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Brecs I, Skuja S, Kasyanov V, Groma V, Kalejs M, Svirskis S, Ozolanta I, Stradins P. From Biomechanical Properties to Morphological Variations: Exploring the Interplay between Aortic Valve Cuspidity and Ascending Aortic Aneurysm. J Clin Med 2024; 13:4225. [PMID: 39064264 PMCID: PMC11277922 DOI: 10.3390/jcm13144225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Background: This research explores the biomechanical and structural characteristics of ascending thoracic aortic aneurysms (ATAAs), focusing on the differences between bicuspid aortic valve aneurysms (BAV-As) and tricuspid aortic valve aneurysms (TAV-As) with non-dilated aortas to identify specific traits of ATAAs. Methods: Clinical characteristics, laboratory indices, and imaging data from 26 adult patients operated on for aneurysms (BAV-A: n = 12; TAV-A: n = 14) and 13 controls were analyzed. Biomechanical parameters (maximal aortic diameter, strain, and stress) and structural analyses (collagen fiber organization, density, fragmentation, adipocyte deposits, and immune cell infiltration) were assessed. Results: Significant differences in biomechanical parameters were observed. Median maximal strain was 40.0% (control), 63.4% (BAV-A), and 45.3% (TAV-A); median maximal stress was 0.59 MPa (control), 0.78 MPa (BAV-A), and 0.48 MPa (TAV-A). BAV-A showed higher tangential modulus and smaller diameter, with substantial collagen fragmentation (p < 0.001 vs. TAV and controls). TAV-A exhibited increased collagen density (p = 0.025), thickening between media and adventitia layers, and disorganized fibers (p = 0.036). BAV-A patients had elevated adipocyte deposits and immune cell infiltration. Conclusions: This study highlights distinct pathological profiles associated with different valve anatomies. BAV-A is characterized by smaller diameters, higher biomechanical stress, and significant collagen deterioration, underscoring the necessity for tailored clinical strategies for effective management of thoracic aortic aneurysm.
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Affiliation(s)
- Ivars Brecs
- Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (V.K.); (M.K.); (I.O.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Sandra Skuja
- Joint Laboratory of Electron Microscopy, Riga Stradins University, 9 Kronvalda Boulevard, LV-1010 Riga, Latvia; (S.S.); (V.G.)
| | - Vladimir Kasyanov
- Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (V.K.); (M.K.); (I.O.); (P.S.)
- Laboratory of Biomechanics, Riga Stradins University, 5a Ratsupites Street, LV-1067 Riga, Latvia
| | - Valerija Groma
- Joint Laboratory of Electron Microscopy, Riga Stradins University, 9 Kronvalda Boulevard, LV-1010 Riga, Latvia; (S.S.); (V.G.)
| | - Martins Kalejs
- Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (V.K.); (M.K.); (I.O.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Simons Svirskis
- Institute of Microbiology and Virology, Riga Stradins University, 5 Ratsupites Street, LV-1067 Riga, Latvia;
| | - Iveta Ozolanta
- Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (V.K.); (M.K.); (I.O.); (P.S.)
- Laboratory of Biomechanics, Riga Stradins University, 5a Ratsupites Street, LV-1067 Riga, Latvia
| | - Peteris Stradins
- Faculty of Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia; (V.K.); (M.K.); (I.O.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
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2
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Yang Y, Feng H, Tang Y, Wang Z, Qiu P, Huang X, Chang L, Zhang J, Chen YE, Mizrak D, Yang B. Bioengineered vascular grafts with a pathogenic TGFBR1 variant model aneurysm formation in vivo and reveal underlying collagen defects. Sci Transl Med 2024; 16:eadg6298. [PMID: 38718134 PMCID: PMC11193908 DOI: 10.1126/scitranslmed.adg6298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/17/2024] [Indexed: 05/30/2024]
Abstract
Thoracic aortic aneurysm (TAA) is a life-threatening vascular disease frequently associated with underlying genetic causes. An inadequate understanding of human TAA pathogenesis highlights the need for better disease models. Here, we established a functional human TAA model in an animal host by combining human induced pluripotent stem cells (hiPSCs), bioengineered vascular grafts (BVGs), and gene editing. We generated BVGs from isogenic control hiPSC-derived vascular smooth muscle cells (SMCs) and mutant SMCs gene-edited to carry a Loeys-Dietz syndrome (LDS)-associated pathogenic variant (TGFBR1A230T). We also generated hiPSC-derived BVGs using cells from a patient with LDS (PatientA230T/+) and using genetically corrected cells (Patient+/+). Control and experimental BVGs were then implanted into the common carotid arteries of nude rats. The TGFBR1A230T variant led to impaired mechanical properties of BVGs, resulting in lower burst pressure and suture retention strength. BVGs carrying the variant dilated over time in vivo, resembling human TAA formation. Spatial transcriptomics profiling revealed defective expression of extracellular matrix (ECM) formation genes in PatientA230T/+ BVGs compared with Patient+/+ BVGs. Histological analysis and protein assays validated quantitative and qualitative ECM defects in PatientA230T/+ BVGs and patient tissue, including decreased collagen hydroxylation. SMC organization was also impaired in PatientA230T/+ BVGs as confirmed by vascular contraction testing. Silencing of collagen-modifying enzymes with small interfering RNAs reduced collagen proline hydroxylation in SMC-derived tissue constructs. These studies demonstrated the utility of BVGs to model human TAA formation in an animal host and highlighted the role of reduced collagen modifying enzyme activity in human TAA formation.
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MESH Headings
- Animals
- Humans
- Receptor, Transforming Growth Factor-beta Type I/metabolism
- Receptor, Transforming Growth Factor-beta Type I/genetics
- Induced Pluripotent Stem Cells/metabolism
- Collagen/metabolism
- Blood Vessel Prosthesis
- Aortic Aneurysm, Thoracic/genetics
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/metabolism
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Rats, Nude
- Disease Models, Animal
- Rats
- Bioengineering
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Gene Editing
- Loeys-Dietz Syndrome/genetics
- Loeys-Dietz Syndrome/pathology
- Male
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Affiliation(s)
- Ying Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hao Feng
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
- Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Ying Tang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
- Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Zhenguo Wang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ping Qiu
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Xihua Huang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lin Chang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jifeng Zhang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yuqing Eugene Chen
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Dogukan Mizrak
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
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Gaye B, Vignac M, Gådin JR, Ladouceur M, Caidahl K, Olsson C, Franco-Cereceda A, Eriksson P, Björck HM. Predictive machine learning models for ascending aortic dilatation in patients with bicuspid and tricuspid aortic valves undergoing cardiothoracic surgery: a prospective, single-centre and observational study. BMJ Open 2024; 14:e067977. [PMID: 38508639 PMCID: PMC10961501 DOI: 10.1136/bmjopen-2022-067977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The objective of this study was to develop clinical classifiers aiming to identify prevalent ascending aortic dilatation in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). DESIGN AND SETTING A prospective, single-centre and observational cohort. PARTICIPANTS The study involved 543 BAV and 491 TAV patients with aortic valve disease and/or ascending aortic dilatation, excluding those with coronary artery disease, undergoing cardiothoracic surgery at the Karolinska University Hospital (Sweden). MAIN OUTCOME MEASURES Predictors of high risk of ascending aortic dilatation (defined as ascending aorta with a diameter above 40 mm) were identified through the application of machine learning algorithms and classic logistic regression models. EXPOSURES Comprehensive multidimensional data, including valve morphology, clinical information, family history of cardiovascular diseases, prevalent diseases, demographic details, lifestyle factors, and medication. RESULTS BAV patients, with an average age of 60.4±12.4 years, showed a higher frequency of aortic dilatation (45.3%) compared with TAV patients, who had an average age of 70.4±9.1 years (28.9% dilatation, p <0.001). Aneurysm prediction models for TAV patients exhibited mean area under the receiver-operating-characteristic curve (AUC) values above 0.8, with the absence of aortic stenosis being the primary predictor, followed by diabetes and high-sensitivity C reactive protein. Conversely, prediction models for BAV patients resulted in AUC values between 0.5 and 0.55, indicating low usefulness for predicting aortic dilatation. Classification results remained consistent across all machine learning algorithms and classic logistic regression models. CONCLUSION AND RECOMMENDATION Cardiovascular risk profiles appear to be more predictive of aortopathy in TAV patients than in patients with BAV. This adds evidence to the fact that BAV-associated and TAV-associated aortopathy involves different pathways to aneurysm formation and highlights the need for specific aneurysm preventions in these patients. Further, our results highlight that machine learning approaches do not outperform classical prediction methods in addressing complex interactions and non-linear relations between variables.
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Affiliation(s)
- Bamba Gaye
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maxime Vignac
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jesper R Gådin
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Kenneth Caidahl
- Clinical Physiology Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Christian Olsson
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per Eriksson
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna M Björck
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Freiholtz D, Bergman O, Lång K, Poujade FA, Paloschi V, Granath C, Lindeman JHN, Olsson C, Franco-Cereceda A, Eriksson P, Björck HM. Bicuspid aortic valve aortopathy is characterized by embryonic epithelial to mesenchymal transition and endothelial instability. J Mol Med (Berl) 2023; 101:801-811. [PMID: 37162557 PMCID: PMC10299957 DOI: 10.1007/s00109-023-02316-5] [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: 12/15/2022] [Revised: 02/24/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart malformation frequently associated with ascending aortic aneurysm (AscAA). Epithelial to mesenchymal transition (EMT) may play a role in BAV-associated AscAA. The aim of the study was to investigate the type of EMT associated with BAV aortopathy using patients with a tricuspid aortic valve (TAV) as a reference. The state of the endothelium was further evaluated. Aortic biopsies were taken from patients undergoing open-heart surgery. Aortic intima/media miRNA and gene expression was analyzed using Affymetrix human transcriptomic array. Histological staining assessed structure, localization, and protein expression. Migration/proliferation was assessed using ORIS migration assay. We show different EMT types associated with BAV and TAV AscAA. Specifically, in BAV-associated aortopathy, EMT genes related to endocardial cushion formation were enriched. Further, BAV vascular smooth muscle cells were less proliferative and migratory. In contrast, TAV aneurysmal aortas displayed a fibrotic EMT phenotype with medial degenerative insults. Further, non-dilated BAV aortas showed a lower miRNA-200c-associated endothelial basement membrane LAMC1 expression and lower CD31 expression, accompanied by increased endothelial permeability indicated by increased albumin infiltration. Embryonic EMT is a characteristic of BAV aortopathy, associated with endothelial instability and vascular permeability of the non-dilated aortic wall. KEY MESSAGES: Embryonic EMT is a feature of BAV-associated aortopathy. Endothelial integrity is compromised in BAV aortas prior to dilatation. Non-dilated BAV ascending aortas are more permeable than aortas of tricuspid aortic valve patients.
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Affiliation(s)
- David Freiholtz
- Section of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Otto Bergman
- Division of Cardiovascular Medicine, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm Solna, Sweden
| | - Karin Lång
- Division of Cardiovascular Medicine, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm Solna, Sweden
| | - Flore-Anne Poujade
- Division of Cardiovascular Medicine, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm Solna, Sweden
| | - Valentina Paloschi
- Division of Cardiovascular Medicine, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm Solna, Sweden
| | - Carl Granath
- Section of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan H N Lindeman
- Department of Vascular Surgery, Department of Surgery, Medical Center Leiden, Leiden University, Leiden, the Netherlands
| | - Christian Olsson
- Section of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Section of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per Eriksson
- Division of Cardiovascular Medicine, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm Solna, Sweden
| | - Hanna M Björck
- Division of Cardiovascular Medicine, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm Solna, Sweden.
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5
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Bergeron A, Hertig V, Villeneuve L, Sirois MG, Demers P, El-Hamamsy I, Calderone A. Structural dysregulation of the pulmonary autograft was associated with a greater density of p16 INK4A-vascular smooth muscle cells. Cardiovasc Pathol 2023; 63:107512. [PMID: 36529416 DOI: 10.1016/j.carpath.2022.107512] [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: 09/16/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The present study tested the hypothesis that a senescent phenotype of vascular smooth muscle cells (VSMCs) may represent the seminal event linked to maladaptive pulmonary autograft remodeling of a small number of patients that underwent the Ross procedure. The diameter of the pulmonary autograft (47±4 mm) of three male patients was significantly greater compared to the pulmonary artery (26±1 mm) excised from bicuspid aortic valve (BAV) patients. The pulmonary autograft was associated with a neointimal region and the adjacent medial region was significantly thinner compared to the pulmonary artery of BAV patients. Structural dysregulation was evident as elastin content of the medial region was significantly reduced in the pulmonary autograft compared to the pulmonary artery of BAV patients. By contrast, collagen content of the medial region of the pulmonary autograft and the pulmonary artery of BAV patients was not significantly different. Reduced medial elastin content of the pulmonary autograft was associated with increased protein levels of matrix metalloproteinase-9. The latter phenotype was not attributed to a robust inflammatory response as the percentage of Mac-2(+)-infiltrating monocytes/macrophages was similar between groups. A senescent phenotype was identified as protein levels of the cell cycle inhibitor p27kip1 were upregulated and the density of p16INK4A/non-muscle myosin IIB(+)-VSMCs was significantly greater in the pulmonary autograft compared to the pulmonary artery of BAV patients. Thus, senescent VSMCs may represent the predominant cellular source of increased matrix metalloproteinase-9 protein expression translating to maladaptive pulmonary autograft remodeling characterized by elastin degradation, medial thinning and neointimal formation.
