A Predictive Toxicokinetic Model for Nickel Leaching from Vascular Stents

In vitro testing methods offer valuable insights into the corrosion vulnerability of metal implants and enable prompt comparison between devices. However, they fall short in predicting the extent of leaching and the biodistribution of implant byproducts under in vivo conditions. Physiologically based toxicokinetic (PBTK) models are capable of quantitatively establishing such correlations and therefore provide a powerful tool in advancing nonclinical methods to test medical implants and assess patient exposure to implant debris. In this study, we present a multicompartment PBTK model and a simulation engine for toxicological risk assessment of vascular stents. The mathematical model consists of a detailed set of constitutive equations that describe the transfer of nickel ions from the device to peri-implant tissue and circulation and the nickel mass exchange between blood and the various tissues/organs and excreta. Model parameterization was performed using (1) in-house-produced data from immersion testing to compute the device-specific diffusion parameters and (2) full-scale animal in situ implantation studies to extract the mammalian-specific biokinetic functions that characterize the time-dependent biodistribution of the released ions. The PBTK model was put to the test using a simulation engine to estimate the concentration-time profiles, along with confidence intervals through probabilistic Monte Carlo, of nickel ions leaching from the implanted devices and determine if permissible exposure limits are exceeded. The model-derived output demonstrated prognostic conformity with reported experimental data, indicating that it may provide the basis for the broader use of modeling and simulation tools to guide the optimal design of implantable devices in compliance with exposure limits and other regulatory requirements.

Pirfenidone-Loaded Polymeric Micelles as an Effective Mechanotherapeutic to Potentiate Immunotherapy in Mouse Tumor Models

Ongoing research is actively exploring the use of immune checkpoint inhibitors to treat solid tumors by inhibiting the PD-1/PD-L1 axis and reactivating the function of cytotoxic T effector cells. Many types of solid tumors, however, are characterized by a dense and stiff stroma and are difficult to treat. Mechanotherapeutics have formed a recent class of drugs that aim to restore biomechanical abnormalities of the tumor microenvironment, related to increased stiffness and hypo-perfusion. Here, we have developed a polymeric formulation containing pirfenidone, which has been successful in restoring the tumor microenvironment in breast tumors and sarcomas. We found that the micellar formulation can induce similar mechanotherapeutic effects to mouse models of 4T1 and E0771 triple negative breast tumors and MCA205 fibrosarcoma tumors but with a dose 100-fold lower than that of the free pirfenidone. Importantly, a combination of pirfenidone-loaded micelles with immune checkpoint inhibition significantly delayed primary tumor growth, leading to a significant improvement in overall survival and in a complete cure for the E0771 tumor model. Furthermore, the combination treatment increased CD4+ and CD8+ T cell infiltration and suppressed myeloid-derived suppressor cells, creating favorable immunostimulatory conditions, which led to immunological memory. Ultrasound shear wave elastography (SWE) was able to monitor changes in tumor stiffness during treatment, suggesting optimal treatment conditions. Micellar encapsulation is a promising strategy for mechanotherapeutics, and imaging methods, such as SWE, can assist their clinical translation.

An in vivo investigation on the effects of stent implantation on hematological and hemorheological parameters

BACKGROUND

Even though cardiovascular stenting is widely used for the treatment of coronary artery disease, information on how it can affect the hematological and hemorheological profile is scarce in the literature. Most of the work on this issue is based on theoretical or computational fluid dynamics models, lacking in-depth in vitro and in vivo experimental verification.

OBJECTIVE

This work investigates, in an in vivo setting, the effects of stenting and the implantation time-course on hematological and hemorheological parameters that could potentially compromise the device's functionality and longevity.

METHODS

Custom-made self-expanding nitinol stents were implanted in the common carotid artery of male CD1 mice. Whole blood samples were collected from control (non-stented) and stented animals at 5 and 10 weeks post-implantation. Hematological measurements and blood viscosity, red blood cell aggregation, and deformability were performed using standard techniques.

RESULTS

Implant-induced changes were observed in some of the hematological and hemorheological indices. Blood viscosity seems to have been negatively affected by an increased hematocrit and reduced RBC deformability, at 10 weeks post-implantation, despite a slight decrease in RBC aggregation.

CONCLUSIONS

Although the alterations observed may be the result of the peri-implant inflammatory response, the physiological consequences due to hemorheological changes need to be further investigated.

