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Aortic Valve Mechanobiology – AORTIC VALVE MECHANOBIOLOGY – THE EFFECT OF CYCLIC STRETCH A Dissertation Presented to The Academic Faculty by Kartik Balachandran In Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy in Bioengineering Department of Biomedical Engineering Georgia Institute of Technology May 2010 AORTIC VALVE MECHANOBIOLOGY – THE EFFECT OF CYCLIC STRETCH Approved by: Dr. Ajit P. Yoganathan, Advisor Dr. Robert M. Nerem Georgia Institute of Technology Georgia Institute of Technology Dr. Hanjoong Jo Dr. Michael S. Sacks Georgia Institute of Technology University of Pittsburgh and Emory University Dr. Adrian H. Chester Dr. Stephen L. Hilbert Imperial College, London Children’s Mercy Hospital Date Approved: Jan 13, 2010 To my family, ACKNOWLEDGEMENTS This dissertation represents more than five years of work and it would not have been possible without the support and encouragement of several people. First and foremost, I would like to thank my advisor Dr. Ajit Yoganathan for taking me on as a student. I am thankful that he had enough confidence in me to put a person with a Mechanical Engineering background into the exciting world of heart valve biology. Apart from research, he has given me the opportunity to mentor students, to travel the world to present my work, and to collaborate with different research groups. These opportunities have definitely provided me a great foundation to begin my academic career. I would also like to thank Drs. Bob Nerem, Hanjoong Jo, Stephen Hilbert, Michael Sacks and Adrian Chester for being part of my thesis committee. Their critical input has constantly refined and molded my thesis over the last five years. I am especially thankful to Dr. Chester for mentoring and training me during my visit to HHSC in 2007, to Dr. Jo, for allowing me to use the resources of his lab, and to Dr. Sacks for the initial design of the stretch bioreactor. I would like to acknowledge Holifield Farms, Covington, GA for donating the porcine hearts for this study. This thesis work was supported by the National Science Foundation through the ERC program at Georgia Institute of Technology under award number EEC-9731643, and by the American Heart Association Predoctoral Fellowship award number 09PRE2060605. Sanity was maintained in the crazy, fast-paced world of the Cardiovascular Fluid Mechanics Laboratory with the help and support of great friends and colleagues. Udayan, iv Karan, Nishi, Vivek, Vasudha, Anish, Shruti,Vik and Cecilia, you guys made these last two years normal again. Kartik S, Murali and Philippe, thank you for the enriching conversations on research, sports, XBOX, philosophy and everything else. I will never forget the good times we had together in the lab. Yash, Ayona, Rahul and the rest of the pot-luck gang, thank you for the great food and company. Everyone knows that good research only is possible with good food. Yap, Erin, Hiroumi, Diane, Hélène, Prasad, Jorge, Dr. Boz, Ismail, David, Chris, JP, Brandon, Andrew, Neela, Shiva, Kerem, Zhaoming, Suchitra, Yun, James, Resmi, and Anna, it was amazing working with all of you. I could not have asked for a better set of colleagues and friends here. Chrissy, Christina, Darshin, Kaitlyn, Samiya, Patrick, Mike, Brian, and Phillip, thank you for assisting me in my research. Randy and Casey, thank you for your help in training me in western blotting and RNA extraction. Michelle, Colly, LaKeisha, Gail and Cosetta, thank you all for your assistance in the administrative tasks. Last, but definitely not least, I am very grateful to my family for providing me with encouragement and loving support. Thank you amma and appa! Amma, I knew you always wanted me to do a PhD and have always pushed me academically. I hope I have made you proud. Thank you Smitha. You have been a constant source of strength and support, and kept me motivated and going even when it seemed like things were not working out. I also appreciate the patience of both our parents and siblings as we went through this journey in Georgia Tech. This thesis is dedicated to them. v TABLE OF CONTENTS ACKNOWLEDGEMENTS …………………………………………………………….. iv LIST OF TABLES ……………………………………………………………………... xii LIST OF FIGURES …………………………………………………………………… xiii LIST OF ABBREVIATIONS ………………………………………………………... xxiv SUMMARY ……………………………………………………………………..….... xxvi CHAPTER 1 INTRODUCTION .................................................................................... 1 CHAPTER 2 BACKGROUND AND SIGNIFICANCE ............................................... 5 2.1 The Heart and the Cardiac Cycle ....................................................................... 5 2.2 The Aortic Valve - Anatomy.............................................................................. 9 2.3 Aortic Valve Cusp Structure ............................................................................ 