1
|
Szatmáry Z, Bardet SM, Mounier J, Janot K, Cortese J, Perrin ML, Couquet C, Deniau G, Hauquier F, Migneret R, Guenin E, Maire M, Michel JB, Forestier G, Le Flahec A, Leger-Bretou C, Mounayer C, Chaubet F, Rouchaud A. Fucoidan-coated coils improve healing in a rabbit elastase aneurysm model. J Neurointerv Surg 2024; 16:824-829. [PMID: 37491380 DOI: 10.1136/jnis-2023-020596] [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: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Recanalization of coiled aneurysms remains unresolved. To limit aneurysm recanalization after embolization with coils, we propose an innovative approach to optimize aneurysm healing using fucoidan-coated coils. OBJECTIVE To evaluate the short-term efficacy and long-term safety of the new coil system with conventional angiography, histology, and multiphoton microscopy for follow-up of fibrosis and neointima formation. METHODS We conducted a feasibility study on rabbit elastase-induced aneurysms. Embolization was carried out with bare platinum coils, fucoidan-coated coils, or dextran-coated coils. Aneurysms were controlled after 1 month by digital subtraction angiography (DSA). Aneurysm samples were collected and processed for histological analysis. Aneurysm healing and fibrosis were measured by quantifying collagen according to the histological healing score by combining standard light microscopy and multiphoton imaging. We divided 27 rabbits into three groups: bare platinum group, fucoidan group, and dextran group as controls. RESULTS Angiographic grading showed a trend toward less recanalization in the fucoidan group, although there were no significant differences among the three groups (P=0.21). Histological healing was significantly different according to the presence of more collagen in the neck area of aneurysms in the fucoidan group versus the bare platinum group (P=0.011), but not in the dextran group. Histological index was significantly better at the aneurysm neck in the fucoidan group than in the bare platinum group (P=0.004). Collagen organization index was also significantly better in the fucoidan group than in the bare platinum group (P=0.007). CONCLUSION This proof-of-concept study demonstrated the feasibility and efficacy of treatment with fucoidan-coated coils to improve aneurysm healing. The results in this rabbit in vivo model showed that fucoidan-coated coils have the potential to improve healing following endovascular treatment.
Collapse
Affiliation(s)
- Zoltán Szatmáry
- Department of Interventional Neuroradiology, Limoges University, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | | | - Jérémy Mounier
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | - Kevin Janot
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
- Department of Interventional Neuroradiology, CHRU Tours CPU, Tours, France
| | - Jonathan Cortese
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
- Department of Interventional Neuroradiology-NEURI Brain Vascular Center APHP, Hospital Bicetre, Le Kremlin-Bicêtre, France
| | | | - Cladue Couquet
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | - Guy Deniau
- UMR CEA, CNRS 3685, NIMBE, LICSEN, Paris-Saclay University, Gif-sur-Yvette, France
| | - Fanny Hauquier
- UMR CEA, CNRS 3685, NIMBE, LICSEN, Paris-Saclay University, Gif-sur-Yvette, France
- Department of Chemistry and Health and Life Sciences, CNAM, Paris, France
| | - Rodolphe Migneret
- INSERM, UMRS 1148, LVTS, Paris, France
- Institut Galilée, Sorbonne North Paris University, Villetaneuse, France
| | - Erwann Guenin
- Laboratoire TIMR, Centre de Recherche Royallieu Rue du Dr Schweitzer - CS 6031960200, Compiègne, France
| | - Murielle Maire
- INSERM, UMRS 1148, LVTS, Paris, France
- Institut Galilée, Sorbonne North Paris University, Villetaneuse, France
| | | | - Géraud Forestier
- Department of Interventional Neuroradiology, Limoges University, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | | | | | - Charbel Mounayer
- Department of Interventional Neuroradiology, Limoges University, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | - Frederic Chaubet
- INSERM, UMRS 1148, LVTS, Paris, France
- Institut Galilée, Sorbonne North Paris University, Villetaneuse, France
| | - Aymeric Rouchaud
- Department of Interventional Neuroradiology, Limoges University, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| |
Collapse
|
2
|
Janot K, Boulouis G, Forestier G, Bala F, Cortese J, Szatmáry Z, Bardet SM, Baudouin M, Perrin ML, Mounier J, Couquet C, Yardin C, Segonds G, Dubois N, Martinez A, Lesage PL, Ding YH, Kadirvel R, Dai D, Mounayer C, Terro F, Rouchaud A. WEB shape modifications: angiography-histopathology correlations in rabbits. J Neurointerv Surg 2024; 16:302-307. [PMID: 37192788 DOI: 10.1136/jnis-2023-020193] [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: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND WEB Shape Modification (WSM) over time is frequent after aneurysm treatment. In this study, we explored the relationship between histopathological changes and angiographic evolution over time in experimental aneurysms in rabbits treated with the Woven EndoBridge (WEB) procedure. METHODS Quantitative WSM was assessed using flat-panel computed tomography (FPCT) during follow-up by calculating height and width ratio (HR, WR), defined as the ratio between either measurement at an index time point and the measurement immediately after WEB implantation. The index time point varied from 1 day to 6 months. HR and WR were evaluated with angiographic and histopathological assessments of aneurysm healing. RESULTS Final HR of devices varied from 0.30 to 1.02 and final WR varied from 0.62 to 1.59. Altogether, at least 5% of HR and WR variations were observed in 37/40 (92.5%) and 28/40 (70%) WEB devices, respectively, at the time of final assessment. There was no significant correlation between complete or incomplete occlusion groups and HR or WR (p=0.15 and p=0.43). Histopathological analysis revealed a significant association between WR and aneurysm healing and fibrosis 1 month following aneurysm treatment (both p<0.05). CONCLUSION Using longitudinal FPCT assessment, we observed that WSM affects both the height and width of the WEB device. No significant association was found between WSM and aneurysm occlusion status. Although presumably a multifactorial phenomenon, the histopathological analysis highlighted a significant association between width variations, aneurysm healing and fibrosis in the first month following aneurysm treatment.
