Clinical Focus

  • Vascular Surgery
  • Endovascular Surgery
  • Digital Health
  • Health Information Technology
  • Precision Medicine

Academic Appointments

Administrative Appointments

  • Lead Director, Biodesign for Digital Health, Stanford Byers Center for Biodesign (2018 - Present)
  • Medical Director, Wound Clinic, VAPAHCS (2014 - Present)
  • Medical Director, Vascular Laboratory, VAPAHCS (2012 - Present)

Professional Education

  • Board Certification: Vascular Surgery, American Board of Surgery (2010)
  • Board Certification: General Surgery, American Board of Surgery (2007)
  • Fellowship:Northwestern University Medical Center (2007) IL
  • Residency:UCSF - East Bay Surgery Program (2005) CA
  • Internship:UCSF - East Bay Surgery Program (1999) CA
  • Medical Education:Boston University School of Medicine (1998) MA

Research & Scholarship

Current Research and Scholarly Interests

We launched a national precision medicine PAD trial called, VascTrac ( This trial is mobile phone based and leverages Apple's ResearchKit Platform to monitor a patient's activity both pre- and post-intervention. We are validating mobile phone surveillance for PAD patients and are currently enrolling.

Clinical Trials

  • VascTrac Peripheral Arterial Disease (PAD) Study Not Recruiting

    VascTrac is a mobile medical application that tracks users' physical activity levels in order to predict endovascular failure of patients with Peripheral Artery Disease.

    Stanford is currently not accepting patients for this trial.

    View full details

  • Study of the Effectiveness of Telmisartan in Slowing the Progression of Abdominal Aortic Aneurysms Recruiting

    The purpose of this study is to determine if telmisartan is effective in slowing the progression of abdominal aortic aneurysms and reducing circulating concentrations of Abdominal Aortic Aneurysms (AAA) biomarkers.

    View full details


All Publications

  • Use of a proactive duplex ultrasound protocol for hemodialysis access. Journal of vascular surgery Itoga, N. K., Ullery, B. W., Tran, K., Lee, G. K., Aalami, O. O., Bech, F. R., Zhou, W. 2016; 64 (4): 1042-1049 e1


    Arteriovenous fistula (AVF) creation is the preferred approach for hemodialysis access; however, the maturation of AVFs is known to be poor. We established a proactive early duplex ultrasound (DUS) surveillance protocol for evaluating AVFs before attempted access. This study determined the effect of this protocol related to improving AVF maturation.From 2008 to 2013, 153 patients received new upper extremity AVFs and an early DUS surveillance protocol at a single academic institution. The protocol involved an early DUS evaluation before hemodialysis cannulation of the AVF at 4 to 8 weeks after AVF creation. A positive DUS result was identified as a peak systolic velocity of >375 cm/s or a >50% stenosis on gray scale imaging, along with decreased velocity in the outflow vein. Patients with positive DUS findings underwent prophylactic endovascular or open intervention to assist with AVF maturation. Nature of secondary interventions, as well as AVF patency and maturation, were assessed. Overall clinical outcomes and fistula patency were investigated.During the study period, 183 upper extremity AVFs were created in 153 patients, including 82 radiocephalic, 63 brachiocephalic, and 38 brachiobasilic AVFs. A mortality rate of 43% (n = 66) was observed in a median follow-up period of 34.5 months (interquartile range, 19.6-46.9). A total of 164 early DUS were performed at a median of 6 weeks (interquartile range, 3.4-9.6 weeks) after the initial creation. Early DUS showed nine AVFs were occluded and were excluded from further analysis. Hemodynamically significant lesions were found in 62 AVFs (40%); however, only 17 (11%) were associated with an abnormal physical examination. Positive DUS finding prompted a secondary intervention in 81% of the patients. Among those with positive early DUS findings, AVF maturation was 70% in those undergoing a secondary intervention compared with 25% in those not undergoing a prophylactic intervention (P = .011). Primary-assisted patency for AVFs with early positive and negative DUS findings were 83% and 96% at 6 months, 64% and 89% at 1 year, and 52% and 82% at 2 years, respectively (P < .001).Early DUS surveillance of AVFs before initial access is reasonable to identify problematic AVFs that may not be reliably detected on clinical examination. Although DUS criteria for AVFs have yet to be universally accepted, proactive early postoperative DUS interrogation assists in the early detection of dysfunctional AVFs and improvement of fistula maturation. Despite improved patency in those with positive DUS findings who undergo prophylactic secondary intervention, overall patency remains inferior to those without an abnormality detected on early DUS imaging.

