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Beekers I, Langeveld SAG, Meijlink B, van der Steen AFW, de Jong N, Verweij MD, Kooiman K. Internalization of targeted microbubbles by endothelial cells and drug delivery by pores and tunnels. J Control Release 2022; 347:460-475. [PMID: 35545132 DOI: 10.1016/j.jconrel.2022.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/09/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022]
Abstract
Ultrasound insonification of microbubbles can locally enhance drug delivery by increasing the cell membrane permeability. To aid development of a safe and effective therapeutic microbubble, more insight into the microbubble-cell interaction is needed. In this in vitro study we aimed to investigate the initial 3D morphology of the endothelial cell membrane adjacent to individual microbubbles (n = 301), determine whether this morphology was affected upon binding and by the type of ligand on the microbubble, and study its influence on microbubble oscillation and the drug delivery outcome. High-resolution 3D confocal microscopy revealed that targeted microbubbles were internalized by endothelial cells, while this was not the case for non-targeted or IgG1-κ control microbubbles. The extent of internalization was ligand-dependent, since αvβ3-targeted microbubbles were significantly more internalized than CD31-targeted microbubbles. Ultra-high-speed imaging (~17 Mfps) in combination with high-resolution confocal microscopy (n = 246) showed that microbubble internalization resulted in a damped microbubble oscillation upon ultrasound insonification (2 MHz, 200 kPa peak negative pressure, 10 cycles). Despite damped oscillation, the cell's susceptibility to sonoporation (as indicated by PI uptake) was increased for internalized microbubbles. Monitoring cell membrane integrity (n = 230) showed the formation of either a pore, for intracellular delivery, or a tunnel (i.e. transcellular perforation), for transcellular delivery. Internalized microbubbles caused fewer transcellular perforations and smaller pore areas than non-internalized microbubbles. In conclusion, studying microbubble-mediated drug delivery using a state-of-the-art imaging system revealed receptor-mediated microbubble internalization and its effect on microbubble oscillation and resulting membrane perforation by pores and tunnels.
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Affiliation(s)
- Inés Beekers
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC University Medical Center Rotterdam, Office Ee2302, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Health, ORTEC B.V., Houtsingel 5, 2719 EA Zoetermeer, the Netherlands.
| | - Simone A G Langeveld
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC University Medical Center Rotterdam, Office Ee2302, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Bram Meijlink
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC University Medical Center Rotterdam, Office Ee2302, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Antonius F W van der Steen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC University Medical Center Rotterdam, Office Ee2302, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Nico de Jong
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC University Medical Center Rotterdam, Office Ee2302, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Laboratory of Medical Imaging, Department of Imaging Physics, Delft University of Technology, Building 22, Room D218, Lorentzweg 1, 2628 CJ Delft, the Netherlands
| | - Martin D Verweij
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC University Medical Center Rotterdam, Office Ee2302, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Laboratory of Medical Imaging, Department of Imaging Physics, Delft University of Technology, Building 22, Room D218, Lorentzweg 1, 2628 CJ Delft, the Netherlands
| | - Klazina Kooiman
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC University Medical Center Rotterdam, Office Ee2302, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
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Vigne J, Thackeray J, Essers J, Makowski M, Varasteh Z, Curaj A, Karlas A, Canet-Soulas E, Mulder W, Kiessling F, Schäfers M, Botnar R, Wildgruber M, Hyafil F. Current and Emerging Preclinical Approaches for Imaging-Based Characterization of Atherosclerosis. Mol Imaging Biol 2019; 20:869-887. [PMID: 30250990 DOI: 10.1007/s11307-018-1264-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Atherosclerotic plaques can remain quiescent for years, but become life threatening upon rupture or disruption, initiating clot formation in the vessel lumen and causing acute myocardial infarction and ischemic stroke. Whether and how a plaque ruptures is determined by its macroscopic structure and microscopic composition. Rupture-prone plaques usually consist of a thin fibrous cap with few smooth muscle cells, a large lipid core, a dense infiltrate of inflammatory cells, and neovessels. Such lesions, termed high-risk plaques, can remain asymptomatic until the thrombotic event. Various imaging technologies currently allow visualization of morphological and biological characteristics of high-risk atherosclerotic plaques. Conventional protocols are often complex and lack specificity for high-risk plaque. Conversely, new imaging approaches are emerging which may overcome these limitations. Validation of these novel imaging techniques in preclinical models of atherosclerosis is essential for effective translational to clinical practice. Imaging the vessel wall, as well as its biological milieu in small animal models, is challenging because the vessel wall is a small structure that undergoes continuous movements imposed by the cardiac cycle as it is adjacent to circulating blood. The focus of this paper is to provide a state-of-the-art review on techniques currently available for preclinical imaging of atherosclerosis in small animal models and to discuss the advantages and limitations of each approach.
