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Shahbad R, Pipinos M, Jadidi M, Desyatova A, Gamache J, MacTaggart J, Kamenskiy A. Structural and Mechanical Properties of Human Superficial Femoral and Popliteal Arteries. Ann Biomed Eng 2024; 52:794-815. [PMID: 38321357 DOI: 10.1007/s10439-023-03435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024]
Abstract
The femoropopliteal artery (FPA) is the main artery in the lower limb. It supplies blood to the leg muscles and undergoes complex deformations during limb flexion. Atherosclerotic disease of the FPA (peripheral arterial disease, PAD) is a major public health burden, and despite advances in surgical and interventional therapies, the clinical outcomes of PAD repairs continue to be suboptimal, particularly in challenging calcified lesions and biomechanically active locations. A better understanding of human FPA mechanical and structural characteristics in relation to age, risk factors, and the severity of vascular disease can help develop more effective and longer-lasting treatments through computational modeling and device optimization. This review aims to summarize recent research on the main biomechanical and structural properties of human superficial femoral and popliteal arteries that comprise the FPA and describe their anatomy, composition, and mechanical behavior under different conditions.
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Affiliation(s)
- Ramin Shahbad
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA
| | - Margarita Pipinos
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA
| | - Majid Jadidi
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA
| | - Anastasia Desyatova
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA
| | - Jennifer Gamache
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska at Omaha, Biomechanics Research Building, Omaha, NE, 68182, USA.
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Gheysen L, Maes L, Famaey N, Segers P. Growth and remodeling of the dissected membrane in an idealized dissected aorta model. Biomech Model Mechanobiol 2024; 23:413-431. [PMID: 37945985 PMCID: PMC10963465 DOI: 10.1007/s10237-023-01782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
While transitioning from the acute to chronic phase, the wall of a dissected aorta often expands in diameter and adaptations in thickness and microstructure take place in the dissected membrane. Including the mechanisms, leading to these changes, in a computational model is expected to improve the accuracy of predictions of the long-term complications and optimal treatment timing of dissection patients. An idealized dissected wall was modeled to represent the elastin and collagen production and/or degradation imposed by stress- and inflammation-mediated growth and remodeling, using the homogenized constrained mixture theory. As no optimal growth and remodeling parameters have been defined for aortic dissections, a Latin hypercube sampling with 1000 parameter combinations was assessed for four inflammation patterns, with a varying spatial extent (full/local) and temporal evolution (permanent/transient). The dissected membrane thickening and microstructure was considered together with the diameter expansion over a period of 90 days. The highest success rate was found for the transient inflammation patterns, with about 15% of the samples leading to converged solutions after 90 days. Clinically observed thickening rates were found for 2-4% of the transient inflammation samples, which represented median total diameter expansion rates of about 5 mm/year. The dissected membrane microstructure showed an elastin decrease and, in most cases, a collagen increase. In conclusion, the model with the transient inflammation pattern allowed the reproduction of clinically observed dissected membrane thickening rates, diameter expansion rates and adaptations in microstructure, thus providing guidance in reducing the parameter space in growth and remodeling models of aortic dissections.
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Affiliation(s)
- Lise Gheysen
- Institute for Biomedical Engineering and Technology, Electronics and Information Systems, Ghent University, Ghent, Belgium.
| | - Lauranne Maes
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Nele Famaey
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Patrick Segers
- Institute for Biomedical Engineering and Technology, Electronics and Information Systems, Ghent University, Ghent, Belgium
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Gheysen L, Maes L, Caenen A, Segers P, Peirlinck M, Famaey N. Uncertainty quantification of the wall thickness and stiffness in an idealized dissected aorta. J Mech Behav Biomed Mater 2024; 151:106370. [PMID: 38224645 DOI: 10.1016/j.jmbbm.2024.106370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024]
Abstract
Personalized treatment informed by computational models has the potential to markedly improve the outcome for patients with a type B aortic dissection. However, existing computational models of dissected walls significantly simplify the characteristic false lumen, tears and/or material behavior. Moreover, the patient-specific wall thickness and stiffness cannot be accurately captured non-invasively in clinical practice, which inevitably leads to assumptions in these wall models. It is important to evaluate the impact of the corresponding uncertainty on the predicted wall deformations and stress, which are both key outcome indicators for treatment optimization. Therefore, a physiology-inspired finite element framework was proposed to model the wall deformation and stress of a type B aortic dissection at diastolic and systolic pressure. Based on this framework, 300 finite element analyses, sampled with a Latin hypercube, were performed to assess the global uncertainty, introduced by 4 uncertain wall thickness and stiffness input parameters, on 4 displacement and stress output parameters. The specific impact of each input parameter was estimated using Gaussian process regression, as surrogate model of the finite element framework, and a δ moment-independent analysis. The global uncertainty analysis indicated minor differences between the uncertainty at diastolic and systolic pressure. For all output parameters, the 4th quartile contained the major fraction of the uncertainty. The parameter-specific uncertainty analysis elucidated that the material stiffness and relative thickness of the dissected membrane were the respective main determinants of the wall deformation and stress. The uncertainty analysis provides insight into the effect of uncertain wall thickness and stiffness parameters on the predicted deformation and stress. Moreover, it emphasizes the need for probabilistic rather than deterministic predictions for clinical decision making in aortic dissections.
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Affiliation(s)
- Lise Gheysen
- Institute for Biomedical Engineering and Technology, Electronics and Information Systems, Ghent University, Belgium.
| | - Lauranne Maes
- Biomechanics Section, Mechanical Engineering, KU Leuven, Belgium
| | - Annette Caenen
- Institute for Biomedical Engineering and Technology, Electronics and Information Systems, Ghent University, Belgium; Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Patrick Segers
- Institute for Biomedical Engineering and Technology, Electronics and Information Systems, Ghent University, Belgium
| | - Mathias Peirlinck
- Department of BioMechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, the Netherlands
| | - Nele Famaey
- Biomechanics Section, Mechanical Engineering, KU Leuven, Belgium
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Kazim M, Razian SA, Zamani E, Varandani D, Shahbad R, Desyatova A, Jadidi M. Variability in structure, morphology, and mechanical properties of the descending thoracic and infrarenal aorta around their circumference. J Mech Behav Biomed Mater 2024; 150:106332. [PMID: 38160644 DOI: 10.1016/j.jmbbm.2023.106332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
Aortic diseases, such as aneurysms, atherosclerosis, and dissections, demonstrate a preferential development and progression around the aortic circumference, resulting in a highly heterogeneous disease state around the circumference. Differences in the aorta's structural composition and mechanical properties may be partly responsible for this phenomenon. Our goal in this study was to analyze the mechanical and structural properties of the human aorta at its lateral, anterior, posterior, and medial quadrants in two regions prone to circumferentially inhomogeneous diseases, descending Thoracic Aorta (TA) and Infrarenal Aorta (IFR). Human aortas were obtained from 10 donors (64 ± 11 years) and dissected from their loose surrounding tissue. Mechanical properties were determined in all four quadrants of TA and IFR using planar biaxial testing and fitted to three common constitutive models. The structure of tissues was assessed using Movat Pentachrome stained histology slides. We observed that the anterior quadrant exhibited the greatest thickness, followed by the lateral region, in both the TA and IFR. In TA, the posterior wall appeared as the stiffest location in most samples, while in IFR, the anterior wall was the stiffest. We observed a higher glycosaminoglycans content in the lateral and posterior regions of the IFR. We found elastin density to be similar in TA lateral, anterior, and posterior quadrants, while in IFR, the anterior region demonstrated the highest elastin density. Despite significant variations between subjects, this study highlights the distinct morphometrical, mechanical, and structural properties between the quadrants of both TA and IFR.
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Affiliation(s)
- Madihah Kazim
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | | | - Elham Zamani
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | - Dheeraj Varandani
- Department of Computer Science, University of Nebraska Omaha, Omaha, NE, USA
| | - Ramin Shahbad
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | | | - Majid Jadidi
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA.
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Wang M, Ching-Johnson JA, Yin H, O’Neil C, Li AX, Chu MWA, Bartha R, Pickering JG. Mapping microarchitectural degeneration in the dilated ascending aorta with ex vivo diffusion tensor imaging. EUROPEAN HEART JOURNAL OPEN 2024; 4:oead128. [PMID: 38162403 PMCID: PMC10755346 DOI: 10.1093/ehjopen/oead128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
Aims Thoracic aortic aneurysms (TAAs) carry a risk of catastrophic dissection. Current strategies to evaluate this risk entail measuring aortic diameter but do not image medial degeneration, the cause of TAAs. We sought to determine if the advanced magnetic resonance imaging (MRI) acquisition strategy, diffusion tensor imaging (DTI), could delineate medial degeneration in the ascending thoracic aorta. Methods and results Porcine ascending aortas were subjected to enzyme microinjection, which yielded local aortic medial degeneration. These lesions were detected by DTI, using a 9.4 T MRI scanner, based on tensor disorientation, disrupted diffusion tracts, and altered DTI metrics. High-resolution spatial analysis revealed that fractional anisotropy positively correlated, and mean and radial diffusivity inversely correlated, with smooth muscle cell (SMC) and elastin content (P < 0.001 for all). Ten operatively harvested human ascending aorta samples (mean subject age 61.6 ± 13.3 years, diameter range 29-64 mm) showed medial pathology that was more diffuse and more complex. Nonetheless, DTI metrics within an aorta spatially correlated with SMC, elastin, and, especially, glycosaminoglycan (GAG) content. Moreover, there were inter-individual differences in slice-averaged DTI metrics. Glycosaminoglycan accumulation and elastin degradation were captured by reduced fractional anisotropy (R2 = 0.47, P = 0.043; R2 = 0.76, P = 0.002), with GAG accumulation also captured by increased mean diffusivity (R2 = 0.46, P = 0.045) and increased radial diffusivity (R2 = 0.60, P = 0.015). Conclusion Ex vivo high-field DTI can detect ascending aorta medial degeneration and can differentiate TAAs in accordance with their histopathology, especially elastin and GAG changes. This non-destructive window into aortic medial microstructure raises prospects for probing the risks of TAAs beyond lumen dimensions.
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Affiliation(s)
- Mofei Wang
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St. N. London, Canada, N6A 5B7
- Department of Biochemistry, Western University, 1151 Richmond St. N. London, Canada, N6A 3K7
| | - Justin A Ching-Johnson
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St. N. London, Canada, N6A 5B7
- Department of Medical Biophysics, Western University, 1151 Richmond St. N. London, Canada, N6A 3K7
| | - Hao Yin
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St. N. London, Canada, N6A 5B7
| | - Caroline O’Neil
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St. N. London, Canada, N6A 5B7
| | - Alex X Li
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St. N. London, Canada, N6A 5B7
| | - Michael W A Chu
- Department of Surgery, Western University, 1151 Richmond St. N. London, Canada, N6A 3K7
- London Health Sciences Centre, 339 Windermere Rd, London, Ontario, Canada, N6A 5A5
| | - Robert Bartha
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St. N. London, Canada, N6A 5B7
- Department of Medical Biophysics, Western University, 1151 Richmond St. N. London, Canada, N6A 3K7
| | - J Geoffrey Pickering
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St. N. London, Canada, N6A 5B7
- Department of Biochemistry, Western University, 1151 Richmond St. N. London, Canada, N6A 3K7
- Department of Medical Biophysics, Western University, 1151 Richmond St. N. London, Canada, N6A 3K7
- London Health Sciences Centre, 339 Windermere Rd, London, Ontario, Canada, N6A 5A5
- Department of Medicine, Western University, 1151 Richmond St. N. London, Canada N6A 3K7
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Ruiz-Rodríguez MJ, Oller J, Martínez-Martínez S, Alarcón-Ruiz I, Toral M, Sun Y, Colmenar Á, Méndez-Olivares MJ, López-Maderuelo D, Kern CB, Nistal JF, Evangelista A, Teixido-Tura G, Campanero MR, Redondo JM. Versican accumulation drives Nos2 induction and aortic disease in Marfan syndrome via Akt activation. EMBO Mol Med 2024; 16:132-157. [PMID: 38177536 PMCID: PMC10897446 DOI: 10.1038/s44321-023-00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 01/06/2024] Open
Abstract
Thoracic aortic aneurysm and dissection (TAAD) is a life-threatening condition associated with Marfan syndrome (MFS), a disease caused by fibrillin-1 gene mutations. While various conditions causing TAAD exhibit aortic accumulation of the proteoglycans versican (Vcan) and aggrecan (Acan), it is unclear whether these ECM proteins are involved in aortic disease. Here, we find that Vcan, but not Acan, accumulated in Fbn1C1041G/+ aortas, a mouse model of MFS. Vcan haploinsufficiency protected MFS mice against aortic dilation, and its silencing reverted aortic disease by reducing Nos2 protein expression. Our results suggest that Acan is not an essential contributor to MFS aortopathy. We further demonstrate that Vcan triggers Akt activation and that pharmacological Akt pathway inhibition rapidly regresses aortic dilation and Nos2 expression in MFS mice. Analysis of aortic tissue from MFS human patients revealed accumulation of VCAN and elevated pAKT-S473 staining. Together, these findings reveal that Vcan plays a causative role in MFS aortic disease in vivo by inducing Nos2 via Akt activation and identify Akt signaling pathway components as candidate therapeutic targets.
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Affiliation(s)
- María Jesús Ruiz-Rodríguez
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jorge Oller
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Laboratory of Vascular Pathology, Hospital IIS-Fundación Jiménez Díaz, 28040, Madrid, Spain
| | - Sara Martínez-Martínez
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Iván Alarcón-Ruiz
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marta Toral
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Yilin Sun
- Cell-Cell Communication & Inflammation Unit, Centro de Biología Molecular Severo Ochoa (CBMSO), Consejo Superior de Investigaciones Científicas-Universidad Autónoma de Madrid, Madrid, 28049, Spain
| | - Ángel Colmenar
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - María José Méndez-Olivares
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Dolores López-Maderuelo
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Christine B Kern
- Medical University of South Carolina (MUSC), Charleston, SC, 29425, USA
| | - J Francisco Nistal
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Surgery, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Facultad de Medicina, Universidad de Cantabria, Santander, 39005, Spain
| | | | - Gisela Teixido-Tura
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron (VHIR), Barcelona, 08035, Spain
| | - Miguel R Campanero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Cell-Cell Communication & Inflammation Unit, Centro de Biología Molecular Severo Ochoa (CBMSO), Consejo Superior de Investigaciones Científicas-Universidad Autónoma de Madrid, Madrid, 28049, Spain.
| | - Juan Miguel Redondo
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Cell-Cell Communication & Inflammation Unit, Centro de Biología Molecular Severo Ochoa (CBMSO), Consejo Superior de Investigaciones Científicas-Universidad Autónoma de Madrid, Madrid, 28049, Spain.