On the development of physiologically based toxicokinetic (PBTK) models for cardiovascular implants

Local and systemic contamination caused by metal ions leaching from medical device materials is a significant and continuing health problem. The increasing need for verification and validation, and the imposition of stringent government regulations to ensure that the products comply with the quality, safety, and performance standards, have led regulatory bodies worldwide to strongly recommend the use of modeling and simulation tools to support medical device submissions. A previously published physiologically based toxicokinetic (PBTK) model, is here expanded and enriched by an additional separate tissue compartment to better resemble normal physiology and by the introduction of time-dependent functions to describe all biokinetic parameters. The new model is exercised in conjunction with state-of-the-art probabilistic, Monte Carlo methodology to calculate the predictions' confidence intervals and incorporate variability associated with toxicological biodistribution studies. The quantitative consistency of the model-derived predictions is validated against reported data following the implantation of nickel-containing cardiovascular devices in humans and minipigs. Finally, a new methodology for compartmental toxicological risk assessment is presented that can be used for forward or reverse dosimetry. Our work is aimed at providing a computational tool to optimize the device design characteristics and safeguard that the substances released do not exceed permissible exposure limits.

Multilevel Assessment of Stent-Induced Inflammation in the Adjacent Vascular Tissue

A recent U.S. Food and Drug Administration report presented the currently available scientific information related to biological response to metal implants. In this work, a multilevel approach was employed to assess the implant-induced and biocorrosion-related inflammation in the adjacent vascular tissue using a mouse stent implantation model. The implications of biocorrosion on peri-implant tissue were assessed at the macroscopic level via in vivo imaging and histomorphology. Elevated matrix metalloproteinase activity, colocalized with the site of implantation, and histological staining indicated that stent surface condition and implantation time affect the inflammatory response and subsequent formation and extent of neointima. Hematological measurements also demonstrated that accumulated metal particle contamination in blood samples from corroded-stetted mice causes a stronger immune response. At the cellular level, the stent-induced alterations in the nanostructure, cytoskeleton, and mechanical properties of circulating lymphocytes were investigated. It was found that cells from corroded-stented samples exhibited higher stiffness, in terms of Young's modulus values, compared to noncorroded and sham-stented samples. Nanomechanical modifications were also accompanied by cellular remodeling, through alterations in cell morphology and stress (F-actin) fiber characteristics. Our analysis indicates that surface wear and elevated metal particle contamination, prompted by corroded stents, may contribute to the inflammatory response and the multifactorial process of in-stent restenosis. The results also suggest that circulating lymphocytes could be a novel nanomechanical biomarker for peri-implant tissue inflammation and possibly the early stage of in-stent restenosis. Large-scale studies are warranted to further investigate these findings.

miR-223-3p and miR-24-3p as novel serum-based biomarkers for myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is the most common adult-onset muscular dystrophy, primarily characterized by muscle wasting and weakness. Many biomarkers already exist in the rapidly developing biomarker research field that aim to improve patients' care. Limited work, however, has been performed on rare diseases, including DM1. We have previously shown that specific microRNAs (miRNAs) can be used as potential biomarkers for DM1 progression. In this report, we aimed to identify novel serum-based biomarkers for DM1 through high-throughput next-generation sequencing. A number of miRNAs were identified that are able to distinguish DM1 patients from healthy individuals. Two miRNAs were selected, and their association with the disease was validated in a larger panel of patients. Further investigation of miR-223-3p, miR-24-3p, and the four previously identified miRNAs, miR-1-3p, miR-133a-3p, miR-133b-3p, and miR-206-3p, showed elevated levels in a DM1 mouse model for all six miRNAs circulating in the serum compared to healthy controls. Importantly, the levels of miR-223-3p, but not the other five miRNAs, were found to be significantly downregulated in five skeletal muscles and heart tissues of DM1 mice compared to controls. This result provides significant evidence for its involvement in disease manifestation.

