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Dwyer KD, Kant RJ, Soepriatna AH, Roser SM, Daley MC, Sabe SA, Xu CM, Choi BR, Sellke FW, Coulombe KLK. One Billion hiPSC-Cardiomyocytes: Upscaling Engineered Cardiac Tissues to Create High Cell Density Therapies for Clinical Translation in Heart Regeneration. Bioengineering (Basel) 2023; 10:587. [PMID: 37237658 PMCID: PMC10215511 DOI: 10.3390/bioengineering10050587] [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: 04/01/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Despite the overwhelming use of cellularized therapeutics in cardiac regenerative engineering, approaches to biomanufacture engineered cardiac tissues (ECTs) at clinical scale remain limited. This study aims to evaluate the impact of critical biomanufacturing decisions-namely cell dose, hydrogel composition, and size-on ECT formation and function-through the lens of clinical translation. ECTs were fabricated by mixing human induced pluripotent stem-cell-derived cardiomyocytes (hiPSC-CMs) and human cardiac fibroblasts into a collagen hydrogel to engineer meso-(3 × 9 mm), macro- (8 × 12 mm), and mega-ECTs (65 × 75 mm). Meso-ECTs exhibited a hiPSC-CM dose-dependent response in structure and mechanics, with high-density ECTs displaying reduced elastic modulus, collagen organization, prestrain development, and active stress generation. Scaling up, cell-dense macro-ECTs were able to follow point stimulation pacing without arrhythmogenesis. Finally, we successfully fabricated a mega-ECT at clinical scale containing 1 billion hiPSC-CMs for implantation in a swine model of chronic myocardial ischemia to demonstrate the technical feasibility of biomanufacturing, surgical implantation, and engraftment. Through this iterative process, we define the impact of manufacturing variables on ECT formation and function as well as identify challenges that must still be overcome to successfully accelerate ECT clinical translation.
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Affiliation(s)
- Kiera D. Dwyer
- School of Engineering, Brown University Center for Biomedical Engineering, Providence, RI 02912, USA; (K.D.D.)
| | - Rajeev J. Kant
- School of Engineering, Brown University Center for Biomedical Engineering, Providence, RI 02912, USA; (K.D.D.)
| | - Arvin H. Soepriatna
- School of Engineering, Brown University Center for Biomedical Engineering, Providence, RI 02912, USA; (K.D.D.)
| | - Stephanie M. Roser
- School of Engineering, Brown University Center for Biomedical Engineering, Providence, RI 02912, USA; (K.D.D.)
| | - Mark C. Daley
- School of Engineering, Brown University Center for Biomedical Engineering, Providence, RI 02912, USA; (K.D.D.)
| | - Sharif A. Sabe
- Cardiovascular Research Center, Cardiovascular Institute, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Division of Cardiothoracic Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Cynthia M. Xu
- Cardiovascular Research Center, Cardiovascular Institute, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Division of Cardiothoracic Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Bum-Rak Choi
- Cardiovascular Research Center, Cardiovascular Institute, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Frank W. Sellke
- Cardiovascular Research Center, Cardiovascular Institute, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Division of Cardiothoracic Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Kareen L. K. Coulombe
- School of Engineering, Brown University Center for Biomedical Engineering, Providence, RI 02912, USA; (K.D.D.)
