Assessment of Stiffness of Large to Small Arteries in Multistage Renal Disease Model: A Numerical Study

Arterial stiffness (AS), as assessed via pulse wave velocity (PWV), is a major biomarker for cardiovascular risk assessment in patients with chronic kidney disease (CKD). However, the mechanisms responsible for the changes in PWV in the presence of kidney disease are not yet fully elucidated. In the present study, we aimed to investigate the direct effects attributable to biomechanical changes in the arterial tree caused by staged renal removal, independent of any biochemical or compensatory effects. Particularly, we simulated arterial pressure and flow using a previously validated one-dimensional (1-D) model of the cardiovascular system with different kidney configurations: two kidneys (2KDN), one single kidney (1KDN), no kidneys (0KDN), and a transplanted kidney (TX) attached to the external iliac artery. We evaluated the respective variations in blood pressure (BP), as well as AS of large-, medium-, and small-sized arteries via carotid-femoral PWV (cfPWV), carotid-radial PWV (crPWV), and radial-digital PWV (rdPWV), respectively. Our results showed that BP was increased in 1KDN and 0KDN, and that systolic BP values were restored in the TX configuration. Furthermore, a rise was reported in all PWVs for all tested configurations. The relative difference in stiffness from 2KDN to 0KDN was higher in the case of crPWV (15%) in comparison with the increase observed for cfPWV (11%). In TX, we observed a restoration of the PWVs to values close to 1KDN. Globally, it was demonstrated that alterations of the outflow boundaries to the renal arteries with staged kidney removal led to changes in BP and central and peripheral PWV in line with previously reported clinical data. Our findings suggest that the PWV variations observed in clinical practice with different stages of kidney disease may be partially attributed to biomechanical alterations of the arterial tree and their effect on BP.

Performance and safety of treatment options for erectile dysfunction in patients with spinal cord injury: A review of the literature

BACKGROUND

For a large proportion of patients with spinal cord injury, sexuality and reproduction are important issues. However, sparse data exist regarding available treatment options for this patient population.

OBJECTIVES

We sought to review performance and safety rates of all currently available treatment options for erectile dysfunction in spinal cord injury men.

MATERIALS AND METHODS

A systematic literature review without time restrictions was performed using PubMed/EMBASE database for English-, Italian-, German-, and Spanish-language articles. Articles' selection was performed according to the PRISMA guidelines. Relevant papers on erectile dysfunction in spinal cord injury patients were included in the final analyses.

RESULTS AND DISCUSSION

Overall, 47 studies were eligible for inclusion in this review. Of these, most evidence dealt with phosphodiesterase 5-inhibitors and intracavernous drug injection. Both treatment options are associated with high levels of performance and with patients/partners' satisfaction; side effects are acceptable. Overall, penile prostheses and vacuum erection devices are in general less approved by spinal cord injury patients and are correlated with increased rates of complications in comparison with phosphodiesterase 5-inhibitors and intracavernous drug injection. Sacral neuromodulation, transcutaneous electrical nerve stimulation, and intraurethral suppositories have been poorly studied, but preliminary studies did not show convincing results.

CONCLUSION

The best treatment options for erectile dysfunction in spinal cord injury patients emerged to be phosphodiesterase 5-inhibitors and intracavernous drug injection. The choice of erectile dysfunction treatment should be based on several aspects, including residual erectile function, spinal cord injury location, and patients' comorbidities. Future studies assessing the applicability of less well-studied treatments, as well as evaluating innovative options, are needed in this specific population.

eyeWatch™ System Combined with Non-plated Intraorbital Tube Insertion for the Management of Refractory Glaucoma: A Case Series

Introduction

The eyeWatch™ is a novel device in glaucoma surgery aiming at the control of aqueous flow through the use of an external magnetic control unit. We propose the modification of this approach through the use of an injectable perforated tube rather than a plated valve.

Materials and methods

Procedures were performed at the Department of Ophthalmology of the University of Crete. Three blind painful eyes of three patients were included. All patients were operated under topical anesthesia. A purpose designed blunt-ended injector was used to insert intraorbitally a perforated 4 cm-long silicone tube. The tube was then connected to an eyeWatch™ device which was placed in a standard fashion along the superior–temporal quadrant of the eyeball. The procedure was uneventful in cases I and II, whereas in case III the tube had to be trimmed by 1.5 cm because of cicatricial changes in the orbit. The eyeWatch™ was left closed (position VI) at the conclusion of surgeries. Patients were examined on the 1-day, 1-week, 2-week, 1-month, 3-month, and 6-month intervals and in one case on the 12-month interval.

