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Nichay NR, Dokuchaeva AA, Kulyabin YY, Boyarkin EV, Kuznetsova EV, Rusakova YL, Murashov IS, Vaver AA, Bogachev-Prokophiev AV, Zhuravleva IY. Epoxy- versus Glutaraldehyde-Treated Bovine Jugular Vein Conduit for Pulmonary Valve Replacement: A Comparison of Morphological Changes in a Pig Model. Biomedicines 2023; 11:3101. [PMID: 38002101 PMCID: PMC10669752 DOI: 10.3390/biomedicines11113101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
Valved conduits are often required to replace pulmonary arteries (PA). A widely used Contegra device is made of bovine jugular vein (BJV), preserved with glutaraldehyde (GA) and iso-propanol. However, it has several drawbacks that may be attributed to its chemical treatment. We hypothesized that the use of an alternative preservation compound may significantly improve BJV conduit performance. This study aimed to compare the macroscopic and microscopic properties of the BJV treated with diepoxide (DE) and GA in a porcine model. Twelve DE-BJVs and four Contegra conduits were used for PA replacement in minipigs. To assess the isolated influence of GA, we included an additional control group-BJV treated with 0.625% GA (n = 4). The animals were withdrawn after 6 months of follow-up and the conduits were examined. Explanted DE-BJV had a soft elastic wall with no signs of thrombosis or calcification and good conduit integration, including myofibroblast germination, an ingrowth of soft connective tissue formations and remarkable neoangiogenesis. The inner surface of DE-BJVs was covered by a thin neointimal layer with a solid endothelium. Contegra grafts had a stiffer wall with thrombosis on the leaflets. Calcified foci, chondroid metaplasia, and hyalinosis were observed within the wall. The distal anastomotic sites had hyperplastic neointima, partially covered with the endothelium. The wall of GA-BJV was stiff and rigid with degenerative changes, a substantial amount of calcium deposits and dense fibrotic formations in adventitia. An irregular neointimal layer was presented in the anastomotic sites without endothelial cover in the GA BJV wall. These results demonstrate that DE treatment improves conduit integration and the endothelialization of the inner surface while preventing the mineralization of the BJV, which may reduce the risk of early conduit dysfunction.
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Affiliation(s)
- Nataliya R. Nichay
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
- Cardiovascular Department, Novosibirsk State Medical University, Ministry of Health of Russian Federation, 52 Krasny Prospect, Novosibirsk 630091, Russia
| | - Anna A. Dokuchaeva
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Yuriy Yu. Kulyabin
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Evgeniy V. Boyarkin
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Elena V. Kuznetsova
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Yanina L. Rusakova
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Ivan S. Murashov
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Andrey A. Vaver
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Alexander V. Bogachev-Prokophiev
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Irina Yu. Zhuravleva
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
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Kostyunin AE, Glushkova TV, Lobov AA, Ovcharenko EA, Zainullina BR, Bogdanov LA, Shishkova DK, Markova VE, Asanov MA, Mukhamadiyarov RA, Velikanova EA, Akentyeva TN, Rezvova MA, Stasev AN, Evtushenko A, Barbarash LS, Kutikhin AG. Proteolytic Degradation Is a Major Contributor to Bioprosthetic Heart Valve Failure. J Am Heart Assoc 2022; 12:e028215. [PMID: 36565196 PMCID: PMC9973599 DOI: 10.1161/jaha.122.028215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Whereas the risk factors for structural valve degeneration (SVD) of glutaraldehyde-treated bioprosthetic heart valves (BHVs) are well studied, those responsible for the failure of BHVs fixed with alternative next-generation chemicals remain largely unknown. This study aimed to investigate the reasons behind the development of SVD in ethylene glycol diglycidyl ether-treated BHVs. Methods and Results Ten ethylene glycol diglycidyl ether-treated BHVs excised because of SVD, and 5 calcified aortic valves (AVs) replaced with BHVs because of calcific AV disease were collected and their proteomic profile was deciphered. Then, BHVs and AVs were interrogated for immune cell infiltration, microbial contamination, distribution of matrix-degrading enzymes and their tissue inhibitors, lipid deposition, and calcification. In contrast with dysfunctional AVs, failing BHVs suffered from complement-driven neutrophil invasion, excessive proteolysis, unwanted coagulation, and lipid deposition. Neutrophil infiltration was triggered by an asymptomatic bacterial colonization of the prosthetic tissue. Neutrophil elastase, myeloblastin/proteinase 3, cathepsin G, and matrix metalloproteinases (MMPs; neutrophil-derived MMP-8 and plasma-derived MMP-9), were significantly overexpressed, while tissue inhibitors of metalloproteinases 1/2 were downregulated in the BHVs as compared with AVs, together indicative of unbalanced proteolysis in the failing BHVs. As opposed to other proteases, MMP-9 was mostly expressed in the disorganized prosthetic extracellular matrix, suggesting plasma-derived proteases as the primary culprit of SVD in ethylene glycol diglycidyl ether-treated BHVs. Hence, hemodynamic stress and progressive accumulation of proteases led to the extracellular matrix degeneration and dystrophic calcification, ultimately resulting in SVD. Conclusions Neutrophil- and plasma-derived proteases are responsible for the loss of BHV mechanical competence and need to be thwarted to prevent SVD.
