1
|
Fenski M, Abazi E, Gröschel J, Hadler T, Kappelmayer D, Kolligs F, Prieto C, Botnar R, Kunze KP, Schulz-Menger J. Cardiovascular magnetic resonance reveals myocardial involvement in patients with active stage of inflammatory bowel disease. Clin Res Cardiol 2024:10.1007/s00392-024-02503-5. [PMID: 39102000 DOI: 10.1007/s00392-024-02503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Active inflammatory bowel disease (A-IBD) but not remission (R-IBD) has been associated with an increased risk of cardiovascular death and hospitalization for heart failure. OBJECTIVES Using cardiovascular magnetic resonance (CMR), this study aims to assess adverse myocardial remodeling in patients with IBD in correlation with disease activity. METHODS Forty-four IBD patients without cardiovascular disease (24 female, median-age: 39.5 years, 26 A-IBD, 18 R-IBD) and 44 matched healthy volunteers (HV) were prospectively enrolled. The disease stage was determined by endoscopic and patient-reported criteria. Participants underwent CMR for cardiac phenotyping: cine imaging and strain analysis were performed to assess ventricular function. T1 mapping, extracellular volume and late-gadolinium enhanced images were obtained to assess focal and diffuse myocardial fibrosis. Simultaneous T1 and T2 elevation (T1 > 1049.3 ms, T2 > 54 ms) was considered to indicate a myocardial segment was inflamed. RESULTS 16/44 (16.4%) IBD patients described dyspnea on exertion and 10/44 (22.7%) reported chest pain. A-IBD patients showed impaired ventricular function, indicated by reduced global circumferential and radial strain despite preserved left-ventricular ejection fraction. 16% of all IBD patients had focal fibrosis in a non-ischemic pattern. A-IDB patients had increased markers of diffuse left ventricular fibrosis (T1-values: A-IBD: 1022.0 ± 34.83 ms, R-IBD: 1010.10 ± 32.88 ms, HV: 990.61 ± 29.35 ms, p < .01). Significantly more participants with A-IDB (8/26, 30.8%) had at least one inflamed myocardial segment than patients in remission (0/18) and HV (1/44, 2.3%, p < .01). Markers of diffuse fibrosis correlated with disease activity. CONCLUSION This study, using CMR, provides evidence of myocardial involvement and patterns of adverse left ventricular remodeling in patients with IBD. CLINICAL TRIAL REGISTRATION ISRCTN30941346.
Collapse
Affiliation(s)
- Maximilian Fenski
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany
| | - Endri Abazi
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany
| | - Jan Gröschel
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany
| | - Thomas Hadler
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany
| | - Diane Kappelmayer
- Department of Internal Medicine and Gastroenterology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Frank Kolligs
- Department of Internal Medicine and Gastroenterology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karl-Philipp Kunze
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| |
Collapse
|
2
|
Juliana N, Abd Aziz NAS, Maluin SM, Abu Yazit NA, Azmani S, Kadiman S, Hafidz KM, Mohd Fahmi Teng NI, Das S. Nutritional Status and Post-Cardiac Surgery Outcomes: An Updated Review with Emphasis on Cognitive Function. J Clin Med 2024; 13:4015. [PMID: 39064055 PMCID: PMC11277625 DOI: 10.3390/jcm13144015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Nutritional status significantly influences cardiac surgery outcomes, with malnutrition contributing to poorer results and increased complications. This study addresses the critical gap in understanding by exploring the relationship between pre-operative nutritional status and post-operative cognitive dysfunction (POCD) in adult cardiac patients. Methods: A comprehensive search across key databases investigates the prevalence of malnutrition in pre-operative cardiac surgery patients, its effects, and its association with POCD. Factors exacerbating malnutrition, such as chronic illnesses and reduced functionality, are considered. The study also examines the incidence of POCD, its primary association with CABG procedures, and the impact of malnutrition on complications like inflammation, pulmonary and cardiac failure, and renal injury. Discussions: Findings reveal that 46.4% of pre-operative cardiac surgery patients experience malnutrition, linked to chronic illnesses and reduced functionality. Malnutrition significantly contributes to inflammation and complications, including POCD, with an incidence ranging from 15 to 50%. CABG procedures are particularly associated with POCD, and malnutrition prolongs intensive care stays while increasing vulnerability to surgical stress. Conclusions: The review underscores the crucial role of nutrition in recovery and advocates for a universally recognized nutrition assessment tool tailored to diverse cardiac surgery patients. Emphasizing pre-operative enhanced nutrition as a potential strategy to mitigate inflammation and improve cognitive function, the review highlights the need for integrating nutrition screening into clinical practice to optimize outcomes for high-risk cardiac surgery patients. However, to date, most data came from observational studies; hence, there is a need for future interventional studies to test the hypothesis that pre-operative enhanced nutrition can mitigate inflammation and improve cognitive function in this patient population.
Collapse
Affiliation(s)
- Norsham Juliana
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia; (S.M.M.); (S.A.)
| | - Nur Adilah Shuhada Abd Aziz
- Department of Anesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (N.A.S.A.A.); (N.A.A.Y.); (S.K.); (K.M.H.)
| | - Sofwatul Mokhtarah Maluin
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia; (S.M.M.); (S.A.)
| | - Noor Anisah Abu Yazit
- Department of Anesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (N.A.S.A.A.); (N.A.A.Y.); (S.K.); (K.M.H.)
| | - Sahar Azmani
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia; (S.M.M.); (S.A.)
- KPJ Research Centre, KPJ Healthcare University, Nilai 71800, Negeri Sembilan, Malaysia
| | - Suhaini Kadiman
- Department of Anesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (N.A.S.A.A.); (N.A.A.Y.); (S.K.); (K.M.H.)
| | - Kamilah Muhammad Hafidz
- Department of Anesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (N.A.S.A.A.); (N.A.A.Y.); (S.K.); (K.M.H.)
| | | | - Srijit Das
- Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| |
Collapse
|
3
|
Sato R, Vatic M, Peixoto da Fonseca GW, Anker SD, von Haehling S. Biological basis and treatment of frailty and sarcopenia. Cardiovasc Res 2024:cvae073. [PMID: 38828887 DOI: 10.1093/cvr/cvae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/23/2022] [Accepted: 12/20/2022] [Indexed: 06/05/2024] Open
Abstract
In an ageing society, the importance of maintaining healthy life expectancy has been emphasized. As a result of age-related decline in functional reserve, frailty is a state of increased vulnerability and susceptibility to adverse health outcomes with a serious impact on healthy life expectancy. The decline in skeletal muscle mass and function, also known as sarcopenia, is key in the development of physical frailty. Both frailty and sarcopenia are highly prevalent in patients not only with advanced age but also in patients with illnesses that exacerbate their progression like heart failure (HF), cancer, or dementia, with the prevalence of frailty and sarcopenia in HF patients reaching up to 50-75% and 19.5-47.3%, respectively, resulting in 1.5-3 times higher 1-year mortality. The biological mechanisms of frailty and sarcopenia are multifactorial, complex, and not yet fully elucidated, ranging from DNA damage, proteostasis impairment, and epigenetic changes to mitochondrial dysfunction, cellular senescence, and environmental factors, many of which are further linked to cardiac disease. Currently, there is no gold standard for the treatment of frailty and sarcopenia, however, growing evidence supports that a combination of exercise training and nutritional supplement improves skeletal muscle function and frailty, with a variety of other therapies being devised based on the underlying pathophysiology. In this review, we address the involvement of frailty and sarcopenia in cardiac disease and describe the latest insights into their biological mechanisms as well as the potential for intervention through exercise, diet, and specific therapies.
Collapse
Affiliation(s)
- Ryosuke Sato
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Mirela Vatic
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Guilherme Wesley Peixoto da Fonseca
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| |
Collapse
|
4
|
Vlachakis PK, Theofilis P, Kachrimanidis I, Giannakopoulos K, Drakopoulou M, Apostolos A, Kordalis A, Leontsinis I, Tsioufis K, Tousoulis D. The Role of Inflammasomes in Heart Failure. Int J Mol Sci 2024; 25:5372. [PMID: 38791409 PMCID: PMC11121241 DOI: 10.3390/ijms25105372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Heart failure (HF) poses a significant world health challenge due to the increase in the aging population and advancements in cardiac care. In the pathophysiology of HF, the inflammasome has been correlated with the development, progression, and complications of HF disease. Discovering biomarkers linked to inflammasomes enhances understanding of HF diagnosis and prognosis. Directing inflammasome signaling emerges as an innovative therapeutic strategy for managing HF. The present review aims to delve into this inflammatory cascade, understanding its role in the development of HF, its potential role as biomarker, as well as the prospects of modulating inflammasomes as a therapeutic approach for HF.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Dimitris Tousoulis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.V.); (P.T.); (I.K.); (K.G.); (M.D.); (A.A.); (A.K.); (I.L.); (K.T.)
| |
Collapse
|
5
|
Poveda J, González-Lafuente L, Vázquez-Sánchez S, Mercado-García E, Rodríguez-Sánchez E, García-Consuegra I, Sanz AB, Segura J, Fernández-Velasco M, Liaño F, Ruilope LM, Ruiz-Hurtado G. Targeting the TWEAK-Fn14 pathway prevents dysfunction in cardiac calcium handling after acute kidney injury. J Pathol 2023; 261:427-441. [PMID: 37776271 DOI: 10.1002/path.6200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 10/02/2023]
Abstract
Heart and kidney have a closely interrelated pathophysiology. Acute kidney injury (AKI) is associated with significantly increased rates of cardiovascular events, a relationship defined as cardiorenal syndrome type 3 (CRS3). The underlying mechanisms that trigger heart disease remain, however, unknown, particularly concerning the clinical impact of AKI on cardiac outcomes and overall mortality. Tumour necrosis factor-like weak inducer of apoptosis (TWEAK) and its receptor fibroblast growth factor-inducible 14 (Fn14) are independently involved in the pathogenesis of both heart and kidney failure, and recent studies have proposed TWEAK as a possible therapeutic target; however, its specific role in cardiac damage associated with CRS3 remains to be clarified. Firstly, we demonstrated in a retrospective longitudinal clinical study that soluble TWEAK plasma levels were a predictive biomarker of mortality in patients with AKI. Furthermore, the exogenous application of TWEAK to native ventricular cardiomyocytes induced relevant calcium (Ca2+ ) handling alterations. Next, we investigated the role of the TWEAK-Fn14 axis in cardiomyocyte function following renal ischaemia-reperfusion (I/R) injury in mice. We observed that TWEAK-Fn14 signalling was activated in the hearts of AKI mice. Mice also showed significantly altered intra-cardiomyocyte Ca2+ handling and arrhythmogenic Ca2+ events through an impairment in sarcoplasmic reticulum Ca2+ -adenosine triphosphatase 2a pump (SERCA2a ) and ryanodine receptor (RyR2 ) function. Administration of anti-TWEAK antibody after reperfusion significantly improved alterations in Ca2+ cycling and arrhythmogenic events and prevented SERCA2a and RyR2 modifications. In conclusion, this study establishes the relevance of the TWEAK-Fn14 pathway in cardiac dysfunction linked to CRS3, both as a predictor of mortality in patients with AKI and as a Ca2+ mishandling inducer in cardiomyocytes, and highlights the cardioprotective benefits of TWEAK targeting in CRS3. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
Collapse
Affiliation(s)
- Jonay Poveda
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura González-Lafuente
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sara Vázquez-Sánchez
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elisa Mercado-García
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Rodríguez-Sánchez
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Inés García-Consuegra
- Proteomics Unit, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Belén Sanz
- Nephrology Laboratory, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid and REDINREN, Madrid, Spain
| | - Julián Segura
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Fernández-Velasco
- IdiPAZ Institute for Health Research/Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, CIBER-CV, Madrid, Spain
| | - Fernando Liaño
- Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), Madrid, Spain
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Doctoral Studies and Research, European University of Madrid, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research Imas12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
6
|
Damluji AA, Alfaraidhy M, AlHajri N, Rohant NN, Kumar M, Al Malouf C, Bahrainy S, Ji Kwak M, Batchelor WB, Forman DE, Rich MW, Kirkpatrick J, Krishnaswami A, Alexander KP, Gerstenblith G, Cawthon P, deFilippi CR, Goyal P. Sarcopenia and Cardiovascular Diseases. Circulation 2023; 147:1534-1553. [PMID: 37186680 PMCID: PMC10180053 DOI: 10.1161/circulationaha.123.064071] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be particularly important among those with chronic disease states. Early recognition of sarcopenia is important because it can provide an opportunity for interventions to reverse or delay the progression of muscle disorder, which may ultimately impact cardiovascular outcomes. Relying on body mass index is not useful for screening because many patients will have sarcopenic obesity, a particularly important phenotype among older cardiac patients. In this review, we aimed to: (1) provide a definition of sarcopenia within the context of muscle wasting disorders; (2) summarize the associations between sarcopenia and different cardiovascular diseases; (3) highlight an approach for a diagnostic evaluation; (4) discuss management strategies for sarcopenia; and (5) outline key gaps in knowledge with implications for the future of the field.
