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Citric acid as a decalcifying agent for the excised calcified human heart valves
Necmi Köse1, Barlas Naim Aytaçoğlu, Necat Yilmaz
1From Department of Cardiovascular Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey.
Insights
Citric acid effectively reduced calcium in excised human heart valves in vitro without damaging tissue structure. This suggests potential for oral citric acid to treat valve calcification.
Area of Science:
- Biochemistry
- Cardiovascular Research
- Biomaterials Science
Background:
- Cardiac valvular pathologies often involve calcification, leading to mechanical and functional disorders.
- Valvular replacement is a common outcome for severe calcification.
- Investigating novel therapeutic approaches for valve calcification is crucial.
Purpose of the Study:
- To investigate the efficacy of citric acid in decalcifying excised human heart valves in vitro.
- To assess the impact of citric acid treatment on the morphological integrity of valvular tissue.
- To explore the potential for systemic citric acid application in treating native heart valve calcification.
Main Methods:
- Excised human mitral and/or aortic valves were treated with citric acid solution (3.8%, pH 7.4) at 37°C for 48 hours.
- Control valves were maintained in a phosphate-buffered saline solution with glutaraldehyde.
- Biochemical and histopathological analyses were performed to compare calcium levels and tissue morphology.
Main Results:
- Citric acid treatment significantly reduced calcium and phosphate levels in heart valve specimens compared to controls (p=0.001 and p=0.035).
- Histopathological evaluation revealed no significant adverse changes to collagen and elastin fibers.
- Irregular calcific formations around collagen fibers were notably decreased in the citric acid-treated group.
Conclusions:
- Citric acid effectively decalcifies human heart valves in vitro while preserving tissue morphology.
- These findings support further investigation into the systemic administration of citric acid for treating native valve calcification.
Objective:
Cardiac valvular pathologies are frequently encountered as mechanical and functional disorders due to the calcification of the valves whatever the etiologies are. This pathophysiologic table usually ends up with valvular replacement. In this study, we aimed to decrease/eliminate the calcium in the excised calcified human heart valves by using citric acid in vitro hence bringing about the question for possible oral treatment of calcification of the valves by citric acid ingestion.
Methods:
Fourteen pieces of mitral and/or aortic valves excised from 12 patients undergoing valve replacement were placed in a freshly prepared phosphate buffered saline solution containing 0.625% glutaraldehyde at +4 0C for 48 h. They were rinsed with 0.9% NaCl and divided into two groups; study and control. Control tissues were further treated in a freshly prepared solution with identical properties for another 5 days. Study tissues were placed into a solution containing 3.8% citric acid (pH 7.4) and kept for 48 h at +37 degrees C, then rinsed with 0.9% NaCl and transferred into a fresh solution containing 0.625% glutaraldehyde with phosphate buffer at 37 0C for 3 more days. Specimens were biochemically and histopathologically evaluated and compared using Mann Whitney U test.
Results:
Calcium and phosphate levels in the study group were lower than in the control group (852.5+/-913.41 microg g-1 vs 413.05+/-519.53 microg g-1, p=0.001 and 207.6+/-321.86 microg g-1 vs 124.4+/-289.48 microg g-1, p=0.035, respectively). Malondialdehyde and protein level values were changed insignificantly in the control and study groups. Histopathologic evaluation showed that collagen and elastin fibers were similar in both groups. In the study group, irregular and fusiform calcific formations around the collagen fibers were significantly decreased.
Conclusions:
Decalcifying human heart valves in vitro conditions with citric acid without an adverse change to the morphology of the valvular tissue specimens is meaningful. We believe that forwarding and looking for the answer to the question "whether systemic application of citric acid could lead to the decalcification and/or reduction of calcification in the native human heart valves" would be expressive.
