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Fantini DA, Yang G, Khanna A, Subramanian D, Phillippi JA, Huang NF. Overcoming big bottlenecks in vascular regeneration. Commun Biol 2024; 7:876. [PMID: 39020071 PMCID: PMC11255241 DOI: 10.1038/s42003-024-06567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 07/05/2024] [Indexed: 07/19/2024] Open
Abstract
Bioengineering and regenerative medicine strategies are promising for the treatment of vascular diseases. However, current limitations inhibit the ability of these approaches to be translated to clinical practice. Here we summarize some of the big bottlenecks that inhibit vascular regeneration in the disease applications of aortic aneurysms, stroke, and peripheral artery disease. We also describe the bottlenecks preventing three-dimensional bioprinting of vascular networks for tissue engineering applications. Finally, we describe emerging technologies and opportunities to overcome these challenges to advance vascular regeneration.
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Affiliation(s)
- Dalia A Fantini
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Guang Yang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Epicrispr Biotechnologies, Inc, South San Francisco, CA, USA
| | | | - Divya Subramanian
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, USA
| | - Julie A Phillippi
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Ngan F Huang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford, CA, USA.
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA.
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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Struczewska P, Razian SA, Townsend K, Jadidi M, Shahbad R, Zamani E, Gamache J, MacTaggart J, Kamenskiy A. Mechanical, structural, and physiologic differences between above and below-knee human arteries. Acta Biomater 2024; 177:278-299. [PMID: 38307479 DOI: 10.1016/j.actbio.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/07/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
Peripheral Artery Disease (PAD) affects the lower extremities and frequently results in poor clinical outcomes, especially in the vessels below the knee. Understanding the biomechanical and structural characteristics of these arteries is important for improving treatment efficacy, but mechanical and structural data on tibial vessels remain limited. We compared the superficial femoral (SFA) and popliteal (PA) arteries that comprise the above-knee femoropopliteal (FPA) segment to the infrapopliteal (IPA) anterior tibial (AT), posterior tibial (PT), and fibular (FA) arteries from the same 15 human subjects (average age 52, range 42-67 years, 87 % male). Vessels were imaged using μCT, evaluated with biaxial mechanical testing and constitutive modeling, and assessed for elastin, collagen, smooth muscle cells (SMCs), and glycosaminoglycans (GAGs). IPAs were more often diseased or calcified compared to the FPAs. They were also twice smaller, 53 % thinner, and significantly stiffer than the FPA longitudinally, but not circumferentially. IPAs experienced 48 % higher physiologic longitudinal stresses (62 kPa) but 27 % lower circumferential stresses (24 kPa) and similar cardiac cycle stretch of <1.02 compared to the FPA. IPAs had lower longitudinal pre-stretch (1.12) than the FPAs (1.29), but there were no differences in the stored elastic energy during pulsation. The physiologic circumferential stiffness was similar in the above and below-knee arteries (718 kPa vs 754 kPa). Structurally, IPAs had less elastin, collagen, and GAGs than the FPA, but maintained similar SMC content. Our findings contribute to a better understanding of segment-specific human lower extremity artery biomechanics and may inform the development of better medical devices for PAD treatment. STATEMENT OF SIGNIFICANCE: Peripheral Artery Disease (PAD) in the lower extremity arteries exhibits distinct characteristics and results in different clinical outcomes when treating arteries above and below the knee. However, their mechanical, structural, and physiologic differences are poorly understood. Our study compared above- and below-knee arteries from the same middle-aged human subjects and demonstrated distinct differences in size, structure, and mechanical properties, leading to variations in their physiological behavior. These insights could pave the way for creating location-specific medical devices and treatments for PAD, offering a more effective approach to its management. Our findings provide new, important perspectives for clinicians, researchers, and medical device developers interested in treating PAD in both above- and below-knee locations.
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Affiliation(s)
| | | | | | - Majid Jadidi
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | - Ramin Shahbad
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | - Elham Zamani
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | - Jennifer Gamache
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA.
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Azhar A, Basheer M, Abdelgawad MS, Roshdi H, Kamel MF. Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage. INT J LOW EXTR WOUND 2023; 22:518-523. [PMID: 34142882 DOI: 10.1177/15347346211027063] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetic foot ulcer syndrome is a common complication of diabetes mellitus. Three main factors contribute to it: neuropathy, vasculopathy, and infection. This study was conducted to evaluate the prevalence of peripheral arterial disease (PAD) in diabetic foot ulcer patients and its impact on limb salvage as an outcome. This prospective cross-sectional study included 392 cases, who were divided according to the presence of PAD into 2 groups; patients with PAD were labeled as PAD +ve (172 cases) and those without PAD were labeled as PAD -ve (22 cases). All cases were clinically assessed, and routine laboratory examinations were ordered. Moreover, duplex ultrasound was done for suspected cases of having PAD by examination. Computed tomography angiography was ordered for patients who are in need of a revascularization procedure. Cases were managed by debridement and/or revascularization. After that, these cases were assessed clinically and radiologically for vascularity and infection and the possibility for amputation was evaluated. Infection was classified using Wagner Classification System, and revascularization was decided according to the TASC II system. The incidence of PAD in cases with diabetic foot ulcer syndrome was 43.87%. No difference was detected between the 2 groups regarding age and gender (P > .05). The prevalence of smoking, hemodialysis, ischemic heart disease (IHD), and hypertension was more significantly higher in cases with PAD (P < .05). Revascularization procedures were only performed in cases that had documented severe PAD or chronic limb-threatening ischemia in addition to foot ulcer and/or infection. With regard to limb salvage, it was more significantly performed in cases without PAD (82.3% vs 48.3% in PAD cases; P < .001). Male gender, smoking, ankle-brachial pressure index, hemodialysis, IHD, neuropathy, HbA1C, PAD, and high Wagner classification were predictors of limb amputation (P < .05). PAD is associated with worse outcomes in diabetic foot ulcer patients. Not only does it constitute a great number among diabetic foot ulcer patients, but it also has a negative impact on limb salvage.
