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Stroganov S, Harris T, Fellus-Alyagor L, Ben Moyal L, Plitman Mayo R, Golani O, Hirsch D, Ben-Dor S, Brandis A, Mehlman T, Kovo M, Biron-Shental T, Dekel N, Neeman M. The differential regulation of placenta trophoblast bisphosphoglycerate mutase in fetal growth restriction: preclinical study in mice and observational histological study of human placenta. eLife 2024; 13:e82631. [PMID: 38314803 PMCID: PMC10883672 DOI: 10.7554/elife.82631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
Background Fetal growth restriction (FGR) is a pregnancy complication in which a newborn fails to achieve its growth potential, increasing the risk of perinatal morbidity and mortality. Chronic maternal gestational hypoxia, as well as placental insufficiency are associated with increased FGR incidence; however, the molecular mechanisms underlying FGR remain unknown. Methods Pregnant mice were subjected to acute or chronic hypoxia (12.5% O2) resulting in reduced fetal weight. Placenta oxygen transport was assessed by blood oxygenation level dependent (BOLD) contrast magnetic resonance imaging (MRI). The placentae were analyzed via immunohistochemistry and in situ hybridization. Human placentae were selected from FGR and matched controls and analyzed by immunohistochemistry (IHC). Maternal and cord sera were analyzed by mass spectrometry. Results We show that murine acute and chronic gestational hypoxia recapitulates FGR phenotype and affects placental structure and morphology. Gestational hypoxia decreased labyrinth area, increased the incidence of red blood cells (RBCs) in the labyrinth while expanding the placental spiral arteries (SpA) diameter. Hypoxic placentae exhibited higher hemoglobin-oxygen affinity compared to the control. Placental abundance of Bisphosphoglycerate mutase (BPGM) was upregulated in the syncytiotrophoblast and spiral artery trophoblast cells (SpA TGCs) in the murine gestational hypoxia groups compared to the control. Hif1α levels were higher in the acute hypoxia group compared to the control. In contrast, human FGR placentae exhibited reduced BPGM levels in the syncytiotrophoblast layer compared to placentae from healthy uncomplicated pregnancies. Levels of 2,3 BPG, the product of BPGM, were lower in cord serum of human FGR placentae compared to control. Polar expression of BPGM was found in both human and mouse placentae syncytiotrophoblast, with higher expression facing the maternal circulation. Moreover, in the murine SpA TGCs expression of BPGM was concentrated exclusively in the apical cell side, in direct proximity to the maternal circulation. Conclusions This study suggests a possible involvement of placental BPGM in maternal-fetal oxygen transfer, and in the pathophysiology of FGR. Funding This work was supported by the Weizmann Krenter Foundation and the Weizmann - Ichilov (Tel Aviv Sourasky Medical Center) Collaborative Grant in Biomedical Research, by the Minerva Foundation, by the ISF KillCorona grant 3777/19.