Results

No major complications were observed. The intraocular pressure (IOP) remained under 15 mm Hg without anti-glaucomatous medications in all postoperative intervals in cases I and 2 with readjustment of eyeWatch™ at position IV. In case III, despite the change of the eyeWatch™ to the open position, the IOP remained high (40 mm Hg).

Discussion

The combination of the eyeWatch™ with an insertable perforated tube instead of a standard non-valved plate may prove a valid minimally invasive option. Modifications of the technique, such as an increased number and diameter of tube perforations, increased inserted tube length, perhaps aided by a sharp-ended injector, and selection of the insertion quadrant, may increase the effectiveness of the method.

Clinical significance

eyeWatch™ combined with a single tube instead of a plated valve is a feasible, quick, and minimally invasive technique that can be used in glaucoma surgery.

How to cite this article

Detorakis ET, Villamarin A, Roy S, et al. eyeWatch™ System Combined with Non-plated Intraorbital Tube Insertion for the Management of Refractory Glaucoma: A Case Series. J Curr Glaucoma Pract 2020;14(2):64–67.

A 1D computer model of the arterial circulation in horses: An important resource for studying global interactions between heart and vessels under normal and pathological conditions

Arterial rupture in horses has been observed during exercise, after phenylephrine administration or during parturition (uterine artery). In human pathophysiological research, the use of computer models for studying arterial hemodynamics and understanding normal and abnormal characteristics of arterial pressure and flow waveforms is very common. The objective of this research was to develop a computer model of the equine arterial circulation, in order to study local intra-arterial pressures and flow dynamics in horses. Morphologically, large differences exist between human and equine aortic arch and arterial branching patterns. Development of the present model was based on post-mortem obtained anatomical data of the arterial tree (arterial lengths, diameters and branching angles); in vivo collected ultrasonographic flow profiles from the common carotid artery, external iliac artery, median artery and aorta; and invasively collected pressure curves from carotid artery and aorta. These data were used as input for a previously validated (in humans) 1D arterial network model. Data on terminal resistance and arterial compliance parameters were tuned to equine physiology. Given the large arterial diameters, Womersley theory was used to compute friction coefficients, and the input into the arterial system was provided via a scaled time-varying elastance model of the left heart. Outcomes showed plausible predictions of pressure and flow waveforms throughout the considered arterial tree. Simulated flow waveform morphology was in line with measured flow profiles. Consideration of gravity further improved model based predicted waveforms. Derived flow waveform patterns could be explained using wave power analysis. The model offers possibilities as a research tool to predict changes in flow profiles and local pressures as a result of strenuous exercise or altered arterial wall properties related to age, breed or gender.

Mapping the site-specific accuracy of loop-based local pulse wave velocity estimation and reflection magnitude: a 1D arterial network model analysis

OBJECTIVE

Local pulse wave velocity (PWV) can be estimated from the waterhammer equation and is an essential component of wave separation analysis. However, previous studies have demonstrated inaccuracies in the estimations of local PWV due to the presence of reflections. In this study we compared the estimates of local PWV from the PU-loop, ln(D)U-loop, QA-loop and ln(D)P-loop methods along the complete human arterial tree, and analyzed the impact of the estimations on subsequent wave separation analysis.

APPROACH

Estimated values were derived from the numerical outputs (pressure, flow, flow velocity, area and diameter waveforms) of a 1D model of the human circulation, and compared against a reference PWV obtained from the Bramwell-Hill equation in a reference configuration, and in a configuration with lower distensibility representing ageing.

MAIN RESULTS

When including all nodes, the overall performance of the methods was poor (correlations and mean differences of R ²  <  0.4 and 3.0  ±  4.1 m s^-1 for the PU-loop, R ²  <  0.07 and  -0.7  ±  2.3 m s^-1 for the ln(D)U-loop, and R ²  <  0.06 and  -0.4  ±  2.3 m s^-1 for the QA-loop). Focusing on specific sites, the ln(D)U- and QA-loop methods yielded acceptable results in the thoracic aorta and iliac arteries, while the PU-loop method was acceptable at the aortic arch. The reflection-insensitive ln(D)P-loop method performed well over the complete network (R ²  =  0.9 and 0.3  ±  0.3 m s^-1), as did a previously proposed reflection-correction method for most vascular sites. Large errors in PWV estimation are attenuated in subsequent wave separation analysis, but the errors are site-dependent.

SIGNIFICANCE

We conclude that the performances of the PU-loop, ln(D)U-loop and QA-loop methods are highly site-specific. The results should be interpreted with caution at all times.

