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Satoh Y, Ono Y, Takahashi R, Katayama H, Iwaoka M, Yoshino O, Arai K. Seleno-relaxin analogues: effect of internal and external diselenide bonds on the foldability and a fibrosis-related factor of endometriotic stromal cells. RSC Chem Biol 2024; 5:729-737. [PMID: 39092438 PMCID: PMC11289879 DOI: 10.1039/d4cb00095a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/30/2024] [Indexed: 08/04/2024] Open
Abstract
Human relaxin-2 (H2 relaxin) is a peptide hormone of about 6 kDa, first identified as a reproductive hormone involved in vasoregulation during pregnancy. It has recently attracted strong interest because of its diverse functions, including anti-inflammatory, anti-fibrotic, and vasodilatory, and has been suggested as a potential peptide-based drug candidate for a variety of diseases. Mature H2 relaxin is constituted by the A- and B-chains stabilized by two interchain disulfide (SS) bridges and one intrachain SS linkage. In this study, seleno-relaxins, SeRlx-α and SeRlx-β, which are [C11UA,C11UB] and [C10UA,C15UA] variants of H2 relaxin, respectively, were synthesized via a one-pot oxidative chain assembly (folding) from the component A- and B-chains. The substitution of SS bonds in a protein with their analogue, diselenide (SeSe) bonds, has been shown to alter the physical, chemical, and physiological properties of the protein. The surface SeSe bond (U11A-U11B) enhanced the yield of chain assembly while the internal SeSe bond (U10A-U15A) improved the reaction rate of the folding, indicating that these bridges play a major role in controlling the thermodynamics and kinetics, respectively, of the folding mechanism. Furthermore, SeRlx-α and SeRlx-β effectively reduced the expression of a tissue fibrosis-related factor in human endometriotic stromal cells. Thus, the findings of this study indicate that the S-to-Se substitution strategy not only enhances the foldability of relaxin, but also provides new guidance for the development of novel relaxin formulations for endometriosis treatment.
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Affiliation(s)
- Yuri Satoh
- Department of Chemistry, School of Science, Tokai University Kitakaname Hiratsuka-shi Kanagawa 259-1292 Japan +81-463-50-2094 +81-463-58-1211
| | - Yosuke Ono
- Department of Obstetrics and Gynecology, University of Yamanashi 1110 Shimokato Chuo-shi Yamanashi 409-3898 Japan
| | - Rikana Takahashi
- Department of Chemistry, School of Science, Tokai University Kitakaname Hiratsuka-shi Kanagawa 259-1292 Japan +81-463-50-2094 +81-463-58-1211
| | - Hidekazu Katayama
- Department of Bioengineering, School of Engineering, Tokai University Kitakaname Hiratsuka-shi Kanagawa 259-1292 Japan
| | - Michio Iwaoka
- Department of Chemistry, School of Science, Tokai University Kitakaname Hiratsuka-shi Kanagawa 259-1292 Japan +81-463-50-2094 +81-463-58-1211
- Institute of Advanced Biosciences, Tokai University Kitakaname Hiratsuka-shi Kanagawa 259-1292 Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Yamanashi 1110 Shimokato Chuo-shi Yamanashi 409-3898 Japan
| | - Kenta Arai
- Department of Chemistry, School of Science, Tokai University Kitakaname Hiratsuka-shi Kanagawa 259-1292 Japan +81-463-50-2094 +81-463-58-1211
- Institute of Advanced Biosciences, Tokai University Kitakaname Hiratsuka-shi Kanagawa 259-1292 Japan
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2
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Dimitriadis K, Damianaki A, Bletsa E, Pyrpyris N, Tsioufis P, Theofilis P, Beneki E, Tatakis F, Kasiakogias A, Oikonomou E, Petras D, Siasos G, Aggeli K, Tsioufis K. Renal Congestion in Heart Failure: Insights in Novel Diagnostic Modalities. Cardiol Rev 2024:00045415-990000000-00224. [PMID: 38427026 DOI: 10.1097/crd.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Heart failure is increasingly prevalent and is estimated to increase its burden in the following years. A well-reported comorbidity of heart failure is renal dysfunction, where predominantly changes in the patient's volume status, tubular necrosis or other mechanical and neurohormonal mechanisms seem to drive this impairment. Currently, there are established biomarkers evaluating the patient's clinical status solely regarding the cardiovascular or renal system. However, as the coexistence of heart and renal failure is common and related to increased mortality and hospitalization for heart failure, it is of major importance to establish novel diagnostic techniques, which could identify patients with or at risk for cardiorenal syndrome and assist in selecting the appropriate management for these patients. Such techniques include biomarkers and imaging. In regards to biomarkers, several peptides and miRNAs indicative of renal or tubular dysfunction seem to properly identify patients with cardiorenal syndrome early on in the course of the disease, while changes in their serum levels can also be helpful in identifying response to diuretic treatment. Current and novel imaging techniques can also identify heart failure patients with early renal insufficiency and assess the volume status and the effect of treatment of each patient. Furthermore, by assessing the renal morphology, these techniques could also help identify those at risk of kidney impairment. This review aims to present all relevant clinical and trial data available in order to provide an up-to-date summary of the modalities available to properly assess cardiorenal syndrome.
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Affiliation(s)
- Kyriakos Dimitriadis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | | | - Evanthia Bletsa
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | - Nikolaos Pyrpyris
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Theofilis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Eirini Beneki
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Fotis Tatakis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandros Kasiakogias
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | | | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Hospital, University of Athens, Athens, Greece
| | - Konstantina Aggeli
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- From the First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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3
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Signaling Pathways Regulating Human Cervical Ripening in Preterm and Term Delivery. Cells 2022; 11:cells11223690. [PMID: 36429118 PMCID: PMC9688647 DOI: 10.3390/cells11223690] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
At the end of gestation, the cervical tissue changes profoundly. As a result of these changes, the uterine cervix becomes soft and vulnerable to dilation. The process occurring in the cervical tissue can be described as cervical ripening. The ripening is a process derivative of enzymatic breakdown and inflammatory response. Therefore, it is apparent that cervical remodeling is a derivative of the reactions mediated by multiple factors such as hormones, prostaglandins, nitric oxide, and inflammatory cytokines. However, despite the research carried out over the years, the cellular pathways responsible for regulating this process are still poorly understood. A comprehensive understanding of the entire process of cervical ripening seems crucial in the context of labor induction. Greater knowledge could provide us with the means to help women who suffer from dysfunctional labor. The overall objective of this review is to present the current understanding of cervical ripening in terms of molecular regulation and cell signaling.
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Experimental Static Cold Storage of the Rat Uterus: Protective Effects of Relaxin- or Erythropoietin-Supplemented HTK-N Solutions. Biomedicines 2022; 10:biomedicines10112730. [DOI: 10.3390/biomedicines10112730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/16/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Uterus transplantation (UTx) is the only treatment method for women with absolute uterine infertility. Currently, the number of grafts retrieved from deceased donors is increasing; hence, prolonged cold ischemia time is inevitable. Thus, this study was designed to assess the effect of the novel relaxin (RLN)- or erythropoietin (EPO)-supplemented Custodiol-N (HTK-N) solutions in an experimental uterus static cold storage (SCS) model. A total of 15 Sprague Dawley rats were used. Uterus horns were randomly assigned into three groups (n = 10/group). SCS was performed by keeping samples at 4 °C in HTK-N solution without or with different additives: 10 IU/mL EPO or 20 nM RLN. Tissue samples were taken after 8 and 24 h of preservation. Uterine tissue histology, and biochemical and immunohistochemical markers were analyzed. No significant differences in SCS-induced tissue damage were observed between groups after 8 h of preservation. Uterine tissue histology, MDA, SOD levels and the TUNEL-positive cell number showed severe damage in HTK-N without additives after 24 h of preservation. This damage was significantly attenuated by adding RLN to the preservation solution. EPO showed no favorable effect. Our study shows that RLN as an additive to an HTK-N solution can serve as an effective uterine tissue preservative in the uterus SCS setting.
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5
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Klimontov VV, Koroleva EA, Khapaev RS, Korbut AI, Lykov AP. Carotid Artery Disease in Subjects with Type 2 Diabetes: Risk Factors and Biomarkers. J Clin Med 2021; 11:72. [PMID: 35011813 PMCID: PMC8745306 DOI: 10.3390/jcm11010072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023] Open
Abstract
Carotid atherosclerosis (CA) and, especially, carotid artery stenosis (CAS), are associated with a high risk of cardiovascular events in subjects with type 2 diabetes (T2D). In this study, we aimed to identify risk factors and biomarkers of subclinical CA and CAS in T2D individuals. High-resolution ultrasonography of carotid arteries was performed in 389 patients. Ninety-five clinical parameters were evaluated, including diabetic complications and comorbidities; antihyperglycemic, hypolipidemic, and antihypertensive therapy; indices of glycemic control and glucose variability (GV); lipid panels; estimated glomerular filtration rate (eGFR); albuminuria; blood cell count; and coagulation. Additionally, serum levels of calponin-1, relaxin, L-citrulline, and matrix metalloproteinase-2 and -3 (MMP-2, -3) were measured by ELISA. In univariate analysis, older age, male sex, diabetes duration, GV, diabetic retinopathy, chronic kidney disease, coronary artery disease, peripheral artery disease, and MMP-3 were associated with subclinical CA. In addition to these factors, long-term arterial hypertension, high daily insulin doses, eGFR, and L-citrulline were associated with CAS. In multivariate logistic regression, age, male sex, BMI, GV, and eGFR predicted CA independently; male sex, BMI, diabetes duration, eGFR, and L-citrulline were predictors of CAS. These results can be used to develop screening and prevention programs for CA and CAS in T2D subjects.
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Affiliation(s)
- Vadim V. Klimontov
- Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia; (E.A.K.); (R.S.K.); (A.I.K.); (A.P.L.)
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6
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Bausys A, Maneikyte J, Leber B, Weber J, Feldbacher N, Strupas K, Dschietzig TB, Schemmer P, Stiegler P. Custodiol ® Supplemented with Synthetic Human Relaxin Decreases Ischemia-Reperfusion Injury after Porcine Kidney Transplantation. Int J Mol Sci 2021; 22:ijms222111417. [PMID: 34768845 PMCID: PMC8583819 DOI: 10.3390/ijms222111417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 01/04/2023] Open
Abstract
Objective. Ischemia-reperfusion injury (IRI) is inevitable after kidney transplantation (KT), impairing outcomes. Relaxin-2 (RLX) is a promising insulin-related peptide hormone that protects against renal IRI in rodents, although large animal models are needed before RLX can be tested in a human setting. Methods. In this blinded, randomized, and placebo-controlled experimental study kidneys from 19 donor pigs were retrieved after perfusion with Custodiol® ± RLX (5 or 20 nmol/L) and underwent static cold storage (SCS) for 24 and 48 h, respectively. Subsequently, KT was performed after unilateral right nephrectomy. Study outcomes included markers for kidney function, oxidative stress, lipid peroxidation, and endothelial cell damage. PCR analysis for oxidative stress and apoptosis-related gene panels as well as immunohistochemistry were performed. Results. RLX upregulated SOD2 and NFKB expression to 135% (p = 0.042) and 125% (p = 0.019), respectively, while RIPK1 expression was downregulated to 82% (p = 0.016) of corresponding controls. Further RLX significantly downregulated RIPK1 and MLKL expression and decreased the number of Caspase 3- and MPO-positive cells in grafts after SCS. Conclusions. RLX supplemented Custodiol® significantly decreased IRI via both antioxidant and anti-apoptotic mechanisms. Clinical trials are warranted to implement synthetic human RLX as a novel additive to preservation solutions against IRI.
