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Spehlmann ME, Rangrez AY, Dhotre DP, Schmiedel N, Chavan N, Bang C, Müller OJ, Shouche YS, Franke A, Frank D, Frey N. Heart Failure Severity Closely Correlates with Intestinal Dysbiosis and Subsequent Metabolomic Alterations. Biomedicines 2022; 10:biomedicines10040809. [PMID: 35453559 PMCID: PMC9033061 DOI: 10.3390/biomedicines10040809] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 02/01/2023] Open
Abstract
Growing evidence suggests an altered gut microbiome in patients with heart failure (HF). However, the exact interrelationship between microbiota, HF, and its consequences on the metabolome are still unknown. We thus aimed here to decipher the association between the severity and progression of HF and the gut microbiome composition and circulating metabolites. Using a mouse model of transverse aortic constriction (TAC), gut bacterial diversity was found to be significantly lower in mice as early as day 7 post-TAC compared to Sham controls (p = 0.03), with a gradual progressive decrease in alpha-diversity on days 7, 14, and 42 (p = 0.014, p = 0.0016, p = 0.0021) compared to day 0, which coincided with compensated hypertrophy, maladaptive hypertrophy, and overtly failing hearts, respectively. Strikingly, segregated analysis based on the severity of the cardiac dysfunction (EF < 40% vs. EF 40−55%) manifested marked differences in the abundance and the grouping of several taxa. Multivariate analysis of plasma metabolites and bacterial diversity produced a strong correlation of metabolic alterations, such as reduced short-chain fatty acids and an increase in primary bile acids, with a differential abundance of distinct bacteria in HF. In conclusion, we showed that HF begets HF, likely via a vicious cycle of an altered microbiome and metabolic products.
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Affiliation(s)
- Martina E. Spehlmann
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Rosalind-Franklin Str. 12, 24105 Kiel, Germany; (M.E.S.); (N.S.); (O.J.M.); (D.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
| | - Ashraf Y. Rangrez
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Rosalind-Franklin Str. 12, 24105 Kiel, Germany; (M.E.S.); (N.S.); (O.J.M.); (D.F.)
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
- Correspondence: (A.Y.R.); (N.F.)
| | - Dhiraj P. Dhotre
- National Centre for Cell Science, Pune 411021, India; (D.P.D.); (N.C.); (Y.S.S.)
| | - Nesrin Schmiedel
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Rosalind-Franklin Str. 12, 24105 Kiel, Germany; (M.E.S.); (N.S.); (O.J.M.); (D.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
| | - Nikita Chavan
- National Centre for Cell Science, Pune 411021, India; (D.P.D.); (N.C.); (Y.S.S.)
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Rosalind-Franklin-Strasse 12, 24105 Kiel, Germany; (C.B.); (A.F.)
| | - Oliver J. Müller
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Rosalind-Franklin Str. 12, 24105 Kiel, Germany; (M.E.S.); (N.S.); (O.J.M.); (D.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
| | - Yogesh S. Shouche
- National Centre for Cell Science, Pune 411021, India; (D.P.D.); (N.C.); (Y.S.S.)
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Rosalind-Franklin-Strasse 12, 24105 Kiel, Germany; (C.B.); (A.F.)
| | - Derk Frank
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Rosalind-Franklin Str. 12, 24105 Kiel, Germany; (M.E.S.); (N.S.); (O.J.M.); (D.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Rosalind-Franklin Str. 12, 24105 Kiel, Germany; (M.E.S.); (N.S.); (O.J.M.); (D.F.)
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
- Correspondence: (A.Y.R.); (N.F.)
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Kaye DM, Nanayakkara S, Wang B, Shihata W, Marques FZ, Esler M, Lambert G, Mariani J. Characterization of Cardiac Sympathetic Nervous System and Inflammatory Activation in HFpEF Patients. JACC Basic Transl Sci 2022; 7:116-127. [PMID: 35257038 PMCID: PMC8897162 DOI: 10.1016/j.jacbts.2021.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
Although there is evidence for activation of the sympathetic nervous system and inflammatory pathways in peripheral blood samples, their relationship to myocardial activity is unknown. Using arterial and coronary sinus blood sampling, we have shown the presence of cardiac and systemic sympathetic activation in HFpEF patients. However although systemic inflammatory activation was readily apparent, there was detectable myocardial release of inflammatory cytokines. Key hemodynamic and demographic factors that typically cluster together in HFpEF appeared to drive cardiac sympathetic activation. The data suggest that there may be a role for antiadrenergic therapies in selected HFpEF patients.
We have shown that systemic and cardiac sympathetic activation is present in heart failure with preserved ejection fraction (HFpEF) patients. Conversely, whereas systemic inflammatory activation was also detected in HFpEF, we did not detect local myocardial release of inflammatory cytokines. Activation of the sympathetic system correlated with both hemodynamic and demographic factors that characteristically cluster together in HFpEF. Together these data suggest that there may be a role for antiadrenergic therapies in certain HFpEF patients. The study does not implicate locally derived cytokines in the myocardial biology of HFpEF, although systemic sources may contribute to the global pathophysiology of HFpEF.
