251
|
Kim KI, Bae J, Koo BK, Youn TJ, Kim SH, Chae IH, Kim HS, Sohn DW, Oh BH, Lee MM, Park YB, Choi YS. Long-term clinical outcomes of dissections after intracoronary beta-radiation with rhenium-188-diethylene triamine penta-acetic acid-filled balloon system. Int J Cardiol 2005; 104:190-6. [PMID: 16168813 DOI: 10.1016/j.ijcard.2004.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2004] [Revised: 12/20/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intracoronary radiation with a rhenium-188 ((188)Re)-filled balloon is safe and efficiently reduces restenosis, but there is a potential risk of a (188)Re-filled balloon induced dissection. Little is known about the effect of radiation on dissection resolution and the late clinical outcome of dissection after brachytherapy. METHODS After successful catheter-based treatments of de novo or restenotic lesion, 256 patients were randomly assigned to the radiation or control group. The (188)Re-filled balloon system was designed to deliver 17.6 Gy in 1.0-mm tissue depth. RESULTS Dissections were identified in 15 patients among the 138 patients of the radiation group (10.9%). Additional stents were deployed in 10 patients to cover the flow-limiting dissection. Binary restenosis rate (53.3% vs. 16.3%, p=0.001) and target vessel revascularization (TVR) rate (53.3% vs. 11.1%, p<0.001) were significantly higher in patients with the dissection at 9 months. Geographic miss (GM) was identified in 4 of the 10 patients who underwent additional stenting. Binary restenosis rate in the GM group (100%; 4 of 4 patients) was significantly higher than the non-GM group (33.3%; 2 of 6 patients, p=0.02). Long-term follow-up of the patients with dissections who had not undergone TVR (n=7, mean follow-up duration: 640.7+/-387.3 days) has demonstrated persistent unhealed dissections. CONCLUSIONS Intracoronary radiation impairs the healing process after vessel injury and residual dissection after brachytherapy leads to adverse clinical outcomes, which was mainly due to GM in case of stent implantation.
Collapse
|
252
|
Koo BK, Kang HJ, Youn TJ, Chae IH, Choi DJ, Kim HS, Sohn DW, Oh BH, Lee MM, Park YB, Choi YS, Tahk SJ. Physiologic assessment of jailed side branch lesions using fractional flow reserve. J Am Coll Cardiol 2005; 46:633-7. [PMID: 16098427 DOI: 10.1016/j.jacc.2005.04.054] [Citation(s) in RCA: 252] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 04/20/2005] [Accepted: 04/25/2005] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study was performed to evaluate the feasibility of the physiologic assessment of jailed side branches using fractional flow reserve (FFR) and to compare the measured FFR with the stenosis severity assessed by quantitative coronary angiography (QCA). BACKGROUND It is not well-known which side branches should be treated after stent implantation at main branches and how to assess the functional significance of these lesions. METHODS Ninety-seven jailed side branch lesions (vessel size > 2.0 mm, percent stenosis > 50% by visual estimation) after stent implantation at main branches were consecutively enrolled. The FFR was measured using a pressure wire at 5 mm distal and proximal to the ostial lesion of the jailed side branch. RESULTS The FFR measurement was successful in 94 lesions. Mean FFRs were 0.94 +/- 0.04 and 0.85 +/- 0.11 at the main branches and jailed side branches, respectively. There was a negative correlation between the percent stenosis and FFR (r = -0.41, p < 0.001). However, no lesion with < 75% stenosis had FFR < 0.75. Among 73 lesions with > or = 75% stenosis, only 20 lesions were functionally significant. CONCLUSIONS The FFR measurement in jailed side branch lesions is both safe and feasible. Quantitative coronary angiography is unreliable in the assessment of the functional severity of jailed side branch lesions, and measurement of FFR suggests that most of these lesions do not have functional significance.
Collapse
|
253
|
Yoon CH, Hur J, Park KW, Kim JH, Lee CS, Oh IY, Kim TY, Cho HJ, Kang HJ, Chae IH, Yang HK, Oh BH, Park YB, Kim HS. Synergistic neovascularization by mixed transplantation of early endothelial progenitor cells and late outgrowth endothelial cells: the role of angiogenic cytokines and matrix metalloproteinases. Circulation 2005; 112:1618-27. [PMID: 16145003 DOI: 10.1161/circulationaha.104.503433] [Citation(s) in RCA: 479] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Two types of cells are cultured from the human peripheral blood, early endothelial progenitor cells (EPCs) and outgrowth endothelial cells (OECs), as previously reported. Here, we further characterize these cells, especially with respect to their different origins and functions both in vitro and in vivo. We also investigated whether the combination of these different cell types shows synergism during neovascularization. METHODS AND RESULTS Early EPCs were heterogeneously made up of both CD14+ monocyte-derived cells, which secrete cytokines, and CD14(-)-derived cells, which contain high levels of (CD34+)KDR+ cells. OECs were cultured almost exclusively from CD14- cells, not CD14+ cells, and were distinct from mature endothelial cells in terms of proliferation potential, KDR+ expression level, and telomerase activity. A portion of cells from CD14- cells and early EPCs produced rapidly proliferating, capillary-forming cells in both the Matrigel plug and the ischemic hind limb similar to OECs. Early EPCs and OECs expressed receptors for vascular endothelial growth factor and interleukin-8, cytokines secreted by early EPCs. There was a differential increase in matrix metalloproteinases (MMPs): MMP-9 in early EPCs and MMP-2 in OECs. In vitro, the angiogenic capability of the 2 cell types was augmented by mutual interaction through cytokines and MMPs. Injection of a mixture of the 2 cells resulted in superior neovascularization in vivo to any single-cell-type transplantation. CONCLUSIONS Distinct origins of the different types of EPCs exist that have different functions in neovascularization. Mixed transplantation of these cells results in synergistic neovascularization through cytokines and MMPs.
