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Umeno T, Mori K, Iwai R, Kawashima T, Shuto T, Nakashima Y, Tajikawa T, Nakayama Y, Miyamoto S. Carotid Artery Bypass Surgery of In-Body Tissue Architecture-Induced Small-Diameter Biotube in a Goat Model: A Pilot Study. Bioengineering (Basel) 2024; 11:203. [PMID: 38534477 DOI: 10.3390/bioengineering11030203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/31/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
Biotubes are autologous tubular tissues developed within a patient's body through in-body tissue architecture, and they demonstrate high potential for early clinical application as a vascular replacement. In this pilot study, we used large animals to perform implantation experiments in preparation for preclinical testing of Biotube. The biological response after Biotube implantation was histologically evaluated. The designed Biotubes (length: 50 cm, internal diameter: 4 mm, and wall thickness: 0.85 mm) were obtained by embedding molds on the backs of six goats for a predetermined period (1-5 months). The same goats underwent bypass surgery on the carotid arteries using Biotubes (average length: 12 cm). After implantation, echocardiography was used to periodically monitor patency and blood flow velocity. The maximum observation period was 6 months, and tissue analysis was conducted after graft removal, including the anastomosis. All molds generated Biotubes that exceeded the tensile strength of normal goat carotid arteries, and eight randomly selected Biotubes were implanted. Thrombotic occlusion occurred immediately postoperatively (1 tube) if anticoagulation was insufficient, and two tubes, with insufficient Biotube strength (<5 N), were ruptured within a week. Five tubes maintained patency for >2 months without aneurysm formation. The spots far from the anastomosis became stenosed within 3 months (3 tubes) when Biotubes had a wide intensity distribution, but the shape of the remaining two tubes remained unchanged for 6 months. The entire length of the bypass region was walled with an αSMA-positive cell layer, and an endothelial cell layer covered most of the lumen at 2 months. Complete endothelial laying of the luminal surface was obtained at 3 months after implantation, and a vascular wall structure similar to that of native blood vessels was formed, which was maintained even at 6 months. The stenosis was indicated to be caused by fibrin adhesion on the luminal surface, migration of repair macrophages, and granulation formation due to the overproliferation of αSMA-positive fibroblasts. We revealed the importance of Biotubes that are homogeneous, demonstrate a tensile strength > 5 N, and are implanted under appropriate antithrombotic conditions to achieve long-term patency of Biotube. Further, we clarified the Biotube regeneration process and the mechanism of stenosis. Finally, we obtained the necessary conditions for a confirmatory implant study planned shortly.
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Affiliation(s)
- Tadashi Umeno
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan
| | - Kazuki Mori
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan
| | - Ryosuke Iwai
- Institute of Frontier Science and Technology, Okayama University of Science, Okayama 700-0005, Japan
| | - Takayuki Kawashima
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan
| | - Takashi Shuto
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan
| | - Yumiko Nakashima
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan
| | - Tsutomu Tajikawa
- Department of Mechanical Engineering, Faculty of Engineering Science, Kansai University, Osaka 564-8680, Japan
| | | | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan
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2
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Russu E, Arbanasi EM, Chirila TV, Muresan AV. Therapeutic strategies based on non-ionizing radiation to prevent venous neointimal hyperplasia: the relevance for stenosed arteriovenous fistula, and the role of vascular compliance. Front Cardiovasc Med 2024; 11:1356671. [PMID: 38374996 PMCID: PMC10875031 DOI: 10.3389/fcvm.2024.1356671] [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: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
We have reviewed the development and current status of therapies based on exposure to non-ionizing radiation (with a photon energy less than 10 eV) aimed at suppressing the venous neointimal hyperplasia, and consequentially at avoiding stenosis in arteriovenous grafts. Due to the drawbacks associated with the medical use of ionizing radiation, prominently the radiation-induced cardiovascular disease, the availability of procedures using non-ionizing radiation is becoming a noteworthy objective for the current research. Further, the focus of the review was the use of such procedures for improving the vascular access function and assuring the clinical success of arteriovenous fistulae in hemodialysis patients. Following a brief discussion of the physical principles underlying radiotherapy, the current methods based on non-ionizing radiation, either in use or under development, were described in detail. There are currently five such techniques, including photodynamic therapy (PDT), far-infrared therapy, photochemical tissue passivation (PTP), Alucent vascular scaffolding, and adventitial photocrosslinking. The last three are contingent on the mechanical stiffening achievable by the exogenous photochemical crosslinking of tissular collagen, a process that leads to the decrease of venous compliance. As there are conflicting opinions on the role of compliance mismatch between arterial and venous conduits in a graft, this aspect was also considered in our review.
