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Wang B, Gao C, Lim S, Wang R, Zhu CJ, Onuma Y, Wang Y, Gao R, Serruys PWJC, Lee RJ, Tao L. Percutaneous Alginate Hydrogel Endomyocardial Injection with a Novel Dedicated Catheter Delivery System: An Animal Feasibility Study. J Cardiovasc Transl Res 2024; 17:842-850. [PMID: 38376702 PMCID: PMC11371841 DOI: 10.1007/s12265-024-10497-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
The objective of this preclinical study was to evaluate the feasibility and safety of transcatheter endocardial alginate hydrogel injection (TEAi) in a large animal model, utilizing the high-stiffness XDROP® alginate hydrogel in combination with the dedicated EndoWings® catheter-based system. All swine (n = 9) successfully underwent TEAi without complications. Acute results from a subset of animals (n = 5) demonstrated the ability of the catheter to access a wide range of endomyocardial areas and achieve consecutive circumferential hydrogel distribution patterns within the mid-left ventricular wall. Histological examinations at 6 months (n = 4) demonstrated that the XDROP® remained localized within the cardiac tissue. In addition, serial echocardiographic imaging showed that XDROP® had no adverse impacts on LV systolic and diastolic functions. In conclusion, this innovative combination technology has the potential to overcome the translational barriers related to alginate hydrogel delivery to the myocardium.
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Affiliation(s)
- Bo Wang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Scott Lim
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cun-Jun Zhu
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yoshinobu Onuma
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Sichuan, China
| | - Runlin Gao
- Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Patrick W J C Serruys
- Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland.
| | - Randall J Lee
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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2
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Rakshit P, Giri TK, Mukherjee K. Progresses and perspectives on natural polysaccharide based hydrogels for repair of infarcted myocardium. Int J Biol Macromol 2024; 269:132213. [PMID: 38729464 DOI: 10.1016/j.ijbiomac.2024.132213] [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: 01/31/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Abstract
Myocardial infarction (MI) is serious health threat and impairs the quality of life. It is a major causative factor of morbidity and mortality. MI leads to the necrosis of cardio-myocytes, cardiac remodelling and dysfunction, eventually leading to heart failure. The limitations of conventional therapeutic and surgical interventions and lack of heart donors have necessitated the evolution of alternate treatment approaches for MI. Polysaccharide hydrogel based repair of infarcted myocardium have surfaced as viable option for MI treatment. Polysaccharide hydrogels may be injectable hydrogels or cardiac patches. Injectable hydrogels can in situ deliver cells and bio-actives, facilitating in situ cardiac regeneration and repair. Polysaccharide hydrogel cardiac patches reduce cardiac wall stress, and inhibit ventricular expansion and promote angiogenesis. Herein, we discuss about MI pathophysiology and myocardial microenvironment and how polysaccharide hydrogels are designed to mimic and support the microenvironment for cardiac repair. We also put forward the versatility of the different polysaccharide hydrogels in mimicking diverse cardiac properties, and acting as a medium for delivery of cells, and therapeutics for promoting angiogenesis and cardiac repair. The objectives of this review is to summarize the factors leading to MI and to put forward how polysaccharide based hydrogels promote cardiac repair. This review is written to enable researchers understand the factors promoting MI so that they can undertake and design novel hydrogels for cardiac regeneration.
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Affiliation(s)
- Pallabita Rakshit
- Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, West Bengal, India
| | - Tapan Kumar Giri
- Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, West Bengal, India
| | - Kaushik Mukherjee
- Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, West Bengal, India.
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3
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Motchon YD, Sack KL, Sirry MS, Nchejane NJ, Abdalrahman T, Nagawa J, Kruger M, Pauwels E, Van Loo D, De Muynck A, Van Hoorebeke L, Davies NH, Franz T. In silico Mechanics of Stem Cells Intramyocardially Transplanted with a Biomaterial Injectate for Treatment of Myocardial Infarction. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00734-1. [PMID: 38782879 DOI: 10.1007/s13239-024-00734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Biomaterial and stem cell delivery are promising approaches to treating myocardial infarction. However, the mechanical and biochemical mechanisms underlying the therapeutic benefits require further clarification. This study aimed to assess the deformation of stem cells injected with the biomaterial into the infarcted heart. METHODS A microstructural finite element model of a mid-wall infarcted myocardial region was developed from ex vivo microcomputed tomography data of a rat heart with left ventricular infarct and intramyocardial biomaterial injectate. Nine cells were numerically seeded in the injectate of the microstructural model. The microstructural and a previously developed biventricular finite element model of the same rat heart were used to quantify the deformation of the cells during a cardiac cycle for a biomaterial elastic modulus (Einj) ranging between 4.1 and 405,900 kPa. RESULTS The transplanted cells' deformation was largest for Einj = 7.4 kPa, matching that of the cells, and decreased for an increase and decrease in Einj. The cell deformation was more sensitive to Einj changes for softer (Einj ≤ 738 kPa) than stiffer biomaterials. CONCLUSIONS Combining the microstructural and biventricular finite element models enables quantifying micromechanics of transplanted cells in the heart. The approach offers a broader scope for in silico investigations of biomaterial and cell therapies for myocardial infarction and other cardiac pathologies.
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Affiliation(s)
- Y D Motchon
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa.
| | - K L Sack
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
- Cardiac Rhythm Management, Medtronic Inc, Minneapolis, MN, USA
| | - M S Sirry
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
- Department of Biomedical Engineering, School of Engineering and Computing, American International University, Al Jahra, Kuwait
| | - N J Nchejane
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
| | - T Abdalrahman
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
| | - J Nagawa
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa
| | - M Kruger
- Cardiovascular Research Unit, University of Cape Town, Observatory, South Africa
| | - E Pauwels
- Centre for X-ray Tomography, Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - D Van Loo
- Centre for X-ray Tomography, Department of Physics and Astronomy, Ghent University, Ghent, Belgium
- XRE nv, Bollebergen 2B box 1, Ghent, 9052, Belgium
| | - A De Muynck
- Centre for X-ray Tomography, Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - L Van Hoorebeke
- Centre for X-ray Tomography, Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - N H Davies
- Cardiovascular Research Unit, University of Cape Town, Observatory, South Africa
| | - T Franz
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa.
- Bioengineering Science Research Group, Department of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK.
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4
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Zhu S, Zhang W, Xu C, Huang J, Zou C. An injectable polyacrylamide/chitosan-based hydrogel with highly adhesive, stretchable and electroconductive properties loaded with irbesartan for treatment of myocardial ischemia-reperfusion injury. Int J Biol Macromol 2024; 266:131175. [PMID: 38552696 DOI: 10.1016/j.ijbiomac.2024.131175] [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: 01/04/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
Myocardial ischemia-reperfusion injury (MIRI) significantly contributes to the high incidence of complications and mortality associated with acute myocardial infarction. Recently, injectable electroconductive hydrogels (IECHs) have emerged as promising tools for replicating the mechanical, electroconductive, and physiological characteristics of cardiac tissue. Herein, we aimed to develop a novel IECH by incorporating irbesartan as a drug delivery system (DDS) for cardiac repair. Our approach involved merging a conductive poly-thiophene derivative (PEDOT: PSS) with an injectable dual-network adhesive hydrogel (DNAH) comprising a catechol-branched polyacrylamide network and a chitosan-hyaluronic acid covalent network. The resulting P-DNAH hydrogel, benefitting from a high conducting polymer content, a chemically crosslinked network, a robust dissipative matrix, and dynamic oxidation of catechol to quinone exhibited superior mechanical strength, desirable conductivity, and robust wet-adhesiveness. In vitro experiments with the P-DNAH hydrogel carrying irbesartan (P-DNAH-I) demonstrated excellent biocompatibility by cck-8 kit on H9C2 cells and a rapid initial release of irbesartan. Upon injection into the infarcted hearts of MIRI mouse models, the P-DNAH-I hydrogel effectively inhibited the inflammatory response and reduced the infarct size. In conclusion, our results suggest that the P-DNAH hydrogel, possessing suitable mechanical properties and electroconductivity, serves as an ideal IECH for DDS, delivering irbesartan to promote heart repair.
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Affiliation(s)
- Shasha Zhu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Wei Zhang
- Shandong Academy of Pharmaceutical Science, Key Laboratory of Biopharmaceuticals, Engineering Laboratory of Polysaccharide Drugs, National-Local Joint Engineering Laboratory of Polysaccharide Drugs, Jinan 250101, China; CAS Key Laboratory of Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou 215123, China
| | - Chunming Xu
- Department of Cardiology, Zhangjiagang First People Hospital, Suzhou 215600, China
| | - Jie Huang
- CAS Key Laboratory of Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou 215123, China
| | - Cao Zou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
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5
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Le HT, Mahara A, Fukazawa K, Nagasaki T, Yamaoka T. Widely distributable and retainable in-situ gelling material for treating myocardial infarction. Acta Biomater 2024; 176:221-233. [PMID: 38242190 DOI: 10.1016/j.actbio.2024.01.013] [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: 10/10/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
Intramyocardial hydrogel injection is a promising therapy to prevent negative remodeling following myocardial infarction (MI). In this study, we report a mechanism for in-situ gel formation without external stimulation, resulting in an injectable and tissue-retainable hydrogel for MI treatment, and investigate its therapeutic outcomes. A liquid-like polymeric solution comprising poly(3-acrylamidophenylboronic acid-co-acrylamide) (BAAm), polyvinyl alcohol (PVA), and sorbitol (S) increases the viscous modulus by reducing the pre-added sorbitol concentration is developed. This solution achieves a sol-gel transition in-vitro in heart tissue by spontaneously diffusing the sorbitol. After intramyocardial injection, the BAAm/PVA/S with lower initial viscous modulus widely spreads in the myocardium and gelate compared to a viscoelastic alginate (ALG) hydrogel and is retained longer than the BAAm/S solution. Serial echocardiogram analyses prove that injecting the BAAm/PVA/S into the hearts of subacute MI rats significantly increases the fraction shortening and ejection shortening and attenuates the expansion of systolic LV diameter for up to 21 d after injection compared to the saline injection as a control, but the ALG injection does not. In addition, histological evaluation shows that only the BAAm/PVA/S decreases the infarct size and increases the wall thickness 21 d after injection. The BAAm/PVA/S intramyocardial injection is better at restraining systolic ventricular dilatation and cardiac failure in the rat MI model than in the control groups. Our findings highlight an effective injectable hydrogel therapy for MI by optimizing injectability-dependent distribution and retention of injected material. STATEMENT OF SIGNIFICANCE: In-situ gelling material is a promising strategy for intramyocardial hydrogel injection therapy for myocardial infarction (MI). Since the sol-gel transition of reported materials is driven by external stimulation such as temperature, pH, or ultraviolet, their application in vivo remains challenging. In this study, we first reported a synthetic in-situ gelling material (BAAm/PVA/S) whose gelation is stimulated by spontaneously reducing pre-added sorbitol after contacting the heart tissue. The BAAm/PVA/S solution spreads evenly, and is retained for at least 21 d in the heart tissue. Our study demonstrated that intramyocardial injection of the BAAm/PVA/S with more extensive distribution and longer retention had better effects on preventing LV dilation and improving cardiac function after MI than that of viscoelastic ALG and saline solution. We expect that these findings provide fundamental information for the optimum design of injectable biomaterials for treating MI.
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Affiliation(s)
- Hue Thi Le
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe Shimmachi, Suita, Osaka 564-8565, Japan; Department of Physiology, Hanoi Medical University, Hanoi 10000, Vietnam
| | - Atsushi Mahara
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe Shimmachi, Suita, Osaka 564-8565, Japan
| | - Kyoko Fukazawa
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe Shimmachi, Suita, Osaka 564-8565, Japan
| | - Takeshi Nagasaki
- Department of Applied Chemistry and Bioengineering, Graduate School of Engineering, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka 558-8585, Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe Shimmachi, Suita, Osaka 564-8565, Japan; Department of Clinical Engineering, Faculty of Health Sciences, Komatsu University, He 14-1, Mukai-motoori-machi, Komatsu, Ishikawa 923-0961, Japan.