Collapse
|
254
|
Zhang SY, Park KW, Oh S, Cho HJ, Cho HJ, Park JS, Cho YS, Koo BK, Chae IH, Choi DJ, Kim HS, Lee MM. NF-kappaB decoy potentiates the effects of radiation on vascular smooth muscle cells by enhancing apoptosis. Exp Mol Med 2005; 37:18-26. [PMID: 15761248 DOI: 10.1038/emm.2005.3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
NF-kappaB promotes cell survival against external stress such as radiation. We examined whether NF-kappaB decoy transfection enhances the antiproliferative effects of radiation on vascular smooth muscle cells (VSMCs) in vitro. The irradiation induced activation or nuclear translocation of NF-kappaB p65 in VSMCs was confirmed by immunofluorescence. NF-kappaB decoy transfection resulted in inhibition of the radiation-induced NF-kappaB activation in VSMCs and the subsequent reduction of transcription and translocation of ICAM, iNOS, and TNF-alpha, downstream molecules under the control of NF-kappaB. By using MTT assay, NF-kappaB decoy augmented the antiproliferative effects of radiation, where the effect of low dose radiation (2 and 8-Gy) of the cells transfected with NF-kappaB decoy was equivalent to the high dose (16-Gy) irradiated non-transfected cells at 48 h after irradiation: 1.06+/-0.16, 1.11+/-0.22, 1.20+/-0.25, respectively. The decrease in proliferation and survival of the radiation treated cells by flow cytometry analysis showed that NF-kappaB inhibition did not show any additive effects on the cell cycle of the irradiated VSMCs, while apoptosis was significantly increased after NF-kappaB decoy transfection in the irradiated VSMCs (apoptosis fraction: 13.33+/-2.08% vs. 26.29+/-7.43%, for radiation only vs. radiation+NF-kappaB decoy transfection, P < 0.05). In addition, at 48 h, NF-kappaB decoy transfection dose dependently (10 microM vs. 20 microM) inhibited proliferation of 16Gy-irradiated VSMCs, and showed greater antiproliferative efficacy than 100 microM sulfasalazine, a specific NF-kappaB inhibitor. These results indicate that NF-kappaB inhibition reduces proliferation and survival of irradiated VSMCs, likely by increased apoptosis rather than additive cell cycle arrest and suggest the possibility of adjunctive gene therapy using NF-kappaB decoy to improve efficacy and to decrease the adverse effects of intracoronary radiation therapy.
Collapse
MESH Headings
- Animals
- Aorta/cytology
- Aorta/radiation effects
- Apoptosis
- Cell Cycle/physiology
- Cell Cycle/radiation effects
- Cell Proliferation/radiation effects
- Cells, Cultured
- Gamma Rays
- Intercellular Adhesion Molecule-1/metabolism
- Male
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/physiology
- Muscle, Smooth, Vascular/radiation effects
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/radiation effects
- NF-kappa B/antagonists & inhibitors
- NF-kappa B/metabolism
- Nitric Oxide Synthase/metabolism
- Nitric Oxide Synthase Type II
- Protein Transport
- Rats
- Rats, Sprague-Dawley
- Transcription, Genetic
- Transfection
- Tumor Necrosis Factor-alpha/metabolism
Collapse
|
255
|
Kim HS, Cho HJ, Cho HJ, Park SJ, Park KW, Chae IH, Oh BH, Park YB, Lee MM. The essential role of p21 in radiation-induced cell cycle arrest of vascular smooth muscle cell. J Mol Cell Cardiol 2005; 37:871-80. [PMID: 15380677 DOI: 10.1016/j.yjmcc.2004.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2004] [Revised: 06/02/2004] [Accepted: 06/23/2004] [Indexed: 11/26/2022]
Abstract
The biologic mechanisms for the success and failure of intravascular radiation therapy after angioplasty have not been well studied. We investigated the molecular mechanism of radiation-induced cell cycle arrest in vascular smooth muscle cell (VSMC) and examined whether p21 knock-out is a cause of radiation failure. Using different dosages of gamma radiation, we evaluated the effect of radiation on VSMC apoptosis and cell cycle progression, and its action mechanism. Irradiation significantly retarded the growth of cultured VSMC, which was not due to induction of apoptosis but mainly due to cell cycle arrest. Radiation showed remarkable cell cycle arrest at G1 and G2 phase (G0/G1:S:G2/M phases = 61%:34%:5% with 0 Gy versus 61%:9%:30% with 16 Gy, 12 h after radiation). In immunoblot analysis and kinase assay, radiation increased the expression of p21 and decreased the expression and activity of CDK2 and 1. In contrast, radiation did not affect the expression and activity of CDK4 and 6, nor the expression of p27 and p16. When p21 was knocked out, cell cycle of VSMC was not arrested by radiation, leading to increased proliferation. These finding provide the evidence that radiation inhibits VSMC proliferation through cell cycle arrest by enhancing p21 expression and suppressing CDK1 and 2. This observation supports the key role of p21 in radiation-induced cell cycle arrest and the degree of p21 expression may be the possible mechanism of radiation failure and delayed restenosis.
