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Tan RP, Ryder I, Yang N, Lam YT, Santos M, Michael PL, Robinson DA, Ng MK, Wise SG. Macrophage Polarization as a Novel Therapeutic Target for Endovascular Intervention in Peripheral Artery Disease. JACC Basic Transl Sci 2021; 6:693-704. [PMID: 34466756 PMCID: PMC8385566 DOI: 10.1016/j.jacbts.2021.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022]
Abstract
Peripheral artery disease (PAD) has a significant impact on human health, affecting 200 million people globally. Advanced PAD severely diminishes quality of life, affecting mobility, and in its most severe form leads to limb amputation and death. Treatment of PAD is among the least effective of all endovascular procedures in terms of long-term efficacy. Chronic inflammation is a key driver of PAD; however, stents and coated balloons eluting antiproliferative drugs are most commonly used. As a result, neither stents nor coated balloons produce durable clinical outcomes in the superficial femoral artery, and both have recently been associated with significantly increased mortality. This review summarizes the most common clinical approaches and limitations to treating PAD and highlights the necessity to address the underlying causes of inflammation, identifying macrophages as a novel therapeutic target in the next generation of endovascular PAD intervention.
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Key Words
- BMS, bare-metal stent
- CAD, coronary artery disease
- DES, drug-eluting stent
- FP, femoropopliteal
- IL, interleukin
- MI, myocardial infarction
- PAD, peripheral artery disease
- PTA, percutaneous transluminal angioplasty
- SFA, superficial femoral artery
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- drug-eluting balloon
- drug-eluting stent
- endovascular intervention
- macrophage polarization
- paclitaxel
- peripheral arterial disease
- vascular healing
- vascular inflammation
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Affiliation(s)
- Richard P. Tan
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Address for correspondence: Dr. Richard P. Tan, Charles Perkins Centre, University of Sydney, Johns Hopkins Drive, Camperdown, Sydney, New South Wales 2006, Australia
| | - Isabelle Ryder
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nianji Yang
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Yuen Ting Lam
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Miguel Santos
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Praveesuda L. Michael
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - David A. Robinson
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Martin K. Ng
- Department of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Steven G. Wise
- Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- University of Sydney Nano Institute, University of Sydney, Sydney, New South Wales, Australia
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Castro C, Pereira AH. Histological changes secondary to use of anti-angiogenic therapy after interruption of vasa vasorum flow in the descending aorta: results in a porcine model. J Vasc Bras 2019; 18:e20180095. [PMID: 31320887 PMCID: PMC6629455 DOI: 10.1590/1677-5449.180095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background Anti-angiogenic regulators may have therapeutic implications for onset and progression of atherosclerosis. Objectives To demonstrate histological changes secondary to the use of bevacizumab in the aorta of pigs after interruption of flow in the vasa vasorum. Methods Twelve pigs were divided into two groups. The intercostal arteries of the descending aorta were dissected and ligated and wrapped with a polyvinyl chloride membrane. The treatment group received an intravenous dose of bevacizumab. After 15 days, the animals were euthanized and the aorta removed. Histological slides were prepared for control and treatment groups and for non-manipulated areas and analyzed for degree of angiogenesis, injury, inflammation, and intimal thickening. Data were expressed as mean (SD) of scores and groups were compared using the Mann-Whitney test. The Poisson distribution was used to calculate 95% confidence intervals for mean scores, in order to determine effect statistics. Results Bevacizumab had adverse effects on all treated pigs. The analysis using a Scale of Magnitudes for Effect Statistics showed a trend toward a decrease in angiogenesis [0.58 (1.79/-0.63)] and injury [0.55 (1.76/-0.66)] and an increase in inflammation [0.67 (1.89/-0.55)] with threshold moderate effects. There was no difference in intimal thickening [0 (1.19/-1.19)]. Conclusions The medication exhibited a trend toward reduced angiogenesis and injury, but no reduction in the inflammatory process or intimal thickening of the aortic wall. These findings are in disagreement with studies that correlate neovascularization with increased migration of inflammatory cells. Bevacizumab exhibited toxicity in the porcine model.
