C O N T E M P O R A R Y C A R D I O L O G Y Vascular Disease and Injury Preclinical Research Edited by Daniel I. Simon, MD Campbell Rogers, MD HUMANA PRESS V D I ASCULAR ISEASE AND NJURY CC CC OONNTTEEMMPPOORRAARRYY AARRDDIIOOLLOOGGYY CCCHHHRRRIIISSSTTTOOOPPPHHHEEERRR PPP... CCCAAANNNNNNOOONNN SSSEEERRRIIIEEESSS EEEDDDIIITTTOOORRR Vascular Disease and Injury: Preclinical Research, edited by Daniel I. Simon and Campbell Rogers, 2001 Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics,edited by William B. White, 2001 Preventive Cardiology: Strategies for the Prevention and Treatment of Coronary Artery Disease, edited by JoAnne Micale Foody, 2001 Nitric Oxide and the Cardiovascular System,edited by Joseph Loscalzo and Joseph A. Vita, 2000 Management of Acute Coronary Syndromes, edited by Christopher P. Cannon, 1999 Minimally Invasive Cardiac Surgery,edited by Mehmet C. Oz and Daniel J. Goldstein, 1999 Annotated Atlas of Electrocardiography: A Guide to Confident Interpretation, edited by Thomas M. Blake, 1999 Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease, edited by A. Michael Lincoff and Eric J. Topol, 1999 V D ASCULAR ISEASE I AND NJURY P R RECLINICAL ESEARCH Edited by D I. S , ANIEL IMON MD C R , AMPBELL OGERS MD Brigham and Women's Hospital Boston, MA Foreword by V J. D , ICTOR ZAU MD Brigham and Women's Hospital Boston, MA H P UMANA RESS T , N J OTOWA EW ERSEY © 2001 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256- 8341; E-mail: [email protected] or visit our Website: http://humanapress.com All rights reserved. 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II. Rogers, Campbell. III. Contemporary cardiology (Totowa, N.J. : unnnumbered) [DNLM: 1. Vascular Diseases. 2. Blood Vessels—injuries. 3. Blood Vessels—transplantation. 4. Disease Models, Animal. WG 500 V331265 2000] RC691.4. V35 2000 616.1'3—dc21 00-039603 F OREWORD We have entered an era of biomedicine marked by an explosion of new data and information and an impressively rapid translation of basic science discov- eries to clinical applications. Nowhere is this more apparent than in the field of cardiovascular medicine, where in recent years significant advances have been made in our understanding of the etiology, pathophysiology, diagnosis, and therapy of coronary heart disease, atherosclerosis, hypertension, and congestive heart failure, among other diseases. New molecules, genes, and signaling path- ways are being discovered at an unprecedented rate, and new drugs, devices, and surgical innovations are being developed that transform medical practice. The most common cause of cardiovascular disorders is vascular disease. Central to the pathobiology of vascular disease is injury to the blood vessel. Data derived from experimental studies and human investigations have suggested that the major forms of vascular disease, i.e., atherosclerosis, restenosis, graft stenosis, and transplant vasculopathy, are the result of the body’s response to various forms of biochemical, mechanical, infectious, and immunological inju- ries. The elucidation of the biological processes of response to injury (such as endothelial dysfunction, oxidation stress, inflammation, proliferation, and apoptosis) and the mediators of these processes (including nitric oxide, reactive oxygen species, cytokines, chemokines, and growth factors) have not only im- proved our understanding of vascular diseases, but have resulted in novel therapies. Discoveries in this area have been highly dependent on in vitro investigation, experimental animal models, and other preclinical studies. Accordingly, there is much demand for a book that brings together the voluminous preclinical information on this diverse subject: for a single source that can provide access to all the important data on vascular injury, compare and contrast the different models and conditions, provide insights into common themes and mechanisms unifying these diseases, and also identify differential processes that are specific to the various conditions. Such analysis will be of great use to students and researchers interested in vascular disease and therapy. The rapid advances in vascular research have also created a significant chal- lenge for researchers, especially those new to the field. Despite recent achieve- ments in information technology, obtaining access to data that are properly linked, annotated, and interpreted is still a major difficulty. Furthermore, with the proliferation of ideas, resources, and technologies, the task of locating and v vi Foreword then selecting sources for equipment, reagents, and animals has often become