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Lee J, Gilliland T, Koyama S, Nakao T, Dron J, Lannery K, Wong M, Peloso GM, Hornsby W, Natarajan P. Integrative metabolomics differentiate coronary artery disease, peripheral artery disease, and venous thromboembolism risks. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.21.23291103. [PMID: 37425786 PMCID: PMC10327201 DOI: 10.1101/2023.06.21.23291103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Rationale Arterial and venous cardiovascular conditions, such as coronary artery disease (CAD), peripheral artery disease (PAD), and venous thromboembolism (VTE), are genetically correlated. Interrogating distinct and overlapping mechanisms may shed new light on disease mechanisms. Objective In this study, we aimed to: identify and compare (1) epidemiologic and (2) causal, genetic relationships between metabolites and CAD, PAD, and VTE. Methods We used metabolomic data from 95,402 individuals in the UK Biobank, excluding individuals with prevalent cardiovascular disease. Logistic regression models adjusted for age, sex, genotyping array, first five principal components of ancestry, and statin use estimated the epidemiologic associations of 249 metabolites with incident CAD, PAD, or VTE. Bidirectional two-sample Mendelian randomization (MR) estimated the causal effects between metabolites and cardiovascular phenotypes using genome-wide association summary statistics for metabolites (N = 118,466 from UK Biobank), CAD (N = 184,305 from CARDIoGRAMplusC4D 2015), PAD (N = 243,060 from Million Veterans Project) and VTE (N = 650,119 from Million Veterans Project). Multivariable MR (MVMR) was performed in subsequent analyses. Results We found that 194, 111, and 69 metabolites were epidemiologically associated (P < 0.001) with CAD, PAD, and VTE, respectively. Metabolomic profiles exhibited variable similarity between disease pairs: CAD and PAD (N = 100 shared associations, R2 = 0.499), CAD and VTE (N = 68, R2 = 0.455), and PAD and VTE (N = 54, R2 = 0.752). MR revealed 28 metabolites that increased risk for both CAD and PAD and 2 metabolites that increased risk for CAD but decreased risk for VTE. Despite strong epidemiologic overlap, no metabolites had a shared genetic relationship between PAD and VTE. MVMR revealed several metabolites with shared causal effects on CAD and PAD related to cholesterol content within very-low-density lipoprotein particles. Conclusions While common arterial and venous conditions are associated with overlapping metabolomic profiles, MR prioritized the role of remnant cholesterol in arterial diseases but not venous thrombosis.
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Affiliation(s)
- Jiwoo Lee
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Thomas Gilliland
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Satoshi Koyama
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Tetsushi Nakao
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Jacqueline Dron
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Kim Lannery
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Megan Wong
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Whitney Hornsby
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Pradeep Natarajan
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Gherasie FA, Popescu MR, Bartos D. Acute Coronary Syndrome: Disparities of Pathophysiology and Mortality with and without Peripheral Artery Disease. J Pers Med 2023; 13:944. [PMID: 37373933 DOI: 10.3390/jpm13060944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
There are a number of devastating complications associated with peripheral artery disease, including limb amputations and acute limb ischemia. Despite the overlap, atherosclerotic diseases have distinct causes that need to be differentiated and managed appropriately. In coronary atherosclerosis, thrombosis is often precipitated by rupture or erosion of fibrous caps around atheromatous plaques, which leads to acute coronary syndrome. Regardless of the extent of atherosclerosis, peripheral artery disease manifests itself as thrombosis. Two-thirds of patients with acute limb ischemia have thrombi associated with insignificant atherosclerosis. A local thrombogenic or remotely embolic basis of critical limb ischemia may be explained by obliterative thrombi in peripheral arteries of patients without coronary artery-like lesions. Studies showed that thrombosis of the above-knee arteries was more commonly due to calcified nodules, which are the least common cause of luminal thrombosis associated with acute coronary events in patients with acute coronary syndrome. Cardiovascular mortality was higher in peripheral artery disease without myocardial infarction/stroke than in myocardial infarction/stroke without peripheral artery disease. The aim of this paper is to gather published data regarding the disparities of acute coronary syndrome with and without peripheral artery disease in terms of pathophysiology and mortality.
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Affiliation(s)
| | - Mihaela-Roxana Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 011461 Bucharest, Romania
| | - Daniela Bartos
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Department of Internal Medicine, Clinical University Emergency Hospital, 014461 Bucharest, Romania
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Babaei S, Dai B, Abbey CK, Ambreen Y, Dobrucki WL, Insana MF. Monitoring Muscle Perfusion in Rodents During Short-Term Ischemia Using Power Doppler Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1465-1475. [PMID: 36967332 PMCID: PMC10106419 DOI: 10.1016/j.ultrasmedbio.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The aim of this work was to evaluate the reliability of power Doppler ultrasound (PD-US) measurements made without contrast enhancement to monitor temporal changes in peripheral blood perfusion. METHODS On the basis of pre-clinical rodent studies, we found that combinations of spatial registration and clutter filtering techniques applied to PD-US signals reproducibly tracked blood perfusion in skeletal muscle. Perfusion is monitored while modulating hindlimb blood flow. First, in invasive studies, PD-US measurements in deep muscle with laser speckle contrast imaging (LSCI) of superficial tissues made before, during and after short-term arterial clamping were compared. Then, in non-invasive studies, a pressure cuff was employed to generate longer-duration hindlimb ischemia. Here, B-mode imaging was also applied to measure flow-mediated dilation of the femoral artery while, simultaneously, PD-US was used to monitor downstream muscle perfusion to quantify reactive hyperemia. Measurements in adult male and female mice and rats, some with exercise conditioning, were included to explore biological variables. RESULTS PD-US methods are validated through comparisons with LSCI measurements. As expected, no significant differences were found between sexes or fitness levels in flow-mediated dilation or reactive hyperemia estimates, although post-ischemic perfusion was enhanced with exercise conditioning, suggesting there could be differences between the hyperemic responses of conduit and resistive vessels. CONCLUSION Overall, we found non-contrast PD-US imaging can reliably monitor relative spatiotemporal changes in muscle perfusion. This study supports the development of PD-US methods for monitoring perfusion changes in patients at risk for peripheral artery disease.
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Affiliation(s)
- Somaye Babaei
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Bingze Dai
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Craig K Abbey
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA
| | - Yamenah Ambreen
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Wawrzyniec L Dobrucki
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Michael F Insana
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Abstract
Peripheral artery disease (PAD) is a common type of atherosclerotic disease of the lower extremities associated with reduced quality of life and ambulatory capacity. Major adverse cardiovascular events and limb amputations are the leading cause of morbidity and mortality in this population. Optimal medical therapy is therefore critical in these patients to prevent adverse events. Risk factor modifications, including blood pressure control and smoking cessation, in addition to antithrombotic agents, peripheral vasodilators, and supervised exercise therapy are key pillars of medical therapy. Revascularization procedures represent key touch points between patients and health care providers and serve as opportunities to optimize medical therapy and improve long-term patency rates and outcomes. This review summarizes the aspects of medical therapy that all providers should be familiar with when caring for patients with PAD in the peri-revascularization period.
