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Kim JH, Jang EH, Ryu JY, Lee J, Kim JH, Ryu W, Youn YN. Sirolimus-Embedded Silk Microneedle Wrap to Prevent Neointimal Hyperplasia in Vein Graft Model. Int J Mol Sci 2023; 24:ijms24043306. [PMID: 36834717 PMCID: PMC9967879 DOI: 10.3390/ijms24043306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
We investigated the role of a sirolimus-embedded silk microneedle (MN) wrap as an external vascular device for drug delivery efficacy, inhibition of neointimal hyperplasia, and vascular remodeling. Using dogs, a vein graft model was developed to interpose the carotid or femoral artery with the jugular or femoral vein. The control group contained four dogs with only interposed grafts; the intervention group contained four dogs with vein grafts in which sirolimus-embedded silk-MN wraps were applied. After 12-weeks post-implantation, 15 vein grafts in each group were explanted and analyzed. Vein grafts applied with the rhodamine B-embedded silk-MN wrap showed far higher fluorescent signals than those without the wrap. The diameter of vein grafts in the intervention group decreased or remained stable without dilatation; however, it increased in the control group. The intervention group had femoral vein grafts with a significantly lower mean neointima-to-media ratio, and had vein grafts with an intima layer showing a significantly lower collagen density ratio than the control group. In conclusion, sirolimus-embedded silk-MN wrap in a vein graft model successfully delivered the drug to the intimal layer of the vein grafts. It prevented vein graft dilatation, avoiding shear stress and decreasing wall tension, and it inhibited neointimal hyperplasia.
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Affiliation(s)
- Jung-Hwan Kim
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Eui Hwa Jang
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ji-Yeon Ryu
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jiyong Lee
- School of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Jae Ho Kim
- School of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Wonhyoung Ryu
- School of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Correspondence: ; Tel.: +82-2-2228-8487
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Goldstein DJ. Device Profile of the VEST for External Support of SVG Coronary Artery Bypass Grafting: Historical Development, Current Status and Future Directions. Expert Rev Med Devices 2021; 18:921-931. [PMID: 34311644 DOI: 10.1080/17434440.2021.1960504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A search for strategies to address saphenous vein graft (SVG) failure - the main factor limiting the long-term success of coronary bypass grafting - has led to trialing of external stenting technologies. AREAS COVERED The manuscript covers historical development and current status of external scaffolding for the treatment of SVG intimal hyperplasia. Comprehensive literature review and personal communication with VGS leadership, the developer of the VEST device, served as the sources. EXPERT OPINION If the external scaffolding concept proves to be successful in mitigating the intimal hyperplasia inherent to arterialized saphenous vein conduits, it could have a dramatic impact on the recurrence of anginal symptoms, the need for repeat revascularization, and the incidence of myocardial infarction following CABG surgery. These laudable sequelae could ultimately convey significant public health repercussions by reducing healthcare resource use and improving the long-term survival and quality of life of CABG recipients.
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Affiliation(s)
- Daniel J Goldstein
- Montefiore Medical Center - Cardiothoracic Surgery, Bainbridge Ave MAP Building, 5th Fl Bronx, New York, USA
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3
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de Vries MR, Quax PHA. Inflammation in Vein Graft Disease. Front Cardiovasc Med 2018; 5:3. [PMID: 29417051 PMCID: PMC5787541 DOI: 10.3389/fcvm.2018.00003] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/08/2018] [Indexed: 12/23/2022] Open
Abstract
Bypass surgery is one of the most frequently used strategies to revascularize tissues downstream occlusive atherosclerotic lesions. For venous bypass surgery the great saphenous vein is the most commonly used vessel. Unfortunately, graft efficacy is low due to the development of vascular inflammation, intimal hyperplasia and accelerated atherosclerosis. Moreover, failure of grafts leads to significant adverse outcomes and even mortality. The last couple of decades not much has changed in the treatment of vein graft disease (VGD). However, insight is the cellular and molecular mechanisms of VGD has increased. In this review, we discuss the latest insights on VGD and the role of inflammation in this. We discuss vein graft pathophysiology including hemodynamic changes, the role of vessel wall constitutions and vascular remodeling. We show that profound systemic and local inflammatory responses, including inflammation of the perivascular fat, involve both the innate and adaptive immune system.
