Platelet deposition after angioplasty is abolished by restoration of the endothelial cell monolayer

Notoginsenoside Fc Accelerates Reendothelialization following Vascular Injury in Diabetic Rats by Promoting Endothelial Cell Autophagy

Interventional therapies, such as percutaneous transluminal angioplasty and endovascular stent implantation, are used widely for the treatment of diabetic peripheral vascular complications. Reendothelialization is an essential process in vascular injury following interventional therapy, and hyperglycemia in diabetes mellitus (DM) plays an important role in damaging endothelial layer integrity, leading to the retardance of reendothelialization and excessive neointimal formation. Notoginsenoside Fc (Fc), a novel saponin isolated from Panax notoginseng, effectively counteracts platelet aggregation. Nevertheless, the potential effects and molecular mechanisms of Fc on reendothelialization have yet to be explored. In this study, we present novel findings that show the benefit of Fc in accelerating reendothelialization and alleviating excessive neointimal formation following carotid artery injury in diabetic Sprague-Dawley rats in vivo. Simultaneously, the decreased autophagy of the injured carotid artery in diabetic rats was restored by Fc treatment. Our in vitro results also demonstrated that Fc promoted endothelial cell proliferation and migration under high-glucose treatment by increasing autophagy. In summary, this study supported the notion that Fc could accelerate reendothelialization following vascular injury in diabetic rats by promoting autophagy, suggesting that Fc may exert therapeutic benefits for early endothelial injury and restenosis following intervention in diabetes-associated vascular diseases.

The modulation of platelet and endothelial cell adhesion to vascular graft materials by perlecan

Controlled neo-endothelialisation is critical to the patency of small diameter vascular grafts. Endothelialisation and platelet adhesion to purified endothelial cell-derived perlecan, the major heparan sulfate (HS) proteoglycan in basement membranes, were investigated using in vivo and in vitro assays. Expanded polytetrafluoroethylene (ePTFE) vascular grafts were coated with perlecan and tested in an ovine carotid interposition model for a period of 6 weeks and assessed using light and scanning microscopy. Enhanced endothelial cell growth and reduced platelet adhesion were observed on the perlecan coated grafts when compared to uncoated controls implanted in the same sheep (n=5). Perlecan was also found to stimulate endothelial cell proliferation in vitro over a period of 6 days in the presence of plasma proteins and fibroblastic growth factor 2 (FGF-2), however in the absence of FGF-2 endothelial cell growth could not be maintained during this period. Perlecan was found to be anti-adhesive for platelets, however after removal of the HS chains attached to perlecan, platelet adhesion and aggregation were supported. These results suggest a role for HS chains of perlecan in improving graft patency by selectively promoting endothelial cell proliferation while modulating platelet adhesion.

Defining the potential for cell therapy for vascular disease using animal models

Cell-based therapeutics are currently being developed for a wide array of unmet medical needs. As obstructive vascular disease is the major cause of mortality in the world, cell-based strategies aimed at developing novel therapies or improving current therapies are currently under study. These studies are based on the evolving understanding of the biology of vascular progenitor cells, which has in turn led to the availability of well-defined sources of vascular cells for delivery. Crucial to the development of these approaches is the preclinical testing of cell delivery in animal models. This review highlights the crucial steps involved in the selection of cell sources and generation, delivery approaches, animal models to be used, and endpoints to be studied, in the context of cell delivery for vascular disease. Furthermore, the development of cell delivery to induce angiogenesis in ischemic limbs and to improve the response to large vessel injury will be discussed.

Therapeutic uses of autologous endothelial cells for vascular disease

Endothelial cells play important structural and functional roles in vascular homoeostasis. Perturbations in endothelial cell number and function are directly involved with the initiation and progression of multiple cardiovascular diseases, including atherosclerosis, hypertension and congestive heart failure. Attempts to modify these disorders have included pharmacological strategies to improve vascular and thus endothelial function. A goal of biological approaches to these disorders is the delivery of endothelial cells that might act to provide beneficial endothelial-derived factors. However, this approach has generally been limited by the lack of readily available autologous endothelial cells for delivery. The isolation of circulation-derived endothelial progenitor cells allows for direct access to autologous endothelial cells for preclinical and clinical studies. Preclinical studies using autologous endothelial cells have demonstrated beneficial effects when delivered in animal models of vascular injury and grafting. These effects are related to the endothelial nature of the cells and may be paracrine in nature. Ongoing studies are aimed at defining the nature of these effects and optimizing delivery strategies cognizant of these mechanisms.