Collapse
Affiliation(s)
- Kevin Janot
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Grégoire Boulouis
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Géraud Forestier
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Fouzi Bala
- Interventional Neuroradiology, University Hospital of Tours, Tours, France
| | - Jonathan Cortese
- NEURI The Brain Vascular Center, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | | | | | | | | | - Jérémy Mounier
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | - Claude Couquet
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| | - Catherine Yardin
- Histology, Cytology, Cellular Biology and Cytogenetics, University Hospital of Limoges, Limoges, France
| | | | | | | | | | | | | | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Charbel Mounayer
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Faraj Terro
- Cell Biology, University Hospital of Limoges, Limoges, France
| | - Aymeric Rouchaud
- Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
- XLIM UMR CNRS 7252, University of Limoges, Limoges, France
| |
Collapse
|
3
|
Peng Q, Guo R, Zhou Y, Teng R, Cao Y, Mu S. Comparison of Gelatin/Polylysine- and Silk Fibroin/SDF-1α-Coated Mesenchymal Stem Cell-Seeded Intracranial Stents. Macromol Biosci 2022; 23:e2200402. [PMID: 36541928 DOI: 10.1002/mabi.202200402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Endothelialization of the aneurysmal neck is essential for aneurysm healing after endovascular treatment. Mesenchymal stem cell (MSC)-seeded stents can promote aneurysm repair. The biological effects of coated and uncoated nitinol intracranial stents seeded with MSCs on vascular cells and macrophage proliferation and inflammation are investigated. Two stent coatings that exert pro-aggregation effects on MSCs via different mechanisms are examined: gelatin/polylysine (G/PLL), which enhances cell adhesion, and silk fibroin/SDF-1α (SF/SDF-1α), which enhances chemotaxis. The aim is to explore the feasibility of MSC-seeded coated stents in the treatment of intracranial aneurysms. The G/PLL coating provides the highest cytocompatibility and blood compatibility substrate for MSCs and vascular cells and promotes cell adhesion and proliferation. Moreover, it enhances MSC secretion and regulation of vascular cell and macrophage proliferation and chemotaxis. Although the SF/SDF-1α coating promotes MSC secretion and vascular cell chemotaxis, it induces a greater degree of macrophage proliferation, chemotaxis, and secretion of pro-inflammatory factors. MSC-seeded stents coated with G/PLL may benefit stent surface endothelialization and reduce the inflammatory response after endovascular treatment of intracranial aneurysm. These effects may improve aneurysm healing and increase the cure rate.
