N6-methyladenosine in RNA of atherosclerotic plaques: An epitranscriptomic signature of human carotid atherosclerosis

BACKGROUND

More than 170 post-transcriptional RNA modifications regulate the localization, processing and function of cellular RNAs, and aberrant RNA modifications have been linked to a range of human diseases. The RNA modification landscape in atherosclerosis, the main underlying cause of cardiovascular diseases, is still largely unknown.

METHODS

We used mass spectrometry to analyse a selection of RNA-modifying enzymes and the N6-methyladenosine (m⁶A) in carotid atherosclerotic lesion samples representing early and advanced stages of atherosclerosis as compared to non-atherosclerotic arteries from healthy controls.

FINDINGS

(i) the detection of different levels of several enzymes involved in methylations occurring in rRNA and mRNA; (ii) these findings included changes in the levels of methyltransferases ('writers'), binding proteins ('readers') and demethylases ('erasers') during atherosclerosis as compared to non-atherosclerotic control arteries, with generally the most prominent differences in samples from early atherosclerotic lesions; and (iii) these changes were accompanied by a marked downregulation of m⁶A in rRNA, the most abundant and well-studied modification in mRNA with a wide range of effects on cell biology.

INTERPRETATION

We show for the first time that RNA-modifying enzymes and the well-studied RNA modification m⁶A are differentially regulated in atherosclerotic lesions, which potentially could help creating new prognostic and treatment strategies.

YKL-40 (Chitinase-3-Like Protein 1) Serum Levels in Aortic Stenosis

BACKGROUND

Identification of novel biomarkers could provide prognostic information and improve risk stratification in patients with aortic stenosis (AS). YKL-40 (chitinase-3-like protein 1), a protein involved in atherogenesis, is upregulated in human calcific aortic valves. We hypothesized that circulating YKL-40 would be elevated and associated with the degree of AS severity and outcome in patients with symptomatic AS.

METHODS

Plasma YKL-40 was analyzed in 2 AS populations, one severe AS (n=572) with outcome measures and one with mixed severity (n=67). YKL-40 expression in calcified valves and in an experimental pressure overload model was assessed.

RESULTS

We found (1) patients with AS had upregulated circulating YKL-40 compared with healthy controls (median 109 versus 34 ng/mL, P<0.001), but levels were not related to the degree of AS severity. (2) High YKL-40 levels (quartile 4) were associated with long-term (median follow-up 4.7 years) all-cause mortality (adjusted hazard ratio, 1.93 [95% CI, 1.37-2.73], P<0.001). (3) YKL-40 protein expression in human calcific valves co-localized with its putative receptor IL-13rα2 in close proximity to valve interstitial cells. (4) Myocardial YKL-40 increased in experimental pressure overload (6-fold in decompensated versus sham mice).

CONCLUSIONS

YKL-40 levels were elevated in AS and associated with mortality but not with other metrics of disease severity including the degree of AS severity. Despite scientific rationale for its role in AS, the clinical utility of circulating YKL-40 as a biomarker is limited. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01794832.

Cholesterol crystals use complement to increase NLRP3 signaling pathways in coronary and carotid atherosclerosis

BACKGROUND

During atherogenesis, cholesterol precipitates into cholesterol crystals (CC) in the vessel wall, which trigger plaque inflammation by activating the NACHT, LRR and PYD domains-containing protein 3 (NLRP3) inflammasome. We investigated the relationship between CC, complement and NLRP3 in patients with cardiovascular disease.

METHODS

We analysed plasma, peripheral blood mononuclear cells (PBMC) and carotid plaques from patients with advanced atherosclerosis applying ELISAs, multiplex cytokine assay, qPCR, immunohistochemistry, and gene profiling.

FINDINGS

Transcripts of interleukin (IL)-1beta(β) and NLRP3 were increased and correlated in PBMC from patients with acute coronary syndrome (ACS). Priming of these cells with complement factor 5a (C5a) and tumour necrosis factor (TNF) before incubation with CC resulted in increased IL-1β protein when compared to healthy controls. As opposed to healthy controls, systemic complement was significantly increased in patients with stable angina pectoris or ACS. In carotid plaques, complement C1q and C5b-9 complex accumulated around CC-clefts, and complement receptors C5aR1, C5aR2 and C3aR1 were higher in carotid plaques compared to control arteries. Priming human carotid plaques with C5a followed by CC incubation resulted in pronounced release of IL-1β, IL-18 and IL-1α. Additionally, mRNA profiling demonstrated that C5a and TNF priming followed by CC incubation upregulated plaque expression of NLRP3 inflammasome components.