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Affiliation(s)
- Margreet R de Vries
- Department of Surgery, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Paul H A Quax
- Department of Surgery, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
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4
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Klesius A, Konerding MA, Knez P, Dzemali O, Schmitz-Rixen T, Ackermann H, Moritz A, Kleine P. External Stenting with a New Polyester Mesh Reduces Neointimal Hyperplasia of Vein Grafts in a Sheep Model. Int J Artif Organs 2018; 30:930-8. [DOI: 10.1177/039139880703001011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective External stents placed around vein grafts have demonstrated effectiveness in reducing neointimal hyperplasia by preventing distension of the thin-walled vein grafts when exposed to arterial pressure. However, the ideal stent material has yet to be defined. The following study investigates the short- and long-term effects of an innovative polyester mesh stent designed with optimized adaptation of circumferential compliance. Methods Following in vitro definition of the ideal macro-porous polyester stent material, a total of 12 sheep underwent implantation of bilateral carotid artery vein graft bypasses. In six sheep, the short-term outcome (four weeks of implantation) was investigated by comparing the newly-designed stent to native veins, micro-porous PTFE stent grafts and metallic Biocompound® stents (BCGs). Flow volume and graft diameter were measured prior to explantation. Grafts were evaluated histologically with respect to morphometry and immunoassaying. In the long-term group (6-month implantation time), the polyester stent was compared to native veins. Results All stents effectively prevented dilatation of the graft. Perfused vessel diameters of the polyester veins were 8.3±0.6 mm. BCG as well as PTFE veins showed diameter reduction to 7.4±0.7mm (p<0.05) and 7.8±0.4 mm (p<0.05), respectively. Both in the short and long terms, the new polyester stent led to significantly higher reduction of neointimal hyperplasia and luminal encroachment compared to the native vessel. It proved superior to PTFE stenting, while the Biocompound® material failed to prove efficacy. Conclusions It was demonstrated that the new macro-porous polyester mesh stent reduced neointimal hyperplasia more effectively than other commercially available stents.
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Affiliation(s)
- A.A. Klesius
- Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Frankfurt - Germany
| | - M. A. Konerding
- Department of Anatomy, Johannes Gutenberg-University, Mainz - Germany
| | - P. Knez
- Department of Vascular Surgery, J.W. Goethe University, Frankfurt - Germany
| | - O. Dzemali
- Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Frankfurt - Germany
| | - T. Schmitz-Rixen
- Department of Vascular Surgery, J.W. Goethe University, Frankfurt - Germany
| | - H. Ackermann
- Department of Biomedical Statistics, J.W. Goethe University, Frankfurt - Germany
| | - A. Moritz
- Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Frankfurt - Germany
| | - P. Kleine
- Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Frankfurt - Germany
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5
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Mawhinney JA, Mounsey CA, Taggart DP. The potential role of external venous supports in coronary artery bypass graft surgery†. Eur J Cardiothorac Surg 2017; 53:1127-1134. [DOI: 10.1093/ejcts/ezx432] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - David P Taggart
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
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6
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Animal models of atherosclerosis. Eur J Pharmacol 2017; 816:3-13. [DOI: 10.1016/j.ejphar.2017.05.010] [Citation(s) in RCA: 296] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 04/07/2017] [Accepted: 05/04/2017] [Indexed: 12/31/2022]
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Kupreishvili K, Meischl C, Vonk ABA, Stooker W, Eijsman L, Blom AM, Quax PHA, van Hinsbergh VWM, Niessen HWM, Krijnen PAJ. Arterial Blood Pressure Induces Transient C4b-Binding Protein in Human Saphenous Vein Grafts. Ann Vasc Surg 2017; 41:259-264. [PMID: 28163174 DOI: 10.1016/j.avsg.2016.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/12/2016] [Accepted: 10/31/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Complement is an important mediator in arterial blood pressure-induced vein graft failure. Previously, we noted activation of cell protective mechanisms in human saphenous veins too. Here we have analyzed whether C4b-binding protein (C4bp), an endogenous complement inhibitor, is present in the vein wall. METHODS Human saphenous vein segments obtained from patients undergoing coronary artery bypass grafting (n = 55) were perfused in vitro at arterial blood pressure with either autologous blood for 1, 2, 4, or 6 hr or with autologous blood supplemented with reactive oxygen species scavenger N-acetylcysteine. The segments were subsequently analyzed quantitatively for presence of C4bp and complement activation product C3d using immunohistochemistry. RESULTS Perfusion induced deposition of C3d and C4bp within the media of the vessel wall, which increased reproducibly and significantly over a period of 4 hr up to 3.8% for C3d and 81% for C4bp of the total vessel area. Remarkably after 6 hr of perfusion, the C3d-positive area decreased significantly to 1.3% and the C4bp-positive area to 19% of the total area of the vein. The areas positive for both C4bp and C3d were increased in the presence of N-acetylcysteine. CONCLUSIONS Exposure to arterial blood pressure leads to a transient presence of C4bp in the vein wall. This may be part of a cell-protective mechanism to counteract arterial blood pressure-induced cellular stress and inflammation in grafted veins.