Co-localization of microstructural damage and excessive mechanical strain at aortic branches in angiotensin-II-infused mice

Animal models of aortic aneurysm and dissection can enhance our limited understanding of the etiology of these lethal conditions particularly because early-stage longitudinal data are scant in humans. Yet, the pathogenesis of often-studied mouse models and the potential contribution of aortic biomechanics therein remain elusive. In this work, we combined micro-CT and synchrotron-based imaging with computational biomechanics to estimate in vivo aortic strains in the abdominal aorta of angiotensin-II-infused ApoE-deficient mice, which were compared with mouse-specific aortic microstructural damage inferred from histopathology. Targeted histology showed that the 3D distribution of micro-CT contrast agent that had been injected in vivo co-localized with precursor vascular damage in the aortic wall at 3 days of hypertension, with damage predominantly near the ostia of the celiac and superior mesenteric arteries. Computations similarly revealed higher mechanical strain in branching relative to non-branching regions, thus resulting in a positive correlation between high strain and vascular damage in branching segments that included the celiac, superior mesenteric, and right renal arteries. These results suggest a mechanically driven initiation of damage at these locations, which was supported by 3D synchrotron imaging of load-induced ex vivo delaminations of angiotensin-II-infused suprarenal abdominal aortas. That is, the major intramural delamination plane in the ex vivo tested aortas was also near side branches and specifically around the celiac artery. Our findings thus support the hypothesis of an early mechanically mediated formation of microstructural defects at aortic branching sites that subsequently propagate into a macroscopic medial tear, giving rise to aortic dissection in angiotensin-II-infused mice.

Abstract P250: Unveiling Binding Pocket Structure Of Mas Receptor And Its Interaction With Angiotensin-(1-7)

Substantial amount of preclinical data points out Mas receptor as a promising pharmacological target to treat cardiovascular diseases. Here, we aimed to characterize Mas binding pocket and its interaction with Angiotensin-(Ang)-1-7, in order to provide insights for potential structure-based drug discovery. Homology modeling based on AT1 and AT2 crystal structures, combined with peptide docking (Schrodinger TM ) and molecular dynamics simulations (Gromacs) were employed to generate hypothesis about crucial interactions in protein-ligand complex. Proposed model was further validated in vitro using HEK cells transiently transfected with wild-type Mas or mutant Mas (Arg245Ala). Mas-receptor activation was assessed by FOXO1 dephosphorylation at Ser256 after 5 minutes incubation with Ang-1-7 (10 -7 M). Model of Mas/Ang-(1-7) complex revealed electrostatic interaction between Ang-(1-7) C-terminus and Mas Arg245. Interestingly, while Ang-1-7 incubation reduced FOXO1 phosphorylation by 35 % in HEK-Mas wild type (1.000 vs. 0.654 A.U., p<0.01, n=8), this effect was abolished in HEK-Mas mutant (1.000 vs. 0.990 A.U., n.s. , n=5). In sum, Arg245 of Mas is essential for the receptor activation, which is in accordance with A-779 antagonism (C-terminus modification of Ang-(1-7)), endorsing our proposed structure model. Further elucidation of the ligand-receptor interactions may drive rational drug discovery and lead to development of improved strategies for Mas targeting.

Modulation of nNOSser852 phosphorylation and translocation by PKA/PP1 pathway in endothelial cells

Neuronal nitric oxide synthase (nNOS) is now considered an important player in vascular function. It has a protective role in atherosclerosis and hypertension. However, despite its importance, little is known about the mechanisms that regulate its activity in vascular cells. Here we explore the mechanisms by which nNOS is activated in endothelium. We evaluated aorta relaxation response and phosphorylation of nNOS during protein phosphatases 1 and 2 (PP1 and PP2) inhibition, in eNOS silenced mice. PP1 translocation and interaction between the nuclear inhibitor of PP1 (NIPP1) and PP1 was evaluated in endothelial EA.hy926 cells. We demonstrate here that acetylcholine (Ach)-induced relaxation is completely abolished by nNOS inhibition in eNOS silenced mice aorta which also decreased NO and H₂O₂ concentrations. ACh induced dephosphorylation of nNOS^ser852 in aorta after 20 min stimulation. Endothelial cells also showed a decrease in nNOS^ser852 phosphorylation during 20 min of ACh stimulation. PP2 inhibition had no effect on Ach-induced nNOS^Ser852 dephosphorylation in endothelial cells and did not modify Ach-induced vasodilation in aorta from eNOS silenced mice. Non-selective PP1/PP2 inhibition prevented nNOSSer852 dephosphorylation in endothelial cells and prevented Ach-induced vasodilation in eNOS silenced mice. ACh induced time-dependent PP1 and NIPP1 dissociation and PP1 translocation to cytoplasm. Protein kinase A (PKA) inhibition abolished PP1 translocation and further nNOS^ser852 dephosphorylation. In addition, 8-Br-cAMP reduced NIPP1/PP1 interaction, stimulated PP1 translocation and nNOS^ser852 dephosphorylation. Moreover, PKA Inhibition led to a decreased nNOS translocation to perinuclear region. Taken together, our results elucidate a mechanism whereby PP1 is activated by a cAMP/PKA-dependent pathway, leading to dephosphorylation of nNOS^ser852 and subsequent NO and possible H₂O₂ production resulting in endothelium-dependent vascular relaxation.

