1
|
Shahsanaei F, Gharibzadeh A, Behrooj S, Abbaszadeh S, Nourmohammadi M. A systematic review and bioinformatic study on clinical, paraclinical, and genetic factors predisposing to stent restenosis following percutaneous coronary intervention. BMC Cardiovasc Disord 2024; 24:304. [PMID: 38877398 PMCID: PMC11177414 DOI: 10.1186/s12872-024-03955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/22/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Stent restenosis is a relatively common phenomenon among patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). It seems that a set of clinical, laboratory, and even genetic factors make people susceptible to such a phenomenon and in fact, this is multi-factorial. We aimed to first determine the underlying clinical and laboratory risk factors for the occurrence of stent re-stenosis after PCI based on a systematic review study, and after that, through a bioinformatics study, to evaluate the related genes and microRNAs with the occurrence of stent re-stenosis. MAIN TEXT In the first step, the manuscript databases including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords to introduce clinical and laboratory determinants of stent re-stenosis. In the bioinformatic phase, and following a review of the literature to identify genes and microRNAs involved in restenosis, the interaction of each gene with other genes associated with stent re-stenosis was determined by GeneMANIA network analysis and Cytoscape software. Overall, 67 articles (including 40,789 patients) on clinical and biochemical predictors for stent restenosis and 25 articles on genetic determinants of this event were eligible for the final analysis. The predictors for this event were categorized into four subgroups patient-based parameters including traditional cardiovascular risk profiles, stent-based parameters including type and diametric characteristics of the stents used, coronary lesion-based parameters including several two target lesions and coronary involvement severity and laboratory-based parameters particularly related to activation of inflammatory processes. In the bioinformatic phase, we uncovered 42 genes that have been described to be involved in such a phenomenon considering a special position for genes encoding inflammatory cytokines. Also, 12 microRNAs have been pointed to be involved in targeting genes involved in stent re-stenosis. CONCLUSIONS The incidence of stent re-stenosis will be the result of a complex interaction of clinical risk factors, laboratory factors mostly related to the activation of inflammatory processes, and a complex network of gene-to-gene interactions.
Collapse
Affiliation(s)
- Farzad Shahsanaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abdullah Gharibzadeh
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Soudabeh Behrooj
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Shahin Abbaszadeh
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Mahboobeh Nourmohammadi
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| |
Collapse
|
2
|
Merinopoulos I, Bhalraam U, Holmes T, Tsampasian V, Corballis N, Gunawardena T, Sawh C, Maart C, Wistow T, Ryding A, Eccleshall SC, Smith J, Vassiliou VS. Circulating intermediate monocytes CD14++CD16+ are increased after elective percutaneous coronary intervention. PLoS One 2023; 18:e0294746. [PMID: 38096193 PMCID: PMC10721025 DOI: 10.1371/journal.pone.0294746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
AIM Inflammation plays a central role in the pathogenesis of atherosclerosis and in the sequelae of percutaneous coronary intervention (PCI). Previous work demonstrated that intermediate monocytes (CD14++CD16+) are associated with adverse cardiovascular events, yet monocyte subset response following elective PCI has not been described. This article explores the changes in monocyte subset and humoral response after elective PCI. METHODS This prospective study included 30 patients without inflammatory diseases being referred for elective PCI. We included patients treated with drug coated balloons or 2nd generation drug eluting stents. Patients underwent blood tests at baseline (prior to PCI), four hours, two weeks and two months later. Analyses were performed in terms of monocyte subsets (classical CD14++CD16-, intermediate CD14++CD16+ and non-classical CD14+CD16++), gene expression of CD14+ leucocytes and humoral biomarkers. RESULTS Intermediate monocytes decreased significantly four hours after PCI, were recovered at two weeks, and increased significantly at two months post elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group. Gene expression analysis of CD14+ leucocytes showed IL18 had decreased expression at two weeks, CXCR4 and IL1β decreased at two months, while pentraxin 3 increased at two weeks and two months. In terms of humoral biomarkers, hsTnI remains elevated up to two weeks post PCI while IL6 and TNFα remain elevated till two months post PCI. CONCLUSION Intermediate monocytes increase significantly two months following elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group suggesting that the PCI strategy could be one of the ways to modulate the inflammatory response post PCI.