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Affiliation(s)
- Koba Kupreishvili
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Christof Meischl
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexander B A Vonk
- Department of Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Wim Stooker
- Department of Cardiac Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Leon Eijsman
- Department of Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiac Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Anna M Blom
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Paul H A Quax
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Victor W M van Hinsbergh
- Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans W M Niessen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
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de Vries MR, Simons KH, Jukema JW, Braun J, Quax PHA. Vein graft failure: from pathophysiology to clinical outcomes. Nat Rev Cardiol 2016; 13:451-70. [PMID: 27194091 DOI: 10.1038/nrcardio.2016.76] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Occlusive arterial disease is a leading cause of morbidity and mortality worldwide. Aside from balloon angioplasty, bypass graft surgery is the most commonly performed revascularization technique for occlusive arterial disease. Coronary artery bypass graft surgery is performed in patients with left main coronary artery disease and three-vessel coronary disease, whereas peripheral artery bypass graft surgery is used to treat patients with late-stage peripheral artery occlusive disease. The great saphenous veins are commonly used conduits for surgical revascularization; however, they are associated with a high failure rate. Therefore, preservation of vein graft patency is essential for long-term surgical success. With the exception of 'no-touch' techniques and lipid-lowering and antiplatelet (aspirin) therapy, no intervention has hitherto unequivocally proven to be clinically effective in preventing vein graft failure. In this Review, we describe both preclinical and clinical studies evaluating the pathophysiology underlying vein graft failure, and the latest therapeutic options to improve patency for both coronary and peripheral grafts.
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Affiliation(s)
- Margreet R de Vries
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Karin H Simons
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - J Wouter Jukema
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Paul H A Quax
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
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9
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Abstract
Saphenous vein remains a widely used conduit in coronary surgery. However, the long-term success of surgical myocardial revascularization is largely limited by the development of neointimal hyperplasia and superimposed atherosclerosis in vein grafts. Although strategies for preventing vein graft failure have been constantly explored, few therapeutic interventions to date have shown sustained benefits in the clinical setting. The application of external support has emerged as a promising strategy for modulating the overall biomechanical responses in venous wall. Nonetheless, clinical translation of this intervention has been formerly challenged, primarily due to several technique limitations. The purpose of the current review is to summarize the possible mechanisms involved in the external support strategy for preventing vein graft failure. Furthermore, several previously tested biomaterials and delivery techniques are also highlighted.
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Affiliation(s)
- Jia Hu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China
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10
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Ewing MM, de Vries MR, Nordzell M, Pettersson K, de Boer HC, van Zonneveld AJ, Frostegård J, Jukema JW, Quax PHA. Annexin A5 therapy attenuates vascular inflammation and remodeling and improves endothelial function in mice. Arterioscler Thromb Vasc Biol 2010; 31:95-101. [PMID: 20947818 DOI: 10.1161/atvbaha.110.216747] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Annexin A5 (AnxA5) has antithrombotic, antiapoptotic, and antiinflammatory properties; we investigated its effectiveness against vascular inflammation, remodeling, and dysfunction in accelerated atherosclerosis. METHODS AND RESULTS AnxA5 (1 mg/kg per day or vehicle) was investigated in vascular injury models in hypercholesterolemic apolipoprotein E (ApoE)3*Leiden mice. AnxA5 treatment reduced adhesion and infiltration of leukocytes by 71% to 69% (P=0.015, P=0.031) and macrophages by 51% to 87% (P=0.014, P=0.018), as well as monocyte chemotactic protein-1 and tumor necrosis factor-α expression in a femoral artery inflammation model (perivascular cuff for 3 days), indicating reduced vascular inflammation. In a vein graft model, 28 days of AnxA5 treatment reduced vein graft thickening (48%; P=0.006) and leukocyte infiltration (46%; P=0.003). In these mice, reduced plasma concentrations of IFN-γ (-72%; P=0.040), granulocyte colony-stimulating factor (-41%; P=0.010), and macrophage inflammatory protein-1β (MIP-1β) (-66%; P=0.020) were measured, indicating reduced systemic inflammation. An in vitro endothelial cell model shows the importance of AnxA5's anticoagulant properties in reducing vascular inflammation. Endothelium-mediated dilatation in hypercholesterolemic ApoE((-/-)) mice was improved by 3 days of AnxA5 treatment, shown by improved systolic and diastolic blood pressure reductions in response to metacholine, which could be abolished by l-Nitro-Arginine-Methyl Ester (l-NAME), indicating nitric oxide involvement. CONCLUSIONS AnxA5 reduced local vascular and systemic inflammation and vascular remodeling and improved vascular function, indicating that it has a therapeutic potential against atherosclerotic cardiovascular diseases.