Age-Related Exosomal and Endogenous Expression Patterns of miR-1, miR-133a, miR-133b, and miR-206 in Skeletal Muscles

Skeletal muscle growth and maintenance depend on two tightly regulated processes, myogenesis and muscle regeneration. Both processes involve a series of crucial regulatory molecules including muscle-specific microRNAs, known as myomiRs. We recently showed that four myomiRs, miR-1, miR-133a, miR-133b, and miR-206, are encapsulated within muscle-derived exosomes and participate in local skeletal muscle communication. Although these four myomiRs have been extensively studied for their function in muscles, no information exists regarding their endogenous and exosomal levels across age. Here we aimed to identify any age-related changes in the endogenous and muscle-derived exosomal myomiR levels during acute skeletal muscle growth. The four endogenous and muscle-derived myomiRs were investigated in five skeletal muscles (extensor digitorum longus, soleus, tibialis anterior, gastrocnemius, and quadriceps) of 2-week–1-year-old wild-type male mice. The expression of miR-1, miR-133a, and miR-133b was found to increase rapidly until adolescence in all skeletal muscles, whereas during adulthood it remained relatively stable. By contrast, endogenous miR-206 levels were observed to decrease with age in all muscles, except for soleus. Differential expression of the four myomiRs is also inversely reflected on the production of two protein targets; serum response factor and connexin 43. Muscle-derived exosomal miR-1, miR-133a, and miR-133b levels were found to increase until the early adolescence, before reaching a plateau phase. Soleus was found to be the only skeletal muscle to release exosomes enriched in miR-206. In this study, we showed for the first time an in-depth longitudinal analysis of the endogenous and exosomal levels of the four myomiRs during skeletal muscle development. We showed that the endogenous expression and extracellular secretion of the four myomiRs are associated to the function and size of skeletal muscles as the mice age. Overall, our findings provide new insights for the myomiRs’ significant role in the first year of life in mice.

Muscle-derived exosomes encapsulate myomiRs and are involved in local skeletal muscle tissue communication

Exosomes are extracellular vesicles that are released from most cell types encapsulating specific molecular cargo. Exosomes serve as mediators of cell-to-cell and tissue-to-tissue communications under normal and pathological conditions. It has been shown that exosomes carrying muscle-specific miRNAs, myomiRs, are secreted from skeletal muscle cells in vitro and are elevated in the blood of muscle disease patients. The aim of this study was to investigate the secretion of exosomes encapsulating the four myomiRs from skeletal muscle tissues and to assess their role in inter-tissue communication between neighboring skeletal muscles in vivo. We demonstrate, for the first time, that isolated, intact skeletal muscle tissues secrete exosomes encapsulating the four myomiRs, miR-1, miR-133a, miR-133b, and miR-206. Notably, we show that the sorting of the four myomiRs within exosomes varies between skeletal muscles of different muscle fiber-type composition. miR-133a and miR-133b downregulation in TA muscles caused a reduction of their levels in neighboring skeletal muscles and in serum exosomes. In conclusion, our results reveal that skeletal muscle-derived exosomes encapsulate the four myomiRs, some of which enter the blood, while a portion is used for the local communication between proximal muscle tissues. These findings provide important evidence regarding novel pathways implicated in skeletal muscle function.

Advanced Constitutive Modeling of the Thixotropic Elasto-Visco-Plastic Behavior of Blood: Steady-State Blood Flow in Microtubes

The present work focuses on the in-silico investigation of the steady-state blood flow in straight microtubes, incorporating advanced constitutive modeling for human blood and blood plasma. The blood constitutive model accounts for the interplay between thixotropy and elasto-visco-plasticity via a scalar variable that describes the level of the local blood structure at any instance. The constitutive model is enhanced by the non-Newtonian modeling of the plasma phase, which features bulk viscoelasticity. Incorporating microcirculation phenomena such as the cell-free layer (CFL) formation or the Fåhraeus and the Fåhraeus-Lindqvist effects is an indispensable part of the blood flow investigation. The coupling between them and the momentum balance is achieved through correlations based on experimental observations. Notably, we propose a new simplified form for the dependence of the apparent viscosity on the hematocrit that predicts the CFL thickness correctly. Our investigation focuses on the impact of the microtube diameter and the pressure-gradient on velocity profiles, normal and shear viscoelastic stresses, and thixotropic properties. We demonstrate the microstructural configuration of blood in steady-state conditions, revealing that blood is highly aggregated in narrow tubes, promoting a flat velocity profile. Additionally, the proper accounting of the CFL thickness shows that for narrow microtubes, the reduction of discharged hematocrit is significant, which in some cases is up to 70%. At high pressure-gradients, the plasmatic proteins in both regions are extended in the flow direction, developing large axial normal stresses, which are more significant in the core region. We also provide normal stress predictions at both the blood/plasma interface (INS) and the tube wall (WNS), which are difficult to measure experimentally. Both decrease with the tube radius; however, they exhibit significant differences in magnitude and type of variation. INS varies linearly from 4.5 to 2 Pa, while WNS exhibits an exponential decrease taking values from 50 mPa to zero.