Collapse
Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - U Bhalraam
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Terri Holmes
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Vasiliki Tsampasian
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Natasha Corballis
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Tharusha Gunawardena
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Chris Sawh
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Clint Maart
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Trevor Wistow
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Simon C. Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - James Smith
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Vassilios S. Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Institute of Continuing Education, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
3
|
Merinopoulos I, Gunawardena T, Corballis N, Tsampasian V, Eccleshall SC, Smith J, Vassiliou VS. The role of inflammation in percutaneous coronary intervention, from balloon angioplasty to drug eluting stents. Minerva Cardiol Angiol 2023; 71:631-642. [PMID: 35785928 DOI: 10.23736/s2724-5683.22.06091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The role of inflammation in percutaneous coronary intervention (PCI) has been investigated in numerous studies. Both pre-PCI and post-PCI inflammatory status have been demonstrated to be linked with patient outcomes. C-reactive protein continues to be the most studied inflammatory biomarker, while a growing number of additional biomarkers, including cytokines and immune cells, are being assessed. As insights are gained into the complexities of the inflammatory response to PCI, it becomes evident that a targeted approach is necessary to ensure optimal patient outcomes. Here, we review the biomarkers that can predict patient outcomes following PCI and specifically how they differ for balloon angioplasty, bare metal stents and drug eluting stents. A specific focus is given to human studies and periprocedural inflammation rather than inflammation associated with myocardial infarction.
Collapse
Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tharusha Gunawardena
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Natasha Corballis
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Vassiliki Tsampasian
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Simon C Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - James Smith
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK -
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
4
|
The relationship between fibrinogen-to-albumin ratio and in-stent restenosis in patients with coronary artery disease undergoing drug-eluting stenting. Coron Artery Dis 2021; 31:586-589. [PMID: 32271235 DOI: 10.1097/mca.0000000000000890] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND In-stent restenosis (ISR) remains a significant clinical problem in patients with coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI). Recent studies identified the fibrinogen-to-albumin ratio (FAR) as a novel inflammatory marker to predict inflammation in chronic diseases. This study aimed to investigate the relationship between FAR and ISR in patients with DES implantation. METHODS A total of 506 consecutive CAD patients were enrolled. Subjects history of successful native vessel PCI with DES at least 12 months prior to undergoing repeat angiography for chest pain. Patients were divided between ISR group (n = 125) and no-ISR group (n = 381). ISR was defined as luminal stenosis ≥50% located within the stent or up to 5 mm beyond the stent edges by the quantitative coronary analysis. Laboratory parameters were measured before angiography. Significant factors associated with ISR were evaluated by multivariate logistic regression analysis. RESULTS Baseline characteristics were similar between the ISR and no-ISR groups. The ISR group had significantly higher FAR level compared with the no-ISR group (73.26 ± 17.68 vs. 64.90 ± 15.88, P < 0.05). Furthermore, the ISR group had significantly lower albumin level and higher prevalence of diabetes mellitus compared to no-ISR (P < 0.05). In a multivariate analysis, FAR (odds ratio [OR] = 1.039, 95% confidence interval (CI) = 1.024-1.054), albumin (OR = 0.923, 95% CI = 0.389-0.977) and diabetes mellitus (OR = 2.663, 95% CI = 1.587-4.468) were significantly associated with ISR. CONCLUSION FAR is significantly associated with the development of ISR in CAD patients undergoing PCI with DES implantation.
Collapse
|
5
|
Vascular Wall Reactions to Coronary Stents-Clinical Implications for Stent Failure. Life (Basel) 2021; 11:life11010063. [PMID: 33477361 PMCID: PMC7829777 DOI: 10.3390/life11010063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/21/2022] Open
Abstract
Coronary stents belong to the most commonly implanted devices worldwide. A number of different types of stent exist, with very different mechanical and biochemical characteristics that influence their interactions with vascular tissues. Inappropriate inflammatory reactions are the major cause of the two major complications that follow implantation of stents in a percentage as high as 5-20%. It is therefore important to understand these reactions and how different they are among different generations of stents.