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Affiliation(s)
- Mark M Ewing
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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11
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Desai M, Mirzay-Razzaz J, von Delft D, Sarkar S, Hamilton G, Seifalian AM. Inhibition of neointimal formation and hyperplasia in vein grafts by external stent/sheath. Vasc Med 2010; 15:287-97. [DOI: 10.1177/1358863x10366479] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Synthetic and to a lesser extent vein graft failure is still a major problem in the treatment of peripheral arterial disease, with neointimal hyperplasia being the main cause for graft occlusion in the medium and long term. This review aims to establish the current status of external stents or sheaths in the prevention of intimal hyperplasia in small diameter (< 6 mm) vein grafts.
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Affiliation(s)
- Mital Desai
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK, Cardiovascular Haemodynamic Group, University College London, London, UK
| | - Jalaledin Mirzay-Razzaz
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK, Cardiovascular Haemodynamic Group, University College London, London, UK
| | - Dirk von Delft
- Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Sandip Sarkar
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK
| | - George Hamilton
- Vascular Unit, Royal Free Hampstead NHS Trust Hospital, London, UK
| | - Alexander M Seifalian
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK, Cardiovascular Haemodynamic Group, University College London, London, UK,
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12
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Ding SF, Ni M, Liu XL, Qi LH, Zhang M, Liu CX, Wang Y, Lv HX, Zhang Y. A causal relationship between shear stress and atherosclerotic lesions in apolipoprotein E knockout mice assessed by ultrasound biomicroscopy. Am J Physiol Heart Circ Physiol 2010; 298:H2121-9. [PMID: 20382850 DOI: 10.1152/ajpheart.00308.2009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study was undertaken to examine the hemodynamic state using the latest ultrasound biomicroscopy (UBM) technique and to investigate the effect of local shear stress on the development of atherosclerosis in the constrictive collar-treated carotid arteries of apolipoprotein E-deficient (apoE(-/-)) mice. Fifty-six male apoE(-/-) mice fed a high-lipid diet were divided into an interventional group (n = 48) and the control group (n = 8). Constrictive and nonconstrictive collars were placed around the carotid artery of the mice in the interventional group and the control group, respectively. The carotid lumen diameters and flow velocities were measured by UBM, and shear stress in the lesion region was calculated. Histopathology and electron microscopy were performed to observe the morphological changes in the carotid artery. In the region proximal to the constrictive collar, shear stress was significantly reduced 2 days after collar placement and remained low over time compared with the baseline level. In contrast, within the constrictive collar region, shear stress was increased significantly. Although endothelial permeability was enhanced in both regions, monocyte chemotaxis protein-1 (MCP-1) expression, macrophage infiltration, and atherosclerotic lesions were more prominent in the region proximal to the constrictive collar. Moreover, increased MCP-1 expression was observed as early as 2 days after constrictive collar placement, which preceded the morphological changes of the vessel wall. In conclusion, UBM offers a noninvasive and reliable technique for measuring shear stress in apoE(-/-) mice. Persistent low shear stress promotes endothelial permeability and enhances MCP-1 expression and macrophage recruitment, which were essential in the pathogenesis of atherosclerosis in apoE(-/-) mice.
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Affiliation(s)
- Shi Fang Ding
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital, Shandong University, Jinan, Shandong, China
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13
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Eefting D, de Vries MR, Grimbergen JM, Karper JC, van Bockel JH, Quax PH. In vivo suppression of vein graft disease by nonviral, electroporation-mediated, gene transfer of tissue inhibitor of metalloproteinase-1 linked to the amino terminal fragment of urokinase (TIMP-1.ATF), a cell-surface directed matrix metalloproteinase inhibitor. J Vasc Surg 2010; 51:429-37. [DOI: 10.1016/j.jvs.2009.09.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 09/10/2009] [Accepted: 09/12/2009] [Indexed: 11/16/2022]
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14
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Eefting D, Bot I, de Vries MR, Schepers A, van Bockel JH, Van Berkel TJC, Biessen EAL, Quax PHA. Local lentiviral short hairpin RNA silencing of CCR2 inhibits vein graft thickening in hypercholesterolemic apolipoprotein E3-Leiden mice. J Vasc Surg 2009; 50:152-60. [PMID: 19563963 DOI: 10.1016/j.jvs.2009.03.