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Riaz H, Khan SU, Rahman H, Shah NP, Kaluski E, Lincoff AM, Nissen SE. Effects of high-density lipoprotein targeting treatments on cardiovascular outcomes: A systematic review and meta-analysis. Eur J Prev Cardiol 2018; 26:533-543. [PMID: 30861690 DOI: 10.1177/2047487318816495] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain. DESIGN We conducted a meta-analysis to investigate the effects of high-density lipoprotein cholesterol modifiers (niacin, fibrates and cholesteryl ester transfer protein inhibitors) on cardiovascular outcomes. METHODS Thirty-one randomized controlled trials (154,601 patients) with a follow-up of 6 months or more and a sample size of 100 or more patients were selected using MEDLINE, EMBASE and CENTRAL database (inception January 2018). RESULTS High-density lipoprotein cholesterol modifiers had no statistically significant effect on cardiovascular mortality in terms of relative risk (RR) (RR 0.94, 95% confidence interval (CI) 0.89-1.00, P = 0.05, I2 = 13%) or absolute risk (risk difference -0.0001, 95% CI -0.0014, 0.0011, P = 0.84, I2 = 28%). High-density lipoprotein cholesterol modifiers reduced the RR of myocardial infarction (RR 0.87, 95% CI 0.82-0.93, P < 0.001, I2 = 37%). This significant effect was derived by the use of fibrates (RR 0.80, 95% CI 0.73-0.87, P < 0.001, I2 = 22%) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol. High-density lipoprotein cholesterol modifiers had no effect on stroke (RR 1.00, 95% CI 0.93-1.09, P = 0.94, I2 = 25%) or all-cause mortality (RR 1.02, 95% CI 0.97-1.08, P = 0.48, I2 = 49%). Meta-regression analyses failed to demonstrate a significant association of pharmacologically increased high-density lipoprotein cholesterol with key endpoints. In studies with background statin therapy, high-density lipoprotein cholesterol modifiers had no statistically significant impact on cardiovascular mortality, myocardial infarction, stroke or all-cause mortality ( P > 0.05). CONCLUSION The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality, stroke or all-cause mortality. The beneficial effect on myocardial infarction was lost when drugs were used with statin therapy.
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Affiliation(s)
- Haris Riaz
- 1 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Safi U Khan
- 2 Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Hammad Rahman
- 3 Department of Medicine, Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA
| | - Nishant P Shah
- 1 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Edo Kaluski
- 4 Department of Cardiovascular Medicine, Guthrie Health System/Robert Packer Hospital, Sayre, PA, USA
| | - A Michael Lincoff
- 1 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Steven E Nissen
- 1 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Yu XH, Zhang DW, Zheng XL, Tang CK. Cholesterol transport system: An integrated cholesterol transport model involved in atherosclerosis. Prog Lipid Res 2018; 73:65-91. [PMID: 30528667 DOI: 10.1016/j.plipres.2018.12.002] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/30/2018] [Accepted: 12/01/2018] [Indexed: 02/07/2023]
Abstract
Atherosclerosis, the pathological basis of most cardiovascular disease (CVD), is closely associated with cholesterol accumulation in the arterial intima. Excessive cholesterol is removed by the reverse cholesterol transport (RCT) pathway, representing a major antiatherogenic mechanism. In addition to the RCT, other pathways are required for maintaining the whole-body cholesterol homeostasis. Thus, we propose a working model of integrated cholesterol transport, termed the cholesterol transport system (CTS), to describe body cholesterol metabolism. The novel model not only involves the classical view of RCT but also contains other steps, such as cholesterol absorption in the small intestine, low-density lipoprotein uptake by the liver, and transintestinal cholesterol excretion. Extensive studies have shown that dysfunctional CTS is one of the major causes for hypercholesterolemia and atherosclerosis. Currently, several drugs are available to improve the CTS efficiently. There are also several therapeutic approaches that have entered into clinical trials and shown considerable promise for decreasing the risk of CVD. In recent years, a variety of novel findings reveal the molecular mechanisms for the CTS and its role in the development of atherosclerosis, thereby providing novel insights into the understanding of whole-body cholesterol transport and metabolism. In this review, we summarize the latest advances in this area with an emphasis on the therapeutic potential of targeting the CTS in CVD patients.
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Affiliation(s)
- Xiao-Hua Yu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Medical Research Experiment Center, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, China
| | - Da-Wei Zhang
- Department of Pediatrics and Group on the Molecular and Cell Biology of Lipids, University of Alberta, Alberta, Canada
| | - Xi-Long Zheng
- Department of Biochemistry and Molecular Biology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Health Sciences Center, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada
| | - Chao-Ke Tang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Medical Research Experiment Center, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan 421001, China.
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Parsons C, Agasthi P, Mookadam F, Arsanjani R. Reversal of coronary atherosclerosis: Role of life style and medical management. Trends Cardiovasc Med 2018; 28:524-531. [DOI: 10.1016/j.tcm.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 12/26/2022]
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Atkinson T, Packwood W, Xie A, Liang S, Qi Y, Ruggeri Z, Lopez J, Davidson BP, Lindner JR. Assessment of Novel Antioxidant Therapy in Atherosclerosis by Contrast Ultrasound Molecular Imaging. J Am Soc Echocardiogr 2018; 31:1252-1259.e1. [PMID: 30213420 PMCID: PMC6218294 DOI: 10.1016/j.echo.2018.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ultrasound molecular imaging was used to evaluate the therapeutic effects of antioxidant therapy with EUK-207, which has superoxide dismutase and catalase activities, on suppressing high-risk atherosclerotic features. METHODS Mice with age-dependent atherosclerosis produced by deletion of the low-density lipoprotein receptor and Apobec-1 were studied at 20 and 40 weeks of age. EUK-207 or vehicle was administered for the preceding 8 weeks. Therapy for 28 weeks was also studied for 40-week-old mice. Ultrasound molecular imaging of the thoracic aorta was performed with contrast agents targeted to endothelial P-selectin, von Willebrand factor A1-domain, and platelet glycoprotein Ibα or control agent. Aortic plaque area and macrophage content were assessed by histology. RESULTS In 20-week-old double-knockout mice, EUK-207 compared with sham therapy produced only nonsignificant trends for reduction in molecular imaging signal for endothelial P-selectin, von Willebrand factor A1-domain, and platelet adhesion. At 40 weeks, EUK-207 given for 8 or 28 weeks significantly (P < .05) reduced signal for all three endothelial-associated events essentially to background levels, with the exception of glycoprotein Ibα signal after 8 weeks (P = .06). On aortic histology, EUK-207 therapy for 8 weeks did not affect plaque area or macrophage content at either age. However, EUK-207 for 28 weeks almost completely suppressed plaque development (350 ± 258 vs 4 ± 6 × 103 μm2, P = .014) and macrophage content (136 ± 103 vs 3 ± 2 × 103 μm2, P = .002) compared with control mice at 40 weeks. CONCLUSIONS Molecular imaging can be used to assess vascular responses to antioxidants and has demonstrated that certain antioxidants reduce vascular endothelial activation and platelet adhesion, but reductions in plaque size and macrophage content occurs only with long-duration therapy that is started early.
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Affiliation(s)
- Tamara Atkinson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Portland VA Medical Center, Portland, Oregon
| | - William Packwood
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Aris Xie
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Sherry Liang
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Yue Qi
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Zaverio Ruggeri
- Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, California
| | | | - Brian P Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Portland VA Medical Center, Portland, Oregon
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon.
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105
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Affiliation(s)
- Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,National Heart & Lung Institute, Hammersmith Hospital, Imperial College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Senders ML, Hernot S, Carlucci G, van de Voort JC, Fay F, Calcagno C, Tang J, Alaarg A, Zhao Y, Ishino S, Palmisano A, Boeykens G, Meerwaldt AE, Sanchez-Gaytan BL, Baxter S, Zendman L, Lobatto ME, Karakatsanis NA, Robson PM, Broisat A, Raes G, Lewis JS, Tsimikas S, Reiner T, Fayad ZA, Devoogdt N, Mulder WJM, Pérez-Medina C. Nanobody-Facilitated Multiparametric PET/MRI Phenotyping of Atherosclerosis. JACC Cardiovasc Imaging 2018; 12:2015-2026. [PMID: 30343086 PMCID: PMC6461528 DOI: 10.1016/j.jcmg.2018.07.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/11/2018] [Accepted: 07/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to develop an integrative positron emission tomography (PET) with magnetic resonance imaging (MRI) procedure for accurate atherosclerotic plaque phenotyping, facilitated by clinically approved and nanobody radiotracers. BACKGROUND Noninvasive characterization of atherosclerosis remains a challenge in clinical practice. The limitations of current diagnostic methods demonstrate that, in addition to atherosclerotic plaque morphology and composition, disease activity needs to be evaluated. METHODS We screened 3 nanobody radiotracers targeted to different biomarkers of atherosclerosis progression, namely vascular cell adhesion molecule (VCAM)-1, lectin-like oxidized low-density lipoprotein receptor (LOX)-1, and macrophage mannose receptor (MMR). The nanobodies, initially radiolabeled with copper-64 (64Cu), were extensively evaluated in Apoe–/– mice and atherosclerotic rabbits using a combination of in vivo PET/MRI readouts and ex vivo radioactivity counting, autoradiography, and histological analyses. RESULTS The 3 nanobody radiotracers accumulated in atherosclerotic plaques and displayed short circulation times due to fast renal clearance. The MMR nanobody was selected for labeling with gallium-68 (68Ga), a short-lived radioisotope with high clinical relevance, and used in an ensuing atherosclerosis progression PET/MRI study. Macrophage burden was longitudinally studied by 68Ga-MMR–PET, plaque burden by T2-weighted MRI, and neovascularization by dynamic contrast-enhanced (DCE) MRI. Additionally, inflammation and microcalcifications were evaluated by fluorine-18 (18F)-labeled fluorodeoxyglucose (18F-FDG) and 18F-sodium fluoride (18F-NaF) PET, respectively. We observed an increase in all the aforementioned measures as disease progressed, and the imaging signatures correlated with histopathological features. CONCLUSIONS We have evaluated nanobody-based radiotracers in rabbits and developed an integrative PET/MRI protocol that allows noninvasive assessment of different processes relevant to atherosclerosis progression. This approach allows the multiparametric study of atherosclerosis and can aid in early stage anti-atherosclerosis drug trials.