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Affiliation(s)
- Sima Stroganov
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Talia Harris
- Chemical Research Support Weizmann Institute of Science, Rehovot, Israel
| | | | - Lital Ben Moyal
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Romina Plitman Mayo
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Ofra Golani
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Dana Hirsch
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Shifra Ben-Dor
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Alexander Brandis
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Tevie Mehlman
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Michal Kovo
- OBGYN, Meir Medical Center, Kfar Saba, Israel
- Tel Aviv University, School of Medicine, Tel Aviv, Israel
| | - Tal Biron-Shental
- OBGYN, Meir Medical Center, Kfar Saba, Israel
- Tel Aviv University, School of Medicine, Tel Aviv, Israel
| | - Nava Dekel
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Michal Neeman
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
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Mekler T, Plitman Mayo R, Weissmann J, Marom G. Impact of tissue porosity and asymmetry on the oxygen uptake of the human placenta: A numerical study. Placenta 2022; 129:15-22. [PMID: 36183458 DOI: 10.1016/j.placenta.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study proposes a computational fluid dynamics model of a human placenta's independent exchange unit (placentome) to assess the effect that the inner villi distribution and decidual veins (DVs) location and number, have on the oxygen uptake. METHODS The internal placentome porosity distribution was altered in symmetric morphology, while asymmetry was introduced by varying the location and number of DVs. The DV asymmetry was introduced by either displacing them circumferentially, thereby changing the angle between them, or by adding DVs in the inlet cross-section. The results were analyzed by the changes in the normalized oxygen mass fraction and the oxygen uptake. RESULTS Oxygenated blood was shown to be delivered deeper into the placentome when the area of non-homogeneous porosity was larger. The largest oxygen uptake was achieved in the asymmetric model with the smallest angle distance between the DVs, where a 10% decrease relative to the farthest case was obtained. Placing DVs adjacent to the spiral artery opening enhanced the drainage of oxygenated blood. DISCUSSION This study demonstrates the importance of the local porosity distribution for the proper perfusion of the intervillous space and proposes a novel approach to improve our understanding of the role of the DVs in placental oxygen uptake.
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Affiliation(s)
- Tirosh Mekler
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Romina Plitman Mayo
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel.
| | - Jonathan Weissmann
- Department of Biomedical Engineering, The Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, 6997801, Israel.
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Avni Biron I, Maayan Y, Mishael T, Hadar E, Neeman M, Plitman Mayo R, Sela HY, Yagel S, Goldenberg R, Ben Ya’acov A, Grisaru Granovsky S, Ollech JE, Edelman-Klapper H, Rabinowitz KM, Pauker MH, Yanai H, Goren S, Cohen D, Dotan I, Bar-Gil Shitrit A. SARS-CoV-2 IgG Antibody Levels in Women with IBD Vaccinated during Pregnancy. Vaccines (Basel) 2022; 10:1833. [PMID: 36366342 PMCID: PMC9699106 DOI: 10.3390/vaccines10111833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Regulatory agencies supported vaccination of pregnant women with SARS-CoV-2 mRNA vaccines, including patients with IBD. No data exist regarding these vaccines in IBD during pregnancy. AIM To assess the serologic response to two doses of the mRNA SARS-CoV-2 BNT162b2 vaccine in pregnant women with IBD vaccinated during pregnancy, compared to that of pregnant women without IBD, and non-pregnant women with IBD. METHODS Anti-spike antibody levels were assessed in all women and in cord blood of consenting women. RESULTS From December 2020 to December 2021, 139 women were assessed: pregnant with IBD-36, pregnant without IBD-61, and not pregnant with IBD-42. Antibodies were assessed in cords of two and nine newborns of women with and without IBD, respectively. Mean gestational ages at administration of the second vaccine doses were 22.0 weeks in IBD and 23.2 weeks in non-IBD, respectively. Mean (SD) duration from the second vaccine dose to serology analysis in pregnant women with IBD, without IBD, and in non-pregnant women with IBD was 10.6 (4.9), 16.4 (6.3), and 4.3 (1.0) weeks, respectively. All women mounted a serologic response. In multivariable analysis, no correlation was found between the specific group and antibody levels. In both pregnancy groups, an inverse correlation between antibody levels and the interval from the second vaccine dose was demonstrated. Cord blood antibody levels exceeded maternal levels in women with and without IBD. CONCLUSION All patients with IBD mounted a serologic response. The interval between vaccine administration to serology assessment was the most important factor determining antibody levels. A third vaccine dose should be considered in pregnant women with IBD vaccinated at early stages of pregnancy.