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Affiliation(s)
- Augustinas Bausys
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
- Department of Abdominal Surgery, National Cancer Institute, 10224 Vilnius, Lithuania
| | - Juste Maneikyte
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-81181
| | - Jennifer Weber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
| | - Nicole Feldbacher
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Thomas Bernd Dschietzig
- Relaxera GmbH & Co. KG, 64625 Bensheim, Germany;
- MHB Medizinische Hochschule Brandenburg, 16816 Neuruppin, Germany
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
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7
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Martin B, Vanderpool RR, Henry BL, Palma JB, Gabris B, Lai YC, Hu J, Tofovic SP, Reddy RP, Mora AL, Gladwin MT, Romero G, Salama G. Relaxin Inhibits Ventricular Arrhythmia and Asystole in Rats With Pulmonary Arterial Hypertension. Front Cardiovasc Med 2021; 8:668222. [PMID: 34295927 PMCID: PMC8290063 DOI: 10.3389/fcvm.2021.668222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) leads to right ventricular cardiomyopathy and cardiac dysfunctions where in the clinical setting, cardiac arrest is the likely cause of death, in ~70% of PAH patients. We investigated the cardiac phenotype of PAH hearts and tested the hypothesis that the insulin-like hormone, Relaxin could prevent maladaptive cardiac remodeling and protect against cardiac dysfunctions in a PAH animal model. PAH was induced in rats with sugen (20 mg/kg), hypoxia then normoxia (3-weeks/each); relaxin (RLX = 0, 30 or 400 μg/kg/day, n ≥ 6/group) was delivered subcutaneously (6-weeks) with implanted osmotic mini-pumps. Right ventricle (RV) hemodynamics and Doppler-flow measurements were followed by cardiac isolation, optical mapping, and arrhythmia phenotype. Sugen-hypoxia (SuHx) treated rats developed PAH characterized by higher RV systolic pressures (50 ± 19 vs. 22 ± 5 mmHg), hypertrophy, reduced stroke volume, ventricular fibrillation (VF) (n = 6/11) and bradycardia/arrest (n = 5/11); both cardiac phenotypes were suppressed with dithiothreitol (DTT = 1 mM) (n = 0/2/group) or RLX (low or high dose, n = 0/6/group). PAH hearts developed increased fibrosis that was reversed by RLX-HD, but not RLX-LD. Relaxin decreased Nrf2 and glutathione transferases but not glutathione-reductase. High-dose RLX improved pulmonary arterial compliance (measured by Doppler flow), suppressed VF even after burst-pacing, n = 2/6). Relaxin suppressed VF and asystole through electrical remodeling and by reversing thiol oxidative stress. For the first time, we showed two cardiac phenotypes in PAH animals and their prevention by RLX. Relaxin may modulate maladaptive cardiac remodeling in PAH and protect against arrhythmia and cardiac arrest.
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Affiliation(s)
- Brian Martin
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rebecca R Vanderpool
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brian L Henry
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joshua B Palma
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Beth Gabris
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yen-Chun Lai
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jian Hu
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stevan P Tofovic
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rajiv P Reddy
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ana L Mora
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.,Aging Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mark T Gladwin
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Guillermo Romero
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Guy Salama
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
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8
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Martins RC, Pintalhão M, Leite-Moreira A, Castro-Chaves P. Relaxin and the Cardiovascular System: from Basic Science to Clinical Practice. Curr Mol Med 2021; 20:167-184. [PMID: 31642776 DOI: 10.2174/1566524019666191023121607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/07/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022]
Abstract
The peptide hormone relaxin was originally linked to reproductive physiology, where it is believed to mediate systemic and renal hemodynamic adjustments to pregnancy. Recently, its broad range of effects in the cardiovascular system has been the focus of intensive research regarding its implications under pathological conditions and potential therapeutic potential. An understanding of the multitude of cardioprotective actions prompted the study of serelaxin, recombinant human relaxin-2, for the treatment of acute heart failure. Despite early promising results from phase II studies, recently revealed RELAX-AHF-2 outcomes were rather disappointing and the treatment for acute heart failure remains an unmet medical need. This article reviews the physiologic actions of relaxin on the cardiovascular system and its relevance in the pathophysiology of cardiovascular disease. We summarize the most updated clinical data and discuss future directions of serelaxin for the treatment of acute heart failure. This should encourage additional work to determine how can relaxin's beneficial effects be exploited for the treatment of cardiovascular disease.
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Affiliation(s)
- Rafael Clara Martins
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiovascular Research Centre, Porto, Portugal.,Internal Medicine Department, São João Hospital Centre, Porto, Portugal
| | - Mariana Pintalhão
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiovascular Research Centre, Porto, Portugal.,Internal Medicine Department, São João Hospital Centre, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiovascular Research Centre, Porto, Portugal.,Cardiothoracic Surgery Department, São João Hospital Centre, Porto, Portugal
| | - Paulo Castro-Chaves
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiovascular Research Centre, Porto, Portugal.,Internal Medicine Department, São João Hospital Centre, Porto, Portugal
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Corcoran D, Radjenovic A, Mordi IR, Nazir SA, Wilson SJ, Hinder M, Yates DP, Machineni S, Alcantara J, Prescott MF, Gugliotta B, Pang Y, Tzemos N, Semple SI, Newby DE, McCann GP, Squire I, Berry C. Vascular effects of serelaxin in patients with stable coronary artery disease: a randomized placebo-controlled trial. Cardiovasc Res 2021; 117:320-329. [PMID: 32065620 PMCID: PMC7797213 DOI: 10.1093/cvr/cvz345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/20/2019] [Accepted: 01/23/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The effects of serelaxin, a recombinant form of human relaxin-2 peptide, on vascular function in the coronary microvascular and systemic macrovascular circulation remain largely unknown. This mechanistic, clinical study assessed the effects of serelaxin on myocardial perfusion, aortic stiffness, and safety in patients with stable coronary artery disease (CAD). METHODS AND RESULTS In this multicentre, double-blind, parallel-group, placebo-controlled study, 58 patients were randomized 1:1 to 48 h intravenous infusion of serelaxin (30 µg/kg/day) or matching placebo. The primary endpoints were change from baseline to 47 h post-initiation of the infusion in global myocardial perfusion reserve (MPR) assessed using adenosine stress perfusion cardiac magnetic resonance imaging, and applanation tonometry-derived augmentation index (AIx). Secondary endpoints were: change from baseline in AIx and pulse wave velocity, assessed at 47 h, Day 30, and Day 180; aortic distensibility at 47 h; pharmacokinetics and safety. Exploratory endpoints were the effect on cardiorenal biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), endothelin-1, and cystatin C]. Of 58 patients, 51 were included in the primary analysis (serelaxin, n = 25; placebo, n = 26). After 2 and 6 h of serelaxin infusion, mean placebo-corrected blood pressure reductions of -9.6 mmHg (P = 0.01) and -13.5 mmHg (P = 0.0003) for systolic blood pressure and -5.2 mmHg (P = 0.02) and -8.4 mmHg (P = 0.001) for diastolic blood pressure occurred. There were no between-group differences from baseline to 47 h in global MPR (-0.24 vs. -0.13, P = 0.44) or AIx (3.49% vs. 0.04%, P = 0.21) with serelaxin compared with placebo. Endothelin-1 and cystatin C levels decreased from baseline in the serelaxin group, and there were no clinically relevant changes observed with serelaxin for NT-proBNP or hsTnT. Similar numbers of serious adverse events were observed in both groups (serelaxin, n = 5; placebo, n = 7) to 180-day follow-up. CONCLUSION In patients with stable CAD, 48 h intravenous serelaxin reduced blood pressure but did not alter myocardial perfusion.
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Affiliation(s)
- David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Golden Jubilee National Hospital, Glasgow, UK
| | - Aleksandra Radjenovic
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Ify R Mordi
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Golden Jubilee National Hospital, Glasgow, UK
| | - Sheraz A Nazir
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Simon J Wilson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Markus Hinder
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Denise P Yates
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | | | - Jose Alcantara
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | | | - Yinuo Pang
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Niko Tzemos
- London Health Science Centre, University of Western Ontario, London, Ontario, Canada
| | - Scott I Semple
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Golden Jubilee National Hospital, Glasgow, UK
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Loungani RS, Teerlink JR, Metra M, Allen LA, Butler J, Carson PE, Chen CW, Cotter G, Davison BA, Eapen ZJ, Filippatos GS, Gimpelewicz C, Greenberg B, Holbro T, Januzzi JL, Lanfear DE, Pang PS, Piña IL, Ponikowski P, Miller AB, Voors AA, Felker GM. Cause of Death in Patients With Acute Heart Failure: Insights From RELAX-AHF-2. JACC-HEART FAILURE 2020; 8:999-1008. [PMID: 33189635 DOI: 10.1016/j.jchf.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study sought to better understand the discrepant results of 2 trials of serelaxin on acute heart failure (AHF) and short-term mortality after AHF by analyzing causes of death of patients in the RELAX-AHF-2 (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF-2) trial. BACKGROUND Patients with AHF continue to suffer significant short-term mortality, but limited systematic analyses of causes of death in this patient population are available. METHODS Adjudicated cause of death of patients in RELAX-AHF-2, a randomized, double-blind, placebo-controlled trial of serelaxin in patients with AHF across the spectrum of ejection fraction (EF), was analyzed. RESULTS By 180 days of follow-up, 11.5% of patients in RELAX-AHF-2 died, primarily due to heart failure (HF) (38% of all deaths). Unlike RELAX-AHF, there was no apparent effect of treatment with serelaxin on any category of cause of death. Older patients (≥75 years) had higher rates of mortality (14.2% vs. 8.8%) and noncardiovascular (CV) death (27% vs. 19%) compared to younger patients. Patients with preserved EF (≥50%) had lower rates of HF-related mortality (30% vs. 40%) but higher non-CV mortality (36% vs. 20%) compared to patients with reduced EF. CONCLUSIONS Despite previous data suggesting benefit of serelaxin in AHF, treatment with serelaxin was not found to improve overall mortality or have an effect on any category of cause of death in RELAX-AHF-2. Careful adjudication of events in the serelaxin trials showed that older patients and those with preserved EF had fewer deaths from HF or sudden death and more deaths from other CV causes and from noncardiac causes. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; NCT01870778).
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Affiliation(s)
- Rahul S Loungani
- Division of Cardiology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, California, USA
| | - Marco Metra
- Cardiology, ASST Civil Hospitals, and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Peter E Carson
- Department of Cardiology, Washington VA Medical Center, Washington, DC, USA
| | - Chien-Wei Chen
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Gad Cotter
- Momentum Research, Durham, North Carolina, USA
| | | | | | - Gerasimos S Filippatos
- School of Medicine, University of Cyprus, Nicosia, Cyprus, Greece; Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Barry Greenberg
- University of California San Diego Health, Cardiovascular Institute, La Jolla, California, USA
| | | | - James L Januzzi
- Division of Cardiology, Department of Medicine, Harvard Medical School, and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - David E Lanfear
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ileana L Piña
- Division of Cardiology, Wayne State University, Detroit, Michigan, USA
| | - Piotr Ponikowski
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Alan B Miller
- Department of Cardiology, University of Florida, Jacksonville, Florida, USA
| | - Adriaan A Voors
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - G Michael Felker
- Division of Cardiology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
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Relaxin Positively Influences Ischemia-Reperfusion Injury in Solid Organ Transplantation: A Comprehensive Review. Int J Mol Sci 2020; 21:ijms21020631. [PMID: 31963613 PMCID: PMC7013572 DOI: 10.3390/ijms21020631] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/07/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023] Open
Abstract
In recent decades, solid organ transplantation (SOT) has increased the survival and quality of life for patients with end-stage organ failure by providing a potentially long-term treatment option. Although the availability of organs for transplantation has increased throughout the years, the demand greatly outweighs the supply. One possible solution for this problem is to extend the potential donor pool by using extended criteria donors. However, organs from such donors are more prone to ischemia reperfusion injury (IRI) resulting in higher rates of delayed graft function, acute and chronic graft rejection and worse overall SOT outcomes. This can be overcome by further investigating donor preconditioning strategies, graft perfusion and storage and by finding novel therapeutic agents that could reduce IRI. relaxin (RLX) is a peptide hormone with antifibrotic, antioxidant, anti-inflammatory and cytoprotective properties. The main research until now focused on heart failure; however, several preclinical studies showed its potentials for reducing IRI in SOT. The aim of this comprehensive review is to overview currently available literature on the possible role of RLX in reducing IRI and its positive impact on SOT.