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Affiliation(s)
- Max L Senders
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medical Biochemistry, Academic Medical Center, Amsterdam, the Netherlands
| | - Sophie Hernot
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, Brussels, Belgium
| | - Giuseppe Carlucci
- Bernard and Irene Schwarz Center for Biomedical Imaging, New York University, New York, New York; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jan C van de Voort
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Francois Fay
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Chemistry, York College of The City University of New York, New York, New York
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jun Tang
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Amr Alaarg
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomaterials Science and Technology, Technical Medical Centre. University of Twente, Enschede, the Netherlands
| | - Yiming Zhao
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Seigo Ishino
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anna Palmisano
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Unit of Clinical Research in Radiology, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
| | - Gilles Boeykens
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anu E Meerwaldt
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brenda L Sanchez-Gaytan
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Baxter
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laura Zendman
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark E Lobatto
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Nicolas A Karakatsanis
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip M Robson
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexis Broisat
- Bioclinic Radiopharmaceutics Laboratory, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche S 1039, Grenoble, France
| | - Geert Raes
- Research Group of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium; Laboratory of Myeloid Cell Immunology, Vlaams Instituut voor Biotechnologie Inflammation Research Center, Ghent, Belgium
| | - Jason S Lewis
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York; Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sotirios Tsimikas
- Division of Cardiovascular Diseases, Sulpizio Cardiovascular Center, Department of Medicine, University of California-La Jolla, San Diego, California
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nick Devoogdt
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, Brussels, Belgium
| | - Willem J M Mulder
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medical Biochemistry, Academic Medical Center, Amsterdam, the Netherlands.
| | - Carlos Pérez-Medina
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Hoogeveen RM, Nahrendorf M, Riksen NP, Netea MG, de Winther MPJ, Lutgens E, Nordestgaard BG, Neidhart M, Stroes ESG, Catapano AL, Bekkering S. Monocyte and haematopoietic progenitor reprogramming as common mechanism underlying chronic inflammatory and cardiovascular diseases. Eur Heart J 2018; 39:3521-3527. [PMID: 29069365 PMCID: PMC6174026 DOI: 10.1093/eurheartj/ehx581] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/11/2017] [Accepted: 10/12/2017] [Indexed: 12/19/2022] Open
Abstract
A large number of cardiovascular events are not prevented by current therapeutic regimens. In search for additional, innovative strategies, immune cells have been recognized as key players contributing to atherosclerotic plaque progression and destabilization. Particularly the role of innate immune cells is of major interest, following the recent paradigm shift that innate immunity, long considered to be incapable of learning, does exhibit immunological memory mediated via epigenetic reprogramming. Compelling evidence shows that atherosclerotic risk factors promote immune cell migration by pre-activation of circulating innate immune cells. Innate immune cell activation via metabolic and epigenetic reprogramming perpetuates a systemic low-grade inflammatory state in cardiovascular disease (CVD) that is also common in other chronic inflammatory disorders. This opens a new therapeutic area in which metabolic or epigenetic modulation of innate immune cells may result in decreased systemic chronic inflammation, alleviating CVD, and its co-morbidities.
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Affiliation(s)
- Renate M Hoogeveen
- Department of Vascular Medicine, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands
| | - Matthias Nahrendorf
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, 55 Fruit Street Boston, MA, USA
| | - Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, Nijmegen, The Netherlands
| | - Menno P J de Winther
- Department of Medical Biochemistry, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands
| | - Esther Lutgens
- Institute for Cardiovascular Prevention (IPEK), Ludwig Maximilians University (LMU), Pettenkoferstraße 9, Munich, Germany
| | - Børge G Nordestgaard
- The Copenhagen General Population Study and Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Ringvej 75, Herlev, Copenhagen, Denmark
| | - Michel Neidhart
- Center of Experimental Rheumatology, University Hospital Zurich, Schlieren, Switzerland
| | - Erik S G Stroes
- Department of Vascular Medicine, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and IRCCS Multimedica, Via Balzaretti, Milano, Italy
| | - Siroon Bekkering
- Department of Vascular Medicine, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, Nijmegen, The Netherlands
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Bellinge JW, Francis RJ, Majeed K, Watts GF, Schultz CJ. In search of the vulnerable patient or the vulnerable plaque: 18F-sodium fluoride positron emission tomography for cardiovascular risk stratification. J Nucl Cardiol 2018; 25:1774-1783. [PMID: 29992525 DOI: 10.1007/s12350-018-1360-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains a leading cause of death. Preventative therapies that reduce CVD are most effective when targeted to individuals at high risk. Current risk stratification tools have only modest prognostic capabilities, resulting in over-treatment of low-risk individuals and under-treatment of high-risk individuals. Improved methods of CVD risk stratification are required. Molecular imaging offers a novel approach to CVD risk stratification. In particular, 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) has shown promise in the detection of both high-risk atherosclerotic plaque features and vascular calcification activity, which predicts future development of new vascular calcium deposits. The rate of change of coronary calcium scores, measured by serial computed tomography scans over a 2-year period, is a strong predictor of CVD risk. Vascular calcification activity, as measured with 18F-NaF PET, has the potential to provide prognostic information similar to consecutive coronary calcium scoring, with a single-time-point convenience. However, owing to the rapid motion and small size of the coronary arteries, new solutions are required to address the traditional limitations of PET imaging. Two different methods of coronary PET analysis have been independently proposed and here we compare their respective strengths, weaknesses, and the potential for clinical translation.
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Affiliation(s)
- Jamie W Bellinge
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia.
- School of Medicine, University of Western Australia, Perth, Australia.
| | - Roslyn J Francis
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Gerald F Watts
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Carl J Schultz
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
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Imaging in Clinical Research: Synergy Not Surrogacy. J Am Soc Echocardiogr 2018; 31:A17-A18. [PMID: 30176996 DOI: 10.1016/j.echo.2018.07.004] [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: 11/21/2022]
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110
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Comparison between visual and numerical metrics for the evaluation of patients with Takayasu arteritis with 18F-FDG-PET. Nucl Med Commun 2018; 39:779-788. [DOI: 10.1097/mnm.0000000000000867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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111
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van der Laan SW, Harshfield EL, Hemerich D, Stacey D, Wood AM, Asselbergs FW. From lipid locus to drug target through human genomics. Cardiovasc Res 2018; 114:1258-1270. [PMID: 29800275 DOI: 10.1093/cvr/cvy120] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/16/2018] [Indexed: 12/14/2022] Open
Abstract
In the last decade, over 175 genetic loci have robustly been associated to levels of major circulating blood lipids. Most loci are specific to one or two lipids, whereas some (SUGP1, ZPR1, TRIB1, HERPUD1, and FADS1) are associated to all. While exposing the polygenic architecture of circulating lipids and the underpinnings of dyslipidaemia, these genome-wide association studies (GWAS) have provided further evidence of the critical role that lipids play in coronary heart disease (CHD) risk, as indicated by the 2.7-fold enrichment for macrophage gene expression in atherosclerotic plaques and the association of 25 loci (such as PCSK9, APOB, ABCG5-G8, KCNK5, LPL, HMGCR, NPC1L1, CETP, TRIB1, ABO, PMAIP1-MC4R, and LDLR) with CHD. These GWAS also confirmed known and commonly used therapeutic targets, including HMGCR (statins), PCSK9 (antibodies), and NPC1L1 (ezetimibe). As we head into the post-GWAS era, we offer suggestions for how to move forward beyond genetic risk loci, towards refining the biology behind the associations and identifying causal genes and therapeutic targets. Deep phenotyping through lipidomics and metabolomics will refine and increase the resolution to find causal and druggable targets, and studies aimed at demonstrating gene transcriptional and regulatory effects of lipid associated loci will further aid in identifying these targets. Thus, we argue the need for deeply phenotyped, large genetic association studies to reduce costs and failures and increase the efficiency of the drug discovery pipeline. We conjecture that in the next decade a paradigm shift will tip the balance towards a data-driven approach to therapeutic target development and the application of precision medicine where human genomics takes centre stage.
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Affiliation(s)
- Sander W van der Laan
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Eric L Harshfield
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts Causeway, Cambridge CB1 8RN, UK
- Department of Clinical Neurosciences, University of Cambridge, R3, Box 83, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Daiane Hemerich
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
- CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - David Stacey
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, the Netherlands
- Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, UK
- Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, UK
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Choo EH, Han EJ, Kim CJ, Kim SH, O JH, Chang K, Seung KB. Effect of Pioglitazone in Combination with Moderate Dose Statin on Atherosclerotic Inflammation: Randomized Controlled Clinical Trial Using Serial FDG-PET/CT. Korean Circ J 2018; 48:591-601. [PMID: 29968431 PMCID: PMC6031718 DOI: 10.4070/kcj.2017.0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 02/18/2018] [Accepted: 03/14/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Non-statin therapy plus lower intensity statin might be an alternative in patients with coronary artery disease (CAD). A recent data suggested an anti-inflammatory therapy can reduce recurrent cardiovascular events and pioglitazone is also an intriguing inflammatory-modulating agent. However, limited data exist on whether pioglitazone on top of statins further attenuates plaque inflammation. METHODS Statin-naïve patients with stable CAD and carotid plaques of ≥3 mm were randomly prescribed moderate dose atorvastatin (20 mg/day), or moderate dose atorvastatin plus pioglitazone (30 mg/day) for 3 months. The primary endpoint was the change in the arterial inflammation of the carotid artery measured by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) during 3 months. RESULTS Of the 41 randomized patients, 33 underwent an evaluation by fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT; 17 atorvastatin plus pioglitazone and 16 atorvastatin patients). The addition of pioglitazone significantly improved the insulin sensitivity and increased the high-density lipoprotein cholesterol after 3 months. Although a reduction in the (FDG) uptake by pioglitazone on top of atorvastatin in carotid arteries with plaque showed marginally statistical significance in the entire patient group (atorvastatin plus pioglitazone; -0.10±0.07 and atorvastatin -0.06±0.04, p=0.058), pioglitazone showed a further reduction of the fluorodeoxyglucose (FDG) uptake among patients who had a baseline FDG uptake above the median (atorvastatin plus pioglitazone; -0.14±0.04 and atorvastatin -0.03±0.03, p<0.001). CONCLUSIONS Pioglitazone demonstrated marginally significant anti-inflammatory effects in addition to moderate dose atorvastatin. This may have been due to the lack of power of the study. However, pioglitazone may have an anti-inflammatory effect in those patients with high plaque inflammation (Trial registry at ClinicalTrials.gov, NCT01341730).
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Affiliation(s)
- Eun Ho Choo
- Department of Cardiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Eun Ji Han
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chan Joon Kim
- Department of Cardiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joo Hyun O
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kiyuk Chang
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki Bae Seung
- Department of Cardiology, The Catholic University of Korea College of Medicine, Seoul, Korea.
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113
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Affiliation(s)
- Ying Wang
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael T Osborne
- Department of Radiology, Massachusetts General Hospital, Boston, MA.,Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Brian Tung
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Ming Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yaming Li
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning, China
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114
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Nicholls SJ. CETP-Inhibition and HDL-Cholesterol: A Story of CV Risk or CV Benefit, or Both. Clin Pharmacol Ther 2018; 104:297-300. [PMID: 29901215 DOI: 10.1002/cpt.1118] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/06/2022]
Abstract
Inhibitors of cholesteryl ester transfer protein (CETP) were developed due to their ability to raise HDL-C levels. Preclinical studies demonstrated favorable effects on atherosclerotic plaque with CETP inhibitory approaches in animal models. While these agents raise HDL-C and lower LDL-C, most have not proven to reduce cardiovascular event rates in large outcome trials. The state of opinion after all of these clinical trials is reviewed.
