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Irawany V, Nasution VAF, Amalia N. Bilateral vertebral artery injury leads to brain death following traumatic brain injury: a case report. J Med Case Rep 2024; 18:106. [PMID: 38491407 PMCID: PMC10943836 DOI: 10.1186/s13256-024-04432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/02/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Vertebral artery injury is a rare condition in trauma settings. In the advanced stages, it causes death. CASE A 31-year-old Sundanese woman with cerebral edema, C2-C3 anterolisthesis, and Le Fort III fracture after a motorcycle accident was admitted to the emergency room. On the fifth day, she underwent arch bar maxillomandibular application and debridement in general anesthesia with a hyperextended neck position. Unfortunately, her rigid neck collar was removed in the high care unit before surgery. Her condition deteriorated 72 hours after surgery. Digital subtraction angiography revealed a grade 5 bilateral vertebral artery injury due to cervical spine displacement and a grade 4 left internal carotid artery injury with a carotid cavernous fistula (CCF). The patient was declared brain death as not improved cerebral perfusion after CCF coiling. CONCLUSIONS Brain death due to cerebral hypoperfusion following cerebrovascular injury in this patient could be prevented by early endovascular intervention and cervical immobilisation.
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Affiliation(s)
- Vera Irawany
- Fatmawati National General Hospital, Jakarta, Indonesia
- Anesthesiology and Intensive Care Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Vizzi A F Nasution
- Anesthesiology and Intensive Care Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
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Nagi M, D'Audiffret A, Katz D. External carotid artery pseudoaneurysm rupture in a patient with polycystic kidney disease: Case report and review of literature. Vascular 2024; 32:143-146. [PMID: 36049120 DOI: 10.1177/17085381221124707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular abnormalities, including dissections and aneurysms, can be found in patients with autosomal dominant kidney disease (ADPKD). While intracranial aneurysms have been reported in 10%-25% of ADPCKD, occurrences at other locations are exceedingly rare. METHOD This is a first case report of a patient with ADPCKD who presented with a rupture of the left external carotid artery pseudoaneurysm. CONCLUSION Rupture of a carotid artery aneurysm is rare with potentially high morbidity. An endovascular and surgical approach are effective strategies for successful management that depends on etiology, location, and surgeon experience.
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Affiliation(s)
- Mohamed Nagi
- Department of Vascular Surgery, RUSH University Medical Center, Chicago, IL, USA
| | | | - Daniel Katz
- Department of Vascular Surgery, RUSH University Medical Center, Chicago, IL, USA
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Balu A, Pangal DJ, Kugener G, Donoho DA. Pilot Analysis of Surgeon Instrument Utilization Signatures Based on Shannon Entropy and Deep Learning for Surgeon Performance Assessment in a Cadaveric Carotid Artery Injury Control Simulation. Oper Neurosurg (Hagerstown) 2023; 25:e330-e337. [PMID: 37655892 DOI: 10.1227/ons.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Assessment and feedback are critical to surgical education, but direct observational feedback by experts is rarely provided because of time constraints and is typically only qualitative. Automated, video-based, quantitative feedback on surgical performance could address this gap, improving surgical training. The authors aim to demonstrate the ability of Shannon entropy (ShEn), an information theory metric that quantifies series diversity, to predict surgical performance using instrument detections generated through deep learning. METHODS Annotated images from a publicly available video data set of surgeons managing endoscopic endonasal carotid artery lacerations in a perfused cadaveric simulator were collected. A deep learning model was implemented to detect surgical instruments across video frames. ShEn score for the instrument sequence was calculated from each surgical trial. Logistic regression using ShEn was used to predict hemorrhage control success. RESULTS ShEn scores and instrument usage patterns differed between successful and unsuccessful trials (ShEn: 0.452 vs 0.370, P < .001). Unsuccessful hemorrhage control trials displayed lower entropy and less varied instrument use patterns. By contrast, successful trials demonstrated higher entropy with more diverse instrument usage and consistent progression in instrument utilization. A logistic regression model using ShEn scores (78% accuracy and 97% average precision) was at least as accurate as surgeons' attending/resident status and years of experience for predicting trial success and had similar accuracy as expert human observers. CONCLUSION ShEn score offers a summative signal about surgeon performance and predicted success at controlling carotid hemorrhage in a simulated cadaveric setting. Future efforts to generalize ShEn to additional surgical scenarios can further validate this metric.
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Affiliation(s)
- Alan Balu
- Department of Neurosurgery, Georgetown University School of Medicine, Washington , District of Columbia, USA
| | - Dhiraj J Pangal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles , California , USA
| | - Guillaume Kugener
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles , California , USA
| | - Daniel A Donoho
- Division of Neurosurgery, Children's National Hospital, Washington , District of Columbia , USA
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Santhosh NU, Bhattacharjee S, Bathala L. Spontaneous Extracranial Carotid Artery Pseudoaneurysm: A Rare Entity. Neurol India 2023; 71:785-786. [PMID: 37635521 DOI: 10.4103/0028-3886.383832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- N U Santhosh
- Department of Neurosurgery, Aster CMI, Bangalore, Karnataka, India
| | | | - Lokesh Bathala
- Department of Neurology, Aster CMI, Bangalore, Karnataka, India
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Poupore NS, Jungbauer WN, Nguyen SA, White DR, Pecha PP, Carroll WW. The Utility of CTA in Pediatric Oropharyngeal Trauma: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:25-37. [PMID: 35394644 DOI: 10.1002/lary.30133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE(S) To analyze the utility of computed tomography angiography (CTA) in identifying internal carotid artery (ICA) injury and reducing cerebrovascular accident (CVA) incidence in children presenting with normal neurologic exams after oropharyngeal trauma (OT). DATA SOURCES PubMed, Scopus, CINAHL, and Cochrane. REVIEW METHODS A systematic review and meta-analysis were performed following PRISMA guidelines. Of 1,185 studies screened, 95 studies of pediatric OT met inclusion criteria. Meta-analysis of proportions was performed. RESULTS A total of 1224 children with OT were analyzed. Excluding case reports, the weighted proportion of a CVA after OT was 0.31% (95% CI 0.06-0.93). If a child presented without neurologic deficits, 0.30% (95% CI 0.05-0.95) returned with new neurologic deficits. An ICA injury was identified in 0.89% (95% CI 0.16-2.74) of screening CTAs. No difference in CVA incidence was seen in children with screening CTA (0.52% [95% CI 0.02-2.15]) compared to children without screening CTA (0.42% [95% CI 0.06-1.37]). Patients who developed CVA had a higher proportion of injuries >2 cm, injuries at the posterior pillar or tonsil, and injuries with a writing utensil or popsicle stick compared to patients without CVA. CONCLUSION The proportion of children experiencing an ICA injury leading to CVA after sustaining OT is low. CTAs infrequently show ICA changes in children with normal neurological exams. Children who receive CTAs do not have a significantly lower incidence of CVAs than children who do not receive CTAs. Clinicians should weigh the risks and benefits of a CTA based on an individual child's presentation and discuss this with caregivers for shared decision-making. Laryngoscope, 133:25-37, 2023.
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Affiliation(s)
- Nicolas S Poupore
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, U.S.A
| | - W Nicholas Jungbauer
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
- University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - David R White
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - William W Carroll
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Tian Y, Xu N, Yan M, Chen J, Hung KL, Hou X, Wang S, Li W. Strategies to avoid internal carotid artery injury in “sandwich” atlantoaxial dislocation patients during surgery. Acta Neurochir (Wien) 2022; 165:1155-1160. [PMID: 36534186 DOI: 10.1007/s00701-022-05449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To elucidate the anatomic relationship between the internal carotid artery (ICA) and the bony structures of the craniovertebral junction among "sandwich" atlantoaxial dislocation (AAD) patients, and to analyze the risks of injury during surgical procedures. METHODS The distance from the medial wall of ICA to the midsagittal plane (D1), the shortest distance between the ICA wall and the anterior cortex of the lateral mass of atlas (LMA) (D2) on the most caudal and cranial levels of LMA and the angle (A) between the sagittal plane passing through the screw entry point of C1 lateral mass(C1LM) screw and the medial tangent line of the vessel passing through the entry point were measured. Besides, the location of ICA in front of the atlantoaxial vertebra was divided into 4 categories (Z1-Z4). RESULTS There was a statistically difference between the male and female patients regarding D1, and the difference between D2 at level a and level b as well as angle A between the left and right sides were statistically different (p < 0.05). Ninety-two ICAs (57.5%) were anteriorly located in Z3, 50 (31.3%) were located in Z4, 17 were located in Z2, and only one ICA was located in Z1 in all 80 patients. CONCLUSIONS In "sandwich" AAD patients, particular attention should be paid to excessively medialized ICA to avoid ICA injury during trans-oral procedures, and the risk of injuring the ICA with more cranially and medially angulated C1LM screw placement was relatively less during posterior fixation procedures. A novel classification of ICA location was used to describe the relationship between ICA and LMA.