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Affiliation(s)
- Alexandre Bergeron
- Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Vanessa Hertig
- Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Louis Villeneuve
- Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Martin G Sirois
- Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Department of Pharmacology & Physiology, Université de Montréal, Quebec, Montreal, Canada
| | - Philippe Demers
- Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Department of Cardiac Surgery, Université de Montréal, Montreal, Quebec Canada
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Angelino Calderone
- Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Department of Pharmacology & Physiology, Université de Montréal, Quebec, Montreal, Canada.
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6
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He Y, Chen Y, Yao L, Wang J, Sha X, Wang Y. The Inflamm-Aging Model Identifies Key Risk Factors in Atherosclerosis. Front Genet 2022; 13:865827. [PMID: 35706446 PMCID: PMC9191626 DOI: 10.3389/fgene.2022.865827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Atherosclerosis, one of the main threats to human life and health, is driven by abnormal inflammation (i.e., chronic inflammation or oxidative stress) during accelerated aging. Many studies have shown that inflamm-aging exerts a significant impact on the occurrence of atherosclerosis, particularly by inducing an immune homeostasis imbalance. However, the potential mechanism by which inflamm-aging induces atherosclerosis needs to be studied more thoroughly, and there is currently a lack of powerful prediction models.Methods: First, an improved inflamm-aging prediction model was constructed by integrating aging, inflammation, and disease markers with the help of machine learning methods; then, inflamm-aging scores were calculated. In addition, the causal relationship between aging and disease was identified using Mendelian randomization. A series of risk factors were also identified by causal analysis, sensitivity analysis, and network analysis.Results: Our results revealed an accelerated inflamm-aging pattern in atherosclerosis and suggested a causal relationship between inflamm-aging and atherosclerosis. Mechanisms involving inflammation, nutritional balance, vascular homeostasis, and oxidative stress were found to be driving factors of atherosclerosis in the context of inflamm-aging.Conclusion: In summary, we developed a model integrating crucial risk factors in inflamm-aging and atherosclerosis. Our computation pipeline could be used to explore potential mechanisms of related diseases.
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Affiliation(s)
- Yudan He
- Department of Biomedical Engineering, School of Intelligent Sciences, China Medical University, Shenyang, China
| | - Yao Chen
- Department of Biomedical Engineering, School of Intelligent Sciences, China Medical University, Shenyang, China
| | - Lilin Yao
- Department of Biomedical Engineering, School of Intelligent Sciences, China Medical University, Shenyang, China
| | - Junyi Wang
- Department of Biomedical Engineering, School of Intelligent Sciences, China Medical University, Shenyang, China
| | - Xianzheng Sha
- Department of Biomedical Engineering, School of Intelligent Sciences, China Medical University, Shenyang, China
| | - Yin Wang
- Department of Biomedical Engineering, School of Intelligent Sciences, China Medical University, Shenyang, China
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Yin Wang,
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7
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Bergeron A, Hertig V, Villeneuve L, Chauvette V, El‐Hamamsy I, Calderone A. The ascending aorta of male hypertensive bicuspid aortic valve patients preferentially associated with a cellular aneurysmal phenotype. Physiol Rep 2022; 10:e15251. [PMID: 35439345 PMCID: PMC9017972 DOI: 10.14814/phy2.15251] [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] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 05/10/2023] Open
Abstract
Male sex and hypertension represent risk factors in the progression of an aortic aneurysm. The present study examined the morphological/cellular phenotype of the ascending aorta (AA) of male and female patients diagnosed with a bicuspid aortic valve (BAV) to test the hypothesis that hypertension-induced remodeling of male BAV patients preferentially recapitulated the expression of a panel of proteins favoring aneurysm formation. The diameter of the AA of hypertensive male (35 ± 6 mm) and female (39 ± 5 mm) BAV patients was comparable to normotensive patients reflecting an early phase of vessel expansion. Morphological/structural remodeling of the medial region of the AA of male normotensive and hypertensive BAV patients were comparable. Protein levels of non-muscle myosin IIB, the cell cycle inhibitor p27kip1, tumor suppressor p53 and matrix metalloproteinase-2 and -9 were significantly upregulated in the AA of male hypertensive BAV patients. In female hypertensive BAV patients, collagen content was significantly increased whereas elastin content and medial width of the AA were similar to normotensive BAV patients. In the AA of female hypertensive BAV patients, matrix metalloproteinase-9 and p27kip1 protein levels were unchanged whereas p53 and matrix metalloproteinase-2 protein expression was significantly reduced. Nestin protein levels were diminished in the AA of male and female hypertensive BAV patients. Thus, sexual dimorphic remodeling of the AA was prevalent in hypertensive BAV patients. Moreover, during the early phase of vessel expansion, the AA of male hypertensive BAV patients was preferentially associated with the upregulation of a panel of proteins linked to progressive dilatation and potential aneurysm formation.
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Affiliation(s)
- Alexandre Bergeron
- Research CenterMontreal Heart Institute and Université de MontréalMontrealQuebecCanada
| | - Vanessa Hertig
- Research CenterMontreal Heart Institute and Université de MontréalMontrealQuebecCanada
| | - Louis Villeneuve
- Research CenterMontreal Heart Institute and Université de MontréalMontrealQuebecCanada
| | - Vincent Chauvette
- Research CenterMontreal Heart Institute and Université de MontréalMontrealQuebecCanada
- Department of Cardiac SurgeryUniversité de MontréalMontrealQuebecCanada
| | - Ismail El‐Hamamsy
- Department of Cardiovascular SurgeryIcahn School of Medicine at Mount SinaiMount Sinai HospitalNew YorkNew YorkUSA
| | - Angelino Calderone
- Research CenterMontreal Heart Institute and Université de MontréalMontrealQuebecCanada
- Department of Pharmacology & PhysiologyUniversité de MontréalQuebecMontrealCanada
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8
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Koenig SN, Cavus O, Williams J, Bernier M, Tonniges J, Sucharski H, Dew T, Akel M, Baker P, Madiai F, De Giorgi F, Scietti L, Faravelli S, Forneris F, Mohler PJ, Bradley EA. New mechanistic insights to PLOD1-mediated human vascular disease. Transl Res 2022; 239:1-17. [PMID: 34400365 PMCID: PMC8671190 DOI: 10.1016/j.trsl.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
Heritable thoracic aortic disease and familial thoracic aortic aneurysm/dissection are important causes of human morbidity/mortality, most without identifiable genetic cause. In a family with familial thoracic aortic aneurysm/dissection, we identified a missense p. (Ser178Arg) variant in PLOD1 segregating with disease, and evaluated PLOD1 enzymatic activity, collagen characteristics and in human aortic vascular smooth muscle cells, studied the effect on function. Comparison with homologous PLOD3 enzyme indicated that the pathogenic variant may affect the N-terminal glycosyltransferase domain, suggesting unprecedented PLOD1 activity. In vitro assays demonstrated that wild-type PLOD1 is capable of processing UDP-glycan donor substrates, and that the variant affects the folding stability of the glycosyltransferase domain and associated enzymatic functions. The PLOD1 substrate lysine was elevated in the proband, however the enzymatic product hydroxylysine and total collagen content was not different, albeit despite collagen fibril narrowing and preservation of collagen turnover. In VSMCs overexpressing wild-type PLOD1, there was upregulation in procollagen gene expression (secretory function) which was attenuated in the variant, consistent with loss-of-function. In comparison, si-PLOD1 cells demonstrated hypercontractility and upregulation of contractile markers, providing evidence for phenotypic switching. Together, the findings suggest that the PLOD1 product is preserved, however newly identified glucosyltransferase activity of PLOD1 appears to be affected by folding stability of the variant, and is associated with compensatory vascular smooth muscle cells phenotypic switching to support collagen production, albeit with less robust fibril girth. Future studies should focus on the impact of PLOD1 folding/variant stability on the tertiary structure of collagen and ECM interactions.
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Affiliation(s)
- Sara N Koenig
- The Ohio State University College of Medicine, Department of Physiology and Cell Biology, Columbus, Ohio; The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio
| | - Omer Cavus
- The Ohio State University College of Medicine, Department of Physiology and Cell Biology, Columbus, Ohio; The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio
| | - Jordan Williams
- The Ohio State University College of Medicine, Department of Physiology and Cell Biology, Columbus, Ohio; The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio
| | - Matthew Bernier
- The Ohio State University Mass Spectrometry and Proteomics Facility, Office of Research, Columbus, Ohio
| | - Jeff Tonniges
- The Ohio State University Microscopy and Imaging Facility (CMIF), Office of Research, Columbus, Ohio
| | - Holly Sucharski
- The Ohio State University College of Medicine, Department of Physiology and Cell Biology, Columbus, Ohio; The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio
| | - Trevor Dew
- The Ohio State University College of Medicine, Department of Physiology and Cell Biology, Columbus, Ohio; The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio
| | - Muhannad Akel
- The Ohio State University College of Medicine, Department of Physiology and Cell Biology, Columbus, Ohio; The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio
| | - Peter Baker
- Nationwide Children's Hospital, Department of Pathology, Columbus, Ohio
| | - Francesca Madiai
- The Ohio State University College of Medicine, Department of Physiology and Cell Biology, Columbus, Ohio; The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio
| | - Francesca De Giorgi
- The Armenise-Harvard Laboratory of Structural Biology, Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Luigi Scietti
- The Armenise-Harvard Laboratory of Structural Biology, Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Silvia Faravelli
- The Armenise-Harvard Laboratory of Structural Biology, Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Federico Forneris
- The Armenise-Harvard Laboratory of Structural Biology, Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Peter J Mohler
- The Ohio State University College of Medicine, Department of Physiology and Cell Biology, Columbus, Ohio; The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio
| | - Elisa A Bradley
- The Dorothy Davis Heart and Lung Research Institute and the Frick Center for Heart Failure and Arrhythmia, The Ohio State University, Columbus, Ohio; The Ohio State University College of Medicine and Wexner Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Columbus, Ohio.
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9
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Li H, Xu H, Wen H, Wang H, Zhao R, Sun Y, Bai C, Ping J, Song L, Luo M, Chen J. Lysyl hydroxylase 1 (LH1) deficiency promotes angiotensin II (Ang II)-induced dissecting abdominal aortic aneurysm. Theranostics 2021; 11:9587-9604. [PMID: 34646388 PMCID: PMC8490513 DOI: 10.7150/thno.65277] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/03/2021] [Indexed: 12/13/2022] Open
Abstract
Rationale: The progressive disruption of extracellular matrix (ECM) proteins, particularly early elastin fragmentation followed by abnormalities in collagen fibril organization, are key pathological processes that contribute to dissecting abdominal aortic aneurysm (AAA) pathogenesis. Lysyl hydroxylase 1 (LH1) is essential for type I/III collagen intermolecular crosslinking and stabilization. However, its function in dissecting AAA has not been explored. Here, we investigated whether LH1 is significantly implicated in dissecting AAA progression and therapeutic intervention. Methods and Results: Sixteen-week-old male LH1-deficient and wild-type (WT) mice on the C57Bl/6NCrl background were infused with angiotensin II (Ang II, 1000 ng/kg per minute) via subcutaneously implanted osmotic pumps for 4 weeks. Ang II increased LH1 levels in the abdominal aortas of WT mice, whereas mice lacking LH1 developed dissecting AAA. To evaluate the related mechanism, we performed whole-transcriptomic analysis, which demonstrated that LH1 deficiency aggravated gene transcription alterations; in particular, the expression of thrombospondin-1 was markedly upregulated in the aortas of LH1-deficient mice. Furthermore, targeting thrombospondin-1 with TAX2 strongly inhibited the proinflammatory process, matrix metalloproteinase (MMP) activity and vascular smooth muscle cells (VSMCs) apoptosis, ultimately decreasing the incidence of dissecting AAA. Restoration of LH1 protein expression in LH1-deficient mice by intraperitoneal injection of an adeno-associated virus normalized thrombospondin-1 levels, subsequently alleviating dissecting AAA formation and preserving aortic structure and function. Consistently, in human AAA specimens, decreased LH1 expression was associated with increased thrombospondin-1 levels. Conclusions: LH1 deficiency contributes to dissecting AAA pathogenesis, at least in part, by upregulating thrombospondin-1 expression, which subsequently enables proinflammatory processes, MMP activation and VSMCs apoptosis. Our study provides evidence that LH1 is a potential critical therapeutic target for AAA.
