No / T-type Ca2+ channels regulate proliferation in a number of tissue types, including vascular smooth muscle and various cancers. In such tissues, up-regulation of the inducible enzyme heme oxygenase-1 (HO-1) is often observed, and hypoxia is a key factor in its induction. HO-1 degrades heme to generate carbon monoxide (CO) along with Fe2+ and biliverdin. Since CO is increasingly recognized as a regulator of ion channels (Peers et al. 2015), we have explored the possibility that it may regulate proliferation via modulation of T-type Ca2+ channels. Whole-cell patch-clamp recordings revealed that CO (applied as the dissolved gas or via CORM donors) inhibited all 3 isoforms of T-type Ca2+ channels (Cav3.1-3.3) when expressed in HEK293 cells with similar IC50 values, and induction of HO-1 expression also suppressed T-type currents (Boycott et al. 2013). CO/HO-1 induction also suppressed the elevated basal [Ca2+ ]i in cells expressing these channels and reduced their proliferative rate to levels seen in non-transfected control cells (Duckles et al. 2015). Proliferation of vascular smooth muscle cells (both A7r5 and human saphenous vein cells) was also suppressed either by T-type Ca2+ channel inhibitors (mibefradil and NNC 55-0396), HO-1 induction or application of CO. Effects of these blockers and CO were non additive. Although L-type Ca2+ channels were also sensitive to CO (Scragg et al. 2008), they did not influence proliferation. Our data suggest that HO-1 acts to control proliferation via CO modulation of T-type Ca2+ channels.

Yes / Increased cardiovascular morbidity and mortality in individuals with type 2 diabetes (T2DM) is a significant clinical problem. Despite advancements in achieving good glycaemic control, this patient population remains susceptible to macrovascular complications. We previously discovered that vascular smooth muscle cells (SMC) cultured from T2DM patients exhibit persistent phenotypic aberrancies distinct from those of individuals without a diagnosis of T2DM. Notably, persistently elevated expression levels of microRNA-145 co-exist with characteristics consistent with aging, DNA damage and senescence. We hypothesised that increased expression of microRNA-145 plays a functional role in DNA damage signalling and subsequent cellular senescence specifically in SMC cultured from the vasculature of T2DM patients. In this study, markers of DNA damage and senescence were unambiguously and permanently elevated in native T2DM versus non-diabetic (ND)-SMC. Exposure of ND cells to the DNA-damaging agent etoposide inflicted a senescent phenotype, increased expression of apical kinases of the DNA damage pathway and elevated expression levels of microRNA-145. Overexpression of microRNA-145 in ND-SMC revealed evidence of functional links between them; notably increased secretion of senescence-associated cytokines and chronic activation of stress-activated intracellular signalling pathways, particularly the mitogen-activated protein kinase, p38a. Exposure to conditioned media from microRNA-145 overexpressing cells resulted in chronic p38a signalling in naïve cells, evidencing a paracrine induction and reinforcement of cell senescence. We conclude that targeting of microRNA-145 may provide a route to novel interventions to eliminate DNA-damaged and senescent cells in the vasculature and to this end further detailed studies are warranted.

Yes / (1) Abdominal aortic aneurysm (AAA) is a silent, progressive disease with significant mortality from rupture. Whilst screening programmes are now able to detect this pathology early in its development, no therapeutic intervention has yet been identified to halt or retard aortic expansion. The inability to obtain aortic tissue from humans at early stages has created a necessity for laboratory models, yet it is essential to create a timeline of events from EARLY to END stage AAA progression. (2) We used a previously validated ex vivo porcine bioreactor model pre-treated with protease enzyme to create "aneurysm" tissue. Mechanical properties, histological changes in the intact vessel wall, and phenotype/function of vascular smooth muscle cells (SMC) cultured from the same vessels were investigated. (3) The principal finding was significant hyperproliferation of SMC from EARLY stage vessels, but without obvious histological or SMC aberrancies. END stage tissue exhibited histological loss of α-smooth muscle actin and elastin; mechanical impairment; and, in SMC, multiple indications of senescence. (4) Aortic SMC may offer a therapeutic target for intervention, although detailed studies incorporating intervening time points between EARLY and END stage are required. Such investigations may reveal mechanisms of SMC dysfunction in AAA development and hence a therapeutic window during which SMC differentiation could be preserved or reinstated. / This research was funded in part by The Leeds Teaching Hospitals Charitable Foundation (R11/8002). E.R.C. was supported by a PhD studentship from the Engineering and Physical Sciences Research Council (EPSRC; EP/F500513/1). R.J.H. was the recipient of an Intercalated Batchelor of Science Degree in Science award from the Royal College of Surgeons of England. M.A.B.(FS/18/12/33270 and FS/12/54/29671), K.I.B. (FS/12/26/29395), and K.J.G. (FS/11/91/29090) were supported by BHF Clinical Research Training Fellowships.