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13
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Hong J, Yun CO. Relaxin gene therapy: A promising new treatment option for various diseases with aberrant fibrosis or irregular angiogenesis. Mol Cell Endocrinol 2019; 487:80-84. [PMID: 30641100 DOI: 10.1016/j.mce.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/31/2022]
Abstract
Relaxin (RLX) is an insulin-like polypeptide hormone that was initially introduced for its pregnancy-related function. Subsequent studies revealed that RLX possesses anti-fibrotic functions in tumors and nonreproductive tissues, such as skin, lungs, and others. This aspect of the RLX has been explored for the treatment of various illnesses, such as cardiac fibrosis, liver fibrosis, and solid tumors. With gene therapy coming into age with increasing number of products being approved by regulatory bodies in Europe and United States, we aim to discuss how RLX have been utilized in scope of gene therapy for treatment of various illnesses.
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Affiliation(s)
- JinWoo Hong
- Department of Bioengineering, College of Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 133-791, Seoul, Republic of Korea
| | - Chae-Ok Yun
- Department of Bioengineering, College of Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 133-791, Seoul, Republic of Korea; Institute of Nano Science and Technology (INST), Hanyang University, Republic of Korea.
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Serum relaxin level predicts recurrence of atrial fibrillation after radiofrequency catheter ablation. Heart Vessels 2019; 34:1543-1551. [PMID: 30937522 DOI: 10.1007/s00380-019-01386-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/15/2019] [Indexed: 01/10/2023]
Abstract
Relaxin, an emerging biomarker in heart failure, is involved in fibrosis and inflammation. The value of relaxin in predicting recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) is unknown and the subject of this study. We prospectively enrolled 248 consecutive patients with AF (paroxysmal in 127 and persistent in 121) who underwent RFCA at our center after measurement of circulating levels of relaxin by ELISA. Kaplan-Meier analysis with log-rank test and multivariate analysis were used to assess the association between pre-RFCA relaxin levels and post-RFCA AF recurrence at 18 months follow-up. At mean 16.3 ± 3.8 months post-RFCA, 195 (78.6%) patients maintained sinus rhythm, and their pre-RFCA relaxin level was lower than that in patients with AF recurrence (P < 0.001). From lowest to highest pre-RFCA relaxin level tertiles (T1; 82.10-< 234.36; T2; 234.36-< 342.26; and T3; 342.26-740.63 ng/L), AF recurrence rate increased significantly (8.5%, 20.5% and 34.9%, respectively; Kaplan-Meier analysis with log-rank test, χ2 = 18.44, P < 0.001). Using a cutoff of 285.4 ng/L, pre-RFCA relaxin level predicted AF recurrence during follow-up with sensitivity of 77.4% and specificity of 55.9% (area under the receiver operating characteristic curve = 0.71). On multivariate Cox proportional hazard model, relaxin level by tertile (T2, hazard ratio 2.678; 95% confidence interval 1.110-6.460; P = 0.028, and T3, hazard ratio 4.745; 95% confidence interval 2.075-10.854; P < 0.001, respectively compared with the T1) was the independent factor predicting recurrence. Elevated pre-RFCA relaxin level is associated with post-RFCA AF recurrence. A simple measurement of relaxin level therefore might help identify patients at high risk of AF recurrence after RFCA.Clinical Trial Registration chictr.org.cn identifier: ChiCTR-OOC-15006130.
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Maggioni AP, López-Sendón J, Nielsen OW, Hallén J, Aalamian-Mattheis M, Wang Y, Ertl G. Efficacy and safety of serelaxin when added to standard of care in patients with acute heart failure: results from a PROBE study, RELAX-AHF-EU. Eur J Heart Fail 2019; 21:322-333. [PMID: 30604559 DOI: 10.1002/ejhf.1368] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/23/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022] Open
Abstract
AIM Serelaxin is a recombinant human relaxin-2 hormone, which confers receptor-mediated vasodilatation in a tissue-specific fashion. The RELAX-AHF-EU study assessed the effect of serelaxin when added to standard-of-care (SoC) therapy on worsening heart failure (WHF)/all-cause death through Day 5 in patients hospitalised for acute heart failure (AHF) in Europe. METHODS AND RESULTS This multicentre, prospective, randomised, open-label, blinded-endpoint validation study enrolled hospitalised AHF patients and randomised (2:1) eligible patients (mild-to-moderate renal impairment and systolic blood pressure ≥ 125 mmHg) within 16 h of presentation with signs/symptoms of AHF, to receive 48 h intravenous infusion of 30 μg/kg/day serelaxin + SoC or SoC alone. The primary endpoint was adjudicated WHF/all-cause death through Day 5. Of 3183 patients targeted, 2666 were randomised when the study was terminated early by the sponsor due to the neutral results of the pivotal RELAX-AHF-2 study. Adjudicated WHF/all-cause death through Day 5 was significantly reduced in the serelaxin + SoC vs. SoC group (5.0% vs. 6.9%; hazard ratio 0.71; 95% confidence interval 0.51-0.98; P = 0.0172) (absolute risk reduction 1.9%, number needed to treat 53). The difference between treatment groups was not significant for WHF/all-cause death/heart failure rehospitalisation through Day 14 and length of hospital stay. A significantly smaller proportion of patients in the serelaxin + SoC vs. SoC group experienced persistent heart failure signs/symptoms at each visit until Day 4, or renal deterioration through Day 5 (all P ≤ 0.01). Overall incidence of treatment-emergent adverse events was comparable between treatment groups. Hypotension and decrease in haemoglobin/haematocrit were more frequent in the serelaxin + SoC group. CONCLUSION When added to SoC, serelaxin reduced adjudicated WHF or all-cause death through Day 5 in AHF patients. The results from this open-label study should be considered in the context of the totality of the double-blind, randomised evidence on serelaxin in AHF.
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Affiliation(s)
- Aldo P Maggioni
- Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy
| | - José López-Sendón
- Cardiology, Hospital La Paz, IdiPaz, Universidad Autonoma de Madrid, Madrid, Spain
| | | | | | | | - Yaqin Wang
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Georg Ertl
- Comprehensive Heart Failure Center, University Hospital, Würzburg, Germany
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Kim HJ, Kim MA, Kim HL, Shim WJ, Park SM, Kim M, Yoon HJ, Shin MS, Hong KS, Shin GJ, Kim YH, Na JO, Jeong JO. Effects of multiparity on left ventricular diastolic dysfunction in women: cross-sectional study of the KoRean wOmen'S chest pain rEgistry (KoROSE). BMJ Open 2018; 8:e026968. [PMID: 30593559 PMCID: PMC6318513 DOI: 10.1136/bmjopen-2018-026968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the association between left ventricular (LV) diastolic dysfunction and multiparity in patients with suspected coronary artery disease (CAD). DESIGN Cross-sectional study. SETTING Linked secondary and tertiary care records from 29 cardiac centres which participated in KoRean wOmen'S chest pain rEgistry. PARTICIPANTS 960 women with suspected CAD who underwent invasive coronary angiography from February 2011 to May 2017. The patients were classified by parity number, as follows: low-parity, 0 to <3; multiparity, ≥3 pregnancies. MAIN OUTCOME MEASURE Prevalence of LV diastolic dysfunction. RESULTS There were 302 and 658 low-parity and multiparity patients, respectively. The prevalence of LV diastolic dysfunction was significantly higher in the multiparity than in the low-parity group. The multiparity group had significantly lower E and e´ septal velocities and E/A ratio, and had a significantly higher E/e´ ratio and right ventricular systolic pressure, which are parameters of LV diastolic dysfunction, than the low-parity group. The prevalence of CAD was significantly higher in the multiparity than in the low-parity group. Receiver operating characteristic curve analysis identified a parity of 2.5 as the cut-off for predicting LV diastolic dysfunction (area under the curve, 0.66; sensitivity, 74.1%; specificity, 52.0%; 95% CI 0.607 to 0.706; p<0.001). After adjustment for confounding factors, multivariate regression analysis showed that multiparity had a 1.80-fold increased risk for LV diastolic dysfunction (OR 1.80, 95% CI 1.053 to 3.081, p=0.032). CONCLUSIONS The prevalence of LV diastolic dysfunction was higher in multiparity than in low-parity women with suspected CAD. Multiparity was an independent risk factor for LV diastolic dysfunction. LV diastolic dysfunction should be evaluated in multiparous women for the risk of subsequent cardiovascular disease and facilitate the initiation of appropriate treatment.
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Affiliation(s)
- Hyun-Jin Kim
- Chungbuk Regional Cardiovascular Center, Chungbuk National University Hospital, Cheongju, Chungcheongbuk-do, Korea
| | - Myung-A Kim
- Cardiovascular Center, Seoul National University Boramae Medical Hospital, Seoul, Korea
| | - Hack-Lyoung Kim
- Cardiovascular Center, Seoul National University Boramae Medical Hospital, Seoul, Korea
| | - Wan Joo Shim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Seong Mi Park
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Mina Kim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Mi Seung Shin
- Department of Cardiology, Gachon Medical School Gil Medical Center, Incheon, Korea
| | - Kyung-Soon Hong
- Department of Cardiology, Hanllym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Gil Ja Shin
- Department of Cardiology, Ewha Womans University Hospital, Seoul, Korea
| | - Yong-Hyun Kim
- Department of Cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Department of Cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Jin-Ok Jeong
- Department of Cardiology, Chungnam National University Hospital, Daejeon, Korea
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Sanidas E, Tsakalis K, Papadopoulos DP, Zerva K, Velliou M, Perrea D, Mantzourani M, Iliopoulos D, Barbetseas J. The impact of apelin and relaxin plasma levels in masked hypertension and white coat hypertension. J Clin Hypertens (Greenwich) 2018; 21:48-52. [PMID: 30525273 DOI: 10.1111/jch.13449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/19/2018] [Accepted: 09/29/2018] [Indexed: 12/17/2022]
Abstract
Masked hypertension (HTN) and white coat hypertension represent two reverse forms of clinical HTN with questionable prognostic significance. Recent evidence supports that low apelin and relaxin plasma levels contribute to vascular damage accelerating atherogenesis and predisposing to HTN and cardiovascular (CV) events. The aim of this study was to compare apelin and relaxin plasma levels between patients with masked hypertension (MH) and those with white coat HTN (WCH). Overall, 130 patients not receiving antihypertensive therapy were studied. All patients underwent 24-hour ambulatory BP monitoring (ABPM) and office BP measurements. Plasma apelin and relaxin levels were measured by ELISA method. According to BP recordings, 24 subjects had MH (group A) and 32 had WCH (group B). Apelin (200 ± 111 pg/mL vs 305 ± 127 pg/mL, P < 0.01) and relaxin (35.2 ± 6.7 pg/mL vs 46.8 ± 23.6 pg/mL, P < 0.01) plasma levels were significantly lower in patients with MH compared to those with WCH, respectively. In conclusion, our findings showed that patients with MH had significantly lower apelin and relaxin levels compared to those with WCH. This observation implies an additional prognostic role for adipokines supporting the concept that MH is closer to essential HTN whereas WCH is a more benign condition.
