Morbidity and mortality associated with creation of elastase-induced saccular aneurysms in a rabbit model.

BACKGROUND AND PURPOSE: Elastase-induced aneurysms in rabbits have been proposed as a useful preclinical tool for device development. The object of this study was to report rates of morbidity and mortality associated with the creation and embolization of elastase-induced rabbit aneurysms and to assess the impact of operator experience on these rates. MATERIALS AND METHODS: Elastase-induced model aneurysms were created in New Zealand white rabbits (n = 700). One neuroradiologist/investigator, naive to the aneurysm-creation procedure at the outset of the experiments, performed all surgeries. All morbidity and deaths related to aneurysm creation (n = 700) and embolization procedures (n = 529) were categorized into acute and chronic deaths. Data were analyzed with single-regression analysis and analysis of variance. To assess the impact of increasing operator experience, we broke the number of animals into 50-animal increments. RESULTS: There were 121 (17%) deaths among 700 subjects. Among 700 aneurysm-creation procedures, 59 deaths (8.4%) were noted. Among 529 aneurysm-embolization procedures, 43 deaths (8.1%) were noted. Nineteen additional deaths (2.7% of 700 subjects) were unrelated to the procedures. Simple regression-indicated mortality associated with procedures diminished with increasing operator experience (R(2) = 0.38, P = .0180), and that for each 50-rabbit increment mortality was reduced, on average, by 0.6%. CONCLUSIONS: Mortality rates of approximately 8% are associated with both experimental aneurysm creation and with embolization in the rabbit elastase-induced aneurysm model. Increasing operator experience is inversely correlated with mortality, and the age of the rabbit is positively associated with morbidity.

Endovascular treatment of experimental aneurysms with use of fibroblast transfected with replication-deficient adenovirus containing bone morphogenetic protein-13 gene.

BACKGROUND AND PURPOSE: Modified coils have failed to improve long-term recanalization of aneurysms. This study examined whether ex vivo transduction of replication-deficient adenovirus containing the bone morphogenetic protein-13 gene (Ad-BMP-13) in fibroblast allografts would improve angiographic results via increased collagen synthesis, compared with fibroblast-coated platinum coils (FBC) and bare platinum coils (PA). MATERIALS AND METHODS: Aneurysms were embolized with Ad-BMP-13-coated coils (n = 20). Rabbits were sacrificed at 14 days and at 1, 3, and 6 months after implantation. Digital subtraction angiography (DSA) evaluated stability after embolization. Histologic specimens were examined with a qualitative grading system. Masson trichrome evaluated collagen deposition. Findings were compared with previously reported controls for PA and FBC in the same model and time points. RESULTS: The grading system showed a greater total score (P = .0002) in Ad-BMP-13 (6.8 +/- 1.6) and FBC (6.3 +/- 2.4) compared with PA (4.7 +/- 2.4). A group main effects test showed that aneurysm neck tissue coverage in Ad-BMP-13 (2.5 +/- 1.1) was higher (P = .0007) than both FBC (1.6 +/- 1.4) and PA (0.9 +/- 1.1). Ad-BMP-13 had more (P < .0001) collagen deposition than the FBC and PA. One- and 3-month Ad-BMP-13 collagen depositions increased (P < .05) over the FBC and PA. Finally, Ad-BMP-13 showed radiographic stability in 15 (75%) cases, coil compaction in 4 (20%) cases, and progressive occlusion in 1 (5%) case. There were no differences in angiographic results (P = .6522). CONCLUSION: The Ad-BMP-13-coated coils can improve neck coverage and dome fibrosis in the rabbit model, even in the absence of observed differences in angiographic outcome.

Endovascular treatment of aneurysms: healing mechanisms in a Swine model are associated with increased expression of matrix metalloproteinases, vascular cell adhesion molecule-1, and vascular endothelial growth factor, and decreased expression of tissue inhibitors of matrix metalloproteinases.

