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Felix B, Aldoohan F, Kadirage HU, Keelathara Sajeev S, Kayani M, Hag Saeed MAI, Vempatapu S, Nasim K, Pendem H, Armenta AP, Nazir Z. Assessment of the Impact of Comorbidities on Outcomes in Non-ST Elevation Myocardial Infarction (NSTEMI) Patients: A Narrative Review. Cureus 2024; 16:e65568. [PMID: 39192929 PMCID: PMC11348641 DOI: 10.7759/cureus.65568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
Non-ST-segment elevation myocardial infarction (NSTEMI) is associated with significant morbidity and mortality, occurring when the heart's need for oxygen cannot be met. It is defined by elevated cardiac biomarkers without ST-segment elevation and often carries a poorer prognosis than most ST-segment elevation events. NSTEMI usually results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus/atheromatous material. Patients with NSTEMI often have multiple comorbidities, which can worsen their prognosis and complicate treatment. This study aims to investigate the impact of comorbidities such as hypertension (HTN), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), obesity, dyslipidemia, and smoking on patients with NSTEMI. The prevalence of each comorbidity is examined individually within the NSTEMI population to provide a clearer picture of how frequently these conditions co-occur with NSTEMI and how they affect the established NSTEMI treatment protocols. This paper sheds light on the interaction between NSTEMI and commonly associated comorbidities through a comprehensive literature review and data analysis. This is critical for optimizing clinical decision-making and enhancing patient care, ultimately improving outcomes in this high-risk patient population.
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Affiliation(s)
- Bryan Felix
- Medical Student, Avalon University School of Medicine, Los Angeles, USA
| | - Fawaz Aldoohan
- Internal Medicine, American Academy of Research and Academics, Delaware, USA
| | | | | | - Maryam Kayani
- Cardiology, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, PAK
| | | | - Sruthi Vempatapu
- Internal Medicine, Nandamuri Taraka Rama Rao (NTR) University of Health Sciences, Hyderabad, IND
| | - Khadija Nasim
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Harini Pendem
- Internal Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, IND
| | - Annia P Armenta
- Internal Medicine, Universidad Autónoma de Guadalajara, Guadalajara, MEX
| | - Zahra Nazir
- Internal Medicine, Combined Military Hospital (CMH), Quetta, PAK
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Alkatiri AH, Qalby N, Mappangara I, Zainal ATF, Cramer MJ, Doevendans PA, Qanitha A. Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1303685. [PMID: 38529334 PMCID: PMC10961461 DOI: 10.3389/fcvm.2024.1303685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024] Open
Abstract
Background Hyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes. Methods We conducted a comprehensive search for articles on PubMed and Embase using search strategies which yielded 4,061 articles. After full-text screening, 66 articles were included for systematic review, and 62 articles were further selected for meta-analysis. Results The 66 included articles spanned the years 2005-2023. Of these, 45 articles reported admission blood glucose, 13 articles used HbA1c, and 7 articles studied fasting blood glucose. Most studies defined STEMI with primary PCI as their inclusion criteria. Mortality was the most often outcome reported related to hyperglycemia. Overall, 55 (83.3%) studies were at low risk of bias. Both admission and fasting blood glucose were significantly related to short- and long-term mortality after STEMI, with a pooled risk ratio (RR) of 3.02 (95%CI: 2.65-3.45) and 4.47 (95% CI: 2.54-7.87), respectively. HbA1c showed substantial association with long-term mortality (HR 1.69, 95% CI: 1.31-2.18)) with a pooled RR of 1.58 (95% CI 1.26-1.97). In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31-2.17), heart failure (pooled RR 1.56, 95% CI: 1.37-1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65-5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21-3.28), and composite major adverse cardiac and cerebrovascular events (MACCE) (pooled RR 1.99, 95% CI: 1.54-2.58). Conclusions Our study demonstrated that hyperglycemia has a strong association with poor outcomes after STEMI. Admission and fasting blood glucose are predictors for short-term outcomes, while HbA1c is more appropriate for predicting longer-term outcomes in STEMI patients. Systematic Review Registration PROSPERO 2021 (CRD42021292985).
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Affiliation(s)
- Abdul Hakim Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Makassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, Indonesia
| | - Nurul Qalby
- Department of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Makassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, Indonesia
| | | | - Maarten J. Cramer
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pieter A. Doevendans
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Andriany Qanitha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Doctoral Study Program, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Liu J, Li X, Ding L, Li W, Niu X, Gao D. GRK2 participation in cardiac hypertrophy induced by isoproterenol through the regulation of Nrf2 signaling and the promotion of NLRP3 inflammasome and oxidative stress. Int Immunopharmacol 2023; 117:109957. [PMID: 37012864 DOI: 10.1016/j.intimp.2023.109957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE In cases of heart failure, cardiac hypertrophy may be caused by the upregulation of G-protein-coupled receptor kinase 2 (GRK2). Both NLRP3 inflammasome and oxidative stress contribute to cardiovascular disease. In this study, we clarified the effect of GRK2 on cardiac hypertrophy in H9c2 cells induced by isoproterenol (ISO) and examined the underlying mechanisms. METHODS We randomly categorized H9c2 cells into five groups: an ISO group, a paroxetine plus ISO group, a GRK2 small-interfering RNA (siRNA) plus ISO group, a GRK2 siRNA combined with ML385 plus ISO group, and a control group. To determine the effect of GRK2 on cardiac hypertrophy induced by ISO, we carried out CCK8 assays, RT-PCR, TUNEL staining, ELISA assay, DCFH-DA staining, immunofluorescence staining, and western blotting. RESULTS By using paroxetine or siRNA to inhibit GRK2, we significantly decreased cell viability; reduced the mRNA levels of ANP, BNP, and β-MHC; and limited the apoptosis rate and protein levels of cleaved caspase-3 and cytochrome c in H9c2 cells treated with ISO. We also found that oxidative stress induced by ISO could be mitigated with paroxetine or GRK2 siRNA. This result was validated by decreased activities of the antioxidant enzymes CAT, GPX, and SOD and increased MDA levels and ROS production. We observed that the protein expression of NLRP3, ASC, and caspase-1 and the intensity of NLRP3 could be inhibited by paroxetine or GRK2 siRNA. Both paroxetine and GRK2 siRNA were able to abolish the increase in GRK2 expression induced by ISO. They also could increase protein levels of HO-1, nuclear Nrf2, and Nrf2 immunofluorescence intensity; however, they could not change the protein level of cytoplasmic Nrf2. By combining treatment with ML385, we were able to reverse GRK2 inhibition on H9c2 cells treated with ISO. CONCLUSION According to the results of this study, GRK2 participated in cardiac hypertrophy induced by ISO by mitigating NLRP3 inflammasome and oxidative stress through the signaling of Nrf2 in H9c2 cells.
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Affiliation(s)
- Jing Liu
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710068, Shaanxi Province, China; Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, Shaanxi Province, China
| | - Xiaoli Li
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710068, Shaanxi Province, China
| | - Lu Ding
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, Shaanxi Province, China
| | - Wei Li
- Department of Cardiology, Xi'an International Medical Center Hospital, Xi'an 710100, Shaanxi Province, China
| | - Xiaolin Niu
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, Shaanxi Province, China.
| | - Dengfeng Gao
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710068, Shaanxi Province, China.
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Matarrese P, Maccari S, Gambardella L, Vona R, Barbagallo F, Vezzi V, Stati T, Grò MC, Giovannetti A, Catalano L, Molinari P, Marano G, Ambrosio C. Benzodiazepine diazepam regulates cell surface β1-adrenergic receptor density in human monocytes. Eur J Pharmacol 2023; 948:175700. [PMID: 37001579 DOI: 10.1016/j.ejphar.2023.175700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
Downregulation of cell surface β-adrenergic receptors (β-AR) is an important adaptive response that prevents deleterious effects of receptor overstimulation. Various factors including reactive oxygen species cause β-AR downregulation. In this study, we evaluated the effects of ligands of the peripheral benzodiazepine receptor (PBR), a key protein in regulating oxidative stress, on surface density of endogenous β1-and β2-ARs in highly differentiated cells such as human monocytes, which express both β-AR subtypes. β-AR expression in human monocytes was evaluated by flow cytometry, qPCR and western blotting. Monocyte treatment with β-AR agonist isoproterenol did not change surface β1-AR density while downregulating surface β2-AR density. This effect was antagonized by the β-blocker propranolol. An opposite response was observed with benzodiazepine diazepam that led to a time-dependent reduction in β1-AR density. In particular, while no significant downregulation was observed after 3 h of treatment, only 63% of β1-ARs were still present on the cell surface after 48 h of treatment with diazepam at 1 μM. Treatment with the PBR antagonist PK11195, but not with propranolol, antagonized the effects of diazepam. No change in β1-AR-mRNA or protein levels was observed at any time after diazepam treatment. We also found that diazepam did not affect Gs-protein or β-arrestin-2 recruitment for both β-ARs in engineered fibroblasts, further suggesting that diazepam activity on β1-AR density is mediated by PBR. Finally, no sex-related differences were found. Collectively, these results indicate that monocyte β1-ARs are resistant to catecholamine-mediated downregulation and suggest that PBR plays an important role in regulating β1-AR density.
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de Moura AL, Brum PC, de Carvalho AETS, Spadari RC. Effect of stress on the chronotropic and inotropic responses to β-adrenergic agonists in isolated atria of KOβ2 mice. Life Sci 2023; 322:121644. [PMID: 37004731 DOI: 10.1016/j.lfs.2023.121644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/06/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
Altered sensitivity to the chronotropic and inotropic effects of catecholamines and reduction in β1/β2-adrenoceptor (β1/β2-AR) ratio were reported in failing and in senescent human heart, as well as in isolated atria and ventricle of rats submitted to stress. This was due to downregulation of β1-AR with or without up-regulation of β2-AR. AIMS To investigate the stress-induced behavior of β1-AR in the heart of mice expressing a non-functional β2-AR subtype. The guiding hypothesis is that the absence of β2-AR signaling will not affect the behavior of β1-AR during stress and that those are independent processes. MATERIALS AND METHODS The chronotropic and inotropic responses to β-AR agonists in isolated atria of stressed mice expressing a non-functional β2-AR were analyzed. The mRNA and protein expressions of β1- and β2-AR were also determined. KEY FINDINGS No deaths were observed in mice under stress protocol. Atria of stressed mice displayed reduced sensitivity to isoprenaline compared to the controls, an effect that was abolished by the β2- and β1-AR antagonists 50 nM ICI118,551 and 300 nM CGP20712A, respectively. Sensitivity and maximum response to the β-agonists dobutamine and salbutamol were not altered by stress or ICI118,551. The responses to dobutamine and salbutamol were prevented by CGP20712A. The expression of β1-AR was reduced at protein levels. SIGNIFICANCE Collectively, our data provide evidence that the cardiac β2-AR is not essential for survival in a stressful situation and that the stress-induced reduction of β1-AR expression was independent of the β2-AR presence.
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Gambardella J, Fiordelisi A, Sorriento D, Cerasuolo F, Buonaiuto A, Avvisato R, Pisani A, Varzideh F, Riccio E, Santulli G, Iaccarino G. Mitochondrial microRNAs Are Dysregulated in Patients with Fabry Disease. J Pharmacol Exp Ther 2023; 384:72-78. [PMID: 35764328 PMCID: PMC9827504 DOI: 10.1124/jpet.122.001250] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 01/13/2023] Open
Abstract
Fabry disease (FD) is a lysosomal storage disorder caused by mutations in the gene for α-galactosidase A, inducing a progressive accumulation of globotriaosylceramide (GB3) and its metabolites in different organs and tissues. GB3 deposition does not fully explain the clinical manifestations of FD, and other pathogenetic mechanisms have been proposed, requiring the identification of new biomarkers for monitoring FD patients. Emerging evidence suggests the involvement of mitochondrial alterations in FD. Here, we propose mitochondrial-related microRNAs (miRs) as potential biomarkers of mitochondrial involvement in FD. Indeed, we demonstate that miRs regulating different aspects of mitochondrial homeostasis including expression and assembly of respiratory chain, mitogenesis, antioxidant capacity, and apoptosis are consistently dysregulated in FD patients. Our data unveil a novel noncoding RNA signature of FD patients, indicating mitochondrial-related miRs as new potential pathogenic players and biomarkers in FD. SIGNIFICANCE STATEMENT: This study demonstrates for the first time that a specific signature of circulating mitochondrial miRs (mitomiRs) is dysregulated in FD patients. MitomiRs regulating fundamental aspects of mitochondrial homeostasis and fitness, including expression and assembly of the respiratory chain, mitogenesis, antioxidant capacity, and apoptosis are significantly dysregulated in FD patients. Taken together, these new findings introduce mitomiRs as unprecedented biomarkers of FD and point at mitochondrial dysfunction as a novel potential mechanistic target for therapeutic approaches.
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Affiliation(s)
- Jessica Gambardella
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Antonella Fiordelisi
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Daniela Sorriento
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Federica Cerasuolo
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Antonietta Buonaiuto
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Roberta Avvisato
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Antonio Pisani
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Fahimeh Varzideh
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Eleonora Riccio
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences (J.G., A.F., D.S., F.C., A.B., R.A., G.I.); Interdepartmental Center of Research on Hypertension and Related Conditions (J.G., G.I.), and Department of Public Health (A.P., E.R.); Federico II University, Naples, Italy; and Departments of Medicine (Cardiology) and Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research, Einstein-Sinai Diabetes Research Center, Albert Einstein College of Medicine, New York City, New York (J.G., F.V., G.S.)