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Affiliation(s)
- Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania
| | - Emil-Marian Arbanasi
- Clinic of Vascular Surgery, Mures County Emergency Hospital, Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania
- Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania
| | - Traian V. Chirila
- Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania
- Queensland Eye Institute, Woolloongabba, QLD, Australia
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
- Australian Institute of Bioengineering and Nanotechnology (AIBN), University of Queensland, St Lucia, QLD, Australia
| | - Adrian V. Muresan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Targu Mures, Romania
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Gierig M, Wriggers P, Marino M. Arterial tissues and their inflammatory response to collagen damage: A continuum in silico model coupling nonlinear mechanics, molecular pathways, and cell behavior. Comput Biol Med 2023; 158:106811. [PMID: 37011434 DOI: 10.1016/j.compbiomed.2023.106811] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/03/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Abstract
Damage in soft biological tissues causes an inflammatory reaction that initiates a chain of events to repair the tissue. This work presents a continuum model and its in silico implementation that describe the cascade of mechanisms leading to tissue healing, coupling mechanical as well as chemo-biological processes. The mechanics is described by means of a Lagrangian nonlinear continuum mechanics framework and follows the homogenized constrained mixtures theory. Plastic-like damage, growth and remodeling as well as homeostasis are taken into account. The chemo-biological pathways account for two molecular and four cellular species, and are activated by damage of collagen molecules in fibers. To consider proliferation, differentiation, diffusion and chemotaxis of species, diffusion-advection-reaction equations are employed. To the best of authors' knowledge, the proposed model combines for the first time such high number of chemo-mechano-biological mechanisms in a consistent continuum biomechanical framework. The resulting set of coupled differential equations describe balance of linear momentum, evolution of kinematic variables as well as mass balance equations. They are discretized in time according to a backward Euler finite difference scheme, and in space through a finite element Galerkin discretization. The features of the model are firstly demonstrated presenting the species dynamics and highlighting the influence of damage intensities on the growth outcome. In terms of a biaxial test, the chemo-mechano-biological coupling and the model's applicability to reproduce normal as well as pathological healing are shown. A last numerical example underlines the model's applicability to complex loading scenarios and inhomogeneous damage distributions. Concluding, the present work contributes towards comprehensive in silico models in biomechanics and mechanobiology.
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Affiliation(s)
- Meike Gierig
- Institute of Continuum Mechanics, Leibniz University of Hannover, An der Universität 1, 30823 Garbsen, Germany.
