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Grewal N, Dolmaci O, Klautz A, Legue J, Driessen A, Klautz R, Poelmann R. The role of transforming growth factor beta in bicuspid aortic valve aortopathy. Indian J Thorac Cardiovasc Surg 2023; 39:270-279. [PMID: 38093932 PMCID: PMC10713891 DOI: 10.1007/s12055-023-01513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 12/17/2023] Open
Abstract
A bicuspid aortic valve (BAV) is the most prevalent congenital cardiac deformity, which is associated with an increased risk to develop a thoracic aortic aneurysm and/or an aortic dissection as compared to persons with a tricuspid aortic valve. Due to the high prevalence of a BAV in the general population and the associated life-long increased risk for adverse vascular events, BAV disease places a considerable burden on the public health. The aim of the present review is to discuss the role of transforming growth factor beta (TGF-β) signaling in the development of the vascular wall and on how this complex signaling pathway may be involved in thoracic aortic aneurysm formation in tricuspid and BAV patients.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Onur Dolmaci
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Juno Legue
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Antoine Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Grewal N, Klautz RJM, Poelmann RE. Intrinsic histological and morphological abnormalities of the pediatric thoracic aorta in bicuspid aortic valve patients are predictive for future aortopathy. Pathol Res Pract 2023; 248:154620. [PMID: 37392550 DOI: 10.1016/j.prp.2023.154620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Patients with a bicuspid aortic valve (BAV) have an increased risk to develop aortic complications. Many studies are pointing towards a possible embryonic explanation for the development of both a bicuspid aortic valve as well as a defective ascending aortic wall in these patients. The fetal and newborn ascending aortic wall has however scarcely been studied in bicuspid aortic valve patients. We hypothesize that early histopathological defects might already be visible in the fetal and pediatric ascending aortic wall of bicuspid aortic valve patients, indicating at an early embryonic defect. METHODS Non-dilated BAV ascending aortic wall samples were collected (n = 40), categorized in five age groups: premature (age range 17.5 weeks + days GA till 37.6 weeks + days GA) 2. neonate (age range 1 - 21 days) 3. infant (age range 1 month - 4 years) 4. adolescent (age range 12 years - 15 years) and 5. adult (age range 41 - 72 years). Specimen were studied for intimal and medial histopathological features. RESULTS The premature ascending aortic wall has a significantly thicker intimal and significantly thinner medial layer as compared to all other age categories (p < 0.05). After birth the intimal thickness decreases significantly. The medial layer increases in thickness before adulthood (p < 0.05) with an increasing number of elastic lamellae (p < 0.01) and interlamellar mucoid extracellular matrix accumulation (p < 0.0001). Intimal atherosclerosis was scarce and medial histopathological features such as overall medial degeneration, smooth muscle cell nuclei loss and elastic fiber fragmentation were not appreciated in the BAV ascending aortic wall of any age. CONCLUSIONS The main characteristics of a bicuspid ascending aortic wall are already present before adulthood, albeit not before birth. Considering the early manifestations of ascending aortic wall pathology in bicuspid aortic valve patients, the pediatric population should be considered while searching for markers predictive for future aortopathy.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, The Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Grewal N, Klautz R, Poelmann RE. Can transforming growth factor beta and downstream signalers distinguish bicuspid aortic valve patients susceptible for future aortic complications? Cardiovasc Pathol 2023; 63:107498. [PMID: 36403918 DOI: 10.1016/j.carpath.2022.107498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with a bicuspid aortic valve have an extreme high risk to develop a thoracic aortic aneurysm and dissection (TAAD). TAADs form a leading cause of death worldwide, with the majority of deaths being preventable if individuals at risk are identified and properly managed. Risk stratification for TAADs in bicuspidy is so far solely based on the aortic diameter. Exclusive use of aortic wall dimension, as in the current guidelines, is however not sufficient in selecting patients vulnerable for future aortic wall complications. Moreover, there are no effective medical treatments for TAADs to retain progressive aortic dilatation and thus prevent or delay aortic complications. Only surgical replacement of the aorta increases life expectancy in patients with a risk for a TAAD. Therefore, the next major challenge in the management of TAADs is the development of a personalized patient-tailored risk stratification for early detection of patients with an increased risk for TAADs, who will benefit from surgical resection of the aorta. Several signaling pathways have been studied in recent times to develop a patient specific risk stratification model. In this paper we discuss TGF-β signaling and downstream signalers as potential markers for future aortic complications in bicuspid aortic valve patients.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Grewal N, Klautz R, Poelmann RE. Commentary: Transforming growth factor serum concentrations in patients with proven non-syndromic aortopathy. Front Cardiovasc Med 2023; 10:1097201. [PMID: 36818342 PMCID: PMC9931743 DOI: 10.3389/fcvm.2023.1097201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: Nimrat Grewal,
| | - Robert Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Grewal N, Driessen A, Klautz RJM, Poelmann RE. Can general histopathology distinguish bicuspid aortopathy? J Card Surg 2022; 37:4207-4208. [PMID: 36335626 DOI: 10.1111/jocs.17103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoine Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert E Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Herrero-Cervera A, Espinós-Estévez C, Martín-Vañó S, Taberner-Cortés A, Aguilar-Ballester M, Vinué Á, Piqueras L, Martínez-Hervás S, González-Navarro H. Dissecting Abdominal Aortic Aneurysm Is Aggravated by Genetic Inactivation of LIGHT (TNFSF14). Biomedicines 2021; 9:biomedicines9111518. [PMID: 34829747 PMCID: PMC8615201 DOI: 10.3390/biomedicines9111518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Abdominal aortic aneurysm (AAA), is a complex disorder characterized by vascular vessel wall remodeling. LIGHT (TNFSF14) is a proinflammatory cytokine associated with vascular disease. In the present study, the impact of genetic inactivation of Light was investigated in dissecting AAA induced by angiotensin II (AngII) in the Apolipoprotein E-deficient (Apoe−/−) mice. Studies in aortic human (ah) vascular smooth muscle cells (VSMC) to study potential translation to human pathology were also performed. AngII-treated Apoe−/−Light−/− mice displayed increased abdominal aorta maximum diameter and AAA severity compared with Apoe−/− mice. Notably, reduced smooth muscle α-actin+ area and Acta2 and Col1a1 gene expression were observed in AAA from Apoe−/−Light−/− mice, suggesting a loss of VSMC contractile phenotype compared with controls. Decreased Opn and augmented Sox9 expression, which are associated with detrimental and non-contractile osteochondrogenic VSMC phenotypes, were also seen in AngII-treated Apoe−/−Light−/− mouse AAA. Consistent with a role of LIGHT preserving VSMC contractile characteristics, LIGHT-treatment of ahVSMCs diminished the expression of SOX9 and of the pluripotency marker CKIT. These effects were partly mediated through lymphotoxin β receptor (LTβR) as the silencing of its gene ablated LIGHT effects on ahVSMCs. These studies suggest a protective role of LIGHT through mechanisms that prevent VSMC trans-differentiation in an LTβR-dependent manner.