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Forzano I, Mone P, Mottola G, Kansakar U, Salemme L, De Luca A, Tesorio T, Varzideh F, Santulli G. Efficacy of the New Inotropic Agent Istaroxime in Acute Heart Failure. J Clin Med 2022; 11:7503. [PMID: 36556120 PMCID: PMC9786901 DOI: 10.3390/jcm11247503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Current therapeutic strategies for acute heart failure (AHF) are based on traditional inotropic agents that are often associated with untoward effects; therefore, finding new effective approaches with a safer profile is dramatically needed. Istaroxime is a novel compound, chemically unrelated to cardiac glycosides, that is currently being studied for the treatment of AHF. Its effects are essentially related to its inotropic and lusitropic positive properties exerted through a dual mechanism of action: activation of the sarcoplasmic reticulum Ca2+ ATPase isoform 2a (SERCA2a) and inhibition of the Na+/K+-ATPase (NKA) activity. The advantages of istaroxime over the available inotropic agents include its lower arrhythmogenic action combined with its capability of increasing systolic blood pressure without augmenting heart rate. However, it has a limited half-life (1 hour) and is associated with adverse effects including pain at the injection site and gastrointestinal issues. Herein, we describe the main mechanism of action of istaroxime and we present a systematic overview of both clinical and preclinical trials testing this drug, underlining the latest insights regarding its adoption in clinical practice for AHF.
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Affiliation(s)
- Imma Forzano
- Division of Cardiology, Department of Advanced Biomedical Sciences, “Federico II” University, 80131 Naples, Italy
| | - Pasquale Mone
- Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Gaetano Mottola
- Casa di Cura “Montevergine”, Mercogliano, 83013 Avellino, Italy
| | - Urna Kansakar
- Division of Cardiology, Department of Advanced Biomedical Sciences, “Federico II” University, 80131 Naples, Italy
| | - Luigi Salemme
- Casa di Cura “Montevergine”, Mercogliano, 83013 Avellino, Italy
| | - Antonio De Luca
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Vanvitelli”, 81100 Caserta, Italy
| | - Tullio Tesorio
- Casa di Cura “Montevergine”, Mercogliano, 83013 Avellino, Italy
| | - Fahimeh Varzideh
- Division of Cardiology, Department of Advanced Biomedical Sciences, “Federico II” University, 80131 Naples, Italy
| | - Gaetano Santulli
- Division of Cardiology, Department of Advanced Biomedical Sciences, “Federico II” University, 80131 Naples, Italy
- Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA
- Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Neuroimmunology and Inflammation (INI), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY 10461, USA
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8
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Lipoprotein a Combined with Fibrinogen as an Independent Predictor of Long-Term Prognosis in Patients with Acute Coronary Syndrome: A Multi-Center Retrospective Study. J Cardiovasc Dev Dis 2022; 9:jcdd9100322. [PMID: 36286274 PMCID: PMC9604333 DOI: 10.3390/jcdd9100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Patients with acute coronary syndrome (ACS) still have a high risk of recurrence of major adverse cardiovascular and cerebrovascular events (MACCE). However, there are rare studies on the prediction of MACCE in patients with ACS using lipoprotein a [Lp(a)] combined with fibrinogen. The aim of this study was to analyze the predictive value of Lp(a) combined with fibrinogen for the long-term prognosis of patients with ACS. Methods: 804 patients with ACS admitted to 11 tertiary general hospitals in Chengdu from January 2017 to June 2019 were included in the study. According to the Lp(a) 300 mg/L, patients were assigned to the non-high Lp(a) group and high Lp(a) group. Patients were assigned to the non-high or high fibrinogen groups using the fibrinogen level of 3.08 g/L. Subsequently, patients were divided into group A, B, or C by Lp(a) combined with fibrinogen. The study endpoints were MACCE, including all-cause death, non-fatal myocardial infarction, non-fatal stroke, and revascularization. The incidences of MACCE among groups were compared. Lp(a), fibrinogen, Lp(a) combined with fibrinogen classifications were each added into the basic model to construct three new models. The C-index, net reclassification index (NRI) and integrated discrimination improvement (IDI) of the three new models were then compared. Results: The median follow-up was 16 months. During follow-up, the cumulative incidence of MACCE in group C was significantly higher than that measured in group A and B (p < 0.001). The results of the multivariate Cox regression analysis of MACCE showed that Lp(a) ≥300 mg/L with fibrinogen ≥3.08 g/L was an independent predictor of MACCE. According to the GRACE score and the statistical analyses, the basic model was constructed, which had a C-index of 0.694. The C-index, NRI, and IDI of the new model constructed using the basic model + Lp(a) combined with fibrinogen classification were 0.736, 0.095, and 0.094 respectively. Conclusions: Single Lp(a), single fibrinogen and Lp(a) combined with fibrinogen were independent predictors of MACCE in patients with ACS. The predictive value of Lp(a) combined with fibrinogen in patients with ACS was better than that of single Lp(a) and single fibrinogen.
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9
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Chivers SB, Brackley AD, Jeske NA. Raf kinase inhibitory protein reduces bradykinin receptor desensitization. J Neurochem 2022; 162:156-165. [PMID: 35526109 PMCID: PMC9283312 DOI: 10.1111/jnc.15614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
Inflammatory hyperalgesia represents a nociceptive phenotype that can become persistent in nature through dynamic protein modifications. However, a large gap in knowledge exists concerning how the integration of intracellular signaling molecules coordinates a persistent inflammatory phenotype. Herein, we demonstrate that Raf Kinase Anchoring Protein (RKIP) interrupts a vital canonical desensitization pathway to maintain bradykinin (BK) receptor activation in primary afferent neurons. Biochemical analyses of primary neuronal cultures indicate bradykinin-stimulated PKC phosphorylation of RKIP at Ser153. Furthermore, BK exposure increases G-protein Receptor Kinase 2 (GRK2) binding to RKIP, inhibiting pharmacological desensitization of the BK receptor. Additional studies found that molecular RKIP down-regulation increases BK receptor desensitization in real-time imaging of primary afferent neurons, identifying a key pathway integrator in the desensitization process that controls multiple GRK2-sensitive G-protein coupled receptors. Therefore, RKIP serves as an integral scaffolding protein that inhibits BK receptor desensitization.
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Affiliation(s)
- Samuel B. Chivers
- Departments of Oral & Maxillofacial SurgeryUniversity of Texas Health San AntonioSan AntonioTexasUSA
| | | | - Nathaniel A. Jeske
- Departments of Oral & Maxillofacial SurgeryUniversity of Texas Health San AntonioSan AntonioTexasUSA
- PhysiologyUniversity of Texas Health San AntonioSan AntonioTexasUSA
- PharmacologyUniversity of Texas Health San AntonioSan AntonioTexasUSA
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10
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Nagalli S, Kikkeri NS, Nasir U, Rai Ahuja K, Ali Waheed T, Bhatia N. Trends and In-Hospital Outcomes of Patients Admitted with ST Elevation Myocardial Infarction and Chronic Total Occlusions: Insights from a National Database. Curr Probl Cardiol 2022; 48:101132. [PMID: 35114292 DOI: 10.1016/j.cpcardiol.2022.101132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Chronic total occlusion (CTO) is seen in a minority of ST-elevation myocardial infarction (STEMI) patients and is implicated in poor outcomes due to "double jeopardy". There is no large national data evaluating the trend and outcomes of STEMI patients who have a CTO (STEMI-CTO). We analyzed the Nationwide In-patients sample database from 2008-2011 and compared the trends, clinical characteristics, and in-hospital outcomes of STEMI patients with and without CTO. An increasing trend of CTO was seen in STEMI patients from 2008 to 2011. STEMI-CTO patients were younger, more likely develop cardiogenic shock, undergo percutaneous coronary intervention and thrombolysis. In this large, contemporary, national database, we also found that STEMI-CTO patients were more likely to have iatrogenic cardiac & vascular complications and undergo percutaneous mechanical circulatory support. We did not find significant difference in in-hospital deaths between STEMI-CTO patients and those without CTO.
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Affiliation(s)
- Shivaraj Nagalli
- Department of Internal Medicine, Brookwood Baptist Health, Alabaster, Alabama, USA.
| | - Nidhi Shankar Kikkeri
- Department of Internal Medicine, Reading Hospital - Tower Health, Reading, Pennsylvania, USA
| | - Usama Nasir
- Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Keerat Rai Ahuja
- Department of Cardiovascular Disease, Reading Hospital - Tower Health, Reading, Pennsylvania, USA
| | - Tayyab Ali Waheed
- Department of Cardiovascular Disease, Reading Hospital - Tower Health, Reading, Pennsylvania, USA
| | - Nirmanmoh Bhatia
- Department of Cardiovascular Disease, Heart South Vascular Institute
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11
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Jankauskas SS, Kansakar U, Varzideh F, Wilson S, Mone P, Lombardi A, Gambardella J, Santulli G. Heart failure in diabetes. Metabolism 2021; 125:154910. [PMID: 34627874 PMCID: PMC8941799 DOI: 10.1016/j.metabol.2021.154910] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022]
Abstract
Heart failure and cardiovascular disorders represent the leading cause of death in diabetic patients. Here we present a systematic review of the main mechanisms underlying the development of diabetic cardiomyopathy. We also provide an excursus on the relative contribution of cardiomyocytes, fibroblasts, endothelial and smooth muscle cells to the pathophysiology of heart failure in diabetes. After having described the preclinical tools currently available to dissect the mechanisms of this complex disease, we conclude with a section on the most recent updates of the literature on clinical management.
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Affiliation(s)
- Stanislovas S Jankauskas
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Urna Kansakar
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Fahimeh Varzideh
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Scott Wilson
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Pasquale Mone
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Angela Lombardi
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Jessica Gambardella
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA; International Translational Research and Medical Education (ITME), Department of Advanced Biomedical Science, "Federico II" University, 80131 Naples, Italy
| | - Gaetano Santulli
- Department of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY 10461, USA; Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY 10461, USA; International Translational Research and Medical Education (ITME), Department of Advanced Biomedical Science, "Federico II" University, 80131 Naples, Italy.
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12
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Du X. Sympatho-adrenergic mechanisms in heart failure: new insights into pathophysiology. MEDICAL REVIEW (BERLIN, GERMANY) 2021; 1:47-77. [PMID: 37724075 PMCID: PMC10388789 DOI: 10.1515/mr-2021-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 09/20/2023]
Abstract
The sympathetic nervous system is activated in the setting of heart failure (HF) to compensate for hemodynamic instability. However, acute sympathetic surge or sustained high neuronal firing rates activates β-adrenergic receptor (βAR) signaling contributing to myocardial remodeling, dysfunction and electrical instability. Thus, sympatho-βAR activation is regarded as a hallmark of HF and forms pathophysiological basis for β-blocking therapy. Building upon earlier research findings, studies conducted in the recent decades have significantly advanced our understanding on the sympatho-adrenergic mechanism in HF, which forms the focus of this article. This review notes recent research progress regarding the roles of cardiac β2AR or α1AR in the failing heart, significance of β1AR-autoantibodies, and βAR signaling through G-protein independent signaling pathways. Sympatho-βAR regulation of immune cells or fibroblasts is specifically discussed. On the neuronal aspects, knowledge is assembled on the remodeling of sympathetic nerves of the failing heart, regulation by presynaptic α2AR of NE release, and findings on device-based neuromodulation of the sympathetic nervous system. The review ends with highlighting areas where significant knowledge gaps exist but hold promise for new breakthroughs.
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Affiliation(s)
- Xiaojun Du
- Faculty of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, 76 West Yanta Road, Xi’an710061, Shaanxi, China
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia
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13
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Why Do We Not Assess Sympathetic Nervous System Activity in Heart Failure Management: Might GRK2 Serve as a New Biomarker? Cells 2021; 10:cells10020457. [PMID: 33669936 PMCID: PMC7924864 DOI: 10.3390/cells10020457] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) represents the end-stage condition of several structural and functional cardiovascular diseases, characterized by reduced myocardial pump function and increased pressure load. The dysregulation of neurohormonal systems, especially the hyperactivity of the cardiac adrenergic nervous system (ANS), constitutes a hallmark of HF and exerts a pivotal role in its progression. Indeed, it negatively affects patients’ prognosis, being associated with high morbidity and mortality rates, with a tremendous burden on global healthcare systems. To date, all the techniques proposed to assess the cardiac sympathetic nervous system are burdened by intrinsic limits that hinder their implementation in clinical practice. Several biomarkers related to ANS activity, which may potentially support the clinical management of such a complex syndrome, are slow to be implemented in the routine practice for several limitations due to their assessment and clinical impact. Lymphocyte G-protein-coupled Receptor Kinase 2 (GRK2) levels reflect myocardial β-adrenergic receptor function in HF and have been shown to add independent prognostic information related to ANS overdrive. In the present manuscript, we provide an overview of the techniques currently available to evaluate cardiac ANS in HF and future perspectives in this field of relevant scientific and clinical interest.
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14
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Gambardella J, Sorriento D, Bova M, Rusciano M, Loffredo S, Wang X, Petraroli A, Carucci L, Mormile I, Oliveti M, Bruno Morelli M, Fiordelisi A, Spadaro G, Campiglia P, Sala M, Trimarco B, Iaccarino G, Santulli G, Ciccarelli M. Role of Endothelial G Protein-Coupled Receptor Kinase 2 in Angioedema. Hypertension 2020; 76:1625-1636. [PMID: 32895019 DOI: 10.1161/hypertensionaha.120.15130] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Excessive BK (bradykinin) stimulation is responsible for the exaggerated permeabilization of the endothelium in angioedema. However, the molecular mechanisms underlying these responses have not been investigated. BK receptors are Gq-protein-coupled receptors phosphorylated by GRK2 (G protein-coupled receptor kinase 2) with a hitherto unknown biological and pathophysiological significance. In the present study, we sought to identify the functional role of GRK2 in angioedema through the regulation of BK signaling. We found that the accumulation of cytosolic Ca2+ in endothelial cells induced by BK was sensitive to GRK2 activity, as it was significantly augmented by inhibiting the kinase. Accordingly, permeabilization and NO production induced by BK were enhanced, as well. In vivo, mice with reduced GRK2 levels in the endothelium (Tie2-CRE/GRK2fl+/fl-) exhibited an increased response to BK in terms of vascular permeability and extravasation. Finally, patients with reduced GRK2 levels displayed a severe phenotype of angioedema. Taken together, these findings establish GRK2 as a novel pivotal regulator of BK signaling with an essential role in the pathophysiology of vascular permeability and angioedema.