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6
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Avendaño R, Midgett D, Melvinsdottir I, Thorn SL, Uman S, Pickell Z, Lee SR, Liu Z, Mamarian M, Duncan JS, Spinale FG, Burdick JA, Sinusas AJ. Improvement in cardiac function and regional LV strain following intramyocardial injection of a theranostic hydrogel early postmyocardial infarction in a porcine model. J Appl Physiol (1985) 2023; 135:405-420. [PMID: 37318987 PMCID: PMC10538987 DOI: 10.1152/japplphysiol.00342.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 06/17/2023] Open
Abstract
Myocardial infarction (MI) is often complicated by left ventricular (LV) remodeling and heart failure. We evaluated the feasibility of a multimodality imaging approach to guide delivery of an imageable hydrogel and assessed LV functional changes with therapy. Yorkshire pigs underwent surgical occlusions of branches of the left anterior descending and/or circumflex artery to create an anterolateral MI. We evaluated the hemodynamic and mechanical effects of intramyocardial delivery of an imageable hydrogel in the central infarct area (Hydrogel group, n = 8) and a Control group (n = 5) early post-MI. LV and aortic pressure and ECG were measured and contrast cineCT angiography was performed at baseline, 60 min post-MI, and 90 min post-hydrogel delivery. LV hemodynamic indices, pressure-volume measures, and normalized regional and global strains were measured and compared. Both Control and Hydrogel groups demonstrated a decline in heart rate, LV pressure, stroke volume, ejection fraction, and pressure-volume loop area, and an increase in myocardial performance (Tei) index and supply/demand (S/D) ratio. After hydrogel delivery, Tei index and S/D ratio were reduced to baseline levels, diastolic and systolic functional indices either stabilized or improved, and radial strain and circumferential strain increased significantly in the MI regions (ENrr: +52.7%, ENcc: +44.1%). However, the Control group demonstrated a progressive decline in all functional indices to levels significantly below those of Hydrogel group. Thus, acute intramyocardial delivery of a novel imageable hydrogel to MI region resulted in rapid stabilization or improvement in LV hemodynamics and function.NEW & NOTEWORTHY Our study demonstrates that contrast cineCT imaging can be used to evaluate the acute effects of intramyocardial delivery of a therapeutic hydrogel to the central MI region early post MI, which resulted in a rapid stabilization of LV hemodynamics and improvement in regional and global LV function.
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Affiliation(s)
- Ricardo Avendaño
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Dan Midgett
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
| | - Inga Melvinsdottir
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Stephanie L Thorn
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Selen Uman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Zachary Pickell
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Shin Rong Lee
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Zhao Liu
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
| | - Marina Mamarian
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - James S Duncan
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Francis G Spinale
- Department of Cell Biology & Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina, United States
| | - Jason A Burdick
- Biofrontiers Institute, University of Colorado Boulder, Boulder, Colorado, United States
- Department of Chemical and Biological Engineering, University of Colorado Boulder, Boulder, Colorado, United States
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
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7
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Motchon YD, Sack KL, Sirry MS, Kruger M, Pauwels E, Van Loo D, De Muynck A, Van Hoorebeke L, Davies NH, Franz T. Effect of biomaterial stiffness on cardiac mechanics in a biventricular infarcted rat heart model with microstructural representation of in situ intramyocardial injectate. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3693. [PMID: 36864599 PMCID: PMC10909490 DOI: 10.1002/cnm.3693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/19/2022] [Accepted: 01/29/2023] [Indexed: 05/13/2023]
Abstract
Intramyocardial delivery of biomaterials is a promising concept for treating myocardial infarction. The delivered biomaterial provides mechanical support and attenuates wall thinning and elevated wall stress in the infarct region. This study aimed at developing a biventricular finite element model of an infarcted rat heart with a microstructural representation of an in situ biomaterial injectate, and a parametric investigation of the effect of the injectate stiffness on the cardiac mechanics. A three-dimensional subject-specific biventricular finite element model of a rat heart with left ventricular infarct and microstructurally dispersed biomaterial delivered 1 week after infarct induction was developed from ex vivo microcomputed tomography data. The volumetric mesh density varied between 303 mm-3 in the myocardium and 3852 mm-3 in the injectate region due to the microstructural intramyocardial dispersion. Parametric simulations were conducted with the injectate's elastic modulus varying from 4.1 to 405,900 kPa, and myocardial and injectate strains were recorded. With increasing injectate stiffness, the end-diastolic median myocardial fibre and cross-fibre strain decreased in magnitude from 3.6% to 1.1% and from -6.0% to -2.9%, respectively. At end-systole, the myocardial fibre and cross-fibre strain decreased in magnitude from -20.4% to -11.8% and from 6.5% to 4.6%, respectively. In the injectate, the maximum and minimum principal strains decreased in magnitude from 5.4% to 0.001% and from -5.4% to -0.001%, respectively, at end-diastole and from 38.5% to 0.06% and from -39.0% to -0.06%, respectively, at end-systole. With the microstructural injectate geometry, the developed subject-specific cardiac finite element model offers potential for extension to cellular injectates and in silico studies of mechanotransduction and therapeutic signalling in the infarcted heart with an infarct animal model extensively used in preclinical research.
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Affiliation(s)
- Y. D. Motchon
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human BiologyUniversity of Cape TownCape TownSouth Africa
| | - Kevin L. Sack
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human BiologyUniversity of Cape TownCape TownSouth Africa
- Department of SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - M. S. Sirry
- Department of Biomedical Engineering, School of Engineering and ComputingAmerican International UniversityAl JahraKuwait
| | - M. Kruger
- Cardiovascular Research Unit, MRC IUCHRUUniversity of Cape TownCape TownSouth Africa
| | - E. Pauwels
- Centre for X‐ray Tomography, Department of Physics and AstronomyGhent UniversityGhentBelgium
- Nuclear MedicineUniversity Hospitals LeuvenLeuvenBelgium
| | - D. Van Loo
- Centre for X‐ray Tomography, Department of Physics and AstronomyGhent UniversityGhentBelgium
- XRE nv, Bollebergen 2B box 1, 9052GhentBelgium
| | - A. De Muynck
- Centre for X‐ray Tomography, Department of Physics and AstronomyGhent UniversityGhentBelgium
| | - L. Van Hoorebeke
- Centre for X‐ray Tomography, Department of Physics and AstronomyGhent UniversityGhentBelgium
| | - Neil H. Davies
- Cardiovascular Research Unit, MRC IUCHRUUniversity of Cape TownCape TownSouth Africa
| | - Thomas Franz
- Biomedical Engineering Research Centre, Division of Biomedical Engineering, Department of Human BiologyUniversity of Cape TownCape TownSouth Africa
- Bioengineering Science Research Group, Faculty of Engineering and Physical SciencesUniversity of SouthamptonSouthamptonUK
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8
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An injectable conductive hydrogel restores electrical transmission at myocardial infarct site to preserve cardiac function and enhance repair. Bioact Mater 2023; 20:339-354. [PMID: 35784639 PMCID: PMC9210214 DOI: 10.1016/j.bioactmat.2022.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
Myocardial infarction (MI) leads to massive cardiomyocyte death and deposition of collagen fibers. This fibrous tissue disrupts electrical signaling in the myocardium, leading to cardiac systolic and diastolic dysfunction, as well as arrhythmias. Conductive hydrogels are a promising therapeutic strategy for MI. Here, we prepared a highly water-soluble conductive material (GP) by grafting polypyrrole (PPy) onto non-conductive gelatin. This component was added to the gel system formed by the Schiff base reaction between oxidized xanthan gum (OXG) and gelatin to construct an injectable conductive hydrogel. The prepared self-healing OGGP3 (3 wt% GP) hydrogel had good biocompatibility, elastic modulus, and electrical conductivity that matched the natural heart. The prepared biomaterials were injected into the rat myocardial scar tissue 2 days after MI. We found that the cardiac function of the rats treated with OGGP3 was improved, making it more difficult to induce arrhythmias. The electrical resistivity of myocardial fibrous tissue was reduced, and the conduction velocity of myocardial tissue was increased. Histological analysis showed reduced infarct size, increased left ventricular wall thickness, increased vessel density, and decreased inflammatory response in the infarcted area. Our findings clearly demonstrate that the OGGP3 hydrogel attenuates ventricular remodeling and inhibits infarct dilation, thus showing its potential for the treatment of MI. An injectable self-healing conductive hydrogel was synthesized for the treatment of myocardial infarction (MI). The OGGP3 hydrogel had elastic modulus (20.77 kPa) and conductivity (5.52 × 10−4 S/cm) that matched the natural heart. The hydrogel could protect cardiac function, reduce arrhythmia susceptibility and the resistivity of cardiac scar tissue. The hydrogel could increase left ventricular wall thickness, reduce infarct size and cardiac fibrosis in the infarcted area. The hydrogel could promote the expression level of cardiac-specific markers, induce angiogenesis, and reduce inflammation.
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9
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Ai X, Yan B, Witman N, Gong Y, Yang L, Tan Y, Chen Y, Liu M, Lu T, Luo R, Wang H, Chien KR, Wang W, Fu W. Transient secretion of VEGF protein from transplanted hiPSC-CMs enhances engraftment and improves rat heart function post MI. Mol Ther 2023; 31:211-229. [PMID: 35982619 PMCID: PMC9840120 DOI: 10.1016/j.ymthe.2022.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/15/2022] [Accepted: 08/12/2022] [Indexed: 01/28/2023] Open
Abstract
Cell-based therapies offer an exciting and novel treatment for heart repair following myocardial infarction (MI). However, these therapies often suffer from poor cell viability and engraftment rates, which involve many factors, including the hypoxic conditions of the infarct environment. Meanwhile, vascular endothelial growth factor (VEGF) has previously been employed as a therapeutic agent to limit myocardial damage and simultaneously induce neovascularization. This study took an approach to transiently overexpress VEGF protein, in a controlled manner, by transfecting human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) with VEGF mRNA prior to transplantation. The conditioning of iPSC-CMs with VEGF mRNA ultimately led to greater survival rates of the transplanted cells, which promoted a stable vascular network in the grafted region. Furthermore, bulk RNA transcriptomics data and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed that phosphoinositide 3-kinase (PI3K)-protein kinase B (Akt) and AGE-RAGE signaling pathways were significantly upregulated in the VEGF-treated iPSC-CMs group. The over-expression of VEGF from iPSC-CMs stimulated cell proliferation and partially attenuated the hypoxic environment in the infarcted area, resulting in reduced ventricular remodeling. This study provides a valuable solution for the survival of transplanted cells in tissue-engineered heart regeneration and may further promote the application of modified mRNA (modRNA) in the field of tissue engineering.
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Affiliation(s)
- Xuefeng Ai
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Bingqian Yan
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Nevin Witman
- Department of Cell and Molecular Biology, Karolinska Institutet, 17165 Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Yiqi Gong
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Li Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yao Tan
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Ying Chen
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Minglu Liu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Tingting Lu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Runjiao Luo
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Huijing Wang
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Kenneth R Chien
- Department of Cell and Molecular Biology, Karolinska Institutet, 17165 Stockholm, Sweden
| | - Wei Wang
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Wei Fu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China.
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10
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Lee M, Kim MC, Lee JY. Nanomaterial-Based Electrically Conductive Hydrogels for Cardiac Tissue Repair. Int J Nanomedicine 2022; 17:6181-6200. [PMID: 36531116 PMCID: PMC9748845 DOI: 10.2147/ijn.s386763] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/23/2022] [Indexed: 08/28/2023] Open
Abstract
Cardiovascular disease is one of major causes of deaths, and its incidence has gradually increased worldwide. For cardiovascular diseases, several therapeutic approaches, such as drugs, cell-based therapy, and heart transplantation, are currently employed; however, their therapeutic efficacy and/or practical availability are still limited. Recently, biomaterial-based tissue engineering approaches have been recognized as promising for regenerating cardiac function in patients with cardiovascular diseases, including myocardial infarction (MI). In particular, materials mimicking the characteristics of native cardiac tissues can potentially prevent pathological progression and promote cardiac repair of the heart tissues post-MI. The mechanical (softness) and electrical (conductivity) properties of biomaterials as non-biochemical cues can improve the cardiac functions of infarcted hearts by mitigating myocardial cell death and subsequent fibrosis, which often leads to cardiac tissue stiffening and high electrical resistance. Consequently, electrically conductive hydrogels that can provide mechanical strength and augment the electrical activity of the infarcted heart tissue are considered new functional materials capable of mitigating the pathological progression to heart failure and stimulating cardiac regeneration. In this review, we highlight nanomaterial-incorporated hydrogels that can induce cardiac repair after MI. Nanomaterials, including carbon-based nanomaterials and recently discovered two-dimensional nanomaterials, offer great opportunities for developing functional conductive hydrogels owing to their excellent electrical conductivity, large surface area, and ease of modification. We describe recent results using nanomaterial-incorporated conductive hydrogels as cardiac patches and injectable hydrogels for cardiac repair. While further evaluations are required to confirm the therapeutic efficacy and toxicity of these materials, they could potentially be used for the regeneration of other electrically active tissues, such as nerves and muscles.