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Affiliation(s)
- Irit Avni Biron
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Yair Maayan
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- Department of Military Medicine and “Tzameret”, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Medical Corps, Israel Defense Forces, Rehovot 7661041, Israel
| | - Tali Mishael
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
- Obstetrics and Gynecology Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva 49100, Israel
| | - Michal Neeman
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Romina Plitman Mayo
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Hen Y. Sela
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- Obstetrics and Gynecology Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Simcha Yagel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- Obstetrics and Gynecology Department, Mount Scopus Hadassah Medical Center, Jerusalem 9103102, Israel
| | - Rosalind Goldenberg
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
| | - Ami Ben Ya’acov
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
| | - Sorina Grisaru Granovsky
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
- Obstetrics and Gynecology Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Jacob E. Ollech
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Hadar Edelman-Klapper
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Keren Masha Rabinowitz
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv 69978, Israel
| | - Maor H. Pauker
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Henit Yanai
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Sophy Goren
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Dani Cohen
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Iris Dotan
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 4919001, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 9436008, Israel
| | - Ariella Bar-Gil Shitrit
- IBD MOM Unit, Shaare Zedek Medical Center, Digestive Diseases Institute, Jerusalem 9436008, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
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Beharier O, Plitman Mayo R, Raz T, Nahum Sacks K, Schreiber L, Suissa-Cohen Y, Chen R, Gomez-Tolub R, Hadar E, Gabbay-Benziv R, Moshkovich YJ, Biron-Shental T, Shechter-Maor G, Farladansky-Gershnabel S, Yitzhak Sela H, Benyamini-Raischer H, Sela ND, Goldman-Wohl D, Shulman Z, Many A, Barr H, Yagel S, Neeman M, Kovo M. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. J Clin Invest 2021; 131:154834. [PMID: 34596052 DOI: 10.1172/jci154834] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Beharier O, Plitman Mayo R, Raz T, Nahum Sacks K, Schreiber L, Suissa-Cohen Y, Chen R, Gomez-Tolub R, Hadar E, Gabbay-Benziv R, Jaffe Moshkovich Y, Biron-Shental T, Shechter-Maor G, Farladansky-Gershnabel S, Yitzhak Sela H, Benyamini-Raischer H, Sela ND, Goldman-Wohl D, Shulman Z, Many A, Barr H, Yagel S, Neeman M, Kovo M. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. J Clin Invest 2021; 131:150319. [PMID: 34014840 DOI: 10.1172/jci150319] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUNDThe significant risks posed to mothers and fetuses by COVID-19 in pregnancy have sparked a worldwide debate surrounding the pros and cons of antenatal SARS-CoV-2 inoculation, as we lack sufficient evidence regarding vaccine effectiveness in pregnant women and their offspring. We aimed to provide substantial evidence for the effect of the BNT162b2 mRNA vaccine versus native infection on maternal humoral, as well as transplacentally acquired fetal immune response, potentially providing newborn protection.METHODSA multicenter study where parturients presenting for delivery were recruited at 8 medical centers across Israel and assigned to 3 study groups: vaccinated (n = 86); PCR-confirmed SARS-CoV-2 infected during pregnancy (n = 65), and unvaccinated noninfected controls (n = 62). Maternal and fetal blood samples were collected from parturients prior to delivery and from the umbilical cord following delivery, respectively. Sera IgG and IgM titers were measured using the Milliplex MAP SARS-CoV-2 Antigen Panel (for S1, S2, RBD, and N).RESULTSThe BNT162b2 mRNA vaccine elicits strong maternal humoral IgG response (anti-S and RBD) that crosses the placenta barrier and approaches maternal titers in the fetus within 15 days following the first dose. Maternal to neonatal anti-COVID-19 antibodies ratio did not differ when comparing sensitization (vaccine vs. infection). IgG transfer ratio at birth was significantly lower for third-trimester as compared with second trimester infection. Lastly, fetal IgM response was detected in 5 neonates, all in the infected group.CONCLUSIONAntenatal BNT162b2 mRNA vaccination induces a robust maternal humoral response that effectively transfers to the fetus, supporting the role of vaccination during pregnancy.FUNDINGIsrael Science Foundation and the Weizmann Institute Fondazione Henry Krenter.