Collapse
Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | - Maha Alfaraidhy
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | - Noora AlHajri
- Cleveland Clinic, Abu Dhabi, United Arab Emirates (N.A.)
| | | | | | | | | | | | - Wayne B Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
| | - Daniel E Forman
- University of Pittsburgh and the Pittsburgh Geriatric Research Education and Clinical Center, PA (D.E.F.)
| | | | | | | | - Karen P Alexander
- Duke Clinical Research Institute, Duke University, Durham, NC (K.P.A.)
| | - Gary Gerstenblith
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | | | - Christopher R deFilippi
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
| | - Parag Goyal
- University of Arizona, Tucson (N.N.R., P.G.)
| |
Collapse
|
7
|
Song YK, Yuan HX, Jian YP, Chen YT, Liang KF, Liu XJ, Ou ZJ, Liu JS, Li Y, Ou JS. Pentraxin 3 in Circulating Microvesicles: a Potential Biomarker for Acute Heart Failure After Cardiac Surgery with Cardiopulmonary Bypass. J Cardiovasc Transl Res 2022; 15:1414-1423. [PMID: 35879589 DOI: 10.1007/s12265-022-10253-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 10/16/2022]
Abstract
The aim of this study was to investigate whether pentraxin 3 (PTX3) in microvesicles (MVs) can be a valuable biomarker for the prediction of acute heart failure (AHF) after cardiac surgery with cardiopulmonary bypass (CPB). One hundred and twenty-four patients undergoing cardiac surgery with CPB were included and analyzed (29 with AHF and 95 without AHF). The concentrations of PTX3 in MVs isolated from plasma were measured by ELISA kits before, 12 h, and 3 days after surgery. Patients' demographics, medical history, surgical data, and laboratory results were collected. The levels of PTX3 in MVs were significantly elevated during perioperative surgery, which was increased more in the AHF group. The concentrations of PTX3 in MVs at postoperative 12 h were independent risk factors for AHF with the area under the ROC curve of 0.920. The concentration of PTX3 in MVs may be a novel biomarker for prediction of AHF after cardiac surgery.
Collapse
Affiliation(s)
- Yuan-Kai Song
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Hao-Xiang Yuan
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Yu-Peng Jian
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Ya-Ting Chen
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Kai-Feng Liang
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Xiao-Jun Liu
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Zhi-Jun Ou
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- Division of Hypertension and Vascular Diseases, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Sheng Liu
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Yan Li
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China.
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
| | - Jing-Song Ou
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China.
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Brain Function and Disease, Guangzhou, China.
| |
Collapse
|
8
|
Wang Z, Qin Z, Yuan R, Guo J, Xu S, Lv Y, Xu Y, Lu Y, Gao J, Yu F, Tang L, Zhang L, Bai J, Cui X, Zhang J, Tang J. Systemic immune-inflammation index as a prognostic marker for advanced chronic heart failure with renal dysfunction. ESC Heart Fail 2022; 10:478-491. [PMID: 36316302 PMCID: PMC9871671 DOI: 10.1002/ehf2.14217] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS We aim to investigate the correlation between high levels of the systemic immune-inflammation index (SII) and long-term mortality and major cardiovascular adverse events in advanced chronic heart failure patients with renal dysfunction. METHODS AND RESULTS Seven hundred seventeen advanced chronic heart failure patients with renal dysfunction, who visited the First affiliated hospital of Zhengzhou University from September 2019 to December 2020, were included. All-cause mortalities (ACM) were selected as primary endpoints and major cardiovascular adverse events (MACEs) as the secondary endpoints. Based on the receiver operating characteristic (ROC) curve and the Youden index, the optimal cut-off values of SII for ACM and MACEs were 1228 and 1406. In the group where ACM were the primary endpoint, patients were categorized into the low-SII group (n = 479) and the high-SII group (n = 238). Patients in the group using MACEs as the secondary endpoint were also categorized into the low-SII groups (n = 514) and the high-SII groups (n = 203). Univariate and multivariate COX regression were used to screen the independent predictors for ACM and MACEs, revealing the relationship between SII levels and endpoints. According to the univariate COX analysis, SII was the risk factor (hazard ratio [HR] = 2.144, 95% confidence interval [CI]: 1.565-2.938, P < 0.001) for the ACM subgroup. It was also the risk factor (HR = 1.625, CI: 1.261-2.905, P < 0.001) for the MACEs subgroup. Multivariate COX regression analysis indicated that the occurrence of ACM and MACEs in high-level SII and low-level SII patients had statistical differences. The incidence of ACM increased by 70.3% (HR = 1.703; 95% CI: 1.200-2.337; P = 0.002) in patients of the high SII level group, the incidence of MACEs increased by 58.3% (HR = 1.583, 95% CI: 1.213-2.065, P = 0.001). Kaplan-Meier (K-M) survival analysis further suggested that patients with a high SII level had an increased risk of having ACM (log-rank P < 0.001) and MACEs (log-rank P < 0.001) within 30 months. SII could be considered as a novel predictor of the occurrence of ACM and MACEs for patients with advanced chronic heart failure and renal dysfunction. CONCLUSIONS This study suggested that SII is a novel independent predictor of mortality in advanced chronic heart failure patients with renal dysfunction, and it should be considered in current clinical management.
Collapse
Affiliation(s)
- Zeyu Wang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Zhen Qin
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Ruixia Yuan
- Clinical Big Data CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Jiacheng Guo
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Shuai Xu
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Yan Lv
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Yanyan Xu
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Yongzheng Lu
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Jiamin Gao
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Fengyi Yu
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Laiyi Tang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Li Zhang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Jing Bai
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Xiaolin Cui
- School of MedicineThe Chinese University of Hong KongShenzhenChina
| | - Jinying Zhang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| | - Junnan Tang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Henan Province Key Laboratory of Cardiac Injury and RepairZhengzhouChina,Henan Province Clinical Research Center for Cardiovascular DiseasesZhengzhouChina
| |
Collapse
|
9
|
Zheng Y, Xu L, Dong N, Li F. NLRP3 inflammasome: The rising star in cardiovascular diseases. Front Cardiovasc Med 2022; 9:927061. [PMID: 36204568 PMCID: PMC9530053 DOI: 10.3389/fcvm.2022.927061] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Cardiovascular diseases (CVDs) are the prevalent cause of mortality around the world. Activation of inflammasome contributes to the pathological progression of cardiovascular diseases, including atherosclerosis, abdominal aortic aneurysm, myocardial infarction, dilated cardiomyopathy, diabetic cardiomyopathy, heart failure, and calcific aortic valve disease. The nucleotide oligomerization domain-, leucine-rich repeat-, and pyrin domain-containing protein 3 (NLRP3) inflammasome plays a critical role in the innate immune response, requiring priming and activation signals to provoke the inflammation. Evidence shows that NLRP3 inflammasome not only boosts the cleavage and release of IL-1 family cytokines, but also leads to a distinct cell programmed death: pyroptosis. The significance of NLRP3 inflammasome in the CVDs-related inflammation has been extensively explored. In this review, we summarized current understandings of the function of NLRP3 inflammasome in CVDs and discussed possible therapeutic options targeting the NLRP3 inflammasome.
Collapse
|
10
|
Giannattasio S, Citarella A, Trocchianesi S, Filardi T, Morano S, Lenzi A, Ferretti E, Crescioli C. Cell-Target-Specific Anti-Inflammatory Effect of Empagliflozin: In Vitro Evidence in Human Cardiomyocytes. Front Mol Biosci 2022; 9:879522. [PMID: 35712355 PMCID: PMC9194473 DOI: 10.3389/fmolb.2022.879522] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 12/21/2022] Open
Abstract
The antidiabetic sodium–glucose cotransporter type 2 inhibitor (SGLT2i) empagliflozin efficiently reduces heart failure (HF) hospitalization and cardiovascular death in type 2 diabetes (T2D). Empagliflozin-cardioprotection likely includes anti-inflammatory effects, regardless glucose lowering, but the underlying mechanisms remain unclear. Inflammation is a primary event in diabetic cardiomyopathy (DCM) and HF development. The interferon (IFN)γ-induced 10-kDa protein (IP-10/CXCL10), a T helper 1 (Th1)-type chemokine, promotes cardiac inflammation, fibrosis, and diseases, including DCM, ideally representing a therapeutic target. This preliminary study aims to explore whether empagliflozin directly affects Th1-challenged human cardiomyocytes, in terms of CXCL10 targeting. To this purpose, empagliflozin dose–response curves were performed in cultured human cardiomyocytes maintained within a Th1-dominant inflammatory microenvironment (IFNγ/TNFα), and CXCL10 release with the intracellular IFNγ-dependent signaling pathway (Stat-1) was investigated. To verify possible drug–cell-target specificity, the same assays were run in human skeletal muscle cells. Empagliflozin dose dependently inhibited CXCL10 secretion (IC50 = 76,14 × 10-9 M) in association with Stat-1 pathway impairment only in Th1-induced human cardiomyocytes, suggesting drug-selective cell-type-targeting. As CXCL10 plays multifaceted functions in cardiac remodeling toward HF and currently there is no effective method to prevent it, these preliminary data might be hypothesis generating to open new scenarios in the translational approach to SGLT2i-dependent cardioprotection.
Collapse
Affiliation(s)
- Silvia Giannattasio
- Laboratory of Endocrine Research, Department of Movement, Human and Health Sciences, Section of Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- Laboratory of Nutrigenetic and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Anna Citarella
- Laboratory of Oncogemics, Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Sofia Trocchianesi
- Laboratory of Molecular Medicine “Alberto Gulino” Group, Department of Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Tiziana Filardi
- Laboratory of Oncogemics, Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Susanna Morano
- Laboratory of Oncogemics, Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Lenzi
- Laboratory of Oncogemics, Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Elisabetta Ferretti
- Laboratory of Oncogemics, Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Elisabetta Ferretti, ; Clara Crescioli,
| | - Clara Crescioli
- Laboratory of Endocrine Research, Department of Movement, Human and Health Sciences, Section of Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- *Correspondence: Elisabetta Ferretti, ; Clara Crescioli,
| |
Collapse
|
11
|
Dyck JRB, Sossalla S, Hamdani N, Coronel R, Weber NC, Light PE, Zuurbier CJ. Cardiac mechanisms of the beneficial effects of SGLT2 inhibitors in heart failure: Evidence for potential off-target effects. J Mol Cell Cardiol 2022; 167:17-31. [PMID: 35331696 DOI: 10.1016/j.yjmcc.2022.03.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 02/07/2023]
Abstract
Sodium glucose cotransporter 2 inhibitors (SGLT2i) constitute a promising drug treatment for heart failure patients with either preserved or reduced ejection fraction. Whereas SGLT2i were originally developed to target SGLT2 in the kidney to facilitate glucosuria in diabetic patients, it is becoming increasingly clear that these drugs also have important effects outside of the kidney. In this review we summarize the literature on cardiac effects of SGLT2i, focussing on pro-inflammatory and oxidative stress processes, ion transport mechanisms controlling sodium and calcium homeostasis and metabolic/mitochondrial pathways. These mechanisms are particularly important as disturbances in these pathways result in endothelial dysfunction, diastolic dysfunction, cardiac stiffness, and cardiac arrhythmias that together contribute to heart failure. We review the findings that support the concept that SGLT2i directly and beneficially interfere with inflammation, oxidative stress, ionic homeostasis, and metabolism within the cardiac cell. However, given the very low levels of SGLT2 in cardiac cells, the evidence suggests that SGLT2-independent effects of this class of drugs likely occurs via off-target effects in the myocardium. Thus, while there is still much to be understood about the various factors which determine how SGLT2i affect cardiac cells, much of the research clearly demonstrates that direct cardiac effects of these SGLT2i exist, albeit mediated via SGLT2-independent pathways, and these pathways may play a role in explaining the beneficial effects of SGLT2 inhibitors in heart failure.