Resveratrol loaded polymeric micelles for theranostic targeting of breast cancer cells

Treatment of breast cancer underwent extensive progress in recent years with molecularly targeted therapies. However, non-specific pharmaceutical approaches (chemotherapy) persist, inducing severe side-effects. Phytochemicals provide a promising alternative for breast cancer prevention and treatment. Specifically, resveratrol (res) is a plant-derived polyphenolic phytoalexin with potent biological activity but displays poor water solubility, limiting its clinical use. Here we have developed a strategy for delivering res using a newly synthesized nano-carrier with the potential for both diagnosis and treatment.

Methods: Res-loaded nanoparticles were synthesized by the emulsion method using Pluronic F127 block copolymer and Vitamin E-TPGS. Nanoparticle characterization was performed by SEM and tunable resistive pulse sensing. Encapsulation Efficiency (EE%) and Drug Loading (DL%) content were determined by analysis of the supernatant during synthesis. Nanoparticle uptake kinetics in breast cancer cell lines MCF-7 and MDA-MB-231 as well as in MCF-10A breast epithelial cells were evaluated by flow cytometry and the effects of res on cell viability via MTT assay.

Results: Res-loaded nanoparticles with spherical shape and a dominant size of 179±22 nm were produced. Res was loaded with high EE of 73±0.9% and DL content of 6.2±0.1%. Flow cytometry revealed higher uptake efficiency in breast cancer cells compared to the control. An MTT assay showed that res-loaded nanoparticles reduced the viability of breast cancer cells with no effect on the control cells.

Conclusions: These results demonstrate that the newly synthesized nanoparticle is a good model for the encapsulation of hydrophobic drugs. Additionally, the nanoparticle delivers a natural compound and is highly effective and selective against breast cancer cells rendering this type of nanoparticle an excellent candidate for diagnosis and therapy of difficult to treat mammary malignancies.

Tumor response to a mastermind inhibitor protein

e17601

Background: Notch signalling is implicated in tumorigenesis prompting scientists to research and develop anti-Notch therapeutics. Drugging the Notch pathway has been a challenge due to severe G-I toxicity seen by many small-molecule inhibitors. Mastermind is a key nuclear factor that mediates Notch activity. We generated a novel protein drug, Syntana-4, that inhibits the Notch pathway at the Mastermind transcriptional level. Syntana-4 consists of the cell penetrating domain of Antennapedia, fused to a truncated peptide from Mastermind-like (MAML) that behaves in a dominant-negative fashion inhibiting Notch. Syntana-4 translocates into the cell nucleus, suppressing Notch activity and inducing apoptosis in Notch-driven cancer cells. Methods: We have conducted pharmacokinetics (PK), pharmacodynamics (PD) and toxicology studies, in combination with innovative imaging including in vivo flow cytometry and whole-body fluorescence reflectance imaging to define the behaviour of Syntana-4, determine its mode of action and establish a safety and efficacy profile in an orthotopic model of breast cancer in SCID mice based on the implantation of MDA-MB-231 cells into mammary fat pads. Samples of blood and tissues were examined for toxicity, apoptosis and immunogenicity. Results: We found that Syntana-4 was well-tolerated by normal cells and organs and was not immunogenic. Also, it was shown that free, non-internalized drug was rapidly cleared from the circulation. Whole body imaging showed that the drug in tissues was cleared within 24 hrs. Assessment of tumor growth demonstrated a reduction in tumor growth as evidenced by an overall increase of less than 50% in the intensity of fluorescence signal in the treated group compared to a 3-fold increase in signal and thus tumour size in untreated group by day 14. Conclusions: Syntana-4, a Mastermind inhibitor, was found to be well-tolerated and non-immunogenic in healthy animals. This drug targets the oncogenic Notch mechanism and can be applied across tumours with genetic defects in Notch signalling including breast, prostate, etc. We have demonstrated the utility of an innovative molecular imaging system emulating a clinical ‘phase I/II’ study in an orthotopic cancer model in order to measure the biodistribution, PK, PD, mode of action, toxicity and efficacy of a first-in-class biological therapy prior to entering the clinic. This innovative approach could be useful for accurate selection of lead drug candidates prior to entering clinical development.

