Heart valves (HVs) are fluidic control components of the heart that ensure unidirectional blood flow during the cardiac cycle. However, this description does not adequately describe the biomechanical ramifications of their function in that their mechanics are multi-modal. Moreover, they must replicate their cyclic function over an entire lifetime, with an estimated total functional demand of least 3×10 9 cycles. The focus of the present review is on the functional biomechanics of heart valves. Thus, the focus of the present review is on functional biomechanics, referring primarily to biosolid as well as several key biofluid mechanical aspects underlying heart valve physiological function. Specifically, we refer to the mechanical behaviors of the extra-cellular matrix structural proteins, underlying cellular function, and their integrated relation to the major aspects of valvular hemodynamic function. While we focus on the work from the author's laboratories, relevant works of other investigators have been included whenever appropriate. We conclude with a summary of important future trends. KeywordsHeart valves; biomechanics; soft tissue mechanics; cell mechanics; mechanobiology I -Heart Valve Physiologic Function -IntroductionHeart valves (HVs) are fluidic control components of the heart that ensure unidirectional blood flow during the cardiac cycle. Essentially, HVs are passive tissues that are directed to open and close due to inertial forces exerted by the surrounding blood. However, this description does not adequately describe the biomechanical ramifications of their function in that their mechanics are multi-modal and their loading cycle is repeated every second. For example, they must replicate this feat with each heart beat; over a period of 70 years the reader's HVs will open and close nearly 3×10 9 times.Anatomically, there are two types of valves: semilunar and atrio-ventricular (sometimes also known as "sigmodial"). The semilunar valves (pulmonary (PV) and aortic (AV)) prevent For correspondence: Michael S. Sacks, Ph.D., 100 Technology drive, Room 234, University of Pittsburgh, Pittsburgh, PA 15219, Tel: 412-235-5146, Fax: 412-235-5160, Email: msacks@pitt.edu. CONFLICT OF INTERESTThe authors have no conflict of interest, financial or otherwise, that would affect their impartiality of this work.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript retrograde flow back into the ventricles during diastole. Because of their anatomical location, they form nearly a perfec...

provided expertise to develop 18 F nutrient uptake assays. F.X. and M.N.T injected and handled mice for 18 F nutrient uptake assays, and performed and provided expertise for PET imaging and autoradiography. T.H. and W.D.M. performed and provided expertise for intrarenal Renca experiments. R.W.J. and V.T.M generated and provided expertise for PyMT GEMM tumors. R.E.B and C.S.W. generated and provided expertise for AOM/DSS CRC tumors. B.I.R. R.T.O. and M.H.W. generated the pTZeo-EL-thy1.1 transposon construct and engineered MC38 cells using this transposon system. B.I.R, M.Z.M, and A.S. performed in vivo 2NBDG studies. J.E.B. provided expertise in characterizing TAM. A.R.P provided expertise in flow sorting for mRNA transcript analysis. B.I.R. and M.Z.M performed extracellular flux and mRNA transcript experiments. F.M.M. and E.F.M performed and provided expertise in cell staining for light microscopy. E.F.M performed light microscopy and pathologic examination of MC38 tumors. A.A (VU) conducted transcriptomic analysis. B.I.R and M.Z.M. analyzed all data generated in this study. J.C.R. and W.K.R. obtained funding for this study.Data Availability Statement (DAS) All data will be made available upon reasonable request to JCR/WKR. Tumor mRNA transcript data that support the findings of this study have been deposited in Gene Expression Omnibus (GEO) under accession GSE165223. These data are also found in Supplementary Information Table 4. Code Availability Statement (CAS)The code used to support tumor mRNA transcript analysis has been previously published (see methods references) and will be made available upon request to JCR/WKR.