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Affiliation(s)
- Andrea Herrero-Cervera
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (A.H.-C.); (S.M.-V.); (A.T.-C.); (M.A.-B.); (Á.V.); (L.P.); (S.M.-H.)
| | | | - Susana Martín-Vañó
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (A.H.-C.); (S.M.-V.); (A.T.-C.); (M.A.-B.); (Á.V.); (L.P.); (S.M.-H.)
| | - Alida Taberner-Cortés
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (A.H.-C.); (S.M.-V.); (A.T.-C.); (M.A.-B.); (Á.V.); (L.P.); (S.M.-H.)
| | - María Aguilar-Ballester
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (A.H.-C.); (S.M.-V.); (A.T.-C.); (M.A.-B.); (Á.V.); (L.P.); (S.M.-H.)
| | - Ángela Vinué
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (A.H.-C.); (S.M.-V.); (A.T.-C.); (M.A.-B.); (Á.V.); (L.P.); (S.M.-H.)
| | - Laura Piqueras
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (A.H.-C.); (S.M.-V.); (A.T.-C.); (M.A.-B.); (Á.V.); (L.P.); (S.M.-H.)
- Department of Pharmacology, University of Valencia, 46010 Valencia, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Sergio Martínez-Hervás
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (A.H.-C.); (S.M.-V.); (A.T.-C.); (M.A.-B.); (Á.V.); (L.P.); (S.M.-H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
- Endocrinology and Nutrition Service, Clinic Hospital of Valencia, 46010 Valencia, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Herminia González-Navarro
- INCLIVA, Institute of Health Research, 46010 Valencia, Spain; (A.H.-C.); (S.M.-V.); (A.T.-C.); (M.A.-B.); (Á.V.); (L.P.); (S.M.-H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
- Biochemistry and Molecular Biology Department, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-96-386-44-03; Fax: +34-96-398-78-60
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Marfan Syndrome Versus Bicuspid Aortic Valve Disease: Comparative Analysis of Obstetric Outcome and Pregnancy-Associated Immediate and Long-Term Aortic Complications. J Clin Med 2020; 9:jcm9041124. [PMID: 32326432 PMCID: PMC7230569 DOI: 10.3390/jcm9041124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 12/19/2022] Open
Abstract
Pregnancy poses a threat to women with aortopathy. Conclusive data on the obstetric and aortic outcome in this risk collective, especially when it comes to aortic complications in the long term, are still missing. This study offers a comparative analysis of pregnancy-associated outcome in 113 consecutive women with Marfan syndrome or bicuspid aortic valve disease, including 46 ever-pregnant and 37 never-pregnant women with Marfan syndrome, and 23 ever-pregnant and 7 never-pregnant females with bicuspid aortic valve disease. The overall obstetric outcome was comparable between ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease (p = 0.112). Pregnancy-associated aortic dissection occurred in two women with Marfan syndrome (3%) during a total of 62 completed pregnancies, whereas no single case of aortic event occurred in women with bicuspid aortic valve disease during a total of 36 completed pregnancies (p = 0.530). In the long-term follow-up, aortic dissection occurred in 21% of ever-pregnant women with Marfan syndrome, but in none of the women with bicuspid aortic valve disease (p = 0.022). Proximal aortic surgery was performed with similar frequency in ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease in the long term (p = 0.252). However, ever-pregnant women with Marfan syndrome were younger when surgery was performed (44 ± 9 vs. 59 ± 7 years; p = 0.041). In Marfan syndrome, long-term growth of the aorta was comparable between ever-pregnant and never-pregnant women. Pregnancy thus exhibited an increased immediate aortic risk only in women with Marfan syndrome, but not in women with bicuspid aortic valve disease. Previous pregnancy did not relate to an increased long-term risk of adverse aortic events in women with Marfan syndrome or with bicuspid aortic valve disease.
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Bons LR, Geenen LW, van den Hoven AT, Dik WA, van den Bosch AE, Duijnhouwer AL, Siebelink HMJ, Budde RPJ, Boersma E, Wessels MW, van de Laar IMBH, DeRuiter MC, Goumans MJ, Loeys BL, Roos-Hesselink JW. Blood biomarkers in patients with bicuspid aortic valve disease. J Cardiol 2020; 76:287-294. [PMID: 32265086 DOI: 10.1016/j.jjcc.2020.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/10/2020] [Accepted: 02/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with a bicuspid aortic valve (BAV) are at risk of developing valve deterioration and aortic dilatation. We aimed to investigate whether blood biomarkers are associated with disease stage in patients with BAV. METHODS Serum levels of high sensitivity C-reactive protein (hsCRP), high sensitivity troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and total transforming growth factor-beta 1 (TGF-ß1) were measured in adult BAV patients with valve dysfunction or aortic pathology. Age-matched general population controls were included for TGFß-1 measurements. Correlation analyses and multivariable linear regression were used to determine the association between (2log-transformed) biomarker levels and aortic valve regurgitation, aortic valve stenosis, aortic dilatation, or left ventricular function. RESULTS hsCRP and hsTnT were measured in the total group of 183 patients (median age 34 years, 25th-75th percentile 23-46), NT-proBNP in 162 patients, and TGF-ß1 beta in 108 patients. Elevated levels of NT-proBNP were found in 20% of the BAV patients, elevated hsTnT in 6%, and elevated hsCRP in 7%. Higher hsTnT levels were independently associated with aortic regurgitation [odds ratio per doubling (OR2log) 1.34, 95% CI 1.01;1.76] and higher NT-proBNP levels with aortic valve maximal velocity (ß2log 0.17, 95%CI 0.07;0.28) and aortic regurgitation (OR2log 1.41, 95%CI 1.11;1.79). Both BAV patients with (9.9 ± 2.7 ng/mL) and without aortic dilatation (10.4 ± 2.9 ng/mL) showed lower TGF-ß1 levels compared to general population controls (n = 85, 11.8 ± 3.2 ng/mL). CONCLUSIONS Higher NT-proBNP and hsTNT levels were associated with aortic valve disease in BAV patients. TGF-ß1 levels were lower in BAV patients than in the general population, and not related to aortic dilatation. Longitudinal data are needed to further investigate the prognostic value of biomarkers in these patients.
