transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2023-15-4-515-528transplantologiya-829Research ArticleОБЗОРНЫЕ СТАТЬИ И ЛЕКЦИИREVIEW ARTICLES AND LECTURESСовременный взгляд на кальцификацию ксенобиопротезов клапанов сердца и стратегии их антикальцификационной защитыModern view on calcification of xenogenic bioprosthetic heart valves and their anti-calcification treatment strategieshttps://orcid.org/0000-0001-6099-0315КостюнинА. Е.KostyuninA. E.

Александр Евгеньевич Костюнин - канд. биол. наук, научный сотрудник лаборатории новых биоматериалов.

650002, Кемерово, Сосновый б-р, д. 6

Alexander E. Kostyuni - Cand. Sci. (Biol.), Researcher of the Laboratory of New Biomaterials.

6 Sosnovy Blvd., Kemerovo 650002

rhabdophis_tigrina@mail.ruhttps://orcid.org/0000-0003-4890-0393ГлушковаТ. В.GlushkovaT. V.

Татьяна Владимировна Глушкова - канд. биол. наук, старший научный сотрудник лаборатории новых биоматериалов.

650002, Кемерово, Сосновый б-р, д. 6

Tatyana V. Glushkova - Cand. Sci. (Biol.), Senior Researcher of the Laboratory of New Biomaterials.

6 Sosnovy Blvd., Kemerovo 650002

bio.tvg@mail.ruhttps://orcid.org/0000-0003-1341-204XСтасевА. Н.StasevA. N.

Александр Николаевич Стасев - канд. мед. наук, научный сотрудник лаборатории пороков сердца.

650002, Кемерово, Сосновый б-р, д. 6

Alexander N. Stasev - Cand. Sci. (Med.) Researcher of the Laboratory of Heart Diseases.

6 Sosnovy Blvd., Kemerovo 650002

StasAN@kemcardio.ruhttps://orcid.org/0000-0001-7477-3979ОвчаренкоЕ. А.OvcharenkoE. A.

Евгений Андреевич Овчаренко - кандидат технических наук, заведующий лабораторией новых биоматериалов.

650002, Кемерово, Сосновый б-р, д. 6

Evgeny A. Ovcharenko - Cand. Sci. (Tech.), Head of the Laboratory of New Biomaterials.

6 Sosnovy Blvd., Kemerovo 650002

ov.eugene@gmail.comФГБНУ «НИИ комплексных проблем сердечно-сосудистых заболеваний»РоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian Federation202320122023154515528Copyright © Костюнин А.Е., Глушкова Т.В., Стасев А.Н., Овчаренко Е.А., 20232023Костюнин А.Е., Глушкова Т.В., Стасев А.Н., Овчаренко Е.А.Kostyunin A.E., Glushkova T.V., Stasev A.N., Ovcharenko E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/829Цель

Цель. Цель настоящего обзора состоит в анализе публикаций, посвященных исследованиям патофизиологических механизмов кальцификации ксеногенных биопротезов клапанов сердца, а также в обосновании новых перспективных методов антикальцификационной защиты этих медицинских изделий.

Материал и методы

Материал и методы. Анализируемые статьи представлены в базах данных и электронных библиотеках PubMed, Google Scholar и eLibrary. Поисковые запросы основаны на сочетаниях слов "bioprosthetic heart valves", "structural valve degeneration", "calcification", "cyclic loading", "inflammation", "proteolysis", "proteolytic enzymes", "decellularization", "anticalcium treatment". Также поиск происходил с использованием списков литературы, приведенных в релевантных статьях. Предпочтение отдавали работам, опубликованным с января 2013 по январь 2023 года.

Результаты

Результаты. Нами рассмотрены ключевые аспекты кальцификации ксенобиопротезов клапанов сердца и основные стратегии их антикальцификационной обработки. Показано, что за кальцификацией искусственных клапанов стоит сложный комплекс механизмов, который включает, но не ограничивается: 1) связыванием кальция в химически стабилизированном биоматериале свободными группами консерванта; 2) осаждением кальция на остаточных клетках донора и клеточном дебрисе; 3) возникновением прокальцифицирующих изменений в биоткани под действием протеолиза, механического и оксидативного стресса; 4) клеточно-опосредованной биоминерализацией. Несмотря на современные многоступенчатые подходы к консервации биологической ткани, включающие обработку химическими агентами, которые препятствуют осаждению кальция в ее структуре, решить проблему кальцификации ксенобиопротезов пока не удалось. Вероятно, причина неудачи заключается в гетерогенности патофизиологических механизмов кальцификации: разработанные на текущий момент методы антикальцификационной защиты не способны противостоять всем путям развития кальциноза искусственных клапанов.

Заключение

Заключение. Кальцификация створчатого аппарата ксенобиопротезов клапанов сердца – это сложный многофакторный процесс и главная причина дисфункций рассматриваемых медицинских изделий. Потенциально инновационный подход с использованием гидрогелей полимеров в качестве наполнителя биоткани может полностью предотвратить ее кальцификацию.

Aim

Aim. The aim of this review was to analyze publications describing studies focusing on the pathophysiological mechanisms of calcification of bioprosthetic heart valves, and to substantiate new and promising methods of calcification prevention for the implantable medical devices.

Material and methods

Material and methods. Databases and electronic libraries such as PubMed, Google Scholar and eLibrary were used for searching relevant articles. Search queries included the following word combinations: “bioprosthetic heart valves”, “structural valve degeneration”, “calcification”, “cyclic loading”, “inflammation”, “proteolysis”, “proteolytic enzymes”, “decellularization”, “anticalcification treatment”. The references in relevant articles were used for the search as well. Preference was given to works published from January 2013 to January 2023.

Results

Results. We have considered the key aspects of bioprosthetic heart valves calcification and the main strategies of calcification prevention. Calcification of bioprosthetic heart valves incorporates a complex set of mechanisms that includes, but is not limited to: 1) binding of calcium in chemically stabilized biomaterial by free groups of the preservative; 2) precipitation of calcium on residual donor cells and cell debris; 3) pro-calcifying changes in biological material due to proteolysis, mechanical and oxidative stress; 4) cell-mediated biomineralization. Despite modern advances in biopreservation, such as treatment with chemical agents that prevent the deposition of calcium, the problem of bioprosthetic heart valves calcification still prevails. The cause of it lies in the heterogeneity of the pathophysiological mechanisms behind the mineralization of biomaterial: the currently developed methods of calcification prevention cannot block all ways of bioprosthetic heart valves calcification.

Conclusion

Conclusion. Calcification of bioprosthetic heart valves leaflets is a complex process that underlies the main cause of dysfunction of the medical devices. Supposedly, a new innovative approach that involves polymer hydrogel filler in biomaterials can completely prevent its calcification.

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The authors declare that there are no conflicts of interest present.