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Increased Plasma Concentrations of Extracellular Vesicles Are Associated with Pro-Inflammatory and Pro-Thrombotic Characteristics of Left and Right Ventricle Mechanical Support Devices. J Cardiovasc Dev Dis 2023; 10:jcdd10010021. [PMID: 36661916 PMCID: PMC9866833 DOI: 10.3390/jcdd10010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Mechanical circulatory support (MCS) allows for functional left and right heart ventricle replacement. MCS induces a systemic inflammatory reaction and prothrombotic state leading to an increased risk of thrombus formation. The extracellular vesicles (EVs) are nanoparticles released from active/injured cells characterized by prothrombotic properties. Simple inflammatory parameters from whole blood count analysis have established a clinical role in everyday practice to describe immune-inflammatory activation. We hypothesized that increased plasma concentrations of EVs might be associated with the proinflammatory and pro-thrombotic characteristics of left ventricle assist device (LVAD) and right ventricle assist device (RVAD) devices. We presented a pilot study showing the concentration of peripheral blood serum, right and left ventricle mechanical assist device extracellular concentration in relation to thrombotic complication in patients treated with a biventricular pulsatile assist device (BIVAD). The observation was based on 12 replacements of pulsatile pumps during 175 days of observation. The proinflammatory characteristics of LVAD were noted. The proinflammatory and procoagulant activation by RVAD was observed. The results may provide possible explanations for the worse results of right-sided mechanical supports observed in clinical practice.
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2
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Sun W, Zhang J, Shah A, Arias K, Berk Z, Griffith BP, Wu ZJ. Neutrophil dysfunction due to continuous mechanical shear exposure in mechanically assisted circulation in vitro. Artif Organs 2022; 46:83-94. [PMID: 34516005 PMCID: PMC8688241 DOI: 10.1111/aor.14068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Leukocytes play an important role in the body's immune system. The aim of this study was to assess alterations in neutrophil phenotype and function in pump-assisted circulation in vitro. METHODS Human blood was circulated for four hours in three circulatory flow loops with a CentriMag blood pump operated at a flow of 4.5 L/min at three rotational speeds (2100, 2800, and 4000 rpm), against three pressure heads (75, 150, and 350 mm Hg), respectively. Blood samples were collected hourly for analyses of neutrophil activation state (Mac-1, CD62L, CD162), neutrophil reactive oxygen species (ROS) production, apoptosis, and neutrophil phagocytosis. RESULTS Activated neutrophils indicated by both Mac-1 expression and decreased surface expression of CD62L and CD162 receptors increased with time in three loops. The highest level of neutrophil activation was observed in the loop with the highest rotational speed. Platelet-neutrophil aggregates (PNAs) progressively increased in two loops with lower rotational speeds. PNAs peaked at one hour after circulation and decreased subsequently in the loop with the highest rotational speed. Neutrophil ROS production dramatically increased at one hour after circulation and decreased subsequently in all three loops with similar levels and trends. Apoptotic neutrophils increased with time in all three loops. Neutrophil phagocytosis capacity in three loops initially elevated at one hour after circulation and decreased subsequently. Apoptosis and altered phagocytosis were dependent on rotational speed. CONCLUSIONS Our study revealed that the pump-assisted circulation induced neutrophil activation, apoptosis, and functional impairment. The alterations were strongly associated with pump operating condition and duration.
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Affiliation(s)
- Wenji Sun
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jiafeng Zhang
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Katherin Arias
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA,Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Zachary Berk
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bartley P Griffith
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zhongjun J Wu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA,Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
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3
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Dlouha D, Ivak P, Netuka I, Novakova S, Konarik M, Tucanova Z, Lanska V, Hlavacek D, Wohlfahrt P, Hubacek JA, Pitha J. The effect of long-term left ventricular assist device support on flow-sensitive plasma microRNA levels. Int J Cardiol 2021; 339:138-143. [PMID: 34197842 DOI: 10.1016/j.ijcard.2021.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Implantation of current generation left ventricular assist devices (LVADs) in the treatment of end-stage heart failure (HF), not only improves HF symptoms and end-organ perfusion, but also leads to cellular and molecular responses, presumably in response to the continuous flow generated by these devices. MicroRNAs (miRNAs) are important post-transcriptional regulators of gene expression in multiple biological processes, including the pathogenesis of HF. In our study, we examined the influence of long-term LVAD support on changes in flow-sensitive miRNAs in plasma. MATERIALS AND METHODS Blood samples from patients with end-stage heart failure (N = 33; age = 55.7 ± 11.6 years) were collected before LVAD implantation and 3, 6, 9, and 12 months after implantation. Plasma levels of the flow-sensitive miRNAs; miR-10a, miR-10b, miR-146a, miR-146b, miR-663a, miR-663b, miR-21, miR-155, and miR-126 were measured using quantitative PCR. RESULTS Increasing quantities of miR-126 (P < 0.03) and miR-146a (P < 0.02) was observed at each follow-up visit after LVAD implantation. A positive association between miR-155 and Belcaro score (P < 0.04) and an inverse correlation between miR-126 and endothelial function, measured as the reactive hyperemia index (P < 0.05), was observed. CONCLUSIONS Our observations suggest that after LVAD implantation, low pulsatile flow up-regulates plasma levels of circulating flow-sensitive miRNAs, contributing to endothelial dysfunction and vascular remodeling.