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Affiliation(s)
- Alexander E. Kostyunin
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Tatiana V. Glushkova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Arseniy A. Lobov
- Department of Regenerative BiomedicineResearch Institute of CytologySt. PetersburgRussian Federation
| | - Evgeny A. Ovcharenko
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Bozhana R. Zainullina
- Centre for Molecular and Cell TechnologiesSt. Petersburg State University Research ParkSt. Petersburg State University, Universitetskaya EmbankmentSt. PetersburgRussian Federation
| | - Leo A. Bogdanov
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Daria K. Shishkova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Victoria E. Markova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Maksim A. Asanov
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Rinat A. Mukhamadiyarov
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Elena A. Velikanova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Tatiana N. Akentyeva
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Maria A. Rezvova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Alexander N. Stasev
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Alexey V. Evtushenko
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Leonid S. Barbarash
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Anton G. Kutikhin
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
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Huang X, Zheng C, Ding K, Zhang S, Lei Y, Wei Q, Yang L, Wang Y. Dual-crosslinked bioprosthetic heart valves prepared by glutaraldehyde crosslinked pericardium and poly-2-hydroxyethyl methacrylate exhibited improved antithrombogenicity and anticalcification properties. Acta Biomater 2022; 154:244-258. [PMID: 36306983 DOI: 10.1016/j.actbio.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023]
Abstract
Bioprosthetic heart valves (BHVs) have been widely used due to the revolutionary transcatheter aortic valve replacement (TAVR) techniques but suffer from a limited lifespan. Previous modification methods of BHVs mainly rely on glutaraldehyde precrosslinking and subsequent modification. In this study, we have engineered a Poly-2-Hydroxyethyl methacrylate (pHEMA) coated BHV based on co-crosslinking and co-polymerization strategies. Our BHV overcomes previous limitations of glutaraldehyde prefixation by introducing free molecules before crosslinking to achieve the crosslinking and allyl moiety immobilization simultaneously. Decellularized porcine pericardium and 2-Amino-4-pentenoic acid (APA) are firstly co-crosslinked by glutaraldehyde to obtain alkenylated porcine pericardium (APA-PP), then APA-PP is copolymerized with hydrophilic monomer 2-Hydroxyethyl methacrylate (HEMA) to prepare pHEMA grafted porcine pericardium (HEMA-PP). Compared with traditional glutaraldehyde crosslinked pericardium (GA), HEMA-PP exhibits decreased cytotoxicity and significantly increased endothelialial cells proliferation (7-folds higher than GA after 3-day incubation). In vitro and ex vivo hemocompatibility studies demonstrate the superiority of HEMA-PP in anti-thrombogenicity, where the platelet adhesion decreased by levels of approximately 89% compared to GA. Moreover, HEMA-PP maintains structurally stable with a low level of calcification in the subcutaneous model. The hydrodynamic performance and durability are proven to meet the requirements of ISO 5840-3. Altogether, HEMA-PP may have the potential for future clinical application. STATEMENT OF SIGNIFICANCE: Currently, bioprosthetic heart valves (BHVs) have drawbacks including cytotoxicity, calcification and thrombosis, which would accelerate structural valvular degeneration and limit the service life of BHVs. We developed a new modification strategy that could simultaneously improve the biocompatibility, anti-calcification and anti-thrombotic properties of BHVs. Moreover, the appropriate durability and hydrodynamic property demonstrated the potential of our strategy for clinical application. This work will potentially prolong the service life of BHVs and provide new insight for the modification of BHVs.
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Affiliation(s)
- Xueyu Huang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Cheng Zheng
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Kailei Ding
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Shumang Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Qingrong Wei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Li Yang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China.