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Affiliation(s)
- Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Australia
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115
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Yoon HE, Kim Y, Kim SD, Oh JK, Chung YA, Shin SJ, Yang CW, Seo SM. A Pilot Trial to Examine the Changes in Carotid Arterial Inflammation in Renal Transplant Recipients as Assessed by 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography Computed Tomography (PET/CT). Ann Transplant 2018; 23:412-421. [PMID: 29904040 PMCID: PMC6248031 DOI: 10.12659/aot.909212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Inflammatory activity of the artery can be assessed by measuring 18F-fluorodeoxyglucose (18F-FDG) uptake with positron emission tomography computed tomography (PET/CT). Improvement in vascular function after renal transplantation has been reported, but no studies have used 18F-FDG PET/CT to examine the changes in vascular inflammation. This study investigated the changes in the inflammatory activity in the carotid artery after renal transplantation in patients with chronic kidney disease (CKD). MATERIAL AND METHODS 18F-FDG PET/CT was performed before and at 4 months after transplantation. We quantified 18F-FDG uptake as the target-to-background ratio (TBR) in the carotid artery in 10 CKD patients. TBR was evaluated in the whole carotid artery (WH) and most-diseased segment (MDS), and the mean and maximum values were analyzed. The concentrations of inflammatory cytokines, including tumor necrosis factor-alpha, interleukin-6, plasminogen activator inhibitor-1, and endothelin-1, were measured. RESULTS Eight patients showed a decrease in mean or maximum TBR. The average mean or maximum TBRs in the WH and MDS of the right and left arteries were all reduced after transplantation. The average mean TBR for the right WH decreased significantly (% reduction [95% CI]) by -5.74% [-15.37, -0.02] (p=0.047). TBRs did not correlate significantly with cytokine concentrations. The changes in cytokine concentrations after transplantation varied. CONCLUSIONS 18F-FDG uptake by the WH and MDS tended to reduce after renal transplantation. Therefore, renal transplantation may confer an anti-inflammatory effect on carotid atherosclerosis in patients with CKD; however, this effect is not large enough to be demonstrated in this study with small sample size.
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Affiliation(s)
- Hye Eun Yoon
- Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, South Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yaeni Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, South Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Dong Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Jin Kyoung Oh
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Yong-An Chung
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Seok Joon Shin
- Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, South Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea; , , South Korea
| | - Suk Min Seo
- Cardiovascular Center and Cardiology Division, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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116
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Gazing into smoldering volcanoes: precision cardiac imaging. Future Sci OA 2018; 4:FSO294. [PMID: 29796298 PMCID: PMC5961440 DOI: 10.4155/fsoa-2018-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 11/17/2022] Open
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117
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Moccetti F, Weinkauf CC, Davidson BP, Belcik JT, Marinelli ER, Unger E, Lindner JR. Ultrasound Molecular Imaging of Atherosclerosis Using Small-Peptide Targeting Ligands Against Endothelial Markers of Inflammation and Oxidative Stress. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1155-1163. [PMID: 29548756 DOI: 10.1016/j.ultrasmedbio.2018.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to evaluate a panel of endothelium-targeted microbubble (MB) ultrasound contrast agents bearing small peptide ligands as a human-ready approach for molecular imaging of markers of high-risk atherosclerotic plaque. Small peptide ligands with established affinity for human P-selectin, VCAM-1, LOX-1 and von Willebrand factor (VWF) were conjugated to the surface of lipid-stabilized MBs. Contrast-enhanced ultrasound (CEUS) molecular imaging of the thoracic aorta was performed in wild-type and gene-targeted mice with advanced atherosclerosis (DKO). Histology was performed on carotid endarterectomy samples from patients undergoing surgery for unstable atherosclerosis to assess target expression in humans. In DKO mice, CEUS signal for all four targeted MBs was significantly higher than that for control MBs, and was three to sevenfold higher than in wild-type mice, with the highest signal achieved for VCAM-1 and VWF. All molecular targets were present on the patient plaque surface but expression was greatest for VCAM-1 and VWF. We conclude that ultrasound contrast agents bearing small peptide ligands feasible for human use can be targeted against endothelial cell adhesion molecules for inflammatory cells and platelets for imaging advanced atherosclerotic disease.
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Affiliation(s)
- Federico Moccetti
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Craig C Weinkauf
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Brian P Davidson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA; Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - J Todd Belcik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA; Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA.
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118
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Morton J, Bao S, Vanags LZ, Tsatralis T, Ridiandries A, Siu CW, Ng KM, Tan JTM, Celermajer DS, Ng MKC, Bursill CA. Strikingly Different Atheroprotective Effects of Apolipoprotein A-I in Early- Versus Late-Stage Atherosclerosis. ACTA ACUST UNITED AC 2018; 3:187-199. [PMID: 30062204 PMCID: PMC6059906 DOI: 10.1016/j.jacbts.2017.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 01/23/2023]
Abstract
The atheroprotective effects of apoA-I are dependent on the plaque stage from which apoA-I is infused. The atheroprotective effects of apoA-I infusions are also impaired in older mice with a greater disease milieu. Ex vivo studies with mouse HDL found an impairment in HDL functionality with increasing disease/age of the mice as well as a reduced ability of apoA-I infusions to improve the atheroprotective functions of HDL. Our study provides understanding regarding the disparity between the very positive results of HDL/apoA-I raising in preclinical studies, largely performed in younger animals with early-stage disease, and the large-scale HDL-raising clinical trials in more elderly patients with established plaque that have failed to show benefit.
Preclinical studies have shown benefit of apolipoprotein A-I (apoA-I)/high-density lipoprotein (HDL) raising in atherosclerosis; however, this has not yet translated into a successful clinical therapy. Our studies demonstrate that apoA-I raising is more effective at reducing early-stage atherosclerosis than late-stage disease, indicating that the timing of HDL raising is a critical factor in its atheroprotective effects. To date, HDL-raising clinical trials have only been performed in aged patients with advanced atherosclerotic disease. Our findings therefore provide insight, related to important temporal aspects of HDL raising, as to why the clinical trials have thus far been largely neutral.
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Key Words
- Bcl-xL, B-cell lymphoma-extra large
- HCAEC, human coronary artery endothelial cell
- HDL, high-density lipoprotein
- HFD, high-fat diet
- LDL, low-density lipoprotein
- LVApoAI, lentivirus overexpressing apolipoprotein A-I
- LVGFP, lentivirus overexpressing green fluorescence protein
- MCP, monocyte chemoattractant protein
- SAA, serum amyloid amylase
- SMC, smooth muscle cell
- SNP, single-nucleotide polymorphism
- TNF, tumor necrosis factor
- VCAM, vascular cell adhesion molecule
- apoA-I, apolipoprotein A-I
- apoE−/−, apolipoprotein E deficient
- atherosclerosis
- cholesterol
- high-density lipoproteins
- micro-CT, micro-computed tomography
- rHDL, reconstituted high-density lipoprotein
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Affiliation(s)
- Jamie Morton
- Immunobiology Group, The Heart Research Institute, Sydney, Australia.,Department of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Shisan Bao
- Discipline of Pathology, University of Sydney, Sydney, Australia
| | - Laura Z Vanags
- Immunobiology Group, The Heart Research Institute, Sydney, Australia.,Department of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Tania Tsatralis
- Immunobiology Group, The Heart Research Institute, Sydney, Australia
| | - Anisyah Ridiandries
- Immunobiology Group, The Heart Research Institute, Sydney, Australia.,Department of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Kwong-Man Ng
- Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Joanne T M Tan
- Immunobiology Group, The Heart Research Institute, Sydney, Australia.,Department of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David S Celermajer
- Immunobiology Group, The Heart Research Institute, Sydney, Australia.,Department of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Martin K C Ng
- Immunobiology Group, The Heart Research Institute, Sydney, Australia.,Department of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christina A Bursill
- Immunobiology Group, The Heart Research Institute, Sydney, Australia.,Department of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
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119
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Barter PJ, Rye KA. Cholesteryl Ester Transfer Protein Inhibitors as Agents to Reduce Coronary Heart Disease Risk. Cardiol Clin 2018; 36:299-310. [DOI: 10.1016/j.ccl.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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120
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Andrews JPM, Fayad ZA, Dweck MR. New methods to image unstable atherosclerotic plaques. Atherosclerosis 2018; 272:118-128. [PMID: 29602139 PMCID: PMC6463488 DOI: 10.1016/j.atherosclerosis.2018.03.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 12/11/2022]
Abstract
Atherosclerotic plaque rupture is the primary mechanism responsible for myocardial infarction and stroke, the top two killers worldwide. Despite being potentially fatal, the ubiquitous prevalence of atherosclerosis amongst the middle aged and elderly renders individual events relatively rare. This makes the accurate prediction of MI and stroke challenging. Advances in imaging techniques now allow detailed assessments of plaque morphology and disease activity. Both CT and MR can identify certain unstable plaque characteristics thought to be associated with an increased risk of rupture and events. PET imaging allows the activity of distinct pathological processes associated with atherosclerosis to be measured, differentiating patients with inactive and active disease states. Hybrid integration of PET with CT or MR now allows for an accurate assessment of not only plaque burden and morphology but plaque biology too. In this review, we discuss how these advanced imaging techniques hold promise in redefining our understanding of stable and unstable coronary artery disease beyond symptomatic status, and how they may refine patient risk-prediction and the rationing of expensive novel therapies.
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Affiliation(s)
- Jack P M Andrews
- Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, Edinburgh EH16 4SB, UK
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, Edinburgh EH16 4SB, UK
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121
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Profiling of dalcetrapib metabolites in human plasma by accelerator mass spectrometry and investigation of the free phenothiol by derivatisation with methylacrylate. J Pharm Biomed Anal 2018; 152:143-154. [DOI: 10.1016/j.jpba.2018.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/17/2022]
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122
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Parasrampuria DA, Benet LZ, Sharma A. Why Drugs Fail in Late Stages of Development: Case Study Analyses from the Last Decade and Recommendations. AAPS JOURNAL 2018. [PMID: 29536211 DOI: 10.1208/s12248-018-0204-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
New drug development is both resource and time intensive, where later clinical stages result in significant costs. We analyze recent late-stage failures to identify drugs where failures result from inadequate scientific advances as well as drugs where we believe pitfalls could have been avoided. These can be broadly classified into two categories: 1) where science is mature and the failures can be avoided through rigorous and prospectively determined decision-making criteria, scientific curiosity, and discipline to follow up on emerging findings; and 2) where problems encountered in Phase 3 failures cannot be explained at this time, as the science is not sufficiently advanced and companies/investigators need to recognize the possibility of deficiency of our knowledge. Through these case studies, key themes critical for successful drug development emerge-understanding the therapeutic pathway including receptor and signaling biology, pharmacological responses related to safety and efficacy, pharmacokinetics of the drug and exposure at target site, optimum dose, and dosing regimen; and identification of patient sub-populations likely to respond and will have a favorable benefit-risk profile, design of clinical trials, and a quantitative framework that can guide data-driven decision making. It is essential that the right studies are conducted early in the development process to answer the key questions, with the emphasis on learning in the early stages of development, whereas Phase 3 should be reserved for confirming the safety and efficacy. Utilization of innovative technology in identifying patients based on molecular signature of their disease, rapid assessment of pharmacological response, mechanistic modeling of emerging data, seamless operational processes to reduce start-up and wind-down time for clinical trials through use of electronic health records and data mining, and development of novel and objective clinical efficacy endpoints are some concepts for improving the success rate.