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Affiliation(s)
- Mingyu Lee
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae Young Lee
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
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11
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Ghanta RK, Pugazenthi A, Zhao Y, Sylvester C, Wall MJ, Mazur RA, Russell LN, Lampe KJ. Influence of Supraphysiologic Biomaterial Stiffness on Ventricular Mechanics and Myocardial Infarct Reinforcement. Acta Biomater 2022; 149:30-39. [PMID: 35820592 DOI: 10.1016/j.actbio.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022]
Abstract
Injectable intramyocardial biomaterials have promise to limit adverse ventricular remodeling through mechanical and biologic mechanisms. While some success has been observed by injecting materials to regenerate new tissue, optimal biomaterial stiffness to thicken and stiffen infarcted myocardium to limit adverse remodeling has not been determined. In this work, we present an in-vivo study of the impact of biomaterial stiffness over a wide range of stiffness moduli on ventricular mechanics. We utilized injectable methacrylated polyethylene glycol (PEG) hydrogels fabricated at 3 different mechanical moduli: 5 kPa (low), 25 kPa (medium/myocardium), and 250 kPa (high/supraphysiologic). We demonstrate that the supraphysiological high stiffness favorably alters post-infarct ventricular mechanics and prevents negative tissue remodeling. Lower stiffness materials do not alter mechanics and thus to be effective, must instead target biological reparative mechanisms. These results may influence rationale design criteria for biomaterials developed for infarct reinforcement therapy. STATEMENT OF SIGNIFICANCE: Acellular biomaterials for cardiac application can provide benefit via mechanical and biological mechanisms post myocardial infarction. We study the role of biomaterial mechanical characteristics on ventricular mechanics in myocardial infarcts. Previous studies have not measured the influence of injected biomaterials on ventricular mechanics, and consequently rational design criteria is unknown. By utilizing an in-vivo assessment of ventricular mechanics, we demonstrate that low stiffness biomaterial do not alter pathologic ventricular mechanics. Thus, to be effective, low stiffness biomaterials must target biological reparative mechanisms. Physiologic and supra-physiologic biomaterials favorably alter post-infarct mechanics and prevents adverse ventricular remodeling.
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Affiliation(s)
- Ravi K Ghanta
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX United States; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX United States.
| | - Aarthi Pugazenthi
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX United States
| | - Yunge Zhao
- Department of Surgery, University of Maryland, Baltimore, MD United States
| | - Christopher Sylvester
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX United States; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX United States
| | - Mathew J Wall
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX United States
| | - Rachel A Mazur
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA United States
| | - Lauren N Russell
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA United States
| | - Kyle J Lampe
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA United States
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12
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Schmitt PR, Dwyer KD, Coulombe KLK. Current Applications of Polycaprolactone as a Scaffold Material for Heart Regeneration. ACS APPLIED BIO MATERIALS 2022; 5:2461-2480. [PMID: 35623101 DOI: 10.1021/acsabm.2c00174] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite numerous advances in treatments for cardiovascular disease, heart failure (HF) remains the leading cause of death worldwide. A significant factor contributing to the progression of cardiovascular diseases into HF is the loss of functioning cardiomyocytes. The recent growth in the field of cardiac tissue engineering has the potential to not only reduce the downstream effects of injured tissues on heart function and longevity but also re-engineer cardiac function through regeneration of contractile tissue. One leading strategy to accomplish this is via a cellularized patch that can be surgically implanted onto a diseased heart. A key area of this field is the use of tissue scaffolds to recapitulate the mechanical and structural environment of the native heart and thus promote engineered myocardium contractility and function. While the strong mechanical properties and anisotropic structural organization of the native heart can be largely attributed to a robust extracellular matrix, similar strength and organization has proven to be difficult to achieve in cultured tissues. Polycaprolactone (PCL) is an emerging contender to fill these gaps in fabricating scaffolds that mimic the mechanics and structure of the native heart. In the field of cardiovascular engineering, PCL has recently begun to be studied as a scaffold for regenerating the myocardium due to its facile fabrication, desirable mechanical, chemical, and biocompatible properties, and perhaps most importantly, biodegradability, which make it suitable for regenerating and re-engineering function to the heart after disease or injury. This review focuses on the application of PCL as a scaffold specifically in myocardium repair and regeneration and outlines current fabrication approaches, properties, and possibilities of PCL incorporation into engineered myocardium, as well as provides suggestions for future directions and a roadmap toward clinical translation of this technology.
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Affiliation(s)
- Phillip R Schmitt
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, Rhode Island 02912, United States
| | - Kiera D Dwyer
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, Rhode Island 02912, United States
| | - Kareen L K Coulombe
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, Rhode Island 02912, United States
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13
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Zhu K, Jiang D, Wang K, Zheng D, Zhu Z, Shao F, Qian R, Lan X, Qin C. Conductive nanocomposite hydrogel and mesenchymal stem cells for the treatment of myocardial infarction and non-invasive monitoring via PET/CT. J Nanobiotechnology 2022; 20:211. [PMID: 35524274 PMCID: PMC9077894 DOI: 10.1186/s12951-022-01432-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/21/2022] [Indexed: 12/31/2022] Open
Abstract
Background Injectable hydrogels have great promise in the treatment of myocardial infarction (MI); however, the lack of electromechanical coupling of the hydrogel to the host myocardial tissue and the inability to monitor the implantation may compromise a successful treatment. The introduction of conductive biomaterials and mesenchymal stem cells (MSCs) may solve the problem of electromechanical coupling and they have been used to treat MI. In this study, we developed an injectable conductive nanocomposite hydrogel (GNR@SN/Gel) fabricated by gold nanorods (GNRs), synthetic silicate nanoplatelets (SNs), and poly(lactide-co-glycolide)-b-poly (ethylene glycol)-b-poly(lactide-co-glycolide) (PLGA-PEG-PLGA). The hydrogel was used to encapsulate MSCs and 68Ga3+ cations, and was then injected into the myocardium of MI rats to monitor the initial hydrogel placement and to study the therapeutic effect via 18F-FDG myocardial PET imaging. Results Our data showed that SNs can act as a sterically stabilized protective shield for GNRs, and that mixing SNs with GNRs yields uniformly dispersed and stabilized GNR dispersions (GNR@SN) that meet the requirements of conductive nanofillers. We successfully constructed a thermosensitive conductive nanocomposite hydrogel by crosslinking GNR@SN with PLGA2000-PEG3400-PLGA2000, where SNs support the proliferation of MSCs. The cation-exchange capability of SNs was used to adsorb 68Ga3+ to locate the implanted hydrogel in myocardium via PET/CT. The combination of MSCs and the conductive hydrogel had a protective effect on both myocardial viability and cardiac function in MI rats compared with controls, as revealed by 18F-FDG myocardial PET imaging in early and late stages and ultrasound; this was further validated by histopathological investigations. Conclusions The combination of MSCs and the GNR@SN/Gel conductive nanocomposite hydrogel offers a promising strategy for MI treatment. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12951-022-01432-7.
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Affiliation(s)
- Ke Zhu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Dawei Jiang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Kun Wang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Danzha Zheng
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Ziyang Zhu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Fuqiang Shao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Ruijie Qian
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chunxia Qin
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei, China. .,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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14
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Midgett DE, Thorn SL, Ahn SS, Uman S, Avendano R, Melvinsdottir I, Lysyy T, Kim JS, Duncan JS, Humphrey JD, Papademetris X, Burdick JA, Sinusas AJ. CineCT platform for in vivo and ex vivo measurement of 3D high resolution Lagrangian strains in the left ventricle following myocardial infarction and intramyocardial delivery of theranostic hydrogel. J Mol Cell Cardiol 2022; 166:74-90. [PMID: 35227737 PMCID: PMC9035115 DOI: 10.1016/j.yjmcc.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 02/07/2023]
Abstract
Myocardial infarction (MI) produces acute changes in strain and stiffness within the infarct that can affect remote areas of the left ventricle (LV) and drive pathological remodeling. We hypothesized that intramyocardial delivery of a hydrogel within the MI region would lower wall stress and reduce adverse remodeling in Yorkshire pigs (n = 5). 99mTc-Tetrofosmin SPECT imaging defined the location and geometry of induced MI and border regions in pigs, and in vivo and ex vivo contrast cine computed tomography (cineCT) quantified deformations of the LV myocardium. Serial in vivo cineCT imaging provided data in hearts from control pigs (n = 3) and data from pigs (n = 5) under baseline conditions before MI induction, post-MI day 3, post-MI day 7, and one hour after intramyocardial delivery of a hyaluronic acid (HA)-based hydrogel with shear-thinning and self-healing properties to the central infarct area. Isolated, excised hearts underwent similar cineCT imaging using an ex vivo perfused heart preparation with cyclic LV pressurization. Deformations were evaluated using nonlinear image registration of cineCT volumes between end-diastole (ED) and end-systole (ES), and 3D Lagrangian strains were calculated from the displacement gradients. Post-MI day 3, radial, circumferential, maximum principal, and shear strains were reduced within the MI region (p < 0.04) but were unchanged in normal regions (p > 0.6), and LV end diastolic volume (LV EDV) increased (p = 0.004), while ejection fraction (EF) and stroke volume (SV) decreased (p < 0.02). Post-MI day 7, radial strains in MI border zones increased (p = 0.04) and dilation of LV EDV continued (p = 0.052). There was a significant negative linear correlation between regional radial and maximum principal/shear strains and percent infarcted tissue in all hearts (R2 > 0.47, p < 0.004), indicating that cineCT strain measures could predict MI location and degree of injury. Post-hydrogel day 7 post-MI, LV EDV was significantly reduced (p = 0.009), EF increased (p = 0.048), and radial (p = 0.021), maximum principal (p = 0.051), and shear strain (p = 0.047) increased within regions bordering the infarct. A smaller strain improvement within the infarct and normal regions was also noted on average along with an improvement in SV in 4 out of 5 hearts. CineCT provides a reliable method to assess regional changes in strains post-MI and the therapeutic effects of intramyocardial hydrogel delivery.
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Affiliation(s)
- D E Midgett
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America; Department of Biomedical Engineering, Yale University, New Haven, CT, United States of America
| | - S L Thorn
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - S S Ahn
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States of America
| | - S Uman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States of America
| | - R Avendano
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - I Melvinsdottir
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - T Lysyy
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - J S Kim
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
| | - J S Duncan
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States of America; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
| | - J D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States of America
| | - X Papademetris
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States of America; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
| | - J A Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States of America
| | - A J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America; Department of Biomedical Engineering, Yale University, New Haven, CT, United States of America; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America.