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University of Hannover, An der Universität 1, 30823 Garbsen, Germany
| | - Michele Marino
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy
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4
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Jansen J, Escriva X, Godeferd F, Feugier P. In silico experiments of intimal hyperplasia development: disendothelization in an axisymmetric idealized artery. Biomech Model Mechanobiol 2023:10.1007/s10237-023-01720-7. [PMID: 37115374 DOI: 10.1007/s10237-023-01720-7] [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: 08/31/2022] [Accepted: 04/09/2023] [Indexed: 04/29/2023]
Abstract
We use in silico experiments to study the role of the hemodynamics and of the type of disendothelization on the physiopathology of intimal hyperplasia. We apply a multiscale bio-chemo-mechanical model of intimal hyperplasia on an idealized axisymmetric artery that suffers two kinds of disendothelizations. The model predicts the spatio-temporal evolution of the lesions development, initially localized at the site of damages, and after few days displaced downstream of the damaged zones, these two stages being observed whatever the kind of damage. Considering macroscopic quantities, the model sensitivity to pathology-protective and pathology-promoting zones is qualitatively consistent with experimental findings. The simulated pathological evolutions demonstrate the central role of two parameters: (a) the initial damage shape on the morphology of the incipient stenosis, and (b) the local wall shear stresses on the overall spatio-temporal dynamics of the lesion.
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Affiliation(s)
- Jérôme Jansen
- Laboratoire de Mécanique des Fluides et d'Acoustique, UMR5509, Univ Lyon, CNRS, Ecole Centrale de Lyon, INSA Lyon, Univ Claude Bernard Lyon 1, 36 Av. Guy de Collongue, 69134, Écully, France.
| | - Xavier Escriva
- Laboratoire de Mécanique des Fluides et d'Acoustique, UMR5509, Univ Lyon, CNRS, Ecole Centrale de Lyon, INSA Lyon, Univ Claude Bernard Lyon 1, 36 Av. Guy de Collongue, 69134, Écully, France
| | - Fabien Godeferd
- Laboratoire de Mécanique des Fluides et d'Acoustique, UMR5509, Univ Lyon, CNRS, Ecole Centrale de Lyon, INSA Lyon, Univ Claude Bernard Lyon 1, 36 Av. Guy de Collongue, 69134, Écully, France
| | - Patrick Feugier
- Laboratoire de Mécanique des Fluides et d'Acoustique, UMR5509, Univ Lyon, CNRS, Ecole Centrale de Lyon, INSA Lyon, Univ Claude Bernard Lyon 1, 36 Av. Guy de Collongue, 69134, Écully, France
- Service de Chirurgie Vasculaire et Endovasculaire, LYVES Groupement Hospitalo-Universitaire Lyon Sud, Université Claude Bernard Lyon 1 Lyon, 69100, Villeurbanne, France
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5
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Giri S, Suo C, Pardi R, Fishbein GA, Rezvani K, Chen Y, Wang X. COP9 Signalosome Promotes Neointimal Hyperplasia via Deneddylation and CSN5-Mediated Nuclear Export. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.11.536468. [PMID: 37090553 PMCID: PMC10120714 DOI: 10.1101/2023.04.11.536468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Neointimal hyperplasia (NH) is a common pathological response to vascular injury and mediated primarily by vascular smooth muscle cell (VSMC) migration and proliferation. The COP9 signalosome (CSN) is formed by 8 canonical subunits (CSN1 through CSN8) with its deneddylation activity residing in CSN5. Each or some of CSN subunits may have deneddylation-independent function. Despite strong evidence linking the CSN to cell cycle regulation in cancer cells, the role of the CSN in vascular biology remains obscure. METHODS Neointimal CSN5 expression in the lung tissue of pulmonary hypertension (PAH) patients was assessed with immunohistochemistry. Adult mice with smooth muscle cell-restricted CSN5 knockout (CSN5-SMKO) or CSN8 hypomorphism (CSN8-hypo) and cultured mouse VSMCs were studied to determine the role and governing mechanisms of the CSN in NH. NH was induced by ligation of the left common carotid artery (LCCA) and PDGF-BB stimulation was used to mimic the vascular injury in cell cultures. RESULTS Remarkably higher CSN5 levels were detected in the neointimal VSMCs of the pulmonary arteries of human PAH. LCCA ligation induced NH and significantly increased the mRNA and protein levels of CSN subunits in the LCCA wall of adult wild type mice. CSN5-SMKO impaired Cullin deneddylation and the nuclear export of p27 in vessel walls and markedly inhibited VSMC proliferation in mice. On the contrary, CSN8-hypo significantly exacerbated NH and VSMC proliferation in vivo and in cellulo . Cytoplasmic CSN5 mini-complexes and the nuclear export of p27 were significantly increased in CSN8-hypo mouse vessels and cultured CSN8-hypo VSMCs. Nuclear export inhibition with leptomycin attenuated the PDGF-BB-induced increases in VSMC proliferation in both CSN8-hypo and control VSMCs. Further, genetically disabling CSN5 nuclear export but not disabling CSN5 deneddylase activity suppressed the hyperproliferation and restored p27 nuclear localization in CSN8 hypomorphic VSMCs. Interestingly, CSN deneddylase inhibition by CSN5i-3 did not alter the hyperproliferation of cultured CSN8-hypo VSMCs but suppressed wild type VSMC proliferation in cellulo and in vivo and blocked neointimal formation in wild type mice. CONCLUSION The CSN promotes VSMC proliferation and NH in injured vessels through deneddylation activity and CSN5-mediated nuclear export.