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Affiliation(s)
- Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Romina Plitman Mayo
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Tal Raz
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food & Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Kira Nahum Sacks
- Department Obstetrics and Gynecology, Wolfson Medical Center, Holon; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, Wolfson Medical Center, Holon; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Suissa-Cohen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Rachel Gomez-Tolub
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Rinat Gabbay-Benziv
- The Hillel Yaffe Medical Center, Hadera, Israel; affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Yuval Jaffe Moshkovich
- The Hillel Yaffe Medical Center, Hadera, Israel; affiliated to the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shechter-Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Farladansky-Gershnabel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hen Yitzhak Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Hedi Benyamini-Raischer
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel affiliated with Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nitzan D Sela
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel affiliated with Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ziv Shulman
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Ariel Many
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Barr
- The Nancy and Stephen Grand Israel National Center for Personalized Medicine (G-INCPM), Weizmann Institute of Science, Rehovot, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Michal Kovo
- Department Obstetrics and Gynecology, Wolfson Medical Center, Holon; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Marom G, Plitman Mayo R, Again N, Raanani E. Numerical Biomechanics Models of the Interaction Between a Novel Transcatheter Mitral Valve Device and the Subvalvular Apparatus. Innovations (Phila) 2021; 16:327-333. [PMID: 33818178 PMCID: PMC8414811 DOI: 10.1177/1556984521999362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective Mitral valve regurgitation (MR) is a common valvular heart disease where
improper closing causes leakage. Currently, no transcatheter mitral valve
device is commercially available. Raanani (co-author) and colleagues have
previously proposed a unique rotational implantation, ensuring anchoring by
metallic arms that pull the chordae tendineae. This technique is now being
implemented in a novel device design. The aim of this study is to quantify
the rotational implantation effect on the mitral annulus kinematics and on
the stresses in the chordae and papillary muscles. Methods Finite element analysis of the rotational step of the implantation in a whole
heart model is employed to compare 5 arm designs with varying diameters
(25.9 mm to 32.4 mm) and rotation angles (up to 140°). The arm rotation that
grabs the chordae was modeled when the valve was in systolic
configuration. Results An increase in the rotation angle results in reduced mitral annulus
perimeters. Larger rotation angles led to higher chordae stresses with the
29.8 mm experiencing the maximum stresses. The calculated chordae stresses
suggest that arm diameter should be <27.8 mm and the rotation angle
<120°. Conclusions The upper limit of this diameter range is preferred in order to reduce the
stresses in the papillary muscles while grabbing more chords. The findings
of this study can help improving the design and performance of this unique
device and procedural technique.
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Affiliation(s)
- Gil Marom
- 26745 School of Mechanical Engineering, Tel Aviv University, Israel
| | | | - Nadav Again
- The Sheba Fund for Health Services and Research, Tel Hashomer, Israel
| | - Ehud Raanani
- 26744 Leviev Cardiothoracic and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Yaakobovich H, Plitman Mayo R, Zaretsky U, Finkelstein A, Weiss D, Marom G. The effect of clinically recommended Evolut sizes on anchorage forces after BASILICA. J Biomech 2021; 118:110303. [PMID: 33601185 DOI: 10.1016/j.jbiomech.2021.110303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
Coronary artery obstruction (CAO), a fatal complication of transcatheter aortic valve replacement (TAVR), is commonly found after Valve-in-Valve implantation inside a degenerated bioprosthetic valve. Leaflet laceration (BASILICA technique) has been proposed to prevent CAO and to potentially reduce the risk of leaflet thrombosis. We have previously demonstrated that this technique can reduce the anchorage forces of the TAVR device, which may lead to future complications. In this short communication, we hypothesize that the anchorage force reduction can be minimized by implanting a TAVR with a larger diameter, if two sizes are clinically recommended. We evaluated this hypothesis by employing finite element models of the deployments of the Evolut 26 and 29 mm inside a 27 mm Mitroflow valve, with and without leaflet lacerations. The results show that a laceration substantially decreases the contact area between the Evolut stent and the Mitroflow valve. The larger Evolut has a larger contact area and stronger anchorage forces. Additionally, the anchorage forces are less sensitive to additional lacerations in the larger Evolut (29 case). The results suggest that a larger self-expending device can ensure stronger anchorage and can lower the risk of possible migration, when TAVR is performed in a lacerated bioprosthesis.