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 03/09/2009] [Accepted: 03/14/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Inflammatory responses to vascular injury are key events in vein graft disease and accelerated atherosclerosis, which may result in bypass failure. The monocyte chemoattractant protein-1 (MCP-1)/CC-chemokine receptor (CCR)-2 pathway is hypothesized to play a central role. A murine model for vein graft disease was used to study the effect of local application of lentiviral short hairpin RNA (shRNA) targeted against CCR2. METHODS A venous interposition was placed into the carotid artery of hypercholesterolemic apolipoprotein E3-Leiden (APOE*3-Leiden) mice to induce vein graft thickening with features of accelerated atherosclerosis. To demonstrate the efficacy of the lentiviral shRNA targeting murine CCR2 (shCCR2) in blocking vein graft disease in vivo, lentiviral shCCR2 or a control lentivirus was used to infect the vein graft locally (n = 8). RESULTS Vascular CCR2 and MCP-1 messenger RNA expression levels were significantly upregulated during lesion progression in the vein graft. Infection of smooth muscle cells (SMCs) with a lentiviral shRNA targeting shCCR2 completely abolished MCP-1-induced SMC migration and inhibited SMC proliferation in vitro (n = 3 per group). Morphometric analysis of sections of grafts showed a significant 38% reduction in vein graft thickening in the shCCR2-treated mice 4 weeks after surgery (control, 0.42 +/- 0.05 mm(2); shCCR2, 0.26 +/- 0.03 mm(2); P = .007). CONCLUSION Vascular CCR2 contributes to vein graft disease, and local application of shRNA against CCR2 to the vessel wall prevents vein graft thickening in hypercholesterolemic mice, suggesting that local overexpressing of shRNA using organ-targeted lentiviral gene delivery may be a promising therapeutic tool to improve vein graft disease in bypassed patients. CLINICAL RELEVANCE Vein graft disease is an important clinical issue that results from an inflammatory response. The monocyte chemoattractant protein (MCP)-1/CC-chemokine receptor (CCR)-2 pathway plays a key role in the initiation and development of vein graft disease. This study demonstrates that perivascular overexpression of short hairpin RNA, targeted against CCR2, inhibits vein graft thickening. These data show that organ-targeted gene therapy against CCR2 in the vessel wall could be a promising therapeutic tool to improve vein graft patency in bypassed patients.
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Affiliation(s)
- Daniël Eefting
- Gaubius Laboratory, TNO Quality of Life, Leiden, The Netherlands
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15
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John LCH. Biomechanics of coronary artery and bypass graft disease: potential new approaches. Ann Thorac Surg 2009; 87:331-8. [PMID: 19101335 DOI: 10.1016/j.athoracsur.2008.07.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 07/08/2008] [Accepted: 07/09/2008] [Indexed: 12/01/2022]
Abstract
The contribution of biomechanical factors to the incidence and distribution of coronary artery and bypass graft disease is underrecognized. This review examined the literature to determine which factors were relevant and the evidence for their importance. It identified two primary biomechanical factors that predispose to disease: (1) low-wall shear stress and (2) high-wall mechanical stress or strain. A range of secondary biomechanical factors have also been identified and include: vessel geometry; vessel movement; vessel wall characteristics and the presence of reflection waves. Potential surgical approaches for minimizing these effects are discussed.
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Affiliation(s)
- Lindsay C H John
- Department of Cardiothoracic Surgery, Kings College Hospital, London, United Kingdom.
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16
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Fat-covered vein graft. Tech Hand Up Extrem Surg 2008; 12:56-8. [PMID: 18388756 DOI: 10.1097/bth.0b013e318153451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vein graft is widely used in peripheral vascular surgery. Many free flaps and replantation failures are the result of technical problems in performing the anastomoses. A remarkable number of these technical errors are caused by tension or improper placement of the surgical union. Use of a vein graft may prevent tensioning and give us a more accessible repair site. However, the use of a graft not only doubles the repair side, but may also increase the risk of circulatory disturbance. Many technical, mechanical, and histological factors were cited as factors in the formation of thrombus. The use of a vein graft with a fatty tissue cover may prevent many of the potential risk factors.
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Cheng J, Du J. Mechanical Stretch Simulates Proliferation of Venous Smooth Muscle Cells Through Activation of the Insulin-Like Growth Factor-1 Receptor. Arterioscler Thromb Vasc Biol 2007; 27:1744-51. [PMID: 17541019 DOI: 10.1161/atvbaha.107.147371] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Activation and proliferation of vascular smooth muscle cells (VSMCs) occur in the venous neointima of vein grafts. VSMCs in a grafted vein are subjected to mechanical stretch; our goal is to understand the essential mechanical stretch-regulated signals that influence VSMCs during neointimal formation in vein grafts. METHODS AND RESULTS In cultured vein VSMCs, mechanical stretch induces proliferation and upregulation of both IGF-1 and IGF-1R. Stretch of VSMCs sustained tyrosine phosphorylation of both IGF-1R and its substrate, IRS-1; these responses were related to mechanical stretch-induced activation of Src and autocrine IGF-1 production. Mechanical stretch-activated IGF-1R is functional because there is a prolonged activation of IRS-1-associated phosphatidylinositol-3 kinase (PI3K). When we knocked out IGF-1R, the mechanical stretch-induced increase in VSMC proliferation was blocked. To link mechanical stretch-activated IGF-1R cell signaling to venous VSMC proliferation in vivo, we also studied a vein graft model. Tamoxifen-inducible null deletion of IGF-1R in mice reduced the formation of neointima in the vein graft. CONCLUSIONS Our results demonstrate for the first time that mechanical stretch activates IGF-1/IGF-1R signals in venous VSMCs, and we have uncovered a signaling pathway that leads to neointima formation in vivo.
