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Kugo H, Moriyama T, Zaima N. Nicotine induces vasa vasorum stenosis in the aortic wall. Biotech Histochem 2024:1-7. [PMID: 38780082 DOI: 10.1080/10520295.2024.2352724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Abdominal aortic aneurysm (AAA) is a vascular disease that involves aortic wall dilation. Cigarette smoking is an established risk factor and rupture, and nicotine may be a major contributor to the onset of AAA. In humans the condition is associated with stenosis of the vasa vasorum (VV), which may be caused by nicotine. In this study, we evaluated the effects of nicotine on VV pathology. After 4 weeks of nicotine administration to rats using an osmotic pump, the VV patency rate in the nicotine administration group was significantly lower than that in the control group. The levels of Ki-67, a cell proliferation marker, were significantly increased in the regions containing VV in the nicotine group, as were hypoxia inducible factor-α levels. Collagen levels around VV were significantly lower in the nicotine group than in the controls. Our data suggest that nicotine can cause VV stenosis by inducing abnormal proliferation of smooth muscle cells in the VV. The increased risk of AAA development due to cigarette smoking may be partially explained by nicotine-induced VV denaturation and collagen fiber degradation.
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Affiliation(s)
- Hirona Kugo
- Department of Applied Biological Chemistry, Graduate School of Agriculture, Kindai University, Nara City, Japan
| | - Tatsuya Moriyama
- Department of Applied Biological Chemistry, Graduate School of Agriculture, Kindai University, Nara City, Japan
- Agricultural Technology and Innovation Research Institute, Kindai University, Nara City, Japan
| | - Nobuhiro Zaima
- Department of Applied Biological Chemistry, Graduate School of Agriculture, Kindai University, Nara City, Japan
- Agricultural Technology and Innovation Research Institute, Kindai University, Nara City, Japan
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2
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Simionescu D, Tharayil N, Leonard E, Carlyle W, Schwarz A, Ning K, Carsten C, Garcia JCC, Carter A, Owens C, Simionescu A. Binding of Pentagalloyl Glucose to Aortic Wall Proteins: Insights from Peptide Mapping and Simulated Docking Studies. Bioengineering (Basel) 2023; 10:936. [PMID: 37627822 PMCID: PMC10451288 DOI: 10.3390/bioengineering10080936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Pentagalloyl glucose (PGG) is currently being investigated as a non-surgical treatment for abdominal aortic aneurysms (AAAs); however, the molecular mechanisms of action of PGG on the AAA matrix components and the intra-luminal thrombus (ILT) still need to be better understood. To assess these interactions, we utilized peptide fingerprinting and molecular docking simulations to predict the binding of PGG to vascular proteins in normal and aneurysmal aorta, including matrix metalloproteinases (MMPs), cytokines, and fibrin. We performed PGG diffusion studies in pure fibrin gels and human ILT samples. PGG was predicted to bind with high affinity to most vascular proteins, the active sites of MMPs, and several cytokines known to be present in AAAs. Finally, despite potential binding to fibrin, PGG was shown to diffuse readily through thrombus at physiologic pressures. In conclusion, PGG can bind to all the normal and aneurysmal aorta protein components with high affinity, potentially protecting the tissue from degradation and exerting anti-inflammatory activities. Diffusion studies showed that thrombus presence in AAAs is not a barrier to endovascular treatment. Together, these results provide a deeper understanding of the clinical potential of PGG as a non-surgical treatment of AAAs.
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Affiliation(s)
- Dan Simionescu
- Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, Clemson, SC 29634, USA; (J.C.C.G.); (A.C.)
| | - Nishanth Tharayil
- Multi-User Analytical Lab (MUAL) & Metabolomic Core, Clemson University, Clemson, SC 29634, USA; (N.T.); (E.L.)
| | - Elizabeth Leonard
- Multi-User Analytical Lab (MUAL) & Metabolomic Core, Clemson University, Clemson, SC 29634, USA; (N.T.); (E.L.)
| | - Wenda Carlyle
- Nectero Medical Inc., Mesa, AZ 85281, USA; (W.C.); (A.S.); (K.N.)
| | - Alex Schwarz
- Nectero Medical Inc., Mesa, AZ 85281, USA; (W.C.); (A.S.); (K.N.)
| | - Kelvin Ning
- Nectero Medical Inc., Mesa, AZ 85281, USA; (W.C.); (A.S.); (K.N.)
| | | | - Juan Carlos Carrillo Garcia
- Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, Clemson, SC 29634, USA; (J.C.C.G.); (A.C.)
| | - Alexander Carter
- Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, Clemson, SC 29634, USA; (J.C.C.G.); (A.C.)
| | - Collin Owens
- Tissue Engineering Laboratory, Department of Bioengineering, Clemson University, Clemson, SC 29634, USA; (C.O.); (A.S.)
| | - Agneta Simionescu
- Tissue Engineering Laboratory, Department of Bioengineering, Clemson University, Clemson, SC 29634, USA; (C.O.); (A.S.)
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3
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Xu Y, Yang S, Xue G. The role of long non-coding RNA in abdominal aortic aneurysm. Front Genet 2023; 14:1153899. [PMID: 37007957 PMCID: PMC10050724 DOI: 10.3389/fgene.2023.1153899] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
The abdominal aortic aneurysm (AAA) is characterized by segmental expansion of the abdominal aorta and a high mortality rate. The characteristics of AAA suggest that apoptosis of smooth muscle cells, the production of reactive oxygen species, and inflammation are potential pathways for the formation and development of AAA. Long non-coding RNA (lncRNA) is becoming a new and essential regulator of gene expression. Researchers and physicians are focusing on these lncRNAs to use them as clinical biomarkers and new treatment targets for AAAs. LncRNA studies are beginning to emerge, suggesting that they may play a significant but yet unidentified role in vascular physiology and disease. This review examines the role of lncRNA and their target genes in AAA to increase our understanding of the disease’s onset and progression, which is crucial for developing potential AAA therapies.
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4
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Throop A, Bukac M, Zakerzadeh R. Prediction of wall stress and oxygen flow in patient-specific abdominal aortic aneurysms: the role of intraluminal thrombus. Biomech Model Mechanobiol 2022; 21:1761-1779. [PMID: 35908098 DOI: 10.1007/s10237-022-01618-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
In this study, the biomechanical role of intraluminal thrombus (ILT) in an abdominal aortic aneurysm (AAA) is investigated. The implications of ILT in AAA are controversial in literature. Previous studies have demonstrated that ILT provides a biomechanical advantage by decreasing wall stress, whereas other studies have associated ILT with inhibiting oxygen transport and inducing aortic wall weakening. Therefore, we sought to explore the connection between ILT, mechanical stresses, and oxygen flow in different geometries of patient-specific aneurysms with varying ILT morphologies. The objective is to investigate the extent to which ILT influences the prediction of aneurysmal wall stresses that are associated with rupture, as well as oxygen concentrations to measure tissue oxygen deprivation. Three patient-specific AAA geometries are considered, and two models, one with ILT and one without ILT, are created for each patient to assess the effect of ILT presence. A fluid-structure interaction approach is used to couple the blood flow, wall deformation, and oxygen mass transport. Results are presented for hemodynamics patterns, wall stress measures, and oxygen metrics within the arterial wall. While ILT is found to reduce wall stress, simulations confirm that ILT decreases oxygen transport within the tissue significantly, leading to wall hypoxia.
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Affiliation(s)
- Alexis Throop
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, 413 Libermann Hall, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
| | - Martina Bukac
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN, USA
| | - Rana Zakerzadeh
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, 413 Libermann Hall, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA.
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5
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The Detrimental Role of Intraluminal Thrombus Outweighs Protective Advantage in Abdominal Aortic Aneurysm Pathogenesis: The Implications for the Anti-Platelet Therapy. Biomolecules 2022; 12:biom12070942. [PMID: 35883500 PMCID: PMC9313225 DOI: 10.3390/biom12070942] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 02/01/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) is a common cardiovascular disease resulting in morbidity and mortality in older adults due to rupture. Currently, AAA treatment relies entirely on invasive surgical treatments, including open repair and endovascular, which carry risks for small aneurysms (diameter < 55 mm). There is an increasing need for the development of pharmacological intervention for early AAA. Over the last decade, it has been increasingly recognized that intraluminal thrombus (ILT) is involved in the growth, remodeling, and rupture of AAA. ILT has been described as having both biomechanically protective and biochemically destructive properties. Platelets are the second most abundant cells in blood circulation and play an integral role in the formation, expansion, and proteolytic activity of ILT. However, the role of platelets in the ILT-potentiated AAA progression/rupture remains unclear. Researchers are seeking pharmaceutical treatment strategies (e.g., anti-thrombotic/anti-platelet therapies) to prevent ILT formation or expansion in early AAA. In this review, we mainly focus on the following: (a) the formation/deposition of ILT in the progression of AAA; (b) the dual role of ILT in the progression of AAA (protective or detrimental); (c) the function of platelet activity in ILT formation; (d) the application of anti-platelet drugs in AAA. Herein, we present challenges and future work, which may motivate researchers to better explain the potential role of ILT in the pathogenesis of AAA and develop anti-platelet drugs for early AAA.
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Masuda S, Fujimura S, Takao H, Takeshita K, Suzuki T, Uchiyama Y, Karagiozov K, Ishibashi T, Fukudome K, Yamamoto M, Murayama Y. Effects of different stent wire mesh densities on hemodynamics in aneurysms of different sizes. PLoS One 2022; 17:e0269675. [PMID: 35687558 PMCID: PMC9187070 DOI: 10.1371/journal.pone.0269675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Intracranial stents are used to treat aneurysms by diverting the blood flow from entering into the aneurysmal dome. Although delayed rupture is rare, clinical outcomes are extremely poor in such cases. Hemodynamics after stent deployment may be related to delayed rupture and a better understanding of the basic characteristics of pressure changes resulting from stent deployment is needed; therefore, this study investigated the relationships between hemodynamics in aneurysms of different sizes treated using stents of different wire mesh densities. Methods Using computational fluid dynamics analysis, parameters related to velocity, volume flow rate, pressure, and residual volume inside the aneurysm were evaluated in digital models of 5 basic aneurysms of differing sizes (Small, Medium, Medium-Large, Large, and Giant) and using 6 different types of stent (varying number of wires, stent pitch and wire mesh density) for each aneurysm. Results Regardless of the aneurysm size, the velocity inside the aneurysm and the volume flow rate into the aneurysm were observed to continuously decrease up to 89.2% and 78.1%, respectively, with increasing stent mesh density. In terms of pressure, for giant aneurysms, the pressure on the aneurysmal surface elevated to 10.3%, then decreased to 5.1% with increasing stent mesh density. However, in smaller aneurysms, this pressure continuously decreased with increasing stent mesh density. The flow-diverting effect of the stents was limited when a stent with low mesh density (under 20%) was used with a giant aneurysm. Conclusions The present results indicate that the selection of appropriate stents according to aneurysm size may contribute to reduced risks of hemodynamic alternations related to stent deployment, which could reduce the incidence of delayed rupture.
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Affiliation(s)
- Shunsuke Masuda
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
- Cybernet Systems Co., Ltd., Tokyo, Japan
| | - Soichiro Fujimura
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hiroyuki Takao
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
- * E-mail:
| | - Kohei Takeshita
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Suzuki
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
- Digital Health & SYNGO Department, Siemens Healthcare K.K., Tokyo, Japan
| | - Yuya Uchiyama
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koji Fukudome
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Makoto Yamamoto
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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7
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Endothelial Dysfunction in the Pathogenesis of Abdominal Aortic Aneurysm. Biomolecules 2022; 12:biom12040509. [PMID: 35454098 PMCID: PMC9030795 DOI: 10.3390/biom12040509] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 12/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA), defined as a focal dilation of the abdominal aorta beyond 50% of its normal diameter, is a common and potentially life-threatening vascular disease. The molecular and cellular mechanisms underlying AAA pathogenesis remain unclear. Healthy endothelial cells (ECs) play a critical role in maintaining vascular homeostasis by regulating vascular tone and maintaining an anti-inflammatory, anti-thrombotic local environment. Increasing evidence indicates that endothelial dysfunction is an early pathologic event in AAA formation, contributing to both oxidative stress and inflammation in the degenerating arterial wall. Recent studies utilizing single-cell RNA sequencing revealed heterogeneous EC sub-populations, as determined by their transcriptional profiles, in aortic aneurysm tissue. This review summarizes recent findings, including clinical evidence of endothelial dysfunction in AAA, the impact of biomechanical stress on EC in AAA, the role of endothelial nitric oxide synthase (eNOS) uncoupling in AAA, and EC heterogeneity in AAA. These studies help to improve our understanding of AAA pathogenesis and ultimately may lead to the generation of EC-targeted therapeutics to treat or prevent this deadly disease.