    View details for DOI 10.1016/j.jvs.2016.03.442

    View details for PubMedID 27183858

  • Novel Use of Google Glass for Procedural Wireless Vital Sign Monitoring. Surgical innovation Liebert, C. A., Zayed, M. A., Aalami, O., Tran, J., Lau, J. N. 2016; 23 (4): 366-373


    This study investigates the feasibility and potential utility of head-mounted displays for real-time wireless vital sign monitoring during surgical procedures.In this randomized controlled pilot study, surgery residents (n = 14) performed simulated bedside procedures with traditional vital sign monitors and were randomized to addition of vital sign streaming to Google Glass. Time to recognition of preprogrammed vital sign deterioration and frequency of traditional monitor use was recorded. User feedback was collected by electronic survey.The experimental group spent 90% less time looking away from the procedural field to view traditional monitors during bronchoscopy (P = .003), and recognized critical desaturation 8.8 seconds earlier; the experimental group spent 71% (P = .01) less time looking away from the procedural field during thoracostomy, and recognized hypotension 10.5 seconds earlier. Trends toward earlier recognition of deterioration did not reach statistical significance. The majority of participants agreed that Google Glass increases situational awareness (64%), is helpful in monitoring vitals (86%), is easy to use (93%), and has potential to improve patient safety (85%).In this early feasibility study, use of streaming to Google Glass significantly decreased time looking away from procedural fields and resulted in a nonsignificant trend toward earlier recognition of vital sign deterioration. Vital sign streaming with Google Glass or similar platforms is feasible and may enhance procedural situational awareness.

    View details for DOI 10.1177/1553350616630142

    View details for PubMedID 26848138

  • Erratum to: 'TElmisartan in the management of abDominal aortic aneurYsm (TEDY): The study protocol for a randomized controlled trial'. Trials Morris, D. R., Cunningham, M. A., Ahimastos, A. A., Kingwell, B. A., Pappas, E., Bourke, M., Reid, C. M., Stijnen, T., Dalman, R. L., Aalami, O. O., Lindeman, J. H., Norman, P. E., Walker, P. J., Fitridge, R., Bourke, B., Dear, A. E., Pinchbeck, J., Jaeggi, R., Golledge, J. 2016; 17 (1): 43-?

    View details for DOI 10.1186/s13063-016-1183-x

    View details for PubMedID 26791257

  • A Prospective Evaluation of Using IVUS during Percutaneous Superficial Femoral Artery Interventions ANNALS OF VASCULAR SURGERY Hitchner, E., Zayed, M., Varu, V., Lee, G., Aalami, O., Zhou, W. 2015; 29 (1): 28-33


    The outcomes of endovascular interventions of the superficial femoral artery (SFA) are variable. Completion angiography is typically performed to confirm satisfactory outcomes after SFA angioplasty and/or stenting. However, two-dimensional angiography may not accurately reflect the extent of residual stenosis. We sought to determine whether intravascular ultrasound (IVUS) can help with residual disease assessment and procedure outcome.Patients with anticipated SFA disease were prospectively recruited to the study. Patients with primary SFA disease on diagnostic angiography were included. After SFA endovascular intervention with angioplasty and/or stenting, a completion angiogram was performed to confirm satisfactory results before IVUS evaluation. IVUS-detected maximal residual stenosis, maximal residual lesion volume, and number of nonconsecutive posttreatment SFA segments with >50% residual stenosis were evaluated. Periprocedural ankle-brachial indexes (ABIs), Short Form 36 (SF-36) surveys, and Walking Impairment Questionnaires were also collected.Fifty-nine patients were prospectively enrolled. Thirty-three received angioplasty only, and 26 received angioplasty and stenting. All patients were men, mean age was 67 years, and major comorbidities included coronary artery disease (53%), active smoking (56%), hypertension (88%), and diabetes (68%). The angioplasty-only cohort had more nonconsecutive areas of >50% residual stenosis (P = 0.004), greater residual stenosis (P = 0.03), and smaller minimal lumen diameters after treatment (P = 0.01) than the angioplasty and stenting cohort. However, there was no significant difference in ABI between the 2 groups and no difference in ABI improvement after intervention. Sixty-four percent of all patients demonstrated a >0.2 increase in postintervention ABI. Improvement in ABI at 1 month after procedure significantly correlated with postintervention SF-36 survey physical scores (r = 0.435, P = 0.007).IVUS evaluation provides more-accurate intraprocedural insight on the extent of residual stenosis after SFA interventions. Future studies are warranted to determine whether IVUS-guided postangioplasty and/or stenting can impact long-term interventional outcome.

    View details for DOI 10.1016/j.avsg.2014.07.026

    View details for Web of Science ID 000346239900005

    View details for PubMedID 25194552

  • TElmisartan in the management of abDominal aortic aneurYsm (TEDY): The study protocol for a randomized controlled trial. Trials Morris, D. R., Cunningham, M. A., Ahimastos, A. A., Kingwell, B. A., Pappas, E., Bourke, M., Reid, C. M., Stijnen, T., Dalman, R. L., Aalami, O. O., Lindeman, J. H., Norman, P. E., Walker, P. J., Fitridge, R., Bourke, B., Dear, A. E., Pinchbeck, J., Jaeggi, R., Golledge, J. 2015; 16: 274-?


