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Hu X, Diao Y, Hao Z, Hao M, Xie M, Rong H, Zhu T. Histopathological analysis of the wall enhancement of the spinal dural arteriovenous fistulae's draining veins. Acta Neurol Belg 2024; 124:927-934. [PMID: 38430359 DOI: 10.1007/s13760-024-02483-3] [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: 09/18/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The mechanism behind SDAVF is still unclear. We discovered that the vessel wall of the SDAVF-DV occasionally showed enhancement in MRI, and this study assessed the relationship between the enhancement of the draining vein's wall and its histology. METHODS For histopathologic analysis, 16 draining vein samples from 16 patients with SDAVF were included, 3 normal arteries and 3 normal veins were chosen as comparison. We assessed the imaging and microscopic characteristics of the draining veins in SDAVF patients. The former included the presence of significant enhancement of the wall of the draining vein in MRI, and the latter included the adherence, aggregation, infiltration of pro-inflammatory factors and inflammatory cells. Immuno-histochemical staining was performed using IL-1β, IL-8, TGF-β as well as MPO and MMP-9, and positive results were counted. Multiple logistic regression analysis was used to determine whether the infiltration of inflammatory cells was connected to vessel wall enhancement in the SDAVF-DV. RESULTS Infiltration of inflammatory cells was significantly higher in SDAVF-DV compared to normal vessels, 7 out of 16 patients significantly had enhancement of the vessel wall of SDAVF-DV, and logistic regression analysis showed that samples with more infiltration of inflammatory cells were more likely to show enhancement of the SDAVF-DV walls. CONCLUSION There was considerable inflammatory cells infiltration in SDAVF-DV, and this may explain why their vessel wall had such a significant enhancement in MRI.
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Affiliation(s)
- Xiaojun Hu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuhang Diao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenghao Hao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingyu Hao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Minghao Xie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongtao Rong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Zhu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
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Pushevski V, Dejanov P, Rambabova-Bushljetikj I, Petrusevska G, Popov Z, Ivanovski N. Pathohistomorphometric and Immuno-Histologic Changes in Early Arteriovenous Fistula Failure in Patients with Chronic Kidney Disease. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2024; 45:13-20. [PMID: 39008640 DOI: 10.2478/prilozi-2024-0010] [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] [Indexed: 07/17/2024]
Abstract
BACKGROUND Hemodialysis is a prevalent treatment for the end-stage chronic kidney disease (CKD) worldwide. The primary arteriovenous fistula (AVF), widely considered the optimal hemodialysis access method, fails to mature in up to two-thirds of the cases. The etiology of the early AVF failure, defined as thrombosis or inability to use within three months post-creation remains less understood, and is influenced by various factors including patient demographics, surgical techniques, and genetic predispositions. Neointimal hyperplasia is a primary histological finding in stenotic lesions leading to the AVF failure. However, there are insufficient data on the cellular phenotypes and the impact of the preexisting CKD-related factors. This study aims to investigate the histological, morphometric, and immunohistochemical alterations in the fistula vein, pre-, peri-, and post-early failure. MATERIALS AND METHODS Eighty-nine stage 4-5 CKD patients underwent standard preoperative assessment, including the Doppler ultrasound, before a typical radio-cephalic AVF creation. Post-failure, a new AVF was created proximally. The vein specimens were collected during the surgery, processed, and analyzed for morphometric analyses and various cellular markers, including Vimentin, TGF, and Ki 67. RESULTS The study enrolled 89 CKD patients, analyzing various aspects of their condition and AVF failures. The histomorphometric analysis revealed substantial venous luminal stenosis and varied endothelial changes. The immunohistologic analysis showed differential marker expressions pre- and post-AVF creation. CONCLUSION This study highlights the complexity of the early AVF failures in CKD patients. The medial hypertrophy emerged as a significant preexisting lesion, while the postoperative analyses indicated a shift towards neointimal hyperplasia. The research underscores the nuanced interplay of vascular remodeling, endothelial damage, and cellular proliferation in the AVF outcomes.
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Affiliation(s)
- Vladimir Pushevski
- 1University Clinic of Nephrology, Skopje, RN Macedonia
- 2Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | - Petar Dejanov
- 1University Clinic of Nephrology, Skopje, RN Macedonia
- 2Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | - Irena Rambabova-Bushljetikj
- 1University Clinic of Nephrology, Skopje, RN Macedonia
- 2Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | - Gordana Petrusevska
- 2Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
- 3Insitutute of Pathology, Skopje, RN Macedonia
| | - Zivko Popov
- 2Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
- 4Macedonian Academy of Sciences and Arts, Skopje, RN Macedonia
| | - Ninoslav Ivanovski
- 2Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
- 5Zan Mitrev Clinic, Skopje, RN Macedonia
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Chang CJ, Lai YJ, Tung YC, Wu LS, Hsu LA, Tseng CN, Chang GJ, Yang KC, Yeh YH. Osteopontin mediation of disturbed flow-induced endothelial mesenchymal transition through CD44 is a novel mechanism of neointimal hyperplasia in arteriovenous fistulae for hemodialysis access. Kidney Int 2023; 103:702-718. [PMID: 36646166 DOI: 10.1016/j.kint.2022.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/19/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023]
Abstract
In dysfunctional arteriovenous fistulae (AVF) for hemodialysis access, neointimal hyperplasia (NH) is prone to occur in the region exposed to disturbed flow. We hypothesized that disturbed flow contributes to NH in AVF by inducing endothelial mesenchymal transition (EndMT) through activation of the osteopontin/CD44 axis. In rats with aortocaval fistula, a rodent model of AVF, we demonstrated development of EndMT and expression of osteopontin and CD44 specifically in the vicinity of the arteriovenous junction using immunostaining. Duplex scan confirmed this region was exposed to a disturbed flow. A mixed ultrastructural phenotype of endothelium and smooth muscle cells was found in luminal endothelial cells of the arteriovenous junction by electron microscopy ascertaining the presence of EndMT. Endothelial lineage tracing using Cdh5-Cre/ERT2;ROSA26-tdTomato transgenic mice showed that EndMT was involved in NH of AVF since the early stage and that the endothelial-derived cells contributed to 24% of neointimal cells. In human umbilical vein endothelial cells (HUVECs) in culture, osteopontin treatment induced EndMT, which was suppressed by CD44 knockdown. Exposure to low oscillatory wall shear stress using a parallel-plate system induced EndMT in HUVECs, also suppressed by osteopontin or CD44 knockdown. In AVF of CD44 knockout mice, EndMT was mitigated and NH decreased by 35% compared to that in wild-type mice. In dysfunctional AVF of patients with uremia, expressions of osteopontin, CD44, and mesenchymal markers in endothelial cells overlying the neointima was also found by immunostaining. Thus, the osteopontin/CD44 axis regulates disturbed flow-induced EndMT, plays an important role in neointimal hyperplasia of AVF, and may act as a potential therapeutic target to prevent AVF dysfunction.
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Affiliation(s)
- Chi-Jen Chang
- Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ying-Ju Lai
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chang Tung
- Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lung-Sheng Wu
- Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lung-An Hsu
- Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Nan Tseng
- Division of Cardiac Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kai-Chien Yang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Grenier C, Caillon A, Munier M, Grimaud L, Champin T, Toutain B, Fassot C, Blanc-Brude O, Loufrani L. Dual Role of Thrombospondin-1 in Flow-Induced Remodeling. Int J Mol Sci 2021; 22:12086. [PMID: 34769516 PMCID: PMC8584526 DOI: 10.3390/ijms222112086] [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] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
(1) Background: Chronic increases in blood flow, as in cardiovascular diseases, induce outward arterial remodeling. Thrombospondin-1 (TSP-1) is known to interact with matrix proteins and immune cell-surface receptors, but its contribution to flow-mediated remodeling in the microcirculation remains unknown. (2) Methods: Mesenteric arteries were ligated in vivo to generate high- (HF) and normal-flow (NF) arteries in wild-type (WT) and TSP-1-deleted mice (TSP-1-/-). After 7 days, arteries were isolated and studied ex vivo. (3) Results: Chronic increases in blood flow induced outward remodeling in WT mice (increasing diameter from 221 ± 10 to 280 ± 10 µm with 75 mmHg intraluminal pressure) without significant effect in TSP-1-/- (296 ± 18 to 303 ± 14 µm), neutropenic or adoptive bone marrow transfer mice. Four days after ligature, pro inflammatory gene expression levels (CD68, Cox2, Gp91phox, p47phox and p22phox) increased in WT HF arteries but not in TSP-1-/- mice. Perivascular neutrophil accumulation at day 4 was significantly lower in TSP-1-/- than in WT mice. (4) Conclusions: TSP-1 origin is important; indeed, circulating TSP-1 participates in vasodilation, whereas both circulating and tissue TSP-1 are involved in arterial wall thickness and diameter expansion.
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Affiliation(s)
- Céline Grenier
- UMR CNRS 6015, 49100 Angers, France; (C.G.); (A.C.); (M.M.); (L.G.); (T.C.); (B.T.); (C.F.)
- INSERM U1083, 49100 Angers, France
- MITOVASC Institute, University of Angers, 49100 Angers, France
| | - Antoine Caillon
- UMR CNRS 6015, 49100 Angers, France; (C.G.); (A.C.); (M.M.); (L.G.); (T.C.); (B.T.); (C.F.)
- INSERM U1083, 49100 Angers, France
- MITOVASC Institute, University of Angers, 49100 Angers, France
| | - Mathilde Munier
- UMR CNRS 6015, 49100 Angers, France; (C.G.); (A.C.); (M.M.); (L.G.); (T.C.); (B.T.); (C.F.)
- INSERM U1083, 49100 Angers, France
- MITOVASC Institute, University of Angers, 49100 Angers, France
| | - Linda Grimaud
- UMR CNRS 6015, 49100 Angers, France; (C.G.); (A.C.); (M.M.); (L.G.); (T.C.); (B.T.); (C.F.)
- INSERM U1083, 49100 Angers, France
- MITOVASC Institute, University of Angers, 49100 Angers, France
| | - Tristan Champin
- UMR CNRS 6015, 49100 Angers, France; (C.G.); (A.C.); (M.M.); (L.G.); (T.C.); (B.T.); (C.F.)
- INSERM U1083, 49100 Angers, France
- MITOVASC Institute, University of Angers, 49100 Angers, France
| | - Bertrand Toutain
- UMR CNRS 6015, 49100 Angers, France; (C.G.); (A.C.); (M.M.); (L.G.); (T.C.); (B.T.); (C.F.)