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Affiliation(s)
- David M Kaye
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Shane Nanayakkara
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Bing Wang
- Department of Cardiology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Waled Shihata
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Francine Z Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, Australia
| | - Murray Esler
- Human Neurotransmitter Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Gavin Lambert
- Iverson Health Innovation Research Institute and School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Justin Mariani
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Alfred Hospital, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
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53
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Gut Microbiome and Organ Fibrosis. Nutrients 2022; 14:nu14020352. [PMID: 35057530 PMCID: PMC8781069 DOI: 10.3390/nu14020352] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/07/2023] Open
Abstract
Fibrosis is a pathological process associated with most chronic inflammatory diseases. It is defined by an excessive deposition of extracellular matrix proteins and can affect nearly every tissue and organ system in the body. Fibroproliferative diseases, such as intestinal fibrosis, liver cirrhosis, progressive kidney disease and cardiovascular disease, often lead to severe organ damage and are a leading cause of morbidity and mortality worldwide, for which there are currently no effective therapies available. In the past decade, a growing body of evidence has highlighted the gut microbiome as a major player in the regulation of the innate and adaptive immune system, with severe implications in the pathogenesis of multiple immune-mediated disorders. Gut microbiota dysbiosis has been associated with the development and progression of fibrotic processes in various organs and is predicted to be a potential therapeutic target for fibrosis management. In this review we summarize the state of the art concerning the crosstalk between intestinal microbiota and organ fibrosis, address the relevance of diet in different fibrotic diseases and discuss gut microbiome-targeted therapeutic approaches that are current being explored.
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54
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Liu H, Nguyen HH, Yoon KT, Lee SS. Pathogenic Mechanisms Underlying Cirrhotic Cardiomyopathy. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:849253. [PMID: 36926084 PMCID: PMC10013066 DOI: 10.3389/fnetp.2022.849253] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/18/2022] [Indexed: 12/14/2022]
Abstract
Cardiac dysfunction associated with cirrhosis in the absence of preexisting heart disease is a condition known as cirrhotic cardiomyopathy (CCM). Cardiac abnormalities consist of enlargement of cardiac chambers, attenuated systolic and diastolic contractile responses to stress stimuli, and repolarization changes. CCM may contribute to cardiovascular morbidity and mortality after liver transplantation and other major surgeries, and also to the pathogenesis of hepatorenal syndrome. The underlying mechanisms of CCM are poorly understood and as such medical therapy is an area of unmet medical need. The present review focuses on the pathogenic mechanisms responsible for development of CCM. The two major concurrent mechanistic pathways are the inflammatory phenotype due to portal hypertension, and protein/lipid synthetic/metabolic defects due to cirrhosis and liver insufficiency. The inflammatory phenotype arises from intestinal congestion due to portal hypertension, resulting in bacteria/endotoxin translocation into the systemic circulation. The cytokine storm associated with inflammation, particularly TNFα acting via NFκB depresses cardiac function. They also stimulate two evanescent gases, nitric oxide and carbon monoxide which produce cardiodepression by cGMP. Inflammation also stimulates the endocannabinoid CB-1 pathway. These systems inhibit the stimulatory beta-adrenergic contractile pathway. The liver insufficiency of cirrhosis is associated with defective synthesis or metabolism of several substances including proteins and lipids/lipoproteins. The protein defects including titin and collagen contribute to diastolic dysfunction. Other protein abnormalities such as a switch of myosin heavy chain isoforms result in systolic dysfunction. Lipid biochemical changes at the cardiac sarcolemmal plasma membrane result in increased cholesterol:phospholipid ratio and decreased membrane fluidity. Final common pathway changes involve abnormal cardiomyocyte intracellular ion kinetics, particularly calcium. In conclusion, cirrhotic cardiomyopathy is caused by two pathways of cellular and molecular dysfunction/damage due to hepatic insufficiency and portal hypertension.
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Affiliation(s)
- Hongqun Liu
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Henry H Nguyen
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Ki Tae Yoon
- Liver Center, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Samuel S Lee
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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55
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Tuerhongjiang G, Guo M, Qiao X, Lou B, Wang C, Wu H, Wu Y, Yuan Z, She J. Interplay Between Gut Microbiota and Amino Acid Metabolism in Heart Failure. Front Cardiovasc Med 2021; 8:752241. [PMID: 34746265 PMCID: PMC8566708 DOI: 10.3389/fcvm.2021.752241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 11/14/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome of which the incidence is on the rise worldwide. Cardiometabolic disorders are associated with the deterioration of cardiac function and progression of HF. Recently, there has been renewed interest in gut microbiota (GM) and its metabolites in the cardiovascular disease. HF-caused hypoperfusion could increase intestinal permeability, and a “leaky” bowel leads to bacterial translocation and make its metabolites more easily enter the circulation. Considerable evidence shows that the composition of microbiota and amino acids (AAs) has been altered in HF patients, and AAs could serve as a diagnostic and prognostic biomarker in HF. The findings indicate that the gut–amino acid–HF axis may play a key role in the progression of HF. In this paper, we focus on the interrelationship between the AA metabolism and GM alterations during the development of heart failure. We also discuss the potential prognostic and therapeutic value of the gut–amino acid–HF axis in the cortex of HF.
