formulation functionalized with tailored recombinant humanized type III collagen exerts one-produces-multi effects in response to injured tissue following stent implantation. We demonstrate that the one-produces-multi coating possesses anticoagulation, anti-inflammatory, and intimal hyperplasia suppression properties. We perform transcriptome analysis to indicate that the drug-free coating favors the endothelialization process and induces the conversion of smooth muscle cells to a contractile phenotype. We find that compared to drug-eluting stents, our drug-free stent reduces in-stent restenosis in rabbit and porcine models and improves vascular neointimal healing in a rabbit model. Collectively, the one-produces-multi drug-free system represents a promising strategy for the next-generation of stents.
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Affiliation(s)
- Haoshuang Wu
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, Chengdu, 610065, China
| | - Li Yang
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, Chengdu, 610065, China
| | - Rifang Luo
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, Chengdu, 610065, China
| | - Li Li
- Institute of Clinical Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Tiantian Zheng
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, Chengdu, 610065, China
| | - Kaiyang Huang
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, Chengdu, 610065, China
| | - Yumei Qin
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, Chengdu, 610065, China
| | - Xia Yang
- Shanxi Key Laboratory of Functional Proteins, Shanxi Jinbo Bio-Pharmaceutical Co., Ltd., Taiyuan, 030032, Shanxi, China
| | - Xingdong Zhang
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, Chengdu, 610065, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, Chengdu, 610065, China.
- Tianfu Jincheng Laboratory (Frontier Medical Center), Chengdu, 610213, China.
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5
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Teeraratkul C, Tomaiuolo M, Stalker TJ, Mukherjee D. Investigating clot-flow interactions by integrating intravital imaging with in silico modeling for analysis of flow, transport, and hemodynamic forces. Sci Rep 2024; 14:696. [PMID: 38184693 PMCID: PMC10771506 DOI: 10.1038/s41598-023-49945-x] [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] [Received: 05/03/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024] Open
Abstract
As a blood clot forms, grows, deforms, and embolizes following a vascular injury, local clot-flow interactions lead to a highly dynamic flow environment. The local flow influences transport of biochemical species relevant for clotting, and determines the forces on the clot that in turn lead to clot deformation and embolization. Despite this central role, quantitative characterization of this dynamic clot-flow interaction and flow environment in the clot neighborhood remains a major challenge. Here, we propose an approach that integrates dynamic intravital imaging with computer geometric modeling and computational flow and transport modeling to develop a unified in silico framework to quantify the dynamic clot-flow interactions. We outline the development of the methodology referred to as Intravital Integrated In Silico Modeling or IVISim, and then demonstrate the method on a sample set of simulations comprising clot formation following laser injury in two mouse cremaster arteriole injury model data: one wild-type mouse case, and one diYF knockout mouse case. Simulation predictions are verified against experimental observations of transport of caged fluorescent Albumin (cAlb) in both models. Through these simulations, we illustrate how the IVISim methodology can provide insights into hemostatic processes, the role of flow and clot-flow interactions, and enable further investigations comparing and contrasting different biological model scenarios and parameter variations.
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Affiliation(s)
- Chayut Teeraratkul
- Paul M Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, USA
| | - Maurizio Tomaiuolo
- Cardeza Foundation for Hematologic Research, Department of Medicine, Thomas Jefferson University, Philadelphia, USA
| | | | - Debanjan Mukherjee
- Paul M Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, USA.
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van Rijn K, Schepers A, van der Meer RW, van Rijswijk CS, van Schaik J, van der Vorst JR. Therapeutic management of in-stent thrombosis after thoracic endovascular aortic repair for blunt thoracic aortic injury in a coronavirus disease 2019 patient. J Vasc Surg Cases Innov Tech 2023; 9:101297. [PMID: 37767352 PMCID: PMC10520436 DOI: 10.1016/j.jvscit.2023.101297] [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: 05/30/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023] Open
Abstract
A 27-year-old man underwent thoracic endovascular aortic repair for blunt thoracic aortic injury. Fourteen months later, he presented with intermittent paraplegia, congestive heart failure, and a decline of kidney function as a result of high-grade aortic stenosis caused by in-stent thrombosis. He had a concurrent infection with coronavirus disease 2019. The patient was successfully treated using axillofemoral bypass, followed by stent relining 2 weeks later. The possible risk factors and the optimal therapeutic approach for in-stent thrombosis remain unknown, because only a limited number of cases describing this rare complication have been reported.
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Affiliation(s)
- Karen van Rijn
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Jan van Schaik
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joost R. van der Vorst
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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7
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Farag M, Peverelli M, Spinthakis N, Gue YX, Egred M, Gorog DA. Spontaneous Reperfusion in Patients with Transient ST-Elevation Myocardial Infarction-Prevalence, Importance and Approaches to Management. Cardiovasc Drugs Ther 2023; 37:169-180. [PMID: 34245445 DOI: 10.1007/s10557-021-07226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 01/19/2023]
Abstract
Patients with transient ST-elevation myocardial infarction (STEMI) or spontaneous resolution (SpR) of the ST-segment elevation on electrocardiogram could potentially represent a unique group of patients posing a therapeutic management dilemma. In this review, we discuss the potential mechanisms underlying SpR, its relation to clinical outcomes and the proposed management options for patients with transient STEMI with a focus on immediate versus early percutaneous coronary intervention. We performed a structured literature search of PubMed and Cochrane Library databases from inception to December 2020. Studies focused on SpR in patients with acute coronary syndrome were selected. Available data suggest that deferral of angiography and revascularization within 24-48 h in these patients is reasonable and associated with similar or perhaps better outcomes than immediate angiography. Further randomized trials are needed to elucidate the best pharmacological and invasive strategies for this cohort.
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Affiliation(s)
- Mohamed Farag
- Cardiothoracic Department, Freeman Hospital, Newcastle Upon Tyne, UK.
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK.
| | - Marta Peverelli
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Nikolaos Spinthakis
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Ying X Gue
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Diana A Gorog
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
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8
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Genome-wide analyses of early-onset acute myocardial infarction identify 29 novel loci by whole genome sequencing. Hum Genet 2023; 142:231-243. [PMID: 36336746 DOI: 10.1007/s00439-022-02495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/09/2022] [Indexed: 11/08/2022]
Abstract
Early-onset acute myocardial infarction (AMI) may have a higher genetic predisposition than late-onset AMI. The present study aimed to identify and characterize germline variants that affect early-onset AMI using whole-genome sequencing (WGS). We performed a genome-wide association study based on the WGS of 1239 Koreans, including 596 early-onset AMI patients and 643 healthy individuals. Patients with AMI who underwent percutaneous coronary intervention (PCI) caused by atherothrombotic occlusive lesions were included in the study. A total of 29 novel loci were found to be associated with early-onset AMI. These loci are involved in thrombosis, fibrinolysis, inflammation, and lipid metabolism. One of the associated single nucleotide variants (SNVs), rs1614576, located upstream of PRKCB, is known to be associated with thrombus formation. Additionally, the results revealed a novel locus, rs78631167, located upstream of PLAUR which plays a critical role in regulating plasminogen activation and is related to fibrinolysis. The association between early-onset AMI and rs9357455, which is located upstream of PHACTR1 and regulates inflammation in AMI, was found. Moreover, we identified a lipid metabolism related genetic risk locus, rs5072, in the APOA1-AS gene. This study provides new evidence supporting the genetic association between early-onset AMI and thrombosis and fibrinolysis, as well as inflammation and lipid metabolism, by analyzing the whole-genome of 596 patients with early-onset AMI who have been treated with PCI. Our findings highlight potential genetic markers for the prediction and management of AMI, as well as for understanding the etiology of AMI.