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Affiliation(s)
- Jessica Gambardella
- From the Department of Advanced Biomedical Science (J.G., D.S., A.F., B.T., G.I., G. Santulli), University of Naples Federico II, NA, Italy.,Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute (J.G., X.W., M.B.M., G. Santulli), Albert Einstein College of Medicine, Montefiore University Hospital, NY.,Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM) (J.G., X.W., M.B.M., G. Santulli), Albert Einstein College of Medicine, Montefiore University Hospital, NY.,International Translational Research and Medical Education Consortium (ITME), NA, Italy (J.G., B.T., G. Santulli)
| | - Daniela Sorriento
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences (M.B., S.L., A.P., L.C., I.M., G. Spadaro), University of Naples Federico II, NA, Italy
| | - Maria Bova
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences (M.B., S.L., A.P., L.C., I.M., G. Spadaro), University of Naples Federico II, NA, Italy
| | - Mariarosaria Rusciano
- Montevergine Hospital, Mercogliano, Italy (M.R.).,Department of Medicine and Surgery (M.R., M.O., M.C.), University of Salerno, Italy
| | - Stefania Loffredo
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences (M.B., S.L., A.P., L.C., I.M., G. Spadaro), University of Naples Federico II, NA, Italy
| | - Xujun Wang
- Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute (J.G., X.W., M.B.M., G. Santulli), Albert Einstein College of Medicine, Montefiore University Hospital, NY.,Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM) (J.G., X.W., M.B.M., G. Santulli), Albert Einstein College of Medicine, Montefiore University Hospital, NY
| | - Angelica Petraroli
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences (M.B., S.L., A.P., L.C., I.M., G. Spadaro), University of Naples Federico II, NA, Italy
| | - Laura Carucci
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences (M.B., S.L., A.P., L.C., I.M., G. Spadaro), University of Naples Federico II, NA, Italy
| | - Ilaria Mormile
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences (M.B., S.L., A.P., L.C., I.M., G. Spadaro), University of Naples Federico II, NA, Italy
| | - Marco Oliveti
- Department of Medicine and Surgery (M.R., M.O., M.C.), University of Salerno, Italy
| | - Marco Bruno Morelli
- Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute (J.G., X.W., M.B.M., G. Santulli), Albert Einstein College of Medicine, Montefiore University Hospital, NY.,Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM) (J.G., X.W., M.B.M., G. Santulli), Albert Einstein College of Medicine, Montefiore University Hospital, NY
| | - Antonella Fiordelisi
- From the Department of Advanced Biomedical Science (J.G., D.S., A.F., B.T., G.I., G. Santulli), University of Naples Federico II, NA, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences (M.B., S.L., A.P., L.C., I.M., G. Spadaro), University of Naples Federico II, NA, Italy
| | - Pietro Campiglia
- Division of Biomedicine, Department of Pharmaceutical Science (P.C., M.S.), University of Salerno, Italy
| | - Marina Sala
- Division of Biomedicine, Department of Pharmaceutical Science (P.C., M.S.), University of Salerno, Italy
| | - Bruno Trimarco
- International Translational Research and Medical Education Consortium (ITME), NA, Italy (J.G., B.T., G. Santulli)
| | - Guido Iaccarino
- From the Department of Advanced Biomedical Science (J.G., D.S., A.F., B.T., G.I., G. Santulli), University of Naples Federico II, NA, Italy
| | - Gaetano Santulli
- From the Department of Advanced Biomedical Science (J.G., D.S., A.F., B.T., G.I., G. Santulli), University of Naples Federico II, NA, Italy.,Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute (J.G., X.W., M.B.M., G. Santulli), Albert Einstein College of Medicine, Montefiore University Hospital, NY.,Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM) (J.G., X.W., M.B.M., G. Santulli), Albert Einstein College of Medicine, Montefiore University Hospital, NY.,International Translational Research and Medical Education Consortium (ITME), NA, Italy (J.G., B.T., G. Santulli)
| | - Michele Ciccarelli
- Department of Medicine and Surgery (M.R., M.O., M.C.), University of Salerno, Italy
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15
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Gambardella J, Wang X, Mone P, Khondkar W, Santulli G. Genetics of adrenergic signaling drives coronary artery calcification. Atherosclerosis 2020; 310:88-90. [PMID: 32863027 DOI: 10.1016/j.atherosclerosis.2020.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Jessica Gambardella
- Department of Medicine and Molecular Pharmacology, Albert Einstein College of Medicine - Montefiore University Hospital, New York City, 10461, NY, United States; Department of Molecular Pharmacology, Albert Einstein College of Medicine - Montefiore University Hospital, New York City, 10461, NY, United States; Department of Advanced Biomedical Sciences, "Federico II" University, Naples, 80131, Italy; International Translational Research and Medical Education (ITME), Naples, 80100, Italy.
| | - Xujun Wang
- Department of Medicine and Molecular Pharmacology, Albert Einstein College of Medicine - Montefiore University Hospital, New York City, 10461, NY, United States; Department of Molecular Pharmacology, Albert Einstein College of Medicine - Montefiore University Hospital, New York City, 10461, NY, United States
| | - Pasquale Mone
- Department of Medicine and Molecular Pharmacology, Albert Einstein College of Medicine - Montefiore University Hospital, New York City, 10461, NY, United States
| | - Wafiq Khondkar
- Department of Medicine and Molecular Pharmacology, Albert Einstein College of Medicine - Montefiore University Hospital, New York City, 10461, NY, United States
| | - Gaetano Santulli
- Department of Medicine and Molecular Pharmacology, Albert Einstein College of Medicine - Montefiore University Hospital, New York City, 10461, NY, United States; Department of Molecular Pharmacology, Albert Einstein College of Medicine - Montefiore University Hospital, New York City, 10461, NY, United States; Department of Advanced Biomedical Sciences, "Federico II" University, Naples, 80131, Italy; International Translational Research and Medical Education (ITME), Naples, 80100, Italy
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16
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Klenke S, Lehmann N, Erbel R, Jöckel KH, Siffert W, Frey UH, Peters J. Genetic variations in G-protein signal pathways influence progression of coronary artery calcification: Results from the Heinz Nixdorf Recall study. Atherosclerosis 2020; 310:102-108. [PMID: 32680596 DOI: 10.1016/j.atherosclerosis.2020.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Coronary artery calcification (CAC) is one of the most sensitive and specific markers of coronary atherosclerosis and believed to be heritable. We hypothesized that functionally relevant single-nucleotide polymorphisms (SNPs) in the G-protein signal pathway, which have been previously related to coronary artery disease, are associated with CAC progression. METHODS 3108 participants from the Heinz Nixdorf Recall study with CAC measurements at both baseline (CACb) and 5-year follow-up (CAC5y) were included. We genotyped SNPs rs1042714 (ADRB2), rs6026584 and rs12481583 (GNAS), and rs5443 (GNB3) and defined a priori risk alleles derived from literature data. Regression analyses were applied to measures of 5-year CAC progression, unadjusted, adjusted for age, sex, and adjusted for age, sex, log(CACb+1) as well as for cardiovascular risk factors. RESULTS The presence of one or more risk alleles was associated with a 26.9% (95% CI 5.5-52.4) increase in 5-year CAC progression (p = 0.011) and a 29.2% (95% CI 5.9-57.6) accelerated increase of CAC over the 5-year period compared to what was expected with respect to the baseline CAC percentile value (p = 0.012). Each of those risk alleles increased the 5-year CAC progression by 4.4% (95% CI 1.3-7.6, p = 0.006) and resulted in a 4.9% accelerated increase of CAC over the 5-year period (95% CI 1.6-8.4, p = 0.004). These unadjusted data did not change after adjustment. CONCLUSIONS Genetic variations in the G-protein signal pathway are associated with CAC progression in a cumulative fashion, indicating the importance of the pathway for genetic heritability in CAC progression and coronary artery disease.
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Affiliation(s)
- Stefanie Klenke
- Klinik für Anästhesiologie & Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany.
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, Universität Duisburg-Essen, Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, Universität Duisburg-Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Universität Duisburg-Essen, Germany
| | - Winfried Siffert
- Institut für Pharmakogenetik, Universität Duisburg-Essen and Universitätsklinikum Essen, Germany
| | - Ulrich H Frey
- Klinik für Anästhesiologie & Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany; Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Peters
- Klinik für Anästhesiologie & Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
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17
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Pei J, Wang X, Xing Z, Chen P, Su W, Deng S, Hu X. Association between admission systolic blood pressure and major adverse cardiovascular events in patients with acute myocardial infarction. PLoS One 2020; 15:e0234935. [PMID: 32559257 PMCID: PMC7304596 DOI: 10.1371/journal.pone.0234935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/04/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Several studies have previously demonstrated that higher systolic blood pressure level means lower risk of adverse cardiovascular outcomes. However, there is a lack of further investigation into the nonlinear relationship between admission systolic blood pressure (SBP) and adverse outcomes of acute myocardial infarction (AMI) patients. OBJECTIVES The aim of this study was to investigate the specific relationship between admission SBP and incidence of major adverse cardiovascular events (MACE) in 30 days for AMI patients. METHODS AND RESULTS Using data from the ACS-QUIK trial, we analyzed 21,364 patients from Kerala, India. In univariate linear-regression model, the OR was 0.90 per 10mmHg, the confidence interval (CI) was 95% (0.87-0.92) and P < 0.0001. The generalized additive model (GAM) showed a nearly U-shaped curve between admission SBP and MACE. Using a two-piecewise linear regression model, we calculated an inflection point of 159 mmHg. We found that the higher admission SBP is associated with lower incidence of MACE of AMI patients. In addition, subgroups with different LVEF have distinct effects on blood pressure-related outcomes. Lower SBP has a greater risk when LVEF < 40%. CONCLUSION The present study revealed the U-shaped relationship between admission SBP and the risk of adverse cardiovascular outcome. The admission SBP could be a marker to provide clinical assessment and treatment. TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02256657.
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Affiliation(s)
- Junyu Pei
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hu'nan, China
| | - Xiaopu Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hu'nan, China
| | - Zhenhua Xing
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hu'nan, China
| | - Pengfei Chen
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hu'nan, China
| | - Wen Su
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hu'nan, China
| | - Simin Deng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hu'nan, China
| | - Xinqun Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hu'nan, China
- * E-mail:
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18
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Lai S, Fu X, Yang S, Zhang S, Lin Q, Zhang M, Chen H. G protein-coupled receptor kinase-2: A potential biomarker for early diabetic cardiomyopathy. J Diabetes 2020; 12:247-258. [PMID: 31680450 PMCID: PMC7064927 DOI: 10.1111/1753-0407.12991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND G protein-coupled receptor kinase-2 (GRK2) has been shown as a key regulator of cardiac function, and the myocardial GRK2 levels are mirrored by the levels in peripheral blood mononuclear cells (PBMCs). In this study, we evaluated the myocardial and PBMCs GRK2 levels in early diabetic cardiomyopathy (DCM). METHODS C57BL/KS-db/db male diabetic mice at 12 weeks of age, as the type 2 diabetes (T2DM) animal model of early DCM were evaluated. Forty-four T2DM patients with left ventricular diastolic dysfunction (LVDD), without evidence of hypertension, coronary artery diseases, congestive heart failure, and diabetic complications and without evidence of ischemia in a maximal treadmill exercise test, were recruited as the DM + LVDD group; 30 age-matched T2DM patients without LVDD were recruited as the DM control group. Left ventricular diastolic function was evaluated by cardiac tissue Doppler. The pseudonormal pattern of ventricular filling and E'/A' < 1 were regarded as LVDD. RESULTS Compared to 8-week-old diabetic mice and 12-week-old control mice, GRK2-mRNA level and expression in myocardial tissues of 12-week-old diabetic mice were significantly increased, as well as the left ventricular wall thickness and systolic function. And the collagen volume fraction (CVF), collagen-3 expression, P53 expression, and cell apoptotic rate in the myocardium of 12-week-old diabetic mice elevated as well. The GRK2-mRNA level in PBMCs of DM with LVDD was significantly higher than in DM control without LVDD. CONCLUSIONS GRK2 expression increased in the myocardial tissue and the PBMCs at the early stage of DCM. These data support further research on the role of GRK2 as the clinical biomarker for early DCM.
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Affiliation(s)
- Shuiqing Lai
- Department of Endocrinology, Guangdong Provincial People's Hospital / Guangdong Academy of Medical SciencesGuangdong Provincial Geriatrics InstituteGuangzhouP. R. China
| | - Xiaoying Fu
- Department of Endocrinology, Guangdong Provincial People's Hospital / Guangdong Academy of Medical SciencesGuangdong Provincial Geriatrics InstituteGuangzhouP. R. China
| | - Shufen Yang
- Shantou University Medical CollegeShantouP. R. China
| | - Shuting Zhang
- Department of Endocrinology, Guangdong Provincial People's Hospital / Guangdong Academy of Medical SciencesGuangdong Provincial Geriatrics InstituteGuangzhouP. R. China
| | - Qiuxiong Lin
- Guangdong Provincial Key Laboratory of Clinical PharmacologyGuangdong Cardiovascular InstituteGuangzhouP. R. China
| | - Mengzhen Zhang
- Guangdong Provincial Key Laboratory of Clinical PharmacologyGuangdong Cardiovascular InstituteGuangzhouP. R. China
| | - Hongmei Chen
- Department of Endocrinology, Guangdong Provincial People's Hospital / Guangdong Academy of Medical SciencesGuangdong Provincial Geriatrics InstituteGuangzhouP. R. China
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19
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Sardu C, Santulli G, Guerra G, Trotta MC, Santamaria M, Sacra C, Testa N, Ducceschi V, Gatta G, Amico MD, Sasso FC, Paolisso G, Marfella R. Modulation of SERCA in Patients with Persistent Atrial Fibrillation Treated by Epicardial Thoracoscopic Ablation: The CAMAF Study. J Clin Med 2020; 9:E544. [PMID: 32079238 PMCID: PMC7074346 DOI: 10.3390/jcm9020544] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate atrial fibrillation (AF) recurrence and Sarcoplasmic Endoplasmic Reticulum Calcium ATPase (SERCA) levels in patients treated by epicardial thoracoscopic ablation for persistent AF. BACKGROUND Reduced levels of SERCA have been reported in the peripheral blood cells of patients with AF. We hypothesize that SERCA levels can predict the response to epicardial ablation. METHODS We designed a prospective, multicenter, observational study to recruit, from October 2014 to June 2016, patients with persistent AF receiving an epicardial thoracoscopic pulmonary vein isolation. RESULTS We enrolled 27 patients. Responders (n = 15) did not present AF recurrence after epicardial ablation at one-year follow-up; these patients displayed a marked remodeling of the left atrium, with a significant reduction of inflammatory cytokines, B type natriuretic peptide (BNP), and increased levels of SERCA compared to baseline and to nonresponders (p < 0.05). Furthermore, mean AF duration (Heart rate (HR) 1.235 (1.037-1.471), p < 0.05), Left atrium volume (LAV) (HR 1.755 (1.126-2.738), p < 0.05), BNP (HR 1.945 (1.895-1.999), p < 0.05), and SERCA (HR 1.763 (1.167-2.663), p < 0.05) were predictive of AF recurrence. CONCLUSIONS Our data indicate for the first time that baseline values of SERCA in patients with persistent AF might be predictive of failure to epicardial ablative approach. Intriguingly, epicardial ablation was associated with increased levels of SERCA in responders. Therefore, SERCA might be an innovative therapeutic target to improve the response to epicardial ablative treatments.