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Affiliation(s)
- Halit Yaakobovich
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Uri Zaretsky
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Dar Weiss
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel; Department of Biomedical Engineering, Yale University, CT, USA
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel.
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Plitman Mayo R, Yaakobovich H, Finkelstein A, Shadden SC, Marom G. Impact of BASILICA on the thrombogenicity potential of valve-in-valve implantations. J Biomech 2021; 118:110309. [PMID: 33601181 DOI: 10.1016/j.jbiomech.2021.110309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/03/2021] [Indexed: 01/17/2023]
Abstract
Subclinical leaflet thrombosis is becoming a major concern in valve-in-valve procedures, whereby a transcatheter aortic valve device is deployed inside a failed bioprosthetic surgical valve. Blood flow stagnation and prolonged residence times in the neo-sinuses have been suggested as possible explanations for leaflet thrombosis. The BASILICA technique, which was originally developed to treat coronary flow obstruction, has also been proposed as an alternative to reduce the risk of thrombus formation. The aim of this study is to understand the impact of BASILICA on the valve-in-valve thrombogenicity using computational fluid dynamics simulations. To this end, two Eulerian and two Lagrangian approaches were employed to estimate near-wall stagnation measures in eight valve-in-valve models. The models included an intact or lacerated Sorin Mitroflow surgical valve, and either a SAPIEN or Evolut transcatheter aortic valve device. The Lagrangian approaches predicted a high number of particles and vortices concentration in the proximal areas of the neo-sinuses, while the Eulerian approaches did so in the distal areas. As a consequence, this study demonstrated that Lagrangian approaches are better predictors of subclinical leaflet thrombosis, since they match experimental and clinical findings. Additionally, the SAPIEN valve possess a higher risk for developing leaflet thrombosis, and two lacerations are shown to provide the best results in terms of development of vortices and accumulation of particles within the neo-sinuses. This study highlights the potential of computational modeling in aiding clinicians in their decision-making in valve-in-valve and BASILICA procedures.
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Affiliation(s)
| | - Halit Yaakobovich
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Shawn C Shadden
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel.
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Plitman Mayo R, Yaakobovich H, Finkelstein A, Shadden SC, Marom G. Numerical models for assessing the risk of leaflet thrombosis post-transcatheter aortic valve-in-valve implantation. R Soc Open Sci 2020; 7:201838. [PMID: 33489295 PMCID: PMC7813235 DOI: 10.1098/rsos.201838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/20/2020] [Indexed: 05/04/2023]
Abstract
Leaflet thrombosis has been suggested as the reason for the reduced leaflet motion in cases of hypoattenuated leaflet thickening of bioprosthetic aortic valves. This work aimed to estimate the risk of leaflet thrombosis in two post-valve-in-valve (ViV) configurations, using five different numerical approaches. Realistic ViV configurations were calculated by modelling the deployments of the latest version of transcatheter aortic valve devices (Medtronic Evolut PRO, Edwards SAPIEN 3) in the surgical Sorin Mitroflow. Computational fluid dynamics simulations of blood flow followed the dry models. Lagrangian and Eulerian measures of near-wall stagnation were implemented by particle and concentration tracking, respectively, to estimate the thrombogenicity and to predict the risk locations. Most of the numerical approaches indicate a higher leaflet thrombosis risk in the Edwards SAPIEN 3 device because of its intra-annular implantation. The Eulerian approaches estimated high-risk locations in agreement with the wall sheer stress (WSS) separation points. On the other hand, the Lagrangian approaches predicted high-risk locations at the proximal regions of the leaflets matching the low WSS magnitude regions of both transcatheter aortic valve implantation models and reported clinical and experimental data. The proposed methods can help optimizing future designs of transcatheter aortic valves with minimal thrombotic risks.
