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Solache-Berrocal G, Barral-Varela AM, Areces-Rodríguez S, Junco-Vicente A, Vallina-Álvarez A, Corte-Torres MD, Valdivielso JM, Llosa JC, Morís C, Martín M, Rodríguez I. Correlation of Micro-Computed Tomography Assessment of Valvular Mineralisation with Histopathological and Immunohistochemical Features of Calcific Aortic Valve Disease. J Clin Med 2019; 9:E29. [PMID: 31877754 PMCID: PMC7019701 DOI: 10.3390/jcm9010029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/10/2019] [Accepted: 12/19/2019] [Indexed: 01/22/2023] Open
Abstract
Aortic valve stenosis is a serious disease with increasing prevalence in developed countries. Research aimed at uncovering the molecular mechanisms behind its main cause, aortic valve calcification, is thus crucial for the development of future therapies. It is frequently difficult to measure the extent of mineralisation in soft tissues and some methods require the destruction of the sample. Micro-computed tomography (µCT), a non-destructive technique, was used to quantify the density and volume of calcium deposits on cusps from 57 explanted aortic valves. Conventional and immunostaining techniques were used to characterise valve tissue degeneration and the inflammatory and osteogenic stage with several markers. Although most of the analysed cusps came from severe stenosis patients, the µCT parameter bone volume/tissue volume ratio distinguished several degrees of mineralisation that correlated with the degree of structural change in the tissue and the amount of macrophage infiltration as determined by CD68 immunohistochemistry. Interestingly, exosomal markers CD63 and Alix co-localised with macrophage infiltration surrounding calcium deposits, suggesting that those vesicles could be produced at least in part by these immune cells. In conclusion, we have shown that the ex vivo assessment of aortic valve mineralisation with µCT reflects the molecular and cellular changes in pathological valves during progression towards stenosis. Thus, our results give additional validity to quantitative μCT as a convenient laboratory tool for basic research on this type of cardiovascular calcification.
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Affiliation(s)
- Guillermo Solache-Berrocal
- Cardiac Pathology Research Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (G.S.-B.); (C.M.)
- REDinREN from Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain;
| | - Ana María Barral-Varela
- Cardiac Surgery Department, Complejo Asistencial Universitario de Salamanca (CAUSA), 37007 Salamanca, Spain;
| | - Sheila Areces-Rodríguez
- Cardiology Department, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (S.A.-R.); (A.J.-V.); (J.C.L.)
| | - Alejandro Junco-Vicente
- Cardiology Department, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (S.A.-R.); (A.J.-V.); (J.C.L.)
| | - Aitana Vallina-Álvarez
- Biobank of the Principality of Asturias, Hospital Universitario Central de Asturias (HUCA), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (A.V.-Á.); (M.D.C.-T.)
- University Institute of Oncology of the Principality of Asturias (IUOPA), University of Oviedo, 33011 Oviedo, Spain
| | - María Daniela Corte-Torres
- Biobank of the Principality of Asturias, Hospital Universitario Central de Asturias (HUCA), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (A.V.-Á.); (M.D.C.-T.)
| | - José Manuel Valdivielso
- REDinREN from Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain;
- Vascular and Renal Translational Research Group, Biomedical Research Institute of Lleida (IRBLleida), 25198 Lleida, Spain
| | - Juan Carlos Llosa
- Cardiology Department, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (S.A.-R.); (A.J.-V.); (J.C.L.)
| | - César Morís
- Cardiac Pathology Research Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (G.S.-B.); (C.M.)
- REDinREN from Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain;
- Cardiology Department, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (S.A.-R.); (A.J.-V.); (J.C.L.)
| | - María Martín
- Cardiac Pathology Research Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (G.S.-B.); (C.M.)
- REDinREN from Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain;
- Cardiology Department, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (S.A.-R.); (A.J.-V.); (J.C.L.)
| | - Isabel Rodríguez
- Cardiac Pathology Research Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (G.S.-B.); (C.M.)