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8
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Carbino B, Guy A, Durka M, Zakerzadeh R. The Effects of Geometric Features of Intraluminal Thrombus on the Vessel Wall Oxygen Deprivation. Front Bioeng Biotechnol 2022; 10:814995. [PMID: 35419349 PMCID: PMC8997837 DOI: 10.3389/fbioe.2022.814995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/21/2022] [Indexed: 12/20/2022] Open
Abstract
The objective of this paper is to analyze the association of intraluminal thrombus (ILT) presence and morphology with oxygen transport in abdominal aortic aneurysms (AAA) and local hypoxia. The biomechanical role of the ILT layer in the evolution of the aneurysm is still not fully understood. ILT has been shown to create an inflammatory environment by reducing oxygen flux to the arterial wall and therefore decreasing its strength. It has been also hypothesized that the geometry of the ILT may further affect AAA rupture. However, no previous research has attempted to explore the effect of morphological features of ILT on oxygen distributions within the AAA, in a systematic manner. In this study, we perform a comprehensive analysis to investigate how physiologically meaningful variations in ILT geometric characteristics affect oxygen transport within an AAA. We simulate twenty-seven AAA models with variable ILT dimensions and investigate the extent to which ILT attenuates oxygen concentration in the arterial wall. Geometric variations studied include ILT thickness and ILT length, as well as the bulge diameter of the aneurysm which is related to ILT curvature. Computer simulations of coupled fluid flow-mass transport between arterial wall, ILT, and blood are solved and spatial variations of oxygen concentrations within the ILT and wall are obtained. The comparison of the results for all twenty-seven simulations supports the hypothesis that the presence of ILT in AAA correlates to significantly impaired oxygen transport to the aneurysmal wall. Mainly, we observed that ILT thickness and length are the parameters that influence decreased oxygen flow and concentration values the most, and thick thrombi exacerbate hypoxic conditions in the arterial wall, which may contribute to increased tissue degradation. Conversely, we observed that the arterial wall oxygen concentration is nearly independent of the AAA bulge diameter. This confirms that consideration of ILT size and anatomy is crucial in the analysis of AAA development.
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Affiliation(s)
- Burton Carbino
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, United States
| | - Alexander Guy
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, United States
| | - Michael Durka
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, United States
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rana Zakerzadeh
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, United States
- *Correspondence: Rana Zakerzadeh,
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9
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Mangarova DB, Bertalan G, Jordan J, Brangsch J, Kader A, Möckel J, Adams LC, Sack I, Taupitz M, Hamm B, Braun J, Makowski MR. Microscopic multifrequency magnetic resonance elastography of ex vivo abdominal aortic aneurysms for extracellular matrix imaging in a mouse model. Acta Biomater 2022; 140:389-397. [PMID: 34818577 DOI: 10.1016/j.actbio.2021.11.026] [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: 08/06/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022]
Abstract
An abdominal aortic aneurysm (AAA) is a permanent dilatation of the abdominal aorta, usually accompanied by thrombus formation. The current clinical imaging modalities cannot reliably visualize the thrombus composition. Remodeling of the extracellular matrix (ECM) during AAA development leads to stiffness changes, providing a potential imaging marker. 14 apolipoprotein E-deficient mice underwent surgery for angiotensin II-loaded osmotic minipump implantation. 4 weeks post-op, 5 animals developed an AAA. The aneurysm was imaged ex vivo by microscopic multifrequency magnetic resonance elastography (µMMRE) with an in-plane resolution of 40 microns. Experiments were performed on a 7-Tesla preclinical magnetic resonance imaging scanner with drive frequencies between 1000 Hz and 1400 Hz. Shear wave speed (SWS) maps indicating stiffness were computed based on tomoelastography multifrequency inversion. As control, the aortas of 5 C57BL/6J mice were examined with the same imaging protocol. The regional variation of SWS in the thrombus ranging from 0.44 ± 0.07 to 1.20 ± 0.31 m/s was correlated fairly strong with regional histology-quantified ECM accumulation (R2 = 0.79). Our results suggest that stiffness changes in aneurysmal thrombus reflect ECM remodeling, which is critical for AAA risk assessment. In the future, µMMRE could be used for a mechanics-based clinical characterization of AAAs in patients. STATEMENT OF SIGNIFICANCE: To our knowledge, this is the first study mapping the stiffness of abdominal aortic aneurysms with microscopic resolution of 40 µm. Our work revealed that stiffness critically changes due to extracellular matrix (ECM) remodeling in the aneurysmal thrombus. We were able to image various levels of ECM remodeling in the aneurysm reflected in distinct shear wave speed patterns with a strong correlation to regional histology-quantified ECM accumulation. The generated results are significant for the application of microscopic multifrequency magnetic resonance elastography for quantification of pathological remodeling of the ECM and may be of great interest for detailed characterization of AAAs in patients.
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Affiliation(s)
- Dilyana B Mangarova
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; Department of Veterinary Medicine, Institute of Veterinary Pathology, Freie Universität Berlin, Robert-von-Ostertag-Str. 15, Building 12, Berlin 4163, Germany.
| | - Gergely Bertalan
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Jakob Jordan
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Julia Brangsch
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Avan Kader
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; Department of Biology, Chemistry and Pharmacy, Institute of Biology, Freie Universität Berlin, Königin-Luise-Str. 1-3, Berlin 14195, Germany.
| | - Jana Möckel
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Lisa C Adams
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Matthias Taupitz
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Jürgen Braun
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; Institute for Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, Berlin 12200, Germany.
| | - Marcus R Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany.
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10
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Siennicka A, Adamowicz M, Grzesch N, Kłysz M, Woźniak J, Cnotliwy M, Galant K, Jastrzębska M. Association of Aneurysm Tissue Neutrophil Mediator Levels with Intraluminal Thrombus Thickness in Patients with Abdominal Aortic Aneurysm. Biomolecules 2022; 12:biom12020254. [PMID: 35204755 PMCID: PMC8961541 DOI: 10.3390/biom12020254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
An intraluminal thrombus (ILT), which accumulates large numbers of neutrophils, plays a key role in abdominal aortic aneurysm (AAA) pathogenesis. This study aimed to compare levels of selected neutrophil inflammatory mediators in thick and thin ILT, plus adjacent AAA walls, to determine whether levels depend on ILT thickness. Neutrophil mediator levels were analysed by enzyme-linked immunosorbent assays in thick and thin segments of ILT, plus adjacent aneurysm wall sections, taken from one aneurysm sac each from 36 AAA patients. In aneurysmal walls covered by thick ILT, neutrophil elastase and TNF-a levels were significantly higher, as were concentrations of IL-6, in thick ILT compared to thin layers. Positive correlations of NGAL, MPO, and neutrophil elastase were observed between thick ILT and the adjacent wall and thin ILT and the adjacent wall, suggesting that these mediators probably infiltrate thick AAA compartments as well as thin. These observations might support the idea that neutrophil mediators and inflammatory cytokines differentially accumulate in AAA tissues according to ILT thickness. The increased levels of neutrophil mediators within thicker AAA segments might suggest the existence of an intensified proinflammatory state that in turn presumably might preferentially weaken the AAA wall at that region.
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Affiliation(s)
- Aldona Siennicka
- Department of Laboratory Diagnostics, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (A.S.); (M.A.); (N.G.); (M.J.)
| | - Monika Adamowicz
- Department of Laboratory Diagnostics, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (A.S.); (M.A.); (N.G.); (M.J.)
| | - Natalie Grzesch
- Department of Laboratory Diagnostics, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (A.S.); (M.A.); (N.G.); (M.J.)
| | - Magdalena Kłysz
- Department of Laboratory Diagnostics, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (A.S.); (M.A.); (N.G.); (M.J.)
- Correspondence: ; Tel.: +48-914661505
| | - Jarosław Woźniak
- Institute of Mathematics, University of Szczecin, Wielkopolska 15, 70-451 Szczecin, Poland;
| | - Miłosław Cnotliwy
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland;
| | - Katarzyna Galant
- Department of Laboratory Medicine, Chair of Microbiology, Immunological Diagnostics and Laboratory Medicine, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland;
| | - Maria Jastrzębska
- Department of Laboratory Diagnostics, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (A.S.); (M.A.); (N.G.); (M.J.)
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11
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Busch A, Bleichert S, Ibrahim N, Wortmann M, Eckstein HH, Brostjan C, Wagenhäuser MU, Goergen CJ, Maegdefessel L. Translating mouse models of abdominal aortic aneurysm to the translational needs of vascular surgery. JVS Vasc Sci 2021; 2:219-234. [PMID: 34778850 PMCID: PMC8577080 DOI: 10.1016/j.jvssci.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Abdominal aortic aneurysm (AAA) is a condition that has considerable socioeconomic impact and an eventual rupture is associated with high mortality and morbidity. Despite decades of research, surgical repair remains the treatment of choice and no medical therapy is currently available. Animal models and, in particular, murine models, of AAA are a vital tool for experimental in vivo research. However, each of the different models has individual limitations and provide only partial mimicry of human disease. This narrative review addresses the translational potential of the available mouse models, highlighting unanswered questions from a clinical perspective. It is based on a thorough presentation of the available literature and more than a decade of personal experience, with most of the available models in experimental and translational AAA research. Results From all the models published, only the four inducible models, namely the angiotensin II model (AngII), the porcine pancreatic elastase perfusion model (PPE), the external periadventitial elastase application (ePPE), and the CaCl2 model have been widely used by different independent research groups. Although the angiotensin II model provides features of dissection and aneurysm formation, the PPE model shows reliable features of human AAA, especially beyond day 7 after induction, but remains technically challenging. The translational value of ePPE as a model and the combination with β-aminopropionitrile to induce rupture and intraluminal thrombus formation is promising, but warrants further mechanistic insights. Finally, the external CaCl2 application is known to produce inflammatory vascular wall thickening. Unmet translational research questions include the origin of AAA development, monitoring aneurysm growth, gender issues, and novel surgical therapies as well as novel nonsurgical therapies. Conclusion New imaging techniques, experimental therapeutic alternatives, and endovascular treatment options provide a plethora of research topics to strengthen the individual features of currently available mouse models, creating the possibility of shedding new light on translational research questions.
