Heard at the British Cardiovascular Society conference

The role of nanomedicine in CV diagnosis

Nanomedicine will play an increasingly important role in future diagnosis and treatment of cardiovascular disease, a subject explored in detail by four expert speakers at the British Cardiovascular Society conference in Manchester in June.

Report: Mark Nicholls

Source: Shutterstock/Shilova Ekaterina

portrait of dave newby
Dave Newby, Professor of Cardiology at the University of Edinburgh

The conference heard that the technology – dealing with dimensions and tolerances of less than 100 nanometres, especially the manipulation of individual atoms and molecules – is a critical component in increasingly more precise and detailed approaches in cardiology. Speakers tackled areas such as nanomaterials for cardiovascular repair and regeneration, magnetic nanoparticles for atherosclerosis and the development of novel MRI tools assessing atheromatous plaque inflammation and stress analysis. 

Dave Newby, Professor of Cardiology at the University of Edinburgh in Scotland, who focused on magnetic nanoparticles in clinical cardiovascular disease, highlighted how magnetic resonance imaging agents have an application to cardiovascular disease, predominantly with macrophages.

Tracking active inflammation

What we need to know: is there a heart attack round the corner and what can we do to stop it happening?

Dave Newby

‘Macrophages,’ he said, ‘are important in lots of cardiovascular diseases – plaque rupture, heart attacks and aneurysms, for example – and resolution of injury and inflammation within that.’ Nanomedicine and advanced imaging to look at biology are particularly topical at the moment. ‘It’s not just structure of the body,’ he added, ‘but also about what the tissue in the body is actually doing. Nanoparticles can tell us about where there is active inflammation and where macrophages are active. That can be useful because it helps us understand disease biology; where injury is happening, how diseases are occurring and how the body heals.’

Experts are using MRI, PET and other technologies to exploit the role of nanomedicine in this field as they assess blockages in the artery and the size of the disease. ‘What we need to know is whether the biology is dormant, is it just going to lie there and stay unchanged for the next 10 years and never cause a problem or is there a heart attack round the corner and what can we do to stop it happening?’ The professor outlined his work in identifying on-going inflammation using ultra-small superparamagnetic iron oxides (USPIOs) to identify hot areas within the aneurysm that are growing. The research showed that if the aneurysm lights up with the MR agent it will grow bigger and surgery will be necessary, or the likelihood of the aneurysm bursting increased.

Representative histological sections of the aortic wall. 
A: Haematoxylin and...
Representative histological sections of the aortic wall.
A: Haematoxylin and eosin (×20) of the full thickness of the aortic wall including atherosclerotic plaque, adherent thrombus and periadventitial fatty tissue.
B: Elastin–van Gieson stain (×100) of the aortic wall showing complete destruction of the normal wall structure including fibrosis (collagen, pink) of the media and adventitia and virtual absence of intact medial elastic fibres (black).
C: Prussian blue staining for iron demonstrating colocalisation of CD68-postive macrophages (×400; brown) with
D: Ultra small superparamagnetic particles of iron oxide particles (×400;blue).
E: High-power (×1000) Prussian blue staining shows intracytoplasmic accumulation of USPIO within macrophages.

Source: Richards et al. Circ Cardiovasc Imaging 2011;4:274-281

Understanding cardiac injury

In his presentation Newby also described how the heart heals after myocardial infarction and how, via iron nanoparticles, imaging can show how much inflammation there is in the heart and how this activity relates to the resolution and scarring of the heart attack. ‘We do not know yet whether modifying cellular inflammation will make things better or worse,’ he said, ‘because it could go either way. If a heart does not heal well, it can burst and rupture but if it overdoes it and heals too much then you get remodelling and heart failure.’ Work with nanomedicine in this area, Newby added, is ‘the first steps towards trying to understand how the heart is responding to the injury of the heart attack.’

USPIO imaging in the Abdominal Aortic Aneurysm
USPIO imaging in the Abdominal Aortic Aneurysm

Other session speakers: 

  • Dr Iwona Cicha from the University Hospital Erlangen, Germany (Magnetic nanoparticles for atherosclerosis - in vitro and in vivo preclinical studies); 
  • Professor Patrick Hsieh, research fellow and affiliate attending surgeon at the Institute of Biomedical Sciences, Academia Sinica, Taiwan (Nanomaterials for cardiovascular repair and regeneration); 
  • Professor Jonathan Gillard, Professor of Neuroradiology at the University of Cambridge, UK (Development of novel MRI tools assessing atheromatous plaque inflammation and stress analysis).


Profile:

Dave Newby is British Heart Foundation Professor of Cardiology at the University of Edinburgh, Director of the Edinburgh Clinical Research Facility and a Consultant Interventional Cardiologist at Royal Infirmary of Edinburgh, Scotland. His principal research focus is on advanced imaging with particular relevance to acute coronary syndromes, valvular heart disease and heart failure.

25.08.2018

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