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John SE, Donegan S, Scordas TC, Qi W, Sharma P, Liyanage K, Wilson S, Birchall I, Ooi A, Oxley TJ, May CN, Grayden DB, Opie NL. Vascular remodeling in sheep implanted with endovascular neural interface. J Neural Eng 2022; 19. [PMID: 36240737 DOI: 10.1088/1741-2552/ac9a77] [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: 09/01/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Abstract
Objective.The aim of this work was to assess vascular remodeling after the placement of an endovascular neural interface (ENI) in the superior sagittal sinus (SSS) of sheep. We also assessed the efficacy of neural recording using an ENI.Approach.The study used histological analysis to assess the composition of the foreign body response. Micro-CT images were analyzed to assess the profiles of the foreign body response and create a model of a blood vessel. Computational fluid dynamic modeling was performed on a reconstructed blood vessel to evaluate the blood flow within the vessel. Recording of brain activity in sheep was used to evaluate efficacy of neural recordings.Main results.Histological analysis showed accumulated extracellular matrix material in and around the implanted ENI. The extracellular matrix contained numerous macrophages, foreign body giant cells, and new vascular channels lined by endothelium. Image analysis of CT slices demonstrated an uneven narrowing of the SSS lumen proportional to the stent material within the blood vessel. However, the foreign body response did not occlude blood flow. The ENI was able to record epileptiform spiking activity with distinct spike morphologies.Significance. This is the first study to show high-resolution tissue profiles, the histological response to an implanted ENI and blood flow dynamic modeling based on blood vessels implanted with an ENI. The results from this study can be used to guide surgical planning and future ENI designs; stent oversizing parameters to blood vessel diameter should be considered to minimize detrimental vascular remodeling.