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Affiliation(s)
- Hao Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Haochen Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Hongyan Wen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Hongyue Wang
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ranxu Zhao
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yingying Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Congxia Bai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jiedan Ping
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Li Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Mingyao Luo
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China
| | - Jingzhou Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch of National Center for Cardiovascular Diseases, Zhengzhou 450046, China
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10
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Haunschild J, Barnard SJ, Misfeld M, Saeed D, Davierwala P, Leontyev S, Mende M, Borger MA, Etz CD. Proximal aortic aneurysms: correlation of maximum aortic diameter and aortic wall thickness. Eur J Cardiothorac Surg 2021; 60:322-330. [PMID: 33822923 DOI: 10.1093/ejcts/ezab147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The goal of therapy of proximal aortic aneurysms is to prevent an aortic catastrophe, e.g. acute dissection or rupture. The decision to intervene is currently based on maximum aortic diameter complemented by known risk factors like bicuspid aortic valve, positive family history or rapid growth rate. When applying Laplace's law, wall tension is determined by pressure × radius divided by aortic wall thickness. Because current imaging modalities lack precision, wall thickness is currently neglected. The purpose of our study was therefore to correlate maximum aortic diameter with aortic wall thickness and known indices for adverse aortic events. METHODS Aortic samples from 292 patients were collected during cardiac surgery, of whom 158 presented with a bicuspid aortic valve and 134, with a tricuspid aortic valve. Aortic specimens were obtained during the operation and stored in 4% formaldehyde. Histological staining and analysis were performed to determine the thickness of the aortic wall. RESULTS Patients were 62 ± 13 years old at the time of the operation; 77% were men. The mean aortic dimensions were 44 mm, 41 mm and 51 mm at the aortic root, sinotubular junction and ascending aorta, respectively. Aortic valve stenosis was the most frequent (49%) valvular dysfunction, followed by aortic valve regurgitation (33%) and combined dysfunction (10%). The maximum aortic diameter at the ascending level did not correlate with the thickness of the media (R = 0.07) or the intima (R = 0.28) at the convex sample site. There was also no correlation of the ascending aortic diameter with age (R = -0.18) or body surface area (R = 0.07). The thickness of the intima (r = 0.31) and the media (R = 0.035) did not correlate with the Svensson index of aortic risk. Similarly, there was a low (R = 0.29) or absent (R = -0.04) correlation between the aortic size index and the intima or media thickness, respectively. There was a similar relationship of median thickness of the intima in the 4 aortic height index risk categories (P < 0.001). CONCLUSIONS Aortic diameter and conventional indices of aortic risk do not correlate with aortic wall thickness. Other indices may be required in order to identify patients at high risk for aortic complications.
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Affiliation(s)
- Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany
| | - Sarah Jane Barnard
- Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,The Discipline of Medicine, The Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Diyar Saeed
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Piroze Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Sergey Leontyev
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Meinhard Mende
- Centre for Clinical Trials, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany
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11
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Current pharmacological management of aortic aneurysm. J Cardiovasc Pharmacol 2021; 78:211-220. [PMID: 33990514 DOI: 10.1097/fjc.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Aortic aneurysm (AA) remains one of the primary causes of death worldwide. Of the major treatments, prophylactic operative repair is used for AA to avoid potential aortic dissection (AD) or rupture. To halt the development of AA and alleviate its progression into AD, pharmacological treatment has been investigated for years. Currently, β-adrenergic blocking agents, losartan, irbesartan, angiotensin-converting-enzyme inhibitors, statins, antiplatelet agents, doxycycline, and metformin have been investigated as potential candidates for preventing AA progression. However, the paradox between preclinical successes and clinical failures still exists, with no medical therapy currently available for ideally negating the disease progression. This review describes the current drugs used for pharmacological management of AA and their individual potential mechanisms. Preclinical models for drug screening and evaluation are also discussed to gain a better understanding of the underlying pathophysiology and ultimately find new therapeutic targets for AA.
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12
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Balint B, Federspiel JM, Schwab T, Ehrlich T, Ramsthaler F, Schäfers HJ. Aortic Regurgitation Is Associated With Ascending Aortic Remodeling in the Nondilated Aorta. Arterioscler Thromb Vasc Biol 2021; 41:1179-1190. [PMID: 33441026 DOI: 10.1161/atvbaha.120.315739] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The probability of aortic complications in patients with bicuspid aortic valve is higher in association with aortic regurgitation (AR) compared with aortic stenosis (AS) or normally functioning valves. The objective of this study was to determine whether this is related to the specific characteristics of aneurysmatic dilatation that includes AR or whether AR itself has a negative impact on the aortic wall, independent of aneurysmatic dilatation. Approach and Results: Nondilated aortic specimens were harvested intraoperatively from individuals with tricuspid aortic valves and either AS (n=10) or AR (n=16). For controls, nondilated aortas were harvested during autopsies from individuals with tricuspid aortic valves and no evidence of aortic valve disease (n=10). Histological and immunohistochemical analyses revealed that compared with control aortas, overall medial degeneration was more severe in AR-aortas (P=0.005) but not AS-aortas (P=0.23). This pathological remodeling included mucoid extracellular matrix accumulation (P=0.005), elastin loss (P=0.003), elastin fragmentation (P=0.008), and decreased expression of fibrillin (P=0.003) and collagen (P=0.008). Furthermore, eNOS (endothelial nitric oxide synthase) expression was decreased in the intima (P=0.0008) and in vasa vasorum (P=0.004) of AR-aortas but not AS-aortas (all P>0.05). Likewise, subendothelial apoptosis was increased in AR-aortas (P=0.03) but not AS-aortas (P=0.50). CONCLUSIONS AR has a negative effect on the nondilated ascending aortic wall. Accordingly, our results support the need for more detailed studies of the aortic wall in relation to aortic valve disease and may ultimately lead to more aggressive clinical monitoring and/or surgical criteria for patients with relevant AR. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Brittany Balint
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Jan M Federspiel
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Tanja Schwab
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Tristan Ehrlich
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Frank Ramsthaler
- Institute of Forensic Medicine (F.R.), Saarland University Medical Center, Homburg, Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic- and Cardiovascular Surgery (B.B., J.M.F., T.S., T.E., H.-J.S.), Saarland University Medical Center, Homburg, Saar, Germany
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13
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Salmasi MY, Pirola S, Sasidharan S, Fisichella SM, Redaelli A, Jarral OA, O'Regan DP, Oo AY, Moore JE, Xu XY, Athanasiou T. High Wall Shear Stress can Predict Wall Degradation in Ascending Aortic Aneurysms: An Integrated Biomechanics Study. Front Bioeng Biotechnol 2021; 9:750656. [PMID: 34733832 PMCID: PMC8558434 DOI: 10.3389/fbioe.2021.750656] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/24/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Blood flow patterns can alter material properties of ascending thoracic aortic aneurysms (ATAA) via vascular wall remodeling. This study examines the relationship between wall shear stress (WSS) obtained from image-based computational modelling with tissue-derived mechanical and microstructural properties of the ATAA wall using segmental analysis. Methods: Ten patients undergoing surgery for ATAA were recruited. Exclusions: bicuspid aortopathy, connective tissue disease. All patients had pre-operative 4-dimensional flow magnetic resonance imaging (4D-MRI), allowing for patient-specific computational fluid dynamics (CFD) analysis and anatomically precise WSS mapping of ATAA regions (6-12 segments per patient). ATAA samples were obtained from surgery and subjected to region-specific tensile and peel testing (matched to WSS segments). Computational pathology was used to characterize elastin/collagen abundance and smooth muscle cell (SMC) count. Results: Elevated values of WSS were predictive of: reduced wall thickness [coef -0.0489, 95% CI (-0.0905, -0.00727), p = 0.022] and dissection energy function (longitudinal) [-15,0, 95% CI (-33.00, -2.98), p = 0.048]. High WSS values also predicted higher ultimate tensile strength [coef 0.136, 95% CI (0 0.001, 0.270), p = 0.048]. Additionally, elevated WSS also predicted a reduction in elastin levels [coef -0.276, 95% (CI -0.531, -0.020), p = 0.035] and lower SMC count ([oef -6.19, 95% CI (-11.41, -0.98), p = 0.021]. WSS was found to have no effect on collagen abundance or circumferential mechanical properties. Conclusions: Our study suggests an association between elevated WSS values and aortic wall degradation in ATAA disease. Further studies might help identify threshold values to predict acute aortic events.
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Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Sumesh Sasidharan
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Serena M Fisichella
- Department of Chemical Engineering, Imperial College London, London, United Kingdom.,Politecnico di Milano, Milan, Italy
| | | | - Omar A Jarral
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Aung Ye Oo
- Barts Heart Centre, London, United Kingdom
| | - James E Moore
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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14
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Babici D, Kudej RK, McNulty T, Zhang J, Oydanich M, Berkman T, Nishimura K, Bishop SP, Vatner DE, Vatner SF. Mechanisms of increased vascular stiffness down the aortic tree in aging, premenopausal female monkeys. Am J Physiol Heart Circ Physiol 2020; 319:H222-H234. [PMID: 32530752 DOI: 10.1152/ajpheart.00153.2020] [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: 12/11/2022]
Abstract
Protection against increased vascular stiffness in young women is lost after menopause. However, little is known about vascular stiffness in older, premenopausal females, because most of the prior work has been conducted in rodents, which live for only 1-3 yr and do not go through menopause. The goal of the current investigation was to quantitate differences in stiffness down the aortic tree and the mechanisms mediating those differences in older, premenopausal (24 ± 0.7 yr) versus young adult (7 ± 0.7 yr) female nonhuman primates. Aortic stiffness (β), calculated from direct and continuous measurements of aortic diameter and pressure in chronically instrumented, conscious macaque monkeys, increased 2.5-fold in the thoracic aorta and fivefold in the abdominal aorta in old premenopausal monkeys. The aortic histological mechanisms mediating increased vascular stiffness, i.e., collagen/elastin ratio, elastin, and collagen disarray, and the number of breaks in elastin and collagen fibers were greater in the old premenopausal versus young monkeys and greater in the abdominal versus the thoracic aorta and greatest in the iliac artery. In addition, more immature and less cross-linked fibers of collagen were found in the aortas of young females. Aortic stiffness increased in old premenopausal female monkeys, more so in the abdominal aorta than in the thoracic aorta. Histological mechanisms mediating the increased aortic stiffness were augmented in the old premenopausal females, greater in the abdominal versus the thoracic aorta, and greatest in the iliac artery.NEW & NOTEWORTHY This is the first study to examine vascular stiffness down the aortic tree in aging premenopausal females (24 ± 0.7 yr old), whereas prior work studied mainly rodents, which are short-lived and do not undergo menopause. Histological mechanisms mediating vascular stiffness in older premenopausal females increased progressively down the aortic tree, with greater increases in the abdominal aorta compared with the thoracic aorta and with the greatest increases and differences observed in the iliac artery.
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Affiliation(s)
- Denis Babici
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Raymond K Kudej
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
| | - Tara McNulty
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Jie Zhang
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Marko Oydanich
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Tolga Berkman
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Koichi Nishimura
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Sanford P Bishop
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dorothy E Vatner
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Stephen F Vatner
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers, New Jersey Medical School, Newark, New Jersey
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15
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Cardiac Neural Crest Cells: Their Rhombomeric Specification, Migration, and Association with Heart and Great Vessel Anomalies. Cell Mol Neurobiol 2020; 41:403-429. [PMID: 32405705 DOI: 10.1007/s10571-020-00863-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/05/2020] [Indexed: 02/06/2023]
Abstract
Outflow tract abnormalities are the most frequent congenital heart defects. These are due to the absence or dysfunction of the two main cell types, i.e., neural crest cells and secondary heart field cells that migrate in opposite directions at the same stage of development. These cells directly govern aortic arch patterning and development, ascending aorta dilatation, semi-valvular and coronary artery development, aortopulmonary septation abnormalities, persistence of the ductus arteriosus, trunk and proximal pulmonary arteries, sub-valvular conal ventricular septal/rotational defects, and non-compaction of the left ventricle. In some cases, depending on the functional defects of these cells, additional malformations are found in the expected spatial migratory area of the cells, namely in the pharyngeal arch derivatives and cervico-facial structures. Associated non-cardiovascular anomalies are often underestimated, since the multipotency and functional alteration of these cells can result in the modification of multiple neural, epidermal, and cervical structures at different levels. In most cases, patients do not display the full phenotype of abnormalities, but congenital cardiac defects involving the ventricular outflow tract, ascending aorta, aortic arch and supra-aortic trunks should be considered as markers for possible impaired function of these cells. Neural crest cells should not be considered as a unique cell population but on the basis of their cervical rhombomere origins R3-R5 or R6-R7-R8 and specific migration patterns: R3-R4 towards arch II, R5-R6 arch III and R7-R8 arch IV and VI. A better understanding of their development may lead to the discovery of unknown associated abnormalities, thereby enabling potential improvements to be made to the therapeutic approach.