    Experimental studies suggest that angiotensin II plays a central role in the pathogenesis of abdominal aortic aneurysm. This trial aims to evaluate the efficacy of the angiotensin receptor blocker telmisartan in limiting the progression of abdominal aortic aneurysm.Telmisartan in the management of abdominal aortic aneurysm (TEDY) is a multicentre, parallel-design, randomised, double-blind, placebo-controlled trial with an intention-to-treat analysis. We aim to randomly assign 300 participants with small abdominal aortic aneurysm to either 40 mg of telmisartan or identical placebo and follow patients over 2 years. The primary endpoint will be abdominal aortic aneurysm growth as measured by 1) maximum infra-renal aortic volume on computed tomographic angiography, 2) maximum orthogonal diameter on computed tomographic angiography, and 3) maximum diameter on ultrasound. Secondary endpoints include change in resting brachial blood pressure, abdominal aortic aneurysm biomarker profile and health-related quality of life. TEDY is an international collaboration conducted from major vascular centres in Australia, the United States and the Netherlands.Currently, no medication has been convincingly demonstrated to limit abdominal aortic aneurysm progression. TEDY will examine the potential of a promising treatment strategy for patients with small abdominal aortic aneurysms.Australian and Leiden study centres: Australian New Zealand Clinical Trials Registry ACTRN12611000931976 , registered on 30 August 2011; Stanford study centre: NCT01683084 , registered on 5 September 2012.

    View details for DOI 10.1186/s13063-015-0793-z

    View details for PubMedID 26081587

  • Targeting of Sp1 transcription factor: a novel therapeutic approach for Keloids, an in vitro analysis EXPERIMENTAL DERMATOLOGY Mukhopadhyay, A., Khoo, A., Cheong, H. H., Chan, S. Y., Aalami, O., Lim, I. J., Phan, T. T. 2007; 16 (12): 1023-1031


    Keloid scars are fibroproliferative disorders characterized by the accumulation of extracellular matrix (ECM) components resulting in a fibrotic condition. Several ECM promoters are regulated by Sp1. Thus, our aim was to investigate the role of Sp1 in keloid pathogenesis and investigate the antiproliferative and antifibrotic effects of Wp631 and mitoxantrone, potent inhibitors of Sp1-activated transcription. An elevated level of Sp1 was observed in tissue extracts obtained from keloid tissue. Serum stimulation elevated Sp1 levels in keloid fibroblasts (KF). Under coculture conditions Sp1 seemed to be downregulated. Wp631 and mitoxanthrone in serum growth factors resulted in a reduced expression of ECM components in KF. Both Wp631 and mitoxanthrone were also able to inhibit the proliferation of normal and keloid keratinocytes and fibroblasts significantly. As Wp631 seems to be potent in downregulating the ECM components in KF and also inhibiting the proliferation of these cells it could be explored as a possible therapeutic agent in the treatment of keloids.

    View details for DOI 10.1111/j.1600-0625.2007.00627.x

    View details for Web of Science ID 000251189300008

    View details for PubMedID 18031462

  • mTOR as a potential therapeutic target for treatment of keloids and excessive scars EXPERIMENTAL DERMATOLOGY Ong, C. T., Khoo, Y. T., Mukhopadhyay, A., Do, D. V., Lim, I. J., Aalami, O., Phan, T. T. 2007; 16 (5): 394-404


    Keloid is a dermal fibroproliferative disorder characterized by excessive deposition of extracellular matrix (ECM) components such as collagen, glycoproteins and fibronectin. The mammalian target of rapamycin (mTOR) is a serine/theronine kinase which plays an important role in the regulation of metabolic processes and translation rates. Published reports have shown mTOR as regulator of collagen expression and its inhibition induces a decrease in ECM deposition. Our aim was to investigate the role of mTOR in keloid pathogenesis and investigate the effect of rapamycin on proliferating cell nuclear antigen (PCNA), cyclin D1, collagen, fibronectin and alpha-smooth muscle actin (alpha-SMA) expression in normal fibroblasts (NF) and keloid fibroblasts (KF). Tissue extracts obtained from keloid scar demonstrated elevated expression of mTOR, p70KDa S6 kinase (p70S6K) and their activated forms, suggesting an activated state in keloid scars. Serum stimulation highlighted the heightened responsiveness of KF to mitogens and the importance of mTOR and p70S6K during early phase of wound healing. Application of rapamycin to monoculture NF and KF, dose- and time-dependently downregulates the expression of cytoplasmic PCNA, cyclin D1, fibronectin, collagen and alpha-SMA, demonstrating the anti-proliferative effect and therapeutic potential of rapamycin in the treatment of keloid scars. The inhibitory effect of rapamycin was found to be reversible following recovery in the expression of proteins following the removal of rapamycin from the culture media. These results demonstrate the important role of mTOR in the regulation of cell cycle and the expression of ECM proteins: fibronectin, collagen and alpha-SMA.