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15
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Random and aligned electrospun poly(ε-caprolactone) (PCL)/poly(1,8-octanediol-co-citrate) (POC) fiber mats for cardiac tissue engineering using benign solvents. Eur Polym J 2021. [DOI: 10.1016/j.eurpolymj.2021.110772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Leong CO, Leong CN, Liew YM, Al Abed A, Aziz YFA, Chee KH, Sridhar GS, Dokos S, Lim E. The role of regional myocardial topography post-myocardial infarction on infarct extension. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3501. [PMID: 34057819 DOI: 10.1002/cnm.3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/26/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
Infarct extension involves necrosis of healthy myocardium in the border zone (BZ), progressively enlarging the infarct zone (IZ) and recruiting the remote zone (RZ) into the BZ, eventually leading to heart failure. The mechanisms underlying infarct extension remain unclear, but myocyte stretching has been suggested as the most likely cause. Using human patient-specific left-ventricular (LV) numerical simulations established from cardiac magnetic resonance imaging (MRI) of myocardial infarction (MI) patients, the correlation between infarct extension and regional mechanics abnormality was investigated by analysing the fibre stress-strain loops (FSSLs). FSSL abnormality was characterised using the directional regional external work (DREW) index, which measures FSSL area and loop direction. Sensitivity studies were also performed to investigate the effect of infarct stiffness on regional myocardial mechanics and potential for infarct extension. We found that infarct extension was correlated to severely abnormal FSSL in the form of counter-clockwise loop at the RZ close to the infarct, as indicated by negative DREW values. In regions demonstrating negative DREW values, we observed substantial fibre stretching in the isovolumic relaxation (IVR) phase accompanied by a reduced rate of systolic shortening. Such stretching in IVR phase in part of the RZ was due to its inability to withstand the high LV pressure that was still present and possibly caused by regional myocardial stiffness inhomogeneity. Further analysis revealed that the occurrence of severely abnormal FSSL due to IVR fibre stretching near the RZ-BZ boundary was due to a large amount of surrounding infarcted tissue, or an excessively stiff IZ.
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Affiliation(s)
- Chen Onn Leong
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Neng Leong
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Amr Al Abed
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Socrates Dokos
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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17
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Caggiano LR, Holmes JW. A Comparison of Fiber Based Material Laws for Myocardial Scar. JOURNAL OF ELASTICITY 2021; 145:321-337. [PMID: 35095176 PMCID: PMC8797542 DOI: 10.1007/s10659-021-09845-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/10/2021] [Indexed: 06/14/2023]
Abstract
The mechanics of most soft tissues in the human body are determined by the organization of their collagen fibers. Predicting how mechanics will change during growth and remodeling of those tissues requires constitutive laws that account for the density and dispersion of collagen fibers. Post-infarction scar in the heart, a mechanically and structurally complex material, does not yet have a validated fiber-based constitutive model. In this study, we tested four different constitutive laws employing exponential or polynomial strain-energy functions and accounting for either mean fiber orientation alone or the details of the fiber distribution about that mean. We quantified the goodness of fit of each law to mechanical testing data from 6-week-old myocardial scar in the rat using both sum of squared error (SSE) and the Akaike Information Criterion (AIC) to account for differences in the number of material parameters within the constitutive laws. We then compared their ability to prospectively predict the mechanics of independent myocardial scar samples from other time points during healing. Our analysis suggests that a constitutive law with a polynomial form that incorporates detailed information about collagen fiber distribution using a structure tensor provides excellent fits with just two parameters and reasonable predictions of myocardial scar mechanics from measured structure alone in scars containing sufficiently high collagen content.
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Affiliation(s)
- Laura R. Caggiano
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jeffrey W. Holmes
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
- School of Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Dwyer KD, Coulombe KL. Cardiac mechanostructure: Using mechanics and anisotropy as inspiration for developing epicardial therapies in treating myocardial infarction. Bioact Mater 2021; 6:2198-2220. [PMID: 33553810 PMCID: PMC7822956 DOI: 10.1016/j.bioactmat.2020.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 12/14/2022] Open
Abstract
The mechanical environment and anisotropic structure of the heart modulate cardiac function at the cellular, tissue and organ levels. During myocardial infarction (MI) and subsequent healing, however, this landscape changes significantly. In order to engineer cardiac biomaterials with the appropriate properties to enhance function after MI, the changes in the myocardium induced by MI must be clearly identified. In this review, we focus on the mechanical and structural properties of the healthy and infarcted myocardium in order to gain insight about the environment in which biomaterial-based cardiac therapies are expected to perform and the functional deficiencies caused by MI that the therapy must address. From this understanding, we discuss epicardial therapies for MI inspired by the mechanics and anisotropy of the heart focusing on passive devices, which feature a biomaterials approach, and active devices, which feature robotic and cellular components. Through this review, a detailed analysis is provided in order to inspire further development and translation of epicardial therapies for MI.
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Affiliation(s)
- Kiera D. Dwyer
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
| | - Kareen L.K. Coulombe
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
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19
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Biotherapeutic-loaded injectable hydrogels as a synergistic strategy to support myocardial repair after myocardial infarction. J Control Release 2021; 335:216-236. [PMID: 34022323 DOI: 10.1016/j.jconrel.2021.05.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022]
Abstract
Myocardial infarction (MI) has been considered as the leading cause of cardiovascular-related deaths worldwide. Although traditional therapeutic agents including various bioactive species such as growth factors, stem cells, and nucleic acids have demonstrated somewhat usefulness for the restoration of cardiac functions, the therapeutic efficiency remains unsatisfactory most likely due to the off-target-associated side effects and low localized retention of the used therapeutic agents in the infarcted myocardium, which constitutes a substantial barrier for the effective treatment of MI. Injectable hydrogels are regarded as a minimally invasive technology that can overcome the clinical and surgical limitations of traditional stenting by a modulated sol-gel transition and localized transport of a variety of encapsulated cargoes, leading to enhanced therapeutic efficiency and improved patient comfort and compliance. However, the design of injectable hydrogels for myocardial repair and the mechanism of action of bioactive substance-loaded hydrogels for MI repair remain unclear. To elucidate these points, we summarized the recent progresses made on the use of injectable hydrogels for encapsulation of various therapeutic substances for MI treatment with an emphasis on the mechanism of action of hydrogel systems for myocardial repair. Specifically, the pathogenesis of MI and the rational design of injectable hydrogels for myocardial repair were presented. Next, the mechanisms of various biotherapeutic substance-loaded injectable hydrogels for myocardial repair was discussed. Finally, the potential challenges and future prospects for the use of injectable hydrogels for MI treatment were proposed for the purpose of drawing theoretical guidance on the development of novel therapeutic strategies for efficient treatment of MI.
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20
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Cutugno S, Ingrassia T, Nigrelli V, Pasta S. On the Left Ventricular Remodeling of Patients with Stenotic Aortic Valve: A Statistical Shape Analysis. Bioengineering (Basel) 2021; 8:66. [PMID: 34068270 PMCID: PMC8153107 DOI: 10.3390/bioengineering8050066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 12/04/2022] Open
Abstract
The left ventricle (LV) constantly changes its shape and function as a response to pathological conditions, and this process is known as remodeling. In the presence of aortic stenosis (AS), the degenerative process is not limited to the aortic valve but also involves the remodeling of LV. Statistical shape analysis (SSA) offers a powerful tool for the visualization and quantification of the geometrical and functional patterns of any anatomic changes. In this paper, a SSA method was developed to determine shape descriptors of the LV under different degrees of AS and thus to shed light on the mechanistic link between shape and function. A total of n=86 patients underwent computed tomography (CT) for the evaluation of valvulopathy were segmented to obtain the LV surface and then were automatically aligned to a reference template by rigid registrations and transformations. Shape modes of the anatomical LV variation induced by the degree of AS were assessed by principal component analysis (PCA). The first shape mode represented nearly 50% of the total variance of LV shape in our patient population and was mainly associated to a spherical LV geometry. At Pearson's analysis, the first shape mode was positively correlated to both the end-diastolic volume (p<0.01, R=0.814) and end-systolic volume (p<0.01, and R=0.922), suggesting LV impairment in patients with severe AS. A predictive model built with PCA-related shape modes achieved better performance in stratifying the occurrence of adverse events with respect to a baseline model using clinical demographic data as risk predictors. This study demonstrated the potential of SSA approaches to detect the association of complex 3D shape features with functional LV parameters.
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Affiliation(s)
| | - Tommaso Ingrassia
- Dipartimento di Ingegneria (DING), Università degli Studi di Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy; (S.C.); (V.N.); (S.P.)
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21
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Synthesis of thermogel modified with biomaterials as carrier for hUSSCs differentiation into cardiac cells: Physicomechanical and biological assessment. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 119:111517. [DOI: 10.1016/j.msec.2020.111517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022]
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22
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Wu Y, Chang T, Chen W, Wang X, Li J, Chen Y, Yu Y, Shen Z, Yu Q, Zhang Y. Release of VEGF and BMP9 from injectable alginate based composite hydrogel for treatment of myocardial infarction. Bioact Mater 2021; 6:520-528. [PMID: 32995677 PMCID: PMC7492819 DOI: 10.1016/j.bioactmat.2020.08.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 12/28/2022] Open
Abstract
Myocardial infarction (MI) is one of cardiovascular diseases that pose a serious threat to human health. The pathophysiology of MI is complex and contains several sequential phases including blockage of a coronary artery, necrosis of myocardial cells, inflammation, and myocardial fibrosis. Aiming at the treatment of different stages of MI, in this work, an injectable alginate based composite hydrogel is developed to load vascular endothelial active factor (VEGF) and silk fibroin (SF) microspheres containing bone morphogenetic protein 9 (BMP9) for releasing VEGF and BMP9 to realize their respective functions. The results of in vitro experiments indicate a rapid initial release of VEGF during the first few days and a relatively slow and sustained release of BMP9 for days, facilitating the formation of blood vessels in the early stage and inhibiting myocardial fibrosis in the long-term stage, respectively. Intramyocardial injection of such composite hydrogel into the infarct border zone of mice MI model via multiple points promotes angiogenesis and reduces the infarction size. Taken together, these results indicate that the dual-release of VEGF and BMP9 from the composite hydrogel results in a collaborative effect on the treatment of MI and improvement of heart function, showing a promising potential for cardiac clinical application.
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Affiliation(s)
- Yong Wu
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
| | - Tianqi Chang
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
| | - Weiqian Chen
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
| | - Xiaoyu Wang
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
| | - Jingjing Li
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
| | - Yueqiu Chen
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
| | - You Yu
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
| | - Zhenya Shen
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
| | - Qian Yu
- State and Local Joint Engineering Laboratory for Novel Functional Polymeric Materials, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou, 215123, PR China
| | - Yanxia Zhang
- Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Medical College, Soochow University, Suzhou, 215000, PR China
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23
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Fan L, Namani R, Choy JS, Awakeem Y, Kassab GS, Lee LC. Role of coronary flow regulation and cardiac-coronary coupling in mechanical dyssynchrony associated with right ventricular pacing. Am J Physiol Heart Circ Physiol 2020; 320:H1037-H1054. [PMID: 33356963 DOI: 10.1152/ajpheart.00549.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mechanical dyssynchrony (MD) affects left ventricular (LV) mechanics and coronary perfusion. To understand the multifactorial effects of MD, we developed a computational model that bidirectionally couples the systemic circulation with the LV and coronary perfusion with flow regulation. In the model, coronary flow in the left anterior descending (LAD) and left circumflex (LCX) arteries affects the corresponding regional contractility based on a prescribed linear LV contractility-coronary flow relationship. The model is calibrated with experimental measurements of LV pressure and volume, as well as LAD and LCX flow rate waveforms acquired under regulated and fully dilated conditions from a swine under right atrial (RA) pacing. The calibrated model is applied to simulate MD. The model can simultaneously reproduce the reduction in mean LV pressure (39.3%), regulated flow (LAD: 7.9%; LCX: 1.9%), LAD passive flow (21.6%), and increase in LCX passive flow (15.9%). These changes are associated with right ventricular pacing compared with RA pacing measured in the same swine only when LV contractility is affected by flow alterations with a slope of 1.4 mmHg/mL2 in a contractility-flow relationship. In sensitivity analyses, the model predicts that coronary flow reserve (CFR) decreases and increases in the LAD and LCX with increasing delay in LV free wall contraction. These findings suggest that asynchronous activation associated with MD impacts 1) the loading conditions that further affect the coronary flow, which may explain some of the changes in CFR, and 2) the coronary flow that reduces global contractility, which contributes to the reduction in LV pressure.NEW & NOTEWORTHY A computational model that couples the systemic circulation of the left ventricular (LV) and coronary perfusion with flow regulation is developed to study the effects of mechanical dyssynchrony. The delayed contraction in the LV free wall with respect to the septum has a significant effect on LV function and coronary flow reserve.