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Affiliation(s)
- Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, 100191, China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, 100191, China
| | - Ming Yan
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, 100191, China
| | - Jinguo Chen
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, 100191, China
| | - Kan-Lin Hung
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, 100191, China
| | - Xiangyu Hou
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, 100191, China
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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Giorgianni A, Agosti E, Terrana A, Pozzi F, Sileo G, Nativo L, Balbi S, Motta A, Castelnuovo P, Locatelli D, Turri-Zanoni M. Emergency endovascular treatment of cavernous internal carotid artery acute bleeding with flow diverter stent: a single-center experience. Acta Neurochir (Wien) 2021; 163:2055-2061. [PMID: 32808087 PMCID: PMC8195932 DOI: 10.1007/s00701-020-04517-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/30/2020] [Indexed: 11/05/2022]
Abstract
Background and objective To describe our single-center experience in the treatment of cavernous internal carotid artery (ICA) acute bleeding with flow diverter stent (FDS), as a single endovascular procedure or combined with an endoscopic endonasal approach. Methods We analyze a case series of 5 patients with cavernous ICA acute bleeding, i.e., 3 iatrogenic, 1 post-traumatic, and 1 erosive neoplastic. After an immediate nasal packing to temporarily bleeding control, patients underwent digital subtraction angiography (DSA) to identify the site of the ICA injury. A concomitant balloon occlusion test (BOT) was performed, to exclude post-occlusive ischemic neurological damage. An FDS was placed with parallel intravenous infusion of abciximab in 3 cases and tirofiban in 2 cases. In two patients, an innovative “sandwich technique” combining the endovascular reconstruction with an extracranial intrasphenoidal cavernous ICA resurfacing with autologous flaps or grafts by endoscopic endonasal approach was performed. Results No patient had periprocedural ischemic-hemorrhagic complications. All patients had a regular clinical evolution, without general complications or new onset of focal neurological deficits. No further bleeding occurred in 3 patients, while 2 cases experienced a mild rebleeding in a period ranging from 5 to 15 days after the endovascular procedure. In these two cases, we proceeded with an endoscopic endonasal procedure to resurface the exposed ICA wall in the sphenoid sinus. Conclusions Although the treatment of choice for cavernous ICA acute bleeding remains the occlusion of the injured vessel, in cases of poor hemodynamic compensation at the BTO, the endovascular FDS emergency placement can be effective. A combined endoscopic endonasal technique to support the extracranial side of the vessel using autologous flaps or grafts can be performed to prevent the risk of rebleeding.
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Affiliation(s)
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy.
| | - Alberto Terrana
- Department of Neuroradiology, ASST Sette Laghi, Varese, Italy
| | - Fabio Pozzi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Luca Nativo
- Department of Neuroradiology, ASST Sette Laghi, Varese, Italy
| | - Sergio Balbi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy
| | - Alessandro Motta
- Department of Anesthesiology e Resuscitation, ASST Sette Laghi, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Department of Anesthesiology e Resuscitation, ASST Sette Laghi, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Yuan S, Zhang T. Boeravinone B Protects Brain against Cerebral Ichemia Reperfusion Injury in Rats: Possible Role of Anti-inflammatory and Antioxidant. J Oleo Sci 2021; 70:927-936. [PMID: 34193669 DOI: 10.5650/jos.ess21037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is well known that inflammatory reactions and oxidative stress play a key role in the pathogenesis of cerebral ischemia and secondary injury. Boeravinone B (BB) proofed their anti-inflammatory and antioxidant effect, but their neuroprotective effects still unknown. In this experimental study, we explore the neuro-protective effect of Boeravinone B on the ischemia/reperfusion and explore the possible mechanism. Male Wistar rats were used for the current experimental study. First induces natural I/R injury in rats and treated with BB and nifedipine, respectively. Rats were subjected to ischemia after 6 consecutive days by occlusion of the bilateral common carotid arteries (BCCAO). Neurological score, biochemical, antioxidant, pro-inflammatory cytokines and inflammatory parameters were estimated in the serum and brain tissue. BB treatment significantly (p < 0.001) suppressed neuronal injury, dose-dependently decreased the cerebral water content. BB treatment altered the pro-inflammatory cytokines, antioxidant and inflammatory mediators in the serum and brain tissue. BB regulated the expression of glycine (Gly), glutamic acid (Glu), taurine (Tau), aspartic acid (Asp) and γ-aminobutyric acid (GABA) and enhanced the activity of Na+, K+ ATPase and Ca2+ ATPase. BB significantly (p < 0.001) reduced antioxidant enzymes such as glutathione (GSH), glutathione peroxidase (GPx), catalase (CAT), malondialdehyde (MDA), glutathione reductase (GR); inflammatory cytokines include interleukin-4 (IL-4), interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), interleukin-6 (IL-6) and interleukin-1β (IL-1β); inflammatory mediators include prostaglandin (PGE2), nuclear kappa factor B (NF-κB) and cyclooxygenase-2 (COX-2), respectively. In this study, we have found that Boeravinone B exhibited protection against cerebral I/R by reducing oxidative stress and inflammatory reaction.
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Affiliation(s)
- Shaojie Yuan
- Department of Neurology, Xingtai People's Hospital
| | - Tong Zhang
- Department of Neurology, Xingtai People's Hospital
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Silva CBR, Rebouças JC, Nunes SLO, de Luccia N, Pereira RMR. Successful endovascular correction of common carotid pseudoaneurysm secondary to Behçet's disease: case report and review of the literature. Clin Exp Rheumatol 2020; 38 Suppl 127:94-97. [PMID: 32452346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/03/2020] [Indexed: 06/11/2023]
Abstract
Behçet's disease (BD) is a chronic, multisystemic, inflammatory disease characterised by recurrent mucocutaneous, ocular, musculoskeletal, central nervous system, gastrointestinal and vascular manifestations, which may affect blood vessels of any size (1). Venous involvement is more common, but arterial involvement accounts for the major cause of mortality (2, 3). Choosing the adequate technique and timing for correcting aneurysms in BD is still challenging. The authors report a case of a 37-year-old male patient with common carotid pseudoaneurysm at the time of diagnosis, which was successfully treated by an endovascular stent placement after adequate immunosuppression. A review of the literature about this issue was also done.
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Affiliation(s)
| | - Juliana Cabral Rebouças
- Vascular Surgery Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Sergio L O Nunes
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Nelson de Luccia
- Vascular Surgery Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Rosa Maria R Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.
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OuYang M, Wang Y. In Reply to the Letter to the Editor Regarding "Endovascular Treatment of Infectious Pseudoaneurysm of Internal Carotid Artery". World Neurosurg 2019; 127:675. [PMID: 31266123 DOI: 10.1016/j.wneu.2019.03.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Mang OuYang
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Yang Wang
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China.
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Ben RJ, Jao JC, Chang CY, Tzeng JS, Hwang LC, Chen PC. Longitudinal investigation of ischemic stroke using magnetic resonance imaging: Animal model. J Xray Sci Technol 2019; 27:935-947. [PMID: 31306147 DOI: 10.3233/xst-190538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Arterial embolism is a major cause of ischemic stroke. Currently, digital subtraction angiography (DSA) is the gold standard in clinical arterial embolization examinations. However, it is invasive and risky. OBJECTIVE This study aims to longitudinally assess the progression of carotid artery embolism in middle cerebral artery occlusion animal model (MCAO) using magnetic resonance imaging (MRI) techniques. METHODS Turbo spin echo (TSE), time of flight magnetic resonance angiography (TOF-MRA) and diffusion weighted magnetic resonance imaging (DWI) were used to evaluate the image characteristics of cerebral tissues at 1, 2, 3, 7, 14, 21 and 28 days after MCAO microsurgery on Sprague-Dawley (SD) rats. Quantitative analysis was performed and compared in MCAO hemisphere and contralateral normal hemisphere. Furthermore, pathologic section using triphenyl tetrazolium chloride (TTC) stain was performed as well. RESULTS TOF-MRA showed carotid signal void in the embolism side, which is evidence of artery occlusion. The used MRI techniques showed that edema gradually dissipated within one week, but there was no significant change afterwards. The time-varying signal intensity of MRI techniques in MCAO hemisphere changed significantly, but there were no significant changes in contralateral normal hemisphere. Cerebral injury was also confirmed by analysis of pathology images. CONCLUSIONS The MCAO animal model was successfully established on SD rats using the microsurgery to assess arterial embolization of intracranial tissue injury.
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Affiliation(s)
- Ren-Jy Ben
- Department of Biomedical Engineering, I-Shou University, Jiaosu Village, Yanchao District, Kaohsiung City, Taiwan, R.O.C
- Department of Electrical Engineering, I-Shou University, Dashu District, Kaohsiung City, Taiwan, R.O.C
| | - Jo-Chi Jao
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan, R.O.C
| | - Chiung-Yun Chang
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan, R.O.C
| | - Jiun-Siang Tzeng
- Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan, R.O.C
| | - Lain-Chyr Hwang
- Department of Electrical Engineering, I-Shou University, Dashu District, Kaohsiung City, Taiwan, R.O.C
| | - Po-Chou Chen
- Department of Biomedical Engineering, I-Shou University, Jiaosu Village, Yanchao District, Kaohsiung City, Taiwan, R.O.C
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Liu HC, Wang W, Li Y, Dong H, Sun BW, Xu Y, Zhao JW, Zhang JL, Zhang TM, Kang J. [The diagnosis and treatment of traumatic optic nerve neuropathy combined with carotid artery injury]. Zhonghua Yi Xue Za Zhi 2018; 98:3183-3186. [PMID: 30392279 DOI: 10.3760/cma.j.issn.0376-2491.2018.39.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: To discuss the diagnosis and treatment strategy of traumatic optic nerve neuropathy (TON) combined with carotid artery injury. Methods: Retrospective analyses were performed 397 cases of TON at Neurosurgery department of Beijing Tongren Hospital, Capital Medical University (CMU), from January 2016 to December 2017.The clinical experience was concluded. Results: 9 cases of Traumatic Pseudo Aneurysm (TPA) and 16 cases of Traumatic Carotid Artery-Cavernous Sinus Fistula (TCCF) were found.7 cases of TPA were treated by covered stent, the other 2 cases were treated by detachable balloons.11 cases of TCCF were treated by detachable balloons, and 5 cases of fistulas were found spontaneously closed by DSA after 1-3 months.There was no disability rate and mortality in this study. Conclusion: TON combined with carotid artery injury was a critical situation, and sometime without obvious symptoms and sign, which was easily miss diagnosed.It should be with more concern in diagnosing and treating in such cases, to avoid disability rate and mortality.