Simultaneous isolation of platelet factor 4 and glycoprotein IIb–IIIa complex from rabbit platelets, and characterization of specific chicken antibodies to assay them

Rabbits are frequently used as models for studying coagulation and platelet disorders. However, few reports on literature have dealt with the purification and characterization of rabbit platelet proteins. Herein a protocol for the simultaneous purification of rabbit platelet factor 4 (PF4) and platelet glycoprotein IIb-IIIa (GPIIb-IIIa, integrin alpha(IIb)beta(3)) is described. Specific antibodies were raised in laying chicken, which were used for assaying PF4 by ELISA, and GPIIb-IIIa by direct immunofluorescence and flow cytometry. Furthermore, the binding of monoclonal antibodies specific for GPIIb-IIIa complex (P2), ligand-induced binding site of GPIIIa (LIBS1) and rabbit P-selectin (12A7), as well as of polyclonal IgY specific for rabbit GPIIb-IIIa, was compared in quiescent and thrombin-activated platelets. Polyclonal anti-rabbit PF4 IgY was a specific and sensitive probe that could be used for assaying PF4 in plasma samples. GPIIb-IIIa expression was increased in thrombin-activated platelets, as evaluated by flow cytometric analysis using P2 and polyclonal antibodies raised in chickens. Rabbit GPIIb-IIIa also exhibited a conformational modification that caused the appearance of ligand-induced binding sites. Increased P-selectin expression, used as a positive control, was also noticeable in thrombin-activated platelets. These data evidence that antibodies raised in laying chickens specific to rabbit PF4 and GPIIb-IIIa, as well as certain monoclonal antibodies specific for human GPIIb-IIIa, may be used for investigating rabbit platelet physiology.

A selective somatostatin type-2 receptor agonist inhibits neointimal thickening and enhances endothelial cell growth and morphology following aortic balloon injury in the rabbit

Somatostatin analogs have been shown to inhibit vascular smooth muscle cell (VSMC) proliferation and attenuate neointimal thickening following experimental balloon catheter injury. In this study, the effects of a selective agonist for the somatostatin receptor subtype 2, PRL-2486, on neointimal thickening and endothelial cell regrowth 2 weeks following balloon catheterization of male New Zealand White rabbits were determined. Rabbits treated 2 days prior to and 2 weeks after catheter injury with 10 microg/kg/day PRL-2486 (PRL-tx) had decreased I/M ratios (intimal area/medial area x 100; p < 0.05) but had no effect at lower (5 microg/kg/day) or higher (20 microg/kg/day) doses. PRL-tx had significantly decreased VSMC proliferation compared to untreated animals. PRL-tx increased endothelial regrowth by over 2-fold (p < 0.002) and improved endothelial cell morphology. Endothelial-dependent relaxation responses to acetylcholine were attenuated by catheter injury, and were not improved with PRL-tx. These data suggest that the PRL-2486-mediated inhibition of neointimal thickening exhibits a bell-shaped dose-response curve. This inhibition may be due in part to decreased VSMC proliferation, which may be a function of enhanced endothelial regrowth, but not the return of endothelium-dependent vascular function.

Monocyte adhesion to balloon-injured arteries: the influence of endothelial cell seeding

OBJECTIVE

Deendothelialization of injuries of the artery disrupts normal vascular homeostasis, affecting both the structural integrity of the blood vessel wall, as well as the interaction of the arterial surface with blood components such as platelets, leukocytes, and circulating proteins. Leukocyte and, in particular, monocyte recruitment to damaged vessels has been implicated in the pathogenesis of intimal hyperplasia. We hypothesize that reendothelialization is an important modulator of monocyte adhesion to healing arterial surfaces.