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Affiliation(s)
| | - Joshua A. Beckman
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Mohan B, Singal G, Singh AK, Singh B, Singla A, Hatwal J, Uppal A, Tandon R, Singh G, Goyal A, Chhabra ST, Aslam N, Roy A, Wander GS, Batta A. Prevalence and predictors of lower extremity atherosclerotic disease amongst high-risk patients using ankle brachial index. Indian Heart J 2023:S0019-4832(23)00048-2. [PMID: 37003536 DOI: 10.1016/j.ihj.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/15/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION The prevalence of lower extremity artery disease (LEAD) continues to increase worldwide. This is expected to translate into logarithmic rise in lower-limb amputations especially in the developing world. Majority of patients suffering from LEAD remain asymptomatic until late and are vulnerable to limb-threatening complications unless actively screened and treated. METHODS This was a prospective, single-center, observational study to determine the prevalence and predictors of LEAD. Patients with known atherosclerotic vascular disease (but not known LEAD) or those at risk were enrolled. All underwent ABI measurement as per the standard protocol. A threshold of ABI ≤ 0.90 was taken to diagnose LEAD. RESULTS A total of 1000 patients were enrolled. The mean age of the group was 61.4±10.0 years and the prevalence of LEAD was 10.2%. Amongst those who had LEAD, the majority of patients (69.6%) had no symptoms. The prevalence of LEAD in diabetic population in our study was 13.2% and in coronary artery disease patients it was 30.9%. Factors independently linked to LEAD on regression analysis included advanced age, presence of diabetes, smoking history, lower serum HDL and a lower ejection fraction. CONCLUSIONS The vast majority of patients suffering from LEAD are asymptomatic. Early diagnoses and institution of appropriate medical and physical therapy can prevent excess morbidity and mortality due to LEAD. Factors independently linked to LEAD are advanced age, presence of diabetes, smoking history, lower serum HDL and a lower ejection fraction. The presence of either of these should signal undertaking of appropriate steps to unmask underlying LEAD.
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Affiliation(s)
- Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Gautam Singal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Adesh Kumar Singh
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Bhupinder Singh
- Department of Cardiology, All India Institute of Medical Sciences, Bathinda, Punjab-151001, INDIA
| | - Ankur Singla
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Juniali Hatwal
- Department of Internal Medicine, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, INDIA
| | - Aditya Uppal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Rohit Tandon
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Gurbhej Singh
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Abhishek Goyal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Shibba Takkar Chhabra
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Naved Aslam
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar- New Delhi, 110029, INDIA
| | - Gurpreet Singh Wander
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, INDIA.
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Zierfuss B, Stangl H, Schernthaner GH. Non-esterified fatty acids: Another piece in the puzzle of PAD risk stratification? Atherosclerosis 2023; 370:1-2. [PMID: 36914540 DOI: 10.1016/j.atherosclerosis.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Bernhard Zierfuss
- Division of Angiology, Department of Medicine, Medical University of Vienna, Austria
| | - Herbert Stangl
- Center of Pathobiochemistry and Genetics, Institute for Medical Chemistry, Medical University of Vienna, Austria
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Setyawati A, Sangkala MS, Malasari S, Jafar N, Sjattar EL, Syahrul S, Rasyid H. Virgin Coconut Oil: A Dietary Intervention for Dyslipidaemia in Patients with Diabetes Mellitus. Nutrients 2023; 15:nu15030564. [PMID: 36771272 PMCID: PMC9920521 DOI: 10.3390/nu15030564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Hyperlipidaemia is causally related to coronary artery diseases (CAD) and peripheral artery diseases (PAD) in people with Diabetes Mellitus (DM). An in vivo study confirmed that virgin coconut oil (VCO) could maintain levels of lipids in the blood as effectively as conventional therapy. Therefore, this study aimed to determine the effect of VCO on the lipid profiles and ankle-brachial index (ABI) of patients with DM. In this experimental study with pre- and post-test design and a control group, the participants were selected purposively. The ABI was evaluated on the first visit. Baseline lipid profile readings were taken. Each participant took 1.2 mL/kgBW of VCO daily and divided it into three doses. After 30 days of taking VCO, laboratory examinations and ABI were repeated, and adverse events were evaluated. The dependent t-test and Wilcoxon sign rank test with a significance level of α ≤ 0.05 showed a significant decrease in low-density lipoprotein (LDL) (p = 0.002), a significant increase in high-density lipoprotein (HDL) levels (p = 0.031), a significant decrease in energy intake (p = 0.046) and cholesterol intake (p = 0.023) at the endpoint in the VCO group. In conclusion, this therapy is beneficial for maintaining lipid profile when combined with dietary therapy. Future studies should investigate the duration and dosage of VCO on patients to maintain lipid-linked protein.
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Affiliation(s)
- Andina Setyawati
- Lecturer of Medical and Surgical Nursing Department of Nursing Faculty, Universitas Hasanuddin, Makassar 90245, Indonesia
- Correspondence: ; Tel.: +62-8121521639
| | - Moh Syafar Sangkala
- Lecturer of Medical and Surgical Nursing Department of Nursing Faculty, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Silvia Malasari
- Lecturer of Community, Family, and Gerontology Nursing Department of Nursing Faculty, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Nuurhidayat Jafar
- Lecturer of Community, Family, and Gerontology Nursing Department of Nursing Faculty, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Elly L Sjattar
- Lecturer of Medical and Surgical Nursing Department of Nursing Faculty, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Syahrul Syahrul
- Lecturer of Community, Family, and Gerontology Nursing Department of Nursing Faculty, Universitas Hasanuddin, Makassar 90245, Indonesia
| | - Haerani Rasyid
- Lecturer of Medicine Faculty, Universitas Hasanuddin, Makassar 90245, Indonesia
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Marillier M, Bernard AC, Verges S, Moran-Mendoza O, Neder JA. Quantifying leg muscle deoxygenation during incremental cycling in hypoxemic patients with fibrotic interstitial lung disease. Clin Physiol Funct Imaging 2022; 43:192-200. [PMID: 36582169 DOI: 10.1111/cpf.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hypoxaemia and cardiocirculatory abnormalities may impair muscle oxygen (O2 ) delivery relative to O2 requirements thereby increasing the rate of O2 extraction during incremental exercise in fibrotic interstitial lung disease (f-ILD). Using changes in deoxyhaemoglobin concentration ([HHb]) by near-infrared spectroscopy (NIRS) as a proxy of O2 extraction, we investigated whether a simplified (double-linear) approach, previously tested in heart failure, would provide useful estimates of muscle deoxygenation in f-ILD. METHODS A total of 25 patients (23 men, 72 ± 8 years; 20 with idiopathic pulmonary fibrosis, lung diffusing capacity for carbon monoxide = 44 ± 11% predicted) and 12 age- and sex-matched healthy controls performed incremental cycling to symptom limitation. Changes in vastus lateralis [HHb] assessed by NIRS were analysed in relation to work rate (WR) and O2 uptake throughout the exercise. RESULTS Patients showed lower exercise capacity than controls (e.g., peak WR = 67 ± 18% vs. 105 ± 20% predicted, respectively; p < 0.001). The [HHb] response profile was typically S-shaped, presenting three distinct phases. Exacerbated muscle deoxygenation in patients versus controls was evidenced by: (i) a steeper mid-exercise [HHb]-WR slope (0.30 ± 0.22 vs. 0.11 ± 0.08 μmol/W; p = 0.008) (Phase 2), and (ii) a larger late-exercise increase in [HHb] (p = 0.002) (Phase 3). Steeper [HHb]-WR slope was associated with lower peak WR (r = -0.70) and greater leg discomfort (r = 0.77; p < 0.001) in f-ILD. CONCLUSION This practical approach to interpreting [HHb] during incremental exercise might prove useful to determine the severity of muscle deoxygenation and the potential effects of interventions thereof in hypoxemic patients with f-ILD.