Collapse
MESH Headings
- Animals
- Aorta/cytology
- Cell Cycle/genetics
- Cell Cycle/physiology
- Cell Cycle/radiation effects
- Cell Cycle Proteins/analysis
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/physiology
- Cell Proliferation
- Cells, Cultured
- Coronary Restenosis/genetics
- Coronary Restenosis/metabolism
- Cyclin-Dependent Kinase Inhibitor p21
- Cyclin-Dependent Kinases/metabolism
- Cytoplasm/chemistry
- Gamma Rays
- Male
- Mice
- Mice, Inbred BALB C
- Mice, Knockout
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/radiation effects
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/radiation effects
- Rats
- Rats, Sprague-Dawley
Collapse
|
256
|
Koo BK, Kim CH, Na SH, Youn TJ, Chae IH, Choi DJ, Kim HS, Lee MM, Oh BH, Park YB, Choi YS, Tahk SJ. Intracoronary Continuous Adenosine Infusion A Novel and Effective Way of Inducing Maximal Hyperemia for Fractional Flow Reserve Measurement. Circ J 2005; 69:908-12. [PMID: 16041158 DOI: 10.1253/circj.69.908] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Various methods are used to induce maximal hyperemia for physiologic studies, but the feasibility and efficacy of continuous intracoronary (IC) infusion of adenosine for measurement of fractional flow reserve (FFR) has not been well-defined. METHODS AND RESULTS Patients with intermediate coronary artery stenosis were consecutively enrolled. In the phase I study, FFR was measured after 3 dosages of IC adenosine infusion (180, 240 and 300 microg/min) in 30 patients. The phase II study was performed to compare the hyperemic efficacy of IC infusion (240 microg/min) with IC bolus injection (40, 80 microg) and intravenous (IV) infusion (140 microg x kg (-1) x min(-1)) of adenosine in 20 patients. In the phase I study, no significant differences in FFR were observed with the 3 different doses of IC infusion (p = 0.06). In the phase II study, FFR after an IC bolus injection (0.83+/-0.06) was significantly higher than with IV (0.79+/-0.07) or IC (0.78+/-0.09) infusion (p < 0.01). However, no difference in FFR was observed for IC and IV infusions. CONCLUSION IC infusion of adenosine seems to be a safe and effective method of inducing maximal hyperemia for FFR measurement.
Collapse
|
257
|
Cho YS, Kim MA, Hwang KK, Koo BK, Oh S, Chae IH, Kim HS, Lee DS, Oh BH, Lee MM, Park YB, Choi YS. Two-year clinical follow-up results of intracoronary radiation therapy with rhenium-188-diethylene triamine penta-acetic acid-filled balloon. Catheter Cardiovasc Interv 2004; 63:274-81. [PMID: 15505867 DOI: 10.1002/ccd.20169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We investigated the 2-year clinical follow-up results as well as 6-month angiographic and clinical follow-up results of intracoronary radiation therapy using a rhenium-188-diethylene triamine penta-acetic acid ((188)Re-DTPA)-filled balloon system. The study comprised of 161 patients with significant de novo (83%) or in-stent restenosis (17%) lesions. Irradiation to deliver 17.6 Gy at a depth of 1.0 mm into the vessel wall was carried out after successful intervention. At 6-month follow-up, binary restenosis developed with significantly lower frequency in the radiation group than in the control group (24.3% vs. 46.3%; P = 0.009), although target lesion revascularization rate did not show significant benefit. At 2-year follow-up, cumulative target lesion revascularization rate was not significantly different between radiation group (n = 86) and control group (n = 75; 20.0% vs. 26.0%; P = 0.368). The rate of major adverse cardiac events including death, myocardial infarction, and target lesion revascularization did not show significant difference between two groups either (22.3% vs. 30.1%; P = 0.266). In conclusion, although significant reduction in restenosis rate was noted at 6-month angiographic follow-up, intracoronary radiation therapy mostly in patients with de novo lesion did not show significant clinical benefit in 6-month and 2-year follow-up results. The benefit was noted only in a small subgroup of patients with in-stent restenosis.