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Affiliation(s)
- Romina Plitman Mayo
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biological Regulation, Weizmann Institute of Science, Herzl Street 234, Rehovot, Israel
| | - Halit Yaakobovich
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Shawn C. Shadden
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
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Plitman Mayo R, Abbas Y, Charnock-Jones DS, Burton GJ, Marom G. Three-dimensional morphological analysis of placental terminal villi. Interface Focus 2019; 9:20190037. [PMID: 31485319 DOI: 10.1098/rsfs.2019.0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 11/12/2022] Open
Abstract
Transport of nutrients and waste between the maternal and fetal circulations during pregnancy takes place at the final branches of the placental villous trees. Therefore, and unsurprisingly, pregnancy complications have been related to the maldevelopment of terminal villi. However, a deep analysis of placental villous morphology has been limited by tissue processing and imaging techniques. In this proof-of-principle study, placental lobules were fixed by perfusion and small clumps of villi were stained, sectioned optically and reconstructed. Morphological and network analyses were suggested and demonstrated on samples of normal placentas. The results show that most parameters are almost constant within a placenta but that there exists an inter-individual variation. Network analysis suggests that the feto-placental capillary network has several paths within an individual villus, serving as an efficient transport system. Three-dimensional reconstruction from confocal laser scanning microscopy images is a potent technique able to quantify placental architecture and capture the significant irregularities in vessel diameter and membrane thickness. This approach has the potential to become a powerful tool to further our understanding of the differences in placental structure which may underlie pregnancy complications.
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Affiliation(s)
| | - Yassen Abbas
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK.,Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - D Stephen Charnock-Jones
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK.,Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge CB2 0SW, UK
| | - Graham J Burton
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
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Erlich A, Pearce P, Mayo RP, Jensen OE, Chernyavsky IL. Physical and geometric determinants of transport in fetoplacental microvascular networks. Sci Adv 2019; 5:eaav6326. [PMID: 31001587 PMCID: PMC6469945 DOI: 10.1126/sciadv.aav6326] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/01/2019] [Indexed: 05/14/2023]
Abstract
Across mammalian species, solute exchange takes place in complex microvascular networks. In the human placenta, the primary exchange units are terminal villi that contain disordered networks of fetal capillaries and are surrounded externally by maternal blood. We show how the irregular internal structure of a terminal villus determines its exchange capacity for diverse solutes. Distilling geometric features into three parameters, obtained from image analysis and computational fluid dynamics, we capture archetypal features of the structure-function relationship of terminal villi using a simple algebraic approximation, revealing transitions between flow- and diffusion-limited transport at vessel and network levels. Our theory accommodates countercurrent effects, incorporates nonlinear blood rheology, and offers an efficient method for testing network robustness. Our results show how physical estimates of solute transport, based on carefully defined geometrical statistics, provide a viable method for linking placental structure and function and offer a framework for assessing transport in other microvascular systems.
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Affiliation(s)
- Alexander Erlich
- School of Mathematics, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Philip Pearce
- Department of Mathematics, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139-4307, USA
| | - Romina Plitman Mayo
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
- Homerton College, University of Cambridge, Cambridge CB2 8PH, UK
| | - Oliver E. Jensen
- School of Mathematics, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Igor L. Chernyavsky
- School of Mathematics, University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
- Corresponding author.
