Ann Thorac Surg 2000;70:1152-1153
© 2000 The Society of Thoracic Surgeons
Thoracic surgery directors association award
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DR KOH TAKEUCHI (Hirosaki, Japan): I appreciate your elegant study. One of my questions is related to the signal transduction pathway for apoptosis. Which pathway is involved in this apoptotic cell death? Maybe the reactive kinase, MAP kinase, or in further download may be the NF-kB. Because in the next stage we may have to prevent the apoptosis. Because if the apoptosis is related to the following event, we may have to prevent apoptosis. To do that, we have to know which signal transduction pathway is involved in this apoptosis.
DR RODRIGUEZ: That is an excellent question. This study suggests that apoptosis is a mechanism responsible for the loss of contractile smooth muscle cells early after grafting. The specific apoptotic pathway is yet to be elucidated and may involve the pathways you suggest. In order to implement future treatments, studies investigating the specific pathway responsible for apoptosis are needed.
DR WATTS R. WEBB (New Orleans, LA): I was wondering if apoptosis is the correct term. Is this preprogrammed death or is this degeneration due to noxious factors in the environment, such as the total change in the pressure? And do you know what the noxious factors may be?
DR RODRIGUEZ: Thank you for your question. In this study, we used TUNEL as well as confocal and electron microscopy to evaluate cell death. The changes observed were consistent with apoptosis.
Now, the specific noxious factors responsible for the apoptosis of the contractile smooth muscle cells are currently under investigation. These may include pressure changes (as you suggest), ischemia, and/or generation of reactive oxygen species.
DR G. HOSSEIN ALMASSI (Milwaukee, WI): I enjoyed your paper. In clinical practice there is too much emphasis placed on the technique of saphenous vein harvesting: how you manage it before the implantation, pharmacologically, which solution you use, and what pressure for distention, which in the early/mid 1970s led to the so-called Bonchek distention apparatus. Can you comment on how you did manage these veins before you implanted them in the carotid system?
DR RODRIGUEZ: Thank you for your comments. In this study, the saphenous veins were harvested using the no-touch technique. They were placed in saline solution for 30 minutes and were not distended before grafting.
In previous studies, comparing saphenous veins that were distended and nondistended before grafting, we showed similar medial degeneration and medial smooth muscle cell apoptosis early after grafting.
Related Article
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Contractile smooth muscle cell apoptosis early after saphenous vein grafting
- Evelio Rodriguez, Erica H. Lambert, Michael G. Magno, and John D. Mannion
Ann. Thorac. Surg. 2000 70: 1145-1152.
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