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Affiliation(s)
- Dana Dlouha
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Ivak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.; Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.; Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sarka Novakova
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Miroslav Konarik
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Zuzana Tucanova
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Lanska
- Statistical Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Hlavacek
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.; Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Wohlfahrt
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav A Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.; 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Pitha
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Roka-Moiia Y, Ammann KR, Miller-Gutierrez S, Sweedo A, Palomares D, Italiano J, Sheriff J, Bluestein D, Slepian MJ. Shear-mediated platelet activation in the free flow II: Evolving mechanobiological mechanisms reveal an identifiable signature of activation and a bi-directional platelet dyscrasia with thrombotic and bleeding features. J Biomech 2021; 123:110415. [PMID: 34052772 DOI: 10.1016/j.jbiomech.2021.110415] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/03/2021] [Indexed: 01/17/2023]
Abstract
Shear-mediated platelet activation (SMPA) in the "free flow" is the net result of a range of cell mechanobiological mechanisms. Previously, we outlined three main groups of mechanisms including: 1) mechano-destruction - i.e. additive platelet (membrane) damage; 2) mechano-activation - i.e. activation of shear-sensitive ion channels and pores; and 3) mechano-transduction - i.e. "outside-in" signaling via a range of transducers. Here, we report on recent advances since our original report which describes additional features of SMPA. A clear "signature" of SMPA has been defined, allowing differentiation from biochemically-mediated activation. Notably, SMPA is characterized by mitochondrial dysfunction, platelet membrane eversion, externalization of anionic phospholipids, and increased thrombin generation on the platelet surface. However, SMPA does not lead to integrin αIIbβ3 activation or P-selectin exposure due to platelet degranulation, as is commonly observed in biochemical activation. Rather, downregulation of GPIb, αIIbβ3, and P-selectin surface expression is evident. Furthermore, SMPA is accompanied by a decrease in overall platelet size coupled with a concomitant, progressive increase in microparticle generation. Shear-ejected microparticles are highly enriched in GPIb and αIIbβ3. These observations indicate the enhanced diffusion, migration, or otherwise dispersion of platelet adhesion receptors to membrane zones, which are ultimately shed as receptor-rich PDMPs. The pathophysiological consequence of this progressive shear accumulation phenomenon is an associated dyscrasia of remaining platelets - being both reduced in size and less activatable via biochemical means - a tendency to favor bleeding, while concomitantly shed microparticles are highly prothrombotic and increase the tendency for thrombosis in both local and systemic milieu. These mechanisms and observations offer direct clinical utility in allowing measurement and guidance of the net balance of platelet driven events in patients with implanted cardiovascular therapeutic devices.
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Affiliation(s)
- Yana Roka-Moiia
- Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ 85721, United States; Arizona Center for Accelerated Biomedical Innovation, University of Arizona, Tucson, AZ 85721, United States
| | - Kaitlyn R Ammann
- Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ 85721, United States; Arizona Center for Accelerated Biomedical Innovation, University of Arizona, Tucson, AZ 85721, United States
| | - Samuel Miller-Gutierrez
- Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ 85721, United States; Arizona Center for Accelerated Biomedical Innovation, University of Arizona, Tucson, AZ 85721, United States
| | - Alice Sweedo
- Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ 85721, United States; Arizona Center for Accelerated Biomedical Innovation, University of Arizona, Tucson, AZ 85721, United States
| | - Daniel Palomares
- Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ 85721, United States; Arizona Center for Accelerated Biomedical Innovation, University of Arizona, Tucson, AZ 85721, United States
| | - Joseph Italiano
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Jawaad Sheriff
- Department of Biomedical Engineering, Stony Brook University, NY 11794, United States
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, NY 11794, United States
| | - Marvin J Slepian
- Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ 85721, United States; Department of Biomedical Engineering, Stony Brook University, NY 11794, United States; Arizona Center for Accelerated Biomedical Innovation, University of Arizona, Tucson, AZ 85721, United States.