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Affiliation(s)
- Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
- Department of Medical Sciences, International University of Health and Medical Sciences “Saint Camillus”, 00131Rome, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, International Translational Research and Medical Education Academic Research Unit (ITME), “Federico II” University, 80138 Naples, Italy;
- Department of Medicine, Albert Einstein College of Medicine, Fleischer Institute for Diabetes and Metabolism (FIDAM), Montefiore University Hospital, New York, NY 10461, USA
| | - Germano Guerra
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86010, Campobasso, Italy;
| | - Maria Consiglia Trotta
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
| | - Matteo Santamaria
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (M.D.A.)
| | - Cosimo Sacra
- Cardiovascular and Arrhythmias Department, Catholic University of Sacred Heart, 86010 Campobasso, Italy; (C.S.); (N.T.)
| | - Nicola Testa
- Cardiovascular and Arrhythmias Department, Catholic University of Sacred Heart, 86010 Campobasso, Italy; (C.S.); (N.T.)
| | - Valentino Ducceschi
- Cardiovascular and Arrhythmias Department, “Vecchio Pellegrini” Hospital; 80138 Naples, Italy;
| | - Gianluca Gatta
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
| | - Michele D’ Amico
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (M.D.A.)
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (G.G.); (F.C.S.); (G.P.); (R.M.)
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20
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Cardiosomal microRNAs Are Essential in Post-Infarction Myofibroblast Phenoconversion. Int J Mol Sci 2019; 21:ijms21010201. [PMID: 31892162 PMCID: PMC6982041 DOI: 10.3390/ijms21010201] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 12/14/2022] Open
Abstract
The inclusion of microRNAs (miRNAs) in extracellular microvesicles/exosomes (named cardiosomes when deriving from cardiomyocytes) allows their active transportation and ensures cell-cell communication. We hypothesize that cardiosomal miRNAs play a pivotal role in the activation of myofibroblasts following ischemic injury. Using a murine model of myocardial infarction (MI), we tested our hypothesis by measuring in isolated fibroblasts and cardiosomes the expression levels of a set of miRNAs, which are upregulated in cardiomyocytes post-MI and involved in myofibroblast phenoconversion. We found that miR-195 was significantly upregulated in cardiosomes and in fibroblasts isolated after MI compared with SHAM conditions. Moreover, primary isolated cardiac fibroblasts were activated both when incubated with cardiosomes isolated from ischemic cardiomyocytes and when cultured in conditioned medium of post-MI cardiomyocytes, whereas no significant effect was observed following incubation with cardiosomes or medium from sham cardiomyocytes. Taken together, our findings indicate for the first time that a cardiomyocyte-specific miRNA, transferred to fibroblasts in form of exosomal cargo, is crucial in the activation of myofibroblasts.
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21
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Sustained GRK2-dependent CREB activation is essential for α 2-adrenergic receptor-induced PC12 neuronal differentiation. Cell Signal 2019; 66:109446. [PMID: 31678682 DOI: 10.1016/j.cellsig.2019.109446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/18/2022]
Abstract
Many aspects of neuronal development, such as neuronal survival and differentiation, are regulated by the transcription factor cAMP-response element-binding protein (CREB). We have previously reported that α2-adrenergic receptors (ARs), members of the G protein-coupled receptor (GPCR) superfamily, induce neuronal differentiation of rat pheochromocytoma (PC)-12 cells in a subtype-specific manner, i.e. α2A<α2B<α2C. Herein, we sought to investigate CREB`s involvement in this α2AR-dependent neurogenic process. We used a combination of gene reporter assays and immunoblotting analysis, coupled with co-immunoprecipitation and morphological analysis, in transfected PC12 cell lines. Chronic α2B- or α2C-AR activation results in sustained CREB activation, which is both necessary and sufficient for neuronal differentiation of PC12 cells expressing these two α2ARs. In contrast, chronic α2A activation only leads to transient CREB activation, insufficient for PC12 neuronal differentiation. However, upon CREB overexpression, α2A-AR triggers neuronal differentiation similarly to α2B- or α2C-ARs. Importantly, NGF (Nerve Growth Factor)`s TrkA receptor transactivation is essential for the sustained activation of CREB by all three α2 subtypes in PC12 cells, whereas protein kinase A (PKA), the prototypic kinase that phosphorylates CREB, is not. Instead, TrkA-activated GPCR-kinase (GRK)-2 mediates the sustained CREB activation during α2AR-induced neuronal differentiation of PC12 cells. In conclusion, catecholaminergic-induced neuronal differentiation of PC12 cells through α2ARs uses a non-canonical pathway involving TrkA transactivation and subsequent GRK2-dependent, sustained phosphorylation/activation of CREB. These findings provide novel insights into catecholaminergic neurogenesis and suggest that α2AR agonists, combined with NGF analogs or GRK2 stimulators, may exert neurogenic/neuroprotective effects.
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22
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Kushnir A, Santulli G, Reiken SR, Coromilas E, Godfrey SJ, Brunjes DL, Colombo PC, Yuzefpolskaya M, Sokol SI, Kitsis RN, Marks AR. Ryanodine Receptor Calcium Leak in Circulating B-Lymphocytes as a Biomarker in Heart Failure. Circulation 2019; 138:1144-1154. [PMID: 29593014 DOI: 10.1161/circulationaha.117.032703] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Advances in congestive heart failure (CHF) management depend on biomarkers for monitoring disease progression and therapeutic response. During systole, intracellular Ca2+ is released from the sarcoplasmic reticulum into the cytoplasm through type-2 ryanodine receptor/Ca2+ release channels. In CHF, chronically elevated circulating catecholamine levels cause pathological remodeling of type-2 ryanodine receptor/Ca2+ release channels resulting in diastolic sarcoplasmic reticulum Ca2+ leak and decreased myocardial contractility. Similarly, skeletal muscle contraction requires sarcoplasmic reticulum Ca2+ release through type-1 ryanodine receptors (RyR1), and chronically elevated catecholamine levels in CHF cause RyR1-mediated sarcoplasmic reticulum Ca2+ leak, contributing to myopathy and weakness. Circulating B-lymphocytes express RyR1 and catecholamine-responsive signaling cascades, making them a potential surrogate for defects in intracellular Ca2+ handling because of leaky RyR channels in CHF. METHODS Whole blood was collected from patients with CHF, CHF following left-ventricular assist device implant, and controls. Blood was also collected from mice with ischemic CHF, ischemic CHF+S107 (a drug that specifically reduces RyR channel Ca2+ leak), and wild-type controls. Channel macromolecular complex was assessed by immunostaining RyR1 immunoprecipitated from lymphocyte-enriched preparations. RyR1 Ca2+ leak was assessed using flow cytometry to measure Ca2+ fluorescence in B-lymphocytes in the absence and presence of RyR1 agonists that empty RyR1 Ca2+ stores within the endoplasmic reticulum. RESULTS Circulating B-lymphocytes from humans and mice with CHF exhibited remodeled RyR1 and decreased endoplasmic reticulum Ca2+ stores, consistent with chronic intracellular Ca2+ leak. This Ca2+ leak correlated with circulating catecholamine levels. The intracellular Ca2+ leak was significantly reduced in mice treated with the Rycal S107. Patients with CHF treated with left-ventricular assist devices exhibited a heterogeneous response. CONCLUSIONS In CHF, B-lymphocytes exhibit remodeled leaky RyR1 channels and decreased endoplasmic reticulum Ca2+ stores consistent with chronic intracellular Ca2+ leak. RyR1-mediated Ca2+ leak in B-lymphocytes assessed using flow cytometry provides a surrogate measure of intracellular Ca2+ handling and systemic sympathetic burden, presenting a novel biomarker for monitoring response to pharmacological and mechanical CHF therapy.
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Affiliation(s)
- Alexander Kushnir
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University College of Physicians and Surgeons, New York (A.K., G.S., S.R.R., A.R.M.).,Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York (A.K., E.C., S.J.G., D.L.B., P.C.C., M.Y., A.R.M.)
| | - Gaetano Santulli
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University College of Physicians and Surgeons, New York (A.K., G.S., S.R.R., A.R.M.)
| | - Steven R Reiken
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University College of Physicians and Surgeons, New York (A.K., G.S., S.R.R., A.R.M.)
| | - Ellie Coromilas
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York (A.K., E.C., S.J.G., D.L.B., P.C.C., M.Y., A.R.M.)
| | - Sarah J Godfrey
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York (A.K., E.C., S.J.G., D.L.B., P.C.C., M.Y., A.R.M.)
| | - Danielle L Brunjes
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York (A.K., E.C., S.J.G., D.L.B., P.C.C., M.Y., A.R.M.)
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York (A.K., E.C., S.J.G., D.L.B., P.C.C., M.Y., A.R.M.)
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York (A.K., E.C., S.J.G., D.L.B., P.C.C., M.Y., A.R.M.)
| | - Seth I Sokol
- Department of Medicine, Division of Cardiology, Jacobi Medical Center, Bronx, NY (S.I.S.)
| | - Richard N Kitsis
- Departments of Medicine and Cell Biology, Wilf Family Cardiovascular Research Institute, Albert Einstein Cancer Center, Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY (R.N.K.)
| | - Andrew R Marks
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Columbia University College of Physicians and Surgeons, New York (A.K., G.S., S.R.R., A.R.M.).,Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York (A.K., E.C., S.J.G., D.L.B., P.C.C., M.Y., A.R.M.)
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23
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Konstantinou K, Tsioufis C, Koumelli A, Mantzouranis M, Kasiakogias A, Doumas M, Tousoulis D. Hypertension and patients with acute coronary syndrome: Putting blood pressure levels into perspective. J Clin Hypertens (Greenwich) 2019; 21:1135-1143. [PMID: 31301119 DOI: 10.1111/jch.13622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
Arterial hypertension is a well-established cardiovascular risk factor, and blood pressure (BP) control has largely improved the prognosis of hypertensive patients. A number of studies have assessed the role of BP levels in the prognosis of patients with acute coronary syndromes. Pathophysiologic links of hypertension to acute myocardial infarction (MI) include endothelial dysfunction, autonomic nervous system dysregulation, impaired vasoreactivity, and a genetic substrate. A history of hypertension is highly prevalent among patients presenting with MI, and some, but not all, studies have associated it with a worse prognosis. Some data support that low levels of admission and in-hospital BP may indicate an increased risk for subsequent events. Risk scores used in patients with MI have, therefore, included BP levels and a history of hypertension in their variables. Of note, good long-term BP control, ideally initiated prior to discharge, should be pursued in order to improve secondary prevention.
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Affiliation(s)
- Konstantinos Konstantinou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Areti Koumelli
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Manos Mantzouranis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Alexandros Kasiakogias
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Michalis Doumas
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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24
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Association of Prehospital Epinephrine Administration With Survival Among Patients With Traumatic Cardiac Arrest Caused By Traffic Collisions. Sci Rep 2019; 9:9922. [PMID: 31289342 PMCID: PMC6616542 DOI: 10.1038/s41598-019-46460-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/28/2019] [Indexed: 01/26/2023] Open
Abstract
For traumatic cardiac arrest (TCA), the effect of prehospital epinephrine administration was unclear. The aim of this study was to evaluate the relationship between prehospital epinephrine administration and survival in patients with TCA caused by traffic collisions. We conducted a nationwide, prospective, population-based observational study involving patients who experienced out-of-hospital cardiac arrest (OHCA) by using the All-Japan Utstein Registry. Blunt trauma patients with TCA who received prehospital epinephrine were compared with those who did not receive prehospital epinephrine. The primary outcome was 1-month survival of patients. The secondary outcome was prehospital return of spontaneous circulation (ROSC). A total of 5,204 patients with TCA were analyzed. Of those, 758 patients (14.6%) received prehospital epinephrine (Epinephrine group), whereas the remaining 4,446 patients (85.4%) did not receive prehospital epinephrine (No epinephrine group). Eleven (1.5%) and 41 (0.9%) patients in the Epinephrine and No epinephrine groups, respectively, survived for 1 month. In addition, 74 (9.8%) and 40 (0.9%) patients achieved prehospital ROSC in the Epinephrine and No epinephrine groups, respectively. In multivariable logistic regression models, prehospital epinephrine administration was not associated with 1-month survival (odds ratio [OR] 1.495, 95% confidence interval [CI] 0.758 to 2.946) and was associated with prehospital ROSC (OR 3.784, 95% CI 2.102 to 6.812). A propensity score-matched analysis showed similar results for 1-month survival (OR 2.363, 95% CI 0.606 to 9,223) and prehospital ROSC (OR 6.870, 95% CI 3.326 to 14.192). Prehospital epinephrine administration in patients with TCA was not associated with 1-month survival, but was beneficial in regard to prehospital ROSC.