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Affiliation(s)
- Sam E John
- The Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Sam Donegan
- The Department of Medicine, University of Melbourne, Victoria, Australia
| | - Theodore C Scordas
- The Department of Medicine, University of Melbourne, Victoria, Australia
| | - Weijie Qi
- The Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Prayshita Sharma
- The Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia
| | - Kishan Liyanage
- The Department of Medicine, University of Melbourne, Victoria, Australia
| | - Stefan Wilson
- The Department of Medicine, University of Melbourne, Victoria, Australia
| | - Ian Birchall
- Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Andrew Ooi
- The Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Thomas J Oxley
- The Department of Medicine, University of Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Clive N May
- Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - David B Grayden
- The Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia.,Graeme Clark Institute for Biomedical Engineering, University of Melbourne, Victoria, Australia
| | - Nicholas L Opie
- The Department of Medicine, University of Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Victoria, Australia
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7
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An agent-based model of vibration-induced intimal hyperplasia. Biomech Model Mechanobiol 2022; 21:1457-1481. [DOI: 10.1007/s10237-022-01601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
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8
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Jansen J, Escriva X, Godeferd F, Feugier P. Multiscale bio-chemo-mechanical model of intimal hyperplasia. Biomech Model Mechanobiol 2022; 21:709-734. [DOI: 10.1007/s10237-022-01558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
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9
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Khosravi R, Ramachandra AB, Szafron JM, Schiavazzi DE, Breuer CK, Humphrey JD. A computational bio-chemo-mechanical model of in vivo tissue-engineered vascular graft development. Integr Biol (Camb) 2021; 12:47-63. [PMID: 32222759 DOI: 10.1093/intbio/zyaa004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/26/2020] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
Abstract
Stenosis is the primary complication of current tissue-engineered vascular grafts used in pediatric congenital cardiac surgery. Murine models provide considerable insight into the possible mechanisms underlying this situation, but they are not efficient for identifying optimal changes in scaffold design or therapeutic strategies to prevent narrowing. In contrast, computational modeling promises to enable time- and cost-efficient examinations of factors leading to narrowing. Whereas past models have been limited by their phenomenological basis, we present a new mechanistic model that integrates molecular- and cellular-driven immuno- and mechano-mediated contributions to in vivo neotissue development within implanted polymeric scaffolds. Model parameters are inferred directly from in vivo measurements for an inferior vena cava interposition graft model in the mouse that are augmented by data from the literature. By complementing Bayesian estimation with identifiability analysis and simplex optimization, we found optimal parameter values that match model outputs with experimental targets and quantify variability due to measurement uncertainty. Utility is illustrated by parametrically exploring possible graft narrowing as a function of scaffold pore size, macrophage activity, and the immunomodulatory cytokine transforming growth factor beta 1 (TGF-β1). The model captures salient temporal profiles of infiltrating immune and synthetic cells and associated secretion of cytokines, proteases, and matrix constituents throughout neovessel evolution, and parametric studies suggest that modulating scaffold immunogenicity with early immunomodulatory therapies may reduce graft narrowing without compromising compliance.
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Affiliation(s)
- Ramak Khosravi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | | | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Daniele E Schiavazzi
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.,Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
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10
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Lima ML, Silva HSM, Lougon LN, Barros FS, Gomes WJ. Remodeling of ipsilateral ulnar artery after radial artery harvesting for coronary artery bypass graft. Can J Physiol Pharmacol 2021; 99:231-236. [PMID: 33590782 DOI: 10.1139/cjpp-2020-0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are controversies in the literature on the blood supply to the forearm after surgical removal of the radial artery in coronary artery bypass grafting (CABG). The objective was to investigate the arterial remodeling of the ulnar artery after the removal of the radial artery in myocardial revascularization by means of ultrasound examination with color Doppler in the pre- and post-operative periods. This paper describes an observational prospective study of the remodeling of the left brachial and ulnar arteries (donor arm) in 103 right-handed non-consecutive adult patients undergoing CABG with removal of the ipsilateral radial artery using the color Doppler ultrasound examination. In the ulnar artery, a significant increase (P < 0.05) was seen in the following measurements: lumen diameter by 13%, lumen area by 26%, peak systolic flow by 40%, and average flow by 46%. Intima-media thickness measured in the ulnar artery did not show a statistically significant difference (P = 0.22), except in diabetic patients (P = 0.007). We conclude that the ulnar artery undergoes positive physiological remodeling, adapting to the new requirements of chronic increase in flow after the ipsilateral removal of the radial artery to serve as a graft in CABG. There was no evidence of increased intima-media thickness, except in diabetic patients.