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Soleimani M, Deo R, Hudobivnik B, Poyanmehr R, Haverich A, Wriggers P. Mathematical modeling and numerical simulation of arterial dissection based on a novel surgeon's view. Biomech Model Mechanobiol 2023; 22:2097-2116. [PMID: 37552344 PMCID: PMC10613153 DOI: 10.1007/s10237-023-01753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/16/2023] [Indexed: 08/09/2023]
Abstract
This paper presents a mathematical model for arterial dissection based on a novel hypothesis proposed by a surgeon, Axel Haverich, see Haverich (Circulation 135(3):205-207, 2017. https://doi.org/10.1161/circulationaha.116.025407 ). In an attempt and based on clinical observations, he explained how three different arterial diseases, namely atherosclerosis, aneurysm and dissection have the same root in malfunctioning Vasa Vasorums (VVs) which are micro capillaries responsible for artery wall nourishment. The authors already proposed a mathematical framework for the modeling of atherosclerosis which is the thickening of the artery walls due to an inflammatory response to VVs dysfunction. A multiphysics model based on a phase-field approach coupled with mechanical deformation was proposed for this purpose. The kinematics of mechanical deformation was described using finite strain theory. The entire model is three-dimensional and fully based on a macroscopic continuum description. The objective here is to extend that model by incorporating a damage mechanism in order to capture the tearing (rupture) in the artery wall as a result of micro-injuries in VV. Unlike the existing damage-based model of the dissection in the literature, here the damage is driven by the internal bleeding (hematoma) rather than purely mechanical external loading. The numerical implementation is carried out using finite element method (FEM).
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Affiliation(s)
- Meisam Soleimani
- Institute of Continuum Mechanics, Leibniz University, Hannover, Germany.
| | - Rohan Deo
- Institute of Continuum Mechanics, Leibniz University, Hannover, Germany
| | - Blaz Hudobivnik
- Institute of Continuum Mechanics, Leibniz University, Hannover, Germany
| | - Reza Poyanmehr
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medical School, Hannover, Germany
| | - Axel Haverich
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medical School, Hannover, Germany
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University, Hannover, Germany
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Lau C, Muthu ML, Siddiqui IF, Li L, Reinhardt DP. High-Fat Diet Has a Protective Sex-Dependent Effect on Aortic Aneurysm Severity in a Marfan Syndrome Mouse Model. Can J Cardiol 2023; 39:1553-1567. [PMID: 37482239 DOI: 10.1016/j.cjca.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Marfan syndrome (MFS) is a genetic disorder caused by mutations in fibrillin-1 and is characterized by thoracic aortic aneurysms and other complications. Previous studies revealed sexual dimorphisms in formation of aortic aneurysm in patients with MFS. The current study aimed to investigate the combined role of a high-fat diet (HFD) and biological sex in aortic disease using the mgR/mgR MFS mouse model. METHODS Male and female mgR/mgR mice, as well as wild-type (WT) littermate mice, were fed a control diet (CD [10% fat]) or HFD (60% fat) from 4 to 12 weeks of age. Key aortic disease parameters analyzed included the diameter of the aortic wall; elastic fibre fragmentation; proteoglycan content; mRNA levels of Mmp12, Col1a1, Col3a1, and Fbn1; and fibrillin-1 deposition in the aortic wall. RESULTS HFD-fed female mgR/mgR mice had significantly reduced aortic diameters (35%), elastic fibre fragmentation (56%), pathologically enhanced proteoglycans (45%), and expression of Mmp12 (64%), Col1a1 (41%), and Col3a1 (43%) compared with male mgR/mgR mice on HFD. Fibrillin-1 deposition and Fbn1 mRNA levels were unaffected. The data reveal a protective effect of HFD in female mice. In contrast, CD did not exert any protective effects. CONCLUSIONS This study demonstrates a specific sexual dimorphism in MFS mice, with HFD exerting an explicit protective effect on severity of aortic disease in female mice. These preclinical data may be useful for developing nutritional recommendations for individuals with MFS in the longer term.
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Affiliation(s)
- Cori Lau
- Faculty of Medicine and Health Sciences, Department of Anatomy and Cell Biology, McGill University, Montréal, Québec, Canada
| | - Muthu L Muthu
- Faculty of Medicine and Health Sciences, Department of Anatomy and Cell Biology, McGill University, Montréal, Québec, Canada
| | - Iram Fatima Siddiqui
- Faculty of Medicine and Health Sciences, Department of Anatomy and Cell Biology, McGill University, Montréal, Québec, Canada
| | - Ling Li
- Faculty of Medicine and Health Sciences, Department of Anatomy and Cell Biology, McGill University, Montréal, Québec, Canada
| | - Dieter P Reinhardt
- Faculty of Medicine and Health Sciences, Department of Anatomy and Cell Biology, McGill University, Montréal, Québec, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, Québec, Canada.
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Fatima K, Uzair SU, Salman A, Jawed A, Husain MA, Shah MG, Hasnain MA, Jawed A, Vohra LI, Lal PM. Fluoroquinolones and the risk of aortic aneurysm or aortic dissection: an updated systematic review and meta-analysis including 53,651,283 patients. Minerva Cardiol Angiol 2023; 71:485-493. [PMID: 36468763 DOI: 10.23736/s2724-5683.22.06124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The association between fluoroquinolone use and the risk of aortic aneurysm as well as the risk of aortic dissections remains uncertain, primarily due to conflicting findings from observational studies. We sought to conduct a double-systematic review and meta-analysis of all observational studies to assess the existence and extent of both these associations. The aim of our study is to assess the role of Fluoroquinolone on aortic aneurysm and aortic dissection in comparison to other antibiotics. EVIDENCE ACQUISITION MEDLINE and Cochrane CENTRAL were systematically searched up till June 2021 for observational studies studying the correlation between fluoroquinolone usage and aortic aneurysms and dissections. Random-effects pooling was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CI). To assess publication bias, propensity score matching was conducted, and heterogeneity was evaluated by using I2 statistics. EVIDENCE SYNTHESIS Of 688 potentially relevant articles, 635 titles were screened. Ten studies were included in the systematic review, and 4 observational studies with 53,651,283 participants were eligible to be included in the meta-analysis. Pooled estimates showed that fluoroquinolone use was associated with a higher risk of aortic aneurysm when compared to other Antibiotics (HR 1.84, 95% CI 1.10-2.48; P<0.00001). However, fluoroquinolones had no significant effect on the risk of developing aortic dissection (HR 1.09, 95% CI 0.96-1.25; P=0.19). CONCLUSIONS The present analysis suggests that fluoroquinolone usage is more strongly linked to aortic aneurysm than other antibiotics. However, there was no statistically significant link between fluoroquinolone and aortic dissection. As a result, clinicians should exercise caution when administering fluoroquinolone to patients who have a history of or are at risk of aortic disease.
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Affiliation(s)
- Kaneez Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed U Uzair
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Ariba Salman
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Areesha Jawed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mustafa A Husain
- Department of Medicine, Ziauddin University, Karachi, Pakistan -
| | - Meerab G Shah
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad A Hasnain
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Aleeza Jawed
- Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Laiba I Vohra
- Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Priyanka M Lal
- Department of Medicine, Ziauddin University, Karachi, Pakistan
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Gheysen L, Maes L, Famaey N, Segers P. Pulse wave velocity: A clinical measure to aid material parameter estimation in computational arterial biomechanics. J Biomech 2023; 149:111482. [PMID: 36791516 DOI: 10.1016/j.jbiomech.2023.111482] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Determining proper material parameters from clinical data remains a large, though unavoidable, challenge in patient-specific computational cardiovascular modeling. In an attempt to couple the clinical and modelling practice, this study investigated whether pulse wave velocity (PWV), a clinical arterial stiffness measure, can guide in determining appropriate parameter values for the Gasser-Ogden-Holzapfel (GOH) constitutive model. The reduction and uncertainty analysis was demonstrated on a cylindrical descending thoracic aorta model. Starting from discretized ranges of GOH parameters and using a full factorial design, the parameter sets yielding a physiological PWV (3.5-12.5 m/s) at diastolic pressure (80 mmHg; PWV80) were selected and their PWV at dicrotic notch pressure (110 mmHg; PWV110) was determined. These PWV measures were applied to determine the reduction of the 7D GOH parameter space, the 2D subspaces and the remaining uncertainty in case only PWV80 or both measurements are available. The resulting 12,032 parameter sets lead to a 7D parameter space reduction of ≥ 82.5 % using PWV80, which increased to 96.0 % when including PWV110, in particular at 3.5-8.5 m/s. A similar trend was observed for the remaining uncertainty and the 2D subspaces comprised of medial collagen fiber parameters, while scarce reductions were found for the adventitial and elastin parameters. In conclusion, PWV80 and PWV110 are complementary measures with the potential to reduce the GOH parameter space in arterial models, in particular for media- and collagen-related parameters. Moreover, this approach has the advantage that it allows the estimation of the remaining uncertainty after parameter space reduction.
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Affiliation(s)
- Lise Gheysen
- Institute for Biomedical Engineering and Technology, Department of Electronics and Information Systems, Ghent University, Belgium
| | - Lauranne Maes
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Belgium
| | - Nele Famaey
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Belgium
| | - Patrick Segers
- Institute for Biomedical Engineering and Technology, Department of Electronics and Information Systems, Ghent University, Belgium
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11
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Halsey G, Sinha D, Dhital S, Wang X, Vyavahare N. Role of elastic fiber degradation in disease pathogenesis. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166706. [PMID: 37001705 DOI: 10.1016/j.bbadis.2023.166706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
Elastin is a crucial extracellular matrix protein that provides structural integrity to tissues. Crosslinked elastin and associated microfibrils, named elastic fiber, contribute to biomechanics by providing the elasticity required for proper function. During aging and disease, elastic fiber can be progressively degraded and since there is little elastin synthesis in adults, degraded elastic fiber is not regenerated. There is substantial evidence linking loss or damage of elastic fibers to the clinical manifestation and pathogenesis of a variety of diseases. Disruption of elastic fiber networks by hereditary mutations, aging, or pathogenic stimuli results in systemic ailments associated with the production of elastin degradation products, inflammatory responses, and abnormal physiology. Due to its longevity, unique mechanical properties, and widespread distribution in the body, elastic fiber plays a central role in homeostasis of various physiological systems. While pathogenesis related to elastic fiber degradation has been more thoroughly studied in elastic fiber rich tissues such as the vasculature and the lungs, even tissues containing relatively small quantities of elastic fibers such as the eyes or joints may be severely impacted by elastin degradation. Elastic fiber degradation is a common observation in certain hereditary, age, and specific risk factor exposure induced diseases representing a converging point of pathological clinical phenotypes which may also help explain the appearance of co-morbidities. In this review, we will first cover the role of elastic fiber degradation in the manifestation of hereditary diseases then individually explore the structural role and degradation effects of elastic fibers in various tissues and organ systems. Overall, stabilizing elastic fiber structures and repairing lost elastin may be effective strategies to reverse the effects of these diseases.
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Affiliation(s)
- Gregory Halsey
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Dipasha Sinha
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Saphala Dhital
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Xiaoying Wang
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Naren Vyavahare
- Department of Bioengineering, Clemson University, SC 29634, United States of America.
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12
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Regional and directional delamination properties of healthy human ascending aorta and sinotubular junction. J Mech Behav Biomed Mater 2023; 138:105603. [PMID: 36512974 DOI: 10.1016/j.jmbbm.2022.105603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 07/23/2022] [Accepted: 11/20/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE Acute type A aortic dissection (AD) is a catastrophic event associated with high mortality. Biomechanics can provide an understanding of the forces that lead the initial intimal tear to propagate, resulting in aortic dissection. We previously studied the material properties of normal human aortic roots. In this study, our objective was to determine the regional and directional delamination properties of healthy human ascending aorta (AscAo) and sinotubular junction (STJ). RESULTS From 19 healthy donor hearts, total 107 samples from the AscAo and STJ were collected and tested along the circumferential and longitudinal directions. Specimens were subjected to uniaxial peeling testing with a manually created tear in the medial layer. The lateral AscAo subregion (greater curvature) had significantly lower delamination strength and dissection energy than anterior, medial, and posterior subregions in the longitudinal direction. Regionally, the delamination strength at AscAo was significantly lower than at STJ overall (p = 0.02) and in circumferential direction (p = 0.02) only. Directionally, the delamination strength at AscAo overall and in the anterior AscAo was significant lower in circumferential direction than longitudinal direction. Dissection energy demonstrated similar regional and directional trend as delamination strength. In addition, both dissection energy and delamination strength were correlated positively with thickness and negatively with age in the AscAo. In addition, the dissection energy was negatively related to stiffness at physiologic mean blood pressure. CONCLUSIONS The greater curvature of the AscAo had the lowest delamination strength and dissection energy suggesting that region was most vulnerable to dissection propagation distally. Increased thickness of AscAo would be protective of dissection propagation while propagation would be more likely with increased AscAo stiffness.