The effects of stenting on hemorheological parameters: An in vitro investigation under various blood flow conditions

 Despite their wide clinical usage, stent functionality may be compromised by complications at the site of implantation, including early/late stent thrombosis and occlusion. Although several studies have described the effect of fluid-structure interaction on local haemodynamics, there is yet limited information on the effect of the stent presence on specific hemorheological parameters. The current work investigates the red blood cell (RBC) mechanical behavior and physiological changes as a result of flow through stented vessels. Blood samples from healthy volunteers were prepared as RBC suspensions in plasma and in phosphate buffer saline at 45% haematocrit. Self-expanding nitinol stents were inserted in clear perfluoroalkoxy alkane tubing which was connected to a syringe, and integrated in a syringe pump. The samples were tested at flow rates of 17.5, 35 and 70 ml/min, and control tests were performed in non-stented vessels. For each flow rate, the sample viscosity, RBC aggregation and deformability, and RBC lysis were estimated. The results indicate that the presence of a stent in a vessel has an influence on the hemorheological characteristics of blood. The viscosity of all samples increases slightly with the increase of the flow rate and exposure. RBC aggregation and elongation index (EI) decrease as the flow rate and exposure increases. RBC lysis for the extreme cases is evident. The results indicate that the stresses developed in the stent area for the extreme conditions could be sufficiently high to influence the integrity of the RBC membrane.

Nanotribological response of a-C:H coated metallic biomaterials: the cases of stainless steel, titanium, and niobium

Background Wear and corrosion have been identified as two of the major forms of medical implant failures. This study aims to improve the surface, protective and tribological characteristics of bare metals used for medical implants, so as to improve scratch resistance and increase lifetime. Methods Hydrogenated amorphous carbon (a-C:H) films were deposited, using plasma enhanced chemical vapor deposition (PECVD), on stainless steel (SS), titanium (Ti) and niobium (Nb) metal plates. Nanomechanical and nanotribological responses were investigated before and after a-C:H deposition. Film thickness and density were quantified through X-ray reflectivity, and surface morphology before and after deposition were measured using atomic force microscopy, whereas the tribomechanical characteristics were probed using instrumented indentation. Results and conclusions Films of approximately 40 nm in thickness and density of 1.7 g/cm³ were deposited. The a-C:H films reduce the roughness and coefficient of friction while improving the tribomechanical response compared with bare metals for Ti, SS and Nb plates. The very good tribomechanical properties of a-C:H make it a promising candidate material for protective coating on metallic implants.

Identification of exosomal muscle-specific miRNAs in serum of myotonic dystrophy patients relating to muscle disease progress

Myotonic dystrophy type 1 (DM1) is the most common form of adult-onset muscular dystrophy, which is characterised by progressive muscle wasting and the discovery of reliable blood-based biomarkers could be useful for the disease progress monitoring. There have been some reports showing that the presence of specific miRNAs in blood correlates with DM1. In one of these, our group identified four muscle-specific miRNAs, miR-1, miR-133a, miR-133b and miR-206, which correlated with the progression of muscle wasting observed in DM1 patients. The levels of the four muscle-specific miRNAs were elevated in the serum of DM1 patients compared to healthy participants and were also elevated in the serum of progressive muscle wasting DM1 patients compared to disease-stable DM1 patients. The aim of this work was to characterise the ontology of these four muscle-specific miRNAs in the blood circulation of DM1 patients. Here we show that the four muscle-specific miRNAs are encapsulated within exosomes isolated from DM1 patients. Our results show for the first time, the presence of miRNAs encapsulated within exosomes in blood circulation of DM1 patients. More interestingly, the levels of the four exosomal muscle-specific miRNAs are associated with the progression of muscle wasting in DM1 patients. We propose that exosomal muscle-specific miRNAs may be useful molecular biomarkers for monitoring the progress of muscle wasting in DM1 patients. There has been a growing interest regarding the clinical applications of exosomes and their role in prognosis and therapy of various diseases and the above results contribute towards this way.