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Kanji R, Leader J, Memtsas V, Gorog DA. Measuring Thrombus Stability at High Shear, Together With Thrombus Formation and Endogenous Fibrinolysis: First Experience Using the Global Thrombosis Test 3 (GTT-3). Clin Appl Thromb Hemost 2023; 29:10760296231181917. [PMID: 37551011 PMCID: PMC10411283 DOI: 10.1177/10760296231181917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 08/09/2023] Open
Abstract
Thrombus formation in a severely stenosed artery is initiated by high shear activation of platelets, with soluble platelet agonists, such as ADP and thromboxane, playing only a secondary role in the growth and stability of the thrombus. Conventional platelet function tests, however, assess only the soluble agonist-dependent pathway of platelet aggregation. As the thrombus evolves, its stability and ability to withstand dislodgement by arterial flow will determine whether complete and persistent vessel occlusion will occur. The Global Thrombosis Test (GTT), an automated point-of-care technique, simulates the formation of thrombus in whole blood under high shear flow (shear rate >12 000 s-1) and measures the time for occlusive thrombus formation and spontaneous, endogenous thrombolysis/fibrinolysis. The latest GTT-3 model subjects the growing thrombus to upstream pressure, resembling that in a medium-sized artery, and provides an additional assessment of thrombus stability and fibrinolysis rate. It can be used in 3 programs, including a new "hypershear" mode, whereby repetitive cycles of pressure are applied to the growing thrombus, increasing shear rate to ∼22 000 s-1, such as that in patients on mechanical circulatory support. In addition to assessing the risk of arterial thrombosis, the GTT-3 could be used to assess the impact of antithrombotic medications on thrombus stability at high shear. Although current antiplatelet medications target the biochemical axis of platelet aggregation (soluble agonists) and also increase bleeding risk, novel shear-selective antiplatelet therapies may prevent thrombosis while preserving hemostasis. Future studies are needed to assess the usefulness of assessing thrombus stability on cardiovascular and pharmacological evaluation.
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Affiliation(s)
- Rahim Kanji
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, London, UK
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joshua Leader
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, London, UK
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Vassilios Memtsas
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, London, UK
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Diana A Gorog
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, London, UK
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
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Ye F, Zhang B, Qiu L, Zhang Y, Zhang Y, Zhang J, Zhao Q, Lu L, Zhang Z. In vivo real-time red blood cell migration and microcirculation flow synergy imaging-surveyed thrombolytic therapy with iron-oxide complexes. Mater Today Bio 2022; 16:100408. [PMID: 36097598 PMCID: PMC9463387 DOI: 10.1016/j.mtbio.2022.100408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
Nanotherapeutics as a nascent method has attracted widely interest on the treatment of thrombosis. However, due to the limited temporal and spatial resolution of conventional imaging modalities, the dynamic visualization the thrombogenesis and evaluation of the effect of thrombolytic drugs are facing severely difficulties in vivo. In addition, the development of high targeting, short circulation time, and small size thrombolysis nanotherapeutics agents requires further research. Herein, we report a synergy imaging modality that combining a label-free capillary microscopy and laser speckle microcirculation imaging, which realized dynamic visualization of single red blood cell migration and large-field dynamic blood flow. In this work, we investigated the red blood cells migration and blood flow velocity response before and after treated through introducing a functional nano-thrombolytics, iron-oxide complexes coated urokinase (IPN@UK) on an orthotopic animal model in vivo. The functionalized IPN@UK nanocomposites exhibited outstanding thrombolysis effect. Significantly, whole-course changes, including red blood cell activity, complex thrombolytic therapeutics, were well surveilled and evaluated using dual-modality combining imaging strategy. These results show this synergy imaging strategy not only can achieve multiscale non-invasive visualization of dynamic thrombus events in real-time, but also can quantify hemodynamics information of thrombus. Our study demonstrates the potential of this synergy imaging method, which for early detection of thrombus, evaluation of the effect of drug thrombolysis, developing the thrombolytic drugs, and imaging-guide thrombolytic therapy in living systems.
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Affiliation(s)
- Fei Ye
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519000, PR China
| | - Bei Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Shenzhen Research Institute of Xiamen University, Xiamen University, Xiamen, 361102, PR China
| | - Lige Qiu
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519000, PR China
| | - Yunrui Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Shenzhen Research Institute of Xiamen University, Xiamen University, Xiamen, 361102, PR China
| | - Yang Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Shenzhen Research Institute of Xiamen University, Xiamen University, Xiamen, 361102, PR China
| | - Jian Zhang
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Department of Biomedical Engineering, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, 511436, PR China
| | - Qingliang Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Shenzhen Research Institute of Xiamen University, Xiamen University, Xiamen, 361102, PR China
- Corresponding author.
| | - Ligong Lu
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519000, PR China
- Corresponding author.
| | - Zhenlin Zhang
- Department of Pharmacy, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519000, PR China
- Corresponding author.
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Chen Z, Lu W, Li Y, Liu P, Yang Y, Jiang L. Solid-Liquid State Transformable Magnetorheological Millirobot. ACS APPLIED MATERIALS & INTERFACES 2022; 14:30007-30020. [PMID: 35727886 DOI: 10.1021/acsami.2c05251] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Magnetically actuated soft millirobots (magneto-robot) capable of accomplishing on-demand tasks in a remote-control manner using noninvasive magnetic fields are of great interest in biomedical settings. However, the solid magneto-robots are usually restricted by the limited deformability due to the predesigned shape, while the liquid magneto-robots are capable of in situ shape reconfiguration but limited by the low stiffness and geometric instability due to the fluidity. Herein, we propose a magneto-active solid-liquid state transformable millirobot (named MRF-Robot) made from a magnetorheological fluid (MRF). The MRF-Robot can transform freely and rapidly between the Newtonian fluid in the liquid state upon a weak magnetic field (∼0 mT) and the Bingham plasticity in the solid state upon a strong magnetic field (∼100 mT). The MRF-Robot in the liquid state can realize diverse behaviors of large deformation, smooth navigation, in situ splitting, merging, and gradient pulling actuated by a weak magnetic field with a high gradient. The MRF-Robot in the solid state is distinguished for the controllable locomotion with reconfigured shapes and versatile object manipulations (including pull, push, and rotate the objects) driven by a strong magnetic field with a high gradient. Moreover, the MRF-Robot could continuously maneuver to accomplish diverse tasks in the comprehensive scenes and achieve liquid-drug delivery, thrombus clearance, and fluid-flow blockage in the phantom vascular model under magnetic actuation.
