centro biotecnologie avanzate

LABORATORY OF: Vascular and Endovascular Surgery
CONTACT PERSON:Prof. Domenico Palombo (San Martino Hospital and University of Genova)
Phone +39 010-5552424
E-mail: domenico.palombo@hsanmartino.it

Description of Laboratory and Expertise:

Vascular and Endovascular Surgery Unit (Dir: Prof. Domenico Palombo)
Http://chirurgiavascolare.hsanmartino.it
ABC External Unit for Vascular Research (Dir: Prof. Domenico Palombo)

Abstract of Activities:

Our Vascular Surgery Unit at San Martino Hospital (SMH) gives diagnostic evaluation of arterial and venous blood flow in the lower extremities, particulary for patients with walking deficit or lesions related to reduced blood flow (claudication or limb salvage). We have certified expertise in diagnosis and management of aneurysmal and occlusive disease of the thoracic and abdominal aorta or both, in addition to peripheral aneurysms and aortic dissections. We also have expertise in the management of cerebrovascular disease including prevention and treatment of stroke or transient ischemic attacks for both primary and recurrent lesions. We provide both open and catheter-based (angioplasty and stenting) treatment for carotid disease to ensure the best outcome for each patient. We also have special expertise in the management of venous insufficiency, using several techniques and thoracic outlet syndrome. The SMH Division performs over 1000 operative vascular procedures each year and provides training for vascular surgery residents.
The team is involved in several national and international Vascular trials and also in vascular biology research in order to perform new generation of vascular grafts: i.e. biodegradable electrospin vascular prostheses. This activity is pursued at the laboratory of Stem cell biology of ABC and validated by microsurgery in experimental animal models.

Detailed Research Activities:

Biodegradable synthetic vascular Prosthesis: experimental aortic replacement in a rat
Model:No prosthetic material showing an acceptable patency rate when used in diameter below 6 mm is presently available. In the 4 to 6 mm diameter range ( medium-diameter vascular grafts) prostheses are required for by passing or replacing medium size vessels, whilst prostheses less than 4 mm in diameter are required primarily for bypassing or replacing distal tibial arteries, coronary arteries, and other small vessels. Many materials have been proposed and tested as arterial substitutes but to date, and for the last 30 years, the only two which have given acceptable patency rates are expanded polytetrafluorethylene (ePTFE) and polyethylene terephatale (Dacron).Those graft materials perform best only in high flow-low resistance locations but when used as smaller diameter grafts they do not approach the saphenous vein in terms of long-term patency. Unfortunately, the availability of saphenous vein may be limited due to previous peripheral reconstruction, thrombophlebitis or coronary artery surgery. Thus , the investigation of alternative grafts materials and innovative graft fabrication approaches is a priority in current vascular surgery research. The proposal of this research at ABC is to evaluate biocompatibility, patency and mechanical properties of electrospin polymer grafts. The electrospin scaffolds are non-toxic, dimensionally stable in an “in vitro” culture environment, easily fabricated, and possess controlled mechanical properties that simulate the ultrastructure of native blood vessels.
The first step of our research is to evaluate the effectiveness of coating the internal surface of an ePTFE scaffold with Human Umbilical Vein Endothelial cell (HUVEC)(Cell Bank IST-Genoa) and the coating of the external surface with Mesenchymal Stem Cell (MSCs), and to assess its long term patency after aortic rat implantation.
In the future , we hope that biodegradable vascular substitutes will provide the possibility of application on small diameter prosthetic grafts in artificial blood vessels.

