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用于肾去神经支配介入研究的未经处理猪的肾脏自发病变的历史发生率。

Historical Incidence of Spontaneous Lesions in Kidneys from Naïve Swine Utilized In Interventional Renal Denervation Studies.

作者信息

Rouselle Serge D, Dillon Krista N, Rousselle-Sabiac Theo H, Brady Dane A, Tunev Stefan, Tellez Armando

机构信息

Alizee Pathology, Thurmont, MD, 21788, USA.

Medtronic Cardiovascular, Santa Rosa, CA, USA.

出版信息

J Cardiovasc Transl Res. 2016 Aug;9(4):360-7. doi: 10.1007/s12265-016-9697-x. Epub 2016 May 17.

Abstract

The use of preclinical animal models is integral to the safety assessment, pathogenesis research, and testing of diagnostic technologies and therapeutic interventions. With inherent similarity to human anatomy and physiology, various porcine models have been the preferred preclinical model in some research areas such as medical devices, wound healing, and skin therapies. The porcine model has been the cornerstone for interventional cardiology for the evaluation and development of this catheter-based renal denervation (RDN) therapy. The porcine model provides similar vascular access and renal neurovascular anatomy to humans. In these preclinical studies, the downstream kidneys from treated arteries are assessed for possible histopathological changes in the vessel dependent territories. In assessing renal safety following RDN, it becomes critical to distinguish treatment-related changes from pre-existing background pathologies. The incidence of background pathological changes in porcine kidneys has not been previously established in normal clinically healthy. Samples from the cranial, middle, and caudal portion of 331 naïve kidneys from 181 swine were processed histologically to slides and evaluated microscopically. The most commonly encountered spontaneous changes were chronic pyelonephritis found in nearly half of the evaluated naïve kidneys (∼40 %; score 1 = 91 %, score 2 = 8.4 %, score 3 = 0.76 %) followed by chronic interstitial inflammation in 9.7 % of the kidneys (score 1 = 90.6 %, score 2 = 9.4 %). Interestingly, there were a few rare spontaneous vascular changes that could potentially affect data interpretation in interventional and toxicology studies: arteritis and arteriolar dissection. The presence of pelvic cysts was a common occurrence (6.3 %) in the kidney. The domestic swine is a widely used preclinical species in interventional research, namely in the emerging field of transcatheter renal denervation. This retrospective study presents the historical incidence of spontaneous lesions recorded in the kidneys from naive pigs enrolled in renal denervation studies. There were commonly encountered changes of little pathological consequence such as pyelonephritis or pelvic cysts and rare vascular changes such as arteritis and arteriolar dissection that were of greater potential impact on study data interpretation. These results offer a benchmark by which to gage the potential effect of a procedure or treatment on renal histopathology in swine and assist in data interpretation.

摘要

临床前动物模型的使用对于安全评估、发病机制研究以及诊断技术和治疗干预的测试至关重要。由于与人类解剖学和生理学具有内在相似性,各种猪模型在某些研究领域,如医疗设备、伤口愈合和皮肤治疗等方面,一直是首选的临床前模型。猪模型一直是介入心脏病学评估和开发这种基于导管的肾去神经支配(RDN)疗法的基石。猪模型提供了与人类相似的血管通路和肾神经血管解剖结构。在这些临床前研究中,对治疗动脉下游的肾脏进行评估,以确定血管依赖区域可能存在的组织病理学变化。在评估RDN后的肾脏安全性时,区分与治疗相关的变化和预先存在的背景病变变得至关重要。猪肾脏中背景病理变化的发生率在正常临床健康的猪中尚未确定。对来自181头猪的331个未处理肾脏的颅部、中部和尾部样本进行组织学处理制成玻片,并进行显微镜评估。最常见的自发变化是慢性肾盂肾炎,在近一半的评估未处理肾脏中发现(约40%;评分1 = 91%,评分2 = 8.4%,评分3 = 0.76%),其次是9.7%的肾脏出现慢性间质性炎症(评分1 = 90.6%,评分2 = 9.4%)。有趣的是,有一些罕见的自发血管变化可能会影响介入和毒理学研究中的数据解释:动脉炎和小动脉夹层。肾盂囊肿的存在在肾脏中很常见(发生率为6.3%)。家猪是介入研究中广泛使用的临床前物种,特别是在经导管肾去神经支配这一新兴领域。这项回顾性研究呈现了参与肾去神经支配研究的未处理猪肾脏中记录的自发病变的历史发生率。常见的病理后果较小的变化,如肾盂肾炎或肾盂囊肿,以及罕见的血管变化,如动脉炎和小动脉夹层,对研究数据解释具有更大的潜在影响。这些结果提供了一个基准,据此可以衡量一种程序或治疗对猪肾脏组织病理学的潜在影响,并有助于数据解释。

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