referring to fig1 a and 1b , a cell sampling device 10 according to one embodiment of the present disclosure is shown . the cell sampling device 10 may be utilized to sample pulmonary artery endothelial cells for endothelial phenotypic profiling in pah and other forms of pulmonary hypertension . the cell sampling device 10 includes forceps 12 adapted for use internally of the body , for example in connection with vascular procedures . the forceps 12 include an elongated sheath 14 for introduction into the body and navigation to an area of interest . the forceps 12 include a control handle 16 at a proximal end 18 coupled to the elongated sheath 14 which extends over the main length of the cell sampling device 10 . at a distal end 20 , an endovascular brush 22 may extend from the elongated sheath 14 in an expanded position , as will be described in further detail below . as shown in fig2 , the elongated sheath 14 may be a tubular member that defines an access lumen 24 extending from the proximal end 18 to the distal end 20 . the elongated sheath 14 may receive at least a portion of the endovascular brush 22 , which may be inserted into the elongated sheath 14 in preparation for catheterization . the elongated sheath 14 may vary dimensionally to accommodate various endovascular brush sizes . in one embodiment , the elongated sheath 14 is approximately 120 cm long in order to cover the entire length of the endovascular brush 22 , and has an inner diameter of about 1 . 8 mm . in one non - limiting example , the elongated sheath 14 may be constructed of a transparent or semitransparent material so that the endovascular brush is visible through the elongated sheath 14 . in addition , the elongated sheath 14 may be small enough such that it can be inserted into a catheter 26 , such as a 5 f or 6 f coronary artery guiding catheter , a 7 f myocardial biopsy sheath , or any suitable guiding sheath to allow the elongated sheath 14 to be delivered to a pulmonary vasculature 28 . referring again to fig1 a , the forceps 12 include the control handle 16 and an actuation control 30 . the actuation control 30 may be coupled to a shaft 32 of the endovascular brush 22 , as shown in fig2 , such that movement of the actuation control 30 results in movement of the endovascular brush 22 within the access lumen 24 . the actuation control 30 can include any type of actuating mechanism capable of imparting bidirectional axial movement to the shaft 32 within the elongated sheath 14 . loops 33 are provided in the control handle 16 and the actuation control 30 to form finger holes useful in grasping and manipulating the forceps 12 . referring now to fig1 b , the endovascular brush 22 includes a brush segment 34 , at a distal end of the endovascular brush 22 , and the shaft 32 extending from the brush segment 34 to the proximal end of the endovascular brush 22 . the brush segment 34 includes a plurality of brush elements 36 configured to retain sampled cells on the brush segment 34 . the plurality of brush elements 36 may be abrasive elements that allow a user to remove tissue , such as endothelial cells , from the pulmonary vasculature 28 by rubbing or grazing an intravascular surface with the plurality of brush elements 36 . various types of brush elements 36 may be used to provide such functionality , including fibers , bristles , ridges , corrugations , and the like . the endovascular brush 22 may further include a rounded tip 38 , such as a spherical or semispherical tip , to inhibit injury to the vascular tissue during catheterization and / or sampling of endothelial cells . in one non - limiting example , the rounded tip 38 may include one or more radiopaque markers 40 at the distal end , or be made of a radiopaque material , allowing at least a portion of the endovascular brush 22 to be imaged for intraoperative image guidance . for example , the radiopaque markers 40 may be used to mark the intravascular location of the endovascular brush 22 of the cell sampling device 10 with fluoroscopy . with continued reference to fig1 b , the plurality of brush elements 36 may be configured about the brush segment 34 in a variety of ways and still achieve the desired functionality . in one non - limiting example , the plurality of brush elements 36 may be disposed radially about the shaft 32 to form a conical or tapered shape . the tapered shape of the brush elements 36 may allow the endovascular brush 22 to extend into vessels with progressively narrower diameters and to ensure contact with the vessel wall , for example . the tapered brush elements 36 may have a distal diameter d 1 ranging from about 1 mm to about 3 mm , and a proximal diameter d 2 ranging from about 2 . 