Preventing maritime transport of pathogens: the remarkable antimicrobial properties of silver-supported catalysts for ship ballast water disinfection

Ship ballast water (SBW) antimicrobial treatment is considered as a priority issue for the shipping industry. The present work investigates the possibility of utilizing antimicrobial catalysis as an effective method for the treatment of SBW. Taking into account the well-known antimicrobial properties of ionic silver (Ag⁺), five silver-supported catalysts (Ag/γ-Al₂O₃) with various loadings (0.05, 0.1, 0.2, 0.5, and 1 wt%) were prepared and examined for the antimicrobial treatment of SBW. The bactericidal activity of the aforementioned catalysts was investigated towards the inhibition of Escherichia coli (Gram-negative) and Escherichia faecalis (Gram-positive) bacteria. Catalytic experiments were conducted in a three-phase continuous flow stirred tank reactor, used in a semi-batch mode. It was found that using the catalyst with the lowest metal loading, the inhibition of E. coli reached 95.8% after 30 minutes of treatment of an E. coli bacterial solution, while the inhibition obtained for E. faecalis was 76.2% after 60 minutes of treatment of an E. faecalis bacterial solution. Even better results (100% inhibition after 5 min of reaction) were obtained using the catalysts with higher Ag loadings. The results of the present work indicate that the prepared monometallic catalysts exert their antimicrobial activity within a short period of time, revealing, for the first time ever, that the field of antimicrobial heterogeneous catalysis using deposited ionic silver on a solid support may prove decisive for the disinfection of SBW.

Abstract 1977: Therapeutic miRNAs targeted selectively to tumors by mesenchymal stem cell derived microparticles

Introduction: MiRNAs have been implicated in the development of some if not all cancer types and have been identified as attractive targets for therapy. However, systemic delivery of bare miRNAs faces its own set of limitations because of degradation by RNases and filtration and excretion by the kidneys. In this work we propose miRNAs as therapeutic agents. We have developed a novel system for miRNA delivery applicable for both local and systemic administration with the use of mesenchymal stem cell (MSC) microparticles (MPs).

Methodology: MSCs were isolated from the Wharton's jelly of human umbilical cords. The MSC cultures were subjected to serum deprivation, leading to the formation of MPs (secreted membrane vehicles <1μm) which were harvested and characterized by SEM, PCR, FACS and Fluorescence Microscopy. Breast (MDA-MB-231 & MCF-7), colon (RKO & HT-29) and ovarian adenocarcinoma (SKOV3) cell lines were then exposed to MPs. The response to treatment was evaluated by cell morphology, proliferation, migration, gene expression and apoptosis. Furthermore, the therapeutic potential of MPs was tested in vivo in xenograft tumor mouse models. Innovative imaging modalities such as in vivo flow cytometry and whole body fluorescence-bioluminescence were employed to dynamically investigate the biodistribution and homing kinetics of MPs in mice.

Results: In vitro experiments confirmed that MSC-derived MPs can be internalized by the various cancer cell lines and induce a biological effect as evidenced by membrane damage, cell shrinkage and blebbing in the recipient cell. Significantly, there was evidence that MPs induce apoptosis, inhibit cell proliferation and tumor growth attenuation in a dose/time-dependent manner. The pro-apoptotic and anti-migration effects of MPs in cancer cells were almost completely abrogated by RNase treatment before administration to cultures. In vivo studies demonstrated that we were able to monitor and quantify fluorescently labelled MPs in circulation and to detect and image the biodistribution and incorporation in cells and organs in healthy and tumor-bearing mice.

Conclusion: MSC-derived MPs containing miRNAs possess tumor inhibitory properties both in vitro and in vivo. Administration of MPs after RNase treatment induces the loss of anti-cancer properties suggesting a horizontal transfer of small RNAs from MPs to cancer cells. MPs formulated to contain specific miRNAs, could affect the action of genes associated with carcinogenesis, neovascularization, metastasis and other cancer characteristics, thus leading to therapeutic benefit.

Citation Format: Marianna Prokopi, Agamemnon Epenetos, Andreas Anayiotos, Costas Pitsillides, Konstantinos Kapnisis, Christina Kousparou. Therapeutic miRNAs targeted selectively to tumors by mesenchymal stem cell derived microparticles. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1977. doi:10.1158/1538-7445.AM2014-1977

Assessment of passive cardiovascular implant devices for MRI compatibility

PURPOSE

The increasing popularity of both magnetic resonance angiography and minimally invasive cardiovascular interventional procedures has led to the requirement for the development of implant devices that not only provide for patient safety, but produce minimal artifacts in diagnostic images. The purpose of this paper is to assess and discuss physical principles and ASTM testing standards related to the MRI compatibility of implanted devices.