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Affiliation(s)
- Mathieu Marillier
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.,HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Anne-Catherine Bernard
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.,HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Samuel Verges
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Onofre Moran-Mendoza
- Interstitial Lung Disease Program, Queen's University and Hotel Dieu Hospital, Kingston, Ontario, Canada
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
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Xiu X, Zhang H, Xue A, Cooper DN, Yan L, Yang Y, Yang Y, Zhao H. Genetic evidence for a causal relationship between type 2 diabetes and peripheral artery disease in both Europeans and East Asians. BMC Med 2022; 20:300. [PMID: 36042491 PMCID: PMC9429730 DOI: 10.1186/s12916-022-02476-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Observational studies have revealed that type 2 diabetes (T2D) is associated with an increased risk of peripheral artery disease (PAD). However, whether the two diseases share a genetic basis and whether the relationship is causal remain unclear. It is also unclear as to whether these relationships differ between ethnic groups. METHODS By leveraging large-scale genome-wide association study (GWAS) summary statistics of T2D (European-based: Ncase = 21,926, Ncontrol = 342,747; East Asian-based: Ncase = 36,614, Ncontrol = 155,150) and PAD (European-based: Ncase = 5673, Ncontrol = 359,551; East Asian-based: Ncase = 3593, Ncontrol = 208,860), we explored the genetic correlation and putative causal relationship between T2D and PAD in both Europeans and East Asians using linkage disequilibrium score regression and seven Mendelian randomization (MR) models. We also performed multi-trait analysis of GWAS and two gene-based analyses to reveal candidate variants and risk genes involved in the shared genetic basis between T2D and PAD. RESULTS We observed a strong genetic correlation (rg) between T2D and PAD in both Europeans (rg = 0.51; p-value = 9.34 × 10-15) and East Asians (rg = 0.46; p-value = 1.67 × 10-12). The MR analyses provided consistent evidence for a causal effect of T2D on PAD in both ethnicities (odds ratio [OR] = 1.05 to 1.28 for Europeans and 1.15 to 1.27 for East Asians) but not PAD on T2D. This putative causal effect was not influenced by total cholesterol, body mass index, systolic blood pressure, or smoking initiation according to multivariable MR analysis, and the genetic overlap between T2D and PAD was further explored employing an independent European sample through polygenic risk score regression. Multi-trait analysis of GWAS revealed two novel European-specific single nucleotide polymorphisms (rs927742 and rs1734409) associated with the shared genetic basis of T2D and PAD. Gene-based analyses consistently identified one gene ANKFY1 and gene-gene interactions (e.g., STARD10 [European-specific] to AP3S2 [East Asian-specific]; KCNJ11 [European-specific] to KCNQ1 [East Asian-specific]) associated with the trans-ethnic genetic overlap between T2D and PAD, reflecting a common genetic basis for the co-occurrence of T2D and PAD in both Europeans and East Asians. CONCLUSIONS Our study provides the first evidence for a genetically causal effect of T2D on PAD in both Europeans and East Asians. Several candidate variants and risk genes were identified as being associated with this genetic overlap. Our findings emphasize the importance of monitoring PAD status in T2D patients and suggest new genetic biomarkers for screening PAD risk among patients with T2D.
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Affiliation(s)
- Xuehao Xiu
- Department of Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Haoyang Zhang
- Department of Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China.,School of Data and Computer Science, Sun Yat-sen University, Guangzhou, 510000, China
| | - Angli Xue
- Garvan-Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, Sydney, NSW, Australia.,Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Li Yan
- Department of Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Yuedong Yang
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, 510000, China.
| | - Yuanhao Yang
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia. .,Mater Research Institute, Translational Research Institute, Brisbane, QLD, Australia.
| | - Huiying Zhao
- Department of Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China.
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López-Montoya P, Cerqueda-García D, Rodríguez-Flores M, López-Contreras B, Villamil-Ramírez H, Morán-Ramos S, Molina-Cruz S, Rivera-Paredez B, Antuna-Puente B, Velázquez-Cruz R, Villarreal-Molina T, Canizales-Quinteros S. Association of Gut Microbiota with Atherogenic Dyslipidemia, and Its Impact on Serum Lipid Levels after Bariatric Surgery. Nutrients 2022; 14:nu14173545. [PMID: 36079803 PMCID: PMC9460232 DOI: 10.3390/nu14173545] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Gut microbiota has been suggested to modulate circulating lipids. However, the relationship between the gut microbiota and atherogenic dyslipidemia (AD), defined as the presence of both low HDL-C and hypertriglyceridemia, is not fully understood. Moreover, because obesity is among the main causes of secondary AD, it is important to analyze the effect of gut microbiota composition on lipid profiles after a weight loss intervention. We compared the microbial diversity and taxonomic composition in patients with AD (n = 41) and controls (n = 38) and sought correlations of genera abundance with serum lipid levels in 20 patients after weight loss induced by Roux-en-Y gastric bypass (RYGB) surgery. Gut microbiota composition was profiled using next-generation sequencing of 16S rRNA. Gut microbiota diversity was significantly lower in atherogenic dyslipidemia. Moreover, relative abundance of two genera with LDA score >3.5 (Megasphaera and LPS-producing Escherichia-Shigella), was significantly higher in AD subjects, while the abundance of four short chain fatty acids (SCFA) producing-genera (Christensenellaceae R-7, Ruminococcaceae UCG-014; Akkermansia and [Eubacterium] eligens group) was significantly higher in controls. Notably, [Eubacterium] eligens group abundance was also significantly associated with higher HDL-C levels in RYGB patients one year after surgery. Although dietary polyunsaturated fatty acid/saturated fatty acid (PUFA/SFA) ratio and PUFA intake were higher in controls than in AD subjects, of the four genera differentiated in cases and controls, only Akkermansia abundance showed a positive and significant correlation with PUFA/SFA ratio. Our results suggest that SCFA-producing bacteria promote a healthy lipid homeostasis, while the presence of LPS-producing bacteria such Escherichia-Shigella may contribute to the development of atherogenic dyslipidemia.