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Affiliation(s)
- Zhipeng Chen
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, P. R. China
| | - Weibin Lu
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, P. R. China
| | - Yuanyuan Li
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, P. R. China
| | - Pengfei Liu
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, P. R. China
| | - Yawen Yang
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, P. R. China
| | - Lelun Jiang
- Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, P. R. China
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Failure Analysis of TEVG’s II: Late Failure and Entering the Regeneration Pathway. Cells 2022; 11:cells11060939. [PMID: 35326390 PMCID: PMC8946846 DOI: 10.3390/cells11060939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 12/21/2022] Open
Abstract
Tissue-engineered vascular grafts (TEVGs) are a promising alternative to treat vascular disease under complex hemodynamic conditions. However, despite efforts from the tissue engineering and regenerative medicine fields, the interactions between the material and the biological and hemodynamic environment are still to be understood, and optimization of the rational design of vascular grafts is an open challenge. This is of special importance as TEVGs not only have to overcome the surgical requirements upon implantation, they also need to withhold the inflammatory response and sustain remodeling of the tissue. This work aims to analyze and evaluate the bio-molecular interactions and hemodynamic phenomena between blood components, cells and materials that have been reported to be related to the failure of the TEVGs during the regeneration process once the initial stages of preimplantation have been resolved, in order to tailor and refine the needed criteria for the optimal design of TEVGs.
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13
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Gorog DA, Yamamoto J. Global Thrombosis Test: Occlusion Is Attributable to Shear-Induced Platelet Thrombus Formation. TH OPEN 2022; 5:e591-e597. [PMID: 34984319 DOI: 10.1055/s-0041-1741108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom.,Clinical Pharmaceutical and Biological Science, School of Life and Medical Science, University of Hertfordshire, United Kingdom
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14
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Scarparo P, Improta R, Wilschut J, Kardys I, Den Dekker WK, Daemen J, Zijlstra F, Van Mieghem NM, Diletti R. Very long-term clinical outcomes after direct stenting in patient presenting with ST-segment elevation myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:144-150. [DOI: 10.1016/j.carrev.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 02/03/2023]
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15
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Gorog DA, Yamamoto J. Global Thrombosis Test: Occlusion Is Attributable to Shear-Induced Platelet Thrombus Formation. TH OPEN 2021. [PMID: 34984319 PMCID: PMC8847114 DOI: 10.1055/a-1704-1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Diana A. Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
- Clinical Pharmaceutical and Biological Science, School of Life and Medical Science, University of Hertfordshire, United Kingdom
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16
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Shim Y, Kwon I, Park Y, Lee HW, Kim J, Kim YD, Nam HS, Park S, Heo JH. Characterization of Ferric Chloride-Induced Arterial Thrombosis Model of Mice and the Role of Red Blood Cells in Thrombosis Acceleration. Yonsei Med J 2021; 62:1032-1041. [PMID: 34672137 PMCID: PMC8542466 DOI: 10.3349/ymj.2021.62.11.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The ferric chloride (FeCl3)-induced thrombosis model is widely used for thrombosis research. However, it lacks standardization with uncertainty in the exact mechanism of thrombosis. This study aimed to characterize thrombus formation in a mouse model. MATERIALS AND METHODS We investigated thrombus formation and stability using various FeCl3 concentrations (10%, 20%, 30%, 40%, and 50%, w/v) in carotid arteries of the Institute of Cancer Research (ICR) and C57BL/6N mice using the FeCl3-induced thrombosis model. We also investigated thrombus histopathology using immunohistochemistry and electron microscopy. RESULTS Higher FeCl3 concentrations induced dose-dependent, faster, larger, and more stable thrombus formation in both strains of mice. However, the ICR mice showed better dose-responses in thrombus formation and stability compared to the C57BL/6N mice. Thrombi were fibrin- and platelet-rich without significant changes across FeCl3 concentrations. However, the content of red blood cells (RBCs) increased with increasing FeCl3 concentrations (p for trend <0.001) and inversely correlated with time to occlusion (r=-0.65, p<0.001). While platelets and fibrin were evenly distributed over the thrombus, RBCs were predominantly located near the FeCl3 treatment area. Transmission electron microscopy showed that RBCs attached to and were surrounded by aggregates of degranulated platelets, suggesting their potential role in platelet activation. CONCLUSION Faster and larger thrombus formation is induced in a dose-dependent manner by a wide range of FeCl3 concentrations, but the stable thrombus formation requires higher FeCl3 concentrations. Mouse strain affects thrombus formation and stability. RBCs and their interaction with platelets play a key role in the acceleration of FeCl3-induced thrombosis.
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Affiliation(s)
- Yeseul Shim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Institute for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Il Kwon
- Integrative Research Institute for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Youngseon Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Institute for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Heow Won Lee
- Integrative Research Institute for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Jayoung Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Institute for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Institute for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Integrative Research Institute for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Institute for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea.
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17
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Berry J, Peaudecerf FJ, Masters NA, Neeves KB, Goldstein RE, Harper MT. An "occlusive thrombosis-on-a-chip" microfluidic device for investigating the effect of anti-thrombotic drugs. LAB ON A CHIP 2021; 21:4104-4117. [PMID: 34523623 PMCID: PMC8547327 DOI: 10.1039/d1lc00347j] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/05/2021] [Indexed: 05/03/2023]
Abstract
Cardiovascular disease remains one of the world's leading causes of death. Myocardial infarction (heart attack) is triggered by occlusion of coronary arteries by platelet-rich thrombi (clots). The development of new anti-platelet drugs to prevent myocardial infarction continues to be an active area of research and is dependent on accurately modelling the process of clot formation. Occlusive thrombi can be generated in vivo in a range of species, but these models are limited by variability and lack of relevance to human disease. Although in vitro models using human blood can overcome species-specific differences and improve translatability, many models do not generate occlusive thrombi. In those models that do achieve occlusion, time to occlusion is difficult to measure in an unbiased and objective manner. In this study we developed a simple and robust approach to determine occlusion time of a novel in vitro microfluidic assay. This highlighted the potential for occlusion to occur in thrombosis microfluidic devices through off-site coagulation, obscuring the effect of anti-platelet drugs. We therefore designed a novel occlusive thrombosis-on-a-chip microfluidic device that reliably generates occlusive thrombi at arterial shear rates by quenching downstream coagulation. We further validated our device and methods by using the approved anti-platelet drug, eptifibatide, recording a significant difference in the "time to occlude" in treated devices compared to control conditions. These results demonstrate that this device can be used to monitor the effect of antithrombotic drugs on time to occlude, and, for the first time, delivers this essential data in an unbiased and objective manner.