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Affiliation(s)
- Cyro Castro
- Grupo Hospitalar Conceição - GHC, Cirurgia Vascular, Porto Alegre, RS, Brasil
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Turk T, Rubin O, Šarić G, Mišević T, Kopačin V, Kovač D, Ivković V, Farkaš V, Šerić V. INFLAMMATORY RESPONSE FOLLOWING PERIPHERAL ENDOVASCULAR TREATMENT CORRELATES WITH THE EXTENT OF PERIPROCEDURAL ARTERIAL INJURY. Acta Clin Croat 2018; 57:630-637. [PMID: 31168199 PMCID: PMC6544099 DOI: 10.20471/acc.2018.57.04.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
- The aim was to examine whether the postprocedural change in C-reactive protein (CRP) and fibrinogen levels was associated with the extent of periprocedural arterial injury caused by endovascular treatment (EVT). The study recruited 71 patients undergoing EVT. Eighty-four patients that underwent angiography served as a control group. CRP and fibrinogen were measured at baseline, and at 8, 24 and 48 hours following the procedure. In all experimental group patients, lesion complexity, percutaneous transluminal angioplasty (PTA) treated segment length, balloon inflation time and stented segment length were recorded. There was significant increase in plasma CRP and fibrinogen levels 48 hours following EVT (p<0.001). There was no significant difference in CRP and fibrinogen levels among different TASC groups. CRP levels were significantly higher in stent subgroup compared to PTA subgroup. Significant positive correlation was found between PTA treated segment length and CRP increase between 8 and 24 hours following EVT (r=0.313, p=0.02), balloon inflation time and CRP increase in the aforementioned time frame (r=0.270, p=0.03), as well as between CRP increase at 8 hours and stented segment length (r=0.535, p=0.01). This study showed that the arterial injury caused by EVT reflected on the level of inflammatory biomarkers.
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Affiliation(s)
| | - Otmar Rubin
- 1Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Gordan Šarić
- 1Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Tonći Mišević
- 1Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vjekoslav Kopačin
- 1Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Damir Kovač
- 1Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vedran Ivković
- 1Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vedran Farkaš
- 1Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vatroslav Šerić
- 1Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Surgery, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Oliveira JRDE, Aquino MDEA, Barros S, Pitta GBB, Pereira AH. Alterations of blood flow pattern after triple stent endovascular treatment of saccular abdominal aortic aneurysm: a porcine model. Rev Col Bras Cir 2017; 43:154-9. [PMID: 27556538 DOI: 10.1590/0100-69912016003004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/06/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to determine the blood flow pattern changes after endovascular treatment of saccular abdominal aortic aneurysm with triple stent. METHODS we conducted a hemodynamic study of seven Landrace and Large White pigs with saccular aneurysms of the infrarenal abdominal aorta artificially produced according to the technique described. The animals were subjected to triple stenting for endovascular aneurysm. We evaluated the pattern of blood flow by duplex scan before and after stent implantation. We used the non-paired Mann-Whitney test for statistical analysis. RESULTS there was a significant decrease in the average systolic velocity, from 127.4cm/s in the pre-stent period to 69.81cm/s in the post-stent phase. There was also change in the flow pattern from turbulent in the aneurysmal sac to laminate intra-stent. CONCLUSION there were changes in the blood flow pattern of saccular abdominal aortic aneurysm after endovascular treatment with triple stent. OBJETIVO determinar as alterações do padrão do fluxo sanguíneo após tratamento endovascular do aneurisma sacular de aorta abdominal com triplo stent. MÉTODOS estudo hemodinâmico de sete suínos das raças Landrace e Large White portadores de aneurismas saculares de aorta abdominal infrarrenal artificialmente produzidos segundo técnica descrita. Os animais foram submetidos a implante de triplo stent para correção endovascular do aneurisma e reavaliados por duplex scan quanto ao padrão do fluxo sanguíneo antes e após o implante dos stents. A análise estatística foi realizada com o teste Mann-Whitney não pareado. RESULTADOS verificou-se uma queda significativa da velocidade sistólica média de 127,4cm/s na fase pré-stent para 69,81cm/s na fase pós-stent. Houve ainda mudança no padrão do fluxo de turbilhonar no saco aneurismático para laminar intrastent. CONCLUSÃO o estudo demonstrou alterações do padrão do fluxo sanguíneo do aneurisma sacular de aorta abdominal após tratamento endovascular com triplo stent.