5 mm to about 5 mm . other alternatives for the shape of the brush elements 36 include , but are not limited to , the incorporation of a curve in the brush , flat , one side flat or curved with a cylindrical inflatable balloon attached to the other side , helical , fan , oval , square , triangular , octagonal , or rectangular . rapid blood flow in human arteries can easily wash away the endothelial or other target cells that have been dislodged from the vessel wall by the cell sampling device 10 . accordingly , the plurality of brush elements 36 may be configured to retain the sampled endothelial cells in the presence of the moving fluid . in one embodiment , the size , shape , surface texture , spacing of the brush elements ( e . g ., the fibers or bristles ) or a combination thereof are configured to provide a space or spaces where focal blood flow is relatively slow , which reduces the likelihood of target cells from being washed away in the fluid flow and correspondingly increases the likelihood for dislodged cells to remain on the brush elements 36 . the brush elements 36 , including fibers , bristles , or other elements may be modified to incorporate cell - specific antibodies to capture and retain cells or coated with a biological that will facilitate cell adhesion . additionally , thrombogenicity may be tailored or reduced in various ways . for example , the brush elements 36 may be constructed from a non - thrombogenic material , such as platinum , or may be formed from a thrombogenic material coated or impregnated with a non - or antithrombogenic substance or agent , such as heparin , hirudin , and the like , to reduce the material &# 39 ; s thrombogenicity . this aspect reduces thrombus formation as a result of contact between the brush elements 36 and blood . the brush elements 36 may be constructed of made of polyurethane , polyester , polyglycolic acid , pfte , polypropylene , polyethylene , nylon , rayon , or dacron , for example , to provide a softer bristle that is less likely to cause intimal dissection , vessel perforation or other type of vascular injury . in some embodiments , the configuration of the brush elements 36 may also vary and can be arranged in a homogeneous manner or contain open or closed areas , be wavy , bent , straight , or folded in different patterns , for example . in one non - limiting example , the brush segment 34 may be relatively flexible and elastic such that the brush segment 34 may be flexed , bent , turned , bowed , twisted , stretched , compressed , or otherwise deformed , from an original shape , without breaking , and capable of recovering the original shape from the deformed shape . this flexibility of the brush segment 34 may be achieved , for example , by forming the brush segment 34 from a material having suitable flexibility and elasticity so that the brush segment 34 returns to the original shape upon removal of the deforming forces . with continued reference to fig1 b , the shaft 32 of the endovascular brush 22 may be made of various materials and in various lengths . the shaft 32 should generally be of sufficient length to access the pulmonary vasculature 28 from a selected point of entry . in one embodiment , the shaft 32 may be constructed of a stainless steel alloy , titanium , nitinol , or nickel alloys , for example . referring now to fig5 , a flow chart setting forth exemplary steps 100 for sampling endothelial cells from arteries and veins within a subject &# 39 ; s pulmonary vasculature 28 is provided . to start the process , at process block 102 , the elongated sheath 14 may be inserted into the guiding catheter 26 that has been inserted into the a target artery 42 ( see fig2 ), proximal to the intended site of interest , such as at a vascular site have a lesion thereon . the elongated sheath 14 may be inserted into the guiding catheter 26 until the distal end 20 of the elongated sheath 14 engages a distal end of the catheter 26 , as shown in fig2 . next , at process block 104 , a user may insert the endovascular brush 22 into the access lumen 24 of the elongated sheath 14 , such that the endovascular brush 22 is in a retracted position , as shown in fig2 . at process block 106 , the actuation control 30 of the forceps 12 may be used to axially translate the endovascular brush 22 from the retracted position to the expanded position , as shown in fig4 . activation of the actuation control 30 may push the shaft 32 linearly through the access lumen 24 of the elongated sheath 14 , thereby advancing the brush elements 36 into the elongated sheath 14 toward the target artery 42 , as shown in fig3 . in one non - limiting example , the endovascular brush 22 may be inserted through the subject &# 39 ; s right ventricular apex and advanced to the pulmonary artery under direct visualization , such as through biplane fluoroscopic guidance and ultravist 370 contrast imaging . as shown in fig4 , the actuation control 30 may be used to push the brush elements 36 out from the elongated sheath 14 to expose the brush elements 36 in the target artery 42 . next , at process block 108 , the brush elements 36 may be used to obtain endothelial cells 44 from the target artery 42 . once inserted into the target artery 42 , the brush elements 36 may expand and provide the necessary pressure against the target artery 42 to remove endothelial cells 44 there from . in one non - limiting example , the location of the brush elements 36 in relation to the target artery 42 may be confirmed by imaging the site of interest , for example , with x - ray imaging , fluoroscopy , and / or contrast injection if necessary , to ensure that the brush elements 36 come into contact or overlap the intended vascular segment or lesion . the endothelial cells 44 may then be sampled from the target artery 42 by pulling the actuation control 30 in a swift motion , which causes the shaft 32 to retract , and the brush elements 36 to rub against or scrape the target artery 42 , and capture the endothelial cells 44 there from . then , at process block 110 , the endovascular brush 22 may be retracted into the catheter 26 and into the access lumen 24 of the elongated sheath 14 , as shown in fig2 . in some embodiments , at process block 112 , endothelial phenotypic profiling may be applied to the captured endothelial cells 44 to determine a state of the pulmonary vasculature at process block 114 . for example , the state of the pulmonary vasculature may indicate the presence of pah . additionally , or alternatively , once the cell sampling device 10 is removed from the subject , the brush elements 36 of the endovascular brush 22 may be immersed in dissociation medium to collect the cells . the dissociation medium may then be centrifuged and the isolated endothelial cells 44 may be plated on a chamber slide and allowed to adhere . the cells may then be assessed for endothelial origin by immunofluorescent staining for cd31 , or allowed to expand in culture . in one non - limiting example , to evaluate the efficacy of the cell sampling device 10 to sample pulmonary artery endothelial cells for phenotypic analysis by genome array expression profiling , the endothelial cells retrieved may be quantified using a hemocytometer . a 10 μl aliquot of suspended cells may be quantified by the hemocytometer and a total number determined by the average count per square multiplied by the dilution factor and multiplied by 10 4 . if the number of cells retrieved is insufficient to obtain enough rna for microarray analysis , the cells may be plated in a p25 tissue culture dish , for example , and expanded . briefly , cells may be placed in endothelial cell medium ( lonza ) with 2 . 5 % fetal bovine serum . once the plate is confluent , the cells may be harvested for rna isolation . the percentage of cells that are true endothelial cells may be determined using immunofluorescence immunohistochemistry to detect cd31 expression . to characterize endothelial gene expression , rna may be isolated from cells using , for example , an rneasy minikit ( qiagen ) and endothelial phenotype may be analyzed using a gene expression microarray that contains approximately 43 , 603 oligonucleotide probes . cdna may be labeled using cyanine - 3 - ctp and hybridized with the microarray slide at approximately 65 ° c . for about 17 hours . the slides may then be washed according the manufacturer &# 39 ; s instructions and scanned with , for example , an agilent dna microarray scanner . the images may be analyzed using agilent feature extraction software , and data may be normalized and functional gene categories may be assigned using the annotation , visualization and integrated discovery ( david ) bioinformatics database . for each time - point that the endothelial cells are harvested , an endothelial phenotypic profile may be defined by a panel of up to 5 genes that show the greatest differential expression between a sham and pulmonary hypertension subjects . these genes may be validated using standard qrt - pcr methodology ( abi biosystems ). preference may be given to genes that are also differentially expressed over time in the pulmonary hypertension model . the endothelial ( patho ) phenotypes may then be compared with the hemodynamic variables to identify patterns of gene expression that predict or correlate with hemodynamic indices of pulmonary hypertension . in yet another non - limiting example , the endovascular brush 22 may be by evaluated by assessing the pulmonary artery using angiography , histology , and electron microscopy to verify injury and / or damage to the pulmonary artery was minimal . after user of the endovascular brush 22 , selective pulmonary angiography may be used to determine if there has been a perforation ( e . g ., leakage of contrast dye ), a dissection ( e . g ., “ hang - up ” of contrast dye outside the vessel ), thrombus formation in situ ( e . g ., intravascular dye stain with filling defect ), or vessel occlusion ( e . g ., abrupt cut - off with dye “ hang - up ”). to perform the angiogram , the endovascular brush 22 may be removed from the guiding catheter 26 and a sf pigtail catheter , for example , may be advanced over a wire to the recently sampled pulmonary artery and placement confirmed using biplane angiography . a 20 cc injection of ultravist 370 contrast may be performed using a power injector and recorded as a cine angiogram . angiograms may be reviewed by one or more operators to verify the absence of any vascular injury patterns . the present disclosure has been described in terms of one or more preferred embodiments , and it should be appreciated that many equivalents , alternatives , variations , and modifications , aside from those expressly stated , are possible and within the scope of the disclosure .
systems and methods directed to sampling endothelial cells within a pulmonary vasculature are provided . the system and method may include a cell sampling device having an elongated sheath extending from a proximal end to a distal end of the cell sampling device and defining an access lumen . an endovascular brush includes brush elements coupled to a shaft . the endovascular brush is dimensioned to be received in the access lumen of the elongated sheath . an actuation control is coupled to the shaft of the endovascular brush to axially translate the endovascular brush between a retracted position and an expanded position . upon translation of the endovascular brush from the retracted position to the expanded position , the brush elements moves from within the access lumen to the pulmonary vasculature to obtain endothelial cells from a target artery of the pulmonary vasculature .