BACKGROUND AND PURPOSE: The mechanism of aneurysm healing after coiling remains poorly understood. The purpose of the study was to obtain a better understanding of the cellular and molecular events that are associated with aneurysm healing after endovascular coiling in a swine aneurysm model. MATERIALS AND METHODS: Twenty sidewall aneurysms were created surgically in common carotid arteries in 10 swine. These aneurysms were embolized immediately after creation by using platinum coils by endovascular means. Two and 12 weeks after implantation, aneurysm samples were collected for histologic and biochemical analysis. RESULTS: All aneurysms were completely or nearly completely occluded angiographically at the time of embolization and at follow-up. At 2 weeks, aneurysm cavities were filled with inflammatory cells and myofibroblasts. At 12 weeks, aneurysm cavities were filled with richly vascularized fibrous tissue and disorganized collagen bundles. The expression of matrix metalloproteinase (MMP)-2 and -9 was found to be elevated at 2 weeks. Expression remained greater than that in control tissue at 12 weeks but was significantly decreased compared with the earlier time point. Expression of tissue inhibitors of MMPs (TIMPs) was diminished at both time points. Expression of vascular cell adhesion molecule-1 (VCAM-1) and vascular endothelial growth factor (VEGF) was elevated at both 2 weeks and 12 weeks. Endothelial nitric oxide synthase expression was not different from that in controls. Transforming growth factor-beta expression was elevated at 2 weeks only. CONCLUSION: The coil occlusion in this model that is prone to heal is associated with increased expression of MMP-2, MMP-9, VCAM-1, and VEGF, and decreased expression of TIMPs.

Control of aneurysm volume by adjusting the position of ligation during creation of elastase-induced aneurysms: a prospective study.

BACKGROUND AND PURPOSE: Animal models with appropriate volume are crucial for preclinical assessment of aneurysm therapies. Our purpose was to control the aneurysm volume by adjusting the position of ligation during creation of elastase-induced aneurysms in rabbits. MATERIALS AND METHODS: Sixty elastase-induced aneurysms in rabbits were created. Two different methods were used for creation, including group 1 (n=30) by using a lower ligation (from the origin of the right common carotid artery [RCCA] to the ligation point, 10 mm) and group 2 (n=30) by using a higher ligation (from the origin of the RCCA to the ligation point, 15 mm). Aneurysm sizes (neck diameter, width, and height) and volumes in the 2 groups were measured and calculated, and they were compared by using the Student t test. RESULTS: The mean aneurysm neck diameter, width, and height for group 2 were significantly larger than those of group 1 (3.3 +/- 0.8 versus 2.7 +/- 0.6 mm, P<.001; 3.7 +/- 0.7 versus 2.5 +/- 0.7 mm, P<.001; 9.0 +/- 1.7 versus 7.3 +/- 1.9 mm, P<.001, respectively). The aneurysm volume in group 2 was significantly larger than that in group 1 (102.4 +/- 54.8 mm(3) versus 36.6 +/- 26.8 mm(3), P<.001). CONCLUSION: The aneurysm volume of elastase-induced models in rabbits can be controlled by adjusting the position of the ligation. Using a higher ligation can create relatively more voluminous aneurysms, compared with using a lower ligation.

Can neck size in elastase-induced aneurysms be controlled? A retrospective study.

BACKGROUND AND PURPOSE: Reproducible animal models with appropriate neck size are crucial for preclinical assessment of aneurysm therapies. Our purpose was to determine whether the neck size of elastase-induced aneurysms could be controlled by adjusting the position of the temporary occlusion balloon. METHODS: Seventy-two elastase-induced aneurysms in rabbits were retrospectively analyzed. Three groups (group 1, n = 35; group 2, n = 32; group 3, n = 5) were defined according to different balloon position (lowest, intermediate, and highest, respectively) related to the origin of right common carotid artery (CCA). Aneurysm sizes in different groups were measured and compared; parent artery dilation was assessed as present or absent. The Wilcoxon rank sum test, the Fisher exact test, and the chi(2) test were used for statistics process. RESULTS: The mean aneurysm neck diameter in group 1 was significantly wider than that in group 2 (P = .0001). The proportion of wide-necked (diameter of neck >4 mm) aneurysms in group 1 was significantly higher than that in group 2 (P = .0011). The mean dome/neck ratio in group 1 was smaller than that of group 2 (P = .0031). Aneurysm width and height and the frequency of parent artery dilation were not different in groups 1 and 2 (P = .43, P = .10, and P = .25). No aneurysms formed in group 3. CONCLUSION: The neck size of elastase-induced aneurysms can be controlled by adjusting the position of the inflated balloon, with balloon positioning that bridges from the CCA to the subclavian/brachiocephalic arteries yielding narrow-necked aneurysms.

Intra-arterial digital subtraction angiography through the ear artery for experimental aneurysm imaging.