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13
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Yang X, Xu C, Yao F, Ding Q, Liu H, Luo C, Wang D, Huang J, Li Z, Shen Y, Yang W, Li Z, Yu F, Fu Y, Wang L, Ma Q, Zhu J, Xu F, Cong X, Kong W. Targeting endothelial tight junctions to predict and protect thoracic aortic aneurysm and dissection. Eur Heart J 2023; 44:1248-1261. [PMID: 36638776 DOI: 10.1093/eurheartj/ehac823] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/16/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
AIMS Whether changes in endothelial tight junctions (TJs) lead to the formation of thoracic aortic aneurysm and dissection (TAAD) and serve as an early indicator and therapeutic target remains elusive. METHODS AND RESULTS Single-cell RNA sequencing analysis showed aberrant endothelial TJ expressions in the thoracic aortas of patients with TAAD. In a β-aminopropionitrile (BAPN)-induced TAAD mouse model, endothelial TJ function was disrupted in the thoracic aortas at an early stage (5 and 10 days) as observed by a vascular permeability assay, while the intercellular distribution of crucial TJ components was significantly decreased by en face staining. For the non-invasive detection of endothelial TJ function, two dextrans of molecular weights 4 and 70 kDa were conjugated with the magnetic resonance imaging (MRI) contrast agent Gd-DOTA to synthesize FITC-dextran-DOTA-Gd and rhodamine B-dextran-DOTA-Gd. MRI images showed that both probes accumulated in the thoracic aortas of the BAPN-fed mice. Particularly, the mice with increased accumulated signals from 5 to 10 days developed TAAD at 14 days, whereas the mice with similar signals between the two time points did not. Furthermore, the protease-activated receptor 2 inhibitor AT-1001, which seals TJs, alleviated the BAPN-induced impairment of endothelial TJ function and expression and subsequently reduced TAAD incidence. Notably, endothelial-targeted ZO-1 conditional knockout increased TAAD incidence. Mechanistically, vascular inflammation and edema were observed in the thoracic aortas of the BAPN-fed mice, whereas these phenomena were attenuated by AT-1001. CONCLUSION The disruption of endothelial TJ function is an early event prior to TAAD formation, herein serving as a potential indicator and a promising target for TAAD.
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Affiliation(s)
- Xueyuan Yang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Chen Xu
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology, Ministry of Education), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Fang Yao
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen 518057, China.,State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.,Key Laboratory of Pluripotent Stem Cells in Cardiac Repair and Regeneration, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Qianhui Ding
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Hao Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Congcong Luo
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Daidai Wang
- Department of Emergency, Peking University Third Hospital, Beijing 100191, China
| | - Jiaqi Huang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Zhiqing Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Yicong Shen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Weijie Yang
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology, Ministry of Education), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Zhuofan Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Fang Yu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Yi Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Li Wang
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen 518057, China.,State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.,Key Laboratory of Pluripotent Stem Cells in Cardiac Repair and Regeneration, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Qingbian Ma
- Department of Emergency, Peking University Third Hospital, Beijing 100191, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Fujian Xu
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology, Ministry of Education), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Xin Cong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Wei Kong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
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Daoud F, Arévalo Martínez M, Holst J, Holmberg J, Albinsson S, Swärd K. Role of smooth muscle YAP and TAZ in protection against phenotypic modulation, inflammation, and aneurysm development. Biochem Pharmacol 2022; 206:115307. [DOI: 10.1016/j.bcp.2022.115307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/02/2022]
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15
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Tokgoz A, Wang S, Sastry P, Sun C, Figg NL, Huang Y, Bennett MR, Sinha S, Gillard JH, Sutcliffe MPF, Teng Z. Association of Collagen, Elastin, Glycosaminoglycans, and Macrophages With Tissue Ultimate Material Strength and Stretch in Human Thoracic Aortic Aneurysms: A Uniaxial Tension Study. J Biomech Eng 2022; 144:101001. [PMID: 35274123 DOI: 10.1115/1.4054060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Indexed: 11/08/2022]
Abstract
Fiber structures and pathological features, e.g., inflammation and glycosaminoglycan (GAG) deposition, are the primary determinants of aortic mechanical properties which are associated with the development of an aneurysm. This study is designed to quantify the association of tissue ultimate strength and extensibility with the structural percentage of different components, in particular, GAG, and local fiber orientation. Thoracic aortic aneurysm (TAA) tissues from eight patients were collected. Ninety-six tissue strips of thickened intima, media, and adventitia were prepared for uni-extension tests and histopathological examination. Area ratios of collagen, elastin, macrophage and GAG, and collagen fiber dispersion were quantified. Collagen, elastin, and GAG were layer-dependent and the inflammatory burden in all layers was low. The local GAG ratio was negatively associated with the collagen ratio (r2 = 0.173, p < 0.05), but positively with elastin (r2 = 0.037, p < 0.05). Higher GAG deposition resulted in larger local collagen fiber dispersion in the media and adventitia, but not in the intima. The ultimate stretch in both axial and circumferential directions was exclusively associated with elastin ratio (axial: r2 = 0.186, p = 0.04; circumferential: r2 = 0.175, p = 0.04). Multivariate analysis showed that collagen and GAG contents were both associated with ultimate strength in the circumferential direction, but not with the axial direction (collagen: slope = 27.3, GAG: slope = -18.4, r2 = 0.438, p = 0.002). GAG may play important roles in TAA material strength. Their deposition was found to be associated positively with the local collagen fiber dispersion and negatively with ultimate strength in the circumferential direction.
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Affiliation(s)
- Aziz Tokgoz
- Department of Engineering, University of Cambridge, Cambridge CB2 1TN, UK
| | - Shuo Wang
- Department of Radiology, University of Cambridge, Cambridge CB2 1TN, UK; Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai 200437, China; Shanghai Key Laboratory of MICCAI, Shanghai, China
| | - Priya Sastry
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | - Chang Sun
- Department of Radiology, University of Cambridge, Cambridge CB2 1TN, UK
| | - Nichola L Figg
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai 200437, China
| | - Yuan Huang
- Department of Radiology, University of Cambridge, Cambridge CB2 1TN, UK; Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging, University of Cambridge, Cambridge CB2 1TN, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | - Sanjay Sinha
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge CB2 1TN, UK
| | | | - Michael P F Sutcliffe
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
| | - Zhongzhao Teng
- Department of Engineering, University of Cambridge, Cambridge CB2 1TN, UK; Department of Radiology, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100083, China; Nanjing Jingsan Medical Science and Technology, Ltd., Jiangsu, China
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16
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Is There Enough Evidence to Support the Role of Glycosaminoglycans and Proteoglycans in Thoracic Aortic Aneurysm and Dissection?—A Systematic Review. Int J Mol Sci 2022; 23:ijms23169200. [PMID: 36012466 PMCID: PMC9408983 DOI: 10.3390/ijms23169200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
Altered proteoglycan (PG) and glycosaminoglycan (GAG) distribution within the aortic wall has been implicated in thoracic aortic aneurysm and dissection (TAAD). This review was conducted to identify literature reporting the presence, distribution and role of PGs and GAGs in the normal aorta and differences associated with sporadic TAAD to address the question; is there enough evidence to establish the role of GAGs/PGs in TAAD? 75 studies were included, divided into normal aorta (n = 51) and TAAD (n = 24). There is contradictory data regarding changes in GAGs upon ageing; most studies reported an increase in GAG sub-types, often followed by a decrease upon further ageing. Fourteen studies reported changes in PG/GAG or associated degradation enzyme levels in TAAD, with most increased in disease tissue or serum. We conclude that despite being present at relatively low abundance in the aortic wall, PGs and GAGs play an important role in extracellular matrix maintenance, with differences observed upon ageing and in association with TAAD. However, there is currently insufficient information to establish a cause-effect relationship with an underlying mechanistic understanding of these changes requiring further investigation. Increased PG presence in serum associated with aortic disease highlights the future potential of these biomolecules as diagnostic or prognostic biomarkers.
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17
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Michel JB, Lagrange J, Regnault V, Lacolley P. Conductance Artery Wall Layers and Their Respective Roles in the Clearance Functions. Arterioscler Thromb Vasc Biol 2022; 42:e253-e272. [PMID: 35924557 DOI: 10.1161/atvbaha.122.317759] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evolutionary organization of the arterial wall into layers occurred concomitantly with the emergence of a highly muscularized, pressurized arterial system that facilitates outward hydraulic conductance and mass transport of soluble substances across the arterial wall. Although colliding circulating cells disperse potential energy within the arterial wall, the different layers counteract this effect: (1) the endothelium ensures a partial barrier function; (2) the media comprises smooth muscle cells capable of endocytosis/phagocytosis; (3) the outer adventitia and perivascular adipocytic tissue are the final receptacles of convected substances. While the endothelium forms a physical and a biochemical barrier, the medial layer is avascular, relying on the specific permeability properties of the endothelium for metabolic support. Different components of the media interact with convected molecules: medial smooth muscle cells take up numerous molecules via scavenger receptors and are capable of phagocytosis of macro/micro particles. The outer layers-the highly microvascularized innervated adventitia and perivascular adipose tissue-are also involved in the clearance functions of the media: the adventitia is the seat of immune response development, inward angiogenesis, macromolecular lymphatic drainage, and neuronal stimulation. Consequently, the clearance functions of the arterial wall are physiologically essential, but also may favor the development of arterial wall pathologies. This review describes how the walls of large conductance arteries have acquired physiological clearance functions, how this is determined by the attributes of the endothelial barrier, governed by endocytic and phagocytic capacities of smooth muscle cells, impacting adventitial functions, and the role of these clearance functions in arterial wall diseases.
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18
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Li Z, Luo T, Wang S, Jia H, Gong Q, Liu X, Sutcliffe MPF, Zhu H, Liu Q, Chen D, Xiong J, Teng Z. Mechanical and histological characteristics of aortic dissection tissues. Acta Biomater 2022; 146:284-294. [PMID: 35367380 DOI: 10.1016/j.actbio.2022.03.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/14/2022]
Abstract
AIMS This study investigated the association between the macroscopic mechanical response of aortic dissection (AoD) flap, its fibre features, and patient physiological features and clinical presentations. METHODS Uniaxial test was performed with tissue strips in both circumferential and longitudinal directions from 35 patients with (AoD:CC) and without (AoD:w/oCC) cerebral/coronary complications, and 19 patients with rheumatic or valve-related heart diseases (RH). A Bayesian inference framework was used to estimate the expectation of material constants (C1, D1, and D2) of the modified Mooney-Rivlin strain energy density function. Histological examination was used to visualise the elastin and collagen in the tissue strips and image processing was performed to quantify their area percentages, fibre misalignment and waviness. RESULTS The elastin area percentage was negatively associated with age (p = 0.008), while collagen increased about 6% from age 40 to 70 (p = 0.03). Elastin fibre was less dispersed and wavier in old patients and no significant association was found between patient age and collagen fibre dispersion or waviness. Features of fibrous microstructures, either elastin or collagen, were comparable between AoD:CC and AoD:w/oCC group. Elastin and collagen area percentages were positively correlated with C1 and D2, respectively, while the elastin and collagen waviness were negatively correlated with C1 and D2, respectively. Elastin dispersion was negatively correlated to D2. Multivariate analysis showed that D2 was an effective parameter which could differentiate patient groups with different age and clinical presentations, as well as the direction of tissue strip. CONCLUSION Fibre dispersion and waviness in the aortic dissection flap changed with patient age and clinical presentations, and these can be captured by the material constants in the strain energy density function. STATEMENT OF SIGNIFICANCE Aortic dissection (AoD) is a severe cardiovascular disease. Understanding the mechanical property of intimal flap is essential for its risk evaluation. In this study, mechanical testing and histology examination were combined to quantify the relationship between mechanical presentations and microstructure features. A Bayesian inference framework was employed to estimate the expectation of the material constants in the modified Mooney-Rivlin constitutive equation. It was found that fibre dispersion and waviness in the AoD flap changed with patient age and clinical presentations, and these could be captured by the material constants. This study firstly demonstrated that the expectation of material constants can be used to characterise tissue microstructures and differentiate patients with different clinical presentations.
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19
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Syed MBJ, Fletcher AJ, Debono S, Forsythe RO, Williams MC, Dweck MR, Shah ASV, Macaskill MG, Tavares A, Denvir MA, Lim K, Wallace WA, Kaczynski J, Clark T, Sellers SL, Masson N, Falah O, Chalmers RTA, Tambyraja AL, van Beek EJR, Newby DE. 18F-Sodium Fluoride Positron Emission Tomography and Computed Tomography in Acute Aortic Syndrome. JACC Cardiovasc Imaging 2022; 15:1291-1304. [PMID: 35798405 DOI: 10.1016/j.jcmg.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/01/2022] [Accepted: 01/07/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute aortic syndrome is associated with aortic medial degeneration. 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) detects microscopic tissue calcification as a marker of disease activity. OBJECTIVES In a proof-of-concept study, this investigation aimed to establish whether 18F-NaF PET combined with computed tomography (CT) angiography could identify aortic medial disease activity in patients with acute aortic syndrome. METHODS Patients with aortic dissection or intramural hematomas and control subjects underwent 18F-NaF PET/CT angiography of the aorta. Aortic 18F-NaF uptake was measured at the most diseased segment, and the maximum value was corrected for background blood pool activity (maximum tissue-to-background ratio [TBRmax]). Radiotracer uptake was compared with change in aortic size and major adverse aortic events (aortic rupture, aorta-related death, or aortic repair) over 45 ± 13 months. RESULTS Aortic 18F-NaF uptake co-localized with histologically defined regions of microcalcification and elastin disruption. Compared with control subjects, patients with acute aortic syndrome had increased 18F-NaF uptake (TBRmax: 1.36 ± 0.39 [n = 20] vs 2.02 ± 0.42 [n = 47] respectively; P < 0.001) with enhanced uptake at the site of intimal disruption (+27.5%; P < 0.001). 18F-NaF uptake in the false lumen was associated with aortic growth (+7.1 mm/year; P = 0.011), and uptake in the outer aortic wall was associated with major adverse aortic events (HR: 8.5 [95% CI: 1.4-50.4]; P = 0.019). CONCLUSIONS In patients with acute aortic syndrome, 18F-NaF uptake was enhanced at sites of disease activity and was associated with aortic growth and clinical events. 18F-NaF PET/CT holds promise as a noninvasive marker of disease severity and future risk in patients with acute aortic syndrome. (18F Sodium Fluoride PET/CT in Acute Aortic Syndrome [FAASt]; NCT03647566).