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Affiliation(s)
- Melchior L Lima
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Héber S M Silva
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Lourival N Lougon
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Fanilda S Barros
- Cardiovascular Surgery Center, Meridional Hospital, R. Meridional, 200 - Alto Lage, Cariacica, Espírito Santo, 29151-920, Brazil
| | - Walter J Gomes
- Discipline of Cardiovascular Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
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11
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Jansen J, Escriva X, Godeferd FS, Feugier P. A phenomenological and multiscale modeling of arterial growth and remodeling under endofibrosis. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1812852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. Jansen
- Laboratoire de Mécanique des Fluides et d’Acoustique, CNRS, Université de Lyon, ECL, UCBL, INSA, France
| | - X. Escriva
- Laboratoire de Mécanique des Fluides et d’Acoustique, CNRS, Université de Lyon, ECL, UCBL, INSA, France
| | - F. S. Godeferd
- Laboratoire de Mécanique des Fluides et d’Acoustique, CNRS, Université de Lyon, ECL, UCBL, INSA, France
| | - P. Feugier
- Service de Chirurgie Vasculaire et Endovasculaire – Groupement Hospitalo-Universitaire Lyon Sud, Pierre-Bénite, France
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12
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Donadoni F, Pichardo-Almarza C, Homer-Vanniasinkam S, Dardik A, Díaz-Zuccarini V. Multiscale, patient-specific computational fluid dynamics models predict formation of neointimal hyperplasia in saphenous vein grafts. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:292-306. [PMID: 32566808 PMCID: PMC7296340 DOI: 10.1016/j.jvscit.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/15/2019] [Indexed: 11/28/2022]
Abstract
Stenosis due to neointimal hyperplasia (NIH) is among the major causes of peripheral graft failure. Its link to abnormal hemodynamics in the graft is complex, and isolated use of hemodynamic markers is insufficient to fully capture its progression. Here, a computational model of NIH growth is presented, establishing a link between computational fluid dynamics simulations of flow in the lumen and a biochemical model representing NIH growth mechanisms inside the vessel wall. For all three patients analyzed, NIH at proximal and distal anastomoses was simulated by the model, with values of stenosis comparable to the computed tomography scans.
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Affiliation(s)
- Francesca Donadoni
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom
| | - Cesar Pichardo-Almarza
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Certara Quantitative Systems Pharmacology (QSP), Canterbury, United Kingdom
| | - Shervanthi Homer-Vanniasinkam
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Alan Dardik
- Yale University School of Medicine, Vascular Biology and Therapeutics, New Haven, Conn.,Department of Surgery, VA Connecticut Healthcare Systems, West Haven, Conn
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
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13
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Donadoni F, Bonfanti M, Pichardo-Almarza C, Homer-Vanniasinkam S, Dardik A, Díaz-Zuccarini V. An in silico study of the influence of vessel wall deformation on neointimal hyperplasia progression in peripheral bypass grafts. Med Eng Phys 2019; 74:137-145. [PMID: 31540730 DOI: 10.1016/j.medengphy.2019.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
Abstract
Neointimal hyperplasia (NIH) is a major obstacle to graft patency in the peripheral arteries. A complex interaction of biomechanical factors contribute to NIH development and progression, and although haemodynamic markers such as wall shear stress have been linked to the disease, these have so far been insufficient to fully capture its behaviour. Using a computational model linking computational fluid dynamics (CFD) simulations of blood flow with a biochemical model representing NIH growth mechanisms, we analyse the effect of compliance mismatch, due to the presence of surgical stitches and/or to the change in distensibility between artery and vein graft, on the haemodynamics in the lumen and, subsequently, on NIH progression. The model enabled to simulate NIH at proximal and distal anastomoses of three patient-specific end-to-side saphenous vein grafts under two compliance-mismatch configurations, and a rigid wall case for comparison, obtaining values of stenosis similar to those observed in the computed tomography (CT) scans. The maximum difference in time-averaged wall shear stress between the rigid and compliant models was 3.4 Pa, and differences in estimation of NIH progression were only observed in one patient. The impact of compliance on the haemodynamic-driven development of NIH was small in the patient-specific cases considered.