quite complicated. For all these reasons, Vascular Disease and Injury: Preclinical Researchis important and timely. The book is a tour de force, assembling leading experts to review the essential topics of vascular diseases under a single cover. Impor- tantly, the book provides a “how-to” guide, paying attention to the practicality of the content by including equipment lists and sources for animals, diet, and reagents. In my opinion, this book is the most comprehensive available on this subject and will undoubtedly become a classic in the field. Simon and Rogers, through their meticulous attention and innovative efforts in developing this book, have set high standards for the definition of translational research. Victor J. Dzau, MD Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School Chairman, Department of Medicine, Brigham and Women’s Hospital Boston, MA P REFACE Issues related to arterial vascular injury are central to the cardiovascular practitioner and research scientist alike. Whether acute (i.e., mechanically induced) or chronic (i.e., hypertension, atherosclerosis, and immune-mediated), vascular injury and the responses it elicits are leading causes of disease today, producing such acute ischemic syndromes as transient ischemic attacks, stroke, unstable angina pectoris, and acute myocardial infarction, as well as restenosis following percutaneous angioplasty or revascularization surgeries. The development of effective cardiovascular therapeutics to treat or prevent atherosclerosis and restenosis relies on preclinical research—both cell biological studies and obser- vations and findings from animal models. We have found that no one resource is available for a comprehensive presentation of animal models related to vascular disease. We hope thatVascular Disease and Injury: Preclinical Researchwill provide such a medium by presenting topics related to vascular injury in an organized and comprehensive fashion. Our approach is to present issues related to vascular disease and injury in five major areas: acute mechanical injury and vascular repair, models of arterial thrombosis, chronic atherosclerotic models, vascular disease in transplanted vessels,and vas- cular disease in models of systemic and pulmonary arterial hypertension. We have aimed to provide a “how-to” guide and have, therefore, worked to ensure that each chapter is highly practical by including equipment lists, current sources for animals, diet and reagents, schematic diagrams and, when pertinent, photo- micrographs of sample histology. In Part I of the book,Acute Mechanical Injury and Vascular Repair,Drs. Welt and Rogers review the widely used rabbit iliac artery models of balloon- and stent-induced angioplasty. Dr. Schwartz follows with a comprehensive presenta- tion of the classic porcine overstretch stent model, emphasizing the relationship he has characterized between the degree of vascular injury and resultant neointimal thickening that follows. Dr. Carter extends this model into an atherosclerotic milieu. Drs. Nedelman and Rogers then apply central elements of these lower animal models to nonhuman primate experimental angioplasty and stenting, a burgeoning field suited to evaluation of human-targeted biologics. Since venous conduits are used extensively with high failure rates in coronary and peripheral bypass procedures, Dr. Dzau’s group provides a chapter on pathologic responses in experimental models of arterial-venous grafting. Murine systems allow cardio- vascular researchers to take advantage of key transgenic and knockout strains. Therefore, we have provided extensive material on recently described models of vii viii Preface acute and chronic vascular injury in mice. Dr. Lindner, who pioneered the use of mice in this field, discusses wire denudation and ligation models of neointimal thickening. Drs. Chen, Rogers, and Simon then describe a recently published model of arterial dilation and endothelial denudation that is accompanied by inflammatory cell recruitment and neointimal thickening. Drs. Eitzman and Westrick present a very interesting vascular photochemical model that has com- ponents of thrombosis, as well as neointimal thickening. Finally, Dr. Coller’s group discusses their approach using a femoral wire injury model, a modifica- tion of the carotid wire denudation resulting in increased neointimal thickening. In Part II, two chapters will focus on Models of Arterial Thrombosis. In the first, Drs. Fay, Parker, and Zhu use perivascular ferric chloride to induce arterial injury and thrombosis in the mouse carotid. These investigators have exploited this