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Plitman Mayo R, Charnock-Jones DS, Burton GJ, Oyen ML. Three-dimensional modeling of human placental terminal villi. Placenta 2016; 43:54-60. [PMID: 27324100 DOI: 10.1016/j.placenta.2016.05.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Placental transport is the main factor affecting the health and development of the fetus. Due to the placenta's geometrical and mathematical complexity, the structure-function relations of placental terminal villi have not been successfully modeled. Hence, a novel modeling approach is proposed. METHODS Computational models of four different specimens were generated from the three-dimensional reconstruction of confocal laser scanning microscopic image stacks. To evaluate the capabilities of the proposed methodology, stationary oxygen diffusion transport was calculated in the terminal villus volumes. RESULTS The reconstructions automatically provided the spatial arrangement of the fetal capillaries inside the terminal villi. The surface and volume ratios between the fetal capillaries and the villus were also calculated, and the effects of model parameters on the placental diffusive capacity were assessed by parametric analysis. DISCUSSION The potential of three-dimensional reconstructions combined with finite element analysis as a research tool for the human placenta was tested. The methodology herein could serve in the future as a simulation platform for complicated in vivo and in vitro scenarios.
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Affiliation(s)
- Romina Plitman Mayo
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK; Nanoscience Centre, Department of Engineering, University of Cambridge, Cambridge, UK
| | - D Stephen Charnock-Jones
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK; Department of Obstetrics & Gynaecology, University of Cambridge, Cambridge, UK
| | - Graham J Burton
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Michelle L Oyen
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK; Nanoscience Centre, Department of Engineering, University of Cambridge, Cambridge, UK.
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Yosibash Z, Plitman Mayo R, Dahan G, Trabelsi N, Amir G, Milgrom C. Predicting the stiffness and strength of human femurs with real metastatic tumors. Bone 2014; 69:180-90. [PMID: 25284156 DOI: 10.1016/j.bone.2014.09.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Predicting patient specific risk of fracture in femurs with metastatic tumors and the need for surgical intervention are of major clinical importance. Recent patient-specific high-order finite element methods (p-FEMs) based on CT-scans demonstrated accurate results for healthy femurs, so that their application to metastatic affected femurs is considered herein. METHODS Radiographs of fresh frozen proximal femur specimens from donors that died of cancer were examined, and seven pairs with metastatic tumor were identified. These were CT-scanned, instrumented by strain-gauges and loaded in stance position at three inclination angles. Finally the femurs were loaded until fracture that usually occurred at the neck. Histopathology was performed to determine whether metastatic tumors are present at fractured surfaces. Following each experiment p-FE models were created based on the CT-scans mimicking the mechanical experiments. The predicted displacements, strains and yield loads were compared to experimental observations. RESULTS The predicted strains and displacements showed an excellent agreement with the experimental observations with a linear regression slope of 0.95 and a coefficient of regression R(2)=0.967. A good correlation was obtained between the predicted yield load and the experimental observed yield, with a linear regression slope of 0.80 and a coefficient of regression R(2)=0.78. DISCUSSION CT-based patient-specific p-FE models of femurs with real metastatic tumors were demonstrated to predict the mechanical response very well. A simplified yield criterion based on the computation of principal strains was also demonstrated to predict the yield force in most of the cases, especially for femurs that failed at small loads. In view of the limited capabilities to predict risk of fracture in femurs with metastatic tumors used nowadays, the p-FE methodology validated herein may be very valuable in making clinical decisions.
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Affiliation(s)
- Zohar Yosibash
- Department of Mechanical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Romina Plitman Mayo
- Department of Mechanical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Dahan
- Department of Mechanical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nir Trabelsi
- Department of Mechanical Engineering, Shamoon College of Engineering, Beer-Sheva, Israel
| | - Gail Amir
- Department of Pathology, Hadassah University Hospital, Jerusalem, Israel
| | - Charles Milgrom
- Department of Orthopaedics, Hadassah University Hospital, Jerusalem, Israel
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Mayo RP. Heated ultrasonic nebulizer. Respir Ther 1977; 7:49. [PMID: 10236049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Mayo RP. A nurse can be a man or a woman. Am J Nurs 1976; 76:1318-9. [PMID: 1047986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Mayo RP. The Budget Director Responds . . . Science 1970; 169:39. [PMID: 17811804 DOI: 10.1126/science.169.3940.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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