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Affiliation(s)
- Lidia R Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laurie W Geenen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem A Dik
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Clinical Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marja W Wessels
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid M B H van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Laboratory for Cardiovascular Cell Biology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bart L Loeys
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Shar JA, Liu J, Atkins SK, Sucosky P. Letter by Shar et al Regarding Article, “Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve: A Time-Resolved 3-Dimensional Phase-Contrast Magnetic Resonance Imaging Study”. Arterioscler Thromb Vasc Biol 2020; 40:e114-e115. [DOI: 10.1161/atvbaha.120.314049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jason A. Shar
- From the Department of Mechanical and Materials Engineering, Wright State University, Russ Engineering Center, Dayton, OH (J.A.S., J.L., P.S.)
| | - Janet Liu
- From the Department of Mechanical and Materials Engineering, Wright State University, Russ Engineering Center, Dayton, OH (J.A.S., J.L., P.S.)
| | - Samantha K. Atkins
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.K.A.)
| | - Philippe Sucosky
- From the Department of Mechanical and Materials Engineering, Wright State University, Russ Engineering Center, Dayton, OH (J.A.S., J.L., P.S.)
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The Development of the Ascending Aortic Wall in Tricuspid and Bicuspid Aortic Valve: A Process from Maturation to Degeneration. J Clin Med 2020; 9:jcm9040908. [PMID: 32225051 PMCID: PMC7230962 DOI: 10.3390/jcm9040908] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Patients with a bicuspid aortic valve (BAV) have an increased risk for aortic dilation and dissection. In this study, we provide a histological stratification of the developing aorta in the tricuspid aortic valve (TAV) and the BAV populations as a reference for future studies on aortopathy and related syndromes. Methods: Non-dilated TAV and BAV ascending aortic wall samples were collected, including 60 TAV (embryonic–70 years) and 32 BAV specimens (fetal–72 years, categorized in eight age groups. Results: In TAV, intimal development starts in the neonatal phase. After birth, the thickness of the medial layer increases significantly by increase of elastic lamellae up to and including the “young child” phase stabilizing afterwards. The BAV shows already prenatal intimal thickening becoming significantly thinner after birth subsequently stabilizing. In BAV, increase in elastic lamellae is seen between the young child and the adolescent phases, stabilizing afterwards. Conclusions: Vascular development in TAV is described in three phases: maturation, stabilization, and degeneration. For BAV, the development can be described in two phases: maturation (already prenatally) and degeneration. After birth, the development of the aorta is characterized by degeneration, leading to weakening of the ascending aortic wall and increasing the risk of aortopathy.
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Malashicheva A, Kostina A, Kostareva A, Irtyuga O, Gordeev M, Uspensky V. Notch signaling in the pathogenesis of thoracic aortic aneurysms: A bridge between embryonic and adult states. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165631. [PMID: 31816439 DOI: 10.1016/j.bbadis.2019.165631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/23/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022]
Abstract
Aneurysms of the thoracic aorta are a "silent killer" with no evident clinical signs until the fatal outcome. Molecular and genetic bases of thoracic aortic aneurysms mainly include transforming growth factor beta signaling, smooth muscle contractile units and metabolism genes, and extracellular matrix genes. In recent studies, a role of Notch signaling, among other pathways, has emerged in disease pathogenesis. Notch is a highly conserved signaling pathway that regulates the development and differentiation of many types of tissues and influences major cellular processes such as cell proliferation, differentiation and apoptosis. Mutations in several Notch signaling components have been associated with a number of heart defects, demonstrating an essential role of Notch signaling both in cardiovascular system development and its maintenance during postnatal life. This review discusses the role of Notch signaling in the pathogenesis of thoracic aortic aneurysms considering development and maintenance of the aortic root and how developmental regulations by Notch signaling may influence thoracic aortic aneurysms.
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Affiliation(s)
- Anna Malashicheva
- Almazov National Medical Research Centre, Akkuratova, 2, 197341 Saint Petersburg, Russia; Institute of Cytology, Russian Academy of Sciences, Tikhoretskiy, 4, 194064 Saint Petersburg, Russia; Saint Petersburg State University, Department of Embryology, Universitetskaya nab., 7/9, 199034, Saint Petersburg, Russia.
| | - Aleksandra Kostina
- Almazov National Medical Research Centre, Akkuratova, 2, 197341 Saint Petersburg, Russia; Institute of Cytology, Russian Academy of Sciences, Tikhoretskiy, 4, 194064 Saint Petersburg, Russia
| | - Anna Kostareva
- Almazov National Medical Research Centre, Akkuratova, 2, 197341 Saint Petersburg, Russia
| | - Olga Irtyuga
- Almazov National Medical Research Centre, Akkuratova, 2, 197341 Saint Petersburg, Russia
| | - Mikhail Gordeev
- Almazov National Medical Research Centre, Akkuratova, 2, 197341 Saint Petersburg, Russia
| | - Vladimir Uspensky
- Almazov National Medical Research Centre, Akkuratova, 2, 197341 Saint Petersburg, Russia
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12
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Poelmann RE, Gittenberger-de Groot AC. Development and evolution of the metazoan heart. Dev Dyn 2019; 248:634-656. [PMID: 31063648 PMCID: PMC6767493 DOI: 10.1002/dvdy.45] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 12/19/2022] Open
Abstract
The mechanisms of the evolution and development of the heart in metazoans are highlighted, starting with the evolutionary origin of the contractile cell, supposedly the precursor of cardiomyocytes. The last eukaryotic common ancestor is likely a combination of several cellular organisms containing their specific metabolic pathways and genetic signaling networks. During evolution, these tool kits diversified. Shared parts of these conserved tool kits act in the development and functioning of pumping hearts and open or closed circulations in such diverse species as arthropods, mollusks, and chordates. The genetic tool kits became more complex by gene duplications, addition of epigenetic modifications, influence of environmental factors, incorporation of viral genomes, cardiac changes necessitated by air‐breathing, and many others. We evaluate mechanisms involved in mollusks in the formation of three separate hearts and in arthropods in the formation of a tubular heart. A tubular heart is also present in embryonic stages of chordates, providing the septated four‐chambered heart, in birds and mammals passing through stages with first and second heart fields. The four‐chambered heart permits the formation of high‐pressure systemic and low‐pressure pulmonary circulation in birds and mammals, allowing for high metabolic rates and maintenance of body temperature. Crocodiles also have a (nearly) separated circulation, but their resting temperature conforms with the environment. We argue that endothermic ancestors lost the capacity to elevate their body temperature during evolution, resulting in ectothermic modern crocodilians. Finally, a clinically relevant paragraph reviews the occurrence of congenital cardiac malformations in humans as derailments of signaling pathways during embryonic development. The cardiac regulatory toolkit contains many factors including epigenetic, genetic, viral, hemodynamic, and environmental factors, but also transcriptional activators, repressors, duplicated genes, redundancies and dose‐dependancies. Numerous toolkits regulate mechanisms including cell‐cell interactions, EMT, mitosis patterns, cell migration and differentiation and left/right sidedness involved in the development of endocardial cushions, looping, septum complexes, pharyngeal arch arteries, chamber and valve formation and conduction system. Evolutionary development of the yolk sac circulation likely preceded the advent of endothermy in amniotes. Parallel evolutionary traits regulate the development of contractile pumps in various taxa often in conjunction with the gut, lungs and excretory organs.