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Affiliation(s)
- Francesca Donadoni
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Mirko Bonfanti
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, W1W 7TS, UK
| | - Cesar Pichardo-Almarza
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Shervanthi Homer-Vanniasinkam
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Leeds Teaching Hospitals NHS Trust, LS1 3EX, UK; Division of Surgery, University of Warwick, Warwick, UK
| | - Alan Dardik
- The Department of Surgery, Yale University School of Medicine, New Haven, CT, USA; Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, W1W 7TS, UK.
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14
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Casarin S, Berceli SA, Garbey M. A Twofold Usage of an Agent-Based Model of Vascular Adaptation to Design Clinical Experiments. JOURNAL OF COMPUTATIONAL SCIENCE 2018; 29:59-69. [PMID: 30931048 PMCID: PMC6438199 DOI: 10.1016/j.jocs.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Several computational models of Vein Graft Bypass (VGB) adaptation have been developed in order to improve the surgical outcome and they all share a common property: their accuracy relies on a winning choice of their driving coefficients which are best to be retrieved from experimental data. Since experiments are time-consuming and resources-demanding, the golden standard is to know in advance which measures need to be retrieved on the experimental table and out of how many samples. Accordingly, our goal is to build a computational framework able to pre-design an effective experimental structure to optimize the computational models setup. Our hypothesis is that an Agent-Based Model (ABM) developed by our group is comparable enough to a true set of experiments to be used to generate reliable virtual experimental data. Thanks to a twofold usage of our ABM, we created a filter to be posed before the real experiment in order to drive its optimal design. This work is the natural continuation of a previous study from our group [1], where the attention was posed on simple single-cellular events models. With this new version we focused on more complex models with the purpose of verifying that the complexity of the experimental setup grows proportionally with the accuracy of the model itself.
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Affiliation(s)
- Stefano Casarin
- Center for Computational Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Scott A. Berceli
- Department of Surgery, University of Florida, Gainesville, FL, USA
- Malcom Randall VAMC, Gainesville, FL, USA
| | - Marc Garbey
- Center for Computational Surgery, Houston Methodist Research Institute, Houston, TX, USA
- LASIE UMR 7356 CNRS, University of La Rochelle, La Rochelle, France
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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15
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Mitsouras D, Tao M, de Vries MR, Trocha K, Miranda OR, Vemula PK, Ding K, Imanzadeh A, Schoen FJ, Karp JM, Ozaki CK, Rybicki FJ. Early animal model evaluation of an implantable contrast agent to enhance magnetic resonance imaging of arterial bypass vein grafts. Acta Radiol 2018; 59:1074-1081. [PMID: 29378421 DOI: 10.1177/0284185117753656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Non-invasive monitoring of autologous vein graft (VG) bypass grafts is largely limited to detecting late luminal narrowing. Although magnetic resonance imaging (MRI) delineates vein graft intima, media, and adventitia, which may detect early failure, the scan time required to achieve sufficient resolution is at present impractical. Purpose To study VG visualization enhancement in vivo and delineate whether a covalently attached MRI contrast agent would enable quicker longitudinal imaging of the VG wall. Material and Methods Sixteen 12-week-old male C57BL/6J mice underwent carotid interposition vein grafting. The inferior vena cava of nine donor mice was treated with a gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA)-based contrast agent, with control VGs labeled with a vehicle. T1-weighted (T1W) MRI was performed serially at postoperative weeks 1, 4, 12, and 20. A portion of animals was sacrificed for histopathology following each imaging time point. Results MRI signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were significantly higher for treated VGs in the first three time points (1.73 × higher SNR, P = 0.0006, and 5.83 × higher CNR at the first time point, P = 0.0006). However, MRI signal enhancement decreased consistently in the study period, to 1.29 × higher SNR and 2.64 × higher CNR, by the final time point. There were no apparent differences in graft morphometric analyses in Masson's trichrome-stained sections. Conclusion A MRI contrast agent that binds covalently to the VG wall provides significant increase in T1W MRI signal with no observed adverse effects in a mouse model. Further optimization of the contrast agent to enhance its durability is required.