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Affiliation(s)
- Lei Fan
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - Ravi Namani
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - Jenny S Choy
- California Medical Innovation Institute, San Diego, California
| | - Yousif Awakeem
- California Medical Innovation Institute, San Diego, California
| | | | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
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24
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Nguyen TD, Kadri OE, Voronov RS. An Introductory Overview of Image-Based Computational Modeling in Personalized Cardiovascular Medicine. Front Bioeng Biotechnol 2020; 8:529365. [PMID: 33102452 PMCID: PMC7546862 DOI: 10.3389/fbioe.2020.529365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular diseases account for the number one cause of deaths in the world. Part of the reason for such grim statistics is our limited understanding of the underlying mechanisms causing these devastating pathologies, which is made difficult by the invasiveness of the procedures associated with their diagnosis (e.g., inserting catheters into the coronal artery to measure blood flow to the heart). Likewise, it is also difficult to design and test assistive devices without implanting them in vivo. However, with the recent advancements made in biomedical scanning technologies and computer simulations, image-based modeling (IBM) has arisen as the next logical step in the evolution of non-invasive patient-specific cardiovascular medicine. Yet, due to its novelty, it is still relatively unknown outside of the niche field. Therefore, the goal of this manuscript is to review the current state-of-the-art and the limitations of the methods used in this area of research, as well as their applications to personalized cardiovascular investigations and treatments. Specifically, the modeling of three different physics – electrophysiology, biomechanics and hemodynamics – used in the cardiovascular IBM is discussed in the context of the physiology that each one of them describes and the mechanisms of the underlying cardiac diseases that they can provide insight into. Only the “bare-bones” of the modeling approaches are discussed in order to make this introductory material more accessible to an outside observer. Additionally, the imaging methods, the aspects of the unique cardiac anatomy derived from them, and their relation to the modeling algorithms are reviewed. Finally, conclusions are drawn about the future evolution of these methods and their potential toward revolutionizing the non-invasive diagnosis, virtual design of treatments/assistive devices, and increasing our understanding of these lethal cardiovascular diseases.
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Affiliation(s)
- Thanh Danh Nguyen
- Otto H. York Department of Chemical and Materials Engineering, Newark College of Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Olufemi E Kadri
- Otto H. York Department of Chemical and Materials Engineering, Newark College of Engineering, New Jersey Institute of Technology, Newark, NJ, United States.,UC-P&G Simulation Center, University of Cincinnati, Cincinnati, OH, United States
| | - Roman S Voronov
- Otto H. York Department of Chemical and Materials Engineering, Newark College of Engineering, New Jersey Institute of Technology, Newark, NJ, United States.,Department of Biomedical Engineering, Newark College of Engineering, New Jersey Institute of Technology, Newark, NJ, United States
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25
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Cardiac Stem Cell-Loaded Delivery Systems: A New Challenge for Myocardial Tissue Regeneration. Int J Mol Sci 2020; 21:ijms21207701. [PMID: 33080988 PMCID: PMC7589970 DOI: 10.3390/ijms21207701] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in Western countries. Post-myocardial infarction heart failure can be considered a degenerative disease where myocyte loss outweighs any regenerative potential. In this scenario, regenerative biology and tissue engineering can provide effective solutions to repair the infarcted failing heart. The main strategies involve the use of stem and progenitor cells to regenerate/repair lost and dysfunctional tissue, administrated as a suspension or encapsulated in specific delivery systems. Several studies demonstrated that effectiveness of direct injection of cardiac stem cells (CSCs) is limited in humans by the hostile cardiac microenvironment and poor cell engraftment; therefore, the use of injectable hydrogel or pre-formed patches have been strongly advocated to obtain a better integration between delivered stem cells and host myocardial tissue. Several approaches were used to refine these types of constructs, trying to obtain an optimized functional scaffold. Despite the promising features of these stem cells’ delivery systems, few have reached the clinical practice. In this review, we summarize the advantages, and the novelty but also the current limitations of engineered patches and injectable hydrogels for tissue regenerative purposes, offering a perspective of how we believe tissue engineering should evolve to obtain the optimal delivery system applicable to the everyday clinical scenario.
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26
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Zhao D, Niu P, Sun X, Yin Z, Tan W, Huo Y. Mechanical difference of left ventricle between rabbits of myocardial infarction and hypertrophy. J Biomech 2020; 111:110021. [PMID: 32927116 DOI: 10.1016/j.jbiomech.2020.110021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/21/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
The analysis of cardiac wall stress is of importance to understand the development of heart failure (HF). The aim of the study is to carry out the cardiac mechanics analysis to show the changes of left ventricular (LV) wall stresses after LV hypertrophy (LVH) and myocardial infarction (MI). Here, LVH and MI were generated in rabbit hearts through the transverse aortic constriction (TAC) and the distal left circumflex (LCx) artery ligation operations, respectively. Physiological and CT measurements were carried out at postoperative 2 and 4 weeks, based on which a finite element (FE) model was developed to perform the mechanics computation. We found a gradual increase of end-diastolic myofiber stress in free wall and interventricular septum of LVH and MI (higher stress in the free wall than the septum). In the interventricular septum, the 4-weeks LVH group has the highest ED myofiber stresses (11.378 ± 3.022 kPa), while the 4-weeks MI group has the highest ED myofiber stresses (13.494 ± 2.835 kPa) in the free wall. LVH increased myocardial volume (3.49 ± 0.07 and 4.52 ± 0.26 ml at postoperative 2 and 4 weeks) while MI increased LV volume (from 2.75 ± 0.29 to 4.19 ± 0.27 ml). LVH and MI had different distributions of local myofiber stress.
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Affiliation(s)
- Dongliang Zhao
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Pei Niu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Xiaotong Sun
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Zhongjie Yin
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Wenchang Tan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China; PKU-HKUST Shenzhen-Hong Kong Institution, Shenzhen, Guangdong, China; Shenzhen Graduate School, Peking University, Shenzhen, Guangdong, China.
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hong Kong Institution, Shenzhen, Guangdong, China; Institute of Mechanobiology & Medical Engineering, School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China.
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27
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Li DS, Avazmohammadi R, Rodell CB, Hsu EW, Burdick JA, Gorman JH, Gorman RC, Sacks MS. How hydrogel inclusions modulate the local mechanical response in early and fully formed post-infarcted myocardium. Acta Biomater 2020; 114:296-306. [PMID: 32739434 PMCID: PMC7484038 DOI: 10.1016/j.actbio.2020.07.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022]
Abstract
Expansion of myocardium after myocardial infarction (MI) has long been identified as the primary mechanism that drives adverse left ventricular (LV) remodeling towards heart failure and death. Direct injection of hydrogels into the myocardium to mechanically constrain the infarct has demonstrated promise in limiting its remodeling and expansion. Despite early successes, there remain open questions in the determination of optimal hydrogel therapies, key application characteristics for which include injected polymer volume, stiffness, and spatial placement. Addressing these questions is complicated by the substantial variations in infarct type and extent, as well as limited understanding of the underlying mechanisms. Herein, we present an investigation on how hydrogel inclusions affect the effective tissue-level stiffness and strain fields in myocardium using full three-dimensional (3D) finite element simulations at early and late post-MI time points. We calibrated our simulations to triaxial mechanical and structural measurements of cuboidal LV myocardial specimens of post-infarcted myocardium, 0 and 4 weeks post-MI, injected with a dual-crosslinking hyaluronic acid-based hydrogel. Simulations included multiple deformation modes that spanned the anticipated physiological range in order to assess the effects of variations in inclusion size, location, and modulus on tissue-level myocardial mechanics. We observed significant local stiffening in the hydrogel-injected specimens that was highly dependent on the volume and mechanical properties of the injected hydrogel. Simulations revealed that the primary effect of the injections under physiological loading was a reduction in myocardial strain. This result suggests that hydrogel injections reduce infarct expansion by limiting the peak strains over the cardiac cycle. Overall, our study indicated that modulation of local effective tissue stiffness and corresponding strain reduction are governed by the volume and stiffness of the hydrogel, but relatively insensitive to its transmural placement. These findings provide important insights into mechanisms for ameliorating post-MI remodeling, as well as guidance for the future design of post-MI therapies.
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Affiliation(s)
- David S Li
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Reza Avazmohammadi
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA; Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Christopher B Rodell
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA; Polymeric Biomaterials Laboratory, Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward W Hsu
- Preclinical Imaging Core Facility, Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Jason A Burdick
- Polymeric Biomaterials Laboratory, Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael S Sacks
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
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28
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Zilla P, Deutsch M, Bezuidenhout D, Davies NH, Pennel T. Progressive Reinvention or Destination Lost? Half a Century of Cardiovascular Tissue Engineering. Front Cardiovasc Med 2020; 7:159. [PMID: 33033720 PMCID: PMC7509093 DOI: 10.3389/fcvm.2020.00159] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
The concept of tissue engineering evolved long before the phrase was forged, driven by the thromboembolic complications associated with the early total artificial heart programs of the 1960s. Yet more than half a century of dedicated research has not fulfilled the promise of successful broad clinical implementation. A historical account outlines reasons for this scientific impasse. For one, there was a disconnect between distinct eras each characterized by different clinical needs and different advocates. Initiated by the pioneers of cardiac surgery attempting to create neointimas on total artificial hearts, tissue engineering became fashionable when vascular surgeons pursued the endothelialisation of vascular grafts in the late 1970s. A decade later, it were cardiac surgeons again who strived to improve the longevity of tissue heart valves, and lastly, cardiologists entered the fray pursuing myocardial regeneration. Each of these disciplines and eras started with immense enthusiasm but were only remotely aware of the preceding efforts. Over the decades, the growing complexity of cellular and molecular biology as well as polymer sciences have led to surgeons gradually being replaced by scientists as the champions of tissue engineering. Together with a widening chasm between clinical purpose, human pathobiology and laboratory-based solutions, clinical implementation increasingly faded away as the singular endpoint of all strategies. Moreover, a loss of insight into the healing of cardiovascular prostheses in humans resulted in the acceptance of misleading animal models compromising the translation from laboratory to clinical reality. This was most evident in vascular graft healing, where the two main impediments to the in-situ generation of functional tissue in humans remained unheeded–the trans-anastomotic outgrowth stoppage of endothelium and the build-up of an impenetrable surface thrombus. To overcome this dead-lock, research focus needs to shift from a biologically possible tissue regeneration response to one that is feasible at the intended site and in the intended host environment of patients. Equipped with an impressive toolbox of modern biomaterials and deep insight into cues for facilitated healing, reconnecting to the “user needs” of patients would bring one of the most exciting concepts of cardiovascular medicine closer to clinical reality.
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Affiliation(s)
- Peter Zilla
- Christiaan Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa.,Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Manfred Deutsch
- Karl Landsteiner Institute for Cardiovascular Surgical Research, Vienna, Austria
| | - Deon Bezuidenhout
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Neil H Davies
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Tim Pennel
- Christiaan Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
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29
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Li W. Biomechanics of infarcted left ventricle: a review of modelling. Biomed Eng Lett 2020; 10:387-417. [PMID: 32864174 DOI: 10.1007/s13534-020-00159-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Mathematical modelling in biomechanics of infarcted left ventricle (LV) serves as an indispensable tool for remodelling mechanism exploration, LV biomechanical property estimation and therapy assessment after myocardial infarction (MI). However, a review of mathematical modelling after MI has not been seen in the literature so far. In the paper, a systematic review of mathematical models in biomechanics of infarcted LV was established. The models include comprehensive cardiovascular system model, essential LV pressure-volume and stress-stretch models, constitutive laws for passive myocardium and scars, tension models for active myocardium, collagen fibre orientation optimization models, fibroblast and collagen fibre growth/degradation models and integrated growth-electro-mechanical model after MI. The primary idea, unique characteristics and key equations of each model were identified and extracted. Discussions on the models were provided and followed research issues on them were addressed. Considerable improvements in the cardiovascular system model, LV aneurysm model, coupled agent-based models and integrated electro-mechanical-growth LV model are encouraged. Substantial attention should be paid to new constitutive laws with respect to stress-stretch curve and strain energy function for infarcted passive myocardium, collagen fibre orientation optimization in scar, cardiac rupture and tissue damage and viscoelastic effect post-MI in the future.