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Affiliation(s)
- Robert E Poelmann
- Institute of Biology, Department of Animal Sciences and Health, Leiden University, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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13
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Balint B, Yin H, Nong Z, Arpino JM, O'Neil C, Rogers SR, Randhawa VK, Fox SA, Chevalier J, Lee JJ, Chu MWA, Pickering JG. Seno-destructive smooth muscle cells in the ascending aorta of patients with bicuspid aortic valve disease. EBioMedicine 2019; 43:54-66. [PMID: 31078518 PMCID: PMC6562112 DOI: 10.1016/j.ebiom.2019.04.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/22/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background Ascending aortic aneurysms constitute an important hazard for individuals with a bicuspid aortic valve (BAV). However, the processes that degrade the aortic wall in BAV disease remain poorly understood. Methods We undertook in situ analysis of ascending aortas from 68 patients, seeking potentially damaging cellular senescence cascades. Aortas were assessed for senescence-associated-ß-galactosidase activity, p16Ink4a and p21 expression, and double-strand DNA breaks. The senescence-associated secretory phenotype (SASP) of cultured-aged BAV aortic smooth muscle cells (SMCs) was evaluated by transcript profiling and consequences probed by combined immunofluorescence and circular polarization microscopy. The contribution of p38 MAPK signaling was assessed by immunostaining and blocking strategies. Findings We uncovered SMCs at varying depths of cellular senescence within BAV- and tricuspid aortic valve (TAV)-associated aortic aneurysms. Senescent SMCs were also abundant in non-aneurysmal BAV aortas but not in non-aneurysmal TAV aortas. Multivariable analysis revealed that BAV disease independently associated with SMC senescence. Furthermre, SMC senescence was heightened at the convexity of aortas associated with right-left coronary cusp fusion. Aged BAV SMCs had a pronounced collagenolytic SASP. Moreover, senescent SMCs in the aortic wall were enriched with surface-localized MMP1 and surrounded by weakly birefringent collagen fibrils. The senescent-collagenolytic SMC phenotype depended on p38 MAPK signaling, which was chronically activated in BAV aortas. Interpretation We have identified a cellular senescence-collagen destruction axis in at-risk ascending aortas. This novel “seno-destructive” SMC phenotype could open new opportunities for managing BAV aortopathy. Fund Canadian Institutes of Health Research, Lawson Health Research Institute, Heart and Stroke Foundation of Ontario/Barnett-Ivey Chair.
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Affiliation(s)
- Brittany Balint
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada; Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada
| | - Hao Yin
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada
| | - Zengxuan Nong
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada
| | - John-Michael Arpino
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada; Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada
| | - Caroline O'Neil
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada
| | - Stephanie R Rogers
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada
| | - Varinder K Randhawa
- Departments of Medicine (Cardiology), The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada
| | - Stephanie A Fox
- Department of Surgery, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada; London Health Sciences Centre, 339 Windermere Rd., London, ON N6A 5A5, Canada
| | - Jacqueline Chevalier
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada; Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada
| | - Jason J Lee
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada; Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada
| | - Michael W A Chu
- Department of Surgery, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada; London Health Sciences Centre, 339 Windermere Rd., London, ON N6A 5A5, Canada
| | - J Geoffrey Pickering
- Robarts Research Institute, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5B7, Canada; Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada; Departments of Medicine (Cardiology), The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada; London Health Sciences Centre, 339 Windermere Rd., London, ON N6A 5A5, Canada; Department of Biochemistry, The University of Western Ontario, 1151 Richmond St. N., London, ON N6A 5C1, Canada.
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14
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Tobin SW, Alibhai FJ, Lee MM, Yeganeh A, Wu J, Li SH, Guo J, Tsang K, Tumiati L, Rocha R, Butany J, Yau TM, Ouzounian M, David TE, Weisel RD, Li RK. Novel mediators of aneurysm progression in bicuspid aortic valve disease. J Mol Cell Cardiol 2019; 132:71-83. [PMID: 31047984 DOI: 10.1016/j.yjmcc.2019.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/06/2019] [Accepted: 04/20/2019] [Indexed: 12/28/2022]
Abstract
Bicuspid aortic valve (BAV) disease is a congenital abnormality that is associated with ascending aortic aneurysm yet many of the molecular mechanisms remain unknown. To identify novel molecular mechanisms of aneurysm formation we completed microarray analysis of the proximal (severely dilated) and distal (less dilated) regions of the ascending aorta from five patients with BAV. We identified 180 differentially expressed genes, 40 of which were validated by RT-qPCR. Most genes had roles in inflammation and endothelial cell function including cytokines and growth factors, cell surface receptors and the Activator Protein 1 (AP-1) transcription factor family (FOS, FOSB and JUN) which was chosen for further study. AP-1 was differentially expressed within paired BAV aneurysmal samples (n = 8) but not Marfan patients (n = 5). FOS protein was significantly enriched in BAV aortas compared to normal aortas but unexpectedly, ERK1/2 activity, an upstream regulator of FOS was reduced. ERK1/2 activity was restored when BAV smooth muscle cells were cultured in vitro. An mRNA-miRNA network within paired patient samples identified AP-1 as a central hub of miRNA regulation. FOS knockdown in BAV SMCs increased expression of miR-27a, a stretch responsive miRNA. AP-1 and miR-27a were also dysregulated in a mouse model of aortic constriction. In summary, this study identified a central role for AP-1 signaling in BAV aortic dilatation by using paired mRNA-miRNA patient sample. Upstream analysis of AP-1 regulation showed that the ERK1/2 signaling pathway is dysregulated and thus represents a novel chain of mediators of aortic dilatation in BAV which should be considered in future studies.
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Affiliation(s)
- Stephanie W Tobin
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Faisal J Alibhai
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Myunghyun M Lee
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Azadeh Yeganeh
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Jie Wu
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Laboratory of Medical Genetics, Harbin Medical University, Harbin, China
| | - Shu-Hong Li
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Jian Guo
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Katherine Tsang
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Laura Tumiati
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Rodolfo Rocha
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Jagdish Butany
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - Terrence M Yau
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Tirone E David
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Richard D Weisel
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Ren-Ke Li
- Division of Cardiovascular Surgery, Toronto General Hospital Research Institute and Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada.