    View details for DOI 10.1111/j.1600-0625.2007.00550.x

    View details for Web of Science ID 000245605500002

    View details for PubMedID 17437482

  • Differential gene expression between juvenile and adult dura mater: A window into what genes play a role in the regeneration of membranous bone PLASTIC AND RECONSTRUCTIVE SURGERY Wan, D. C., Aalami, O. O., Wang, Z., Nacamuli, R. P., Lorget, F., Derynck, R., Longaker, M. T. 2006; 118 (4): 851-861


    Although reossification of large calvarial defects is possible in children, adults lack this tissue engineering capacity. In this study, the authors compared the differences in gene expression between juvenile and adult dura mater using a mouse cDNA microarray with 42,000 unique elements.Non-suture-associated parietal bone was harvested from 6-day-old and 60-day-old mice. The dura mater was carefully dissected from the calvarial disk and snap-frozen. RNA was extracted from pooled dura mater for microarray analysis. The 25 most differentially expressed genes were listed, as were selected bone-related genes. In addition, quantitative real-time reverse-transcriptase polymerase chain reaction confirmation of selected genes-BMP-2, BMP-4, and BMP-7; and osteopontin (OP), osteocalcin (OC), and FGFR-1-was performed.Juvenile dura mater expressed significantly greater amounts of BMP-2 and OP. Minimal difference in OC expression was observed between juvenile and adult dura mater. Extracellular matrix proteins (Col3a1, 5a1, 6a1, and fibronectin 1), osteoblast differentiation markers (Runx2/Cbfa1, Itm2a, and FGFR-1), and the growth factor Ptn were among other genes with greater expression in juvenile dura mater. Markers of osteoclasts (Acp5, MMP9, Ctsk) and the multiple candidate gene Ntrk2 were also expressed at higher levels in the juvenile dura mater.These findings suggest a more differentiated osteoprogenitor population to exist along with a greater presence of osteoclasts in the juvenile dura mater relative to adults. In addition to establishing a baseline difference in gene expression between juvenile and adult dura mater, new genes potentially critical to the regenerative potential of juvenile calvaria were identified.

    View details for DOI 10.1097/01.prs.0000232366.23897.2b

    View details for Web of Science ID 000240700100004

    View details for PubMedID 16980845

  • Effects of JAK3 inhibition with CP-690,550 on immune cell populations and their functions in nonhuman primate recipients of kidney allografts TRANSPLANTATION Paniagua, R., Si, M. S., Flores, M. G., Rousvoal, G., Zhang, S., Aalami, O., Campbell, A., Changelian, P. S., Reitz, B. A., Borie, D. C. 2005; 80 (9): 1283-1292


    Janus Kinase (JAK) 3 is a tyrosine kinase essential for proper signal transduction downstream of selected cytokine receptors and for robust T-cell and natural killer cells activation and function. JAK3 inhibition with CP-690,550 prevents acute allograft rejection. To provide further insight into the mechanisms of efficacy, we investigated the immunomodulatory effects of CP-690,550 in vitro and in vivo in nonhuman primates.Pharmacodynamic assessments of lymphocyte activation, function, proliferation and phenotype were performed in three settings: in vitro in whole blood isolated from untransplanted cynomolgus monkeys (cynos), in vivo in blood from untransplanted cynos dosed with CP-690,550 for 8 days, and in vivo in blood from transplanted cynos immunosuppressed with CP-690,550. Cell surface activation markers expression, IL-2- enhanced IFN-gamma production, lymphocyte proliferation and immune cell phenotype analyzes were performed with multiparametric flow cytometry.In vitro exposure to CP-690,550 resulted in significant reduction of IL-2-enhanced IFN-gamma production by T-cells (maximum inhibition of 55-63%), T-cell surface expression of CD25 (50% inhibitory concentration (IC50); 0.18 microM) and CD71 (IC50; 1.6 microM), and T-cell proliferative capacities measured by proliferating cell nuclear antigen expression (IC50; 0.87 microM). Similar results were observed in animals dosed with CP-690,550. In addition, transplanted animals displayed significant reduction of NK cell (90% from baseline) and T-cell numbers whereas CD8 effector memory T-cell populations were unaffected.Potent in vitro and in vivo immunomodulatory effects of the JAK3 inhibitor CP-690,550 likely contribute to its efficacy in the prevention of organ allograft rejection.