Collapse
|
6
|
Sukhanov S, Higashi Y, Yoshida T, Mummidi S, Aroor AR, Jeffrey Russell J, Bender SB, DeMarco VG, Chandrasekar B. The SGLT2 inhibitor Empagliflozin attenuates interleukin-17A-induced human aortic smooth muscle cell proliferation and migration by targeting TRAF3IP2/ROS/NLRP3/Caspase-1-dependent IL-1β and IL-18 secretion. Cell Signal 2021; 77:109825. [PMID: 33160017 PMCID: PMC8118186 DOI: 10.1016/j.cellsig.2020.109825] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Chronic inflammation and persistent oxidative stress contribute to the development and progression of vascular proliferative diseases. We hypothesized that the proinflammatory cytokine interleukin (IL)-17A induces oxidative stress and amplifies inflammatory signaling in human aortic smooth muscle cells (SMC) via TRAF3IP2-mediated NLRP3/caspase-1-dependent mitogenic and migratory proinflammatory cytokines IL-1β and IL-18. Further, we hypothesized that these maladaptive changes are prevented by empagliflozin (EMPA), an SGLT2 (Sodium/Glucose Cotransporter 2) inhibitor. Supporting our hypotheses, exposure of cultured SMC to IL-17A promoted proliferation and migration via TRAF3IP2, TRAF3IP2-dependent superoxide and hydrogen peroxide production, NLRP3 expression, caspase-1 activation, and IL-1β and IL-18 secretion. Furthermore, NLRP3 knockdown, caspase-1 inhibition, and pretreatment with IL-1β and IL-18 neutralizing antibodies and IL-18BP, each attenuated IL-17A-induced SMC migration and proliferation. Importantly, SMC express SGLT2, and pre-treatment with EMPA attenuated IL-17A/TRAF3IP2-dependent oxidative stress, NLRP3 expression, caspase-1 activation, IL-1β and IL-18 secretion, and SMC proliferation and migration. Importantly, silencing SGLT2 attenuated EMPA-mediated inhibition of IL-17A-induced cytokine secretion and SMC proliferation and migration. EMPA exerted these beneficial antioxidant, anti-inflammatory, anti-mitogenic and anti-migratory effects under normal glucose conditions and without inducing cell death. These results suggest the therapeutic potential of EMPA in vascular proliferative diseases.
Collapse
Affiliation(s)
- Sergiy Sukhanov
- Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Yusuke Higashi
- Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Tadashi Yoshida
- Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Srinivas Mummidi
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA.
| | - Annayya R Aroor
- Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA; Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA.
| | - Jacob Jeffrey Russell
- Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA; Biomedical Sciences, University of Missouri, Columbia, MO 65211, USA.
| | - Shawn B Bender
- Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA; Biomedical Sciences, University of Missouri, Columbia, MO 65211, USA; Dalton Cardiovascular Center, University of Missouri, Columbia, MO, USA.
| | - Vincent G DeMarco
- Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA; Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA; Dalton Cardiovascular Center, University of Missouri, Columbia, MO, USA; Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA.
| | - Bysani Chandrasekar
- Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA; Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA; Dalton Cardiovascular Center, University of Missouri, Columbia, MO, USA; Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA.