Numerical assessment and comparison of pulse wave velocity methods aiming at measuring aortic stiffness

Pulse waveform analyses have become established components of cardiovascular research. Recently several methods have been proposed as tools to measure aortic pulse wave velocity (aPWV). The carotid-femoral pulse wave velocity (cf-PWV), the current clinical gold standard method for the noninvasive assessment of aPWV, uses the carotid-to-femoral pulse transit time difference (cf-PTT) and an estimated path length to derive cf-PWV.

OBJECTIVE

The heart-ankle PWV (ha-PWV), brachial-ankle PWV (ba-PWV) and finger-toe (ft-PWV) are also methods presuming to approximate aPWV based on time delays between physiological cardiovascular signals at two locations (~heart-ankle PTT, ha-PTT; ~brachial-ankle PTT, ba-PTT; ~finger-toe PTT, ft-PTT) and a path length typically derived from the subject's height. To test the validity of these methods, we used a detailed 1D arterial network model (143 arterial segments) including the foot and hand circulation.

APPROACH

The arterial tree dimensions and properties were taken from the literature and completed with data from patient scans. We calculated PTTs with all the methods mentioned above. The calculated PTTs were compared with the aortic PTT (aPTT), which is considered as the absolute reference method in this study.

MAIN RESULTS

The correlation between methods and aPTT was good and significant, cf-PTT (R ²  =  0.97; P  <  0.001; mean difference 5  ±  2 ms), ha-PTT (R ²  =  0.96; P  <  0.001; 150  ±  23 ms), ba-PTT (R ²  =  0.96; P  <  0.001; 70  ±  13 ms) and ft-PTT (R ²  =  0.95; P  <  0.001; 14  ±  10 ms). Consequently, good correlation was also observed for the PWV values derived with the tested methods, but absolute values differed because of the different path lengths used.

SIGNIFICANCE

In conclusion, our computer model-based analyses demonstrate that for PWV methods based on peripheral signals, pulse transit time differences closely correlate with the aortic transit time, supporting the use of these methods in clinical practice.

Hemodynamic Impact of the C-Pulse Cardiac Support Device: A One-Dimensional Arterial Model Study

The C-Pulse is a novel extra-aortic counter-pulsation device to unload the heart in patients with heart failure. Its impact on overall hemodynamics, however, is not fully understood. In this study, the function of the C-Pulse heart assist system is implemented in a one-dimensional (1-D) model of the arterial tree, and central and peripheral pressure and flow waveforms with the C-Pulse turned on and off were simulated. The results were studied using wave intensity analysis and compared with in vivo data measured non-invasively in three patients with heart failure and with invasive data measured in a large animal (pig). In all cases the activation of the C-Pulse was discernible by the presence of a diastolic augmentation in the pressure and flow waveforms. Activation of the device initiates a forward traveling compression wave, whereas a forward traveling expansion wave is associated to the device relaxation, with waves exerting an action in the coronary and the carotid vascular beds. We also found that the stiffness of the arterial tree is an important determinant of action of the device. In settings with reduced arterial compliance, the same level of aortic compression demands higher values of external pressure, leading to stronger hemodynamic effects and enhanced perfusion. We conclude that the 1-D model may be used as an efficient tool for predicting the hemodynamic impact of the C-Pulse system in the entire arterial tree, complementing in vivo observations.

Role of ERK1/2 activation and nNOS uncoupling on endothelial dysfunction induced by lysophosphatidylcholine

BACKGROUND AND AIMS

Lysophosphatidylcholine (LPC) - a main component of oxidized LDL - is involved in endothelial dysfunction that precedes atherosclerosis, with an increased superoxide anions and a reduced NO production via endothelial NO synthase (eNOS) uncoupling. However, there is no evidence about the mechanisms involved in neuronal NOS (nNOS) uncoupling. Extracellular signal-regulated kinase (ERK) is related to the control of NO production and inflammatory gene transcription activation in atherosclerosis. Our aim was to investigate the role of nNOS/ERK1/2 pathway on endothelial dysfunction induced by LPC, in mouse aorta and human endothelial cells.

METHODS

Thoracic aorta from wild type mice was used to perform vascular reactivity studies in the presence or absence of LPC. Human endothelial cells were used to investigate the effect of LPC on expression of nNOS and his products NO and H₂O₂.