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Affiliation(s)
- Jizhong Cheng
- Baylor College of Medicine, Division of Nephrology, Houston, TX 77030, USA
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18
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Haraguchi T, Okada K, Tabata Y, Maniwa Y, Hayashi Y, Okita Y. Controlled Release of Basic Fibroblast Growth Factor From Gelatin Hydrogel Sheet Improves Structural and Physiological Properties of Vein Graft in Rat. Arterioscler Thromb Vasc Biol 2007; 27:548-55. [PMID: 17170380 DOI: 10.1161/01.atv.0000254811.11741.2b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives—
Autologous vein grafts are still widely used, but their long-term patency is suboptimal. The objective of the current study was to determine whether wrapping a vein graft in gelatin hydrogel sheet incorporating basic fibroblast growth factor improves their mechanical and physiological properties.
Methods and Results—
Autologous femoral vein was interposed into the abdominal aorta in rats. The rats were divided into 3 groups: nontreated grafts (group A), grafts wrapped in basic fibroblast growth factor-free gelatin hydrogel sheet (group B), and grafts wrapped in basic fibroblast growth factor-impregnated gelatin hydrogel sheet (group C). On day 1, endothelial desquamation was observed in group A, and the media in groups A and B were disrupted, staining positive in the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay. In contrast, the media in group C remained intact and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling–negative, associated with activation of MAPK. Graft dilation was significantly inhibited in groups B and C compared with group A, with those in group C showing the smallest degree of neointimal proliferation. At 8 weeks grafts in group C developed neointima with homogeneous elastic laminae, presence of rigid neoadventitia that displayed neovascularity, and the highest blood flow velocity.
Conclusions—
Wrapping vein grafts in basic fibroblast growth factor- impregnated gelatin hydrogel sheet improved their structural and physiological properties, and might therefore also improve long-term patency.
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MESH Headings
- Anastomosis, Surgical
- Animals
- Aorta, Abdominal/surgery
- Blood Flow Velocity
- Blotting, Western
- Delayed-Action Preparations
- Disease Models, Animal
- Endothelium, Vascular/pathology
- Femoral Vein/pathology
- Femoral Vein/transplantation
- Fibroblast Growth Factor 2/administration & dosage
- Fibroblast Growth Factor 2/metabolism
- Gelatin
- Graft Occlusion, Vascular/prevention & control
- Graft Rejection
- Graft Survival
- Hydrogels
- Immunohistochemistry
- In Situ Nick-End Labeling
- Neovascularization, Physiologic/drug effects
- Neovascularization, Physiologic/physiology
- Probability
- Rats
- Rats, Sprague-Dawley
- Reference Values
- Sensitivity and Specificity
- Transplantation, Autologous
- Vascular Patency
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Affiliation(s)
- Tomonori Haraguchi
- Division of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe University Graduate School of Medicine, Kobe 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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19
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Wales L, Gosling M, Taylor GW, Davies AH, Powell JT. The potassium channel opener levcromakalim causes expansive remodelling of experimental vein grafts. J Vasc Surg 2006; 44:159-65. [PMID: 16828441 DOI: 10.1016/j.jvs.2006.02.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 02/26/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Maintenance of luminal area is essential for the optimal performance of venous bypass grafts. However, injury and response to the arterial circulation evoke vascular remodelling that favors intimal hyperplasia, with luminal encroachment and inward remodelling. Potassium channel-opening drugs reduce tissue workload and peripheral vascular resistance and through these mechanisms could favor outward or expansive remodelling of vein grafts. We tested the hypothesis that levcromakalim, a potassium channel opener, would enhance expansive remodelling in vein grafts. METHODS A randomized, double-blind, placebo-controlled trial was conducted in 33 rats with vena cava-to-aorta bypass grafts. Drugs were administered via osmotic pump for 7 days after surgery. Half the cohort had bromodeoxyuridine (BrdU) infused at day 6. Morphometric analysis was conducted of pressure perfusion-fixed grafts harvested at 1 week and 4 weeks. RESULTS At 1 week, lumen area was similar in both groups (1.82 +/- 0.39 mm(2) placebo vs 1.85 +/- 0.36 mm(2) levcromakalim), although medial cell density and BrdU staining were significantly increased in the placebo group. At 4 weeks, lumen area was unchanged in the placebo group (1.88 +/- 0.51 mm(2)) but had increased to 2.32 +/- 0.46 mm(2) in the levcromakalim group (P = .039 vs 1 week), with a very significant reduction in the intimal area (levcromakalim, 0.06 +/- 0.02 mm(2) vs placebo, 0.33 +/- 0.17 mm(2); P = .001). CONCLUSIONS Early, short-term treatment with levcromakalim favors expansive remodelling of experimental vein grafts to mimic the effect of external stenting. This expansive remodelling was associated with a reduction in medial cell proliferation at 1 week. CLINICAL RELEVANCE Critical limb ischemia can be treated by bypass surgery or angioplasty, but inward remodelling with restenosis is a common problem. There has been little previous experimental work to identify treatments associated with expansive remodelling, which would increase the chances of vessel patency. Here, in a randomized trial, we show that short-term treatment with a potassium channel opener (a class of drug that can be used to treat hypertension) results in strong, expansive remodelling, with increases the lumen area and graft size of experimental vein grafts by >25%.