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Affiliation(s)
- Maaz B J Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Alexander J Fletcher
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Samuel Debono
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark G Macaskill
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Adriana Tavares
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Martin A Denvir
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kelvin Lim
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - William A Wallace
- Department of Pathology, University of Edinburgh, Edinburgh, United Kingdom
| | - Jakub Kaczynski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tim Clark
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh. Edinburgh, United Kingdom
| | - Stephanie L Sellers
- Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, British Colombia, Canada
| | - Neil Masson
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Orwa Falah
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Roderick T A Chalmers
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Andrew L Tambyraja
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh. Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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20
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Tsang KM, Knutsen RH, Billington CJ, Lindberg E, Steenbock H, Fu YP, Wardlaw-Pickett A, Liu D, Malide D, Yu ZX, Bleck CKE, Brinckmann J, Kozel BA. Copper-Binding Domain Variation in a Novel Murine Lysyl Oxidase Model Produces Structurally Inferior Aortic Elastic Fibers Whose Failure Is Modified by Age, Sex, and Blood Pressure. Int J Mol Sci 2022; 23:6749. [PMID: 35743192 PMCID: PMC9223555 DOI: 10.3390/ijms23126749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 12/23/2022] Open
Abstract
Lysyl oxidase (LOX) is a copper-binding enzyme that cross-links elastin and collagen. The dominant LOX variation contributes to familial thoracic aortic aneurysm. Previously reported murine Lox mutants had a mild phenotype and did not dilate without drug-induced provocation. Here, we present a new, more severe mutant, Loxb2b370.2Clo (c.G854T; p.Cys285Phe), whose mutation falls just N-terminal to the copper-binding domain. Unlike the other mutants, the C285F Lox protein was stably produced/secreted, and male C57Bl/6J Lox+/C285F mice exhibit increased systolic blood pressure (BP; p < 0.05) and reduced caliber aortas (p < 0.01 at 100mmHg) at 3 months that independently dilate by 6 months (p < 0.0001). Multimodal imaging reveals markedly irregular elastic sheets in the mutant (p = 2.8 × 10−8 for breaks by histology) that become increasingly disrupted with age (p < 0.05) and breeding into a high BP background (p = 6.8 × 10−4). Aortic dilation was amplified in males vs. females (p < 0.0001 at 100mmHg) and ameliorated by castration. The transcriptome of young Lox mutants showed alteration in dexamethasone (p = 9.83 × 10−30) and TGFβ-responsive genes (p = 7.42 × 10−29), and aortas from older C57Bl/6J Lox+/C285F mice showed both enhanced susceptibility to elastase (p < 0.01 by ANOVA) and increased deposition of aggrecan (p < 0.05). These findings suggest that the secreted Lox+/C285F mutants produce dysfunctional elastic fibers that show increased susceptibility to proteolytic damage. Over time, the progressive weakening of the connective tissue, modified by sex and blood pressure, leads to worsening aortic disease.
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Affiliation(s)
- Kit Man Tsang
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
| | - Russell H. Knutsen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
| | - Charles J. Billington
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Eric Lindberg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
| | - Heiko Steenbock
- Institute of Virology and Cell Biology, University of Lübeck, 23562 Lübeck, Germany; (H.S.); (J.B.)
| | - Yi-Ping Fu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
| | - Amanda Wardlaw-Pickett
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
- Johns Hopkins University Applied Physics Lab, Laurel, MD 20724, USA
| | - Delong Liu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
| | - Daniela Malide
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
| | - Zu-Xi Yu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
| | - Christopher K. E. Bleck
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
| | - Jürgen Brinckmann
- Institute of Virology and Cell Biology, University of Lübeck, 23562 Lübeck, Germany; (H.S.); (J.B.)
- Department of Dermatology, University of Lübeck, 23562 Lübeck, Germany
| | - Beth A. Kozel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.M.T.); (R.H.K.); (C.J.B.J.); (E.L.); (Y.-P.F.); (A.W.-P.); (D.L.); (D.M.); (Z.-X.Y.); (C.K.E.B.)
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21
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Montavon B, Winter LE, Gan Q, Arasteh A, Montaño AM. Mucopolysaccharidosis Type IVA: Extracellular Matrix Biomarkers in Cardiovascular Disease. Front Cardiovasc Med 2022; 9:829111. [PMID: 35620518 PMCID: PMC9127057 DOI: 10.3389/fcvm.2022.829111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular disease (CVD) in Mucopolysaccharidosis Type IVA (Morquio A), signified by valvular disease and cardiac hypertrophy, is the second leading cause of death and remains untouched by current therapies. Enzyme replacement therapy (ERT) is the gold-standard treatment for MPS disorders including Morquio A. Early administration of ERT improves outcomes of patients from childhood to adulthood while posing new challenges including prognosis of CVD and ERT's negligible effect on cardiovascular health. Thus, having accurate biomarkers for CVD could be critical. Here we show that cathepsin S (CTSS) and elastin (ELN) can be used as biomarkers of extracellular matrix remodeling in Morquio A disease. We found in a cohort of 54 treatment naïve Morquio A patients and 74 normal controls that CTSS shows promising attributes as a biomarker in young Morquio A children. On the other hand, ELN shows promising attributes as a biomarker in adolescent and adult Morquio A. Plasma/urine keratan sulfate (KS), and urinary glycosaminoglycan (GAG) levels were significantly higher in Morquio A patients (p < 0.001) which decreased with age of patients. CTSS levels did not correlate with patients' phenotypic severity but differed significantly between patients (median range 5.45-8.52 ng/mL) and normal controls (median range 9.61-15.9 ng/mL; p < 0.001). We also studied α -2-macroglobulin (A2M), C-reactive protein (CRP), and circulating vascular cell adhesion molecule-1 (sVCAM-1) in a subset of samples to understand the relation between ECM biomarkers and the severity of CVD in Morquio A patients. Our experiments revealed that CRP and sVCAM-1 levels were lower in Morquio A patients compared to normal controls. We also observed a strong inverse correlation between urine/plasma KS and CRP (p = 0.013 and p = 0.022, respectively) in Morquio A patients as well as a moderate correlation between sVCAM-1 and CTSS in Morquio A patients at all ages (p = 0.03). As the first study to date investigating CTSS and ELN levels in Morquio A patients and in the normal population, our results establish a starting point for more elaborate studies in larger populations to understand how CTSS and ELN levels correlate with Morquio A severity.
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Affiliation(s)
- Brittany Montavon
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Linda E. Winter
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Qi Gan
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, MO, United States
| | | | - Adriana M. Montaño
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, MO, United States
- Department of Biochemistry and Molecular Biology, School of Medicine, Saint Louis University, St. Louis, MO, United States
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22
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Zalghout S, Vo S, Arocas V, Jadoui S, Hamade E, Badran B, Oudar O, Charnaux N, Longrois D, Boulaftali Y, Bouton MC, Richard B. Syndecan-1 Is Overexpressed in Human Thoracic Aneurysm but Is Dispensable for the Disease Progression in a Mouse Model. Front Cardiovasc Med 2022; 9:839743. [PMID: 35548440 PMCID: PMC9082175 DOI: 10.3389/fcvm.2022.839743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Glycosaminoglycans (GAGs) pooling has long been considered as one of the histopathological characteristics defining thoracic aortic aneurysm (TAA) together with smooth muscle cells (SMCs) apoptosis and elastin fibers degradation. However, little information is known about GAGs composition or their potential implication in TAA pathology. Syndecan-1 (SDC-1) is a heparan sulfate proteoglycan that is implicated in extracellular matrix (ECM) interaction and assembly, regulation of SMCs phenotype, and various aspects of inflammation in the vascular wall. Therefore, the aim of this study was to determine whether SDC-1 expression was regulated in human TAA and to analyze its role in a mouse model of this disease. In the current work, the regulation of SDC-1 was examined in human biopsies by RT-qPCR, ELISA, and immunohistochemistry. In addition, the role of SDC-1 was evaluated in descending TAA in vivo using a mouse model combining both aortic wall weakening and hypertension. Our results showed that both SDC-1 mRNA and protein are overexpressed in the media layer of human TAA specimens. RT-qPCR experiments revealed a 3.6-fold overexpression of SDC-1 mRNA (p = 0.0024) and ELISA assays showed that SDC-1 protein was increased 2.3 times in TAA samples compared with healthy counterparts (221 ± 24 vs. 96 ± 33 pg/mg of tissue, respectively, p = 0.0012). Immunofluorescence imaging provided evidence that SMCs are the major cell type expressing SDC-1 in TAA media. Similarly, in the mouse model used, SDC-1 expression was increased in TAA specimens compared to healthy samples. Although its protective role against abdominal aneurysm has been reported, we observed that SDC-1 was dispensable for TAA prevalence or rupture. In addition, SDC-1 deficiency did not alter the extent of aortic wall dilatation, elastin degradation, collagen deposition, or leukocyte recruitment in our TAA model. These findings suggest that SDC-1 could be a biomarker revealing TAA pathology. Future investigations could uncover the underlying mechanisms leading to regulation of SDC-1 expression in TAA.
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Affiliation(s)
- Sara Zalghout
- LVTS, INSERM, U1148, Paris, France
- Université Sorbonne Paris Nord, Villetaneuse, France
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
| | - Sophie Vo
- LVTS, INSERM, U1148, Paris, France
- Université Sorbonne Paris Nord, Bobigny, France
| | - Véronique Arocas
- LVTS, INSERM, U1148, Paris, France
- Université de Paris, Paris, France
| | - Soumaya Jadoui
- LVTS, INSERM, U1148, Paris, France
- Université Sorbonne Paris Nord, Bobigny, France
| | - Eva Hamade
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
| | - Bassam Badran
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
| | - Olivier Oudar
- LVTS, INSERM, U1148, Paris, France
- Université Sorbonne Paris Nord, Bobigny, France
| | - Nathalie Charnaux
- LVTS, INSERM, U1148, Paris, France
- Université Sorbonne Paris Nord, Bobigny, France
| | - Dan Longrois
- LVTS, INSERM, U1148, Paris, France
- Université de Paris, Paris, France
| | - Yacine Boulaftali
- LVTS, INSERM, U1148, Paris, France
- Université de Paris, Paris, France
| | | | - Benjamin Richard
- LVTS, INSERM, U1148, Paris, France
- Université Sorbonne Paris Nord, Bobigny, France
- *Correspondence: Benjamin Richard
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23
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Tsuruda T, Yamashita A, Otsu M, Koide M, Nakamichi Y, Sekita-Hatakeyama Y, Hatakeyama K, Funamoto T, Chosa E, Asada Y, Udagawa N, Kato J, Kitamura K. Angiotensin II Induces Aortic Rupture and Dissection in Osteoprotegerin-Deficient Mice. J Am Heart Assoc 2022; 11:e025336. [PMID: 35411794 PMCID: PMC9238451 DOI: 10.1161/jaha.122.025336] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The biological mechanism of action for osteoprotegerin, a soluble decoy receptor for the receptor activator of nuclear factor‐kappa B ligand in the vascular structure, has not been elucidated. The study aim was to determine if osteoprotegerin affects aortic structural integrity in angiotensin II (Ang II)‐induced hypertension. Methods and Results Mortality was higher (P<0.0001 by log‐rank test) in 8‐week‐old male homozygotes of osteoprotegerin gene‐knockout mice given subcutaneous administration of Ang II for 28 days, with an incidence of 21% fatal aortic rupture and 23% aortic dissection, than in age‐matched wild‐type mice. Ang II‐infused aorta of wild‐type mice showed that osteoprotegerin immunoreactivity was present with proteoglycan. The absence of osteoprotegerin was associated with decreased medial and adventitial thickness and increased numbers of elastin breaks as well as with increased periostin expression and soluble receptor activator of nuclear factor‐kappa B ligand concentrations. PEGylated human recombinant osteoprotegerin administration decreased all‐cause mortality (P<0.001 by log‐rank test), the incidence of fatal aortic rupture (P=0.08), and aortic dissection (P<0.001) with decreasing numbers of elastin breaks, periostin expressions, and soluble receptor activator of nuclear factor‐kappa B ligand concentrations in Ang II‐infused osteoprotegerin gene‐knockout mice. Conclusions These data suggest that osteoprotegerin protects against aortic rupture and dissection in Ang II‐induced hypertension by inhibiting receptor activator of nuclear factor‐kappa B ligand activity and periostin expression.
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Affiliation(s)
- Toshihiro Tsuruda
- Division of Internal Medicine, Cardiovascular Medicine and Nephrology Faculty of Medicine University of Miyazaki Japan
| | - Atsushi Yamashita
- Department of Pathology Faculty of Medicine University of Miyazaki Japan
| | - Misa Otsu
- Division of Internal Medicine, Cardiovascular Medicine and Nephrology Faculty of Medicine University of Miyazaki Japan
| | - Masanori Koide
- Institute for Oral Science Matsumoto Dental University Nagano Japan
| | - Yuko Nakamichi
- Institute for Oral Science Matsumoto Dental University Nagano Japan
| | | | - Kinta Hatakeyama
- Department of Pathology National Cerebral and Cardiovascular Center Osaka Japan
| | - Taro Funamoto
- Division of Orthopedic Surgery Department of Medicine of Sensory and Motor Organs Faculty of Medicine University of Miyazaki Japan
| | - Etsuo Chosa
- Division of Orthopedic Surgery Department of Medicine of Sensory and Motor Organs Faculty of Medicine University of Miyazaki Japan
| | - Yujiro Asada
- Department of Pathology Faculty of Medicine University of Miyazaki Japan
| | - Nobuyuki Udagawa
- Department of Biochemistry Matsumoto Dental University Nagano Japan
| | - Johji Kato
- Frontier Science Research Center University of Miyazaki Japan
| | - Kazuo Kitamura
- Frontier Science Research Center University of Miyazaki Japan
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24
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Tucker NJ, Eitan T, Yoon JG, Rosinski BF, Rodriguez ER, Tan CD, Svensson LG. Differences in Aortic Histopathology in Patients Undergoing Valve Reimplantation Surgery for Various Clinical Syndromes. AORTA 2022; 10:69-76. [PMID: 35933987 PMCID: PMC9357507 DOI: 10.1055/s-0042-1743536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives
The study aims to investigate aortic histopathologic differences among patients undergoing aortic valve reimplantation, suggest different mechanisms of aortic root aneurysm pathogenesis, and identify factors associated with long-term success of reimplantation.