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Affiliation(s)
| | | | - Svetlana Barros
- - Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brasil
| | - Guilherme Benjamin Brandão Pitta
- - Programa de Pós-Graduação em Ciências Cirúrgicas do Departamento de Cirurgia da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Adamastor Humberto Pereira
- - Programa de Pós-Graduação em Ciências Cirúrgicas do Departamento de Cirurgia da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Longhi JA, Pereira AH. Effect of cilostazol on neointimal hyperplasia in iliac arteries of pigs after transluminal angioplasty. Rev Col Bras Cir 2015; 42:175-80. [PMID: 26291259 DOI: 10.1590/0100-69912015003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/10/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate whether systemic administration of cilostazol reduces neointimal hyperplasia in iliac arteries of pigs submitted to balloon catheter angioplasty. METHODS twenty pigs underwent angioplasty with a 6x40 mm balloon catheter in the right common iliac artery, guided by Doppler ultrasound. The animals were randomized into two groups: group 1 (n=10), which received 50mg cilostazol twice a day, and group 2 (n=10), control. After 30 days, the animals were killed and the iliac arteries prepared for histological analysis. The histological sections were digitized and analyzed by digital morphometry. Statistical analysis was performed using the Student t and Mann-Whitney tests. RESULTS when comparing the iliac arteries submitted to angioplasty with those not subjected to angioplasty, there was significant neointimal hyperplasia (0.228 versus 0.119 mm2; p=0.0001). In arteries undergoing angioplasty, there was no difference between group 1 (cilostazol) and group 2 (control) as for the lumen area (2.277 versus 2.575 mm2; p=0.08), the tunica intima (0.219 versus 0.237 mm2; p=0.64), the tunica media (2.262 vs. 2.393 mm2; p=0.53) and the neointimal occlusion percentage (8.857 vs. 9.257 %; p=0.82). CONCLUSION the use of cilostazol 50mg administered in two daily doses did not reduce neointimal hyperplasia in iliac arteries of pigs submitted to balloon angioplasty catheter.
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Houbballah R, Robaldo A, Albadawi H, Titus J, LaMuraglia GM. A novel model of accelerated intimal hyperplasia in the pig iliac artery. Int J Exp Pathol 2011; 92:422-7. [PMID: 22050434 DOI: 10.1111/j.1365-2613.2011.00790.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There is no good animal model of large artery injury-induced intimal hyperplasia (IH). Those available are reproducible, providing only a few layers of proliferating cells or have the disadvantage of the presence of a metallic stent that complicates histology evaluation. This study was designed to develop a new, simple model of accelerated IH based on balloon injury in conjunction with disruption of the Internal Elastic Lamina (IEL) in pig external iliac arteries. Iliac artery injury (n = 24) was performed in 12 Yorkshire pigs divided in two groups: Group I (n = 10), overdistention injury induced by an oversized non-compliant balloon; Group II (n = 14), arterial wall disruption by pulling back an isometric cutting balloon (CB) followed by stretching with a compliant Fogarty Balloon (FB). At two weeks, arteries were processed for morphometric analysis and immunohistochemistry (IHC) for smooth muscle cells (SMC) and proliferating cell nuclear antigen (PCNA). When comparing the two groups, at 2 weeks, arteries of group II had a higher incidence of IH (100%vs. 50%, P = 0.0059), increased intimal areas (2.54 ± 0.33 mm(2) vs. 0.93 ± 0.36 mm(2) , P = 0.004), increased intimal area/Media area ratios (0.95 ± 0.1 vs. 0.28 ± 0.05; P < 0.0001) and decreased lumen areas (6.24 ± 0.44 vs. 9.48 ± 1.56, P = 0.026). No thrombosis was noticed in Group II. Neointima was composed by proliferating SMC located with the highest concentration in the area of IEL disruption (IHC). Arterial injury by pulling back CB and FB induces significant IH in pig iliac arteries by two weeks without thrombosis. This model is superior to the classical overdistention non-compliant model and should be useful and cost-effective for preclinical testing of procedures designed to inhibit IH in large peripheral arteries.