Research in collaboration with cardiologists:Inflammation is involved in the progression of atherosclerosis and its complications. Recent studies on animal models reported evidencefor distinct monocyte subsets, differential chemokine receptor usage, and phenotypic modulation of macrophages in murine models of genetic and high-fat diet-induced disease. In humans two major subsets in peripheral blood have been recognized: the 'classical' CD14CD16 monocytes, representing up to 95% of the monocytes in a healthy individual, and the 'non-classical' CD14CD16 monocytes comprising the remaining fraction of monocytes. Interest in CD16 monocytes has been fueled in part by observations that this subset was elevated in blood during inflammatory conditions including atherosclerosis.
Previous studies confirmed the involvement of Angiotensin II in development of atherosclerosis and abdominal aortic aneurysms .
Object of this study is to evaluate the use of AT1 inhibitors to modulate the systemic and local inflammatory response in patients with abdominal aortic aneurysms (AAA) enrolled for surgical intervention. Evaluation of inflammatory markers and of the role of monocyte subsets will be performed on peripheral blood samples before and after administration (1 month) of AT1 inhibitor. The relationships between the monocyte subsets ratio and the chronic inflammatory response will be investigated. Evaluation will be addressed also on lesion samples obtained during surgical repair procedure.
Monocytes and mature macrophages are prominent in the host response to lipid accumulation in major arteries, the development of atherosclerotic plaques, and their complications; hypercholesterolemia in animal model was associated with gradual monocytosis, that decreased upon statin-induced reduction of cholesterol.
Object of this study will be to evaluate the circulating inflammatory markers, immune response, and immunocompetent cell patterns on patients that undergo carotid endoarterectomy. The distribution of infiltrated white cells and the protease activity will be investigated on surgical specimens. The effect of statin treatment on these patients will be evaluated.

Application and Developments:

In summary, our mission is to provide a model of clinical and scientific excellence in diagnosis and treatment of vascular diseases, to deliver the highest quality of care to our patients by a team of dedicated surgeons and nurses. Furthermore our Vascular Surgery Unit is actively engaged in clinical and basic research. This research relies on a multidisciplinary approach to vascular diseases and includes professors and residents.

Ongoing Collaborations:

Centro Cellule staminali e Terapia Cellulare. Dipartimento Emato-Oncologia. Azienda Ospedaliera Universitaria “San Martino di Genova” (Dir: Prof. Francesco Frassoni).

Unità Operativa di Cardiologia. D.I.M.I. Azienda Ospedaliera Universitaria “San Martino” di Genova. (Prof.Giorgio Ghigliotti).

Department of Biochemistry, University of Genoa. Levels and roles of Abscisic Acid in the arterosclerotic plaque. (Prof. Elena Zocchi)

Department of Cardiovascular Surgery- Geneva University Hospital - Switzerland
(Prof Afksendiyos Kalangos).

Center of Cardiovascular diseases of the Army- Bucarest - Romania ( Dr. Ionel Droc)

Recent and significant publications:

Palombo D., Lucertini G., Mambrini S., Zettin M. Subtle cererbral damage after shunting vs non shunting durino carotid endarterectomy. Eur J Vasc Endovasc Surg. 2007 Nov; 34 (5): 546-51

Palombo D., Vola M., Lucertini G., Mazzei R., Ferrero E., Grana A., Castagnola M. Cardiac risk assessment of asymptomatic patients by stress echocardiography bifore infrarenal aortic aneurysm surgery. J Cardiovasc Surg. 2005 Feb; 46 (1): 31-6

Palombo D., Valenti D., Ferri M., Gaggiano A., Mazzei R., Vola M., Tettoni S. Changes in the proximal neck of abdominal aortic aneurysms early after endovascular treatment. Ann Vasc Surg. 2003 jul; 17 (4): 408-10

Valenti D., Gaggiano A., Berardi G., Ferri M., Mazzei R., Roda G., Palombo D. Intra-operative assessment of technical defects after carotid endarterectomy: a comparison between angiography and color duplex scan. Cardiovasc Surg. 2003 Feb; 11 (1): 26-9

Palombo D., Maione M., Cifiello BI., Udini M., Maggio D., Lupo M. Matrix metalloproteinases. Their role in degenerative chronic diseases of abdominal aorta. J Cardiovasc Surg. 1999 Apr; 40 (2): 257-60