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25
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Pathological cardiac hypertrophy: the synergy of adenylyl cyclases inhibition in cardiac and immune cells during chronic catecholamine stress. J Mol Med (Berl) 2019; 97:897-907. [PMID: 31062036 DOI: 10.1007/s00109-019-01790-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/18/2019] [Accepted: 04/26/2019] [Indexed: 12/21/2022]
Abstract
Response to stressors in our environment and daily lives is an adaptation conserved through evolution as it is beneficial in enhancing the survival and continuity of humans. Although stressors have evolved, the drastic physiological response they elicit still remains unchanged. The chronic secretion and circulation of catecholamines to produce physical responses when they are not required may result in pathological consequences which affect cardiac function drastically. This review seeks to point out the probable implication of chronic stress in inducing an inflammation disorder in the heart. We discussed the likely synergy of a G protein-independent stimuli signaling via β2-adrenergic receptors in both cardiomyocytes and immune cells during chronic catecholamine stress. To explain this synergy, we hypothesized the possibility of adenylyl cyclases having a regulatory effect on G protein-coupled receptor kinases. This was based on the negative correlations they exhibit during normal cardiac function and heart failures. As such, the downregulation of adenylyl cyclases in cardiomyocytes and immune cells during chronic catecholamine stress enhances the expressions of G protein-coupled receptor kinases. In addition, we explain the maladaptive roles played by G protein-coupled receptor kinase and extracellular signal-regulated kinase in the synergistic cascade that pathologically remodels the heart. Finally, we highlighted the therapeutic potentials of an adenylyl cyclases stimulator to attenuate pathological cardiac hypertrophy (PCH) and improve cardiac function in patients developing cardiac disorders due to chronic catecholamine stress.
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26
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Rodriguez-Serrano M, Rueda J, Buendía F, Monto F, Aguero J, Osa A, Cano O, Martínez-Dolz L, D'Ocon P. β2-Adrenoceptors and GRK2 as Potential Biomarkers in Patients With Chronic Pulmonary Regurgitation. Front Pharmacol 2019; 10:93. [PMID: 30837872 PMCID: PMC6390728 DOI: 10.3389/fphar.2019.00093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/24/2019] [Indexed: 01/11/2023] Open
Abstract
Pulmonary regurgitation (PR) is a frequent complication after repair of congenital heart disease. Three different GRK isoforms (GRK2, GRK5, and GRK3) and two β-adrenoceptors (β1-AR and β2-AR) are present in peripheral blood mononuclear cells (PBMC) and their expression changes as a consequence of the hemodynamic and neurohumoral alterations that occur in some cardiovascular diseases. Therefore, they could be useful as biomarkers in PR. A prospective study was conducted to describe the expression (TaqMan Gene Expression Assays) of β-ARs and GRKs in PBMC isolated (Ficoll® gradient) from patients with severe PR before and after pulmonary valve replacement and establish if this expression correlates to clinical status. 23 patients with severe PR were included and compared with 22 healthy volunteers (controls). PR patients before the PVR had a significantly lower expression of β2-AR (513.8 ± 261.2 mRNA copies) vs. controls (812.5 ± 497.2 mRNA copies), so as GRK2 expression (503.4 ± 364.9 copies vs. 858.1 ± 380.3 mRNA copies). The expression of β2-AR and GRK2 significantly decreases in symptomatic and asymptomatic patients, as well as in patients under treatment with beta-blockers and non-treated patients. The expression of β2-AR and GRK2 in PR patients recovers the normal values after pulmonary valve replacement (754,8 ± 77,1 and 897,8 ± 87,4 copies, respectively). Therefore, changes in the expression of β2-AR and GRK2 in PBMC of PR patients, could be considered as potential biomarkers to determine clinical decisions.
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Affiliation(s)
| | - Joaquín Rueda
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Francisco Buendía
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Fermi Monto
- Departamento de Farmacología, Facultad de Farmacia, Universitat de València, Valencia, Spain.,Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BIOTECMED), Universitat de València, Valencia, Spain
| | - Jaime Aguero
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Área de Fisiopatología del Miocardio, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Ana Osa
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Oscar Cano
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Martínez-Dolz
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar D'Ocon
- Departamento de Farmacología, Facultad de Farmacia, Universitat de València, Valencia, Spain.,Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BIOTECMED), Universitat de València, Valencia, Spain
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27
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Murga C, Arcones AC, Cruces-Sande M, Briones AM, Salaices M, Mayor F. G Protein-Coupled Receptor Kinase 2 (GRK2) as a Potential Therapeutic Target in Cardiovascular and Metabolic Diseases. Front Pharmacol 2019; 10:112. [PMID: 30837878 PMCID: PMC6390810 DOI: 10.3389/fphar.2019.00112] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 12/20/2022] Open
Abstract
G protein-coupled receptor kinase 2 (GRK2) is a central signaling node involved in the modulation of many G protein-coupled receptors (GPCRs) and also displaying regulatory functions in other cell signaling routes. GRK2 levels and activity have been reported to be enhanced in patients or in preclinical models of several relevant pathological situations, such as heart failure, cardiac hypertrophy, hypertension, obesity and insulin resistance conditions, or non-alcoholic fatty liver disease (NAFLD), and to contribute to disease progression by a variety of mechanisms related to its multifunctional roles. Therefore, targeting GRK2 by different strategies emerges as a potentially relevant approach to treat cardiovascular disease, obesity, type 2 diabetes, or NAFLD, pathological conditions which are frequently interconnected and present as co-morbidities.
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Affiliation(s)
- Cristina Murga
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa (UAM-CSIC), Universidad Autónoma de Madrid, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Alba C Arcones
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa (UAM-CSIC), Universidad Autónoma de Madrid, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Marta Cruces-Sande
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa (UAM-CSIC), Universidad Autónoma de Madrid, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ana M Briones
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Farmacología, Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Mercedes Salaices
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Farmacología, Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Federico Mayor
- Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa (UAM-CSIC), Universidad Autónoma de Madrid, Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
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28
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Lieu M, Koch WJ. GRK2 and GRK5 as therapeutic targets and their role in maladaptive and pathological cardiac hypertrophy. Expert Opin Ther Targets 2019; 23:201-214. [PMID: 30701991 DOI: 10.1080/14728222.2019.1575363] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION One in every four deaths in the United States is attributed to cardiovascular disease, hence the development and employment of novel and effective therapeutics are necessary to improve the quality of life and survival of affected patient. Pathological hypertrophy is a maladaptive response by the heart to relieve wall stress that could result from cardiovascular disease. Maladaptive hypertrophy can lead to further disease progression and complications such as heart failure; hence, efforts to target hypertrophy to prevent and treat further morbidity and mortality are necessary. Areas covered: This review summarizes the compelling literature that describes the mechanistic role of GRK2 and GRK5 in maladaptive cardiac hypertrophy; it examines the approaches to inhibit these kinases in hypertrophic animal models and furthermore, it assesses the potential of GRK2 and GRK5 as therapeutic targets for hypertrophy. Expert opinion: GRK2 and GRK5 are novel therapeutic targets for pathological hypertrophy and may have added benefits of ameliorating morbidity and mortality. Despite the lesser researched role of GRK2 in cardiac hypertrophy, it may be the advantageous strategy for treating cardiac hypertrophy because of its role in other maladaptive pathways. Anti-GRK2 therapy optimization and the discovery and development of specific GRK2 and GRK5 small-molecule inhibitors is necessary for the eventual application of successful, effective therapeutics.
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Affiliation(s)
- Melissa Lieu
- a Center for Translational Medicine, Department of Pharmacology, Lewis Katz School of Medicine , Temple University , Philadelphia , PA , USA
| | - Walter J Koch
- a Center for Translational Medicine, Department of Pharmacology, Lewis Katz School of Medicine , Temple University , Philadelphia , PA , USA
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The Amino-Terminal Domain of GRK5 Inhibits Cardiac Hypertrophy through the Regulation of Calcium-Calmodulin Dependent Transcription Factors. Int J Mol Sci 2018; 19:ijms19030861. [PMID: 29543709 PMCID: PMC5877722 DOI: 10.3390/ijms19030861] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 01/19/2023] Open
Abstract
We have recently demonstrated that the amino-terminal domain of G protein coupled receptor kinase (GRK) type 5, (GRK5-NT) inhibits NFκB activity in cardiac cells leading to a significant amelioration of LVH. Since GRK5-NT is known to bind calmodulin, this study aimed to evaluate the functional role of GRK5-NT in the regulation of calcium-calmodulin-dependent transcription factors. We found that the overexpression of GRK5-NT in cardiomyoblasts significantly reduced the activation and the nuclear translocation of NFAT and its cofactor GATA-4 in response to phenylephrine (PE). These results were confirmed in vivo in spontaneously hypertensive rats (SHR), in which intramyocardial adenovirus-mediated gene transfer of GRK5-NT reduced both wall thickness and ventricular mass by modulating NFAT and GATA-4 activity. To further verify in vitro the contribution of calmodulin in linking GRK5-NT to the NFAT/GATA-4 pathway, we examined the effects of a mutant of GRK5 (GRK5-NTPB), which is not able to bind calmodulin. When compared to GRK5-NT, GRK5-NTPB did not modify PE-induced NFAT and GATA-4 activation. In conclusion, this study identifies a double effect of GRK5-NT in the inhibition of LVH that is based on the regulation of multiple transcription factors through means of different mechanisms and proposes the amino-terminal sequence of GRK5 as a useful prototype for therapeutic purposes.
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Said SM, Saygili E, Rana OR, Genz C, Hahn J, Bali R, Varshney S, Albouaini K, Prondzinsky R, Braun-Dullaeus RC. Takotsubo Cardiomyopathy: What we have Learned in the Last 25 Years? (A Comparative Literature Review). Curr Cardiol Rev 2016; 12:297-303. [PMID: 26864096 PMCID: PMC5304252 DOI: 10.2174/1573403x12666160211125601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 01/07/2023] Open
Abstract
We performed a comparative literature review, to elucidate the major features of the Takotsubo (stress) cardiomyopathy (TCM) collected in last 25 years. TCM is characterized by left- or biventricular apical ballooning with a clinical presentation, electrocardiographic abnormalities, and biomarker profils similar to those seen in acute myocardial infarction. Epidemiological studies have shown that TCM is more common in postmenopausal women; however exact figures are not available. The underlying aetiology is still largely undetermined. Elevated catecholamine levels, lack of estrogen, disturbed myocardial fatty acid metabolism and plaque rupture with spontaneous thrombolysis are potentially discussed mechanisms responsible for inducing a prolonged stunned myocardium. Strong emotional or physical stress is the most frequently described trigger in the literature. Therapy recommendations include appropriate antiplatelet treatment, β-blockers and ACE inhibitors. The abnormal kinetics usually resolve or improve within a month and carry a favorable prognosis in most cases. However, all the suspected complications of an acute myocardial infarction, including cardiogenic shock or lethal arrhythmias, may still occur.
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Affiliation(s)
- Samir M Said
- Department of Cardiology, University Hospital Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
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Santulli G, Iaccarino G. Adrenergic signaling in heart failure and cardiovascular aging. Maturitas 2016; 93:65-72. [PMID: 27062709 PMCID: PMC5036981 DOI: 10.1016/j.maturitas.2016.03.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 12/15/2022]
Abstract
Both cardiovascular disease and aging are associated with changes in the sympathetic nervous system. Indeed, mounting evidence indicates that adrenergic receptors are functionally involved in numerous processes underlying both aging and cardiovascular disorders, in particular heart failure. This article will review the pathophysiological role of the sympathetic nervous system in heart failure and cardiovascular aging.
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Affiliation(s)
- Gaetano Santulli
- College of Physicians & Surgeons, Columbia University Medical Center, New York, NY, USA.
| | - Guido Iaccarino
- Division of Internal Medicine, Department of Medicine and Surgery, University of Salerno, Italy.
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Zhang J, Liu C, Pan C, Bai M, Zhang J, Peng Y, Zheng D, Zhang Z. Effect of multiple clinical factors on recurrent angina after percutaneous coronary intervention: A retrospective study from 398 ST-segment elevation myocardial infarction patients. Medicine (Baltimore) 2016; 95:e5015. [PMID: 27741110 PMCID: PMC5072937 DOI: 10.1097/md.0000000000005015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Recurrent angina (RA) has an important influence on health status of patients after percutaneous coronary intervention (PCI). This study aimed to retrospectively investigate the effect of multiple clinical factors on both short-term and long-term development of RA.A total of 398 ST-segment elevation myocardial infarction (STEMI) patients were studied for up to 12 months. The primary clinical outcome, RA, was assessed at 1-month and 12-month. In multivariate analyses, the effect of clinical factors, including baseline demographics, medical history, infarction-related arteries, procedural characteristics of PCI, and the use of medicines, was investigated in patients with and without RA.The Logistic regression analysis showed that the patients with treatment through radial approach PCI (odds ratio [OR]: 0.42, 95% confidence interval [CI]: 0.18-0.96, P < 0.05) were less likely to have RA during 1-month assessment. During 12 months after PCI, male patients (OR: 0.53, 95% CI: 0.29-0.96, P < 0.05), and/or those treated with radial approach PCI (OR: 0.45, 95% CI: 0.21-0.97, P < 0.05) were less likely to have RA, whereas the patients with infarction related artery (IRA) in left anterior descending (LAD) (OR: 2.41, 95% CI: 1.20-4.84, P < 0.01) were more likely to have RA at follow-up. The Cox regression analysis further revealed that the patients with infarction of the LAD artery (hazard ratio [HR]: 2.08, 95% CI: 1.10-3.92, P < 0.05), but not with treatment through radial artery during PCI (HR: 0.42, 95% CI: 0.18-0.96, P < 0.05) had higher potential of development of RA during 12 months after PCI.We studied the effects of multiple clinical factors on the development of RA after PCI. Our findings suggest that patients with infarction of the LAD artery, and/or treatment not through radial artery during PCI were associated with higher risk of RA and may require close follow-up.