Yes / Early vascular ageing (EVA) is a pathological phenomenon whereby the vascular system ages more quickly than chronological age. This underpins many cardiovascular diseases including the complications of type 2 diabetes, aneurysm formation and hypertension. Smooth muscle cells (SMC) are the principal cell type in the vascular wall and maintain vascular tone. EVA-related phenotypic switching of these cells contributes towards disease progression. EVA is distinct from chronological ageing, and research is ongoing to identify a definitive molecular signature of EVA. This will facilitate the discovery of new clinical tests for early detection of EVA and identify therapeutic targets to halt (or prevent) EVA in SMC, thus reducing macrovascular morbidity and mortality.

Yes / Coronary microvascular dysfunction (CMD) is an under-diagnosed condition characterized by functional alteration of the small coronary arterioles and the cardiac capillary bed. The vessels do not dilate appropriately in response to changes in cardiac oxygen demand, leading to chest pain and symptoms of angina. These blood vessels contain two major cell types: the endothelial cells, which line the blood vessels and detect changes in oxygen demand, and smooth muscle cells (SMC) which respond to these changes by contracting or relaxing to provide an optimal blood supply to the cardiac tissue. Many CMD studies have focused on the endothelial cells as these cells secrete vasorelaxants and vasoconstrictors. However, comparably fewer studies have examined SMC despite their functional role in contracting and relaxing. A variety of health conditions and lifestyle choices, such as diabetes, hypertension and cigarette smoking, can promote the development of both CMD and macrovascular coronary artery disease; a condition where SMC have been studied extensively. This review article will consider the influence of CMD on SMC phenotype. It will discuss the structural, cellular and molecular changes in CMD, and will summarise how co-morbidities can have differing effects on micro- and macro-vascular SMC phenotype and function, which complicates the development of new therapeutic avenues for CMD.

The uterosacral ligament (USL) and the cardinal ligament (CL) are two major suspensory tissues that provide structural support to the vagina/cervix/uterus complex. These ligaments have been studied mainly due for their role in the surgical repair for pelvic organ prolapse (POP). POP, which is the descent of a pelvic organ from its normal place towards the vaginal walls and into the vaginal cavity, affects an estimated 3.3 million women in the United States annually. Despite their important mechanical function, little is known about the elastic and viscoelastic properties of the USL and CL due to ethical concerns with in vivo testing of human tissues and the lack of accepted animal models. The goal of this first study is to help establish an appropriate animal model for studying the mechanics of these pelvic supportive ligaments. To achieve this, the first rigorous comparison of histological and planar equi-biaxial mechanical properties of the swine and human USLs was completed. Relative collagen, smooth muscle, and elastin contents were quantified from histological sections and the USL was found to have similar components in both species, with a comparable relative collagen content. Using the digital image correlation (DIC) method to calculate the in-plane Lagrangian strain, no differences in the peak strain during precon- ditioning/cyclic loading tests, secant modulus of the pre-creep/elastic response, and strain at the end of creep tests were detected in the USLs from the two species along both axial loading directions (the main in vivo loading direction and the direction that is perpendicular to it). Because these ligaments are subjected to repeated constant loads in vivo, the effect of re- peated biaxial loads at three different load levels (1 N, 2 N, or 3 N) on elastic and creep properties of the swine CL was investigated. The results showed that CL was elastically anisotropic, as statistical differences were found between the mean strains along the two axial loading directions for specimens at all three different load levels. The increase in strain over time by the end of the 3rd creep test was comparable along the axial loading direc- tions. The greatest mean normalized strain (or, equivalently, the largest increase in strain over time) was measured at the end of the 1st creep test, regardless of the equi-biaxial load magnitude or loading direction. Overall, these experimental findings validate the use of swine as an appropriate animal model and offer new knowledge of the mechanical properties of the USL and CL that can guide the development of better treatment methods such as surgical reconstruction for POP. / Ph. D. / The uterosacral ligament (USL) and the cardinal ligament (CL) are two major suspensory tissues that provide structural support to the vagina/cervix/uterus complex. These ligaments have been studied mainly due for their role in the surgical repair for pelvic organ prolapse (POP). POP, which is the descent of a pelvic organ from its normal place towards the vaginal walls and into the vaginal cavity, affects an estimated 3.3 million women in the United States annually. Despite their important mechanical function, little is known about the elastic and viscoelastic properties of the USL and CL due to ethical concerns with in vivo testing of human tissues and the lack of accepted animal models. The goal of this first study is to help establish an appropriate animal model for studying the mechanics of these pelvic supportive ligaments. To achieve this, the first rigorous comparison of histological and planar equi-biaxial mechanical properties of the swine and human USLs was completed. Relative collagen, smooth muscle, and elastin contents were quantified from histological sections and the USL was found to have similar components in both species, with a comparable relative collagen content. Using the digital image correlation (DIC) method to calculate the in-plane Lagrangian strain, no differences in the peak strain during preconditioning/cyclic loading tests, secant modulus of the pre-creep/elastic response, and strain at the end of creep tests were detected in the USLs from the two species along both axial loading directions (the main in vivo loading direction and the direction that is perpendicular to it). Because these ligaments are subjected to repeated constant loads in vivo, the effect of repeated biaxial loads at three different load levels (1 N, 2 N, or 3 N) on elastic and creep properties of the swine CL was investigated. The results showed that CL was elastically anisotropic, as statistical differences were found between the mean strains along the two axial loading directions for specimens at all three different load levels. The increase in strain over time by the end of the 3rd creep test was comparable along the axial loading directions. The greatest mean normalized strain (or, equivalently, the largest increase in strain over time) was measured at the end of the 1st creep test, regardless of the equi-biaxial load magnitude or loading direction. Overall, these experimental findings validate the use of swine as an appropriate animal model and offer new knowledge of the mechanical properties of the USL and CL that can guide the development of better treatment methods such as surgical reconstruction for POP.