ANALYSIS AND REVIEW OF IMAGING COMPATIBILITY AND SAFETY OF COMMON IMPLANTS AND DEVICES

Standard procedures are described to assess safety and ability to image near implanted stents and heart valves made from different materials and of varying geometry. MRI physical principles, material properties and MR simulations are discussed in the context of estimation of ferromagnetic force, displacement, torque, tissue heating, susceptibility artifacts, and radiofrequency shielding in cardiovascular stents and heart valves during MR imaging.

CONCLUSION

MRI compatibility is a function of both material composition and device geometry. MR-safe devices are available that provide for reduced image artifacts over stainless-steel devices.

Numerical simulation of in vitro pulsatile flow and its study using FRISK, a rapid phase contrast technique

PURPOSE

To test the potential of a phase contrast magnetic resonance (PC-MR) sparse sampling technique, fragmented regional interpolation segmentation for k-space (FRISK), to capture complex flow features within a breathhold duration by using numerical simulations and experimental approaches.

MATERIALS AND METHODS

Computational fluid dynamics (CFD) data of three models were generated: a two-chamber orifice flow model simulating valvular regurgitation, a femoral artery model, and a U-shaped model simulating the aortic arch. These data were used to simulate conventional and FRISK PC-MR data acquisitions. FRISK parameters can be adapted for different flow fields to capture either high temporal information or complexly varying spatial information with a temporal component or a mixture of both. In vivo PC-MR images on a healthy volunteer were sampled to compare conventional PC-MR with novel FRISK imaging.

RESULTS

In our simulations of three representative models, when only the errors from different sampling sequences were considered, FRISK was shown to maintain or even improve data accuracy while cutting the scan time by at least 50% compared to corresponding conventional PC-MR. By adapting the FRISK parameters for flowfields with different features, FRISK was capable of capturing in-plane and through-plane velocity information with excellent detail in approximately 20 heartbeats breathhold duration. The results of the in vivo MR experiment were consistent with the simulation results, showing that breathhold FRISK imaging improved spatial resolution of the data and maintained adequate temporal resolution compared with breathhold conventional imaging.

CONCLUSION

FRISK, a new MRI sampling sequence that sparsely samples data and aligns acquired data during postprocessing, provides a scan time advantage of approximately a factor of 2 compared to conventional scans, and allowed rapid or breathhold scanning while obtaining acceptable accuracy.

Extension of Rapid Phase-Contrast Magnetic Resonance Imaging Using BRISK in Multidirectional Flow

We developed BRISK-CON-VPS, a rapid phase-contrast cine approach that is a hybrid of the BRISK-VPS (Block Regional Interpolation Scheme for k-space) and conventional (CONV-VPS) scanning employing k-space views per segment (VPS). BRISK-CON-VPS allows data acquisition approximately four times faster than CONV-VPS imaging and has the advantage compared to BRISK-VPS that it can potentially be incorporated into real-time applications. In BRISK-CON-VPS contiguous regions of k-space are sampled using a views per segment factor that is varied as a function of distance from the k-space center. Computational fluid dynamics (CFD) data were used to simulate CONV-VPS, BRISK-VPS, and BRISK-CON-VPS. BRISK-CON-VPS was simulated by incrementing the VPS progressively with increasing distance from the k-space origin while BRISK-VPS was simulated using a uniform VPS applied to the sparse sampling scheme. Simulations showed that up to a base VPS of 5, both BRISK-CON-VPS and BRISK-VPS retained excellent axial-velocity accuracy. Secondary in-plane velocity flow fields were well represented with BRISK-CON-VPS and BRISK-VPS up to a base VPS of 3. CONV-VPS, BRISK-CON-VPS, and BRISK-VPS were applied in vivo and shown to provide comparable quantitative flow data. BRISK-CON-VPS accomplishes breath-hold acquisitions as efficiently as BRISK-VPS, but without requiring data interpolation or under-sampling k-space.