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16
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Hackenberg KAM, Rajabzadeh-Oghaz H, Dreier R, Buchholz BA, Navid A, Rocke DM, Abdulazim A, Hänggi D, Siddiqui A, Macdonald RL, Meng H, Etminan N. Collagen Turnover in Relation to Risk Factors and Hemodynamics in Human Intracranial Aneurysms. Stroke 2020; 51:1624-1628. [PMID: 32192404 DOI: 10.1161/strokeaha.120.029335] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Determinants for molecular and structural instability, that is, impending growth or rupture, of intracranial aneurysms (IAs) remain uncertain. To elucidate this, we endeavored to estimate the actual turnover rates of the main molecular constituent in human IA (collagen) on the basis of radiocarbon (14C) birth dating in relation to IA hemodynamics. Methods- Collagen turnover rates in excised human IA samples were calculated using mathematical modeling of 14C birth dating data of collagen in relation to risk factors and histological markers for collagen maturity/turnover in selected IA. Hemodynamics were simulated using image-based computational fluid dynamics. Correlation, logistic regression, and receiver operating characteristic analyses were performed. Results- Collagen turnover rates were estimated in 46 IA (43 patients); computational fluid dynamics could be performed in 20 IA (20 patients). The mean collagen turnover rate (γ) constituted 126% (±1% error) per year. For patients with arterial hypertension, γ was greater than 2600% annually, whereas γ was distinctly lower with 32% (±1% error) per year for patients without risk factors, such as smoking and hypertension. There was a distinct association between histological presence of rather immature collagen in human IA and the presence of modifiable risk factors. Spatial-temporal averaged wall shear stress predicted rapid collagen turnover (odds ratio, 1.6 [95% CI, 1.0-2.7]). Receiver operating characteristic analysis demonstrated a good test accuracy (area under the curve, 0.798 [95% CI, 0.598-0.998]) for average wall shear stress with a threshold ≥4.9 Pa for rapid collagen turnover. Conclusions- Our data indicate that turnover rates and stability of collagen in human IA are strongly associated with the presence of modifiable risk factors and aneurysmal hemodynamics. These findings underline the importance of strict risk factor modification in patients with unruptured IA. Future should include more detailed risk factor data to establish a more causal understanding of hemodynamics and the rupture risk of individual IA.
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Affiliation(s)
- Katharina A M Hackenberg
- From the Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (K.A.M.H., A.A., D.H., N.E.)
| | - Hamidreza Rajabzadeh-Oghaz
- Department of Mechanical and Aerospace Engineering, Canon Stroke and Vascular Research Center (H.R.-O.), University at Buffalo, New York
| | - Rita Dreier
- Institute for Physiological Chemistry and Pathobiochemistry, Westfalian Wilhelms-University, Münster, Germany (R.D.)
| | - Bruce A Buchholz
- Center for Accelerator Mass Spectrometry (B.A.B.), Lawrence Livermore National Laboratory, Livermore, CA
| | - Ali Navid
- Biosciences and Biotechnology Division (A.N.), Lawrence Livermore National Laboratory, Livermore, CA
| | - David M Rocke
- Biosciences and Biotechnology Division (A.N.), Lawrence Livermore National Laboratory, Livermore, CA
| | - Amr Abdulazim
- From the Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (K.A.M.H., A.A., D.H., N.E.)
| | - Daniel Hänggi
- From the Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (K.A.M.H., A.A., D.H., N.E.)
| | - Adnan Siddiqui
- Department of Neurosurgery, Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences (A.S.), University at Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences (A.S.), University at Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Jacobs Institute (A.S.), University at Buffalo, New York
| | - R Loch Macdonald
- Department of Neurological Surgery, UCSF Fresno, CA (R.L.M.).,Department of Surgery, University of Toronto, Ontario, Canada (R.L.M.)
| | - Hui Meng
- Department of Mechanical and Aerospace Engineering, Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences (H.M.), University at Buffalo, New York.,Department of Biomedical Engineering, Jacobs School of Medicine and Biomedical Sciences (H.M.), University at Buffalo, New York.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences (H.M.), University at Buffalo, New York
| | - Nima Etminan
- From the Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (K.A.M.H., A.A., D.H., N.E.)
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17
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Borger MA, Fedak PWM, Stephens EH, Gleason TG, Girdauskas E, Ikonomidis JS, Khoynezhad A, Siu SC, Verma S, Hope MD, Cameron DE, Hammer DF, Coselli JS, Moon MR, Sundt TM, Barker AJ, Markl M, Della Corte A, Michelena HI, Elefteriades JA. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg 2019; 156:e41-e74. [PMID: 30011777 DOI: 10.1016/j.jtcvs.2018.02.115] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 01/17/2018] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
Bicuspid aortic valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with bicuspid aortic valve disease, with thoracic aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of bicuspid aortic valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of bicuspid aortic valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of bicuspid aortic valve aortopathy and to guide the daily management of these complex patients.
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Affiliation(s)
- Michael A Borger
- Leipzig Heart Center, Cardiac Surgery, University of Leipzig, Leipzig, Germany.
| | - Paul W M Fedak
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC
| | - Ali Khoynezhad
- Memorial Care Heart and Vascular Institute, Memorial Care Long Beach Medical Center, Long Beach, Calif
| | - Samuel C Siu
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Subodh Verma
- Department of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hope
- San Francisco (UCSF) Department of Radiology & Biomedical Imaging, University of California, San Francisco, Calif
| | - Duke E Cameron
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Donald F Hammer
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Texas Heart Institute, Baylor College of Medicine, Houston, Tex
| | - Marc R Moon
- Section of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Michael Markl
- Departments of Radiology and Biomedical Engineering, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn
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18
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Messner B, Bernhard D. Bicuspid aortic valve-associated aortopathy: Where do we stand? J Mol Cell Cardiol 2019; 133:76-85. [PMID: 31152748 DOI: 10.1016/j.yjmcc.2019.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 01/30/2023]
Abstract
Herein we summarize the current knowledge on the bicuspid aortic valve (BAV)-associated aortopathy regarding clinical presentation and disease sub-classification, genetic background, hemodynamics, histopathology, cells and signaling, animal models, and biomarkers. Despite enormous efforts in research in all of the above areas, important issues remain unknown: (i) what is the ontogenetic basis of BAV development? (ii) how can we explain the diversity of BAV and associated aortopathy phenotypes? (iii) what are the signaling processes in aortopathy pathogenesis and how can we interfere with these processes? Despite undoubtedly great progress that has been made in the understanding of BAV-associated aortopathy, so far researchers have put together a heap of Lego bricks, but at present it is unclear if the bricks are compatible, how they fit together, and which parts are missing to build the true model of the BAV aorta. A joint approach is needed to accelerate research progress.
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Affiliation(s)
- Barbara Messner
- Cardiac Surgery Research Laboratory, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - David Bernhard
- Center for Medical Research, Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
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19
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Bicuspid aortic valve, atherosclerosis and changes of lipid metabolism: Are there pathological molecular links? J Mol Cell Cardiol 2019; 129:231-235. [DOI: 10.1016/j.yjmcc.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 12/19/2022]
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20
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Mimler T, Nebert C, Eichmair E, Winter B, Aschacher T, Stelzmueller ME, Andreas M, Ehrlich M, Laufer G, Messner B. Extracellular matrix in ascending aortic aneurysms and dissections - What we learn from decellularization and scanning electron microscopy. PLoS One 2019; 14:e0213794. [PMID: 30883576 PMCID: PMC6422325 DOI: 10.1371/journal.pone.0213794] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/28/2019] [Indexed: 01/24/2023] Open
Abstract
Pathological impairment of elastic fiber and other extracellular matrix (ECM) components are described for the aortic media of ascending thoracic aortic aneurysms (aTAA) but the exact pathological impairment of the structure and its degree still needs further investigations. To evaluate the quantity and quality of elastic fiber sheets and other ECM structures (e.g. collagen), cells were removed from different types of aneurysmal tissues (tricuspid aortic valve [TAV] associated-, bicuspid aortic valve [BAV] associated-aneurysmal tissue and acute aortic dissections [AAD]) using 2.5% sodium hydroxide (NaOH) and compared to decellularized control aortic tissue. Likewise, native tissue has been analysed. To evaluate the 2D- (histological evaluation, fluorescence- and auto-fluorescence based staining methods) and the 3D structure (scanning electron microscopic [SEM] examination) of the medial layer we first analysed for a successful decellularization. After proving for successful decellularization, we quantified the amount of elastic fiber sheets, elastin and other ECM components including collagen. Aside from clearly visible focal elastic fiber loss in TAV-aTAA tissue, decellularization resulted in reduction of elastic fiber auto-fluorescence properties, which is perhaps an indication from a disease-related qualitative impairment of elastic fibers, visible only after contact with the alkaline solution. Likewise, the loss of collagen amount in BAV-aTAA and TAV-aTAA tissue (compared to non-decellularized tissue) after contact with NaOH indicates a prior disease-associated impairment of collagen. Although the amount of ECM was not changed in type A dissection tissue, detailed electron microscopic evaluation revealed changes in ECM quality, which worsened after contact with alkaline solution but were not visible after histological analyses. Apart from the improved observation of the samples using electron microscopy, contact of aneurysmal and dissected tissue with the alkaline decellularization solution revealed potential disease related changes in ECM quality which can partly be connected to already published data, but have to be proven by further studies.
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Affiliation(s)
- Teresa Mimler
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Clemens Nebert
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Eva Eichmair
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Birgitta Winter
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Thomas Aschacher
- Department of Surgery, Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Martin Andreas
- Department of Surgery, Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marek Ehrlich
- Department of Surgery, Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Surgery, Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Messner
- Department of Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Vienna, Austria
- * E-mail:
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21
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Abstract
Current management of aortic aneurysms relies exclusively on prophylactic operative repair of larger aneurysms. Great potential exists for successful medical therapy that halts or reduces aneurysm progression and hence alleviates or postpones the need for surgical repair. Preclinical studies in the context of abdominal aortic aneurysm identified hundreds of candidate strategies for stabilization, and data from preoperative clinical intervention studies show that interventions in the pathways of the activated inflammatory and proteolytic cascades in enlarging abdominal aortic aneurysm are feasible. Similarly, the concept of pharmaceutical aorta stabilization in Marfan syndrome is supported by a wealth of promising studies in the murine models of Marfan syndrome-related aortapathy. Although some clinical studies report successful medical stabilization of growing aortic aneurysms and aortic root stabilization in Marfan syndrome, these claims are not consistently confirmed in larger and controlled studies. Consequently, no medical therapy can be recommended for the stabilization of aortic aneurysms. The discrepancy between preclinical successes and clinical trial failures implies shortcomings in the available models of aneurysm disease and perhaps incomplete understanding of the pathological processes involved in later stages of aortic aneurysm progression. Preclinical models more reflective of human pathophysiology, identification of biomarkers to predict severity of disease progression, and improved design of clinical trials may more rapidly advance the opportunities in this important field.
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Affiliation(s)
- Jan H. Lindeman
- Dept. Vascular Surgery, Leiden University Medical Center, The Netherlands
| | - Jon S. Matsumura
- Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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22
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Sticchi E, De Cario R, Magi A, Giglio S, Provenzano A, Nistri S, Pepe G, Giusti B. Bicuspid Aortic Valve: Role of Multiple Gene Variants in Influencing the Clinical Phenotype. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8386123. [PMID: 30255099 PMCID: PMC6145047 DOI: 10.1155/2018/8386123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/20/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
Background. Bicuspid aortic valve (BAV) is a common congenital heart defect with increased prevalence of aortic dilatation and dissection. BAV has an autosomal dominant pattern of inheritance with reduced penetrance and variable expressivity. BAV has been described as an isolated trait or associated with other clinical manifestations in syndromic conditions. Identification of a syndromic condition in a BAV patient is clinically relevant in order to personalize indication to aortic surgery. We aimed to point out how genetic diagnosis by next-generation sequencing (NGS) can improve management of a patient with complex BAV clinical picture. Methods and Results. We describe a 45-year-old Caucasian male with BAV, thoracic aortic root and ascending aorta dilatation, and connective features evocative but inconclusive for clinical diagnosis of Marfan syndrome (MFS). Targeted (91 genes) NGS was used. Proband genetic variants were investigated in first-degree relatives. Proband carried 5 rare variants in 4 genes: FBN1(p.Asn542Ser and p.Lys2460Arg), NOTCH1(p.Val1739Met), LTBP1(p.Arg1330Gln), and TGFBR3(p.Arg423Trp). The two FBN1 variants were inherited in cis by the mother, showing systemic features evocative of MFS, but with a milder phenotype than that observed in the proband. Careful clinical observation along with the presence of the FBN1 variants allowed diagnosis of MFS in the proband and in his mother. NOTCH1 variant was found in mother and brother, not exhibiting BAV, thus not definitely supporting/excluding association with BAV. Interestingly, the proband, his brother and father, all showing root dilatation, and his sister, with upper range aortic root dimension, were carriers of a TGFBR3 variant. LTBP1 might also modulate the vascular phenotype. Conclusions. Our results underline the usefulness of NGS together with family evaluation in diagnosis of patients with monogenic traits and overlapping clinical manifestations due to contribution of the same genes and/or presence of comorbidities determined by different genes.