Collapse
|
258
|
Bae JW, Koo BK, Kim KI, Kang HJ, Cho YS, Youn TJ, Chung WY, Chae IH, Kim HS, Lee MM, Oh BH, Park YB. Two-year outcomes of repeated brachytherapy in patients with restenosis after intracoronary radiation therapy. Am J Cardiol 2004; 94:1061-3. [PMID: 15476627 DOI: 10.1016/j.amjcard.2004.06.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 06/30/2004] [Accepted: 06/30/2004] [Indexed: 10/26/2022]
Abstract
This study compared the 2-year outcomes of repeat brachytherapy (n = 10) and conventional percutaneous intervention (n = 14) in patients with restenosis after intracoronary brachytherapy with a rhenium-188-filled balloon system. The short-term target lesion revascularization rate was significantly lower in the repeat brachytherapy group (0% vs 36%, p = 0.038), and additional target lesion revascularization was required in 2 patients with repeat brachytherapy during 2-year follow-up. There were no vascular complications related to repeat brachytherapy.
Collapse
|
259
|
Chae IH, Park KW, Kim HS, Oh BH. Nitric oxide-induced apoptosis is mediated by Bax/Bcl-2 gene expression, transition of cytochrome c, and activation of caspase-3 in rat vascular smooth muscle cells. Clin Chim Acta 2004; 341:83-91. [PMID: 14967162 DOI: 10.1016/j.cccn.2003.11.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Revised: 11/04/2003] [Accepted: 11/05/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND In contrast to the anti-apoptotic action of nitric oxide (NO) on endothelial cells, NO exerts a pro-apoptotic effect on vascular smooth muscle cells (VSMCs). This study was designed to elucidate the mechanism underlying NO-induced apoptosis in rat VSMCs. METHODS AND RESULTS (1) Using the terminal deoxynucleotidyl transferase-mediated digoxigenin-11-dUTP nick end labeling (TUNEL) assay and fluorescence activated cell sorter (FACS) analyses, apoptosis of rat VSMCs were confirmed after exposure to sodium nitroprusside (SNP) (0.5 to 4 mmol/l), an exogenous NO donor. The effects of SNP were blocked by hemoglobin. (2) A universal caspase inhibitor, z-VAD-fmk, dose-dependently inhibited NO-induced apoptosis. VSMCs degraded Ac-DEVD-pNA rather than Ac-WHED-pNA after exposure to SNP, which suggested that the activation of caspase 3 rather than caspase 1 was involved in the process. Immunoblot analysis confirmed the activation of caspase-3. (3) Exposure to SNP induced the release of cytochrome c from the mitochondria to the cytosol, which was detected by immunoblot analysis of mitochondrial and cytosol fractions. (4) SNP exposure increased the ratio of Bax/Bcl-2 protein expression twofold by immunoblot analysis. CONCLUSIONS The mechanism of NO-induced apoptosis in rat VSMCs involves an increase in the ratio of Bax/Bcl-2 gene expression, which leads to the release of cytochrome c from the mitochondria to the cytosol, finally activating caspase-3 and resultant apoptosis.
Collapse
MESH Headings
- Animals
- Aorta, Thoracic/cytology
- Aorta, Thoracic/enzymology
- Aorta, Thoracic/metabolism
- Apoptosis/physiology
- Blotting, Western
- Caspase 3
- Caspases/metabolism
- Cell Count
- Cell Survival/physiology
- Cells, Cultured
- Cytochromes c/genetics
- Cytoplasm/enzymology
- Enzyme Activation/physiology
- Flow Cytometry
- Gene Expression/genetics
- Gene Expression/physiology
- Genes, bcl-2/genetics
- In Situ Nick-End Labeling
- Male
- Mitochondria, Muscle/enzymology
- Muscle, Smooth, Vascular/enzymology
- Nitric Oxide/physiology
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-bcl-2
- Rats
- Rats, Sprague-Dawley
- Tetrazolium Salts
- Thiazoles
- bcl-2-Associated X Protein
Collapse
|
260
|
Koo BK, Lee MM, Oh S, Chae IH, Kim HS, Sohn DW, Oh BH, Park YB, Choi YS, Lee DS. Effects of β-radiation with a 188rhenium-filled balloon catheter system on non-stented adjacent coronary artery segments. Int J Cardiol 2004; 96:73-7. [PMID: 15203264 DOI: 10.1016/j.ijcard.2003.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2003] [Revised: 07/19/2003] [Accepted: 07/25/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The effects of beta-radiation with a (188)rhenium ((188)Re)-filled balloon catheter system on angiographically normal reference segments have not been well defined. METHODS In the Seoul National University Post-Angioplasty Rhenium irradiation (SPARE) trial, patients with de novo or restenotic lesions were first treated with a conventional catheter-based technique and then randomized to either a radiation group or a control group. Irradiation was performed using a (188)Re-filled conventional balloon catheter system. Among 97 radiation group enrolled in this