    View details for DOI 10.1097/

    View details for Web of Science ID 000233732600021

    View details for PubMedID 16314797

  • Smad3 signalling plays an important role in keloid pathogenesis via epithelial-mesenchymal interactions JOURNAL OF PATHOLOGY Phan, T. T., Lim, I. J., Aalami, O., Lorget, F., Khoo, A., Tan, E. K., Mukhopadhyay, A., Longaker, M. T. 2005; 207 (2): 232-242


    Smad signalling plays important roles in developmental and cancer biology as well as in fibropathogenesis. Its role in keloid biology is not known. Epithelial-mesenchymal interactions, originally described in normal skin, have recently been established to play a significant role in keloid pathogenesis, and demonstrate the important influence of keratinocyte paracrine factor signalling on fibroblast behaviour. The present study investigated the role of downstream Smad cascade induction in this interaction. Normal fibroblasts (NF) and keloid fibroblasts (KF) were co-cultured in serum-free medium with normal keratinocytes (NK) or keloid keratinocytes (KK) for 5 days, after which fibroblast cell lysates were subjected to western blot and immunoprecipitation analysis to quantify the levels of Smad and Smad2/3/4 binding complex. In another set of experiments, wild-type (wt), Smad2-null (Smad2-/-) and Smad3-null (Smad3-/-) mouse embryonic fibroblasts (MEF) were assayed for cell proliferation and collagen production after serum-free co-culture with KK or exposure to conditioned media collected from serum-free KK/KF co-culture. Compared to normal skin, keloids expressed high basal levels of TGFbetaR1 and TGFbetaR2, Smad2, 3 and 4 and phospho-Smad2. Upregulation of TGFbetaR1 and TGFbetaR2, Smad3 and p-Smad2 was observed in KF co-cultured with KK, together with enhanced Smad3 phosphorylation and Smad2/3/4 binding complex production. When MEF-wt, MEF-Smad2-/- or MEF-Smad3-/- were co-cultured with KK or exposed to KK/KF co-culture conditioned media, enhanced proliferation and collagen production were seen in MEF-wt and MEF-Smad2-/- but not in MEF-Smad3-/- cells. The activation of Smad signalling, importantly that of Smad3, appears to be one facet of the complex epithelial-mesenchymal interactions in keloid pathogenesis, resulting in active KF proliferation and collagen-ECM production in co-culture with KK. This finding suggests the suppression of Smad signalling as a novel approach in keloid therapy.

    View details for DOI 10.1002/path.1826

    View details for Web of Science ID 000232213500012

    View details for PubMedID 16052471

  • Differential transcriptional expression profiles of juvenile and adult calvarial bone PLASTIC AND RECONSTRUCTIVE SURGERY Aalami, O. O., Nacamuli, R. P., Salim, A., Fong, K. D., Lenton, K. A., Song, H. M., Fang, T. D., Longaker, M. T. 2005; 115 (7): 1986-1994


    It has widely been observed that young children are capable of reossifying large calvarial defects, while adults lack this endogenous tissue-engineering capacity. The ability of juvenile animals to regenerate calvarial defects has been investigated in multiple animal models, including mice. In this study, the authors used cDNA microarrays to investigate the expression of osteogenesis-associated genes upstream and downstream of Runx2 in juvenile and adult mouse calvaria.Nonsuture-associated parietal bone discs were harvested from 6-day-old (n = 50) and 60-day-old (n = 35) male CD-1 mice. After separation of the underlying dura mater and overlying pericranium, the calvarial discs were snap-frozen and RNA was extracted from pooled samples of calvaria for microarray analysis. Genes analyzed included cytokines, receptors, and cell-surface and matrix proteins both upstream and downstream of Runx2.Genes associated with the Runx2 pathway had notably higher levels in the juvenile versus adult calvaria. All genes except for osteocalcin were expressed at least twofold higher in the juvenile calvaria. This pattern was validated with quantitative real-time polymerase chain reaction. In addition, mRNA for potent osteoinductive growth factors was present at higher levels in the juvenile compared with the adult calvaria.These findings reflect a genomic environment of active osteoblast differentiation and ossification in the juvenile calvaria compared with the adult "quiescent" calvarial tissue. These data suggest that a decreased osteogenic potential of adult calvarial osteoblasts may, in part, explain the inability of adult animals to heal calvarial defects.