Collapse
Affiliation(s)
- Qichen Peng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Ruimin Guo
- Healthina Academy of Biomedicine, Tianjin Economic-Technological Development Area, HAB-TEDA, Tianjin, 300457, China.,Tangyi holdings (Shenzhen) Co., LTD, Shenzhen, 518101, China
| | - Yangyang Zhou
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Ruidi Teng
- Healthina Academy of Biomedicine, Tianjin Economic-Technological Development Area, HAB-TEDA, Tianjin, 300457, China.,Tangyi holdings (Shenzhen) Co., LTD, Shenzhen, 518101, China
| | - Yulin Cao
- Healthina Academy of Biomedicine, Tianjin Economic-Technological Development Area, HAB-TEDA, Tianjin, 300457, China.,Tangyi holdings (Shenzhen) Co., LTD, Shenzhen, 518101, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| |
Collapse
|
4
|
Panchendrabose K, Muram S, Belanger BL, Eesa M, Almekhlafi MA, Goyal M, Wong JH, Sen A, Menon BK, Har B, Mitha AP. Intra-arterial injection of mesenchymal stem cells to accelerate neointima formation after endovascular stenting in a rabbit model. J Neurosurg 2022; 137:691-698. [PMID: 35090127 DOI: 10.3171/2021.11.jns212372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Delayed neointima formation over a neurovascular stent is associated with thrombotic complications that can lead to stroke. The purpose of this study was to evaluate whether an intra-arterial injection of mesenchymal stem cells (MSCs) after stent placement leads to improved neointima and reduced thrombus formation over the device. METHODS Solitaire stents were placed into the aortas of rabbits that were divided into MSC and control groups. The MSC group received an intra-arterial injection of MSCs through the same microcatheter used for stent deployment. Optical coherence tomography (OCT) was used to evaluate and compare neointima and thrombus formation in a blinded fashion. Explanted specimens were also imaged with scanning electron microscopy (SEM) and evaluated by observers blinded to group allocation using an endothelialization scoring system. RESULTS The 3-day MSC group was similar to the 7-day controls in terms of stent strut coverage ratio and maximum neointimal thickness, but these values were significantly higher than the 3-day control group based on a hierarchical mixed-effects linear regression analysis. SEM revealed a significantly higher endothelialization score for the MSC group compared with controls at the same time point. There was no difference in thrombus formation between any of the groups. CONCLUSIONS The intra-arterial injection of MSCs after endovascular stenting accelerated early neointima formation but had no effect on thrombus formation in this study. Larger studies are required to verify these findings and determine the durability and mechanism of this effect.
Collapse
Affiliation(s)
| | | | | | - Muneer Eesa
- 2Department of Clinical Neurosciences
- 4Department of Radiology
| | | | - Mayank Goyal
- 2Department of Clinical Neurosciences
- 4Department of Radiology
| | - John H Wong
- 2Department of Clinical Neurosciences
- 3Hotchkiss Brain Institute
- 4Department of Radiology
| | - Arindom Sen
- 5Department of Chemical and Petroleum Engineering, Schulich School of Engineering, and
| | | | - Bryan Har
- 6Department of Cardiac Sciences, University of Calgary, Alberta, Canada
| | - Alim P Mitha
- 1Biomedical Engineering
- 2Department of Clinical Neurosciences
- 3Hotchkiss Brain Institute
- 4Department of Radiology
- 6Department of Cardiac Sciences, University of Calgary, Alberta, Canada
| |
Collapse
|
5
|
Emerging Polymer Materials in Trackable Endovascular Embolization and Cell Delivery: From Hype to Hope. Biomimetics (Basel) 2022; 7:biomimetics7020077. [PMID: 35735593 PMCID: PMC9221114 DOI: 10.3390/biomimetics7020077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Minimally invasive endovascular embolization is a widely used clinical technique used for the occlusion of blood vessels to treat various diseases. Different occlusive agents ranging from gelatin foam to synthetic polymers such as poly(vinyl alcohol) (PVA) have been commercially used for embolization. However, these agents have some drawbacks, such as undesired toxicity and unintended and uncontrolled occlusion. To overcome these issues, several polymer-based embolic systems are under investigation including biocompatible and biodegradable microspheres, gelling liquid embolic with controlled occlusive features, and trackable microspheres with enhanced safety profiles. This review aims to summarize recent advances in current and emerging polymeric materials as embolization agents with varying material architectures. Furthermore, this review also explores the potential of combining injectable embolic agents and cell therapy to achieve more effective embolization with the promise of outstanding results in treating various devastating diseases. Finally, limitations and challenges in developing next-generation multifunctional embolic agents are discussed to promote advancement in this emerging field.
Collapse
|
6
|
Chau SM, Herting SM, Noltensmeyer DA, Ahmed H, Maitland DJ, Raghavan S. Macrophage activation in response to shape memory polymer foam-coated aneurysm occlusion devices. J Biomed Mater Res B Appl Biomater 2022; 110:1535-1544. [PMID: 35090200 DOI: 10.1002/jbm.b.35015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/17/2021] [Accepted: 01/19/2022] [Indexed: 01/30/2023]
Abstract
Brain aneurysms can be treated with embolic coils using minimally invasive approaches. It is advantageous to modulate the biologic response of platinum embolic coils. Our previous studies demonstrated that shape memory polymer (SMP) foam coated embolization coils (FCC) devices demonstrate enhanced healing responses in animal models compared with standard bare platinum coil (BPC) devices. Macrophages are the most prevalent immune cell type that coordinate the greater immune response to implanted materials. Hence, we hypothesized that the highly porous SMP foam coatings on embolic coils activate a pro-regenerative healing phenotype. To test this hypothesis, we analyzed the number and type of infiltrating macrophages in FCC or BPC devices implanted in a rabbit elastase aneurysm model. FCC devices elicited a great number of infiltration macrophages, skewed significantly to a pro-regenerative M2-like phenotype 90 days following implantation. We devised an in vitro assay, where monocyte-derived macrophages were placed in close association with FCC or BPC devices for 6-72 h. Macrophages encountering SMP FCC-devices demonstrated highly mixed activation phenotypes at 6 h, heavily skewing toward an M2-like phenotype by 72 h, compared with macrophages encountering BPC devices. Macrophage activation was evaluated using gene expression analysis, and secreted cytokine evaluation. Together, our results demonstrate that FCC devices promoted a pro-regenerative macrophage activation phenotype, compared with BPC devices. Our in vitro findings corroborate with in vivo observations that SMP-based modification of embolic coils can promote better healing of the aneurysm site, by sustaining a pro-healing macrophage phenotype.
