Treatment of coronary chronic total occlusion by transradial approach: Current trends and expert recommendations

The aim of this review is to highlight the technical details and the scientific data on percutaneous coronary interventions (PCIs) in chronic total occlusion (CTO) performed by transradial approach (TRA). Transfemoral approach (TFA) is commonly regarded as the standard for CTO PCI, but there is a growing number of CTO recanalization procedures performed by TRA. We discuss the relevant technical details to approach a CTO by transradial access, especially the compatibility of various CTO recanalization techniques with specific guiding catheter sizes. Randomized prospective trials in this field are lacking and only data from observational studies are available. We can conclude that transradial access for CTO PCI is feasible and could be very useful in selected patients. In our opinion, transradial access in CTO PCIs should be limited to operators and centers highly experienced in CTO recanaliza¬tion and in TRA

Perspectives in manipulating EVs for therapeutic applications : focus on cancer treatment

Extracellular vesicles (EVs) receive special attention from oncologists due to their assumed usefulness as prognostic markers, vaccines to induce anti-cancer immune response, and physiological delivery tools. The latter application, which supports the reduction of side effects of treatment, is still fraught with many challenges, including established methods for loading EVs with selected cargo and directing them towards target cells. EVs could be loaded with selected cargo either in vitro using several physicochemical techniques, or in vivo by modification of parental cell, which may have an advantage over in vitro procedures, since some of them significantly influence EVs’ properties. Otherwise, our research findings suggest that EVs could be passively supplemented with micro RNAs (miRNAs) or miRNA antagonists to induce expected biological effect. Furthermore, our observations imply that antigen-specific antibody light chains could coat the surface of EVs to increase the specificity of cell targeting. Finally, the route of EVs’ administration also determines their bioavailability and eventually induced therapeutic effect. Besides, EV membrane lipids may possibly possess immune adjuvant activity. The review summarizes the current knowledge on the possibilities to manipulate EVs to use them as a delivery tool, with the special emphasis on anti-cancer therapy

Poziom wiedzy o przewlekłych okluzjach tętnic wieńcowych wśród polskich lekarzy

Wstęp: Przewlekłe okluzje tętnic (CTO) stwierdza się w ok. 30% angiogramów pacjentów z chorobą niedokrwienną serca. W ostatnich latach skuteczność zabiegów przezskórnej rewaskularyzacji CTO wzrasta, ale jednocześnie udrożnienia CTO stanowią coraz niższy odsetek wszystkich interwencji wieńcowych. Jednym z czynników zniechęcających do podejmowania tych wymagających technicznie zabiegów może być brak wiedzy na temat CTO. Cel: Próba określenia stanu wiedzy na temat przewlekłych okluzji tętnic wieńcowych wśród polskich lekarzy. Metody: W badaniu wzięli udział lekarze zainteresowani zagadnieniami przewlekłych okluzji tętnic wieńcowych. Zostało ono przeprowadzone przy użyciu ankiety zawierającej pytania dotyczące podstawowych informacji na temat przewlekłych okluzji tętnic wieńcowych. Wyniki: W badaniu wzięło udział 115 osób, w większości kardiolodzy nieinwazyjni. Jedynie 36,5% uczestników badania potrafiło prawidłowo określić częstość występowania CTO. W 62,5% respondenci jako preferowaną formę terapii wskazali leczenie zachowawcze. Większość uczestników badania (77,4%) dostrzega konieczność wykazania niedokrwienia i żywotności mięśnia sercowego zaopatrywanego przez zamknięte naczynie przed rewaskularyzacją przewlekłej niedrożności tętnicy wieńcowej. Wnioski: Poziom wiedzy na temat CTO wśród polskich lekarzy jest niewystarczający. Konieczne są dalsze działania edukacyjne w tym zakresie skierowane nie tylko do kardiologów interwencyjnych, ale też pozostałych lekarzy zajmujących się pacjentami z chorobą wieńcową.Background: Chronic total occlusions (CTO) are diagnosed in about 30% of angiograms in patients with coronary artery disease. In recent years the efficacy of percutaneous revascularisation of CTO has been on rise but simultaneously has constituted increasingly smaller percentage of all coronary interventions. One of the causes discouraging from such technically demanding procedures may be the lack of knowledge of CTO. Aim: An attempt to assess the state of knowledge of coronary CTO among Polish physicians. Methods: In the study participated physicians with an interest in the subject of CTO. Study was performed with a questionnaire including questions regarding basic knowledge of coronary CTO. Results: In the study participated 115 physicians , most of them were non-invasive cardiologists. Only 36.5% of responders could provide incidence of CTO correctly. 62.5% of responders chose medical therapy as a preferable method of treatment. A majority of participants (77.4%) appreciated the need to demonstrate ischaemia and myocardial viability in the region supplied by the occluded artery before revascularisation of a CTO. Conclusions: The level of knowledge about coronary CTO among Polish physicians is not sufficient. Further education in this subject is necessary not only among interventional cardiologist but also among other doctors providing care for patients with coronary artery disease

Does the effectiveness of recanalization of chronic occlusion depend on the location of the obstruction?