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Affiliation(s)
- Elena Sticchi
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
| | - Rosina De Cario
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
| | - Alberto Magi
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
| | - Sabrina Giglio
- Department of Biomedical Experimental and Clinical Sciences 'Mario Serio', University of Florence, Italy
- Medical Genetic Unit, Meyer Children's University Hospital, Florence, Italy
| | - Aldesia Provenzano
- Department of Biomedical Experimental and Clinical Sciences 'Mario Serio', University of Florence, Italy
| | - Stefano Nistri
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Italy
| | - Guglielmina Pepe
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
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23
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Krizhanovskii C, Franco-Cereceda A. Diabetes, Incretin Therapy and Thoracic Aortic Aneurysm - What Does the Evidence Show? Curr Vasc Pharmacol 2018; 17:432-439. [PMID: 30156160 DOI: 10.2174/1570161116666180828155622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/18/2022]
Abstract
Epidemiological evidence supports a reduced prevalence of Thoracic Aortic Aneurysm (TAA) and Abdominal Aortic Aneurysm (AAA) in patients with Diabetes (DM). The mechanisms underlying this negative association are unknown. Some studies support that hyperglycemia has effects on the Extracellular Matrix (ECM), resulting in collagen cross-links and altered proteolytic activity, which ultimately counteracts aneurysm formation. However, recent experimental research indicates that incretin- based anti-diabetic therapy and Glucagon-Like Peptide-1 (GLP-1) may reduce the formation of TAA. GLP-1 is a peptide hormone, released from intestinal L-cells in response to hormonal, neural and nutrient stimuli. In addition to potentiation of meal-stimulated insulin secretion, GLP-1 signaling exerts numerous pleiotropic effects on various tissues, including protective effects on the myocardium and vascular endothelium. Recent studies also report protective effects of GLP-1 based therapy on the formation of aneurysms in animal models and direct effects of GLP-1 signaling on the molecular mechanisms suggested to influence TAA formation, including inflammation, proteolytic activity and collagen composition. In this narrative review, we present the available evidence for effects of GLP-1 on experimental aneurysm development and discuss the potential role of GLP-1 in aneurysm formation based on available data from pre-clinical and clinical studies.
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Affiliation(s)
- Camilla Krizhanovskii
- Sodertalje Hospital, Department of Internal Medicine, SE-152 86 Sodertalje, Sweden.,Sodertalje Hospital, Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Sodertalje Hospital, Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
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Hirata Y, Aoki H, Shojima T, Takagi K, Takaseya T, Akasu K, Tobinaga S, Fukumoto Y, Tanaka H. Activation of the AKT Pathway in the Ascending Aorta With Bicuspid Aortic Valve. Circ J 2018; 82:2485-2492. [PMID: 30089758 DOI: 10.1253/circj.cj-17-1465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dilatation of the ascending aorta affects those patients with bicuspid aortic valve (BAV), even after valvular surgery, possibly due to tissue fragility. The goal of the study was the molecular characterization of aorta with BAV compared to that with normal tricuspid aortic valve (TAV). Methods and Results: The subjects were patients who underwent surgery for aortic valve stenosis in 2013 and 2014. Nine patients with BAV and 13 with TAV were examined. There was no difference in the clinical characteristics or grade of aortic valve stenosis, but the diameters of the ascending aorta were significantly higher in the BAV group. The ascending aortic specimens were subjected to transcriptome analyses, which revealed the changes in receptor tyrosine kinase (RTK) pathway-related genes between TAV and BAV samples. Immunohistochemical study revealed higher staining of phosphorylated AKT (pAKT) in the media of the ascending aorta in the BAV group, regardless of the size of ascending aorta, whereas total AKT did not show such a difference. Immunofluorescence staining revealed the AKT activation was mainly in the medial vascular smooth muscle cells. CONCLUSIONS The results showed that the RTK-AKT pathway in the medial layer of the ascending aorta is activated in aortae with BAV. Activation of this pathway may be associated with fragility and dilatation of the ascending aorta with BAV.
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Affiliation(s)
- Yuichiro Hirata
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Hiroki Aoki
- Cardiovascular Research Institute, Kurume University
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Kohji Akasu
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Satoru Tobinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Hiroyuki Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
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25
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Cai J, Wang J, Ye K, Li D, Ai C, Sheng D, Jin W, Liu X, Zhi Y, Jiang J, Chen J, Mo X, Chen S. Dual-layer aligned-random nanofibrous scaffolds for improving gradient microstructure of tendon-to-bone healing in a rabbit extra-articular model. Int J Nanomedicine 2018; 13:3481-3492. [PMID: 29950830 PMCID: PMC6014388 DOI: 10.2147/ijn.s165633] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tendon/ligament injuries are common sports injuries. Clinically, the repair of a ruptured tendon or ligament to its bony insertion is needed, but the enthesis structure is not well reestablished following surgical repair. Herein, we fabricated dual-layer aligned-random scaffold (ARS) by electrospinning and aimed to investigate the effect of the scaffold on tendon-to-bone healing in vivo. MATERIALS AND METHODS The random and dual-layer aligned-random silk fbroin poly(L-lactic acid-co-e-caprolactone) (P(LLA-CL)) nanofibrous scaffolds were successfully fabricated by electrospinning methods. Ninety New Zealand white rabbits were randomly divided into three groups (random scaffold [RS], ARS, and control groups), and they were subjected to surgery to establish an extra-articular tendon-to-bone healing model with autologous Achilles tendon. RESULTS Histological assessment showed that the ARS significantly increased the area of metachromasia, decreased the interface width, and improved collagen maturation and organization at the tendon-bone interface compared with the RS and control groups. Microcomputed tomography analysis showed that the bone tunnel area of RS and ARS groups was significantly smaller than those of the control group. Real-time polymerase chain reaction showed that BMP-2 and osteopontin expression levels of the tissue at the interface between the bone and graft in the RS and ARS groups were higher than those of the control group at 6 weeks. Collagen I expression level of the ARS group was significantly higher than those of the RS and control groups at 6 and 12 weeks. Moreover, the ARS groups had a better ultimate load-to-failure and stiffness than the RS and control groups. CONCLUSION ARS could effectively augment the tendon-to-bone integration and improve gradient microstructure in a rabbit extra-articular model by inducing the new bone formation, increasing the area of fibrocartilage, and improving collagen organization and maturation. The dual-layer aligned-random silk fibroin/P(LLA-CL) nanofibrous scaffold is proved to be a promising biomaterial for tendon-to-bone healing.
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Affiliation(s)
- Jiangyu Cai
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Juan Wang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Kaiqiang Ye
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Dandan Li
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Chengchong Ai
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Wenhe Jin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xingwang Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yunlong Zhi
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jia Jiang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Shanghai BJ-KMC Medical Technology Co., Ltd, Shanghai 201707, China
- State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai 200433, China
| | - Xiumei Mo
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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Altered DNA methylation indicates an oscillatory flow mediated epithelial-to-mesenchymal transition signature in ascending aorta of patients with bicuspid aortic valve. Sci Rep 2018; 8:2777. [PMID: 29426841 PMCID: PMC5807320 DOI: 10.1038/s41598-018-20642-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/23/2018] [Indexed: 12/30/2022] Open
Abstract
Disturbed flow has been suggested to contribute to aneurysm susceptibility in bicuspid aortic valve (BAV) patients. Lately, flow has emerged as an important modulator of DNA methylation. Hear we combined global methylation analysis with in vitro studies of flow-sensitive methylation to identify biological processes associated with BAV-aortopathy and the potential contribution of flow. Biopsies from non-dilated and dilated ascending aortas were collected from BAV (n = 21) and tricuspid aortic valve (TAV) patients (n = 23). DNA methylation and gene expression was measured in aortic intima-media tissue samples, and in EA.hy926 and primary aortic endothelial cells (ECs) isolated from BAV and TAV exposed to oscillatory (±12 dynes/cm2) or laminar (12 dynes/cm2) flow. We show methylation changes related to epithelial-mesenchymal-transition (EMT) in the non-dilated BAV aorta, associated with oscillatory flow related to endocytosis. The results indicate that the flow-response in BAV ECs involves hypomethylation and increased expression of WNT/β-catenin genes, as opposed to an angiogenic profile in TAV ECs. The EMT-signature was exasperated in dilated BAV aortas. Aberrant EMT in BAV aortic walls could contribute to increased aneurysm susceptibility, and may be due to disturbed flow-exposure. Perturbations during the spatiotemporally related embryonic development of ascending aorta and semilunar valves can however not be excluded.
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27
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van de Pol V, Kurakula K, DeRuiter MC, Goumans MJ. Thoracic Aortic Aneurysm Development in Patients with Bicuspid Aortic Valve: What Is the Role of Endothelial Cells? Front Physiol 2017; 8:938. [PMID: 29249976 PMCID: PMC5714935 DOI: 10.3389/fphys.2017.00938] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/06/2017] [Indexed: 12/28/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most common type of congenital cardiac malformation. Patients with a BAV have a predisposition for the development of thoracic aortic aneurysm (TAA). This pathological aortic dilation may result in aortic rupture, which is fatal in most cases. The abnormal aortic morphology of TAAs results from a complex series of events that alter the cellular structure and extracellular matrix (ECM) composition of the aortic wall. Because the major degeneration is located in the media of the aorta, most studies aim to unravel impaired smooth muscle cell (SMC) function in BAV TAA. However, recent studies suggest that endothelial cells play a key role in both the initiation and progression of TAAs by influencing the medial layer. Aortic endothelial cells are activated in BAV mediated TAAs and have a substantial influence on ECM composition and SMC phenotype, by secreting several key growth factors and matrix modulating enzymes. In recent years there have been significant advances in the genetic and molecular understanding of endothelial cells in BAV associated TAAs. In this review, the involvement of the endothelial cells in BAV TAA pathogenesis is discussed. Endothelial cell functioning in vessel homeostasis, flow response and signaling will be highlighted to give an overview of the importance and the under investigated potential of endothelial cells in BAV-associated TAA.
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Affiliation(s)
- Vera van de Pol
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Kondababu Kurakula
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Marco C. DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
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28
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Polyamine concentration is increased in thoracic ascending aorta of patients with bicuspid aortic valve. Heart Vessels 2017; 33:327-339. [DOI: 10.1007/s00380-017-1087-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/13/2017] [Indexed: 12/26/2022]
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29
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Ekici F, Uslu D, Bozkurt S. Elasticity of ascending aorta and left ventricular myocardial functions in children with bicuspid aortic valve. Echocardiography 2017; 34:1660-1666. [DOI: 10.1111/echo.13664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Filiz Ekici
- Department of Pediatric Cardiology; Akdeniz University Faculty of Medicine; Antalya Turkey
| | - Diyar Uslu
- Department of Pediatric Cardiology; Akdeniz University Faculty of Medicine; Antalya Turkey
| | - Selen Bozkurt
- Department of Biostatistics and Medical Informatics; Akdeniz University Faculty of Medicine; Antalya Turkey
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30
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Busch A, Grimm C, Hartmann E, Paloschi V, Kickuth R, Lengquist M, Otto C, Eriksson P, Kellersmann R, Lorenz U, Maegdefessel L. Vessel wall morphology is equivalent for different artery types and localizations of advanced human aneurysms. Histochem Cell Biol 2017; 148:425-433. [PMID: 28478588 DOI: 10.1007/s00418-017-1575-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 12/11/2022]
Abstract
Aneurysm formation occurs most frequently as abdominal aortic aneurysm (AAA), but is also seen in other localizations like thoracic or peripheral aneurysm. While initial mechanisms for aneurysm induction remain elusive, observations from AAA samples show transmural inflammation with proteolytic imbalance and repair mechanisms triggered by the innate immune system. However, limited knowledge exists about aneurysm pathology, especially for others than AAA. We compared 42 AAA, 15 popliteal, 3 ascending aortic, five iliac, two femoral, two brachial, one visceral and two secondary aneurysms to non-aneurysmatic controls by histologic analysis, immunohistochemistry and cytokine expression. Muscular and elastic type arteries show a uniform way of aneurysm formation. All samples show similar morphology. The changes compared to controls are distinct and include matrix remodeling with smooth muscle cell phenotype switch and angiogenesis, adventitial lymphoid cell accumulation and M1 macrophage homing together with neutrophil inflammation. Inflammatory cytokines are up-regulated accordingly. Comparative analysis of different disease entities can identify characteristic pathomechanisms. The phenotype of human advanced aneurysm disease is observed for elastic and muscular type arteries, does not differ between disease localizations and might, thus, be a unique response of the vasculature to the still unknown trigger of aneurysm formation.