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Affiliation(s)
- Gulinigaer Tuerhongjiang
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Manyun Guo
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Xiangrui Qiao
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Bowen Lou
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Chen Wang
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Haoyu Wu
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Yue Wu
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Zuyi Yuan
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
| | - Jianqing She
- Department of Cardiovascular, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China
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56
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Nakai M, Ribeiro RV, Stevens BR, Gill P, Muralitharan RR, Yiallourou S, Muir J, Carrington M, Head GA, Kaye DM, Marques FZ. Essential Hypertension Is Associated With Changes in Gut Microbial Metabolic Pathways: A Multisite Analysis of Ambulatory Blood Pressure. Hypertension 2021; 78:804-815. [PMID: 34333988 DOI: 10.1161/hypertensionaha.121.17288] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Michael Nakai
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, Australia (M.N., R.R.M., F.Z.M.)
| | - Rosilene V Ribeiro
- Charles Perkins Centre, University of Sydney, Australia (R.V.R.).,School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Australia (R.V.R.)
| | - Bruce R Stevens
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine, Gainesville (B.R.S.)
| | - Paul Gill
- Department of Gastroenterology (P.G., J.M.), Monash University, Melbourne, Australia
| | - Rikeish R Muralitharan
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, Australia (M.N., R.R.M., F.Z.M.).,Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur (R.R.M.)
| | - Stephanie Yiallourou
- Preclinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Australia (S.Y., M.C.)
| | - Jane Muir
- Department of Gastroenterology (P.G., J.M.), Monash University, Melbourne, Australia
| | - Melinda Carrington
- Preclinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Australia (S.Y., M.C.)
| | - Geoffrey A Head
- Department of Pharmacology, Faculty of Medicine Nursing and Health Sciences (G.A.H.), Monash University, Melbourne, Australia.,Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (G.A.H.)
| | - David M Kaye
- Clinical School, Faculty of Medicine Nursing and Health Sciences (D.M.K.), Monash University, Melbourne, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia (D.M.K., F.Z.M.).,Department of Cardiology, Alfred Hospital, Melbourne, Australia (D.M.K.)
| | - Francine Z Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, Australia (M.N., R.R.M., F.Z.M.).,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia (D.M.K., F.Z.M.)
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57
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Beale AL, O'Donnell JA, Nakai ME, Nanayakkara S, Vizi D, Carter K, Dean E, Ribeiro RV, Yiallourou S, Carrington MJ, Marques FZ, Kaye DM. The Gut Microbiome of Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2021; 10:e020654. [PMID: 34212778 PMCID: PMC8403331 DOI: 10.1161/jaha.120.020654] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Risk factors for heart failure with preserved ejection fraction (HFpEF) include hypertension, age, sex, and obesity. Emerging evidence suggests that the gut microbiota independently contributes to each one of these risk factors, potentially mediated via gut microbial‐derived metabolites such as short‐chain fatty acids. In this study, we determined whether the gut microbiota were associated with HFpEF and its risk factors. Methods and Results We recruited 26 patients with HFpEF and 67 control participants from 2 independent communities. Patients with HFpEF were diagnosed by exercise right heart catheterization. We assessed the gut microbiome by bacterial 16S rRNA sequencing and food intake by the food frequency questionnaire. There was a significant difference in α‐diversity (eg, number of microbes) and β‐diversity (eg, type and abundance of microbes) between both cohorts of controls and patients with HFpEF (P=0.001). We did not find an association between β‐diversity and specific demographic or hemodynamic parameters or risk factors for HFpEF. The Firmicutes to Bacteroidetes ratio, a commonly used marker of gut dysbiosis, was lower, but not significantly so (P=0.093), in the patients with HFpEF. Compared with controls, the gut microbiome of patients with HFpEF was depleted of bacteria that are short‐chain fatty acid producers. Consistent with this, participants with HFpEF consumed less dietary fiber (17.6±7.7 versus 23.2±8.8 g/day; P=0.016). Conclusions We demonstrate key changes in the gut microbiota in patients with HFpEF, including the depletion of bacteria that generate metabolites known to be important for cardiovascular homeostasis. Further studies are required to validate the role of these gut microbiota and metabolites in the pathophysiology of HFpEF.
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Affiliation(s)
- Anna L Beale
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia.,Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Joanne A O'Donnell
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - Michael E Nakai
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - Shane Nanayakkara
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia
| | - Donna Vizi
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Kaye Carter
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Eliza Dean
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Rosilene V Ribeiro
- School of Life and Environmental Sciences, Charles Perkins Centre University of Sydney Australia
| | - Stephanie Yiallourou
- Pre-Clinical Disease and Prevention Baker Heart and Diabetes Institute Melbourne Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention Baker Heart and Diabetes Institute Melbourne Australia
| | - Francine Z Marques
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - David M Kaye
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia.,Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
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