- REDinREN from Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain;
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Mazur P, Wypasek E, Gawęda B, Sobczyk D, Kapusta P, Natorska J, Malinowski KP, Tarasiuk J, Bochenek M, Wroński S, Chmielewska K, Kapelak B, Undas A. Stenotic Bicuspid and Tricuspid Aortic Valves - Micro-Computed Tomography and Biological Indices of Calcification. Circ J 2017; 81:1043-1050. [PMID: 28344201 DOI: 10.1253/circj.cj-16-1166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Valve calcification is well estimated by ex-vivo micro-computed tomography (micro-CT). The objective of this study was to investigate the associations between micro-CT findings and biological indices of calcification in aortic stenosis (AS), as well as differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV).Methods and Results:Aortic valves and plasma were obtained from patients undergoing valve surgery. Valves were dissected and underwent micro-CT, genetic analyses, and calcium content assessment. Plasma levels of calcification markers were measured. Forty-two patients with isolated severe AS, including 22 with BAV, were studied. BAV patients had a lower median CT value (140.0 [130.0-152.0] vs. 157.0 [147.0-176.0], P=0.002) and high-density calcification (HDC) fraction (9.3 [5.7-23.3] % vs. 21.3 [14.3-31.2] %, P=0.01), as compared with TAV. Calcification fraction (CF) correlated with AS severity (measured as maximal transvalvular pressure gradient [r=0.34, P=0.03], maximal flow velocity [r=0.38, P=0.02], and indexed aortic valve area [r=-0.37, P=0.02]). For TAV patients only, mRNA expression of integrin-binding sialoprotein correlated with CF (r=0.45, P=0.048), and the receptor activator of the nuclear factor κ-B ligand transcript correlated with HDC corrugation (r=0.54, P=0.01). CONCLUSIONS TAV patients with AS present more mineralized calcifications in micro-CT than BAV subjects. The relative volume of calcifications increases with the AS severity. In TAV patients, upregulated expression of genes involved in osteoblastogenesis in AS correlates with leaflet mineralization in micro-CT.
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Affiliation(s)
- Piotr Mazur
- John Paul II Hospital.,Institute of Cardiology, Jagiellonian University Medical College Krakow
| | - Ewa Wypasek
- John Paul II Hospital.,Institute of Cardiology, Jagiellonian University Medical College Krakow
| | - Bogusław Gawęda
- Institute of Cardiology, Jagiellonian University Medical College Krakow
| | - Dorota Sobczyk
- Institute of Cardiology, Jagiellonian University Medical College Krakow
| | - Przemysław Kapusta
- John Paul II Hospital.,Institute of Cardiology, Jagiellonian University Medical College Krakow
| | - Joanna Natorska
- John Paul II Hospital.,Institute of Cardiology, Jagiellonian University Medical College Krakow
| | | | - Jacek Tarasiuk
- Department of Condensed Matter Physics, Faculty of Physics and Applied Computer Science, AGH University of Science and Technology
| | - Maciej Bochenek
- John Paul II Hospital.,Institute of Cardiology, Jagiellonian University Medical College Krakow
| | - Sebastian Wroński
- Department of Condensed Matter Physics, Faculty of Physics and Applied Computer Science, AGH University of Science and Technology
| | - Katarzyna Chmielewska
- Department of Condensed Matter Physics, Faculty of Physics and Applied Computer Science, AGH University of Science and Technology
| | - Bogusław Kapelak
- John Paul II Hospital.,Institute of Cardiology, Jagiellonian University Medical College Krakow
| | - Anetta Undas
- John Paul II Hospital.,Institute of Cardiology, Jagiellonian University Medical College Krakow
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Maizato MJS, Pires MD, Canzian M, Higa OZ, Pitombo RNM, Leirner AA. Histological evaluation of biocompatibility of lyophilized bovine pericardium implanted subcutaneously in rats. Artif Organs 2008; 32:268-71. [PMID: 18370939 DOI: 10.1111/j.1525-1594.2008.00541.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This article aims at investigating in vivo evaluation of lyophilization procedure on the biocompatibility of bovine pericardium treated with glutaraldehyde (GA). The bovine pericardium was fixed with 0.5% glutaraldehyde during 10 days and preserved in 4% formaldehyde (FA). Two groups of samples were prepared from treated membranes: Group 1, nonlyophilized samples and Group 2, lyophilized samples. Male Sprague-Dawley rats (4 weeks after birth) were anesthetized (pentobarbital sodium 25 mg/kg of body weight) and in each one were implanted subcutaneously in the dorsal region a sample from Group 1 and another from Group 2. These samples were explanted after 30 days for histological analysis. No intercurrences took place after the surgery. No differences (P > 0.05) in the calcification, granulomatous reaction, mononuclear infiltration, and granulation tissue development was observed between both groups. The implanted lyophilized samples presented a trend for a reduced inflammatory reaction. Lyophilization of the bovine pericardium does not seem to increase the above listed tissue reaction.