Collapse
Affiliation(s)
- Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, 93053 Regensburg, Germany; Klinik für Kardiologie und Pneumologie, Georg-August-Universität Goettingen, DZHK (German Centre for Cardiovascular Research), Robert-Koch Str. 40, D-37075 Goettingen, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital Ruhr University Bochum, Bochum, Germany
| | - Ruben Coronel
- Department of Experimental Cardiology, Amsterdam University Medical Centers, Location AMC, Cardiovascular Science, Amsterdam, the Netherlands
| | - Nina C Weber
- Department of Anesthesiology - L.E.I.C.A, Amsterdam University Medical Centers, Location AMC, Cardiovascular Science, Amsterdam, the Netherlands
| | - Peter E Light
- Alberta Diabetes Institute, Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Coert J Zuurbier
- Department of Anesthesiology - L.E.I.C.A, Amsterdam University Medical Centers, Location AMC, Cardiovascular Science, Amsterdam, the Netherlands.
| |
Collapse
|
12
|
|
13
|
Philippaert K, Kalyaanamoorthy S, Fatehi M, Long W, Soni S, Byrne NJ, Barr A, Singh J, Wong J, Palechuk T, Schneider C, Darwesh AM, Maayah ZH, Seubert JM, Barakat K, Dyck JR, Light PE. Cardiac Late Sodium Channel Current Is a Molecular Target for the Sodium/Glucose Cotransporter 2 Inhibitor Empagliflozin. Circulation 2021; 143:2188-2204. [PMID: 33832341 PMCID: PMC8154177 DOI: 10.1161/circulationaha.121.053350] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND SGLT2 (sodium/glucose cotransporter 2) inhibitors exert robust cardioprotective effects against heart failure in patients with diabetes, and there is intense interest to identify the underlying molecular mechanisms that afford this protection. Because the induction of the late component of the cardiac sodium channel current (late-INa) is involved in the etiology of heart failure, we investigated whether these drugs inhibit late-INa. METHODS Electrophysiological, in silico molecular docking, molecular, calcium imaging, and whole heart perfusion techniques were used to address this question. RESULTS The SGLT2 inhibitor empagliflozin reduced late-INa in cardiomyocytes from mice with heart failure and in cardiac Nav1.5 sodium channels containing the long QT syndrome 3 mutations R1623Q or ΔKPQ. Empagliflozin, dapagliflozin, and canagliflozin are all potent and selective inhibitors of H2O2-induced late-INa (half maximal inhibitory concentration = 0.79, 0.58, and 1.26 µM, respectively) with little effect on peak sodium current. In mouse cardiomyocytes, empagliflozin reduced the incidence of spontaneous calcium transients induced by the late-INa activator veratridine in a similar manner to tetrodotoxin, ranolazine, and lidocaine. The putative binding sites for empagliflozin within Nav1.5 were investigated by simulations of empagliflozin docking to a three-dimensional homology model of human Nav1.5 and point mutagenic approaches. Our results indicate that empagliflozin binds to Nav1.5 in the same region as local anesthetics and ranolazine. In an acute model of myocardial injury, perfusion of isolated mouse hearts with empagliflozin or tetrodotoxin prevented activation of the cardiac NLRP3 (nuclear-binding domain-like receptor 3) inflammasome and improved functional recovery after ischemia. CONCLUSIONS Our results provide evidence that late-INa may be an important molecular target in the heart for the SGLT2 inhibitors, contributing to their unexpected cardioprotective effects.
Collapse
Affiliation(s)
- Koenraad Philippaert
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| | - Subha Kalyaanamoorthy
- Faculty of Medicine and Dentistry (S.K., A.M.D., J.M.S., K.B.), University of Alberta, Edmonton, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences (S.K., A.M.D., J.M.S., K.B.), University of Alberta, Edmonton, Canada
| | - Mohammad Fatehi
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| | - Wentong Long
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| | - Shubham Soni
- Department of Pediatrics (S.S., N.J.B., Z.H.M., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Nikole J. Byrne
- Department of Pediatrics (S.S., N.J.B., Z.H.M., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Amy Barr
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| | - Jyoti Singh
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| | - Jordan Wong
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| | - Taylor Palechuk
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| | - Chloe Schneider
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| | - Ahmed M. Darwesh
- Faculty of Medicine and Dentistry (S.K., A.M.D., J.M.S., K.B.), University of Alberta, Edmonton, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences (S.K., A.M.D., J.M.S., K.B.), University of Alberta, Edmonton, Canada
| | - Zaid H. Maayah
- Department of Pediatrics (S.S., N.J.B., Z.H.M., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - John M. Seubert
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
- Faculty of Medicine and Dentistry (S.K., A.M.D., J.M.S., K.B.), University of Alberta, Edmonton, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences (S.K., A.M.D., J.M.S., K.B.), University of Alberta, Edmonton, Canada
| | - Khaled Barakat
- Faculty of Medicine and Dentistry (S.K., A.M.D., J.M.S., K.B.), University of Alberta, Edmonton, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences (S.K., A.M.D., J.M.S., K.B.), University of Alberta, Edmonton, Canada
- Li Ka Shing Institute of Virology (K.B.), University of Alberta, Edmonton, Canada
| | - Jason R.B. Dyck
- Department of Pediatrics (S.S., N.J.B., Z.H.M., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Peter E. Light
- Alberta Diabetes Institute (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada.xs
- Department of Pharmacology (K.P., M.F., W.L., A.B., J.S., J.W., T.P., C.S., J.M.S., P.E.L.), University of Alberta, Edmonton, Canada
| |
Collapse
|
14
|
de Carvalho AETS, Cordeiro MA, Rodrigues LS, Ortolani D, Spadari RC. Stress-induced differential gene expression in cardiac tissue. Sci Rep 2021; 11:9129. [PMID: 33911098 PMCID: PMC8080723 DOI: 10.1038/s41598-021-88267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/17/2021] [Indexed: 11/09/2022] Open
Abstract
The stress response is adaptive and aims to guarantee survival. However, the persistence of a stressor can culminate in pathology. Catecholamines released as part of the stress response over activate beta adrenoceptors (β-AR) in the heart. Whether and how stress affects the expression of components of the intracellular environment in the heart is still, however, unknown. This paper used microarray to analyze the gene expression in the left ventricle wall of rats submitted to foot shock stress, treated or not treated with the selective β2-AR antagonist ICI118,551 (ICI), compared to those of non-stressed rats also treated or not with ICI, respectively. The main findings were that stress induces changes in gene expression in the heart and that β2-AR plays a role in this process. The vast majority of genes disregulated by stress were exclusive for only one of the comparisons, indicating that, in the same stressful situation, the profile of gene expression in the heart is substantially different when the β2-AR is active or when it is blocked. Stress induced alterations in the expression of such a large number of genes seems to be part of stress-induced adaptive mechanism.
Collapse
Affiliation(s)
- Ana Elisa T S de Carvalho
- Laboratory of Stress Biology, Department of Biosciences, Institute of Health and Society, Campus Baixada Santista, Federal University of São Paulo (UNIFESP), Rua Silva Jardim,136, sala 310, Santos, São Paulo, 11020-015, Brazil.
| | - Marco A Cordeiro
- Laboratory of Stress Biology, Department of Biosciences, Institute of Health and Society, Campus Baixada Santista, Federal University of São Paulo (UNIFESP), Rua Silva Jardim,136, sala 310, Santos, São Paulo, 11020-015, Brazil
| | - Luana S Rodrigues
- Laboratory of Stress Biology, Department of Biosciences, Institute of Health and Society, Campus Baixada Santista, Federal University of São Paulo (UNIFESP), Rua Silva Jardim,136, sala 310, Santos, São Paulo, 11020-015, Brazil
| | - Daniela Ortolani
- Laboratory of Stress Biology, Department of Biosciences, Institute of Health and Society, Campus Baixada Santista, Federal University of São Paulo (UNIFESP), Rua Silva Jardim,136, sala 310, Santos, São Paulo, 11020-015, Brazil
| | - Regina C Spadari
- Laboratory of Stress Biology, Department of Biosciences, Institute of Health and Society, Campus Baixada Santista, Federal University of São Paulo (UNIFESP), Rua Silva Jardim,136, sala 310, Santos, São Paulo, 11020-015, Brazil.
| |
Collapse
|
15
|
Sobieszek G, Powrózek T, Skwarek-Dziekanowska A, Małecka-Massalska T. Clinical Significance of TNFRSF1A36T/C Polymorphism in Cachectic Patients with Chronic Heart Failure. J Clin Med 2021; 10:jcm10051095. [PMID: 33807923 PMCID: PMC7961661 DOI: 10.3390/jcm10051095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: One of the main factors contributing to the development of nutritional deficits in chronic heart failure (CHF) patients is the systemic inflammatory process. Progressing inflammatory response leads to exacerbation of the disease and could develop into cardiac cachexia (CC), characterized by involuntary weight loss followed by muscle wasting. The aim of this study was to assess the relationship between rs767455 (36 T/C) of the TNFRSF1A and the occurrence of nutritional disorders in CHF patients with cachexia. Materials and Methods: We enrolled 142 CHF individuals who underwent cardiac and nutritional screening in order to assess cardiac performance and nutritional status. The relationship between TNFRSF1A rs767455 genotypes and patients' features was investigated. Results: A greater distribution of the TT genotype among cachectic patients in contrast to non-cachectic individuals was found (TT frequencies of 62.9% and 37.1%, respectively; p = 0.013). We noted a significantly lower albumin concentration (p = 0.039) and higher C-reactive protein (CRP) levels (p = 0.019) in patients with the TT genotype. Regarding cardiac parameters, CHF individuals bearing the TT genotype demonstrated a significant reduction in ejection fraction (EF) (p = 0.033) in contrast to other genotype carriers; moreover, they had a significantly higher concentration of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in the blood (p = 0.018). We also noted a lower frequency of TT genotype carriers among individuals qualified as grades I or II of the New York Heart Association (NYHA) (p = 0.006). The multivariable analysis selected the TT genotype as an unfavorable factor related to a higher chance of cachexia in CHF patients (Odds ratio (OR) = 2.56; p = 0.036). Conclusions: The rs767455TT genotype of TNFRSF1A can be considered as an unfavorable factor related to a higher risk of cachexia in CHF patients.
