Experts discuss pressing issues in cardiothoracic pathology
St Petersburg University has hosted a symposium "Fundamental Science − Cardiothoracic Medicine" as part of the 30th Congress of the World Society of Cardiovascular and Thoracic Surgeons (WSTCS). Leading specialists from St Petersburg University have discussed the pathogenesis of atherosclerosis, tissue engineering, pharmacology and other current issues in cardiothoracic pathology.
Yehuda Shoenfeld, Head of the Laboratory of the Mosaic of Autoimmunity, founder and head of the Zabludowicz Centre for Autoimmune Diseases and President of Ariel University, was one of the keynote speakers.
Professor Shoenfeld noted that it is crucial to understand the whole range of triggers in order to study, treat and prevent autoimmune diseases. These factors are commonly referred to in medicine as the "mosaic of autoimmunity", as is the name of the laboratory headed by Yehuda Shoenfeld at St Petersburg University.
30th Congress of the World Society of Cardiovascular and Thoracic Surgeons (WSTCS)
In his report on "Autoimmune aspects of atherosclerosis and their significance for immunomodulation", Professor Shoendeld stressed that it is an integrated approach that allows better study and treatment of autoimmune diseases, and it also refers to atherosclerosis. Atherosclerosis is a chronic inflammatory process in large and medium-sized arterial vessels caused by low density lipoproteins in the inner layer of the artery. This process leads to the formation of atherosclerotic plaques in the vessels that can proliferate and block the arterial lumen.
Professor Shoenfeld observed that inflammation develops due to autoimmune factors, as the human immune system has atherosclerotic related cells that cause the body to perceive the contents of such plaques as an antigen.
Genetic predisposition, environmental factors including exposure to infections, diet and the ecology, and the effects of drugs and substances that strengthen immune responses can all contribute to the development of autoimmune diseases.
Professor Yehuda Shoenfeld, Head of the Laboratory of the Mosaic of Autoimmunity at St Petersburg University
Viktor Gurevich, Head of the Department of Atherosclerosis at the Clinical Research and Education Centre "Cardiology" at St Petersburg University, noted significant effect of statin therapy that can substantially reduce the risk of clinical complications of atherosclerosis. He added that innovative drugs, used to regulate lipoprotein metabolism at the genetic level, are of particular importance for increasing the effectiveness of antiatherogenic therapy.
Professor Tatiana Tennikova, Acting Head of the Department of Medical Chemistry at St Petersburg University, spoke about modern approaches to creating "smart" drug delivery systems and highly efficient carriers for tissue engineering. One of the activities of the Laboratory of Biomaterials and the Laboratory of Biohybrid Technologies of St Petersburg University is the development and research of complex polymeric systems capable of forming nano-, micro- and macrostructures altered by various biological ligands. The polymeric particles serve a therapeutic function in the case of delivery systems by the gradual and controlled release of encapsulated drugs at the focus of the disease.
’Targeted drug delivery is achieved by grafting vector molecules capable of biospecific interaction with cell receptors. In the case of macrostructures, the carrier can be functionalised with ligands that ensure rapid cell adhesion (i.e. the ability to bind) followed by cell mass growth and rebirth into the appropriate tissue,’ said Professor Tennikova.
These clever delivery systems offer amazing opportunities for modern healthcare by reducing doses of toxic drug compounds through targeted transport, prolonging their effects, and ensuring they are effectively protected from enzymatic degradation.
Professor Tatiana Tennikova, Acting Head of the Department of Medical Chemistry at St Petersburg University
Professor Viktor Kashchenko, Head of the Department of Faculty Surgery at St Petersburg University, spoke about the implementation of augmented reality and decision-making systems in clinical practice. As the expert noted, augmented reality surgery is actually the transfer of the diagnostic potential of the clinic to the operating theatre, when the images obtained during examination are used during the surgery.
The approach is based on the use of special marks during the computed tomography scan to mark the location of organs and the tumour to be removed. Doctors then place a marker during surgery, which allows the virtual image to be synchronised with reality. For example, by wearing augmented reality glasses, the surgeon can clearly monitor the situation, observing structures that are invisible to the simple eye. This makes it possible, for example, to monitor for probable bleeding and to assess the resectability of the tumour.
Each patient can actually be described as a new traffic situation, and it is safer to operate when we have a navigator that enables us to choose the most appropriate route.
Viktor Kashchenko, Head of the Department of Faculty Surgery at St Petersburg University
’Additional information about the patient enables us to decide on the surgical procedure for each individual patient − this is what personalised medicine is all about. Today, we use ICG fluorescence navigation for this purpose. This is a combination of angiographic, cholangiographic and lymphographic examinations, each of which makes it possible to visualise a particular anatomical structure,’ said Viktor Kashchenko, Head of the Department of Faculty Surgery at St Petersburg University.
The technology also makes it possible to use a special substance that, when exposed to light, stains the damaged vessels that need to be removed. Vadim Pischik, Professor in the Department of Hospital Surgery at St Petersburg University presented a surgery using this technology at the 30th Annual Meeting of the World Society of Cardiovascular and Thoracic Surgeons (WSCTS).
During the symposium, Valerii Zolotykh, a graduate of St Petersburg University, plastic surgeon and oncologist, shared the results of a year’s follow-up of patients with silicone breast implants and the effect of the implants on autoimmunity.
The study was supervised by: Piotr Yablonsky, Vice-Rector for Medical Activities; Yehuda Shoenfeld, Head of the Laboratory of the Mosaic of Autoimmunity; and Leonid Churilov, Head of the Department of Pathology. The study involved: Vladimir Utekhin, Head of Teaching at the Department of Pathology; Iurii Stroev, Professor in the Department of Pathology; Tatiana Novitskaia, Associate Professor in the Department of Pathology; and Anton Gvozdetskii, a graduate of St Petersburg University.
The study found a rise in autoantibodies to thyroid hormone receptors (TSH) in 106 healthy patients who had undergone breast surgery, with and without implants. Thus, 80% of patients with implants had higher than normal THS levels six months after surgery.
’During follow-up, we discovered an adjuvant, i.e. an immune response enhancing effect of the silicone implant on autoimmunity to the thyroid gland. This is likely to occur because the thyroid hormone receptor is synthesised in the mammary gland. We believe that the risk of autoimmune thyroid diseases associated with silicone should be considered among contraindications to implants. Also, during follow-up of the patients who have undergone mammoplasty it is mandatory to check markers of thyroid diseases’, said Valerii Zolotykh.
The experts plan to continue monitoring patients for five years after surgery under a grant supported by the Government of the Russian Federation.
The experts from St Petersburg University also discussed: vasa vasorum (specialised vessels that are in the arterial vessel wall) and their changes in atherosclerosis; non-lipid factors in the progression of abdominal aortic aneurysms; and other aspects of cardiovascular and thoracic surgery.