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Affiliation(s)
- Albert Busch
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
| | - Sonja Bleichert
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Nahla Ibrahim
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Markus Wortmann
- Department of Vascular and Endovascular Surgery, Universitaetsklinik Heidelberg, Heidelberg, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany
| | - Christine Brostjan
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Markus U Wagenhäuser
- Department of Vascular and Endovascular Surgery, Heinrich-Heine-University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Ind
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
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12
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Ducas AA, Kuhn DCS, Bath LC, Lozowy RJ, Boyd AJ. Increased matrix metalloproteinase 9 activity correlates with flow-mediated intraluminal thrombus deposition and wall degeneration in human abdominal aortic aneurysm. JVS Vasc Sci 2021; 1:190-199. [PMID: 34617048 PMCID: PMC8489223 DOI: 10.1016/j.jvssci.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/17/2020] [Indexed: 11/15/2022] Open
Abstract
Objective We have previously demonstrated that human abdominal aortic aneurysm (AAA) rupture occurs in zones of low wall shear stress where flow recirculation and intraluminal thrombus (ILT) deposition are increased. Matrix metalloproteinase-9 (MMP-9) is involved in the pathogenesis of AAA via its lytic effect on collagen and elastin. We hypothesize that flow-mediated ILT deposition promotes increased local inflammatory and MMP-9 activity that leads to AAA wall degeneration. The purpose of this study was to examine the correlation between predicted pulsatile flow dynamics and regional differences in MMP-9, elastin, collagen, and ILT deposition in human AAA. Methods Full-thickness aortic tissue samples were collected from 24 patients undergoing open AAA repair. Control infrarenal aortic tissue was obtained from 6 patients undergoing aortobifemoral bypass. Full-thickness aortic tissue and ILT were assessed for MMP-9 levels using a cytokine array assay. Histologic and immunohistochemical assessment of inflammation, collagen and elastin content, and MMP-9 levels were also measured. Three-dimensional AAA geometry was generated from computed tomography angiogram (CTA) images using Mimics software and computational fluid dynamics was used to predict pulsatile aortic blood flow. Results The majority of AAA showed eccentric ILT deposition which was correlated with predicted recirculation blood flow (R2 = –0.17; P < .05). The regions of high ILT were associated with significant increases in inflammation and loss of elastin and collagen compared with regions of low ILT, or with control tissue. MMP-9 was significantly higher in areas of high ILT deposition compared with areas devoid of ILT. Tissue MMP-9 was correlated with the thickness of ILT deposition (R2 = 0.46; P < .05), and was also present in high levels in thick compared with thin ILT. Conclusions We have shown a correlation between flow-mediated ILT deposition with increased tissue levels of MMP-9 activity, increased inflammatory infiltrate, and decreased elastin and collagen content in stereotactically sampled human AAA, suggesting that ILT deposition is associated with local increases in proteolytic activity that may preferentially weaken and promote rupture at selected regions.
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Affiliation(s)
- Annie A Ducas
- Department of Surgery, University of Manitoba, Manitoba, Canada
| | - David C S Kuhn
- Department of Mechanical Engineering, University of Manitoba, Manitoba, Canada
| | - Lauren C Bath
- Faculty of Medicine, University of Manitoba, Manitoba, Canada
| | - Richard J Lozowy
- Department of Mechanical Engineering, University of Manitoba, Manitoba, Canada
| | - April J Boyd
- Department of Surgery, University of Manitoba, Manitoba, Canada
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13
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Boyd AJ. Intraluminal thrombus: Innocent bystander or factor in abdominal aortic aneurysm pathogenesis? JVS Vasc Sci 2021; 2:159-169. [PMID: 34617066 PMCID: PMC8489244 DOI: 10.1016/j.jvssci.2021.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) represent a complex multifactorial hemodynamic, thrombotic, and inflammatory process that can ultimately result in aortic rupture and death. Despite improved screening and surgical management of AAAs, the mortality rates have remained high after rupture, and little progress has occurred in the development of nonoperative treatments. Intraluminal thrombus (ILT) is present in most AAAs and might be involved in AAA pathogenesis. The present review examined the latest clinical and experimental evidence for possible involvement of the ILT in AAA growth and rupture. METHODS A literature review was performed after a search of the PubMed database from 2012 to June 2020 using the terms "abdominal aortic aneurysm" and "intraluminal thrombus." RESULTS The structure, composition, and hemodynamics of ILT formation and propagation were reviewed in relation to the hemostatic and proteolytic factors favoring ILT deposition. The potential effects of the ILT on AAA wall degeneration and rupture, including a review of the current controversies regarding the position, thickness, and composition of ILT, are presented. Although initially potentially protective against increased wall stress, increasing evidence has shown that an increased volume and greater age of the ILT have direct detrimental effects on aortic wall integrity, which might predispose to an increased rupture risk. CONCLUSIONS ILT does not appear to be an innocent bystander in AAA pathophysiology. However, its exact role remains elusive and controversial. Despite computational evidence of a possible protective role of the ILT in reducing wall stress, increasing evidence has shown that the ILT promotes AAA wall degeneration in humans and in animal models. Further research, with large animal models and with more chronic ILT is crucial for a better understanding of the role of the ILT in AAAs and for the potential development of targeted therapies to slow or halt AAA progression.
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Affiliation(s)
- April J. Boyd
- Department of Vascular Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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McClarty DB, Kuhn DCS, Boyd AJ. Hemodynamic Changes in an Actively Rupturing Abdominal Aortic Aneurysm. J Vasc Res 2021; 58:172-179. [PMID: 33780963 DOI: 10.1159/000514237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/05/2021] [Indexed: 11/19/2022] Open
Abstract
Computational fluid dynamics were used to assess hemodynamic changes in an actively rupturing abdominal aortic aneurysm (AAA) over a 9-day period. Active migration of contrast from the lumen into the thickest region of intraluminal thrombus (ILT) was demonstrated until it ultimately breached the adventitial layer. Four days after symptom onset, there was a discrete disruption of adventitial calcium with bleb formation at the site of future rupture. Rupture occurred in a region of low wall shear stress and was associated with a marked increase in AAA diameter from 6.6 to 8.4 cm. The cross-sectional area of the flow lumen increased across all time points from 6.28 to 12.08 cm2. The increase in luminal area preceded the increase in AAA diameter and was characterized by an overall deceleration in recirculation flow velocity with a coinciding increase in flow velocity penetrating the ILT. We show that there are significant hemodynamic and structural changes in the AAA flow lumen in advance of any appreciable increase in aortic diameter or rupture. The significant increase in AAA diameter with rupture suggests that AAA may actually rupture at smaller sizes than those measured on day of rupture. These findings have implications for algorithms the predict AAA rupture risk.
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Affiliation(s)
- Davis B McClarty
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David C S Kuhn
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
| | - April J Boyd
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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Time-Dependent Pathological Changes in Hypoperfusion-Induced Abdominal Aortic Aneurysm. BIOLOGY 2021; 10:biology10020149. [PMID: 33672844 PMCID: PMC7917844 DOI: 10.3390/biology10020149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
Simple Summary Abdominal aortic aneurysm (AAA) is a vascular disease that involves gradual dilation of the abdominal aorta and has a high mortality due to rupture. Hypoperfusion due to the obstruction of vasa vasorum, which is a blood supply system in the aortic wall, may be an important factor involved in AAA pathophysiology. A time-dependent analysis is important to understand the pathological cascade following hypoperfusion in the aortic wall. In our study, time-dependent analysis using a hypoperfusion-induced animal model showed that the dynamics of many AAA-related factors might be associated with the increased hypoxia-inducible factor-1α level. Hypoperfusion due to stenosis of the vasa vasorum might be a new drug target for AAA therapeutics. Abstract Hypoperfusion due to vasa vasorum stenosis can cause wall hypoxia and abdominal aortic aneurysm (AAA) development. Even though hypoperfusion is an important contributor toward pathological changes in AAA, the correlation between hypoperfusion and AAA is not fully understood. In this study, a time-dependent semi-quantitative pathological analysis of hypoperfusion-induced aortic wall changes was performed to understand the mechanisms underlying the gradual degradation of the aortic wall leading to AAA formation. AAA-related factors evaluated in this study were grouped according to the timing of dynamic change, and five groups were formed as follows: first group: angiotensin II type 1 receptor, endothelin-1 (ET-1), and malondialdehyde (MDA); second group: matrix metalloproteinase (MMP)-2, -9, -12, M1 macrophages (Mac387+ cells), and monocyte chemotactic protein-1; third group: synthetic smooth muscle cells (SMCs); fourth group: neutrophil elastase, contractile SMCs, and angiotensinogen; and the fifth group: M2 macrophages (CD163+ cells). Hypoxia-inducible factor-1α, ET-1, MDA, and MMP-9 were colocalized with alpha-smooth muscle actin cells in 3 h, suggesting that hypoperfusion-induced hypoxia directly affects the activities of contractile SMCs in the initial stage of AAA. Time-dependent pathological analysis clarified the cascade of AAA-related factors. These findings provide clues for understanding complicated multistage pathologies in AAA.
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16
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Zakerzadeh R, Cupac T, Dorfner N, Guy A. Coupled Hemodynamics and Oxygen Diffusion in Abdominal Aortic Aneurysm: A Computational Sensitivity Study. Cardiovasc Eng Technol 2021; 12:166-182. [PMID: 33469846 DOI: 10.1007/s13239-020-00508-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Abdominal Aortic Aneurysms (AAA) have extreme medical prevalence as an asymptomatic cause of death in developed countries. The probability of AAA rupture is promoted by the localized oxygen loss in the AAA wall which occurs in part because many AAAs contain a layer called intraluminal thrombus (ILT). Considering this strong clinical association, the purpose of this study is to investigate the key features that constitute to the oxygen diffusion, and therefore hypoxia in AAA. METHODS A three-dimensional model of AAA containing ILT is created and numerical simulations are performed to simulate blood flow and oxygen distribution within the AAA. The model accounts for blood flow in the lumen and oxygen transport in the lumen, ILT, and arterial wall. The sub-model of the ILT is fully coupled with the wall sub-model as well as with the subdomain of the blood flow. The sensitivity of the oxygen flow with respect to the parameters of the problem is also analyzed. RESULTS Model simulations are used to investigate the relation between AAA physical properties, hemodynamics, and oxygen concentration in different geometries of AAA. The results demonstrate that the diameter of the AAA bulge has little effect on the oxygen flow, but that the thickness of the ILT layer has a profound effect. Moreover, a significant sensitivity to the oxygen supply from vasa vasorum and its notable impact on oxygen transport within AAA are observed. The variability of the arterial wall oxygen concentration to the oxygen reaction rate remains however very low. CONCLUSION The presence of an ILT significantly impairs oxygen transport from the lumen to the wall. This study confirms that consideration of ILT size and anatomy may be important in considering the severity of a AAA, however, other parameters can also affect thrombus-mediated oxygen delivery within the aneurysmal wall.
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Affiliation(s)
- Rana Zakerzadeh
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, 413 Libermann Hall, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA.
| | - Tanja Cupac
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, 413 Libermann Hall, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
| | - Nina Dorfner
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, 413 Libermann Hall, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
| | - Alexander Guy
- Department of Engineering, Rangos School of Health Sciences, Duquesne University, 413 Libermann Hall, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
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17
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Suzuki Y, Tanaka H, Horinouchi T, Sano H, Honkura N, Unno N, Miwa S, Urano T. Fibrinolysis-resistant carbonylated fibrin detected in thrombi attached to the vascular wall of abdominal aortic aneurysms. Sci Rep 2020; 10:20728. [PMID: 33244022 PMCID: PMC7691368 DOI: 10.1038/s41598-020-77582-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/03/2020] [Indexed: 12/22/2022] Open
Abstract
In this study, we investigated how carbonylation of fibrinogen by acrolein modified its indispensable function to enhance fibrinolysis after being converted to fibrin and contributed to generating a fibrinolysis-resistant fibrin clot. Acrolein-treated fibrinogen was subjected to tissue plasminogen activator-induced fibrinolysis assay and the effect of lysine residue carbonylation in fibrinogen on fibrinolysis was analyzed. The acrolein-treated fibrinogen-derived fibrin clot appeared more resistant to fibrinolysis and the N-acetyl 3-formyl-3,4-dehydropiperidino (FDP)-Lysine levels in the lysed solution were positively correlated with the duration of clot lysis. The lysine analog 6-amino hexanoic acid (6AHA), which mimics the C-terminal lysine of fibrin, was carbonylated and its enhancing effect on Glu1-plasminogen activation was evaluated. After incubation with acrolein, 6AHA was converted to N-acetyl FDP-6AHA, losing its ability to enhance Glu1-plasminogen activation. These results suggest that fibrinogen carbonylation by acrolein to generate N-acetyl FDP-Lysine resulted in the generation of fibrinolysis-resistant fibrin by attenuating the C-terminal lysine-dependent activation of the Glu1-plasminogen. In abdominal aortic aneurysms, fibrin(ogen) containing the acrolein adduct N-acetyl FDP-Lysine was detected in the vascular wall-attached thrombi. These results suggest that this mechanism is likely involved in the modification of fibrinolysis-resistant thrombi and to their persistence for a long period.