Collapse
Affiliation(s)
- Grzegorz Sobieszek
- Department of Cardiology, 1st Military Clinical Hospital with the Outpatient Clinic, 20-080 Lublin, Poland;
- Correspondence: (G.S.); (T.P.); Tel.: +48-261-183-614 (G.S.); +48-814-486-080 (T.P.)
| | - Tomasz Powrózek
- Department of Human Physiology, Medical University of Lublin, 20-059 Lublin, Poland;
- Correspondence: (G.S.); (T.P.); Tel.: +48-261-183-614 (G.S.); +48-814-486-080 (T.P.)
| | - Aneta Skwarek-Dziekanowska
- Department of Cardiology, 1st Military Clinical Hospital with the Outpatient Clinic, 20-080 Lublin, Poland;
| | | |
Collapse
|
16
|
The interplay between gastrointestinal and cardiovascular diseases: a narrative review focusing on the clinical perspective. Eur J Gastroenterol Hepatol 2021; 32:132-139. [PMID: 32516176 DOI: 10.1097/meg.0000000000001779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Both cardiovascular and gastrointestinal disorders represent considerable health burden on community clinics and hospitals with overwhelming economic cost. An overlap in the occurrence of these disorders is encountered in daily practice. Both affect each other in bidirectional manner through several mechanisms including altered hemodynamics, systemic inflammation, bacterial overgrowth and interactions and adverse effects of medications. In addition, to the known overlap in the symptoms occurrence of upper gastrointestinal tract diseases and cardiovascular diseases (CVDs). Awareness of this interplay and its clinical manifestations optimizes patient management, and could prevent catastrophic consequences and even save lives. In this review, we highlighted the clinical aspects of this bidirectional association between gastrointestinal and CVDs aiming to shed light on this topic and improve patients' care.
Collapse
|
17
|
Poveda J, Vázquez-Sánchez S, Sanz AB, Ortiz A, Ruilope LM, Ruiz-Hurtado G. TWEAK-Fn14 as a common pathway in the heart and the kidneys in cardiorenal syndrome. J Pathol 2021; 254:5-19. [PMID: 33512736 DOI: 10.1002/path.5631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022]
Abstract
There is a complex relationship between cardiac and renal disease, often referred to as the cardiorenal syndrome. Heart failure adversely affects kidney function, and both acute and chronic kidney disease are associated with structural and functional changes to the myocardium. The pathological mechanisms and contributing interactions that surround this relationship remain poorly understood, limiting the opportunities for therapeutic intervention. The cytokine tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and its receptor, fibroblast growth factor-inducible 14 (Fn14), are abundantly expressed in injured kidneys and heart. The TWEAK-Fn14 axis promotes responses that drive tissue injury such as inflammation, proliferation, fibrosis, and apoptosis, while restraining the expression of tissue protective factors such as the anti-aging factor Klotho and the master regulator of mitochondrial biogenesis peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α). High levels of TWEAK induce cardiac remodeling, and promote inflammation, tubular and podocyte injury and death, fibroblast proliferation, and, ultimately, renal fibrosis. Accordingly, targeting the TWEAK-Fn14 axis is protective in experimental kidney and heart disease. TWEAK has also emerged as a biomarker of kidney damage and cardiovascular outcomes and has been successfully targeted in clinical trials. In this review, we update our current knowledge of the roles of the TWEAK-Fn14 axis in cardiovascular and kidney disease and its potential contribution to the cardiorenal syndrome. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Jonay Poveda
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sara Vázquez-Sánchez
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana B Sanz
- Research Institute - Fundacion Jimenez Diaz, Autonoma University, Madrid, Spain.,REDINREN, Madrid, Spain
| | - Alberto Ortiz
- Research Institute - Fundacion Jimenez Diaz, Autonoma University, Madrid, Spain.,REDINREN, Madrid, Spain
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.,School of Doctoral Studies and Research, European University of Madrid, Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
18
|
Krysztofiak H, Wleklik M, Migaj J, Dudek M, Uchmanowicz I, Lisiak M, Kubielas G, Straburzyńska-Migaj E, Lesiak M, Kałużna-Oleksy M. Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure. Clin Interv Aging 2020; 15:2041-2051. [PMID: 33173285 PMCID: PMC7646468 DOI: 10.2147/cia.s273967] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).
Collapse
Affiliation(s)
- Helena Krysztofiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Marta Wleklik
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | | | - Magdalena Lisiak
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Kubielas
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| |
Collapse
|
19
|
Byrne NJ, Soni S, Takahara S, Ferdaoussi M, Al Batran R, Darwesh AM, Levasseur JL, Beker D, Vos DY, Schmidt MA, Alam AS, Maayah ZH, Schertzer JD, Seubert JM, Ussher JR, Dyck JRB. Chronically Elevating Circulating Ketones Can Reduce Cardiac Inflammation and Blunt the Development of Heart Failure. Circ Heart Fail 2020; 13:e006573. [PMID: 32493060 DOI: 10.1161/circheartfailure.119.006573] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous studies have shown beneficial effects of acute infusion of the primary ketone body, β-hydroxybutyrate, in heart failure (HF). However, whether chronic elevations in circulating ketones are beneficial remains unknown. METHODS To chronically elevate circulating ketones in mice, we deleted the expression of the ketolytic, rate-limiting-enzyme, SCOT (succinyl-CoA:3-ketoacid-CoA transferase 1; encoded by Oxct1), in skeletal muscle. Tamoxifen-inducible skeletal muscle-specific Oxct1Muscle-/- knockout (n=32) mice and littermate controls (wild type; WT; n=35) were subjected to transverse aortic constriction (TAC) surgery to induce HF. RESULTS Deletion of SCOT in skeletal, but not cardiac muscle resulted in elevated concentrations of fasted circulating β-hydroxybutyrate in knockout mice compared with WT mice (P=0.030). Five weeks following TAC, WT mice progressed to HF, whereas knockout mice with elevated fasting circulating ketones were largely protected from the TAC-induced effects observed in WT mice (ejection fraction, P=0.011; mitral E/A, P=0.012). Furthermore, knockout mice with TAC had attenuated expression of markers of sterile inflammation and macrophage infiltration, which were otherwise elevated in WT mice subjected to TAC. Lastly, addition of β-hydroxybutyrate to isolated hearts was associated with reduced NLRP3 (nucleotide-binding domain-like receptor protein 3)-inflammasome activation, which has been previously shown to play a role in contributing to HF-induced cardiac inflammation. CONCLUSIONS These data show that chronic elevation of circulating ketones protects against the development of HF that is associated with the ability of β-hydroxybutyrate to directly reduce inflammation. These beneficial effects of ketones were associated with reduced cardiac NLRP3 inflammasome activation, suggesting that ketones may modulate cardiac inflammation via this mechanism.
Collapse
Affiliation(s)
- Nikole J Byrne
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics (N.J.B., S.S., Z.H.M., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Shubham Soni
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics (N.J.B., S.S., Z.H.M., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute (S.S., R.A.B., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Shingo Takahara
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (S.T.)
| | - Mourad Ferdaoussi
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Rami Al Batran
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute (S.S., R.A.B., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Faculty of Medicine and Dentistry, and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.B., A.M.D., J.M.S., J.R.U.), University of Alberta, Edmonton, Canada
| | - Ahmed M Darwesh
- Faculty of Medicine and Dentistry, and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.B., A.M.D., J.M.S., J.R.U.), University of Alberta, Edmonton, Canada
| | - Jody L Levasseur
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Donna Beker
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Dyonne Y Vos
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Mya A Schmidt
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Abrar S Alam
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Zaid H Maayah
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics (N.J.B., S.S., Z.H.M., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Jonathan D Schertzer
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada (J.D.S.)
| | - John M Seubert
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pharmacology (J.M.S), University of Alberta, Edmonton, Canada.,Faculty of Medicine and Dentistry, and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.B., A.M.D., J.M.S., J.R.U.), University of Alberta, Edmonton, Canada
| | - John R Ussher
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute (S.S., R.A.B., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Faculty of Medicine and Dentistry, and Faculty of Pharmacy and Pharmaceutical Sciences (R.A.B., A.M.D., J.M.S., J.R.U.), University of Alberta, Edmonton, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre (N.J.B., S.S., S.T., M.F., R.A.B., J.L.L., D.B., D.Y.V., M.A.S., A.S.A., Z.H.M., J.M.S., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics (N.J.B., S.S., Z.H.M., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute (S.S., R.A.B., J.R.U., J.R.B.D.), University of Alberta, Edmonton, Canada
| |
Collapse
|
20
|
Pasini E, Comini L, Dioguardi FS, Grossetti F, Olivares A, Zanelli E, Aquilani R, Scalvini S. Hypoalbuminemia as a marker of protein metabolism disarrangement in patients with stable chronic heart failure. Minerva Med 2020; 111:226-238. [PMID: 32166926 DOI: 10.23736/s0026-4806.20.06244-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite therapeutic advances, chronic heart failure (CHF)-related mortality and hospitalization is still unacceptably high. Evidence shows that muscular wasting, sarcopenia, cachexia are independent predictors of mortality and morbidity in CHF and are signs of protein metabolism disarrangement (PMD), which involve all body proteins including circulating one. We postulate that circulating human serum albumin (HSA) could be a marker of PMD and catabolic low-grade inflammation (LGI) in CHF patients. METHODS One hundred sixty-six stable CHF patients (73% males), with optimized therapy referred to cardiac rehabilitation, were retrospectively divided into three groups based on their HSA concentration: ≥3.5 g/dL (normal value), 3.2-3.49 g/dL (low value); ≤3.19 g/dL (severe value). Hematochemical analyses (including circulating proteins and inflammatory markers) and body mass composition (by Bioelectrical Impedance Vector Analysis) were collected and compared. Correlations and multivariate regression were performed. RESULTS Despite being overweight (BMI=27 kg/m2), 75% of patients had reduced HSA (<3.5 g/dL) with suspectable sarcopenia, and 35% of all patients had remarkably lower albumin concentrations (<3.19 g/dL). Hypoalbuminemic patients were disable, older, with reduced muscular proteins, bilirubin and hemoglobin, increased extracellular water and LGI (P<0.01). HSA correlated with all of these parameters (all: P<0.01). Age, LGI, BMI, free-fat Mass, and bilirubin were independent predictors of HSA concentration. All these findings were male-dependent. CONCLUSIONS HSA could be considered a simple marker of PMD and LGI in CHF patients. Evaluation of PMD and gender differences should be considered in new CHF clinical trials.
Collapse
Affiliation(s)
- Evasio Pasini
- Cardiac Rehabilitation of the Institute of Lumezzane, Clinical Scientific Institutes Maugeri IRCCS, Brescia, Italy -
| | - Laura Comini
- Clinical Scientific Institutes Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | | | | | - Adriana Olivares
- Clinical Scientific Institutes Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Emanuela Zanelli
- Cardiac Rehabilitation of the Institute of Lumezzane, Clinical Scientific Institutes Maugeri IRCCS, Brescia, Italy
| | - Roberto Aquilani
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Simonetta Scalvini
- Cardiac Rehabilitation of the Institute of Lumezzane, Clinical Scientific Institutes Maugeri IRCCS, Brescia, Italy
| |
Collapse
|
21
|
Byrne NJ, Matsumura N, Maayah ZH, Ferdaoussi M, Takahara S, Darwesh AM, Levasseur JL, Jahng JWS, Vos D, Parajuli N, El-Kadi AOS, Braam B, Young ME, Verma S, Light PE, Sweeney G, Seubert JM, Dyck JRB. Empagliflozin Blunts Worsening Cardiac Dysfunction Associated With Reduced NLRP3 (Nucleotide-Binding Domain-Like Receptor Protein 3) Inflammasome Activation in Heart Failure. Circ Heart Fail 2020; 13:e006277. [PMID: 31957470 DOI: 10.1161/circheartfailure.119.006277] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although empagliflozin was shown to profoundly reduce cardiovascular events in diabetic patients and blunt the decline in cardiac function in nondiabetic mice with established heart failure (HF), the mechanism of action remains unknown. METHODS AND RESULTS We treated 2 rodent models of HF with 10 mg/kg per day empagliflozin and measured activation of the NLRP3 (nucleotide-binding domain-like receptor protein 3) inflammasome in the heart. We show for the first time that beneficial effects of empagliflozin in HF with reduced ejection fraction (HF with reduced ejection fraction [HFrEF]; n=30-34) occur in the absence of changes in circulating ketone bodies, cardiac ketone oxidation, or increased cardiac ATP production. Of note, empagliflozin attenuated activation of the NLRP3 inflammasome and expression of associated markers of sterile inflammation in hearts from mice with HFrEF, implicating reduced cardiac inflammation as a mechanism of empagliflozin that contributes to sustained function in HFrEF in the absence of diabetes mellitus. In addition, we validate that the beneficial cardiac effects of empagliflozin in HF with preserved ejection fraction (HFpEF; n=9-10) are similarly associated with reduced activation of the NLRP3 inflammasome. Lastly, the ability of empagliflozin to reduce inflammation was completely blunted by a calcium (Ca2+) ionophore, suggesting that empagliflozin exerts its benefit upon restoring optimal cytoplasmic Ca2+ levels in the heart. CONCLUSIONS These data provide evidence that the beneficial cardiac effects of empagliflozin are associated with reduced cardiac inflammation via blunting activation of the NLRP3 inflammasome in a Ca2+-dependent manner and hence may be beneficial in treating HF even in the absence of diabetes mellitus.