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5
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Roka-Moiia Y, Li M, Ivich A, Muslmani S, Kern KB, Slepian MJ. Impella 5.5 Versus Centrimag: A Head-to-Head Comparison of Device Hemocompatibility. ASAIO J 2021; 66:1142-1151. [PMID: 33136602 PMCID: PMC7594535 DOI: 10.1097/mat.0000000000001283] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Despite growing use of mechanical circulatory support, limitations remain related to hemocompatibility. Here, we performed a head-to-head comparison of the hemocompatibility of a centrifugal cardiac assist system-the Centrimag, with that of the latest generation of an intravascular microaxial system-the Impella 5.5. Specifically, hemolysis, platelet activation, microparticle (MP) generation, and von Willebrand factor (vWF) degradation were evaluated for both devices. Freshly obtained porcine blood was recirculated within device propelled mock loops for 4 hours, and alteration of the hemocompatibility parameters was monitored over time. We found that the Impella 5.5 and Centrimag exhibited low levels of hemolysis, as indicated by minor increase in plasma free hemoglobin. Both devices did not induce platelet degranulation, as no alteration of β-thromboglobulin and P-selectin in plasma occurred, rather minor downregulation of platelet surface P-selectin was detected. Furthermore, blood exposure to shear stress via both Centrimag and Impella 5.5 resulted in a minor decrease of platelet count with associated ejection of procoagulant MPs, and a decrease of vWF functional activity (but not plasma level of vWF-antigen). Greater MP generation was observed with the Centrimag relative to the Impella 5.5. Thus, the Impella 5.5 despite having a lower profile and higher impeller rotational speed demonstrated good and equivalent hemocompatibility, in comparison with the predicate Centrimag, with the advantage of lower generation of MPs.
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Affiliation(s)
- Yana Roka-Moiia
- From the Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona
| | - Mengtang Li
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Adriana Ivich
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Sami Muslmani
- From the Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona
| | - Karl B. Kern
- From the Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona
| | - Marvin J. Slepian
- From the Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona
- Department of Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, Arizona
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Roka-Moiia Y, Miller-Gutierrez S, Palomares DE, Italiano JE, Sheriff J, Bluestein D, Slepian MJ. Platelet Dysfunction During Mechanical Circulatory Support: Elevated Shear Stress Promotes Downregulation of α IIbβ 3 and GPIb via Microparticle Shedding Decreasing Platelet Aggregability. Arterioscler Thromb Vasc Biol 2021; 41:1319-1336. [PMID: 33567867 DOI: 10.1161/atvbaha.120.315583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Yana Roka-Moiia
- Department of Medicine (Y.R.-M., S.M.-G.), Sarver Heart Center, University of Arizona, Tucson
| | - Samuel Miller-Gutierrez
- Department of Medicine (Y.R.-M., S.M.-G.), Sarver Heart Center, University of Arizona, Tucson
| | - Daniel E Palomares
- Department of Biomedical Engineering (D.E.P., M.J.S.), Sarver Heart Center, University of Arizona, Tucson
| | - Joseph E Italiano
- Brigham and Woman's Hospital, Harvard Medical School, Boston, MA (J.E.I.)
| | - Jawaad Sheriff
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY (J.S., D.B., M.J.S.)
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY (J.S., D.B., M.J.S.)
| | - Marvin J Slepian
- Department of Biomedical Engineering (D.E.P., M.J.S.), Sarver Heart Center, University of Arizona, Tucson.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY (J.S., D.B., M.J.S.)