- INSERM U1083, 49100 Angers, France
- MITOVASC Institute, University of Angers, 49100 Angers, France
| | - Céline Fassot
- UMR CNRS 6015, 49100 Angers, France; (C.G.); (A.C.); (M.M.); (L.G.); (T.C.); (B.T.); (C.F.)
- INSERM U1083, 49100 Angers, France
- MITOVASC Institute, University of Angers, 49100 Angers, France
| | | | - Laurent Loufrani
- UMR CNRS 6015, 49100 Angers, France; (C.G.); (A.C.); (M.M.); (L.G.); (T.C.); (B.T.); (C.F.)
- INSERM U1083, 49100 Angers, France
- MITOVASC Institute, University of Angers, 49100 Angers, France
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5
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Jeon JW, Kim HR, Lee E, Lee JI, Ham YR, Na KR, Lee KW, Kim JJ, Choi DE. Effect of cilostazol on arteriovenous fistula in hemodialysis patients. Nefrologia 2021; 41:625-631. [PMID: 36165152 DOI: 10.1016/j.nefroe.2022.01.006] [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: 08/08/2020] [Accepted: 12/02/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The maturation and patency of permanent vascular access are critical in patients requiring hemodialysis. Although numerus trials have been attempted to achieve permanently patent vascular access, little have been noticeable. Cilostazol, a phosphodiesterase-3 inhibitor, has been shown to be effective in peripheral arterial disease including vascular injury-induced intimal hyperplasia. We therefore aimed to determine the effect of cilostazol on the patency and maturation of permanent vascular access. METHODS This single-center, retrospective study included 194 patients who underwent arteriovenous fistula surgery to compare vascular complications between the cilostazol (n=107) and control (n=87) groups. RESULTS The rate of vascular complications was lower in the cilostazol group than in the control group (36.4% vs. 51.7%; p=0.033), including maturation failure (2.8% vs. 11.5%; p=0.016). The rate of reoperation due to vascular injury after hemodialysis initiation following fistula maturation was also significantly lower in the cilostazol group than in the control group (7.5% vs. 28.7%; p<0.001). However, there were no significant differences in the requirement for percutaneous transluminal angioplasty (PTA), rate of PTA, and the interval from arteriovenous fistula surgery to PTA between the cilostazol and control groups. CONCLUSION Cilostazol might be beneficial for the maturation of permanent vascular access in patients requiring hemodialysis.
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Affiliation(s)
- Jae Wan Jeon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Hae Ri Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Eujin Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong In Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Young Rok Ham
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kang Wook Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jwa-Jin Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Dae Eun Choi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea.
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6
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Contenti J, Durand M, Vido S, Declemy S, Raffort J, Carboni J, Bonnet S, Koelsch C, Hassen-Khodja R, Gual P, Mazure NM, Sadaghianloo N. Plasmatic osteopontin and vascular access dysfunction in hemodialysis patients: a cross-sectional, case-control study (The OSMOSIS Study). J Nephrol 2021; 35:527-534. [PMID: 34468976 DOI: 10.1007/s40620-021-01129-4] [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: 10/28/2020] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Despite close follow-up of patients with native arteriovenous fistulas (AVFs), up to 10% experience thrombosis each year. The OSMOSIS Study (Osteopontin as a Marker of Stenosis) tested the hypothesis that the systemic osteopontin level, a pro-inflammatory mediator related to vascular remodelling and intimal hyperplasia, increases in AVF stenosis, and may be used in clinical surveillance. METHODS Our cross-sectional study compared the level of plasmatic osteopontin (pOPN) between patients with a well-functioning AVF (control group) and patients who required revision of their AVF due to stenosis (stenosis group). Blood samples were collected before dialysis (control group) or before intervention (stenosis group) from the AVF arm, and from the opposite arm as a within-subject control. pOPN level was measured by enzyme-linked immunosorbent assay. RESULTS A total of 76 patients were included in the study. Baseline characteristics were similar between the groups (mean age, 70 years; men, 63%; AVF duration, 39 months), apart from prevalence of type 2 diabetes (T2D) (control group, 33%; stenosis group, 57%; p = 0.04). pOPN levels were similar between the AVF arm and the contralateral arm (551 ± 42 ng/mL vs. 521 ± 41 ng/mL, respectively, p = 0.11, paired t-test). Patients in the stenosis group displayed a higher pOPN level than patients in the control group (650.2 ± 59.8 ng/mL vs. 460.5 ± 61.2, respectively, p = 0.03; two-way ANOVA). T2D was not identified as an associated factor in a multivariate analysis (p = 0.50). CONCLUSIONS The level of pOPN in hemodialysis patients was associated with the presence of AVF stenosis requiring intervention. Thus, its potential as a diagnostic biomarker should be assessed in a vascular access surveillance program.
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Affiliation(s)
- Julie Contenti
- Department of Emergency Medicine, Centre Hospitalier Universitaire de Nice, Nice, France.,Centre Méditerranéen de Médecine Moléculaire, INSERM U1065, Université Côte d'Azur, Nice, France
| | - Matthieu Durand
- Department of Urology and Andrology and Renal Transplantation, Centre Hospitalier Universiatire de Nice, Nice, France.,Institute of Research on Cancer and Aging of Nice, INSERM U1081-CNRS, UMR 7284, Université Côte d'Azur, Nice, France
| | - Sandor Vido
- Department of Nephrology and Hemodialysis, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Serge Declemy
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 1, 30 Ave de la voie Romaine, 06000, Nice, France
| | - Juliette Raffort
- Clinical Chemistry Laboratory (J.R), Centre Hospitalier Universitaire de Nice, Nice, France
| | - Joseph Carboni
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 1, 30 Ave de la voie Romaine, 06000, Nice, France
| | - Sophie Bonnet
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 1, 30 Ave de la voie Romaine, 06000, Nice, France.,Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Christophe Koelsch
- Department of Anesthesiology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Réda Hassen-Khodja
- Centre Méditerranéen de Médecine Moléculaire, INSERM U1065, Université Côte d'Azur, Nice, France.,Department of Vascular Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 1, 30 Ave de la voie Romaine, 06000, Nice, France
| | - Philippe Gual
- Centre Méditerranéen de Médecine Moléculaire, INSERM U1065, Université Côte d'Azur, Nice, France
| | - Nathalie M Mazure
- Centre Méditerranéen de Médecine Moléculaire, INSERM U1065, Université Côte d'Azur, Nice, France
| | - Nirvana Sadaghianloo
- Centre Méditerranéen de Médecine Moléculaire, INSERM U1065, Université Côte d'Azur, Nice, France. .,Department of Vascular Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 1, 30 Ave de la voie Romaine, 06000, Nice, France.
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7
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Jeon JW, Kim HR, Lee E, Lee JI, Ham YR, Na KR, Lee KW, Kim JJ, Choi DE. Effect of cilostazol on arteriovenous fistula in hemodialysis patients. Nefrologia 2021; 41:S0211-6995(21)00060-6. [PMID: 33985859 DOI: 10.1016/j.nefro.2020.12.013] [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: 08/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The maturation and patency of permanent vascular access are critical in patients requiring hemodialysis. Although numerus trials have been attempted to achieve permanently patent vascular access, little have been noticeable. Cilostazol, a phosphodiesterase-3 inhibitor, has been shown to be effective in peripheral arterial disease including vascular injury-induced intimal hyperplasia. We therefore aimed to determine the effect of cilostazol on the patency and maturation of permanent vascular access. METHODS This single-center, retrospective study included 194 patients who underwent arteriovenous fistula surgery to compare vascular complications between the cilostazol (n=107) and control (n=87) groups. RESULTS The rate of vascular complications was lower in the cilostazol group than in the control group (36.4% vs. 51.7%; p=0.033), including maturation failure (2.8% vs. 11.5%; p=0.016). The rate of reoperation due to vascular injury after hemodialysis initiation following fistula maturation was also significantly lower in the cilostazol group than in the control group (7.5% vs. 28.7%; p<0.001). However, there were no significant differences in the requirement for percutaneous transluminal angioplasty (PTA), rate of PTA, and the interval from arteriovenous fistula surgery to PTA between the cilostazol and control groups. CONCLUSION Cilostazol might be beneficial for the maturation of permanent vascular access in patients requiring hemodialysis.
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Affiliation(s)
- Jae Wan Jeon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Hae Ri Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Eujin Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong In Lee
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Young Rok Ham
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kang Wook Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jwa-Jin Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Dae Eun Choi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Nephrology, Chungnam National University Hospital, Daejeon, Republic of Korea.
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Abstract
The complex development of the brain vascular system can be broken down by embryonic stages and anatomic locations, which are tightly regulated by different factors and pathways in time and spatially. The adult brain is relatively quiescent in angiogenesis. However, under disease conditions, such as trauma, stroke, or tumor, angiogenesis can be activated in the adult brain. Disruption of any of the factors or pathways may lead to malformed vessel development. In this chapter, we will discuss factors and pathways involved in normal brain vasculogenesis and vascular maturation, and the pathogenesis of several brain vascular malformations.
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Affiliation(s)
- Yao Yao
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, GA, United States
| | - Sonali S Shaligram
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, CA, United States
| | - Hua Su
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California San Francisco, San Francisco, CA, United States.