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Affiliation(s)
- Yuko Suzuki
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Tanaka
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takahiro Horinouchi
- Department of Cellular Pharmacology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideto Sano
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Honkura
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Unno
- The Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Soichi Miwa
- Toyooka Hospital, Toyooka Public Hospitals' Association, Toyooka, Japan
| | - Tetsumei Urano
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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18
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DeRoo E, Zhou T, Liu B. The Role of RIPK1 and RIPK3 in Cardiovascular Disease. Int J Mol Sci 2020; 21:E8174. [PMID: 33142926 PMCID: PMC7663726 DOI: 10.3390/ijms21218174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular diseases, including peripheral arterial and venous disease, myocardial infarction, and stroke, are the number one cause of death worldwide annually. In the last 20 years, the role of necroptosis, a newly identified form of regulated necrotic cell death, in cardiovascular disease has come to light. Specifically, the damaging role of two kinase proteins pivotal in the necroptosis pathway, Receptor Interacting Protein Kinase 1 (RIPK1) and Receptor Interacting Protein Kinase 3 (RIPK3), in cardiovascular disease has become a subject of great interest and importance. In this review, we provide an overview of the current evidence supporting a pathologic role of RIPK1 and RIPK3 in cardiovascular disease. Moreover, we highlight the evidence behind the efficacy of targeted RIPK1 and RIPK3 inhibitors in the prevention and treatment of cardiovascular disease.
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Affiliation(s)
| | | | - Bo Liu
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; (E.D.); (T.Z.)
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19
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Zakerzadeh R, Cupac T, Durka M. Oxygen transport in a permeable model of abdominal aortic aneurysm. Comput Methods Biomech Biomed Engin 2020; 24:215-229. [PMID: 32960082 DOI: 10.1080/10255842.2020.1821193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This paper reports on modelling and simulation of the coupled mass and momentum transport through the arterial lumen and the porous arterial wall of an abdominal aortic aneurysm (AAA). The effect of porous structure and intramural flow, which is usually neglected, is essential to quantify the oxygen concentration in the aneurysmal wall and will be addressed in this work via a novel coupled fluid-porous structure-mass transport model for AAA. The computational solver provides a prediction of the filtration velocity and oxygen concentration in the artery and further simulations are used to investigate the relation between the wall oxygen concentration and permeability. The results demonstrate the essential coupling between blood and filtration flow and specifically how their interactions affect oxygen transport.
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Affiliation(s)
- Rana Zakerzadeh
- Department of Biomedical Engineering, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Tanja Cupac
- Department of Biomedical Engineering, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Michael Durka
- Department of Mechanical Engineering & Material Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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20
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Stockle J, Romero DA, Amon CH. Optimization of porous stents for endovascular repair of abdominal aortic aneurysms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3336. [PMID: 32212322 DOI: 10.1002/cnm.3336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/21/2020] [Accepted: 03/17/2020] [Indexed: 06/10/2023]
Abstract
This study presents a simulation-based methodology to design porous stents to induce suitable hemodynamic environments inside abdominal aortic aneurysm (AAA) sacs. In the proposed methodology, an optimization algorithm iteratively modifies the porosity distribution of the stent and executes a computational fluid dynamics (CFD) simulation to determine the effect of these changes on the hemodynamic conditions inside the aneurysm sac. The optimization iterations proceed until relevant hemodynamic parameters are within ranges prescribed a priori by the user as desirable to control the progression of the AAA. The resulting porosity distribution uniquely describes the porous stent design that can control the hemodynamic environment (eg, shear stress at the aneurysm wall, pressure distribution, residence time), reducing AAA rupture risks and improving treatment efficacy. To demonstrate its potential, the proposed methodology is applied to idealized AAA geometry under steady-state flow conditions, though it may be easily applied to more complex AAA geometries under transient, pulsatile flow conditions. The proposed methodology has the potential to enable the design of a new generation of porous stents tailored to patient-specific geometries and flow conditions, to improve patient outcomes.
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Affiliation(s)
- Juan Stockle
- Escuela de Ingenieria Industrial, Universidad Diego Portales, Santiago, Chile
| | - David A Romero
- Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Cristina H Amon
- Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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21
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Magnetic resonance imaging assessment of proteolytic enzyme concentrations and biologic properties of intraluminal thrombus in abdominal aortic aneurysms. J Vasc Surg 2020; 72:1025-1034. [PMID: 32067878 DOI: 10.1016/j.jvs.2019.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether magnetic resonance imaging (MRI) can be used in assessment of biologic activity of intraluminal thrombus (ILT) and proteolytic processes of the abdominal aortic aneurysm wall. METHODS Using MRI, 50 patients with asymptomatic infrarenal abdominal aortic aneurysm were analyzed at the maximum aneurysm diameter on T1-weighted images in the arterial phase after administration of contrast material. Relative ILT signal intensity (SI) was determined as the ratio between ILT SI and psoas muscle SI. During surgery, the full thickness of the ILT and the adjacent part of the aneurysm wall were harvested at the maximal diameter for biochemical analysis. The concentrations of matrix metalloproteinase 9 and neutrophil elastase (NE/ELA) were analyzed in harvested thrombi, and the concentrations of collagen type III, elastin, and proteoglycans were analyzed in harvested aneurysm walls. RESULTS A significant positive correlation was found between the NE/ELA concentration of the ILT and the relative SI (ρ = 0.309; P = .029). Furthermore, a negative correlation was observed between the elastin content of the aneurysm wall and the relative SI (ρ = -0.300; P = .034). No correlations were found between relative SI and concentration of matrix metalloproteinase 9, NE/ELA, collagen type III, or proteoglycan 4 in the aneurysm wall. CONCLUSIONS These findings indicate a potential novel use of MRI in prediction of thrombus proteolytic enzyme concentrations and the extracellular matrix content of the aneurysm wall, thus providing additional information for the risk of potential aneurysm rupture.
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22
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Ravindran K, Casabella AM, Cebral J, Brinjikji W, Kallmes DF, Kadirvel R. Mechanism of Action and Biology of Flow Diverters in the Treatment of Intracranial Aneurysms. Neurosurgery 2020; 86:S13-S19. [PMID: 31838528 PMCID: PMC6911734 DOI: 10.1093/neuros/nyz324] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022] Open
Abstract
Flow diverters have drastically changed the landscape of intracranial aneurysm treatment and are now considered first-line therapy for select lesions. Their mechanism of action relies on intrinsic alteration in hemodynamic parameters, both at the parent artery and within the aneurysm sac. Moreover, the device struts act as a nidus for endothelial cell growth across the aneurysm neck ultimately leading to aneurysm exclusion from the circulation. In silico computational analyses and investigations in preclinical animal models have provided valuable insights into the underlying biological basis for flow diverter therapy. Here, we review the present understanding pertaining to flow diverter biology and mechanisms of action, focusing on stent design, induction of intra-aneurysmal thrombosis, endothelialization, and alterations in hemodynamics.
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Affiliation(s)
| | | | - Juan Cebral
- Bioengineering Department, George Mason University, Fairfax, Virginia
| | | | | | - Ram Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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23
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Sweid A, Starke RM, Herial N, Chalouhi N, Das S, Baldassari MP, Alexander TD, Tjoumakaris S, Gooch MR, Hasan D, Rosenwasser RH, Romo V, Jabbour P. Predictors of Complications, Functional Outcome, and Morbidity in a Large Cohort Treated With Flow Diversion. Neurosurgery 2019; 87:730-743. [DOI: 10.1093/neuros/nyz508] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
A dramatic improvement in obliteration rates of large, wide-necked aneurysms has been observed after the FDA approved the Pipeline Embolization Device (PED) in 2011.
OBJECTIVE
To assess the predictors of complications, morbidity, and unfavorable outcomes in a large cohort of patients with aneurysms treated with PED.
METHODS
A retrospective chart review of a prospectively maintained database for subjects treated with flow diversion from 2010 to 2019.
RESULTS
A total of 598 aneurysms were treated during a period extending from 2010 to 2019 (84.28% females, mean age 55.5 yr, average aneurysm size 8.49 mm). Morbidity occurred at a rate of 5.8% and mortality at a rate of 2.2%. Ischemic stroke occurred at a rate of 3%, delayed aneurysmal rupture (DAR) at 1.2%, and distal intraparenchymal hemorrhage (DIPH) at 1.5%. On multivariate analysis, the predictor of stroke was aneurysm size >15 mm. Predictors of DAR were previous subarachnoid hemorrhage (SAH), increasing aneurysm size, and posterior circulation aneurysm. Predictors of DIPH were using more than 1 PED and baseline P2Y12 value. Predictors of in-stent stenosis were the increasing year of treatment and balloon angioplasty, whereas increasing age and previous treatment were negatively associated with in-stent stenosis. Predictors of morbidity were posterior circulation aneurysms, increasing aneurysm size, and hypertension, and incidental aneurysm diagnosis was protective for morbidity.
CONCLUSION
Flow diversion is a safe and effective treatment option for aneurysms. A better understanding of predictive factors of complications, morbidity, and functional outcomes is of high importance for a more accurate risk assessment.
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Affiliation(s)
- Ahmad Sweid
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert M Starke
- Department of Neurosurgery, University of Miami Hospital, Miami, Florida
| | - Nabeel Herial
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nohra Chalouhi
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Somnath Das
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael P Baldassari
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Tyler D Alexander
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - M Reid Gooch
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Robert H Rosenwasser
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Victor Romo
- Department of Anesthesia, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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24
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Lebas H, Yahiaoui K, Martos R, Boulaftali Y. Platelets Are at the Nexus of Vascular Diseases. Front Cardiovasc Med 2019; 6:132. [PMID: 31572732 PMCID: PMC6749018 DOI: 10.3389/fcvm.2019.00132] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022] Open
Abstract
Platelets are important actors of cardiovascular diseases (CVD). Current antiplatelet drugs that inhibit platelet aggregation have been shown to be effective in CVD treatment. However, the management of bleeding complications is still an issue in vascular diseases. While platelets can act individually, they interact with vascular cells and leukocytes at sites of vascular injury and inflammation. The main goal remains to better understand platelet mechanisms in thrombo-inflammatory diseases and provide new lines of safe treatments. Beyond their role in hemostasis and thrombosis, recent studies have reported the role of several aspects of platelet functions in CVD progression. In this review, we will provide a comprehensive overview of platelet mechanisms involved in several vascular diseases.
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Affiliation(s)
- Héloïse Lebas
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Paris Cite, Univ Paris Diderot, Paris, France
| | - Katia Yahiaoui
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Paris Cite, Univ Paris Diderot, Paris, France
| | - Raphaël Martos
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Paris Cite, Univ Paris Diderot, Paris, France
| | - Yacine Boulaftali
- Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Paris Cite, Univ Paris Diderot, Paris, France
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25
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Qiu Y, Wang Y, Fan Y, Peng L, Liu R, Zhao J, Yuan D, Zheng T. Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view. Med Phys 2019; 46:4263-4275. [PMID: 31206182 DOI: 10.1002/mp.13658] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/27/2019] [Accepted: 06/05/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Intraluminal thrombus (ILTs) are found in most abdominal aortic aneurysms (AAAs) of clinically relevant size; however, the role of ILTs in AAA ruptures remains unclear. This study investigated the role of the presence and thickness of ILTs in AAA ruptures by analyzing the hemodynamic environment in ruptured AAAs (RAAAs). METHODS Three-dimensional reconstructions from computed tomography scans were performed, and 13 RAAA cases were categorized into a no-ILT group, a thin-layered ILT group (thickness < 3 mm), and a thick-layered ILT group. The hemodynamic features of the RAAAs were assessed using computational fluid dynamics simulation. RESULTS The thin- and thick-layered ILT groups showed significant differences in aneurysm diameters (P < 0.05). The three types of AAAs ruptured at different flow regions, with different hemodynamic features: (a) the no-ILT AAAs ruptured at regions of flow recirculation where velocity and wall shear stresses (WSSs) were close to zero; (b) the thin-layered ILT AAAs ruptured at sites at which the dominant flow impinged the wall; and (c) the thick-layered ILT AAAs ruptured at the border of the dominant flow channel and recirculation zone where the flow velocity and pressure changed dramatically. CONCLUSIONS Hemodynamic characteristics influence the rupture mechanisms of particular AAAs differently on the basis of the presence and thickness of ILTs. Recirculation flows and low WSSs may have negative effects by inducing local rupture or positive effects by promoting the formation of thin-layered ILTs. However, eccentrically located thick-layered ILTs may increase the rupture risk of small AAAs because of their location in the sac lumen, which results in chaotic flow patterns and rapid increases in flow resistance.
