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Children with congenital heart defects and patients with faulty or failing valves have the need for a suitable aortic heart valve replacement. Current treatment options have several downfalls and heavy investigation is being done into the design of an engineered valve to find an alternative that would alleviate many of these issues. Understanding the physiology of how cells interact in vivo is crucial to the construction of such valve. This study investigates the effect of cyclic strain in aortic valve endothelial cells on the adhesion molecules, PECAM-1, [Beta]1-Integrin, VE-Cadherin and Vinculin. Experiments found that cyclic strain plays a role in the development of cell/cell and cell/extracellular matrix adhesions and junctions and is extremely important in the pre-conditioning of a tissue engineered construct. Without this strain the new valve would be more susceptible to inflammation, injury or possible failure after being implanted into the patient.
The aortic valve (AV) functions in arguably the most demanding mechanical environment in the body. The AV experiences fluid shear stress, cyclic pressure and mechanical strain in vivo. Recent evidence has shown the progression of degenerative aortic valve disease (AVD) to be an active cellular mediated process, altering the conception of the AV as a passive tissue. AVD has shown a strong correlation with altered hemodynamics and tissue mechanics. Aortic valve endothelial cells (AVECs) line the fibrosa (aortic facing) and ventricularis (left ventricle facing) surfaces of the valve. AVECs sense and respond to circulating stimuli in the blood stream while maintaining a non-thrombogenic layer. AVEC activation has been implicated in the initiation and progression of AVD, but the role of cyclic strain has yet to be elucidated. The hypothesis of this dissertation is that altered mechanical forces have a causal relationship with aortic valvular endothelial cell activation. To test this hypothesis 1) the role of in vitro cyclic strain in regulating expression of pro-inflammatory adhesion molecule was elucidated 2) cyclic strain-dependent activation of side-specific aortic valve endothelial cells was investigated 3) a novel stretch bioreactor was developed to dramatically increase the ability to correlate valvular endothelium response to physiologically relevant applied planar biaxial loads. The results from this study further the field of heart valve mechanobiology by correlating AVEC physiological and pathophysiological function to cellular and tissue level strain. Elucidating the AVEC response to an altered mechanical environment may result in novel clinical diagnostic and therapeutic approaches to the initiation and progression of degenerative AVD. Furthermore, a cardiovascular health outreach program, Bulldogs for Heart Health, has been designed and implemented to combat the startling rise in childhood obesity in the state of Mississippi. It is the hope that these results, novel methods, and outreach initiatives developed will significantly impact the study of the mechanobiology of the aortic valve endothelial cell and potential treatment and prevention of cardiovascular disease.
The endothelium is an excellent example of where biology meets physics and engineering. It must convert mechanical forces into chemical signals to maintain homeostasis. It also controls the immune response, drug delivery through the vasculature, and cancer metastasis. Basic understanding of these processes is starting to emerge and the knowledge ga
This book provides comprehensive reviews on our most recent understanding of the molecular and cellular mechanisms underlying atherosclerosis and calcific aortic valve disease (CAVD) as visualized in animal models and patients using optical molecular imaging, PET-CT, ultrasound and MRI. In addition to presenting up-to-date information on the multimodality imaging of specific pro-inflammatory or pro-calcification pathways in atherosclerosis and CAVD, the book addresses the intriguing issue of whether cardiovascular calcification is an inflammatory disease, as has been recently supported by several preclinical and clinical imaging studies. In order to familiarize researchers and clinicians from other specialties with the basic mechanisms involved, chapters on the fundamental pathobiology of atherosclerosis and CAVD are also included. The imaging chapters, written by some of the foremost investigators in the field, are so organized as to reveal the nature of the involved mechanisms as disease progresses.
Due to population aging, calcific aortic valve disease (CAVD) has become the most common heart valve disease in Western countries. No therapies exist to slow this disease progression, and surgical valve replacement is the only effective treatment. Calcific Aortic Valve Disease covers the contemporary understanding of basic valve biology and the mechanisms of CAVD, provides novel insights into the genetics, proteomics, and metabolomics of CAVD, depicts new strategies in heart valve tissue engineering and regenerative medicine, and explores current treatment approaches. As we are on the verge of understanding the mechanisms of CAVD, we hope that this book will enable readers to comprehend our current knowledge and focus on the possibility of preventing disease progression in the future.
