Pathology of the Aorta and Aorta as Homograft.
Gaetano ThieneCristina BassoMila Della BarberaPublished in: Journal of cardiovascular development and disease (2021)
The aorta is not a rigid tube, it is an "organ" with lamellar units, consisting of elastic fibers, extracellular matrix and smooth muscle cells in between as parenchyma. Several diseases may occur in the natural history of the aorta, requiring replacement of both semilunar cusps and ascending aorta. They may be congenital defects, such as bicuspid aortic valve and isthmal coarctation with aortopathy; genetically determined, such as Marfan and William syndromes; degenerative diseases, such as atherosclerosis and medial necrosis with aortic dilatation, valve incompetence and dissecting aneurysm; inflammatory diseases such as Takayasu arteritis, syphilis, giant cell and IgM4 aortitis; neoplasms; and trauma. Aortic homografts from cadavers, including both the sinus portion with semilunar cusps and the tubular portion, are surgically employed to replace a native sick ascending aorta. However, the antigenicity of allograft cells, in the lamellar units and interstitial cells in the cusps, is maintained. Thus, an immune reaction may occur, limiting durability. After proper decellularization and 6 months' implantation in sheep, endogenous cell repopulation was shown to occur in both the valve and aortic wall, including the endothelium, without evidence of inflammation and structural deterioration/calcification in the mid-term. The allograft was transformed into an autograft.
Keyphrases
- aortic valve
- aortic stenosis
- transcatheter aortic valve replacement
- aortic valve replacement
- transcatheter aortic valve implantation
- induced apoptosis
- extracellular matrix
- oxidative stress
- pulmonary artery
- cell cycle arrest
- cardiovascular disease
- coronary artery
- giant cell
- aortic dissection
- nitric oxide
- stem cells
- men who have sex with men
- heart failure
- human immunodeficiency virus
- single cell
- mesenchymal stem cells
- cell therapy
- bone marrow
- left ventricular
- cell proliferation
- antiretroviral therapy