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Affiliation(s)
- Yue Qiu
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Yi Wang
- Department of Computer Science, Sichuan University of Science and Engineering, Zigong, Sichuan, 643000, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, P. R. China
| | - Liqing Peng
- The Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Liu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jichun Zhao
- Department Vascular Surgery of West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ding Yuan
- Department Vascular Surgery of West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
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26
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Biomechanical Restoration Potential of Pentagalloyl Glucose after Arterial Extracellular Matrix Degeneration. Bioengineering (Basel) 2019; 6:bioengineering6030058. [PMID: 31277241 PMCID: PMC6783915 DOI: 10.3390/bioengineering6030058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to quantify pentagalloyl glucose (PGG) mediated biomechanical restoration of degenerated extracellular matrix (ECM). Planar biaxial tensile testing was performed for native (N), enzyme-treated (collagenase and elastase) (E), and PGG (P) treated porcine abdominal aorta specimens (n = 6 per group). An Ogden material model was fitted to the stress-strain data and finite element computational analyses of simulated native aorta and aneurysmal abdominal aorta were performed. The maximum tensile stress of the N group was higher than that in both E and P groups for both circumferential (43.78 ± 14.18 kPa vs. 10.03 ± 2.68 kPa vs. 13.85 ± 3.02 kPa; p = 0.0226) and longitudinal directions (33.89 ± 8.98 kPa vs. 9.04 ± 2.68 kPa vs. 14.69 ± 5.88 kPa; p = 0.0441). Tensile moduli in the circumferential direction was found to be in descending order as N > P > E (195.6 ± 58.72 kPa > 81.8 ± 22.76 kPa > 46.51 ± 15.04 kPa; p = 0.0314), whereas no significant differences were found in the longitudinal direction (p = 0.1607). PGG binds to the hydrophobic core of arterial tissues and the crosslinking of ECM fibers is one of the possible explanations for the recovery of biomechanical properties observed in this study. PGG is a beneficial polyphenol that can be potentially translated to clinical practice for preventing rupture of the aneurysmal arterial wall.
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27
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Salman HE, Ramazanli B, Yavuz MM, Yalcin HC. Biomechanical Investigation of Disturbed Hemodynamics-Induced Tissue Degeneration in Abdominal Aortic Aneurysms Using Computational and Experimental Techniques. Front Bioeng Biotechnol 2019; 7:111. [PMID: 31214581 PMCID: PMC6555197 DOI: 10.3389/fbioe.2019.00111] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is the dilatation of the aorta beyond 50% of the normal vessel diameter. It is reported that 4-8% of men and 0.5-1% of women above 50 years of age bear an AAA and it accounts for ~15,000 deaths per year in the United States alone. If left untreated, AAA might gradually expand until rupture; the most catastrophic complication of the aneurysmal disease that is accompanied by a striking overall mortality of 80%. The precise mechanisms leading to AAA rupture remains unclear. Therefore, characterization of disturbed hemodynamics within AAAs will help to understand the mechanobiological development of the condition which will contribute to novel therapies for the condition. Due to geometrical complexities, it is challenging to directly quantify disturbed flows for AAAs clinically. Two other approaches for this investigation are computational modeling and experimental flow measurement. In computational modeling, the problem is first defined mathematically, and the solution is approximated with numerical techniques to get characteristics of flow. In experimental flow measurement, once the setup providing physiological flow pattern in a phantom geometry is constructed, velocity measurement system such as particle image velocimetry (PIV) enables characterization of the flow. We witness increasing number of applications of these complimentary approaches for AAA investigations in recent years. In this paper, we outline the details of computational modeling procedures and experimental settings and summarize important findings from recent studies, which will help researchers for AAA investigations and rupture mechanics.
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Affiliation(s)
| | - Burcu Ramazanli
- Department of Mechanical Engineering, Middle East Technical University, Ankara, Turkey
| | - Mehmet Metin Yavuz
- Department of Mechanical Engineering, Middle East Technical University, Ankara, Turkey
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28
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Patnaik SS, Simionescu DT, Goergen CJ, Hoyt K, Sirsi S, Finol EA. Pentagalloyl Glucose and Its Functional Role in Vascular Health: Biomechanics and Drug-Delivery Characteristics. Ann Biomed Eng 2019; 47:39-59. [PMID: 30298373 PMCID: PMC6318003 DOI: 10.1007/s10439-018-02145-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/28/2018] [Indexed: 02/08/2023]
Abstract
Pentagalloyl glucose (PGG) is an elastin-stabilizing polyphenolic compound that has significant biomedical benefits, such as being a free radical sink, an anti-inflammatory agent, anti-diabetic agent, enzymatic resistant properties, etc. This review article focuses on the important benefits of PGG on vascular health, including its role in tissue mechanics, the different modes of pharmacological administration (e.g., oral, intravenous and endovascular route, intraperitoneal route, subcutaneous route, and nanoparticle based delivery and microbubble-based delivery), and its potential therapeutic role in vascular diseases such as abdominal aortic aneurysms (AAA). In particular, the use of PGG for AAA suppression and prevention has been demonstrated to be effective only in the calcium chloride rat AAA model. Therefore, in this critical review we address the challenges that lie ahead for the clinical translation of PGG as an AAA growth suppressor.
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Affiliation(s)
- Sourav S Patnaik
- Vascular Biomechanics and Biofluids Laboratory, Department of Mechanical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249-0670, USA
| | - Dan T Simionescu
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Kenneth Hoyt
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shashank Sirsi
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ender A Finol
- Vascular Biomechanics and Biofluids Laboratory, Department of Mechanical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249-0670, USA.
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29
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Cameron SJ, Russell HM, Owens AP. Antithrombotic therapy in abdominal aortic aneurysm: beneficial or detrimental? Blood 2018; 132:2619-2628. [PMID: 30228233 PMCID: PMC6302498 DOI: 10.1182/blood-2017-08-743237] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/10/2018] [Indexed: 12/13/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative vascular pathology resulting in significant morbidity and mortality in older adults due to rupture and sudden death. Despite 150 000 new cases and nearly 15 000 deaths annually, the only approved treatment of AAA is surgical or endovascular intervention when the risk for aortic rupture is increased. The goal of the scientific community is to develop novel pharmaceutical treatment strategies to reduce the need for surgical intervention. Because most clinically relevant AAAs contain a complex structure of fibrin, inflammatory cells, platelets, and red blood cells in the aneurysmal sac known as an intraluminal thrombus (ILT), antithrombotic therapies have emerged as potential pharmaceutical agents for the treatment of AAA progression. However, the efficacy of these treatments has not been shown, and the effects of shrinking the ILT may be as detrimental as they are beneficial. This review discusses the prospect of anticoagulant and antiplatelet (termed collectively as antithrombotic) therapies in AAA. Herein, we discuss the role of the coagulation cascade and platelet activation in human and animal models of AAA, the composition of ILT in AAA, a possible role of the ILT in aneurysm stabilization, and the implications of antithrombotic drugs in AAA treatment.
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Affiliation(s)
- Scott J Cameron
- Department of Medicine (Cardiology) and
- Department of Surgery (Cardiac Surgery), University of Rochester School of Medicine, Rochester, NY; and
| | - Hannah M Russell
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
| | - A Phillip Owens
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
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30
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Homocysteine-Enhanced Proteolytic and Fibrinolytic Processes in Thin Intraluminal Thrombus and Adjacent Wall of Abdominal Aortic Aneurysm: Study In Vitro. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3205324. [PMID: 30643799 PMCID: PMC6311307 DOI: 10.1155/2018/3205324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/12/2018] [Accepted: 11/26/2018] [Indexed: 01/11/2023]
Abstract
Homocysteine (Hcy) may affect the pathogenesis of abdominal aortic aneurysms (AAAs) through enhancement of proteolysis and an impaired coagulation/fibrinolysis system. Intensified haemostatic capacity may promote local proteolytic degradation of the aortic wall. This study aimed to examine the effects of Hcy on haemostatic and proteolytic processes in samples of thick and thin fragments of the ILT and underlying walls. Subjects and Methods. Thirty-six patients who underwent AAA surgery were enrolled. Aneurysm tissue sections were incubated with DL-Hcy (100 and 500 μmol/L) in a series of experiments and analyzed for concentration/activity of proteolytic and haemostatic markers by enzyme-linked immunosorbent assay. Results. Incubation of wall underlying thin ILT segments (B) with DL-Hcy resulted in an increase of active MMP-2 levels compared to control tissue (9.54 ± 5.88 versus 7.44 ± 4.48, p=0.011). DL-Hcy also induced t-PA and plasminogen concentration increases in thin thrombus sections (B1) compared to control tissue (respectively: 1.39 ± 1.65 versus 0.84 ± 0.74, p=0.024; 11.64 ± 5.05 versus 10.34 ± 5.52, p=0.018). In contrast, wall adjacent to thick thrombus segments (A) showed decreases in MMP-2 and TF activities compared to control (respectively, 5.89 ± 3.39 versus 7.26 ± 5.49, p=0.046; 67.13 ± 72.59 versus 114.46 ± 106.29, p=0.007). In thick ILT sections (A1), DL-Hcy decreased MMP-2 activity and t-PA and plasminogen concentrations compared to control tissue (respectively, 2.53 ± 2.02 versus 3.28 ± 2.65, p=0.006; 0.67 ± 0.57 versus 0.96 ± 0.91, p=0.021; 9.25 ± 4.59 versus 12.63 ± 9.56, p=0.017). In addition, analysis revealed positive correlations at all sites between activities/concentrations of MMP-2, TF, and PAI-1 measured in control tissues and after incubation with DL-Hcy. Conclusions. These data indicate the potential for excess Hcy to enhance damage of arterial wall in thinner AAA segments as a result of the increased activity of MMP-2 and fibrinolytic factors.
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31
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Kapetanios DM, Karkos CD, Papazoglou KO. Changes in circulating markers of coagulation and fibrinolysis after EVAR. INT ANGIOL 2018; 37:444-450. [DOI: 10.23736/s0392-9590.18.04046-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Boyd AJ. Invited commentary. J Vasc Surg 2018; 68:37S-38S. [DOI: 10.1016/j.jvs.2017.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/27/2022]
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33
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Wiernicki I, Parafiniuk M, Kolasa-Wołosiuk A, Gutowska I, Kazimierczak A, Clark J, Baranowska-Bosiacka I, Szumilowicz P, Gutowski P. Relationship between aortic wall oxidative stress/proteolytic enzyme expression and intraluminal thrombus thickness indicates a novel pathomechanism in the progression of human abdominal aortic aneurysm. FASEB J 2018; 33:885-895. [PMID: 30351992 DOI: 10.1096/fj.201800633r] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The possibility that oxidative stress promotes degradation of the extracellular matrix and a relationship between intraluminal thrombus (ILT) thickness and proteolytic activity within the abdominal aortic aneurysm (AAA) wall has been suggested. In the present study, the hypothesis that thin ILT is correlated with an increase in oxidative stress-related enzymes and matrix metalloproteinase-9 (MMP-9) expression within the human AAA wall was investigated. We also studied the antioxidant activity of superoxide dismutases, catalase, glutathione peroxidase, glutathione reductase, and thioredoxin within the full-thickness AAA wall and through fluoroimmunohistochemical staining of catalase and MMP-9 expression within the inner and outer media, in relation to ILT thickness. Reactive oxygen species control the degradation and remodeling of the extracellular matrix by up-regulating proteolytic enzymes, such as MMPs. Results showed that oxidative stress and proteolytic enzyme expression were simultaneously, significantly higher within thin thrombus (≤10 mm)-covered aneurysm wall when compared with the wall covered by thick thrombus (≥25 mm). These findings provide the first demonstration, to our knowledge, of a causative link between oxidative stress instigating proteolytic enzyme expression at the tissue level and human AAA development. Presence of a thin circumferential thrombus should always be considered as a risk factor for the greatest increase in aneurysm growth rate and rupture, giving an indication for surgery timing.-Wiernicki, I., Parafiniuk, M., Kolasa-Wołosiuk, A., Gutowska, I., Kazimierczak, A., Clark, J., Baranowska-Bosiacka, I., Szumilowicz, P., Gutowski, P. Relationship between aortic wall oxidative stress/proteolytic enzyme expression and intraluminal thrombus thickness indicates a novel pathomechanism in the progression of human abdominal aortic aneurysm.