METHODS

New Zealand white rabbits (n = 20) were subjected to bilateral iliofemoral artery balloon injury. Cultured, autologous venous endothelial cells (ECs) were immediately seeded onto one vessel, whereas the contralateral artery received medium alone, to accelerate endothelial relining. Vessels were harvested (5-9 days after injury) for analysis of permeability (Evans Blue dye exclusion), endothelial coverage (anti-CD31 immunohistochemistry), monocyte adhesion (ex vivo binding of 51Na2CrO4-labeled monocytic THP-1 cells), and monocyte recruitment (RAM-11 immunohistochemistry).

RESULTS

Improved EC coverage was evidenced by positive staining for CD31 in the seeded vessels. Vessel wall permeability was markedly reduced in EC-seeded arteries (29% +/- 10% vs 99% +/- 0% surface Evans blue staining, P <.005), consistent with restoration of a functional endothelial barrier. EC seeding significantly reduced ex vivo THP-1 binding to vessels explanted at a mean of 8 days after injury (45,170 +/- 8939 vs 85,994 +/- 16,500 cells/cm2, P <.05). However, RAM-11 staining revealed no significant difference in overall macrophage accumulation between seeded and control vessels 1 week after injury (111 +/- 22 vs 95 +/- 14 cells/section, P =.36).

CONCLUSIONS

Immediate seeding of a balloon-injured rabbit artery with cultured ECs results in accelerated restoration of the endothelial lining. At 1 week, barrier function is improved, and the seeded vessel surface is less adhesive to activated monocytes ex vivo, as compared with injured controls. Nonetheless, EC-seeded and nonseeded arteries demonstrate similar total macrophage accumulation over 1 week. These data suggest that after mechanical arterial injury, endothelial coverage may be one important variable influencing leukocyte adhesion.

Effectiveness of endothelial cell seeding on patency of damaged vascular surfaces in a canine model

The effects of endothelial cell seeding, which is assumed to be an effective technique to improve patency rates of denuded vascular surfaces, were investigated in an experimental model. In this study, after anesthetic induction, jugular veins of 16 dogs were harvested bilaterally. Endothelial cells were extracted enzymatically by collagenase from these veins and were passaged into a culture medium until they grew to a reasonable number. After 3 weeks, dogs were anesthetized again in a similar fashion and bilateral femoral veins were exposed and experimental intimal denudation was performed. Subsequently, one femoral artery was injected with cell solution and the other with saline solution as a control. Two weeks after the injections, arteriographic studies of femoral arteries were performed and arterial specimens were taken for histological evaluation. Our results suggest that endothelial seeding might improve the patency rate in elective but urgent cases in which endarterectomy, percutaneous transluminal angioplasty, or similar vascular procedures are considered.

Delivery of endothelial cells to balloon-dilated rabbit arteries with use of a local delivery catheter

PURPOSE

Experiments were performed to determine if a local delivery catheter could deliver endothelial cells that would be retained on the luminal surface of balloon-dilated arteries.

MATERIALS AND METHODS

Six New Zealand White rabbits underwent carotid catheterization, arteriography, and balloon angioplasty of an external iliac artery. A local delivery catheter (Dispatch) was then positioned at the site of angioplasty and the 3-mm balloon was inflated. Cultured rabbit endothelial cells (1.26 +/- 0.3 x 10(6) ), previously stained with fluorescent dye PKH26, were delivered to the artery in three infusions separated by 10 minutes. The delivery balloon was deflated and removed 25 minutes after the last delivery. The arteries were then perfusion-fixed in situ at physiologic pressure, removed, and divided into four segments, and the segments were rapidly frozen and cryosectioned. Eight sections from each arterial segment were examined by means of epifluorescence microscopy. The luminal surface of each artery was visually divided into eight sectors of equal length and each sector was assigned a score based on the degree of endothelial coverage (0 = no coverage, 1 = <50% coverage, 2 = >50% coverage).

RESULTS

The endothelial coverage score for the six arteries averaged 0.40 +/- 0.46 (SD; range, 0.04-1.24). Areas of each artery receiving scores of 0, 1, and 2 averaged 68%, 25%, and 7%, respectively. Average coverage scores were 0.42, 0.38, 0.51, and 0.28 for individual segments along the length of the artery.

CONCLUSIONS

The Dispatch local delivery catheter is able to deliver endothelial cells that adhere to balloon-dilated arteries. Although the magnitude of cellular retention was modest and varied among arteries, the retention along the length of each artery was constant.