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Affiliation(s)
- Wenguang Li
- School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
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30
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Ramírez WA, Gizzi A, Sack KL, Guccione JM, Hurtado DE. In-silico study of the cardiac arrhythmogenic potential of biomaterial injection therapy. Sci Rep 2020; 10:12990. [PMID: 32737400 PMCID: PMC7395773 DOI: 10.1038/s41598-020-69900-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
Biomaterial injection is a novel therapy to treat ischemic heart failure (HF) that has shown to reduce remodeling and restore cardiac function in recent preclinical studies. While the effect of biomaterial injection in reducing mechanical wall stress has been recently demonstrated, the influence of biomaterials on the electrical behavior of treated hearts has not been elucidated. In this work, we developed computational models of swine hearts to study the electrophysiological vulnerability associated with biomaterial injection therapy. The propagation of action potentials on realistic biventricular geometries was simulated by numerically solving the monodomain electrophysiology equations on anatomically-detailed models of normal, HF untreated, and HF treated hearts. Heart geometries were constructed from high-resolution magnetic resonance images (MRI) where the healthy, peri-infarcted, infarcted and gel regions were identified, and the orientation of cardiac fibers was informed from diffusion-tensor MRI. Regional restitution properties in each case were evaluated by constructing a probability density function of the action potential duration (APD) at different cycle lengths. A comparative analysis of the ventricular fibrillation (VF) dynamics for every heart was carried out by measuring the number of filaments formed after wave braking. Our results suggest that biomaterial injection therapy does not affect the regional dispersion of repolarization when comparing untreated and treated failing hearts. Further, we found that the treated failing heart is more prone to sustain VF than the normal heart, and is at least as susceptible to sustained VF as the untreated failing heart. Moreover, we show that the main features of VF dynamics in a treated failing heart are not affected by the level of electrical conductivity of the biogel injectates. This work represents a novel proof-of-concept study demonstrating the feasibility of computer simulations of the heart in understanding the arrhythmic behavior in novel therapies for HF.
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Affiliation(s)
- William A Ramírez
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alessio Gizzi
- Nonlinear Physics and Mathematical Modeling Lab, Department of Engineering, Campus Bio-Medico University of Rome, Rome, Italy
| | - Kevin L Sack
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Julius M Guccione
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Daniel E Hurtado
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
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31
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Sack KL, Aliotta E, Choy JS, Ennis DB, Davies NH, Franz T, Kassab GS, Guccione JM. Intra-myocardial alginate hydrogel injection acts as a left ventricular mid-wall constraint in swine. Acta Biomater 2020; 111:170-180. [PMID: 32428678 PMCID: PMC7368390 DOI: 10.1016/j.actbio.2020.04.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
Despite positive initial outcomes emerging from preclinical and early clinical investigation of alginate hydrogel injection therapy as a treatment for heart failure, the lack of knowledge about the mechanism of action remains a major shortcoming that limits the efficacy of treatment design. To identify the mechanism of action, we examined previously unobtainable measurements of cardiac function from in vivo, ex vivo, and in silico states of clinically relevant heart failure (HF) in large animals. High-resolution ex vivo magnetic resonance imaging and histological data were used along with state-of-the-art subject-specific computational model simulations. Ex vivo data were incorporated in detailed geometric computational models for swine hearts in health (n = 5), ischemic HF (n = 5), and ischemic HF treated with alginate hydrogel injection therapy (n = 5). Hydrogel injection therapy mitigated elongation of sarcomere lengths (1.68 ± 0.10μm [treated] vs. 1.78 ± 0.15μm [untreated], p<0.001). Systolic contractility in treated animals improved substantially (ejection fraction = 43.9 ± 2.8% [treated] vs. 34.7 ± 2.7% [untreated], p<0.01). The in silico models realistically simulated in vivo function with >99% accuracy and predicted small myofiber strain in the vicinity of the solidified hydrogel that was sustained for up to 13 mm away from the implant. These findings suggest that the solidified alginate hydrogel material acts as an LV mid-wall constraint that significantly reduces adverse LV remodeling compared to untreated HF controls without causing negative secondary outcomes to cardiac function. STATEMENT OF SIGNIFICANCE: Heart failure is considered a growing epidemic and hence an important health problem in the US and worldwide. Its high prevalence (5.8 million and 23 million, respectively) is expected to increase by 25% in the US alone by 2030. Heart failure is associated with high morbidity and mortality, has a 5-year mortality rate of 50%, and contributes considerably to the overall cost of health care ($53.1 billion in the US by 2030). Despite positive initial outcomes emerging from preclinical and early clinical investigation of alginate hydrogel injection therapy as a treatment for heart failure, the lack of knowledge concerning the mechanism of action remains a major shortcoming that limits the efficacy of treatment design. To understand the mechanism of action, we combined high-resolution ex vivo magnetic resonance imaging and histological data in swine with state-of-the-art subject-specific computational model simulations. The in silico models realistically simulated in vivo function with >99% accuracy and predicted small myofiber strain in the vicinity of the solidified hydrogel that was sustained for up to 13 mm away from the implant. These findings suggest that the solidified alginate hydrogel material acts as a left ventricular mid-wall constraint that significantly reduces adverse LV remodeling compared to untreated heart failure controls without causing negative secondary outcomes to cardiac function. Moreover, if the hydrogel can be delivered percutaneously rather than via the currently used open-chest procedure, this therapy may become routine for heart failure treatment. A minimally invasive procedure would be in the best interest of this patient population; i.e., one that cannot tolerate general anesthesia and surgery, and it would be significantly more cost-effective than surgery.
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Affiliation(s)
- Kevin L Sack
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California at San Francisco, Box 0118, UC Hall Room U-158, San Francisco, CA, United States; Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Eric Aliotta
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Jenny S Choy
- California Medical Innovations Institute, Inc., San Diego, California, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Neil H Davies
- Cardiovascular Research Unit, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Thomas Franz
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa; Bioengineering Science Research Group, Engineering Sciences, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - Ghassan S Kassab
- California Medical Innovations Institute, Inc., San Diego, California, USA
| | - Julius M Guccione
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California at San Francisco, Box 0118, UC Hall Room U-158, San Francisco, CA, United States.
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Estrada AC, Yoshida K, Clarke SA, Holmes JW. Longitudinal Reinforcement of Acute Myocardial Infarcts Improves Function by Transmurally Redistributing Stretch and Stress. J Biomech Eng 2020; 142:021009. [PMID: 31201738 PMCID: PMC7104755 DOI: 10.1115/1.4044030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 06/04/2019] [Indexed: 01/20/2023]
Abstract
A wide range of emerging therapies, from surgical restraint to biomaterial injection to tissue engineering, aim to improve heart function and limit adverse remodeling following myocardial infarction (MI). We previously showed that longitudinal surgical reinforcement of large anterior infarcts in dogs could significantly enhance systolic function without restricting diastolic function, but the underlying mechanisms for this improvement are poorly understood. The goal of this study was to construct a finite element model that could match our previously published data on changes in regional strains and left ventricular function following longitudinal surgical reinforcement, then use the model to explore potential mechanisms for the improvement in systolic function we observed. The model presented here, implemented in febio, matches all the key features of our experiments, including diastolic remodeling strains in the ischemic region, small shifts in the end-diastolic pressure-volume relationship (EDPVR), and large changes in the end-systolic pressure-volume relationship (ESPVR) in response to ischemia and to patch application. Detailed examination of model strains and stresses suggests that longitudinal reinforcement reduces peak diastolic fiber stretch and systolic fiber stress in the remote myocardium and shifts those peaks away from the endocardial surface by reshaping the left ventricle (LV). These findings could help to guide the development of novel therapies to improve post-MI function by providing specific design objectives.
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Affiliation(s)
- Ana Cristina Estrada
- Department of Biomedical Engineering, University of
Virginia, P.O. Box 800759, Health System,
Charlottesville, VA 22908
| | - Kyoko Yoshida
- Department of Biomedical Engineering, University of
Virginia, P.O. Box 800759, Health System,
Charlottesville, VA 22908
| | - Samantha A. Clarke
- Department of Biomedical Engineering, University of
Virginia, P.O. Box 800759, Health System,
Charlottesville, VA 22908
| | - Jeffrey W. Holmes
- Department of Biomedical Engineering, University of
Virginia, P.O. Box 800759, Health System,
Charlottesville, VA 22908; Department of Medicine, School of
Medicine, University of Virginia, P.O. Box
800759, Health System, Charlottesville, VA 22908; Robert M. Berne
Cardiovascular Research Center, University of Virginia,
P.O. Box 800759, Health System, Charlottesville, VA
22908; The Center for Engineering in Medicine, University
of Virginia, P.O. Box 800759, Health System,
Charlottesville, VA 22908
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Wu T, Cui C, Huang Y, Liu Y, Fan C, Han X, Yang Y, Xu Z, Liu B, Fan G, Liu W. Coadministration of an Adhesive Conductive Hydrogel Patch and an Injectable Hydrogel to Treat Myocardial Infarction. ACS APPLIED MATERIALS & INTERFACES 2020; 12:2039-2048. [PMID: 31859471 DOI: 10.1021/acsami.9b17907] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over the past decade, tissue-engineering strategies, mainly involving injectable hydrogels and epicardial biomaterial patches, have been pursued to treat myocardial infarction. However, only limited therapeutic efficacy is achieved with a single means. Here, a combined therapy approach is proposed, that is, the coadministration of a conductive hydrogel patch and injectable hydrogel to the infarcted myocardium. The self-adhesive conductive hydrogel patch is fabricated based on Fe3+-induced ionic coordination between dopamine-gelatin (GelDA) conjugates and dopamine-functionalized polypyrrole (DA-PPy), which form a homogeneous network. The injectable and cleavable hydrogel is formed in situ via a Schiff base reaction between oxidized sodium hyaluronic acid (HA-CHO) and hydrazided hyaluronic acid (HHA). Compared with a single-mode system, injecting the HA-CHO/HHA hydrogel intramyocardially followed by painting a conductive GelDA/DA-PPy hydrogel patch on the heart surface results in a more pronounced improvement of the cardiac function in terms of echocardiographical, histological, and angiogenic outcomes.
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Affiliation(s)
- Tengling Wu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
| | - Chunyan Cui
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
| | - Yuting Huang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Medical Experiment Center , Tianjin University of Traditional Chinese Medicine , Tianjin 300193 , China
| | - Yang Liu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
| | - Chuanchuan Fan
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
| | - Xiaoxu Han
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
| | - Yang Yang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
| | - Ziyang Xu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
| | - Bo Liu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
| | - Guanwei Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Medical Experiment Center , Tianjin University of Traditional Chinese Medicine , Tianjin 300193 , China
| | - Wenguang Liu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials , Tianjin University , Tianjin 300350 , China
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Norahan MH, Pourmokhtari M, Saeb MR, Bakhshi B, Soufi Zomorrod M, Baheiraei N. Electroactive cardiac patch containing reduced graphene oxide with potential antibacterial properties. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 104:109921. [DOI: 10.1016/j.msec.2019.109921] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/16/2019] [Accepted: 06/26/2019] [Indexed: 12/30/2022]
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Matsumura Y, Zhu Y, Jiang H, D'Amore A, Luketich SK, Charwat V, Yoshizumi T, Sato H, Yang B, Uchibori T, Healy KE, Wagner WR. Intramyocardial injection of a fully synthetic hydrogel attenuates left ventricular remodeling post myocardial infarction. Biomaterials 2019; 217:119289. [DOI: 10.1016/j.biomaterials.2019.119289] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 12/27/2022]
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Vogt L, Rivera LR, Liverani L, Piegat A, El Fray M, Boccaccini AR. Poly(ε-caprolactone)/poly(glycerol sebacate) electrospun scaffolds for cardiac tissue engineering using benign solvents. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 103:109712. [DOI: 10.1016/j.msec.2019.04.091] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/19/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022]
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Fan Y, Ronan W, Teh I, Schneider JE, Varela CE, Whyte W, McHugh P, Leen S, Roche E. A comparison of two quasi-static computational models for assessment of intra-myocardial injection as a therapeutic strategy for heart failure. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3213. [PMID: 31062508 DOI: 10.1002/cnm.3213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
Myocardial infarction, or heart attack, is the leading cause of mortality globally. Although the treatment of myocardial infarct has improved significantly, scar tissue that persists can often lead to increased stress and adverse remodeling of surrounding tissue and ultimately to heart failure. Intra-myocardial injection of biomaterials represents a potential treatment to attenuate remodeling, mitigate degeneration, and reverse the disease process in the tissue. In vivo experiments on animal models have shown functional benefits of this therapeutic strategy. However, a poor understanding of the optimal injection pattern, volume, and material properties has acted as a barrier to its widespread clinical adoption. In this study, we developed two quasistatic finite element simulations of the left ventricle to investigate the mechanical effect of intra-myocardial injection. The first model employed an idealized left ventricular geometry with rule-based cardiomyocyte orientation. The second model employed a subject-specific left ventricular geometry with cardiomyocyte orientation from diffusion tensor magnetic resonance imaging. Both models predicted cardiac parameters including ejection fraction, systolic wall thickening, and ventricular twist that matched experimentally reported values. All injection simulations showed cardiomyocyte stress attenuation, offering an explanation for the mechanical reinforcement benefit associated with injection. The study also enabled a comparison of injection location and the corresponding effect on cardiac performance at different stages of the cardiac cycle. While the idealized model has lower fidelity, it predicts cardiac function and differentiates the effects of injection location. Both models represent versatile in silico tools to guide optimal strategy in terms of injection number, volume, site, and material properties.