The book will provide an overview of the roles of vascular adhesion molecules in health and disease, with chapters on their cell biology, followed by chapters reviewing their importance in specific disease processes. Vascular adhesion molecules are vital for the physiological processes of leukocyte trafficking and also critically involved in the enhanced leukocyte emigration that is a key feature of all inflammatory and immune diseases. The book is designed to provide up-to-date, linked reviews of the subject suitable for postgraduate students entering the field or research workers from allied disciplines needing a modern overview.
Calcified aortic valve disease (CAVD) is an increasingly prevalent pathology that often manifests in the degenerative calcification of the valve tissue. Currently, the only treatment for aortic valve calcification is surgical intervention, and a clinically useful molecular signature of CAVD progression has not yet been found. Recent clinical trials testing lipid-lowering therapies were ineffective against aortic stenosis progression, which emphasizes that CAVD may undergo a distinctly different pathogenesis from that of atherosclerosis. While CAVD is no longer believed to be a passive degenerative process, the cellular mechanisms by which the valve calcifies are not wholly understood. There remains a need to understand cellular mechanisms of valve pathogenesis, as well as an in-depth analysis of the altogether unique calcified lesions that form as a result of the disease. The focus of this dissertation was the development of a 3D construct in which the interplay between valve endothelial (VEC) and valve interstitial cells (VIC) could be illuminated in various calcification-prone environments. The completion of this work yielded insights into cellular responses to osteogenic, mineralized, and altered mechanical environments, which could be used to identify potential therapeutic targets or early diagnosis strategies in the future. A 3D hydrogel construct was first developed for the co-culture of interstitial and endothelial cells, which is more physiologically relevant than current 2D models. Under osteogenic conditions, endothelial cells were found to have a protective effect against VIC activation and calcification (Chapter 2). Next, the mineralized lesions and surrounding organic tissue in calcified valves were characterized and found to have a heterogeneous composition of apatite and calcium phosphate mineral crystals (Chapter 3). These findings prompted the use of synthetically derived hydroxyapatite nanoparticles of two different maturation states in order to better evaluate cellular response to a highly mineralized matrix, characteristic of later stages of valve disease (Chapter 4). Finally, the effects of an altered mechanical environment, as is typical in valve disease, were examined by increasing mechanical tension in 3D hydrogel constructs and applying cyclic mechanical strain (Chapter 5). Overall, this body of work has made significant advancements in understanding individual and incorporative cellular responses to osteogenic, mineralized and mechanical 3D environments. This work has contributed to the emerging appreciation that 3-dimensional multi-cellular co-cultures are vital to mechanistic understanding of valve pathogenesis. Our 3D platform shows great promise for future studies, and could enable direct screening of molecular mechanisms of calcification and testing of potential molecular inhibitors.
The book represents a paradigm shift from the traditional static model of investigation of oxidative biology to the dynamic model of vascular oxidative stress. The investigation of vascular biology and cardiovascular medicine is made possible by the use of tissue engineering, nanotechnology and stem cell research. This is the first textbook to target a wide readership from academia to industry and government agencies in the field of cardiovascular diseases.
This succinct text fills the demand for a resource covering the pathology of cardiovascular diseases. Addresses ischemic heart disease, reviewing the many recent advances that have led to new concepts in cardiovascular pathology and pathophysiology. Emphasizes general approaches to heart examination and outlines expectations and limitations of pathologic assessment of cardiovascular disease. Written by well-known experts in the field, this 2nd Edition is completely updated and efficiently reorganized to be more concise and streamlined. Offers the expertise of two new authors-Allen Burke, MD and Andrew Farb, MD Presents brand-new chapters on Coronary Heart Disease and Its Syndromes Pathology of Vascular Interventions Pericardial Diseases Cardiac Tumors and Diseases of the Aorta Features meticulous updates throughout as well as completely up-to-date references Contains many new color plates and illustrations.