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9
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Reliability of preoperative venous mapping ultrasonography in predicting for autogenous arteriovenous fistula maturation. J Vasc Surg 2020; 73:1787-1793. [PMID: 33091513 DOI: 10.1016/j.jvs.2020.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autogenous arteriovenous fistula creation is the preferred route for vascular access for hemodialysis. Although preoperative venous mapping ultrasonography has been advocated as an operative planning adjunct and recently incorporated into the Society for Vascular Surgery clinical guidelines, controversy remains regarding its usefulness for predicting access success. The purpose of the present retrospective clinical study was to test the hypothesis that vein size measured on routine preoperative venous mapping is a poor predictor of primary fistula maturation. METHODS Consecutive upper extremity autogenous arteriovenous fistulas created by three dedicated vascular surgeons were retrospectively reviewed. The demographic characteristics, preoperative venous mapping, functional maturation, and patency were analyzed. The clinically relevant variables were tested for predictive significance using a logistic regression model. RESULTS A total of 199 upper extremity autogenous arteriovenous fistulas had been created during a 5-year period. Patients were aged 70 ± 16 years (range, 20-96 years), and 62% were men. Most had already been undergoing dialysis before fistula creation (83%), usually via a tunneled central venous catheter (62%). Radial-cephalic, brachial-cephalic, and brachial-basilic arteriovenous fistulas had been created in 82 patients (41%), 76 patients (38%), and 10 patients (5%), respectively. Fistula maturation, defined as a palpable thrill and/or successful cannulation of the fistula with the ability to deliver a flow rate of 400 mL/min, was achieved in 67% of the patients. A higher body mass index was associated with nonmaturation on both univariate and multivariate analyses (success, 28.6 ± 7.7 kg/m2; vs failed, 31.6 ± 9.4 kg/m2; P = .029; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10; P < .01). On univariate analysis, the maximum target vein diameter assessed by preoperative venous mapping was slightly larger in the group achieving successful maturation (2.9 ± 1.1 mm vs 2.6 ± 0.9 mm; P = .014). However, neither the maximum target vein diameter nor a target vein size >3 mm was significantly predictive of maturation on multivariate analysis (maximum vein diameter: OR, 0.65; 95% CI, 0.35-1.22; P = .176; vein size >3 mm: OR, 0.91; 95% CI, 0.32-2.60; P = .857). After a median follow-up of 15 months (interquartile range, 26 months), the primary functional patency, primary-assisted patency, and secondary patency rates were 39.1% ± 0.6%, 94.5% ± 0.6%, and 97.9% ± 0.5%. No association of vein diameter with long-term patency was found. CONCLUSIONS Despite the national fistula-first initiatives, most patients still undergo access via catheter at the initiation of hemodialysis. The use of routine preoperative venous mapping does not predict successful primary maturation. Also, no clinically useful predictor of fistula maturation was identified in the present study.
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Sadaghianloo N, Contenti J, Dufies M, Parola J, Rouleau M, Lee S, Peyron J, Fabbri L, Hassen‐Khodja R, Pouysségur J, Bost F, Jean‐Baptiste E, Dardik A, Mazure NM. Co-culture of human fibroblasts, smooth muscle and endothelial cells promotes osteopontin induction in hypoxia. J Cell Mol Med 2020; 24:2931-2941. [PMID: 32032472 PMCID: PMC7077551 DOI: 10.1111/jcmm.14905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/20/2019] [Accepted: 11/23/2019] [Indexed: 12/17/2022] Open
Abstract
Arteriovenous fistulas (AVFs) are the preferred vascular access for haemodialysis of patients suffering from end-stage renal disease, a worldwide public health problem. However, they are prone to a high rate of failure due to neointimal hyperplasia and stenosis. This study aimed to determine if osteopontin (OPN) was induced in hypoxia and if OPN could be responsible for driving AVF failure. Identification of new factors that participate in remodelling of AVFs is a challenge. Three cell lines representing the cells of the three layers of the walls of arteries and veins, fibroblasts, smooth muscle cells and endothelial cells, were tested in mono- and co-culture in vitro for OPN expression and secretion in normoxia compared to hypoxia after silencing the hypoxia-inducible factors (HIF-1α, HIF-2α and HIF-1/2α) with siRNA or after treatment with an inhibitor of NF-kB. None of the cells in mono-culture showed OPN induction in hypoxia, whereas cells in co-culture secreted OPN in hypoxia. The changes in oxygenation that occur during AVF maturation up-regulate secretion of OPN through cell-cell interactions between the different cell layers that form AVF, and in turn, these promote endothelial cell proliferation and could participate in neointimal hyperplasia.
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Affiliation(s)
- Nirvana Sadaghianloo
- Université Côte d’AzurInstitute for Research on Cancer and Aging of Nice (IRCAN)CNRS‐UMR 7284‐Inserm U1081Centre Antoine LacassagneUniversity of Nice Sophia‐AntipolisNiceFrance
- Department of Vascular SurgeryCentre Hospitalier Universitaire de NiceNiceFrance
- Present address:
Centre de Méditerranéen de Médecine Moléculaire (C3M)INSERM U1065Université Côte d’AzurNice Cedex 03France
| | - Julie Contenti
- Université Côte d’AzurInstitute for Research on Cancer and Aging of Nice (IRCAN)CNRS‐UMR 7284‐Inserm U1081Centre Antoine LacassagneUniversity of Nice Sophia‐AntipolisNiceFrance
- Department of Emergency MedicineCentre Hospitalier Universitaire de NiceNiceFrance
- Present address:
Centre de Méditerranéen de Médecine Moléculaire (C3M)INSERM U1065Université Côte d’AzurNice Cedex 03France
| | | | - Julien Parola
- Université Côte d’AzurInstitute for Research on Cancer and Aging of Nice (IRCAN)CNRS‐UMR 7284‐Inserm U1081Centre Antoine LacassagneUniversity of Nice Sophia‐AntipolisNiceFrance
| | | | - Shinrong Lee
- Department of Surgery and the Vascular Biology and Therapeutics ProgramYale UniversityNew HavenCTUSA
- Department of Vascular SurgeryVA Connecticut Healthcare SystemsWest HavenCTUSA
| | - Jean‐François Peyron
- Université Côte d’AzurInstitute for Research on Cancer and Aging of Nice (IRCAN)CNRS‐UMR 7284‐Inserm U1081Centre Antoine LacassagneUniversity of Nice Sophia‐AntipolisNiceFrance
| | - Lucilla Fabbri
- Université Côte d’AzurInstitute for Research on Cancer and Aging of Nice (IRCAN)CNRS‐UMR 7284‐Inserm U1081Centre Antoine LacassagneUniversity of Nice Sophia‐AntipolisNiceFrance
- Present address:
Centre de Méditerranéen de Médecine Moléculaire (C3M)INSERM U1065Université Côte d’AzurNice Cedex 03France
| | - Réda Hassen‐Khodja
- Department of Vascular SurgeryCentre Hospitalier Universitaire de NiceNiceFrance
- Present address:
Centre de Méditerranéen de Médecine Moléculaire (C3M)INSERM U1065Université Côte d’AzurNice Cedex 03France
| | - Jacques Pouysségur
- Université Côte d’AzurInstitute for Research on Cancer and Aging of Nice (IRCAN)CNRS‐UMR 7284‐Inserm U1081Centre Antoine LacassagneUniversity of Nice Sophia‐AntipolisNiceFrance
- Centre Scientifique de Monaco (CSM)MonacoMonaco
| | - Frédéric Bost
- Université Côte d’AzurInstitute for Research on Cancer and Aging of Nice (IRCAN)CNRS‐UMR 7284‐Inserm U1081Centre Antoine LacassagneUniversity of Nice Sophia‐AntipolisNiceFrance
| | - Elixène Jean‐Baptiste
- Department of Vascular SurgeryCentre Hospitalier Universitaire de NiceNiceFrance
- Present address:
Centre de Méditerranéen de Médecine Moléculaire (C3M)INSERM U1065Université Côte d’AzurNice Cedex 03France
| | - Alan Dardik
- Department of Surgery and the Vascular Biology and Therapeutics ProgramYale UniversityNew HavenCTUSA
- Department of Vascular SurgeryVA Connecticut Healthcare SystemsWest HavenCTUSA
| | - Nathalie M. Mazure
- Université Côte d’AzurInstitute for Research on Cancer and Aging of Nice (IRCAN)CNRS‐UMR 7284‐Inserm U1081Centre Antoine LacassagneUniversity of Nice Sophia‐AntipolisNiceFrance
- Present address:
Centre de Méditerranéen de Médecine Moléculaire (C3M)INSERM U1065Université Côte d’AzurNice Cedex 03France
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Temporal Change of Extracellular Matrix during Vein Arterialization Remodeling in Rats. J Cardiovasc Dev Dis 2019; 6:jcdd6010007. [PMID: 30717394 PMCID: PMC6463024 DOI: 10.3390/jcdd6010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/26/2019] [Accepted: 01/30/2019] [Indexed: 11/17/2022] Open
Abstract
The global expression profile of the arterialized rat jugular vein was established to identify candidate genes and cellular pathways underlying the remodeling process. The arterialized jugular vein was analyzed on days 3 and 28 post-surgery and compared with the normal jugular vein and carotid artery. A gene array platform detected 9846 genes in all samples. A heatmap analysis uncovered patterns of gene expression showing that the arterialized vein underwent a partial transition from vein to artery from day 3 to 28 post-surgery. The same pattern was verified for 1845 key differentially expressed genes by performing a pairwise comparison of the jugular vein with the other groups. Interestingly, hierarchical clustering of 60 genes with altered expression on day 3 and day 28 displayed an expression pattern similar to that of the carotid artery. Enrichment analysis results and the network relationship among genes modulated during vein arterialization showed that collagen might play a role in the early remodeling process. Indeed, the total collagen content was increased, with the augmented expression of collagen I, collagen IV, and collagen V in arterialized veins. Additionally, there was an increase in the expression of versican and Thy-1 and a decrease in the expression of biglycan and β1-integrin. Overall, we provide evidence that vein arterialization remodeling is accompanied by consistent patterns of gene expression and that collagen may be an essential element underlying extracellular matrix changes that support the increased vascular wall stress of the new hemodynamic environment.
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Lü P, Jiao Q, Shimura D, Kusakari Y, Liu F, Minamisawa S. Distinct Vascular Remodeling Pattern of Adult Rats with Carotid-Jugular Shunt. Ann Vasc Surg 2018; 49:168-178. [PMID: 29501904 DOI: 10.1016/j.avsg.2017.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/26/2017] [Accepted: 12/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous research has revealed that patent vein grafts lose their venous identity Eph-B4 but do not gain arterial identity ephrin-B2 during adaptation to the arterial circulation, and vascular identity marker, for example, the Eph-B4 signaling is a critical determinant of venous wall thickness of vein grafts. But what is the remodeling pattern, especially the remodeling pattern of vascular identity in the venous segment of arteriovenous shunt at a late stage postoperation has not been fully explored. This study was conducted to characterize the remodeling pattern of shear stress, vascular identity, structural composition and morphology, and transcriptional profiles in jugular segment of carotid-jugular (CJ) shunt and/or pulmonary artery (PA), which delivers an increased amount of mixed blood at a late stage postoperation in adult rats. METHODS CJ shunt was created in adult Wistar rats via end-to-end anastomosis of carotid artery (CA) and jugular vein (JV). At the time of 15 weeks, after hemodynamics test, remodeled jugular segment of CJ shunt, PA, and sham-operated corresponding vessels were isolated. Reverse transcription polymerase chain reaction, microarray, western blot, immunohistochemistry experiments, and morphology analyses were performed. RESULTS CJ shunt shear stresses have been patterned to some sort of balance with no significant difference in shear stress between carotid segment and jugular segment (P > 0.05). Immunohistochemical analysis reveals that venous identity marker Eph-B4 is lost, but arterial identity markers ephrin-B2 and regulator of G-protein signaling 5 are gained in jugular segment of CJ shunt (P < 0.01), and these 2 arterial identity markers further strengthened in PA (P < 0.01) in shunted rats compared with controls. Jugular segment of CJ shunt undergoes significant intimal hyperplasia with strong expression of smooth muscle cell markers (P < 0.05) and demonstrates a distinct transcriptional profiles which reveals that transcripts of 5 arterial markers are significantly upregulated (P < 0.05 or < 0.01) compared with sham-operated JV; among them, G-protein signaling 5 is exactly the gene with the largest fold change (10.14-fold) in all genes tested by microarray experiment. CONCLUSIONS Venous identity is lost, but arterial identity is gained in jugular segment of CJ shunt and arterial identity further strengthened in PA in adult shunted rats during late adaptation.