Collapse
Affiliation(s)
- Sarah M Chau
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
- TAMU Master of Biotechnology Program, Texas A&M University, College Station, Texas, USA
| | - Scott M Herting
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Dillon A Noltensmeyer
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Hamzah Ahmed
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Duncan J Maitland
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Shreya Raghavan
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas, USA
| |
Collapse
|
7
|
Kim S, Nowicki KW, Gross BA, Wagner WR. Injectable hydrogels for vascular embolization and cell delivery: The potential for advances in cerebral aneurysm treatment. Biomaterials 2021; 277:121109. [PMID: 34530233 DOI: 10.1016/j.biomaterials.2021.121109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022]
Abstract
Cerebral aneurysms are vascular lesions caused by the biomechanical failure of the vessel wall due to hemodynamic stress and inflammation. Aneurysmal rupture results in subarachnoid hemorrhage often leading to death or disability. Current treatment options include open surgery and minimally invasive endovascular options aimed at secluding the aneurysm from the circulation. Cerebral aneurysm embolization with appropriate materials is a therapeutic approach to prevent rupture and the resultant clinical sequelae. Metallic platinum coils are a typical, practical option to embolize cerebral aneurysms. However, the development of an alternative treatment modality is of interest because of poor occlusion permanence, coil migration, and coil compaction. Moreover, minimizing the implanted foreign materials during therapy is of importance not just to patients, but also to clinicians in the event an open surgical approach has to be pursued in the future. Polymeric injectable hydrogels have been investigated for transcatheter embolization and cell therapy with the potential for permanent aneurysm repair. This review focuses on how the combination of injectable embolic biomaterials and cell therapy may achieve minimally invasive remodeling of a degenerated cerebral artery with promise for superior outcomes in treatment of this devastating disease.
Collapse
Affiliation(s)
- Seungil Kim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kamil W Nowicki
- Department of Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley A Gross
- Department of Neurosurgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - William R Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
8
|
Yang G, Qin H, Liu B, Zhao X, Yin H. Mesenchymal stem cells-derived exosomes modulate vascular endothelial injury via miR-144-5p/PTEN in intracranial aneurysm. Hum Cell 2021; 34:1346-1359. [PMID: 34240392 DOI: 10.1007/s13577-021-00571-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/22/2021] [Indexed: 12/27/2022]
Abstract
Phosphatase and tensin homolog (PTEN) is known to be involved in the pathogenesis of intracranial aneurysm (IA). This study investigated the molecular mechanism of exosomal miR-144-5p (ex-miR-144-5p) and PTEN in IA. Ex-miR-144-5p expression was assessed in serum from individuals with ruptured intracranial aneurysm (RA) or unruptured intracranial aneurysm (UA), and healthy controls (HC). Vascular endothelial cells (VECs) were co-cultured with exosomes isolated from mesenchymal stem cells (MSCs) with transfection of miR-144-5p mimic or miR-144-5p inhibitor. IA rats were induced by combing systemic hypertension and intrathecal elastase injection. VECs were transfected with miR-144-5p mimic or inhibitor to verify the impacts of miR-144-5p on cell viability and proliferation. The connection between miR-144-5p and PTEN was verified by luciferase activity assay. Our data proved that ex-miR-144-5p was decreased in both UA and RA patients. MiR-144-5p overexpression in MSCs-derived exosome promoted VEC viability, inhibited VEC proliferation of VEs, and decreased the protein levels of matrix metalloproteinase-9 (MMP-9), proliferating cell nuclear antigen (PCNA) and osteopontin (OPN). IA rats injected with ex-miR-144-5p mimic showed significant luminal dilation, declined smooth muscle layers, and thinned vascular wall. Besides, inhibited cell apoptosis and decreased protein expressions were also observed. However, ex-miR-144-5p inhibitor had the opposite effects both in vivo and in vitro. We validated that miR-144-5p directly targeted PTEN. MiR-144-5p mimic increased cell viability and proliferation and reduced protein expressions, which could be blunted by PTEN overexpression. This study suggests that miR-144-5p elevates PTEN expression, thereby boosting apoptosis and attenuating viability of VECs in IA.