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Affiliation(s)
- Priscilla López-Montoya
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City 14610, Mexico
- Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City 14610, Mexico
- Programa de Maestría en Ciencias Bioquímicas, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
| | - Daniel Cerqueda-García
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City 14610, Mexico
- Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City 14610, Mexico
| | - Marcela Rodríguez-Flores
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Blanca López-Contreras
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City 14610, Mexico
- Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City 14610, Mexico
| | - Hugo Villamil-Ramírez
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City 14610, Mexico
- Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City 14610, Mexico
| | - Sofía Morán-Ramos
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City 14610, Mexico
- Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City 14610, Mexico
| | - Selene Molina-Cruz
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City 14610, Mexico
- Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City 14610, Mexico
- Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
| | - Berenice Rivera-Paredez
- Centro de Investigación en Políticas, Población y Salud (CIPPS), Facultad de Medicina-UNAM, Mexico City 04510, Mexico
| | - Bárbara Antuna-Puente
- Infection Disease Division, Department of Medicine, Queen’s University, Kingston, ON K7L3N6, Canada
| | | | | | - Samuel Canizales-Quinteros
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City 14610, Mexico
- Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City 14610, Mexico
- Correspondence:
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14
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Shih PK, Chen JX, Lin MC, Wu SC. Risk of peripheral artery occlusive disease in patients with lower leg fracture who received fixation and non-fixation treatments: A population cohort study. PLoS One 2022; 17:e0272068. [PMID: 35925984 PMCID: PMC9352030 DOI: 10.1371/journal.pone.0272068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background The risk of peripheral artery occlusive disease (PAOD) in patients with lower leg fracture who underwent fixation procedures is not yet completely understood. Therefore, the current study aimed to examine the risk of subsequent PAOD in patients with lower leg fracture who received fixation and non-fixation treatments. Methods We included 6538 patients with lower leg fracture who received non-fixation treatment and a matched cohort comprising 26152 patients who received fixation treatment from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence and risk of PAOD in patients with lower leg fracture who received fixation and non-fixation treatments were evaluated via the stratification of different characteristics and comorbidities. Results Non-fixation treatment, male sex, older age (≥ 50 years old), diabetes mellitus, and gout were associated with a significantly higher risk of lower extremity PAOD compare to each comparison group, respectively. Moreover, there was a significant correlation between fixation treatment and a lower risk of lower extremity PAOD in women (adjusted hazard ratio [aHR] = 0.58, 95% confidence interval [CI] = 0.38–0.90), women aged > 50 years (aHR = 0.61, 95% CI = 0.38–0.96), and patients with coronary artery disease (aHR = 0.43, 95% CI = (0.23–0.81). Further, patients with fixation treatment had a significantly lower risk of lower extremity PAOD within 2 years after trauma (aHR = 0.57, 95% CI = 0.34–0.97). The Kaplan–Meier analysis showed that the cumulative incidence of PAOD was significantly higher in the non-fixation treatment group than in the fixation treatment group at the end of the 10-year follow-up period (log-rank test: P = 0.022). Conclusion Patients with lower leg fracture who received non-fixation treatment had a significantly higher risk of PAOD than those who received fixation treatment. Moreover, the risk of PAOD was higher in women aged > 50 years, as well as in coronary artery disease patients who received non-fixation treatment than in those who received fixation treatment. Therefore, regular assessment of vessel patency are recommended for these patients. Nevertheless, further studies must be conducted to validate the results of our study.
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Affiliation(s)
- Pin-Keng Shih
- School of medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jian-Xun Chen
- School of medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- School of medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
| | - Shih-Chi Wu
- School of medicine, China Medical University, Taichung, Taiwan
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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15
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Kim S, Pendleton AA, McGinigle K. Peripheral Artery Disease: Diagnosis, Treatment, and Outcomes in Females. Semin Vasc Surg 2022; 35:155-161. [DOI: 10.1053/j.semvascsurg.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022]
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16
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Stafeev I, Boldyreva M, Michurina S, Mamontova E, Ratner E, Menshikov M, Parfyonova Y. Grain-Based Dietary Background Impairs Restoration of Blood Flow and Skeletal Muscle During Hindlimb Ischemia in Comparison With Low-Fat and High-Fat Diets. Front Nutr 2022; 8:809732. [PMID: 35083264 PMCID: PMC8784406 DOI: 10.3389/fnut.2021.809732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Among vascular pathologies associated with obesity, peripheral artery disease (PAD) occupies the important position. In clinical practice, nutritional interventions are recommended for patients with PAD. In this work, we investigated how the different dietary backgrounds affect the regeneration rate of ischemic hindlimb in mice. Methods: Male C57BL/6J mice were housed on three types of diet: low-fat (LFD), high-fat (HFD), and grain-based diet (GBD) for 13 weeks. Metabolic parameters including FBG level, ITT, and GTT were evaluated. The blood flow was assessed by laser Doppler scanning on 7, 14, and 21 days after hindlimb ischemia. Necrotic area of m.tibialis, macrophage infiltration, and angiogenesis/arteriogenesis were evaluated by histology. Glucose uptake in recovered skeletal muscle was analyzed using [3H]-2-deoxyglucose, and GLUT1 and GLUT4 expression were assessed by Western blotting. Results: In our work, we developed three experimental groups with different metabolic parameters: LFD with normal glucose metabolism, GBD with mild hyperglycemia, and HFD with impaired glucose tolerance. GBD-fed mice had a tendency to increase necrosis of m. tibialis and significantly higher macrophage infiltration than LFD and HFD groups. Moreover, GBD-fed mice had a trend to decreased blood flow recovery and significantly impaired arteriogenesis. Recovered skeletal muscle of GBD-fed mice had lower glucose uptake and decreased level of GLUT4 expression. Conclusion: Thus, we conclude that dietary background and metabolic status determine the rate of post-ischemic regeneration including angiogenesis, skeletal muscle recovery and metabolic activity. The most effective regeneration is supported by LFD, while the lowest rate of regeneration occurs on GBD.