Collapse
Affiliation(s)
- Nikole J Byrne
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Nobutoshi Matsumura
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.R.B.D.), University of Alberta, Edmonton, Canada.,Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (N.M., S.T., A.M.D.)
| | - Zaid H Maayah
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Mourad Ferdaoussi
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Shingo Takahara
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.R.B.D.), University of Alberta, Edmonton, Canada.,Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (N.M., S.T., A.M.D.)
| | - Ahmed M Darwesh
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (N.M., S.T., A.M.D.)
| | - Jody L Levasseur
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada
| | | | - Dyonne Vos
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada
| | - Nirmal Parajuli
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada.,Division of Biomedical Science, Sanford School of Medicine, University of South Dakota, Vermillion (N.P.)
| | - Ayman O S El-Kadi
- Faculty of Pharmacy and Pharmaceutical Sciences (A.O.S.E.-K., J.M.S.), University of Alberta, Edmonton, Canada
| | - Branko Braam
- Division of Nephrology, Faculty of Medicine and Dentistry (B.B.), University of Alberta, Edmonton, Canada.,Department of Medicine, Faculty of Medicine and Dentistry (B.B.), University of Alberta, Edmonton, Canada
| | - Martin E Young
- Department of Medicine, University of Alabama at Birmingham (M.E.Y.)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Canada (S.V.)
| | - Peter E Light
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pharmacology, Faculty of Medicine and Dentistry (P.E.L., J.M.S.), University of Alberta, Edmonton, Canada
| | - Gary Sweeney
- Deparment of Biology, York University, Toronto, Canada (J.W.S.J., G.S.)
| | - John M Seubert
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pharmacology, Faculty of Medicine and Dentistry (P.E.L., J.M.S.), University of Alberta, Edmonton, Canada.,Faculty of Pharmacy and Pharmaceutical Sciences (A.O.S.E.-K., J.M.S.), University of Alberta, Edmonton, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., D.V., N.P., P.E.L., J.M.S., J.R.B.D.), University of Alberta, Edmonton, Canada.,Alberta Diabetes Institute, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.L.L., N.P., P.E.L., J.R.B.D.), University of Alberta, Edmonton, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry (N.J.B., N.M., Z.H.M., M.F., S.T., J.R.B.D.), University of Alberta, Edmonton, Canada
| |
Collapse
|
22
|
Perticone M, Zito R, Miceli S, Pinto A, Suraci E, Greco M, Gigliotti S, Hribal ML, Corrao S, Sesti G, Perticone F. Immunity, Inflammation and Heart Failure: Their Role on Cardiac Function and Iron Status. Front Immunol 2019; 10:2315. [PMID: 31632400 PMCID: PMC6779858 DOI: 10.3389/fimmu.2019.02315] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022] Open
Abstract
Aims: Heart failure is a clinical syndrome characterized by subclinical systemic inflammation and immune system activation associated with iron deficiency. No data exist on the various activations of immune-mediated mechanisms of inflammation in heart failure patients with reduced/preserved ejection fraction. We aimed to (1) investigate possible differences in inflammatory parameters and oxidative stress, and (2) detect a different iron status between groups. Materials and Methods: We enrolled 50 consecutive Caucasian outpatients with heart failure. All patients underwent echocardiographic measurements, laboratory determinations, evaluation of iron status and Toll-like receptors, and NF-κB expression in peripheral blood mononuclear cells, as well as pro-inflammatory cytokines. All statistical calculations were made using SPSS for Mac version 21.0. Results: Patients with reduced ejection fraction showed significantly lower hemoglobin levels (12.3 ± 1.4 vs. 13.6 ± 1.4 g/dl), serum iron (61.4 ± 18.3 vs. 93.7 ± 33.7 mcg/dl), transferrin iron binding capacity (20.7 ± 8.4 vs. 31.1 ± 15.6 %), and e-GFR values (78.1 ± 36.1 vs. 118.1 ± 33.9 ml/min/1.73 m2) in comparison to patients with preserved ejection fraction, while unsaturated iron binding capacity (272.6 ± 74.9 vs. 221.7 ± 61.4 mcg/dl), hepcidin (4.61 ± 0.89 vs. 3.28 ± 0.69 ng/ml), and creatinine (1.34 ± 0.55 vs. 1.03 ± 0.25 mg/dl) were significantly higher in the same group. When considering inflammatory parameters, patients with reduced ejection fraction showed significantly higher expression of both Toll-like receptors-2 (1.90 ± 0.97 vs. 1.25 ± 0.76 MFI) and Toll-like receptors-4 (4.54 ± 1.32 vs. 3.38 ± 1.62 MFI), respectively, as well as a significantly higher activity of NF-κB (2.67 ± 0.60 vs. 1.07 ± 0.30). Furthermore, pro-inflammatory cytokines, interleukin-1, and interleukin-6, was significantly higher in patients with reduced ejection fraction, while the protective cytokine interleukin-10 was significantly lower in the same group. Correlational analyses demonstrated a significant and inverse relationship between left ventricular function and inflammatory parameters in patients with reduced ejection fraction, as well as a direct correlation between ferritin and inflammatory parameters. Conclusions: Our data demonstrate a different immune-mediated inflammatory burden in heart failure patients with reduced or preserved ejection fraction, as well as significant differences in iron status. These data contribute to further elucidate pathophysiologic mechanisms leading to cardiac dysfunction.
Collapse
Affiliation(s)
- Maria Perticone
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Roberta Zito
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Sofia Miceli
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Mater Domini, Catanzaro, Italy
| | - Angelina Pinto
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Edoardo Suraci
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Marta Greco
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Simona Gigliotti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Marta Letizia Hribal
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Salvatore Corrao
- Department of Internal Medicine 2, National Relevance and High Specialization Hospital Trust, Palermo, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| |
Collapse
|
23
|
Virzì GM, Breglia A, Ankawi G, Bolin C, de Cal M, Cianci V, Vescovo G, Ronco C. Plasma Lipopolysaccharide Concentrations in Cardiorenal Syndrome Type 1. Cardiorenal Med 2019; 9:308-315. [PMID: 31238313 DOI: 10.1159/000500480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome (CRS) type 1 is characterized by a rapid worsening of cardiac function that leads to acute kidney injury (AKI). This study evaluated the role of lipopolysaccharide (LPS) in the development of AKI in patients with acute heart failure (AHF) and its relationship with renal parameters, to enable a better comprehension of the pathophysiology of CRS type 1. METHODS We enrolled 32 AHF patients, 15 of whom were classified as having CRS type 1. Eight of these 15 exhibited AKI at the time of admission (caused by AHF) and the other 7 developed AKI during their stay in hospital (in the first 48 h). We evaluated the plasmatic LPS concentrations as well as conventional (serum creatinine [sCr] and urea) and unconventional (neutrophil gelatinase-associated lipocalin [NGAL] and cystatin C) renal markers. RESULTS LPS levels were significantly higher in the CRS type 1 patients. No significant difference in LPS level was found in patients who were admitted with AKI and those developed AKI in hospital, but there was a tendency towards a higher level of LPS in CRS type 1 patients admitted with AKI. The LPS concentrations at admission were similar in CRS type 1 survivors (n = 12) and nonsurvivors (n = 3) (p = 0.22). We observed a positive correlation between LPS level and NGAL, Scr at admission and peak Scr during hospitalization and urea at admission. CONCLUSION CRS type 1 patients present with an increased level of LPS and there is a direct correlation between LPS and renal parameters. This pilot research is the first study to explore the premise of LPS as novel pathophysiological factor in CRS type 1.
Collapse
Affiliation(s)
- Grazia Maria Virzì
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy, .,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy,
| | - Andrea Breglia
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Emergency Department of Arzignano Hospital, Arzignano, Italy
| | - Ghada Ankawi
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Internal Medicine and Nephrology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Chiara Bolin
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Vito Cianci
- Emergency Department of Arzignano Hospital, Arzignano, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit, Sant'Antonio Hospital Padua, Padua, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,Nephrology, Department of Medicine, University of Padua, Padua, Italy
| |
Collapse
|
24
|
Lipopolysaccharide in systemic circulation induces activation of inflammatory response and oxidative stress in cardiorenal syndrome type 1. J Nephrol 2019; 32:803-810. [DOI: 10.1007/s40620-019-00613-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/15/2019] [Indexed: 01/21/2023]
|
25
|
Adams V, Linke A. Impact of exercise training on cardiovascular disease and risk. Biochim Biophys Acta Mol Basis Dis 2019; 1865:728-734. [DOI: 10.1016/j.bbadis.2018.08.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/03/2018] [Accepted: 08/15/2018] [Indexed: 01/07/2023]
|
26
|
Núñez J, García-Blas S, Comín-Colet J. Iron deficiency and risk of early readmission following hospitalization for acute heart failure. Reply. Eur J Heart Fail 2018; 18:881. [PMID: 27427315 DOI: 10.1002/ejhf.588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 01/26/2023] Open
Affiliation(s)
- Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Josep Comín-Colet
- Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| |
Collapse
|
27
|
Holland NA, Francisco JT, Johnson SC, Morgan JS, Dennis TJ, Gadireddy NR, Tulis DA. Cyclic Nucleotide-Directed Protein Kinases in Cardiovascular Inflammation and Growth. J Cardiovasc Dev Dis 2018; 5:E6. [PMID: 29367584 PMCID: PMC5872354 DOI: 10.3390/jcdd5010006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular disease (CVD), including myocardial infarction (MI) and peripheral or coronary artery disease (PAD, CAD), remains the number one killer of individuals in the United States and worldwide, accounting for nearly 18 million (>30%) global deaths annually. Despite considerable basic science and clinical investigation aimed at identifying key etiologic components of and potential therapeutic targets for CVD, the number of individuals afflicted with these dreaded diseases continues to rise. Of the many biochemical, molecular, and cellular elements and processes characterized to date that have potential to control foundational facets of CVD, the multifaceted cyclic nucleotide pathways continue to be of primary basic science and clinical interest. Cyclic adenosine monophosphate (cyclic AMP) and cyclic guanosine monophosphate (cyclic GMP) and their plethora of downstream protein kinase effectors serve ubiquitous roles not only in cardiovascular homeostasis but also in the pathogenesis of CVD. Already a major target for clinical pharmacotherapy for CVD as well as other pathologies, novel and potentially clinically appealing actions of cyclic nucleotides and their downstream targets are still being discovered. With this in mind, this review article focuses on our current state of knowledge of the cyclic nucleotide-driven serine (Ser)/threonine (Thr) protein kinases in CVD with particular emphasis on cyclic AMP-dependent protein kinase (PKA) and cyclic GMP-dependent protein kinase (PKG). Attention is given to the regulatory interactions of these kinases with inflammatory components including interleukin 6 signals, with G protein-coupled receptor and growth factor signals, and with growth and synthetic transcriptional platforms underlying CVD pathogenesis. This article concludes with a brief discussion of potential future directions and highlights the importance for continued basic science and clinical study of cyclic nucleotide-directed protein kinases as emerging and crucial controllers of cardiac and vascular disease pathologies.