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Affiliation(s)
- Jess Berry
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK.
| | - François J Peaudecerf
- Department of Civil, Environmental, and Geomatic Engineering, ETH Zürich, 8093 Zürich, Switzerland
| | - Nicole A Masters
- Department of Bioengineering, Department of Pediatrics, Section of Hematology, Oncology, and Bone Marrow Transplant, Hemophilia and Thrombosis Center, University of Colorado Denver|Anschutz Medical Campus, Aurora, CO, USA
| | - Keith B Neeves
- Department of Bioengineering, Department of Pediatrics, Section of Hematology, Oncology, and Bone Marrow Transplant, Hemophilia and Thrombosis Center, University of Colorado Denver|Anschutz Medical Campus, Aurora, CO, USA
| | - Raymond E Goldstein
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, UK
| | - Matthew T Harper
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK.
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18
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Ye G, Cao R, Lu J, Qi P, Hu S, Chen K, Tan T, Chen J, Wang D. Histological composition behind CT-based thrombus density and perviousness in acute ischemic stroke. Clin Neurol Neurosurg 2021; 207:106804. [PMID: 34304067 DOI: 10.1016/j.clineuro.2021.106804] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clot composition could impact recanalization outcomes of thrombectomy, and preoperative imaging markers may help know about the histological components of thrombus. METHODS Consecutive patients who underwent thrombectomy from June 2017 to December 2019 were reviewed. The mean Hounsfield unit (HU) of thrombus (aHU) and contralateral artery (cHU) were recorded based on non-enhanced CT. The relative thrombus density was calculated (dHU=aHU-cHU). Hyperdense artery sign (HAS) was identified if dHU≥ 4HU. The clot perviousness was evaluated via thrombus attenuation increase (δHU) on contrast-enhanced CT compared to non-enhanced CT. Pervious clots were identified when δHU≥ 11HU. Tissue quantification for thrombus was based on Martius Scarlet Blue staining, using the Orbit Imaging Analysis Software. Spearman rank correlations was used to detect the association between imaging markers and clot composition. The differences in clinical characteristics were compared according to the presence of HAS or pervious clots. RESULTS Fifty-three patients were included. The dHU was positively correlated with erythrocyte fractions (r = 0.337, p = 0.014), while there was no significant association between aHU and erythrocyte components (r = 0.146, p = 0.296). HAS (+) patients showed a comparable proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3 (94.6% vs. 87.5%, p = 0.740) and modified Rankin Scale score (mRS) 0-2 (35.1% vs. 56.3%, p = 0.152) compared with those HAS (-). Forty-seven cases were available for the analysis of clot perviousness. Clot perviousness was negatively associated with platelet fractions (r = -0.577, p < 0.001). Patients with pervious clots also showed a comparable proportion of mTICI 2b-3 (86.2% vs. 100%, p = 0.283) and mRS 0-2 (37.9% vs. 50.0%, p = 0.416) compared with impervious clots. CONCLUSIONS This study suggests that relative thrombus density was positively correlated with erythrocyte fractions, while clot perviousness showed a negative relationship with platelet components. Yet, the presence of HAS or pervious clots did not show significant associations with recanalization and clinical outcomes. The conclusions should be drawn with caution.
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Affiliation(s)
- Gengfan Ye
- Department of Neurosurgery, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, PR China
| | - Ruoyao Cao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Tianhua Tan
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China.
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19
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Kanji R, Kubica J, Navarese EP, Gorog DA. Endogenous fibrinolysis-Relevance to clinical thrombosis risk assessment. Eur J Clin Invest 2021; 51:e13471. [PMID: 33296082 DOI: 10.1111/eci.13471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/11/2022]
Abstract
The development of an obstructive luminal thrombus is pathological and considered a failure of endogenous fibrinolysis. The consequences may be fatal, or result in lasting downstream organ damage. Therefore, assessment of endogenous fibrinolytic status in an individual may identify those at risk of occlusive thrombus formation and provide prognostic information. Arterial thrombi are more platelet rich and more resistant to fibrinolysis than venous thrombi. Several recent studies using global tests of fibrinolysis in patients with acute coronary syndromes (ACS) have shown that despite dual antiplatelet therapy, patients with impaired fibrinolytic status have an increased risk of adverse cardiovascular events, compared with those with effective fibrinolytic function. Such data add significantly to the predictive value of established cardiovascular risk factors and conventional biomarkers. Most data reported have been obtained with the Global Thrombosis Test and the turbidimetric plasma clot lysis assay. A few small studies in patients with ischaemic stroke suggest a similar predictive role of fibrinolytic status assessment in these patients. Studies reporting an association between impaired fibrinolysis and future venous thrombotic events are limited, and in the form of case-control studies. Viscoelastic assays may have a role in the prediction of venous thromboembolic risk. Assays of fibrinolytic function should be used to obtain a more accurate risk of future thrombotic events, particularly in the setting of ACS. The availability of point-of-care tests helps facilitate this and should encourage future studies to assess personalised antithrombotic treatment combinations to optimise fibrinolytic status and reduce thrombosis risk.
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Affiliation(s)
- Rahim Kanji
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.,Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Eliano P Navarese
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.,Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.,Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, UK.,School of Life and Medical Sciences, Postgraduate Medical School, University of Hertfordshire, Stevenage, UK
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20
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Lanzer P, Widimsky P, Gorog DA, Mazighi M, Liebeskind D, Cognard C. Endovascular thrombectomy 2020: open issues. Eur Heart J Suppl 2021; 22:M13-M18. [PMID: 33664635 PMCID: PMC7916414 DOI: 10.1093/eurheartj/suaa161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mechanical thrombectomy is now well - established first - line treatment for selected patients with large artery occlusions of the anterior circulation. However, number of technical and procedural issues remains open to assure optimal outcomes in majority of patients including those suffering from posterior circulation perfusion defects. This brief review addresses some of the open issues and refers to the ongoing trials to close the existing knowledge gaps.
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Affiliation(s)
- Peter Lanzer
- Cardiovascular Medicine,Mitteldeutsches Herzzentrum Standort Bitterfeld, Klinikum Bitterfeld-Wolfen, Friedrich-Ludwig-Jahn-Straße 2, D-06749 Bitterfeld-Wolfen, Germany
| | - Petr Widimsky
- Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Diana A Gorog
- Department of Medicine, National Heart & Lung Institute, Imperial College, London, UK.,Cardiology, Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
| | - Mikael Mazighi
- Stroke Unit, Lariboisière Hospital, Paris, France.,Department of Interventional Neuroradiology Department - Fondation Ophtalmologique Adolphe de Rothschild Hospital, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris University, Paris, France
| | - David Liebeskind
- Neurology, Neurology Statename California, Ronald Reagan UCLA Medical Center, USA
| | - Christophe Cognard
- Department of Neuroradiology, University Hopital Pierre Paul Riquet, Toulouse, France
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21
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Eun MY, Kim JY, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Kim CK, Oh K, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Seo WK. Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke. J Stroke 2021; 23:113-123. [PMID: 33600708 PMCID: PMC7900398 DOI: 10.5853/jos.2020.03440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF). METHODS Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered. RESULTS Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups. CONCLUSIONS ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.