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Affiliation(s)
- Ireneusz Wiernicki
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | - Miroslaw Parafiniuk
- Department of Forensic Medicine, Pomeranian Medical University, Szczecin, Poland
| | | | - Izabela Gutowska
- Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland
| | - Arkadiusz Kazimierczak
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | - Jeremy Clark
- Department of Clinical and Molecular Biochemistry, Faculty of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Irena Baranowska-Bosiacka
- Department of Biochemistry and Medical Chemistry, Faculty of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Pawel Szumilowicz
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Gutowski
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
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Behr Andersen C, Lindholt JS, Urbonavicius S, Halekoh U, Jensen PS, Stubbe J, Rasmussen LM, Beck HC. Abdominal Aortic Aneurysms Growth Is Associated With High Concentrations of Plasma Proteins in the Intraluminal Thrombus and Diseased Arterial Tissue. Arterioscler Thromb Vasc Biol 2018; 38:2254-2267. [DOI: 10.1161/atvbaha.117.310126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Porosity of the intraluminal thrombus (ILT) is believed to convey biologically active components from the bloodstream toward the aneurismal wall. Accumulation of molecules in the abdominal aortic aneurysmatic tissue may influence vascular protein turnover and regulate abdominal aortic aneurysm growth. We sought to identify proteins with concentrations in the ILT and the abdominal aortic aneurysm wall which associate with aneurysmal expansion rate.
Approach and Results—
Proteomic analysis by liquid chromatography tandem-mass spectrometry of separated wall and ILT samples was correlated with preoperative aneurysmal growth rate in 24 individuals operated electively for infrarenal abdominal aortic aneurysm. The median preoperative growth rate was 3.8 mm/y (interquartile range, 3) and the mean observational time was 3.3±1.7 years. Plasma components dominated the group of proteins with tissue concentrations, which correlate positively with growth rates (
P
<0.001, Fisher exact test, both in the ILT and the wall). In contrast, in the wall and thrombus samples, ECM (extracellular matrix) proteins were significantly more prevalent in the group of proteins with negative correlations to growth rates (
P
<0.05, Fisher exact test). Similarly, a long series of proteins, related to cellular functions correlated negatively to growth rates.
Conclusions—
When the preoperative aneurysmatic growth rate has been high, the concentration of many plasma proteins residing in the ILT and the aneurysmatic tissue is also high, compatible with the hypothesis of increased tissue porosity and accumulation of plasma components as a driver of aneurysm expansion. Moreover, many matrix and cellular proteins which are found in high concentrations in slower-growing aneurysms provides new knowledge about potential treatment targets.
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Affiliation(s)
- Carsten Behr Andersen
- From the Cardiovascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark (C.B.A., J.S.L., S.U.)
| | - Jes S. Lindholt
- From the Cardiovascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark (C.B.A., J.S.L., S.U.)
- Department of Heart, Lung and Vascular Surgery T (J.S.L.)
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
| | - Sigitas Urbonavicius
- From the Cardiovascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark (C.B.A., J.S.L., S.U.)
| | | | - Pia Søndergaard Jensen
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
- Department of Clinical Biochemistry and Pharmacology, Centre for Clinical Proteomics (P.S.J., L.M.R., H.C.B.), Odense University Hospital, Denmark
| | - Jane Stubbe
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
- Cardiovascular and Renal Research (J.S.), University of Southern Denmark, Odense
| | - Lars Melholt Rasmussen
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
- Department of Clinical Biochemistry and Pharmacology, Centre for Clinical Proteomics (P.S.J., L.M.R., H.C.B.), Odense University Hospital, Denmark
| | - Hans Christian Beck
- Centre for Individualised Medicine of Arterial Diseases, Cardiovascular Centre of Excellence (J.S.L., P.S.J., J.S., L.M.R., H.C.B.)
- Department of Clinical Biochemistry and Pharmacology, Centre for Clinical Proteomics (P.S.J., L.M.R., H.C.B.), Odense University Hospital, Denmark
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35
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Martufi G, Forneris A, Nobakht S, Rinker KD, Moore RD, Di Martino ES. Case Study: Intra-Patient Heterogeneity of Aneurysmal Tissue Properties. Front Cardiovasc Med 2018; 5:82. [PMID: 30018968 PMCID: PMC6037694 DOI: 10.3389/fcvm.2018.00082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/11/2018] [Indexed: 01/03/2023] Open
Abstract
Introduction: Current recommendations for surgical treatment of abdominal aortic aneurysms (AAAs) rely on the assessment of aortic diameter as a marker for risk of rupture. The use of aortic size alone may overlook the role that vessel heterogeneity plays in aneurysmal progression and rupture risk. The aim of the current study was to investigate intra-patient heterogeneity of mechanical and fluid mechanical stresses on the aortic wall and wall tissue histopathology from tissue collected at the time of surgical repair. Methods: Finite element analysis (FEA) and computational fluid dynamics (CFD) simulations were used to predict the mechanical wall stress and the wall shear stress fields for a non-ruptured aneurysm 2 weeks prior to scheduled surgery. During open repair surgery one specimen partitioned into different regions was collected from the patient's diseased aorta according to a pre-operative map. Histological analysis and mechanical testing were performed on the aortic samples and the results were compared with the predicted stresses. Results: The preoperative simulations highlighted the presence of altered local hemodynamics particularly at the proximal segment of the left anterior area of the aneurysm. Results from the post-operative assessment on the surgical samples revealed a considerable heterogeneity throughout the aortic wall. There was a positive correlation between elastin fragmentation and collagen content in the media. The tensile tests demonstrated a good prediction of the locally varying constitutive model properties predicted using geometrical variables, i.e., wall thickness and thrombus thickness. Conclusions: The observed large regional differences highlight the local response of the tissue to both mechanical and biological factors. Aortic size alone appears to be insufficient to characterize the large degree of heterogeneity in the aneurysmal wall. Local assessment of wall vulnerability may provide better risk of rupture predictions.
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Affiliation(s)
- Giampaolo Martufi
- Department of Civil Engineering, University of Calgary, Calgary, AB, Canada.,Unit for Health Innovation, School for Technology and Health, Royal Institute of Technology, KTH, Huddinge, Sweden
| | - Arianna Forneris
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
| | - Samaneh Nobakht
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
| | - Kristina D Rinker
- Department of Chemical and Petroleum Engineering, University of Calgary, Calgary, AB, Canada.,Centre for Bioengineering Research and Education and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Randy D Moore
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Elena S Di Martino
- Department of Civil Engineering, University of Calgary, Calgary, AB, Canada.,Centre for Bioengineering Research and Education and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
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36
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Modulation of Immune-Inflammatory Responses in Abdominal Aortic Aneurysm: Emerging Molecular Targets. J Immunol Res 2018; 2018:7213760. [PMID: 29967801 PMCID: PMC6008668 DOI: 10.1155/2018/7213760] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/18/2018] [Accepted: 03/31/2018] [Indexed: 12/24/2022] Open
Abstract
Abdominal aortic aneurysm (AAA), a deadly vascular disease in human, is a chronic degenerative process of the abdominal aorta. In this process, inflammatory responses and immune system work efficiently by inflammatory cell attraction, proinflammatory factor secretion and subsequently MMP upregulation. Previous studies have demonstrated various inflammatory cell types in AAA of human and animals. The majority of cells, such as macrophages, CD4+ T cells, and B cells, play an important role in the diseased aortic wall through phenotypic modulation. Furthermore, immunoglobulins also greatly affect the functions and differentiation of immune cells in AAA. Recent evidence suggests that innate immune system, especially Toll-like receptors, chemokine receptors, and complements are involved in the progression of AAAs. We discussed the innate immune system, inflammatory cells, immunoglobulins, immune-mediated mechanisms, and key cytokines in the pathogenesis of AAA and particularly emphasis on a further trend and application of these interventions. This current understanding may offer new insights into the role of inflammation and immune response in AAA.
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Siennicka A, Zuchowski M, Kaczmarczyk M, Cnotliwy M, Clark JS, Jastrzębska M. Tissue factor levels and the fibrinolytic system in thin and thick intraluminal thrombus and underlying walls of abdominal aortic aneurysms. J Vasc Surg 2018; 68:30S-37S. [PMID: 29571624 DOI: 10.1016/j.jvs.2017.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/08/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND The hemostatic system cooperates with proteolytic degradation in processes allowing abdominal aortic aneurysm (AAA) formation. In previous studies, it has been suggested that aneurysm rupture depends on intraluminal thrombus (ILT) thickness, which varies across each individual aneurysm. We hypothesized that hemostatic components differentially accumulate in AAA tissue in relation to ILT thickness. Thick (A1) and thin (B1) segments of ILTs and aneurysm wall sections A (adjacent to A1) and B (adjacent to B1) from one aneurysm sac were taken from 35 patients undergoing elective repair. METHODS Factor levels were measured using enzyme-linked immunosorbent assay of protein extract. RESULTS Tissue factor (TF) activities were significantly higher in thinner segments of AAA (B1 vs A1, P = .003; B vs A, P < .001; B vs A1, P < .001; B vs B1, P = .001). Significantly higher tissue plasminogen activator was found in thick thrombus-covered wall segments (A) than in B, A1, and B1 (P = .015, P < .001, and P < .001, respectively). Plasminogen concentrations were highest in ILT. Concentrations of α2-antiplasmin in thin ILT adjacent walls (B) were higher compared with wall (A) adjacent to thick ILT (P = .021) and thick ILT (A1; P < .001). Significant correlations between levels of different factors were mostly found in thick ILT (A1). However, no correlations were found at B sites, except for a correlation between plasmin and TF activities (r = 0.55; P = .004). CONCLUSIONS These results suggest that higher TF activities are present in thinner AAA regions. These parameters and local fibrinolysis may be part of the processes leading to destruction of the aneurysm wall.
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Affiliation(s)
- Aldona Siennicka
- Department of Laboratory Diagnostics, Pomeranian Medical University, Szczecin, Poland.
| | - Marta Zuchowski
- Department of Laboratory Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Mariusz Kaczmarczyk
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Miłosław Cnotliwy
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | - Jeremy Simon Clark
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Maria Jastrzębska
- Department of Laboratory Diagnostics, Pomeranian Medical University, Szczecin, Poland
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Man V, Polzer S, Gasser T, Novotny T, Bursa J. Impact of isotropic constitutive descriptions on the predicted peak wall stress in abdominal aortic aneurysms. Med Eng Phys 2018; 53:49-57. [DOI: 10.1016/j.medengphy.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/24/2017] [Accepted: 01/03/2018] [Indexed: 12/16/2022]
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Kemmerling EMC, Peattie RA. Abdominal Aortic Aneurysm Pathomechanics: Current Understanding and Future Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1097:157-179. [DOI: 10.1007/978-3-319-96445-4_8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Virag L, Wilson JS, Humphrey JD, Karšaj I. Potential biomechanical roles of risk factors in the evolution of thrombus-laden abdominal aortic aneurysms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2017; 33:10.1002/cnm.2893. [PMID: 28447404 PMCID: PMC5658277 DOI: 10.1002/cnm.2893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/23/2017] [Accepted: 04/23/2017] [Indexed: 05/22/2023]
Abstract
Abdominal aortic aneurysms (AAAs) typically harbour an intraluminal thrombus (ILT), yet most prior computational models neglect biochemomechanical effects of thrombus on lesion evolution. We recently proposed a growth and remodelling model of thrombus-laden AAAs that introduced a number of new constitutive relations and associated model parameters. Because values of several of these parameters have yet to be elucidated by clinical data and could vary significantly from patient to patient, the aim of this study was to investigate the possible extent to which these parameters influence AAA evolution. Given that some of these parameters model potential effects of factors that influence the risk of rupture, this study also provides insight into possible roles of common risk factors on the natural history of AAAs. Despite geometrical limitations of a cylindrical domain, findings support current thought that smoking, hypertension, and female sex likely increase the risk of rupture. Although thrombus thickness is not a reliable risk factor for rupture, the model suggests that the presence of ILT may have a destabilizing effect on AAA evolution, consistent with histological findings from human samples. Finally, simulations support two hypotheses that should be tested on patient-specific geometries in the future. First, ILT is a potential source of the staccato enlargement observed in many AAAs. Second, ILT can influence rupture risk, positively or negatively, via competing biomechanical (eg, stress shielding) and biochemical (ie, proteolytic) effects. Although further computational and experimental studies are needed, the present findings highlight the importance of considering ILT when predicting aneurysmal enlargement and rupture risk.