RESULTS

LPC reduced acetylcholine (ACh)-induced vasodilation in mouse aorta (Emax_CT/LPC = ∼95 ± 2/62 ± 3%, p = 0.0004) and increased phenylephrine-induced vasoconstriction (Emax_CT/LPC = ∼4 ± 0,1/6 ± 0,1 mN/mm, p = 0.0002), with a reduction in NO (fluorescence intensity_CT/LPC = 91 ± 3/62±2 × 10³, p = 0.0002) and H₂O₂ (fluorescence intensity_CT/LPC = ∼16 ± 0,8/10 ± 0,7 × 10³, p = 0.0041) production evocated by ACh. An inhibition of nNOS by TRIM (Emax_CT/CT+TRIM = ∼93 ± 1/43 ± 3%, p = 0,0048; Emax_LPC/LPC+TRIM = ∼62 ± 3/65 ± 3%) or H₂O₂ degradation by catalase (Emax_CT/CT+cat = ∼93 ± 1/46 ± 2%, p < 0,001; Emax_LPC/LPC+cat = ∼62,8 ± 3,2/60,5 ± 4,7%) reduced the relaxation in the control but not in LPC group. PD98059, an ERK1/2 inhibitor, abolished the increase in vasoconstriction in LPC-treated vessels (Emax_LPC/LPC+PD = ∼6 ± 0,1/3 ± 0,1 mN/mm, p = 0.0001). LPC also reduced the dimer/monomer proportion and increased nNOS^ser852 phosphorylation.

CONCLUSIONS

LPC induced nNOS uncoupling and nNOS^Ser852 phosphorylation, reduced NO and H₂O₂ production and improved superoxide production by modulating ERK1/2 activity in human and murine endothelial cells.

Contribution of the Arterial System and the Heart to Blood Pressure during Normal Aging - A Simulation Study

During aging, systolic blood pressure continuously increases over time, whereas diastolic pressure first increases and then slightly decreases after middle age. These pressure changes are usually explained by changes of the arterial system alone (increase in arterial stiffness and vascular resistance). However, we hypothesise that the heart contributes to the age-related blood pressure progression as well. In the present study we quantified the blood pressure changes in normal aging by using a Windkessel model for the arterial system and the time-varying elastance model for the heart, and compared the simulation results with data from the Framingham Heart Study. Parameters representing arterial changes (resistance and stiffness) during aging were based on literature values, whereas parameters representing cardiac changes were computed through physiological rules (compensated hypertrophy and preservation of end-diastolic volume). When taking into account arterial changes only, the systolic and diastolic pressure did not agree well with the population data. Between 20 and 80 years, systolic pressure increased from 100 to 122 mmHg, and diastolic pressure decreased from 76 to 55 mmHg. When taking cardiac adaptations into account as well, systolic and diastolic pressure increased from 100 to 151 mmHg and decreased from 76 to 69 mmHg, respectively. Our results show that not only the arterial system, but also the heart, contributes to the changes in blood pressure during aging. The changes in arterial properties initiate a systolic pressure increase, which in turn initiates a cardiac remodelling process that further augments systolic pressure and mitigates the decrease in diastolic pressure.

In vivo testing of a novel adjustable glaucoma drainage device

PURPOSE

We report on the in vivo testing of a novel noninvasively adjustable glaucoma drainage device (AGDD), which features an adjustable outflow resistance, and assess the safety and efficiency of this implant.

METHODS

Under general anesthesia, the AGDD was implanted on seven white New Zealand rabbits for a duration of 4 months under a scleral flap in a way analogous to the Ex-PRESS device and set in an operationally closed position. The IOP was measured on a regular basis on the operated and control eyes using a rebound tonometer. Once a month the AGDD was adjusted noninvasively from its fully closed to its fully open position and the resulting pressure drop was measured. The contralateral eye was not operated and served as control. After euthanization, the eyes were collected for histology evaluation.

RESULTS

The mean preoperative IOP was 11.1 ± 2.4 mm Hg. The IOP was significantly lower for the operated eye (6.8 ± 2 mm Hg) compared to the nonoperated eye (13.1 ± 1.6 mm Hg) during the first 8 days after surgery. When opening the AGDD from its fully closed to fully open position, the IOP dropped significantly from 11.2 ± 2.9 to 4.8 ± 0.9 mm Hg (P < 0.05).

CONCLUSIONS

Implanting the AGDD is a safe and uncomplicated surgical procedure. The fluidic resistance was noninvasively adjustable during the postoperative period with the AGDD between its fully closed and fully open positions.

A new adjustable glaucoma drainage device

PURPOSE

This work is focused on the testing of a new experimental noninvasively adjustable glaucoma drainage device (AGDD) that allows for the control of its outflow resistance to modulate intraocular pressure (IOP) in a customized fashion.