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Affiliation(s)
- Mi-Yeon Eun
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Young Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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22
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Teeraratkul C, Irwin Z, Shadden SC, Mukherjee D. Computational investigation of blood flow and flow-mediated transport in arterial thrombus neighborhood. Biomech Model Mechanobiol 2021; 20:701-715. [PMID: 33438148 DOI: 10.1007/s10237-020-01411-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022]
Abstract
A pathologically formed blood clot or thrombus is central to major cardiovascular diseases like heart attack and stroke. Detailed quantitative evaluation of flow and flow-mediated transport processes in the thrombus neighborhood within large artery hemodynamics is crucial for understanding disease progression and assessing treatment efficacy. This, however, remains a challenging task owing to the complexity of pulsatile viscous flow interactions with arbitrary shape and heterogeneous microstructure of realistic thrombi. Here, we address this challenge by conducting a systematic parametric simulation-based study on characterizing unsteady hemodynamics and flow-mediated transport in the neighborhood of an arterial thrombus. We use a hybrid particle-continuum-based finite element approach to handle arbitrary thrombus shape and microstructural variations. Results from a cohort of 50 different unsteady flow scenarios are presented, including unsteady vortical structures, pressure gradient across the thrombus boundary, finite time Lyapunov exponents, and dynamic coherent structures that organize advective transport. We clearly illustrate the combined influence of three key parameters-thrombus shape, microstructure, and extent of wall disease-in terms of: (a) determining hemodynamic features in the thrombus neighborhood and (b) governing the balance between advection, permeation, and diffusion to regulate transport processes in the thrombus neighborhood.
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Affiliation(s)
- Chayut Teeraratkul
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, United States of America
| | - Zachariah Irwin
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, United States of America
| | - Shawn C Shadden
- Department of Mechanical Engineering, University of California, Berkeley, United States of America
| | - Debanjan Mukherjee
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, United States of America.
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23
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Wu H, Su M, Jin H, Li X, Wang P, Chen J, Chen J. Rutin-Loaded Silver Nanoparticles With Antithrombotic Function. Front Bioeng Biotechnol 2020; 8:598977. [PMID: 33324624 PMCID: PMC7723967 DOI: 10.3389/fbioe.2020.598977] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
In this paper, we fabricated rutin-loaded silver nanoparticles (Rutin@AgNPs) as the nano-anticoagulant with antithrombotic function. The serum stability, anticoagulation activity, and bleeding risk of Rutin@AgNPs were evaluated. The results showed Rutin@AgNPs had good serum stability, hemocompatibility, and cytocompatibility. The anticoagulation activity of rutin was maintained, and its stability and aqueous solubility were improved. The Rutin@AgNPs could provide a sustained release to prolong the half-life of rutin. The results of the coagulation parameter assay and thrombus formation test in mice model showed that the activated partial thromboplastin time and prothrombin time were prolonged, and Rutin@AgNPs inhibited the thrombosis in the 48 h period. Moreover, the limited bleeding time indicated that the Rutin@AgNPs significantly minimized the hemorrhage risk of rutin. This Rutin@AgNPs is a potential anticoagulant for antithrombotic therapy.
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Affiliation(s)
| | | | | | | | | | - Jingxiao Chen
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Pharmaceutical Sciences, Jiangnan University, Wuxi, China
| | - Jinghua Chen
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Pharmaceutical Sciences, Jiangnan University, Wuxi, China
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24
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Abstract
Studies using whole blood platelet aggregometry as a laboratory research tool, provided important insights into the mechanism and modulators of platelet aggregation. Subsequently, a number of point-of-care (POC) platelet function tests (PFTs) were developed for clinical use, based on the concept that an individual’s thrombotic profile could be assessed in vitro by assessing the response to stimulation of platelet aggregation by specific, usually solo agonists such as adenosine diphosphate (ADP), collagen and thrombin. However, adjusting antiplatelet medication in order to improve the results of such POC PFTs has not translated into a meaningful reduction in cardiovascular events, which may be attributable to important differences between the POC PFT techniques and in vivo conditions, including patient-to-patient variability. Important limitations of most tests include the use of citrate-anticoagulated blood. Citrate directly and irreversibly diminishes platelet function and even after recalcification, it may result in altered platelet aggregation in response to ADP, epinephrine or collagen, and interfere with thrombin generation from activated platelets. Furthermore, most tests do not employ flowing blood and therefore do not assess the effect of high shear forces on platelets that initiate, propagate and stabilize arterial thrombi. Finally, the effect of endogenous thrombolysis, due to fibrinolysis and dislodgement, which ultimately determines the outcome of a thrombotic stimulus, is mostly not assessed. In order to accurately reflect an individual’s predisposition to arterial thrombosis, future tests of thrombotic status which overcome these limitations should be used, to improve cardiovascular risk prediction and to guide pharmacotherapy.
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Affiliation(s)
- Diana A Gorog
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London, SW3 6LY, UK.
- University of Hertfordshire, Hertfordshire, UK.
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Novotny J, Oberdieck P, Titova A, Pelisek J, Chandraratne S, Nicol P, Hapfelmeier A, Joner M, Maegdefessel L, Poppert H, Pircher J, Massberg S, Friedrich B, Zimmer C, Schulz C, Boeckh-Behrens T. Thrombus NET content is associated with clinical outcome in stroke and myocardial infarction. Neurology 2020; 94:e2346-e2360. [PMID: 32434865 DOI: 10.1212/wnl.0000000000009532] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 01/07/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To investigate whether immune cell composition and content of neutrophil extracellular traps (NETs) in relation to clinical outcome are different between acute ischemic stroke (AIS) and acute myocardial infarction (AMI), we performed histologic analysis and correlated results with clinical and procedural parameters. METHODS We retrieved thrombi from patients with AIS (n = 71) and AMI (n = 72) during endovascular arterial recanalization and analyzed their immune cell composition and NET content by immunohistology. We then associated thrombus composition with procedural parameters and outcome in AIS and with cardiac function in patients with AMI. Furthermore, we compared AIS thrombi with AMI thrombi and differentiated Trial of Org 10172 in Acute Stroke Treatment classifications to address potential differences in thrombus pathogenesis. RESULTS Amounts of leukocytes (p = 0.133) and neutrophils (p = 0.56) were similar between AIS and AMI thrombi. Monocytes (p = 0.0052), eosinophils (p < 0.0001), B cells (p < 0.0001), and T cells (p < 0.0001) were more abundant in stroke compared with AMI thrombi. NETs were present in 100% of patients with AIS and 20.8% of patients with AMI. Their abundance in thrombi was associated with poor outcome scores in patients with AIS and with reduced ejection fraction in patients with AMI. CONCLUSION In our detailed histologic analysis of arterial thrombi, thrombus composition and especially abundance of leukocyte subsets differed between patients with AIS and AMI. The presence and amount of NETs were associated with patients' outcome after AIS and AMI, supporting a critical impact of NETs on thrombus stability in both conditions.