Collapse
Affiliation(s)
- Nathan A Holland
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
| | - Jake T Francisco
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
| | - Sean C Johnson
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
| | - Joshua S Morgan
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
| | - Troy J Dennis
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
| | - Nishitha R Gadireddy
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
| | - David A Tulis
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA.
| |
Collapse
|
28
|
Kobayashi H, Kobayashi Y, Yokoe I, Akashi Y, Takei M, Giles JT. Magnetic Resonance Imaging-Detected Myocardial Inflammation and Fibrosis in Rheumatoid Arthritis: Associations With Disease Characteristics and N-Terminal Pro-Brain Natriuretic Peptide Levels. Arthritis Care Res (Hoboken) 2017; 69:1304-1311. [PMID: 27813364 DOI: 10.1002/acr.23138] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/13/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Myocardial dysfunction and heart failure (HF) are increased in rheumatoid arthritis (RA), yet there are few studies of the myocardium in RA. METHODS RA patients with no known heart disease or risk factors underwent gadolinium-enhanced cardiac magnetic resonance imaging (MRI). Images were assessed for left-ventricular (LV) structural and functional parameters and for myocardial late gadolinium enhancement (LGE; an indicator of myocardial fibrosis) and T2-weighted imaging (an indicator of active inflammation). We modeled the associations between RA characteristics and N-terminal pro-brain natriuretic protein (NT-proBNP) levels with LGE and T2-weighted imaging. We also assessed whether LGE and/or T2-weighted imaging were associated with abnormal LV structure or dysfunction. RESULTS A total of 60 RA patients were studied. LGE was present in 19 (32%) and T2-weighted imaging in 7 (12%), 5 of whom also had LGE. After adjustment for relevant confounders, higher odds of LGE with each swollen joint (odds ratio [OR] 1.87, P = 0.008), each log unit higher C-reactive protein level (OR 3.36, P = 0.047), and each log unit higher NT-proBNP (OR 20.61, P = 0.009) were found. NT-proBNP was also significantly higher (135%) among those with T2-weighted imaging than in those without T2-weighted imaging or LGE. Higher LV mass index and LV mass:end diastolic volume ratio were observed in those with T2-weighted imaging than in those with no myocardial abnormalities and in those with LGE without T2-weighted imaging; however, ejection fraction was not reduced in those with either LGE or T2-weighted imaging. CONCLUSION These data suggest that cardiac MRI findings indicating myocardial inflammation/fibrosis are correlated with RA disease activity and alterations in myocardial structure known to precede clinical HF.
Collapse
Affiliation(s)
| | | | | | - Yosikatsu Akashi
- St. Marianna University School of Medicine, Kawasaki, Japan, and Nihon University School of Medicine, Tokyo, Japan
| | - Masami Takei
- Nihon University School of Medicine, Tokyo, Japan
| | - Jon T Giles
- Columbia University, College of Physicians and Surgeons, New York, New York
| |
Collapse
|
29
|
Bigazzi F, Adorni MP, Puntoni M, Sbrana F, Lionetti V, Pino BD, Favari E, Recchia FA, Bernini F, Sampietro T. Analysis of Serum Cholesterol Efflux Capacity in a Minipig Model of Nonischemic Heart Failure. J Atheroscler Thromb 2017; 24:853-862. [PMID: 27980243 PMCID: PMC5556192 DOI: 10.5551/jat.37101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: Circulating levels of high-density lipoprotein cholesterol (HDL-C) are decreased in patients with heart failure (HF). We tested whether HDL-C serum levels are associated with cardiac contractile dysfunction in a minipig HF model. Methods: Blood samples were collected from 13 adult male minipigs: 1) before pacemaker implantation, 2) 10 days after surgery, and 3) 3 weeks after high-rate LV pacing. Serum cholesterol efflux capacity (CEC), an index of HDL functionality, was assessed through four mechanisms: ATP Binding Cassette transporter A1 (ABCA1), ATP Binding Cassette transporter G1 (ABCG1), Scavenger Receptor-Class B Type I (SR-BI) and Passive Diffusion (PD). Results: HDL-C serum levels significantly decrease in minipigs with HF compared with baseline (p < 0.0001). Serum CEC mediated by PD and SR-BI, but not ABCA1 or ABCG1, significantly decrease in animals with HF (p < 0.05 and p < 0.005, respectively). Discussion: HDL-C serum levels and partial serum CEC reduction may play a pathophysiological role in the cardiac function decay sustained by high-rate LV pacing, opening new avenues to understand of the pathogenesis of nonischemic myocardial remodeling.
Collapse
Affiliation(s)
| | | | | | | | - Vincenzo Lionetti
- Fondazione Toscana Gabriele Monasterio.,Laboratory of Medical Science, Institute of Life Sciences, Scuola Superiore Sant'Anna
| | | | | | - Fabio A Recchia
- Laboratory of Medical Science, Institute of Life Sciences, Scuola Superiore Sant'Anna.,Department of Physiology, Temple University School of Medicine
| | | | | |
Collapse
|
30
|
Samson N, Paulin R. Epigenetics, inflammation and metabolism in right heart failure associated with pulmonary hypertension. Pulm Circ 2017; 7:572-587. [PMID: 28628000 PMCID: PMC5841893 DOI: 10.1177/2045893217714463] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/19/2017] [Indexed: 12/19/2022] Open
Abstract
Right ventricular failure (RVF) is the most important prognostic factor for both morbidity and mortality in pulmonary arterial hypertension (PAH), but also occurs in numerous other common diseases and conditions, including left ventricle dysfunction. RVF remains understudied compared with left ventricular failure (LVF). However, right and left ventricles have many differences at the morphological level or the embryologic origin, and respond differently to pressure overload. Therefore, knowledge from the left ventricle cannot be extrapolated to the right ventricle. Few studies have focused on the right ventricle and have permitted to increase our knowledge on the right ventricular-specific mechanisms driving decompensation. Here we review basic principles such as mechanisms accounting for right ventricle hypertrophy, dysfunction, and transition toward failure, with a focus on epigenetics, inflammatory, and metabolic processes.
Collapse
Affiliation(s)
- Nolwenn Samson
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Roxane Paulin
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| |
Collapse
|
31
|
Lainscak M, Vitale C. Biological and chronological age in heart failure: role of immunosenescence. J Cardiovasc Med (Hagerstown) 2017; 17:857-859. [PMID: 27782930 DOI: 10.2459/jcm.0000000000000448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Mitja Lainscak
- aDepartment of Cardiology bDepartment of Research and Education, General Hospital Celje, Celje cFaculty of Medicine, University of Ljubljana, Ljubljana, Slovenia dDepartment of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | | |
Collapse
|
32
|
Bowman JD, Surani S, Horseman MA. Endotoxin, Toll-like Receptor-4, and Atherosclerotic Heart Disease. Curr Cardiol Rev 2017; 13:86-93. [PMID: 27586023 PMCID: PMC5452150 DOI: 10.2174/1573403x12666160901145313] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/28/2016] [Accepted: 08/25/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Endotoxin is a lipopolysaccharide (LPS) constituent of the outer membrane of most gram negative bacteria. Ubiquitous in the environment, it has been implicated as a cause or con-tributing factor in several disparate disorders from sepsis to heatstroke and Type II diabetes mellitus. Starting at birth, the innate immune system develops cellular defense mechanisms against environmen-tal microbes that are in part modulated through a series of receptors known as toll-like receptors. Endo-toxin, often referred to as LPS, binds to toll-like receptor 4 (TLR4)/ myeloid differentiation protein 2 (MD2) complexes on various tissues including cells of the innate immune system, smooth muscle and endothelial cells of blood vessels including coronary arteries, and adipose tissue. Entry of LPS into the systemic circulation ultimately leads to intracellular transcription of several inflammatory mediators. The subsequent inflammation has been implicated in the development and progression atherosclerosis and subsequent coronary artery disease and heart failure. Objective: The potential roles of endotoxin and TLR4 are reviewed regarding their role in the pathogen-esis of atherosclerotic heart disease. Conclusion: Atherosclerosis is initiated by inflammation in arterial endothelial and subendothelial cells, and inflammatory processes are implicated in its progression to clinical heart disease. Endotoxin and TLR4 play a central role in the inflammatory process, and represent potential targets for therapeutic intervention. Therapy with HMG-CoA inhibitors may reduce the expression of TLR4 on monocytes. Other therapeutic interventions targeting TLR4 expression or function may prove beneficial in athero-sclerotic disease prevention and treatment.
Collapse
Affiliation(s)
- John D Bowman
- Department of Pharmacy Practice, Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, TX, United States
| | - Salim Surani
- Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Michael A Horseman
- Department of Pharmacy Practice, Rangel College of Pharmacy, Texas A&M Health Science Center, Kingsville, TX, United States
| |
Collapse
|
33
|
Wigger O, Bloechlinger S, Berger D, Häner J, Zanchin T, Windecker S, Räber L, Schefold JC. Baseline serum bicarbonate levels independently predict short-term mortality in critically ill patients with ischaemic cardiogenic shock. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 7:45-52. [PMID: 28838261 DOI: 10.1177/2048872616683526] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cardiogenic shock is a feared complication of acute myocardial infarction with high mortality rates. Data on the predictive role of acid base dysregulation in this clinical setting are sparse. We therefore embarked on investigating the predictive role of serum bicarbonate in critically ill intensive care unit (ICU) patients with cardiogenic shock. METHODS A total of 165 ischaemic cardiogenic shock patients (118 men, aged 68.4 years (interquartile range 59.0-77.4), APACHE II score 26.0 (interquartile range 21.0-29.0), after percutaneous coronary intervention were included in a single-centre analysis. Percutaneous coronary intervention-related data such as left ventricular ejection fraction and laboratory indices were recorded and routine clinical follow-up was obtained at hospital discharge and at one year. All-cause mortality was assessed and data were analysed using univariate and multivariate models. RESULTS All-cause mortality was highest (17%) during the first 48 hours following ICU admission (28-day mortality rate 43%). In a multiple regression model, age (hazard ratio (HR) 1.035, 95% confidence interval (CI) 1.011-1.059, P=0.004), APACHE II score (HR 1.036, 95% CI 1.002-1.072, P=0.037) and baseline serum bicarbonate levels (HR 0.93, 95% CI 0.866-0.998, P=0.046) independently predicted 28-day mortality (overall model fit χ2 22.9, P<0.0001). The HR for patients in the lowest baseline serum bicarbonate tertile for 365-day mortality was HR 2.06 (95% CI 1.20-3.53). CONCLUSIONS In a large cohort of consecutive cardiogenic shock patients hospitalised in the ICU, low serum bicarbonate levels at admission independently predicted mortality. Given the widespread availability of blood gas analysers in ICUs, we propose baseline serum bicarbonate levels as an additional biomarker for identification and stratification of cardiogenic shock patients at risk.