| |
Collapse
|
7
|
Ishimatsu T, Sasaki KI, Kakuma T, Harada A, Hirakawa Y, Fukumoto Y, Ueno T. Serum interleukin-18 levels as a predictor for patients with genetic dysfunction of cytochrome P450 2C19 in dual antiplatelet therapy with clopidogrel. J Cardiol 2020; 76:479-486. [PMID: 32616329 DOI: 10.1016/j.jjcc.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND P2Y12 reaction unit (PRU) is an index of platelet activity upon treatment with clopidogrel. In spite of suitable P2Y12 reactions in dual antiplatelet therapy (DAPT) with clopidogrel after percutaneous coronary intervention (PCI), cardiovascular events actually occur in some patients, possibly due to a genetic dysfunction of cytochrome P450 2C19 (CYP2C19), which is a major metabolic enzyme of clopidogrel. As testing the CYP2C19 phenotypes to predict such patients may lack general versatility in daily clinical practice, the aim of this study was to examine whether measuring the blood levels of some cytokines in patients showing desirable PRUs in DAPT with clopidogrel could be a substitute for testing the CYP2C19 phenotypes. METHODS We analyzed relationships among PRU, serum levels of 51 cytokines, and CYP2C19 phenotypes in 22 patients receiving DAPT with aspirin and clopidogrel after PCI. RESULTS Seventeen, 18, and 19 of 22 patients indicated PRU ≤ 208, PRU ≤ 230, and PRU ≤ 262, respectively. Approximately 60% of the patients had a genetically metabolic dysfunction of CYP2C19, and the serum levels of interleukin-18 were independently increased in those patients (p = 0.024 in patients with PRU ≤ 208, p = 0.021 with PRU ≤ 230, and p = 0.020 with PRU ≤ 262). The area under the curves in plot receiver operating characteristics curves for the serum levels of interleukin-18 were 0.94, 0.96, and 0.90 in the non-extensive metabolizer patients with PRU ≤ 208, PRU ≤ 230, and PRU ≤ 262, respectively. CONCLUSIONS The serum levels of interleukin-18 may be a predictor to diagnose patients who receive undesirable DAPT with clopidogrel, possibly due to the genetic dysfunction of CYP2C19 in spite of suitable P2Y12 reactions after PCI.
Collapse
Affiliation(s)
- Takashi Ishimatsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.
| | | | | | | | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takafumi Ueno
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| |
Collapse
|
8
|
Ljuca F, Hadžiefendić B, Jahić E, Tihić N, Lukić S. Pentraxin 3 might be better prognostic serum marker than IL-6, IL-10, and high-sensitivity C-reactive protein for major adverse cardiovascular events in patients with ST-elevation myocardial infarction after bare-metal stent implantation. Saudi Med J 2020; 40:1202-1208. [PMID: 31828271 PMCID: PMC6969622 DOI: 10.15537/smj.2019.12.24737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives: To assess the prognostic value of pentraxin 3 (PTX3) in patients with ST-elevation myocardial infarction (STEMI) after bare-metal stent (BMS) implantation. Methods: In this prospective study, PTX3, interleukin (IL-6), IL-10, high-sensitivity c-reactive protein (hsCRP), and cardiac troponin I (cTnI) plasma values were determined before and 24hours after BMS implantation in 97 consecutively enrolled patients with STEMI who were admitted to University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina between February 2016 and February 2017. Patients were followed for 24 months to assess major adverse cardiovascular events (MACEs). Results: At 24 hours after percutaneous coronary intervention (PCI), plasma values of PTX3, IL-6, hsCRP, and cTnI were significantly increased; and IL-10 levels were significantly decreased compared with the values determined before PCI. Patients with MACEs had significantly higher plasma PTX3 levels at 24 hours after BMS-PCI than in patients without MACEs. Patients with PTX3 plasma values ≥5042 ng/ml had a significantly higher risk of MACEs than patients with PTX3 levels <5.042 ng/mL. Pentraxin 3 levels exhibited strong and significant correlations with IL-6 and IL-10 levels. Pentraxin 3, cTnI, and IL-6, but not hsCRP levels have showed independent association with MACEs, according to the multivariate Cox regression analysis. Conclusion: Pentraxin 3 might be better serum prognostic marker than IL-6, IL-10 or high sensitivity CRP for MACEs after BMS-PCI. It might help to make better risk stratification of those patients who are undergoing BMS-PCI.
Collapse
Affiliation(s)
- Farid Ljuca
- Department of Physiology, School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina. E-mail.