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Affiliation(s)
- Julia Novotny
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Paul Oberdieck
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Anna Titova
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Jaroslav Pelisek
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Sue Chandraratne
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Philipp Nicol
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Alexander Hapfelmeier
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Michael Joner
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Lars Maegdefessel
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Holger Poppert
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Joachim Pircher
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Steffen Massberg
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Benjamin Friedrich
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Claus Zimmer
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany
| | - Christian Schulz
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany.
| | - Tobias Boeckh-Behrens
- From the Medizinische Klinik und Poliklinik I (J.N., P.O., A.T., S.C., J. Pircher, S.M., C.S.), Klinikum der Universität München, Ludwig-Maximilians-Universität; DZHK (German Center for Cardiovascular Research) (J.N., P.N., M.J., L.M., J. Pircher, S.M., C.S.), Partner Site Munich Heart Alliance; Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie (J. Pelisek, L.M.), Klinikum rechts der Isar, Technische Universität München; Deutsches Herzzentrum München (P.N., M.J.), Technische Universität München; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, School of Medicine, Technische Universität München; Neurologische Klinik und Poliklinik (H.P.), Klinikum rechts der Isar, Technische Universität München; and Abteilung für Diagnostische und Interventionelle Neuroradiologie (B.F., C.Z., T.B.-B.), Klinikum rechts der Isar, Technische Universität München, Germany.
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Su M, Dai Q, Chen C, Zeng Y, Chu C, Liu G. Nano-Medicine for Thrombosis: A Precise Diagnosis and Treatment Strategy. NANO-MICRO LETTERS 2020; 12:96. [PMID: 34138079 PMCID: PMC7770919 DOI: 10.1007/s40820-020-00434-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/13/2020] [Indexed: 05/11/2023]
Abstract
Thrombosis is a global health issue and one of the leading factors of death. However, its diagnosis has been limited to the late stages, and its therapeutic window is too narrow to provide reasonable and effective treatment. In addition, clinical thrombolytics suffer from a short half-life, allergic reactions, inactivation, and unwanted tissue hemorrhage. Nano-medicines have gained extensive attention in diagnosis, drug delivery, and photo/sound/magnetic-theranostics due to their convertible properties. Furthermore, diagnosis and treatment of thrombosis using nano-medicines have also been widely studied. This review summarizes the recent advances in this area, which revealed six types of nanoparticle approaches: (1) in vitro diagnostic kits using "synthetic biomarkers"; (2) in vivo imaging using nano-contrast agents; (3) targeted drug delivery systems using artificial nanoparticles; (4) microenvironment responsive drug delivery systems; (5) drug delivery systems using biological nanostructures; and (6) treatments with external irradiation. The investigations of nano-medicines are believed to be of great significance, and some of the advanced drug delivery systems show potential applications in clinical theranotics.
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Affiliation(s)
- Min Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine School of Public Health, Xiamen University, Xiamen, 361102, People's Republic of China
- State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, People's Republic of China
| | - Qixuan Dai
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine School of Public Health, Xiamen University, Xiamen, 361102, People's Republic of China
| | - Chuan Chen
- Department of Pharmacy, Xiamen Medical College, Xiamen, 361023, People's Republic of China
| | - Yun Zeng
- Department of Pharmacy, Xiamen Medical College, Xiamen, 361023, People's Republic of China
| | - Chengchao Chu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine School of Public Health, Xiamen University, Xiamen, 361102, People's Republic of China.
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361102, People's Republic of China.
| | - Gang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine School of Public Health, Xiamen University, Xiamen, 361102, People's Republic of China.
- State Key Laboratory of Physical Chemistry of Solid Surfaces, The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, People's Republic of China.
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Sinnaeve PR, Van de Werf F. Endogenous fibrinolysis in STEMI: important before and after primary PCI. Eur Heart J 2020; 40:306-308. [PMID: 30496395 DOI: 10.1093/eurheartj/ehy760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Peter R Sinnaeve
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Chernysh IN, Spiewak R, Cambor CL, Purohit PK, Weisel JW. Structure, mechanical properties, and modeling of cyclically compressed pulmonary emboli. J Mech Behav Biomed Mater 2020; 105:103699. [PMID: 32279846 DOI: 10.1016/j.jmbbm.2020.103699] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/15/2022]
Abstract
Pulmonary embolism occurs when blood flow to a part of the lungs is blocked by a venous thrombus that has traveled from the lower limbs. Little is known about the mechanical behavior of emboli under compressive forces from the surrounding musculature and blood pressure. We measured the stress-strain responses of human pulmonary emboli under cyclic compression, and showed that emboli exhibit a hysteretic stress-strain curve. The fibrin fibers and red blood cells (RBCs) are damaged during the compression process, causing irreversible changes in the structure of the emboli. We showed using electron and confocal microscopy that bundling of fibrin fibers occurs due to compression, and damage is accumulated as more cycles are applied. The stress-strain curves depend on embolus structure, such that variations in composition give quantitatively different responses. Emboli with a high fibrin component demonstrate higher normal stress compared to emboli that have a high RBC component. We compared the compression response of emboli to that of whole blood clots containing various volume fractions of RBCs, and found that RBCs rupture at a certain critical stress. We describe the hysteretic response characteristic of foams, using a model of phase transitions in which the compressed foam is segregated into coexisting rarefied and densified phases whose fractions change during compression. Our model takes account of the rupture of RBCs in the compressed emboli and stresses due to fluid flow through their small pores. Our results can help in classifying emboli as rich in fibrin or rich in red blood cells, and can help in understanding what responses to expect when stresses are applied to thrombi in vivo.