Collapse
Affiliation(s)
- Olivier Wigger
- 1 Department of Cardiology, Bern University Hospital, Switzerland
| | - Stefan Bloechlinger
- 1 Department of Cardiology, Bern University Hospital, Switzerland
- 2 Department of Intensive Care Medicine, Bern University Hospital, Switzerland
| | - David Berger
- 3 Department of Intensive Care Medicine, Bern University Hospital, Switzerland
| | - Jonas Häner
- 1 Department of Cardiology, Bern University Hospital, Switzerland
| | - Thomas Zanchin
- 1 Department of Cardiology, Bern University Hospital, Switzerland
| | | | - Lorenz Räber
- 1 Department of Cardiology, Bern University Hospital, Switzerland
| | - Joerg C Schefold
- 3 Department of Intensive Care Medicine, Bern University Hospital, Switzerland
| |
Collapse
|
34
|
|
35
|
Akar FG. Starve a fever to heal a heart? Interleukin-18 gives new meaning to an old adage. Am J Physiol Heart Circ Physiol 2016; 311:H311-2. [PMID: 27342879 DOI: 10.1152/ajpheart.00445.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Fadi G Akar
- The Cardiovascular Institute, Ichan School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
36
|
Loncar G, Springer J, Anker M, Doehner W, Lainscak M. Cardiac cachexia: hic et nunc. J Cachexia Sarcopenia Muscle 2016; 7:246-60. [PMID: 27386168 PMCID: PMC4929818 DOI: 10.1002/jcsm.12118] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/18/2016] [Indexed: 12/12/2022] Open
Abstract
Cardiac cachexia (CC) is the clinical entity at the end of the chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely, the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. A better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia, and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF.
Collapse
Affiliation(s)
- Goran Loncar
- Department of Cardiology Clinical Hospital Zvezdara Belgrade Serbia; School of Medicine University of Belgrade Belgrade Serbia
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Markus Anker
- Department of Cardiology Charité - Universitätsmedizin Berlin Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin Charité Universitätsmedizin Berlin Germany
| | - Mitja Lainscak
- Department of Cardiology and Department of Research and Education General Hospital Celje Celje Slovenia; Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| |
Collapse
|
37
|
Todd MA, Shkolnikov VM, Goldman N. Why are well-educated Muscovites more likely to survive? Understanding the biological pathways. Soc Sci Med 2016; 157:138-47. [PMID: 27085072 PMCID: PMC5282593 DOI: 10.1016/j.socscimed.2016.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 12/25/2022]
Abstract
There are large socioeconomic disparities in adult mortality in Russia, although the biological mechanisms are not well understood. With data from the study of Stress, Aging, and Health in Russia (SAHR), we use Gompertz hazard models to assess the relationship between educational attainment and mortality among older adults in Moscow and to evaluate biomarkers associated with inflammation, neuroendocrine function, heart rate variability, and clinical cardiovascular and metabolic risk as potential mediators of that relationship. We do this by assessing the extent to which the addition of biomarker variables into hazard models of mortality attenuates the association between educational attainment and mortality. We find that an additional year of education is associated with about 5% lower risk of age-specific all-cause and cardiovascular mortality. Inflammation biomarkers are best able to account for this relationship, explaining 25% of the education-all-cause mortality association, and 35% of the education-cardiovascular mortality association. Clinical markers perform next best, accounting for 13% and 23% of the relationship between education and all-cause and cardiovascular mortality, respectively. Although heart rate biomarkers are strongly associated with subsequent mortality, they explain very little of the education-mortality link. Neuroendocrine biomarkers fail to account for any portion of the link. These findings suggest that inflammation may be important for understanding mortality disparities by socioeconomic status.
Collapse
Affiliation(s)
- Megan A Todd
- Office of Population Research and the Woodrow Wilson School of Public and International Affairs, Princeton University, USA.
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str., 1, Rostock, 18057, Germany; New Economic School, ul. Novaya, 100A, Moscow, 143026, Skolkovo, Russia.
| | - Noreen Goldman
- Office of Population Research and the Woodrow Wilson School of Public and International Affairs, Princeton University, Wallace Hall, Princeton, NJ, 08544, USA.
| |
Collapse
|
38
|
Olshansky B. Vagus nerve modulation of inflammation: Cardiovascular implications. Trends Cardiovasc Med 2016; 26:1-11. [DOI: 10.1016/j.tcm.2015.03.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 12/26/2022]
|
39
|
Erectile dysfunction in heart failure rats is associated with increased neurogenic contractions in cavernous tissue and internal pudendal artery. Life Sci 2016; 145:9-18. [DOI: 10.1016/j.lfs.2015.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/24/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
|
40
|
Silva N, Bettencourt P, Guimarães JT. The lymphocyte-to-monocyte ratio: an added value for death prediction in heart failure. Nutr Metab Cardiovasc Dis 2015; 25:1033-1040. [PMID: 26482565 DOI: 10.1016/j.numecd.2015.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/18/2015] [Accepted: 07/13/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIM Leukocytes and their subpopulation have been long implicated in the progression of the syndrome of heart failure (HF), especially heart infiltration cells. Previous reports have suggested that they can predict worse outcome in patients with HF, and can also affect the function of other cells and myocardial extracellular matrix remodeling process. However, the lymphocyte-to-monocyte ratio (LMR) and its possible value as prognostic marker have not been evaluated. METHODS AND RESULTS A total of 390 patients with acute HF were recruited and followed for 6 months. Their total blood count with leukocyte differential was obtained. Two groups were formed according to the endpoints of HF death and optimal cut-off value of LMR, and were compared. A multivariate Cox-regression model was used to establish the prognostic value with the endpoints of HF and all-cause mortality. Median age of the patients was 78 years and 48.5% of them were men. No major difference was observed between the clinical characteristics of the two groups. Patients who died of HF had significantly higher values of B-type natriuretic peptide and lower values of LMR. Leukocyte and monocyte counts revealed a multivariate-adjusted risk for both endpoints, whereas relative lymphocyte counts had only significant value for all-cause mortality. The multivariate-adjusted hazard ratios for the 6-month HF and all-cause mortality in patients with LMR values < 2.0 were, respectively, 2.28 (95% CI: 1.25-4.15) and 2.39 (95% CI: 1.39-4.10). CONCLUSION Our results show that, upon discharge from hospital after an episode of acute HF, a lower value of LMR is independently associated with a higher risk of mortality within 6 months.
Collapse
Affiliation(s)
- N Silva
- Unidade I&D Cardiovascular do Porto, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal; Departamento de Bioquímica, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal; Serviço de Patologia Clínica, Centro Hospitalar São João, 4202-451 Porto, Portugal.
| | - P Bettencourt
- Unidade I&D Cardiovascular do Porto, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal; Serviço de Medicina Interna, Centro Hospitalar São João, 4202-451 Porto, Portugal
| | - J T Guimarães
- Departamento de Bioquímica, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal; Serviço de Patologia Clínica, Centro Hospitalar São João, 4202-451 Porto, Portugal; EPIUnit, Instituto de Saúde Pública da Universidade do Porto, 4050-600 Porto, Portugal
| |
Collapse
|
41
|
Cardiac cachexia: hic et nunc: "hic et nunc" - here and now. Int J Cardiol 2015; 201:e1-12. [PMID: 26545926 DOI: 10.1016/j.ijcard.2015.10.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 02/07/2023]
Abstract
Cardiac cachexia (CC) is the clinical entity at the end of chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. Better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick-up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF.
Collapse
|
42
|
Holland NA, Becak DP, Shannahan JH, Brown JM, Carratt SA, Winkle L, Pinkerton KE, Wang CM, Munusamy P, Baer DR, Sumner SJ, Fennell TR, Lust RM, Wingard CJ. Cardiac Ischemia Reperfusion Injury Following Instillation of 20 nm Citrate-capped Nanosilver. ACTA ACUST UNITED AC 2015; 6. [PMID: 26966636 DOI: 10.4172/2157-7439.s6-006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Silver nanoparticles (AgNP) have garnered much interest due to their antimicrobial properties, becoming one of the most utilized nano-scale materials. However, any potential evocable cardiovascular injury associated with exposure has not been reported to date. We have previously demonstrated expansion of myocardial infarction after intratracheal (IT) instillation of carbon-based nanomaterials. We hypothesized pulmonary exposure to Ag core AgNP induces a measureable increase in circulating cytokines, expansion of cardiac ischemia-reperfusion (I/R) injury and is associated with depressed coronary constrictor and relaxation responses. Secondarily, we addressed the potential contribution of silver ion release on AgNP toxicity. METHODS Male Sprague-Dawley rats were exposed to 200 μl of 1 mg/ml of 20 nm citrate-capped Ag core AgNP, 0.01, 0.1, 1 mg/ml Silver Acetate (AgAc), or a citrate vehicle by intratracheal (IT) instillation. One and 7 days following IT instillation the lungs were evaluated for inflammation and the presence of silver; serum was analyzed for concentrations of selected cytokines; cardiac I/R injury and coronary artery reactivity were assessed. RESULTS AgNP instillation resulted in modest pulmonary inflammation with detection of silver in lung tissue and alveolar macrophages, elevation of serum cytokines: G-CSF, MIP-1α, IL-1β, IL-2, IL-6, IL-13, IL-10, IL-18, IL-17α, TNFα, and RANTES, expansion of I/R injury and depression of the coronary vessel reactivity at 1 day post IT compared to vehicle treated rats. Silver within lung tissue was persistent at 7 days post IT instillation and was associated with an elevation in cytokines: IL-2, IL-13, and TNFα and expansion of I/R injury. AgAc resulted in a concentration dependent infarct expansion and depressed vascular reactivity without marked pulmonary inflammation or serum cytokine response. CONCLUSIONS Based on these data, IT instillation of AgNP increases circulating levels of several key cytokines, which may contribute to persistent expansion of I/R injury possibly through an impaired vascular responsiveness.
Collapse
Affiliation(s)
- N A Holland
- Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - D P Becak
- Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Jonathan H Shannahan
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado Anschutz Medical Campus, Aurora, USA
| | - J M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado Anschutz Medical Campus, Aurora, USA
| | - S A Carratt
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California at Davis, Davis, California, USA
| | - Lsv Winkle
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California at Davis, Davis, California, USA
| | - K E Pinkerton
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California at Davis, Davis, California, USA
| | - C M Wang
- Pacific Northwest National Laboratory, EMSL, Richland, USA
| | - P Munusamy
- Pacific Northwest National Laboratory, EMSL, Richland, USA
| | - Don R Baer
- Pacific Northwest National Laboratory, EMSL, Richland, USA
| | - S J Sumner
- RTI International, Discovery Sciences, Research Triangle Park, USA
| | - T R Fennell
- RTI International, Discovery Sciences, Research Triangle Park, USA
| | - R M Lust
- Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - C J Wingard
- Department of Physiology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| |
Collapse
|
43
|
Protective effect of heme oxygenase-1 on Wistar rats with heart failure through the inhibition of inflammation and amelioration of intestinal microcirculation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:353-65. [PMID: 26346675 PMCID: PMC4554778 DOI: 10.11909/j.issn.1671-5411.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/11/2015] [Accepted: 04/02/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Myocardial infarction (MI) has likely contributed to the increased prevalence of heart failure (HF). As a result of reduced cardiac function, splanchnic blood flow decreases, causing ischemia in villi and damage to the intestinal barrier. The induction of heme oxygenase-1 (HO-1) could prevent, or lessen the effects of stress and inflammation. Thus, the effect and mechanism thereof of HO-1 on the intestines of rats with HF was investigated. METHODS Male Wistar rats with heart failure through ligation of the left coronary artery were identified with an left ventricular ejection fraction of < 45% through echocardiography and then divided into various experimental groups based on the type of peritoneal injection they received [MI: saline; MI + Cobalt protoporphyrin (CoPP): CoPP solution; and MI + Tin mesoporphyrin IX dichloride (SnMP): SnMP solution]. The control group was comprised of rats without coronary ligation. Echocardiography was performed before ligation for a baseline and eight weeks after ligation in order to evaluate the cardiac function of the rats. The bacterial translocation (BT) incidence, mesenteric microcirculation, amount of endotoxins in the vein serum, ileum levels of HO-1, carbon oxide (CO), nitric oxide (NO), interleukin (IL)-10, tumour necrosis factor-α (TNF-α), and the ileum morphology were determined eight weeks after the operation. RESULTS The rats receiving MI + CoPP injections exhibited a recovery in cardiac function, an amelioration of mesenteric microcirculation and change in morphology, a lower BT incidence, a reduction in serum and ileac NO and TNF-α levels, and an elevation in ileac HO-1, CO, and interleukin-10 (IL-10) levels compared to the MI group (P < 0.05). The rats that received the MI + SnMP injections exhibited results inverse to the MI (P < 0.05) group. CONCLUSIONS HO-1 exerted a protective effect on the intestines of rats with HF by inhibiting the inflammation and amelioration of microcirculation through the CO pathway. This protective effect could be independent from the recovery of cardiac function.