study from April 1998 through May 2001, 20 patients with de novo lesions who received brachytherapy with a balloon at least 10 mm longer than the length of an implanted stent, were selected and their post-intervention and follow-up intravascular ultrasound (IVUS) images were analyzed. Each reference segment was divided into two segments; full dose-irradiation with injury segment (irradiated segment; from the stent edge to the radiopaque balloon markers), and low dose-irradiation without injury segment (edge segment; 5-mm long segment proximal or distal to the location of radiopaque markers). In control group, serial IVUS analysis was available only in 10 patients, and IVUS parameters of the non-stented adjacent segments in these patients were compared to those of irradiated segments in radiation group patients. RESULTS Forty irradiated and 38 edge segments of the 20 radiation group patients were analyzed. In proximal irradiated segments, no significant changes were found in external elastic membrane (EEM), lumen or in the plaque plus media (P&M) areas. In distal irradiated segments, significant increases in the EEM (12.5+/-4.5 to 14.0+/-5.0 mm(2), P<0.01) and P&M areas (5.5+/-2.0 to 6.6+/-2.3 mm(2), P<0.01) were found to occur without a change in lumen area. In proximal edge segments, P&M areas were significantly increased (9.0+/-1.7 to 10.5+/-2.6 mm(2), P=0.03). No significant changes in EEM, lumen or P&M areas were observed in the distal edge segments. Comparisons between the irradiated segments (n=40) in the radiation group and the non-stented adjacent segments (n=19) in the control group showed a significant difference in the percentage change of EEM areas (18.5+/-33.2% in radiation group vs. -3.1+/-32.1% in control group, P=0.02). CONCLUSIONS beta-radiation with a (188)Re-filled conventional balloon catheter system appears to have no significant deleterious effect on angiographically normal reference segments over a 6 months follow up after brachytherapy.
Collapse
|
261
|
Jo SH, Seo JB, Zhang SY, Park JS, Cho YS, Choi JH, Koo BK, Kim YJ, Oh S, Chae IH, Kim HS, Sohn DW, Oh BH, Lee MM, Park YB, Choi YS. 1136-91 Contribution of genetic characteristics of vascular adrenergic receptor to variant angina. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
262
|
Cho HJ, Kim HS, Cho HJ, Sik Park J, Chae IH, Oh BH, Lee MM, Park YB, Choi YS. 1158-54 Knock-out of P21 escapes radiation-induced cell cycle arrest and apoptosis in vascular smooth muscle cell. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
263
|
Park SJ, Kim HS, Yang HM, Park KW, Youn SW, Jeon SI, Kim DH, Koo BK, Chae IH, Choi DJ, Oh BH, Lee MM, Park YB. Thalidomide as a potent inhibitor of neointimal hyperplasia after balloon injury in rat carotid artery. Arterioscler Thromb Vasc Biol 2004; 24:885-91. [PMID: 14988093 DOI: 10.1161/01.atv.0000124924.21961.c3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Inflammation is one of the main pathogeneses of neointimal hyperplasia after coronary intervention. Thalidomide, because of its potent antiinflammatory and immunomodulatory properties, is being re-evaluated in several clinical fields. Therefore, we examined whether thalidomide therapy affects neointimal formation. METHODS AND RESULTS In male Sprague-Dawley rats, 100 mg/kg of either thalidomide or sucrose (control) was administered daily from 3 days before injury to 2 weeks after conventional carotid artery denudation injury. Thalidomide administration resulted in a significant reduction of neointimal formation (neointima to media ratio 1.26+/-0.29 versus 0.35+/-0.13, P<0.001) and proliferative activity of vascular smooth muscle cells. In addition, arterial macrophage infiltration and local expressions of tumor necrosis factor alpha (TNF-alpha) and basic fibroblast growth factor (bFGF) in the injured arteries as measured by immunohistochemistry and immunoblot analysis were significantly reduced by thalidomide treatment. Serum TNF-alpha, measured by ELISA, was also significantly reduced in the thalidomide-treated animals compared with controls after injury (856+/-213 versus 449+/-68 pg/mL on day 3, P=0.001; 129+/-34 versus 63+/-18 pg/mL on day 14, P=0.001), and we observed a good positive correlation between the serum TNF-alpha levels and the severity of neointimal growth. CONCLUSIONS We found that thalidomide, through its antiinflammatory and antiproliferative effects, significantly inhibits neointimal hyperplasia in balloon-injured rat carotid arteries. Our results suggest a potential role of thalidomide as a potent inhibitor of neointimal formation after angioplasty.
