Cardiovascular diseases remain the major cause of death throughout the world and can be primarily attributed to atherosclerotic vascular disease leading to stroke and coronary heart disease (CHD).... Show moreCardiovascular diseases remain the major cause of death throughout the world and can be primarily attributed to atherosclerotic vascular disease leading to stroke and coronary heart disease (CHD). Improved primary prevention and the introduction and subsequent optimization of percutaneous coronary interventions (PCI) for myocardial ischemia due to obstructive CHD have significantly improved patient outcome and reduced morbidity and mortality. The insight into disease pathology has however expanded tremendously over the past decade and continuing research has shifted the focus of interest towards post-interventional accelerated atherosclerosis development due to a dysfunctional (auto) immune inflammatory response, responsible for vascular remodeling, re-occlusion and recurrence of symptoms. The aim of this thesis therefore was to investigate the role of the immune system in this pathophysiological process that ultimately results in post-interventional atherosclerotic vascular remodeling and apply this insight for the development of new immune-modulatory therapies in a preclinical setting. Show less
The studies described in this thesis focus on gene therapeutic strategies to target pathological vascular wall remodeling after PT(C)A or bypass surgery. Inflammatory processes and extracellular... Show moreThe studies described in this thesis focus on gene therapeutic strategies to target pathological vascular wall remodeling after PT(C)A or bypass surgery. Inflammatory processes and extracellular proteases, both activated by mechanical and vascular injury caused by these interventions, are thought to contribute largely to the development of post-angioplasty restenosis and vein graft disease. Therefore, viral and non-viral gene therapy techniques were used in these studies to deliver genes encoding protective as well as inhibiting proteins in order to modulate the inflammatory cascade (i.e. IL-10 and the MCP-1/CCR-2 pathway) in the first part of this thesis and the plasminogen activator and MMP-system in the second part. Finally, the expression of several involving genes was blocked locally by RNA interference techniques in the last part of this thesis. The possibilities and effects of these gene therapy applications were studied in cell cultures, in a human saphenous vein organ culture model and in two mouse models of restenosis and vein graft disease. Altogether, these studies provided more insight into the pathophysiology of post-interventional remodeling and several potential therapeutic strategies were assessed. Show less
The aim of this thesis was to gain more insight in the involvement of inflammatory processes in vessel wall remodeling seen after PTA or bypass surgery and put these processes in the perspective of... Show moreThe aim of this thesis was to gain more insight in the involvement of inflammatory processes in vessel wall remodeling seen after PTA or bypass surgery and put these processes in the perspective of restenosis, vein graft failure and potential therapeutic preventive strategies. Therefore, we firstly focused on inflammation in general, using the anti-inflammatory agent Dexamethasone, assessing the effects of such a broad approach on restenosis and vein graft remodeling. Then, we further focused on some specific parts of the immune system, namely Interleukin 10 (IL10), chemokines and the complement cascade. Il10 was chosen because it is one of the most studied anti-inflammatory cytokines and this property makes it a potential candidate for ant-restenosis therapy. Furthermore, it was hypothesized that chemokines are involved in vascular remodeling, since they are generally known for their regulatory properties regarding influx of inflammatory cells to tissues and this is one of the first phenomena seen in vascular remodeling. The complement cascade was studied in this context since it contains pro-inflammatory activity and some end-products of the cascade, like chemokines, are potent chemotactic agents. Show less
Aderverkalking (atherosclerose) is een ziekte waarbij door verdikking van de vaatwand vernauwing van slagaderen optreedt. Door deze vernauwing is het mogelijk dat er te weinig zuurstofrijk bloed de... Show moreAderverkalking (atherosclerose) is een ziekte waarbij door verdikking van de vaatwand vernauwing van slagaderen optreedt. Door deze vernauwing is het mogelijk dat er te weinig zuurstofrijk bloed de organen bereikt. In het geval van atherosclerose in slagaderen die hart of hersen van bloed moeten verzien leidt de vernauwing niet zelden tot de dood. Het feit dat atherosclerose de belangrijkste onderliggende oorzaak is van wereldwijde sterfte onderstreept het maatschappelijk belang van ontwikkeling van een adequate therapie tegen atherosclerose. In dit proefschrift werden nieuwe vaccinatietechnieken aangewend om het proces van atherosclerose tegen te gaan. Door de tolerantie voor lichaamseigen stoffen of cellen te doorbreken met deze vaccinatietechnieken bleek het mogelijk te zijn atherosclerose in muizen sterk af te remmen. Het wegnemen van de functie van ontstekingsbevorderende eiwitten (interleukinen 12 en 17) met deze vaccinatietechieken leidde tot een 70-90% afname in atherosclerose. Ook het met vaccinatie specifiek opruimen van cellen die betrokkken zijn bij atherosclerose-geassocieerde processen, zoals nieuwvaatvorming, bleek een geschikte methode te zijn om atherosclerose tegen te gaan. Het voordeel van de nieuwe vaccinatietechnieken die bij dit onderzoek zijn gebruikt is gelegen in het feit dat met enkele injecties voor lange tijd (ten minste 24 weken) bescherming tegen atherosclerose bewerkstelligd kan worden. Andere voordelen van deze vaccinaties zijn het gebrek aan afweerreacties tegen lichaamsvreemde medicijnen en de lage productiekosten van dergelijke vaccins. De combinatie van de sterke afname in atherosclerose en de bijkomende voordelen van de vaccinatietechnieken leidde in dit proefschrift tot de conclusie dat vaccinatie een belangrijke bijdrage kan leveren aan de ontwikkeling van therapieën tegen hart- en vaatziekten in mensen. Show less