INTERPRETATION

We demonstrate that CC are important local- and systemic complement activators, and we reveal that the interaction between CC and complement could exert its effect by activating the NLRP3 inflammasome, thus promoting the progression of atherosclerosis.

Strengthening core competences of medical and public health students for public health emergencies

Background

The importance of public health capacity development with a focus on public health emergencies and humanitarian assistance is continuously increasing at the global scale. In the time of Public Health Emergencies of International Concern is crucial to provide basic training in core public health competences to all health professionals, including students. Faculty of Medicine & Dentistry, Palacký University Olomouc, Czech Republic (full ASPHER member), implemented in medical as well as public health curricula new topics focused on core competences of health professionals in the area of public health emergencies and humanitarian assistance.

Objectives

To strengthen competences and skills of medical as well as public health students to prepare them better for public health emergencies and humanitarian assistance in the time of increasing risk of global public health emergencies. New modules were proposed and tested in all education programmes at our Faculty of Medicine & Dentistry, Palacký University Olomouc (CZ): General Medicine (Czech and English programmes), Dentistry (Czech and English programmes) and Public Health (Czech programme).

Results

New modules on Public Health Emergencies, including preparedness, responses, risk management and risk communication were successfully tested in all education programmes during the academic year 2018/19 and fully implemented for the academic year 2019/20. New module has blended learning structure based on combination of face-to-face seminars and exercises with e-learning parts, including self-assessment. New module is presented in details.

Conclusions

This new education module fully supports international recommendations to strengthen public health competences and skills of medical as well as public health students to be ready for any unexpected public health emergencies at all levels, in particular at the local community level. COVID-19 pandemic confirmed.

Supported by university project CZ.02.69/0.0/16_015/0002337

Key messages

Medical and public health students with competences and skills on public health emergencies and humanitarian assistance will be an asset for any public health emergency of international concern.

New education module on public health emergencies will support both medical and public health students to be prepared for risk communication, advocacy and action if needed and called to action.

Review of pandemic plans, varying international approaches focusing on medical students’ contribution

A review of pandemic plans and international approaches to pandemics focusing on the responsibilities of medical students should they be called to help in times of need. Are there specific guidelines or competencies in place with respect to medical students? Are medical students being utilised to their maximal capability when compared across different nations on an international basis? These questions were kept in mind during the evaluation and analysis of publicly available pandemic plans and other international systems concerning the approach to pandemics. The main differences, strengths and weaknesses of these responses will be highlighted. The presentation will conclude with proposals of the specific role medical students could play in the pandemic response and the importance of their contribution on an international level.

Future visions for medical education, the importance of public health themes in education and beyond

Steps for the future improvement of competencies evaluation and fulfilment were studied, with the eventual goal of the unification of guidelines internationally to ensure the standardisation and uniformity of the quality of medical education. The future vision for the integration of public health into medical education curriculums, highlighting the importance of public health in medical education and its application in a wide variety of situations across medical education and beyond in practise as a medical professional in a range of specialities. The need for ways to increase engagement of medical students within public health issues will also be discussed.

Personal experiences of medical school education: methods to evaluate competency and ways to improve

Personal experiences of medical school education and the manner in which it is delivered will be discussed. Examples of approaches used for student evaluation of different competencies and the methods to track their progress and development were identified. They were appraised, with their strengths and weaknesses discussed. Ideas to improve the approaches for competencies assessment in medical students were also explored.

Comparing European guidelines for medical student education focusing on emergency preparedness

A review of a variety of European guidelines for the assessment of medical students and their education, progression and preparedness for practise post-medical school. The various approaches were compared and contrasted with the advantages and disadvantages of each being evaluated. Their approaches towards emergency situation preparedness, or lack thereof, were also assessed.