| | | | | | | | | |
Collapse
|
9
|
Hashemi SM, Baktashian M, Moghaddam KH, Salehi M, Soflaei SS, Ferns G, Pasdar A, Mobarhan MG. The association between genetic polymorphisms of the interleukin-10, tumor necrosis factor-alpha, and annexin A5 gene loci and restenosis after percutaneous coronary angioplasty and stenting. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2019; 24:68. [PMID: 31523254 PMCID: PMC6670002 DOI: 10.4103/jrms.jrms_293_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/06/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Advances in the technology for percutaneous coronary angioplasty, such as coated stents, have reduced its complications, but restenosis remains an important clinical problem. The factors associated with an increased risk of restenosis include diabetes mellitus and multiple coronary artery disease. It is also possible that genetic factors play a role in restenosis although there are little data on this. We have investigated the association of three genetic markers of genes involved in inflammation leading to restenosis. MATERIALS AND METHODS In this case-control study, 306 unrelated Iranian patients who were thought to have restenosis on clinical grounds were investigated. Based on the results of angiography, 104 patients were found to have >50% stenosis within an implanted stent, and these were allocated to the in-stent restenosis (ISR) group; 202 patients with no in-stent stenosis or stenosis ≤50% were allocated to the non-ISR (NISR) group. Demographic data were collected from medical records. Biochemical parameters were measured using routine methods. Genotypes of the interleukin-10 (IL-10), annexin A5 (AnxA5), and tumor necrosis factor-alpha (TNFα) loci were determined using real-time polymerase chain reaction and a high-resolution melting assay. RESULTS Fasting blood glucose, serum triglycerides, and serum high-sensitivity C-reactive protein (hs-CRP) concentrations were higher in the ISR group than in the NISR group (P < 0.05), and a history of diabetes mellitus was significantly related to the presence of restenosis (P < 0.001). There were no significant differences in the frequency of the genetic polymorphisms of IL-10, AnxA5, and TNFα genes and the presence of ISR. CONCLUSION After adjustment for clinical variables, the genetic polymorphisms at the IL-10, TNFα, and ANXA5 gene loci do not appear to be risk factors for >50% ISR in our population. However, our data suggested a significant association between diabetes mellitus, serum hs-CRP, stent type, and restenosis.
Collapse
Affiliation(s)
- Seyed Mohammad Hashemi
- Department of Cardiology, Faculty of Medicine, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Baktashian
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Medical Genetics Laboratory, Al-Zahra Medical and Educational Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mansoor Salehi
- Department of Genetics, Faculty of Medicine and Genetics Laboratory, Al-Zahra Medical and Educational Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Saffar Soflaei
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Modern Sciences and Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon Ferns
- Division of Medical Education, Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PH, UK
| | - Alireza Pasdar
- Department of Modern Sciences and Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour Mobarhan
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
10
|
Zhu X, Chen Y, Xiang L, You T, Jiao Y, Xu W, Chen J. The long-term prognostic significance of high-sensitive C-reactive protein to in-stent restenosis. Medicine (Baltimore) 2018; 97:e10679. [PMID: 29979375 PMCID: PMC6076028 DOI: 10.1097/md.0000000000010679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In the current meta-analysis, we aim to assess the effect of high-sensitive C-reactive protein (hs-CRP) on in-stent restenosis (ISR) outcome in patients receiving stent implantation. METHODS Embase, PubMed, and Cochrane databases were searched through October 2016 using the keywords "high-sensitive C-reactive protein," "in-stent restenosis." An odds ratio (OR) of on ISR endpoints among patients receiving stent implantation was calculated using random-effects models. RESULTS In the meta-analysis of 6 prospective observational studies, there are 1156 coronary heart disease (CHD) patients, a total of 885 stents were implanted and 194 ISR events had been followed up for 6 to 12 months; high-sensitive C-reactive protein levels are associated with the prediction of in-stent restenosis among patients receiving stent implantation. The OR of hs-CRP for ISR was 1.16 [95% confidence interval (CI), 1.01-1.30, P < .05]. CONCLUSIONS This meta-analysis shows that higher levels of hs-CRP are associated with an increased risk of ISR and indicate a poorer prognosis in CHD patients after stent implantation.
