Abstract
Aortic valve stenosis is a serious disease with increasing prevalence in developed countries. Research aimed at uncovering the molecular mechanisms behind its main cause, aortic valve calcification, is thus crucial for the development of future therapies. It is frequently difficult to measure the extent of mineralisation in soft tissues and some methods require the destruction of the sample. Micro-computed tomography (µCT), a non-destructive technique, was used to quantify the density and volume of calcium deposits on cusps from 57 explanted aortic valves. Conventional and immunostaining techniques were used to characterise valve tissue degeneration and the inflammatory and osteogenic stage with several markers. Although most of the analysed cusps came from severe stenosis patients, the µCT parameter bone volume/tissue volume ratio distinguished several degrees of mineralisation that correlated with the degree of structural change in the tissue and the amount of macrophage infiltration as determined by CD68 immunohistochemistry. Interestingly, exosomal markers CD63 and Alix co-localised with macrophage infiltration surrounding calcium deposits, suggesting that those vesicles could be produced at least in part by these immune cells. In conclusion, we have shown that the ex vivo assessment of aortic valve mineralisation with µCT reflects the molecular and cellular changes in pathological valves during progression towards stenosis. Thus, our results give additional validity to quantitative μCT as a convenient laboratory tool for basic research on this type of cardiovascular calcification.
Highlights
Aortic valve stenosis is the most common cardiac valvulopathy in developed countries and its prevalence is expected to increase dramatically in the decades as a consequence of population ageing [1]
Different diagnoses were included in order to obtain tissue samples with a wide range of calcification levels, stenosis remained the most common one (67%)
Our results support the validity of μCT measurement of valve mineralisation using bone histomorphometry parameters as a way of obtaining an objective calcium score that can be correlated with other variables, including molecular ones
Summary
Aortic valve stenosis is the most common cardiac valvulopathy in developed countries and its prevalence is expected to increase dramatically in the decades as a consequence of population ageing [1]. Despite the challenge for national health systems, there still does not exist any pharmacological treatment that can halt or reverse the progression of the stenosis. These patients must undergo a valve replacement procedure in order to restore normal blood flow. Aortic valve replacement is the second most common cardiac procedure currently performed. Between 2014 and 2015, 18,000 of these operations were performed solely in
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