Placement of endothelial cells on the luminal surface of denuded arteries in vitro and in vivo

PURPOSE

Experiments were performed to determine if the percutaneous placement of endothelial cells on denuded arterial surfaces is feasible.

MATERIALS AND METHODS

For in vitro adhesion assays, rabbit microvascular endothelial cells were stained with a fluorescent marker and placed on the luminal surface of disks of denuded rabbit aorta. At varying times thereafter, the nonadherent cells were removed, and the adherent cells were quantitated with use of fluorescence microscopy. For in vivo studies, angioplasty was performed on external iliac arteries in five rabbits, and a double-balloon catheter, positioned at the dilatation site, was used to deliver fluorescent rabbit microvascular endothelial cells. Ten minutes (n = 2), 1 hour (n = 2), 1 day (n = 1), or 3 days (n = 1) after cell placement, the number of fluorescent cells remaining on each artery was determined.

RESULTS

In vitro rabbit microvascular endothelial cell attachment was (a) serum-dependent, peaking with media containing 25% autologous serum; (b) time-dependent, peaking at 30 minutes; and (c) cell density-dependent. In vivo rabbit microvascular endothelial cell attachment was (a) noncircumferential, (b) appeared to be gravity-dependent, and (c) appeared unchanged over 3 days with respect to number of cells per cross-section and length of artery having endothelium.

CONCLUSIONS

Percutaneous delivery of endothelial cells onto denuded arterial surfaces with use of optimal conditions is feasible and these cells remain adherent for at least 3 days.

Endothelial cell seeding of de-endothelialised human arteries: improvement by adhesion molecule induction and flow-seeding technology

OBJECTIVES

To assess re-endothelialisation of denuded human arteries by two different seeding techniques using adhesion molecule induction and a dynamic flow-seeding.

DESIGN

Prospective, open study.

SETTING

University Department of Cardiovascular Surgery.

MATERIALS AND METHODS

In the first group (I) segments of human common carotid arteries (n = 4) were balloon-denuded, short-time seeded with cultured adult human venous endothelial cells (EC) and exposed to a mock circulation. In the second group (II) (n = 4), EC were incubated with a synthetic RGD peptide (arginine-glycine-aspartate) prior to seeding with the aim of upregulating the cellular adhesion molecules and increasing EC attachment. In the third group (III) (n = 4), EC were seeded not using the common technique of instillating cells and sequentially rotating the graft but by a dynamic flow application. The percentage of EC-covered luminal surface was assessed by image analysis of scanning electron micrographs.

RESULTS

EC attachment was significantly increased in groups II (73%) and III (94%) compared with group I (34%). In group III, a preconfluent monolayer could be established immediately after seeding. One hour of artificial perfusion resulted in no significant EC loss in any of the study groups.

CONCLUSIONS

RGD-peptide preincubation improves EC seeding of biological surfaces. Because of accelerated seeding times it may have good potential for clinical applications. The flow-seeding technology may be indispensable if EC seeding of the vascular surface of complete organ systems is required.

The effect of transluminal endothelial seeding on myointimal hyperplasia following angioplasty

Myointimal hyperplasia develops as a generalised response to vascular injury, and may cause stenoses in 40% of all peripheral arterial reconstructions. Disruption of the endothelial monolayer is a prerequisite for the development of intimal hyperplasia, and may be the initiating event in this process. This study examined the hypothesis that restenosis following balloon angioplasty may be reduced by rapid restoration of the endothelial monolayer, achieved by endothelial seeding. Bilateral iliac angioplasties were performed in 11 rabbits. A double balloon catheter was used to seed one angioplasty site with autogenous endothelial cells; the contralateral site was sham seeded with culture medium and acted as a control. Arterial patency rates, the degree of intimal hyperplasia (IH/IEL), and the extent of endothelialisation were quantified at 1 (n = 5) and 3 (n = 6) weeks following balloon dilatation. The results suggest that transluminal endothelial seeding may be a therapeutically applicable technique as it decreases myointimal hyperplasia, and increases patency following angioplasty. This study also illustrates the protective effect of the vascular endothelium following arterial injury, and indicates that intensive efforts should be made to preserve the endothelium during vascular reconstruction.