Collapse
|
11
|
Hoseini F, Mahmazi S, Mahmoodi K, Jafari GA, Soltanpour MS. Evaluation of the Role of -137G/C Single Nucleotide Polymorphism (rs187238) and Gene Expression Levels of the IL-18 in Patients with Coronary Artery Disease. Oman Med J 2018; 33:118-125. [PMID: 29657680 DOI: 10.5001/omj.2018.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objectives Interleukin-18 (IL-18) is a proinflammatory and proatherogenic cytokine, and its genetic variations may contribute to the development of coronary artery disease (CAD). We sought to investigate the role of -137G/C polymorphism and gene expression levels of IL-18 in patients with CAD. Methods The study population included 100 patients with angiographically proven CAD and 100 matched controls. Total RNA and DNA were extracted from leukocytes using appropriate kits. The genotype of -137G/C polymorphism and gene expression level of IL-18 was determined using allele-specific polymerase chain reaction (PCR) and real-time (RT)-PCR assay, respectively. Results The genotypic and allelic distribution of IL-18 -137G/C polymorphism was not significantly different between the two groups (p > 0.050). Moreover, the -137G/C polymorphism did not increase the risk of CAD in dominant and recessive genetic models (p > 0.050). However, subgroup analysis of CAD patients revealed that the IL-18 -137G/C polymorphism was significantly associated with increased risk of CAD in hypertensive patients (odds ratio (OR) = 7.51; 95% confidence interval (CI): 1.24-25.17; p = 0.019) and smokers (OR = 4.90; 95% CI: 1.21-19.70; p = 0.031) but not in the diabetic subpopulation (p = 0.261). The genotype distribution of IL-18 -137G/C genetic polymorphism was significantly different among patients with one, two, and three stenotic vessels (p < 0.050). The gene expression level of IL-18 was significantly higher in the CAD group than the control group (p < 0.001). Moreover, the carriers of CC genotype had significantly lower gene expression levels of IL-18 than carriers of GG genotype (p < 0.050). Conclusions The -137G/C polymorphism of IL-18 may be associated with the CAD risk in hypertensive and smoker subgroup of CAD patients. The -137G/C polymorphism seems to play an important role in determining the severity of CAD. Increased IL-18 gene expression level is a significant risk factor for the development of CAD. The CC genotype of -137G/C polymorphism is associated with lower IL-18 gene expression levels.
Collapse
Affiliation(s)
- Fatemeh Hoseini
- Department of Genetic, Faculty of Basic Sciences, Islamic Azad University, Zanjan Branch, Zanjan, Iran
| | - Sanaz Mahmazi
- Department of Genetic, Faculty of Basic Sciences, Islamic Azad University, Zanjan Branch, Zanjan, Iran
| | - Khalil Mahmoodi
- Department of Cardiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Gholam Ali Jafari
- Department of Microbiology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Soleiman Soltanpour
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
12
|
The Relationship between VEGFA and TGFB1 Polymorphisms and Target Lesion Revascularization after Elective Percutaneous Coronary Intervention. DISEASE MARKERS 2017; 2017:8165219. [PMID: 28811677 PMCID: PMC5546133 DOI: 10.1155/2017/8165219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/10/2017] [Accepted: 06/14/2017] [Indexed: 12/31/2022]
Abstract
Background and Aim The specific association between genetic variation and in-stent restenosis is still only partly understood. The aim of this study is to analyze the relationship between functional polymorphisms in the genes encoding vascular endothelial growth factor A (VEGF-A; rs699947) and transforming growth factor beta 1 (TGF-β1; rs1800470) and target lesion revascularization (TLR) risk. Methods A total of 676 patients (805 lesions) with stable coronary artery disease (SCAD) who received elective percutaneous coronary intervention (PCI) with at least one bare-metal stent implantation were included. The primary study endpoint was TLR at a 4-year follow-up. Results The TLR rate was higher in patients with the VEGFA A/A genotype (15.4%) than in patients with the VEGFA A/C (7.9%) and C/C (8.9%) genotypes (p = 0.009). The VEGFA A/A genotype, after adjustment for clinical and procedural covariates, remained significantly and independently associated with the TLR (hazard ratio—2.09 [95% confidence interval 1.32–3.33, p = 0.0017]). However, we found no association between TLR and the TGFB1 genotype. Conclusion The VEGFA A/A genotype is significantly and independently associated with TLR risk in Polish SCAD patients who received elective PCI with bare-metal stent implantation.