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Affiliation(s)
- Dolly A Parasrampuria
- Global Clinical Pharmacology, Janssen R&D, 1400 McKean Road, Spring House, PA, 19477, United States of America
| | - Leslie Z Benet
- Department of Bioengineering & Therapeutic Sciences, Schools of Pharmacy & Medicine University of California San Francisco (UCSF), 533 Parnassus Avenue, Room U-68, San Francisco, CA, 94143-0912, United States of America
| | - Amarnath Sharma
- Global Clinical Pharmacology, Janssen R&D, 1400 McKean Road, Spring House, PA, 19477, United States of America.
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123
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Moss AJ, Adamson PD, Newby DE, Dweck MR. Positron emission tomography imaging of coronary atherosclerosis. Future Cardiol 2018; 12:483-96. [PMID: 27322032 PMCID: PMC4926532 DOI: 10.2217/fca-2016-0017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Inflammation has a central role in the progression of coronary atherosclerosis. Recent developments in cardiovascular imaging with the advent of hybrid positron emission tomography have provided a window into the molecular pathophysiology underlying coronary plaque inflammation. Using novel radiotracers targeted at specific cellular pathways, the potential exists to observe inflammation, apoptosis, cellular hypoxia, microcalcification and angiogenesis in vivo. Several clinical studies are now underway assessing the ability of this hybrid imaging modality to inform about atherosclerotic disease activity and the prediction of future cardiovascular risk. A better understanding of the molecular mechanisms governing coronary atherosclerosis may be the first step toward offering patients a more stratified, personalized approach to treatment.
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Affiliation(s)
- Alastair J Moss
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Philip D Adamson
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.,Translation Molecular Imaging Institute, Icahn School of Medicine at Mount-Sinai, NY, USA
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124
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Arterial inflammation measured by 18F-FDG-PET-CT to predict coronary events in older subjects. Atherosclerosis 2018; 268:49-54. [DOI: 10.1016/j.atherosclerosis.2017.11.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022]
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125
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Harrison SC, Holmes MV, Burgess S, Asselbergs FW, Jones GT, Baas AF, van ’t Hof FN, de Bakker PIW, Blankensteijn JD, Powell JT, Saratzis A, de Borst GJ, Swerdlow DI, van der Graaf Y, van Rij AM, Carey DJ, Elmore JR, Tromp G, Kuivaniemi H, Sayers RD, Samani NJ, Bown MJ, Humphries SE. Genetic Association of Lipids and Lipid Drug Targets With Abdominal Aortic Aneurysm: A Meta-analysis. JAMA Cardiol 2018; 3:26-33. [PMID: 29188294 PMCID: PMC5833524 DOI: 10.1001/jamacardio.2017.4293] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 09/26/2017] [Indexed: 01/24/2023]
Abstract
Importance Risk factors for abdominal aortic aneurysm (AAA) are largely unknown, which has hampered the development of nonsurgical treatments to alter the natural history of disease. Objective To investigate the association between lipid-associated single-nucleotide polymorphisms (SNPs) and AAA risk. Design, Setting, and Participants Genetic risk scores, composed of lipid trait-associated SNPs, were constructed and tested for their association with AAA using conventional (inverse-variance weighted) mendelian randomization (MR) and data from international AAA genome-wide association studies. Sensitivity analyses to account for potential genetic pleiotropy included MR-Egger and weighted median MR, and multivariable MR method was used to test the independent association of lipids with AAA risk. The association between AAA and SNPs in loci that can act as proxies for drug targets was also assessed. Data collection took place between January 9, 2015, and January 4, 2016. Data analysis was conducted between January 4, 2015, and December 31, 2016. Exposures Genetic elevation of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Main Outcomes and Measures The association between genetic risk scores of lipid-associated SNPs and AAA risk, as well as the association between SNPs in lipid drug targets (HMGCR, CETP, and PCSK9) and AAA risk. Results Up to 4914 cases and 48 002 controls were included in our analysis. A 1-SD genetic elevation of LDL-C was associated with increased AAA risk (odds ratio [OR], 1.66; 95% CI, 1.41-1.96; P = 1.1 × 10-9). For HDL-C, a 1-SD increase was associated with reduced AAA risk (OR, 0.67; 95% CI, 0.55-0.82; P = 8.3 × 10-5), whereas a 1-SD increase in triglycerides was associated with increased AAA risk (OR, 1.69; 95% CI, 1.38-2.07; P = 5.2 × 10-7). In multivariable MR analysis and both MR-Egger and weighted median MR methods, the association of each lipid fraction with AAA risk remained largely unchanged. The LDL-C-reducing allele of rs12916 in HMGCR was associated with AAA risk (OR, 0.93; 95% CI, 0.89-0.98; P = .009). The HDL-C-raising allele of rs3764261 in CETP was associated with lower AAA risk (OR, 0.89; 95% CI, 0.85-0.94; P = 3.7 × 10-7). Finally, the LDL-C-lowering allele of rs11206510 in PCSK9 was weakly associated with a lower AAA risk (OR, 0.94; 95% CI, 0.88-1.00; P = .04), but a second independent LDL-C-lowering variant in PCSK9 (rs2479409) was not associated with AAA risk (OR, 0.97; 95% CI, 0.92-1.02; P = .28). Conclusions and Relevance The MR analyses in this study lend support to the hypothesis that lipids play an important role in the etiology of AAA. Analyses of individual genetic variants used as proxies for drug targets support LDL-C lowering as a potential effective treatment strategy for preventing and managing AAA.
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Affiliation(s)
- Seamus C. Harrison
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge, England
- Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Michael V. Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, England
| | - Stephen Burgess
- Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, England
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, England
| | - Folkert W. Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Genetics, Centre for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
- Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, England
| | - Gregory T. Jones
- Department of Surgery, University of Otago, Dunedin, New Zealand
| | - Annette F. Baas
- Department of Medical Genetics, Centre for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F. N. van ’t Hof
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul I. W. de Bakker
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Genetics, Centre for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Janet T. Powell
- Vascular Surgery Research Group, Imperial College Charing Cross Hospital, London, England
| | - Athanasios Saratzis
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, England
| | - Gert J. de Borst
- Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel I. Swerdlow
- Institute of Cardiovascular Science, University College London, London, England
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, England
| | - Yolanda van der Graaf
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Andre M. van Rij
- Department of Surgery, University of Otago, Dunedin, New Zealand
| | - David J. Carey
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania
| | - James R. Elmore
- Department of Vascular and Endovascular Surgery, Geisinger Health System, Danville, Pennsylvania
| | - Gerard Tromp
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Helena Kuivaniemi
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Robert D. Sayers
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, England
| | - Nilesh J. Samani
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, England
| | - Matthew J. Bown
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, England
| | - Steve E. Humphries
- Department of Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, England
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Present therapeutic role of cholesteryl ester transfer protein inhibitors. Pharmacol Res 2017; 128:29-41. [PMID: 29287689 DOI: 10.1016/j.phrs.2017.12.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/24/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022]
Abstract
Therapeutic interventions aimed at increasing high-density lipoprotein (HDL) levels in order to reduce the residual cardiovascular (CV) risk of optimally drug treated patients have not provided convincing results, so far. Transfer of cholesterol from extrahepatic tissues to the liver appears to be the major atheroprotective function of HDL, and an elevation of HDL levels could represent an effective strategy. Inhibition of the cholesteryl ester transfer protein (CETP), raising HDL-cholesterol (HDL-C) and apolipoprotein A-I (apoA-I) levels, reduces low-density lipoprotein-cholesterol (LDL-C) and apoB levels, thus offering a promising approach. Despite the beneficial influence on cholesterol metabolism, off-target effects and lack of reduction in CV events and mortality (with torcetrapib, dalcetrapib and evacetrapib) highlighted the complex mechanism of CETP inhibition. After the failure of the above mentioned inhibitors in phase III clinical development, possibly due to the short duration of the trials masking benefit, the secondary prevention REVEAL trial has recently shown that the inhibitor anacetrapib significantly raised HDL-C (+104%), reduced LDL-C (-18%), with a protective effect on major coronary events (RR, 0.91; 95%CI, 0.85-0.97; p = 0.004). Whether LDL-C lowering fully accounts for the CV benefit or if HDL-C-rise is a crucial factor still needs to be determined, although the reduction of non-HDL (-18%) and Lp(a) (-25%), should be also taken into account. In spite of the positive results of the REVEAL Study, Merck decided not to proceed in asking regulatory approval for anacetrapib. Dalcetrapib (Dal-GenE study) and CKD-519 remain the two molecules within this area still in clinical development.
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Abstract
Cholesteryl ester transfer protein (CETP) facilitates movement of esterified cholesterol between high-density lipoproteins (HDLs) and apolipoprotein B-containing lipoproteins. By virtue of their ability to raise HDL cholesterol and lower low-density lipoprotein cholesterol, pharmacological inhibitors of CETP have received considerable attention as potential new agents in cardiovascular prevention. While early studies of CETP inhibitors have demonstrated a lack of clinical efficacy and potential toxicity, development of the potent CETP inhibitor, anacetrapib, has moved forward, with emerging evidence suggesting a role in reducing cardiovascular events. The experience with anacetrapib and its potential for use in clinical practice are reviewed here.
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Affiliation(s)
- Belinda A Di Bartolo
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia
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Pérez-Medina C, Hak S, Reiner T, Fayad ZA, Nahrendorf M, Mulder WJM. Integrating nanomedicine and imaging. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2017; 375:rsta.2017.0110. [PMID: 29038380 PMCID: PMC5647268 DOI: 10.1098/rsta.2017.0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 05/05/2023]
Abstract
Biomedical engineering and its associated disciplines play a pivotal role in improving our understanding and management of disease. Motivated by past accomplishments, such as the clinical implementation of coronary stents, pacemakers or recent developments in antibody therapies, disease management now enters a new era in which precision imaging and nanotechnology-enabled therapeutics are maturing to clinical translation. Preclinical molecular imaging increasingly focuses on specific components of the immune system that drive disease progression and complications, allowing the in vivo study of potential therapeutic targets. The first multicentre trials highlight the potential of clinical multimodality imaging for more efficient drug development. In this perspective, the role of integrating engineering, nanotechnology, molecular imaging and immunology to yield precision medicine is discussed.This article is part of the themed issue 'Challenges for chemistry in molecular imaging'.