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15
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The role of hemodynamics in bicuspid aortopathy: a histopathologic study. Cardiovasc Pathol 2019; 41:29-37. [PMID: 31029755 DOI: 10.1016/j.carpath.2019.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A bicuspid aortic valve (BAV) is the most common congenital cardiac malformation and is associated with ascending aortic dilation in 60%-80% of patients. In this study, we aimed to address the role of hemodynamic influences on the development of aortopathy in BAV patients. PATIENT AND METHODS BAV (n=36) and tricuspid aortic valve (TAV) patients (n=17) undergoing aortic valve replacement underwent preoperative flow magnetic resonance imaging (MRI) assessment to detect the area of maximal flow-induced stress in the proximal aorta. Based on these MRI data, paired ascending aortic wall samples [i.e., area of maximal jet impact (jet sample) and the opposite aortic wall (nonjet sample)] were collected during surgery. To study and describe the effects of jet stream on the complete vascular wall, a pathology score was developed based on the recently published aortic consensus paper statement on surgical pathology of the aorta using routine histologic stainings (resorcin fuchsin, hematoxylin-eosin, and Movat) and immunohistochemistry (alpha smooth muscle actin, smooth muscle 22 alpha, platelet endothelial cell adhesion molecule). RESULTS Comparing the jet and nonjet samples in both BAV and TAV, regions of maximal jet impact did not show any difference in the pathology score in the adventitia and the middle and outer media. In the jet samples, the inner media however showed loss of actin expression in both BAV (P<.0001) and the TAV (P=.0074), and the intimal thickness was significantly enlarged in both patient groups (BAV P=.0005, TAV P=.0041), which was not accompanied by loss of elastic lamellae or vascular smooth muscle cell nuclei. CONCLUSIONS In our study population, we could not demonstrate a potential distinct role for hemodynamics in the development of aortopathy in BAV patients even if corrected for aortic diameter, raphe position, or whether the valve is stenotic or regurgitant. The intimal layer and inner media however showed alterations in all jet specimens.
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16
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Grewal N, Gittenberger-de Groot AC. Wall Shear Stress Directional Abnormalities in BAV Aortas: Toward a New Hemodynamic Predictor of Aortopathy? Front Physiol 2019; 10:225. [PMID: 30941050 PMCID: PMC6433698 DOI: 10.3389/fphys.2019.00225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/21/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
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Abstract
UNLABELLED AimWe investigated dimensions and elasticity of whole aorta in patients with bicuspid aortic valve and influence of valve phenotype. METHOD The study group included 44 patients and 42 controls. Patients were divided into groups according to the type of valve opening as horizontal - fusion between right and left coronary cusps - and vertical - fusion between right-non-coronary cusps; according to age they were divided into younger (5-10 years) and older patients (11-16 years). Our study did not include valve phenotype with fusion between left and non-coronary cusps. Systolic-diastolic diameters of aortic annulus, sinus valsalva, sinutubular junction, arcus, and ascending-descending and abdominal aorta were measured and z-scores were obtained. Aortic strain, distensibility, and stiffness index were calculated. Flow-mediated dilatation of brachial artery was studied. RESULTS z-Scores at annulus, sinus valsalva, sinutubular junction, and ascending aorta were higher in study patients (p=0.001, p=0.0001, p=0.0001, p=0.0001, respectively). z-Scores of sinus valsalva and sinotubular junction were higher in the horizontal group than in the vertical group (p=0.006, p=0.023, respectively). z-Score was over +2 in 51% of patients with horizontal morphology and 33% of patients with vertical morphology (p=0.0001). Ascending aorta was more distensible and less stiff in the study group (11.3±5.63 versus 7.91±4.5, p=0.002; 4.76±3.60 versus 6.19±3.44 cm2.dyn-1.10-6, p=0.033, respectively). Stiffness index of ascending, arcus, and abdominal aorta were higher in the horizontal group (p=0.004, p=0.038, p=0.006, respectively). Ascending aorta was more distensible and less stiff in the younger group (p=0.007, p=0.027, respectively) but did not differ in the older group compared with the control group. CONCLUSION Aortic dimensions are enlarged in patients with bicuspid aortic valve starting from childhood, suggesting the presence of generalised aortopathy. Aortic elasticity is increased at young age and decreased with age.
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Hirata Y, Aoki H, Shojima T, Takagi K, Takaseya T, Akasu K, Tobinaga S, Fukumoto Y, Tanaka H. Activation of the AKT Pathway in the Ascending Aorta With Bicuspid Aortic Valve. Circ J 2018; 82:2485-2492. [PMID: 30089758 DOI: 10.1253/circj.cj-17-1465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dilatation of the ascending aorta affects those patients with bicuspid aortic valve (BAV), even after valvular surgery, possibly due to tissue fragility. The goal of the study was the molecular characterization of aorta with BAV compared to that with normal tricuspid aortic valve (TAV). Methods and Results: The subjects were patients who underwent surgery for aortic valve stenosis in 2013 and 2014. Nine patients with BAV and 13 with TAV were examined. There was no difference in the clinical characteristics or grade of aortic valve stenosis, but the diameters of the ascending aorta were significantly higher in the BAV group. The ascending aortic specimens were subjected to transcriptome analyses, which revealed the changes in receptor tyrosine kinase (RTK) pathway-related genes between TAV and BAV samples. Immunohistochemical study revealed higher staining of phosphorylated AKT (pAKT) in the media of the ascending aorta in the BAV group, regardless of the size of ascending aorta, whereas total AKT did not show such a difference. Immunofluorescence staining revealed the AKT activation was mainly in the medial vascular smooth muscle cells. CONCLUSIONS The results showed that the RTK-AKT pathway in the medial layer of the ascending aorta is activated in aortae with BAV. Activation of this pathway may be associated with fragility and dilatation of the ascending aorta with BAV.