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Affiliation(s)
- Rabih Houbballah
- Division of Vascular and Endovascular Surgery of the General Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Elesbão JLDL, Pereira AH, Grüdtner MA, Meyer F. Análise morfométrica da carótida de suínos submetidos a angioplastia com ou sem implante de stent de cromo-cobalto. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010000200006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Contexto: A hiperplasia intimal é a reação tardia mais comum decorrente da angioplastia. O uso de stents de cromo-cobalto é bem estudado na circulação coronariana, porém não há muitos estudos que abordem o uso desses stents nas circulações carotídea e periférica. Objetivo: Analisar mediante morfometria a reação intimal presente na artéria carótida de suínos submetidos a angioplastia isoladamente e a angioplastia seguida de implante de stent de cromo-cobalto. Materiais e métodos: Em oito suínos, foi realizada angioplastia da artéria carótida comum direita e angioplastia seguida de implante de um stent de cromo-cobalto na artéria carótida comum esquerda. Após 4 semanas, os animais foram submetidos a eutanásia para a retirada de amostras de tecido arterial e preparo de lâminas histológicas. As imagens das lâminas foram digitalizadas e analisadas por programa de morfometria digital. A análise estatística foi realizada através da média e desvio padrão das áreas em cada grupo, utilizando-se o Teste t de Student. O valor de p < 0,05 foi considerado significativo. Resultados: O implante do stent provocou maior grau de hiperplasia comparado à angioplastia isolada. A diferença em resposta ao implante de stent foi estatisticamente significativa quando as áreas do lúmen, da lâmina elástica interna e da lâmina elástica externa foram comparadas entre os dois grupos. Não se observou diferença significativa quando se realizou a comparação entre as camadas médias dos dois grupos. Conclusão: O implante de stent de cromo-cobalto gerou um espessamento intimal maior do que o produzido apenas pela angioplastia, porém ele não foi suficiente para reduzir o lúmen arterial.
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Pasa MB, Pereira AH, Castro Júnior C. Morphometric analysis of intimal thickening secondary to stent placement in pig carotid arteries. Acta Cir Bras 2008; 23:165-72. [PMID: 18372962 DOI: 10.1590/s0102-86502008000200009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 12/10/2007] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate intimal thickening secondary to stent placement or to insertion of the delivery system without stent placement in pig carotid arteries. METHODS Stents were placed in the right common carotid arteries of 7 pigs, and 7 other control pigs underwent only insertion of the delivery system without stent placement. Uninjured contralateral common carotid arteries of the two groups were also used as controls. Samples of arterial tissue, obtained from the area adjacent to the distal segment of the stent four weeks after placement, underwent morphometric analysis. Morphometric data were compared with findings for arterial samples from injured arteries of the control group and uninjured contralateral arteries of the two groups. The unpaired Mann-Whitney U test and the Wilcoxon t test for nonparametric samples were used for statistical analysis. RESULTS Greater intimal thickening was found in the group in which stents were placed (p=0.008). Changes in luminal area and media layer were not significantly different between the two groups. The comparison of contralateral carotid arteries of the two groups revealed significant changes in intimal and luminal areas. No statistically significant changes were found in medial layer area. CONCLUSIONS All arteries that underwent stent placement showed intimal thickening without changes in the tunica media at four weeks. Dissection and insertion of the delivery system without stent placement was associated with a lesser degree of intimal thickening.
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