The challenges of imaging based computational fluid dynamics

Image based Computational Fluid Dynamics (CFD) simulation of the cardiovascular system is increasingly becoming important and its application in everyday medical practice can already be envisaged. The goal of this workshop is to address all the factors involved in the development of a computational framework/software for modelling and analyses of the cardiovascular system and provide examples. The development of such framework, requires integration, management and interpretation of data from several technology areas such as a) feature detection and extraction of arterial geometry from imaging data, b) adaptive grid generation techniques for 3-D asymmetric geometries c) hemodynamic modelling, disparate length-scale model, and fluid-tissue interaction with high-performance computing, d) CFD data validation, e) feature extraction/detection and visualisation algorithms, f) graphical user interface to allow remote visualisation of post processed data. These computational tools are employed to study flow in specific problem sites in the vascular tree such as the carotid, femoral, coronary and abdominal arteries. Such studies provide understanding of the factors involved in the initialisation and evolution of arterial disease due to altered flow conditions (as a result of plaque formation) such as flow separation and reversal, and low and oscillatory wall shear stress. It is also used to study the effect of various clinical procedures such as the implantation of stents, vascular grafts, vascular prostheses and artificial valve implants on local and global hemodynamics. This workshop will address a new emerging paradigm in clinical practice known as predictive medicine for effective surgical planning and post surgical rehabilitation. The workshop will also address the difficulties in the implementation of some of the technology areas in this application with examples of carotid, femoral, and abdominal artery simulations.

Comparative MRI compatibility of 316 L stainless steel alloy and nickel-titanium alloy stents

The initial success of coronary stenting is leading to a proliferation in peripheral stenting. A significant portion of the stents used in a clinical setting are made of 316 low carbon stainless steel (SS). Other alloys that have been used for stent manufacture include tantalum, MP35N, and nickel-titanium (NiTi). The ferromagnetic properties of SS cause the production of artifacts in magnetic resonance imaging (MRI). The NiTi alloys, in addition to being known for their shape memory or superelastic properties, have been shown to exhibit reduced interference in MRI. Thus, the objective of this study was to determine the comparative MRI compatibility of SS and NiTi stents. Both gradient echo and spin-echo images were obtained at 1.5 and 4.1 T field strengths. The imaging of stents of identical geometry but differing compositions permitted the quantification of artifacts produced due to device composition by normalizing the radio frequency shielding effects. These images were analyzed for magnitude and spatial extent of signal loss within the lumen and outside the stent. B1 mapping was used to quantify the attenuation throughout the image. The SS stent caused significant signal loss and did not allow for visibility of the lumen. However, the NiTi stent caused only minor artifacting and even allowed for visualization of the signal from within the lumen. In addition, adjustments to the flip angle of standard imaging protocols were shown to improve the quality of signal from within the lumen.

Effect of contrast agent viscosity and injection flow velocity on bolus injection pressures for peripheral venous injection in first-pass myocardial perfusion studies

Myocardial perfusion imaging using Gd contrast agents is typically performed with bolus injections of the contrast agent using a power injector to provide for consistent and sufficiently rapid injection rates for all patients. For protocols in which a peripheral venous injection is called for (e.g. antecubital vein) injection catheters of 18 ga are used where vessel geometry permits. In some patients, particularly women with smaller veins, 20 and 22 ga catheters are used. The effect of catheter size and pressure tubing length can result in high injection pressures that occasionally cause leakage or connector failure. The viscosity of the contrast agent also impacts injection pressure. In this study, a simulation of the injection pathway was constructed with time resolved pressures measured at two points in the pathway. Pressure drops were calculated for a typical MR perfusion injection protocol.

Intramachine and intermachine variability in transesophageal color Doppler images of pulsatile jets. In vitro studies

BACKGROUND

Color Doppler flow mapping is widely used as a marker of severity of valvular regurgitation, and the transesophageal approach has provided high-quality images in patients with poor acoustic windows. However, different instruments produce significantly variable images. Techniques that use jet spatial information to determine the severity of the lesion may need to be derived specifically for the instrument used. Given a lack of standardization of the many commonly used instruments, the goal of this study was to quantify variability between instruments by imaging well-defined jet flow fields created in vitro.

METHODS AND RESULTS

Pulsatile jets were created in vitro using a blood analogue fluid through physiological orifice diameters and imaged from a distal window using six commonly used color Doppler instruments. Transesophageal transducers (5.0 MHz) were used with all instruments studied. Peak jet areas were planimetered and averaged with systematic variations in Nyquist limit, color filter, and sector angle (which produced variations in frame rate). Changes in instrument settings produced significant variation in jet size for all instruments studied. Comparisons within instruments and among instruments were difficult because of preset and ambiguous setting levels. When comparisons were possible between similar settings, variability was dramatic (eg, 57% variability between instruments with very similar Nyquist limits).

CONCLUSIONS

A lack of standardized color Doppler instrument settings prohibits translation of jet area techniques from one instrument to another. This should be taken into consideration when using different machines for clinical study.