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Affiliation(s)
- Yiling Fan
- Mechanical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - William Ronan
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jurgen E Schneider
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Claudia E Varela
- Institute for Medical Engineering Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts
| | - William Whyte
- Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland (RCSI), Dublin, 2, Ireland
- Trinity Centre for Bioengineering, Trinity College Dublin (TCD), College Green, Dublin, 2, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, RCSI, NUIG & TCD, Dublin, 2, Ireland
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts
| | - Peter McHugh
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - Sean Leen
- Mechanical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - Ellen Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Institute for Medical Engineering Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Dabiri Y, Van der Velden A, Sack KL, Choy JS, Kassab GS, Guccione JM. Prediction of Left Ventricular Mechanics Using Machine Learning. FRONTIERS IN PHYSICS 2019; 7:117. [PMID: 31903394 PMCID: PMC6941671 DOI: 10.3389/fphy.2019.00117] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The goal of this paper was to provide a real-time left ventricular (LV) mechanics simulator using machine learning (ML). Finite element (FE) simulations were conducted for the LV with different material properties to obtain a training set. A hyperelastic fiber-reinforced material model was used to describe the passive behavior of the myocardium during diastole. The active behavior of the heart resulting from myofiber contractions was added to the passive tissue during systole. The active and passive properties govern the LV constitutive equation. These mechanical properties were altered using optimal Latin hypercube design of experiments to obtain training FE models with varied active properties (volume and pressure predictions) and varied passive properties (stress predictions). For prediction of LV pressures, we used eXtreme Gradient Boosting (XGboost) and Cubist, and XGBoost was used for predictions of LV pressures, volumes as well as LV stresses. The LV pressure and volume results obtained from ML were similar to FE computations. The ML results could capture the shape of LV pressure as well as LV pressure-volume loops. The results predicted by Cubist were smoother than those from XGBoost. The mean absolute errors were as follows: XGBoost volume: 1.734 ± 0.584 ml, XGBoost pressure: 1.544 ± 0.298 mmHg, Cubist volume: 1.495 ± 0.260 ml, Cubist pressure: 1.623 ± 0.191 mmHg, myofiber stress: 0.334 ± 0.228 kPa, cross myofiber stress: 0.075 ± 0.024 kPa, and shear stress: 0.050 ± 0.032 kPa. The simulation results show ML can predict LV mechanics much faster than the FE method. The ML model can be used as a tool to predict LV behavior. Training of our ML model based on a large group of subjects can improve its predictability for real world applications.
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Affiliation(s)
- Yaghoub Dabiri
- California Medical Innovations Institute, San Diego, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | | | - Kevin L. Sack
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Jenny S. Choy
- California Medical Innovations Institute, San Diego, CA, United States
| | - Ghassan S. Kassab
- California Medical Innovations Institute, San Diego, CA, United States
| | - Julius M. Guccione
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
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40
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Ngoepe M, Passos A, Balabani S, King J, Lynn A, Moodley J, Swanson L, Bezuidenhout D, Davies NH, Franz T. A Preliminary Computational Investigation Into the Flow of PEG in Rat Myocardial Tissue for Regenerative Therapy. Front Cardiovasc Med 2019; 6:104. [PMID: 31448288 PMCID: PMC6692440 DOI: 10.3389/fcvm.2019.00104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022] Open
Abstract
Myocardial infarction (MI), a type of cardiovascular disease, affects a significant proportion of people around the world. Traditionally, non-communicable chronic diseases were largely associated with aging populations in higher income countries. It is now evident that low- to middle-income countries are also affected and in these settings, younger individuals are at high risk. Currently, interventions for MI prolong the time to heart failure. Regenerative medicine and stem cell therapy have the potential to mitigate the effects of MI and to significantly improve the quality of life for patients. The main drawback with these therapies is that many of the injected cells are lost due to the vigorous motion of the heart. Great effort has been directed toward the development of scaffolds which can be injected alongside stem cells, in an attempt to improve retention and cell engraftment. In some cases, the scaffold alone has been seen to improve heart function. This study focuses on a synthetic polyethylene glycol (PEG) based hydrogel which is injected into the heart to improve left ventricular function following MI. Many studies in literature characterize PEG as a Newtonian fluid within a specified shear rate range, on the macroscale. The aim of the study is to characterize the flow of a 20 kDa PEG on the microscale, where the behavior is likely to deviate from macroscale flow patterns. Micro particle image velocimetry (μPIV) is used to observe flow behavior in microchannels, representing the gaps in myocardial tissue. The fluid exhibits non-Newtonian, shear-thinning behavior at this scale. Idealized two-dimensional computational fluid dynamics (CFD) models of PEG flow in microchannels are then developed and validated using the μPIV study. The validated computational model is applied to a realistic, microscopy-derived myocardial tissue model. From the realistic tissue reconstruction, it is evident that the myocardial flow region plays an important role in the distribution of PEG, and therefore, in the retention of material.
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Affiliation(s)
- Malebogo Ngoepe
- Department of Mechanical Engineering, University of Cape Town, Rondebosch, South Africa.,Wallenberg Research Centre, Stellenbosch Institute of Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | - Andreas Passos
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Jesse King
- Department of Mechanical Engineering, University of Cape Town, Rondebosch, South Africa
| | - Anastasia Lynn
- Department of Mechanical Engineering, University of Cape Town, Rondebosch, South Africa
| | - Jasanth Moodley
- Department of Mechanical Engineering, University of Cape Town, Rondebosch, South Africa
| | - Liam Swanson
- Department of Mechanical Engineering, University of Cape Town, Rondebosch, South Africa
| | - Deon Bezuidenhout
- Cardiovascular Research Unit, Department of Surgery, University of Cape Town, Observatory, South Africa
| | - Neil H Davies
- Cardiovascular Research Unit, Department of Surgery, University of Cape Town, Observatory, South Africa
| | - Thomas Franz
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Observatory, South Africa.,Bioengineering Science Research Group, Engineering Sciences, Faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom
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Dabiri Y, Sack K, Rebelo N, Wang P, Wang Y, Choy J, Kassab GS, Guccione J. Method for Calibration of Left Ventricle Material Properties using 3D Echocardiography Endocardial Strains. J Biomech Eng 2019; 141:2738327. [PMID: 31294752 DOI: 10.1115/1.4044215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 12/14/2022]
Abstract
We sought to calibrate mechanical properties of left ventricle (LV) based on 3D speckle tracking echocardiographic imaging data recorded from 16 segments defined by American Heart Association (AHA). The in vivo data were used to create finite element (FE) LV and biventricular (BV) models. The orientation of the fibers in the LV model was rule-based, but diffusion tensor magnetic resonance imaging (DT-MRI) data were used for the fiber directions in the BV model. A nonlinear fiber-reinforced constitutive equation was used to describe the passive behavior of the myocardium, whereas the active tension was described by a model based on tissue contraction (Tmax). Isight was used for optimization, which used Abaqus as the forward solver (Simulia, Providence, USA). The calibration of passive properties based on the end diastolic pressure volume relation (ED PVR) curve resulted in relatively good agreement (mean error = -0.04 ml). The difference between experimental and computational strains decreased after segmental strain metrics, rather than global metrics, were used for calibration: for the LV model, the mean difference reduced from 0.129 to 0.046 (circumferential) and from 0.076 to 0.059 (longitudinal); for the BV model, the mean difference nearly did not change in the circumferential direction (0.061) but reduced in the longitudinal direction from 0.076 to 0.055. The calibration of mechanical properties for myocardium can be improved using segmental strain metrics. The importance of realistic fiber orientation and geometry for modeling of the LV was shown.
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Affiliation(s)
- Yaghoub Dabiri
- Department of Surgery, University of California San Francisco, San Francisco, California, USA; University of California San Francisco, San Francisco, California; California Medical Innovations Institute, San Diego, California, USA; Full Mailing Address: 11107 Roselle Street Suite 211, San Diego, CA 92121
| | - Kevin Sack
- Department of Surgery, University of California San Francisco, San Francisco, California, USA; Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa; Full Mailing Address: Rm 7.26 Anatomy Building, University of Cape Town Medical Campus, Anzio Rd, Cape Town, 7925, South Africa
| | - Nuno Rebelo
- Member of ASME Nuno Rebelo Associates LLC, Fremont, California, USA; Full Mailing Address: 46709 Rancho Higuera Rd, Fremont, CA 94539, USA
| | - Peter Wang
- Dassault Systemes Simulia Corp, 1301 Atwood Avenue, Suite 101W, Johnston, RI 02919, USA; Full Mailing Address: 3979 Freedom Circle, Suite 750, Santa Clara, CA 95054
| | - Yunjie Wang
- Thornton Tomasetti, Cupertino, California, USA; Full Mailing Address: 19200 Stevens Creek Blvd, Suite 100, Cupertino, CA 95014
| | - Jenny Choy
- California Medical Innovations Institute, San Diego, California, USA; Full Mailing Address: 11107 Roselle Street Suite 201, San Diego, CA 92121
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, California, USA; Full Mailing Address: 11107 Roselle Street Suite 211, San Diego, CA 92121
| | - Julius Guccione
- Department of Surgery, University of California San Francisco, San Francisco, California, USA; Full Mailing Address: 4150 Clement St , San Francisco, CA 94121
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Avazmohammadi R, Soares JS, Li DS, Raut SS, Gorman RC, Sacks MS. A Contemporary Look at Biomechanical Models of Myocardium. Annu Rev Biomed Eng 2019; 21:417-442. [PMID: 31167105 PMCID: PMC6626320 DOI: 10.1146/annurev-bioeng-062117-121129] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Understanding and predicting the mechanical behavior of myocardium under healthy and pathophysiological conditions are vital to developing novel cardiac therapies and promoting personalized interventions. Within the past 30 years, various constitutive models have been proposed for the passive mechanical behavior of myocardium. These models cover a broad range of mathematical forms, microstructural observations, and specific test conditions to which they are fitted. We present a critical review of these models, covering both phenomenological and structural approaches, and their relations to the underlying structure and function of myocardium. We further explore the experimental and numerical techniques used to identify the model parameters. Next, we provide a brief overview of continuum-level electromechanical models of myocardium, with a focus on the methods used to integrate the active and passive components of myocardial behavior. We conclude by pointing to future directions in the areas of optimal form as well as new approaches for constitutive modeling of myocardium.
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Affiliation(s)
- Reza Avazmohammadi
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and Department of Biomedical Engineering, University of Texas, Austin, Texas 78712, USA;
| | - João S Soares
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and Department of Biomedical Engineering, University of Texas, Austin, Texas 78712, USA;
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, Virginia 23284, USA
| | - David S Li
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and Department of Biomedical Engineering, University of Texas, Austin, Texas 78712, USA;
| | - Samarth S Raut
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and Department of Biomedical Engineering, University of Texas, Austin, Texas 78712, USA;
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Michael S Sacks
- James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, and Department of Biomedical Engineering, University of Texas, Austin, Texas 78712, USA;
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43
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Browne S, Healy KE. Matrix-assisted cell transplantation for tissue vascularization. Adv Drug Deliv Rev 2019; 146:155-169. [PMID: 30605738 DOI: 10.1016/j.addr.2018.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/30/2018] [Accepted: 12/27/2018] [Indexed: 12/20/2022]
Abstract
Cell therapy offers much promise for the treatment of ischemic diseases by augmenting tissue vasculogenesis. Matrix-assisted cell transplantation (MACT) has been proposed as a solution to enhance cell survival and integration with host tissue following transplantation. By designing semi synthetic matrices (sECM) with the correct physical and biochemical signals, encapsulated cells are directed towards a more angiogenic phenotype. In this review, we describe the choice of cells suitable for pro-angiogenic therapies, the properties that should be considered when designing sECM for transplantation and their relative importance. Pre-clinical models where MACT has been successfully applied to promote angiogenesis are reviewed to show the great potential of this strategy to treat ischemic conditions.