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Affiliation(s)
- Jing Zhang
- Heart Center, the First Affiliated Hospital, Lanzhou University, Lanzhou
| | - Chengyu Liu
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Chenliang Pan
- Heart Center, the First Affiliated Hospital, Lanzhou University, Lanzhou
| | - Ming Bai
- Heart Center, the First Affiliated Hospital, Lanzhou University, Lanzhou
| | - Jin Zhang
- Heart Center, the First Affiliated Hospital, Lanzhou University, Lanzhou
| | - Yu Peng
- Heart Center, the First Affiliated Hospital, Lanzhou University, Lanzhou
| | - Dingchang Zheng
- Health & Well Being Academy, Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK
| | - Zheng Zhang
- Heart Center, the First Affiliated Hospital, Lanzhou University, Lanzhou
- Correspondence: Dr. Zheng Zhang, Heart Center, the First Affiliated Hospital, Lanzhou University, 1 West Donggang Road, Lanzhou 7300000, China (e-mail: )
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Shlomai G, Berkovitch A, Pinchevski-Kadir S, Bornstein G, Leibowitz A, Goldenberg I, Grossman E. The association between normal-range admission potassium levels in Israeli patients with acute coronary syndrome and early and late outcomes. Medicine (Baltimore) 2016; 95:e3778. [PMID: 27281080 PMCID: PMC4907658 DOI: 10.1097/md.0000000000003778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abnormal serum potassium levels are associated with an increased risk of ventricular arrhythmias and mortality in patients with acute myocardial infarction (AMI). The aim of the present study was to evaluate whether different levels of serum potassium, within the normal range, are associated with worse outcomes. The present study comprised 1277 patients with AMI and normal-range admission potassium levels (3.5-5.2 mEq/L), who were enrolled and prospectively followed up in the Acute Coronary Syndrome Israeli Survey between 2010 and 2013. Patients were divided into 4 quartiles based on admission potassium levels; "normal-low" (K ≥ 3.5 and K ≤ 3.9), "normal-moderate" (K > 3.9 and K ≤ 4.18), "normal-high" (K > 4.18 and K ≤ 4.45), and "normal-very high" (K > 4.45 and K ≤ 5.2). We analyzed the association between admission serum potassium levels and 7 days in-hospital complication rates, and 30-day and 1-year all-cause mortality rates. Patients with "normal-very high" potassium displayed increased frequency of baseline clinical risk factors and experienced a higher rate of acute kidney injury during hospitalization compared with the "normal-low" group (7.7% vs 2.4%; P = 0.002). However, the rate of in-hospital ventricular arrhythmias was similar across the range of admission potassium levels (overall P = 0.26), Multivariate analysis showed that compared with "low-normal" potassium values, patients with "normal-very high" potassium levels experienced increased risk for 30-days (adjusted hazard ratio 2.88, 95% confidence interval 1.05-7.87, P = 0.039) and 1-year all-cause mortality (adjusted hazard ratio 1.98, 95% confidence interval 1.05-3.75, P = 0.034). In patients admitted with AMI, admission serum potassium levels of 4.45 to 5.2 mEq/L are not associated with in-hospital ventricular arrhythmias, but are associated with increased short and long-term mortality.
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Affiliation(s)
- Gadi Shlomai
- Department of Internal Medicine D and Hypertension Unit
- The Dr Pinchas Borenstein Talpiot Medical Leadership Program 2013
| | - Anat Berkovitch
- Department of Internal Medicine D and Hypertension Unit
- Heart Institute and the Neufeld Cardiac Research Institute, Leviev Heart Center, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Gil Bornstein
- Department of Internal Medicine D and Hypertension Unit
| | | | - Ilan Goldenberg
- Heart Institute and the Neufeld Cardiac Research Institute, Leviev Heart Center, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Grossman
- Department of Internal Medicine D and Hypertension Unit
- ∗Correspondence: Ehud Grossman, Dean, Sackler Faculty of Medicine, Tel-Aviv University, Head of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel ()
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Zhou X, Liu XL, Ji WJ, Liu JX, Guo ZZ, Ren D, Ma YQ, Zeng S, Xu ZW, Li HX, Wang PP, Zhang Z, Li YM, Benefield BC, Zawada AM, Thorp EB, Lee DC, Heine GH. The Kinetics of Circulating Monocyte Subsets and Monocyte-Platelet Aggregates in the Acute Phase of ST-Elevation Myocardial Infarction: Associations with 2-Year Cardiovascular Events. Medicine (Baltimore) 2016; 95:e3466. [PMID: 27149446 PMCID: PMC4863763 DOI: 10.1097/md.0000000000003466] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In experimental myocardial infarction (MI), a rise in cell counts of circulating monocyte subsets contributes to impaired myocardial healing and to atherosclerotic plaque destabilization. In humans, the prognostic role of monocyte subsets in patients suffering ST-elevation MI (STEMI) is still unclear. In the present study, we aimed to determine the kinetics of the 3 monocyte subsets (classical CD14++CD16-, intermediate CD14++CD16+, and nonclassical CD14+CD16++ monocytes), as well as the subset-specific monocyte-platelet aggregates (MPA), in acute STEMI followed by primary percutaneous coronary intervention (PCI), and their relationships with cardiovascular outcomes during a 2-year follow-up.Monocyte subsets and MPA were measured in 100 STEMI patients receiving primary PCI on days 1, 2, 3, 5, and 7 of symptom onset, which were compared with 60 stable coronary heart disease patients and 35 healthy volunteers. From day 1 to day 7, significant increases in the counts of CD14++CD16+ monocytes and CD14++CD16+ MPA were observed, with peak levels on day 2. During a median follow-up of 2.0 years, 28 first cardiovascular events (defined as cardiovascular death, nonfatal ischemic stroke, recurrent MI, need for emergency or repeat revascularization, and rehospitalization for heart failure) were recorded. After adjustment for confounders, CD14++CD16+ monocytosis (day 1 [HR: 3.428; 95% CI: 1.597-7.358; P = 0.002], day 2 [HR: 4.835; 95% CI: 1.106-21.13; P = 0.04], day 3 [HR: 2.734; 95% CI: 1.138-6.564; P = 0.02], and day 7 [HR: 2.647; 95% CI: 1.196-5.861; P = 0.02]), as well as increased levels of CD14++CD16+ MPA measured on all time points (days 1, 2, 3, 5, and 7), had predictive values for adverse cardiovascular events.In conclusion, our data show the expansion of the CD14++CD16+ monocyte subset during acute phase of STEMI has predictive values for 2-year adverse cardiovascular outcomes in patients treated with primary PCI. Future studies will be warranted to elucidate whether CD14++CD16+ monocytes may become a target cell population for new therapeutic strategies after STEMI.
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Affiliation(s)
- Xin Zhou
- From the Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury (XZ, X-LL, W-JJ, J-XL, Z-ZG, DR, Y-QM, SZ, Z-WX, H-XL, Y-ML), Pingjin Hospital Heart Center, Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Division of Community Health and Humanities (PPW), Faculty of Medicine, Memorial University of Newfoundland, Newfoundland and Labrador, Canada; Department of Radiology (ZZ); Feinberg Cardiovascular Research Institute (BCB, DCL); Department of Pathology (EBT), Northwestern University Feinberg School of Medicine, Chicago, IL, USA; and Department of Internal Medicine IV (AMZ and GHH), Nephrology and Hypertension, Saarland University Medical Center, Homburg, Germany
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Lymperopoulos A, Brill A, McCrink KA. GPCRs of adrenal chromaffin cells & catecholamines: The plot thickens. Int J Biochem Cell Biol 2016; 77:213-9. [PMID: 26851510 DOI: 10.1016/j.biocel.2016.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 12/14/2022]
Abstract
The circulating catecholamines (CAs) epinephrine (Epi) and norepinephrine (NE) derive from two major sources in the whole organism: the sympathetic nerve endings, which release NE on effector organs, and the chromaffin cells of the adrenal medulla, which are cells that synthesize, store and release Epi (mainly) and NE. All of the Epi in the body and a significant amount of circulating NE derive from the adrenal medulla. The secretion of CAs from adrenal chromaffin cells is regulated in a complex way by a variety of membrane receptors, the vast majority of which are G protein-coupled receptors (GPCRs), including adrenergic receptors (ARs), which act as "presynaptic autoreceptors" in this regard. There is a plethora of CA-secretagogue signals acting on these receptors but some of them, most notably the α2ARs, inhibit CA secretion. Over the past few years, however, a few new proteins present in chromaffin cells have been uncovered to participate in CA secretion regulation. Most prominent among these are GRK2 and β-arrestin1, which are known to interact with GPCRs regulating receptor signaling and function. The present review will discuss the molecular and signaling mechanisms by which adrenal chromaffin cell-residing GPCRs and their regulatory proteins modulate CA synthesis and secretion. Particular emphasis will be given to the newly discovered roles of GRK2 and β-arrestins in these processes and particular points of focus for future research will be highlighted, as well.
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Affiliation(s)
- Anastasios Lymperopoulos
- From the Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences, Nova Southeastern University, College of Pharmacy, 3200 S. University Dr., Fort Lauderdale, FL 33328-2018, USA.
| | - Ava Brill
- From the Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences, Nova Southeastern University, College of Pharmacy, 3200 S. University Dr., Fort Lauderdale, FL 33328-2018, USA
| | - Katie A McCrink
- From the Laboratory for the Study of Neurohormonal Control of the Circulation, Department of Pharmaceutical Sciences, Nova Southeastern University, College of Pharmacy, 3200 S. University Dr., Fort Lauderdale, FL 33328-2018, USA
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Tian X, Wang Q, Guo R, Xu L, Chen QM, Hou Y. Effects of paroxetine-mediated inhibition of GRK2 expression on depression and cardiovascular function in patients with myocardial infarction. Neuropsychiatr Dis Treat 2016; 12:2333-2341. [PMID: 27695334 PMCID: PMC5028169 DOI: 10.2147/ndt.s109880] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Paroxetine is a selective serotonin reuptake inhibitor utilized in the treatment of depression and anxiety disorders. Recent studies have identified paroxetine as a G protein-coupled receptor kinase-2 (GRK2) inhibitor capable of reversing cardiac dysfunction and remodeling in experimental models of acute myocardial infarction (AMI). We determine the clinical importance of paroxetine on cardiac functions in patients having AMI with depression (AMID) in comparison with fluoxetine, an unrelated selective serotonin reuptake inhibitor that does not inhibit GRK2. METHODS Diagnosis of depression was based on the 17-item Hamilton Depression Scale and Self-rating Depression Scale in AMI patients after hospital admission. AMID patients were randomly assigned to paroxetine or fluoxetine for treatment of depression. Heart rate variability and cardiac function were evaluated. GRK2 protein levels were measured using peripheral lymphocytes and Western blot. RESULTS GRK2 expression in AMID patients was significantly higher than that in AMI patients without depression. In AMID patients, GRK2 levels were positively correlated with the 17-item Hamilton Depression Scale and the Self-rating Depression Scale scores, and negatively correlated with heart rate variability. Treatment of AMID patients with paroxetine significantly reduced the expression of GRK2, normalized the autonomic nervous system function, and improved cardiac performance. In contrast, fluoxetine normalized the autonomic nervous system but did not reduce the expression of GRK2 nor improved cardiac performance. CONCLUSION This study suggests that paroxetine is effective for improving cardiac function in patients with AMID and such effect correlates with GRK2 reduction.
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Affiliation(s)
- Xiuqing Tian
- Department of Cardiology, Qianfoshan Hospital of Shandong University, Jinan City
| | - Qing Wang
- Department of Cardiology, Qianfoshan Hospital of Shandong University, Jinan City
| | - Rui Guo
- Department of Physiology, Nanjing University of Chinese Medicine, Nanjing City
| | - Lingling Xu
- College of Medicine, Weifang Medical University, Weifang City, People's Republic of China
| | - Qin M Chen
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Yinglong Hou
- Department of Cardiology, Qianfoshan Hospital of Shandong University, Jinan City
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Zhang HP, Zhao Y, Li H, Tang GD, Ai H, Zheng NX, Liu JH, Sun FC. Impact of Chronic Total Occlusion in a Noninfarct-related Artery on Clinical Outcomes in Patients With Acute ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Medicine (Baltimore) 2016; 95:e2441. [PMID: 26765429 PMCID: PMC4718255 DOI: 10.1097/md.0000000000002441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the setting of primary percutaneous coronary intervention (PCI), encountering with chronic total occlusion (CTO) in a noninfarct-related artery (IRA) is not a rare situation. Limited information on the impact of CTO on clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI has raised more concerns. The aim of the present study was to evaluate the effect of concurrent CTO in a non-IRA on the clinical outcomes in patients with STEMI undergoing primary PCI.In the present prospective study, 555 consecutive patients with STEMI who underwent early primary PCI from January 2010 to December 2013 were included. The patients were divided into 2 groups: no CTO and CTO. Data on 12 months follow-up was obtained from 449 patients. The primary endpoint was the composite of hospitalization from angina, reinfarction, heart failure, or re-revascularization, and cardiac death at 12 months follow-up.Of the 555 patients, 75 (13.5%) had CTO in a non-IRA. Compared with patients in no CTO group, more patients in CTO group had hypertension (62.7% vs 46.5%, P = 0.009), diabetes (49.3% vs 35.0%, P = 0.024), and 3-vessel disease (52.0% vs 32.3%, P = 0.001). Patients with CTO had a lower left ventricular ejection fraction (LVEF) (40.1% ± 16.8% vs 54.3% ± 12.1%, P = 0.038), more presented with cardiogenic shock on admission (13.3% vs 4.8%, P = 0.008), compared with patients without CTO. Complete revascularization (CR) was less achieved in CTO group than in no CTO group (33.3% vs 49.1%, P = 0.013). The 12-month cardiac mortality rate was 14.5% versus 6.2% (P = 0.039), the incidence of 12-month primary endpoint was 38.7% versus 21.2% (P = 0.003) for CTO and no CTO group, respectively. Multivariate analysis revealed that after correction for baseline differences, CTO in a non-IRA (hazard ratio 4.183, 95% confidence interval 1.940-6.019, P = 0.001), cardiogenic shock on admission (hazard ratio 3.286, 95% confidence interval 1.097-9.845, P = 0.034), and 3-vessel disease (hazard ratio 2.678, 95% confidence interval 1.221-5.874, P = 0.014) remained an independent predictor of 1-year cardiac mortality in patients with STEMI undergoing primary PCI.CTO in a non-IRA in patients with STEMI undergoing primary PCI is associated with a poor prognosis. The presence of CTO in a non-IRA, cardiogenic shock on admission and 3-vessel disease might be an independent risk factor for greater 1-year cardiac mortality in patients with acute STEMI undergoing primary PCI.