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Affiliation(s)
- Lucy Wales
- Department of Vascular Surgery, Charing Cross Hospital, Imperial College, London, UK
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20
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Schepers A, Pires NMM, Eefting D, de Vries MR, van Bockel JH, Quax PHA. Short-term dexamethasone treatment inhibits vein graft thickening in hypercholesterolemic ApoE3Leiden transgenic mice. J Vasc Surg 2006; 43:809-15. [PMID: 16616241 DOI: 10.1016/j.jvs.2005.11.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Accepted: 11/12/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether the anti-inflammatory agent dexamethasone can inhibit vein graft thickening without the occurrence of serious side effects. METHODS Venous interposition grafting was performed in the common carotid artery of hypercholesterolemic ApoE3Leiden transgenic mice. Mice were treated with dexamethasone (0.15 mg.kg(-1).d(-1) orally), and after 28 days, vein graft thickening was quantified. RESULTS Treatment with dexamethasone resulted in a significant 43% reduction in lesion area without changes in lesion composition when compared with nontreated controls. However, dexamethasone, when administered for a prolonged period of time, is known for its potentially serious side effects. To overcome these potential side effects of prolonged dexamethasone treatment, the effect of a short-term 7-day dexamethasone treatment was studied. This short dexamethasone treatment resulted in a 49% decrease of vein graft thickening at 28 days. Furthermore, it was demonstrated that dexamethasone treatment led to reduced local expression of several proinflammatory cytokines and factors in the vein grafts 24 hours after surgery. Finally, observations in mice were verified in human saphenous organ cultures. Exposure to dexamethasone for either 7 or 28 days significantly reduced intimal hyperplasia formation on cultured saphenous vein segments. CONCLUSIONS Short-term anti-inflammatory treatment with dexamethasone leads to a significant reduction in vein graft thickening over an extended period, possibly by the reduction of early expression of proinflammatory cytokines. This 7-day treatment minimizes the risk of unwanted side effects of long-term dexamethasone treatment and may be a new approach to prevent graft failure.
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Affiliation(s)
- Abbey Schepers
- Gaubius Laboratory, TNO Quality of Life, Leiden University Medical Center, The Netherlands
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21
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Abstract
Stem cell research has the potential to provide solutions to many chronic diseases via the field of regeneration therapy. In vascular biology, endothelial progenitor cells (EPCs) have been identified as contributing to angiogenesis and hence have therapeutic potential to revascularise ischaemic tissues. EPCs have also been shown to endothelialise vascular grafts and therefore may contribute to endothelial maintenance. EPC number has been shown to be reduced in patients with cardiovascular disease, leading to speculation that atherosclerosis may be caused by a consumptive loss of endothelial repair capacity. Animal experiments have shown that EPCs reendothelialise injured vessels and that this reduces neointimal formation, confirming that EPCs have an atheroprotective effect. Smooth muscle cell accumulation in the neointimal space is characteristic of many forms of atherosclerosis, however the source of these cells is now thought to be from smooth muscle progenitor cells (SMPCs) rather than the adjacent media. There is evidence for the presence of SMPCs in the adventitia of animals and that SMPCs circulate in human blood. There is also data to support SMPCs contributing to neointimal formation but their origin remains unknown. This article will review the roles of EPCs and SMPCs in the development of vascular disease by examining experimental data from in vitro studies, animal models of atherosclerosis and clinical studies.