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Affiliation(s)
- Irina N Chernysh
- Department of Cell Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Russell Spiewak
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Carolyn L Cambor
- Department of Pathology and Laboratory of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Prashant K Purohit
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - John W Weisel
- Department of Cell Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Affiliation(s)
- Luca Liberale
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Diana A Gorog
- School of Life and Medical Sciences, Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, London, UK
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Bang OY, Kim BM, Seo WK, Jeon P. Endovascular Therapy for Acute Ischemic Stroke of Intracranial Atherosclerotic Origin-Neuroimaging Perspectives. Front Neurol 2019; 10:269. [PMID: 30949124 PMCID: PMC6435574 DOI: 10.3389/fneur.2019.00269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/28/2019] [Indexed: 12/18/2022] Open
Abstract
Large vessel occlusion (LVO) due to intracranial atherosclerosis (ICAS) is a common cause of acute ischemic stroke (AIS) in Asians. Endovascular therapy (EVT) has been established as the mainstay of treatment in patients with AIS and LVO. However, only a few patients of Asian descent with ICAS-related LVO (ICAS-LVO) were included in recent randomized controlled trials of EVT for AIS. Therefore, the findings of these trials cannot be directly applied to Asian patients with ICAS-LVO. In embolic LVO due to thrombus from the heart or a more proximal vessel, rapid, and complete recanalization can be achieved in more than 70-80% of patients, and it is important to exclude patients with large cores. In contrast, patients with ICAS-LVO usually have favorable hemodynamic profiles (good collateral status, small core, and less severe perfusion deficit), but poor response to EVT (more rescue treatments and longer procedure times are required for successful recanalization due to higher rates of reocclusion). Patients with ICAS-LVO may have different anatomic (plaque, angioarchitecture), hemodynamic (collateral status), and pathophysiologic (thrombus composition) features on neuroimaging compared to patients with embolic LVO. In this review, we discuss these neuroimaging features, their clinical implications with respect to determination of EVT responses, and the need for development of specific EVT devices and procedures for patients with ICAS-LVO.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Shear rate-dependent thrombosis/fibrinolysis tests using non-anticoagulated blood could be useful in the prevention of thrombotic disorders. Future Sci OA 2019; 5:FSO357. [PMID: 30820342 PMCID: PMC6391630 DOI: 10.4155/fsoa-2018-0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/16/2018] [Indexed: 12/04/2022] Open
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Spinthakis N, Farag M, Gue YX, Srinivasan M, Wellsted DM, Gorog DA. Effect of P2Y 12 inhibitors on thrombus stability and endogenous fibrinolysis. Thromb Res 2018; 173:102-108. [PMID: 30500673 DOI: 10.1016/j.thromres.2018.11.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/14/2018] [Accepted: 11/22/2018] [Indexed: 01/01/2023]
Abstract
Although used routinely to reduce thrombotic events in patients with coronary disease, the effects of P2Y12 inhibitors on thrombus stability and endogenous fibrinolysis are largely unknown. Blood taken from patients pre- and post-aspirin (n = 20) and on aspirin alone and on dual antiplatelet therapy comprising aspirin plus clopidogrel (n = 20), ticagrelor (n = 20) or cangrelor (n = 20), was tested using the Global Thrombosis Test. The number of "rebleeds" or drops (D) after early platelet-rich thrombus formation (occlusion time, OT), and before final lasting occlusion, was used as an inverse measure of thrombus stability. Whilst clopidogrel had no effect, ticagrelor and cangrelor both increased D significantly, reflecting increased thrombus instability [D pre- and post-clopidogrel 4.3 ± 1.6 vs. 4.5 ± 1.4, p = 0.833; pre- and post-ticagrelor 4.1 ± 2.4 vs. 6.8 ± 5.1, p = 0.048; pre- and post-cangrelor 3.6 ± 2.0 vs. 7.9 ± 8.9, p = 0.046]. Platelet reactivity was reduced by all P2Y12 inhibitors, demonstrated by OT prolongation (clopidogrel 378 ± 87 s vs. 491 ± 93 s, p < 0.001; ticagrelor 416 ± 122 s vs. 549 ± 121 s, p < 0.001; cangrelor 381 ± 146 s vs. 613 ± 210 s, p < 0.001). The magnitude of OT prolongation compared to baseline (ΔOT) was significantly greater for cangrelor compared to clopidogrel and ticagrelor. Cangrelor was the only agent to enhance fibrinolysis (lysis time pre- and post-cangrelor 1622[1240-2048]s vs. 1388[960-1634]s, p = 0.005). We demonstrate the ability to assess the effect of pharmacotherapy on thrombus stability in vitro and show that P2Y12 inhibitors potentiate thrombus instability at high shear. Cangrelor, and to a lesser extent ticagrelor, de-stabilised thrombus formation and cangrelor also enhanced fibrinolysis. Potentiation of thrombus instability could become a new pharmacological target, that may be particularly important in acute coronary syndromes.
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Affiliation(s)
- Nikolaos Spinthakis
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK; Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | - Mohamed Farag
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK; Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | - Ying X Gue
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK; Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | | | - David M Wellsted
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Diana A Gorog
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK; Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; National Heart & Lung Institute, Imperial College, London, UK.
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Lawson PJ, Moore HB, Moore EE, Gerich ME, Stettler GR, Banerjee A, Schulick RD, Nydam TL. Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability. J Surg Res 2018; 231:54-61. [PMID: 30278969 DOI: 10.1016/j.jss.2018.04.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/07/2018] [Accepted: 04/24/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Elevated clot strength (maximum amplitude [MA]) measured by thrombelastography (TEG) is associated with thrombotic complications. However, it remains unclear how MA translates to thrombotic risks, as this measurement is independent of time, blood flow, and clot degradation. We hypothesize that under flow conditions, increased clot strength correlates to time-dependent measurements of coagulation and resistance to fibrinolysis. MATERIALS AND METHODS Surgical patients at high risk of thrombotic complications were analyzed with TEG and total thrombus-formation analysis system (T-TAS). TEG hypercoagulability was defined as an r <10.2 min, angle >59, MA >66 or LY30 <0.2% (based off of healthy control data, n = 141). The T-TAS AR and PL chips were used to measure clotting at arterial shear rates. T-TAS measurements include occlusion start time, occlusion time (OT), occlusion speed (OSp), and total clot generation (area under the curve). These measurements were correlated to TEG indices (R time, angle, MA, and LY30). Both T-TAS and TEG assays were challenged with tissue plasminogen activator (t-PA) to assess clot resistance to fibrinolysis. RESULTS Thirty subjects were analyzed, including five controls. TEG-defined hypercoagulability by MA was detected in 52% of the inflammatory bowel disease/cancer patients; 0% was detected in the controls. There were no TEG measurements that significantly correlated with T-TAS AR and PL chip. However, in the presence of t-PA, T-TAS AR determined OSp to have an inverse relationship with TEG angle (-0.477, P = 0.012) and LY30 (-0.449, P = 0.019), and a positive correlation with R time (0.441 P = 0.021). In hypercoagulability determined by TEG MA, T-TAS PL had a significantly reduced OT (4:07 versus 6:27 min, P = 0.043). In hypercoagulability defined by TEG LY30, T-TAS PL had discordant findings, with a significantly prolonged OT (6:36 versus 4:30 min, P = 0.044) and a slower OSp (10.5 versus 19.0 kPa/min, P = 0.030). CONCLUSIONS Microfluidic coagulation assessment with T-TAS has an overall poor correlation with most TEG measurements in a predominantly hypercoagulable patient population, except in the presence of t-PA. The one anticipated finding was an elevated MA having a shorter time to platelet-mediated microfluidic occlusion, supporting the role of platelets and hypercoagulability. However, hypercoagulability defined by LY30 had opposing results in which a low LY30 was associated with a longer PL time to occlusion and slower OSp. These discordant findings warrant ongoing investigation into the relationship between clot strength and fibrinolysis under different flow conditions.
