1University Heart Center Hamburg, TSI-Lab, Germany, 2Cardiovascular Research Center, University of Hamburg, 3Department of Medicine, Cardiology Division, Pulmonary Hypertension Program, University of Alberta, 4Department of Medicine, Stanford University School of Medicine, 5Department of Biomedical Sciences, Institute of Physiology, Pathophysiology, and Biophysics, University of Veterinary Medicine, Vienna, 6Translumina GmbH, Hechingen, 7Department of Cardiothoracic Surgery, Stanford University School of Medicine
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Hua, X., Deuse, T., Michelakis, E. D., Haromy, A., Tsao, P. S., Maegdefessel, L., et al. Human Internal Mammary Artery (IMA) Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis. J. Vis. Exp. (63), e3663, doi:10.3791/3663 (2012).
Preclinical in vivo research models to investigate pathobiological and pathophysiological processes in the development of intimal hyperplasia after vessel stenting are crucial for translational approaches1,2.
The commonly used animal models include mice, rats, rabbits, and pigs3-5. However, the translation of these models into clinical settings remains difficult, since those biological processes are already studied in animal vessels but never performed before in human research models6,7. In this video we demonstrate a new humanized model to overcome this translational gap. The shown procedure is reproducible, easy, and fast to perform and is suitable to study the development of intimal hyperplasia and the applicability of diverse stents.
This video shows how to perform the stent technique in human vessels followed by transplantation into immunodeficient rats, and identifies the origin of proliferating cells as human.
1. Internal Mammary Artery (IMA) Preparation
2. Animal Preparation
RNU Nude (Crl:NIH-Foxn1rnu) rats (300-350 g) are housed under conventional conditions in scantainer ventilated cabinets, fed standard rat chow and autoclaved water ad libidum.
3. Representative Results
For histology, the specimens were fixed in 4% formalin, dehydrated in a graded series of alcohol, and infiltrated in a mixture (MMA I) of 80% methylmethacrylate and 20% dibutylphthalate for 1 day, MMA I with 1% dry benzoyl peroxide for 1 day, and MMA I with 3% dry benzoyl peroxide (MMA III) for 1-2 days at 4 °C. Thereafter, the specimens were polymerized in fresh MMA III in glass vials in a water bath on a pre-polymerized base. Slow polymerization was achieved by keeping the vials at 26 °C overnight, increasing the temperature to 28 °C the next morning, and then increasing the temperature gradually by 0.5 °C over 12 h until polymerization occurred. The polymerized blocks were sectioned at 5 μm thickness using a MICROM HM 360 microtome equipped with a tungsten carbide knife.
To identify the origin of proliferating cells (Figure 1), slides were stained with antibodies identifying either the green fluorescent protein (GFP) or rat MHC-I and human smooth muscle cells. For these studies, human IMA was incubated with the reporter gene GFP overnight using lentiviral particles for stable transduction of IMA cells. Dividing daughter cells from human origin could be identified by expressing GFP. After deparaffinization, heat-induced epitope retrieval is performed by heating the slides in antigen retrieval solution using a steamer. The Image-iT FX signal enhancer can be used for the blocking step. Cells of human origin are identified using the mouse monoclonal antibodies against GFP (1:100 diluted in primary antibody diluent (Dako)), and further labeled with goat-anti-mouse IgG, Alexa Fluor 488 (1:1000 diluted in secondary antibody diluent). The smooth muscle cells were marked with the rabbit polycolonal anti-smooth muscle α-actin (1:100 diluted in primary antibody diluent), followed by goat-anti-rabbit IgG, Alexa Fluor 555 (1:1000 diluted in secondary antibody diluents). Each antibody incubation step is performed at 37 °C for 1 hour with three times PBS washing in between. Nuclei are stained with DAPI for 10 minutes. After mounting of the slides using Prolong Gold antifade reagent, samples were analyzed using confocal microscopy.
Figure 1. The neointimal cells as human smooth muscle cells. A: Green= anti GFP, labeling cells of human origin; red=anti human smooth muscle cell actin; blue=DAPI, identifying cell nuclei. B: Green= anti rat MHC-I, labeling cells of rat origin; red=anti human smooth muscle cell actin; blue=DAPI, identifying cell nuclei. Proliferating cells are identified as smooth muscle cells and positive for GFP, but negative for the rat MHC-I molecule. Therefore, proliferating cells are human origin.
Although different in vivo research models are existing to investigate the development of intimal hyperplasia after stent placement, these models still facing translational hurdles to overcome. Furthermore, large animal models are expensive and special housing conditions as well as surgical equipment is not available for all laboratories.
Using a human IMA to study the development of human intimal proliferation and in-stent restenosis was studied before ex situ in organ cultures 8,9. The new humanized IMA model constitutes a translational approach to address the issue of in stent re-stenosis in vivo, by implanting the human IMA into the abdominal aortic position of immunodeficient rats. Human IMA's are a perfect match to the size of the abdominal aorta of rats. Therefore, our presented model is reproducible, easy and fast to perform, does not require special surgical training, and is inexpensive.
The identification of the neointimal cells as human smooth muscle cells closes the translational gap to clinical settings and shows the opportunity to investigate human pathophysiological processes in vivo.
No conflicts of interest declared.
The authors thank Christiane Pahrmann for her contribution. Special thanks to Ethicon, Norderstedt, Hamburg (Germany) for providing the suture material.
Sonja Schrepfer has received a research grant from the Deutsche Forschungsgemeinschaft (DFG) (SCHR992/3 1 and SCHR992/4-1).] The work was supported by the ISHLT Shumway Career Development Grant 2010 and the Falk Research Funding (Stanford University).
|2 French Fogarty catheter||Baxter Internationl Inc.||120602F|
|Yukon Stent||Translumina GmbH, Hechingen, Germany||Use the stent of your choice according to your study protocol|
|RPMI media||Biochrom AG||Nr.F1275|
|heparin||Baxter Internationl Inc.||2B0953|
|Provo-Iodine||Betadine Puredue Pharma||EAN:5995327165830|
|80% ethanol||Geyer||ETV 80/0500|
|Micro clamp||Harvard Apparatus||PY2-61-0186|
|Sutures 8-0||Johnson & Johnson||2808G|
|Sutures 6-0||Johnson & Johnson||1698 H|
|Target retrieval solution, pH9||Dako||S2368|
|Image-iT FX signal enhancer||Invitrogen||I36933|
|mouse monoclonal anti-GFP antibody||BD Biosciences||632381|
|primary antibody diluent||Dako||S3022|
|goat-anti-mouse IgG, Alexa Fluor 488||Invitrogen||A11017|
|secondary antibody diluent||Dako||S0809|
|rabbit polycolonal anti-smooth muscle α-actin||Abcam||ab5694|
|goat-anti-rabbit IgG, Alexa Fluor 555||Invitrogen||A21430|
|Prolong Gold antifade reagent||Invitrogen||P36930|