Deletion of Endonuclease V suppresses chemically induced hepatocellular carcinoma

Endonuclease V (EndoV) is a conserved inosine-specific ribonuclease with unknown biological function. Here, we present the first mouse model lacking EndoV, which is viable without visible abnormalities. We show that endogenous murine EndoV cleaves inosine-containing RNA in vitro, nevertheless a series of experiments fails to link an in vivo function to processing of such transcripts. As inosine levels and adenosine-to-inosine editing often are dysregulated in hepatocellular carcinoma (HCC), we chemically induced HCC in mice. All mice developed liver cancer, however, EndoV^−/− tumors were significantly fewer and smaller than wild type tumors. Opposed to human HCC, adenosine deaminase mRNA expression and site-specific editing were unaltered in our model. Loss of EndoV did not affect editing levels in liver tumors, however mRNA expression of a selection of cancer related genes were reduced. Inosines are also found in certain tRNAs and tRNAs are cleaved during stress to produce signaling entities. tRNA fragmentation was dysregulated in EndoV^−/− livers and apparently, inosine-independent. We speculate that the inosine-ribonuclease activity of EndoV is disabled in vivo, but RNA binding allowed to promote stabilization of transcripts or recruitment of proteins to fine-tune gene expression. The EndoV^−/− tumor suppressive phenotype calls for related studies in human HCC.

Time Domain Characterization of the Cole-Cole Dielectric Model

The Cole-Cole model for a dielectric is a generalization of the Debye relaxation model. The most familiar form is in the frequency domain and this manifests itself in a frequency dependent impedance. Dielectrics may also be characterized in the time domain by means of the current and charge responses to a voltage step, called response and relaxation functions respectively. For the Debye model they are both exponentials while in the Cole-Cole model they are expressed by a generalization of the exponential, the Mittag-Leffler function. Its asymptotes are just as interesting and correspond to the Curie-von Schweidler current response which is known from real-life capacitors and the Kohlrausch stretched exponential charge response.

Legumain is upregulated in acute cardiovascular events and associated with improved outcome - potentially related to anti-inflammatory effects on macrophages

BACKGROUND AND AIMS

We have previously found increased levels of the cysteine protease legumain in plasma and plaques from patients with carotid atherosclerosis. This study further investigated legumain during acute cardiovascular events.

METHODS

Circulating levels of legumain from patients and legumain released from platelets were assessed by enzyme-linked-immunosorbent assay. Quantitative PCR and immunoblotting were used to study expression, while localization was visualized by immunohistochemistry.

RESULTS

In the SUMMIT Malmö cohort (n = 339 with or without type 2 diabetes and/or cardiovascular disease [CVD], and 64 healthy controls), the levels of circulating legumain were associated with the presence of CVD in non-diabetics, with no relation to outcome. In symptomatic carotid plaques and in samples from both coronary and intracerebral thrombi obtained during acute cardiovascular events, legumain was co-localized with macrophages in the same regions as platelets. In vitro, legumain was shown to be present in and released from platelets upon activation. In addition, THP-1 macrophages exposed to releasate from activated platelets showed increased legumain expression. Interestingly, primary peripheral blood mononuclear cells stimulated with recombinant legumain promoted anti-inflammatory responses. Finally, in a STEMI population (POSTEMI; n = 272), patients had significantly higher circulating legumain before and immediately after percutaneous coronary intervention compared with healthy controls (n = 67), and high levels were associated with improved outcome.

CONCLUSIONS

Our data demonstrate for the first time that legumain is upregulated during acute cardiovascular events and is associated with improved outcome.

ASPHER V4 Working Group supports the road map for professionalising the public health workforce

Background

The ASPHER V4 Working Group (WG) was established in 2016 and officially launched during the 9th European Public Health Conference in Vienna. One of the key objectives of the WG is to strengthen public health capacity development in V4 countries. The WG supports the implementation of the recently reviewed European Action Plan for Strengthening Public Health Capacities (EAP). The EAP’s review highlighted the need to focus further action on four enabling Essential Public Health Functions (EPHOs) including human resources for public health. This is why the WG is heavily involved in the recent development of a new Road map for professionalising the public health workforce, one of the products of the recently established Coalition of Partners (CoP) that was convened by the WHO Regional Office for Europe in close cooperation with ASPHER and Maastricht University.