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Affiliation(s)
- Marina J S Maizato
- Bioengineering Division-Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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Melina G, Horkaew P, Amrani M, Rubens MB, Yacoub MH, Yang GZ. Three-dimensional in vivo characterization of calcification in native valves and in Freestyle versus homograft aortic valves. J Thorac Cardiovasc Surg 2005; 130:41-7. [PMID: 15999039 DOI: 10.1016/j.jtcvs.2005.02.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This article describes a novel interactive method for quantitative evaluation of calcium deposits in the aortic valve by means of electron beam tomography data fusion technique. METHODS The technique relied on the use of hierarchic 3-dimensional free-form volume registration with fast global optimization between normally acquired and contrast-enhanced electron beam tomographic volume. A total of 66 contrast-enhanced electron beam tomographic scans of the aortic root were performed in 27 patients, 10 with native aortic valve disease (group A) and 17 from a prospective randomized trial of aortic root replacement (group B, 9 Freestyle grafts [Medtronic, Inc, Minneapolis, Minn] and 8 homografts). To validate the in vivo electron beam tomographic measurements, 5 patients from group A underwent electron beam tomographic scans before the operation and then had their own valves, explanted at the time of surgery, analyzed for calcium quantification by ex vivo electron beam tomography. RESULTS In group A, the mean (+/- SE) calcification score was 6560 +/- 2388, which correlated with peak gradients measured at echocardiography ( r = 0.93, P = .02). In group B, the mean (+/- SE) calcification score was 168 +/- 27, showing a tendency toward a lower calcification for Freestyle valves than for homografts at 2 years after implantation ( P = .052). A mean variability of 6% was found between in vivo electron beam tomographic scores of calcification and those measured on valve specimens after explantation. CONCLUSION We describe a novel method to characterize the degree and location of calcification in both native valves and postoperative valve implants. The technique may be useful in the management of patients with aortic valve disease and has potential as a screening tool for high-risk patients to diagnose early valve calcification and possibly institute corrective measures.
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Affiliation(s)
- Giovanni Melina
- Academic Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College, University of London, London, UK
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Pohle K, Mäffert R, Ropers D, Moshage W, Stilianakis N, Daniel WG, Achenbach S. Progression of aortic valve calcification: association with coronary atherosclerosis and cardiovascular risk factors. Circulation 2001; 104:1927-32. [PMID: 11602496 DOI: 10.1161/hc4101.097527] [Citation(s) in RCA: 269] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent studies demonstrated an influence of atherosclerotic risk factors on the progression of aortic valve stenosis. The extent of aortic valve calcification (AVC) was also found to be a strong predictor of stenosis progression. We investigated the influence of the LDL cholesterol level (LDL), other standard cardiovascular risk factors, and the extent of coronary calcification (CC) on the progression of AVC quantified by electron beam tomography (EBT). METHODS AND RESULTS In 104 patients (64.7+/-8 years, 89 male) with an EBT scan positive for AVC, CC and AVC were quantified using a volumetric score. EBT was repeated at a mean interval of 15 months (10 to 36 months), and the progression of AVC and CC was determined. Patients were divided into 2 groups according to LDL: group 1, LDL</=3.36 mmol/L (130 mg/dL), 57 patients; group 2, LDL>3.36 mmol/L (130 mg/dL), 47 patients. Mean values for CC were 546+/-932 mm(3) in scan 1 and 665+/-1085 mm(3) in scan 2 for AVC 324+/-796 mm(3) and 404+/-1076 mm(3), respectively. The mean progression of CC was 27+/-37% (group 1, 16+/-22%; group 2, 39+/-46%, P</=0.001) and of AVC was 25+/-38% (group 1, 9+/-22%; group 2, 43+/-44%, P</=0.001). CONCLUSIONS Quantification of AVC by EBT permits new insights into the progression of aortic valve sclerosis. We observed a strong influence of LDL cholesterol level on the progression of AVC and CC, suggesting that lipid-lowering therapy may decrease the progression of aortic valve calcification.
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Affiliation(s)
- K Pohle
- Department of Internal Medicine II, University of Erlangen, Germany.
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