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MESH Headings
- Anastomosis, Surgical
- Animals
- Biopsy
- Blotting, Western
- Carotid Arteries/metabolism
- Carotid Arteries/pathology
- Carotid Arteries/physiopathology
- Carotid Arteries/surgery
- Gene Expression Profiling/methods
- Gene Expression Regulation
- Hemodynamics
- Immunohistochemistry
- Jugular Veins/metabolism
- Jugular Veins/pathology
- Jugular Veins/physiopathology
- Jugular Veins/surgery
- Male
- Models, Animal
- Oligonucleotide Array Sequence Analysis
- Pulmonary Artery/metabolism
- Pulmonary Artery/pathology
- Pulmonary Artery/physiopathology
- Pulmonary Artery/surgery
- RGS Proteins/genetics
- RGS Proteins/metabolism
- Rats, Wistar
- Real-Time Polymerase Chain Reaction
- Receptor, EphB2/genetics
- Receptor, EphB2/metabolism
- Receptor, EphB4/genetics
- Receptor, EphB4/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Stress, Mechanical
- Time Factors
- Transcriptome
- Ultrasonography, Doppler, Color
- Vascular Remodeling
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Affiliation(s)
- Ping Lü
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Qibin Jiao
- Department of Cardiology, The Affiliated Hospital of Hangzhou Normal University, Institute of Ageing Research, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Daisuke Shimura
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoichiro Kusakari
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fang Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Susumu Minamisawa
- Department of Cell Physiology, The Jikei University School of Medicine, Tokyo, Japan
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Russell TE, Kasper GC, Seiwert AJ, Comerota AJ, Lurie F. Cilostazol May Improve Maturation Rates and Durability of Vascular Access for Hemodialysis. Vasc Endovascular Surg 2017; 51:120-124. [DOI: 10.1177/1538574417692464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cilostazol is effective in controlling pathophysiological pathways similar or identical to those involved in nonmaturation and failure of the arteriovenous access. This case–control study examined whether cilostazol would improve maturation rates and durability of vascular access for hemodialysis. The treatment group included 33 patients who received cilostazol for ≥30 days prior to creation of a dialysis access and continued with cilostazol therapy for ≥60 days after surgery. The matched (gender, age, race, diabetes, and the year of surgery) control group included 116 patients who underwent the same procedure but did not receive cilostazol prior to and at least 3 months after surgery. Primary outcomes were maturation and, for those that matured, time of functioning access, defined as the time from the first use to irreparable failure of the access. Secondary outcomes were time to maturation, complications, and time to first complication. Study group patients were 3.8 times more likely to experience fistula maturation compared to the controls (88% vs 66%, RR = 3.8, 95% confidence interval: 1.3-11.6, P = .016). Fewer patients in the study group had complications (76% vs 92%, P = .025), and the time from construction of the fistula to the first complication was longer (345.6 ± 441 days vs 198.3 ± 185.0 days, P = .025). Time to maturation was similar in both groups (119.3 ± 62.9 days vs 100.2 ± 61.7 days, P = .2). However, once matured, time to failure was significantly longer in the treatment group (903.7 ± 543.6 vs 381.6 ± 317.2 days, P = .001). Multivariate analysis confirmed that the likelihood of maturation was significantly higher in the treatment group patients. These results suggest that dialysis access patients may benefit from preoperative and postoperative cilostazol therapy. If confirmed by a randomized trial, this treatment will have a major beneficial impact on patients dependent on a well-functioning access for their hemodialysis.
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Affiliation(s)
- Todd E. Russell
- Jobst Vascular Institute, The Toledo Hospital, Toledo, OH, USA
| | | | | | - Anthony J. Comerota
- Jobst Vascular Institute, The Toledo Hospital, Toledo, OH, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Fedor Lurie
- Jobst Vascular Institute, The Toledo Hospital, Toledo, OH, USA
- University of Michigan, Ann Arbor, MI, USA
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14
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Complications chirurgicales de la transplantation rénale. Prog Urol 2016; 26:1066-1082. [DOI: 10.1016/j.purol.2016.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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15
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P2Y 2 receptor modulates shear stress-induced cell alignment and actin stress fibers in human umbilical vein endothelial cells. Cell Mol Life Sci 2016; 74:731-746. [PMID: 27652381 PMCID: PMC5272905 DOI: 10.1007/s00018-016-2365-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/28/2016] [Accepted: 09/12/2016] [Indexed: 10/25/2022]
Abstract
Endothelial cells release ATP in response to fluid shear stress, which activates purinergic (P2) receptor-mediated signaling molecules including endothelial nitric oxide (eNOS), a regulator of vascular tone. While P2 receptor-mediated signaling in the vasculature is well studied, the role of P2Y2 receptors in shear stress-associated endothelial cell alignment, cytoskeletal alterations, and wound repair remains ill defined. To address these aspects, human umbilical vein endothelial cell (HUVEC) monolayers were cultured on gelatin-coated dishes and subjected to a shear stress of 1 Pa. HUVECs exposed to either P2Y2 receptor antagonists or siRNA showed impaired fluid shear stress-induced cell alignment, and actin stress fiber formation as early as 6 h. Similarly, when compared to cells expressing the P2Y2 Arg-Gly-Asp (RGD) wild-type receptors, HUVECs transiently expressing the P2Y2 Arg-Gly-Glu (RGE) mutant receptors showed reduced cell alignment and actin stress fiber formation in response to shear stress as well as to P2Y2 receptor agonists in static cultures. Additionally, we observed reduced shear stress-induced phosphorylation of focal adhesion kinase (Y397), and cofilin-1 (S3) with receptor knockdown as well as in cells expressing the P2Y2 RGE mutant receptors. Consistent with the role of P2Y2 receptors in vasodilation, receptor knockdown and overexpression of P2Y2 RGE mutant receptors reduced shear stress-induced phosphorylation of AKT (S473), and eNOS (S1177). Furthermore, in a scratched wound assay, shear stress-induced cell migration was reduced by both pharmacological inhibition and receptor knockdown. Together, our results suggest a novel role for P2Y2 receptor in shear stress-induced cytoskeletal alterations in HUVECs.
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16
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Kahle B, Schmidtke C, Hunzelmann N, Bartels C, Sievers HH, Steenbock H, Reinhardt DP, Brinckmann J. The Extracellular Matrix Signature in Vein Graft Disease. Can J Cardiol 2016; 32:1008.e11-7. [DOI: 10.1016/j.cjca.2015.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/10/2015] [Accepted: 11/13/2015] [Indexed: 12/15/2022] Open
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17
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Wong DJ, Lu DY, Protack CD, Kuwahara G, Bai H, Sadaghianloo N, Tellides G, Dardik A. Ephrin type-B receptor 4 activation reduces neointimal hyperplasia in human saphenous vein in vitro. J Vasc Surg 2016; 63:795-804. [PMID: 25446283 PMCID: PMC4409444 DOI: 10.1016/j.jvs.2014.09.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vein bypass is an essential therapy for patients with advanced peripheral and coronary artery disease despite development of neointimal hyperplasia. We have shown that stimulation of the receptor tyrosine kinase ephrin type-B receptor 4 (Eph-B4) with its ligand ephrin-B2 prevents neointimal hyperplasia in murine vein grafts. This study determines whether Eph-B4 in adult human veins is capable of phosphorylation and activation of downstream signaling pathways, as well as functional to release nitric oxide (NO) and prevent neointimal hyperplasia in vitro. METHODS Discarded human saphenous veins were taken from the operating room and placed in organ culture without or with ephrin-B2/Fc (2 μg/mL) for 14 days, and the neointima/media ratio was measured in matched veins. Primary human umbilical vein endothelial cells were treated with ephrin-B2/Fc (2 μg/mL) and examined with quantitative polymerase chain reaction, Western blot, immunoassays, and for release of NO. Ephrin-B2/Fc (2 μg/mL) was placed on the adventitia of saphenous veins treated with arterial shear stress for 24 hours in a bioreactor and activated Eph-B4 examined with immunofluorescence. RESULTS The baseline intima/media ratio in saphenous vein rings was 0.456 ± 0.097, which increased to 0.726 ± 0.142 in untreated veins after 14 days in organ culture but only to 0.630 ± 0.132 in veins treated with ephrin-B2/Fc (n = 19, P = .017). Ephrin-B2/Fc stimulated Akt, endothelial NO synthase and caveolin-1 phosphorylation, and NO release (P = .007) from human umbilical vein endothelial cells (n = 6). Ephrin-B2/Fc delivered to the adventitia stimulated endothelial Eph-B4 phosphorylation after 24 hours of arterial stress in a bioreactor (n = 3). CONCLUSIONS Eph-B4 is present and functional in adult human saphenous veins, with intact downstream signaling pathways capable of NO release and prevention of neointimal hyperplasia in vitro. Adventitial delivery of ephrin-B2/Fc activates endothelial Eph-B4 in saphenous veins treated with arterial shear stress in vitro. These results suggest that stimulation of Eph-B4 function may be a candidate strategy for translation to human clinical trials designed to inhibit venous neointimal hyperplasia.