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Affiliation(s)
- Albert Busch
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany. .,Molecular Vascular Medicine Group, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden. .,Clinic for Vascular and Endovascular Surgery, Technical University Munich, Ismaninger Str 22, 81675, Munich, Germany.
| | - Caroline Grimm
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Elena Hartmann
- Institute of Pathology and Comprehensive Cancer Center (CCC) Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - Valentina Paloschi
- Cardiovascular Medicine Unit, Center for Molecular MedicineKarolinska, University hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Mariette Lengquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Christoph Otto
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Per Eriksson
- Cardiovascular Medicine Unit, Center for Molecular MedicineKarolinska, University hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - Richard Kellersmann
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Udo Lorenz
- Clinic for General, Visceral, Vascular & Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Lars Maegdefessel
- Molecular Vascular Medicine Group, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.,Clinic for Vascular and Endovascular Surgery, Technical University Munich, Ismaninger Str 22, 81675, Munich, Germany
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Mookhoek A, Krishnan K, Chitsaz S, Kuang H, Ge L, Schoof PH, Bogers AJ, Takkenberg JJ, Tseng EE. Biomechanics of Failed Pulmonary Autografts Compared to Native Aortic Roots. Ann Thorac Surg 2017; 103:1482-1488. [DOI: 10.1016/j.athoracsur.2016.08.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 11/29/2022]
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Navarrete Santos A, Yan J, Lochmann P, Pfeil H, Petersen M, Simm A, Treede H, Sievers HH, Mohamed SA. Collagen analysis of the ascending aortic dilatation associated with bicuspid aortic valve disease compared with tricuspid aortic valve. Arch Physiol Biochem 2016; 122:289-294. [PMID: 27595307 DOI: 10.1080/13813455.2016.1211710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dilatation of the ascending aorta is a common occurrence in patients with bicuspid aortic valve (BAV). The aim of the current study was to characterize collagen content in advanced glycation end products (AGEs) of dilated aortic tissue from two distinct areas, concave and convex aortic sites in patients with BAV and TAV. Collagen contents extracted from 100 mg tissue was isolated by enzymatic digestion using pepsin and the nondigested material was further digested using cyanogen bromide, insoluble collagen fraction (ICF) was extracted by hydrochloric acid hydrolysis. BAV tissue showed diminished fluorescence of the pepsin extracted fraction (PEF) compared with TAV tissue (12.4 ± 1.0% vs 32.9 ± 7.6%, p = 0.05). Patients with BAV had PEF of collagens significantly diminished in the dilated ascending aorta, especially in its convex portion, in course of aging and increment of dilated diameters. It is suggestible that BAV patients present more highly AGE-modified collagens in their ascending aorta.
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Affiliation(s)
| | - Junfeng Yan
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
| | - Peter Lochmann
- a Department of heart surgery , Martin Luther University , Halle-Wittenberg , Germany and
| | - Heike Pfeil
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
| | - Michael Petersen
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
| | - Andreas Simm
- a Department of heart surgery , Martin Luther University , Halle-Wittenberg , Germany and
| | - Hendrik Treede
- a Department of heart surgery , Martin Luther University , Halle-Wittenberg , Germany and
| | - Hans H Sievers
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
| | - Salah A Mohamed
- b Department of Cardiac and Thoracic Vascular Surgery , UKSH-Campus Luebeck , Luebeck , Germany
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33
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Mookhoek A, Krishnan K, Chitsaz S, Kuang H, Ge L, Schoof PH, Bogers AJJC, Takkenberg JJM, Tseng EE. Biomechanics of Failed Pulmonary Autografts Compared With Normal Pulmonary Roots. Ann Thorac Surg 2016; 102:1996-2002. [PMID: 27457832 DOI: 10.1016/j.athoracsur.2016.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Progressive dilatation of pulmonary autografts after the Ross operation may reflect inadequate remodeling of the native pulmonary root to adapt to systemic circulation. Understanding the biomechanics of autograft root dilatation may aid designing strategies to prevent dilatation. We have previously characterized normal human pulmonary root material properties; however, the mechanical properties of failed autografts are unknown. In this study, failed autograft roots explanted during reoperation were acquired, and their material properties were determined. METHODS Failed pulmonary autograft specimens were obtained from patients undergoing reoperation after the Ross operation. Fresh human native pulmonary roots were obtained from the transplant donor network as controls. Biaxial stretch testing was performed to determine tissue mechanical properties. Tissue stiffness was determined at patient-specific physiologic stresses at pulmonary pressures. RESULTS Nonlinear stress-strain response was present in both failed autografts and normal pulmonary roots. Explanted pulmonary autografts were less stiff than were their native pulmonary root counterparts at 8 mm Hg (134 ± 42 vs 175 ± 49 kPa, respectively) (p = 0.086) and 25 mm Hg (369 ± 105 vs 919 ± 353 kPa, respectively) (p = 0.006). Autograft wall stiffness at both 8 and 25 mm Hg was not correlated with age at the Ross procedure (p = 0.898 and p = 0.813, respectively) or with time in the systemic circulation (p = 0.609 and p = 0.702, respectively). CONCLUSIONS Failed pulmonary autografts retained nonlinear response to mechanical loading typical of healthy human arterial tissue. Remodeling increased wall thickness but decreased wall stiffness in failed autografts. Increased compliance may explain progressive autograft root dilatation in autograft failures.
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Affiliation(s)
- Aart Mookhoek
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kapil Krishnan
- Department of Surgery, University of California San Francisco Medical Center and San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Sam Chitsaz
- Division of Cardiology, Department of Medicine, University of Texas at Houston, Houston, Texas
| | - Heide Kuang
- Department of Surgery, University of California San Francisco Medical Center and San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Liang Ge
- Department of Surgery, University of California San Francisco Medical Center and San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Paul H Schoof
- Department of Pediatric Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elaine E Tseng
- Department of Surgery, University of California San Francisco Medical Center and San Francisco Veterans Affairs Medical Center, San Francisco, California.
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Villard C, Eriksson P, Hanemaaijer R, Lindeman JH, Hultgren R. The composition of collagen in the aneurysm wall of men and women. J Vasc Surg 2016; 66:579-585.e1. [PMID: 27234441 DOI: 10.1016/j.jvs.2016.02.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/12/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Loss of vessel wall integrity by degradation is essential for the development of abdominal aortic aneurysm (AAA) and ultimately its rupture. The observed greater rupture rate in women with AAA might be related to gender differences in the biomechanical properties of the aneurysm wall. The aim of the study was to compare the biomechanically important structure of collagen between men and women with AAA. METHODS Biopsies of the aneurysm walls were obtained during elective open repair of men (n = 14) and women (n = 14) treated for AAA. High-performance liquid chromatography (HPLC), Western blot, messenger RNA expression, and histochemical analyses were performed to assess the cross-linking and the amount and the composition of collagen. RESULTS There was neither a difference in the thickness of the aneurysm wall, nor in the histological evaluation of the collagen composition between the sexes. Relative collagen content in the aneurysm wall was similar in men and women, as assessed by messenger RNA expression and HPLC. Collagen cross-linking differed between the sexes; women had more lysyl pyridinoline (LP) than men (0.140 vs 0.07; P = .005), resulting in a lower hydroxyl pyridinoline (HP):LP ratio (3.28 vs 8.41; P = .003). There was no difference in messenger RNA and protein expressions of lysyl hydroxylase and lysyl oxidase to associate with the lower HP:LP ratio in women. CONCLUSIONS The composition of collagen in the aneurysm wall of men and women are in several aspects similar, with the exception of collagen cross-linking, suggesting that the difference in rupture rate between the sexes rather depend on the composition of other vessel wall structures.
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Affiliation(s)
- Christina Villard
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Per Eriksson
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan H Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Emmott A, Garcia J, Chung J, Lachapelle K, El-Hamamsy I, Mongrain R, Cartier R, Leask RL. Biomechanics of the Ascending Thoracic Aorta: A Clinical Perspective on Engineering Data. Can J Cardiol 2016; 32:35-47. [DOI: 10.1016/j.cjca.2015.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/17/2015] [Accepted: 10/18/2015] [Indexed: 12/14/2022] Open
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36
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Schwanekamp JA, Lorts A, Vagnozzi RJ, Vanhoutte D, Molkentin JD. Deletion of Periostin Protects Against Atherosclerosis in Mice by Altering Inflammation and Extracellular Matrix Remodeling. Arterioscler Thromb Vasc Biol 2015; 36:60-8. [PMID: 26564821 DOI: 10.1161/atvbaha.115.306397] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/29/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Periostin is a secreted protein that can alter extracellular matrix remodeling in response to tissue injury. However, the functional role of periostin in the development of atherosclerotic plaques has yet to be described despite its observed induction in diseased vessels and presence in the serum. APPROACH AND RESULTS Hyperlipidemic, apolipoprotein E-null mice (ApoE(-/) (-)) were crossed with periostin (Postn(-/-)) gene-deleted mice and placed on a high-fat diet for 6 or 14 weeks to induce atherosclerosis. En face analysis of aortas showed significantly decreased lesion areas of ApoE(-/-) Postn(-/-) mice compared with ApoE(-/-) mice, as well as a reduced inflammatory response with less macrophage content. Moreover, diseased aortas from ApoE(-/-) Postn(-/-) mice displayed a disorganized extracellular matrix with less collagen cross linking and smaller fibrotic caps, as well as increased matrix metalloproteinase-2, metalloproteinase-13, and procollagen-lysine, 2-oxoglutarate 5-dioxygenase-1 mRNA expression. Furthermore, the loss of periostin was associated with a switch in vascular smooth muscle cells toward a more proliferative and synthetic phenotype. Mechanistically, the loss of periostin reduced macrophage recruitment by transforming growth factor-β in cellular migration assays. CONCLUSIONS These are the first genetic data detailing the function of periostin as a regulator of atherosclerotic lesion formation and progression. The data suggest that periostin could be a therapeutic target for atherosclerotic plaque formation through modulation of the immune response and extracellular matrix remodeling.
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MESH Headings
- Animals
- Aorta, Thoracic/immunology
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/pathology
- Aortic Diseases/genetics
- Aortic Diseases/immunology
- Aortic Diseases/metabolism
- Aortic Diseases/pathology
- Aortic Diseases/prevention & control
- Apolipoproteins E/deficiency
- Apolipoproteins E/genetics
- Atherosclerosis/genetics
- Atherosclerosis/immunology
- Atherosclerosis/metabolism
- Atherosclerosis/pathology
- Atherosclerosis/prevention & control
- Cell Adhesion Molecules/deficiency
- Cell Adhesion Molecules/genetics
- Cell Movement
- Cell Proliferation
- Cells, Cultured
- Collagen/metabolism
- Diet, High-Fat
- Disease Models, Animal
- Disease Progression
- Extracellular Matrix/metabolism
- Gene Deletion
- Gene Expression Regulation
- Inflammation/genetics
- Inflammation/immunology
- Inflammation/metabolism
- Inflammation/pathology
- Inflammation/prevention & control
- Macrophages/metabolism
- Mice, Inbred C57BL
- Mice, Knockout
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Phenotype
- Plaque, Atherosclerotic
- RNA, Messenger/metabolism
- Signal Transduction
- Time Factors
- Vascular Remodeling
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Affiliation(s)
- Jennifer A Schwanekamp
- From the Department of Pediatrics (J.A.S., A.L., R.J.V., D.V., J.D.M.) and Howard Hughes Medical Institute (J.D.M.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH
| | - Angela Lorts
- From the Department of Pediatrics (J.A.S., A.L., R.J.V., D.V., J.D.M.) and Howard Hughes Medical Institute (J.D.M.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH
| | - Ronald J Vagnozzi
- From the Department of Pediatrics (J.A.S., A.L., R.J.V., D.V., J.D.M.) and Howard Hughes Medical Institute (J.D.M.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH
| | - Davy Vanhoutte
- From the Department of Pediatrics (J.A.S., A.L., R.J.V., D.V., J.D.M.) and Howard Hughes Medical Institute (J.D.M.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH
| | - Jeffery D Molkentin
- From the Department of Pediatrics (J.A.S., A.L., R.J.V., D.V., J.D.M.) and Howard Hughes Medical Institute (J.D.M.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH.