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7
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Pseudoexfoliative Glaucoma, Endothelial Dysfunction, and Arterial Stiffness: The Role of Circulating Apoptotic Endothelial Microparticles. J Glaucoma 2020; 28:749-755. [PMID: 31188231 DOI: 10.1097/ijg.0000000000001303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PRéCIS:: Pseudoexfoliative glaucoma (PExG) patients present with not only endothelial dysfunction and arterial stiffness but also with a specific profile of circulating apoptotic endothelial microparticles which may be owing to the accumulation of pseudoexfoliative material in vessels walls. PURPOSE PExG is characterized by the deposition of pseudoexfoliative material in several tissues and organs including in the cardiovascular system. This study aimed to evaluate the vascular endothelial function, arterial stiffness, inflammatory status, and circulating microparticle (MP) levels in PExG patients compared with those in primary open-angle glaucoma (POAG) patients and control subjects. METHODS Vascular endothelial function was evaluated by flow-mediated dilation. Pulse wave velocity and augmentation index were measured as indices of aortic stiffness and arterial wave reflections, respectively. Growth-differentiation factor-15 and intercellular adhesion molecule1 levels were measured to evaluate the systemic inflammatory status. Circulating MPs that constitute an emerging marker of vascular endothelial dysfunction and platelet activation were isolated and analyzed by flow cytometry. RESULTS There was a stepwise impairment from the control to the POAG patients and PExG subjects in the flow-mediated dilation (8.21%±2.94% vs. 7.56%±3.12% vs. 5.79±3.13, P=0.005), pulse wave velocity (8.14±1.79 vs. 9.21±2.27 vs. 9.95±3.28 m/s, P=0.007), augmentation index (24.71%±7.84% vs. 26.78%±7.21% vs. 29.96%±7.58%, P=0.02), and growth-differentiation factor-15 (P=0.001) and intercellular adhesion molecule1 levels (P=0.08). PExG patients expressed greater levels of total circulating MPs (Annexin V+) (P=0.004) and endothelial-derived MPs (CD144+) (P<0.001) compared with POAG and control subjects. CONCLUSIONS PExG patients with an accumulation of pseudoexfoliative microfibrillar material presented with vascular endothelial dysfunction and arterial wall impairment associated with the levels of circulating proinflammatory molecules and circulating apoptotic endothelial MPs. These findings highlight the underlying systemic pathophysiological mechanisms associated with the progress of the pseudoexfoliative syndrome.
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8
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Silambanan S, Hermes RS, Bhaskar E, Gayathri S. Endothelial Microparticle as an early Marker of Endothelial Dysfunction in Patients with Essential Hypertension: A Pilot Study. Indian J Clin Biochem 2019; 35:245-250. [PMID: 32226258 DOI: 10.1007/s12291-019-00861-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 11/16/2019] [Indexed: 12/21/2022]
Abstract
Hypertension is a global health burden causing immense morbidity and mortality especially from the complications of end-organ damage. It is expected to affect 29% of the population by the year 2025. Hypertension is usually asymptomatic; it is diagnosed by a disease of exclusion. Numerous factors such as inflammation, oxidative stress, genetic predisposition etc. play roles in the pathogenesis of hypertension. Endothelial microparticles (EMPs) are released into the circulation with the onset of changes in endothelium, even before the release of other routine vascular endothelial markers. EMPs mediate inflammation, thrombosis and vasoconstriction of blood vessels in hypertensives. This pilot study was undertaken to assess whether EMPs are early markers of endothelial dysfunction in essential hypertensive patients. The study was conducted as a large case control study in which 525 individuals were involved. It consisted of three study groups: Group I: individuals with normal blood pressure (JNC8), group II: hypertensives without evidence of end-organ damage and group III: hypertensives with evidence of end-organ damage. Homocysteine, hsCRP, fibrinogen, eNOS, oxLDL and other markers were measured. For analysis of EMPs a subset of individuals are taken from each group. Control group of 10 individuals who had homocysteine level more than15μmol/L was taken as Group I. Another 10 individuals were taken randomly of five each from groups II and III. EMPs were analyzed by flow cytometry and were identified as CD31 +, CD42 - microparticles with diameters < 1.0 mm. There was significant increase in EMPs (p = 0.035) in hypertensive individuals with end organ damage. Measurement of EMPs in hypertensive individuals could help physicians in identifying and initiating therapeutic interventions at a very early stage of the disease, thus improving the quality of life.
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Affiliation(s)
- Santhi Silambanan
- Department of Biochemistry, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai 600116 India
| | - R S Hermes
- Department of Biochemistry, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai 600116 India
| | - Emmanuel Bhaskar
- Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai 600116 India
| | - Sri Gayathri
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai 600116 India
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9
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Radley G, Ali S, Pieper IL, Thornton CA. Mechanical shear stress and leukocyte phenotype and function: Implications for ventricular assist device development and use. Int J Artif Organs 2018; 42:133-142. [PMID: 30585115 DOI: 10.1177/0391398818817326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Heart failure remains a disease of ever increasing prevalence in the modern world. Patients with end-stage heart failure are being referred increasingly for mechanical circulatory support. Mechanical circulatory support can assist patients who are ineligible for transplant and stabilise eligible patients prior to transplantation. It is also used during cardiopulmonary bypass surgery to maintain circulation while operating on the heart. While mechanical circulatory support can stabilise heart failure and improve quality of life, complications such as infection and thrombosis remain a common risk. Leukocytes can contribute to both of these complications. Contact with foreign surfaces and the introduction of artificial mechanical shear stress can lead to the activation of leukocytes, reduced functionality and the release of pro-inflammatory and pro-thrombogenic microparticles. Assessing the impact of mechanical trauma to leukocytes is largely overlooked in comparison to red blood cells and platelets. This review provides an overview of the available literature on the effects of mechanical circulatory support systems on leukocyte phenotype and function. One purpose of this review is to emphasise the importance of studying mechanical trauma to leukocytes to better understand the occurrence of adverse events during mechanical circulatory support.