Objectives

Supporting the WHO CoP with a focus on development and further implementation of a new Road map for professionalising public health workforce in V4 countries. Using a new rapid assessment tool to evaluate the state of the public health profession in the Czech Republic. Sharing the report on the current state of public health professions in the Czech Republic with the WG and using it as a comparison of the current state in all V4 countries.

Results

Key strengths and weaknesses of the first rapid assessment of the current state of the public health profession in the Czech Republic are presented. Key actions are proposed for the WG: a) Preparation of a grant proposal to the International V4 Fund and b) Continuing active involvement in CoP activities.

Conclusions

The rapid assessment tool for evaluating the state of the public health profession was successfully implemented in the Czech Republic with the close cooperation of academia, researchers, policy makers and practitioners. The summary confirms that further work on the professionalization of the public health workforce is needed.

Key messages

ASPHER V4 WG is strongly involved in the development of a new road map for professionalising the public health workforce, coordinated by the WHO CoP, ASPHER and Maastricht University. Summary of the first rapid assessment of the current state of the public health profession in the Czech Republic confirms the importance of further action in this area of work.

Towards a consensus on rheological models for elastography in soft tissues

A rising wave of technologies and instruments are enabling more labs and clinics to make a variety of measurements related to tissue viscoelastic properties. These instruments include elastography imaging scanners, rheological shear viscometers, and a variety of calibrated stress-strain analyzers. From these many sources of disparate data, a common step in analyzing results is to fit the measurements of tissue response to some viscoelastic model. In the best scenario, this places the measurements within a theoretical framework and enables meaningful comparisons of the parameters against other types of tissues. However, there is a large set of established rheological models, even within the class of linear, causal, viscoelastic solid models, so which of these should be chosen? Is it simply a matter of best fit to a minimum mean squared error of the model to several data points? We argue that the long history of biomechanics, including the concept of the extended relaxation spectrum, along with data collected from viscoelastic soft tissues over an extended range of times and frequencies, and the theoretical framework of multiple relaxation models which model the multi-scale nature of physical tissues, all lead to the conclusion that fractional derivative models represent the most succinct and meaningful models of soft tissue viscoelastic behavior. These arguments are presented with the goal of clarifying some distinctions between, and consequences of, some of the most commonly used models, and with the longer term goal of reaching a consensus among different sub-fields in acoustics, biomechanics, and elastography that have common interests in comparing tissue measurements.

A multiple relaxation interpretation of the extended Biot model

The biphasic extended Biot poroviscoelastic model takes into account the squirt flow in grain-grain contacts and introduces the bulk and shear relaxation modes associated with it. This model has been criticized for its empirical approach, but here the constitutive equations and the time domain wave equations of the model are derived. This also makes it possible to find single phase viscoelastic equivalents for all three wave solutions of the extended Biot model. Particularly, the viscoelastic equivalents for shear wave propagation can be obtained with considerably fewer parameters than the original model. These equivalents are linear viscoelastic models with springs and dampers for the low frequencies and contain half-order spring-pots for high frequencies. For high frequencies, the non-physicality of the shear relaxation mode is highlighted. The relaxation modes of the extended Biot model are interpreted in the framework of multiple relaxation mechanisms showing that the P- and S-wave modes of the model are not much more complex than that for seawater. The model's near linear frequency dependent attenuation in the intermediate frequency range is the result of weighting each relaxation mechanism appropriately.

Levels of Lipoprotein (a) in patients with coronary artery disease with and without inflammatory rheumatic disease: a cross-sectional study

OBJECTIVES

Patients with various inflammatory rheumatic diseases (IRDs) have increased risk of atherothrombotic disease. Lipoprotein (a) (Lp(a)) is a risk factor for atherosclerosis but its role in IRD with accompanying coronary artery disease (CAD) is still unclear. We aimed to examine if serum Lp(a) levels differed between CAD patients with and without accompanying IRD.

DESIGN

A cross-sectional observational, patient-based cohort study.

SETTING

Referred centre for coronary artery bypass grafting in the South Eastern part of Norway.

PARTICIPANTS

67 CAD patients with IRD (CAD/IRD) and 52 CAD patients without IRD (CAD/non-IRD). All patients were Caucasians, aged >18 years, without any clinically significant infection or malignancy.