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Affiliation(s)
- Lana Virag
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - John S. Wilson
- Department of Radiology, Emory University, Atlanta, GA, USA
| | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
| | - Igor Karšaj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
- Address for Correspondence: Igor Karšaj, Ph.D., Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, Zagreb, 10000, Croatia, Phone: +38516168125,
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Jansen CHP, Brangsch J, Reimann C, Adams L, Hamm B, Botnar RM, Makowski MR. In Vivo High-Frequency Ultrasound for the Characterization of Thrombi Associated with Aortic Aneurysms in an Experimental Mouse Model. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2882-2890. [PMID: 28965722 DOI: 10.1016/j.ultrasmedbio.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
The development of abdominal aortic aneurysm (AAA) associated thrombi plays an important role during the onset and progression of AAAs. The aim of this study was to evaluate the potential of high-frequency ultrasound for characterization of AAA associated thrombi in an apolipoprotein-E-deficient mouse-model. Ultrasound measurements were performed using a high-resolution ultrasound system (Vevo770, FUJIFILM VisualSonics, Inc., Toronto, ON, Canada) with a 30 MHz linear-array transducer (RMV707 B). Magnetic resonance imaging with a 3 Tesla scanner (Achieva MR system, Philips Healthcare, Best, The Netherlands) and a single-loop microscopy coil was performed as a reference standard. All stages of aneurysm development were evaluated by histologic analyses. The "signal-thrombus-matrix" to "signal-blood" ratio on high-frequency ultrasound measurements showed a strong correlation (R2 = 0.81, p <0.05) with the state of extracellular matrix remodeling. Furthermore, size measurements derived from the high-frequency ultrasound correlated well with magnetic resonance imaging and histology. This study demonstrated that high-frequency ultrasound enables the reliable in vivo quantification of extracellular matrix remodeling at various stages of thrombus development, based on the thrombus echogenicity.
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Affiliation(s)
| | | | | | - Lisa Adams
- Department of Radiology, Charité, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Berlin, Germany
| | - Rene M Botnar
- Division of Imaging Sciences, King's College London, London, United Kingdom; BHF Centre of Excellence, King's College London, London, United Kingdom; Cardioascular Division, King's College London, London, United Kingdom; Wellcome Trust and EPSRC Medical Engineering Center, King's College London, London, United Kingdom; NIHR Biomedical Research Centre, King's College London, London, United Kingdom
| | - Marcus R Makowski
- Division of Imaging Sciences, King's College London, London, United Kingdom; Department of Radiology, Charité, Berlin, Germany
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Stevens RRF, Grytsan A, Biasetti J, Roy J, Lindquist Liljeqvist M, Gasser TC. Biomechanical changes during abdominal aortic aneurysm growth. PLoS One 2017; 12:e0187421. [PMID: 29112945 PMCID: PMC5675455 DOI: 10.1371/journal.pone.0187421] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/19/2017] [Indexed: 12/11/2022] Open
Abstract
The biomechanics-based Abdominal Aortic Aneurysm (AAA) rupture risk assessment has gained considerable scientific and clinical momentum. However, such studies have mainly focused on information at a single time point, and little is known about how AAA properties change over time. Consequently, the present study explored how geometry, wall stress-related and blood flow-related biomechanical properties change during AAA expansion. Four patients with a total of 23 Computed Tomography-Angiography (CT-A) scans at different time points were analyzed. At each time point, patient-specific properties were extracted from (i) the reconstructed geometry, (ii) the computed wall stress at Mean Arterial Pressure (MAP), and (iii) the computed blood flow velocity at standardized inflow and outflow conditions. Testing correlations between these parameters identified several nonintuitive dependencies. Most interestingly, the Peak Wall Rupture Index (PWRI) and the maximum Wall Shear Stress (WSS) independently predicted AAA volume growth. Similarly, Intra-luminal Thrombus (ILT) volume growth depended on both the maximum WSS and the ILT volume itself. In addition, ILT volume, ILT volume growth, and maximum ILT layer thickness correlated with PWRI as well as AAA volume growth. Consequently, a large ILT volume as well as fast increase of ILT volume over time may be a risk factor for AAA rupture. However, tailored clinical studies would be required to test this hypothesis and to clarify whether monitoring ILT development has any clinical benefit.
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Affiliation(s)
- Raoul R. F. Stevens
- Department of Biomedical Engineering, University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- KTH Solid Mechanics, School of Engineering Sciences, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Andrii Grytsan
- KTH Solid Mechanics, School of Engineering Sciences, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Jacopo Biasetti
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, United States of America
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - T. Christian Gasser
- KTH Solid Mechanics, School of Engineering Sciences, KTH Royal Institute of Technology, Stockholm, Sweden
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Behr-Andersen C, Gammelgaard L, Fründ ET, Dahl M, Lindholt JS. Magnetic resonance imaging of the intraluminal thrombus in abdominal aortic aneurysms: a quantitative and qualitative evaluation and correlation with growth rate. THE JOURNAL OF CARDIOVASCULAR SURGERY 2017; 60:221-229. [PMID: 28847145 DOI: 10.23736/s0021-9509.17.09921-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of the intraluminal thrombus (ILT) in abdominal aortic aneurysm (AAA) growth remains incompletely understood. MRI is superior to other methods in depicting the morphology of the ILT. This study brings preliminary, but novel information on the presence and morphological characteristics of the ILT and AAA growth rates in a screening cohort. METHODS Cohort study with 46 patients from the Viborg Vascular Trial. All underwent one non-contrast-enhanced magnetic resonance imaging (MRI) at the end of follow-up. ILT presence was noted and, if present, it was allocated to one of four morphological categories based on visual appearance and signal intensity on T2 weighted images. RESULTS The mean growth rate was 1.95 mm/year ±0.87 (SD). The observation time was 5.59±0.63 (SD) years. ILT was present in AAA size groups as follows: 30-34.9 mm 20.00%, 35-39.9 mm 88.89%, 40-44.9 mm 81.25%, 45-49.9 mm 100% and 50-54.9 mm 100%. Out of 46, 8 had no ILT at the time of MRI. The presence of any sort of ILT yielded a significantly increased unadjusted and an adjusted growth rate of 1.09 mm/year (95% CI: 0.48; 1.70) and 1.24 mm/year (95% CI: 0.64; 1.83), respectively. All four thrombus types were retrospectively associated with an increased recorded growth rate compared with "no thrombus". Presence of a thin circumferential thrombus was retrospectively associated with the highest increase in growth rate, viz. 2.09 mm/year (95% CI: 1.23; 2.95). CONCLUSIONS We observed faster growth rate in those AAA that had developed an ILT. Even faster growth was observed amongst those AAA containing a thin ILT located along the inner circumference.
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Affiliation(s)
- Carsten Behr-Andersen
- Cardiovascular Research Center, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark -
| | - Lise Gammelgaard
- Department of Radiology, Viborg Regional Hospital, Viborg, Denmark
| | - Ernst T Fründ
- Elitary Research Center of Individualized Treatment of Arterial Diseases (CIMA), Cardiovascular Center of Excellence (CAVAC), Department of Heart, Lung and Vascular Surgery, University Hospital of Odense, Denmark
| | - Marie Dahl
- Cardiovascular Research Center, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Jes S Lindholt
- Cardiovascular Research Center, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark.,Elitary Research Center of Individualized Treatment of Arterial Diseases (CIMA), Cardiovascular Center of Excellence (CAVAC), Department of Heart, Lung and Vascular Surgery, University Hospital of Odense, Denmark
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Koncar IB, Nikolic D, Milosevic Z, Ilic N, Dragas M, Sladojevic M, Markovic M, Filipovic N, Davidovic L. Morphological and Biomechanical Features in Abdominal Aortic Aneurysm with Long and Short Neck-Case-Control Study in 64 Abdominal Aortic Aneurysms. Ann Vasc Surg 2017; 45:223-230. [PMID: 28666818 DOI: 10.1016/j.avsg.2017.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Both, open and endovascular, procedures are related to higher complication rate in abdominal aortic aneurysm (AAA) with shorter neck. Previous study showed that long-neck AAA might have lower risk of rupture. Estimation of biomechanical forces in AAA improves rupture risk assessment. The aim of this study was to compare morphological features and biomechanical forces in the short- and long-neck AAA with threshold of 15 mm. METHODS Digital Imaging and Communication in Medicine images of 64 aneurysms were prospectively collected and analyzed in a case-control study. Using commercially available software, Peak wall Stress (PWS) and Rupture Risk Equivalent Diameter (RRED) were determined. Difference between the maximal aneurysm diameter (MAD) and RRED was calculated and expressed as an absolute and relative (percentage of the MAD) value. In addition, volume of intraluminal thrombus (ILT) was calculated and expressed relative to AAA volume. RESULTS Study included 64 AAA divided in group with long (36, 56.25%), and short (28, 43.75%) neck. There was no correlation between neck length and MAD, PWS, and RRED (P = 0.646, P = 0.421, and P = 0.405, respectively). Relative ILT volume was greater in the short-neck aneurysms (P = 0.033). Relative difference between RRED and MAD was -4% and -14.8% in short- and long-neck aneurysms, respectively (P = 0.029). The difference between RRED and MAD was positive in 14/28 patients (50%) with short neck and in 6/35 patients (17.14%) with long neck (P = 0.011). CONCLUSIONS Based on our biomechanical analysis, in AAA with neck longer than 15 mm rupture risk might be lower than the risk estimated by its diameter. It might be explained with lower relative volume of ILT.
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Affiliation(s)
- Igor B Koncar
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Dalibor Nikolic
- Research and Development Center for Bioengineering BioIRC, Kragujevac, Serbia; Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | - Zarko Milosevic
- Research and Development Center for Bioengineering BioIRC, Kragujevac, Serbia
| | - Nikola Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Dragas
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Milos Sladojevic
- Clinic for Vascular and Endovascular surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Miroslav Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Nenad Filipovic
- Research and Development Center for Bioengineering BioIRC, Kragujevac, Serbia; Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | - Lazar Davidovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular surgery, Clinical Center of Serbia, Belgrade, Serbia
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Govindarajan V, Rakesh V, Reifman J, Mitrophanov AY. Computational Study of Thrombus Formation and Clotting Factor Effects under Venous Flow Conditions. Biophys J 2017; 110:1869-1885. [PMID: 27119646 PMCID: PMC4850327 DOI: 10.1016/j.bpj.2016.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 11/24/2022] Open
Abstract
A comprehensive understanding of thrombus formation as a physicochemical process that has evolved to protect the integrity of the human vasculature is critical to our ability to predict and control pathological states caused by a malfunctioning blood coagulation system. Despite numerous investigations, the spatial and temporal details of thrombus growth as a multicomponent process are not fully understood. Here, we used computational modeling to investigate the temporal changes in the spatial distributions of the key enzymatic (i.e., thrombin) and structural (i.e., platelets and fibrin) components within a growing thrombus. Moreover, we investigated the interplay between clot structure and its mechanical properties, such as hydraulic resistance to flow. Our model relied on the coupling of computational fluid dynamics and biochemical kinetics, and was validated using flow-chamber data from a previous experimental study. The model allowed us to identify the distinct patterns characterizing the spatial distributions of thrombin, platelets, and fibrin accumulating within a thrombus. Our modeling results suggested that under the simulated conditions, thrombin kinetics was determined predominantly by prothrombinase. Furthermore, our simulations showed that thrombus resistance imparted by fibrin was ∼30-fold higher than that imparted by platelets. Yet, thrombus-mediated bloodflow occlusion was driven primarily by the platelet deposition process, because the height of the platelet accumulation domain was approximately twice that of the fibrin accumulation domain. Fibrinogen supplementation in normal blood resulted in a nonlinear increase in thrombus resistance, and for a supplemented fibrinogen level of 48%, the thrombus resistance increased by ∼2.7-fold. Finally, our model predicted that restoring the normal levels of clotting factors II, IX, and X while simultaneously restoring fibrinogen (to 88% of its normal level) in diluted blood can restore fibrin generation to ∼78% of its normal level and hence improve clot formation under dilution.