Methods
From 2006 to 2017, 568 adults who underwent reimplantation for repair of aortic root aneurysm, including patients with tricuspid aortic valves with no connective tissue disease (TAV/NoCTD,
n
= 314/568; 55.3%), bicuspid aortic valves (BAVs,
n
= 86/568; 15.1%), or connective tissue disease (CTD,
n
= 177/568; 31.2%), were compiled into three comparison groups. Patients with both BAV and CTD (
n
= 9/568; 1.6%) were omitted to increase study power. Patient records were analyzed retrospectively, focusing on pathology reports, which were available for 98.42% of patients, and were classified based on their descriptions of aortic tissue samples, primarily from the noncoronary sinus. Mean follow-up time available for patients was 2.97 years.
Results
Aortitis, medial fibrosis, and smooth muscle loss were more common histopathologic findings in patients with TAV/NoCTD than in patients with BAV and CTD (
p
< 0.05). Cystic medial degeneration was most often found in patients with CTD, then TAV/NoCTD, and least in BAV (
p
< 0.01). Increases in mucopolysaccharides were found more often in the BAV group than in the TAV/NoCTD and CTD groups (
p
< 0.01). There were no differences in the frequency of elastic laminae fragmentation/loss across these three groups. Among all patients, 1.97% (
n
= 11/559) had an unplanned reintervention on the aortic valve after reimplantation, but no significant demographic or histopathologic differences were identified.
Conclusion
Despite some common histopathologic features among patients undergoing aortic valve reimplantation, there were enough distinguishing features among aortic tissue samples of TAV/NoCTD, BAV, and CTD patients to suggest that these groups develop root aneurysms by different mechanisms. No histopathologic features were able to predict the need for late reintervention on the aortic valve.
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Affiliation(s)
| | - Tal Eitan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Justin G. Yoon
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bradley F. Rosinski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela D. Tan
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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25
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Cikach FS, Germano E, Roselli EE, Svensson LG. Ascending aorta mechanics and dimensions in aortopathy – from science to application. Indian J Thorac Cardiovasc Surg 2022; 38:7-13. [PMID: 35463697 PMCID: PMC8980982 DOI: 10.1007/s12055-020-01092-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022] Open
Abstract
The ascending aorta has a unique microstructure and biomechanical properties that allow it to absorb energy during systole and return energy during diastole (Windkessel effect). Derangements in aortic architecture can result in changes to biomechanics and inefficiencies in function. Ultimately biomechanical failure may occur resulting in aortic dissection or rupture. By measuring aortic biomechanics with either in vivo or ex vivo methods, one may be able to predict tissue failure in patients with aortic disease such as aneurysms. An understanding of the biomechanical changes that lead to these tissue-level failures may help guide therapy, disease surveillance, surgical intervention, and aid in the development of new treatments for this deadly condition.
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26
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Braunlin E, Abrahante JE, McElmurry R, Evans M, Smith M, Seelig D, O'Sullivan MG, Tolar J, Whitley CB, McIvor RS. Contribution of the innate and adaptive immune systems to aortic dilation in murine mucopolysaccharidosis type I. Mol Genet Metab 2022; 135:193-205. [PMID: 35165009 PMCID: PMC9109621 DOI: 10.1016/j.ymgme.2022.01.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/23/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adult immunocompetent male C57Bl/6 mucopolysaccharidosis, type I (MPSI) mice develop aortic insufficiency (AI), dilated ascending aortas and decreased cardiac function, findings not observed in immune incompetent adult male NSG MPSI mice. We sought to determine why. METHODS Cardiac ultrasound measurements of ascending aorta and left ventricular dimensions and Doppler interrogation for AI were performed in 6-month-old male B6 MPSI (N = 12), WT (N = 6), NSG MPSI (N = 8), NSG (N = 6) mice. Urinary glycosaminoglycans, RNA sequencing with quantitative PCR were performed and aortic pathology assessed by routine and immunohistochemical staining on subsets of murine aortas. RESULTS Ascending aortic diameters were significantly greater, left ventricular function significantly decreased, and AI significantly more frequent in B6 MPSI mice compared to NSG MPSI mice (p < 0.0001, p = 0.008 and p = 0.02, respectively); NSG and B6 WT mice showed no changes. Urinary glycosaminoglycans were significantly greater in B6 and NSG MPSI mice and both were significantly elevated compared to WT controls (p = 0.003 and p < 0.0001, respectively). By RNA sequencing, all 11 components of the inflammasome pathway were upregulated in B6 MUT, but only Aim2 and Ctsb in NSG MUT mice and none in WT controls. Both B6 and NSG MUT mice demonstrated variably-severe intramural inflammation, vacuolated cells, elastin fragmentation and disarray, and intense glycosaminoglycans on histological staining. B6 MPSI mice demonstrated numerous medial MAC2+ macrophages and adventitial CD3+ T-cells while MAC2+ macrophages were sparse and CD3+ T-cells absent in NSG MPSI mice. CONCLUSIONS Aortic dilation, AI and decreased cardiac function occur in immunocompetent B6 MPSI male mice but not in immune incompetent NSG MPSI mice, unrelated to GAG excretion, upregulation of Ctsb, or routine histologic appearance. Upregulation of all components of the inflammasome pathway in B6 MUT, but not NSG MUT mice, and abundant medial MAC2 and adventitial CD3 infiltrates in B6, but not NSG, MPSI aortas differentiated the two strains. These results suggest that the innate and adaptive immune systems play a role in these cardiac findings which may be relevant to human MPSI.
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Affiliation(s)
- Elizabeth Braunlin
- Department of Pediatrics University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Juan E Abrahante
- University of Minnesota Informatics Institute University of Minnesota, Minneapolis, MN, USA.
| | - Ron McElmurry
- Department of Pediatrics University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Michael Evans
- Biostatistical Design and Analysis Center Clinical and Translational Science Institute University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Miles Smith
- Department of Genetics, Cell Biology and Development University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Davis Seelig
- Comparative Pathology Shared Resource, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, St. Paul, MN, USA.
| | - M Gerard O'Sullivan
- Comparative Pathology Shared Resource, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, St. Paul, MN, USA.
| | - Jakub Tolar
- Department of Blood and Marrow Transplant University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Chester B Whitley
- Gene Therapy Center Department of Pediatrics University of Minnesota Medical School Minneapolis, MN, USA.
| | - R Scott McIvor
- Department of Genetics, Cell Biology and Development University of Minnesota Medical School, Minneapolis, MN, USA.
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27
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Grajciarová M, Turek D, Malečková A, Pálek R, Liška V, Tomášek P, Králičková M, Tonar Z. Are ovine and porcine carotid arteries equivalent animal models for experimental cardiac surgery: A quantitative histological comparison. Ann Anat 2022; 242:151910. [PMID: 35189268 DOI: 10.1016/j.aanat.2022.151910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is a common cardiac surgery. Manufacturing small-diameter (2-5mm) vascular grafts for CABG is important for patients who lack first-choice autologous arterial, or venous conduits. Ovine and porcine common carotid arteries (CCAs) are used as large animal models for in vivo testing of newly developed tissue-engineered arterial grafts. It is unknown to what extent these models are interchangeable and whether the left and right arteries of the same subjects can be used as experimental controls. Therefore, we compared the microscopic structure of paired left and right ovine and porcine CCAs in the proximodistal direction and compared these animal model samples to samples of human coronary arteries (CAs) and human internal thoracic arteries (ITAs). METHODS We compared the histological composition of whole CCAs of sheep (n=22 animals) with whole porcine CCAs (n=21), segments of human CAs (n=21), and human ITAs (n=21). Using unbiased sampling and stereological methods, we quantified the fractions of elastin, total collagen, type I collagen, type III collagen, smooth muscle actin (SMA) and chondroitin sulfate (CS) A, B, and C. We also quantified the densities and distributions of nuclear profiles, nervi vasorum and vasa vasorum as well as the thickness of the intima-media and total wall thickness. RESULTS The differences between the paired samples of left and right CCAs in sheep were substantially greater than the differences in laterality in porcine CCAs. The right ovine CCAs had a smaller fraction of elastin (p<0.001), greater fraction of SMA (p<0.01), and greater intima-media thickness (p<0.001) than the paired left side CCAs. In pigs, the right CCAs had a greater fraction of elastin (p<0.05) and a greater density of vasa vasorum in the media (p<0.001) than the left-side CCAs. The fractions of elastin and CS decreased and the fraction of SMA increased in the proximodistal direction in both the ovine (p<0.001) and porcine (p<0.001) CCAs. Ovine CCAs had a muscular phenotype along their entire length, but porcine CCAs were elastic-type arteries in the proximal segments but muscular type arteries in middle and distal segments. The CCAs of both animals differed from the human CAs and ITAs in most parameters, but the ovine CCAs had a comparable fraction of elastin and CS to human ITAs. CONCLUSIONS From a histological point of view, ovine and porcine CCAs were not equivalent in most quantitative parameters to human CAs and ITAs. Left and right ovine CCAs did not have the same histological composition, which is limiting for their mutual equivalence as sham-operated controls in experiments. These differences should be taken into account when designing and interpreting experiments using these models in cardiac surgery. The complete morphometric data obtained by quantitative evaluation of arterial segments were provided to facilitate the power analysis necessary for justification of the minimum number of samples when planning further experiments. The middle or distal segments of ovine and porcine CCAs remain the most realistic and the best characterized large animal models for testing artificial arterial CABG conduits.
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Affiliation(s)
- Martina Grajciarová
- Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, 301 66 Pilsen, Czech Republic
| | - Daniel Turek
- First Faculty of Medicine, Charles University, Katerinska 32, 121 08 Prague 2, Czech Republic; Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
| | - Anna Malečková
- Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, 301 66 Pilsen, Czech Republic
| | - Richard Pálek
- Department of Surgery and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Husova 3, 306 05 Pilsen, Czech Republic
| | - Václav Liška
- Department of Surgery and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Husova 3, 306 05 Pilsen, Czech Republic
| | - Petr Tomášek
- Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, 301 66 Pilsen, Czech Republic; Department of Forensic Medicine, Second Faculty of Medicine, Charles University and Na Bulovce Hospital, Budinova 2, 180 81 Prague, Czech Republic
| | - Milena Králičková
- Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, 301 66 Pilsen, Czech Republic
| | - Zbyněk Tonar
- Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Karlovarska 48, 301 66 Pilsen, Czech Republic.
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Critical Pressure of Intramural Delamination in Aortic Dissection. Ann Biomed Eng 2022; 50:183-194. [PMID: 35044571 PMCID: PMC8957392 DOI: 10.1007/s10439-022-02906-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/01/2022] [Indexed: 02/03/2023]
Abstract
Computational models of aortic dissection can examine mechanisms by which this potentially lethal condition develops and propagates. We present results from phase-field finite element simulations that are motivated by a classical but seldom repeated experiment. Initial simulations agreed qualitatively and quantitatively with data, yet because of the complexity of the problem it was difficult to discern trends. Simplified analytical models were used to gain further insight. Together, simplified and phase-field models reveal power-law-based relationships between the pressure that initiates an intramural tear and key geometric and mechanical factors-insult surface area, wall stiffness, and tearing energy. The degree of axial stretch and luminal pressure similarly influence the pressure of tearing, which was ~88 kPa for healthy and diseased human aortas having sub-millimeter-sized initial insults, but lower for larger tear sizes. Finally, simulations show that the direction a tear propagates is influenced by focal regions of weakening or strengthening, which can drive the tear towards the lumen (dissection) or adventitia (rupture). Additional data on human aortas having different predisposing disease conditions will be needed to extend these results further, but the present findings show that physiologic pressures can propagate initial medial defects into delaminations that can serve as precursors to dissection.
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Yin M, Ban E, Rego BV, Zhang E, Cavinato C, Humphrey JD, Em Karniadakis G. Simulating progressive intramural damage leading to aortic dissection using DeepONet: an operator-regression neural network. J R Soc Interface 2022; 19:20210670. [PMID: 35135299 PMCID: PMC8826120 DOI: 10.1098/rsif.2021.0670] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/23/2021] [Indexed: 12/28/2022] Open
Abstract
Aortic dissection progresses mainly via delamination of the medial layer of the wall. Notwithstanding the complexity of this process, insight has been gleaned by studying in vitro and in silico the progression of dissection driven by quasi-static pressurization of the intramural space by fluid injection, which demonstrates that the differential propensity of dissection along the aorta can be affected by spatial distributions of structurally significant interlamellar struts that connect adjacent elastic lamellae. In particular, diverse histological microstructures may lead to differential mechanical behaviour during dissection, including the pressure-volume relationship of the injected fluid and the displacement field between adjacent lamellae. In this study, we develop a data-driven surrogate model of the delamination process for differential strut distributions using DeepONet, a new operator-regression neural network. This surrogate model is trained to predict the pressure-volume curve of the injected fluid and the damage progression within the wall given a spatial distribution of struts, with in silico data generated using a phase-field finite-element model. The results show that DeepONet can provide accurate predictions for diverse strut distributions, indicating that this composite branch-trunk neural network can effectively extract the underlying functional relationship between distinctive microstructures and their mechanical properties. More broadly, DeepONet can facilitate surrogate model-based analyses to quantify biological variability, improve inverse design and predict mechanical properties based on multi-modality experimental data.