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Affiliation(s)
- Elias Sanidas
- Hypertension Excellence Centre - ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Kostas Tsakalis
- Hypertension Excellence Centre - ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Dimitrios P Papadopoulos
- Hypertension Excellence Centre - ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Kanella Zerva
- Hypertension Excellence Centre - ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Maria Velliou
- Hypertension Excellence Centre - ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Despoina Perrea
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", University of Athens, Medical School, Athens, Greece
| | - Marina Mantzourani
- 1st Department of Internal Medicine, LAIKO General Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitrios Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", University of Athens, Medical School, Athens, Greece
| | - John Barbetseas
- Hypertension Excellence Centre - ESH, Department of Cardiology, LAIKO General Hospital, Athens, Greece
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Wilson KJ, Xiao J, Chen CZ, Huang Z, Agoulnik IU, Ferrer M, Southall N, Hu X, Zheng W, Xu X, Wang A, Myhr C, Barnaeva E, George ER, Agoulnik AI, Marugan JJ. Optimization of the first small-molecule relaxin/insulin-like family peptide receptor (RXFP1) agonists: Activation results in an antifibrotic gene expression profile. Eur J Med Chem 2018; 156:79-92. [PMID: 30006176 PMCID: PMC6102074 DOI: 10.1016/j.ejmech.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/25/2018] [Accepted: 06/02/2018] [Indexed: 01/08/2023]
Abstract
A dose responsive quantitative high throughput screen (qHTS) of >350,000 compounds against a human relaxin/insulin-like family peptide receptor (RXFP1) transfected HEK293 cell line identified 2-acetamido-N-phenylbenzamides 1 and 3 with modest agonist activity. An extensive structure-activity study has been undertaken to optimize the potency, efficacy, and physical properties of the series, resulting in the identification of compound 65 (ML-290), which has excellent in vivo PK properties with high levels of systemic exposure. This series, exemplified by 65, has produced first-in-class small-molecule agonists of RXFP1 and is a potent activator of anti-fibrotic genes.
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Affiliation(s)
- Kenneth J. Wilson
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Jingbo Xiao
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Catherine Z. Chen
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Zaohua Huang
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, HLSI 419B, Miami, FL 33199
| | - Irina U. Agoulnik
- Department of Cellular Biology and Pharmacology, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, HLSI 419B, Miami, FL 33199
| | - Marc Ferrer
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Noel Southall
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Xin Hu
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Wei Zheng
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Xin Xu
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Amy Wang
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Courtney Myhr
- Department of Cellular Biology and Pharmacology, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, HLSI 419B, Miami, FL 33199
| | - Elena Barnaeva
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Emmett R. George
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
| | - Alexander I. Agoulnik
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, HLSI 419B, Miami, FL 33199
| | - Juan J. Marugan
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, MD 20850
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Kageyama S, Nakamura K, Ke B, Busuttil RW, Kupiec-Weglinski JW. Serelaxin induces Notch1 signaling and alleviates hepatocellular damage in orthotopic liver transplantation. Am J Transplant 2018; 18:1755-1763. [PMID: 29464890 PMCID: PMC6035063 DOI: 10.1111/ajt.14706] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/18/2018] [Accepted: 01/28/2018] [Indexed: 01/25/2023]
Abstract
Liver ischemia-reperfusion injury (IRI) represents a risk factor for early graft dysfunction and an obstacle to expanding donor pool in orthotopic liver transplantation (OLT). We have reported on the crucial role of macrophage Notch1 signaling in mouse warm hepatic IRI model. However, its clinical relevance or therapeutic potential remain unknown. Here, we used Serelaxin (SER), to verify Notch1 induction and putative hepatoprotective function in ischemia-reperfusion-stressed OLT. C57BL/6 mouse livers subjected to extended (18-hour) cold storage were transplanted to syngeneic recipients. SER treatment at reperfusion ameliorated IRI, improved post-OLT survival, decreased neutrophil/macrophage infiltration, and suppressed proinflammatory cytokine programs, while simultaneously increasing Notch intracellular domain (NICD) and hairy and enhancer of split 1 (Hes1) target genes. In bone marrow-derived macrophage cultures, SER suppressed proinflammatory while enhancing antiinflammatory gene expression concomitantly with increased NICD and Hes1. Hepatic biopsies from 21 adult primary liver transplant patients (2 hours postreperfusion) were divided into low-NICD (n = 11) and high-NICD (n = 10) expression groups (western blots). Consistent with our murine findings, human livers characterized by high NICD were relatively IRI resistant, as shown by serum alanine aminotransferase (ALT) levels at day 1 post-OLT. Our study documents the efficacy of SER-Notch1 signaling in mouse OLT and highlights the protective function of Notch1 in liver transplant patients.
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Affiliation(s)
- Shoichi Kageyama
- Correspondence: Jerzy W. Kupiec-Weglinski, M.D. Ph. D., Dumont-UCLA Transplant Center, 77-120 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095, Tel.: (310) 8254196; Fax: (310) 2672358.,
| | - Kojiro Nakamura
- Correspondence: Jerzy W. Kupiec-Weglinski, M.D. Ph. D., Dumont-UCLA Transplant Center, 77-120 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095, Tel.: (310) 8254196; Fax: (310) 2672358.,
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Kageyama S, Nakamura K, Fujii T, Ke B, Sosa RA, Reed EF, Datta N, Zarrinpar A, Busuttil RW, Kupiec-Weglinski JW. Recombinant relaxin protects liver transplants from ischemia damage by hepatocyte glucocorticoid receptor: From bench-to-bedside. Hepatology 2018; 68:258-273. [PMID: 29350771 PMCID: PMC6033647 DOI: 10.1002/hep.29787] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/09/2017] [Accepted: 01/12/2018] [Indexed: 12/18/2022]
Abstract
UNLABELLED Hepatic ischemia-reperfusion injury (IRI) represents a major risk factor of early graft dysfunction and acute/chronic rejection as well as a key obstacle to expanding the donor pool in orthotopic liver transplantation (OLT). Although glucocorticoid receptor (GR) signaling may enhance cytoprotective programs, clinical use of glucocorticoid is limited because of adverse effects, whereas clinical relevance of GR-facilitated cytoprotection in OLT remains unknown. We aimed to evaluate the significance of hepatic GR in clinical OLT and verify the impact of recombinant human relaxin (rhRLX), which may function as a GR agonist in a tissue/disease-specific manner. Fifty-one OLT patients were recruited under an institutional research board (IRB) protocol. Liver biopsies were collected after cold storage (presurgery) and 2 hours postreperfusion (before abdominal closure), followed by western blotting-assisted hepatic analyses. Forty-three percent of OLTs failed to increase GR perioperatively under surgical stress. Post-/pre-GR ratios at postoperative day 1 correlated negatively with serum aspartate aminotransferase (AST)/cleaved caspase-3 and positively with B-cell lymphoma-extra large (Bcl-xL)/B-cell lymphoma 2 (Bcl-2) levels. In a murine OLT model with extended (18-hour) cold storage, treatment with rhRLX ameliorated ischemia-reperfusion (IR) damage and improved survival while up-regulating hepatocyte GR and Bcl-xL/Bcl-2 expression in OLT. rhRLX-induced GR suppressed hepatocyte high-mobility group box 1 (HMGB1) translocation/release, accompanied by decreased Toll-like receptor 4 (TLR4)/receptor for advanced glycation end products (RAGE), suppressed interleukin 1 beta (IL1β), chemokine (C-C motif) ligand 2 (CCL2), C-X-C motif chemokine (CXCL)10, tumor necrosis factor alpha (TNFα), CXCL1, and CXCL2 levels, and attenuated neutrophil/macrophage accumulation in OLT. Inhibition of GR in hepatocyte culture and in OLT diminished rhRLX-mediated cytoprotection. CONCLUSION This translational study underscores the role of rhRLX-GR signaling as a regulator of hepatocellular protection against IR stress in OLT. In the context of a recent phase III clinical trial demonstrating positive outcomes of rhRLX in patients with acute heart failure, studies on rhRLX for the management of IRI in OLT recipients are warranted. (Hepatology 2018;68:258-273).
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Affiliation(s)
- Shoichi Kageyama
- The Dumont-UCLA Transplant Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, CA 90095
| | - Kojiro Nakamura
- The Dumont-UCLA Transplant Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, CA 90095
| | - Takehiro Fujii
- The Dumont-UCLA Transplant Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, CA 90095
| | - Bibo Ke
- The Dumont-UCLA Transplant Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, CA 90095
| | - Rebecca A Sosa
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Nakul Datta
- The Dumont-UCLA Transplant Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, CA 90095
| | - Ali Zarrinpar
- The Dumont-UCLA Transplant Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, CA 90095
| | - Ronald W. Busuttil
- The Dumont-UCLA Transplant Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, CA 90095
| | - Jerzy W. Kupiec-Weglinski
- The Dumont-UCLA Transplant Center, Department of Surgery, Division of Liver and Pancreas Transplantation, University of California, Los Angeles, CA 90095
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22
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Singh A, Laribi S, Teerlink JR, Mebazaa A. Agents with vasodilator properties in acute heart failure. Eur Heart J 2018; 38:317-325. [PMID: 28201723 DOI: 10.1093/eurheartj/ehv755] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 01/05/2023] Open
Abstract
Millions of patients worldwide are admitted for acute heart failure (AHF) each year and physicians caring for these patients are confronted with the short-term challenges of reducing symptoms while preventing end organ dysfunction without causing additional harm, and the intermediate-term challenges of improving clinical outcomes such as hospital readmission and survival. There are limited data demonstrating the efficacy of any currently available therapies for AHF to meet these goals. After diuretics, vasodilators are the most common intravenous therapy for AHF, but neither nitrates, nitroprusside, nor nesiritide have robust evidence supporting their ability to provide meaningful effects on clinical outcomes, except perhaps early symptom improvement. Recently, a number of novel agents with vasodilating properties have been developed for the treatment of AHF. These agents include serelaxin, natriuretic peptides (ularitide, cenderitide), β-arrestin-biased angiotensin II type 1 receptor ligands (TRV120027), nitroxyl donors (CXL-1020, CXL-1427), soluble guanylate cyclase modulators (cinaciguat, vericiguat), short-acting calcium channel blockers (clevidipine), and potassium channel activators (nicorandil). These development programmes range from the stage of early dose-finding studies (e.g. TRV120027, CXL-1427) to large, multicentre mortality trials (e.g. serelaxin, ularitide). There is an urgent need for agents with vasodilating properties that will improve both in-hospital and post-discharge clinical outcomes, and these novel approaches may provide opportunities to address this need.
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Affiliation(s)
- Abhishek Singh
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.,School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Saïd Laribi
- INSERM, UMRS 942, Biomarkers and cardiac diseases, Paris, France.,Emergency Department, APHP, Saint Louis-Lariboisière Hospitals, Paris, France
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.,School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alexandre Mebazaa
- INSERM, UMRS 942, Biomarkers and cardiac diseases, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Anesthesiology and Critical Care, APHP, Saint Louis-Lariboisière Hospitals, Paris, France
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23
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Yu L, Cao L, Sun J, Li Z, Yao F, Zhou Y. Serelaxin, recombinant human relaxin-2, for heart failure patients: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11010. [PMID: 29923986 PMCID: PMC6023957 DOI: 10.1097/md.0000000000011010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Serelaxin, recombinant human relaxin-2, is a hormone with vasodilatory and end-organ protective effects. Recently, it has been licensed to treat acute decompensated heart failure. Here, a systematic review and meta-analysis on randomized controlled trials (RCTs) was performed to assess the effect of serelaxin on mortality and dyspnea improvement in patients with heart failure. METHODS RCTs comparing serelaxin treatment to other heart failure treatments were searched in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. The main endpoints were mortality and dyspnea improvement. Pooled data were assessed by using a random effects model. RESULTS A total of 451 studies were identified, of which 8 studies (8477 participants) were eligible and included in our analysis. Compared with other heart failure treatment group, serelaxin group had no effect on 30-day, 60-day, and 180-day mortality (OR, 0.79; 95% CI, 0.65-0.96). Compared with control group, there was no effect on dyspnea improvement. CONCLUSION Serelaxin treatment is irrelevant with the mortality, and it cannot improve dyspnea of heart failure patients.