The velocity fields of high Reynolds number, turbulent, wall boundary layers in non-equilibrium pressure gradients are experimentally investigated. Experiments in two wall configurations were performed; one with a hydrodynamically smooth test wall composed of flat aluminum panels, and the other with a rough surface consisting of 2 mm tall, staggered, circular cylindrical elements. A representative set of pressure gradient distributions were generated on the research wall by a systematically rotated NACA 0012 airfoil placed in a wind tunnel section to determine the functional dependence of the boundary layer formation on pressure gradient. Particle image velocimetry (PIV) was the primary measurement technique used to determine time-resolved features of the velocity flow field. newline{}newline{} It is shown that regardless of wall condition and Reynolds number, the non-equilibrium turbulent boundary layers exhibit increasingly non-local behavior with streamwise development. This is apparent as a lag to the pressure gradient distribution observed in the streamwise developing integrated boundary layer parameters. These ``history effects" are also prevalent in mean velocity profiles which are exhibited as a cross-over of the favorable and adverse pressure gradient profiles in the logarithmic layer. Similar cross-over points are observed in the Reynolds shear and normal stresses, particularly at the streamwise station downstream of the pressure gradient switch. The primary effect of the rough wall is to increase the magnitude of flow scales, and, while they exhibit the same qualitative history effects as the smooth wall, the rough wall flows show an earlier relaxation to equilibrium. Despite inherent uncertainties of indirect skin friction methods for the rough wall, the effective sandgrain roughness parameter k_s does not show a functional dependency to pressure gradient history. An evaluation of the wall-similarity hypothesis solely based on boundary layer thickness to roughness parameter ratios delta/k_s is insufficient and additional parameters such as pressure gradient histories, local roughness Reynolds numbers, and bias uncertainties due to instrument spatial resolution must be considered. / Doctor of Philosophy / In the interface between a surface and a moving fluid is the boundary layer where high shear and viscous stresses cause the bulk velocity to decrease to zero. When turbulent, this region of fluid is characterized by random, chaotic, and fluctuating motions of varying sizes. Parameters such as pressure gradients and geometric irregularities of the surface, referred to as roughness, can increase fluctuating pressures and velocities within the boundary layer and cause unwanted noise, vibration, and increased drag. Although many studies have evaluated boundary layers with either roughness or pressure gradient independently, most surfaces in practical application are susceptible to the compounding influences of both of these parameters. Thus, it is necessary to expand the current knowledge database to include complex flow fields necessary to improve data driven modeling and vehicle design.newline{}newline{} This study focuses on experimental observations of the turbulent velocity field developing in both a rough and smooth wall boundary layer that is induced to a family of bi-directional pressure gradients generated by the pressure field of a rotating airfoil inside in a wind tunnel. Through statistical observations of the velocity field it was found that the varying pressure gradients caused the flow to develop non-local dependencies such that the response of the downstream boundary layer was dependent on the upstream flow history. The principal effect of roughness was to increase the magnitude of turbulent scales, but to show the same qualitative response to the pressure gradient history as seen in a smooth wall flow. However, direct comparison of rough and smooth wall turbulence statistics by means of the ``wall-similarity hypothesis" requires careful consideration of multiple parameters including these flow histories, scales prescribed by roughness parameters, and bias errors from experiment under-resolution of the velocity field.