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Affiliation(s)
- Peter J Lawson
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Hunter B Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
| | - Ernest E Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Denver Health Medical Center, Denver, Colorado
| | - Mark E Gerich
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Gregory R Stettler
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Anirban Banerjee
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard D Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Trevor L Nydam
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Gorog DA. Potentiation of thrombus instability: a contributory mechanism to the effectiveness of antithrombotic medications. J Thromb Thrombolysis 2018; 45:593-602. [PMID: 29550950 PMCID: PMC5889774 DOI: 10.1007/s11239-018-1641-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The stability of an arterial thrombus, determined by its structure and ability to resist endogenous fibrinolysis, is a major determinant of the extent of infarction that results from coronary or cerebrovascular thrombosis. There is ample evidence from both laboratory and clinical studies to suggest that in addition to inhibiting platelet aggregation, antithrombotic medications have shear-dependent effects, potentiating thrombus fragility and/or enhancing endogenous fibrinolysis. Such shear-dependent effects, potentiating the fragility of the growing thrombus and/or enhancing endogenous thrombolytic activity, likely contribute to the clinical effectiveness of such medications. It is not clear how much these effects relate to the measured inhibition of platelet aggregation in response to specific agonists. These effects are observable only with techniques that subject the growing thrombus to arterial flow and shear conditions. The effects of antithrombotic medications on thrombus stability and ways of assessing this are reviewed herein, and it is proposed that thrombus stability could become a new target for pharmacological intervention.
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Affiliation(s)
- Diana A Gorog
- National Heart & Lung Institute, Imperial College, Dovehouse Street, London, SW3 6LY, UK. .,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK.
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Quantifying Embolism: Label‐Free Volumetric Mapping of Thrombus Structure and Kinesis in a Microfluidic System with Optical Holography. ACTA ACUST UNITED AC 2018. [DOI: 10.1002/adbi.201800089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Khurshid H, Shi Y, Berwin BL, Weaver JB. Evaluating blood clot progression using magnetic particle spectroscopy. Med Phys 2018; 45:3258-3263. [PMID: 29772078 DOI: 10.1002/mp.12983] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the thrombus maturity noninvasively providing the promise of much earlier and more accurate diagnosis of diseases ranging from stroke to myocardial infarction to deep vein thrombosis. METHODS Magnetic spectroscopy of nanoparticle Brownian rotation (MSB), a form of magnetic particle spectroscopy sensitive to Brownian rotation of magnetic nanoparticles, was used for the detection and characterization of blood clots. The nanoparticles' relaxation time was quantified by scaling the MSB spectra in frequency to match the spectra from nanoparticles in a reference state. The nanoparticles' relaxation time, in the bound state, was used to characterize the nanoparticle binding to thrombin on the blood clot. The number of nanoparticles bound to the clot was also estimated. Both the relaxation time and the weight of bound nanoparticles were obtained for clots of several ages, reflecting different stages of development and organization. The impact of clot development was explored using functionalized nanoparticles present during clot formation. RESULTS The relaxation time of the bound nanoparticles decreases for more mature, organized clots. The number of nanoparticles able to bind the clot diminishes quantitatively with clot age. On mature clots, the nanoparticles bind the thrombin on the surface while for developing clots the nanoparticles bind several thrombin molecules or become trapped in the clot matrix during formation. CONCLUSIONS By estimating the magnetic nanoparticles' relaxation time the clot age and organization can be predicted. The purposed methods are quick and minimally invasive for in vivo applications.
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Affiliation(s)
- Hafsa Khurshid
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA.,Department of Applied Physics and Astronomy, University of Sharjah, Sharjah, 27272, UAE
| | - Yipeng Shi
- Department of Physics, Dartmouth College, Hanover, NH, 03755, USA
| | - Brent L Berwin
- Department of Microbiology and Immunology, Geisel School of Medicine, Hanover, NH, 03755, USA
| | - John B Weaver
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA.,Department of Physics, Dartmouth College, Hanover, NH, 03755, USA.,Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
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Curaj A, Wu Z, Rix A, Gresch O, Sternkopf M, Alampour-Rajabi S, Lammers T, van Zandvoort M, Weber C, Koenen RR, Liehn EA, Kiessling F. Molecular Ultrasound Imaging of Junctional Adhesion Molecule A Depicts Acute Alterations in Blood Flow and Early Endothelial Dysregulation. Arterioscler Thromb Vasc Biol 2017; 38:40-48. [PMID: 29191926 DOI: 10.1161/atvbaha.117.309503] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 11/17/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The junctional adhesion molecule A (JAM-A) is physiologically located in interendothelial tight junctions and focally redistributes to the luminal surface of blood vessels under abnormal shear and flow conditions accompanying atherosclerotic lesion development. Therefore, JAM-A was evaluated as a target for molecularly targeted ultrasound imaging of transient endothelial dysfunction under acute blood flow variations. APPROACH AND RESULTS Flow-dependent endothelial dysfunction was induced in apolipoprotein E-deficient mice (n=43) by carotid partial ligation. JAM-A expression was investigated by molecular ultrasound using antibody-targeted poly(n-butyl cyanoacrylate) microbubbles and validated with immunofluorescence. Flow disturbance and arterial remodeling were assessed using functional ultrasound. Partial ligation led to an immediate drop in perfusion at the ligated side and a direct compensatory increase at the contralateral side. This was accompanied by a strongly increased JAM-A expression and JAM-A-targeted microbubbles binding at the partially ligated side and by a moderate and temporary increase in the contralateral artery (≈14× [P<0.001] and ≈5× [P<0.001] higher than control, respectively), both peaking after 2 weeks. Subsequently, although JAM-A expression and JAM-A-targeted microbubbles binding persisted at a higher level at the partially ligated side, it completely normalized within 4 weeks at the contralateral side. CONCLUSIONS Temporary blood flow variations induce endothelial rearrangement of JAM-A, which can be visualized using JAM-A-targeted microbubbles. Thus, JAM-A may be considered as a marker of acute endothelial activation and dysfunction. Its imaging may facilitate the early detection of cardiovascular risk areas, and it enables the therapeutic prevention of their progression toward an irreversible pathological state.
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Affiliation(s)
- Adelina Curaj
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Zhuojun Wu
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Anne Rix
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Oliver Gresch
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Marieke Sternkopf
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Setareh Alampour-Rajabi
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Twan Lammers
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Marc van Zandvoort
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Christian Weber
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Rory R Koenen
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Elisa A Liehn
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Fabian Kiessling
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.).
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