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Affiliation(s)
- Ling Yu
- Heilongjiang University of Traditional Chinese Medicine
| | - Lijuan Cao
- Heilongjiang University of Traditional Chinese Medicine
| | - Jing Sun
- Second Department of Cardiovascular, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province
| | - Zhongyi Li
- Department of Obstetrics and Gynecology, The First Clinical Medical College of Jinan University, Guangzhou, Guangdong Province, China
| | - Fengzhen Yao
- Heilongjiang University of Traditional Chinese Medicine
| | - Yabin Zhou
- Second Department of Cardiovascular, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province
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24
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Aragón-Herrera A, Feijóo-Bandín S, Rodríguez-Penas D, Roselló-Lletí E, Portolés M, Rivera M, Bigazzi M, Bani D, Gualillo O, González-Juanatey JR, Lago F. Relaxin activates AMPK-AKT signaling and increases glucose uptake by cultured cardiomyocytes. Endocrine 2018; 60:103-111. [PMID: 29411306 DOI: 10.1007/s12020-018-1534-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/15/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Many evidences show that the hormone relaxin plays a pivotal role in the physiology and pathology of the cardiovascular system. This pleiotropic hormone exerts regulatory functions through specific receptors in cardiovascular tissues: in experimental animal models it was shown to induce coronary vasodilation, prevent cardiac damage induced by ischemia/reperfusion and revert cardiac hypertrophy and fibrosis. A tight relationship between this hormone and important metabolic pathways has been suggested, but it is at present unknown if relaxin could regulate cardiac metabolism. Our aim was to study the possible effects of relaxin on cardiomyocyte metabolism. METHODS Neonatal rat cardiomyocytes were treated with relaxin and (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assays (MTT) were performed to assess metabolic activity; while 2-deoxy-D-[3H] glucose and BODIPY-labelled fatty acid incorporations were analyzed to measure glucose and fatty acid uptakes, and western blot was utilized to study the intracellular signaling pathways activated by the hormone. RESULTS We observed that relaxin at 10 ng/ml was able to increase the level of metabolic activity of cultured neonatal rat cardiomyocytes; the rate of 2-deoxy-D-[3H]glucose incorporation demonstrated that relaxin also induced an increase in glucose uptake. First evidence is also offered that relaxin can activate the master energy sensor and regulator AMPK in cardiomyocytes. Moreover, the treatment of cardiomyocytes with relaxin also induced dose-dependent increases in ERK1/2, AKT, and AS160 phosphorylation. That raise in AS160 phosphorylation induced by relaxin was prevented by the pretreatment with AMPK and AKT pathways inhibitors, indicating that both molecules play important roles in the relaxin effects reported. CONCLUSION Relaxin can regulate cardiomyocyte metabolism and activate AMPK, the central sensor of energy status that maintains cellular energy homeostasis, and also ERK and AKT, two molecular sensing nodes that coordinate dynamic responses of the cell's metabolic responses.
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Affiliation(s)
- A Aragón-Herrera
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research (IDIS-SERGAS), Santiago de Compostela, Spain
| | - S Feijóo-Bandín
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research (IDIS-SERGAS), Santiago de Compostela, Spain.
- CIBERCV, Institute of Health Carlos III, Madrid, Spain.
| | - D Rodríguez-Penas
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research (IDIS-SERGAS), Santiago de Compostela, Spain
| | - E Roselló-Lletí
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiocirculatory Unit, Health Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
| | - M Portolés
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiocirculatory Unit, Health Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
| | - M Rivera
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiocirculatory Unit, Health Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
| | - M Bigazzi
- Prosperius Institute, Florence, Italy
| | - D Bani
- Prosperius Institute, Florence, Italy
| | - O Gualillo
- Neuroendocrine Interaccions in Rheumatology and Inflammatory Diseases Unit, Institute of Biomedical Research (IDIS-SERGAS), Santiago de Compostela, Spain
| | - J R González-Juanatey
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research (IDIS-SERGAS), Santiago de Compostela, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - F Lago
- Cellular and Molecular Cardiology Unit and Department of Cardiology, Institute of Biomedical Research (IDIS-SERGAS), Santiago de Compostela, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
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25
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Abstract
PURPOSE OF REVIEW In spite of advances in our understanding of acute heart failure (AHF) and its different phenotypic expressions, AHF management is still centered on volume removal with intravenous diuretics. This narrative review describes the pathophysiology underlying hypertensive AHF and appraises therapies targeting these mechanisms. RECENT FINDINGS Vascular redistribution rather than volume overload may be the primary determinant of elevated cardiac filling pressures and subsequent pulmonary congestion in patients with hypertensive AHF; in these patients, vasodilators should be the predominant treatment. Additional therapy with diuretics in hypertensive AHF should be relegated to the treatment of overt volume overload or persistent congestion in spite of optimized hemodynamics. Intravenous nitroglycerin at high doses can rapidly achieve pulmonary decongestion and reduce downstream critical care needs in these patients. The therapeutic role for synthetic peptides with vasodilator properties has yet to be defined. Evidence supporting both old and new vasodilator therapies is limited by a paucity of well-designed studies and failure to demonstrate improvement in long-term outcomes. Targeted study of this phenotype of AHF is needed before vasodilator therapies become incorporated into treatment guidelines.
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Martin B, Gabris-Weber BA, Reddy R, Romero G, Chattopadhyay A, Salama G. Relaxin reverses inflammatory and immune signals in aged hearts. PLoS One 2018; 13:e0190935. [PMID: 29346407 PMCID: PMC5773192 DOI: 10.1371/journal.pone.0190935] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/22/2017] [Indexed: 02/06/2023] Open
Abstract
Background ‘Healthy’ aging drives structural and functional changes in the heart including maladaptive electrical remodeling, fibrosis and inflammation, which lower the threshold for cardiovascular diseases such as heart failure (HF) and atrial fibrillation (AF). Despite mixed results in recent clinical trials, Relaxin-therapy for 2-days could reduce mortality by 37% at 180-days post-treatment, in patients with acute decompensated HF. Relaxin’s short life-span (hours) but long-lasting protective actions led us to test the hypothesis that relaxin acts at a genomic level to reverse maladaptive remodeling in aging and HF. Methods and results Young (9-month) and aged (24-month), male and female F-344/Brown Norway rats were treated with relaxin (0.4 mg/kg/day) for 2-weeks delivered by subcutaneous osmotic mini-pumps or with sodium acetate (controls). The genomic effects of aging and relaxin were evaluated by extracting RNA from the left ventricles and analyzing genomic changes by RNA-sequencing, Ingenuity Pathway Analysis, MetaCore and tissue immunohistochemistry. We found that aging promotes a native inflammatory response with distinct sex-differences and relaxin suppresses transcription of multiple genes and signaling pathways associated with inflammation and HF in both genders. In addition, aging significantly increased: macrophage infiltration and atrial natriuretic peptide levels in female ventricles, and activation of the complement cascade, whereas relaxin reversed these age-related effects. Conclusion These data support the hypothesis that relaxin alters gene transcription and suppresses inflammatory pathways and genes associated with HF and aging. Relaxin’s suppression of inflammation and fibrosis supports its potential as a therapy for cardiovascular and inflammation-related diseases, such as HF, AF and diabetes.
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Affiliation(s)
- Brian Martin
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- School of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Beth Ann Gabris-Weber
- School of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Rajiv Reddy
- School of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Guillermo Romero
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Ansuman Chattopadhyay
- Molecular Biology Information Service, Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Guy Salama
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- School of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
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27
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Beiert T, Knappe V, Tiyerili V, Stöckigt F, Effelsberg V, Linhart M, Steinmetz M, Klein S, Schierwagen R, Trebicka J, Roell W, Nickenig G, Schrickel JW, Andrié RP. Chronic lower-dose relaxin administration protects from arrhythmia in experimental myocardial infarction due to anti-inflammatory and anti-fibrotic properties. Int J Cardiol 2018; 250:21-28. [DOI: 10.1016/j.ijcard.2017.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/30/2017] [Accepted: 09/06/2017] [Indexed: 12/11/2022]
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28
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Shao W, Rosales CB, Gonzalez C, Prieto MC, Navar LG. Effects of serelaxin on renal microcirculation in rats under control and high-angiotensin environments. Am J Physiol Renal Physiol 2018; 314:F70-F80. [PMID: 28978531 DOI: 10.1152/ajprenal.00201.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Serelaxin is a novel recombinant human relaxin-2 that has been investigated for the treatment of acute heart failure. However, its effects on renal function, especially on the renal microcirculation, remain incompletely characterized. Our immunoexpression studies localized RXFP1 receptors on vascular smooth muscle cells and endothelial cells of afferent arterioles and on principal cells of collecting ducts. Clearance experiments were performed in male and female normotensive rats and Ang II-infused male rats. Serelaxin increased mean arterial pressure slightly and significantly increased renal blood flow, urine flow, and sodium excretion rate. Group analysis of all serelaxin infusion experiments showed significant increases in GFR. During infusion with subthreshold levels of Ang II, serelaxin did not alter mean arterial pressure, renal blood flow, GFR, urine flow, or sodium excretion rate. Heart rates were elevated during serelaxin infusion alone (37 ± 5%) and in Ang II-infused rats (14 ± 2%). In studies using the in vitro isolated juxtamedullary nephron preparation, superfusion with serelaxin alone (40 ng/ml) significantly dilated afferent arterioles (10.8 ± 1.2 vs. 13.5 ± 1.1 µm) and efferent arterioles (9.9 ± 0.9 vs. 11.9 ± 1.0 µm). During Ang II superfusion, serelaxin did not alter afferent or efferent arteriolar diameters. During NO synthase inhibition (l-NNA), afferent arterioles also did not show any vasodilation during serelaxin infusion. In conclusion, serelaxin increased overall renal blood flow, urine flow, GFR, and sodium excretion and dilated the afferent and efferent arterioles in control conditions, but these effects were attenuated or prevented in the presence of exogenous Ang II and NO synthase inhibitors.
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Affiliation(s)
- Weijian Shao
- Department of Physiology, Tulane Hypertension and Renal Center of Excellence, Tulane University School of Medicine , New Orleans, Louisiana
| | - Carla B Rosales
- Department of Physiology, Tulane Hypertension and Renal Center of Excellence, Tulane University School of Medicine , New Orleans, Louisiana
| | - Camila Gonzalez
- Department of Physiology, Tulane Hypertension and Renal Center of Excellence, Tulane University School of Medicine , New Orleans, Louisiana
| | - Minolfa C Prieto
- Department of Physiology, Tulane Hypertension and Renal Center of Excellence, Tulane University School of Medicine , New Orleans, Louisiana
| | - L Gabriel Navar
- Department of Physiology, Tulane Hypertension and Renal Center of Excellence, Tulane University School of Medicine , New Orleans, Louisiana
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Abstract
SummaryIntroduction: Varicose veins affect up to 40 % of men and up to 51 % of women. The patho-physiology of primary varicosis (chronic venous insufficiency, CVI) is poorly understood. Here, the available data on possible endocrine mechanisms in healthy and varicose veins are reviewed.Methods: An extensive literature search was conducted in PubMed using the following key words: Chronic venous insufficiency, CVI, chronic venous disease, CVD, varicosis, saphenous vein, pathogenesis, hormone.Results: Several theories ranging from incompetence of the valves to functional, biological or morphologic changes in different layers of the vein wall have been proposed. However, an increasing body of evidence suggests that endocrine mechanisms might be involved in the pathogenesis of primary varicosis. In this respect a growing number of hormones (e.g. estrogen, progesterone, relaxin-2, and oxytocin) and their receptors have been linked to primary varicosis in experimental, pharmacological and histological studies.Conclusion: In summary, endocrine-based mechanisms seem to play a role in the pathogenesis of primary varicosis. This opens up the perspective for pharmacological treatments targeting the various described endocrine regulatory networks.