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Kogan NM, Melamed E, Wasserman E, Raphael B, Breuer A, Stok KS, Sondergaard R, Escudero AVV, Baraghithy S, Attar-Namdar M, Friedlander-Barenboim S, Mathavan N, Isaksson H, Mechoulam R, Müller R, Bajayo A, Gabet Y, Bab I. Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts. J Bone Miner Res 2015; 30:1905-13. [PMID: 25801536 DOI: 10.1002/jbmr.2513] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 02/15/2015] [Accepted: 03/18/2015] [Indexed: 12/16/2022]
Abstract
Cannabinoid ligands regulate bone mass, but skeletal effects of cannabis (marijuana and hashish) have not been reported. Bone fractures are highly prevalent, involving prolonged immobilization and discomfort. Here we report that the major non-psychoactive cannabis constituent, cannabidiol (CBD), enhances the biomechanical properties of healing rat mid-femoral fractures. The maximal load and work-to-failure, but not the stiffness, of femurs from rats given a mixture of CBD and Δ(9) -tetrahydrocannabinol (THC) for 8 weeks were markedly increased by CBD. This effect is not shared by THC (the psychoactive component of cannabis), but THC potentiates the CBD stimulated work-to-failure at 6 weeks postfracture followed by attenuation of the CBD effect at 8 weeks. Using micro-computed tomography (μCT), the fracture callus size was transiently reduced by either CBD or THC 4 weeks after fracture but reached control level after 6 and 8 weeks. The callus material density was unaffected by CBD and/or THC. By contrast, CBD stimulated mRNA expression of Plod1 in primary osteoblast cultures, encoding an enzyme that catalyzes lysine hydroxylation, which is in turn involved in collagen crosslinking and stabilization. Using Fourier transform infrared (FTIR) spectroscopy we confirmed the increase in collagen crosslink ratio by CBD, which is likely to contribute to the improved biomechanical properties of the fracture callus. Taken together, these data show that CBD leads to improvement in fracture healing and demonstrate the critical mechanical role of collagen crosslinking enzymes.
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Affiliation(s)
- Natalya M Kogan
- Bone Laboratory, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eitan Melamed
- Bone Laboratory, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Wasserman
- Bone Laboratory, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bitya Raphael
- Bone Laboratory, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Breuer
- Institute for Drug Research, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kathryn S Stok
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | | | | | - Saja Baraghithy
- Bone Laboratory, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Neashan Mathavan
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,Department of Orthopedics, Lund University, Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,Department of Orthopedics, Lund University, Lund, Sweden
| | - Raphael Mechoulam
- Institute for Drug Research, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ralph Müller
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Alon Bajayo
- Bone Laboratory, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yankel Gabet
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Bab
- Bone Laboratory, Hebrew University of Jerusalem, Jerusalem, Israel
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González-Santamaría J, Villalba M, Busnadiego O, López-Olañeta MM, Sandoval P, Snabel J, López-Cabrera M, Erler JT, Hanemaaijer R, Lara-Pezzi E, Rodríguez-Pascual F. Matrix cross-linking lysyl oxidases are induced in response to myocardial infarction and promote cardiac dysfunction. Cardiovasc Res 2015; 109:67-78. [PMID: 26260798 DOI: 10.1093/cvr/cvv214] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/31/2015] [Indexed: 12/27/2022] Open
Abstract
AIMS After myocardial infarction (MI), extensive remodelling of the extracellular matrix contributes to scar formation. While aiming to preserve tissue integrity, this fibrotic response is also associated with adverse events, including a markedly increased risk of heart failure, ventricular arrhythmias, and sudden cardiac death. Cardiac fibrosis is characterized by extensive deposition of collagen and also by increased stiffness as a consequence of enhanced collagen cross-linking. Members of the lysyl oxidase (LOX) family of enzymes are responsible for the formation of collagen cross-links. This study investigates the contribution of LOX family members to the heart response to MI. METHODS AND RESULTS Experimental MI was induced in C57BL/6 mice by permanent ligation of the left anterior descending coronary artery. The expression of LOX isoforms (LOX and LOXL1-4) was strongly increased upon MI, and this response was accompanied by a significant accumulation of mature collagen fibres in the infarcted area. LOX expression was observed in areas of extensive remodelling, partially overlapping with α-smooth muscle actin-expressing myofibroblasts. Tumour growth factor-β as well as hypoxia-activated pathways contributed to the induction of LOX expression in cardiac fibroblasts. Finally, in vivo post-infarction treatment with the broadband LOX inhibitor β-aminopropionitrile or, selectively, with a neutralizing antibody against the canonical LOX isoform attenuated collagen accumulation and maturation and also resulted in reduced ventricular dilatation and improved cardiac function. CONCLUSION LOX family members contribute significantly to the detrimental effects of cardiac remodelling, highlighting LOX inhibition as a potential therapeutic strategy for post-infarction recovery.
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Affiliation(s)
- José González-Santamaría
- Centro de Biología Molecular 'Severo Ochoa', Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Nicolás Cabrera 1, Madrid E28049, Spain
| | - María Villalba
- Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Melchor Fernández Almagro 3, Madrid E28029, Spain
| | - Oscar Busnadiego
- Centro de Biología Molecular 'Severo Ochoa', Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Nicolás Cabrera 1, Madrid E28049, Spain
| | - Marina M López-Olañeta
- Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Melchor Fernández Almagro 3, Madrid E28029, Spain
| | - Pilar Sandoval
- Centro de Biología Molecular 'Severo Ochoa', Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Nicolás Cabrera 1, Madrid E28049, Spain
| | | | - Manuel López-Cabrera
- Centro de Biología Molecular 'Severo Ochoa', Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Nicolás Cabrera 1, Madrid E28049, Spain
| | - Janine T Erler
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen (UCPH), Copenhagen, Denmark
| | | | - Enrique Lara-Pezzi
- Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Melchor Fernández Almagro 3, Madrid E28029, Spain
| | - Fernando Rodríguez-Pascual
- Centro de Biología Molecular 'Severo Ochoa', Consejo Superior de Investigaciones Científicas (CSIC), Universidad Autónoma de Madrid (UAM), Nicolás Cabrera 1, Madrid E28049, Spain
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39
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Broberg CS, Therrien J. Understanding and treating aortopathy in bicuspid aortic valve. Trends Cardiovasc Med 2015; 25:445-51. [DOI: 10.1016/j.tcm.2014.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/12/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
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40
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Mathieu P, Bossé Y, Huggins GS, Della Corte A, Pibarot P, Michelena HI, Limongelli G, Boulanger MC, Evangelista A, Bédard E, Citro R, Body SC, Nemer M, Schoen FJ. The pathology and pathobiology of bicuspid aortic valve: State of the art and novel research perspectives. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2015; 1:195-206. [PMID: 27499904 PMCID: PMC4939890 DOI: 10.1002/cjp2.21] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/25/2015] [Indexed: 12/12/2022]
Abstract
Bicuspid aortic valve is the most prevalent cardiac valvular malformation. It is associated with a high rate of long‐term morbidity including development of calcific aortic valve disease, aortic regurgitation and concomitant thoracic aortic aneurysm and dissection. Recently, basic and translational studies have identified some key processes involved in the development of bicuspid aortic valve and its morbidity. The development of aortic valve disease and thoracic aortic aneurysm and dissection is the result of complex interactions between genotypes, environmental risk factors and specific haemodynamic conditions created by bicuspid aortic valve anatomy. Herein, we review the pathobiology of bicuspid aortic valve with a special emphasis on translational aspects of these basic findings. Important but unresolved problems in the pathology of bicuspid aortic valve and thoracic aortic aneurysm and dissection are discussed, along with the molecular processes involved.
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Affiliation(s)
- Patrick Mathieu
- Laboratoire d'Études Moléculaires des Valvulopathies (LEMV), Groupe de Recherche en Valvulopathies (GRV), Department of Surgery Quebec Heart and Lung Institute/Research Center, Laval University Quebec Canada
| | - Yohan Bossé
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Gordon S Huggins
- Molecular Cardiology Research Institute Center for Translational Genomics, Tufts Medical Center Boston Massachussetts USA
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Cardiac Surgery Second University of Naples 80131 Naples Italy
| | - Philippe Pibarot
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Hector I Michelena
- Division of Cardiovascular Diseases, Mayo Clinic Rochester Minnesota USA
| | - Giuseppe Limongelli
- Department of Cardiology and Cardiothoracic and Respiratory Sciences, Cardiologia SUN, Monaldi Hospital, AO Colli Naples Italy
| | - Marie-Chloé Boulanger
- Laboratoire d'Études Moléculaires des Valvulopathies (LEMV), Groupe de Recherche en Valvulopathies (GRV), Department of Surgery Quebec Heart and Lung Institute/Research Center, Laval University Quebec Canada
| | - Arturo Evangelista
- Department of Cardiology Hospital Universitary Vall d'Hebron Barcelona Spain
| | - Elisabeth Bédard
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine Center for Perioperative Genomics, Brigham and Women's Hospital Boston Massachusetts USA
| | - Mona Nemer
- Laboratory for Cardiac Development and Differentiation University of Ottawa Ontario Canada
| | - Frederick J Schoen
- Department of Pathology Brigham and Women's Hospital, Harvard Medical School USA
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Carreño JE, Verdugo FJ, Contreras F, Montellano FA, Veloso S, Schalper KA, Sandoval M, Villanueva S, Marusic E, Irarrazabal CE. Spironolactone inhibits the activity of the Na+/H+exchanger in the aorta of mineralocorticoid-induced hypertensive rats. J Renin Angiotensin Aldosterone Syst 2015; 16:1225-31. [DOI: 10.1177/1470320315587193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/24/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Juan E Carreño
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
| | - Fernando J Verdugo
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
| | - Felipe Contreras
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
| | - Felipe A Montellano
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
| | - Sebastian Veloso
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
| | | | - Mauricio Sandoval
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
| | - Sandra Villanueva
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
| | - Elisa Marusic
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
| | - Carlos E Irarrazabal
- Laboratory of Molecular Physiology, Faculty of Medicine, Universidad de los Andes, Chile
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Busnadiego O, Gorbenko Del Blanco D, González-Santamaría J, Habashi JP, Calderon JF, Sandoval P, Bedja D, Guinea-Viniegra J, Lopez-Cabrera M, Rosell-Garcia T, Snabel JM, Hanemaaijer R, Forteza A, Dietz HC, Egea G, Rodriguez-Pascual F. Elevated expression levels of lysyl oxidases protect against aortic aneurysm progression in Marfan syndrome. J Mol Cell Cardiol 2015; 85:48-57. [PMID: 25988230 DOI: 10.1016/j.yjmcc.2015.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 04/28/2015] [Accepted: 05/11/2015] [Indexed: 01/02/2023]
Abstract
Patients with Marfan syndrome (MFS) are at high risk of life-threatening aortic dissections. The condition is caused by mutations in the gene encoding fibrillin-1, an essential component in the formation of elastic fibers. While experimental findings in animal models of the disease have shown the involvement of transforming growth factor-β (TGF-β)- and angiotensin II-dependent pathways, alterations in the vascular extracellular matrix (ECM) may also play a role in the onset and progression of the aortic disease. Lysyl oxidases (LOX) are extracellular enzymes, which initiates the formation of covalent cross-linking of collagens and elastin, thereby contributing to the maturation of the ECM. Here we have explored the role of LOX in the formation of aortic aneurysms in MFS. We show that aortic tissue from MFS patients and MFS mouse model (Fbn1(C1039G/+)) displayed enhanced expression of the members of the LOX family, LOX and LOX-like 1 (LOXL1), and this is associated with the formation of mature collagen fibers. Administration of a LOX inhibitor for 8weeks blocked collagen accumulation and aggravated elastic fiber impairment, and these effects correlated with the induction of a strong and rapidly progressing aortic dilatation, and with premature death in the more severe MFS mouse model, Fbn1(mgR/mgR), without any significant effect on wild type animals. This detrimental effect occurred preferentially in the ascending portion of the aorta, with little or no involvement of the aortic root, and was associated to an overactivation of both canonical and non-canonical TGF-β signaling pathways. The blockade of angiotensin II type I receptor with losartan restored TGF-β signaling activation, normalized elastic fiber impairment and prevented the aortic dilatation induced by LOX inhibition in Fbn1(C1039G/+) mice. Our data indicate that LOX enzymes and LOX-mediated collagen accumulation play a critical protective role in aneurysm formation in MFS.