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Affiliation(s)
- Hui-Ping Zhang
- From the Department of Cardiology, Beijing Hospital, The Fifth Affiliated Hospital of Peking University (H-PZ, YZ, HL, G-DT, HA, N-XZ, F-CS); and Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China (J-HL)
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Batisse-Lignier M, Pereira B, Motreff P, Pierrard R, Burnot C, Vorilhon C, Maqdasy S, Roche B, Desbiez F, Clerfond G, Citron B, Lusson JR, Tauveron I, Eschalier R. Acute and Chronic Pheochromocytoma-Induced Cardiomyopathies: Different Prognoses?: A Systematic Analytical Review. Medicine (Baltimore) 2015; 94:e2198. [PMID: 26683930 PMCID: PMC5058902 DOI: 10.1097/md.0000000000002198] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Pheochromocytoma and paraganglioma (PPG) are rare and late-diagnosed catecholamine secreting tumors, which may be associated with unrecognized and/or severe cardiomyopathies. We performed a computer-assisted systematic search of the electronic Medline databases using the MESH terms "myocarditis," "myocardial infarction," "Takotsubo," "stress cardiomyopathy," "cardiogenic shock", or "dilated cardiomyopathy," and "pheochromocytoma" or "paraganglioma" from 1961 to August 2012. All detailed case reports of cardiomyopathy due to a PPG, without coronary stenosis, and revealed by acute symptoms were included and analyzed. A total of 145 cases reports were collected (49 Takotsubo Cardiomyopathies [TTC] and 96 other Catecholamine Cardiomyopathies [CC]). At initial presentation, prevalence of high blood pressure (87.7%), chest pain (49.0%), headaches (47.6%), palpitations (46.9%), sweating (39.3%), and shock (51.0%) were comparable between CC and TTC. Acute pulmonary edema (58.3% vs 38.8%, P = 0.03) was more frequent in CC. There was no difference in proportion of patients with severe left ventricular systolic dysfunction (LV Ejection Fraction [LVEF] < 30%) at initial presentation between both groups (P = 0.15). LVEF recovery before (64.9% vs 40.8%, P = 0.005) and after surgical resection (97.7% vs 73.3%, P = 0.001) was higher in the TTC group. Death occurred in 11 cases (7.6%). In multivariate analysis, only TTC was associated with a better LV recovery (0.15 [0.03-0.67], P = 0.03). Pheochromocytoma and paraganglioma can lead to different cardiomyopathies with the same brutal and life-threatening initial clinical presentation but with a different recovery rate. Diagnosis of unexplained dilated cardiomyopathy or TTC should lead clinicians to a specific search for PPG.
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Affiliation(s)
- Marie Batisse-Lignier
- From the CHU Clermont-Ferrand, Endocrinology Department, Clermont-Ferrand, France (MB-L, CB, SM, BR, FD, IT); CNRS UMR 6293, Inserm GReD, Clermont-Ferrand, France (MB-L, SM, IT); CHU Clermont-Ferrand, Biostatistics unit (Clinical Research and Innovation Direction), Clermont-Ferrand, France (BP); and Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France (PM, RP, CV, GC, BC, J-RL, RE)
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Novo G, Giambanco S, Guglielmo M, Arvigo L, Sutera MR, Giambanco F, Evola S, Vaccarino L, Bova M, Lio D, Assennato P, Novo S. G-protein-coupled receptor kinase 5 polymorphism and Takotsubo cardiomyopathy. J Cardiovasc Med (Hagerstown) 2015; 16:639-43. [DOI: 10.2459/jcm.0000000000000120] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Pecha S, Flenner F, Söhren KD, Lorenz K, Eschenhagen T, Christ T. β 1 Adrenoceptor antagonistic effects of the supposedly selective β 2 adrenoceptor antagonist ICI 118,551 on the positive inotropic effect of adrenaline in murine hearts. Pharmacol Res Perspect 2015; 3:e00168. [PMID: 26516580 PMCID: PMC4618639 DOI: 10.1002/prp2.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 01/14/2023] Open
Abstract
Studies on the relative contribution of β1- and β2-adrenoceptors (AR) generally employ selective β1- and β2-AR antagonists such as CGP 20712A and ICI 118,551, respectively, and assume that antagonism by one of these compounds indicates mediation by the respective AR subtype. Here, we evaluated the β2-AR-selectivity of ICI 118,551 in ventricular muscle strips of transgenic mice lacking β1-AR (β1-KO), β2-AR (β2-KO), or both (β1/β2-KO). Strips were electrically driven and force development was measured. In wild type (WT), ICI 118,551 (100 nmol/L) shifted the concentration–response curve (CRC) for adrenaline by about 0.5 log units to the right, corresponding to the known affinity of ICI 118,551 to β1-AR but not to β2-AR. Conversely, the phosphodiesterase inhibitor rolipram (10 μmol/L) shifted the CRC to the left, but did not enlarge the ICI 118,551 shift, indicating exclusive β1-AR mediation even when PDE4 is inactive. In line with this, rolipram and ICI 118,551 had similar effects in β2-KO than in WT. In contrast, β1-KO did not show any inotropic reaction to adrenaline (+/− rolipram). In WT, the β1-AR selective antagonist CGP 20712A (100 nmol/L) shifted the CRC for isoprenaline by 2.1 log units, corresponding to the affinity of CGP 20712A to β1-AR. Rolipram increased the sensitivity to adrenaline independently of the presence of CGP 20712A. We conclude that effects sensitive to the β2-AR antagonist ICI 118,551 are not necessarily β2-AR-mediated and CGP 20712A-resistant effects cannot be simply interpreted as β2-AR-mediated. Catecholamine effects in murine ventricles strictly depend on β1-AR, even if PDE 4 is blocked.
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Affiliation(s)
- Simon Pecha
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Cardiovascular Surgery, University Heart Center Hamburg Hamburg, Germany
| | - Frederik Flenner
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; DZHK (German Centre for Cardiovascular Research) Hamburg/Kiel/Lübeck, Germany
| | - Klaus-Dieter Söhren
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; DZHK (German Centre for Cardiovascular Research) Hamburg/Kiel/Lübeck, Germany
| | - Kristina Lorenz
- Department of Pharmacology and Toxicology, University of Wuerzburg Wuerzburg, Germany ; Comprehensive Heart Failure Center, University of Wuerzburg Wuerzburg, Germany
| | - Thomas Eschenhagen
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; DZHK (German Centre for Cardiovascular Research) Hamburg/Kiel/Lübeck, Germany
| | - Torsten Christ
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; DZHK (German Centre for Cardiovascular Research) Hamburg/Kiel/Lübeck, Germany
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Huang B, Wang X, Yang Y, Zhu J, Liang Y, Tan H, Yu L, Gao X, Zhang H, Wang J. Association of Admission Glycaemia With High Grade Atrioventricular Block in ST-Segment Elevation Myocardial Infarction Undergoing Reperfusion Therapy: An Observational Study. Medicine (Baltimore) 2015; 94:e1167. [PMID: 26181562 PMCID: PMC4617096 DOI: 10.1097/md.0000000000001167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Several studies have demonstrated the association between elevated admission glycaemia (AG) and the occurrence of some arrhythmias such as atrial fibrillation, ventricular tachycardia, and ventricular fibrillation after myocardial infarction. However, the impact of elevated AG on the high grade atrioventricular block (AVB) occurrence after ST-segment elevation myocardial infarction (STEMI) remains unclear. Included were 3359 consecutive patients with STEMI who received reperfusion therapy. The primary endpoint was the development of high grade AVB during hospital course. Patients were divided into non-diabetes mellitus (DM), newly diagnosed DM, and previously known DM according to the hemoglobin A1c level. The optimal AG value was determined by receiver operating characteristic curves analysis with AG predicting the high grade AVB occurrence. The best cut-off value of AG for predicting the high grade AVB occurrence was 10.05 mmol/L by ROC curve analysis. The prevalence of AG ≥ 10.05 mmol/L in non-DM, newly diagnosed DM, and previously known DM was 15.7%, 34.1%, and 68.5%, respectively. The incidence of high grade AVB was significantly higher in patients with AG ≥ 10.05 mmol/L than <10.05 mmol/L in non-DM (5.7% vs. 2.1%, P < 0.001) and in newly diagnosed DM (10.2% vs.1.4%, P < 0.001), but was comparable in previously known DM (3.6% vs. 0.0%, P = 0.062). After multivariate adjustment, AG ≥ 10.05 mmol/L was independently associated with increased risk of high grade AVB occurrence in non-DM (HR = 1.826, 95% CI 1.073-3.107, P = 0.027) and in newly diagnosed DM (HR = 5.252, 95% CI 1.890-14.597, P = 0.001). Moreover, both AG ≥ 10.05 mmol/L and high grade AVB were independent risk factors of 30-day all cause-mortality (HR = 1.362, 95% CI 1.006-1.844, P = 0.046 and HR = 2.122, 95% CI 1.154-3.903, P = 0.015, respectively). Our study suggested that elevated AG level (≥10.05 mmol/L) might be an indicator of increased risk of high grade AVB occurrence in patients with STEMI.
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Affiliation(s)
- Bi Huang
- From the State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China (BH, XW, YY, JZ, YL, HT, LY, XG, HZ, JW)
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Moussouttas M, Mearns E, Walters A, DeCaro M. Plasma Catecholamine Profile of Subarachnoid Hemorrhage Patients with Neurogenic Cardiomyopathy. Cerebrovasc Dis Extra 2015; 5:57-67. [PMID: 26120322 PMCID: PMC4478315 DOI: 10.1159/000431155] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/24/2015] [Indexed: 01/10/2023] Open
Abstract
Purpose To investigate the connection between sympathetic function and neurogenic cardiomyopathy (NC), and to determine whether NC is mediated primarily by circulating adrenal epinephrine (EPI) or neuronally transmitted norepinephrine (NE), following subarachnoid hemorrhage (SAH). Methods This is a prospective observational investigation of consecutive severe-grade SAH patients. All participants had transthoracic echocardiography and serological assays for catecholamine levels – dopamine (DA), NE and EPI – within 48 h of hemorrhage onset. Clinical and serological independent predictors of NC were determined using multivariate logistic regression analyses, and the accuracy of predictors was assessed by receiver operating characteristic (ROC) curves. Multivariate linear regression analyses were used to evaluate correlations among the catecholamines. Results The investigation included a total of 94 subjects: the mean age was 55 years, 81% were female and 57% were Caucasian. NC was identified in approximately 10% (9/94) of cases. Univariate analyses revealed associations between NC and worse clinical severity (p = 0.019), plasma DA (p = 0.018) and NE levels (p = 0.024). Plasma NE correlated with DA levels (ρ = 0.206, p = 0.046) and EPI levels (ρ = 0.392, p < 0.001), but was predicted only by plasma EPI in bivariate [parameter estimate (PE) = 1.95, p < 0.001] and multivariate (PE = 1.89, p < 0.001) linear regression models. Multivariate logistic regression analyses consistently demonstrated the predictive value of clinical grade for NC (p < 0.05 for all analyses) except in models incorporating plasma NE, where NC was independently predicted by NE level (OR 1.25, 95% CI 1.01-1.55) over clinical grade (OR 4.19, 95% CI 0.874-20.1). ROC curves similarly revealed the greater accuracy of plasma NE [area under the curve (AUC) 0.727, 95% CI 0.56-0.90, p = 0.02] over clinical grade (AUC 0.704, 95% CI 0.55-0.86, p = 0.05) for identifying the presence or absence of NC. Conclusions Following SAH, the development of NC is primarily related to elevated plasma NE levels. Findings implicate a predominantly neurogenic process mediated by neuronal NE (and not adrenal EPI), but cannot exclude synergy between the catecholamines.
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Affiliation(s)
- Michael Moussouttas
- Neurocritical Care Division, Institute for Neurosciences, Capital Regional Medical Center, Trenton, N.J., USA
| | - Elizabeth Mearns
- Pharmacy Department, Thomas Jefferson Medical Center, Philadelphia, Pa., USA
| | - Arthur Walters
- Department of Neurology, Vanderbilt Medical Center, Nashville, Tenn., USA
| | - Matthew DeCaro
- Division of Cardiology, Department of Medicine, Thomas Jefferson Medical Center, Philadelphia, Pa., USA
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Berezin AE, Kremzer AA, Martovitskaya YV, Samura TA, Berezina TA. The predictive role of circulating microparticles in patients with chronic heart failure. BBA CLINICAL 2015; 3:18-24. [PMID: 26672475 PMCID: PMC4661507 DOI: 10.1016/j.bbacli.2014.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 11/25/2014] [Accepted: 11/29/2014] [Indexed: 01/08/2023]
Abstract
AIM The study aim was to evaluate whether circulating microparticles with apoptotic or non-apoptotic phenotypes are useful for risk assessment of 3-year cumulative fatal and non-fatal cardiovascular events in CHF patients. METHODS The incidence of fatal and non-fatal cardiovascular events, as well as the frequency of occurrence of death from any cause in a cohort of 388 patients with CHF during 3 years of observation was studied prospectively. Circulating levels of NT-pro brain natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and endothelial apoptotic microparticles (EMPs) were measured at baseline. RESULTS Median follow-up was 2.32 years (IQR = 1.8-3.1). During follow-up, 110 cardiovascular events (including 43 fatal cases) were determined. Additionally, 74 subjects were hospitalized repetitively due to worsening CHF and also 16 subjects were readmitted in the hospital due to other cardiovascular reasons. In the univariate logistic regression analysis, the main factors independently related with cumulative endpoints were creatinine, fasting glucose, HbA1c, total cholesterol, uric acid, various types of EPMs, NT-pro-BNP, hs-CRP, NYHA class, decreased left ventricular ejection fraction (LVEF) less 45%, and type 2 diabetes mellitus. In multivariate model NYHA class, decreased LVEF (less 45%), NT-pro-BNP, hs-CRP, CD144 +/CD31 +/annexin V + EMPs, and CD31 +/annexin V + EMPs remained statistically significant for cumulative endpoint. Adding of CD144 +/CD31 +/annexin V + EMCs and CD31 +/annexin V + EMCs to the standard ABC model may improve the relative IDI for cumulative endpoint by 11.4% and 10.5% respectively. CONCLUSION Apoptotic phenotype of circulating microparticles may relate 3-year combined clinical outcomes in CHF patients.