    View details for DOI 10.1097/01.PRS.0000163323.66318.73

    View details for Web of Science ID 000229497700025

    View details for PubMedID 15923847

  • Bone morphogenetic protein 2 and retinoic acid accelerate in vivo bone formation, osteoclast recruitment, and bone turnover TISSUE ENGINEERING Cowan, C. M., Aalami, O. O., Shi, Y. Y., Chou, Y. F., Mari, C., Thomas, R., Quarto, N., Nacamuli, R. P., Contag, C. H., Wu, B., Longaker, M. T. 2005; 11 (3-4): 645-658


    Reconstruction of craniofacial defects presents a substantial biomedical burden, and requires complex surgery. Interestingly, children after age 2 years and adults are unable to heal large skull defects. This nonhealing paradigm provides an excellent model system for craniofacial skeletal tissueengineering strategies. Previous studies have documented the in vivo osteogenic potential of adipose-derived stromal (ADS) cells and bone marrow-derived stromal (BMS) cells. This study investigates the ability to accelerate in vivo osteogenesis on ex vivo recombinant human bone morphogenetic protein 2 (BMP-2) and retinoic acid stimulation. Mouse osteoblasts, ADS cells, and BMS cells were seeded onto apatite-coated PLGA scaffolds, stimulated with rhBMP-2 and retinoic acid ex vivo for 4 weeks, and subsequently implanted into critically sized (4 mm) calvarial defects. Samples were harvested after 2, 4, 8, and 12 weeks. Areas of complete bony bridging were noted as early as 2 weeks in vivo; however, osteoclasts were attracted to the scaffold as identified by calcitonin receptor staining and tartrate-resistant acid phosphatase activity staining. Although the optimal method of in vitro osteogenic priming for mesenchymal cells remains unknown, these results provide evidence that BMP-2 and retinoic acid stimulation of multipotent cells ex vivo can subsequently induce significant quantities of bone formation within a short time period in vivo.

    View details for Web of Science ID 000228999400031

    View details for PubMedID 15869441

  • Applications of a mouse model of calvarial healing: Differences in regenerative abilities of juveniles and adults PLASTIC AND RECONSTRUCTIVE SURGERY Aalami, O. O., Nacamuli, R. P., Lenton, K. A., Cowan, C. M., Fang, T. D., Fong, K. D., Shi, Y. Y., Song, H. M., Sahar, D. E., Longaker, M. T. 2004; 114 (3): 713-720


    Young children are capable of healing large calvarial defects, whereas adults lack this endogenous osseous tissue-engineering capacity. Despite the important clinical implications, little is known about the molecular and cell biology underlying this differential ability. Traditionally, guinea pig, rabbit, and rat models have been used to study the orchestration of calvarial healing. To harness the research potential of knockout and transgenic mice, the authors developed a mouse model for calvarial healing. Nonsuture-associated parietal defects 3, 4, and 5 mm in diameter were made in both juvenile (6-day-old, n = 15) and adult (60-day-old, n = 15) mice. Calvariae were harvested after 8 weeks and analyzed radiographically and histologically. Percentage of healing was quantified using Scion Image software analysis of calvarial radiographs. A significant difference in the ability to heal calvarial defects was seen between 6-day-old and 60-day-old mice when 3-, 4-, or 5-mm defects were created. The authors' analysis revealed that juvenile mice healed a significantly greater percentage of their calvarial defects than adult mice (juvenile mean percentage of healing: 3-mm defects, 59 percent; 4-mm defects, 65 percent; 5-mm defects, 44 percent; adult mean percentage of healing: <5 percent in all groups; p < 0.05). All three defect sizes were found to be critical in the adult, whereas significant healing was seen regardless of the size of the defect in juvenile mice. The establishment of this model will facilitate further, detailed evaluation of the molecular biology underlying the different regenerative abilities of juvenile versus adult mice and enhance research into membranous bone induction by making available powerful tools such as knockout and transgenic animals.

    View details for DOI 10.1097/01.PRS.0000131016.12754.30

    View details for Web of Science ID 000223436200015

    View details for PubMedID 15318051

  • Adipose-derived adult stromal cells heal critical-size mouse calvarial defects NATURE BIOTECHNOLOGY Cowan, C. M., Shi, Y. Y., Aalami, O. O., Chou, Y. F., Mari, C., Thomas, R., Quarto, N., Contag, C. H., Wu, B., Longaker, M. T. 2004; 22 (5): 560-567


    In adults and children over two years of age, large cranial defects do not reossify successfully, posing a substantial biomedical burden. The osteogenic potential of bone marrow stromal (BMS) cells has been documented. This study investigates the in vivo osteogenic capability of adipose-derived adult stromal (ADAS) cells, BMS cells, calvarial-derived osteoblasts and dura mater cells to heal critical-size mouse calvarial defects. Implanted, apatite-coated, PLGA scaffolds seeded with ADAS or BMS cells produced significant intramembranous bone formation by 2 weeks and areas of complete bony bridging by 12 weeks as shown by X-ray analysis, histology and live micromolecular imaging. The contribution of implanted cells to new bone formation was 84-99% by chromosomal detection. These data show that ADAS cells heal critical-size skeletal defects without genetic manipulation or the addition of exogenous growth factors.

