I am an Instructor of Surgery at Harvard Medical School and an Associate Surgeon in the Division of Vascular and Endovascular Surgery at Brigham and Women's Hospital. The following outlines my plan to become an independent clinician-scientist in translational vascular research and a clinical trialist. My proposal capitilizes on the stimulating academic environment and multidisciplinary collaborations engendered by Harvard Medical School, Harvard School of Public Health, and Massachussetts Institute of Technology. Many patients with PAD progress to critical limb ischemia. Autologous vein remains the most durable conduit for bypass surgery, yet failure rates remain significant (30-50% over 5 years). I have previously shown that these patients have a distinct inflammatory phenotype as assessed by C-reactive protein (CRP). Moreover, elevated baseline CRP levels are predictive of adverse cardiovascularand vein graft-related events after peripheral bypass surgery. Bypass grafts in patients with elevated CRP levels exhibit less adaptive dilation in the first few months after the vein is implanted in the arterial circulation, which portends worse graft function after 1 year. Plasma levels of CRP correlate inversely with brachial and coronary artery endothelial function;however, it is not known if CRP is correlated with vein graft endothelial function. This proposal seeks to elucidate the relationships between endothelial function, inflammation, and vein graft adaptation in the arterial environment. I will determine the relationship between systemic (as assessed by the brachial artery) and vein graft-specific endothelial function to early vein graft remodeling. Endothelial function of the vein will be assessed both in vivo and ex vivo techinques.
My second aim i s to determine the association between biomarkers of inflammation and endothelial activation with vein graft- specific endothelial function. My final hypothesis is that reducing systemic inflammation by intensive statin therapy (atorvastatin 80 mg) will improve early vein graft adaptation by improving endothelial function. This hypothesis will be tested by a randomized controlled trial of intensive vs conventional dose atorvastatin given in the peri-operative setting. These studies will provide new insights into the understanding of normal and abnormal adaptive processes of human vein graft healing and will have direct clinical relevance by identifying new biomarkers, surrogate endpoints, and mechanisms of existing therapies for vein graft failure.
|Owens, Christopher D; Gasper, Warren J; Rahman, Amreen S et al. (2015) Vein graft failure. J Vasc Surg 61:203-16|
|Walker, Joy P; Hiramoto, Jade S; Gasper, Warren J et al. (2014) Vitamin D deficiency is associated with mortality and adverse vascular access outcomes in patients with end-stage renal disease. J Vasc Surg 60:176-83|
|Owens, Christopher D; Gasper, Warren J; Walker, Joy P et al. (2014) Safety and feasibility of adjunctive dexamethasone infusion into the adventitia of the femoropopliteal artery following endovascular revascularization. J Vasc Surg 59:1016-24|
|Walker, Joy P; Owens, Christopher D (2013) Current Status of Drug-Eluting Stents and Drug-Eluting Balloons for the Superficial Femoral Artery. Curr Surg Rep 1:90-97|
|Gasper, Warren J; Jimenez, Cynthia A; Walker, Joy et al. (2013) Adventitial nab-rapamycin injection reduces porcine femoral artery luminal stenosis induced by balloon angioplasty via inhibition of medial proliferation and adventitial inflammation. Circ Cardiovasc Interv 6:701-9|
|Owens, Christopher D; Kim, Ji Min; Hevelone, Nathanael D et al. (2012) An integrated biochemical prediction model of all-cause mortality in patients undergoing lower extremity bypass surgery for advanced peripheral artery disease. J Vasc Surg 56:686-95|
|Hiramoto, Jade S; Owens, Christopher D; Kim, Ji Min et al. (2012) Sex-based differences in the inflammatory profile of peripheral artery disease and the association with primary patency of lower extremity vein bypass grafts. J Vasc Surg 56:387-95; discussion 395|
|Pillai, Padmini S; Leeson, Stanley; Porter, Timothy F et al. (2012) Chemical mediators of inflammation and resolution in post-operative abdominal aortic aneurysm patients. Inflammation 35:98-113|
|Owens, C D; Gasper, W J; Conte, M S (2011) Assessing drug elution technologies in the superficial femoral artery. Panminerva Med 53:37-49|
|Owens, Christopher D; Wake, Nicole; Kim, Ji Min et al. (2010) Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease. J Vasc Access 11:329-34|
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