Introduction: In past studies, it has been questioned whether success of recanalization of chronic total occlusion (CTO) depends on the location of the occlusion – the circumflex artery (Cx) was considered as the most difficult to open. Aim: To determine whether the effectiveness of recanalization of CTO depends on the location of the obstruction. Material and methods: From January 2011 to January 2016, a single operator dedicated to chronic total occlusions performed in our center 357 procedures on 337 patients. Results: Among 337 patients included in the study, 83.4% were male. Mean age was 62.8 ±9.3 years. Most of the patients had hypertension (86.4%) and hyperlipidemia (99.4%), and 28.8% of them had diabetes. The most frequently opened artery was the right coronary artery (RCA; 52.4%), followed by the left anterior descending artery (LAD; 29.4%), and last the Cx (18.2%). The mean J-CTO score was comparable between the three groups. The success rate of recanalization of CTO was similar for all arteries: 84.5% in the RCA, 81.9% in the LAD and 89.2% in the Cx (overall p = 0.437). Neither procedural complications nor adverse events depended on the location of the CTO. Conclusions: Our study shows the same efficacy of CTO procedures of all epicardial arteries. We did not observe that effectiveness of recanalization of CTO depends on the location of the obstruction

Antibody light chains dictate the specificity of contact hypersensitivity effector cell suppression mediated by exosomes

Antibody light chains (LCs), formerly considered a waste product of immunoglobulin synthesis, are currently recognized as important players in the activation of the immune response. However, very little is known about the possible immune regulatory functions of LCs. Recently, we reported that hapten-specific LCs coat miRNA-150-carrying exosomes produced by CD8+ suppressor T cells downregulating the contact hypersensitivity (CHS) reaction in an antigen-specific manner, in mice tolerized by intravenous administration of a high dose of hapten-coupled syngeneic erythrocytes. Thus, the current studies aimed at investigating the role of hapten-specific LCs in antigen-specific, exosome-mediated suppression of CHS effector cells. Suppressor T cell-derived exosomes from tolerized B-cell-deficient µMT−/−, NKT-cell-deficient Jα18−/−, and immunoglobulin-deficient JH−/− mice were nonsuppressive, unless supplemented with LCs of specificity strictly respective to the hapten used for sensitization and CHS elicitation in mice. Thus, these observations demonstrate that B1-cell-derived LCs, coating exosomes in vivo and in vitro, actually ensure the specificity of CHS suppression. Our research findings substantially expand current understanding of the newly discovered, suppressor T cell-dependent tolerance mechanism by uncovering the function of antigen-specific LCs in exosome-mediated, cell–cell communication. This express great translational potential in designing nanocarriers for specific targeting of desired cells

Knowledge of chronic total occlusion among Polish interventional cardiologists

Introduction: Chronic total occlusion (CTO) recanalization is indicated in patients with symptoms and evidence of ischemia, but in most cases those types of lesions are still treated medically. In the last few years CTO angioplasty technique has changed dramatically due to considerable advances in techniques and dedicated equipment. Aim: An attempt to assess the state of knowledge of technical aspects of CTO angioplasty of coronary arteries among Polish interventional cardiologists. Material and methods: Questionnaire survey performed during two major Polish invasive cardiology workshops. Results: In the study there participated 113 physicians with an average length of work experience of 13 years, most of them cardiologists certified as independent primary operators. The majority of respondents recognized the need of prevention of thrombotic complications through control of activated coagulation time during the CTO procedures. Prevention of renal complications and X-ray protection are also recognized as a significant part of the procedures. The benefits from the use of over-the-wire microcatheters and balloons, the proper choice of dedicated guidewires, contralateral injections and retrograde technique are underestimated. Conclusions: Despite satisfactory knowledge about indications and qualification for the CTO procedure, the awareness of procedural aspects (particularly the retrograde technique) as well as the dedicated CTO equipment among Polish interventional cardiologists is still insufficient

Modulation of testicular macrophage activity by collagenase

Testicular macrophages (TMs) are located in the interstitial tissue of male gonad. These phagocytic cells take part in forming the organ-specific functional blood-testis barrier and participate in the regulation of the local hormonal balance. In the present study, we isolated TMs from testicular tissues using previously described methods - mechanical (M-TMs) or enzymatic, by treatment with collagenase (E-TMs) and then we studied production by these cells of several cytokines and reactive oxygen intermediates (ROI’s). Similarly treated oil-induced peritoneal macrophages (PMs) were used as control cells. PMs had a higher baseline level of production of TNF-α, IL-6, IL-10 and IL-12 than M-TMs and collagenase treatment increased the production of these cytokines (except IL-12) by both cell populations. This effect was significantly more expressed in TMs. In contrast to PMs, TMs produced little ROI’s when stimulated by zymosan. We conclude that in the case of local inflammation in the testis, ROI-negative TMs do not contribute to the tissue damage and instead may direct the local immune response into humoral pathway