Collapse
Affiliation(s)
- Guojun Yang
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, People's Republic of China
| | - Hao Qin
- Department of Neurosurgery, Zaozhuang Municipal Hospital, No. 41 Longtou Middle Road, Shizhong District, Zaozhuang City, Shandong Province, 277100, People's Republic of China
| | - Bing Liu
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, People's Republic of China
| | - Xinhong Zhao
- Pharmacy Department, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, People's Republic of China
| | - Hang Yin
- Department of Neurosurgery, Zaozhuang Municipal Hospital, No. 41 Longtou Middle Road, Shizhong District, Zaozhuang City, Shandong Province, 277100, People's Republic of China.
| |
Collapse
|
9
|
Ben-Israel D, Belanger BL, Adibi A, Eesa M, Mitha AP, Spackman E. Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective? PLoS One 2021; 16:e0255870. [PMID: 34370777 PMCID: PMC8351982 DOI: 10.1371/journal.pone.0255870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background Unruptured intracranial aneurysms (UIA) are increasingly being treated by endovascular coiling as opposed to open surgical clipping. Unfortunately, endovascular coiling imparts an approximate 25% recanalization rate, leading to additional procedures and increased rupture risk. While a new health technology innovation (HTI) that reduces this recanalization rate would benefit patients, few advancements have been made. We aim to determine whether cost-effectiveness has been a barrier to HTI. Methods A probabilistic Markov model was constructed from the healthcare payer perspective to compare standard endovascular treatment of UIA to standard treatment plus the addition of a HTI adjunct. Costs were measured in 2018 USD and health outcomes were measured in quality-adjusted life-years (QALY). In the base case, the HTI was a theoretical mesenchymal stem cell therapy which reduced the aneurysm recanalization rate by 50% and cost $10,000 per procedure. All other model inputs were derived from the published scientific literature. Results Based on the model results, we found that for a given HTI price (y) and relative risk reduction of aneurysm recanalization (x), the HTI was always cost-effective if the following equation was satisfied: y ≤ 20268 ∙ x, using a willingness-to-pay threshold of $50,000 per QALY. The uncertainty surrounding whether an aneurysm would recanalize was a significant driver within the model. When the uncertainty around the risk of aneurysm recanalization was eliminated, the 10-year projected additional benefit to the United States healthcare system was calculated to be $113,336,994. Conclusion Cost-effectiveness does not appear to be a barrier to innovation in reducing the recanalization rate of UIA treated by endovascular coil embolization. Our model can now be utilized by academia and industry to accentuate economically feasible HTI and by healthcare payers to calculate their maximum willingness-to-pay for a new technology. Our results also indicate that predicting a patient’s baseline risk of aneurysm recanalization is a critical area of future research.
Collapse
Affiliation(s)
- David Ben-Israel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brooke L. Belanger
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amin Adibi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Muneer Eesa
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Alim P. Mitha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| |
Collapse
|
10
|
Szatmary Z, Mounier J, Janot K, Cortese J, Couquet C, Chaubet F, Kadirvel R, Bardet SM, Mounayer C, Rouchaud A. Bioactive refinement for endosaccular treatment of intracranial aneurysms. Neuroradiol J 2021; 34:534-541. [PMID: 34210195 DOI: 10.1177/19714009211024631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endovascular treatment is the first-line therapy for most intracranial aneurysms; however, recanalisation remains a major limitation. Developments in bioengineering and material science have led to a novel generation of coil technologies for aneurysm embolisation that address clinical challenges of aneurysm recurrence. This review presents an overview of modified surface coil technologies and summarises the state of the art regarding their efficacy and limitations based on experimental and clinical results. We also present potential perspectives to develop biologically optimised devices.
