Research

As part of the Jobst Vascular Research Laboratory, the Eliason team brings problems and questions observed in our clinical work with patients with vascular trauma and AAA to the lab bench. Our colleagues, experts in animal model research and molecular techniques, help shape our investigations. The collaborative spirit and synergies inherent in the Jobst Lab and across the University of Michigan Medical School are critical to moving the field forward. 

Motivating our scientific investigations is the need for a greater understanding of the pathways and mechanisms involved in abdominal aortic aneurysm (AAA) formation. Also driving our work is the need to optimize the clinical use of novel hemorrhage-control devices, especially in environments that lack access to emergency medical facilities.   

We use a range of animal models and molecular and morphomic analytical techniques to study vascular trauma and AAA development. For example, we look at many parameters of bleeding, including geospatial correlation between the skeletal structure and vasculature, in order to detect and reduce vascular injury and improve hemorrhage control.

We also study REBOA use for hemorrhage control. More specifically we use our preclinical models to learn how to optimize balloon occlusion, since we have shown that the duration of REBOA use can impact complications and outcomes. 

Using a novel, customized exposure chamber, we also study the relationship of cigarette smoke to the development of AAA, and we compare these effects with those of e-cigarette vapor using the same models.  

Our group was the first to show, in vitro, how crosstalk among smooth muscle cells and endothelial cells in the aorta interact with macrophages when exposed to cigarette smoke extract. Work to understand the communications among these important cell types in response to cigarette smoke has shown that crosstalk changes the regulation of matrix metalloproteinase (MMP) enzymes 2 and 9, which have long been implicated in aneurysm growth. 

We have observed changes in other metabolic markers and structural proteins likely to lead to harmful effects on the cardiovascular system and identified some of the larger regulatory pathways, such as AKT (protein kinase B), (ERK (extracellular signal-related kinase) and MAPK (mitogen-activated protein kinase). These might prove potential therapeutic targets in halting the development of AAA. 

Work on the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in a primate model has shown that REBOA can be life-saving in the face of hemorrhagic shock. Prolonged occlusion, defined as one hour, however, led to evidence of markers of kidney and liver damage and spinal cord injury that were not observed after 30 minutes. We also have found in animal models that traumatic brain injury can worsen complications and outcomes after prolonged REBOA use, again defined as one hour, for traumatic hemorrhage.

Work to use CT imaging and morphomic analysis to correlate skeletal features with the vasculature is providing new information to aid the insertion of the REBOA catheter in situations where image guidance is not available.

The synergies between Dr. Eliason's longtime scientific and clinical interest in AAA formation and treatment as well as new approaches to hemorrhage control have had direct clinical impacts. REBOA now is used in many level 1 trauma centers in the United States. In addition, the U.S. military has added REBOA to its clinical practice guidelines (CPG) for hemorrhage control. Better understanding the physiologic impact of balloon occlusion that occurs for too long can help guide the use of REBOA technology to maximize the benefits for patients and minimize harms. Clinicians are now looking at REBOA use for hemorrhage due to causes other than blunt trauma, such as during childbirth in women with placenta accreta. The feasibility of pre-hospital REBOA is even being explored in the setting of non-traumatic out-of-hospital cardiac arrest. Work using morphomic analysis to correlate bony landmarks with vascular anatomy can help to guide REBOA catheter insertion, particularly in austere environments that lack imaging-guidance capabilities. This work can also help identify traumatic injury patterns most likely to result in vascular trauma and hemorrhage, leading to earlier detection and treatment to prevent hemorrhagic shock.

Our team is excited to explore other potential applications for REBOA, including during childbirth, as well as related technologies. For example, Dr. Kevin Ward of Emergency Medicine and Biomedical Engineering, is looking at the use of gastroesophageal resuscitative occlusion of the aorta, or GROA. In REBOA, the femoral artery is used to insert the catheter and block the aorta; GROA uses the esophagus for insertion and compresses and blocks the aorta from inside the stomach. These types of collaborative research efforts are very valuable to compare and contrast these types of invasive but potentially life-saving therapies.

Related to smoking and aneurysm development, we plan to look more closely at the use of THC and cannabis oils in vaping systems. With the legalization of marijuana in many states, it's important to understand the potential vascular effects of vapors and the role of heating. We also are thinking about ways to streamline access to blood vessels that pose challenges for catheter insertion.

Within the Jobst Vascular Research Laboratory, we work closely with Dr. Dan Myers and Abhijit Ghosh, PhD, on animal model investigations and molecular techniques.

Other collaborations include:

• Innovative hemorrhage control work with Dr. Kevin Ward of the departments of Emergency Medicine and Biomedical Engineering to marry our understanding of hemorrhage control and device development.

• Research to understand the relationship between trauma and vascular injury with Dr. Stuart Wang, a pioneer in the area of analytical morphomics. This work entails use of CT imaging to learn more about traumatic injury patterns and to gain a greater geospatial understanding of the skeletal and vascular anatomy. 

• With Dr. Hasan Alam, a renowned trauma surgeon-scientist, on the impact of traumatic brain injury and REBOA use. 

• With Dr. Dawn Coleman and Abhijit Ghosh, we have a clinical research collaboration related to pediatric aortic and renal vascular diseases, including renovascular hypertension, abdominal aortic coarctation and mid-aortic syndrome.