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Matsuura JH, Rosenthal D, Jerius H, Clark MD, Owens DS. Traumatic Carotid Artery Dissection and Pseudoaneurysm Treated with Endovascular Coils and Stent. J Endovasc Ther 2016; 4:339-43. [PMID: 9418195 DOI: 10.1177/152660289700400403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report a case of post-traumatic internal carotid artery dissection and pseudoaneurysm formation at the C-1 level successfully treated by a percutaneous endovascular technique. Methods and Results: A 20-year-old female presented 72 hours after a motor vehicle accident with incomplete occulosympathetic paresis (Horner's syndrome), carotidynia, and left-sided weakness. Arteriography confirmed the diagnosis of carotid dissection and an associated 1.5-cm × 2.5-cm pseudoaneurysm at the C-1 level. Neuroradiologists embolized the pseudoaneurysm with Guglielmi detachable coils and controlled the dissection with placement of a Wallstent. Conclusions: This report illustrates successful percutaneous endovascular treatment of a carotid dissection and pseudoaneurysm near the base of the skull.
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Affiliation(s)
- J H Matsuura
- Department of Vascular Surgery, Georgia Baptist Medical Center, Medical College of Georgia, Atlanta, USA
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14
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Chung YL, Pan CH, Wang CCN, Hsu KC, Sheu MJ, Chen HF, Wu CH. Methyl Protodioscin, a Steroidal Saponin, Inhibits Neointima Formation in Vitro and in Vivo. J Nat Prod 2016; 79:1635-1644. [PMID: 27227546 DOI: 10.1021/acs.jnatprod.6b00217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Restenosis (or neointimal hyperplasia) remains a clinical limitation of percutaneous coronary angioplasty. Abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) are known to be involved in the development of restenosis. The present study aimed to investigate the ability and molecular mechanisms of methyl protodioscin (1), a steroidal saponin isolated from the root of Dioscorea nipponica, to inhibit neointimal formation. Our study demonstrated that 1 markedly inhibited the growth and migration of VSMCs (A7r5 cells). A cytometric analysis suggested that 1 induced growth inhibition by arresting VSMCs at the G1 phase of the cell cycle. A rat carotid artery balloon injury model indicated that neointima formation of the balloon-injured vessel was markedly reduced after extravascular administration of 1. Compound 1 decreased the expression levels of ADAM15 (a disintegrin and metalloprotease 15) and its downstream signaling pathways in the VSMCs. Moreover, the expressions and activities of matrix metalloproteinases (MMP-2 and MMP-9) were also suppressed by 1 in a concentration-dependent manner. Additionally, the molecular mechanisms appear to be mediated, in part, through the downregulation of ADAM15, FAK, ERK, and PI3K/Akt.
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MESH Headings
- ADAM Proteins/antagonists & inhibitors
- Algorithms
- Animals
- Aorta, Thoracic/cytology
- Carotid Artery Injuries
- Cell Movement
- Cell Proliferation
- Dioscorea/chemistry
- Diosgenin/analogs & derivatives
- Diosgenin/chemistry
- Diosgenin/pharmacology
- Dose-Response Relationship, Drug
- Drugs, Chinese Herbal/chemistry
- Drugs, Chinese Herbal/isolation & purification
- Drugs, Chinese Herbal/pharmacology
- Hyperplasia/drug therapy
- Membrane Proteins/antagonists & inhibitors
- Models, Theoretical
- Molecular Structure
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/cytology
- Neointima/drug therapy
- Phosphatidylinositol 3-Kinases/metabolism
- Plant Roots/chemistry
- Rats
- Rats, Sprague-Dawley
- Saponins/chemistry
- Saponins/isolation & purification
- Saponins/pharmacology
- Signal Transduction
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Affiliation(s)
- Yun-Lung Chung
- School of Pharmacy, China Medical University , Taichung 40402, Taiwan
| | - Chun-Hsu Pan
- Department of Pharmacy, Taipei Medical University , Taipei 11031, Taiwan
| | - Charles C-N Wang
- Department of Biomedical Informatics, Asia University , Taichung 41354, Taiwan
| | - Kai-Cheng Hsu
- Cancer Biology and Drug Dsicovery, Taipei Medical University , Taipei 11031, Taiwan
| | - Ming-Jyh Sheu
- School of Pharmacy, China Medical University , Taichung 40402, Taiwan
| | - Hai-Feng Chen
- School of Pharmaceutical Sciences, Xiamen University , Xiamen 361005, China
| | - Chieh-Hsi Wu
- School of Pharmacy, China Medical University , Taichung 40402, Taiwan
- Department of Pharmacy, Taipei Medical University , Taipei 11031, Taiwan
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15
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Rodriguez MP, Emond ZM, Wang Z, Martinez J, Jiang Q, Kibbe MR. Role of metabolic environment on nitric oxide mediated inhibition of neointimal hyperplasia in type 1 and type 2 diabetes. Nitric Oxide 2013; 36:67-75. [PMID: 24333562 DOI: 10.1016/j.niox.2013.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 11/14/2013] [Accepted: 12/05/2013] [Indexed: 01/14/2023]
Abstract
Nitric oxide (NO) is well known to inhibit neointimal hyperplasia following arterial injury. Previously, we reported that NO was more effective at inhibiting neointimal hyperplasia in a type 2 diabetic environment than control. We also found that NO was ineffective in an uncontrolled type 1 diabetic environment; however, insulin restored the efficacy of NO. Thus, the goal of this study was to more closely evaluate the effect of insulin and glucose on the efficacy of NO at inhibiting neointimal hyperplasia in both type 1 and type 2 diabetic environments using different doses of insulin as well as pioglitazone. Type 1 diabetes was induced in male lean Zucker (LZ) rats with streptozotocin (60 mg/kg IP). Groups included control, moderate glucose control, and tight glucose control. Zucker diabetic fatty (ZDF) rats fed Purina 5008 chow were used as a type 2 diabetic model. Groups included no therapy, insulin therapy, or pioglitazone therapy. After 4 weeks of maintaining group assignments, the carotid artery injury model was performed. Treatment groups included: control, injury and injury plus NO. 2 weeks following arterial injury, in the type 1 diabetic rats, NO most effectively reduced the neointimal area in the moderate and tightly controlled groups (81% and 88% vs. 33%, respectively, p=0.01). In type 2 diabetic rats, the metabolic environment had no impact on the efficacy of NO (81-82% reduction for all groups). Thus, in this study, we show NO is effective at inhibiting neointimal hyperplasia in both type 1 and type 2 diabetic environments. A greater understanding of how the metabolic environment may impact the efficacy of NO may lead to the development of more effective NO-based therapies for patients with diabetes.
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Affiliation(s)
- Monica P Rodriguez
- Division of Vascular Surgery, and Institute for BioNanotechnology in Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Zachary M Emond
- Division of Vascular Surgery, and Institute for BioNanotechnology in Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Zheng Wang
- Division of Vascular Surgery, and Institute for BioNanotechnology in Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Janet Martinez
- Division of Vascular Surgery, and Institute for BioNanotechnology in Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Qun Jiang
- Division of Vascular Surgery, and Institute for BioNanotechnology in Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melina R Kibbe
- Division of Vascular Surgery, and Institute for BioNanotechnology in Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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16
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Cittadini A, Monti MG, Castiello MC, D'Arco E, Galasso G, Sorriento D, Saldamarco L, De Paulis A, Napoli R, Iaccarino G, Saccà L. Insulin-like growth factor-1 protects from vascular stenosis and accelerates re-endothelialization in a rat model of carotid artery injury. J Thromb Haemost 2009; 7:1920-8. [PMID: 19740101 DOI: 10.1111/j.1538-7836.2009.03607.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND IGF-1 is a potent mitogen for vascular smooth muscle cells, but exerts protective effects on endothelial cells that may trigger antiatherogenic mechanisms. OBJECTIVES This study was designed to test the hypothesis that an IGF-1 excess following arterial injury prevents neointima formation and vascular stenosis. METHODS Rats were subjected to carotid balloon injury and treated with IGF-1 (1.2 mg kg(-1) per die) or saline for 10 days. RESULTS In IGF-1 treated animals, high tissue levels of eNOS, Akt and its phosphorylated form were found, confirming activation of IGF-1-dependent signaling pathways. IGF-1 markedly reduced neointima formation and post-injury arterial stenosis. IGF-1 exerted proliferative and anti-apoptotic effects in the media of injured carotids, but inhibited mitotic activity and induced apoptosis in the neointima. Furthermore, IGF-1 stimulated mobilization of progenitor endothelial cells and re-endothelialization of the injured arteries. L-NAME administration inhibited IGF-1 vasculoprotective effects. CONCLUSIONS IGF-1 attenuates post-injury carotid stenosis by exerting differential effects in the neointima and tunica media with regard to the key components of the response to injury. The data point to a novel role of IGF-1 as a potent vasculoprotective factor.
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Affiliation(s)
- A Cittadini
- Department of Internal Medicine, University Federico II, Naples, Italy
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17
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Abstract
BACKGROUND Neointimal development is seen clinically after both vein grafting and balloon catheterization, but may not represent the same pathology under these 2 conditions. This study compared the degree of neointimal hyperplasia after vein grafting or arterial-injury grafts in 2 strains of mice: C57Bl/6 and FVB. METHODS AND RESULTS Jugular vein branches were interpositioned as grafts in the femoral artery of syngenic-matched mice, with graft harvest at 30 days. Wire-injured carotid arteries were grafted to the carotid arteries of syngenic-matched mice, with graft harvest at 14 days. Histomorphometry revealed no strain differences in vein grafts in the extent of position-dependent neointimal thickening or lumen cross-sectional area. Both strains showed significantly thicker neointima and less lumen area at the proximal graft site (vs the mid-graft; p<0.05). In contrast, a significantly greater neointimal thickness was found in the wire-injured carotid grafts of FVB mice vs those of C57Bl/6 mice (p<0.05). CONCLUSIONS Neointimal formation shows a vessel-dependent, strain-dependent difference, with greater arterial neointimal thickening in FVB mice. These data suggest that different mechanisms operate for arterial-injury- vs vein-graft-associated neointimal development and that the difference has a genetic basis.