Digital subtraction angiography through the central artery of the ear was performed to show elastase-induced aneurysms in 34 rabbits. Twenty-eight (82%) aneurysms in which common origins of the bilateral common carotid artery (CCA) were found were well shown. All 6 other aneurysms not well shown had separate origins of the CCAs from the aortic arch (P < .001). This method can be used for angiographic follow-up when there is a common origin of the CCAs.

A longitudinal immunohistochemical study of the healing of experimental aneurysms after embolization with platinum coils.

BACKGROUND AND PURPOSE: The purpose of this study was to probe the cellular mechanism of healing in aneurysms after platinum coil embolization, by using multiple special stains and immunolabels. METHODS: Elastase-induced aneurysms were created and embolized in 28 rabbits. Aneurysms were excised between 2 and 24 weeks after embolization. Specimens were embedded in paraffin, sectioned, and stained with hematoxylin-eosin, Masson trichrome, and multiple immunostains. RESULTS: At 2 weeks, peripheral sparse spindle-nucleated cells were positive for alpha-smooth muscle actin (SMA), myosin, and vimentin, indicating myofibroblastic differentiation. At 4 weeks, all spindle-nucleated cells in the aneurysm were positive for SMA, myosin, desmin, and vimentin. Ten weeks after embolization, positive immunohistochemical staining in the cells populating the aneurysm significantly decreased. Mean positive SMA cells, per high-powered field were 5 +/- 3, 45 +/- 9, 10 +/- 5, 0 +/- 0, and 0 +/- 0 at 2, 4, 10, 16, and 24 weeks, respectively. Findings of a Kruskal-Wallis test showed these data to be significantly different (P =.0001). Post hoc tests revealed significantly greater amounts of SMA-positive staining in the cells at 4 weeks compared with those at 2, 10, 16, and 24 weeks (P < .05). In addition, the 10-week group had significantly more positive cells than the 16- and 24-week groups (P < .05). There was a 78% decrease in apoptotic cells between 4 (37 +/- 11) and 10 weeks (8 +/- 4) after implantation. Apoptotic cells were completely absent beyond 10 weeks. CONCLUSION: Aneurysm healing, in response to platinum coil embolization, appeared to progress through the stages of thrombus formation, granulated tissue organization, and loose connective tissue formation. Myofibroblasts, the key cellular component involved in healing, appeared within the aneurysm early. They progressively reduced in number with time and finally disappeared through the mechanism of apoptosis.

Long-term patency of elastase-induced aneurysm model in rabbits.

BACKGROUND AND PURPOSE: Long-term patency in untreated experimental aneurysms represents a critical attribute of any system proposed for the testing of aneurysm occlusion devices. Our purpose was to evaluate the long-term patency in elastase-induced saccular aneurysm models in rabbits. METHODS: Serial intravenous digital subtractive angiography (IVDSA) was performed in 20 elastase-induced saccular aneurysm models in rabbits 1, 3, 6, 9, 12, and 24 months after creation. Aneurysm dimensions, including neck diameter, width, and height, were measured and calculated from IVDSA images. Comparisons of the aneurysm sizes across time were performed by using the paired Wilcoxon signed rank test and the Friedman test. RESULTS: None of the 20 aneurysms showed spontaneous thrombosis at any time point. Mean dimensions did not change over time for any parameter. Mean aneurysm neck, width, and height were not significantly changed at interval evaluations of 1, 3, 6, 9, 12, and 24 months (P = .210; P = .413, and P = .405, respectively). CONCLUSION: Long-term patency in elastase-induced saccular aneurysm models in rabbits is excellent. Aneurysm dimensions remain stable for as long as 2 years following creation.

The two-component signaling pathway of bacterial chemotaxis: a molecular view of signal transduction by receptors, kinases, and adaptation enzymes.

The chemosensory pathway of bacterial chemotaxis has become a paradigm for the two-component superfamily of receptor-regulated phosphorylation pathways. This simple pathway illustrates many of the fundamental principles and unanswered questions in the field of signaling biology. A molecular description of pathway function has progressed rapidly because it is accessible to diverse structural, biochemical, and genetic approaches. As a result, structures are emerging for most of the pathway elements, biochemical studies are elucidating the mechanisms of key signaling events, and genetic methods are revealing the intermolecular interactions that transmit information between components. Recent advances include (a) the first molecular picture of a conformational transmembrane signal in a cell surface receptor, (b) four new structures of kinase domains and adaptation enzymes, and (c) significant new insights into the mechanisms of receptor-mediated kinase regulation, receptor adaptation, and the phospho-activation of signaling proteins. Overall, the chemosensory pathway and the propulsion system it regulates provide an ideal system in which to probe molecular principles underlying complex cellular signaling and behavior.