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Affiliation(s)
- Yuichiro Hirata
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Hiroki Aoki
- Cardiovascular Research Institute, Kurume University
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Kohji Akasu
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Satoru Tobinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Hiroyuki Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
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Harrison OJ, Cagampang F, Ohri SK, Torrens C, Salhiyyah K, Modi A, Moorjani N, Whetton AD, Townsend PA. Candidate plasma biomarkers for predicting ascending aortic aneurysm in bicuspid aortic valve disease. J Cardiothorac Surg 2018; 13:76. [PMID: 29929532 PMCID: PMC6013884 DOI: 10.1186/s13019-018-0762-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Bicuspid aortic valve (BAV) disease is the most common congenital cardiac abnormality affecting 1–2% of the population and is associated with a significantly increased risk of ascending aortic aneurysm. However, predicting which patients will develop aneurysms remains a challenge. This pilot study aimed to identify candidate plasma biomarkers for monitoring ascending aortic diameter and predicting risk of future aneurysm in BAV patients. Methods Plasma samples were collected pre-operatively from BAV patients undergoing aortic valve surgery. Maximum ascending aortic diameter was measured on pre-operative transoesophageal echocardiography. Maximum diameter ≥ 45 mm was classified as aneurysmal. Sequential Window Acquisition of all THeoretical Mass Spectra (SWATH-MS), an advanced mass spectrometry technique, was used to identify and quantify all proteins within the samples. Protein abundance and aortic diameter were correlated using logistic regression. Levene’s test was used to identify proteins demonstrating low abundance variability in the aneurysmal patients (consistent expression in disease), and high variability in the non-aneurysmal patients (differential expression between ‘at risk’ and not ‘at risk’ patients). Results Fifteen plasma samples were collected (seven non-aneurysmal and 8 aneurysmal BAV patients). The mean age of the patients was 55.5 years and the majority were female (10/15, 67%). Four proteins (haemoglobin subunits alpha, beta and delta and mannan-binding lectin serine protease) correlated significantly with maximal ascending aortic diameter (p < 0.05, r = 0.5–0.6). Five plasma proteins demonstrated significantly lower variability in the aneurysmal group and may indicate increased risk of aneurysm in non-aneurysmal patients (DNA-dependent protein kinase catalytic subunit, lumican, tetranectin, gelsolin and cartilage acidic protein 1). A further 7 proteins were identified only in the aneurysmal group (matrin-3, glucose-6-phosphate isomerase, coactosin-like protein, peptidyl-prolyl cis-trans isomerase A, golgin subfamily B member 1, myeloperoxidase and 2′-deoxynucleoside 5′-phosphate N-hydrolase 1). Conclusions This study is the first to identify candidate plasma biomarkers for predicting aortic diameter and risk of future aneurysm in BAV patients. It provides valuable pilot data and proof of principle that could be used to design a large-scale prospective investigation. Ultimately, a more affordable ‘off-the-shelf’ follow-on blood assay could then be developed in place of SWATH-MS, for use in the healthcare setting. Electronic supplementary material The online version of this article (10.1186/s13019-018-0762-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oliver J Harrison
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. .,Department of Cardiac Surgery, University Hospital Southampton, Southampton General Hospital, Tremona Road, D-level, North Wing (MP 46), Southampton, UK.
| | - Felino Cagampang
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sunil K Ohri
- Department of Cardiac Surgery, University Hospital Southampton, Southampton General Hospital, Tremona Road, D-level, North Wing (MP 46), Southampton, UK
| | - Christopher Torrens
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kareem Salhiyyah
- Department of Cardiac Surgery, University Hospital Southampton, Southampton General Hospital, Tremona Road, D-level, North Wing (MP 46), Southampton, UK
| | | | - Narain Moorjani
- Department of Cardiac Surgery, Papworth Hospital NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Anthony D Whetton
- Stoller Biomarker Discovery Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Paul A Townsend
- Stoller Biomarker Discovery Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Wang YB, Li Y, Deng YB, Liu YN, Zhang J, Sun J, Zhu Y, Li L, Tang QY, Zhou W. Enlarged Size and Impaired Elastic Properties of the Ascending Aorta are Associated with Endothelial Dysfunction and Elevated Plasma Matrix Metalloproteinase-2 Level in Patients with Bicuspid Aortic Valve. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:955-962. [PMID: 29472114 DOI: 10.1016/j.ultrasmedbio.2018.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/17/2017] [Accepted: 01/12/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to test whether enlarged size and impaired elastic properties of the ascending aorta are associated with impaired endothelial function and increases in plasma matrix metalloproteinase (MMP)-2 concentrations in patients with bicuspid aortic valve (BAV) without significant valvular dysfunction. The size and the elasticity of the ascending aorta and the flow-mediated vasodilation (FMD) in the brachial artery in response to hyperemia were evaluated with 2-D echocardiography and high-frequency linear ultrasound in 42 patients with BAV without significant valvular dysfunction and 30 age- and sex-matched healthy controls. In the BAV group, diastolic ascending aortic diameter (AoD) (32.1 ± 8.1 mm vs. 25.3 ± 3.6 mm, p <0.001) and aortic stiffness index (8.0 ± 5.3 vs. 4.0 ± 1.8, p <0.001) were significantly higher, and aortic strain (7.4 ± 3.6% vs. 11.1 ± 3.0%, p <0.001) and aortic distensibility (7.4 ± 4.1 × 10-6cm2/dyn vs. 11.1 ± 4.3 × 10-6cm2/dyn, p <0.001) were significantly lower than those in the control group. The BAV group also had lower FMD (6.5 ± 2.2% vs. 11.9 ± 2.7%, p <0.001) and higher plasma MMP-2 levels (226.7 ± 55.0 ng/mL vs. 177.0 ± 45.3 ng/mL, p <0.001) compared with the control group. In the BAV group, AoD, aortic strain, aortic stiffness index and aortic distensibility significantly correlated with FMD and MMP-2 (all p <0.05). The multivariable linear regression analysis further indicated that FMD and MMP-2 were independently associated with AoD (β = -1.1, p = 0.005, and β = 0.09, p <0.001, respectively). These findings suggest that enlarged size and impaired elastic properties of the ascending aorta are associated with endothelial dysfunction and elevated plasma MMP-2 level in patients with BAV without significant valvular dysfunction. FMD and plasma MMP-2 level are the significant and independent predictors of dilation of the ascending aorta in patients with BAV.
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Affiliation(s)
- Yi-Bin Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Li
- Department of Medical Ultrasound, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ya-Ni Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Sun
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Grewal N, Gittenberger-de Groot AC. Pathogenesis of aortic wall complications in Marfan syndrome. Cardiovasc Pathol 2018; 33:62-69. [PMID: 29433109 DOI: 10.1016/j.carpath.2018.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/01/2018] [Accepted: 01/09/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with Marfan (MFS) syndrome and patients with a bicuspid aortic valve (BAV) are more prone to develop aortic dilation and dissection compared to persons with a tricuspid aortic valve (TAV). To elucidate potential common as well as distinct pathways of clinical relevance, we compared the histopathological substrates of aortic pathology. PATIENT AND METHODS Ascending aortic wall specimen were divided in five groups: BAV (n=36) and TAV (n=23) without and with dilation and non-dilated MFS (n=8). We performed routine histology to study aortic wall features based on the aortic consensus statement. Immunohistological markers for vascular smooth muscle cell (VSMC) maturation, and expression of fibrillin-1 were additionally investigated for the underlying pathogenesis. RESULTS On basis of the routine histology the aorta in MFS was similar to the aorta in dilated TAVs (overall medial degeneration, elastic fiber fragmentation, loss and disorganization, , and VSMC nuclei loss). The other markers aided in clustering the MFS and BAV patients with a significantly lower fibrillin-1 expression as compared to the TAVs (p<0.05), a lower level of differentiated VSMC markers (p<0.05) and elastic fiber thinning. CONCLUSIONS Pathogenesis of aortopathy in MFS overlaps with mechanisms seen in BAV and TAV, leading to a so called double hit hypothesis for aortic complications in MFS. The ascending aortic wall in MFS is immature with undifferentiated VSMCs and low levels of fibrillin-1. The immature media becomes even more vulnerable for aortopathy due to other degenerative features which develop probably as a direct consequence of the fibrillin-1 mutation.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Adriana C Gittenberger-de Groot
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Goumans MJ, Ten Dijke P. TGF-β Signaling in Control of Cardiovascular Function. Cold Spring Harb Perspect Biol 2018; 10:cshperspect.a022210. [PMID: 28348036 DOI: 10.1101/cshperspect.a022210] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Genetic studies in animals and humans indicate that gene mutations that functionally perturb transforming growth factor β (TGF-β) signaling are linked to specific hereditary vascular syndromes, including Osler-Rendu-Weber disease or hereditary hemorrhagic telangiectasia and Marfan syndrome. Disturbed TGF-β signaling can also cause nonhereditary disorders like atherosclerosis and cardiac fibrosis. Accordingly, cell culture studies using endothelial cells or smooth muscle cells (SMCs), cultured alone or together in two- or three-dimensional cell culture assays, on plastic or embedded in matrix, have shown that TGF-β has a pivotal effect on endothelial and SMC proliferation, differentiation, migration, tube formation, and sprouting. Moreover, TGF-β can stimulate endothelial-to-mesenchymal transition, a process shown to be of key importance in heart valve cushion formation and in various pathological vascular processes. Here, we discuss the roles of TGF-β in vasculogenesis, angiogenesis, and lymphangiogenesis and the deregulation of TGF-β signaling in cardiovascular diseases.