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Affiliation(s)
- Minglang Yin
- Center for Biomedical Engineering, Brown University, Providence, RI 02912, USA
- School of Engineering, Brown University, Providence, RI 02912, USA
| | - Ehsan Ban
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Bruno V. Rego
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Enrui Zhang
- Division of Applied Mathematics, Brown University, Providence, RI 02912, USA
| | - Cristina Cavinato
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - George Em Karniadakis
- School of Engineering, Brown University, Providence, RI 02912, USA
- Division of Applied Mathematics, Brown University, Providence, RI 02912, USA
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Rolf-Pissarczyk M, Wollner MP, Pacheco DRQ, Holzapfel GA. Efficient computational modelling of smooth muscle orientation and function in the aorta. Proc Math Phys Eng Sci 2021. [DOI: 10.1098/rspa.2021.0592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding the mechanical effects of smooth muscle cell (SMC) contraction on the initiation and the propagation of cardiovascular diseases such as aortic dissection is critical. Framed by elastic lamellar sheets in the lamellar unit, there are SMCs in the media with a distinct radial tilt, which indicates their contribution to the radial strength. However, the mechanical effects of this type of anisotropy have not been fully discussed. Therefore, in this study, we propose a constitutive framework that models the passive and active mechanics of the aorta, taking into account the dispersed nature of the aortic constituents by applying the discrete fibre dispersion method. We suggest an isoparametric approach by evaluating various numerical integration methods and introducing a non-uniform discretization of the unit hemisphere to increase its computational efficiency. Finally, the constitutive parameters are fitted to layer-specific experimental data and initial computational results are briefly presented. The radial tilt of SMCs is also analysed, which has a noticeable influence on the mechanical behaviour of the aorta. In the absence of sufficient experimental data, the results indicate that the active contribution of SMCs has a remarkable impact on the mechanics of the healthy aorta.
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Affiliation(s)
| | - Maximilian P. Wollner
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
- Institute for Solid Mechanics, Dresden University of Technology, Dresden, Germany
| | | | - Gerhard A. Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
- Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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31
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Weiss D, Latorre M, Rego BV, Cavinato C, Tanski BJ, Berman AG, Goergen CJ, Humphrey JD. Biomechanical consequences of compromised elastic fiber integrity and matrix cross-linking on abdominal aortic aneurysmal enlargement. Acta Biomater 2021; 134:422-434. [PMID: 34332103 DOI: 10.1016/j.actbio.2021.07.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/07/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022]
Abstract
Abdominal aortic aneurysms (AAAs) are characterized histopathologically by compromised elastic fiber integrity, lost smooth muscle cells or their function, and remodeled collagen. We used a recently introduced mouse model of AAAs that combines enzymatic degradation of elastic fibers and blocking of lysyl oxidase, and thus matrix cross-linking, to study progressive dilatation of the infrarenal abdominal aorta, including development of intraluminal thrombus. We quantified changes in biomaterial properties and biomechanical functionality within the aneurysmal segment as a function of time of enlargement and degree of thrombosis. Towards this end, we combined multi-modality imaging with state-of-the art biomechanical testing and histology to quantify regional heterogeneities for the first time and we used a computational model of arterial growth and remodeling to test multiple hypotheses, suggested by the data, regarding the degree of lost elastin, accumulation of glycosaminoglycans, and rates of collagen turnover. We found that standard histopathological findings can be misleading, while combining advanced experimental and computational methods revealed that glycosaminoglycan accumulation is pathologic, not adaptive, and that heightened collagen deposition is ineffective if not cross-linked. In conclusion, loss of elastic fiber integrity can be a strong initiator of aortic aneurysms, but it is the rate and effectiveness of fibrillar collagen remodeling that dictates enlargement. STATEMENT OF SIGNIFICANCE: Precise mechanisms by which abdominal aortic aneurysms enlarge remain unclear, but a recent elastase plus β-aminopropionitrile mouse model provides new insight into disease progression. As in the human condition, the aortic degeneration and adverse remodeling are highly heterogeneous in this model. Our multi-modality experiments quantify and contrast the heterogeneities in geometry and biomaterial properties, and our computational modeling shows that standard histopathology can be misleading. Neither accumulating glycosaminoglycans nor frustrated collagen synthesis slow disease progression, thus highlighting the importance of stimulating adaptive collagen remodeling to limit lesion enlargement.
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Affiliation(s)
- D Weiss
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - M Latorre
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - B V Rego
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - C Cavinato
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - B J Tanski
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - A G Berman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - C J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - J D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA.
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Haunschild J, Barnard SJ, Misfeld M, Saeed D, Davierwala P, Leontyev S, Mende M, Borger MA, Etz CD. Proximal aortic aneurysms: correlation of maximum aortic diameter and aortic wall thickness. Eur J Cardiothorac Surg 2021; 60:322-330. [PMID: 33822923 DOI: 10.1093/ejcts/ezab147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The goal of therapy of proximal aortic aneurysms is to prevent an aortic catastrophe, e.g. acute dissection or rupture. The decision to intervene is currently based on maximum aortic diameter complemented by known risk factors like bicuspid aortic valve, positive family history or rapid growth rate. When applying Laplace's law, wall tension is determined by pressure × radius divided by aortic wall thickness. Because current imaging modalities lack precision, wall thickness is currently neglected. The purpose of our study was therefore to correlate maximum aortic diameter with aortic wall thickness and known indices for adverse aortic events. METHODS Aortic samples from 292 patients were collected during cardiac surgery, of whom 158 presented with a bicuspid aortic valve and 134, with a tricuspid aortic valve. Aortic specimens were obtained during the operation and stored in 4% formaldehyde. Histological staining and analysis were performed to determine the thickness of the aortic wall. RESULTS Patients were 62 ± 13 years old at the time of the operation; 77% were men. The mean aortic dimensions were 44 mm, 41 mm and 51 mm at the aortic root, sinotubular junction and ascending aorta, respectively. Aortic valve stenosis was the most frequent (49%) valvular dysfunction, followed by aortic valve regurgitation (33%) and combined dysfunction (10%). The maximum aortic diameter at the ascending level did not correlate with the thickness of the media (R = 0.07) or the intima (R = 0.28) at the convex sample site. There was also no correlation of the ascending aortic diameter with age (R = -0.18) or body surface area (R = 0.07). The thickness of the intima (r = 0.31) and the media (R = 0.035) did not correlate with the Svensson index of aortic risk. Similarly, there was a low (R = 0.29) or absent (R = -0.04) correlation between the aortic size index and the intima or media thickness, respectively. There was a similar relationship of median thickness of the intima in the 4 aortic height index risk categories (P < 0.001). CONCLUSIONS Aortic diameter and conventional indices of aortic risk do not correlate with aortic wall thickness. Other indices may be required in order to identify patients at high risk for aortic complications.
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Affiliation(s)
- Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany
| | - Sarah Jane Barnard
- Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,The Discipline of Medicine, The Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Diyar Saeed
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Piroze Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Sergey Leontyev
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Meinhard Mende
- Centre for Clinical Trials, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany
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Houben IB, Nama N, Moll FL, van Herwaarden JA, Nordsletten DA, Williams DM, Patel HJ, Figueroa CA, Burris NS. Mapping pre-dissection aortic wall abnormalities: a multiparametric assessment. Eur J Cardiothorac Surg 2021; 57:1061-1067. [PMID: 31995165 DOI: 10.1093/ejcts/ezz381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Maximal aortic diameter is commonly used to assess aortic risk but poorly predicts the timing and location of dissection events in patients with connective tissue disease who undergo regular imaging surveillance. Hence, we aimed to use available surveillance computed tomography angiography (CTA) scans to investigate the correlation between 3-dimensional (3D) growth and cyclic transmural wall stress with the location of intimal tear formation. METHODS Three type B aortic dissection patients with 2 available electrocardiogram (ECG)-gated pre-dissection CTA scans and without surgical repair during the pre-dissection interval were retrospectively identified at our institution. Vascular deformation mapping was used to measure 3D aortic growth between 2 pre-dissection clinical CTA studies. In addition, we performed a computational analysis to estimate cyclic transmural wall stress in patient-specific baseline CTA geometries. RESULTS In all 3 connective tissue disease patients, the site of type B aortic intimal tear co-localized with areas of peak 3D aortic wall growth. Aortic growth was detected by clinical radiological assessment in only 1 case. Co-localization of peak transmural stress and the site of intimal tear formation were found in all cases. CONCLUSIONS Focal areas of growth and transmural wall stress co-localized with the site of intimal tear formation. These hypothesis-generating results suggest a possible new analytic pathway for a more sophisticated assessment of the factors leading to the initiation of dissection in patients with connective tissue disease. These methods could improve on current risk-stratification techniques.
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Affiliation(s)
- Ignas B Houben
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nitesh Nama
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - David A Nordsletten
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - David M Williams
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - C Alberto Figueroa
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Failure Properties of Healthy and Diabetic Rabbit Thoracic Aortas and Their Potential Correlation with Mass Fractions of Collagen. Cardiovasc Eng Technol 2021; 13:69-79. [PMID: 34142313 DOI: 10.1007/s13239-021-00554-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Diabetes Mellitus (DM) plays an important role in aortic remodeling and alters the wall mechanics. The purpose of this study is to investigate and compare multi-directional failure properties of healthy and diabetic thoracic aortas. METHODS Thirty adult rabbits (1.6-2.2 kg) were collected and type 1 diabetic rabbit model was induced by injection of alloxan. A total of 10 control and 20 diabetic (with different time exposure to diabetic condition) rabbit descending thoracic aortas were harvested. Uniaxial tensile (UT) and radial tension (RT) tests were performed to determine circumferential, axial and radial failure stresses of the control and diabetic aortas, which were further correlated with mass fractions (MFs) of collagen. RESULTS Throughout the UT test, there was a clear indication of anisotropic mechanical responses for some diabetic aorta specimens in the high loading domain. There was a trend towards an increase in the mean circumferential and axial failure stresses for the diabetic aortas when compared to the control aortas. However, differences were not statistically significant. The quantified failure stresses in the circumferential direction were, in general, higher than the stress values in the axial direction for both control and diabetic groups. For the RT test, the radial failure stresses of the diabetic aortas (in 8 weeks) were significantly higher than those of the control aortas (95 ± 17 vs. 63 ± 15 kPa, p = 0.01). Strong correlations were identified between the circumferential failure stresses and the MFs of collagen for both control and diabetic aortas. Nevertheless, this correlation was not present in the axial and radial directions. CONCLUSION The results suggest that there is a lower propensity of radial tear occurrence within the diabetic aortic wall. More importantly, time exposure to diabetic condition is not a factor that may change failure properties of the rabbit descending thoracic aortas in the circumferential and axial directions.
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Ban E, Cavinato C, Humphrey JD. Differential propensity of dissection along the aorta. Biomech Model Mechanobiol 2021; 20:895-907. [PMID: 33464476 PMCID: PMC8159901 DOI: 10.1007/s10237-021-01418-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
Aortic dissections progress, in part, by delamination of the wall. Previous experiments on cut-open segments of aorta demonstrated that fluid injected within the wall delaminates the aorta in two distinct modes: stepwise progressive tearing in the abdominal aorta and a more prevalent sudden mode of tearing in the thoracic aorta that can also manifest in other regions. A microstructural understanding that delineates these two modes of tearing has remained wanting. We implemented a phase-field finite-element model of the aortic wall, motivated in part by two-photon imaging, and found correlative relations for the maximum pressure prior to tearing as a function of local geometry and material properties. Specifically, the square of the pressure of tearing relates directly to both tissue stiffness and the critical energy of tearing and inversely to the square root of the torn area; this correlation explains the sudden mode of tearing and, with the microscopy, suggests a mechanism for progressive tearing. Microscopy also confirmed that thick interlamellar radial struts are more abundant in the abdominal region of the aorta, where progressive tearing was observed previously. The computational results suggest that structurally significant radial struts increase tearing pressure by two mechanisms: confining the fluid by acting as barriers to flow and increasing tissue stiffness by holding the adjacent lamellae together. Collectively, these two phase-field models provide new insights into the mechanical factors that can influence intramural delaminations that promote aortic dissection.
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Affiliation(s)
- Ehsan Ban
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA.
| | - Cristina Cavinato
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
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Ghadie NM, St-Pierre JP, Labrosse MR. The Contribution of Glycosaminoglycans/Proteoglycans to Aortic Mechanics in Health and Disease: A Critical Review. IEEE Trans Biomed Eng 2021; 68:3491-3500. [PMID: 33872141 DOI: 10.1109/tbme.2021.3074053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
While elastin and collagen have received a lot of attention as major contributors to aortic biomechanics, glycosaminoglycans (GAGs) and proteoglycans (PGs) recently emerged as additional key players whose roles must be better elucidated if one hopes to predict aortic ruptures caused by aneurysms and dissections more reliably. GAGs are highly negatively charged polysaccharide molecules that exist in the extracellular matrix (ECM) of the arterial wall. In this critical review, we summarize the current understanding of the contributions of GAGs/PGs to the biomechanics of the normal aortic wall, as well as in the case of aortic diseases such as aneurysms and dissections. Specifically, we describe the fundamental swelling behavior of GAGs/PGs and discuss their contributions to residual stresses and aortic stiffness, thereby highlighting the importance of taking these polyanionic molecules into account in mathematical and numerical models of the aorta. We suggest specific lines of investigation to further the acquisition of experimental data to complement simulations and solidify our current understanding. We underscore different potential roles of GAGs/PGs in thoracic aortic aneurysm (TAAD) and abdominal aortic aneurysm (AAA). Namely, we report findings according to which the accumulation of GAGs/PGs in TAAD causes stress concentrations which may be sufficient to initiate and propagate delamination. On the other hand, there seems to be no clear indication of a relationship between the marked reduction in GAG/PG content and the stiffening and weakening of the aortic wall in AAA.