METHODS

Six AGDDs were directly connected to a pressure transducer and a perfusion system continuously delivering saline solution at rate of 2 μL/min. The steady-state pressure was measured and reported as a function of the angular position of the AGDD disk. Ex vivo experiments were conducted on six freshly enucleated rabbit eyes. The IOP was measured, and the flow rate was increased with a syringe pump to simulate elevated IOP associated with glaucoma. After insertion of the implant in the anterior chamber, the position of the disk was sequentially adjusted.

RESULTS

The relation between the pressure drop and the angular position of the AGDD disk is nonlinear. The functional range lies between 80° and 130°, which allows for four or five different reproducible adjustment positions. Above 130° the implant is considered to be closed (no outflow), and below 80° it is considered to be open (minimum resistance to flow).

CONCLUSIONS

The resistance to outflow of the experimental AGDD can be adjusted to keep IOP in the desired physiological range. This feature could be useful for addressing the risk of hypotony in the early postoperative stages and could provide a means to achieve optimal IOP under a wide range of postoperative conditions.

Pathophysiological role of the renin-angiotensin system on erectile dysfunction

BACKGROUND

The renin-angiotensin system (RAS) has been shown to play an active role within the erectile tissues. The aim of this narrative review is to summarize the literature addressing the pathophysiological role of RAS on erectile function. Additionally, we update evidence on recent findings on the role of the Ang-(1-7) and Mas receptor on the erectile function and its therapeutic potential for treating erectile dysfunction (ED).

MATERIALS AND METHODS

This narrative review is based on the material searched and obtained via MEDLINE and PubMed up to November 2012. The search terms we used are 'angiotensin, erectile dysfunction, renin, Mas receptor' in combination with 'pathophysiology, fibrosis, pathways'.

RESULTS

The levels of angiotensin (Ang) II, the main component of this system, are increased in the corpus cavernosum as compared to those found in the systemic circulation. Moreover, emerging evidence indicates that an increased activity of Ang II via AT1 receptor might contribute to the development of ED, whereas the pharmacological blockage of Ang II/AT1 actions has beneficial effects on the erection. On the other hand, the heptapeptide Ang-(1-7), known as a major endogenous counter-regulator of Ang II actions, favours penile erection via the activation of Mas receptor.

CONCLUSIONS

Ang-(1-7) and Mas receptor pathway might be considered as a promising therapeutic target for the treatment of ED.

Brachial artery waveforms for automatic blood pressure measurement

Theoretically the auscultatory method using Korotkoff sounds is more related to the maximum artery closure status, while the oscillometric method is more related to the overall artery closure status under the cuff. Therefore, the latter is less accurate than the former. This work introduces a new method, which is more accurate than the oscillometric method and suitable for automatic devices. To monitor the maximum artery closure status, a piezoelectric film sensor is attached to the skin just above the brachial artery and under the central section of the cuff where maximum cuff pressure is transferred to the arm. Using the waveform features obtained by this sensor, measurement errors of 0.7±2.5 and 1.27±4.53 mmHg were obtained for the systolic and diastolic pressure, respectively. These reflect small deviations from auscultatory clinical data.

Time course of flow-induced adaptation of carotid artery biomechanical properties, structure and zero-stress state in the arteriovenous shunt

Numerous studies have provided evidence of diameter adaptation secondary to flow-overload, but with ambiguous findings vis à vis other morphological parameters and information on the biomechanical aspects of arterial adaptation is rather incomplete. We examined the time course of large-artery biomechanical adaptation elicited by long-term flow-overload in a porcine shunt model between the carotid artery and ipsilateral jugular vein. Post-shunting, the proximal artery flow was doubled and retained so until euthanasia (up to three months post-operatively), without pressure change. This hemodynamic stimulus induced lumen diameter enlargement, accommodated by elastin fragmentation and connective tissue accumulation, as witnessed by optical and confocal microscopy. Heterogeneous mass growth of the adventitia was observed at the expense of the media, associated with declining residual strains and opening angle at three months. The in vitro elastic properties of shunted arteries determined by inflation/extension testing were also modified, with the thickness-pressure curves shifted to larger thicknesses and the diameter-pressure curves shifted to larger diameters at physiologic pressures, resulting in normalization of intramural and shear stresses within fifteen and thirty days, respectively. We infer that the biomechanical adaptation in moderate flow-overload leads to normalization of intimal shear, without, however, restoring compliance and distensibility at mean in vivo pressure to control levels.