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Affiliation(s)
- Gemma Radley
- Swansea University Medical School, Swansea, UK
- Calon Cardio-Technology Ltd, Institute of Life Science, Swansea, UK
| | - Sabrina Ali
- Calon Cardio-Technology Ltd, Institute of Life Science, Swansea, UK
| | - Ina Laura Pieper
- Swansea University Medical School, Swansea, UK
- Scandinavian Real Heart AB, Västerås, Sweden
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10
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McVey MJ, Kuebler WM. Extracellular vesicles: biomarkers and regulators of vascular function during extracorporeal circulation. Oncotarget 2018; 9:37229-37251. [PMID: 30647856 PMCID: PMC6324688 DOI: 10.18632/oncotarget.26433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
Extracellular vesicles (EVs) are generated at increased rates from parenchymal and circulating blood cells during exposure of the circulation to abnormal flow conditions and foreign materials associated with extracorporeal circuits (ExCors). This review describes types of EVs produced in different ExCors and extracorporeal life support (ECLS) systems including cardiopulmonary bypass circuits, extracorporeal membrane oxygenation (ECMO), extracorporeal carbon dioxide removal (ECCO2R), apheresis, dialysis and ventricular assist devices. Roles of EVs not only as biomarkers of adverse events during ExCor/ECLS use, but also as mediators of vascular dysfunction are explored. Manipulation of the number or subtypes of circulating EVs may prove a means of improving vascular function for individuals requiring ExCor/ECLS support. Strategies for therapeutic manipulation of EVs during ExCor/ECLS use are discussed such as accelerating their clearance, preventing their genesis or pharmacologic options to reduce or select which and how many EVs circulate. Strategies to reduce or select for specific types of EVs may prove beneficial in preventing or treating other EV-related diseases such as cancer.
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Affiliation(s)
- Mark J McVey
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, SickKids, Toronto, ON, Canada
| | - Wolfgang M Kuebler
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Heart Institute, Berlin, Germany
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11
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Radley G, Pieper IL, Ali S, Bhatti F, Thornton CA. The Inflammatory Response to Ventricular Assist Devices. Front Immunol 2018; 9:2651. [PMID: 30498496 PMCID: PMC6249332 DOI: 10.3389/fimmu.2018.02651] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/26/2018] [Indexed: 12/27/2022] Open
Abstract
The therapeutic use of ventricular assist devices (VADs) for end-stage heart failure (HF) patients who are ineligible for transplant has increased steadily in the last decade. In parallel, improvements in VAD design have reduced device size, cost, and device-related complications. These complications include infection and thrombosis which share underpinning contribution from the inflammatory response and remain common risks from VAD implantation. An added and underappreciated difficulty in designing a VAD that supports heart function and aids the repair of damaged myocardium is that different types of HF are accompanied by different inflammatory profiles that can affect the response to the implanted device. Circulating inflammatory markers and changes in leukocyte phenotypes receive much attention as biomarkers for mortality and disease progression. However, they are seldom used to monitor progress during and outcomes from VAD therapy or during the design phase for new devices. Even the partial reversal of heart damage associated with heart failure is a desirable outcome from VAD use. Therefore, improved understanding of the interplay between VADs and the recipient's inflammatory response would potentially increase their uptake, improve patient lives, and fuel research related to other blood-contacting medical devices. Here we provide a review of what is currently known about inflammation in heart failure and how this inflammatory profile is altered in heart failure patients receiving VAD therapy.
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Affiliation(s)
- Gemma Radley
- Swansea University Medical School, Swansea, United Kingdom.,Calon Cardio-Technology Ltd, Institute of Life Science, Swansea, United Kingdom
| | - Ina Laura Pieper
- Swansea University Medical School, Swansea, United Kingdom.,Scandinavian Real Heart AB, Västerås, Sweden
| | - Sabrina Ali
- Calon Cardio-Technology Ltd, Institute of Life Science, Swansea, United Kingdom
| | - Farah Bhatti
- Department of Cardiology, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, United Kingdom
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