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Affiliation(s)
- Vijay Govindarajan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Vineet Rakesh
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland.
| | - Alexander Y Mitrophanov
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland
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Lee R, Bellamkonda K, Jones A, Killough N, Woodgate F, Williams M, Cassimjee I, Handa A. Flow Mediated Dilatation and Progression of Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2017; 53:820-829. [PMID: 28416190 PMCID: PMC5496669 DOI: 10.1016/j.ejvs.2017.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/01/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE/BACKGROUND Biomarker(s) for prediction of the future progression rate of abdominal aortic aneurysms (AAA) may be useful to stratify the management of individual patients. AAAs are associated with features of systemic inflammation and endothelial dysfunction. Flow mediated dilatation (FMD) of the brachial artery is a recognised non-invasive measurement for endothelial function. We hypothesised that FMD is a potential biomarker of AAA progression and reflects the temporal changes of endothelial function during AAA progression. METHODS In a prospectively recruited cohort of patients with AAAs (Oxford Abdominal Aortic Aneurysm Study), AAA size was recorded by antero-posterior diameter (APD) (outer to outer) on ultrasound. Annual AAA progression was calculated by (ΔAPD/APD at baseline)/(number of days lapsed/365 days). FMD was assessed at the same time as AAA size measurement. Analyses of data were performed in the overall cohort, and further in subgroups of AAA by size (small: 30-39 mm; moderate: 40-55 mm; large: > 55 mm). RESULTS FMD is inversely correlated with the diameter of AAAs in all patients (n=162, Spearman's r=-.28, p<.001). FMD is inversely correlated with AAA diameter progression in the future 12 months (Spearman's r=-.35, p=.001), particularly in the moderate size group. Furthermore, FMD deteriorates during the course of AAA surveillance (from a median of 2.0% at baseline to 1.2% at follow-up; p=.004), while surgical repair of AAAs (n=50 [open repair n=22, endovascular repair n=28)] leads to an improvement in FMD (from 1.1% pre-operatively to 3.8% post-operatively; p<.001), irrespective of the type of surgery. CONCLUSION FMD is inversely correlated with future AAA progression in humans. FMD deteriorates during the natural history of AAA, and is improved by surgery. The utility of FMD as a potential biomarker in the context of AAA warrants further investigation.
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Affiliation(s)
- R Lee
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - K Bellamkonda
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - A Jones
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - N Killough
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - F Woodgate
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - M Williams
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - I Cassimjee
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - A Handa
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Huang Y, Teng Z, Elkhawad M, Tarkin JM, Joshi N, Boyle JR, Buscombe JR, Fryer TD, Zhang Y, Park AY, Wilkinson IB, Newby DE, Gillard JH, Rudd JHF. High Structural Stress and Presence of Intraluminal Thrombus Predict Abdominal Aortic Aneurysm 18F-FDG Uptake: Insights From Biomechanics. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.004656. [PMID: 27903534 PMCID: PMC5113243 DOI: 10.1161/circimaging.116.004656] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Abdominal aortic aneurysm (AAA) wall inflammation and mechanical structural stress may influence AAA expansion and lead to rupture. We hypothesized a positive correlation between structural stress and fluorine-18-labeled 2-deoxy-2-fluoro-d-glucose (18F-FDG) positron emission tomography–defined inflammation. We also explored the influence of computed tomography–derived aneurysm morphology and composition, including intraluminal thrombus, on both variables. Methods and Results— Twenty-one patients (19 males) with AAAs below surgical threshold (AAA size was 4.10±0.54 cm) underwent 18F-FDG positron emission tomography and contrast-enhanced computed tomography imaging. Structural stresses were calculated using finite element analysis. The relationship between maximum aneurysm 18F-FDG standardized uptake value within aortic wall and wall structural stress, patient clinical characteristics, aneurysm morphology, and compositions was explored using a hierarchical linear mixed-effects model. On univariate analysis, local aneurysm diameter, thrombus burden, extent of calcification, and structural stress were all associated with 18F-FDG uptake (P<0.05). AAA structural stress correlated with 18F-FDG maximum standardized uptake value (slope estimate, 0.552; P<0.0001). Multivariate linear mixed-effects analysis revealed an important interaction between structural stress and intraluminal thrombus in relation to maximum standardized uptake value (fixed effect coefficient, 1.68 [SE, 0.10]; P<0.0001). Compared with other factors, structural stress was the best predictor of inflammation (receiver-operating characteristic curve area under the curve =0.59), with higher accuracy seen in regions with high thrombus burden (area under the curve =0.80). Regions with both high thrombus burden and high structural stress had higher 18F-FDG maximum standardized uptake value compared with regions with high thrombus burdens but low stress (median [interquartile range], 1.93 [1.60–2.14] versus 1.14 [0.90–1.53]; P<0.0001). Conclusions— Increased aortic wall inflammation, demonstrated by 18F-FDG positron emission tomography, was observed in AAA regions with thick intraluminal thrombus subjected to high mechanical stress, suggesting a potential mechanistic link underlying aneurysm inflammation.
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Affiliation(s)
- Yuan Huang
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Zhongzhao Teng
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.).
| | - Maysoon Elkhawad
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Jason M Tarkin
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Nikhil Joshi
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Jonathan R Boyle
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - John R Buscombe
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Timothy D Fryer
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Yongxue Zhang
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Ah Yeon Park
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Ian B Wilkinson
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - David E Newby
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - Jonathan H Gillard
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.)
| | - James H F Rudd
- From the Department of Radiology (Y.H., Z.T., Y.Z., J.H.G.), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (Y.H.), Department of Engineering (Z.T.), Division of Cardiovascular Medicine (M.E., J.M.T., I.B.W., J.H.F.R.), Wolfson Brain Imaging Centre (T.D.F.), and Statistical Laboratory (A.Y.P.), University of Cambridge, United Kingdom; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (N.J., D.E.N.); Department of Vascular Surgery (J.R. Boyle) and Department of Nuclear Medicine (J.R. Buscombe), Addenbrooke's Hospital, Cambridge, United Kingdom; and Department of Vascular Surgery, Changhai Hospital, Shanghai, China (Y.Z.).
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48
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van Noort K, Schuurmann RC, Wermelink B, Slump CH, Kuijpers KC, de Vries JPP. Fluid displacement from intraluminal thrombus of abdominal aortic aneurysm as a result of uniform compression. Vascular 2017; 25:542-548. [PMID: 28441922 DOI: 10.1177/1708538117707612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives The results after aneurysm repair with an endovascular aneurysm sealing (EVAS) system are dependent on the stability of the aneurysm sac and particularly the intraluminal abdominal aortic thrombus (ILT). The postprocedural ILT volume is decreased compared with preprocedural ILT volume in aortic aneurysm patients treated with EVAS. We hypothesize that ILT is not stable in all patients and pressurization of the ILT may result in displacement of fluids from the ILT, no differently than serum is displaced from whole blood when it settles. To date, the mechanism and quantification of fluid displacement from ILT are unknown. Methods The study included 21 patients who underwent elective open abdominal aortic aneurysm repair. The ILT was harvested as a routine procedure during the operation. After excision of a histologic sample of the ILT specimen in four patients, ILT volume was measured and the ILT was compressed in a dedicated compression setup designed to apply uniform compression of 200 mmHg for 5 min. After compression, the volumes of the remaining thrombus and the displaced fluid were measured. Results The median (interquartile-range) of ILT volume before compression was 60 (66) mL, and a median of 5.7 (8.4) mL of fluid was displaced from the ILT after compression, resulting in a median thrombus volume decrease of 11% (10%). Fluid components can be up to 31% of the entire ILT volume. Histologic examination of four ILT specimens showed a reduction of the medial layer of the ILT after compression, which was the result of compression of fluid-containing canaliculi. Conclusions Applying pressure of 200 mmHg to abdominal aortic aneurysm ILT resulted in the displacement of fluid, with a large variation among patients. Fluid displacement may result in decrease of ILT volume during and after EVAS, which might have implications on pre-EVAS volume planning and on stability of the endobags during follow-up which may lead to migration, endoleak or both.
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Affiliation(s)
- Kim van Noort
- 1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.,2 Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Richte Cl Schuurmann
- 1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.,2 Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Bryan Wermelink
- 1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.,2 Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- 3 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Karel C Kuijpers
- 4 Department of Pathology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jean-Paul Pm de Vries
- 1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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49
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Chitosan–Sodium Tetradecyl Sulfate Hydrogel: Characterization and Preclinical Evaluation of a Novel Sclerosing Embolizing Agent for the Treatment of Endoleaks. Cardiovasc Intervent Radiol 2017; 40:576-584. [DOI: 10.1007/s00270-016-1557-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
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50
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Cheheltani R, Pichamuthu JE, Rao J, Weinbaum JS, Kiani MF, Vorp DA, Pleshko N. Fourier Transform Infrared Spectroscopic Imaging-Derived Collagen Content and Maturity Correlates with Stress in the Aortic Wall of Abdominal Aortic Aneurysm Patients. Cardiovasc Eng Technol 2016; 8:70-80. [PMID: 27995569 DOI: 10.1007/s13239-016-0289-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 12/04/2016] [Indexed: 01/22/2023]
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative disease of the aorta characterized by severe disruption of the structural integrity of the aortic wall and its major molecular constituents. From the early stages of disease, elastin in the aorta becomes highly degraded and is replaced by collagen. Questions persist as to the contribution of collagen content, quality and maturity to the potential for rupture. Here, using our recently developed Fourier transform infrared imaging spectroscopy (FT-IRIS) method, we quantified collagen content and maturity in the wall of AAA tissues in pairs of specimens with different wall stresses. CT scans of AAAs from 12 patients were used to create finite element models to estimate stress in different regions of tissue. Each patient underwent elective repair of the AAA, and two segments of the AAA tissues from anatomic regions more proximal or distal with different wall stresses were evaluated by histology and FT-IRIS after excision. For each patient, collagen content was generally greater in the tissue location with lower wall stress, which corresponded to the more distal anatomic regions. The wall stress/collagen ratio was greater in the higher stress region compared to the lower stress region (1.01 ± 1.09 vs. 0.55 ± 0.084, p = 0.02). The higher stress region also corresponded to the location with reduced intraluminal thrombus thickness. Further, collagen maturity tended to decrease with increased collagen content (p = 0.068, R = 0.38). Together, these results suggest that an increase in less mature collagen content in AAA patients does not effectively compensate for the loss of elastin in the aortic wall, and results in a reduced capability to endure wall stresses.
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Affiliation(s)
- Rabee Cheheltani
- Department of Mechanical Engineering, Temple University, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jayashree Rao
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Justin S Weinbaum
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mohammad F Kiani
- Department of Mechanical Engineering, Temple University, Philadelphia, PA, USA
| | - David A Vorp
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Surgery, Department of Cardiothoracic Surgery, and Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy Pleshko
- Department of Bioengineering, Temple University, Philadelphia, PA, USA.
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