Role of renin-angiotensin system in inflammation, immunity and aging

Recent data support the idea that the effects of RAS are not restricted to the cardiovascular and renal systems. Importantly, RAS modulates free radical production and the cellular synthesis of several molecules such as cytokines, chemokines and transcription factors. These functions reflect directly the RAS ability to modulate the cell growth, senescence and migration. Activation of the classic RAS, ACE/Ang II/AT1R, has been strictly related to down regulation of pro-survival genes (Nampt and Sirt3), increase in ROS production and pro-inflammatory cytokines and chemokines release, leading to cell senescence, inflammation and development of autoimmune dysfunctions. However, the new view of RAS, points to the ACE2/Ang-(1-7)/Mas receptor axis as a counter-regulator of the effects of the classic Ang II-mediated effects. This new pathway is not totally elucidated. However, some studies suggest an important role of this novel axis in the control of cytokines release as well as cell migration and synthesis, preventing extra-cellular matrix deposition and cell apoptosis. Classic RAS blockers have been proposed as anti-inflammatory and immunomodulatory agents and some studies suggest a new potential application of RAS blockers in autoimmune diseases. The aim of the present review is to update the novel roles of classical and new RAS components and their possible implication during the physiological aging, in the immune system and inflammation.

Patient-specific mean pressure drop in the systemic arterial tree, a comparison between 1-D and 3-D models

One-dimensional models of the systemic arterial tree are useful tools for studying wave propagation phenomena, however, their formulation for frictional losses is approximate and often based on solutions for developed flow in straight non-tapered arterial segments. Thus, losses due to bifurcations, tortuosity, non-planarity and complex geometry effects cannot be accounted for in 1-D models. This may lead to errors in the estimation of mean pressure. To evaluate these errors, we simulated steady flow in a patient specific model of the entire systemic circulation using a standard CFD code with Newtonian and non-Newtonian blood properties and compared the pressure evolution along three principal and representative arterial pathlines with the prediction of mean pressure, as given by the 1-D model. Pressure drop computed from aortic root up to iliac bifurcation and to distal brachial is less than 1 mmHg and 1-D model predictions agree well with the 3-D model. In smaller vessels like the precerebral and cerebral arteries, the losses are higher (mean pressure drop over 10 mmHg from mean aortic pressure) and are consistently underestimated by the 1-D model. Complex flow patterns resulting from tortuosity, non-planarity and branching yield shear stresses, which are higher than the ones predicted by the 1-D model. In consequence, the 1-D model overestimates mean pressure in peripheral arteries and especially in the cerebral circulation.

Generic and patient-specific models of the arterial tree

Recent advance in imaging modalities used frequently in clinical routine can provide description of the geometrical and hemodynamical properties of the arterial tree in great detail. The combination of such information with models of blood flow of the arterial tree can provide further information, such as details in pressure and flow waves or details in the local flow field. Such knowledge maybe be critical in understanding the development or state of arterial disease and can help clinicians perform better diagnosis or plan better treatments. In the present review, the state of the art of arterial tree models is presented, ranging from 0-D lumped models, 1-D wave propagation model to more complex 3-D fluid-structure interaction models. Our development of a generic and patient-specific model of the human arterial tree permitting to study pressure and flow waves propagation in patients is presented. The predicted pressure and flow waveforms are in good agreement with the in vivo measurements. We discuss the utility of these models in different clinical application and future development of interest.

Wall properties of the apolipoprotein E-deficient mouse aorta

OBJECTIVES

We quantified the dysfunction of the aortic wall, determined structural and elastic properties, and provided histological data of the thoracic aortas of apolipoprotein E (apoE)-deficient mice which are used as model of atherosclerosis.

METHODS

Six young 10-12 week-old (apoE)-deficient mice of both sexes were studied and six age-matched C57BL/6J wild-type mice were used as control group. We performed extension-inflation mechanical tests at three different axial stretches (λ(z) = 1.6, 1.8, and 2.0), under maximally contracted or totally relaxed state of the vascular smooth muscle cells. Classical histology was performed to the arterial segments.

RESULTS

Control aortas were generally more distensible than the (apoE)-deficient mouse aortas under both relaxed and contracted smooth muscle. Also, aortas from (apoE)-deficient mice were stiffer (higher incremental elastic modulus) than control aortas. Control aortas exhibited a higher active diameter response compared to (apoE)-deficient mouse aortas, despite the fact that vascular smooth muscle cell density was increased by approximately 15% in the (apoE)-deficient mouse aortas.

CONCLUSION

We found substantial changes in the structural and elastic properties of the wall, in the active diameter response and in the histology of (apoE)-deficient mouse aortas compared to the control group. Our data can be used in the development of constituent-based models of the arterial wall and in studying the changes in arterial wall properties in presence of disease, such as atherosclerosis.