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Affiliation(s)
- Daniel J Wong
- Vascular Biology and Therapeutics (VBT) Program and the Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Daniel Y Lu
- Vascular Biology and Therapeutics (VBT) Program and the Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Clinton D Protack
- Vascular Biology and Therapeutics (VBT) Program and the Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Go Kuwahara
- Vascular Biology and Therapeutics (VBT) Program and the Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Hualong Bai
- Vascular Biology and Therapeutics (VBT) Program and the Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Nirvana Sadaghianloo
- Vascular Biology and Therapeutics (VBT) Program and the Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - George Tellides
- Vascular Biology and Therapeutics (VBT) Program and the Department of Surgery, Yale University School of Medicine, New Haven, Conn; Department of Surgery, VA Connecticut Healthcare System, West Haven, Conn
| | - Alan Dardik
- Vascular Biology and Therapeutics (VBT) Program and the Department of Surgery, Yale University School of Medicine, New Haven, Conn; Department of Surgery, VA Connecticut Healthcare System, West Haven, Conn.
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18
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Role of Excessive Autophagy Induced by Mechanical Overload in Vein Graft Neointima Formation: Prediction and Prevention. Sci Rep 2016; 6:22147. [PMID: 26915560 PMCID: PMC4768319 DOI: 10.1038/srep22147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/08/2016] [Indexed: 12/26/2022] Open
Abstract
Little is known regarding the interplays between the mechanical and molecular bases for vein graft restenosis. We elucidated the stenosis initiation using a high-frequency ultrasonic (HFU) echogenicity platform and estimated the endothelium yield stress from von-Mises stress computation to predict the damage locations in living rats over time. The venous-arterial transition induced the molecular cascades for autophagy and apoptosis in venous endothelial cells (ECs) to cause neointimal hyperplasia, which correlated with the high echogenicity in HFU images and the large mechanical stress that exceeded the yield strength. The ex vivo perfusion of arterial laminar shear stress to isolated veins further confirmed the correlation. EC damage can be rescued by inhibiting autophagy formation using 3-methyladenine (3-MA). Pretreatment of veins with 3-MA prior to grafting reduced the pathological increases of echogenicity and neointima formation in rats. Therefore, this platform provides non-invasive temporal spatial measurement and prediction of restenosis after venous-arterial transition as well as monitoring the progression of the treatments.
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19
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Yamamoto K, Protack CD, Kuwahara G, Tsuneki M, Hashimoto T, Hall MR, Assi R, Brownson KE, Foster TR, Bai H, Wang M, Madri JA, Dardik A. Disturbed shear stress reduces Klf2 expression in arterial-venous fistulae in vivo. Physiol Rep 2015; 3:3/3/e12348. [PMID: 25780089 PMCID: PMC4393175 DOI: 10.14814/phy2.12348] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Laminar shear stress (SS) induces an antiproliferative and anti-inflammatory endothelial phenotype and increases Klf2 expression. We altered the diameter of an arteriovenous fistula (AVF) in the mouse model to determine whether increased fistula diameter produces disturbed SS in vivo and if acutely increased disturbed SS results in decreased Klf2 expression. The mouse aortocaval fistula model was performed with 22, 25, or 28 gauge needles to puncture the aorta and the inferior vena cava. Duplex ultrasound was used to examine the AVF and its arterial inflow and venous outflow, and SS was calculated. Arterial samples were examined with western blot, immunohistochemistry, and immunofluorescence analysis for proteins and qPCR for RNA. Mice with larger diameter fistulae had diminished survival but increased AVF patency. Increased SS magnitudes and range of frequencies were directly proportional to the needle diameter in the arterial limb proximal to the fistula but not in the venous limb distal to the fistula, with 22-gauge needles producing the most disturbed SS in vivo. Klf2 mRNA and protein expression was diminished in the artery proximal to the fistula in proportion to increasing SS. Increased fistula diameter produces increased SS magnitude and frequency, consistent with disturbed SS in vivo. Disturbed SS is associated with decreased mRNA and protein expression of Klf2. Disturbed SS and reduced Klf2 expression near the fistula are potential therapeutic targets to improve AVF maturation.
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Affiliation(s)
- Kota Yamamoto
- Veterans Affairs Connecticut Healthcare Systems, West Haven, Connecticut Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Clinton D Protack
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Go Kuwahara
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Masayuki Tsuneki
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Pathology, Yale University School of Medicine, New Haven, Connecticut Division of Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Takuya Hashimoto
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michael R Hall
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Roland Assi
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Kirstyn E Brownson
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Trenton R Foster
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Hualong Bai
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Mo Wang
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph A Madri
- Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Alan Dardik
- Veterans Affairs Connecticut Healthcare Systems, West Haven, Connecticut Vascular Biology & Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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20
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Dipeptidyl peptidase 4 inhibitor reduces intimal hyperplasia in rabbit autologous jugular vein graft under poor distal runoff. J Vasc Surg 2015; 63:1360-70. [PMID: 25656593 DOI: 10.1016/j.jvs.2014.12.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/17/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Dipeptidyl peptidase 4 inhibitors are widely used in patients with type 2 diabetes mellitus to accomplish glycemic control through an increase in the blood glucagon-like peptide 1 (GLP-1) concentration. These agents also inhibit vascular inflammation (eg, in atherosclerosis). This study was undertaken to determine whether and how vildagliptin (a potent dipeptidyl peptidase 4 inhibitor) might reduce intimal hyperplasia in vein grafts. METHODS Twelve rabbits were randomly divided into two groups; one group received vildagliptin orally (10 mg/kg/d; n = 6), whereas the control group (n = 6) did not. Vildagliptin administration was started 7 days before rabbits underwent interposition reversed autologous jugular vein grafting and ended at graft harvesting (28 days after the operation). Histochemical changes in the vascular wall were examined, as were changes in the acetylcholine-induced effects on the endothelial Ca(2+) concentration ([Ca(2+)]i) and endothelium-dependent relaxation. RESULTS Under fasting conditions, vildagliptin increased the plasma GLP-1 concentration, without affecting plasma glucose or insulin. Acetylcholine induced endothelium-dependent relaxation only in the vildagliptin group, and this was blocked by the nitric oxide synthase inhibitor N(ω)-nitro-l-arginine. Acetylcholine did not modify the endothelial [Ca(2+)]i in either the control or vildagliptin group. Intimal hyperplasia was significantly less in the vildagliptin group (0.11 ± 0.02 mm, n = 5) than in the controls (0.31 ± 0.06 mm, n = 4; P < .01). CONCLUSIONS Vildagliptin increased the plasma GLP-1 concentration. It also enhanced acetylcholine-induced [Ca(2+)]i-independent endothelial nitric oxide release and reduced vein graft intimal hyperplasia, independently of any glycemic control action.
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21
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Chatterjee S, Nieman GF, Christie JD, Fisher AB. Shear stress-related mechanosignaling with lung ischemia: lessons from basic research can inform lung transplantation. Am J Physiol Lung Cell Mol Physiol 2014; 307:L668-80. [PMID: 25239915 DOI: 10.1152/ajplung.00198.2014] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Cessation of blood flow represents a physical event that is sensed by the pulmonary endothelium leading to a signaling cascade that has been termed "mechanotransduction." This paradigm has clinical relevance for conditions such as pulmonary embolism, lung bypass surgery, and organ procurement and storage during lung transplantation. On the basis of our findings with stop of flow, we postulate that normal blood flow is "sensed" by the endothelium by virtue of its location at the interface of the blood and vessel wall and that this signal is necessary to maintain the endothelial cell membrane potential. Stop of flow is sensed by a "mechanosome" consisting of PECAM-VEGF receptor-VE cadherin that is located in the endothelial cell caveolae. Activation of the mechanosome results in endothelial cell membrane depolarization that in turn leads to activation of NADPH oxidase (NOX2) to generate reactive oxygen species (ROS). Endothelial depolarization additionally results in opening of T-type voltage-gated Ca(2+) channels, increased intracellular Ca(2+), and activation of nitric oxide (NO) synthase with resultant generation of NO. Increased NO causes vasodilatation whereas ROS provide a signal for neovascularization; however, with lung transplantation overproduction of ROS and NO can cause oxidative injury and/or activation of proteins that drive inflammation and cell death. Understanding the key events in the mechanosignaling cascade has important lessons for the design of strategies or interventions that may reduce injury during storage of donor lungs with the goal to increase the availability of lungs suitable for donation and thus improving access to lung transplantation.
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Affiliation(s)
- Shampa Chatterjee
- Institute for Environmental Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennyslvania;
| | - Gary F Nieman
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York; and
| | - Jason D Christie
- Pulmonary Allergy and Critical Care Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Aron B Fisher
- Institute for Environmental Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennyslvania
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22
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Temporal regulation of venous extracellular matrix components during arteriovenous fistula maturation. J Vasc Access 2014; 16:93-106. [PMID: 25262757 DOI: 10.5301/jva.5000290] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The venous limb of arteriovenous fistulae (AVF) adapts to the arterial environment by dilation and wall thickening; however, the temporal regulation of the expression of extracellular matrix (ECM) components in the venous limb of the maturing AVF has not been well characterized. We used a murine model of AVF maturation that recapitulates human AVF maturation to determine the temporal pattern of expression of these ECM components. METHODS Aortocaval fistulae were created in C57BL/6J mice and the venous limb was analyzed on postoperative days 1, 3, 7, 21, and 42. A gene microarray analysis was performed on day 7; results were confirmed by qPCR, histology, and immunohistochemistry. Proteases, protease inhibitors, collagens, glycoproteins, and other non-collagenous proteins were characterized. RESULTS The maturing AVF has increased expression of many ECM components, including increased collagen and elastin. Matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase 1 (TIMP1) showed increased mRNA and protein expression during the first 7 days of maturation. Increased collagen and elastin expression was also significant at day 7. Expression of structural proteins was increased later during AVF maturation. Osteopontin (OPN) expression was increased at day 1 and sustained during AVF maturation. CONCLUSIONS During AVF maturation, there is significantly increased expression of ECM components, each of which shows distinct temporal patterns during AVF maturation. Increased expression of regulatory proteins such as MMP and TIMP precedes increased expression of structural proteins such as collagen and elastin, potentially mediating a controlled pattern of ECM degradation and vessel remodeling without structural failure.