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Affiliation(s)
- Carlos Pérez-Medina
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Translational and Molecular Imaging Institute, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
| | - Sjoerd Hak
- Department of Circulation and Medical Imaging, The Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
- Department of Radiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Zahi A Fayad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Translational and Molecular Imaging Institute, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
| | - Matthias Nahrendorf
- Center for Systems Biology and Department of Imaging, Simches Research Building, 185 Cambridge Street, Boston, MA 02114, USA
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, MA 02114, USA
| | - Willem J M Mulder
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Translational and Molecular Imaging Institute, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
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Ahlman MA, Vigneault DM, Sandfort V, Maass-Moreno R, Dave J, Sadek A, Mallek MB, Selwaness MAF, Herscovitch P, Mehta NN, Bluemke DA. Internal tissue references for 18Fluorodeoxyglucose vascular inflammation imaging: Implications for cardiovascular risk stratification and clinical trials. PLoS One 2017; 12:e0187995. [PMID: 29131857 PMCID: PMC5683610 DOI: 10.1371/journal.pone.0187995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/30/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction 18Fluorodeoxyglucose (FDG) positron emission tomography (PET) uptake in the artery wall correlates with active inflammation. However, in part due to the low spatial resolution of PET, variation in the apparent arterial wall signal may be influenced by variation in blood FDG activity that cannot be fully corrected for using typical normalization strategies. The purpose of this study was to evaluate the ability of the current common methods to normalize for blood activity and to investigate alternative methods for more accurate quantification of vascular inflammation. Materials and methods The relationship between maximum FDG aorta wall activity and mean blood activity was evaluated in 37 prospectively enrolled subjects aged 55 years or more, treated for hyperlipidemia. Target maximum aorta standardized uptake value (SUV) and mean background reference tissue activity (blood, spleen, liver) were recorded. Target-to-background ratios (TBR) and arterial maximum activity minus blood activity were calculated. Multivariable regression was conducted, predicting uptake values based on variation in background reference and target tissue FDG uptake; adjusting for gender, age, lean body mass (LBM), blood glucose, blood pool activity, and glomerular filtration rate (GFR), where appropriate. Results Blood pool activity was positively associated with maximum artery wall SUV (β = 5.61, P<0.0001) as well as mean liver (β = 6.23, P<0.0001) and spleen SUV (β = 5.20, P<0.0001). Artery wall activity divided by blood activity (TBRBlood) or subtraction of blood activity did not remove the statistically significant relationship to blood activity. Blood pool activity was not related to TBRliver and TBRspleen (β = −0.36, P = NS and β = −0.58, P = NS, respectively) Conclusions In otherwise healthy individuals treated for hyperlipidemia, blood FDG activity is associated with artery wall activity. However, variation in blood activity may mask artery wall signal reflective of inflammation, which requires normalization. Blood-based TBR and subtraction do not sufficiently adjust for blood activity. Warranting further investigation, background reference tissues with cellular uptake such as the liver and spleen may better adjust for variation in blood activity to improve assessment of vascular activity.
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Affiliation(s)
- Mark A. Ahlman
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States of America
- * E-mail:
| | - Davis M. Vigneault
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States of America
- Institute of Biomedical Engineering, Department of Engineering, University of Oxford, Oxford, United Kingdom
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, United States of America
| | - Veit Sandfort
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States of America
| | - Roberto Maass-Moreno
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States of America
| | - Jenny Dave
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ahmed Sadek
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Marissa B. Mallek
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States of America
| | - Mariana A. F. Selwaness
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States of America
| | - Peter Herscovitch
- PET Research Department, National Institutes of Health, Bethesda, MD, United States of America
| | - Nehal N. Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States of America
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130
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Lurins J, Lurina D, Tretjakovs P, Mackevics V, Lejnieks A, Rapisarda V, Baylon V. Increased serum chemerin level to predict early onset of aortic valve stenosis. Biomed Rep 2017; 8:31-36. [PMID: 29387388 PMCID: PMC5768061 DOI: 10.3892/br.2017.1010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 11/29/2022] Open
Abstract
Inflammation appears to be the cause of aortic valve (AoV) stenosis and identification of predictive biomarkers is therefore imperative. The aim of the current study was to evaluate the potential role of serum chemerin and fibroblast growth factor-21 (FGF-21) in the pathogenesis of the disease. A total of 102 patients were selected based on certain criteria and divided into an aortic stenosis group and a control group. Patients with AoV stenosis were subdivided into three groups depending on the severity according to the echocardiography criteria: Aortic jet velocity, Vmax (m/sec); mean pressure gradient, PG (mmHg); aortic valve area (AVA), cm2; and indexed AVA, cm2/m2. Patients were graded as: Severe: Vmax >4 m/sec, PG >40 mmHg, AVA <1.0 cm2, indexed AVA <0.6; moderate: Vmax 3.0–4.0 m/sec, PG 20–40 mmHg, AVA 1.0–1.5 cm2, indexed AVA 0.60–0.85; mild: Vmax 2.5–2.9 m/sec, PG <20 mmHg, AVA >1.5 cm2, indexed AVA >0.85. ELISA was used for the detection of chemerin and FGF-21. Post-hoc analysis with Tukey's correction was performed. The highest chemerin levels were found in mild and moderate AoV stenosis and decreased along with the grade of severity, compared with the control group. The FGF-21 level was increased in all the stenosis groups, reaching the highest level at severe stenosis. Receiver-operating characteristic analysis of chemerin in all the AoV stenosis groups without grading the severity included, area under the curve (AUC)=0.76; 0.70–0.80= fair; P<0.001 and for mild AoV stenosis was AUC=0.82; 0.80–0.90= good; P<0.001. In conclusion, chemerin is a good diagnostic biomarker for mild AoV stenosis, while FGF-21 is a moderate diagnostic marker.
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Affiliation(s)
- Juris Lurins
- Department of Doctoral Studies, Riga Stradins University, Riga, LV 1007, Latvia
| | - Dace Lurina
- Zemgale Health Centre, Jelgava, LV 3001, Latvia
| | - Peteris Tretjakovs
- Faculty of Medicine, Department of Human Physiology and Biochemistry, Riga Stradins University, Riga, LV 1007, Latvia
| | - Vitolds Mackevics
- Faculty of Medicine, Department of Internal Diseases, Riga Stradins University, Riga, LV 1002, Latvia
| | - Aivars Lejnieks
- Faculty of Medicine, Department of Internal Diseases, Riga Stradins University, Riga, LV 1002, Latvia
| | - Venerando Rapisarda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University Hospital 'Policlinico-Vittorio Emanuele', University of Catania, I-95123 Catania, Italy
| | - Vincenzo Baylon
- Newton Lewis Institute-ISR - Life Science Park, San Gwann 3000, Malta
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131
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Zupančič E, Fayad ZA, Mulder WJM. Cardiovascular Immunotherapy and the Role of Imaging. Arterioscler Thromb Vasc Biol 2017; 37:e167-e171. [PMID: 29070539 PMCID: PMC5743324 DOI: 10.1161/atvbaha.117.309227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Eva Zupančič
- From the Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (E.Z., Z.A.F., W.J.M.M.); and Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands (W.J.M.M.)
| | - Zahi A Fayad
- From the Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (E.Z., Z.A.F., W.J.M.M.); and Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands (W.J.M.M.)
| | - Willem J M Mulder
- From the Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (E.Z., Z.A.F., W.J.M.M.); and Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands (W.J.M.M.).
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132
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Evans NR, Tarkin JM, Buscombe JR, Markus HS, Rudd JHF, Warburton EA. PET imaging of the neurovascular interface in cerebrovascular disease. Nat Rev Neurol 2017; 13:676-688. [PMID: 28984315 DOI: 10.1038/nrneurol.2017.129] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cerebrovascular disease encompasses a range of pathologies that affect different components of the cerebral vasculature and brain parenchyma. Large artery atherosclerosis, acute cerebral ischaemia, and intracerebral small vessel disease all demonstrate altered metabolic processes that are key to their pathogenesis. Although structural imaging techniques such as MRI are the mainstay of clinical care and research in cerebrovascular disease, they have limited ability to detect these pathophysiological processes in vivo. By contrast, PET can detect and quantify metabolic processes that are relevant to each facet of cerebrovascular disease. Information obtained from PET studies has helped to shape the understanding of key concepts in cerebrovascular medicine, including vulnerable atherosclerotic plaque, salvageable ischaemic penumbra, neuroinflammation and selective neuronal loss after ischaemic insult. PET has also helped to elucidate the relationships between chronic hypoxia, neuroinflammation, and amyloid-β deposition in cerebral small vessel disease. This Review describes how PET-based imaging of metabolic processes at the neurovascular interface has contributed to our understanding of cerebrovascular disease.
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Affiliation(s)
- Nicholas R Evans
- Department of Clinical Neurosciences, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - John R Buscombe
- Department of Nuclear Medicine, Box 219, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Elizabeth A Warburton
- Department of Clinical Neurosciences, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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133
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Wang X, Hao L, Xu X, Li W, Liu C, Zhao D, Cheng M. Design, Synthesis and Biological Evaluation of N,N-Substituted Amine Derivatives as Cholesteryl Ester Transfer Protein Inhibitors. Molecules 2017; 22:molecules22101658. [PMID: 28972557 PMCID: PMC6151529 DOI: 10.3390/molecules22101658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 11/16/2022] Open
Abstract
N,N-Substituted amine derivatives were designed by utilizing a bioisosterism strategy. Consequently, twenty-two compounds were synthesized and evaluated for their inhibitory activity against CETP. Structure-activity relationship (SAR) studies indicate that hydrophilic groups at the 2-position of the tetrazole and 3,5-bistrifluoromethyl groups on the benzene ring provide important contributions to the potency. Among these compounds, compound 17 exhibited excellent CETP inhibitory activity (IC50 = 0.38 ± 0.08 μM) in vitro. Furthermore, compound 17 was selected for an in vitro metabolic stability study.
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Affiliation(s)
- Xinran Wang
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China.
| | - Lijuan Hao
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China.
| | - Xuanqi Xu
- Department of Chemistry, University of Wisconsin-Madison, Madison, WI, 53715, USA.
| | - Wei Li
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China.
| | - Chunchi Liu
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China.
| | - Dongmei Zhao
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China.
| | - Maosheng Cheng
- Key Laboratory of Structure-Based Drug Design & Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, China.
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134
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Teague HL, Ahlman MA, Alavi A, Wagner DD, Lichtman AH, Nahrendorf M, Swirski FK, Nestle F, Gelfand JM, Kaplan MJ, Grinspoon S, Ridker PM, Newby DE, Tawakol A, Fayad ZA, Mehta NN. Unraveling Vascular Inflammation: From Immunology to Imaging. J Am Coll Cardiol 2017; 70:1403-1412. [PMID: 28882238 DOI: 10.1016/j.jacc.2017.07.750] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/17/2022]
Abstract
Inflammation is a critical factor in early atherosclerosis and its progression to myocardial infarction. The search for valid surrogate markers of arterial vascular inflammation led to the increasing use of positron emission tomography/computed tomography. Indeed, vascular inflammation is associated with future risk for myocardial infarction and can be modulated with short-term therapies, such as statins, that mitigate cardiovascular risk. However, to better understand vascular inflammation and its mechanisms, a panel was recently convened of world experts in immunology, human translational research, and positron emission tomographic vascular imaging. This contemporary review first strives to understand the diverse roles of immune cells implicated in atherogenesis. Next, the authors describe human chronic inflammatory disease models that can help elucidate the pathophysiology of vascular inflammation. Finally, the authors review positron emission tomography-based imaging techniques to characterize the vessel wall in vivo.