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Affiliation(s)
- Iurii Stafeev
- National Medical Research Center for Cardiology, Moscow, Russia
| | - Maria Boldyreva
- National Medical Research Center for Cardiology, Moscow, Russia.,Faculty of Biology and Biotechnology, National Research University Higher School of Economics, Moscow, Russia
| | - Svetlana Michurina
- National Medical Research Center for Cardiology, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | - Elizaveta Mamontova
- National Medical Research Center for Cardiology, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | | | | | - Yelena Parfyonova
- National Medical Research Center for Cardiology, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
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17
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Leiherer A, Mündlein A, Brandtner EM, Säly CH, Ramadani H, Vonbank A, Mader A, Dopheide JF, Jylhä A, Lääperi M, Laaksonen R, März W, Fraunberger P, Kleber M, Drexel H. Lipid profiles of patients with manifest coronary versus peripheral atherosclerosis - Is there a difference? J Intern Med 2021; 290:1249-1263. [PMID: 34337800 DOI: 10.1111/joim.13368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM Peripheral arterial disease (PAD) and coronary artery disease (CAD) are both caused by atherosclerosis. Serum lipids and lipoproteins are predictive of the development of atherosclerosis but it is not clear if they differ in the two manifestations, PAD and CAD. We tested whether a more detailed characterization of the lipid and lipoprotein patterns of PAD and CAD allows a clear differentiation between the two atherosclerotic phenotypes. METHODS A cohort of 274 statin-naïve patients with either newly diagnosed imaging proven PAD (n = 89) or stable CAD (n = 185) was characterized using nuclear magnetic resonance- and liquid chromatography-tandem mass spectrometry-based advanced lipid and lipoprotein analysis. An independent cohort of 1239 patients with PAD and CAD was used for validation. RESULTS We found a significant difference in markers of inflammation as well as ceramide and phosphatidylcholine levels between patients with PAD and CAD. In contrast, basic lipid markers including total cholesterol, LDL cholesterol, HDL cholesterol, lipoprotein(a) or detailed lipoprotein profiles did not differ significantly between patients with PAD and CAD. Applying ratios and scores derived from ceramides and phosphatidylcholines further improved the discrimination between PAD and CAD. These significant differences were independent of body composition, from the status of smoking or type 2 diabetes mellitus, and also from apolipoprotein C-III and other inflammatory parameters which were different between CAD and PAD. CONCLUSION The present study clearly suggests that PAD and CAD differ in terms of their ceramide- and phosphatidylcholine-based lipid patterns but not in lipoprotein characteristics.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Medical Central Laboratories, Feldkirch, Austria
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Christoph H Säly
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Hana Ramadani
- Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
| | - Alexander Vonbank
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Jörn F Dopheide
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
| | | | | | - Reijo Laaksonen
- Zora Biosciences, Espoo, Finland.,Finnish Cardiovascular Research Center, University of Tampere, Tampere, Finland
| | - Winfried März
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Synlab Academy, Synlab Holding, Mannheim, Germany
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Medical Central Laboratories, Feldkirch, Austria
| | - Marcus Kleber
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.,Department of Internal Medicine, Academic Teaching Hospital Bregenz, Bregenz, Austria
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18
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Abstract
Peripheral artery disease is a highly morbid yet undertreated atherosclerotic disease. The cornerstones of peripheral artery disease therapy consist of smoking cessation, lipid-lowering therapy, and hypertension treatment. More recently, clinical trials have demonstrated that novel antiplatelet and antithrombotic therapies reduce the risk of both cardiovascular and limb events in this patient population. In this review, we highlight the components of optimal medical therapy of peripheral artery disease and the evidence base for these therapies.
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Affiliation(s)
- Tara A Holder
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 383 PRB, Nashville, TN 37232-0021, USA. https://twitter.com/TaraHolder17
| | - J Antonio Gutierrez
- Division of Cardiology, Department of Medicine, Duke University Medical Center, DUMC 3330, Durham, NC 27710, USA. https://twitter.com/JAGutierrezMD
| | - Aaron W Aday
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 383 PRB, Nashville, TN 37232-0021, USA; Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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19
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Liu X, Wang Y, Wu J, Wang A, Zhang X, Cao Z, Zhao X. Association Between Cumulative Exposure to Increased Low-Density Lipoprotein Cholesterol and the New Occurrence of Peripheral Artery Disease. Front Neurol 2021; 12:696695. [PMID: 34744959 PMCID: PMC8566700 DOI: 10.3389/fneur.2021.696695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis with increased risk of severe cardiovascular and cerebrovascular events. The relationship between one-time measuring of low-density lipoprotein cholesterol (LDL-C) and PAD is inconsistent. Increasing evidence shows that the predictive value of non-high-density lipoprotein cholesterol (non-HDLC) on atherosclerosis disease is superior to LDL-C. We aimed to investigate the relationship between cumulative exposure to increased LDL-C and the risk of newly developed PAD and compare the predictive value of LDL-C with non-HDLC. Materials and Methods: In the Asymptomatic Polyvascular Abnormalities Community study, we enrolled 2,923 participants with LDL-C and non-HDLC measured every 2 years from 2006 to 2012. Cumulative exposure to increased LDL-C and non-HDLC, defined as LDL-C burden and non-HDLC burden, respectively, was calculated as the weighted sum of the difference between the measured value and the cutoff value. A new occurrence of PAD was identified through ankle brachial index measured in 2010 and 2012. Multivariate models were adopted to analyze the association of LDL-C burden and non-HDLC burden with the newly developed PAD. The receiver operating curve was drawn, and the area under the curve was calculated to compare the predictive performance of LDL-C burden with a single measure of LDL-C in 2006 and non-HDL-C burden adjusted with a model including traditional risk factors. Results: Of the 2,923 participants, 5.4% (158/2,923) were diagnosed as newly developed PAD. In the univariate analysis, the highest quartile of LDL-C burden was significantly associated with new occurrence of PAD [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.13-2.73]. After adjustment for confounding factors, the same result was obtained (OR 1.59, 95%CI 1.01-2.49). The non-HDLC burden failed to show any statistical significance on the newly developed PAD (OR 1.31, 95% CI 0.84-2.04). Though LDL-C burden had a tendency to show better predictive performance than non-HDLC, it did not reach statistical significance (AUCLDL-C = 0.554 vs. AUCnon-HDLC = 0.544, P = 0.655). Conclusions: Cumulative exposure to increased LDL-C is an independent risk factor of newly developed PAD. The predictive value of non-HDLC burden was not revealed.
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Affiliation(s)
- Xinmin Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yu Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianwei Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Zhentang Cao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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20
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Zembron-Lacny A, Dziubek W, Tylutka A, Wacka E, Morawin B, Bulinska K, Stefanska M, Wozniewski M, Szuba A. Assessment of Serum Neopterin as a Biomarker in Peripheral Artery Disease. Diagnostics (Basel) 2021; 11:diagnostics11101911. [PMID: 34679610 PMCID: PMC8534562 DOI: 10.3390/diagnostics11101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Neopterin (NPT), a pyrazino-pyrimidine compound mainly produced by activated macrophages, has been regarded as a proinflammatory and proatherosclerotic agent. The study was designed to evaluate NPT level and its interaction with conventional peripheral artery disease (PAD) biomarkers and vascular regenerative potential in severe PAD. The study included 59 patients (females n = 17, males n = 42) aged 67.0 ± 8.2 years classified into two groups based on ankle-brachial index (ABI) measurements (ABI ≤ 0.9 n = 43, ABI ≤ 0.5 n = 16). A total of 60 subjects aged 70.4 ± 5.5 years (females n = 42, males n = 18) with ABI > 0.9 constituted a reference group. NPT concentration reached values above 10 nmol/L in patients with PAD, which differed significantly from reference group (8.15 ± 1.33 nmol/L). High levels of CRP > 5 mg/L, TC > 200 mg/dL as well as lipoproteins LDL > 100 mg/dL and non-HDL > 130 mg/dL were found in the same group, indicating the relationship between NPT and conventional atherogenic markers. The endothelial progenitor cells (EPCs) tended toward lower values in patients with ABI ≤ 0.5 when compared to reference group, and inversely correlated with NPT. These findings indicate a crucial role of NPT in atheromatous process and its usefulness in monitoring PAD severity. However, the role of NPT in chronic PAD needs further studies including relatively high number of subjects.