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23
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Rooke TW, Felty CL. A different way to look at varicose veins. J Vasc Surg Venous Lymphat Disord 2014; 2:207-11. [PMID: 26993192 DOI: 10.1016/j.jvsv.2013.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The development of varicose veins is commonly attributed to vessel wall degeneration. The idea that varicose veins occur because of pathological processes, however, is challenged by certain observations. For example, their high prevalence (50% or greater) in many populations makes it statistically "normal" to have varicose veins; their well-established genetic predisposition raises the possibility that this high prevalence reflects a survival benefit. One way to explain this apparent contradiction is to theorize that varicose veins are produced by the same mechanism(s) that lead to the growth and remodeling of other types of blood vessels. If so, being "good" at forming varicose veins may also predispose to being "good" at forming various types of collateral blood vessels when necessary. METHODS A selected literature review was conducted. Works chosen for review included those suggesting that: the process of varicose vein formation may share the same basic mechanisms as the formation of collateral veins, arteries, and lymphatic vessels; and clinical outcomes may be different between subjects with and without varicose veins. RESULTS Evidence suggests that subjects who are "good" at forming varicose veins may also be "good" at forming various types of collateral vessels, and they may have better overall survival (with less cardiovascular morbidity) than those without varicose veins. CONCLUSIONS Varicose veins may be "the price we pay" for an enhanced ability to form collateral vessels when necessary.
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Affiliation(s)
- Thom W Rooke
- Department of Vascular Medicine, Mayo Clinic, Rochester, Minn.
| | - Cindy L Felty
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
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Terry CM, Dember LM. Novel therapies for hemodialysis vascular access dysfunction: myth or reality? Clin J Am Soc Nephrol 2013; 8:2202-12. [PMID: 24235283 DOI: 10.2215/cjn.07360713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hemodialysis vascular access dysfunction is a major source of morbidity for patients with ESRD. Development of effective approaches to prevent and treat vascular access failure requires an understanding of the underlying mechanisms, suitable models for preclinical testing, systems for targeted delivery of interventions to maximize efficacy and minimize toxicity, and rigorous clinical trials that use appropriate outcome measures. This article reviews the substantial progress and ongoing challenges in developing novel treatments for arteriovenous vascular access failure and focuses on localized rather than systemic interventions.
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Affiliation(s)
- Christi M Terry
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, †Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Yamamoto K, Protack CD, Tsuneki M, Hall MR, Wong DJ, Lu DY, Assi R, Williams WT, Sadaghianloo N, Bai H, Miyata T, Madri JA, Dardik A. The mouse aortocaval fistula recapitulates human arteriovenous fistula maturation. Am J Physiol Heart Circ Physiol 2013; 305:H1718-25. [PMID: 24097429 DOI: 10.1152/ajpheart.00590.2013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several models of arteriovenous fistula (AVF) have excellent patency and help in understanding the mechanisms of venous adaptation to the arterial environment. However, these models fail to exhibit either maturation failure or fail to develop stenoses, both of which are critical modes of AVF failure in human patients. We used high-resolution Doppler ultrasound to serially follow mice with AVFs created by direct 25-gauge needle puncture. By day 21, 75% of AVFs dilate, thicken, and increase flow, i.e., mature, and 25% fail due to immediate thrombosis or maturation failure. Mature AVF thicken due to increased amounts of smooth muscle cells. By day 42, 67% of mature AVFs remain patent, but 33% of AVFs fail due to perianastomotic thickening. These results show that the mouse aortocaval model has an easily detectable maturation phase in the first 21 days followed by a potential failure phase in the subsequent 21 days. This model is the first animal model of AVF to show a course that recapitulates aspects of human AVF maturation.
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Affiliation(s)
- Kota Yamamoto
- Veterans Affairs Connecticut Healthcare Systems, West Haven, Connecticut
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26
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Stack A, Derksen FJ, Sordillo LM, Williams KJ, Stick JA, Brandenberger C, Steibel JP, Robinson NE. Effects of exercise on markers of venous remodeling in lungs of horses. Am J Vet Res 2013; 74:1231-8. [DOI: 10.2460/ajvr.74.9.1231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dember LM, Imrey PB, Beck GJ, Cheung AK, Himmelfarb J, Huber TS, Kusek JW, Roy-Chaudhury P, Vazquez MA, Alpers CE, Robbin ML, Vita JA, Greene T, Gassman JJ, Feldman HI. Objectives and design of the hemodialysis fistula maturation study. Am J Kidney Dis 2013; 63:104-12. [PMID: 23992885 DOI: 10.1053/j.ajkd.2013.06.024] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 06/28/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND A large proportion of newly created arteriovenous fistulas cannot be used for dialysis because they fail to mature adequately to support the hemodialysis blood circuit. The Hemodialysis Fistula Maturation (HFM) Study was designed to elucidate clinical and biological factors associated with fistula maturation outcomes. STUDY DESIGN Multicenter prospective cohort study. SETTING & PARTICIPANTS Approximately 600 patients undergoing creation of a new hemodialysis fistula will be enrolled at 7 centers in the United States and followed up for as long as 4 years. PREDICTORS Clinical, anatomical, biological, and process-of-care attributes identified pre-, intra-, or postoperatively. OUTCOMES The primary outcome is unassisted clinical maturation, defined as successful use of the fistula for dialysis for 4 weeks without maturation-enhancing procedures. Secondary outcomes include assisted clinical maturation, ultrasound-based anatomical maturation, fistula procedures, fistula abandonment, and central venous catheter use. MEASUREMENTS Preoperative ultrasound arterial and venous mapping, flow-mediated and nitroglycerin-mediated brachial artery dilation, arterial pulse wave velocity, and venous distensibility; intraoperative vein tissue collection for histopathologic and molecular analyses; postoperative ultrasounds at 1 day, 2 weeks, 6 weeks, and prior to fistula intervention and initial cannulation. RESULTS Assuming complete data, no covariate adjustment, and unassisted clinical maturation of 50%, there will be 80% power to detect ORs of 1.83 and 1.61 for dichotomous predictor variables with exposure prevalences of 20% and 50%, respectively. LIMITATIONS Exclusion of 2-stage transposition fistulas limits generalizability. The requirement for study visits may result in a cohort that is healthier than the overall population of patients undergoing fistula creation. CONCLUSIONS The HFM Study will be of sufficient size and scope to: (1) evaluate a broad range of mechanistic hypotheses, (2) identify clinical practices associated with maturation outcomes, (3) assess the predictive utility of early indicators of fistula outcome, and (4) establish targets for novel therapeutic interventions to improve fistula maturation.
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Affiliation(s)
- Laura M Dember
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Peter B Imrey
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Alfred K Cheung
- Nephrology and Hypertension Division, University of Utah School of Medicine, Salt Lake City, UT
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - John W Kusek
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Prabir Roy-Chaudhury
- Division of Nephrology and Hypertension, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Miguel A Vazquez
- Division of Nephrology, University of Texas Southwestern, Dallas, TX
| | | | - Michelle L Robbin
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Joseph A Vita
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Tom Greene
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Jennifer J Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Harold I Feldman
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Gene expression changes in venous segment of overflow arteriovenous fistula. Int J Nephrol 2013; 2013:980923. [PMID: 23710358 PMCID: PMC3655589 DOI: 10.1155/2013/980923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/06/2013] [Accepted: 04/06/2013] [Indexed: 12/03/2022] Open
Abstract
Aim. The objective of this study was to characterize coordinated molecular changes in the structure and composition of the walls of venous segments of arteriovenous (AV) fistulas evoked by overflow. Methods. Venous tissue samples were collected from 6 hemodialysis patients with AV fistulas exposed to overflow and from the normal cephalic veins of 4 other hemodialysis patients. Total RNA was extracted from the venous tissue samples, and gene expression between the 2 groups was compared using Whole Human Genome DNA microarray 44 K. Microarray data were analyzed by GeneSpring GX software and Ingenuity Pathway Analysis. Results. The cDNA microarray analysis identified 397 upregulated genes and 456 downregulated genes. Gene ontology analysis with GeneSpring GX software revealed that biological developmental processes and glycosaminoglycan binding were the most upregulated. In addition, most upregulation occurred extracellularly. In the pathway analysis, the TGF beta signaling pathway, cytokines and inflammatory response pathway, hypertrophy model, and the myometrial relaxation and contraction pathway were significantly upregulated compared with the control cephalic vein. Conclusion. Combining microarray results and pathway information available via the Internet provided biological insight into the structure and composition of the venous wall of overflow AV fistulas.
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Rothuizen TC, Wong C, Quax PHA, van Zonneveld AJ, Rabelink TJ, Rotmans JI. Arteriovenous access failure: more than just intimal hyperplasia? Nephrol Dial Transplant 2013; 28:1085-92. [PMID: 23543595 DOI: 10.1093/ndt/gft068] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Haemodialysis vascular access patency is severely compromised by fistula non-maturation and access stenosis. Intimal hyperplasia (IH) is considered the culprit lesion in failed fistulas, resulting in luminal narrowing and stenosis. This review focuses on the biology and pathophysiology of fistula failure and highlights not only the classically associated IH but also some relatively neglected but potentially important contributors such as inadequate outward remodelling. In addition, the complex process and fragile balance of successful fistula maturation might be partially hindered by pre-existent chronic kidney disease-mediated vasculopathy. Further unravelling the (patho)physiology of outward remodelling and IH could contribute to novel therapies and enhance fistula patency.
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Affiliation(s)
- Tonia C Rothuizen
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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30
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Yang C, Guo Y, Jadlowiec CC, Li X, Lv W, Model LS, Collins MJ, Kondo Y, Muto A, Shu C, Dardik A. Vascular endothelial growth factor-A inhibits EphB4 and stimulates delta-like ligand 4 expression in adult endothelial cells. J Surg Res 2013; 183:478-86. [PMID: 23394931 DOI: 10.1016/j.jss.2013.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/18/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND During vein graft adaptation to the arterial circulation, vascular endothelial growth factor (VEGF) A expression transiently increases before becoming downregulated; however, the role of VEGF-A in venous remodeling is not clear. In addition, although VEGF-A stimulates angiogenesis and determines arterial identity in nascent arterial endothelial cells (EC), the role of VEGF-A in regulating identity in adult venous EC is also not clear. MATERIALS AND METHODS EC, wild type (EphB4+/+) or heterozygous knockout (EphB4+/-), were stimulated with VEGF-A (0-100 ng/mL) and examined with quantitative polymerase chain reaction and western blotting. RESULTS VEGF-A (100 ng/mL) inhibited expression of EphB4 and stimulated expression of delta-like ligand 4 (dll4) but did not stimulate either notch or EphrinB2 expression in adult venous EC. Pretreatment with VEGF receptor 2-neutralizing antibody abolished VEGF-stimulated downregulation of EphB4 but not the upregulation of dll4. Pretreatment with PD98059 or wortmannin showed that VEGF-A downregulation of EphB4 and upregulation of dll4 are mitogen-activated protein kinase kinase and extracellular signal-regulated kinase dependent but phosphatidylinositol 3 kinase-Akt independent. Compared with VEGF-induced EphB4 downregulation and dll4 upregulation in control EC, reduced EphB4 signaling in EphB4+/- EC showed even further downregulation of EphB4 and upregulation of dll4. CONCLUSIONS Despite the genetic programming of arterial and venous EC fate, VEGF-A can repress venous identity in adult venous EC without induction of arterial identity. These changes in adult EC in vitro recapitulate the changes in identity described during vein graft adaptation to the arterial environment in vivo.