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Wang D, Luo Y, Myakala K, Orlicky DJ, Dobrinskikh E, Wang X, Levi M. Serelaxin improves cardiac and renal function in DOCA-salt hypertensive rats. Sci Rep 2017; 7:9793. [PMID: 28851937 PMCID: PMC5574886 DOI: 10.1038/s41598-017-09470-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/26/2017] [Indexed: 11/09/2022] Open
Abstract
Serelaxin, a recombinant form of the naturally occurring peptide hormone relaxin-2, is a pleiotropic vasodilating hormone that has been studied in patients with acute heart failure. In this study, the effects of serelaxin on cardiac and renal function, fibrosis, inflammation and lipid accumulation were studied in DOCA-salt treated rats. Uninephrectomized rats were assigned to two groups: controls provided with normal drinking water and DOCA provided with DOCA pellets and sodium chloride drinking water. After 4 weeks, the DOCA-salt rats were randomly selected and implanted with osmotic minipumps delivering vehicle or serelaxin for another 4 weeks. Treatment with serelaxin prevented cardiac and renal dysfunction in DOCA-salt rats. Serelaxin prevented cardiac and renal fibrosis, as determined by Picrosirius Red staining and Second Harmonic Generation (SHG) Microscopy. Treatment of DOCA-salt rats with serelaxin decreased renal inflammation, including the expression of TGF-β, NFκB, MCP-1, IL-1, IL-6, ICAM-1, VCAM-1 and CD68 macrophages. Serelaxin also decreased lipid accumulation in kidney in part by decreasing SREBP-1c, SREBP-2, ChREBP, FATP1, HMGCoAR, and LDL receptor, and increasing Acox1 and ABCA1. In summary, serelaxin reversed DOCA-salt induced cardiac and renal dysfunction.
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Affiliation(s)
- Dong Wang
- Renal Diseases and Hypertension, School of Medicine, University of Colorado ANSCHUTZ MEDICAL CAMPUS, Aurora, Colorado, 80045, USA
| | - Yuhuan Luo
- Renal Diseases and Hypertension, School of Medicine, University of Colorado ANSCHUTZ MEDICAL CAMPUS, Aurora, Colorado, 80045, USA
| | - Komuraiah Myakala
- Renal Diseases and Hypertension, School of Medicine, University of Colorado ANSCHUTZ MEDICAL CAMPUS, Aurora, Colorado, 80045, USA
| | - David J Orlicky
- Department of Pathology, School of Medicine, University of Colorado ANSCHUTZ MEDICAL CAMPUS, Aurora, Colorado, 80045, USA
| | - Evgenia Dobrinskikh
- Renal Diseases and Hypertension, School of Medicine, University of Colorado ANSCHUTZ MEDICAL CAMPUS, Aurora, Colorado, 80045, USA
| | - Xiaoxin Wang
- Renal Diseases and Hypertension, School of Medicine, University of Colorado ANSCHUTZ MEDICAL CAMPUS, Aurora, Colorado, 80045, USA
| | - Moshe Levi
- Renal Diseases and Hypertension, School of Medicine, University of Colorado ANSCHUTZ MEDICAL CAMPUS, Aurora, Colorado, 80045, USA.
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Feijóo-Bandín S, Aragón-Herrera A, Rodríguez-Penas D, Portolés M, Roselló-Lletí E, Rivera M, González-Juanatey JR, Lago F. Relaxin-2 in Cardiometabolic Diseases: Mechanisms of Action and Future Perspectives. Front Physiol 2017; 8:599. [PMID: 28868039 PMCID: PMC5563388 DOI: 10.3389/fphys.2017.00599] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022] Open
Abstract
Despite the great effort of the medical community during the last decades, cardiovascular diseases remain the leading cause of death worldwide, increasing their prevalence every year mainly due to our new way of life. In the last years, the study of new hormones implicated in the regulation of energy metabolism and inflammation has raised a great interest among the scientific community regarding their implications in the development of cardiometabolic diseases. In this review, we will summarize the main actions of relaxin, a pleiotropic hormone that was previously suggested to improve acute heart failure and that participates in both metabolism and inflammation regulation at cardiovascular level, and will discuss its potential as future therapeutic target to prevent/reduce cardiovascular diseases.
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Affiliation(s)
- Sandra Feijóo-Bandín
- Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research and University Clinical HospitalSantiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesMadrid, Spain
| | - Alana Aragón-Herrera
- Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research and University Clinical HospitalSantiago de Compostela, Spain
| | - Diego Rodríguez-Penas
- Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research and University Clinical HospitalSantiago de Compostela, Spain
| | - Manuel Portolés
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesMadrid, Spain
- Cardiocirculatory Unit, Health Research Institute of La Fe University HospitalValencia, Spain
| | - Esther Roselló-Lletí
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesMadrid, Spain
- Cardiocirculatory Unit, Health Research Institute of La Fe University HospitalValencia, Spain
| | - Miguel Rivera
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesMadrid, Spain
- Cardiocirculatory Unit, Health Research Institute of La Fe University HospitalValencia, Spain
| | - José R. González-Juanatey
- Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research and University Clinical HospitalSantiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesMadrid, Spain
| | - Francisca Lago
- Cellular and Molecular Cardiology Research Unit, Institute of Biomedical Research and University Clinical HospitalSantiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesMadrid, Spain
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Beiert T, Tiyerili V, Knappe V, Effelsberg V, Linhart M, Stöckigt F, Klein S, Schierwagen R, Trebicka J, Nickenig G, Schrickel JW, Andrié RP. Relaxin reduces susceptibility to post-infarct atrial fibrillation in mice due to anti-fibrotic and anti-inflammatory properties. Biochem Biophys Res Commun 2017. [DOI: 10.1016/j.bbrc.2017.06.091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Han L, Luo J, Bai S, Jia Y, Chen X, Zhao Y, Chen L, Zhu X, Li Y, Jiang Y, Li X, Yang M, Li D, Teng X, Qi Y. Combined Assessment of Relaxin and B-Type Natriuretic Peptide Improves Diagnostic Value in Patients With Congestive Heart Failure. Am J Med Sci 2017; 354:480-485. [PMID: 29173360 DOI: 10.1016/j.amjms.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND To improve the poor prognosis of congestive heart failure (CHF), early and accurate diagnosis is necessary. Relaxin is an endogenous cardiovascular peptide, and its plasma level is usually increased in patients with CHF. In this pilot study, we aimed to determine the diagnostic value of relaxin and B-type natriuretic peptide (BNP) in patients with and without CHF. MATERIALS AND METHODS The plasma level of relaxin was measured by enzyme-linked immunosorbent assay and plasma level of BNP by fluorescence immunoassay. The area under the receiver operating characteristic curve was used to assess the diagnostic value of relaxin and BNP. RESULTS We included 81 patients with decompenstated CHF and 36 controls. Plasma levels of relaxin and BNP were both higher in CHF patients than in controls. The correlation between plasma levels of relaxin and BNP and between relaxin or BNP and cardiac function was nonlinear. Relaxin had medium diagnostic value, and BNP had higher value for cardiac function and CHF. At a cutoff of 39.76pg/mL relaxin, sensitivity was 82.7%, specificity 55.6%, sum of the highest positive predictive value 80.5% and negative predictive value 58.8%. Although the diagnostic value was not better for relaxin than BNP, their combined assessment improved the sensitivity and specificity of diagnosis for CHF as compared with BNP alone. CONCLUSIONS Combined assessment of relaxin and BNP may improve the diagnosis of decompensated CHF, which may have potential application in the clinic.
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Affiliation(s)
- Ling Han
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Jingguang Luo
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Shanshan Bai
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Ye Jia
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Xin Chen
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Yan Zhao
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Liwei Chen
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Xiaogang Zhu
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Ying Li
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Jiang
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Li
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Ming Yang
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Dongxia Li
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Xu Teng
- Hebei Key Laboratory of Laboratory Animal Science, Hebei Medical University, Shijiazhuang, China.
| | - Yongfen Qi
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
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Umanath K, Emani S. Getting to the Heart of the Matter: Review of Treatment of Cardiorenal Syndrome. Adv Chronic Kidney Dis 2017; 24:261-266. [PMID: 28778367 DOI: 10.1053/j.ackd.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acute decompensated heart failure is a common cause of hospitalization with worsening kidney function or acute kidney injury often complicating the admission, which can result in further dysfunction of both systems in the form of a cardiorenal syndrome. Therapy in this arena has been largely empiric as rigorous clinical trial data to inform therapeutic choices are lacking. Here we review and discuss the available clinical evidence for common approaches to the management of this condition. A multidisciplinary approach to the care of patients with cardiorenal syndrome that relies on the experience of nephrologists and cardiologists to individualize treatment is critical given the paucity of rigorous clinical trial data.
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Aggarwal SR, Herrington DM, Vladutiu CJ, Newman JC, Swett K, Gonzalez F, Kizer JR, Kominiarek MA, Tabb KM, Gallo LC, Talavera GA, Hurwitz BE, Rodriguez CJ. Higher number of live births is associated with left ventricular diastolic dysfunction and adverse cardiac remodelling among US Hispanic/Latina women: results from the Echocardiographic Study of Latinos. Open Heart 2017; 4:e000530. [PMID: 28674618 PMCID: PMC5471863 DOI: 10.1136/openhrt-2016-000530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Female sex is a risk factor for heart failure with preserved ejection fraction (HFpEF). Previous literature suggests that some diastolic dysfunction (DD) develops during pregnancy and may persist postdelivery. Our objective was to examine the relationship between parity and cardiac structure and function in a population-based cohort. Methods Participants included 1172 Hispanic/Latina women, aged ≥45 years, enrolled in the Echocardiographic Study of Latinos from four US communities (Bronx, Miami, San Diego and Chicago). Standard echocardiographic techniques were used to measure cardiac volumes, left ventricular mass, systolic and diastolic function. Using sampling weights and survey statistics, multivariable linear and logistic regression models were constructed adjusting for age, body mass index, diabetes or prediabetes, systolic blood pressure, use of antihypertensive medications, smoking, total cholesterol and high-density lipoprotein cholesterol. Results In the target population, 5.0% were nulliparous (no live births) and 10.5% were grand multiparous (≥5 live births). Among the nulliparous women, 46% had DD as compared with 51%–58% of women with 1–4 live births and 81% of women with ≥5 live births (p<0.01). In full multivariate models, higher parity was significantly associated with greater left ventricular end-systolic volumes, end-diastolic volumes, left atrial volume indices and presence of DD (all p<0.01) but was not associated with ejection fraction. The log odds for having any grade of DD in grand-multiparous women was over three times that seen in nulliparous women (OR=3.4, 95% CI 1.5 to 7.9, p<0.01) in models further adjusted for income and education. Conclusions Higher parity is associated with increased cardiac mass, volumes and the presence of DD. Further studies are needed to elucidate this apparent deleterious relation and whether parity can help explain the increased risk of HFpEF in women.