METHODS

Lp(a) levels in serum were analysed by particle enhanced immunoturbidimetric assay, and Lp(a) levels were related to clinical and biochemical characteristics of the patient population.

RESULTS

We found no differences in serum levels of Lp(a) between CAD patients with and without IRD. In general, we found that Lp(a) correlated poorly with clinical and biochemical parameters including C reactive protein with the same pattern in the CAD/non-IRD and CAD/IRD groups.

CONCLUSIONS

Our data do not support a link between inflammation and Lp(a) levels in CAD and in general Lp(a) levels were not correlated with other risk factors for cardiovascular disease.

Exploiting Ballou's rule for better tissue classification

Ultrasound tissue characterization based on the coefficient of nonlinearity, β_n = 1 + B/2A, has been demonstrated to produce added diagnostic value due to its large variation and sensitivity to tissue structure. However, the parameter has been observed to be significantly correlated to the speed of sound and density. These relationships are analyzed empirically as well as theoretically by developing a pressure-density relation based on a thermodynamic model and the Mie intermolecular potential. The results indicate that for many soft tissues, the coefficient of nonlinearity is largely determined by the isentropic compressibility, κ_s. Consequently, for tissue characterization, estimating the nonlinear response of the medium, given by β_p = β_nκ_s, appears to be beneficial due to correlated quantities.

Imaging localized neuronal activity at fast time scales through biomechanics

Mapping neuronal activity noninvasively is a key requirement for in vivo human neuroscience. Traditional functional magnetic resonance (MR) imaging, with a temporal response of seconds, cannot measure high-level cognitive processes evolving in tens of milliseconds. To advance neuroscience, imaging of fast neuronal processes is required. Here, we show in vivo imaging of fast neuronal processes at 100-ms time scales by quantifying brain biomechanics noninvasively with MR elastography. We show brain stiffness changes of ~10% in response to repetitive electric stimulation of a mouse hind paw over two orders of frequency from 0.1 to 10 Hz. We demonstrate in mice that regional patterns of stiffness modulation are synchronous with stimulus switching and evolve with frequency. For very fast stimuli (100 ms), mechanical changes are mainly located in the thalamus, the relay location for afferent cortical input. Our results demonstrate a new methodology for noninvasively tracking brain functional activity at high speed.

Utility of the Tympanic Membrane Pressure Waveform for Non-invasive Estimation of The Intracranial Pressure Waveform

Time domain analysis of the intracranial pressure (ICP) waveform provides important information about the intracranial pressure-volume reserve capacity. The aim here was to explore whether the tympanic membrane pressure (TMP) waveform can be used to non-invasively estimate the ICP waveform. Simultaneous invasive ICP and non-invasive TMP signals were measured in a total of 28 individuals who underwent invasive ICP measurements as a part of their clinical work up (surveillance after subarachnoid hemorrhage in 9 individuals and diagnostic for CSF circulation disorders in 19 individuals). For each individual, a transfer function estimate between the invasive ICP and non-invasive TMP signals was established in order to explore the potential of the method. To validate the results, ICP waveform parameters including the mean wave amplitude (MWA) were computed in the time domain for both the ICP estimates and the invasively measured ICP. The patient-specific non-invasive ICP signals predicted MWA rather satisfactorily in 4/28 individuals (14%). In these four patients the differences between original and estimated MWA were <1.0 mmHg in more than 50% of observations, and <0.5 mmHg in more than 20% of observations. The study further disclosed that the cochlear aqueduct worked as a physical lowpass filter.

Rheological determinants for simultaneous staging of hepatic fibrosis and inflammation in patients with chronic liver disease