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Affiliation(s)
- Agnieszka Zembron-Lacny
- Department of Applied and Clinical Physiology, Collegium Medicum University of Zielona Gora, 65-417 Zielona Gora, Poland; (A.Z.-L.); (A.T.); (B.M.)
| | - Wioletta Dziubek
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (W.D.); (K.B.); (M.S.); (M.W.)
| | - Anna Tylutka
- Department of Applied and Clinical Physiology, Collegium Medicum University of Zielona Gora, 65-417 Zielona Gora, Poland; (A.Z.-L.); (A.T.); (B.M.)
| | - Eryk Wacka
- Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland
- Correspondence: ; Tel.: +48-534-100-354
| | - Barbara Morawin
- Department of Applied and Clinical Physiology, Collegium Medicum University of Zielona Gora, 65-417 Zielona Gora, Poland; (A.Z.-L.); (A.T.); (B.M.)
| | - Katarzyna Bulinska
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (W.D.); (K.B.); (M.S.); (M.W.)
| | - Malgorzata Stefanska
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (W.D.); (K.B.); (M.S.); (M.W.)
| | - Marek Wozniewski
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (W.D.); (K.B.); (M.S.); (M.W.)
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology Medical University Wroclaw, 50-556 Wroclaw, Poland;
- WROVASC An Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development Wroclaw, 51-124 Wroclaw, Poland
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21
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Levin MG, Zuber V, Walker VM, Klarin D, Lynch J, Malik R, Aday AW, Bottolo L, Pradhan AD, Dichgans M, Chang KM, Rader DJ, Tsao PS, Voight BF, Gill D, Burgess S, Damrauer SM. Prioritizing the Role of Major Lipoproteins and Subfractions as Risk Factors for Peripheral Artery Disease. Circulation 2021; 144:353-364. [PMID: 34139859 PMCID: PMC8323712 DOI: 10.1161/circulationaha.121.053797] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lipoprotein-related traits have been consistently identified as risk factors for atherosclerotic cardiovascular disease, largely on the basis of studies of coronary artery disease (CAD). The relative contributions of specific lipoproteins to the risk of peripheral artery disease (PAD) have not been well defined. We leveraged large-scale genetic association data to investigate the effects of circulating lipoprotein-related traits on PAD risk. METHODS Genome-wide association study summary statistics for circulating lipoprotein-related traits were used in the mendelian randomization bayesian model averaging framework to prioritize the most likely causal major lipoprotein and subfraction risk factors for PAD and CAD. Mendelian randomization was used to estimate the effect of apolipoprotein B (ApoB) lowering on PAD risk using gene regions proxying lipid-lowering drug targets. Genes relevant to prioritized lipoprotein subfractions were identified with transcriptome-wide association studies. RESULTS ApoB was identified as the most likely causal lipoprotein-related risk factor for both PAD (marginal inclusion probability, 0.86; P=0.003) and CAD (marginal inclusion probability, 0.92; P=0.005). Genetic proxies for ApoB-lowering medications were associated with reduced risk of both PAD (odds ratio,0.87 per 1-SD decrease in ApoB [95% CI, 0.84-0.91]; P=9×10-10) and CAD (odds ratio,0.66 [95% CI, 0.63-0.69]; P=4×10-73), with a stronger predicted effect of ApoB lowering on CAD (ratio of effects, 3.09 [95% CI, 2.29-4.60]; P<1×10-6). Extra-small very-low-density lipoprotein particle concentration was identified as the most likely subfraction associated with PAD risk (marginal inclusion probability, 0.91; P=2.3×10-4), whereas large low-density lipoprotein particle concentration was the most likely subfraction associated with CAD risk (marginal inclusion probability, 0.95; P=0.011). Genes associated with extra-small very-low-density lipoprotein particle and large low-density lipoprotein particle concentration included canonical ApoB pathway components, although gene-specific effects were variable. Lipoprotein(a) was associated with increased risk of PAD independently of ApoB (odds ratio, 1.04 [95% CI, 1.03-1.04]; P=1.0×10-33). CONCLUSIONS ApoB was prioritized as the major lipoprotein fraction causally responsible for both PAD and CAD risk. However, ApoB-lowering drug targets and ApoB-containing lipoprotein subfractions had diverse associations with atherosclerotic cardiovascular disease, and distinct subfraction-associated genes suggest possible differences in the role of lipoproteins in the pathogenesis of PAD and CAD.
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Affiliation(s)
- Michael G. Levin
- Division of Cardiovascular Medicine (M.G.L.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Medicine (M.G.L., K.-M.C., D.J.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (M.G.L., K.-M.C., B.F.V., S.M.D.)
| | - Verena Zuber
- MRC Biostatistics Unit (V.Z., S.B.), School of Clinical Medicine, University of Cambridge, UK
- Department of Epidemiology and Biostatistics (V.Z.), Imperial College London, UK
- Dementia Research Institute (V.Z.), Imperial College London, UK
| | - Venexia M. Walker
- Department of Surgery (V.M.W., S.M.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK (V.M.W.)
| | - Derek Klarin
- Malcolm Randall VA Medical Center, Gainesville, FL (D.K.)
- Department of Surgery, University of Florida, Gainesville (D.K.)
| | - Julie Lynch
- VA Informatics and Computing Infrastructure, Department of Veterans Affairs, Salt Lake City Health Care System, UT (J.L.)
- University of Utah School of Medicine, Salt Lake City (J.L.)
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany (R.M.)
| | - Aaron W. Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (A.W.A.)
| | - Leonardo Bottolo
- Department of Medical Genetics (L.B.), School of Clinical Medicine, University of Cambridge, UK
- The Alan Turing Institute, London, UK (L.B.)
| | - Aruna D. Pradhan
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.D.P.)
- Division of Cardiovascular Medicine, VA Boston Medical Center, MA (A.D.P.)
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany (M.D.)
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.)
| | - Kyong-Mi Chang
- Department of Medicine (M.G.L., K.-M.C., D.J.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (M.G.L., K.-M.C., B.F.V., S.M.D.)
| | - Daniel J. Rader
- Department of Medicine (M.G.L., K.-M.C., D.J.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Institute for Translational Medicine and Therapeutics (D.J.R., B.F.V.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Genetics (D.J.R., B.V.F.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Munich Cluster for Systems Neurology (SyNergy), Germany (D.J.R., B.F.V.)
| | - Philip S. Tsao
- Palo Alto VA Healthcare System, CA (P.S.T.)