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Affiliation(s)
- Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark A Ahlman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Abass Alavi
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Andrew H Lichtman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Steven Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul M Ridker
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ahmed Tawakol
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zahi A Fayad
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nehal N Mehta
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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135
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Bec J, Phipps JE, Gorpas D, Ma D, Fatakdawala H, Margulies KB, Southard JA, Marcu L. In vivo label-free structural and biochemical imaging of coronary arteries using an integrated ultrasound and multispectral fluorescence lifetime catheter system. Sci Rep 2017; 7:8960. [PMID: 28827758 PMCID: PMC5566546 DOI: 10.1038/s41598-017-08056-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/03/2017] [Indexed: 11/09/2022] Open
Abstract
Existing clinical intravascular imaging modalities are not capable of accurate detection of critical plaque pathophysiology in the coronary arteries. This study reports the first intravascular catheter combining intravascular ultrasound (IVUS) with multispectral fluorescence lifetime imaging (FLIm) that enables label-free simultaneous assessment of morphological and biochemical features of coronary vessels in vivo. A 3.7 Fr catheter with a fiber-optic channel was constructed based on a 40 MHz clinical IVUS catheter. The ability to safely acquire co-registered FLIm-IVUS data in vivo using Dextran40 solution flushing was demonstrated in swine coronary arteries. FLIm parameters from the arterial wall were consistent with the emission of fluorophores present in healthy arterial wall (collagen, elastin). Additionally, structural and biochemical features from atherosclerotic lesions were acquired in ex vivo human coronary samples and corroborated with histological findings. Current results show that FLIm parameters linked to the amount of structural proteins (e.g. collagen, elastin) and lipids (e.g. foam cells, extracellular lipids) in the first 200 μm of the intima provide important biochemical information that can supplement IVUS data for a comprehensive assessment of plaques pathophysiology. The unique FLIm-IVUS system evaluated here has the potential to provide a comprehensive insight into atherosclerotic lesion formation, diagnostics and response to therapy.
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Affiliation(s)
- Julien Bec
- Department of Biomedical Engineering, University of California Davis, Davis, 95616, CA, USA
| | - Jennifer E Phipps
- Department of Biomedical Engineering, University of California Davis, Davis, 95616, CA, USA
| | - Dimitris Gorpas
- Department of Biomedical Engineering, University of California Davis, Davis, 95616, CA, USA.,Institute of Biological and Medical Imaging, Helmholtz Zentrum, München, Germany
| | - Dinglong Ma
- Department of Biomedical Engineering, University of California Davis, Davis, 95616, CA, USA
| | - Hussain Fatakdawala
- Department of Biomedical Engineering, University of California Davis, Davis, 95616, CA, USA.,Abbott, Sylmar, CA, USA
| | - Kenneth B Margulies
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Jeffrey A Southard
- UC Davis Health System, Division of Cardiovascular Medicine, University of California Davis, Sacramento, 95817, CA, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California Davis, Davis, 95616, CA, USA.
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136
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Egeberg A, Skov L, Joshi AA, Mallbris L, Gislason GH, Wu JJ, Rodante J, Lerman JB, Ahlman MA, Gelfand JM, Mehta NN. The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events. J Am Acad Dermatol 2017; 77:650-656.e3. [PMID: 28826925 DOI: 10.1016/j.jaad.2017.06.028] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/02/2017] [Accepted: 06/12/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Psoriasis is associated with risk of cardiovascular (CV) disease (CVD) and a major adverse CV event (MACE). Whether psoriasis duration affects risk of vascular inflammation and MACEs has not been well characterized. OBJECTIVES We utilized two resources to understand the effect of psoriasis duration on vascular disease and CV events: (1) a human imaging study and (2) a population-based study of CVD events. METHODS First, patients with psoriasis (N = 190) underwent fludeoxyglucose F 18 positron emission tomography/computed tomography (duration effect reported as a β-coefficient). Second, MACE risk was examined by using nationwide registries (adjusted hazard ratios in patients with psoriasis (n = 87,161) versus the general population (n = 4,234,793). RESULTS In the human imaging study, patients were young, of low CV risk by traditional risk scores, and had a high prevalence of cardiometabolic diseases. Vascular inflammation by fludeoxyglucose F 18 positron emission tomography/computed tomography was significantly associated with disease duration (β = 0.171, P = .002). In the population-based study, psoriasis duration had strong relationship with MACE risk (1.0% per additional year of psoriasis duration [hazard ratio, 1.010; 95% confidence interval, 1.007-1.013]). LIMITATIONS These studies utilized observational data. CONCLUSION We found detrimental effects of psoriasis duration on vascular inflammation and MACE, suggesting that cumulative duration of exposure to low-grade chronic inflammation may accelerate vascular disease development and MACEs. Providers should consider inquiring about duration of disease to counsel for heightened CVD risk in psoriasis.
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Affiliation(s)
- Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Lotus Mallbris
- Unit of Dermatology and Venerology, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Danish Heart Foundation, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jashin J Wu
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Justin Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph B Lerman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark A Ahlman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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Variability in quantitative analysis of atherosclerotic plaque inflammation using 18F-FDG PET/CT. PLoS One 2017; 12:e0181847. [PMID: 28800625 PMCID: PMC5553940 DOI: 10.1371/journal.pone.0181847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 07/08/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND 18F-FDG-PET(/CT) is increasingly used in studies aiming at quantifying atherosclerotic plaque inflammation. Considerable methodological variability exists. The effect of data acquisition and image analysis parameters on quantitative uptake measures, such as standardized uptake value (SUV) and target-to-background ratio (TBR) has not been investigated extensively. OBJECTIVE The goal of this study was to explore the effect of several data acquisition and image analysis parameters on quantification of vascular wall 18F-FDG uptake measures, in order to increase awareness of potential variability. METHODS Three whole-body emission scans and a low-dose CT scan were acquired 38, 60 and 90 minutes after injection of 18F-FDG in six rheumatoid arthritis patients with high cardiovascular risk profiles.Data acquisition (1 and 2) and image analysis (3, 4 and 5) parameters comprised:1. 18F-FDG uptake time, 2. SUV normalisation, 3. drawing regions/volumes of interest (ROI's/VOI's) according to: a. hot-spot (HS), b. whole-segment (WS) and c. most-diseased segment (MDS), 4. Background activity, 5. Image matrix/voxel size.Intraclass correlation coefficients (ICC's) and Bland Altman plots were used to assess agreement between these techniques and between observers. A linear mixed model was used to determine the association between uptake time and continuous outcome variables. RESULTS 1. Significantly higher TBRmax values were found at 90 minutes (1,57 95%CI 1,35-1,80) compared to 38 minutes (1,30 95%CI 1,21-1,39) (P = 0,024) 2. Normalising SUV for BW, LBM and BSA significantly influences average SUVmax (2,25 (±0,60) vs 1,67 (±0,37) vs 0,058 (±0,013)). 3. Intraclass correlation coefficients were high in all vascular segments when SUVmax HS was compared to SUVmax WS. SUVmax HS was consistently higher than SUVmax MDS in all vascular segments. 4. Blood pool activity significantly decreases in all (venous and arterial) segments over time, but does not differ between segments. 5. Image matrix/voxel size does not influence SUVmax. CONCLUSION Quantitative measures of vascular wall 18F-FDG uptake are affected mainly by changes in data acquisition parameters. Standardization of methodology needs to be considered when studying atherosclerosis and/or vasculitis.
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Suda M, Kiriyama T, Ishihara K, Onoguchi M, Kobayashi Y, Sakurai M, Shibutani T, Kumita SI. The high matrix acquisition technique for imaging of atherosclerotic plaque inflammation in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography with time-of-flight: Phantom study. J Nucl Cardiol 2017; 24:1161-1170. [PMID: 27197819 DOI: 10.1007/s12350-016-0510-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Motion artifact and partial volume effect caused underestimation of coronary plaque inflammation. This study evaluated the high matrix acquisition technique using time-of-flight (TOF) positron emission tomography/computed tomography for imaging of atherosclerotic plaque inflammation with fluorine-18 fluorodeoxyglucose in small and moving phantoms. METHODS AND RESULTS All images were reconstructed using a conventional algorithm without TOF (4 × 4 × 4 mm3 voxel size) and a high matrix algorithm with TOF (2 × 2 × 2 mm3 voxel size). Microsphere phantoms of 10, 7.9, 6.2, 5.0, and 4.0 mm diameters were acquired in 3-dimensional list-mode for 30 minutes. A heart phantom mimicking cardiac motion consisted of a hot spot simulating a plaque (φ 4 mm, φ 2 mm) on the outside of the left ventricle. In the microsphere and heart phantom study, visual discrimination, maximum activity, and target-to-background ratio using the high matrix algorithm with TOF were better than those using the conventional algorithm without TOF. CONCLUSION The high matrix algorithm with TOF improves detection of small targets in phantoms.
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Affiliation(s)
- Masaya Suda
- Clinical Imaging Center for Healthcare, Nippon Medical School, 1-12-15, Sendagi, Bunkyo, Tokyo, 113-0022, Japan.
| | | | - Keiichi Ishihara
- Clinical Imaging Center for Healthcare, Nippon Medical School, 1-12-15, Sendagi, Bunkyo, Tokyo, 113-0022, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Kanazawa University, Kanazawa, Japan
| | | | - Minoru Sakurai
- Clinical Imaging Center for Healthcare, Nippon Medical School, 1-12-15, Sendagi, Bunkyo, Tokyo, 113-0022, Japan
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Kanazawa University, Kanazawa, Japan
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Bachi K, Mani V, Jeyachandran D, Fayad ZA, Goldstein RZ, Alia-Klein N. Vascular disease in cocaine addiction. Atherosclerosis 2017; 262:154-162. [PMID: 28363516 PMCID: PMC5757372 DOI: 10.1016/j.atherosclerosis.2017.03.019] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 12/11/2022]
Abstract
Cocaine, a powerful vasoconstrictor, induces immune responses including cytokine elevations. Chronic cocaine use is associated with functional brain impairments potentially mediated by vascular pathology. Although the Crack-Cocaine epidemic has declined, its vascular consequences are increasingly becoming evident among individuals with cocaine use disorder of that period, now aging. Paradoxically, during the period when prevention efforts could make a difference, this population receives psychosocial treatment at best. We review major postmortem and in vitro studies documenting cocaine-induced vascular toxicity. PubMed and Academic Search Complete were used with relevant terms. Findings consist of the major mechanisms of cocaine-induced vasoconstriction, endothelial dysfunction, and accelerated atherosclerosis, emphasizing acute, chronic, and secondary effects of cocaine. The etiology underlying cocaine's acute and chronic vascular effects is multifactorial, spanning hypertension, impaired homeostasis and platelet function, thrombosis, thromboembolism, and alterations in blood flow. Early detection of vascular disease in cocaine addiction by multimodality imaging is discussed. Treatment may be similar to indications in patients with traditional risk-factors, with few exceptions such as enhanced supportive care and use of benzodiazepines and phentolamine for sedation, and avoiding β-blockers. Given the vascular toxicity cocaine induces, further compounded by smoking and alcohol comorbidity, and interacting with aging of the crack generation, there is a public health imperative to identify pre-symptomatic markers of vascular impairments in cocaine addiction and employ preventive treatment to reduce silent disease progression.