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Affiliation(s)
- Chenzi Yang
- Interdepartmental Program in Vascular Biology and Therapeutics, Yale University School of Medicine, New Haven, Connecticut 06520-8089, USA
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31
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Maekawa T, Komori K, Morisaki K, Itoh T. Ezetimibe reduces intimal hyperplasia in rabbit jugular vein graft. J Vasc Surg 2012; 56:1689-97. [DOI: 10.1016/j.jvs.2012.05.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/11/2012] [Accepted: 05/14/2012] [Indexed: 12/12/2022]
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Maekawa T, Komori K, Kajikuri J, Itoh T. Characteristics of the actions by which 5-hydroxytryptamine affects electrical and mechanical activities in rabbit jugular vein graft. Br J Pharmacol 2012; 166:1419-32. [PMID: 22251164 DOI: 10.1111/j.1476-5381.2012.01867.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE The vasomodulating actions of 5-HT in vein grafts, and the underlying mechanisms, remain to be fully clarified. Here, we characterized the actions by which 5-HT affects electrical and mechanical activities in rabbit autologous jugular vein grafts. EXPERIMENTAL APPROACH Smooth muscle cell (SMC) membrane potential and isometric tension were measured in vein grafts 4 weeks after implantation into carotid arteries. Changes in the expression of 5-HT receptor subtypes and in myosin heavy chain isoforms (SM1, SM2 and SMemb) were examined by immunohistochemistry and Western blot analysis. KEY RESULTS The walls of grafted veins displayed massive increases in the number of SM1- and SM2-positive SMCs. 5-HT induced a large depolarization and contraction that were each reduced by both 5-HT(2A) - and 5-HT(1B/1D) -receptor antagonists. The 5-HT-induced contraction was not modified by a 5-HT₇ -receptor antagonist. The 5-HT₇ -receptor-selective agonist AS 19 did not induce relaxation during the contraction to prostaglandin F(2α) . Immunohistochemical and Western blot analyses revealed that immunoreactive responses against 5-HT(2A) and 5-HT(1B/1D) receptors were increased in the vein graft. CONCLUSIONS AND IMPLICATIONS 5-HT is able to induce a large contraction in rabbit autologous jugular vein grafts through (i) an increased number of differentiated contractile SMCs; (ii) an increased number of SMCs expressing contractile 5-HT(2A) - and 5-HT(1B/1D) receptors; and (iii) a down-regulation of the function of the relaxant SMC 5-HT₇ receptors. These changes in the vein graft may help it to resist the higher pressure present on the arterial side of the circulation.
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Affiliation(s)
- Takashi Maekawa
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Doyle ME, Perley JP, Skalak TC. Bone marrow-derived progenitor cells augment venous remodeling in a mouse dorsal skinfold chamber model. PLoS One 2012; 7:e32815. [PMID: 22389724 PMCID: PMC3289672 DOI: 10.1371/journal.pone.0032815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 02/06/2012] [Indexed: 12/01/2022] Open
Abstract
The delivery of bone marrow-derived cells (BMDCs) has been widely used to stimulate angiogenesis and arteriogenesis. We identified a progenitor-enriched subpopulation of BMDCs that is able to augment venular remodeling, a generally unexplored area in microvascular research. Two populations of BMDCs, whole bone marrow (WBM) and Lin−/Sca-1+ progenitor cells, were encapsulated in sodium alginate and delivered to a mouse dorsal skinfold chamber model. Upon observation that encapsulated Sca-1+ progenitor cells enhance venular remodeling, the cells and tissue were analyzed on structural and molecular levels. Venule walls were thickened and contained more nuclei after Sca-1+ progenitor cell delivery. In addition, progenitors expressed mRNA transcript levels of chemokine (C-X-C motif) ligand 2 (CXCL2) and interferon gamma (IFNγ) that are over 5-fold higher compared to WBM. Tissues that received progenitors expressed significantly higher protein levels of vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP-1), and platelet derived growth factor-BB (PDGF-BB) compared to tissues that received an alginate control construct. Nine days following cell delivery, tissue from progenitor recipients contained 39% more CD45+ leukocytes, suggesting that these cells may enhance venular remodeling through the modulation of the local immune environment. Results show that different BMDC populations elicit different microvascular responses. In this model, Sca-1+ progenitor cell-derived CXCL2 and IFNγ may mediate venule enlargement via modulation of the local inflammatory environment.
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Affiliation(s)
- Megan E Doyle
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, United States of America.
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Muto A, Yi T, Harrison KD, Dávalos A, Fancher TT, Ziegler KR, Feigel A, Kondo Y, Nishibe T, Sessa WC, Dardik A. Eph-B4 prevents venous adaptive remodeling in the adult arterial environment. J Exp Med 2011; 208:561-75. [PMID: 21339325 PMCID: PMC3058579 DOI: 10.1084/jem.20101854] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 01/21/2011] [Indexed: 01/08/2023] Open
Abstract
Eph-B4 determines mammalian venous differentiation in the embryo but is thought to be a quiescent marker of adult veins. We have previously shown that surgical transposition of a vein into the arterial environment is characterized by loss of venous identity, as indicated by the loss of Eph-B4, and intimal thickening. We used a mouse model of vein graft implantation to test the hypothesis that Eph-B4 is a critical determinant of venous wall thickness during postsurgical adaptation to the arterial environment. We show that stimulation of Eph-B4 signaling, either via ligand stimulation or expression of a constitutively active Eph-B4, inhibits venous wall thickening and preserves venous identity; conversely, reduction of Eph-B4 signaling is associated with increased venous wall thickness. Stimulated Eph-B4 associates with caveolin-1 (Cav-1); loss of Cav-1 or Eph-B4 kinase function abolishes inhibition of vein graft thickening. These results show that Eph-B4 is active in adult veins and regulates venous remodeling. Eph-B4-Cav-1-mediated vessel remodeling may be a venous-specific adaptive mechanism. Controlled stimulation of embryonic signaling pathways such as Eph-B4 may be a novel strategy to manipulate venous wall remodeling in adults.
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Affiliation(s)
- Akihito Muto
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Tai Yi
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Kenneth D. Harrison
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Alberto Dávalos
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Tiffany T. Fancher
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Kenneth R. Ziegler
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Amanda Feigel
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Yuka Kondo
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Toshiya Nishibe
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - William C. Sessa
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
| | - Alan Dardik
- Department of Surgery and Department of Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT 06520
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Johnson EC, Doser TA, Cepurna WO, Dyck JA, Jia L, Guo Y, Lambert WS, Morrison JC. Cell proliferation and interleukin-6-type cytokine signaling are implicated by gene expression responses in early optic nerve head injury in rat glaucoma. Invest Ophthalmol Vis Sci 2011; 52:504-18. [PMID: 20847120 DOI: 10.1167/iovs.10-5317] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE In glaucoma, the optic nerve head (ONH) is the principal site of initial axonal injury, and elevated intraocular pressure (IOP) is the predominant risk factor. However, the initial responses of the ONH to elevated IOP are unknown. Here the authors use a rat glaucoma model to characterize ONH gene expression changes associated with early optic nerve injury. METHODS Unilateral IOP elevation was produced in rats by episcleral vein injection of hypertonic saline. ONH mRNA was extracted, and retrobulbar optic nerve cross-sections were graded for axonal degeneration. Gene expression was determined by microarray and quantitative PCR (QPCR) analysis. Significantly altered gene expression was determined by multiclass analysis and ANOVA. DAVID gene ontology determined the functional categories of significantly affected genes. RESULTS The Early Injury group consisted of ONH from eyes with <15% axon degeneration. By array analysis, 877 genes were significantly regulated in this group. The most significant upregulated gene categories were cell cycle, cytoskeleton, and immune system process, whereas the downregulated categories included glucose and lipid metabolism. QPCR confirmed the upregulation of cell cycle-associated genes and leukemia inhibitory factor (Lif) and revealed alterations in expression of other IL-6-type cytokines and Jak-Stat signaling pathway components, including increased expression of IL-6 (1553%). In contrast, astrocytic glial fibrillary acidic protein (Gfap) message levels were unaltered, and other astrocytic markers were significantly downregulated. Microglial activation and vascular-associated gene responses were identified. CONCLUSIONS Cell proliferation and IL-6-type cytokine gene expression, rather than astrocyte hypertrophy, characterize early pressure-induced ONH injury.
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Affiliation(s)
- Elaine C Johnson
- Kenneth C. Swan Ocular Neurobiology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon 97201, USA.
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Chiu JJ, Chien S. Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. Physiol Rev 2011; 91:327-87. [PMID: 21248169 PMCID: PMC3844671 DOI: 10.1152/physrev.00047.2009] [Citation(s) in RCA: 1411] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Vascular endothelial cells (ECs) are exposed to hemodynamic forces, which modulate EC functions and vascular biology/pathobiology in health and disease. The flow patterns and hemodynamic forces are not uniform in the vascular system. In straight parts of the arterial tree, blood flow is generally laminar and wall shear stress is high and directed; in branches and curvatures, blood flow is disturbed with nonuniform and irregular distribution of low wall shear stress. Sustained laminar flow with high shear stress upregulates expressions of EC genes and proteins that are protective against atherosclerosis, whereas disturbed flow with associated reciprocating, low shear stress generally upregulates the EC genes and proteins that promote atherogenesis. These findings have led to the concept that the disturbed flow pattern in branch points and curvatures causes the preferential localization of atherosclerotic lesions. Disturbed flow also results in postsurgical neointimal hyperplasia and contributes to pathophysiology of clinical conditions such as in-stent restenosis, vein bypass graft failure, and transplant vasculopathy, as well as aortic valve calcification. In the venous system, disturbed flow resulting from reflux, outflow obstruction, and/or stasis leads to venous inflammation and thrombosis, and hence the development of chronic venous diseases. Understanding of the effects of disturbed flow on ECs can provide mechanistic insights into the role of complex flow patterns in pathogenesis of vascular diseases and can help to elucidate the phenotypic and functional differences between quiescent (nonatherogenic/nonthrombogenic) and activated (atherogenic/thrombogenic) ECs. This review summarizes the current knowledge on the role of disturbed flow in EC physiology and pathophysiology, as well as its clinical implications. Such information can contribute to our understanding of the etiology of lesion development in vascular niches with disturbed flow and help to generate new approaches for therapeutic interventions.