It has been speculated that heart valve interstitial cells (VICs) maintain valvular tissue homeostasis through regulated extracellular matrix (primarily collagen) biosynthesis. VICs appear to be phenotypically plastic, inasmuch as they transdifferentiate into myofibroblasts during valve development, disease, and remodeling. Under normal physiological conditions, transvalvular pressures (TVPs) on the right and left side of the heart are vastly different. Hence, we hypothesize that higher left-side TVPs impose larger local tissue stress on VICs, which increases their stiffness through cytoskeletal composition, and that this relation affects collagen biosynthesis. To evaluate this hypothesis, isolated ovine VICs from the four heart valves were subjected to micropipette aspiration to assess cellular stiffness, and cytoskeletal composition and collagen biosynthesis were quantified by using the surrogates smooth muscle alpha-actin (SMA) and heat shock protein 47 (HSP47), respectively. VICs from the aortic and mitral valves were significantly stiffer (P < 0.001) than those from the pulmonary and tricuspid valves. Left-side isolated VICs contained significantly more (P < 0.001) SMA and HSP47 than right-side VICs. Mean VIC stiffness correlated well (r = 0.973) with TVP; SMA and HSP47 also correlated well (r = 0.996) with one another. Assays were repeated for VICs in situ, and, as with in vitro results, left-side VIC protein levels were significantly greater (P < 0.05). These findings suggest that VICs respond to local tissue stress by altering cellular stiffness (through SMA content) and collagen biosynthesis. This functional VIC stress-dependent biosynthetic relation may be crucial in maintaining valvular tissue homeostasis and also prove useful in understanding valvular pathologies.

Implantation of a novel biodegradable PEUU patch onto a subacute myocardial infarction promoted contractile phenotype smooth muscle tissue formation and improved cardiac remodeling and contractile function at the chronic stage. Our findings suggest a new therapeutic option against post-infarct cardiac failure.

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Carcinoid heart disease was one of the first valvular pathologies studied in molecular detail, and early research identified serotonin produced by oncogenic enterochromaffin cells as the likely culprit in causing changes in heart valve tissue. Researchers and physicians in the mid-1960s noted a connection between the use of several ergot-derived medications with structures similar to serotonin and the development of heart valve pathologies similar to those observed in carcinoid patients. The exact serotonergic target that mediated valvular pathogenesis remained a mystery for many years until similar cases were reported in patients using the popular diet drug Fen-Phen in the late 1990s. The Fen-Phen episode sparked renewed interest in serotonin-mediated valve disease, and studies led to the identification of the 5-HT2B receptor as the likely molecular target leading to heart valve tissue fibrosis. Subsequent studies have identified numerous other activators of the 5-HT2B receptor, and consequently, the use of many of these molecules has been linked to heart valve disease. Herein, we: review the molecular properties of the 5-HT2B receptor including factors that differentiate the 5-HT2B receptor from other 5-HT receptor subtypes, discuss the studies that led to the identification of the 5-HT2B receptor as the mediator of heart valve disease, present current efforts to identify potential valvulopathogens by screening for 5-HT2B receptor activity, and speculate on potential therapeutic benefits of 5-HT2B receptor targeting.

Background-Phenotypically, the aortic valve interstitial cell (AVIC) is a dynamic myofibroblast, appearing contractile and activated in times of development, disease, and remodeling. The precise mechanism of phenotypic modulation is unclear, but it is speculated that both biomechanical and biochemical factors are influential. Therefore, we hypothesized that isolated and combined treatments of cyclic tension and TGF-β1 would alter the phenotype and subsequent collagen biosynthesis of AVICs in situ.

Recent studies have suggested that extracellular matrix rigidity regulates cancer invasiveness, including the formation of cellular invadopodial protrusions; however, the relevant mechanical range is unclear. Here, we used a combined analysis of tissue-derived model basement membrane (BM) and stromal matrices and synthetic materials to understand how substrate rigidity regulates invadopodia. Urinary bladder matrix-BM (UBM-BM) was found to be a rigid material with elastic moduli of 3-8 MPa, as measured by atomic force microscopy and low-strain tensile testing. Stromal elastic moduli were ∼6-fold lower, indicating a more compliant material. Using synthetic substrates that span kPa-GPa moduli, we found a peak of invadopodia-associated extracellular matrix degradation centered around 30 kPa, which also corresponded to a peak in invadopodia/cell. Surprisingly, we observed another peak in invadopodia numbers at 2 GPa as well as gene expression changes that indicate cellular sensing of very high moduli. Based on the measured elastic moduli of model stroma and BM, we expected to find more invadopodia formation on the stroma, and this was verified on the stromal versus BM side of UBM-BM. These data suggest that cells can sense a wide range of rigidities, up into the GPa range. Furthermore, there is an optimal rigidity range for invadopodia activity that may be limited by BM rigidity.