No / Cardiovascular disease is the principal cause of death in patients with type 2 diabetes (T2DM). Exposure of the vasculature to metabolic disturbances leaves a persistent imprint on vascular walls, and specifically on smooth muscle cells (SMC) that favours their dysfunction and potentially underlies macrovascular complications of T2DM. Current diabetes therapies and continued development of newer treatments has led to the ability to achieve more efficient glycaemic control. There is also some evidence to suggest that some of these treatments may exert favourable pleiotropic effects, some of which may be at the level of SMC. However, emerging interest in epigenetic markers as determinants of vascular disease, and a putative link with diabetes, opens the possibility for new avenues to develop robust and specific new therapies. These will likely need to target cell-specific epigenetic changes such as effectors of DNA histone modifications that promote or inhibit gene transcription, and/or microRNAs capable of regulating entire cellular pathways through target gene repression. The growing epidemic of T2DM worldwide, and its attendant cardiovascular mortality, dictates a need for novel therapies and personalised approaches to ameliorate vascular complications in this vulnerable population.

Yes / Type 2 diabetes (T2DM) promotes premature atherosclerosis and inferior prognosis after arterial reconstruction. Vascular smooth muscle cells (SMC) respond to patho/physiological stimuli, switching between quiescent contractile and activated synthetic phenotypes under the control of microRNAs (miRs) that regulate multiple genes critical to SMC plasticity. The importance of miRs to SMC function specifically in T2DM is unknown. This study was performed to evaluate phenotype and function in SMC cultured from non-diabetic and T2DM patients, to explore any aberrancies and investigate underlying mechanisms. Saphenous vein SMC cultured from T2DM patients (T2DM-SMC) exhibited increased spread cell area, disorganised cytoskeleton and impaired proliferation relative to cells from non-diabetic patients (ND-SMC), accompanied by a persistent, selective up-regulation of miR-143 and miR-145. Transfection of premiR-143/145 into ND-SMC induced morphological and functional characteristics similar to native T2DM-SMC; modulating miR-143/145 targets Kruppel-like factor 4, alpha smooth muscle actin and myosin VI. Conversely, transfection of antimiR-143/145 into T2DM-SMC conferred characteristics of the ND phenotype. Exposure of ND-SMC to transforming growth factor beta (TGFβ) induced a diabetes-like phenotype; elevated miR-143/145, increased cell area and reduced proliferation. Furthermore, these effects were dependent on miR-143/145. In conclusion, aberrant expression of miR-143/145 induces a distinct saphenous vein SMC phenotype that may contribute to vascular complications in patients with T2DM, and is potentially amenable to therapeutic manipulation.

Yes / Background/purpose Coronary heart disease is the leading cause of morbidity in patients with type 2 diabetes mellitus (T2DM), frequently resulting in a requirement for coronary revascularization using the internal mammary artery (IMA) or saphenous vein (SV). Patency rates of SV grafts are inferior to IMA and further impaired by T2DM whilst IMA patencies appear similar in both populations. Smooth muscle cells (SMC) play a pivotal role in graft integration; we therefore examined the phenotype and proliferative function of IMA- and SV-SMC isolated from non-diabetic (ND) patients or those diagnosed with T2DM. Methods/materials SMC were cultured from fragments of SV or IMA. Morphology was analyzed under light microscopy (spread cell area measurements) and confocal microscopy (F-actin staining). Proliferation was analyzed by cell counting. Levels of RhoA mRNA, protein and activity were measured by real-time RT-PCR, western blotting and G-LISA respectively. Results IMA-SMC from T2DM and ND patients were indistinguishable in both morphology and function. By comparison, SV-SMC from T2DM patients exhibited significantly larger spread cell areas (1.5-fold increase, P < 0.05), truncated F-actin fibers and reduced proliferation (33% reduction, P < 0.05). Furthermore, lower expression and activity of RhoA were observed in SV-SMC of T2DM patients (37% reduction in expression, P < 0.05 and 43% reduction in activity, P < 0.01). Conclusions IMA-SMC appear impervious to phenotypic modulation by T2DM. In contrast, SV-SMC from T2DM patients exhibit phenotypic and functional changes accompanied by reduced RhoA activity. These aberrancies may be epigenetic in nature, compromising SMC plasticity and SV graft adaptation in T2DM patients.