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Affiliation(s)
- Keren Bachi
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Venkatesh Mani
- Translational Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Devi Jeyachandran
- Pathology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Zahi A Fayad
- Translational Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Rita Z Goldstein
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Nelly Alia-Klein
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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Choudhury RP, Birks JS, Mani V, Biasiolli L, Robson MD, L'Allier PL, Gingras MA, Alie N, McLaughlin MA, Basson CT, Schecter AD, Svensson EC, Zhang Y, Yates D, Tardif JC, Fayad ZA. Arterial Effects of Canakinumab in Patients With Atherosclerosis and Type 2 Diabetes or Glucose Intolerance. J Am Coll Cardiol 2017; 68:1769-1780. [PMID: 27737744 PMCID: PMC5064025 DOI: 10.1016/j.jacc.2016.07.768] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/30/2016] [Accepted: 07/06/2016] [Indexed: 12/12/2022]
Abstract
Background Evidence suggests that interleukin (IL)-1β is important in the pathogenesis of atherosclerosis and its complications and that inhibiting IL-1β may favorably affect vascular disease progression. Objectives The goal of this study was to evaluate the effects of IL-1β inhibition with canakinumab versus placebo on arterial structure and function, determined by magnetic resonance imaging. Methods Patients (N = 189) with atherosclerotic disease and either type 2 diabetes mellitus or impaired glucose tolerance were randomized to receive placebo (n = 94) or canakinumab 150 mg monthly (n = 95) for 12 months. They underwent magnetic resonance imaging of the carotid arteries and aorta. Results There were no statistically significant differences between canakinumab compared with placebo in the primary efficacy and safety endpoints. There was no statistically significant change in mean carotid wall area and no effect on aortic distensibility, measured at 3 separate anatomic sites. The change in mean carotid artery wall area was –3.37 mm2 after 12 months with canakinumab versus placebo. High-sensitivity C-reactive protein was significantly reduced by canakinumab compared with placebo at 3 months (geometric mean ratio [GMR]: 0.568; 95% confidence interval [CI]: 0.436 to 0.740; p < 0.0001) and 12 months (GMR: 0.56; 95% CI: 0.414 to 0.758; p = 0.0002). Lipoprotein(a) levels were reduced by canakinumab compared with placebo (–4.30 mg/dl [range: –8.5 to –0.55 mg/dl]; p = 0.025] at 12 months), but triglyceride levels increased (GMR: 1.20; 95% CI: 1.046 to 1.380; p = 0.01). In these patients with type 2 diabetes mellitus or impaired glucose tolerance, canakinumab had no effect compared with placebo on any of the measures assessed by using a standard oral glucose tolerance test. Conclusions There were no statistically significant effects of canakinumab on measures of vascular structure or function. Canakinumab reduced markers of inflammation (high-sensitivity C-reactive protein and interleukin-6), and there were modest increases in levels of total cholesterol and triglycerides. (Safety & Effectiveness on Vascular Structure and Function of ACZ885 in Atherosclerosis and Either T2DM or IGT Patients; NCT00995930)
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Affiliation(s)
- Robin P Choudhury
- Oxford Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
| | - Jacqueline S Birks
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Venkatesh Mani
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luca Biasiolli
- Oxford Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthew D Robson
- Oxford Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Philippe L L'Allier
- Montreal Heart Institute, Université de Montréal, Montreal, Canada; Department of Medicine, Université de Montréal, Montreal, Canada
| | - Marc-Alexandre Gingras
- Montreal Heart Institute, Université de Montréal, Montreal, Canada; Department of Medicine, Université de Montréal, Montreal, Canada
| | - Nadia Alie
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Mary Ann McLaughlin
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Craig T Basson
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Alison D Schecter
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Eric C Svensson
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Yiming Zhang
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Denise Yates
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Canada; Department of Medicine, Université de Montréal, Montreal, Canada
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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141
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Hey SP, Franklin JM, Avorn J, Kesselheim AS. Success, Failure, and Transparency in Biomarker-Based Drug Development. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003121. [DOI: 10.1161/circoutcomes.116.003121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 04/17/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Spencer Phillips Hey
- From the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (S.P.H., J.M.F., J.A., A.S.K.); and Harvard Center for Bioethics, Harvard Medical School, Boston, MA (S.P.H., A.S.K.)
| | - Jessica M. Franklin
- From the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (S.P.H., J.M.F., J.A., A.S.K.); and Harvard Center for Bioethics, Harvard Medical School, Boston, MA (S.P.H., A.S.K.)
| | - Jerry Avorn
- From the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (S.P.H., J.M.F., J.A., A.S.K.); and Harvard Center for Bioethics, Harvard Medical School, Boston, MA (S.P.H., A.S.K.)
| | - Aaron S. Kesselheim
- From the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (S.P.H., J.M.F., J.A., A.S.K.); and Harvard Center for Bioethics, Harvard Medical School, Boston, MA (S.P.H., A.S.K.)
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Dweck MR, Aikawa E, Newby DE, Tarkin JM, Rudd JHF, Narula J, Fayad ZA. Noninvasive Molecular Imaging of Disease Activity in Atherosclerosis. Circ Res 2017; 119:330-40. [PMID: 27390335 PMCID: PMC4939871 DOI: 10.1161/circresaha.116.307971] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/29/2016] [Indexed: 01/05/2023]
Abstract
Major focus has been placed on the identification of vulnerable plaques as a means of improving the prediction of myocardial infarction. However, this strategy has recently been questioned on the basis that the majority of these individual coronary lesions do not in fact go on to cause clinical events. Attention is, therefore, shifting to alternative imaging modalities that might provide a more complete pan-coronary assessment of the atherosclerotic disease process. These include markers of disease activity with the potential to discriminate between patients with stable burnt-out disease that is no longer metabolically active and those with active atheroma, faster disease progression, and increased risk of infarction. This review will examine how novel molecular imaging approaches can provide such assessments, focusing on inflammation and microcalcification activity, the importance of these processes to coronary atherosclerosis, and the advantages and challenges posed by these techniques.
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Affiliation(s)
- Marc R Dweck
- From the Translational and Molecular Imaging Institute (M.R.D., Z.A.F.) and Zena and Michael A. Wiener Cardiovascular Institute (M.R.D., J.N., Z.A.F.), Icahn School of Medicine at Mount Sinai, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D., D.E.N.); Cardiovascular Division, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.); and Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom (J.M.T., J.H.F.R.).
| | - Elena Aikawa
- From the Translational and Molecular Imaging Institute (M.R.D., Z.A.F.) and Zena and Michael A. Wiener Cardiovascular Institute (M.R.D., J.N., Z.A.F.), Icahn School of Medicine at Mount Sinai, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D., D.E.N.); Cardiovascular Division, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.); and Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom (J.M.T., J.H.F.R.)
| | - David E Newby
- From the Translational and Molecular Imaging Institute (M.R.D., Z.A.F.) and Zena and Michael A. Wiener Cardiovascular Institute (M.R.D., J.N., Z.A.F.), Icahn School of Medicine at Mount Sinai, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D., D.E.N.); Cardiovascular Division, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.); and Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom (J.M.T., J.H.F.R.)
| | - Jason M Tarkin
- From the Translational and Molecular Imaging Institute (M.R.D., Z.A.F.) and Zena and Michael A. Wiener Cardiovascular Institute (M.R.D., J.N., Z.A.F.), Icahn School of Medicine at Mount Sinai, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D., D.E.N.); Cardiovascular Division, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.); and Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom (J.M.T., J.H.F.R.)
| | - James H F Rudd
- From the Translational and Molecular Imaging Institute (M.R.D., Z.A.F.) and Zena and Michael A. Wiener Cardiovascular Institute (M.R.D., J.N., Z.A.F.), Icahn School of Medicine at Mount Sinai, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D., D.E.N.); Cardiovascular Division, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.); and Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom (J.M.T., J.H.F.R.)
| | - Jagat Narula
- From the Translational and Molecular Imaging Institute (M.R.D., Z.A.F.) and Zena and Michael A. Wiener Cardiovascular Institute (M.R.D., J.N., Z.A.F.), Icahn School of Medicine at Mount Sinai, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D., D.E.N.); Cardiovascular Division, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.); and Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom (J.M.T., J.H.F.R.)
| | - Zahi A Fayad
- From the Translational and Molecular Imaging Institute (M.R.D., Z.A.F.) and Zena and Michael A. Wiener Cardiovascular Institute (M.R.D., J.N., Z.A.F.), Icahn School of Medicine at Mount Sinai, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D., D.E.N.); Cardiovascular Division, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.); and Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom (J.M.T., J.H.F.R.)
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Pawade TA, Cartlidge TRG, Jenkins WSA, Adamson PD, Robson P, Lucatelli C, Van Beek EJR, Prendergast B, Denison AR, Forsyth L, Rudd JHF, Fayad ZA, Fletcher A, Tuck S, Newby DE, Dweck MR. Optimization and Reproducibility of Aortic Valve 18F-Fluoride Positron Emission Tomography in Patients With Aortic Stenosis. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005131. [PMID: 27733431 PMCID: PMC5068186 DOI: 10.1161/circimaging.116.005131] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. Background— 18F-Fluoride positron emission tomography (PET) and computed tomography (CT) can measure disease activity and progression in aortic stenosis. Our objectives were to optimize the methodology, analysis, and scan–rescan reproducibility of aortic valve 18F-fluoride PET-CT imaging. Methods and Results— Fifteen patients with aortic stenosis underwent repeated 18F-fluoride PET-CT. We compared nongated PET and noncontrast CT, with a modified approach that incorporated contrast CT and ECG-gated PET. We explored a range of image analysis techniques, including estimation of blood-pool activity at differing vascular sites and a most diseased segment approach. Contrast-enhanced ECG-gated PET-CT permitted localization of 18F-fluoride uptake to individual valve leaflets. Uptake was most commonly observed at sites of maximal mechanical stress: the leaflet tips and the commissures. Scan–rescan reproducibility was markedly improved using enhanced analysis techniques leading to a reduction in percentage error from ±63% to ±10% (tissue to background ratio MDS mean of 1.55, bias −0.05, limits of agreement −0·20 to +0·11). Conclusions— Optimized 18F-fluoride PET-CT allows reproducible localization of calcification activity to different regions of the aortic valve leaflet and commonly to areas of increased mechanical stress. This technique holds major promise in improving our understanding of the pathophysiology of aortic stenosis and as a biomarker end point in clinical trials of novel therapies. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02132026.