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Affiliation(s)
- Marie-José Goumans
- Department of Molecular Cell Biology and Cancer Genomics Centre Netherlands, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Peter Ten Dijke
- Department of Molecular Cell Biology and Cancer Genomics Centre Netherlands, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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Forte A, Bancone C, Cobellis G, Buonocore M, Santarpino G, Fischlein TJM, Cipollaro M, De Feo M, Della Corte A. A Possible Early Biomarker for Bicuspid Aortopathy: Circulating Transforming Growth Factor β-1 to Soluble Endoglin Ratio. Circ Res 2017; 120:1800-1811. [PMID: 28420669 DOI: 10.1161/circresaha.117.310833] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE The pathogenesis of bicuspid aortic valve (BAV)-associated aortopathy is poorly understood, and no prognostic biomarker is currently available. OBJECTIVE We aimed to identify putative circulating biomarkers pathogenetically and prognostically linked to bicuspid aortopathy. METHODS AND RESULTS By reverse transcription polymerase chain reaction, we evaluated gene expression variations (versus normal aorta) of transforming growth factor-β1 (TGF-β1), connective tissue growth factor, matrix metalloproteinase-2 (MMP-2), MMP-14, endoglin (ENG), and superoxide dismutase 3 in ascending aorta samples from 50 tricuspid and 70 patients with BAV undergoing surgery for aortic stenosis (aorta diameter ≤45 mm: BAVnon-dil or >45 mm: BAVdil). Expression changes of the TGF-β1 active dimer and ENG were analyzed also by Western blot in ascending aorta samples from other 10 tricuspid aortic valve, 10 BAVnon-dil, and 10 BAVdil patients. The serum concentration of study targets was assessed through ELISA and the ratio of serum TGF-β1/ENG (T/E) was evaluated. All BAVnon-dil patients underwent follow-up echocardiography to assess aortic growth rate. In BAVnon-dil patients, TGF-β1 and MMP-2 gene expression increased significantly, whereas MMP-14 and ENG expression decreased versus controls. Expression changes were confirmed at protein level for TGF-β1 and ENG. TGF-β1 serum concentration significantly decreased in tricuspid aortic valve and BAVnon-dil patients versus healthy subjects. ENG serum concentration decreased in all patients, more markedly in BAVdil. A significant increase of the T/E ratio versus healthy subjects was unique of patients with BAV. In BAVnon-dil patients, a T/E ≥9 was independently associated in multivariable analysis with higher MMP-2 and lower superoxide dismutase 3 gene expression, independent of age and aortic diameter. A significant correlation was observed between baseline T/E ratio and aortic diameter growth rate in BAVnon-dil patients (r=0.66, P<0.001). CONCLUSIONS The novel evidence of a possible value of the T/E ratio as a biomarker of BAV aortopathy was presented: further validation studies are warranted.
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Affiliation(s)
- Amalia Forte
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.).
| | - Ciro Bancone
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.)
| | - Gilda Cobellis
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.)
| | - Marianna Buonocore
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.)
| | - Giuseppe Santarpino
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.)
| | - Theodor J M Fischlein
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.)
| | - Marilena Cipollaro
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.)
| | - Marisa De Feo
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.)
| | - Alessandro Della Corte
- From the Experimental Medicine (A.F., M.C.), Cardiothoracic Sciences (C.B., M.B., M.D.F., A.D.C.), and Biophysics, Biochemistry, and General Pathology (G.C.), University of Campania "L.Vanvitelli", Naples Italy; and Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University, Nürnberg, Germany (G.S., T.J.M.F.)
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Bolar N, Verstraeten A, Van Laer L, Loeys B. Molecular Insights into Bicuspid Aortic Valve Development and the associated aortopathy. AIMS MOLECULAR SCIENCE 2017. [DOI: 10.3934/molsci.2017.4.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Differentiation defect in neural crest-derived smooth muscle cells in patients with aortopathy associated with bicuspid aortic valves. EBioMedicine 2016; 10:282-90. [PMID: 27394642 PMCID: PMC5006642 DOI: 10.1016/j.ebiom.2016.06.045] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 12/20/2022] Open
Abstract
Individuals with bicuspid aortic valves (BAV) are at a higher risk of developing thoracic aortic aneurysms (TAA) than patients with trileaflet aortic valves (TAV). The aneurysms associated with BAV most commonly involve the ascending aorta and spare the descending aorta. Smooth muscle cells (SMCs) in the ascending and descending aorta arise from neural crest (NC) and paraxial mesoderm (PM), respectively. We hypothesized defective differentiation of the neural crest stem cells (NCSCs)-derived SMCs but not paraxial mesoderm cells (PMCs)-derived SMCs contributes to the aortopathy associated with BAV. When induced pluripotent stem cells (iPSCs) from BAV/TAA patients were differentiated into NCSC-derived SMCs, these cells demonstrated significantly decreased expression of marker of SMC differentiation (MYH11) and impaired contraction compared to normal control. In contrast, the PMC-derived SMCs were similar to control cells in these aspects. The NCSC-SMCs from the BAV/TAA also showed decreased TGF-β signaling based on phosphorylation of SMAD2, and increased mTOR signaling. Inhibition of mTOR pathway using rapamycin rescued the aberrant differentiation. Our data demonstrates that decreased differentiation and contraction of patient's NCSC-derived SMCs may contribute to that aortopathy associated with BAV. Model of the BAV/TAA is established using iPSCs differentiated into SMCs through distinct embryonic progenitors. BAV/TAA iPSCs differentiated SMCs from NCSCs were impaired in contractile function, whereas, iPSCs PMCs-SMCs were normal. NCSC-SMCs from BAV/TAA decreased in TGF-β signaling but increased in mTOR signaling. Rapamycin normalized contractile function.