- Department of Medicine, Division of Cardiovascular Medicine, and Stanford Cardiovascular Institute, Stanford University, Palo Alto, CA (P.S.T.)
| | - Benjamin F. Voight
- Institute for Translational Medicine and Therapeutics (D.J.R., B.F.V.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Genetics (D.J.R., B.V.F.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Systems Pharmacology and Translational Therapeutics (B.V.F.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (M.G.L., K.-M.C., B.F.V., S.M.D.)
- Munich Cluster for Systems Neurology (SyNergy), Germany (D.J.R., B.F.V.)
| | - Dipender Gill
- Department of Epidemiology and Biostatistics (D.G.), Imperial College London, UK
- Clinical Pharmacology and Therapeutics Section, Institute for Infection and Immunity, St. George’s, University of London, UK (D.G.)
- Novo Nordisk Research Centre Oxford, Old Road Campus, UK (D.G.)
| | - Stephen Burgess
- MRC Biostatistics Unit (V.Z., S.B.), School of Clinical Medicine, University of Cambridge, UK
- BHF Cardiovascular Epidemiology Unit (S.B.), School of Clinical Medicine, University of Cambridge, UK
| | - Scott M. Damrauer
- Department of Surgery (V.M.W., S.M.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (M.G.L., K.-M.C., B.F.V., S.M.D.)
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22
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Alsaigh T, Di Bartolo BA, Mulangala J, Figtree GA, Leeper NJ. Bench-to-Bedside in Vascular Medicine: Optimizing the Translational Pipeline for Patients With Peripheral Artery Disease. Circ Res 2021; 128:1927-1943. [PMID: 34110900 PMCID: PMC8208504 DOI: 10.1161/circresaha.121.318265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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
Peripheral arterial disease is a growing worldwide problem with a wide spectrum of clinical severity and is projected to consume >$21 billion per year in the United States alone. While vascular researchers have brought several therapies to the clinic in recent years, few of these approaches have leveraged advances in high-throughput discovery screens, novel translational models, or innovative trial designs. In the following review, we discuss recent advances in unbiased genomics and broader omics technology platforms, along with preclinical vascular models designed to enhance our understanding of disease pathobiology and prioritize targets for additional investigation. Furthermore, we summarize novel approaches to clinical studies in subjects with claudication and ischemic ulceration, with an emphasis on streamlining and accelerating bench-to-bedside translation. By providing a framework designed to enhance each aspect of future clinical development programs, we hope to enrich the pipeline of therapies that may prevent loss of life and limb for those with peripheral arterial disease.
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Affiliation(s)
- Tom Alsaigh
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Belinda A. Di Bartolo
- Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | | | - Gemma A. Figtree
- Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Nicholas J. Leeper
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, United States of America
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23
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Apolipoprotein E Gene Polymorphism, Glycated Hemoglobin, and Peripheral Arterial Disease Risk in Chinese Type 2 Diabetic Patients. DISEASE MARKERS 2021; 2020:6040525. [PMID: 32211081 PMCID: PMC7085830 DOI: 10.1155/2020/6040525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/27/2019] [Accepted: 01/16/2020] [Indexed: 11/17/2022]
Abstract
Background The apolipoprotein E (ApoE) gene polymorphism has been found to influence plasma lipid concentration, and its correlation with peripheral arterial disease (PAD) has been investigated. However, it is unclear whether ApoE is associated with PAD in Chinese type 2 diabetes mellitus (T2DM) patients. Therefore, our study is aimed at investigating the relationship between the ApoE gene polymorphism and PAD in Chinese T2DM patients. Methods A total of 192 T2DM patients were divided into two groups: T2DM and T2DM with PAD. The clinical and biochemical parameters were obtained. Polymerase chain reaction was used to identify the genotypes of ApoE. The multivariable logistic regression analysis was used to identify the possible risk factor for PAD. Results There were no significant differences in the genotype and allele frequencies of ApoE between the T2DM and T2DM with PAD groups. However, the T2DM with PAD group tended to have more ε4/ε4/ Conclusions These results demonstrated that there was no evidence of a relationship between ApoE and PAD.
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Vitamin D Deficiency May Not Be an Independent Risk Factor for Peripheral Arterial Disease in Middle-Aged and Elderly Patients with Type 2 Diabetes in China. DISEASE MARKERS 2020; 2020:8854717. [PMID: 33299499 PMCID: PMC7710426 DOI: 10.1155/2020/8854717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022]
Abstract
Background Vitamin D deficiency can lead to the increased severity and prevalence of metabolic disorders. However, the relationship between levels of 25-hydroxyvitamin D (25(OH)D) and peripheral arterial disease (PAD) is controversial. Therefore, the purpose of our study was to explore the relationship between 25(OH)D levels and PAD in middle-aged and elderly type 2 diabetes mellitus (T2DM) patients in China. Methods In this study, a total of 183 patients with T2DM were enrolled and categorized into groups with or without PAD. Clinical and biochemical parameters were assessed, and a Pearson analysis was used to identify a possible association between levels of 25(OH)D and glycated hemoglobin (HbA1c). Some biochemical parameters were also assessed in the T2DM patients with PAD according to vitamin D status. Interactions were also explored among HbA1c control, 25(OH)D levels, and PAD. The possible risk factors for PAD were measured by multivariable logistic regression analyses. Results Firstly, the parameters including age, HbA1c, and disease duration between T2DM and T2DM+PAD groups showed significantly different. In addition, the frequency of smoking in the group of T2DM patients was significantly less than that in the T2DM patients with the PAD group, while the frequency of well-controlled HbA1c in the patients with T2DM was significantly higher. There is a trend that the levels of 25(OH)D and HbA1c are correlated, but no interactions among vitamin D deficiency, HbA1c control, and PAD were found. However, HbA1c significantly differed between groups with vitamin D deficiency and insufficiency in the T2DM patients with PAD. According to the multivariate logistic regression analyses, the PAD risk factors of T2DM patients were family history of diabetes, smoking, age, disease duration, HbA1c, and LDL. Conclusions The findings demonstrate that the deficiency of vitamin D level is not related to PAD, but HbA1c may be linked to the presence of PAD in middle-aged and elderly patients with T2DM in China.
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25
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Attar A. Apolipoproteins and peripheral arterial disease. Eur J Prev Cardiol 2020; 28:1978-1979. [PMID: 34152384 DOI: 10.1093/eurjpc/zwaa099] [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: 11/13/2022]
Affiliation(s)
- Armin Attar
- Department of Cardiovascular Medicine, TAHA Clinical Trial Group, Shiraz University of Medical Sciences, School of Medicine, Zand Street, Shiraz University of Medical Sciences, Shiraz 71344-1864, Iran
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