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Affiliation(s)
- Brian C Cooley
- Allen Bradley Medical Sciences Laboratory, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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18
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Newton JD, Sprigings DC. Central venous catheterization. N Engl J Med 2007; 357:943; author reply 944-5. [PMID: 17806137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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19
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Rajasingh J, Bord E, Luedemann C, Asai J, Hamada H, Thorne T, Qin G, Goukassian D, Zhu Y, Losordo DW, Kishore R. IL-10-induced TNF-alpha mRNA destabilization is mediated via IL-10 suppression of p38 MAP kinase activation and inhibition of HuR expression. FASEB J 2006; 20:2112-4. [PMID: 16935932 DOI: 10.1096/fj.06-6084fje] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inflammation plays an essential role in vascular injury and repair. Mononuclear phagocytes are important contributors in these processes, in part, via adhesive interactions and secretion of proinflammatory cytokines. The antiinflammatory cytokine interleukin (IL)-10 suppresses such responses via deactivation of monocytes/macrophages and repression of inflammatory cytokine expression. The mechanisms of IL-10's suppressive action are, however, incompletely characterized. Here, we report that systemic IL-10 treatment after carotid artery denudation in mice blunts inflammatory cell infiltration and arterial tumor necrosis factor (TNF) expression. At the molecular level, in a human monocytic cell line, U937 IL-10 suppressed LPS-induced mRNA expression of a number of inflammatory cytokines, mainly via posttranscriptional mRNA destabilization. Detailed studies on IL-10 regulation of TNF-alpha mRNA expression identified AU-rich elements (ARE) in the 3' untranslated region as a necessary determinant of IL-10-mediated TNF-alpha mRNA destabilization. IL-10 sensitivity to TNF depends on the ability of IL-10 to inhibit the expression and mRNA-stabilizing protein HuR and via IL-10 mediated repression of p38 mitogen-activated protein (MAP) kinase activation. Because IL-10 function and signaling are important components for control of inflammatory responses, these results may provide insights necessary to develop strategies for modulating vascular repair and other accelerated arteriopathies, including transplant vasculopathy and vein graft hyperplasia.
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Affiliation(s)
- Johnson Rajasingh
- Division of Cardiovascular Research, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA
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20
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Abstract
Behçet's disease is a multi systemic vasculitis of unknown origin characterized by recurrent oral and genital ulcerations, uveitis and skin lesions. Vascular involvement mainly interesting the venous system is present in about 7 to 38% of patients. Arterial involvement is present in 2 to 8% of patients and is associated with a high mortality. It may present as aneurysms, pseudo aneurysms or arterial occlusions. Pseudo aneurysm formation has been reported to be sometimes due to invasive imaging techniques, it may also follow arterial repair. We report two exceptional localizations of iatrogenic pseudo aneurysms due to accidental arterial puncture, involving respectively the internal carotid artery and the humeral artery. We discuss the clinical characteristics and therapeutic modalities of this complication.
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Affiliation(s)
- I Ben Ghorbel
- Service de Médecine Interne, Hôpital La Rabta, 1007 Tunis, Tunisie
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21
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Bültmann A, Herdeg C, Li Z, Münch G, Baumgartner C, Langer H, Kremmer E, Geisler T, May A, Ungerer M, Gawaz M. Local delivery of soluble platelet collagen receptor glycoprotein VI inhibits thrombus formation in vivo. Thromb Haemost 2006; 95:763-6. [PMID: 16676064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Platelet-mediated thrombus formation at the site of vascular injury is a major trigger for thrombo-ischemic complications after coronary interventions. The platelet collagen receptor glycoprotein VI (GPVI) plays a critical role in the initiation of arterial thrombus formation. Endothelial denudation of the right carotid artery in rabbits was induced through balloon injury. Subsequently, local delivery of soluble, dimeric fusion protein of GPVI (GPVI-Fc) (n = 7) or control Fc (n = 7) at the site of vascular injury was performed with a modified double-balloon drug-delivery catheter. Thrombus area within the injured carotid artery was quantified using a computer-assisted image analysis and was used as index of thrombus formation. The extent of thrombus formation was significantly reduced in GPVI-Fc- compared with control Fc-treated carotid arteries (relative thrombus area, GPVI-Fc vs. Fc: 9.3 +/- 4.2 vs. 2.3 +/- 1.7, p < 0.001). Local delivery of soluble GPVI resulted in reduced thrombus formation after catheter-induced vascular injury. These data suggest a selective pharmacological modulation of GPVI-collagen interactions to be important for controlling onset and progression of pathological arterial thrombosis, predominantly or even exclusively at sites of injured carotid arteries in the absence of systemic platelet therapy.
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Affiliation(s)
- Andreas Bültmann
- Medizinische Klinik III, Eberhard Karls Universität Tübingen, Tübingen, Germany
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22
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Jagadeesha DK, Lindley TE, Deleon J, Sharma RV, Miller F, Bhalla RC. Tempol therapy attenuates medial smooth muscle cell apoptosis and neointima formation after balloon catheter injury in carotid artery of diabetic rats. Am J Physiol Heart Circ Physiol 2005; 289:H1047-53. [PMID: 15833798 DOI: 10.1152/ajpheart.01071.2004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Accumulating data support the hypothesis that reactive oxygen species (ROS) play a critical role in the vascular complications observed in diabetes. However, the mechanisms of ROS-mediated vascular complications in diabetes are not clear. We tested the hypothesis that ROS-mediated increase in proapoptotic factor Bax expression leads to medial smooth muscle cell (SMC) apoptosis that is associated with neointima formation. We used a fructose-rich diet for 4 wk to model Type 2 diabetes in rats. SOD mimetic membrane-permeable 4-hydroxy-2,2,6,6,-tetramethylpiperidine-1-oxyl (Tempol, 1 mM) was administered in drinking water to scavenge superoxide starting 1 day before surgery and continued during the duration of the experiment. Vascular injury resulted in a significant increase in medial SMC apoptosis that was associated with neointima formation. The number of medial SMC positive for Bax immunostaining significantly increased in injured arteries compared with uninjured arteries. Superoxide scavenging by Tempol treatment inhibited both the Bax-positive index as well as the apoptotic index of medial SMC in response to vascular injury. Tempol treatment inhibited apoptotic loss of medial SMC, thus increasing their density in the injured arteries. These alterations in the media were associated with a marked decrease in neointima formation in injured arteries. We conclude that Bax expression may play an important role in vascular SMC apoptosis and, finally, that this regulatory mechanism is redox sensitive.
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Affiliation(s)
- D K Jagadeesha
- Department of Anatomy and Cell Biology, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
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23
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24
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Abstract
Background—
Activated protein C resistance due to factor V Leiden (FVL) is a common genetic risk factor for venous thrombosis in humans. Although the impact of FVL on the development of venous thrombosis is well established, its effect on arterial thrombosis and atherosclerosis is controversial.
Methods and Results—
To determine the effect of the FVL mutation on arterial thrombosis in the mouse, wild-type (
Fv
+/+
), heterozygous FVL (
Fv
Q
/+
), and homozygous FVL (
Fv
Q/Q
) mice underwent photochemical carotid arterial injury to induce occlusive thrombosis.
Fv
Q/Q
mice formed occlusive thromboses 27±3 minutes (n=7) after the onset of injury, which was significantly shorter than that observed for
Fv
+/+
mice (56±7 minutes, n=9,
P
<0.01), whereas
Fv
Q
/+
mice (41±7 minutes, n=5) were intermediate (
P
=0.5, compared with
Fv
+/+
). To determine the source of FVL relevant to the enhanced vascular thrombosis, bone marrow transplantation experiments were performed between
Fv
+/+
and
Fv
Q/Q
mice.
Fv
Q/Q
mice transplanted with
Fv
+/+
bone marrow formed occlusive thromboses at 35±5 minutes (n=7,
P
<0.05 compared with
Fv
+/+
mice), whereas
Fv
+/+
mice transplanted with
Fv
Q/Q
bone marrow occluded at 59±7 minutes (n=6,
P
<0.001 compared with
Fv
Q/Q
mice). To assess the effect of the FVL mutation on the development of atherosclerosis,
Fv
Q/Q
mice were crossed with the atherosclerosis-prone apolipoprotein E (ApoE)–deficient strain (
ApoE
−/−
) to generate
Fv
Q/Q
,ApoE
−/−
mice. By 52 weeks of age,
Fv
Q/Q
,ApoE
−/−
mice (n=8) had developed more aortic atherosclerosis (40±6% lesion area) compared with
Fv
+/+
,ApoE
−/−
mice (15±3% lesion area; n=12,
P
<0.02).
Conclusions—
In conclusion, homozygosity for the FVL mutation in mice leads to enhanced arterial thrombosis and atherosclerosis. The source of the FVL leading to accelerated thrombosis appears to be circulating, non–platelet-derived plasma FVL.
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Affiliation(s)
- Daniel T Eitzman
- Division of Cardiology, University of Michigan Medical Center, Ann Arbor 48109-0644, USA.