Collapse
|
264
|
Kim KI, Bae J, Kang HJ, Koo BK, Youn TJ, Kim SH, Chae IH, Kim HS, Sohn DW, Oh BH, Lee MM, Park YB, Choi YS, Lee DS. Three-Year Clinical Follow-up Results of Intracoronary Radiation Therapy Using a Rhenium-188-Diethylene-Triamine-Penta-Acetic-Acid-Filled Balloon System. Circ J 2004; 68:532-7. [PMID: 15170087 DOI: 10.1253/circj.68.532] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intracoronary radiation therapy (IRT) prevents recurrent in-stent restenosis, but its long-term safety and efficacy remain uncertain. In the present study, the long-term clinical outcome of IRT using the rhenium-188 ((188)Re)-filled balloon system was evaluated. METHODS AND RESULTS After successful catheter-based treatment of either a de novo or restenotic lesion, 187 patients were randomly assigned to either the radiation (N=104) or the control (N=83) group. The (188)Re-filled balloon system was designed to deliver 17.6 Gy to 1.0-mm tissue depth. Angiographic restenosis was significantly reduced with IRT at 9 months (18.9% vs 45.9%, p<0.001), but the incidence of major adverse cardiac events (MACE) including death, myocardial infarction, and target-vessel revascularization (TVR) by 3 years showed no difference. Lack of clinical benefit might be related to TVR caused by geographic miss (6/22, 28.6%), balloon-induced unhealed dissection (3/22, 13.6%) and late thrombosis (2/22, 9.1%). In the restenotic subgroup (N=39), the MACE rate within 3 years was significantly reduced with IRT (14.3% vs 54.5%, p=0.01). CONCLUSIONS IRT using the (188)Re -filled balloon system is safe and technically feasible. Although IRT failed to show favorable outcomes for de novo lesion, the clinical benefits for restenotic lesions seem durable for 3 years. Furthermore, preventing geographic miss and dissection might improve long-term outcomes.
Collapse
|
265
|
Cho HJ, Kim HS, Lee MM, Kim DH, Yang HJ, Hur J, Hwang KK, Oh S, Choi YJ, Chae IH, Oh BH, Choi YS, Walsh K, Park YB. Mobilized Endothelial Progenitor Cells by Granulocyte-Macrophage Colony-Stimulating Factor Accelerate Reendothelialization and Reduce Vascular Inflammation After Intravascular Radiation. Circulation 2003; 108:2918-25. [PMID: 14568896 DOI: 10.1161/01.cir.0000097001.79750.78] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Endothelial progenitor cells (EPCs) play a pivotal role in repair and regeneration of damaged vessels. We investigated the role of mobilized EPCs in the healing process after intravascular radiation therapy.
Methods and Results—
One iliac artery of hypercholesterolemic rabbits was subjected to balloon injury and intravascular radiation with a Re-188 balloon and the contralateral iliac artery to balloon injury only. Rabbits received granulocyte-macrophage colony-stimulating factor (recombinant human GM-CSF) (60 μg/d subcutaneously) daily for 1 week, either 7 days before the angioplasty or at the time of angioplasty. Control rabbits received human albumin. GM-CSF significantly increased the double-positive (CD31+ and KDR+) fraction in peripheral blood monocytes and showed a higher number of EPCs than albumin after culture and, furthermore, enhanced migration and incorporation of EPCs. In the albumin group, intravascular radiation therapy reduced neointimal hyperplasia but delayed reendothelialization and aggravated monocyte infiltration. GM-CSF treatment significantly accelerated the reendothelialization and inhibited monocyte infiltration (reendothelialization index, 81±13% in the GM-CSF radiation [n=7] versus 30±11% in the control radiation [n=9] at 2 weeks,
P
<0.01). GM-CSF treatment produced an additional significant reduction in neointimal formation at 14 and 28 days after injury in the intravascular radiation groups (intima to media ratio, 0.14±0.11 in the GM-CSF radiation [n=5] versus 0.36±0.07 in the control radiation [n=5] at 4 weeks,
P
<0.01).
Conclusions—
GM-CSF treatment mobilizes EPCs, accelerates reendothelialization, and reduces monocytes infiltration after intravascular radiation therapy, suggesting that stem cell mobilization is a promising strategy for enhancing the vascular healing process after cytotoxic angioplasty.