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Affiliation(s)
- Jeng-Jiann Chiu
- Division of Medical Engineering Research, National Health Research Institutes, Taiwan
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Achneck HE, Sileshi B, Li M, Partington EJ, Peterson DA, Lawson JH. Surgical aspects and biological considerations of arteriovenous fistula placement. Semin Dial 2010; 23:25-33. [PMID: 20331815 DOI: 10.1111/j.1525-139x.2009.00651.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Since the Fistula First Initiative was formulated in 2003, providers and payers have increasingly emphasized the need to create more arteriovenous fistulae. To maximize the chances of successful fistula maturation, a thorough understanding of the biology and surgical aspects of fistula placement are essential. A functional endothelium in the target vessels is the prerequisite for the adaptive remodeling of the vessel wall, which has to take place after fistula formation. Mechanoreceptors of the endothelium sense the increase in shear stress and, through a variety of activated signaling cascades, induce the necessary changes and vasodilation of the respective vessels. The successful fistula placement starts with a thorough preoperative evaluation, which focuses on protecting the target vessels and avoiding intravenous catheters and devices. Intraoperatively, the risk of endothelial dysfunction and hyperplasia is further minimized through an atraumatic dissection with minimal manipulation of the vein and artery. The surgical technique should also focus on decreasing the vessel compliance mismatch and avoiding an inflammatory response secondary to hematoma formation. Postoperatively, the fistula must be diligently monitored for the complications of thrombosis, postoperative steal syndrome, neuropathy, aneurysm formation, infection, and high-output cardiac failure. Early recognition of a problem is the key to saving an otherwise doomed fistula. An armamentarium of percutaneous techniques is available to the access surgeon to treat the most common causes of failed access formation. However, in some cases a surgical revision of the access site through patch angioplasty, a jump graft, and graft interposition is necessary to create a fistula which can be successfully used for hemodialysis.
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Affiliation(s)
- Hardean E Achneck
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Fancher TT, Muto A, Fitzgerald TN, Magri D, Gortler D, Nishibe T, Dardik A. Control of blood vessel identity: from embryo to adult. Ann Vasc Dis 2008; 1:28-34. [PMID: 23555335 DOI: 10.3400/avd.avdrev07011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Accepted: 01/25/2008] [Indexed: 11/13/2022] Open
Abstract
Arteries and veins have been historically defined by the direction of blood flow and oxygen tension within the vessel, in addition to their functional, hemodynamic, and anatomical differences. It is now known that the molecular identity of these vessels is genetically predetermined, with specific molecular pathways activated during the development of arteries and veins. Eph-B4 is a determinant of venous differentiation and Ephrin-B2 is a determinant of arterial differentiation. Placement of a vein into the higher pressure and flow of the arterial circulation results in adaptation of the vein to the arterial environment. There is selective loss of Eph-B4 expression without induction of Ephrin-B2 expression during vein graft adaptation. These findings suggest that loss of venous identity is the crucial mechanism in vein graft adaptation and that developmentally critical determinants of vessel identity are plastic during adult life.
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Affiliation(s)
- Tiffany T Fancher
- Department of Surgery in Vascular Biology and Therapeutics, Yale University School of Medicine, New Haven, CT, USA ; Department of the Interdepartmental Program in Vascular Biology and Therapeutics, Yale University School of Medicine, New Haven, CT, USA ; Saint Mary's Health System, Waterbury, CT, USA
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Errami M, Galindo CL, Tassa AT, Dimaio JM, Hill JA, Garner HR. Doxycycline attenuates isoproterenol- and transverse aortic banding-induced cardiac hypertrophy in mice. J Pharmacol Exp Ther 2007; 324:1196-203. [PMID: 18089841 DOI: 10.1124/jpet.107.133975] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The United States Food and Drug Administration-approved antibiotic doxycycline (DOX) inhibits matrix metalloproteases, which contribute to the development of cardiac hypertrophy (CH). We hypothesized that DOX might serve as a treatment for CH. The efficacy of DOX was tested in two mouse models of CH: induced by the beta-adrenergic agonist isoproterenol (ISO) and induced by transverse aortic banding. DOX significantly attenuated CH in these models, causing a profound reduction of the hypertrophic phenotype and a lower heart/body weight ratio (p < 0.05, n >/= 6). As expected, ISO increased matrix metalloprotease (MMP) 2 and 9 activities, and administration of DOX reversed this effect. Transcriptional profiles of normal, ISO-, and ISO + DOX-treated mice were examined using microarrays, and the results were confirmed by real-time reverse transcriptase-polymerase chain reaction. Genes (206) were differentially expressed between normal and ISO mice that were reversibly altered between ISO- and ISO + DOX-treated mice, indicating their potential role in CH development and DOX-induced improvement. These genes included those involved in the regulation of cell proliferation and fate, stress, and immune responses, cytoskeleton and extracellular matrix organization, and cardiac-specific signal transduction. The overall gene expression profile suggested that MMP2/9 inactivation was not the only mechanism whereby DOX exerts its beneficial effects. Western blot analysis identified potential signaling events associated with CH, including up-regulation of endothelial differentiation sphingolipid G-protein-coupled receptor 1 receptor and activation of extracellular signal-regulated kinase, p38, and the transcription factor activating transcription factor-2, which were reduced after administration of DOX. These results suggest that DOX might be evaluated as a potential CH therapeutic and also provide potential signaling mechanisms to investigate in the context of CH phenotype development and regression.
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Affiliation(s)
- Mounir Errami
- Division of Translational Research, University of Texas Southwestern Medical Center, 2201 Inwood Rd., Dallas, TX 75390-9185, USA.
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Lacson E, Lazarus JM, Himmelfarb J, Ikizler TA, Hakim RM. Balancing Fistula First With Catheters Last. Am J Kidney Dis 2007; 50:379-95. [PMID: 17720517 DOI: 10.1053/j.ajkd.2007.06.006] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 06/15/2007] [Indexed: 11/11/2022]
Abstract
The success of Fistula First nationwide has been accompanied by an unplanned increase in hemodialysis catheters. Complications related to prolonged hemodialysis catheter use include increased morbidity, mortality, and cost. We hypothesize that the national focus on increasing fistulas may have inadvertently diverted attention away from initiatives to decrease dependence on hemodialysis catheters. Based on a synthesis of guidelines, reviews, published evidence, and the authors' opinions, we propose that the national vascular access initiative be revised to have a dual goal of Fistula First and "Catheters Last." These goals are not mutually exclusive, but rather complementary. We recommend a systematic refocus on interventions that not only increase fistulas, but help avoid extended catheter use. Clearly, the ideal practice for hemodialysis vascular access remains early placement of fistulas with enough maturation time such that they can be used for initiating long-term hemodialysis therapy when the need arises. To effect this change, a reimbursement policy covering the costs associated with permanent access placement before the need for dialysis is essential. Individualized patient management strategies may consider such innovative approaches as initiating patients on peritoneal dialysis therapy or using nonautogenous grafts as bridge accesses in lieu of catheters. For patients who are dialyzing using catheters, immediate active planning for permanent access placement and removal of the catheter is necessary. In the same vein as Fistula First, the renal community should once again be galvanized in working together toward controlling the catheter epidemic in our dialysis population.
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Affiliation(s)
- Eduardo Lacson
- Fresenius Medical Care, North America, Waltham, MA 02451-1457, USA.
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Kudo FA, Muto A, Maloney SP, Pimiento JM, Bergaya S, Fitzgerald TN, Westvik TS, Frattini JC, Breuer CK, Cha CH, Nishibe T, Tellides G, Sessa WC, Dardik A. Venous Identity Is Lost but Arterial Identity Is Not Gained During Vein Graft Adaptation. Arterioscler Thromb Vasc Biol 2007; 27:1562-71. [PMID: 17463332 DOI: 10.1161/atvbaha.107.143032] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives—
Ephrin ligands and Eph receptors are signaling molecules that are differentially expressed on arteries and veins during development. We examined whether Eph-B4, a venous marker, and Ephrin-B2, an arterial marker, are regulated during vein graft adaptation in humans and aged rats.
Methods and Results—
Eph-B4 transcripts and immunodetectable protein are downregulated in endothelial and smooth muscle cells of patent vein grafts in both humans and in aged rats, whereas Ephrin-B2 transcripts and protein are not strongly induced. Other markers of arterial identity, including dll4 and notch-4, are also not induced during vein graft adaptation in aged rats. Because VEGF-A is upstream of the Ephrin–Eph pathway, and expression of VEGF-A is induced only at early time points after exposure of the vein to the arterial environment, we inhibited VEGF-A in vein grafts using an siRNA-based approach. Vein grafts treated with siRNA directed against VEGF-A demonstrated a thicker intima-media containing α-actin, consistent with arterialization, but did not contain Eph-B4 or Ephrin-B2.
Conclusions—
Venous identity is preserved in the veins of aged animals, but is lost during adaptation to the arterial circulation; arterial markers are not induced. Markers of vessel identity are plastic in adults and their selective regulation may mediate vein graft adaptation to the arterial environment in aged animals and humans.
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Affiliation(s)
- Fabio A Kudo
- Yale University School of Medicine, Department of Surgery, New Haven, CT 06519, USA
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Abstract
It has become increasingly clear that the Notch signaling pathway plays a critical role in the development and homeostasis of the cardiovascular system. This notion has emerged from loss- and gain-of-function analysis and from the realization that several hereditary cardiovascular disorders originate from gene mutations that have a direct impact on Notch signaling. Current research efforts are focused on determining the specific cellular and molecular effects of Notch signaling. The rationale for this has stemmed from the clinical importance and therapeutic potential of modulating vascular formation during various disease states. A more complete appreciation of Notch signaling, as it relates to vascular morphogenesis, requires an in-depth knowledge of expression patterns of the various signaling components and a comprehensive understanding of downstream targets. The goal of this review is to summarize current knowledge regarding Notch signaling during vascular development and within the adult vascular wall. Our focus is on the genetic analysis and cellular experiments that have been performed with Notch ligands, receptors, and downstream targets. We also highlight questions and controversies regarding the contribution of this pathway to vascular development.
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Affiliation(s)
- Jennifer J Hofmann
- Molecular Biology Institute, University of California, Los Angeles, CA 90095, USA
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