Collapse
|
13
|
Dai X, Wiernek S, Evans JP, Runge MS. Genetics of coronary artery disease and myocardial infarction. World J Cardiol 2016; 8:1-23. [PMID: 26839654 PMCID: PMC4728103 DOI: 10.4330/wjc.v8.i1.1] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 10/18/2015] [Accepted: 11/10/2015] [Indexed: 02/06/2023] Open
Abstract
Atherosclerotic coronary artery disease (CAD) comprises a broad spectrum of clinical entities that include asymptomatic subclinical atherosclerosis and its clinical complications, such as angina pectoris, myocardial infarction (MI) and sudden cardiac death. CAD continues to be the leading cause of death in industrialized society. The long-recognized familial clustering of CAD suggests that genetics plays a central role in its development, with the heritability of CAD and MI estimated at approximately 50% to 60%. Understanding the genetic architecture of CAD and MI has proven to be difficult and costly due to the heterogeneity of clinical CAD and the underlying multi-decade complex pathophysiological processes that involve both genetic and environmental interactions. This review describes the clinical heterogeneity of CAD and MI to clarify the disease spectrum in genetic studies, provides a brief overview of the historical understanding and estimation of the heritability of CAD and MI, recounts major gene discoveries of potential causal mutations in familial CAD and MI, summarizes CAD and MI-associated genetic variants identified using candidate gene approaches and genome-wide association studies (GWAS), and summarizes the current status of the construction and validations of genetic risk scores for lifetime risk prediction and guidance for preventive strategies. Potential protective genetic factors against the development of CAD and MI are also discussed. Finally, GWAS have identified multiple genetic factors associated with an increased risk of in-stent restenosis following stent placement for obstructive CAD. This review will also address genetic factors associated with in-stent restenosis, which may ultimately guide clinical decision-making regarding revascularization strategies for patients with CAD and MI.
Collapse
Affiliation(s)
- Xuming Dai
- Xuming Dai, Szymon Wiernek, Marschall S Runge, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Szymon Wiernek
- Xuming Dai, Szymon Wiernek, Marschall S Runge, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - James P Evans
- Xuming Dai, Szymon Wiernek, Marschall S Runge, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Marschall S Runge
- Xuming Dai, Szymon Wiernek, Marschall S Runge, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| |
Collapse
|
14
|
Serum Levels of IL-1 β , IL-6, TGF- β , and MMP-9 in Patients Undergoing Carotid Artery Stenting and Regulation of MMP-9 in a New In Vitro Model of THP-1 Cells Activated by Stenting. Mediators Inflamm 2015; 2015:956082. [PMID: 26113783 PMCID: PMC4465715 DOI: 10.1155/2015/956082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022] Open
Abstract
Inflammation plays an important role in the pathophysiological process after carotid artery stenting (CAS). Monocyte is a significant source of inflammatory cytokines in vascular remodeling. Telmisartan could reduce inflammation. In our study, we first found that, after CAS, the serum IL-1β, IL-6, TGF-β, and MMP-9 levels were significantly increased, but only MMP-9 level was elevated no less than 3 months. Second, we established a new in vitro model, where THP-1 monocytes were treated with the supernatants of human umbilical vein endothelial cells (HUVECs) that were scratched by pipette tips, which mimics monocytes activated by mechanical injury of stenting. The treatment enhanced THP-1 cell adhesion, migration and invasion ability, and the phosphorylation of ERK1/2 and Elk-1 and MMP-9 expression were significantly increased. THP-1 cells pretreated with PD98095 (ERK1/2 inhibitor) attenuated the phosphorylation of ERK1/2 and Elk-1 and upregulation of MMP-9, while pretreatment with telmisartan merely decreased the phosphorylation of Elk-1 and MMP-9 expression. These results suggested that IL-1β, IL-6, TGF-β, and MMP-9 participate in the pathophysiological process after CAS. Our new in vitro model mimics monocytes activated by stenting. MMP-9 expression could be regulated through ERK1/2/Elk-1 pathway, and the protective effects of telmisartan after stenting are partly attributed to its MMP-9 inhibition effects via suppression of Elk-1.