Collapse
|
266
|
Kim SH, Park KW, Kim YS, Oh S, Chae IH, Kim HS, Kim CH. Effects of acute hyperglycemia on endothelium-dependent vasodilation in patients with diabetes mellitus or impaired glucose metabolism. ENDOTHELIUM : JOURNAL OF ENDOTHELIAL CELL RESEARCH 2003; 10:65-70. [PMID: 12791513 DOI: 10.1080/10623320303362] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although impaired endothelial function is well known in patients with diabetes mellitus (DM), the precise mechanism and the factors that contribute to this dysfunction remain to be clarified. The authors examined the effect of acute hyperglycemia on endothelium-dependent vasodilation in patients with DM or impaired glucose metabolism in vivo by plethysmography. In eight patients with diabetes mellitus or impaired glucose metabolism, the vasodilatory response to acetylcholine at infusion rates of 7.5, 15, and 30 microg/min was studied in the fasting state and at two levels of hyperglycemia, which were achieved by the infusion of glucose, insulin, and somatostatin. The vasodilatory response to acetylcholine was measured by calculating the forearm blood flow ratio (FBFR), defined as the measured forearm blood flow at a specific acetylcholine infusion rate divided by the baseline forearm blood flow without acetylcholine infusion. The induction of hyperglycemia resulted in a significant reduction in FBFR for all rates of acetylcholine infusion. The FBFR at an acetylcholine infusion rate of 7.5 microg/min was 1.13 +/- 0.07 and 1.19 +/- 0.06 for stages 1 and 2, respectively, compared with 1.36 +/- 0.08 for stage 3 (p < .05). In addition, at an acetylcholine infusion rate of 30 microg/min, the reduction in FBFR was associated with the degree of hyperglycemia (3.72 +/- 0.51, 2.98 +/- 0.42, 2.42 +/- 0.32 for stages 1, 2, and 3 glucose levels, respectively, at an acetylcholine infusion rate of 30 microg/min, p < .05 by analysis of variance [ANOVA]). The results show that the induction of hyperglycemia results in a significant attenuation of endothelial function, and suggests the importance of hyperglycemia in the development of endothelial dysfunction observed in patients with DM or impaired glucose metabolism.
Collapse
|
267
|
Paeng JC, Lee DS, Kang WJ, Yang HM, Chung JK, Jeong JM, Chae IH, Lee MM, Lee MC. Dosimetry in leakage of (188)Re-DTPA during intracoronary balloon brachytherapy. Eur J Nucl Med Mol Imaging 2003; 30:1263-5. [PMID: 12811423 DOI: 10.1007/s00259-003-1235-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2003] [Accepted: 05/02/2003] [Indexed: 10/26/2022]
Abstract
Rhenium-188 is reported to be one of the best radionuclides for intracoronary balloon brachytherapy. Among several preparations of (188)Re available for brachytherapy, (188)Re-diethylene triamine penta-acetic acid (DTPA) and (188)Re-mercaptoacetyltriglycine (MAG3) are recommended owing to their rapid excretion via the renal system and the absence of accumulation in the thyroid. The aim of this study was to calculate the dose of radiation exposure in a real human accident. During a 4-year clinical trial of (188)Re-DTPA balloon brachytherapy in 242 patients, there was one accident involving balloon leakage. Dosimetry was performed by both image-based and biological analysis. The radiation exposure to the whole body was calculated as 113 mGy by image-based analysis and 83 or 88 mGy by biological analysis, which was approximately half the reported dose in the case of (188)Re-perrhenate. The radiation exposures to other vital organs were also within the tolerated ranges. We conclude that (188)Re-DTPA has better clinical feasibility and safety for intracoronary balloon brachytherapy than (188)Re-perrhenate.
Collapse
|
268
|
Park KW, Yang HM, Youn SW, Yang HJ, Chae IH, Oh BH, Lee MM, Park YB, Choi YS, Kim HS, Walsh K. Constitutively active glycogen synthase kinase-3beta gene transfer sustains apoptosis, inhibits proliferation of vascular smooth muscle cells, and reduces neointima formation after balloon injury in rats. Arterioscler Thromb Vasc Biol 2003; 23:1364-9. [PMID: 12805073 DOI: 10.1161/01.atv.0000081633.53390.b4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Glycogen synthase kinase (GSK)-3beta is a crucial factor in many cellular signaling pathways and may play an important role in smooth muscle proliferation and apoptosis after angioplasty. METHODS AND RESULTS To investigate the effect of GSK-3beta modulation on neointima formation, smooth muscle proliferation, and apoptosis after balloon injury in vivo, we delivered adenoviral vectors expressing the constitutively active form of GSK-3beta (GSK-S9A: 9th serine switched to alanine) or a control gene into rat carotid arterial segments after balloon injury with a 2F Fogarty catheter. Viral infusion mixtures (5x108 pfu) were incubated in the arterial lumen for 20 minutes, and the effects of gene delivery were evaluated 3 days and 2 weeks after gene delivery with morphometry and immunohistochemical staining for proliferating and apoptotic cells. There were no significant differences in intimal, medial, and lumen areas at 3 days after the procedure. However, 2 weeks after gene delivery, the active GSK-3beta gene transfer resulted in a significantly lower intima to media ratio (0.29+/-0.06 versus 0.86+/-0.09, P<0.01) and a greater lumen area (0.41+/-0.02 versus 0.31+/-0.01 mm2, P<0.01) compared with the control gene transfected group. This was attributable to a significant reduction in intimal area (0.05+/-0.01 versus 0.15+/-0.02 mm2, P<0.01), whereas the medial area was similar (0.17+/-0.01 versus 0.18+/-0.01 mm2, P=0.21). Proliferation index was significantly reduced both at 3 days and 2 weeks in the active GSK-3beta gene transferred group (2.97+/-0.29% versus 5.71+/-0.50%, P<0.01). In addition, apoptotic index, which was not significantly different between the 2 groups at 3 days, was significantly higher in the active GSK-3beta gene transferred group at 2 weeks (3.14+/-0.68% versus 22.7+/-1.63%, n=10, P<0.01, for control versus active GSK-3beta gene transfer). CONCLUSIONS In vivo delivery of the active GSK-3beta gene inhibits smooth muscle proliferation, sustains apoptosis, and reduces neointima formation after balloon injury in rats and may be a future therapeutic target to limit neointima hyperplasia after angioplasty.
