Ganizada Berta H, Reesink Koen D, Parikh Shaiv, Ramaekers Mitch J F G, Akbulut Asim C, Saraber Pepijn J M H, Debeij Gijs P, Jaminon Armand M, Natour Ehsan, Lorusso Roberto, Wildberger Joachim E, Mees Barend, Schurink Geert Willem, Jacobs Michael J, Cleutjens Jack, Krapels Ingrid, Gombert Alexander, Maessen Jos G, Accord Ryan, Delhaas Tammo, Schalla Simon, Schurgers Leon J, Bidar Elham
Departments of Cardiothoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands.
Department of Biochemistry, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands.
Biomedicines. 2023 Jul 25;11(8):2095. doi: 10.3390/biomedicines11082095.
Current management guidelines for ascending thoracic aortic aneurysms (aTAA) recommend intervention once ascending or sinus diameter reaches 5-5.5 cm or shows a growth rate of >0.5 cm/year estimated from echo/CT/MRI. However, many aTAA dissections (aTAAD) occur in vessels with diameters below the surgical intervention threshold of <55 mm. Moreover, during aTAA repair surgeons observe and experience considerable variations in tissue strength, thickness, and stiffness that appear not fully explained by patient risk factors. To improve the understanding of aTAA pathophysiology, we established a multi-disciplinary research infrastructure: The Maastricht acquisition platform for studying mechanisms of tissue-cell crosstalk (MAPEX). The explicit scientific focus of the platform is on the dynamic interactions between vascular smooth muscle cells and extracellular matrix (i.e., cell-matrix crosstalk), which play an essential role in aortic wall mechanical homeostasis. Accordingly, we consider pathophysiological influences of wall shear stress, wall stress, and smooth muscle cell phenotypic diversity and modulation. Co-registrations of hemodynamics and deep phenotyping at the histological and cell biology level are key innovations of our platform and are critical for understanding aneurysm formation and dissection at a fundamental level. The MAPEX platform enables the interpretation of the data in a well-defined clinical context and therefore has real potential for narrowing existing knowledge gaps. A better understanding of aortic mechanical homeostasis and its derangement may ultimately improve diagnostic and prognostic possibilities to identify and treat symptomatic and asymptomatic patients with existing and developing aneurysms.
目前升主动脉瘤（aTAA）的管理指南建议，一旦升主动脉或窦部直径达到5 - 5.5厘米，或根据超声心动图/CT/MRI估计显示年生长率>0.5厘米，就进行干预。然而，许多升主动脉瘤夹层（aTAAD）发生在直径低于55毫米的手术干预阈值的血管中。此外，在升主动脉瘤修复过程中，外科医生观察到并体验到组织强度、厚度和硬度存在相当大的差异，而这些差异似乎不能完全由患者风险因素来解释。为了更好地理解升主动脉瘤的病理生理学，我们建立了一个多学科研究基础设施：马斯特里赫特组织 - 细胞相互作用机制研究采集平台（MAPEX）。该平台明确的科学重点是血管平滑肌细胞与细胞外基质之间的动态相互作用（即细胞 - 基质相互作用），这在主动脉壁机械稳态中起着至关重要的作用。因此，我们考虑壁面剪切应力、壁面应力以及平滑肌细胞表型多样性和调节的病理生理影响。在组织学和细胞生物学水平上对血流动力学和深度表型进行共同注册是我们平台的关键创新，对于从根本层面理解动脉瘤形成和夹层至关重要。MAPEX平台能够在明确的临床背景下解释数据，因此在缩小现有知识差距方面具有实际潜力。更好地理解主动脉机械稳态及其紊乱最终可能改善诊断和预后可能性，以识别和治疗患有现有和正在发展的动脉瘤的有症状和无症状患者。