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Affiliation(s)
- O Busnadiego
- Centro de Biología Molecular "Severo Ochoa" Consejo Superior de Investigaciones Científicas (C.S.I.C.)/Universidad Autónoma de Madrid (Madrid), Madrid, Spain
| | - D Gorbenko Del Blanco
- Departamento de Biología Celular, Inmunología y Neurociencias, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J González-Santamaría
- Centro de Biología Molecular "Severo Ochoa" Consejo Superior de Investigaciones Científicas (C.S.I.C.)/Universidad Autónoma de Madrid (Madrid), Madrid, Spain
| | - J P Habashi
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J F Calderon
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Sandoval
- Centro de Biología Molecular "Severo Ochoa" Consejo Superior de Investigaciones Científicas (C.S.I.C.)/Universidad Autónoma de Madrid (Madrid), Madrid, Spain
| | - D Bedja
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Guinea-Viniegra
- Fundación Banco Bilbao Vizcaya-CNIO Cancer Cell Biology Program, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - M Lopez-Cabrera
- Centro de Biología Molecular "Severo Ochoa" Consejo Superior de Investigaciones Científicas (C.S.I.C.)/Universidad Autónoma de Madrid (Madrid), Madrid, Spain
| | - T Rosell-Garcia
- Centro de Biología Molecular "Severo Ochoa" Consejo Superior de Investigaciones Científicas (C.S.I.C.)/Universidad Autónoma de Madrid (Madrid), Madrid, Spain
| | - J M Snabel
- TNO Metabolic Health Research, Leiden, The Netherlands
| | - R Hanemaaijer
- TNO Metabolic Health Research, Leiden, The Netherlands
| | - A Forteza
- Hospital Universitario 12 de Octubre, Unidad de Marfan, Madrid, Spain
| | - H C Dietz
- Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Egea
- Departamento de Biología Celular, Inmunología y Neurociencias, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Rodriguez-Pascual
- Centro de Biología Molecular "Severo Ochoa" Consejo Superior de Investigaciones Científicas (C.S.I.C.)/Universidad Autónoma de Madrid (Madrid), Madrid, Spain.
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Paloschi V, Gådin JR, Khan S, Björck HM, Du L, Maleki S, Roy J, Lindeman JHM, Mohamed SA, Tsuda T, Franco-Cereceda A, Eriksson P. Aneurysm development in patients with a bicuspid aortic valve is not associated with transforming growth factor-β activation. Arterioscler Thromb Vasc Biol 2015; 35:973-80. [PMID: 25745062 DOI: 10.1161/atvbaha.114.304996] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Patients with bicuspid aortic valve (BAV) have an increased risk of developing ascending aortic aneurysms. Transforming growth factor-β (TGFβ) is a crucial factor of vascular remodeling, the impaired signaling of which can alter the structure and composition of the extracellular matrix. In this study, we analyzed the activity of TGFβ in aneurysmal and nonaneurysmal ascending aorta from BAV patients, using tricuspid aortic valve (TAV) patients as a reference group. APPROACH AND RESULTS The response to exogenous TGFβ was analyzed with regard to gene expression in primary aortic smooth muscle cells that were isolated from 7 BAV and 5 TAV patients and in valve fibroblasts from 7 BAV and 8 TAV patients. The set of genes that were significantly changed by TGFβ (217 genes) was compared with gene expression profiles of the ascending aorta from BAV and TAV patients (139 arrays). By principle component analysis, based on the 217 genes, gene expression differed significantly in the intima/media region between aneurysmal BAV and TAV aortas, driven by the response in TAV patients. During aneurysm development the levels of phosphorylated SMADs and the availability of free TGFβ were lower in BAV patients compared with TAV. Confocal microscopy analysis showed a higher colocalization of latency associated peptide and latent TGFβ binding protein 3 in BAV aortas. CONCLUSIONS Our findings suggest that TGFβ activation during aneurysm formation is muted in patients with BAV, possibly as a result of an increased TGFβ sequestration in the extracellular space.
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Affiliation(s)
- Valentina Paloschi
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.).
| | - Jesper R Gådin
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Shaukat Khan
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Hanna M Björck
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Lei Du
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Shohreh Maleki
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Joy Roy
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Jan H M Lindeman
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Salah A Mohamed
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Takeshi Tsuda
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Anders Franco-Cereceda
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Per Eriksson
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
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Structure-based constitutive model can accurately predict planar biaxial properties of aortic wall tissue. Acta Biomater 2015; 14:133-45. [PMID: 25458466 DOI: 10.1016/j.actbio.2014.11.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/13/2014] [Accepted: 11/20/2014] [Indexed: 11/21/2022]
Abstract
Structure-based constitutive models might help in exploring mechanisms by which arterial wall histology is linked to wall mechanics. This study aims to validate a recently proposed structure-based constitutive model. Specifically, the model's ability to predict mechanical biaxial response of porcine aortic tissue with predefined collagen structure was tested. Histological slices from porcine thoracic aorta wall (n=9) were automatically processed to quantify the collagen fiber organization, and mechanical testing identified the non-linear properties of the wall samples (n=18) over a wide range of biaxial stretches. Histological and mechanical experimental data were used to identify the model parameters of a recently proposed multi-scale constitutive description for arterial layers. The model predictive capability was tested with respect to interpolation and extrapolation. Collagen in the media was predominantly aligned in circumferential direction (planar von Mises distribution with concentration parameter bM=1.03 ± 0.23), and its coherence decreased gradually from the luminal to the abluminal tissue layers (inner media, b=1.54 ± 0.40; outer media, b=0.72 ± 0.20). In contrast, the collagen in the adventitia was aligned almost isotropically (bA=0.27 ± 0.11), and no features, such as families of coherent fibers, were identified. The applied constitutive model captured the aorta biaxial properties accurately (coefficient of determination R(2)=0.95 ± 0.03) over the entire range of biaxial deformations and with physically meaningful model parameters. Good predictive properties, well outside the parameter identification space, were observed (R(2)=0.92 ± 0.04). Multi-scale constitutive models equipped with realistic micro-histological data can predict macroscopic non-linear aorta wall properties. Collagen largely defines already low strain properties of media, which explains the origin of wall anisotropy seen at this strain level. The structure and mechanical properties of adventitia are well designed to protect the media from axial and circumferential overloads.
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45
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Tsamis A, Pal S, Phillippi JA, Gleason TG, Maiti S, Vorp DA. Effect of aneurysm on biomechanical properties of "radially-oriented" collagen fibers in human ascending thoracic aortic media. J Biomech 2014; 47:3820-4. [PMID: 25468299 DOI: 10.1016/j.jbiomech.2014.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
We recently reported a mechanistic model to link micro-architectural information to the delamination strength (Sd) of human ascending thoracic aorta (ATA). That analysis demonstrated that the number density (N) and failure energy (Uf) of the radially-oriented collagen fibers contribute to the Sd of both aneurysmal (ATAA) and non-aneurysmal (CTRL-ATA) aortic tissue. Among the set of ATAA samples, we studied specimens from patients displaying bicuspid (BAV) and tricuspid aortic valve (TAV) morphologic phenotypes. Results from our prior work were based on the assumption that the Uf was independent of dissection direction. In the current study, we excluded that assumption and hypothesized that Uf correlates with the Sd of ATAA. To test the hypothesis, we used previously-reported experimentally-determined Sd measurements and N of radially-oriented collagen fibers as input in our validated mechanistic model to calculate Uf for BAV-ATAA, TAV-ATAA and CTRL-ATA tissue specimens. The results of our analysis revealed that Uf is significantly lower for both BAV-ATAA and TAV-ATAA compared to CTRL-ATA cases, and does not differ between BAV-ATAA and TAV-ATAA. Furthermore, we found that Uf is consistent between circumferential-radial and longitudinal-radial planes in either of BAV-ATAA, TAV-ATAA or CTRL-ATA specimens. These findings employ a novel mechanistic model to increase our understanding of the putative interrelationship between biomechanical properties, extracellular matrix biology, and failure energy of aortic dissection.
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Affiliation(s)
- Alkiviadis Tsamis
- Departments of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Siladitya Pal
- Departments of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Julie A Phillippi
- Departments of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Thomas G Gleason
- Departments of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Spandan Maiti
- Departments of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.
| | - David A Vorp
- Departments of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Abstract
BACKGROUND The study hypothesis was that thoracic aortic disease (TAD) is associated with a higher-than-expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population-based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance. METHODS AND RESULTS The prevalence of inguinal hernia in subjects with TAD was determined from nation-wide register data and compared to a non-TAD group (patients with isolated aortic stenosis). Groups were balanced using propensity score matching. Multivariable statistical analysis (logistic regression) was performed to identify variables independently associated with hernia. Hernia prevalence was 110 of 750 (15%) in subjects with TAD versus 29 of 301 (9.6%) in non-TAD, P=0.03. This statistically significant difference remained after propensity score matching: 21 of 159 (13%) in TAD versus 14 of 159 (8.9%) in non-TAD, P<0.001. Variables independently associated with hernia in multivariable analysis were male sex (odds ratio [OR] with 95% confidence interval [95% CI]) 3.4 (2.1 to 5.4), P<0.001; increased age, OR 1.02/year (1.004 to 1.04), P=0.014; and TAD, OR 1.8 (1.1 to 2.8), P=0.015. CONCLUSIONS The prevalence of inguinal hernia (15%) in TAD is higher than expected in a general population and higher in TAD, compared to non-TAD. TAD is independently associated with hernia in multivariable analysis. Presence or history of hernia may be of importance in detecting TAD, and the association warrants further study.
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Affiliation(s)
- Christian Olsson
- Cardiovascular Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (C.O., A.F.C.)
| | - Per Eriksson
- Atherosclerosis Research Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden (P.E.)
| | - Anders Franco-Cereceda
- Cardiovascular Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (C.O., A.F.C.)
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47
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Ye X. Invited commentary. Ann Thorac Surg 2014; 98:71. [PMID: 24996698 DOI: 10.1016/j.athoracsur.2014.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 04/21/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Xiaofeng Ye
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.
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48
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Lee J, Shen M, Parajuli N, Oudit GY, McMurtry MS, Kassiri Z. Gender-dependent aortic remodelling in patients with bicuspid aortic valve-associated thoracic aortic aneurysm. J Mol Med (Berl) 2014; 92:939-49. [DOI: 10.1007/s00109-014-1178-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/01/2014] [Accepted: 05/23/2014] [Indexed: 12/19/2022]
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49
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Forsell C, Björck HM, Eriksson P, Franco-Cereceda A, Gasser TC. Biomechanical properties of the thoracic aneurysmal wall: differences between bicuspid aortic valve and tricuspid aortic valve patients. Ann Thorac Surg 2014; 98:65-71. [PMID: 24881863 DOI: 10.1016/j.athoracsur.2014.04.042] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 02/13/2014] [Accepted: 04/04/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND The prevalence for thoracic aortic aneurysms (TAAs) is significantly increased in patients with a bicuspid aortic valve (BAV) compared with patients who have a normal tricuspid aortic valve (TAV). TAA rupture is a life-threatening event, and biomechanics-based simulations of the aorta may help to disentangle the molecular mechanism behind its development and progression. The present study used polarized microscopy and macroscopic in vitro tensile testing to explore collagen organization and mechanical properties of TAA wall specimens from BAV and TAV patients. METHODS Circumferential sections of aneurysmal aortic tissue from BAV and TAV patients were obtained during elective operations. The distribution of collagen orientation was captured by a Bingham distribution, and finite element models were used to estimate constitutive model parameters from experimental load-displacement curves. RESULTS Collagen orientation was almost identical in BAV and TAV patients, with a highest probability of alignment along the circumferential direction. The strength was almost two times higher in BAV samples (0.834 MPa) than in TAV samples (0.443 MPa; p<0.001). The collagen-related stiffness (Cf) was significantly increased in BAV compared with TAV patients (Cf=7.45 MPa vs 3.40 MPa; p=0.003), whereas the elastin-related stiffness was similar in both groups. A trend toward a decreased wall thickness was seen in BAV patients (p=0.058). CONCLUSIONS The aneurysmal aortas of BAV patients show a higher macroscopic strength, mainly due to an increased collagen-related stiffness, compared with TAV patients. The increased wall stiffness in BAV patients may contribute to the higher prevalence for TAAs in this group.
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Affiliation(s)
- Caroline Forsell
- KTH Solid Mechanics, School of Engineering Sciences, Royal Institute of Technology (KTH), Stockholm, Sweden
| | - Hanna M Björck
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Per Eriksson
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Cardiothoracic Surgical Unit, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - T Christian Gasser
- KTH Solid Mechanics, School of Engineering Sciences, Royal Institute of Technology (KTH), Stockholm, Sweden.
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50
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Tourmousoglou C, Lalos S. eComment. Evaluating aortic media changes in ascending aorta aneurysm with bicuspid aortic valve disease. Interact Cardiovasc Thorac Surg 2013; 17:936-7. [PMID: 24243940 DOI: 10.1093/icvts/ivt479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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