The purpose of this study is to investigate the use of fundamental rheological parameters as quantified by MR elastography (MRE) to measure liver fibrosis and inflammation simultaneously in humans. MRE was performed on 45 patients at 3 T using a vibration frequency of 56 Hz. Fibrosis and inflammation scores were obtained from liver biopsies. Biomechanical properties were quantified in terms of complex shear modulus G* as well as shear wave phase velocity c and shear wave attenuation α. A rheological fractional derivative order model was used to investigate the linear dependence of the free model parameters (dispersion slope y, intrinsic speed c0 , and intrinsic relaxation time τ) on histopathology. Leave-one-out cross-validation was then utilized to demonstrate the effectiveness of the model. The intrinsic speed c0 increases with hepatic fibrosis, while an increased relaxation time τ is reflective of more inflammation of the liver parenchyma. The dispersion slope y does not depend either on fibrosis or on inflammation. The proposed rheological model, given this specific parameterization, establishes the functional dependences of biomechanical parameters on histological fibrosis and inflammation. The leave-one-out cross-validation demonstrates that the model allows identification, from the MRE measurements, of the histology scores when grouped into low-/high-grade fibrosis and low-/high-grade inflammation with significance levels of P = 0.0004 (fibrosis) and P = 0.035 (inflammation). The functional dependences of intrinsic speed and relaxation time on fibrosis and inflammation, respectively, shed new light onto the impact hepatic pathological changes on liver tissue biomechanics in humans. The dispersion slope y appears to represent a structural parameter of liver parenchyma not impacted by the severity of fibrosis/inflammation present in this patient cohort. This specific parametrization of the well-established rheological fractional order model is valuable for the clinical assessment of both fibrosis and inflammation scores, going beyond the capability of the plain shear modulus measurement commonly used for MRE.

Spring-damper equivalents of the fractional, poroelastic, and poroviscoelastic models for elastography

In MR elastography, it is common to use an elastic model for the tissue's response in order to interpret the results properly. More complex models, such as viscoelastic, fractional viscoelastic, poroelastic, or poroviscoelastic ones, are also used. These models appear at first sight to be very different, but here it is shown that they may all be expressed in terms of elementary viscoelastic models. For a medium expressed with fractional models, many elementary spring-damper combinations are added, each of them weighted according to a long-tailed distribution of time constants or relaxation frequencies. This may open up a more physical interpretation of fractional models. The shear-wave component of the poroelastic model is shown to be modeled exactly by a three-component Zener model. The extended poroviscoelastic model is found to be equivalent to what is called a non-standard four-parameter model. Accordingly, the large number of parameters in the porous models can be reduced to the same number as in their viscoelastic equivalents. While the individual displacements from the solid and fluid parts cannot be measured individually, the main use of the poro(visco)elastic models is therefore as a physics-based method for determining parameters in a viscoelastic model.

Publisher's Note: Linking the fractional derivative and the Lomnitz creep law to non-Newtonian time-varying viscosity [Phys. Rev. E 94, 032606 (2016)]

This corrects the article DOI: 10.1103/PhysRevE.94.032606.

Increased Levels of Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 in Ischemic Stroke and Transient Ischemic Attack

Background

Soluble lectin‐like oxidized low‐density lipoprotein receptor‐1 (sLOX‐1) has been shown to be increased in patients with acute ischemic stroke. Here, we evaluated plasma sLOX‐1 levels and vascular carotid plaque LOX‐1 (ie, OLR1) gene expression in patients with ischemic stroke and transient ischemic attack (TIA) with particular focus on their relation to time since symptom onset.

Methods and Results

Plasma sLOX‐1 (n=232) and carotid plaque OLR1 gene expression (n=146) were evaluated in patients who were referred to evaluation for carotid endarterectomy, as well as in healthy control plasma (n=81). Patients were categorized according to presence of acute ischemic stroke or transient ischemic attack (n=35) ≤7 days, >7 days ≤3 months (n=90), >3 months (n=40), or no reported symptoms before study inclusion (n=67). Our major findings were the following: (1) Patients with carotid atherosclerosis had increased plasma sLOX‐1 levels as compared with controls. (2) Plaque OLR1 mRNA levels were increased in carotid plaques (n=146) compared with nonatherosclerotic vessels (ie, common iliac arteries of organ donors, n=10). (3) There were no differences in sLOX plasma levels or OLR1 gene expression when analyzed according to the time since relevant cerebral ischemic symptoms. (4) Also patients with severe carotid atherosclerosis without any previous ischemic events had raised sLOX‐1 levels. (5) Immunostaining showed colocalization between LOX‐1 and macrophages within the carotid plaques. (6) Also patients with acute stroke (within 7 days) caused by atrial fibrillation (n=22) had comparable raised sLOX‐1 levels.

Conclusions

sLOX‐1 levels are elevated in patients with ischemic stroke and transient ischemic attack independent of cause and time since the ischemic event.