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25
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Agrotis A, Kanellakis P, Kostolias G, Di Vitto G, Wei C, Hannan R, Jennings G, Bobik A. Proliferation of Neointimal Smooth Muscle Cells after Arterial Injury. J Biol Chem 2004; 279:42221-9. [PMID: 15292181 DOI: 10.1074/jbc.m408121200] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The growth factor signaling mechanisms responsible for neointimal smooth muscle cell (SMC) proliferation and accumulation, a characteristic feature of many vascular pathologies that can lead to restenosis after angioplasty, remain to be identified. Here, we examined the contribution of fibroblast growth factor receptors (FGFRs) 2 and 3 as well as novel fibroblast growth factors (FGFs) to such proliferation. Balloon catheter injury to the rat carotid artery stimulated the expression of two distinctly spliced FGFR-2 isoforms, differing only by the presence or absence of the acidic box, and two distinctly spliced FGFR-3 isoforms containing the acidic box and differing only by the presence of either the IIIb or IIIc exon. Post-injury arterial administration of recombinant adenoviruses expressing dominant negative mutant forms of these FGFRs were used to assess the roles of the endogenous FGFR isoforms in neointimal SMC proliferation. Dominant negative FGFR-2 containing the acidic box inhibited such proliferation by 40%, whereas the dominant negative FGFR-3 forms had little effect. Expression of FGF-9, known to be capable of binding to all four neointimal FGFR-2/-3 isoforms, was abundant within the neointima. FGF-9 markedly stimulated both the proliferation of neointimal SMCs and the activation of extracellular signal-related kinases 1/2, effects which were abrogated by the administration of antisense FGF-9 oligonucleotides to injured arteries and the expression of the dominant negative FGFR-2 adenovirus in cultured neointimal SMCs. These studies demonstrate that, although multiple FGFRs are induced in neointimal SMCs following arterial injury, specific interactions between distinctly spliced FGFR-2 isoforms and FGF-9 contribute to the proliferation of these SMCs.
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MESH Headings
- Animals
- Carotid Artery Injuries
- Catheterization/adverse effects
- Cell Division
- Fibroblast Growth Factor 9
- Fibroblast Growth Factors/analysis
- Fibroblast Growth Factors/biosynthesis
- Fibroblast Growth Factors/physiology
- Mitogen-Activated Protein Kinases/metabolism
- Muscle, Smooth, Vascular/cytology
- Myocytes, Smooth Muscle/cytology
- Protein Isoforms/analysis
- Protein Isoforms/biosynthesis
- Protein-Tyrosine Kinases/analysis
- Protein-Tyrosine Kinases/biosynthesis
- Rats
- Receptor Protein-Tyrosine Kinases/analysis
- Receptor Protein-Tyrosine Kinases/biosynthesis
- Receptor Protein-Tyrosine Kinases/physiology
- Receptor, Fibroblast Growth Factor, Type 2
- Receptor, Fibroblast Growth Factor, Type 3
- Receptors, Fibroblast Growth Factor/analysis
- Receptors, Fibroblast Growth Factor/biosynthesis
- Receptors, Fibroblast Growth Factor/physiology
- Tunica Intima/cytology
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Affiliation(s)
- Alex Agrotis
- Cell Biology Laboratory, Baker Heart Research Institute, St. Kilda Road Central, P. O. Box 6492, Melbourne 8008, Victoria, Australia.
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26
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Shibata R, Kai H, Seki Y, Kusaba K, Takemiya K, Koga M, Jalalidin A, Tokuda K, Tahara N, Niiyama H, Nagata T, Kuwahara F, Imaizumi T. Rho-kinase inhibition reduces neointima formation after vascular injury by enhancing Bax expression and apoptosis. J Cardiovasc Pharmacol 2004; 42 Suppl 1:S43-7. [PMID: 14871028 DOI: 10.1097/00005344-200312001-00011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recently, we have shown that a specific Rho-kinase inhibitor, Y27632 (R-(+)-trans-N-(4-pyridyl)-4-(1-aminoethyl)-cyclohexanecarboxamide), prevents neointima formation after vascular injury associated with increased terminal deoxynucleotidyl transferase-mediated dUTP nickend labeling (TUNEL)+ smooth muscle cells. Because the mechanism of the action of Y27632 remains unclear, we investigated the expression changes in Bcl family proteins, apoptosis regulators of smooth muscle cells, in the rat carotid artery after balloon injury (BI). Y27632 (BI + Y group) or saline (BI group) was administered peritoneally from Day 1 to Day 14 after BI. Y27632 markedly prevented neointima formation at Day 14. In the BI group, TUNEL+ smooth muscle cells were transiently increased in the neointima, but not in the media, with a peak at Day 7, returning to a lower level by Day 14. Y27632 significantly increased TUNEL+ smooth muscle cells at Days 7 and 14. Smooth muscle cell apoptosis was confirmed by electron microscopic examination. At Day 14, although proapoptotic Bax was slightly, but not significantly, increased in the BI group, it was significantly upregulated in the BI + Y group. Antiapoptotic Bcl-xL was upregulated in the BI group, and the upregulated Bcl-xL was not affected by Y27632. These findings indicate that Rho-kinase inhibition induces neointimal smooth muscle cell apoptosis through Bax upregulation, resulting in reduced neointima formation.
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Affiliation(s)
- Rei Shibata
- Cardiovascular Research Institute, Department of Internal Medicine III, Kurume University School of Medicine, Kurume, Japan
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27
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Nanobashvili J, Prager M, Jozkowicz A, Neumayer C, Fügl A, Blumer R, Cabaj A, Wrba F, Polterauer P, Huk I. Positive Effect of Treatment with Synthetic Steroid Hormone Tibolon on Intimal Hyperplasia and Restenosis after Experimental Endothelial Injury of Rabbit Carotid Artery. Eur Surg Res 2004; 36:74-82. [PMID: 15007259 DOI: 10.1159/000076646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2003] [Accepted: 09/08/2003] [Indexed: 11/19/2022]
Abstract
BACKGROUND Arterial intimal hyperplasia and following restenosis may be inhibited by estrogens. We investigated the effect of a synthetic steroid hormone, Tibolon: (a) on intima hyperplasia and restenosis in vivo, and (b) on production of endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF), endothelial cell proliferation and apoptosis in vitro. METHODS Influence of Tibolon treatment (0.1 mg/kg body weight, during 3 days before and 3 weeks after the operation as a drinking solution once daily) on neointimal formation (measured by morphometry) and arterial wall damage (by qualitative histology) were investigated in vivo using an animal model of balloon injury of carotid artery. In human umbilical vein endothelial cells (HUVEC) and human microvascular endothelial cells (HMEC-1), the effect of Tibolon (0.1 microg/ml) on eNOS and VEGF was assessed by ELISA. Cell proliferation was induced by VEGF(165) and measured by BrdU incorporation assay, cell apoptosis was detected colorimetrically measuring DNA fragmentation. RESULTS Balloon injury resulted in neointima formation and prominent damage of the carotid artery wall. Treatment with Tibolon increased luminal area, decreased intimal area and intima to media ratio, and promoted better reparation of damaged vessel wall. In vitro, Tibolon treatment did not influence the expression of eNOS protein in HUVEC as well as cell proliferation rate but reduced apoptosis of endothelial cells by about 40%. Additionally, this treatment suppressed basal and IL-1beta-stimulated synthesis of VEGF in HMEC-1. CONCLUSIONS Tibolon treatment suppressed neointimal formation and promoted better reparation of damaged vessel wall in carotid artery after balloon injury. This positive effect seems to be associated with improved endothelial cell survival resulting possibly in increased NO production. It might be also related to the decrease of VEGF generation.
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Affiliation(s)
- J Nanobashvili
- Department of Vascular Surgery, University of Vienna, Austria.
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28
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Abstract
BACKGROUND Increasing use of transgenic and gene targeting techniques for the investigation of hemostasis and vascular biology has generated interest in experimental models of carotid artery thrombosis in mice. OBJECTIVES We tested the hypothesis that hypoventilation in anesthetized mice may cause hypercapnia, increased carotid artery blood flow, and altered thrombotic responses to photochemical injury of the carotid artery. METHODS Arterial blood gases and carotid artery blood flow were measured in pentobarbital-anesthetized BALB/c or C57BL/6 J mice with and without mechanical ventilation. Photochemical injury of the carotid artery was induced using the rose bengal method. RESULTS Compared with ventilated mice, unventilated mice had a 45% increase in carotid artery blood flow (0.74 +/- 0.04 vs. 0.41 +/- 0.03 mL min-1; P < 0.001) that was associated with an elevation of arterial PCO2 (58 +/- 4 vs. 33 +/- 4 mmHg; P < 0.05) and a decrease in arterial pH (7.18 +/- 0.05 vs. 7.32 +/- 0.03; P < 0.05). Time to first occlusion of the carotid artery after photochemical injury was shorter in ventilated than in unventilated mice (29 +/- 6 vs. 73 +/- 9 min; P < 0.001). Time to stable occlusion was also shorter in ventilated mice (49 +/- 8 vs. 81 +/- 6 min; P < 0.05). Elevated carotid artery blood flow, hypercarbic acidosis, and prolonged occlusion times also were observed in mice ventilated with supplemental carbon dioxide. CONCLUSIONS General anesthesia without mechanical ventilation has the potential to confound studies of experimental thrombosis in vivo by producing hypoventilation, hypercapnia, acidosis, and altered carotid artery blood flow. Mechanical ventilation with maintenance of normal blood gases may enhance the physiological insight gained from experimental models of carotid artery thrombosis in mice.
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Affiliation(s)
- K M Wilson
- Internal Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA
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Guo Y, Li Q, Chen G, Tang J, Gao W. [Adenovirus-mediated transfer of TIMP-4 gene inhibits neointimal formation after balloon injury]. Beijing Da Xue Xue Bao Yi Xue Ban 2003; 35:434-7. [PMID: 12947565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To investigate the effects of human tissue inhibitor of matelloproteinase-4 (TIMP-4) on vascular smooth muscle cells (VSMCs) migration and the neointimal formation after balloon injury in rats. METHODS The cultured VSMCs were transfected with an adenoviral vector containing human TIMP-4 gene, AdTIMP-4. Effect of TIMP-4 on VSMC migration was investigated by monolayer cell scrape. AdTIMP-4, control adenoviral vector or PBS was transduced into the rat carotid artery from the adventitial after carotid artery injury. Cell number within the internal elastic lamina 4 days after gene transfer was counted and neointima/media area ratio 28 days after gene transfer was calculated. RESULTS The migration distance of VSMCs infected with AdTIMP-4 was inhibited markedly. Morphometric analysis demonstrated a statistically significant reduction in the number of cells migrated into neointima compared with controls [(32.5 +/- 4.8) cells per section, (33.8 +/- 7.0) cells per section and (8.2 +/- 2.4) cells per section for uninfected, AdGFP-treated and AdTIMP-4-treated arteries, respectively]. There was a reduction of intima/media ratio of TIMP-4-treated group by 66.5% compared with control groups 28 days after gene transfer (P < 0.01). There was no statistical difference between the control adenoviral vector group and PBS group. CONCLUSION Adenoviral mediated gene transfer of TIMP-4 inhibits migration of VSMC and significantly reduces neointimal hyperplasia in the rat carotid balloon injury model. The TIMP-4 gene transfer is a potential therapeutic approach to preventing neointimal formation after balloon injury.