Collapse
|
15
|
Smirnova NF, Gayral S, Pedros C, Loirand G, Vaillant N, Malet N, Kassem S, Calise D, Goudounèche D, Wymann MP, Hirsch E, Gadeau AP, Martinez LO, Saoudi A, Laffargue M. Targeting PI3Kγ activity decreases vascular trauma-induced intimal hyperplasia through modulation of the Th1 response. ACTA ACUST UNITED AC 2014; 211:1779-92. [PMID: 25073791 PMCID: PMC4144742 DOI: 10.1084/jem.20131276] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Interventional strategies to treat atherosclerosis, such as transluminal angioplasty and stent implantation, often cause vascular injury. This leads to intimal hyperplasia (IH) formation that induces inflammatory and fibroproliferative processes and ultimately restenosis. We show that phosphoinositide 3-kinase γ (PI3Kγ) is a key player in IH formation and is a valid therapeutic target in its prevention/treatment. PI3Kγ-deficient mice and mice expressing catalytically inactive PI3Kγ (PI3Kγ KD) showed reduced arterial occlusion and accumulation of monocytes and T cells around sites of vascular lesion. The transfer of PI3Kγ KD CD4(+) T cells into Rag2-deficient mice greatly reduced vascular occlusion compared with WT cells, clearly demonstrating the involvement of PI3Kγ in CD4(+) T cells during IH formation. In addition we found that IH is associated with increased levels of Th1 and Th17 cytokines. A specific decrease in the Th1 response was observed in the absence of PI3Kγ activity, leading to decreased CXCL10 and RANTES production by smooth muscle cells. Finally, we show that treatment with the PI3Kγ inhibitor AS-605240 is sufficient to decrease IH in both mouse and rat models, reinforcing the therapeutic potential of PI3Kγ inhibition. Altogether, these findings demonstrate a new role for PI3Kγ activity in Th1-controlled IH development.
Collapse
Affiliation(s)
- Natalia F Smirnova
- INSERM, UMR1048, F-31300 Toulouse, France Université Toulouse III, Institut de Maladies Métaboliques et Cardiovasculaires, F-31300 Toulouse, France
| | - Stéphanie Gayral
- INSERM, UMR1048, F-31300 Toulouse, France Université Toulouse III, Institut de Maladies Métaboliques et Cardiovasculaires, F-31300 Toulouse, France
| | - Christophe Pedros
- INSERM, UMR1043, F-31300 Toulouse, France UMR CNRS, U5282, F-31300 Toulouse, France Université de Toulouse, UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), F-31300 Toulouse, France
| | - Gervaise Loirand
- INSERM, UMR1087, F-44007 Nantes, France CNRS 6291, F-44007 Nantes, France
| | - Nathalie Vaillant
- INSERM, UMR1087, F-44007 Nantes, France CNRS 6291, F-44007 Nantes, France
| | - Nicole Malet
- INSERM, UMR1048, F-31300 Toulouse, France Université Toulouse III, Institut de Maladies Métaboliques et Cardiovasculaires, F-31300 Toulouse, France
| | - Sahar Kassem
- INSERM, UMR1043, F-31300 Toulouse, France UMR CNRS, U5282, F-31300 Toulouse, France Université de Toulouse, UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), F-31300 Toulouse, France
| | - Denis Calise
- INSERM, UMR1048, F-31300 Toulouse, France Université Toulouse III, Institut de Maladies Métaboliques et Cardiovasculaires, F-31300 Toulouse, France
| | - Dominique Goudounèche
- Université Toulouse III, Institut de Maladies Métaboliques et Cardiovasculaires, F-31300 Toulouse, France CMEAB, F-31000 Toulouse, France
| | - Matthias P Wymann
- Institute of Biochemistry and Genetics, University of Basel, 4058 Basel, Switzerland
| | - Emilio Hirsch
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Turin, Italy
| | | | - Laurent O Martinez
- INSERM, UMR1048, F-31300 Toulouse, France Université Toulouse III, Institut de Maladies Métaboliques et Cardiovasculaires, F-31300 Toulouse, France
| | - Abdelhadi Saoudi
- INSERM, UMR1043, F-31300 Toulouse, France UMR CNRS, U5282, F-31300 Toulouse, France Université de Toulouse, UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), F-31300 Toulouse, France
| | - Muriel Laffargue
- INSERM, UMR1048, F-31300 Toulouse, France Université Toulouse III, Institut de Maladies Métaboliques et Cardiovasculaires, F-31300 Toulouse, France
| |
Collapse
|