Biography:

Veena Dhawan has completed her PhD from PGIMER and did Post-doctoral Research at Minneapolis USA and Post-graduate Institute of Medical Education and Research, Chandigarh, India. At present, she is working as a Professor in the Department of Experimental Medicine and Biotechnology at PGIMER a National Institute of repute. She has published around 90 papers in reputed journals and written around seven book chapters.

Abstract:

Atherosclerosis is the underlying cause of coronary artery disease (CAD) and a disease of multifactorial etiology. Recent investigations in atherosclerosis have been focused on inflammation and endoplasmic reticulum (ER) stress, providing new insights into the mechanism of the disease. Keeping in view the multifactorial aspects of this disease, novel strategies are urgently needed not only for identification of novel biomarkers, but also to search for remedies for prevention and treatment of this disease. C-reactive protein (CRP) is reported to be a biomarker of inflammation in CAD and is shown to actively contribute to the disease pathology. Our data from in vitro studies provided substantial evidence that MMP-TIMP and RAGE-EN-RAGE interactions significantly contribute to the pathophysiology of coronary artery disease. CRP was found to play a potential role in the induction, amplification, and prolongation of inflammatory response in atherosclerosis via modulating these genes and atorvastatin showed the potential to curb the deleterious effects of CRP. However, it is evident that besides use of several drugs like statins, inflammation persists in CAD patients. Therefore, we conducted studies with Terminalia arjuna (TA), a medicinal plant with a wide variety of applications in traditional medicine and referred to as a cardiotonic in Ayurvedic system of medicine. Evidence in literature demonstrates that TA like atorvastatin possesses pleotropic properties. Studies carried out in our laboratory have clearly demonstrated its anti-inflammatory and antithrombotic properties both in vitro as well as in vivo and in experimental animals. Expression of inflammatory genes eg: was found to be significantly reduced in vitro in a dose and time-dependent manner by Terminalia arjuna. Using a Systems Biology approach, observations of the in vitro study were further validated in a randomized, placebo-controlled, double-blind clinical trial in subjects with stable CAD who received either placebo or T. arjuna (500 mg twice a day; Himalaya) and were followed up to six months. TA was shown to attenuate inflammation and played a pivotal role in modulation of both cellular and humoral immunity. Chronic ER stress is implicated in the pathophysiology of atherosclerosis and is found to be associated with apoptosis. Research work in our lab demonstrated that TA specifically targeted early foam cell apoptosis via activation of unfolded protein response pathway. The data from our studies suggests use of a multipronged approach using novel therapies in terms of combination/adjuvant therapy in clinical studies utilizing indigenous resources of medicinal plants to prevent/treat complex disorders such as CAD.

Biography:

Normunds Sikora has completed his Residency in Cardiac Surgery in 2008. Afterwards, he finished his PhD in Riga Stradins University. He has done efforts to improve the quality of cardiopulmonary bypass in cardiac surgery in Latvia working as Cardiac Surgeon and Specialist in cardiopulmonary bypass in Clinic for Pediatric Cardiology and Cardiac Surgery, Children’s University Hospital, Riga, Latvia. He is also an Assistant Professor in Riga Stradins University, Department of Surgery. He has established Latvian Society of Cardiopulmonary Bypass being its President currently. He is a National Delegate in European Board of Cardiovascular Perfusion. He has established National Education Program in Cardiovascular Perfusion being its Director currently. He has over 10 papers in different local and international medical journals.

Abstract:

Introduction: One of important issues in pediatric cardiac surgery is myocardial protection. When cardioplegic solution is injected into coronary arteries with a pump to ensure myocardial protection, it is necessary to determine the correct delivery pressure to avoid damage of the heart.

Methods: We investigated 12 coronary artery specimens without cardiac pathology retrieved from autopsies of neonates 9.3±9.7 days old and weight 3.99±0.7 kg and compared them to seven adult specimens with no detected atherosclerosis. Specimens were pressurized from 0 to 200 mmHg with the step of 20 mmHg, while maintaining the length of the sample in situ. Structural damages were investigated afterwards with light microscopy and immunohistochemistry.

Results: There was a rapid increase of strain until the inner pressure reached 80-100 mmHg, whilst the increase of stress in the wall of neonatal coronary arteries was less rapid. When the internal pressure exceeds 100 mmHg, the strain of the arterial wall increases much slower, but the wall stress and modulus of elasticity begin to increase rapidly - the structural elements of the arterial wall have been straightened and possible damage may appear. Results were compared with biomechanical properties of arterial wall of adults and differences had been found. Morphologic examination of tensile properties revealed prominent affection of the vascular wall of neonates with accentuated redistribution (loosening) of medial myocytes and adventitial vasa vasorum after being pressurized with the inner pressure of over than 100 mmHg.

Conclusions: Our experimental results show that the delivery pressure of the cardioplegic solution in neonatal coronary arteries should not exceed 100 mmHg. A raised inner pressure may increase the risk of structural damage of the vascular wall leading to the injury of myocardium.