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Affiliation(s)
- Yanhong Guo
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
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30
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Affiliation(s)
- Anita C Thomas
- Centre for Research in Vascular Biology, School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Queensland, Australia.
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32
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Abstract
Intimal hyperplasia is a common complication following vascular interventions. To understand the underlying pathophysiology, the focus has mainly been on the intima and media. The adventitia has been less investigated, although adventitial hyperplasia is seen together with intimal hyperplasia. If the adventitial response is an important part of the process, the adventitia might be a target to inhibit intimal hyperplasia. In the present study we investigated whether an external collar attenuating the adventitial thickness could inhibit a balloon-induced intimal hyperplasia. The common carotid artery was injured in rabbits (n = 6) with a 3-french balloon catheter. The mid portion of the injured artery was encircled with a silicone collar (diameter = 2.0 mm). After 14 days the balloon-induced neointima was reduced by 54 +/- 6.3% underneath the collar. The adventitial and medial thickenings were also attenuated (36 +/- 8.7 and 44 +/- 4.3%, respectively). This study demonstrates that intimal hyperplasia following balloon injury can be inhibited with an external collar. This supports the idea of the adventitia as a potential target to inhibit intimal hyperplasia.
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Affiliation(s)
- Per Fogelstrand
- Wallenberg Laboratory for Cardiovascular Research, Department of Vascular Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
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33
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Sindermann JR, Smith J, Köbbert C, Plenz G, Skaletz-Rorowski A, Solomon JL, Fan L, March KL. Direct evidence for the importance of p130 in injury response and arterial remodeling following carotid artery ligation. Cardiovasc Res 2002; 54:676-83. [PMID: 12031714 DOI: 10.1016/s0008-6363(02)00272-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Remodeling of arterial morphology in atherosclerosis, hypertension, and restenosis following angioplasty involves controlled alterations in total vascular circumference which critically modulate sequelae of changes in vessel wall mass. Despite the clinical relevance of this process little is known about the pathophysiology, especially the correlation between smooth muscle cell proliferation and remodeling. METHODS Carotid artery ligation was applied to mice with targeted disruption of the p130 gene (p130 -/-). Mice were allowed to recover for 3 weeks after ligation and then perfusion fixed for histologic and morphometric analysis. RESULTS P130 -/- mice were indistinguishable from control littermates concerning size and weight. As for the aorta, carotid arteries and femoral arteries, no significant differences were found between the groups with regard to vessel size and cellular density of the vessel wall of non-instrumented vessels. In contrast, following carotid artery ligation we found p130 -/- mice (n=8) to develop a significant increase in vessel wall area compared to controls (n=9). Mean values ranged from 3.07 x 10(-2)+/-0.20 x 10(-2)-3.56 x 10(-2)+/-0.62 x 10(-2) mm(2) for p130 -/- mice versus 2.26 x 10(-2)+/-0.13 x 10(-2)-2.57 x 10(-2)+/-0.26 x 10(-2) mm(2) for controls (p=0.02) along the lesion studied. This increase in vessel wall area was primarily due to a sevenfold mean increase in neointima in p130 -/- mice yielding mean values of 0.43+/-0.18 - 1.19+/-0.70 x 10(-2) mm(2). Remarkably, despite vessel wall increase, the lumen area was not statistically different for both groups. CONCLUSIONS The data indicate that the loss of the cell cycle inhibitor p130 leads to an enhanced injury response, implicating a central role of p130 in cell cycle control during response to injury in the vessel wall. The enhanced injury response in the context of p130 -/- preserves the ability to perform perfect remodeling, thus the remodeling capacity is preserved even in the context of this injury model.
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Affiliation(s)
- Jürgen R Sindermann
- Krannert Institute of Cardiology and Indiana Center for Vascular Biology and Medicine, Indiana University Medical Center, Indianapolis, IN 46202, USA.
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34
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Affiliation(s)
- Jai V Patel
- The Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK.
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35
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Kume M, Komori K, Matsumoto T, Onohara T, Takeuchi K, Yonemitsu Y, Sugimachi K. Administration of a decoy against the activator protein-1 binding site suppresses neointimal thickening in rabbit balloon-injured arteries. Circulation 2002; 105:1226-32. [PMID: 11889018 DOI: 10.1161/hc1002.104903] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transcription factor activator protein-1 (AP-1) is activated and upregulated in injured arterial smooth muscle cells in vivo, yet the exact role of the AP-1--related pathway in vascular disease in vivo has remained unclear. We examined the role of the transfer of synthetic double-stranded cis-element decoy oligodeoxynucleotides (ODNs) in balloon-injured rabbit carotid arteries and the effects of these ODNs on neointimal thickening. METHODS AND RESULTS Transfection of fluorescein isothiocyanate--labeled ODNs using the hemagglutinating virus of Japan liposome method resulted in widespread distribution of fluorescent nuclear signals over the entire medial layer in injured arteries. Gel mobility shift assay revealed that AP-1 DNA binding was activated and that the AP-1 decoy reduced AP-1 DNA binding activity as a result of specific binding affinity to AP-1 in vivo. In morphometric analyses, AP-1 decoy led to a significant reduction in the neointimal area and a significant reduction in cell number and transforming growth factor-beta(1) production of human aortic smooth muscle cells under conditions of platelet-derived growth factor stimulation. CONCLUSIONS Because AP-1 decoy transfection in vivo dramatically prevented neointimal thickening in balloon-injured arteries, AP-1 may be a useful molecular target for gene therapy to reduce restenosis.
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MESH Headings
- Adult
- Animals
- Binding Sites/drug effects
- Binding, Competitive/drug effects
- Carotid Artery Injuries
- Carotid Artery, Common/pathology
- Carotid Stenosis/etiology
- Carotid Stenosis/pathology
- Carotid Stenosis/prevention & control
- Catheterization/adverse effects
- Cell Count
- Cell Division/drug effects
- Cells, Cultured
- DNA/metabolism
- Disease Models, Animal
- Fluorescein-5-isothiocyanate
- Genetic Therapy/methods
- Humans
- Liposomes
- Male
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Oligonucleotides/genetics
- Oligonucleotides/metabolism
- Oligonucleotides/pharmacology
- Rabbits
- Sendai virus/genetics
- Transcription Factor AP-1/antagonists & inhibitors
- Transcription Factor AP-1/metabolism
- Transfection
- Transforming Growth Factor beta/metabolism
- Transforming Growth Factor beta1
- Tunica Intima/drug effects
- Tunica Intima/injuries
- Tunica Intima/metabolism
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Affiliation(s)
- Masazumi Kume
- Department of Surgery and Science, Graduate School of Medical Sciences and Division of Pathophysiological and Experimental Pathology, Kyushu University, Fukuoka, Japan
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Abstract
The deaths of two children who were passengers in motor vehicles involved in accidents were directly attributable to vascular injuries derived from seat belts. In the first case, a 10-year-old boy died as a result of abdominal aortic transection by a lap seat belt, and in the second case a 15-year-old boy died as a result of transection of his common carotid artery by a lap-shoulder seat belt. Although these cases demonstrate rare fatalities associated with seat belt use, there is no doubt that seat belts have significantly reduced mortality and morbidity from traffic accidents. Although it is possible that a fatal outcome might have occurred in each of these cases from other injuries that might have been sustained had seat belts not been worn, appropriate positioning and size of seat belt harnesses might have avoided the lethal injuries.
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Affiliation(s)
- K J Riches
- Forensic Science Centre, Adelaide, South Australia.
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Abstract
PURPOSE To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection. CASE REPORT A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications. CONCLUSIONS Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.
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Affiliation(s)
- Rebecca Holder
- Department of Radiology, Royal Liverpool University Hospital, England, UK
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38
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Abstract
Hyperhomocysteinemia is a significant risk factor in atherosclerosis and thrombosis. However, its role in the development of intimal hyperplasia after arterial reconstructive procedures remains uncertain. We therefore studied the effect of homocysteine on intimal hyperplasia in a rat model of carotid artery balloon injury. Twenty-four Sprague-Dawley rats were divided into three groups: control (saline infusion), and low dose (0.14 mg/day) and high dose (0.71 mg/day) homocysteine delivered continuously via osmotic pumps implanted intraperitoneally. All animals underwent left common carotid artery balloon denudation with sacrifice after 14 days. Plasma homocysteine levels, intimal hyperplasia, and cell proliferation of rat carotid arteries were determined. In vitro rat smooth muscle cell (SMC) proliferation with homocysteine treatment was also performed. Plasma homocysteine levels at sacrifice were 1.80+/-0.35, 2.65+/-0.05 and 3.50+/-0.22 microM in three groups, respectively. Intimal hyperplasia developed in all balloon-injured arteries in both control and homocysteine-treated animals. The intimal area and intima/media area ratio were increased by 92% (P<0.05) and 105% (P<0.05), respectively, in the high dose-homocysteine-treated animals as compared to the control animals. Homocysteine (high dose) also significantly promoted the intimal cell proliferation (bromodeoxyuridine incorporation) by 2.2-fold as compared to controls. Furthermore, homocysteine treatment in the cell culture study showed a concentration-dependent increase of rat SMC proliferation. These data demonstrate that the continuous intraperitoneal administration of homocysteine significantly increases intimal hyperplasia and SMC proliferation after carotid artery balloon injury in the rat as well as in vitro SMC proliferation. This study suggests that, following arterial reconstructive procedures, elevated plasma homocysteine may increase the complications of clinical restenoses that are associated with intimal hyperplasia.