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Affiliation(s)
- Neil Roberts
- Department of Cardiac Surgery, Cardiac and Vascular Sciences, St George's Hospital Medical School, London, UK
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22
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Abstract
A new murine model is presented for interpositional vein grafting into an artery. In ICR (outbred) mice, the femoral vein or a branch of the jugular vein was harvested and placed into a femoral artery defect, using standard microvascular techniques to achieve end-to-end anastomoses with 11-0 nylon suture. The technique requires a high level of microsurgical experience and competence. Success rates (vessel patency) were higher with moderate systemic heparinization (200 units/kg body weight, single i.v. bolus). Vein grafts were successfully transplanted between syngenic C57Bl/6J mice, with patency demonstrated from 1 day to 3 months postoperatively. The model is applicable to studies of vein graft stenosis using murine transgenic/knockout models.
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Affiliation(s)
- Brian C Cooley
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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23
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Xu Q. Mouse Models of Vein Grafts. Arterioscler Thromb Vasc Biol 2004; 24:e185; author reply e185-7. [PMID: 15528486 DOI: 10.1161/01.atv.0000142809.94325.af] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Xu Q. Mouse models of arteriosclerosis: from arterial injuries to vascular grafts. THE AMERICAN JOURNAL OF PATHOLOGY 2004; 165:1-10. [PMID: 15215157 PMCID: PMC2216680 DOI: 10.1016/s0002-9440(10)63270-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Animal models are designed to be preliminary tools for better understanding of the pathogenesis, improvement in diagnosis, prevention, and therapy of arteriosclerosis in humans. Attracted by the well-defined genetic systems, a number of investigators have begun to use the mouse as an experimental system for arteriosclerosis research. Hundreds of inbred lines have been established, and the genetic map is relatively well defined, and both congenic strains and recombinant strains are available to facilitate genetic experimentation. Because arteriosclerosis is a complicated disease, which includes spontaneous (native) atherosclerosis, transplant arteriosclerosis, vein graft atherosclerosis, and angioplasty-induced restenosis, several mouse models for studying all types of arteriosclerosis have recently been established. Using these mouse models, much knowledge concerning the pathogenesis of the disease and therapeutic intervention has been gained, eg, origins of endothelial and smooth muscle cells in lesions of transplant and vein graft atherosclerosis. This review will not attempt to cover all aspects of mouse models, rather focus on models of arterial injuries, vein grafts, and transplant arteriosclerosis, by which the major progress in understanding the mechanisms of the disease has been made. This article will also point out (dis)advantages of a variety of models, and how the models can be appropriately chosen for different purposes of study.
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Affiliation(s)
- Qingbo Xu
- Department of Cardiac and Vascular Sciences, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, United Kingdom.
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25
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Xu Q, Zhang Z, Davison F, Hu Y. Circulating progenitor cells regenerate endothelium of vein graft atherosclerosis, which is diminished in ApoE-deficient mice. Circ Res 2003; 93:e76-86. [PMID: 14512446 DOI: 10.1161/01.res.0000097864.24725.60] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Previously we showed that a large number of endothelial cells in vein grafts undergo apoptosis or necrosis during the first few days followed by endothelial regeneration. In the present study, we investigated endothelial cell death and regeneration in vein grafts using transgenic mice carrying LacZ genes driven by an endothelial TIE2 promoter. When a vein fragment from TIE2-LacZ was isografted into the carotid artery of wild-type mice, the number of beta-gal+ cells were reduced at 3 days and disappeared completely by 4 weeks after grafting. Conversely, beta-gal+ cells were observed on the surface of vein segments donated by wild-type mice isografted into TIE2-LacZ mice at 1 week and reached confluence by 4 weeks, suggesting recipient origins of endothelial cells. Interestingly, beta-gal+ cells were evenly distributed on the surface of the whole vein segment grafted into TIE2-LacZ mice, indicating a contribution of circulating progenitor cells. When wild-type veins were grafted into a chimeric mouse carrying TIE2-LacZ genes in bone marrow cells, a proportion of cells displayed a beta-gal+ staining. Furthermore, the number of CD34+ and Flk+ progenitor cells in blood of apoE-deficient mice were significantly lower than those of wild-type controls, which coincided with diminished beta-gal+ endothelial cells on the surface of vein grafts in TIE2-LacZ/apoE-/- mice. Thus, we provide the first evidence that endothelial cells of vein grafts are derived from circulating progenitor cells, of which one-third are derived from bone marrow progenitor cells. Hyperlipidemia due to apoE deficiency results in a lower number of endothelial progenitors in blood and correlated with enhanced atherosclerosis. The full text of this article is available online at http://www.circresaha.org.
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Affiliation(s)
- Qingbo Xu
- Department of Cardiological Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
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Affiliation(s)
- Anupam Agarwal
- Department of Medicine, Division of Nephrology, Hypertension and Transplantation, University of Florida College of Medicine, Gainesville, Florida, USA.
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