Cysteine and disulfide scanning reveals a regulatory alpha-helix in the cytoplasmic domain of the aspartate receptor.

The transmembrane, homodimeric aspartate receptor of Escherichia coli and Salmonella typhimurium controls the chemotactic response to aspartate, an attractant, by regulating the activity of a cytoplasmic histidine kinase. The cytoplasmic domain of the receptor plays a central role in both kinase regulation and sensory adaptation, although its structure and regulatory mechanisms are unknown. The present study utilizes cysteine and disulfide scanning to probe residues Leu-250 through Gln-309, a region that contains the first of two adaptive methylation segments within the cytoplasmic domain. Following the introduction of consecutive cysteine residues by scanning mutagenesis, the measurement of sulfhydryl chemical reactivities reveals an alpha-helical pattern of exposed and buried positions spanning residues 270-309. This detected helix, termed the "first methylation helix," is strongly amphiphilic; its exposed face is highly anionic and possesses three methylation sites, while its buried face is hydrophobic. In vivo and in vitro assays of receptor function indicate that inhibitory cysteine substitutions are most prevalent on the buried face of the first methylation helix, demonstrating that this face is involved in a critical packing interaction. The buried face is further analyzed by disulfide scanning, which reveals three "lock-on" disulfides that covalently trap the receptor in its kinase-activating state. Each of the lock-on disulfides cross-links the buried faces of the two symmetric first methylation helices of the dimer, placing these helices in direct contact at the subunit interface. Comparative sequence analysis of 56 related receptors suggests that the identified helix is a conserved feature of this large receptor family, wherein it is likely to play a general role in adaptation and kinase regulation. Interestingly, the rapid rates and promiscuous nature of disulfide formation reactions within the scanned region reveal that the cytoplasmic domain of the full-length, membrane-bound receptor has a highly dynamic structure. Overall, the results demonstrate that cysteine and disulfide scanning can identify secondary structure elements and functionally important packing interfaces, even in proteins that are inaccessible to other structural methods.

Use of 19F NMR to probe protein structure and conformational changes.

19F NMR has proven to be a powerful technique in the study of protein structure and dynamics because the 19F nucleus is easily incorporated at specific labeling sites, where it provides a relatively nonperturbing yet sensitive probe with no background signals. Recent applications of 19F NMR in mapping out structural and functional features of proteins, including the galactose-binding protein, the transmembrane aspartate receptor, the CheY protein, dihydrofolate reductase, elongation factor-Tu, and D-lactose dehydrogenase, illustrate the utility of 19F NMR in the analysis of protein conformational states even in molecules too large or unstable for full NMR structure determination. These studies rely on the fact that the chemical shift of 19F is extremely sensitive to changes in the local conformational environment, including van der Waals packing interactions and local electrostatic fields. Additional information is provided by solvent-induced isotope shifts or line broadening of the 19F resonance by aqueous and membrane-bound paramagnetic probes, which may reveal the proximity of a 19F label to bulk solvent or a biological membrane. Finally, the effect of exchanging conformations on the 19F resonance can directly determine the kinetic parameters of the conformational transition.

Attractant- and disulfide-induced conformational changes in the ligand binding domain of the chemotaxis aspartate receptor: a 19F NMR study.

The isolated ligand binding domain of the chemotaxis aspartate receptor is the focus of the present study, which both (a) identifies structural regions involved in the attractant-induced conformational change and (b) investigates the kinetic parameters of attractant binding. To analyze the attractant-induced conformational change within the homodimeric domain, 19F NMR is used to monitor six para-fluorophenylalanine (4-F-Phe) positions within each identical subunit of the homodimer. The binding one molecule of aspartate to the homodimer perturbs three of the 4-F-Phe resonances significantly: 4-F-Phe150 in the attractant binding site, 4-F-Phe107 located 26 A from the site, and 4-F-Phe180 at a distance of 40 A from the site. Comparison of the frequency shifts triggered by aspartate and glutamate reveals that these attractants generate different conformations in the vicinity of the attractant site but trigger indistinguishable long-range conformational effects at distant positions. This long-range conformational change is specific for attractant binding, since formation of the Cys36-Cys36' disulfide bond or the nonphysiological binding of 1,10-phenanthroline to an aromatic pocket distal to the attractant site each yield conformational changes which are significantly more localized. The attractant-triggered perturbations detected at 4-F-Phe107 and 4-F-Phe180 indicate that the structural change includes an intrasubunit component communicated through the domain to its C-terminal region, which, in the full-length receptor, continues through the membrane as the second membrane-spanning helix. It would thus appear that the transmembrane signal is transmitted through this helix.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinetic control of Ca(II) signaling: tuning the ion dissociation rates of EF-hand Ca(II) binding sites.

