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Ueland T, Åkerblom A, Ghukasyan T, Michelsen AE, Becker RC, Bertilsson M, Himmelmann A, James SK, Siegbahn A, Storey RF, Kontny F, Aukrust P, Wallentin L. Admission Levels of DKK1 (Dickkopf-1) Are Associated With Future Cardiovascular Death in Patients With Acute Coronary Syndromes. Arterioscler Thromb Vasc Biol 2019; 39:294-302. [PMID: 30580572 DOI: 10.1161/atvbaha.118.311042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective- The Wnt/wingless signaling antagonist DKK1 (dickkopf-1) regulates platelet-mediated inflammation and may contribute to plaque destabilization. We hypothesized that DKK1 would be associated with cardiovascular outcomes. Approach and Results- We determined DKK1 levels in serum samples obtained before randomization, at discharge, and 1 and 6 months in a subset of 5165 patients with acute coronary syndromes in the PLATO trial (Platelet Inhibition and Patient Outcomes; NCT00391872). The median (interquartile range) DKK1 concentrations were 0.61 (0.20-1.27) ng/mL at baseline and increased during follow-up. The hazard ratio (95% CIs) for the composite end point (cardiovascular death, nonprocedural spontaneous myocardial infarction, or stroke) during 1 year of follow-up, per 50% increase in baseline DKK1 concentration, was 1.06 (1.02-1.10), P=0.0011, and remained significant in fully adjusted analysis with 14 conventional clinical and demographic and 6 biochemical variables, including NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-TnT (high-sensitivity troponin T), and GDF-15 (growth differentiation factor 15; 1.05 [1.00-1.09]; P=0.028). This association was mainly driven by the association with cardiovascular death, where a gradual increase in event rates was observed with increasing quartiles of DKK1 (2.7%, 3.0%, 4.3%, and 5.0%) and remained significant and unmodified in fully adjusted analysis (hazard ratio, 1.10 [1.04-1.17]; P=0.002). Change in DKK1 and levels at 1 month were unrelated to outcomes. A modifying effect of ticagrelor on DKK1 discharge levels was observed but not associated with prognosis. Conclusions- In patients with acute coronary syndromes treated with dual antiplatelet treatment, admission DKK1 levels were independently associated with a composite of cardiovascular death, myocardial infarction, or stroke and with cardiovascular death alone.
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Affiliation(s)
- Thor Ueland
- From the Research Institute of Internal Medicine, National Hospital (T.U., A.E.M., P.A.), University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center (T.U., P.A.), University of Oslo, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Norway (T.U., P.A.)
| | - Axel Åkerblom
- Division of Cardiology, Department of Medical Sciences (A.Å, S.K.J., L.W.), Uppsala University, Sweden.,Uppsala Clinical Research Center (A.Å, T.G., M.B., S.K.J., A.S., L.W.), Uppsala University, Sweden
| | - Tatevik Ghukasyan
- Uppsala Clinical Research Center (A.Å, T.G., M.B., S.K.J., A.S., L.W.), Uppsala University, Sweden
| | - Annika E Michelsen
- From the Research Institute of Internal Medicine, National Hospital (T.U., A.E.M., P.A.), University of Oslo, Norway
| | - Richard C Becker
- Division of Cardiovascular Health and Disease, Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, OH (R.C.B.)
| | - Maria Bertilsson
- Uppsala Clinical Research Center (A.Å, T.G., M.B., S.K.J., A.S., L.W.), Uppsala University, Sweden
| | | | - Stefan K James
- Division of Cardiology, Department of Medical Sciences (A.Å, S.K.J., L.W.), Uppsala University, Sweden.,Uppsala Clinical Research Center (A.Å, T.G., M.B., S.K.J., A.S., L.W.), Uppsala University, Sweden
| | - Agneta Siegbahn
- Uppsala Clinical Research Center (A.Å, T.G., M.B., S.K.J., A.S., L.W.), Uppsala University, Sweden.,Department of Medical Sciences, Clinical Chemistry (A.S.), Uppsala University, Sweden
| | - Robert F Storey
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, United Kingdom (R.F.S.)
| | - Frederic Kontny
- Department of Cardiology, Stavanger University Hospital, Norway (F.K.).,Drammen Heart Center, Norway (F.K.)
| | - Pål Aukrust
- From the Research Institute of Internal Medicine, National Hospital (T.U., A.E.M., P.A.), University of Oslo, Norway.,K.G. Jebsen Inflammatory Research Center (T.U., P.A.), University of Oslo, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Norway (T.U., P.A.).,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Norway (P.A.)
| | - Lars Wallentin
- Division of Cardiology, Department of Medical Sciences (A.Å, S.K.J., L.W.), Uppsala University, Sweden.,Uppsala Clinical Research Center (A.Å, T.G., M.B., S.K.J., A.S., L.W.), Uppsala University, Sweden
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Alzaraa A, Gravante G, Chung WY, Al-Leswas D, Bruno M, Dennison AR, Lloyd DM. Targeted microbubbles in the experimental and clinical setting. Am J Surg 2012; 204:355-66. [PMID: 22920405 DOI: 10.1016/j.amjsurg.2011.10.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 10/12/2011] [Accepted: 10/12/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND Microbubbles have improved ultrasonography imaging techniques over the past 2 decades. Their safety, versatility, and easiness of use have rendered them equal or even superior in some instances to other imaging modalities such as computed tomography and magnetic resonance imaging. Herein, we conducted a literature review to present their types, general behavior in tissues, and current and potential use in clinical practice. METHODS A literature search was conducted for all preclinical and clinical studies involving microbubbles and ultrasonography. RESULTS Different types of microbubbles are available. These generally improve the enhancement of tissues during ultrasonography imaging. They also can be attached to ligands for the target of several conditions such as inflammation, angiogenesis, thrombosis, apoptosis, and might have the potential of carrying toxic drugs to diseased sites, thereby limiting the systemic adverse effects. CONCLUSIONS The use of microbubbles is evolving rapidly and can have a significant impact on the management of various conditions. The potential for their use as targeting agents and gene and drug delivery vehicles looks promising.
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Affiliation(s)
- Ahmed Alzaraa
- Department of Hepatobiliary and Pancreatic Surgery, NHS Trust, Leicester General Hospital, Gwendolen Rd., Leicester, LE5 4PW, UK.
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