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Development of an FEA framework for analysis of subject-specific aortic compliance based on 4D flow MRI. Acta Biomater 2021; 125:154-171. [PMID: 33639309 DOI: 10.1016/j.actbio.2021.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/30/2022]
Abstract
This paper presents a subject-specific in-silico framework in which we uncover the relationship between the spatially varying constituents of the aorta and the non-linear compliance of the vessel during the cardiac cycle uncovered through our MRI investigations. A microstructurally motivated constitutive model is developed, and simulations reveal that internal vessel contractility, due to pre-stretched elastin and actively generated smooth muscle cell stress, must be incorporated, along with collagen strain stiffening, in order to accurately predict the non-linear pressure-area relationship observed in-vivo. Modelling of elastin and smooth muscle cell contractility allows for the identification of the reference vessel configuration at zero-lumen pressure, in addition to accurately predicting high- and low-compliance regimes under a physiological range of pressures. This modelling approach is also shown to capture the key features of elastin digestion and SMC activation experiments. The volume fractions of the constituent components of the aortic material model were computed so that the in-silico pressure-area curves accurately predict the corresponding MRI data at each location. Simulations reveal that collagen and smooth muscle volume fractions increase distally, while elastin volume fraction decreases distally, consistent with reported histological data. Furthermore, the strain at which collagen transitions from low to high stiffness is lower in the abdominal aorta, again supporting the histological finding that collagen waviness is lower distally. The analyses presented in this paper provide new insights into the heterogeneous structure-function relationship that underlies aortic biomechanics. Furthermore, this subject-specific MRI/FEA methodology provides a foundation for personalised in-silico clinical analysis and tailored aortic device development. STATEMENT OF SIGNIFICANCE: This study provides a significant advance in in-silico medicine by capturing the structure/function relationship of the subject-specific human aorta presented in our previous MRI analyses. A physiologically based aortic constitutive model is developed, and simulations reveal that internal vessel contractility must be incorporated, along with collagen strain stiffening, to accurately predict the in-vivo non-linear pressure-area relationship. Furthermore, this is the first subject-specific model to predict spatial variation in the volume fractions of aortic wall constituents. Previous studies perform phenomenological hyperelastic curve fits to medical imaging data and ignore the prestress contribution of elastin, collagen, and SMCs and the associated zero-pressure reference state of the vessel. This novel MRI/FEA framework can be used as an in-silico diagnostic tool for the early stage detection of aortic pathologies.
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Rare Causes of Arterial Hypertension and Thoracic Aortic Aneurysms-A Case-Based Review. Diagnostics (Basel) 2021; 11:diagnostics11030446. [PMID: 33807627 PMCID: PMC8001303 DOI: 10.3390/diagnostics11030446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Thoracic aortic aneurysms may result in dissection with fatal consequences if undetected. A young male patient with no relevant familial history, after having been investigated for hypertension, was diagnosed with an ascending aortic aneurysm involving the aortic root and the proximal tubular segment, associated with a septal atrial defect. The patient underwent a Bentall surgery protocol without complications. Clinical examination revealed dorso-lumbar scoliosis and no other signs of underlying connective tissue disease. Microscopic examination revealed strikingly severe medial degeneration of the aorta, with areas of deep disorganization of the medial musculo-elastic structural units and mucoid material deposition. Genetic testing found a variant of unknown significance the PRKG1 gene encoding the protein kinase cGMP-dependent 1, which is important in blood pressure regulation. There may be genetic links between high blood pressure and thoracic aortic aneurysm determinants. Hypertension was found in FBN1 gene mutations encoding fibrillin and in PRKG1 mutations. Possible mechanisms involving the renin-angiotensin system, the role of oxidative stress, osteopontin, epigenetic modifications and other genes are reviewed. Close follow-up and strict hypertension control are required to reduce the risk of dissection. Hypertension, scoliosis and other extra-aortic signs suggesting a connective tissue disease are possible clues for diagnosis.
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Federspiel JM, Schnabel PA, Tschernig T, Balint B, Schwab T, Laschke MW, Schäfers HJ. Aortic aneurysms with tricuspid aortic valve have more degeneration than unicuspid aortic valve aneurysms. Eur J Cardiothorac Surg 2021; 60:333-340. [PMID: 33675640 DOI: 10.1093/ejcts/ezab101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The unicuspid aortic valve (UAV) is a rare cardiac malformation and is associated with the formation of ascending aortic aneurysms. To characterize its associated aortic wall changes, normal and aneurysmatic ascending aortic wall specimens were analysed, focusing on the potential mechanisms of aneurysm formation. Patients with tricuspid aortic valve (TAV) served as controls. METHODS In a retrospective observational study, 74 specimens (dilated and non-dilated aortas; individuals with UAV and TAV) obtained intraoperatively were studied. Standard stains and immunohistochemical labelling of cleaved caspase-3, cluster of differentiation 31 and endothelial nitric oxide synthase (eNOS) were performed to assess the degree of apoptosis, distribution of eNOS within the aortic wall, smooth muscle cell (SMC) nuclei loss and mucoid extracellular matrix accumulation (MEMA). RESULTS Deeper ingrowth of vasa vasorum was found in dilated aortas. Interestingly, eNOS was expressed mostly in vasa vasorum. More apoptosis was seen in UAV aortas compared to TAV aortas (P < 0.001). Both UAV and TAV aortas were comparable regarding SMC nuclei loss (P = 0.419). In dilated compared to non-dilated aortas regardless valve morphology SMC nuclei loss was increased (P = 0.005) and more pronounced translamellar MEMA was present (P = 0.011). The highest grade of distribution (P = 0.043) and the highest severity (P = 0.005) regarding MEMA were seen in TAV dilated specimens compared to UAV dilated specimens. CONCLUSIONS Aneurysms with UAV show increased apoptosis, the role of which is unclear. Strikingly, more severe MEMA was found in TAV aneurysms compared to UAV aneurysms. Thus, UAV-associated aortic wall changes and resulting aneurysm may be less aggressive than aneurysms with TAV.
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Affiliation(s)
- Jan M Federspiel
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Philipp A Schnabel
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Tschernig
- Institute of Anatomy, Saarland University, Homburg/Saar, Germany
| | - Brittany Balint
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tanja Schwab
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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Creamer TJ, Bramel EE, MacFarlane EG. Insights on the Pathogenesis of Aneurysm through the Study of Hereditary Aortopathies. Genes (Basel) 2021; 12:183. [PMID: 33514025 PMCID: PMC7912671 DOI: 10.3390/genes12020183] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
Thoracic aortic aneurysms (TAA) are permanent and localized dilations of the aorta that predispose patients to a life-threatening risk of aortic dissection or rupture. The identification of pathogenic variants that cause hereditary forms of TAA has delineated fundamental molecular processes required to maintain aortic homeostasis. Vascular smooth muscle cells (VSMCs) elaborate and remodel the extracellular matrix (ECM) in response to mechanical and biochemical cues from their environment. Causal variants for hereditary forms of aneurysm compromise the function of gene products involved in the transmission or interpretation of these signals, initiating processes that eventually lead to degeneration and mechanical failure of the vessel. These include mutations that interfere with transduction of stimuli from the matrix to the actin-myosin cytoskeleton through integrins, and those that impair signaling pathways activated by transforming growth factor-β (TGF-β). In this review, we summarize the features of the healthy aortic wall, the major pathways involved in the modulation of VSMC phenotypes, and the basic molecular functions impaired by TAA-associated mutations. We also discuss how the heterogeneity and balance of adaptive and maladaptive responses to the initial genetic insult might contribute to disease.
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Affiliation(s)
- Tyler J. Creamer
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Emily E. Bramel
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Predoctoral Training in Human Genetics and Molecular Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Elena Gallo MacFarlane
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Brunet J, Pierrat B, Badel P. Review of Current Advances in the Mechanical Description and Quantification of Aortic Dissection Mechanisms. IEEE Rev Biomed Eng 2021; 14:240-255. [PMID: 31905148 DOI: 10.1109/rbme.2019.2950140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aortic dissection is a life-threatening event associated with a very poor outcome. A number of complex phenomena are involved in the initiation and propagation of the disease. Advances in the comprehension of the mechanisms leading to dissection have been made these last decades, thanks to improvements in imaging and experimental techniques. However, the micro-mechanics involved in triggering such rupture events remains poorly described and understood. It constitutes the primary focus of the present review. Towards the goal of detailing the dissection phenomenon, different experimental and modeling methods were used to investigate aortic dissection, and to understand the underlying phenomena involved. In the last ten years, research has tended to focus on the influence of microstructure on initiation and propagation of the dissection, leading to a number of multiscale models being developed. This review brings together all these materials in an attempt to identify main advances and remaining questions.
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Jadidi M, Razian SA, Habibnezhad M, Anttila E, Kamenskiy A. Mechanical, structural, and physiologic differences in human elastic and muscular arteries of different ages: Comparison of the descending thoracic aorta to the superficial femoral artery. Acta Biomater 2021; 119:268-283. [PMID: 33127484 PMCID: PMC7738395 DOI: 10.1016/j.actbio.2020.10.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/28/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022]
Abstract
Elastic and muscular arteries differ in structure, function, and mechanical properties, and may adapt differently to aging. We compared the descending thoracic aortas (TA) and the superficial femoral arteries (SFA) of 27 tissue donors (average 41±18 years, range 13-73 years) using planar biaxial testing, constitutive modeling, and bidirectional histology. Both TAs and SFAs increased in size with age, with the outer radius increasing more than the inner radius, but the TAs thickened 6-fold and widened 3-fold faster than the SFAs. The circumferential opening angle did not change in the TA, but increased 2.4-fold in the SFA. Young TAs were relatively isotropic, but the anisotropy increased with age due to longitudinal stiffening. SFAs were 51% more compliant longitudinally irrespective of age. Older TAs and SFAs were stiffer, but the SFA stiffened 5.6-fold faster circumferentially than the TA. Physiologic stresses decreased with age in both arteries, with greater changes occurring longitudinally. TAs had larger circumferential, but smaller longitudinal stresses than the SFAs, larger cardiac cycle stretch, 36% lower circumferential stiffness, and 8-fold more elastic energy available for pulsation. TAs contained elastin sheets separated by smooth muscle cells (SMCs), collagen, and glycosaminoglycans, while the SFAs had SMCs, collagen, and longitudinal elastic fibers. With age, densities of elastin and SMCs decreased, collagen remained constant due to medial thickening, and the glycosaminoglycans increased. Elastic and muscular arteries demonstrate different morphological, mechanical, physiologic, and structural characteristics and adapt differently to aging. While the aortas remodel to preserve the Windkessel function, the SFAs maintain higher longitudinal compliance.
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Affiliation(s)
- Majid Jadidi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Mahmoud Habibnezhad
- Department of Computer Science, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Eric Anttila
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA.
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Lin HY, Chen MR, Lee CL, Lin SM, Hung CL, Niu DM, Chang TM, Chuang CK, Lin SP. Aortic Root Dilatation in Taiwanese Patients with Mucopolysaccharidoses and the Long-Term Effects of Enzyme Replacement Therapy. Diagnostics (Basel) 2020; 11:diagnostics11010016. [PMID: 33374885 PMCID: PMC7823494 DOI: 10.3390/diagnostics11010016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/04/2020] [Accepted: 12/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Cardiovascular abnormalities have been observed in patients with mucopolysaccharidosis (MPS) of any type, with the most documented abnormalities being valvular regurgitation and stenosis and cardiac hypertrophy. Only a few studies have focused on aortic root dilatation and the long-term effects of enzyme replacement therapy (ERT) in these patients. Methods: We reviewed echocardiograms of 125 Taiwanese MPS patients (age range, 0.1 to 19.1 years; 11 with MPS I, 49 with MPS II, 25 with MPS III, 29 with MPS IVA, and 11 with MPS VI). The aortic root diameter was measured at the sinus of Valsalva. Results: Aortic root dilatation (z score >2) was observed in 47% of the MPS patients, including 66% of MPS IV, 51% of MPS II, 45% of MPS VI, 28% of MPS III, and 27% of MPS I patients. The mean aortic root diameter z score was 2.14 (n = 125). The patients with MPS IV had the most severe aortic root dilatation with a mean aortic root diameter z score of 3.03, followed by MPS II (2.12), MPS VI (2.06), MPS III (1.68), and MPS I (1.03). The aortic root diameter z score was positively correlated with increasing age (n = 125, p < 0.01). For the patients with MPS II, III, and IV, aortic root diameter z score was also positively correlated with increasing age (p < 0.01). For 16 patients who had received ERT and had follow-up echocardiographic data (range 2.0–16.2 years), the mean aortic root diameter z score change was −0.46 compared to baseline (baseline 2.49 versus follow-up 2.03, p = 0.490). Conclusions: Aortic root dilatation was common in the patients with all types of MPS, with the most severe aortic root dilatation observed in those with MPS IV. The severity of aortic root dilatation worsened with increasing age, reinforcing the concept of the progressive nature of this disease. ERT for MPS appears to stabilize the progression of aortic root dilatation.
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Affiliation(s)
- Hsiang-Yu Lin
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (S.-M.L.); (C.-L.H.)
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City 25160, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan;
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Department of Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Ming-Ren Chen
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (S.-M.L.); (C.-L.H.)
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan;
| | - Chung-Lin Lee
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan;
- Department of Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Pediatrics, MacKay Memorial Hospital, Hsinchu 30071, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan;
| | - Shan-Miao Lin
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (S.-M.L.); (C.-L.H.)
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan;
| | - Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (S.-M.L.); (C.-L.H.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Dau-Ming Niu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan;
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Tung-Ming Chang
- Department of Pediatric Neurology, Changhua Christian Children’s Hospital, Changhua 500, Taiwan;
- School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Kuang Chuang
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City 25160, Taiwan
- Department of Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- College of Medicine, Fu-Jen Catholic University, Taipei 24205, Taiwan
- Correspondence: (C.-K.C.); (S.-P.L.); Tel.: +886-2-2809-4661 (ext. 2348) (C.-K.C.); +886-2-2543-3535 (ext. 3090) (S.-P.L.); Fax: +886-2-2808-5952 (C.-K.C.); +886-2-2543-3642 (S.-P.L.)
| | - Shuan-Pei Lin
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (H.-Y.L.); (M.-R.C.); (S.-M.L.); (C.-L.H.)
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City 25160, Taiwan
- Department of Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
- Correspondence: (C.-K.C.); (S.-P.L.); Tel.: +886-2-2809-4661 (ext. 2348) (C.-K.C.); +886-2-2543-3535 (ext. 3090) (S.-P.L.); Fax: +886-2-2808-5952 (C.-K.C.); +886-2-2543-3642 (S.-P.L.)