EF-hand Ca(II) binding sites share a conserved architecture and are prevalent in Ca(II) signaling pathways. The ion binding kinetics of these sites are carefully tuned to provide the physiologically appropriate activation and inactivation time scales. Here we examine kinetic tuning by the side chain at the ninth position of the EF-loop. A model is proposed in which both the size and charge of the side chain contribute to kinetic tuning. To test this model, the ninth loop position of the EF-hand-like site in the Escherichia coli D-galactose binding protein has been engineered and the Tb(III) dissociation kinetics of the resulting sites have been analyzed. Substitutions at this position are observed to generate up to 10(4)-fold changes in Tb(III) dissociation rates, with little effect on Tb(III) affinity. Furthermore, the observed pattern of rate changes confirm the model's predictions; long side chains at the ninth loop position yield slow dissociation kinetics as predicted for a steric block, whereas acidic side chains yield slow dissociation kinetics as expected for an electrostatic barrier.

Guillain-Barré syndrome: a 42-year epidemiologic and clinical study.

The central medical-records linkage system at the Mayo Clinic for the population of Olmsted County, Minnesota, provided the necessary data resource for the identification and follow-up of virtually all diagnosed cases of the Guillain--Barré syndrome over a period of 42 years. During this time, a total of 40 Olmsted County residents had clinical signs and symptoms of the disease. The mean annual incidence rate was 1.7 per 100,000 population. There was a significantly higher incidence rate (P less than 0.01) among patients 40 years of age and older. In four patients malignancies developed; however, the occurrence of the Guillain-Barré syndrome had no significant effect on survivorship in these patients. A case-control comparison of suggested etiologic factors supports the view that there is a significant association between antecedent infections and the Guillain-Barré syndrome.

Quantitation of left ventricular myocardial fiber hypertrophy and interstitial tissue in human hearts with chronically increased volume and pressure overload.

Using new techniques, we quantitated left ventricular myocardial fiber hypertrophy and interstitial tissue in four groups of autopsied hearts free of coronary disease: 1) 22 normal hearts, 2) 20 hearts from patients with mitral incompetence (NYHA Class II-III) who died early after mitral valve replacement from causes other than cardiac failure, 3) 22 hearts from patients with mitral incompetence (NYHA Class III-IV) who died early after mitral valve replacement from cardiac failure with low cardiac output syndrome, and 4) 22 hearts from patients with hypertensive heart disease (NYHA Class II-III). Myocardial fiber hypertrophy was quantitated by measuring cross-sectional myocardial fiber diameter; the proportion of interstitial tissue was quantitated by using a computerized, high-resolution video image-digitizing system. Myocardial fiber average diameter in groups 2, 3 and 4 was significantly higher than group 1. The proportion of interstitial tissue was significantly increased in group 3. In chronic mitral incompetence an increase in left ventricular interstitial tissue may play a role in the development of severe cardiac failure.

Arteriographic patterns early in the onset of the coronary syndromes.

Coronary arteriography in 300 patients within one year of onset of symptoms of coronary arterial disease revealed already severe anatomical coronary disease in three patient groups: those with angina pectoris alone (164 patients), with subendocardial myocardial infarction (63 patients), and with transmural myocardial infarction (73 patients). The number of vessels diseased (larger than or equal to 50% obstruction), distribution of obstruction, and degree of stenosis were similar in the three groups. However, total occlusion of at least one artery was much more common in transmural myocardial infarction and in subendocardial myocardial infarction with elevation of enzyme levels. We suggest that such occlusions occurred at the time of the infarction. Similarities in coronary anatomy between patient subgroups with angina (on exercise or at rest and nocturnal) indicate that factors other than coronary anatomy intervene in precipitating the different types of angina. Vessel disease was not related to smoking, hyperlipidaemia, or hypertension but coronary disease was manifest earlier in life in smokers or those with hyperlipidaemia.