model to investigate the importance of plasminogen activator inhibitor-1 in modulating endogenous fibrinolysis. Finally, Dr. Folts provides a comprehensive overview of his animal preparation for studying in vivo platelet activity and platelet interactions with damaged arterial walls. This model has been instrumental in the clinical development of therapeutics for acute ischemic syndromes and percu- taneous coronary interventions. Part III focuses on Chronic Atherosclerotic Models. Drs. Palinski, Napoli, and Reaven provide an in-depth overview of mouse models of atherosclerosis, in particular the apolipoprotein E (ApoE) and low density lipoprotein (LDL) receptor knockouts. Drs. Aikawa and Libby then present their work regarding progression and regression of atherosclerosis using the classic hypercholesterolemic rabbit model. Finally, Drs. Nicolosi and Kritchevsky present the use of higher animals, including nonhuman primates, for preclinical research in atherosclerosis. Part IV of the book concentrates on Vascular Disease in Transplanted Vessels. Drs. Shi and Hoover discuss the use of a murine carotid loop model of transplant disease that has been helpful in elucidating the important role of proteases, such as plasminogen, in transplant-related vascular disease. Dr. Mitchell then follows with an overview of heterotopic heart transplantation in the mouse. His group has used this model to study the role of cytokines and immune co-stimulatory molecules in parenchymal rejection and accelerated graft arteriosclerosis. The concluding chapter in this section by Drs. Chen and Adams presents exciting material regarding hyperacute vascular rejection in pig- to-primate xenotransplantation. The next set of chapters in Part V concentrates on Vascular Disease in Models of Arterial Hypertension. Dr. Baumbach examines methods for investigating cerebrovascular disease in experimental systemic hypertension. Two chapters are devoted to pulmonary hypertension. In the first, Dr. Rabinovitch provides an in-depth discussion of monocrotaline-induced pulmonary hypertension. She focuses on the cellular and molecular biology of pulmonary vasculopathy, integrating dynamic interactions between smooth muscle cells, extracellular matrix, and the Preface ix endothelium. This leads into the chapter by Drs. Meyrick and Tchekneva on chronic pulmonary hypertension in the hypoxic rat and in the sheep following continuous air embolization. The final section, Part VI, provides an essential foundation in Animal Care and Tissue Processing and analysis. Dr. Marini discusses veterinary issues and anesthesia options, addressing all species covered elsewhere in the book, from mice to nonhuman primates. Key points regarding survival surgery, choice of anes- thetic, and analgesia are included. Histopathologic methods are then discussed by Drs. Seifert, Rogers, and Edelman. This chapter provides the “basics” for tissue harvesting and fixation, and histology methods for routine immunology and electron microscopy. The topics we have chosen to include in Vascular Disease and Injury: Pre- clinical Researchare not meant to be all inclusive and, undoubtedly, a few areas have not been covered. We have simply tried to show the range and breadth of animal models that have been useful in translational cardiovascular research. It is important to end this discussion on a cautionary note. The track record of animal models of vascular repair after injury, as predictors of human responses, is poor. Myriad agents have been proven effective in one or another model, only to fail clinical scrutiny. This fact means that for each experimental approach, by any of the models described in this book, the purpose of research must be to further mechanistic understanding, not to recapitulate human disease in an experimental animal. In closing, we must acknowledge the tremendous efforts of our administrative assistant, Paula McColgan, the series editor, Dr. Christopher Cannon, and the staff of Humana Press. We are indebted to Drs. Eugene Braunwald, Victor J. Dzau, Thomas W. Smith, and Peter Libby for encouraging and supporting our clinician- scientist careers. Dr. Rogers would like to thank most deeply his mentors in the study of vascular injury and repair, Drs. Morris Karnovsky and Elazer Edelman, and to dedicate this book to his wife Nathalie and three children, Camille, Genevieve, and Charles. Dr. Simon would like to honor his mentor in life and medicine, Dr. Norman M. Simon, and to dedicate this book to his wife Dr. Marcy Schwartz and three children Benjamin, Maxwell, and Aaron. Daniel I. Simon, MD Campbell Rogers, MD