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• W2912593385 abstract "Central MessageStatins may decrease calcification of biologic tissue valve prostheses. Macrophages may play a key role in biologic valvular tissue longevity.See Article page 731. Statins may decrease calcification of biologic tissue valve prostheses. Macrophages may play a key role in biologic valvular tissue longevity. See Article page 731. Just more than 100 years has passed since the very first studies showing the link between high-fat diet, increased cholesterol level, and development of atherosclerotic damage to cardiovascular the system.1Konstantinov I.E. Mejevoi N. Anichkov N.M. Nikolai N. Anichkov and his theory of atherosclerosis.Tex Heart Inst J. 2006; 33: 417-423PubMed Google Scholar, 2Konstantinov I.E. Jankovic G.M. Alexander I. Ignatowski: a pioneer in the study of atherosclerosis.Tex Heart Inst J. 2013; 40: 246-249PubMed Google Scholar Simplistically, it appears logical that controlling cholesterol at a normal level through various lipid-lowering strategies, including administration of statins, would reduce atherosclerotic degeneration. The statins are commonly used as a part of lipid-lowering therapy acting as a 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor that is the rate-limiting enzyme in the synthesis of cholesterol (Figure 1). Could the same strategies by used to prevent bioprosthetic valve degeneration? Although the beneficial effect of statins to slow the progress of atherosclerosis has been demonstrated, the use of statins to prevent deterioration and calcification of bioprosthetic tissues remains controversial.3Gilmanov D. Bevilacqua S. Mazzone A. Glauber M. Do statins slow the process of calcification of aortic tissue valves?.Interact Cardiovasc Thorac Surg. 2010; 11: 297-301Crossref PubMed Scopus (30) Google Scholar, 4Farivar R.S. Cohn L.H. Hypercholesterolemia is a risk factor for bioprosthetic valve calcification and explantation.J Thorac Cardiovasc Surg. 2003; 126: 969-975Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar A very interesting and thought-provoking article by Lee and colleagues5Lee S. Kim D.-H. Youn Y.-N. Joo H.C. Yoo K.-J. Lee S.H. Rosuvastatin attenuates bioprosthetic heart valve calcification.J Thorac Cardiovasc Surg. 2019; 158: 731-741.e1Abstract Full Text Full Text PDF Scopus (7) Google Scholar on the effect of statin treatment on bioprosthetic tissue calcification in rats is published in this issue of the Journal. Twenty rats were fed a high-fat diet for 1 month and then randomly assigned to receive either statin therapy with a high-fat diet or a high-fat diet alone. Tissues of 4 types of bioprosthetic valves were implanted subcutaneously and excised 12 weeks later. Lee and colleagues5Lee S. Kim D.-H. Youn Y.-N. Joo H.C. Yoo K.-J. Lee S.H. Rosuvastatin attenuates bioprosthetic heart valve calcification.J Thorac Cardiovasc Surg. 2019; 158: 731-741.e1Abstract Full Text Full Text PDF Scopus (7) Google Scholar found that rats treated with a statin had less calcification and a lower inflammatory infiltrate affecting the cusps of the excised valve. It is tempting to take a closer look at the mechanism of the atherosclerotic damage. Macrophages constantly survey both native and implanted biologic tissues. Macrophages play a crucial role in the clearance of cellular debris and maintaining tissue homeostasis. Fatty streak formation occurs in areas of high shear stress. Macrophages infiltrating fatty streaks engulf lipoproteins and cholesterol in an attempt to clear the tissue of excessive lipoprotein deposits. Overwhelmed by engulfed lipoproteins, macrophages become foam cells that are incapable of effective clearance of debris and, in fact, contribute to tissue degeneration and calcification (Figure 1). Although the role of macrophages in atherosclerosis has been recognized for almost a century, the essential role of macrophages in tissue regeneration has only recently become apparent.6Aurora A.B. Porrello E.R. Tan W. Mahmoud A.I. Hill J.A. Bassel-Duby R. et al.Macrophages are required for neonatal heart regeneration.J Clin Invest. 2014; 124: 1382-1392Crossref PubMed Scopus (500) Google Scholar Cellular senescence has recently been linked to the promotion of age-related pathologies and a decline in tissue regenerative capacity. Interestingly, it was previously demonstrated that senescent cells accumulate in patients with chronic inflammation of the pericardium.7Han L. Li X. Zhang G. Xu Z. Gong D. Lu F. et al.Pericardial interstitial cell senescence responsible for pericardial structural remodeling in idiopathic and postsurgical constrictive pericarditis.J Thorac Cardiovasc Surg. 2017; 154: 966-975.e4Abstract Full Text Full Text PDF Scopus (6) Google Scholar Senescent cells produced more collagen, attracted more white blood cells, and deposited more calcium.7Han L. Li X. Zhang G. Xu Z. Gong D. Lu F. et al.Pericardial interstitial cell senescence responsible for pericardial structural remodeling in idiopathic and postsurgical constrictive pericarditis.J Thorac Cardiovasc Surg. 2017; 154: 966-975.e4Abstract Full Text Full Text PDF Scopus (6) Google Scholar This may in part explain the fact that pericardial bioprostheses are particularly vulnerable to calcification. Effective immune clearance of senescent cells by macrophages could be important in both prevention of structural deterioration and tissue regeneration.8Konstantinov I.E. Ye X.T. Fricke T.A. From cellular senescence to regeneration: a quest for the holy grail for the next generation of surgeons?.J Thorac Cardiovasc Surg. 2017; 154: 953-954Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar For example, salamanders have a remarkable ability to regenerate complex tissues, including heart tissues. Salamanders also have a superbly efficient mechanism of eliminating senescent cells through macrophage-dependent immune clearance.9Yun M.H. Davaapil H. Brockes J.P. Recurrent turnover of senescent cells during regeneration of a complex structure.Elife. 2015; 4: e05505Crossref Scopus (161) Google Scholar Could such a regenerative pathway be emulated to prevent structural deterioration of implanted biologic tissues in patients? The use of a multifaceted strategy to improve macrophage-dependent clearance of metabolic and cellular debris may dramatically improve longevity of bioprosthetic heart valves. Rosuvastatin attenuates bioprosthetic heart valve calcificationThe Journal of Thoracic and Cardiovascular SurgeryVol. 158Issue 3PreviewThere are pathophysiologic similarities between calcification and atherosclerosis because both are the product of an active inflammatory process. The aim of the study was to examine the effects of statin treatment on calcification in commercially available bioprosthetic heart valves. Full-Text PDF Open Access" @default.
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• W2912593385 title "Commentary: From bioprosthetic tissue degeneration to regeneration: A new surgical horizon in the era of regenerative medicine" @default.
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