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Immobilized Bisphosphonates as Potential Inhibitors of Bioprosthetic Calcification: Effects on Various Xenogeneic Cardiovascular Tissues. Biomedicines 2021; 10:biomedicines10010065. [PMID: 35052745 PMCID: PMC8773418 DOI: 10.3390/biomedicines10010065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/20/2022] Open
Abstract
Calcification is the major factor limiting the clinical use of bioprostheses. It may be prevented by the immobilization of bisphosphonic compounds (BPs) on the biomaterial. In this study, we assessed the accumulation and structure of calcium phosphate deposits in collagen-rich bovine pericardium (Pe) and elastin-rich porcine aortic wall (Ao) and bovine jugular vein wall (Ve) cross-linked with glutaraldehyde (GA) or diepoxy compound (DE). These tissues were then modified with pamidronic (PAM) acid or 2-(2′-carboxyethylamino)ethylidene-1,1-bisphosphonic (CEABA) acid. Tissue transformations were studied using Fourier-transform infrared spectroscopy. After subcutaneous implantation of the biomaterials in 220 rats, calcification dynamics were examined using atomic absorption spectrophotometry, light microscopy after von Kossa staining, and scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy The calcium content in all GA-cross-linked tissues and DE-cross-linked Ao increased to 100–160 mg/g on day 60 after implantation. BPs prevented the accumulation of phosphates on the surface of all materials and most effectively inhibited calcification in GA-cross-linked Ao and DE-cross-linked Pe. PAM containing -OH in the R1 group was more effective than CEABA containing -H in R1. The calcification-inhibitory effect of BPs may be realized through their ability to block nucleation and prevent the growth of hydroxyapatite crystals.
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Zhuravleva IY, Karpova EV, Oparina LA, Poveschenko OV, Surovtseva MA, Titov AT, Ksenofontov AL, Vasilieva MB, Kuznetsova EV, Bogachev-Prokophiev AV, Trofimov BA. Cross-linking method using pentaepoxide for improving bovine and porcine bioprosthetic pericardia: A multiparametric assessment study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 118:111473. [PMID: 33255052 DOI: 10.1016/j.msec.2020.111473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
Bioprosthetic heart valves made from bovine pericardium (BP) and porcine pericardium (PP) preserved with glutaraldehyde (GA) are commonly used in valve surgeries but prone to calcification in many patients. In this study, we compared BP and PP preserved with GA, ethylene glycol diglycidyl ether (DE), and 1,2,3,4,6-penta-O-{1-[2-(glycidyloxy)ethoxy]ethyl}-d-glucopyranose (PE). We studied the stabilities of DE and PE in preservation media along with the amino acid (AA) compositions, Fourier-transform infrared spectra, mechanical properties, surface morphologies, thermal stability, calcification, and the cytocompatibility of BP and PP treated with 0.625% GA, 5% DE, 2% PE, and alternating 5% DE and 2% PE for 3 + 11 d and 10 + 10 d, respectively. Both epoxides were stable in the water-buffer solutions (pH 7.4). DE provided high linkage densities in BP and PP owing to reactions with Hyl, Lys, His, Arg, Ser, and Tyr. PE reacted weakly with these AAs but strongly with Met. High cross-linking density obtained using the 10 d + 10 d method provided satisfactory thermal stability of biomaterials. The epoxy preservations improved cytocompatibility and resistance to calcification. PE enhanced the stress/strain properties of the xenogeneic pericardia, perhaps by forming nanostructures that were clearly visualised in BP using scanning electron microscopy. The DE + PE combination, in an alternating cross-linking manner, thus constitutes a promising option for developing bioprosthetic pericardia.
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Affiliation(s)
- Irina Yu Zhuravleva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia.
| | - Elena V Karpova
- N. Vorozhtsov Institute of Organic Chemistry of SB RAS, 9 Lavrentyev Avenue, Novosibirsk 630090, Russia
| | - Ludmila A Oparina
- A. Favorsky Institute of Chemistry SB RAS, 1 Favorsky St., Irkutsk 664033, Russia
| | - Olga V Poveschenko
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Maria A Surovtseva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Anatoly T Titov
- V. Sobolev Institute of Geology and Mineralogy SB RAS, 3 Academician Koptyug Avenue, Novosibirsk 630090, Russia
| | - Alexander L Ksenofontov
- A. Belozersky Research Institute of Physico-Chemical Biology MSU, House 1, Building 40 Leninskye gory, Moscow 119992, Russia
| | - Maria B Vasilieva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Elena V Kuznetsova
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Alexander V Bogachev-Prokophiev
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Boris A Trofimov
- A. Favorsky Institute of Chemistry SB RAS, 1 Favorsky St., Irkutsk 664033, Russia
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