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Affiliation(s)
| | | | | | - Jill C Newman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katrina Swett
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jorge R Kizer
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Karen M Tabb
- University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Linda C Gallo
- San Diego State University, San Diego, California, USA
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Nonhoff J, Ricke-Hoch M, Mueller M, Stapel B, Pfeffer T, Kasten M, Scherr M, von Kaisenberg C, Bauersachs J, Haghikia A, Hilfiker-Kleiner D. Serelaxin treatment promotes adaptive hypertrophy but does not prevent heart failure in experimental peripartum cardiomyopathy. Cardiovasc Res 2017; 113:598-608. [PMID: 28453725 PMCID: PMC5412020 DOI: 10.1093/cvr/cvw245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 10/03/2016] [Accepted: 12/01/2016] [Indexed: 01/20/2023] Open
Abstract
AIMS Peripartum cardiomyopathy (PPCM) is a systolic left ventricular dysfunction developing in the peripartum phase in previously healthy women. Relaxin-2 is a pregnancy hormone with potential beneficial effects in heart failure patients. We evaluated Relaxin-2 as a potential diagnostic marker and/or a therapeutic agent in PPCM. METHODS AND RESULTS In healthy peripartum women, serum Relaxin-2 levels (measured by ELISA in the second half of pregnancy) were elevated showing a decreasing trend in the first postpartum week and returned to non-pregnant levels thereafter. In PPCM patients diagnosed in the first postpartum week, serum Relaxin-2 levels were lower compared to healthy postpartum stage-matched controls. In PPCM patients diagnosed later (0.5-10 months postpartum) Relaxin-2 levels were in the range of non-pregnant controls and not different from healthy postpartum stage-matched controls. In mice, serum Relaxin-1 (functional equivalent of human Relaxin-2) was increased late in pregnancy and rapidly cleared in the first postpartum week. In mice with PPCM due to a cardiomyocyte-specific knockout of STAT3 (CKO) neither low nor high dose of recombinant Relaxin-2 (serelaxin, sRlx-LD: 30 µg/kg/day; sRlx-HD: 300 µg/kg/day) affected cardiac fibrosis, inflammation and heart failure but sRlx-HD increased capillary/cardiomyocyte ratio. sRlx-HD significantly increased heart/body weight ratio and cardiomyocyte cross-sectional area in postpartum CKO and wild-type mice without changing the foetal gene expression program (ANP or β-MHC). sRlx-HD augmented plasma Prolactin levels in both genotypes, which induced cardiac activation of STAT5. In vitro analyses showed that Prolactin induces cardiomyocyte hypertrophy via activation of STAT5. CONCLUSION Although Relaxin-2 levels seemed lower in PPCM patients diagnosed early postpartum, we observed a high pregnancy-related variance of serum Relaxin-2 levels peripartum making it unsuitable as a biomarker for this condition. Supplementation with sRlx may contribute to angiogenesis and compensatory hypertrophy in the diseased heart, but the effects are not sufficient to prevent heart failure in an experimental PPCM model.
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Affiliation(s)
- Justus Nonhoff
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Mirco Mueller
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Britta Stapel
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Tobias Pfeffer
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Martina Kasten
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Michaela Scherr
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Constantin von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Arash Haghikia
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
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Sabbah HN. Silent disease progression in clinically stable heart failure. Eur J Heart Fail 2017; 19:469-478. [PMID: 27976514 PMCID: PMC5396296 DOI: 10.1002/ejhf.705] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/21/2016] [Accepted: 11/02/2016] [Indexed: 12/11/2022] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is a progressive disorder whereby cardiac structure and function continue to deteriorate, often despite the absence of clinically apparent signs and symptoms of a worsening disease state. This silent yet progressive nature of HFrEF can contribute to the increased risk of death-even in patients who are 'clinically stable', or who are asymptomatic or only mildly symptomatic-because it often goes undetected and/or undertreated. Current therapies are aimed at improving clinical symptoms, and several agents more directly target the underlying causes of disease; however, new therapies are needed that can more fully address factors responsible for underlying progressive cardiac dysfunction. In this review, mechanisms that drive HFrEF, including ongoing cardiomyocyte loss, mitochondrial abnormalities, impaired calcium cycling, elevated LV wall stress, reactive interstitial fibrosis, and cardiomyocyte hypertrophy, are discussed. Additionally, limitations of current HF therapies are reviewed, with a focus on how these therapies are designed to counteract the deleterious effects of compensatory neurohumoral activation but do not fully prevent disease progression. Finally, new investigational therapies that may improve the underlying molecular, cellular, and structural abnormalities associated with HF progression are reviewed.
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Leo CH, Fernando DT, Tran L, Ng HH, Marshall SA, Parry LJ. Serelaxin Treatment Reduces Oxidative Stress and Increases Aldehyde Dehydrogenase-2 to Attenuate Nitrate Tolerance. Front Pharmacol 2017; 8:141. [PMID: 28377719 PMCID: PMC5359255 DOI: 10.3389/fphar.2017.00141] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/07/2017] [Indexed: 02/01/2023] Open
Abstract
Background: Glyceryl trinitrate (GTN) is a commonly prescribed treatment for acute heart failure patients. However, prolonged GTN treatment induces tolerance, largely due to increased oxidative stress and reduced aldehyde dehydrogenase-2 (ALDH-2) expression. Serelaxin has several vasoprotective properties, which include reducing oxidative stress and augmenting endothelial function. We therefore tested the hypothesis in rodents that serelaxin treatment could attenuate low-dose GTN-induced tolerance. Methods and Results: Co-incubation of mouse aortic rings ex vivo with GTN (10 μM) and serelaxin (10 nM) for 1 h, restored GTN responses, suggesting that serelaxin prevented the development of GTN tolerance. Male Wistar rats were subcutaneously infused with ethanol (control), low-dose GTN+placebo or low-dose GTN+serelaxin via osmotic minipumps for 3 days. Aortic vascular function and superoxide levels were assessed using wire myography and lucigenin-enhanced chemiluminescence assay respectively. Changes in aortic ALDH-2 expression were measured by qPCR and Western blot respectively. GTN+placebo infusion significantly increased superoxide levels, decreased ALDH-2 and attenuated GTN-mediated vascular relaxation. Serelaxin co-treatment with GTN significantly enhanced GTN-mediated vascular relaxation, reduced superoxide levels and increased ALDH-2 expression compared to GTN+placebo-treated rats. Conclusion: Our data demonstrate that a combination of serelaxin treatment with low dose GTN attenuates the development of GTN-induced tolerance by reducing superoxide production and increasing ALDH-2 expression in the rat aorta. We suggest that serelaxin may improve nitrate efficacy in a clinical setting.
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Affiliation(s)
- Chen Huei Leo
- School of BioSciences, The University of Melbourne, Parkville VIC, Australia
| | | | - Lillie Tran
- School of BioSciences, The University of Melbourne, Parkville VIC, Australia
| | - Hooi Hooi Ng
- School of BioSciences, The University of Melbourne, Parkville VIC, Australia
| | - Sarah A Marshall
- School of BioSciences, The University of Melbourne, Parkville VIC, Australia
| | - Laura J Parry
- School of BioSciences, The University of Melbourne, Parkville VIC, Australia
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40
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Cuthbert JJ, Pellicori P, Shah P, Clark AL. New pharmacological approaches in heart failure therapy: developments and possibilities. Future Cardiol 2017; 13:173-188. [PMID: 28181443 DOI: 10.2217/fca-2016-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There have been few major breakthroughs in heart failure (HF) drug therapies in recent years yet HF morbidity and mortality remain high, and there is a clear need for further research. Several newer agents that appear promising in Phase I and II trials do not progress to show clinical benefit in later trials. Part of the failure to find new therapies may lie in flawed trial design compounded by the need for ever-increasing patient numbers in order to prove outcome benefit. We summarize some of the most recent and promising medical therapies for HF.
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Affiliation(s)
- Joseph J Cuthbert
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Parin Shah
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
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Filippatos G, Farmakis D, Metra M, Cotter G, Davison BA, Felker GM, Greenberg BH, Hua TA, Pang PS, Ponikowski P, Qian M, Severin TA, Voors AA, Teerlink JR. Serelaxin in acute heart failure patients with and without atrial fibrillation: a secondary analysis of the RELAX-AHF trial. Clin Res Cardiol 2017; 106:444-456. [PMID: 28150186 PMCID: PMC5511317 DOI: 10.1007/s00392-016-1074-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Atrial fibrillation (AFib) is a common comorbidity in HF and affects patients' outcome. We sought to assess the effects of serelaxin in patients with and without AFib. METHODS In a post hoc analysis of the RELAX-AHF trial, we compared the effects of serelaxin on efficacy end points, safety end points and biomarkers in 1161 patients with and without AFib on admission electrocardiogram. RESULTS AFib was present in 41.3% of patients. Serelaxin had a similar effect in patients with and without AFib, including dyspnea relief by visual analog scale through day 5 [mean change in area under the curve, 541.11 (33.79, 1048.44), p = 0.0366 in AFib versus 361.80 (-63.30, 786.90), p = 0.0953 in non-AFib, interaction p = 0.5954] and all-cause death through day 180 [HR = 0.42 (0.23, 0.77), p = 0.0051 in AFib versus 0.90 (0.53, 1.52), p = 0.6888 in non-AFib, interaction p = 0.0643]. Serelaxin was similarly safe in the two groups and induced similar reductions in biomarkers of cardiac, renal and hepatic damage. Stroke occurred more frequently in AFib patients (2.8 vs. 0.8%, p = 0.0116) and there was a trend for lower stroke incidence in the serelaxin arm in AFib patients (odds ratios, 0.31, p = 0.0759 versus 3.88, p = 0.2255 in non-AFib, interaction p = 0.0518). CONCLUSIONS Serelaxin was similarly safe and efficacious in improving short- and long-term outcomes and inducing organ protection in acute HF patients with and without AFib.
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Affiliation(s)
- Gerasimos Filippatos
- National and Kapodistrian University of Athens, Medical School, Athens, Greece. .,Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, 1 Rimini St, 12462, Athens, Greece.
| | - Dimitrios Farmakis
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | | | | | | | - Tsushung A Hua
- Novartis Pharmaceuticals Corporation, New Hanover, NJ, USA
| | - Peter S Pang
- Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, USA
| | | | - Min Qian
- Columbia University, New York, NY, USA
| | | | | | - John R Teerlink
- University of California-San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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Cimini D, Corte KD, Finamore R, Andreozzi L, Stellavato A, Pirozzi AVA, Ferrara F, Formisano R, De Rosa M, Chino M, Lista L, Lombardi A, Pavone V, Schiraldi C. Production of human pro-relaxin H2 in the yeast Pichia pastoris. BMC Biotechnol 2017; 17:4. [PMID: 28088197 PMCID: PMC5237503 DOI: 10.1186/s12896-016-0319-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 12/07/2016] [Indexed: 12/16/2022] Open
Abstract
Background Initially known as the reproductive hormone, relaxin was shown to possess other therapeutically useful properties that include extracellular matrix remodeling, anti-inflammatory, anti-ischemic and angiogenic effects. All these findings make relaxin a potential drug for diverse medical applications. Its precursor, pro-relaxin, is an 18 kDa protein, that shows activity in in vitro assays. Since extraction of relaxin from animal tissues raises several issues, prokaryotes and eukaryotes were both used as expression systems for recombinant relaxin production. Most productive results were obtained when using Escherichia coli as a host for human relaxin expression. However, in such host, relaxin precipitated in the form of inclusion bodies and, therefore, required several expensive recovery steps as cell lysis, refolding and reduction. Results To overcome the issues related to prokaryotic expression here we report the production and purification of secreted human pro-relaxin H2 by using the methylotrophic yeast Pichia pastoris as expression host. The methanol inducible promoter AOX1 was used to drive expression of the native and histidine tagged forms of pro-relaxin H2 in dual phase fed-batch experiments on the 22 L scale. Both protein forms presented the correct structure, as determined by mass spectrometry and western blotting analyses, and demonstrated to be biologically active in immune enzymatic assays. The presence of the tag allowed to simplify pro-relaxin purification obtaining higher purity. Conclusions This work presents a strategy for microbial production of recombinant human pro-relaxin H2 in Pichia pastoris that allowed the obtainment of biologically active pro-hormone, with a final concentration in the fermentation broth ranging between 10 and 14 mg/L of product, as determined by densitometric analyses. Electronic supplementary material The online version of this article (doi:10.1186/s12896-016-0319-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Cimini
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy.
| | - K Della Corte
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy
| | - R Finamore
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy
| | - L Andreozzi
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy
| | - A Stellavato
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy
| | - A V A Pirozzi
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy
| | - F Ferrara
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy
| | - R Formisano
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy
| | - M De Rosa
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy
| | - M Chino
- Department of Chemical Sciences, University of Naples Federico II, Via Cintia I, 80126, Naples, Italy
| | - L Lista
- Department of Chemical Sciences, University of Naples Federico II, Via Cintia I, 80126, Naples, Italy
| | - A Lombardi
- Department of Chemical Sciences, University of Naples Federico II, Via Cintia I, 80126, Naples, Italy
| | - V Pavone
- Department of Chemical Sciences, University of Naples Federico II, Via Cintia I, 80126, Naples, Italy
| | - C Schiraldi
- Department of Experimental Medicine, Section of Biotechnology and Molecular Biology, Second University of Naples and University of Campania Luigi Vanvitelli, via de Crecchio 7, 80138, Naples, Italy.