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Affiliation(s)
- Dimitrios Mitsouras
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Ming Tao
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Margreet R de Vries
- Department of Surgery, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Kaspar Trocha
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Oscar R Miranda
- Harvard Stem Cell Institute, Harvard University, Boston, MA, USA
- Harvard-MIT Division of Health Science and Technology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Praveen Kumar Vemula
- Harvard Stem Cell Institute, Harvard University, Boston, MA, USA
- Harvard-MIT Division of Health Science and Technology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kui Ding
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Amir Imanzadeh
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Jeffrey M Karp
- Harvard Stem Cell Institute, Harvard University, Boston, MA, USA
- Harvard-MIT Division of Health Science and Technology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - C Keith Ozaki
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Frank J Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
- Ottawa Hospital Research Institute and Division of Medical Imaging, The Ottawa Hospital Department of Radiology, University of Ottawa, Ottawa, ON, Canada
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16
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Pichardo-Almarza C, Diaz-Zuccarini V. Understanding the Effect of Statins and Patient Adherence in Atherosclerosis via a Quantitative Systems Pharmacology Model Using a Novel, Hybrid, and Multi-Scale Approach. Front Pharmacol 2017; 8:635. [PMID: 28955237 PMCID: PMC5601395 DOI: 10.3389/fphar.2017.00635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Statins are one of the most prescribed drugs to treat atherosclerosis. They inhibit the hepatic HMG-CoA reductase, causing a reduction of circulating cholesterol and LDL levels. Statins have had undeniable success; however, the benefits of statin therapy crystallize only if patients adhere to the prescribed treatment, which is far away from reality since adherence decreases with time with around half of patients discontinue statin therapy within the first year. The objective of this work is to; firstly, demonstrate a formal in-silico methodology based on a hybrid, multiscale mathematical model used to study the effect of statin treatment on atherosclerosis under different patient scenarios, including cases where the influence of medication adherence is examined and secondly, to propose a flexible simulation framework that allows extensions or simplifications, allowing the possibility to design other complex simulation strategies, both interesting features for software development. Methods: Different mathematical modeling paradigms are used to present the relevant dynamic behavior observed in biological/physiological data and clinical trials. A combination of continuous and discrete event models are coupled to simulate the pharmacokinetics (PK) of statins, their pharmacodynamic (PD) effect on lipoproteins levels (e.g., LDL) and relevant inflammatory pathways whilst simultaneously studying the dynamic effect of flow-related variables on atherosclerosis progression. Results: Different scenarios were tested showing the impact of: (1) patient variability: a virtual population shows differences in plaque growth for different individuals could be as high as 100%; (2) statin effect on atherosclerosis: it is shown how a patient with a 1-year statin treatment will reduce his plaque growth by 2-3% in a 2-year period; (3) medical adherence: we show that a patient missing 10% of the total number of doses could increase the plaque growth by ~1% (after 2 years) compared to the same "regular" patient under a 1-year treatment with statins. Conclusions: The results in this paper describe the effect of pharmacological intervention combined with biological/physiological or behavioral factors in atherosclerosis progression and treatment in specific patients. It also provides an exemplar of basic research that can be practically developed into an application software.
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Affiliation(s)
- Cesar Pichardo-Almarza
- Multiscale Cardiovascular Engineering Group (MUSE), Department of Mechanical Engineering, University College LondonLondon, United Kingdom.,Institute of Healthcare Engineering, University College LondonLondon, United Kingdom
| | - Vanessa Diaz-Zuccarini
- Multiscale Cardiovascular Engineering Group (MUSE), Department of Mechanical Engineering, University College LondonLondon, United Kingdom.,Institute of Healthcare Engineering, University College LondonLondon, United Kingdom
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