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Affiliation(s)
- Shane Browne
- Department of Bioengineering, University of California, Berkeley, CA 94720, USA; Department of Materials Science and Engineering, University of California, Berkeley, CA 94720, USA; Centre for Research in Medical Devices (CÚRAM), National University of Ireland, Galway, Ireland
| | - Kevin E Healy
- Department of Bioengineering, University of California, Berkeley, CA 94720, USA; Department of Materials Science and Engineering, University of California, Berkeley, CA 94720, USA.
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Kambe Y, Yamaoka T. Biodegradation of injectable silk fibroin hydrogel prevents negative left ventricular remodeling after myocardial infarction. Biomater Sci 2019; 7:4153-4165. [DOI: 10.1039/c9bm00556k] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Random collagen fiber networks formed by a slowly degrading silk fibroin hydrogel injection prevented left ventricular enlargement after myocardial infarction.
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Affiliation(s)
- Yusuke Kambe
- Department of Biomedical Engineering
- National Cerebral and Cardiovascular Center (NCVC) Research Institute
- Suita
- Japan
| | - Tetsuji Yamaoka
- Department of Biomedical Engineering
- National Cerebral and Cardiovascular Center (NCVC) Research Institute
- Suita
- Japan
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Dabiri Y, Sack KL, Shaul S, Acevedo-Bolton G, Choy JS, Kassab GS, Guccione JM. Intramyocardial Injections to De-Stiffen the Heart: A Subject-Specific in Silico Approach. MOLECULAR & CELLULAR BIOMECHANICS : MCB 2019; 16:185-197. [PMID: 32063808 PMCID: PMC7020624 DOI: 10.32604/mcb.2019.07364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We hypothesized that minimally invasive injections of a softening agent at strategic locations in stiff myocardium could de-stiffen the left ventricle (LV) globally. Physics-based finite element models of the LV were created from LV echocardiography images and pressures recorded during experiments in four swine. Results confirmed animal models of LV softening by systemic agents. Regional de-stiffening of myocardium led to global de-stiffening of LV. The mathematical set up was used to design LV global de-stiffening by regional softening of myocardium. At an end diastolic pressure of 23 mmHg, when 8 ml of the free wall was covered by intramyocardial injections, end diastolic volume (EDV) increased by 15.0%, whereas an increase up to 11 ml due to intramyocardial injections in the septum and free wall led to a 26.0% increase in EDV. Although the endocardial intramyocardial injections occupied a lower LV wall volume, they led to an EDV (44 ml) that was equal compared to intramyocardial injections in the mid-wall (44 ml) and larger compared to intramyocardial injections in the epicardium (41 ml). Using an in silico set up, sites of regional myocardium de-stiffening could be planned in order to globally soften overly stiff LV in heart failure with preserved ejection fraction. This novel treatment is built on subject-specific data. Hypothesis-testing of these simulation findings in animal models is warranted.
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Affiliation(s)
- Yaghoub Dabiri
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
- California Medical Innovations Institute, San Diego, California, USA
| | - Kevin L. Sack
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Semion Shaul
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Gabriel Acevedo-Bolton
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jenny S. Choy
- California Medical Innovations Institute, San Diego, California, USA
| | - Ghassan S. Kassab
- California Medical Innovations Institute, San Diego, California, USA
| | - Julius M. Guccione
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
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Niu H, Li X, Li H, Fan Z, Ma J, Guan J. Thermosensitive, fast gelling, photoluminescent, highly flexible, and degradable hydrogels for stem cell delivery. Acta Biomater 2019; 83:96-108. [PMID: 30541703 PMCID: PMC6296825 DOI: 10.1016/j.actbio.2018.10.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 12/30/2022]
Abstract
Stem cell therapy is a promising approach to regenerate ischemic cardiovascular tissues yet experiences low efficacy. One of the major causes is inferior cell retention in tissues. Injectable cell carriers that can quickly solidify upon injection into tissues so as to immediately increase viscosity have potential to largely improve cell retention. A family of injectable, fast gelling, and thermosensitive hydrogels were developed for delivering stem cells into heart and skeletal muscle tissues. The hydrogels were also photoluminescent with low photobleaching, allowing for non-invasively tracking hydrogel biodistribution and retention by fluorescent imaging. The hydrogels were polymerized by N-isopropylacrylamide (NIPAAm), 2-hydroxyethyl methacrylate (HEMA), 1-vinyl-2-pyrrolidinone (VP), and acrylate-oligolactide (AOLA), followed by conjugation with hypericin (HYP). The hydrogel solutions had thermal transition temperatures around room temperature, and were readily injectable at 4 °C. The solutions were able to quickly solidify within 7 s at 37 °C. The formed gels were highly flexible possessing similar moduli as the heart and skeletal muscle tissues. In vitro, hydrogel fluorescence intensity decreased proportionally to weight loss. After being injected into thigh muscles, the hydrogel can be detected by an in vivo imaging system for 4 weeks. The hydrogels showed excellent biocompatibility in vitro and in vivo, and can stimulate mesenchymal stem cell (MSC) proliferation and paracrine effects. The fast gelling hydrogel remarkably increased MSC retention in thigh muscles compared to slow gelling collagen, and non-gelling PBS. These hydrogels have potential to efficiently deliver stem cells into tissues. Hydrogel degradation can be non-invasively and real-time tracked. STATEMENT OF SIGNIFICANCE: Low cell retention in tissues represents one of the major causes for limited therapeutic efficacy in stem cell therapy. A family of injectable, fast gelling, and thermosensitive hydrogels that can quickly solidify upon injection into tissues were developed to improve cell retention. The hydrogels were also photoluminescent, allowing for non-invasively and real-time tracking hydrogel biodistribution and retention by fluorescent imaging.
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Affiliation(s)
- Hong Niu
- Department of Materials Science and Engineering, The Ohio State University, 2041 College Road, Columbus, OH, USA
| | - Xiaofei Li
- Department of Materials Science and Engineering, The Ohio State University, 2041 College Road, Columbus, OH, USA
| | - Haichang Li
- Department of Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Zhaobo Fan
- Department of Materials Science and Engineering, The Ohio State University, 2041 College Road, Columbus, OH, USA
| | - Jianjie Ma
- Department of Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Jianjun Guan
- Department of Materials Science and Engineering, The Ohio State University, 2041 College Road, Columbus, OH, USA; Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA.
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Curley CJ, Dolan EB, Otten M, Hinderer S, Duffy GP, Murphy BP. An injectable alginate/extra cellular matrix (ECM) hydrogel towards acellular treatment of heart failure. Drug Deliv Transl Res 2018; 9:1-13. [DOI: 10.1007/s13346-018-00601-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Efficacy of intramyocardial injection of Algisyl-LVR for the treatment of ischemic heart failure in swine. Int J Cardiol 2018; 255:129-135. [PMID: 29425550 DOI: 10.1016/j.ijcard.2017.09.179] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/15/2017] [Accepted: 09/20/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Progressive thinning and dilation of the LV due to ischemic heart failure (IHF) increases wall stress and myocardial oxygen consumption. Injectable biopolymers implanted in the myocardial wall have been used to increase wall thickness to reduce chamber volume, decrease wall stress, and improve cardiac function. We sought to evaluate the efficacy of a biopolymer (Algisyl-LVR) to prevent left ventricular (LV) remodeling in a swine model of IHF. METHODS IHF was induced in 11 swine by occluding the marginal obtuse branches of the left circumflex artery. Eight weeks later, Algisyl-LVR was injected into the LV myocardial free wall in five of the 11 animals. Echocardiographic examinations were done every 2weeks for 16weeks. RESULTS Within eight weeks of treatment, the ejection fraction increased from 30.5%±7.7% to 42.4%±3.5% (treated group) vs. 37.3%±3.8% to 34.3%±2.9% (control), p<0.01. Stroke volume increased from 18.5±9.3mL to 41.3±13.3mL (treated group) vs. 25.4±2.3mL to 31.4±5.3mL (control), p<0.05. Wall thickness in end-diastole of the infarcted region changed from 0.69±0.06cm to 0.81±0.13cm (treated group) vs. 0.73±0.09cm to 0.68±0.11cm (control), p<0.05. Sphericity index remained almost unchanged after treatment, although differences were found at the end of the study between both groups (p<0.001). Average myofiber stress changed from 16.3±5.8kPa to 10.2±4.0kPa (treated group) vs. 15.2±4.8kPa to 17.9±5.6kPa (control), p<0.05. CONCLUSIONS Algisyl-LVR is an effective strategy that serves as a micro-LV assist device to reduce stress and hence prevent or reverse maladaptive cardiac remodeling caused by IHF in swine.
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Ahmad F, Prabhu RJ, Liao J, Soe S, Jones MD, Miller J, Berthelson P, Enge D, Copeland KM, Shaabeth S, Johnston R, Maconochie I, Theobald PS. Biomechanical properties and microstructure of neonatal porcine ventricles. J Mech Behav Biomed Mater 2018; 88:18-28. [PMID: 30118921 DOI: 10.1016/j.jmbbm.2018.07.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 12/29/2022]
Abstract
Neonatal heart disorders represent a major clinical challenge, with congenital heart disease alone affecting 36,000 new-borns annually within the European Union. Surgical intervention to restore normal function includes the implantation of synthetic and biological materials; however, a lack of experimental data describing the mechanical behaviour of neonatal cardiac tissue is likely to contribute to the relatively poor short- and long-term outcome of these implants. This study focused on characterising the mechanical behaviour of neonatal cardiac tissue using a porcine model, to enhance the understanding of how this differs to the equivalent mature tissue. The biomechanical properties of neonatal porcine cardiac tissue were characterised by uniaxial tensile, biaxial tensile, and simple shear loading modes, using samples collected from the anterior and posterior walls of the right and left ventricles. Histological images were prepared using Masson's trichrome staining, to enable assessment of the microstructure and correlation with tissue behaviour. The mechanical tests demonstrated that the neonatal cardiac tissue is non-linear, anisotropic, viscoelastic and heterogeneous. Our data provide a baseline describing the biomechanical behaviour of immature porcine cardiac tissue. Comparison with published data also indicated that the neonatal porcine cardiac tissue exhibits one-half the stiffness of mature porcine tissue in uniaxial extension testing, one-third in biaxial extension testing, and one-fourth stiffness in simple shear testing; hence, it provides an indication as to the relative change in characteristics associated with tissue maturation. These data may prove valuable to researchers investigating neonatal cardiac mechanics.
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Affiliation(s)
| | - Ra J Prabhu
- Centre for Advanced Vehicular Systems and Department of Biological Engineering, Mississippi State University, USA
| | - Jun Liao
- Centre for Advanced Vehicular Systems and Department of Biological Engineering, Mississippi State University, USA; Department of Bioengineering, The University of Texas at Arlington, USA.
| | - Shwe Soe
- School of Engineering, Cardiff University, UK
| | | | - Jonathan Miller
- Centre for Advanced Vehicular Systems and Department of Biological Engineering, Mississippi State University, USA
| | - Parker Berthelson
- Centre for Advanced Vehicular Systems and Department of Biological Engineering, Mississippi State University, USA
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Córdova Aquino J, Medellín-Castillo HI. Analysis of the influence of modelling assumptions on the prediction of the elastic properties of cardiac fibres. Comput Methods Biomech Biomed Engin 2018; 21:601-615. [DOI: 10.1080/10255842.2018.1502279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jacobo Córdova Aquino
- Facultad de Ingeniería, Universidad Autónoma de San Luis Potosí, México
- Disión de la DESICA, Universidad Popular de la Chontalpa, Tabasco, México
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