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Affiliation(s)
- Changyi Chen
- Department of Surgery, Division of Vascular Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
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39
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Stansby G, Chan YC, Berwanger CS, Shurey S, Rook GAW, Stanford JL. Prevention of experimental myointimal hyperplasia by immunomodulation. Eur J Vasc Endovasc Surg 2002; 23:23-8. [PMID: 11748944 DOI: 10.1053/ejvs.2001.1549] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION we have tested the hypothesis that treatment with a mycobacterial preparation that modulates the antibody response, would diminish restenosis in a rat angioplasty model. MATERIALS/METHODS male Sprague-Dawley rats were used. All immunisations were given subcutaneously. Group A (control) received normal saline on days 0, 21, and 42. Group B received SRL172 on days 0, 21, and 42. Group C received SRL172 on days 0, 21, and 42, and hsp65/Incomplete Freund's on days 21 and 42. Group D received hsp65/Freund's on days 21 and 42. Right common carotid arteries were balloon-injured on day 63 using a standard technique known to produce MIH and animals were sacrificed on day 77. For each carotid 6 microm cross sections were cut from paraffin blocks. Cross-sectional areas were measured by computerised planimetry. RESULTS balloon injury resulted in MIH in all animals. Data represents mean+/-SEM for the percentage of area enclosed within the internal elastic lamina occupied by MIH (% MIH); which for groups A, B, C, and D was 85+/-11, 24+/-3, 27+/-7, and 17+/-3 respectively. All the treatment groups had significantly less MIH when compared to the control group but no statistically significant difference was found between any of the treatment groups. CONCLUSIONS this is the first report that immunomodulation with mycobacterial material suitable for use in man, can reduce MIH. Since such modulation has low risk, this raises the prospect of an important new therapeutic modality to combat restenosis.
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Affiliation(s)
- G Stansby
- Academic Surgical Unit, Imperial College School of Medicine at St. Mary's, London, UK
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40
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Abstract
The exposure of vascular injuries is contingent on knowledge of anatomy and the limitations and boundaries for proximal and distal control of each artery. In this article, these are conveniently organized into arteries of the neck, of the chest, of the abdomen, and of the extremities. In addition, the interface between the neck and chest, and the chest and the abdomen provide particular challenges because of the need to expose two body regions frequently. The anatomy, the points of proximal and distal control, the details of exposure, and the key maneuvers required to expose particular arteries are reviewed.
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Affiliation(s)
- D B Hoyt
- Division of Trauma, Burns, and Surgical Critical Care, University of California San Diego Medical Center, 92103-8896, USA.
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41
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Cheng B, Tu Z, Mao Z. [Surgical treatment of great vessel injuries of thoracic outlet]. Zhonghua Wai Ke Za Zhi 2001; 39:850-1. [PMID: 11930739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To summarize the experience in surgical treatment of great vessel injury of the thoracic outlet. METHODS Thirty-two cases (24 men and 8 women aged 2-48 years) treated by surgery were collected during the period of 1970-1998. Sharp injury, blunt injury or decelerated injury was the causes. The vessels of injury included the common carotid artery, subclavian artery and accompanying veins. Emergency suture or repair of the artery with polyester patch was performed in 15 patients, aneurysmectomy in 6, resection of vessels with end-to-end anastomosis in 5, Gore-Tex vessel reconstruction in 2, and transplantation of the great saphenous vein in 3. RESULTS Twenty-four patients (75%) were cared and 7 (21.8%) died. CONCLUSIONS In the early period, patients with great vessel injury of the thoracic outlet died from acute bleeding, cerebral ischemia or combined multiple injuries, in the later period, however, false aneurysm develop. The operation is appropriate to the recondition of damaged cut, the effect of evolution in false aneurysm is approving. For large damaged cut or for bigger vessel injuries, the repair with polyester patch, Gore-Tex of blood vessel reconstruction or the transplantation of the great saphenous vein must be used.
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Affiliation(s)
- B Cheng
- Department of Cardiothoracic Surgery, People's Hospital, Wuhan University, Wuhan 430060, China
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Karas RH, van Eickels M, Lydon JP, Roddy S, Kwoun M, Aronovitz M, Baur WE, Conneely O, O'Malley BW, Mendelsohn ME. A complex role for the progesterone receptor in the response to vascular injury. J Clin Invest 2001; 108:611-8. [PMID: 11518735 PMCID: PMC209395 DOI: 10.1172/jci11374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2000] [Accepted: 06/18/2001] [Indexed: 11/17/2022] Open
Abstract
Clinical studies of hormone replacement therapy to prevent cardiovascular diseases have heightened interest in the cardiovascular effects of progestins. However, the role of the progesterone receptor (PR) in vascular biology has not been studied in vivo. We studied ovariectomized female PR knockout (PRKO) mice and their wild-type (WT) littermates using the mouse carotid artery injury model. Placebo-treated PRKO mice showed significantly greater vascular medial hypertrophy and vascular smooth muscle cell (VSMC) proliferation in response to vascular injury than did WT mice. Progesterone had no significant effect in the PRKO mice, but worsened the response to injury in WT mice. VSMCs cultured from PRKO mouse aortae were markedly hyperproliferative, and their growth was not affected by progesterone. In contrast to the in vivo findings, progesterone inhibited proliferation of WT-derived VSMCs. Furthermore, reintroduction of PR into PRKO-derived VSMCs using adenoviral methods restored progesterone-mediated inhibition of proliferation to these cells. This effect was reversed by the PR antagonist, RU 486. Thus, the effects of PR and progesterone differ markedly between cultured VSMCs and intact blood vessels. These data demonstrate a direct role for the PR in regulating the response to vascular injury and VSMC proliferation.
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MESH Headings
- Animals
- Carotid Artery Injuries
- Carotid Artery, Common/pathology
- Cell Division/drug effects
- Cells, Cultured/drug effects
- DNA Replication/drug effects
- Female
- Hormone Antagonists/pharmacology
- Hyperplasia
- Mice
- Mice, Knockout
- Mifepristone/pharmacology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/pathology
- Ovariectomy
- Progesterone/antagonists & inhibitors
- Progesterone/pharmacology
- Receptors, Progesterone/deficiency
- Receptors, Progesterone/drug effects
- Receptors, Progesterone/genetics
- Receptors, Progesterone/physiology
- Recombinant Fusion Proteins/physiology
- Transfection
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Affiliation(s)
- R H Karas
- Molecular Cardiology Research Institute, New England Medical Center Hospitals Inc., Tufts University School of Medicine, Boston, Massachusetts 02111, USA
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Hall JL, Chatham JC, Eldar-Finkelman H, Gibbons GH. Upregulation of glucose metabolism during intimal lesion formation is coupled to the inhibition of vascular smooth muscle cell apoptosis. Role of GSK3beta. Diabetes 2001; 50:1171-9. [PMID: 11334423 DOI: 10.2337/diabetes.50.5.1171] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to define the role of metabolic regulatory genes in the pathogenesis of vascular lesions. The glucose transporter isoform, GLUT1, was significantly increased in the neointima after balloon injury. To define the role of GLUT1 in vascular biology, we established cultured vascular smooth muscle cells (VSMCs) with constitutive upregulation of GLUT1, which led to a threefold increase in glucose uptake as well as significant increases in both nonoxidative and oxidative glucose metabolism as assessed by 13C-nuclear magnetic resonance spectroscopy. We hypothesized that the differential enhancement of glucose metabolism in the neointima contributed to formation of lesions by increasing the resistance of VSMCs to apoptosis. Indeed, upregulation of GLUT1 significantly inhibited apoptosis induced by serum withdrawal (control 20 +/- 1% vs. GLUT1 11 +/- 1%, P < 0.0005) as well as Fas-ligand (control 12 +/- 1% vs. GLUT1 6 +/- 1.0%, P < 0.0005). Provocatively, the enhanced glucose metabolism in GLUT1 overexpressing VSMC as well as neointimal tissue correlated with the inactivation of the proapoptotic kinase, glycogen synthase kinase 3beta (GSK3beta). Transient overexpression of GSK3beta was sufficient to induce apoptosis (control 7 +/- 1% vs. GSK3beta 28 +/- 2%, P < 0.0001). GSK3beta-induced apoptosis was significantly attenuated by GLUT1 overexpression (GSK3beta 29 +/- 3% vs. GLUT1 + GSK3beta 6 +/- 1%, n = 12, P < 0.001), suggesting that the antiapoptotic effect of enhanced glucose metabolism is linked to the inactivation of GSK3beta. Taken together, upregulation of glucose metabolism during intimal lesion formation promotes an antiapoptotic signaling pathway that is linked to the inactivation of GSK3beta.
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Affiliation(s)
- J L Hall
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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44
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Ofer A, Nitecki SS, Braun J, Daitzchman M, Goldsher D, Hoffman A, Engel A. CT Angiography of the Carotid Arteries in Trauma to the Neck. Eur J Vasc Endovasc Surg 2001; 21:401-7. [PMID: 11352513 DOI: 10.1053/ejvs.2001.1330] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES serious vascular injuries to the neck may be asymptomatic or masked by other life-threatening conditions. Angiography, the "gold standard" vascular imaging modality, is an invasive procedure. Moreover, it is time-consuming and thus may delay a needed vascular intervention. The results of screening angiography are negative in more than 80% of cases. Therefore other less invasive and faster screening tests, such as the Doppler ultrasound and magnetic resonance angiography, have been tested. This retrospective study was done to evaluate the use of CT angiography (CTA) in suspected vascular injuries of the neck. METHODS from 1995 to 1998, 16 patients with suspected traumatic carotid artery injury underwent CTA. Twelve of these patients had penetrating injuries and four had blunt injuries to the neck. CTAs were obtained by Elscint Twin Flash Spiral Scanner, while MIP reconstructions were carried out on an Omnipro, Elscint (Indy, Silicon Graphics) work station and interpreted by a radiologist. RESULTS all the CTAs were diagnostic. Positive findings included one complete tear of the right common carotid artery (confirmed by surgery) due to a penetrating injury and one bilateral internal carotid artery thrombosis after blunt injury to the neck. In addition, three patients with multiple trauma were operated on, due to either proximity only or questionable neurological findings. Surgical exploration confirmed the negative findings seen on CTA. CONCLUSION CT angiography of the carotid arteries in cervical trauma may be used as an accurate decisive tool for a needed surgical intervention. More studies with larger number of patients and comparison with angiography are needed.