Aneurysms associated with bicuspid aortic valves (BAV) most commonly involve the ascending aorta and spare the descending aorta. Smooth muscle cells (SMCs) in the ascending and descending aorta arise from neural crest (NC) and paraxial mesoderm (PM), respectively. When induced pluripotent stem cells (iPSCs) from BAV patients were differentiated into NC stem cells (NCSCs)-derived SMCs, these cells demonstrated impaired contraction compared to normal control. In contrast, the PM cells-derived SMCs were similar to control cells. The NCSC-SMCs from the BAV/TAA also showed increased mTOR signaling. Inhibition of mTOR pathway using rapamycin rescued the aberrant differentiation.
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26
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Imatinib treatment attenuates growth and inflammation of angiotensin II induced abdominal aortic aneurysm. Atherosclerosis 2016; 249:101-9. [DOI: 10.1016/j.atherosclerosis.2016.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/18/2016] [Accepted: 04/06/2016] [Indexed: 11/20/2022]
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27
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Activation of Endocannabinoid System Is Associated with Persistent Inflammation in Human Aortic Aneurysm. BIOMED RESEARCH INTERNATIONAL 2015; 2015:456582. [PMID: 26539497 PMCID: PMC4619808 DOI: 10.1155/2015/456582] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/27/2015] [Accepted: 08/30/2015] [Indexed: 11/19/2022]
Abstract
Human aortic aneurysms have been associated with inflammation and vascular remodeling. Since the endocannabinoid system modulates inflammation and tissue remodeling, we investigated its components in human aortic aneurysms. We obtained anterior aortic wall samples from patients undergoing elective surgery for aortic aneurysm or coronary artery disease as controls. Histological and molecular analysis (RT-qPCR) was performed, and endocannabinoid concentration was determined using LC-MRM. Patient characteristics were comparable between the groups except for a higher incidence of arterial hypertension and diabetes in the control group. mRNA level of cannabinoid receptors was significantly higher in aneurysms than in controls. Concentration of the endocannabinoid 2-arachidonoylglycerol was significantly higher, while the second endocannabinoid anandamide and its metabolite arachidonic acid and palmitoylethanolamide were significantly lower in aneurysms. Histology revealed persistent infiltration of newly recruited leukocytes and significantly higher mononuclear cell density in adventitia of the aneurysms. Proinflammatory environment in aneurysms was shown by significant upregulation of M-CSF and PPARγ but associated with downregulation of chemokines. We found comparable collagen-stained area between the groups, significantly decreased mRNA level of CTGF, osteopontin-1, and MMP-2, and increased TIMP-4 expression in aneurysms. Our data provides evidence for endocannabinoid system activation in human aortic aneurysms, associated with persistent low-level inflammation and vascular remodeling.
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28
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Grewal N, Franken R, Mulder BJM, Goumans MJ, Lindeman JHN, Jongbloed MRM, DeRuiter MC, Klautz RJM, Bogers AJJC, Poelmann RE, Groot ACGD. Histopathology of aortic complications in bicuspid aortic valve versus Marfan syndrome: relevance for therapy? Heart Vessels 2015; 31:795-806. [PMID: 26129868 PMCID: PMC4850207 DOI: 10.1007/s00380-015-0703-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 06/12/2015] [Indexed: 11/11/2022]
Abstract
Patients with bicuspid aortic valve (BAV) and patients with Marfan syndrome (MFS) are more prone to develop aortic dilation and dissection compared to persons with a tricuspid aortic valve (TAV). To elucidate potential common and distinct pathways of clinical relevance, we compared the histopathological substrates of aortopathy. Ascending aortic wall biopsies were divided in five groups: BAV (n = 36) and TAV (n = 23) without and with dilation and non-dilated MFS (n = 8). General histologic features, apoptosis, the expression of markers for vascular smooth muscle cell (VSMC) maturation, markers predictive for ascending aortic dilation in BAV, and expression of fibrillin-1 were investigated. Both MFS and BAV showed an altered distribution and decreased fibrillin-1 expression in the aorta and a significantly lower level of differentiated VSMC markers. Interestingly, markers predictive for aortic dilation in BAV were not expressed in the MFS aorta. The aorta in MFS was similar to the aorta in dilated TAV with regard to the presence of medial degeneration and apoptosis, while other markers for degeneration and aging like inflammation and progerin expression were low in MFS, comparable to BAV. Both MFS and BAV aortas have immature VSMCs, while MFS and TAV patients have a similar increased rate of medial degeneration. However, the mechanism leading to apoptosis is expected to be different, being fibrillin-1 mutation induced increased angiotensin-receptor-pathway signaling in MFS and cardiovascular aging and increased progerin in TAV. Our findings could explain why angiotensin inhibition is successful in MFS and less effective in TAV and BAV patients.
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Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Romy Franken
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Postal zone S-5-24, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery and Heart Valve Bank, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert E Poelmann
- Department of Cardiology, Leiden University Medical Center, Postal zone S-5-24, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Biology, Integrative Zoology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriana C Gittenberger-de Groot
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Cardiology, Leiden University Medical Center, Postal zone S-5-24, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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29
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Grewal N, Gittenberger-de Groot AC, DeRuiter MC. Reply to the editor. J Thorac Cardiovasc Surg 2014; 148:2440-2. [PMID: 25444210 DOI: 10.1016/j.jtcvs.2014.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriana C Gittenberger-de Groot
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Dilation of the wall of the thoracic aorta can be found in patients with a tricuspid (TAV) as well as a bicuspid aortic valve (BAV) with and without a syndromic component. BAV is the most common congenital cardiovascular malformation, with a population prevalence of 0.5–2 %. The clinical course is often characterised by aneurysm formation and in some cases dissection. The non-dilated aortic wall is less well differentiated in all BAV as compared with TAV, thereby conferring inherent developmental susceptibility. Furthermore, a turbulent flow, caused by the inappropriate opening of the bicuspid valve, could accelerate the degenerative process in the aortic wall. However, not all patients with bicuspidy develop clinical complications during their life. We postulate that the increased vulnerability for aortic complications in a subset of patients with BAV is caused by a defect in the early development of the aorta and aortic valve. This review discusses histological and molecular genetic aspects of the normal and abnormal development of the aortic wall and semilunar valves. Aortopathy associated with BAV could be the result of a shared developmental defect during embryogenesis.
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