    View details for DOI 10.1038/nbt958

    View details for Web of Science ID 000221159700024

    View details for PubMedID 15077117

  • Mechanisms of murine cranial suture patency mediated by a dominant negative transforming growth factor-beta receptor adenovirus PLASTIC AND RECONSTRUCTIVE SURGERY Song, H. J., Fong, D., Nacamuli, R. P., Warren, S. M., Fang, T. D., Mathy, J. A., Cowan, C. M., Aalami, O. O., Longaker, M. T. 2004; 113 (6): 1685-1697


    Using a physiologic model of mouse cranial suture fusion, the authors' laboratory has previously demonstrated that transforming growth factor (TGF)-betas appear to be more abundantly expressed in the suture complex of the fusing posterior frontal compared with the patent sagittal suture. Furthermore, the authors have shown that by blocking TGF-beta signaling with a replication-deficient adenovirus encoding a defective, dominant negative type II TGF-beta receptor (AdDN-TbetaRII), posterior frontal suture fusion was inhibited. In this study, the authors attempt to further elucidate the role of TGF-beta in cranial suture fusion by investigating possible mechanisms of AdDN-TbetaRII-mediated cranial suture patency using both an established organ culture model and a novel in vitro co-culture system that recapitulates the in vivo anatomic dura mater/cranial suture relationship. In this article, the authors demonstrate that blocking TGF-beta signaling with the AdDN-TbetaRII construct led to inhibition of cellular proliferation in the suture mesenchyme and subjacent dura mater during the early period of predicted posterior frontal suture fusion. Interestingly, co-culture experiments revealed that transfecting osteoblasts with AdDN-TbetaRII led to alterations in the gene expression levels of two important bone-related molecules (Msx2 and osteopontin). Inhibiting TGF-beta signaling prevented time-dependent suppression of Msx2 and prevented induction of osteopontin, thereby retarding osteoblast differentiation. Furthermore, the authors demonstrated that the AdDN-TbetaRII construct was capable of blocking TGF-beta -mediated up-regulation of collagen IalphaI, an extracellular matrix molecule important for bone formation. Collectively, these data strongly suggest that AdDN-TbetaRII maintains posterior frontal patency, in part by altering early events in de novo bone formation, including cellular proliferation and early extracellular matrix production.

    View details for DOI 10.1097/001.PRS.000117363.43699.5B

    View details for Web of Science ID 000221141000019

    View details for PubMedID 15114130

  • In vitro murine posterior frontal suture fate is age-dependent: Implications for cranial suture biology PLASTIC AND RECONSTRUCTIVE SURGERY Song, H. J., Sahar, D. E., Fong, K. D., Nacamuli, R. P., Fang, T. D., Mathy, J. A., Aalami, O. O., Warren, S. M., Longaker, M. T. 2004; 113 (4): 1192-1204


    In CD-1 mice, the posterior frontal suture (analogous to the human metopic suture) fuses while all other cranial sutures remain patent. In an in vitro organ culture model, the authors previously demonstrated that posterior frontal sutures explanted immediately before the onset of suture fusion (at 25 days old) mimic in vivo physiologic fusion. In the first portion of this study, the authors defined how early in development the posterior frontal suture fuses in their tension-free, serum-free organ culture system by serially analyzing posterior frontal suture fusion from calvariae explanted at different stages of postnatal development. Their results revealed a divergence of suture fate leading to abnormal patency or physiologic fusion between the first and second weeks of life, respectively, despite viability and continued growth of the calvarial explants in vitro. From these data, the authors postulated that the gene expression patterns present in the suture complex at the time of explant may determine whether the posterior frontal suture fuses or remains patent in organ culture. Therefore, to elucidate potentially important differences in gene expression within this "window of opportunity," they performed a cDNA microarray analysis on 5-day-old and 15-day-old posterior frontal and sagittal whole suture complexes corresponding to the age ranges for unsuccessful (1 to 7 days old) and successful (14 to 21 days old) in vitro posterior frontal suture fusion. Overall, their microarray results reveal interesting differential expression patterns of candidate genes in different categories, including angiogenic cytokines and mechanosensitive genes potentially important in cranial suture biology.