- Cardiovascular Research Center, Cardiovascular Institute, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
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Alexandrescu DM, Mitu O, Costache II, Macovei L, Mitu I, Alexandrescu A, Georgescu CA. Risk factors associated with intra-stent restenosis after percutaneous coronary intervention. Exp Ther Med 2021; 22:1141. [PMID: 34504587 PMCID: PMC8394103 DOI: 10.3892/etm.2021.10575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
The present study aimed to explore the correlations between clinical, biological, imagistic and procedural factors with the risk of intra-stent restenosis (ISR) in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). An observational cross-sectional study was conducted in a high-volume PCI center over a period of 2 years. A total of 235 consecutive patients diagnosed with angina or acute coronary syndrome treated by PCI were included in the study. Diagnosis of ISR was documented by coronary angiography in patients with suggestive coronary symptoms and ischemic changes in non-invasive or invasive paraclinical investigations. Thus, they were assigned to two groups: With or without ISR. All patients underwent clinical and laboratory examination, providing clinical and paraclinical variables that could be considered risk factors for ISR. Current smokers [risk ratio (RR)=1.63; 95% confidence interval (95% CI): 1.25-2.13], arterial hypertension (RR=1.86; 95% CI: 1.41-2.45), diabetes (RR=1.83; 95% CI: 1.42-2.36), high C-reactive protein (CRP) levels (RR=1.44; 95% CI: 0.93-2.24), chronic kidney disease (CKD) (RR=1.90; 95% CI: 1.53-2.36) and thrombolysis in myocardial infarction (TIMI) score were found to have a significant role in estimating the risk for ISR. Moreover, the ISR group (119 patients) presented with a lower stent inflation pressure when compared to the control group (116 patients) (14.47 vs. 16.14 mmHg, P=0.004). An increased mean stent diameter used for PCI was not associated with a high ISR incidence (P=0.810) as well as complex coronary treated lesions with longer stents (mean length of 24.98 mm in patients without ISR vs. 25.22 mm in patients with ISR; P=0.311). There was an estimated two times higher risk (RR=2.13; 95% CI: 1.17-3.88) concerning multi-stenting and restenosis degree >70%. To conclude, smoking, hypertension, diabetes mellitus, high CRP levels, CKD, TIMI score, stent type, low pressure for stent implantation and multi-stenting were found to be associated with ISR in patients following PCI. Therefore, a close follow-up should be targeted in such patients.
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Affiliation(s)
- Dan-Mihai Alexandrescu
- 1 Medical Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Department of Cardiology-Internal Medicine, Emergency County Hospital, 610136 Piatra Neamt, Romania
| | - Ovidiu Mitu
- 1 Medical Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Irina Iuliana Costache
- 1 Medical Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Liviu Macovei
- 1 Medical Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ivona Mitu
- Department of Morpho-Functional Sciences II, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Alexandrescu
- Department of Cardiology-Internal Medicine, Emergency County Hospital, 610136 Piatra Neamt, Romania
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Zhang Z, Bai J, Huang Y, Wang L. Implementation of a clinical nursing pathway for percutaneous coronary intervention: A randomized controlled trial protocol. Medicine (Baltimore) 2020; 99:e22866. [PMID: 33120826 PMCID: PMC7581146 DOI: 10.1097/md.0000000000022866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Acute myocardial infarction is a very common disease in the emergency room. Emergency percutaneous coronary intervention (PCI) is the first choice to open infarct-related artery in time to regain the active blood flow of myocardial tissue. Clinical nursing pathway (CNP), namely clinical project, is an original nursing mode with good quality, outstanding efficiency, and low treatment spending, so it has attracted more and more attention. However, few studies have reported the implementation of a CNP in PCIs. The purpose of the protocol is to assess the impact of CNP on the clinical efficacy of transradial emergency PCI. METHODS This is a randomized controlled, single center trial which will be implemented from January 2021 to June 2021. Hundred samples diagnosed with acute myocardial infarction will be included in this study. It was authorized via the Ethics Committee of Changshan County People's Hospital (CCPH002348). Patients are assigned to the following groups: control group, given normal routine care; CNP group, treated with CNP plan. The time from door to balloon, hospitalization expenses, length of stay, postoperative complications, patients' satisfaction with treatment are compared and analyzed. All data are collected and analyzed by Social Sciences software version 21.0 (SPSS, Inc., Chicago, IL) program. RESULTS Differences of clinical outcomes between groups (). CONCLUSION This original evidence-based nursing model can be used as the foundation for further research. TRIAL REGISTRATION NUMBER researchregistry6030.
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Affiliation(s)
| | | | | | - Lingling Wang
- Department of Radiology, Changshan County People's Hospital, Zhejiang, China
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Rezvova MA, Ovcharenko EA, Klyshnikov KY, Kudryavtseva YA. Promising polymeric compounds for coronary stent graft membrane. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The literature review discusses the studies on developing the polymer membrane of a coronary stent graft. The new generation of coronary stent grafts is designed to increase the hemocompatibility and ensure its delivery to poorly accessible artery regions. Based on the clinical use results, three groups of promising polymers were identified: biostable polyurethanes, polyvinyl alcohol-based cryogels, bioresorbable compositions based on polylactide-caprolactone and lactic acid-glycolic acid copolymer. However, the possibility of their clinical application requires further experimental studying.
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Affiliation(s)
- M. A. Rezvova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - E. A. Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases
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