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Affiliation(s)
- Tania A Pawade
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.).
| | - Timothy R G Cartlidge
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - William S A Jenkins
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Philip D Adamson
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Phillip Robson
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Christophe Lucatelli
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Edwin J R Van Beek
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Bernard Prendergast
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Alan R Denison
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Laura Forsyth
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - James H F Rudd
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Zahi A Fayad
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Alison Fletcher
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Sharon Tuck
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - David E Newby
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
| | - Marc R Dweck
- From the BHF/Centre for Cardiovascular Science (T.A.P., T.R.G.C., W.S.A.J., P.D.A., D.E.N., M.R.D.), Clinical Research Imaging Centre, Queen's Medical Research Institute (C.L., E.J.R.V.B., A.F.), and Edinburgh Clinical Trials Unit, Western General Hospital (L.F.), University of Edinburgh, United Kingdom; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (P.R., Z.A.F.); Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom (B.P.); Institute for Education in Medical and Dental Sciences, University of Aberdeen, United Kingdom (A.R.D.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Wellcome Trust Clinical Research Facility, Western General Hospital Edinburgh, United Kingdom (S.T.)
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Singh P, Emami H, Subramanian S, Maurovich-Horvat P, Marincheva-Savcheva G, Medina HM, Abdelbaky A, Alon A, Shankar SS, Rudd JHF, Fayad ZA, Hoffmann U, Tawakol A. Coronary Plaque Morphology and the Anti-Inflammatory Impact of Atorvastatin: A Multicenter 18F-Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Study. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004195. [PMID: 27956407 PMCID: PMC5175997 DOI: 10.1161/circimaging.115.004195] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 09/29/2016] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Nonobstructive coronary plaques manifesting high-risk morphology (HRM) associate with an increased risk of adverse clinical cardiovascular events. We sought to test the hypothesis that statins have a greater anti-inflammatory effect within coronary plaques containing HRM. Methods and Results— In this prospective multicenter study, 55 subjects with or at high risk for atherosclerosis underwent 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic imaging at baseline and after 12 weeks of treatment with atorvastatin. Coronary arterial inflammation (18F-fluorodeoxyglucose uptake, expressed as target-to-background ratio) was assessed in the left main coronary artery (LMCA). While blinded to the PET findings, contrast-enhanced computed tomographic angiography was performed to characterize the presence of HRM (defined as noncalcified or partially calcified plaques) in the LMCA. Arterial inflammation (target-to-background ratio) was higher in LMCA segments with HRM than those without HRM (mean±SEM: 1.95±0.43 versus 1.67±0.32 for LMCA with versus without HRM, respectively; P=0.04). Moreover, atorvastatin treatment for 12 weeks reduced target-to-background ratio more in LMCA segments with HRM than those without HRM (12 week-baseline Δtarget-to-background ratio [95% confidence interval]: −0.18 [−0.35 to −0.004] versus 0.09 [−0.06 to 0.26]; P=0.02). Furthermore, this relationship between coronary plaque morphology and change in LMCA inflammatory activity remained significant after adjusting for baseline low-density lipoprotein and statin dose (β=−0.27; P=0.038). Conclusions— In this first study to evaluate the impact of statins on coronary inflammation, we observed that the anti-inflammatory impact of statins is substantially greater within coronary plaques that contain HRM features. These findings suggest an additional mechanism by which statins disproportionately benefit individuals with more advanced atherosclerotic disease. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00703261.
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Affiliation(s)
- Parmanand Singh
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Hamed Emami
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Sharath Subramanian
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Pal Maurovich-Horvat
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Gergana Marincheva-Savcheva
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Hector M Medina
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Amr Abdelbaky
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Achilles Alon
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Sudha S Shankar
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - James H F Rudd
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Zahi A Fayad
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Udo Hoffmann
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.)
| | - Ahmed Tawakol
- From the Division of Cardiology, New York Presbyterian Hospital and Weill Cornell Medical College (P.S.); Cardiac MR PET CT Program, Division of Cardiac Imaging (H.E., S.S., P.M.-H., G.M.-S., Amr Abdelbaky, U.H., A.T.) and Division of Cardiology (A.T.), Massachusetts General Hospital and Harvard Medical School, Boston; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary (P.M.-H.); Fundacion Cardio-Infantil, Bogota, Colombia (H.M.M.); Merck and Company, Inc, Kenilworth, NJ (Achilles Alon, S.S.S.); Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.H.F.R.); and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (Z.A.F.).
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Gupta MK, Lee Y, Boire TC, Lee JB, Kim WS, Sung HJ. Recent strategies to design vascular theranostic nanoparticles. Nanotheranostics 2017; 1:166-177. [PMID: 29071185 PMCID: PMC5646719 DOI: 10.7150/ntno.18531] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/11/2017] [Indexed: 01/08/2023] Open
Abstract
Vascular disease is a leading cause of death and disability worldwide. Current surgical intervention and treatment options for vascular diseases have exhibited limited long-term success, emphasizing the need to develop advanced treatment paradigms for early detection and more effective treatment of dysfunctional cells in a specific blood vessel lesion. Advances in targeted nanoparticles mediating cargo delivery enables more robust prevention, screening, diagnosis, and treatment of vascular disorders. In particular, nanotheranostics integrates diagnostic imaging and therapeutic function into a single agent, and is an emerging platform towards more effective and localized vascular treatment. This review article highlights recent advances and current challenges associated with the utilization of targeted nanoparticles for real-time diagnosis and treatment of vascular diseases. Given recent developments, nanotheranostics offers great potential to serve as an effective platform for targeted, localized, and personalized vascular treatment.
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Affiliation(s)
- Mukesh K. Gupta
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, US
| | - Yunki Lee
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, US
| | - Timothy C. Boire
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, US
| | - Jung-Bok Lee
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, US
| | - Won Shik Kim
- Department of Otorhinolaryngology, Yonsei University, College of Medicine, South Korea
| | - Hak-Joon Sung
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, US
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, US
- Severance Biomedical Science Institute, College of Medicine, Yonsei University, Seoul, South Korea
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146
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Ernst D, Weiberg D, Baerlecken NT, Schlumberger W, Daehnrich C, Schmidt RE, Bengel FM, Derlin T, Witte T. Anti-MYC-associated zinc finger protein antibodies are associated with inflammatory atherosclerotic lesions on 18 F-fluorodeoxyglucose positron emission tomography. Atherosclerosis 2017; 259:12-19. [DOI: 10.1016/j.atherosclerosis.2017.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 12/29/2022]
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147
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Abstract
The evidence from trials of statin therapy suggests that benefits in cardiovascular disease (CVD) event reduction are proportional to the magnitude of low-density lipoprotein cholesterol (LDL-C) lowering. The lack of a threshold at which LDL-C lowering is not beneficial, in terms of CVD prevention observed in these trials, is supported by epidemiological and genetic studies reporting the cardio-protective effects of lifelong low exposure to atherogenic cholesterol in a graded fashion. Providing that intensive LDL-C lowering is safe, these observations suggest that many individuals even at current LDL-C treatment targets could benefit. Here, we review recent safety and efficacy data from trials of adjunctive therapy, with LDL-C lowering beyond that achieved by statin therapy, and their potential implications for current guideline targets. Finally, the application of current guidance in the context of pre-treatment LDL-C concentration and deployment of statin therapy is also discussed. The number of patients requiring treatment to prevent a CVD event with statin treatment has been shown to differ markedly according to the pre-treatment LDL-C concentration even when absolute CVD risk is similar. It produces more likelihood of benefit when absolute LDL-C reduction is greater which is largely dependent on pre-treatment LDL-C concentration. This also has to be taken in consideration when deploying new agents like proprotein convertase subtilisin/kexin type 9 monoclonal antibodies. Patients with highest LDL-C concentration despite maximum statin and ezetimibe therapy will attain most absolute LDL-C reduction when treated with proprotein convertase subtilisin/kexin type 9 monoclonal antibodies, hence benefit most in term of CVD risk reduction.
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Affiliation(s)
- Handrean Soran
- Cardiovascular Research Group, School of Biomedicine, University of Manchester, Core Technology Facility, Manchester, UK.
- Cardiovascular Trials Unit, University Department of Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - Ricardo Dent
- Amgen (Europe) GmbH, Zug, Switzerland
- Esperion Therapeutics Inc., Ann Arbor, MI, USA
| | - Paul Durrington
- Cardiovascular Research Group, School of Biomedicine, University of Manchester, Core Technology Facility, Manchester, UK
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Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees AS, Gelfand JM. Psoriasis and comorbid diseases: Implications for management. J Am Acad Dermatol 2017; 76:393-403. [PMID: 28212760 PMCID: PMC5839668 DOI: 10.1016/j.jaad.2016.07.065] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 12/13/2022]
Abstract
As summarized in the first article in this continuing medical education series, the currently available epidemiologic data suggest that psoriasis may be a risk factor for cardiometabolic disease. Emerging data also suggest associations between psoriasis and other comorbidities beyond psoriatic arthritis, including chronic kidney disease, inflammatory bowel disease, hepatic disease, certain malignancies, infections, and mood disorders. Recognizing the comorbid disease burden of psoriasis is essential for ensuring comprehensive care of patients with psoriasis. The clinical implications of the comorbid diseases that are associated with psoriasis and recommendations for clinical management are reviewed in this article.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Sungat Grewal
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sinéad M Langan
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, United Kingdom
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Alexis Ogdie
- Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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150
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Pruzan AN, Kaufman AE, Calcagno C, Zhou Y, Fayad ZA, Mani V. Feasibility of imaging superficial palmar arch using micro-ultrasound, 7T and 3T magnetic resonance imaging. World J Radiol 2017; 9:79-84. [PMID: 28298968 PMCID: PMC5334505 DOI: 10.4329/wjr.v9.i2.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/17/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To demonstrate feasibility of vessel wall imaging of the superficial palmar arch using high frequency micro-ultrasound, 7T and 3T magnetic resonance imaging (MRI).
METHODS Four subjects (ages 22-50 years) were scanned on a micro-ultrasound system with a 45-MHz transducer (Vevo 2100, VisualSonics). Subjects’ hands were then imaged on a 3T clinical MR scanner (Siemens Biograph MMR) using an 8-channel special purpose phased array carotid coil. Lastly, subjects’ hands were imaged on a 7T clinical MR scanner (Siemens Magnetom 7T Whole Body Scanner) using a custom built 8-channel transmit receive carotid coil. All three imaging modalities were subjectively analyzed for image quality and visualization of the vessel wall.
RESULTS Results of this very preliminary study indicated that vessel wall imaging of the superficial palmar arch was feasible with a whole body 7T and 3T MRI in comparison with micro-ultrasound. Subjective analysis of image quality (1-5 scale, 1: poorest, 5: best) from B mode, ultrasound, 3T SPACE MRI and 7T SPACE MRI indicated that the image quality obtained at 7T was superior to both 3T MRI and micro-ultrasound. The 3D SPACE sequence at both 7T and 3T MRI with isotropic voxels allowed for multi-planar reformatting of images and allowed for less operator dependent results as compared to high frequency micro-ultrasound imaging. Although quantitative analysis revealed that there was no significant difference between the three methods, the 7T Tesla trended to have better visibility of the vessel and its wall.
CONCLUSION Imaging of smaller arteries at the 7T is feasible for evaluating atherosclerosis burden and may be of clinical relevance in multiple diseases.
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