Collapse
Affiliation(s)
- Zoltan Szatmary
- Department of Radiology, Dupuytren Hospital, Limoges University, France
- XLIM UMR CNRS No. 7252, Limoges University, France
| | | | - Kevin Janot
- XLIM UMR CNRS No. 7252, Limoges University, France
- Regional University Hospital Center Tours, Radiology, Diagnostic and Interventional Neuroradiology, France
| | - Jonathan Cortese
- XLIM UMR CNRS No. 7252, Limoges University, France
- Bicêtre Hospital, Interventionnel Neuroradiology, Paris, France
| | | | - Frédéric Chaubet
- Laboratory for Vascular Translational Science, UMRS 1148, INSERM, Université de Paris, France
- Université Sorbonne Paris Nord- Campus de Bobigny, France
| | | | | | - Charbel Mounayer
- Department of Radiology, Dupuytren Hospital, Limoges University, France
- XLIM UMR CNRS No. 7252, Limoges University, France
| | - Aymeric Rouchaud
- Department of Radiology, Dupuytren Hospital, Limoges University, France
- XLIM UMR CNRS No. 7252, Limoges University, France
| |
Collapse
|
11
|
Shrivastava A, Mishra R, Salazar LRM, Chouksey P, Raj S, Agrawal A. Enigma of what is Known about Intracranial Aneurysm Occlusion with Endovascular Devices. J Stroke Cerebrovasc Dis 2021; 30:105737. [PMID: 33774553 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Aneurysmal subarachnoid Hemorrhage is a major cause of neurological morbidity and mortality. Over the years vascular neurosurgery has witnessed technological advances aimed to reduce the morbidity and mortality. Several endovascular devices have been used in clinical practice to achieve this goal in the management of ruptured and unruptured cerebral aneurysms. Recurrence due to recanalization is encountered in all of these endovascular devices as well as illustrated by Barrow Ruptured Aneurysm Trial. Histological and molecular characterization of the aneurysms treated with endovascular devices is an area of active animal and human research studies. Yet, the pathobiology illustrating the mechanisms of aneurysmal occlusion and healing lacks evidence. The enigma of aneurysmal healing following treatment with endovascular devices needs to be de-mystified to understand the biological interaction of endovascular device and aneurysm and thereby guide the future development of endovascular devices aimed at better aneurysm occlusion. We performed a comprehensive and detailed literature review to bring all the known facts of the pathobiology of intracranial aneurysm healing, the knowledge of which is of paramount importance to neurosurgeons, an interventional neuroradiologist, molecular biologist, geneticists, and experts in animal studies. This review serves as a benchmark of what is known and platform for future studies basic science research related to intracranial aneurysms.
Collapse
Affiliation(s)
- Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal 462020, Madhya Pradesh, India.
| | - Rakesh Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | | | - Pradeep Chouksey
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal 462020, Madhya Pradesh, India
| | - Sumit Raj
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal 462020, Madhya Pradesh, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal 462020, Madhya Pradesh, India
| |
Collapse
|
12
|
Ding Y, Dai D, Rouchaud A, Janot K, Asnafi S, Kallmes DF, Kadirvel R. WEB Device Shape Changes in Elastase-Induced Aneurysms in Rabbits. AJNR Am J Neuroradiol 2021; 42:334-339. [PMID: 33303525 PMCID: PMC7872195 DOI: 10.3174/ajnr.a6899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/05/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE While WEB devices have been shown to be safe and effective for aneurysm treatment, WEB-shape modification compression has been associated with incomplete aneurysm occlusion. We explored the relationship between occlusion rates and WEB-shape modification in different WEB device types in an experimental aneurysm model. MATERIALS AND METHODS Elastase-induced aneurysms were created in rabbits and treated with dual-layer (n = 12), single-layer (n = 12), or single-layer sphere (n = 12) WEB devices. Aneurysms were followed up either at 3 or 12 months. Angiographic occlusion was graded using the WEB Occlusion Scale: grade I, complete; grade II, complete but recess filling; grade III, residual neck; or grade IV, residual aneurysm. WEB-shape modification and histologic features were also analyzed. RESULTS Grade I or II occlusion was seen in 16 (44%) aneurysms, and grade I, II, or III ("adequate") occlusion was observed in 22 (61.1%) aneurysms at follow-up. WEB-shape modification was observed in 22 (61.1%) aneurysms. WEB-shape modification was higher in single-layer (9/12) and dual-layer (10/12) devices compared with single-layer sphere devices (3/12). Aneurysms with WEB-shape modification had a higher level of thrombus organization in the dome compared with those without WEB-shape modification (68% [15/22] versus 50% [7/14]). WEB-shape modification was not correlated with angiographic or histologic outcomes but was significantly correlated with levels of fibrosis and smooth muscle cells in the aneurysm. CONCLUSIONS WEB-shape modification is not associated with incomplete aneurysm occlusion of WEB devices in the rabbit model but may be related to connective tissue formation and the healing response to WEB device implantation.
Collapse
Affiliation(s)
- Y Ding
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
| | - D Dai
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
| | - A Rouchaud
- Department of Interventional Neuroradiology (A.R.), University Hospital, Limoges, France
| | - K Janot
- Neuroradiology Department (K.J.), University Hospital of Tours, Tours, France
| | - S Asnafi
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
- Department of Radiology (S.A.), Emory University, Atlanta, Georgia
| | - D F Kallmes
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
| | - R Kadirvel
- From the Department of Radiology (Y.D., D.D., S.A., D.F.K., R.K.), Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
13
|
Jang LK, Alvarado JA, Pepona M, Wasson EM, Nash LD, Ortega JM, Randles A, Maitland DJ, Moya ML, Hynes WF. Three-dimensional bioprinting of aneurysm-bearing tissue structure for endovascular deployment of embolization coils. Biofabrication 2020; 13. [DOI: 10.1088/1758-5090/abbb9b] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/25/2020] [Indexed: 01/30/2023]
|
14
|
Janot K, Herbreteau D, Amelot A, Charbonnier G, Boustia F, Narata AP, Kerleroux B, Bibi R, Papagiannaki C, Rouchaud A, Pierot L. Quantitative evaluation of WEB shape modification: A five-year follow-up study. J Neuroradiol 2020; 47:193-196. [DOI: 10.1016/j.neurad.2019.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/20/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Kevin Janot
- University Hospital of Tours, Neuroradiology Department, 2, boulevard Tonnellé, 37000 Tours, France.