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Affiliation(s)
- A Ofer
- Department of Diagnostic Radiology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Autieri MV. Expression of anaphase-promoting complex 5 in balloon angioplasty-injured rat carotid arteries and mitogen-stimulated human vascular smooth muscle cells. Biochem Biophys Res Commun 2001; 282:723-8. [PMID: 11401522 DOI: 10.1006/bbrc.2001.4650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We utilized differential display to identify differentially expressed mRNAs induced by balloon angioplasty injury. A recently described subunit of the anaphase-promoting complex, APC5, is not expressed in uninjured rat carotid arteries. Expression of APC5 mRNA is detectable as early as 1 day post-injury, reached maximal levels by 3-7 days, and declined by 14 days post-injury. APC5 is not expressed in serum-starved cultured human vascular smooth muscle cells (VSMC), but is strongly induced by mitogenic factors, and to a lesser extent by nonmitogenic cytokines. The kinetics of APC5 expression is associated with cell cycle progression, and corresponds with PCNA expression in PDGF-stimulated human VSMC. Interestingly, APC5 is expressed in most human tissues examined, regardless of their proliferative state. These data are the first description of the cytokine-inducible expression of APC5 and suggest that expression of this gene may represent an important event in the pathogenesis of vascular proliferative diseases.
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MESH Headings
- Amino Acid Sequence
- Anaphase-Promoting Complex-Cyclosome
- Angioplasty, Balloon/adverse effects
- Animals
- Apc5 Subunit, Anaphase-Promoting Complex-Cyclosome
- Carotid Artery Injuries
- Carotid Artery, Common/metabolism
- Cells, Cultured
- Cytokines/pharmacology
- DNA, Complementary/genetics
- Fibroblast Growth Factors/pharmacology
- Gene Expression
- Humans
- Ligases/genetics
- Male
- Mitogens/pharmacology
- Molecular Sequence Data
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Platelet-Derived Growth Factor/pharmacology
- Proliferating Cell Nuclear Antigen/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Sequence Homology, Nucleic Acid
- Ubiquitin-Protein Ligase Complexes
- Ubiquitin-Protein Ligases
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Affiliation(s)
- M V Autieri
- Department of Physiology, Heart Failure Research Group, Temple University School of Medicine, 3420 North Broad Street, Philadelphia, Pennsylvania 19140, USA.
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Affiliation(s)
- O Kohl
- Department of Internal Medicine, Division of Cardiology and Angiology, University Hospital Giebetaen, Germany
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Hainaud P, Bonneau M, Pignaud G, Bal dit Sollier C, André P, Hadjiisky P, Fieffé JP, Caen JP, Herbert JM, Dol F, Drouet LO. The calcium inhibitor SR33805 reduces intimal formation following injury of the porcine carotid artery. Atherosclerosis 2001; 154:301-8. [PMID: 11166762 DOI: 10.1016/s0021-9150(00)00487-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied the effect of SR33805, a calcium channel blocker, in vitro on the proliferation of vascular smooth muscle cells (SMC) stimulated by foetal calf serum, basic fibroblast growth factor and platelet derived growth factor, and in vivo with regard to SMC migration and proliferation which occurred following injury of the porcine carotid artery. The intimal lesion was induced by a silasten collar surgically positioned around the carotid artery and by a stenosis reducing blood flow by 50% for 30 days. Animals received SR33805 (5 mg/kg/day) 8 days before the induction of the lesion and up to 30 days after. In vitro, SR33805 inhibited in a dose-dependent manner growth factor-induced proliferation of SMC (0.20<IC(50)<0.46 microM). In vivo, SR33805 reduced the intima/media ratio of the cross sectional surface area (decrease of 60%, P<0.05) without affecting neointimal SMC density. The medial SMC density was 40% lower in treated than in control animals (upstream, P<0.05 and downstream to the stenosis, P<0.01). Thus, it appears that SR33805 significantly reduced intimal hyperplasia, which occurred after perivascular manipulation of the artery, an effect consistent with its in vitro proliferation inhibitory activity, suggesting that long-term treatment with SR33805 may reduce or delay SMC proliferation.
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Affiliation(s)
- P Hainaud
- Institut des Vaisseaux et du Sang, Hôpital Lariboisière, 8 rue Guy Patin, 75475 Cedex 10, Paris, France
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Abstract
The aim of this study is to determine whether subpopulations of smooth muscle cells (SMC), as distinguished by variations in contractile and cytoskeletal proteins, appear in the neointima at different times after vascular injury, and/or whether subpopulations develop during serial passaging of these cells. Rat aortae and rabbit carotid arteries were injured with a 2F Fogarty balloon catheter and cultures established from the resulting neointima and the media 2, 6, 12, 16 and 24 weeks later. Cultures were examined at passages 1-5 and subpopulations of SMC categorised by intensity of staining for each protein by immunohistochemistry. Two populations of SMC with different staining intensities ('++', '+') were observed for each of the following proteins: alpha-SM actin, SM-myosin, desmin and vimentin. Populations without these proteins were also found. Changes in the percentages of cells expressing these proteins were transitory, indicating that the populations were not limited to a particular tissue (neointima or media), time after injury or passage number. One exception was found in rabbit cultures where the number of desmin-expressing cells quickly decreased with both time after injury and time in culture. Subpopulations of SMC were found at all times after injury in the media and neointima of rat and rabbit arteries, and after multiple passage of these cells. There was no pattern of development of one population suggesting that either no subpopulation has a proliferative or migratory advantage over others, or that only one population exists that is capable of diverse phenotypic changes.
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Affiliation(s)
- A C Thomas
- Centre for Research in Vascular Biology, Department of Anatomical Sciences, The University of Queensland, 4072, Queensland, St Lucia, Australia
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Abstract
BACKGROUND Evaluation of the applicability of intravascular radiofrequency receiver coils by means of a pig in-vivo-experiment for the detection of vessel wall structures at 1.0 Tesla. MATERIALS AND METHODS The intravascular receiver coil was constructed according to a well evaluated single-loop-design, which was mounted onto a balloon catheter for angioplasty. Under fluoroscopy control the balloon catheter was placed in the common carotid artery of a porcine. Images were obtained in a 1.0 Tesla clinical scanner using a fast-spin-echo-, a gradient-echo- and a high resolution spin-echo-sequence. Histological examinations were obtained to detect any vessel wall damage associated with the use of the receiver coil. RESULTS High quality images with a resolution up to 0.16*0.12 mm2 could be acquired in aquisition times of about 5 minutes. Subtle intra- and extra-vascular structures such as the balloon, irregularities of the vessel wall or bordering structures could be visualized. The histological examination showed no vessel damage due to the application of the intravascular receiver coil. CONCLUSIONS The application of intravascular receiver coils for the visualization of the vessel wall is feasible at 1.0 Tesla without histologically detectable trauma to the vessel wall.
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Affiliation(s)
- V Matschl
- Department of Diagnostic Radiology, Physics Department and Material Science Center, Philipps University, Marburg, Germany.
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Abstract
Balloon catheter injury to the rat common carotid artery has been widely used for testing potential therapies for post-angioplasty restenosis. However, the model has become somewhat discredited because a number of drugs that inhibit intimal thickening, measured 14 days after balloon catheter injury, have been found to be ineffective in clinical trials. Probucol has recently been shown to reduce the incidence of post-angioplasty restenosis in a number of small clinical trials, making it possible to reassess the validity of the rat balloon injury model. The effects of probucol on the underlying causes of intimal thickening in balloon-injured rat carotid arteries were quantified. Probucol inhibited medial smooth muscle cell proliferation by 23% on day 4 after injury (P=0.009), and by 65% on day 10 after injury (P=0.026). Smooth muscle cell migration was reduced by 64% (P=0.008) in probucol-treated animals. In marked contrast, intimal smooth muscle cell proliferation was significantly increased by 41% (P=0.024) by probucol. There was no significant effect on intimal thickening or smooth muscle cell death. These data suggest that drugs that inhibit both medial smooth muscle cell proliferation and migration in the rat balloon injury model may prove useful in the treatment of post-angioplasty restenosis.
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MESH Headings
- Administration, Oral
- Angioplasty, Balloon/adverse effects
- Animals
- Anticholesteremic Agents/administration & dosage
- Apoptosis/drug effects
- Carotid Artery Injuries
- Carotid Artery, Common/drug effects
- Carotid Artery, Common/pathology
- Carotid Stenosis/pathology
- Carotid Stenosis/therapy
- Cell Division/drug effects
- Cell Movement/drug effects
- Diet
- Male
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/injuries
- Muscle, Smooth, Vascular/pathology
- Probucol/administration & dosage
- Rats
- Rats, Inbred F344
- Rats, Inbred Lew
- Rats, Sprague-Dawley
- Rats, Wistar
- Reproducibility of Results
- Secondary Prevention
- Tunica Intima/drug effects
- Tunica Intima/injuries
- Tunica Intima/pathology
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Affiliation(s)
- C L Jackson
- Bristol Heart Institute, British Royal Infirmary, Level 7, University of Bristol, BS2 8HW, Bristol, UK
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