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Affiliation(s)
- Jonathan Vigne
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP; INSERM, U-1148, DHU FIRE, University Diderot, Paris, France
| | - James Thackeray
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Jeroen Essers
- Departments of Vascular Surgery, Molecular Genetics, Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
| | - Marcus Makowski
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Zoreh Varasteh
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Adelina Curaj
- Institute for Molecular Cardiovascular Research (IMCAR), Institute for Experimental Molecular Imaging (ExMI), University Hospital Aachen, RWTH, Aachen, Germany
| | - Angelos Karlas
- Institute for Biological and Medical Imaging, Helmholtz Zentrum München, Oberschleissheim, Germany
| | - Emmanuel Canet-Soulas
- Laboratoire CarMeN, INSERM U-1060, Lyon/Hospices Civils Lyon, IHU OPERA Cardioprotection, Université de Lyon, Bron, France
| | - Willem Mulder
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai, New York, USA
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging (ExMI), University Hospital Aachen, RWTH, Aachen, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - René Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Moritz Wildgruber
- Translational Research Imaging Center, Institut für Klinische Radiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Fabien Hyafil
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP; INSERM, U-1148, DHU FIRE, University Diderot, Paris, France. .,Département de Médecine Nucléaire, Centre Hospitalier Universitaire Bichat, 46 rue Henri Huchard, 75018, Paris, France.
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17
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Curaj A, Wu Z, Rix A, Gresch O, Sternkopf M, Alampour-Rajabi S, Lammers T, van Zandvoort M, Weber C, Koenen RR, Liehn EA, Kiessling F. Molecular Ultrasound Imaging of Junctional Adhesion Molecule A Depicts Acute Alterations in Blood Flow and Early Endothelial Dysregulation. Arterioscler Thromb Vasc Biol 2017; 38:40-48. [PMID: 29191926 DOI: 10.1161/atvbaha.117.309503] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 11/17/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The junctional adhesion molecule A (JAM-A) is physiologically located in interendothelial tight junctions and focally redistributes to the luminal surface of blood vessels under abnormal shear and flow conditions accompanying atherosclerotic lesion development. Therefore, JAM-A was evaluated as a target for molecularly targeted ultrasound imaging of transient endothelial dysfunction under acute blood flow variations. APPROACH AND RESULTS Flow-dependent endothelial dysfunction was induced in apolipoprotein E-deficient mice (n=43) by carotid partial ligation. JAM-A expression was investigated by molecular ultrasound using antibody-targeted poly(n-butyl cyanoacrylate) microbubbles and validated with immunofluorescence. Flow disturbance and arterial remodeling were assessed using functional ultrasound. Partial ligation led to an immediate drop in perfusion at the ligated side and a direct compensatory increase at the contralateral side. This was accompanied by a strongly increased JAM-A expression and JAM-A-targeted microbubbles binding at the partially ligated side and by a moderate and temporary increase in the contralateral artery (≈14× [P<0.001] and ≈5× [P<0.001] higher than control, respectively), both peaking after 2 weeks. Subsequently, although JAM-A expression and JAM-A-targeted microbubbles binding persisted at a higher level at the partially ligated side, it completely normalized within 4 weeks at the contralateral side. CONCLUSIONS Temporary blood flow variations induce endothelial rearrangement of JAM-A, which can be visualized using JAM-A-targeted microbubbles. Thus, JAM-A may be considered as a marker of acute endothelial activation and dysfunction. Its imaging may facilitate the early detection of cardiovascular risk areas, and it enables the therapeutic prevention of their progression toward an irreversible pathological state.
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Affiliation(s)
- Adelina Curaj
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Zhuojun Wu
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Anne Rix
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Oliver Gresch
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Marieke Sternkopf
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Setareh Alampour-Rajabi
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Twan Lammers
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Marc van Zandvoort
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Christian Weber
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Rory R Koenen
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Elisa A Liehn
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.)
| | - Fabian Kiessling
- From the Institute for Molecular Cardiovascular Research (IMCAR) (A.C., Z.W., M.S., S.A.-R., M.v.Z., E.A.L.), and Institute for Experimental Molecular Imaging (ExMI) (A.C., Z.W., A.R., T.L., F.K.), University Hospital Aachen, RWTH Aachen, Germany; Victor Babes National Institute of Pathology, Bucharest, Romania (A.C.); AYOXXA Biosystems GmbH, Cologne, Germany (O.G.); Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands (T.L.); Department of Genetics and Molecular Cell Biology, School for Oncology and Developmental Biology (GROW), Maastricht University, The Netherlands (M.v.Z., R.R.K.); Department of Biochemistry, School for Cardiovascular Diseases (CARIM), Maastricht University, The Netherlands (M.v.Z., C.W.); German Centre for Cardiovascular Research, partner site Munich Heart Alliance (DZHK), Germany (C.W.); Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany (C.W.); and Human Genetic Laboratory, University for Medicine and Pharmacy, Craiova, Romania (E.A.L.).
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