| | - Denis Herbreteau
- University Hospital of Tours, Neuroradiology Department, 2, boulevard Tonnellé, 37000 Tours, France
| | - Aymeric Amelot
- University Hospital of La Pitié-Salpétrière, Neurosurgery Department, 47-83, boulevard de l'hopital, 75013 Paris, France
| | - Guillaume Charbonnier
- University Hospital of Besançon, Neuroradiology Department, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - Fakhreddine Boustia
- University Hospital of Tours, Neuroradiology Department, 2, boulevard Tonnellé, 37000 Tours, France
| | - Ana Paula Narata
- University Hospital of Tours, Neuroradiology Department, 2, boulevard Tonnellé, 37000 Tours, France
| | - Basile Kerleroux
- University Hospital of Tours, Neuroradiology Department, 2, boulevard Tonnellé, 37000 Tours, France
| | - Richard Bibi
- University Hospital of Tours, Neuroradiology Department, 2, boulevard Tonnellé, 37000 Tours, France
| | - Chrysanthi Papagiannaki
- University Hospital of Rouen, Neuroradiology Department, 37, boulevard Gambetta, 76000 Rouen, France
| | - Aymeric Rouchaud
- University Hospital of Limoges, Neuroradiology Department, 2, avenue Martin Luther King, 87000 Limoges, France
| | - Laurent Pierot
- University Hospital of Reims, Neuroradiology Department, 45, rue Cognacq-Jay, 51100 Reims, France
| |
Collapse
|
15
|
Iosif C. Neurovascular devices for the treatment of intracranial aneurysms: emerging and future technologies. Expert Rev Med Devices 2020; 17:173-188. [PMID: 32141395 DOI: 10.1080/17434440.2020.1733409] [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: 10/24/2022]
Abstract
Introduction: Despite numerous advances in the endovascular treatment of intracranial aneurysms (IAs), treatment in cases of wide-neck, complex configurations or branching locations remains challenging. Apart from the paradigm shift introduced by flow diverters, several other devices have seen the light or are under development in order to address these challenges.Areas covered: We performed a review of the novel implantable endovascular devices which have been introduced for the treatment of IAs, from 1 January 2014 to 1 September 2019, excluding classic flow diverter and intracranial stent designs.Expert opinion: Alternative designs have been proposed for the treatment of IAs at branching positions, which do not jail the side branches, with or without flow diversion effect, most of which with good initial outcomes. Endosaccular devices have also been proposed, some of which with lower initial total occlusion rates. Alternative materials such as biopolymers have also been proposed and are under bench research. Despite the challenges in the exploitation of some of the new devices, most of them seem to provide solutions to some current technical shortcomings. The exploitation of the biological phenomena and the physical properties of the devices will allow us to expand the therapeutic armamentarium for more complex IA cases.
Collapse
Affiliation(s)
- Christina Iosif
- School of Medicine, European University of Cyprus, Nicosia, Cyprus.,Department of Interventional Neuroradiology, Henry Dunant Hospital, Athens, Greece.,Department of Interventional Neuroradiology, Iaso Hospital, Athens, Greece
| |
Collapse
|
16
|
Nevzati E, Rey J, Coluccia D, Grüter BE, Wanderer S, vonGunten M, Remonda L, Frosen J, Widmer HR, Fandino J, Marbacher S. Aneurysm wall cellularity affects healing after coil embolization: assessment in a rat saccular aneurysm model. J Neurointerv Surg 2019; 12:621-625. [DOI: 10.1136/neurintsurg-2019-015335] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeDespite significant technical advances, recanalization rates after endovascular therapy of ruptured intracranial aneurysms (IAs) remain a clinical challenge. A histopathological hallmark of ruptured human IA walls is mural cell loss. Mural smooth muscle cells (SMCs) are known to promote intraluminal healing in thrombosed experimental aneurysms. In this rat model we assess the natural history and healing process after coil embolization in SMC-rich and decellularized aneurysms.MethodsSaccular aneurysms were created by end-to-side anastomosis of an arterial graft from the descending thoracic aorta of a syngeneic donor rat to the infrarenal abdominal aorta of recipient male Wistar rats. Untreated arterial grafts were immediately transplanted, whereas aneurysms with loss of mural cells were chemically decellularized before implantation. Aneurysms underwent coil implantation during aneurysm anastomosis. Animals were randomly assigned either to the non-decellularized or decellularized group and underwent macroscopic and histological analyses on days 3, 7, 21, or 90 post-coil implantation.ResultsA total of 55 rats underwent macroscopic and histologic analysis. After coil embolization, aneurysms with SMC-rich walls showed a linear course of thrombosis and neointima formation whereas decellularized aneurysms showed marked inflammatory wall degeneration with increased recanalization rates 21 days (p=0.002) and 90 days (p=0.037) later. The SMCs showed the ability to actively migrate into the intra-aneurysmal thrombus and participate in thrombus organization.ConclusionsCoil embolization of aneurysms with highly degenerated walls is prone to further wall degeneration, increased inflammation, and recanalization compared with aneurysms with vital SMC-rich walls.