    View details for DOI 10.1097/01.PRS.0000110203.90911.63

    View details for Web of Science ID 000220618600011

    View details for PubMedID 15083020

  • Postoperative rhabdomyolysis following laparoscopic gastric bypass in the morbidly obese ARCHIVES OF SURGERY Khurana, R. N., Baudendistel, T. E., Morgan, E. F., Rabkin, R. A., Elkin, R. B., Aalami, O. O. 2004; 139 (1): 73-76


    Laparoscopic approaches for weight reduction in the morbidly obese have become common with more than 50,000 bariatric surgical procedures being performed in 2001. The objective of this article is to raise awareness among surgeons of a new complication of rhabdomyolysis from this frequent procedure.Case series extracted from surgical database from January 2, 2001, through December 31, 2002.We identified 5 cases of postoperative rhabdomyolysis in morbidly obese patients who underwent laparoscopic duodenal switch procedures with parietal gastrectomy. The cause, pathogenesis, and clinical features are reviewed and discussed.Postoperative rhabdomyolysis developed in 5 of 353 morbidly obese patients who underwent consecutive laparoscopic duodenal switch procedures, an incidence of 1.4%. All 5 patients were male, had a mean peak serum creatine kinase level of 19 680 U/L, and reported muscle pain in either the buttock, hip, or shoulder regions during the early postoperative period.We hypothesized that morbidly obese patients develop critical surface and deep tissue pressures during bariatric surgery, increasing their risk for tissue injury and rhabdomyolysis. Unexplained elevations in the serum creatinine level or reports of buttock, hip, or shoulder pain in the postoperative period should raise the possibility of rhabdomyolysis and prompt clinical investigation. We recommend routine preoperative and postoperative measurements of the serum creatine kinase and serum creatinine levels to aid detection. Surgeons need to keep a low index of suspicion because early diagnosis and treatment are the cornerstones of successful management of rhabdomyolysis.

    View details for Web of Science ID 000187998500017

    View details for PubMedID 14718280

  • Physiological features of aging persons ARCHIVES OF SURGERY Aalami, O. O., Fang, T. D., Song, H. M., Nacamuli, R. P. 2003; 138 (10): 1068-1076

    View details for Web of Science ID 000186075900006

    View details for PubMedID 14557122

  • Roles of periosteum, dura, and adjacent bone on healing of cranial osteonecrosis - Discussion JOURNAL OF CRANIOFACIAL SURGERY Aalami, O. O., Nacamuli, R. P., Longaker, M. T. 2003; 14 (3): 380-382
  • A mouse model of mandibular distraction osteogenesis 10th International Congress of the International-Society-of-Craniofacial-Surgery Fang, T. D., Nacamuli, R. P., Song, H. M., Thomas, R., Fong, K. D., Aalami, O. O., Longaker, M. T. MEDIMOND PUBLISHING CO. 2003: 397–398
  • Microarray analysis of regional patterning of suture-specific dura mater 10th International Congress of the International-Society-of-Craniofacial-Surgery Nacamuli, R. P., Song, H. M., Fang, T. D., Fong, K. D., Aalami, O. O., Salim, A., Sahar, D. E., Chi, J. T., Longaker, M. T. MEDIMOND PUBLISHING CO. 2003: 459–460
  • Cranial suture fate in an in vitro organ culture model 10th International Congress of the International-Society-of-Craniofacial-Surgery Sahar, D. E., Song, H. M., Fong, K. D., Nacamuli, R. P., Warren, S. M., Mathy, J. A., Fang, T. D., Aalami, O., Longaker, M. T. MEDIMOND PUBLISHING CO. 2003: 473–475
  • Establishment of a young-versus-adult mouse calvarial defect model 10th International Congress of the International-Society-of-Craniofacial-Surgery Aalami, O. O., Nacamuli, R. P., Fong, K. D., Fang, T. D., Song, H. M., Sahar, D. E., Lenton, K. A., Cowan, C. M., Longaker, M. T. MEDIMOND PUBLISHING CO. 2003: 375–377
  • Analysis of de novo bone formation by dura-derived TGF-beta signaling 10th International Congress of the International-Society-of-Craniofacial-Surgery Song, H. M., Nacamuli, R. P., Fong, K. D., Fang, T. D., Aalami, O. A., Warren, S. M., Longaker, M. T. MEDIMOND PUBLISHING CO. 2003: 489–491
  • The osteogenic antagonist BMP-3 is down-regulated during programmed suture fusion in the rat 10th International Congress of the International-Society-of-Craniofacial-Surgery Fong, K. D., Nacamuli, R. P., Lenton, K., Fang, T. D., Song, H. M., Salim, A., Shi, Y. Y., Aalami, O. O., Longaker, M. T. MEDIMOND PUBLISHING CO. 2003: 399–401
  • Microarray analysis comparing juvenile and adult dura mater 10th International Congress of the International-Society-of-Craniofacial-Surgery Aalami, O. O., Fong, K. D., Nacamult, R. P., Fang, T. D., Song, H. M., Sahar, D. E., Lenton, K. A., Cowan, C. M., Chi, J. T., Longaker, M. T. MEDIMOND PUBLISHING CO. 2003: 373–374