11 2.4 Aortic valve mechanics and Function .............................................................. 14 2.4.1 In vivo Tissue Mechanics of the Valve Cusp .................................... 14 2.4.2 Material Properties of Aortic Valve Cusps ........................................ 15 2.5 Aortic valve cell biology .................................................................................. 18 2.5.1 Aortic Valve Endothelial Cells .......................................................... 18 2.5.2 Aortic Valve Interstitial Cells ............................................................ 19 2.6 Degenerative Aortic Valve Disease ................................................................. 22 2.6.1 Aortic Valve Disease ......................................................................... 22 2.7 Treatment Options for Aortic Valve Disease ................................................... 27 2.8 Degenerative Aortic Valve Disease Pathobiology ........................................... 32 2.8.1 Elevated Extracellular Matrix Remodeling and Inflammation .......... 33 2.8.2 Calcific aortic stenosis ....................................................................... 35 2.8.3 Serotonin-Related Valve Degeneration ............................................. 39 2.9 Effect of Mechanical Forces on Aortic Valve Biology .................................... 45 vi 2.9.1 Mechanical Environment of the Aortic Valve ................................... 45 2.9.2 Cellular Mechanisms for Mechanotransduction ................................ 51 2.9.3 Effect of Mechanical Forces on Aortic Valve Degeneration ............. 52 2.10 Rationale For Thesis Research ......................................................................... 58 CHAPTER 3 HYPOTHESIS AND SPECIFIC AIMS ................................................. 59 3.1 Specific Aim 1: Effect of cyclic stretch on extracellular matrix remodeling .. 63 3.2 Specific Aim 2: Effect of cyclic stretch on aortic valve calcification .............. 64 3.3 Specific Aim 3: Effect of cyclic stretch on serotonin-related valvular degeneration ............................................................................................................... 65 CHAPTER 4 MATERIALS AND METHODS ........................................................... 66 4.1 Stretch Bioreactor System Development ......................................................... 67 4.1.1 Introduction to Stretch Bioreactor System ........................................ 67 4.1.2 Derivation of Input Waveforms to Stretch Bioreactor ...................... 70 4.1.3 Control and Feedback of Stretch Bioreactor System ......................... 72 4.2 Mechanical Validation of Stretch Bioreactor ................................................... 74 4.2.1 Quantification of Stretch Environment in Stretch Bioreactor ........... 74 4.2.2 Quantification of Fluid Shear Stress Environment in Stretch Bioreactor .......................................................................................... 76 4.3 Experimental Methods ..................................................................................... 78 4.3.1 Tissue Procurement and Experimental Set-up ................................... 78 4.3.2 Experimental Conditions For Tensile Stretch Bioreactor .................. 80 4.4 Biological Analyses Methods .......................................................................... 84 4.4.1 Extracellular Matrix Assays .............................................................. 84 4.4.2 Histology and Immunohistochemistry ............................................... 87 4.4.3 Immunoblotting ................................................................................. 94 4.4.4 Gelatin Zymography and Reverse Zymography ................................ 95 vii 4.4.5 Alkaline Phosphatase Activity Assay ................................................ 96 4.4.6 Calcium Arsenazo Assay ................................................................... 97 4.5 Image Analysis and Semi-Quantification Using ImageJ Software .................. 98 4.5.1 Analysis of Picrosirius Red Images ................................................... 98 4.5.2 Semi-quantification of Immunohistochemistry Images ..................... 99 4.5.3 Densitometry of Immunoblots and Zymograms .............................. 100 4.6 Uniaxial Mechanical Testing ......................................................................... 101 4.6.1 Tissue preparation and setup ........................................................... 101 4.6.2 Experimental Protocol ..................................................................... 102 4.6.3 Maximum Physiological Load ........................................................
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