Collapse
|
269
|
Park KW, Choi JH, Chae IH, Cho HJ, Oh S, Kim HS, Lee MM, Park YB, Choi YS. Hepatic lipase C514T polymorphism and its relationship with plasma HDL-C levels and coronary artery disease in Koreans. JOURNAL OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2003; 36:237-42. [PMID: 12689525 DOI: 10.5483/bmbrep.2003.36.2.237] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatic lipase is a key enzyme that is involved in HDL-C metabolism. The goal of this study was to find out the frequency of the hepatic lipase C514T polymorphism, and evaluate its relationship with plasma HDL-C levels and coronary artery disease (CAD) in Koreans. Two hundred and twenty four subjects with no previous history of lipid-lowering therapy, 118 patients with significant CAD, and 106 controls were examined with respect to their genotypes, lipid profiles, and other risk factors for CAD. The frequency of the -514T allele was 0.37 in men and 0.35 in women, which were higher than the frequency that was reported in Caucasians, but lower than the frequency that was reported in African-Americans. The -514T allele was associated with significantly higher HDL-C levels in women. After controlling for age, gender, BMI, DM, and smoking, the non-CC genotype was significantly associated with HDL-C levels, and explained 6% of the HDL-C variation in this study. When the genotypes-distribution was compared between the CAD and non-CAD patients, the hepatic lipase C-514T polymorphism was not associated with the presence of CAD. Koreans have a higher frequency of the hepatic lipase gene 514T allele than Caucasians, and the -514T allele is associated with higher plasma HDL-C levels in Korean women, and perhaps non-smoking men. However, our data does not suggest an association between the polymorphism and an increased risk of CAD.
Collapse
|
270
|
Cho HJ, Kim HS, Kim DH, Oh S, Chae IH, Oh BH, Lee MM, Park YB, Choi YS. Mobilized bone marrow stem cells accelerated reendothelialization, reduce vascular inflammation, and prevent restenosis after intravascular radiation. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
271
|
Yang HM, Kim HS, Oh S, Chae IH, Oh BH, Lee MM, Park YB, Choi YS. Role of AKT (protein kinase B) in modulating vascular response to injury. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
272
|
Park KW, Yang HM, Chae IH, Kim HS, Walsh K. Active glycogen synthase kinase-3 gene transfer inhibits smooth muscle proliferation and neointima formation after balloon injury in rats. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
273
|
Cho YS, Koo BK, Chae IH, Lee MM, Park YB. Two-year clinical follow-up of intracoronary radiation therapy using 188Re-DTPA-filled balloon system after coronary artery stenting. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
274
|
Chung WY, Chae IH, Oh IY, Oh S, Sohn DW, Oh BH, Lee MM, Park YB, Choi YS. Images in cardiology: mycotic aneurysm and arteriocaval fistula. Clin Cardiol 2003; 26:45. [PMID: 12539812 PMCID: PMC6654493 DOI: 10.1002/clc.4960260110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
275
|
Cho HJ, Chae IH, Park KW, Ju JR, Oh S, Lee MM, Park YB. Functional polymorphism in the promoter region of the gelatinase B gene in relation to coronary artery disease and restenosis after percutaneous coronary intervention. J Hum Genet 2002; 47:88-91. [PMID: 11916008 DOI: 10.1007/s100380200006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The matrix metalloproteinases appear to play an important role in the development and progression of atherosclerotic lesions. We studied the C-1562T polymorphism of the gelatinase B promoter in relation to coronary artery disease and restenosis after a percutaneous coronary intervention (PCI) in Koreans. To determine the frequency of the C-1562T allele, we examined 63 patients with coronary artery disease who underwent both PCI and 6-month follow-up coronary angiograms (CAGs), and 67 control patients with a normal CAG with respect to their clinical data and genotype. Frequencies of the C/C homozygotes and the non-C/C heterozygotes and homozygotes (C/T and T/T) were 94% and 6% in the normal CAG group, and 76.2% and 23.8% in the patient group, respectively. This gave a relative risk of 0.203 (95% CI: 0.063-0.651, P = 0.005) for coronary artery disease when the C/C genotype was compared with the non-C/C genotype. In the patient groups, the allele frequencies of the C/C and non-C/C were 80% and 20% in the nonrestenotic subgroup, and 71.4% and 28.6% in the restenotic subgroup (P = 0.554). No T/T homozygote was found in any of the groups. We conclude that C/C homozygosity is a potential genetic protective factor for coronary artery disease in Koreans.
Collapse
|