Collapse
|
17
|
Cagnazzo F, Ahmed R, Zannoni R, Dargazanli C, Lefevre PH, Gascou G, Derraz I, Riquelme C, Bonafe A, Costalat V. Predicting Factors of Angiographic Aneurysm Occlusion after Treatment with the Woven EndoBridge Device: A Single-Center Experience with Midterm Follow-Up. AJNR Am J Neuroradiol 2019; 40:1773-1778. [PMID: 31537514 DOI: 10.3174/ajnr.a6221] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/05/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the Woven EndoBridge is increasingly used for the treatment of intracranial aneurysms. We examined factors leading to aneurysm occlusion and Woven EndoBridge shape change during a midterm follow-up. MATERIALS AND METHODS Patients with a minimum 12-month angiographic follow-up were included. Through a univariate and multivariate analysis, independent predictors of adequate occlusion (Raymond-Roy 1/Raymond-Roy 2) and Woven EndoBridge shape change (decrease of the height of the device) were assessed. RESULTS Eighty-six patients/aneurysms were included. The aneurysm mean size was 5.5 mm (range, 3-11.5 mm). The most common locations were the MCA (43/86 = 50%), basilar tip (13/86 = 15.1%), and anterior communicating artery (12/86 = 14%). Twenty-one patients (21/86 = 24%) had acute SAH. Immediate and long-term Raymond-Roy 1/Raymond-Roy 2 occlusion rates were 49% (42/86) and 80% (68/86), respectively. Woven EndoBridge shape change was detected among 22% (19/86) of cases. At binary logistic regression, wide ostium (≥4 mm) (OR = 0.2; 95% CI, 0.01-1; P = .04) and regular aneurysm morphology (OR = 5.9; 95% CI, 1.4-24; P = .01) were independent factors of incomplete and adequate aneurysm occlusion, respectively. In addition, irregular morphology (OR = 5.4; 95%CI, 1.4-19; P = .01) and a wide ostium (OR = 9.8; 95% CI, 1.6-60; P = .03) significantly increased the probability of the Woven EndoBridge shape change. Decrease of the Woven EndoBridge height was more common among incompletely occluded aneurysms (6/12 = 50% versus 13/74 = 17.5%), but it was not an independent prognosticator of occlusion at the multivariate model. CONCLUSIONS The likelihood of good occlusion was 5 times lower in the presence of a wide ostium, whereas aneurysms with regular morphology were 6 times more likely to be occluded. Woven EndoBridge shape modification was strongly influenced by the aneurysm shape and ostium size, and it was not independently associated with the angiographic occlusion.
Collapse
Affiliation(s)
- F Cagnazzo
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
| | - R Ahmed
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - R Zannoni
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - P-H Lefevre
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - G Gascou
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - I Derraz
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - C Riquelme
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - A Bonafe
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| |
Collapse
|
18
|
Mesenchymal Stem Cells Exhibit Both a Proinflammatory and Anti-Inflammatory Effect on Saccular Aneurysm Formation in a Rabbit Model. Stem Cells Int 2019; 2019:3618217. [PMID: 31428158 PMCID: PMC6679866 DOI: 10.1155/2019/3618217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/14/2019] [Accepted: 06/11/2019] [Indexed: 12/29/2022] Open
Abstract
Several studies have demonstrated a potential interaction between mesenchymal stem cells (MSCs) and saccular aneurysms. In this study, we sought to determine whether allogenic bone marrow-derived MSCs had the ability to prevent aneurysm formation in a known rabbit elastase aneurysm model. MSCs were injected intravenously in experimental rabbits at the time of surgical creation and two weeks postcreation and compared with control rabbits receiving vehicle injection. Angiography was used to compare aneurysm measurements four weeks postcreation, and aneurysms were harvested for histological properties. Serum was collected longitudinally to evaluate cytokine alterations. Serum from control animals was also utilized to perform in vitro tests with MSCs to compare the effect of the serologic environment in animals with and without aneurysms on MSC proliferation and cytokine production. While aneurysm morphometric comparisons revealed no differences, significant cytokine alterations were observed in vitro and in vivo, suggesting both anti-inflammatory and proinflammatory processes were occurring in the presence of MSCs. Histological analyses suggested that tunica intima hyperplasia was inhibited in the presence of MSCs.
Collapse
|