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Hamo CE, Butler J, Gheorghiade M, Chioncel O. The bumpy road to drug development for acute heart failure. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Tyler JM, Pang PS, Teerlink JR. Serelaxin in the Treatment of Acute Heart Failure. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sato N, Lam CSP, Teerlink JR, Greenberg BH, Tsutsui H, Oh BH, Zhang J, Lefkowitz M, Hua TA, Holbro T, Marshood M, Wang XL, Ge J. Evaluating the Efficacy, Safety, and Tolerability of Serelaxin When Added to Standard Therapy in Asian Patients With Acute Heart Failure: Design and Rationale of RELAX-AHF-ASIA Trial. J Card Fail 2016; 23:63-71. [PMID: 27825893 DOI: 10.1016/j.cardfail.2016.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/10/2016] [Accepted: 10/28/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute heart failure (AHF), a common and growing health concern worldwide, is associated with high risk of post-discharge rehospitalization and mortality. Existing evidence indicates potential therapeutic benefits of serelaxin in Caucasian AHF patients, but corresponding data in Asians remain scarce. RELAX-AHF-ASIA, a multinational, randomized, double-blind, placebo-controlled, phase III trial, will evaluate the effects of serelaxin on symptom relief and clinical outcomes in Asian AHF patients, with the use of novel assessments. METHODS AND RESULTS Patients with AHF, systolic blood pressure ≥125 mm Hg, and mild to moderate renal dysfunction will be randomized within 16 hours of presentation to receive 48-hour intravenous infusion of 30 µg ⋅ kg-1 ⋅ d-1 serelaxin or placebo in addition to standard therapy. The composite primary end point includes: (1) treatment success (moderate/marked improvement in patient-reported dyspnea and physician-assessed signs of congestion on day 2); (2) treatment failure (in-hospital worsening of signs and/or symptoms of heart failure [HF] requiring intensification of intravenous HF therapy or mechanical ventilation, renal/circulatory support, rehospitalization due to HF/renal-failure, or death through day 5); and (3) unchanged status. Secondary end points include time to in-hospital worsening HF through day 5 and all-cause and cardiovascular deaths through day 180. CONCLUSIONS RELAX-AHF-ASIA, the largest randomized clinical trial in Asian AHF patients to date, has a novel composite primary end point and the potential to become a hallmark of AHF trials.
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Affiliation(s)
- Naoki Sato
- Cardiology and Intensive Care Unit, Nippon Medical School, Musashi-Kosugi Hospital, Kawasaki, Japan.
| | | | - John R Teerlink
- University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, Los Angeles, California
| | - Barry H Greenberg
- Division of Cardiology, University of California, San Diego, La Jolla, California
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Byung-Hee Oh
- Department of Internal Medicine, Seoul National University, College of Medicine, Seoul, South Korea
| | - Jian Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | | | - Tsushung A Hua
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Miriam Marshood
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Xing Li Wang
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Wang D, Zhu H, Yang Q, Sun Y. Effects of relaxin on cardiac fibrosis, apoptosis, and tachyarrhythmia in rats with myocardial infarction. Biomed Pharmacother 2016; 84:348-355. [PMID: 27668534 DOI: 10.1016/j.biopha.2016.09.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/31/2016] [Accepted: 09/15/2016] [Indexed: 11/16/2022] Open
Abstract
Relaxin is safe and efficient to use for treating acute heart failure. However, the electrophysiological and arrhythmogenic effects of relaxin in an experimental healing infarction model remain unknown. In this study, a rat model with myocardial infarction (MI) received relaxin (0.5mg/kg per day) or vehicle (sodium acetate) infusion via implantable mini-pumps for 2 weeks. Thereafter, hemodynamic measurement, electrophysiological study, histological examination, and immunofluorescence labeling were performed. Relaxin treatment significantly attenuated tachyarrhythmia inducibility and cardiac dysfunction in healing infarcted heart. Epicardial monophasic action potentials showed that relaxin significantly reduced the dispersion of action potential duration in postinfarcted hearts. Histological study revealed that relaxin significantly reduced myocardial apoptosis and cardiac fibrotic collagen deposition. Western blot revealed that relaxin treatment significantly suppressed the protein expression levels of TGFβ1, α-SMA, and type I collagen. Furthermore, abnormal alterations of Connexin 43, including reduction and lateralization, were significantly attenuated by relaxin treatment at the infarcted border zone. This study provides strong evidence that continuous relaxin intervention ameliorates cardiac fibrosis and apoptosis, attenuates remodeling of gap junction and focal heterogeneity of repolarization, and reduces vulnerability to tachyarrhythmias.
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Affiliation(s)
- Deguo Wang
- Department of Gerontology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241001, PR China.
| | - Hongjun Zhu
- Department of Cardiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, PR China
| | - Qing Yang
- Department of Gerontology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241001, PR China
| | - Yirun Sun
- Department of Gerontology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241001, PR China
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Abstract
Despite advances in therapy, patients with heart failure (HF) continue to experience unacceptably high rates of hospitalization and death, as well as poor quality of life. As a consequence, there is an urgent need for new treatments that can improve the clinical course of the growing worldwide population of HF patients. Serelaxin and ularatide, both based on naturally occurring peptides, have potent vasodilatory as well as other effects on the heart and kidneys. For both agents, phase 3 studies that are designed to determine whether they improve outcomes in patients with acute HF have completed enrollment. TRV027, a biased ligand for the type 1 angiotensin receptor with effects that extend beyond traditional angiotensin-receptor blockers is also being studied in the acute HF population. Omecamtiv mecarbil, an inotropic agent that improves myocardial contractility by a novel mechanism, and vericiguat, a drug that stimulates soluble guanylate cyclase, are both being developed to treat patients with chronic HF. Finally, despite the negative results of the CUPID study, gene transfer therapy continues to be explored as a means of improving the function of the failing heart. The basis for the use of these drugs and their current status in clinical trials are discussed. (Circ J 2016; 80: 1882-1891).
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Pintalhao M, Castro‐Chaves P, Vasques‐Novoa F, Gonçalves F, Mendonça L, Fontes‐Carvalho R, Lourenço P, Almeida P, Leite‐Moreira A, Bettencourt P. Relaxin serum levels in acute heart failure are associated with pulmonary hypertension and right heart overload. Eur J Heart Fail 2016; 19:218-225. [DOI: 10.1002/ejhf.611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/24/2016] [Accepted: 06/10/2016] [Indexed: 01/05/2023] Open
Affiliation(s)
- Mariana Pintalhao
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Paulo Castro‐Chaves
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Francisco Vasques‐Novoa
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Francisco Gonçalves
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
| | - Luís Mendonça
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Ricardo Fontes‐Carvalho
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Cardiovascular Research Centre Portugal
- Cardiology DepartmentGaia Hospital Centre Gaia Portugal
| | - Patrícia Lourenço
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Pedro Almeida
- Cardiology DepartmentSão João Hospital Centre Porto Portugal
| | - Adelino Leite‐Moreira
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Cardiovascular Research Centre Portugal
- Cardiothoracic Surgery DepartmentSão João Hospital Centre Porto Portugal
| | - Paulo Bettencourt
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
- Department of Medicine, Faculty of MedicineUniversity of Porto Portugal
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Anti-atherosclerotic effects of serelaxin in apolipoprotein E-deficient mice. Atherosclerosis 2016; 251:430-437. [PMID: 27341752 DOI: 10.1016/j.atherosclerosis.2016.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Serelaxin (SLX) is a recombinant form of human relaxin-2, a naturally occurring peptide that regulates maternal cardiovascular adaptations to pregnancy. It is unclear whether SLX has a therapeutic effect on atherosclerosis. Therefore, we investigated direct vascular effects of SLX in a mouse model of atherosclerosis. METHODS 6-8 week-old female apolipoprotein E-deficient mice were fed a high-fat, cholesterol-rich diet for 6 weeks and additionally received a continuous treatment with vehicle or SLX (0.05 or 0.1 μg/h), during the last 4 weeks, via subcutaneously implanted osmotic mini-pumps. Vascular oxidative stress, vasorelaxation and atherosclerotic plaque development were assessed. RESULTS Vascular oxidative stress was reduced in SLX-treated mice (vehicle: 322.67 RLU/s, SLX 0.05 μg/h: 119.76 RLU/s (p < 0.001 vs. vehicle), SLX 0.1 μg/h: 109.33 RLU/s (p < 0.001 vs. vehicle; p = 0.967 vs. 0.05 μg/h SLX)). Further SLX improved endothelium-dependent vasodilatation without influencing endothelium-independent vasorelaxation. Atherosclerotic plaque development was significantly reduced by SLX (vehicle: 0.38 ± 0.02 mm(2), 0.05 μg/h SLX: 0.32 ± 0.02 mm(2) (p = 0.047 vs. vehicle), 0.1 μg/h SLX: 0.29 ± 0.02 mm(2) (p = 0.002 vs. vehicle; p = 0.490 vs. 0.05 μg/h SLX)). Neither vascular macrophage, T-cell or neutrophil infiltration, nor collagen/vascular smooth muscle cell content differed between the groups. We observed a significant down-regulation of the angiotensin II type 1a receptor and a decrease in IL-6 and an increase in IL-10 plasma concentrations. CONCLUSIONS Our data demonstrates novel pleiotropic effects of SLX on vascular oxidative stress, endothelial dysfunction and atherosclerotic plaque burden. Therefore, SLX could serve as a new drug for the treatment of atherosclerosis-related diseases.
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Zhou H, Qu X, Gao Z, Zheng G, Lin J, Su L, Huang Z, Li H, Huang W. Relaxin Level in Patients With Atrial Fibrillation and Association with Heart Failure Occurrence: A STROBE Compliant Article. Medicine (Baltimore) 2016; 95:e3664. [PMID: 27227926 PMCID: PMC4902350 DOI: 10.1097/md.0000000000003664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia requiring medical treatment and has been associated with enhanced atrial fibrosis and heart failure (HF). Relaxin (RLX), an antifibrosis and antiinflammatory peptide hormone, may be used to evaluate atrial fibrosis and is associated with HF occurrence in AF. We aimed to clarify the clinical significance of RLX level in patients with AF.We measured circulating levels of RLX and other fibrosis-related factors in 311 patients with sinus rhythm (SR; n = 116) or AF (n = 195). All discharged AF patients were followed up for the occurrence of HF for a mean of 6 months.Circulating levels of RLX were significantly different in patients with AF as compared with SR (P < 0.001), and in the subgroup analysis of AF. RLX level was correlated with left atrial diameter (LAD; R = 0.358, P < 0.001). Among followed up AF patients, on Kaplan-Meier curve analysis, patients with the third RLX tertile (T3) had a significantly higher HF rate than those with the 1st tertile (T1) (P = 0.002) and the cut-off value was 294.8 ng/L (area under the ROC curve [AUC] = 0.723). On multivariable analysis, HF occurrence with AF was associated with increased tertile of serum RLX level (odds ratio [OR] 2.659; confidence interval [95% CI] 1.434-4.930; P = 0.002).RLX is associated with fibrosis-related biomarkers and significantly elevated in AF. RLX was related to the HF occurrence in patients with AF.
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Affiliation(s)
- Hao Zhou
- From the Department of Cardiovascular Medicine, the First Affiliated Hospital of Wenzhou Medical University; The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
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