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Affiliation(s)
- Alexander E. Berezin
- Internal Medicine Department, State Medical University, 26, Mayakovsky Av., Zaporozhye UA-69035, Ukraine
| | | | | | - Tatyana A. Samura
- Clinical Pharmacology Department, State Medical University, Zaporozhye, Ukraine
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De Metrio M, Milazzo V, Rubino M, Cabiati A, Moltrasio M, Marana I, Campodonico J, Cosentino N, Veglia F, Bonomi A, Camera M, Tremoli E, Marenzi G. Vitamin D plasma levels and in-hospital and 1-year outcomes in acute coronary syndromes: a prospective study. Medicine (Baltimore) 2015; 94:e857. [PMID: 25984675 PMCID: PMC4602571 DOI: 10.1097/md.0000000000000857] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Deficiency in 25-hydroxyvitamin D (25[OH]D), the main circulating form of vitamin D in blood, could be involved in the pathogenesis of acute coronary syndromes (ACS). To date, however, the possible prognostic relevance of 25 (OH)D deficiency in ACS patients remains poorly defined. The purpose of this prospective study was to assess the association between 25 (OH)D levels, at hospital admission, with in-hospital and 1-year morbidity and mortality in an unselected cohort of ACS patients.We measured 25 (OH)D in 814 ACS patients at hospital presentation. Vitamin D serum levels >30 ng/mL were considered as normal; levels between 29 and 21 ng/mL were classified as insufficiency, and levels < 20 ng/mL as deficiency. In-hospital and 1-year outcomes were evaluated according to 25 (OH)D level quartiles, using the lowest quartile as a reference.Ninety-three (11%) patients had normal 25 (OH)D levels, whereas 155 (19%) and 566 (70%) had vitamin D insufficiency and deficiency, respectively. The median 25 (OH)D level was similar in ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients (14.1 [IQR 9.0-21.9] ng/mL and 14.05 [IQR 9.1-22.05] ng/mL, respectively; P = .88). The lowest quartile of 25 (OH)D was associated with a higher risk for several in-hospital complications, including mortality. At a median follow-up of 366 (IQR 364-379) days, the lowest quartile of 25 (OH)D, after adjustment for the main confounding factors, remained significantly associated to 1-year mortality (P < .01). Similar results were obtained when STEMI and NSTEMI patients were considered separately.In ACS patients, severe vitamin D deficiency is independently associated with poor in-hospital and 1-year outcomes. Whether low vitamin D levels represent a risk marker or a risk factor in ACS remains to be elucidated.
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Affiliation(s)
- Monica De Metrio
- From the Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy (MD, VM, MR, AC, MM, IM, JC, NC, FV, AB, MC, ET, GM); and Dipartimento di Scienze Farmacologiche e Biomolecolari, University of Milan, Italy (MC, ET)
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Sato PY, Chuprun JK, Schwartz M, Koch WJ. The evolving impact of g protein-coupled receptor kinases in cardiac health and disease. Physiol Rev 2015; 95:377-404. [PMID: 25834229 PMCID: PMC4551214 DOI: 10.1152/physrev.00015.2014] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
G protein-coupled receptors (GPCRs) are important regulators of various cellular functions via activation of intracellular signaling events. Active GPCR signaling is shut down by GPCR kinases (GRKs) and subsequent β-arrestin-mediated mechanisms including phosphorylation, internalization, and either receptor degradation or resensitization. The seven-member GRK family varies in their structural composition, cellular localization, function, and mechanism of action (see sect. II). Here, we focus our attention on GRKs in particular canonical and novel roles of the GRKs found in the cardiovascular system (see sects. III and IV). Paramount to overall cardiac function is GPCR-mediated signaling provided by the adrenergic system. Overstimulation of the adrenergic system has been highly implicated in various etiologies of cardiovascular disease including hypertension and heart failure. GRKs acting downstream of heightened adrenergic signaling appear to be key players in cardiac homeostasis and disease progression, and herein we review the current data on GRKs related to cardiac disease and discuss their potential in the development of novel therapeutic strategies in cardiac diseases including heart failure.
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Affiliation(s)
- Priscila Y Sato
- Center for Translational Medicine and Department of Pharmacology, Temple University School of Medicine, Philadelphia, Pennsylvania; and Advanced Institutes of Convergence Technology, Suwon, South Korea
| | - J Kurt Chuprun
- Center for Translational Medicine and Department of Pharmacology, Temple University School of Medicine, Philadelphia, Pennsylvania; and Advanced Institutes of Convergence Technology, Suwon, South Korea
| | - Mathew Schwartz
- Center for Translational Medicine and Department of Pharmacology, Temple University School of Medicine, Philadelphia, Pennsylvania; and Advanced Institutes of Convergence Technology, Suwon, South Korea
| | - Walter J Koch
- Center for Translational Medicine and Department of Pharmacology, Temple University School of Medicine, Philadelphia, Pennsylvania; and Advanced Institutes of Convergence Technology, Suwon, South Korea
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Buroker NE. Regulatory SNPs and transcriptional factor binding sites in ADRBK1, AKT3, ATF3, DIO2, TBXA2R and VEGFA. Transcription 2014; 5:e964559. [PMID: 25483406 PMCID: PMC4581348 DOI: 10.4161/21541264.2014.964559] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract Regulatory single nucleotide polymorphisms (rSNPs) which change the transcriptional factor binding sites (TFBS) for transcriptional factors (TFs) to bind DNA were reviewed for the ADRBK1 (GRK2), AKT3, ATF3, DIO2, TBXA2R and VEGFA genes. Changes in the TFBS where TFs attach to regulate these genes may result in human sickness and disease. The highlights of this previous work were reviewed for these genes.
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Affiliation(s)
- Norman E Buroker
- Department of Pediatrics, University of Washington, Seattle, WA USA
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Yang X, Wang T, Lin X, Yue X, Wang Q, Wang G, Fu Q, Ai X, Chiang DY, Miyake CY, Wehrens XHT, Chang J. Genetic deletion of Rnd3/RhoE results in mouse heart calcium leakage through upregulation of protein kinase A signaling. Circ Res 2014; 116:e1-e10. [PMID: 25348166 DOI: 10.1161/circresaha.116.304940] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
RATIONALE Rnd3, a small Rho GTPase, is involved in the regulation of cell actin cytoskeleton dynamics, cell migration, and proliferation. The biological function of Rnd3 in the heart remains unexplored. OBJECTIVE To define the functional role of the Rnd3 gene in the animal heart and investigate the associated molecular mechanism. METHODS AND RESULTS By loss-of-function approaches, we discovered that Rnd3 is involved in calcium regulation in cardiomyocytes. Rnd3-null mice died at the embryonic stage with fetal arrhythmias. The deletion of Rnd3 resulted in severe Ca(2+) leakage through destabilized ryanodine receptor type 2 Ca(2+) release channels. We further found that downregulation of Rnd3 attenuated β2-adrenergic receptor lysosomal targeting and ubiquitination, which in turn resulted in the elevation of β2-adrenergic receptor protein levels leading to the hyperactivation of protein kinase A (PKA) signaling. The PKA activation destabilized ryanodine receptor type 2 channels. This irregular spontaneous Ca(2+) release can be curtailed by PKA inhibitor treatment. Increases in the PKA activity along with elevated cAMP levels were detected in Rnd3-null embryos, in neonatal rat cardiomyocytes, and noncardiac cell lines with Rnd3 knockdown, suggesting a general mechanism for Rnd3-mediated PKA signaling activation. β2-Adrenergic receptor blocker treatment reduced arrhythmia and improved cardiac function. CONCLUSIONS Rnd3 is a novel factor involved in intracellular Ca(2+) homeostasis regulation in the heart. Deficiency of the protein induces ryanodine receptor type 2 dysfunction by a mechanism that attenuates Rnd3-mediated β2-adrenergic receptor ubiquitination, which leads to the activation of PKA signaling. Increased PKA signaling in turn promotes ryanodine receptor type 2 hyperphosphorylation, which contributes to arrhythmogenesis and heart failure.
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Affiliation(s)
- Xiangsheng Yang
- Texas A&M University Health Science Center, Institute of Biosciences and Technology, Houston, TX 77030
| | - Tiannan Wang
- Department of Molecular Physiology & Biophysics, and Medicine (Cardiology), Baylor College of Medicine, Houston, TX 77030
| | - Xi Lin
- Texas A&M University Health Science Center, Institute of Biosciences and Technology, Houston, TX 77030
| | - Xiaojing Yue
- Texas A&M University Health Science Center, Institute of Biosciences and Technology, Houston, TX 77030
| | - Qiongling Wang
- Department of Molecular Physiology & Biophysics, and Medicine (Cardiology), Baylor College of Medicine, Houston, TX 77030
| | - Guoliang Wang
- Department of Molecular Physiology & Biophysics, and Medicine (Cardiology), Baylor College of Medicine, Houston, TX 77030
| | - Qin Fu
- Department of Pharmacology, University of California at Davis, CA 95616
| | - Xun Ai
- Department of Cell and Molecular Physiology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153
| | - David Y Chiang
- Department of Molecular Physiology & Biophysics, and Medicine (Cardiology), Baylor College of Medicine, Houston, TX 77030
| | - Christina Y Miyake
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - Xander H T Wehrens
- Department of Molecular Physiology & Biophysics, and Medicine (Cardiology), Baylor College of Medicine, Houston, TX 77030
| | - Jiang Chang
- Texas A&M University Health Science Center, Institute of Biosciences and Technology, Houston, TX 77030
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Méndez AB, Ordoñez-Llanos J, Ferrero A, Noguero M, Mir T, Mora J, Bayes-Genis A, Mirabet S, Cinca J, Roig E. Prognostic value of increased carbohydrate antigen in patients with heart failure. World J Cardiol 2014; 6:205-212. [PMID: 24772260 PMCID: PMC3999340 DOI: 10.4330/wjc.v6.i4.205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/07/2014] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the prognostic value of carbohydrate antigen 125 (CA125) and whether it adds prognostic information to N-terminal pro-brain natriuretic peptide (NT-proBNP) in stable heart failure (HF) patients.
METHODS: The predictive value of CA125 was retrospectively assessed in 156 patients with stable HF remitted to the outpatient HF unit for monitoring from 2009 to 2011. Patients were included in the study if they had a previous documented episode of HF and received HF treatment. CA125 and NT-proBNP concentrations were measured. The independent association between NT-proBNP or CA125 and mortality was assessed with Cox regression analysis, and their combined predictive ability was tested by the integrated discrimination improvement (IDI) index.
RESULTS: The mean age of the 156 patients was 72 ± 12 years. During follow-up (17 ± 8 mo), 27 patients died, 1 received an urgent heart transplantation and 106 required hospitalization for HF. Higher CA125 values were correlated with outcomes: 58 ± 85 KU/L if hospitalized vs 34 ± 61 KU/L if not (P < 0.05), and 94 ± 121 KU/L in those who died or needed urgent heart transplantation vs 45 ± 78 KU/L in survivors (P < 0.01). After adjusting for propensity scores, the highest risk was observed when both biomarkers were elevated vs not elevated (HR = 8.95, 95%CI: 3.11-25.73; P < 0.001) and intermediate when only NT-proBNP was elevated vs not elevated (HR = 4.15, 95%CI: 1.41-12.24; P < 0.01). Moreover, when CA125 was added to the clinical model with NT-proBNP, a 4% (P < 0.05) improvement in the IDI was found.
CONCLUSION: CA125 > 60 KU/L identified patients in stable HF with poor survival. Circulating CA125 level adds prognostic value to NT-proBNP level in predicting HF outcomes.
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Affiliation(s)
- Gaetano Santulli
- From the Departments of Advanced Biomedical Sciences and Translational Medical Sciences, “Federico II” University, Naples, Italy; and College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
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Corbi G, Conti V, Russomanno G, Longobardi G, Furgi G, Filippelli A, Ferrara N. Adrenergic signaling and oxidative stress: a role for sirtuins? Front Physiol 2013. [PMID: 24265619 DOI: 10.3389/fphys.2013.00324.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The adrenergic system plays a central role in stress signaling and stress is often associated with increased production of ROS. However, ROS overproduction generates oxidative stress, that occurs in response to several stressors. β-adrenergic signaling is markedly attenuated in conditions such as heart failure, with downregulation and desensitization of the receptors and their uncoupling from adenylyl cyclase. Transgenic activation of β2-adrenoceptor leads to elevation of NADPH oxidase activity, with greater ROS production and p38MAPK phosphorylation. Inhibition of NADPH oxidase or ROS significantly reduced the p38MAPK signaling cascade. Chronic β2-adrenoceptor activation is associated with greater cardiac dilatation and dysfunction, augmented pro-inflammatory and profibrotic signaling, while antioxidant treatment protected hearts against these abnormalities, indicating ROS production to be central to the detrimental signaling of β2-adrenoceptors. It has been demonstrated that sirtuins are involved in modulating the cellular stress response directly by deacetylation of some factors. Sirt1 increases cellular stress resistance, by an increased insulin sensitivity, a decreased circulating free fatty acids and insulin-like growth factor (IGF-1), an increased activity of AMPK, increased activity of PGC-1a, and increased mitochondrial number. Sirt1 acts by involving signaling molecules such P-I-3-kinase-Akt, MAPK and p38-MAPK-β. βAR stimulation antagonizes the protective effect of the AKT pathway through inhibiting induction of Hif-1α and Sirt1 genes, key elements in cell survival. More studies are needed to better clarify the involvement of sirtuins in the β-adrenergic response and, overall, to better define the mechanisms by which tools such as exercise training are able to counteract the oxidative stress, by both activation of sirtuins and inhibition of GRK2 in many cardiovascular conditions and can be used to prevent or treat diseases such as heart failure.
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Affiliation(s)
- Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise Campobasso, Italy
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