Collapse
|
44
|
Lima JW, Hentschke VS, Rossato DD, Quagliotto E, Pinheiro L, Almeida E, Dal Lago P, Lukrafka JL. Chronic electroacupuncture of the ST36 point improves baroreflex function and haemodynamic parameters in heart failure rats. Auton Neurosci 2015; 193:31-7. [PMID: 26032957 DOI: 10.1016/j.autneu.2015.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/28/2015] [Accepted: 05/05/2015] [Indexed: 12/20/2022]
Abstract
Electroacupuncture (EA) has been used to treat many diseases, including heart failure (HF). This study aimed to evaluate the effects of chronic stimulation in the ST36 acupuncture point on haemodynamic parameters and baroreflex function in rats with HF. Cardiovascular parameters assessed were heart rate (HR), blood pressure (BP), and the reflex cardiovascular response of HR triggered by stimulation of baroreceptors in animals with HF subsequent to acute myocardial infarction (AMI). Male Wistar rats were divided into three groups: Sham Control - animals without HF and without EA; HF Control group - animals with HF and without EA; and HF EA group - animals with HF that received the EA protocol. Six weeks after surgical induction of AMI, the EA protocol (8 weeks, 5 times a week) was performed. The protocol was applied with EA at the ST36 point, frequency of 2 Hz, pulse of 0.3 ms and intensity of 1-3 mA for 30 min. Haemodynamic parameters and baroreceptor function were assessed. There was no difference between groups in the variables HR, systolic blood pressure (SBP) and diastolic blood pressure (DBP), which were evaluated with awake animals (p>0.05). There was an increase in the mean arterial pressure (MAP) in the HF EA group compared to the HF Control group (p<0.05). The maximum gain of the baroreflex heart rate response (Gain) was higher in the HF EA group than the HF Control and Sham Control groups. Chronic EA in the ST36 point increased the MAP and baroreflex sensitivity in rats with HF.
Collapse
Affiliation(s)
- J W Lima
- Physiology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - V S Hentschke
- Physiology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - D D Rossato
- Physiology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Centro Universitário Franciscano, Brazil
| | - E Quagliotto
- Physiology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - L Pinheiro
- Physiology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - E Almeida
- Physiology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - P Dal Lago
- Physiology Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - J L Lukrafka
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
| |
Collapse
|
45
|
Butts B, Gary RA, Dunbar SB, Butler J. The Importance of NLRP3 Inflammasome in Heart Failure. J Card Fail 2015; 21:586-93. [PMID: 25982825 DOI: 10.1016/j.cardfail.2015.04.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/08/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022]
Abstract
Patients with heart failure continue to suffer adverse health consequences despite advances in therapies over the past 2 decades. Identification of novel therapeutic targets that may attenuate disease progression is therefore needed. The inflammasome may play a central role in modulating chronic inflammation and in turn affecting heart failure progression. The inflammasome is a complex of intracellular interaction proteins that trigger maturation of proinflammatory cytokines interleukin-1β and interleukin-18 to initiate the inflammatory response. This response is amplified through production of tumor necrosis factor α and activation of inducible nitric oxide synthase. The purpose of this review is to discuss recent evidence implicating this inflammatory pathway in the pathophysiology of heart failure.
Collapse
Affiliation(s)
- Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Rebecca A Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, NY.
| |
Collapse
|
46
|
Villanueva MP, Mollar A, Palau P, Carratalá A, Núñez E, Santas E, Bodí V, Chorro FJ, Miñana G, Blasco ML, Sanchis J, Núñez J. Procalcitonin and long-term prognosis after an admission for acute heart failure. Eur J Intern Med 2015; 26:42-8. [PMID: 25592074 DOI: 10.1016/j.ejim.2014.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/09/2014] [Accepted: 12/25/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Traditionally, procalcitonin (PCT) is considered a diagnostic marker of bacterial infections. However, slightly elevated levels of PCT have also been found in patients with heart failure. In this context, it has been suggested that PCT may serve as a proxy for underrecognized infection, endotoxemia, or heightened proinflammatory activity. Nevertheless, the clinical utility of PCT in this setting is scarce. We aimed to evaluate the association between PCT and the risk of long-term outcomes. METHODS AND RESULTS We measured at admission PCT of 261 consecutive patients admitted for acute heart failure (AHF) after excluding active infection. Cox and negative binomial regression methods were used to evaluate the association between PCT and the risk of death and recurrent rehospitalizations, respectively. At a median follow-up of 2years (IQR: 1.0-2.8), 108 deaths, 170 all-cause rehospitalizations and 96 AHF-rehospitalizations were registered. In an adjusted analysis, including well-established risk factors such as natriuretic peptides and indices of renal function, the logarithm of PCT was associated with a higher risk of death (HR=1.43, CI 95%: 1.12-1.82; p=0.004), all-cause rehospitalizations (IRR=1.22, CI 95% 1.02-1.44; p=0.025) and AHF-rehospitalizations (IRR=1.28, CI 95%: 1.02-1.61; p=0.032). The association with these endpoints persisted after adjustment for other inflammatory biomarkers such as white blood cells, C-reactive protein and interleukins. CONCLUSION In patients with AHF and no evidence of infection, PCT was independently and positively associated with the risk of long-term death and recurrent rehospitalizations.
Collapse
Affiliation(s)
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Patricia Palau
- Servicio de Cardiología, Hospital de la Plana, Villarreal, Spain
| | - Arturo Carratalá
- Servicio de Bioquímica Clínica, Hospital Clínico Universitario, Valencia, Spain
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Vicent Bodí
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Francisco J Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital de Manises, Valencia, Spain
| | - Maria L Blasco
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| |
Collapse
|
47
|
|
48
|
Abstract
The extracellular matrix (ECM) is a living network of proteins that maintains the structural integrity of the myocardium and allows the transmission of electrical and mechanical forces between the myocytes for systole and diastole. During ventricular remodeling, as a result of iterations in the hemodynamic workload, collagen, the main component of the ECM, increases and occupies the areas between the myocytes and the vessels. The resultant fibrosis (reparative fibrosis) is initially a compensatory mechanism and may progress adversely influencing tissue stiffness and ventricular function. Replacement fibrosis appears at sites of previous cardiomyocyte necrosis to preserve the structural integrity of the myocardium, but with the subsequent formation of scar tissue and widespread distribution, it has adverse functional consequences. Continued accumulation of collagen impairs diastolic function and compromises systolic mechanics. Nevertheless, the development of fibrosis is a dynamic process wherein myofibroblasts, the principal cellular elements of fibrosis, are not only metabolically active and capable of the production and upregulation of cytokines but also have contractile properties. During the process of reverse remodeling with left ventricular assist device unloading, cellular, structural, and functional improvements are observed in terminal heart failure patients. With the advent of anti-fibrotic pharmacologic therapies, cellular therapy, and ventricular support devices, fibrosis has become an important therapeutic target in heart failure patients. Herein, we review the current concepts of fibrosis as a main component of ventricular remodeling in heart failure patients. Our aim is to integrate the histopathologic process of fibrosis with the neurohormonal, cytochemical, and molecular changes that lead to ventricular remodeling and its physiologic consequences in patients. The concept of fibrosis as living scar allows us to envision targeting this scar as a means of improving ventricular function in heart failure patients.
Collapse
Affiliation(s)
- Ana Maria Segura
- Department of Cardiovascular Pathology Research, Texas Heart Institute at St. Luke's Episcopal Hospital, MC 1-283, PO Box 20345, Houston, TX, 77225-0345, USA,
| | | | | |
Collapse
|
49
|
Kooman JP, Kotanko P, Schols AMWJ, Shiels PG, Stenvinkel P. Chronic kidney disease and premature ageing. Nat Rev Nephrol 2014; 10:732-42. [PMID: 25287433 DOI: 10.1038/nrneph.2014.185] [Citation(s) in RCA: 267] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic kidney disease (CKD) shares many phenotypic similarities with other chronic diseases, including heart failure, chronic obstructive pulmonary disease, HIV infection and rheumatoid arthritis. The most apparent similarity is premature ageing, involving accelerated vascular disease and muscle wasting. We propose that in addition to a sedentary lifestyle and psychosocial and socioeconomic determinants, four major disease-induced mechanisms underlie premature ageing in CKD: an increase in allostatic load, activation of the 'stress resistance response', activation of age-promoting mechanisms and impairment of anti-ageing pathways. The most effective current interventions to modulate premature ageing-treatment of the underlying disease, optimal nutrition, correction of the internal environment and exercise training-reduce systemic inflammation and oxidative stress and induce muscle anabolism. Deeper mechanistic insight into the phenomena of premature ageing as well as early diagnosis of CKD might improve the application and efficacy of these interventions and provide novel leads to combat muscle wasting and vascular impairment in chronic diseases.
Collapse
Affiliation(s)
- Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastrich, Netherlands
| | - Peter Kotanko
- Renal Research Institute, 315 East 62nd Street, 4th floor, NY 10065, New York, USA
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastrich, Netherlands
| | - Paul G Shiels
- Institute of Cancer Sciences, Wolfson Wohl Translational Research Centre, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, UK
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Huddinge, Karolinska Institutet, SE-14157 Stockholm, Sweden
| |
Collapse
|
50
|
Ueland T, Gullestad L, Nymo SH, Yndestad A, Aukrust P, Askevold ET. Inflammatory cytokines as biomarkers in heart failure. Clin Chim Acta 2014; 443:71-7. [PMID: 25199849 DOI: 10.1016/j.cca.2014.09.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 12/18/2022]
Abstract
Inflammation has been implicated in the pathogenesis of heart failure (HF). In addition to their direct involvement as mediators in the pathogenesis of HF, inflammatory cytokines and related mediators could also be suitable markers for risk stratification and prognostication in HF patients. Many reports have suggested that inflammatory cytokines may predict adverse outcome in these patients. However, most studies have been limited in sample size and lacking full adjustment with the most recent and strongest biochemical predictor such as NT-proBNP and high sensitivity troponins. Furthermore, a number of pre-analytical and analytical aspects of cytokine measurements may limit their use as biomarkers. This review focuses on technical, informative and practical considerations concerning the clinical use of inflammatory cytokines as prognostic biomarkers in HF. We focus on the predictive value of tumor necrosis factor (TNF) α, the TNF family receptors sTNFR1 and osteoprotegerin, interleukin (IL)-6 and its receptor gp130, the chemokines MCP-1, IL-8, CXCL16 and CCL21 and the pentraxin PTX-3 in larger prospective fully adjusted studies. No single inflammatory cytokine provides sufficient discrimination to justify the transition to everyday clinical use as a prognosticator in HF. However, while subjecting potential new HF markers to rigorous comparisons with "gold-standard" markers, such as NT-proBNP, using receiver operating characteristics (ROCs) and HF risk models, makes sense from a clinical standpoint, it may pose a threat to a broadening of mechanistic insight if the new markers are dismissed solely on account of lower statistical power.
Collapse
Affiliation(s)
- Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway; KG Jebsen Thrombosis Research and Expertise Center, N-9037 Tromsø, Norway.
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway; KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Norway
| | - Ståle H Nymo
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway; KG Jebsen Thrombosis Research and Expertise Center, N-9037 Tromsø, Norway
| | - Erik T Askevold
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Norway; Clinic for Internal Medicine, Lovisenberg Diakonale Hospital, N-0027 Oslo, Norway
| |
Collapse
|