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Malecki C, Hambly BD, Jeremy RW, Robertson EN. The Role of Inflammation and Myeloperoxidase-Related Oxidative Stress in the Pathogenesis of Genetically Triggered Thoracic Aortic Aneurysms. Int J Mol Sci 2020; 21:ijms21207678. [PMID: 33081376 PMCID: PMC7590002 DOI: 10.3390/ijms21207678] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
Genetically triggered thoracic aortic aneurysms (TAAs) are usually considered to exhibit minimal levels of inflammation. However, emerging data demonstrate that specific features of an inflammatory response can be observed in TAA, and that the extent of the inflammatory response can be correlated with the severity, in both mouse models and in human studies. Myeloperoxidase (MPO) is a key mediator of the inflammatory response, via production of specific oxidative species, e.g., the hypohalous acids. Specific tissue modifications, mediated by hypohalous acids, have been documented in multiple cardiovascular pathologies, including atherosclerosis associated with coronary artery disease, abdominal aortic, and cerebral aneurysms. Similarly, data are now emerging that show the capacity of MPO-derived oxidative species to regulate mechanisms important in TAA pathogenesis, including alterations in extracellular matrix homeostasis, activation of matrix metalloproteinases, induction of endothelial dysfunction and vascular smooth muscle cell phenotypic switching, and activation of ERK1/2 signaling. The weight of evidence supports a role for inflammation in exacerbating the severity of TAA progression, expanding our understanding of the pathogenesis of TAA, identifying potential biomarkers for early detection of TAA, monitoring severity and progression, and for defining potential novel therapeutic targets.
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Affiliation(s)
- Cassandra Malecki
- Discipline of Pathology and Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; (B.D.H.); (R.W.J.); (E.N.R.)
- Correspondence:
| | - Brett D. Hambly
- Discipline of Pathology and Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; (B.D.H.); (R.W.J.); (E.N.R.)
| | - Richmond W. Jeremy
- Discipline of Pathology and Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; (B.D.H.); (R.W.J.); (E.N.R.)
- Cardiology Department, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Elizabeth N. Robertson
- Discipline of Pathology and Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; (B.D.H.); (R.W.J.); (E.N.R.)
- Cardiology Department, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
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Rabin J, Siddiqui A, Gipple J, Taylor B, Scalea TM, Haslach HW. Minor aortic injury may be at risk of progression from uncontrolled shear stress: An in-vitro model demonstrates aortic lesion expansion. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620957426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Non-operative management is considered appropriate treatment for minor aortic injury, while blood pressure and anti-impulse therapy are routinely utilized to prevent higher grade aortic injury progression. However, a universal medical regimen for low grade intimal injuries has not been adopted and risks of low-grade injury progression not well described. The purpose of this study is to determine the fracture response of minimally damaged aortic tissue to the various applied forces. Our hypothesis is that internal circumferential shear within the aortic wall is a primary fracture mode. This knowledge may help guide clinical management to minimize risk of injury progression, including instituting standard medical regimens with anti-impulse therapy and β-blockade for such minor injuries. Methods Human ascending aortic tissue was obtained after aneurysm repair or heart transplant, stored at 4°C and tested within 48 hours. Minor injury was modeled with a small radial notch on the luminal aspect of aortic rings, circumferentially expanded under video acquisition and analyzed to determine lesion propagation. Results 15 rings were obtained from 8 aneurysmal and 4 healthy aortas. All specimens demonstrated circumferential crack propagation. Propagation was longer (8.02 ± 5.92 mm vs 2.70 ± 1.23 mm) and initiation of crack propagation earlier in aneurysmal tissue (1.54 ± 0.17 versus 1.90 ± 0.17 times initial diameter). Conclusions Dilation of minimally injured aortic rings is associated with lesion expansion and injury progression in all specimens including healthy and aneurysmal tissue. This propagation illustrates the mechanical response to increased levels of internal shear, compromising structural integrity and increasing risk of aortic rupture in all injured aortas. Shear forces are routinely generated through normal circumferential aortic expansion with each pulsation, the magnitude of these forces determined by pulse and blood pressure. This suggests minor aortic injuries are not trivial and strategies to reduce shear stress be implemented in all such patients without contraindications to β- blockers.
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Affiliation(s)
- Joseph Rabin
- R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ahmed Siddiqui
- University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Mechanical Engineering, University of Maryland, College Park, Baltimore, MD, USA
| | - Jenna Gipple
- Department of Mechanical Engineering, University of Maryland, College Park, Baltimore, MD, USA
| | - Bradley Taylor
- University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Henry W Haslach
- Department of Mechanical Engineering, University of Maryland, College Park, Baltimore, MD, USA
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Haslach HW, Gipple J, Harwerth J, Rabin J. Interstitial fluid-solid interaction within aneurysmal and non-pathological human ascending aortic tissue under translational sinusoidal shear deformation. Acta Biomater 2020; 113:452-463. [PMID: 32645439 DOI: 10.1016/j.actbio.2020.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/15/2022]
Abstract
The interaction shear force between internal interstitial fluid motion and the solid circumferential-longitudinal medial lamellae helps generate the shear stress involved in dissection of human ascending aorta aneurysmal or non-pathologic tissue. Frequency analysis parameters from the total shear stress versus time response to translational 1 Hz sinusoidal shear deformation over 50 cycles measure the interaction with respect to the three factors: tissue type, sinusoidal deformation amplitude and direction of the shear deformation. Significant 1, 3, and 5 Hz components exist in this order of descending magnitude for shear deformation amplitudes of either 25% or 50% of the specimen length. Evaporation tests indicate that the amount of free water in both aneurysmal and non-pathological tissue is nearly the same. The interstitial fluid-solid interaction under shear deformation is visible in the shoulders of the total shear stress versus time response curve that are caused by the 3 Hz component. During a single deformation cycle, the ratio of the amplitudes of the 3 Hz and the 1 Hz components measures the normalized amount of interaction. Under translational sinusoidal shear deformation at 25% amplitude, this interaction ratio is statistically smaller in non-pathologic than in aneurysmal human ascending aortic tissue in the circumferential direction. The frequency analysis parameters provide evidence that the structural changes in aneurysmal tissue induce an increase in the interstitial fluid-medial solid interaction shear force which contributes to the propensity for aneurysmal rupture. STATEMENT OF SIGNIFICANCE: Circumferential shear force between the interstitial fluid and medial lamellae within the human ascending aortic wall is demonstrably greater in aneurysmal than non-pathologic tissue. This force likely increases with medial elastin degeneration and may facilitate the dissection propensity in aneurysmal tissue. The 3 Hz component in frequency analyses of the total shear stress versus time curve produced by 1 Hz sinusoidal translational shear deformation measures the fluid-solid interaction shear force that is otherwise difficult to isolate. This non-standard examination of the interstitial fluid interaction helps clarify clinical mechanical implications of structural differences between aneurysmal and non-pathologic human ascending aortic tissue. The aneurysmal dissection susceptibility does not appear to depend on the amount of interstitial fluid or the wall thickness compared to non-pathologic tissue.
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Affiliation(s)
- Henry W Haslach
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA.
| | - Jenna Gipple
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - Jason Harwerth
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - Joseph Rabin
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA; R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Yu X, Suki B, Zhang Y. Avalanches and power law behavior in aortic dissection propagation. SCIENCE ADVANCES 2020; 6:eaaz1173. [PMID: 32494736 PMCID: PMC7244314 DOI: 10.1126/sciadv.aaz1173] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
Aortic dissection is a devastating cardiovascular disease known for its rapid propagation and high morbidity and mortality. The mechanisms underlying the propagation of aortic dissection are not well understood. Our study reports the discovery of avalanche-like failure of the aorta during dissection propagation that results from the local buildup of strain energy followed by a cascade failure of inhomogeneously distributed interlamellar collagen fibers. An innovative computational model was developed that successfully describes the failure mechanics of dissection propagation. Our study provides the first quantitative agreement between experiment and model prediction of the dissection propagation within the complex extracellular matrix (ECM). Our results may lead to the possibility of predicting such catastrophic events based on microscopic features of the ECM.
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Affiliation(s)
- Xunjie Yu
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Béla Suki
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Yanhang Zhang
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
- Divison of Materials Science & Engineering, Boston University, Boston, MA 02215, USA
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Shen YH, LeMaire SA, Webb NR, Cassis LA, Daugherty A, Lu HS. Aortic Aneurysms and Dissections Series. Arterioscler Thromb Vasc Biol 2020; 40:e37-e46. [PMID: 32101472 DOI: 10.1161/atvbaha.120.313991] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aortic wall is composed of highly dynamic cell populations and extracellular matrix. In response to changes in the biomechanical environment, aortic cells and extracellular matrix modulate their structure and functions to increase aortic wall strength and meet the hemodynamic demand. Compromise in the structural and functional integrity of aortic components leads to aortic degeneration, biomechanical failure, and the development of aortic aneurysms and dissections (AAD). A better understanding of the molecular pathogenesis of AAD will facilitate the development of effective medications to treat these conditions. Here, we summarize recent findings on AAD published in ATVB. In this issue, we focus on the dynamics of aortic cells and extracellular matrix in AAD; in the next issue, we will focus on the role of signaling pathways in AAD.
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Affiliation(s)
- Ying H Shen
- From the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX (Y.H.S., S.A.L.).,Department of Cardiovascular Surgery, Texas Heart Institute, Houston (Y.H.S., S.A.L.)
| | - Scott A LeMaire
- From the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX (Y.H.S., S.A.L.).,Department of Cardiovascular Surgery, Texas Heart Institute, Houston (Y.H.S., S.A.L.)
| | - Nancy R Webb
- Department of Pharmacology and Nutritional Sciences (N.R.W., L.A.C.), University of Kentucky, Lexington
| | - Lisa A Cassis
- Department of Pharmacology and Nutritional Sciences (N.R.W., L.A.C.), University of Kentucky, Lexington
| | - Alan Daugherty
- Department of Physiology and Saha Cardiovascular Research Center (A.D., H.S.L.), University of Kentucky, Lexington
| | - Hong S Lu
- Department of Physiology and Saha Cardiovascular Research Center (A.D., H.S.L.), University of Kentucky, Lexington
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Jadidi M, Habibnezhad M, Anttila E, Maleckis K, Desyatova A, MacTaggart J, Kamenskiy A. Mechanical and structural changes in human thoracic aortas with age. Acta Biomater 2020; 103:172-188. [PMID: 31877371 DOI: 10.1016/j.actbio.2019.12.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
Aortic mechanical and structural characteristics have profound effects on pathophysiology, but many aspects of physiologic stress-stretch state and intramural changes due to aging remain poorly understood in human tissues. While difficult to assess in vivo due to residual stresses and pre-stretch, physiologic stress-stretch characteristics can be calculated using experimentally-measured mechanical properties and constitutive modeling. Mechanical properties of 76 human descending thoracic aortas (TA) from 13 to 78-year-old donors (mean age 51±18 years) were measured using multi-ratio planar biaxial extension. Constitutive parameters were derived for aortas in 7 age groups, and the physiologic stress-stretch state was calculated. Intramural characteristics were quantified from histological images and related to aortic morphometry and mechanics. TA stiffness increased with age, and aortas became more nonlinear and anisotropic. Systolic and diastolic elastic energy available for pulsation decreased with age from 30 to 8 kPa and from 18 to 5 kPa, respectively. Cardiac cycle circumferential stretch dropped from 1.14 to 1.04, and circumferential and longitudinal physiologic stresses decreased with age from 90 to 72 kPa and from 90 to 17 kPa, respectively. Aortic wall thickness and radii increased with age, while the density of elastin in the tunica media decreased. The number of elastic lamellae and circumferential physiologic stress per lamellae unit remained constant with age at 102±10 and 0.85±0.04 kPa, respectively. Characterization of mechanical, physiological, and structural features in human aortas of different ages can help understand aortic pathology, inform the development of animal models that simulate human aging, and assist with designing devices for open and endovascular aortic repairs. STATEMENT OF SIGNIFICANCE: This manuscript describes mechanical and structural changes occurring in human thoracic aortas with age, and presents material parameters for 4 commonly used constitutive models. Presented data can help better understand aortic pathology, inform the development of animal models that simulate human aging, and assist with designing devices for open and endovascular aortic repairs.
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Affiliation(s)
- Majid Jadidi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Mahmoud Habibnezhad
- Department of Computer Science, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Eric Anttila
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Kaspars Maleckis
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
| | - Anastasia Desyatova
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alexey Kamenskiy
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States.
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Characterization of chemoelastic effects in arteries using digital volume correlation and optical coherence tomography. Acta Biomater 2020; 102:127-137. [PMID: 31794873 DOI: 10.1016/j.actbio.2019.11.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
Understanding stress-strain relationships in arteries is important for fundamental investigations in mechanobiology. Here we demonstrate the essential role of chemoelasticity in determining the mechanical properties of arterial tissues. Stepwise stress-relaxation uniaxial tensile tests were carried out on samples of porcine thoracic aortas immersed in a hyperosmotic solution. The tissue deformations were tracked using optical coherence tomography (OCT) during the tensile tests and digital volume correlation (DVC) was used to obtain measurements of depth-resolved strains across the whole thickness of the tested aortas. The hyperosmotic solution exacerbated chemoelastic effects, and we were able to measure different manifestations of these chemoelastic effects: swelling of the media inducing a modification of its optical properties, and existence of a transverse tensile strain. For the first time ever to our best knowledge, 3D strains induced by chemoelastic effects in soft tissues were quantified thanks to the OCT-DVC method. Without doubt, chemoelasticity plays an essential role in arterial mechanobiology in vivo and future work should focus on characterizing chemoelastic effects in arterial walls under physiological and disease conditions. STATEMENT OF SIGNIFICANCE: Chemoelasticity, coupling osmotic phenomena and mechanical stresses, is essential in soft tissue mechanobiology. For the first time ever, we measure and analyze 3D strain fields induced by these chemoelastic effects thanks to the unique combination of OCT imaging and digital volume correlation.
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