Active axial stress in mouse aorta

The study verifies the development of active axial stress in the wall of mouse aorta over a range of physiological loads when the smooth muscle cells are stimulated to contract. The results obtained show that the active axial stress is virtually independent of the magnitude of pressure, but depends predominately on the longitudinal stretch ratio. The dependence is non-monotonic and is similar to the active stress-stretch dependence in the circumferential direction reported in the literature. The expression for the active axial stress fitted to the experimental data shows that the maximum active stress is developed at longitudinal stretch ratio 1.81, and 1.56 is the longitudinal stretch ratio below which the stimulation does not generate active stress. The study shows that the magnitude of active axial stress is smaller than the active circumferential stress. There is need for more experimental investigations on the active response of different types of arteries from different species and pathological conditions. The results of these studies can promote building of refined constrictive models in vascular rheology.

The "systolic volume balance" method for the noninvasive estimation of cardiac output based on pressure wave analysis

Cardiac output (CO) monitoring is essential for the optimal management of critically ill patients. Several mathematical methods have been proposed for CO estimation based on pressure waveform analysis. Most of them depend on invasive recording of blood pressure and require repeated calibrations, and they suffer from decreased accuracy under specific conditions. A new systolic volume balance (SVB) method, including a simpler empirical form (eSVB), was derived from basic physical principles that govern blood flow and, in particular, a volume balance approach for the conservation of mass ejected into and flowed out of the arterial system during systole. The formulas were validated by a one-dimensional model of the systemic arterial tree. Comparisons of CO estimates between the proposed and previous methods were performed in terms of agreement and accuracy using "real" CO values of the model as a reference. Five hundred and seven different hemodynamic cases were simulated by altering cardiac period, arterial compliance, and resistance. CO could be accurately estimated by the SVB method as follows: CO = C × PP(ao)/(T - P(sm) × T(s)/P(m)) and by the eSVB method as follows: CO = k × C × PP(ao)/T, where C is arterial compliance, PP(ao) is aortic pulse pressure, T is cardiac period, P(sm) is mean systolic pressure, T(s) is systolic duration, P(m) is mean pressure, and k is an empirical coefficient. SVB applied on aortic pressure waves did not require calibration or empirical correction for CO estimation. An empirical coefficient was necessary for brachial pressure wave analysis. The difference of SVB-derived CO from model CO (for brachial waves) was 0.042 ± 0.341 l/min, and the limits of agreement were -0.7 to 0.6 l/min, indicating high accuracy. The intraclass correlation coefficient and root mean square error between estimated and "real" CO were 0.861 and 0.041 l/min, respectively, indicating very good accuracy. eSVB also provided accurate estimation of CO. An in vivo validation study of the proposed methods remains to be conducted.

The activation of the cannabinoid receptor type 2 reduces neutrophilic protease-mediated vulnerability in atherosclerotic plaques

AIMS

The activation of cannabinoid receptor type 2 (CB(2))-mediated pathways might represent a promising anti-atherosclerotic treatment. Here, we investigated the expression of the endocannabinoid system in human carotid plaques and the impact of CB(2) pharmacological activation on markers of plaque vulnerability in vivo and in vitro.

METHODS AND RESULTS

The study was conducted using all available residual human carotid tissues (upstream and downstream the blood flow) from our cohort of patients symptomatic (n = 13) or asymptomatic (n = 27) for ischaemic stroke. Intraplaque levels of 2-arachidonoylglycerol, anandamide N-arachidonoylethanolamine, N-palmitoylethanolamine, N-oleoylethanolamine, and their degrading enzymes (fatty acid amide hydrolase and monoacylglycerol lipase) were not different in human plaque portions. In the majority of human samples, CB(1) (both mRNA and protein levels) was undetectable. In downstream symptomatic plaques, CB(2) protein expression was reduced when compared with asymptomatic patients. In these portions, CB(2) levels were inversely correlated (r = -0.4008, P = 0.0170) with matrix metalloprotease (MMP)-9 content and positively (r = 0.3997, P = 0.0174) with collagen. In mouse plaques, CB(2) co-localized with neutrophils and MMP-9. Treatment with the selective CB(2) agonist JWH-133 was associated with the reduction in MMP-9 content in aortic root and carotid plaques. In vitro, pre-incubation with JWH-133 reduced tumour necrosis factor (TNF)-α-mediated release of MMP-9. This effect was associated with the reduction in TNF-α-induced ERK1/2 phosphorylation in human neutrophils.

CONCLUSION

Cannabinoid receptor type 2 receptor is down-regulated in unstable human carotid plaques. Since CB(2) activation prevents neutrophil release of MMP-9 in vivo and in vitro, this treatment strategy might selectively reduce carotid vulnerability in humans.