1
|
Ba H, Guo Y, Jiang Y, Li Y, Dai X, Liu Y, Li X. Unveiling the metabolic landscape of pulmonary hypertension: insights from metabolomics. Respir Res 2024; 25:221. [PMID: 38807129 PMCID: PMC11131231 DOI: 10.1186/s12931-024-02775-5] [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: 11/27/2023] [Accepted: 03/14/2024] [Indexed: 05/30/2024] Open
Abstract
Pulmonary hypertension (PH) is regarded as cardiovascular disease with an extremely poor prognosis, primarily due to irreversible vascular remodeling. Despite decades of research progress, the absence of definitive curative therapies remains a critical challenge, leading to high mortality rates. Recent studies have shown that serious metabolic disorders generally exist in PH animal models and patients of PH, which may be the cause or results of the disease. It is imperative for future research to identify critical biomarkers of metabolic dysfunction in PH pathophysiology and to uncover metabolic targets that could enhance diagnostic and therapeutic strategies. Metabolomics offers a powerful tool for the comprehensive qualitative and quantitative analysis of metabolites within specific organisms or cells. On the basis of the findings of the metabolomics research on PH, this review summarizes the latest research progress on metabolic pathways involved in processes such as amino acid metabolism, carbohydrate metabolism, lipid metabolism, and nucleotide metabolism in the context of PH.
Collapse
Affiliation(s)
- Huixue Ba
- Department of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China
- Department of Pharmacy, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yingfan Guo
- Department of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Yujie Jiang
- Department of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Ying Li
- Department of Health Management, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xuejing Dai
- Department of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China
- Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China
| | - Yuan Liu
- Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Xiaohui Li
- Department of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China.
- Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China.
| |
Collapse
|
2
|
Ishinoda Y, Masaki N, Hitomi Y, Taruoka A, Kawai A, Iwashita M, Yumita Y, Kagami K, Yasuda R, Ido Y, Toya T, Ikegami Y, Namba T, Nagatomo Y, Miyazaki K, Takase B, Adachi T. A Low Arginine/Ornithine Ratio is Associated with Long-Term Cardiovascular Mortality. J Atheroscler Thromb 2023; 30:1364-1375. [PMID: 36775332 PMCID: PMC10564648 DOI: 10.5551/jat.63779] [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: 07/01/2022] [Accepted: 12/25/2022] [Indexed: 02/13/2023] Open
Abstract
AIMS The long-term prognostic value of the bioavailability of L-arginine, an important source of nitric oxide for the maintenance of vascular endothelial function, has not been investigated fully. We therefore investigated the relationship between amino acid profile and long-term prognosis in patients with a history of standby coronary angiography. METHODS We measured the serum concentrations of L-arginine, L-citrulline, and L-ornithine by high-speed liquid chromatography. We examined the relationship between the L-arginine/L-ornithine ratio and the incidence of all-cause death, cardiovascular death, and major adverse cardiovascular events (MACEs) in 262 patients (202 men and 60 women, age 65±13 years) who underwent coronary angiography over a period of ≤ 10 years. RESULTS During the observation period of 5.5±3.2 years, 31 (12%) patients died, including 20 (8%) of cardiovascular death, while 32 (12%) had MACEs. Cox regression analysis revealed that L-arginine/L-ornithine ratio was associated with an increased risk for all-cause death (unadjusted hazard ratio, 95% confidence interval) (0.940, 0.888-0.995) and cardiovascular death (0.895, 0.821-0.965) (p<0.05 for all). In a model adjusted for age, sex, hypertension, hyperlipidemia, diabetes, current smoking, renal function, and log10-transformed brain natriuretic peptide level, cardiovascular death (0.911, 0.839-0.990, p=0.028) retained an association with a low L-arginine/ L-ornithine ratio. When the patients were grouped according to an L-arginine/L-ornithine ratio of 1.16, the lower L-arginine/L-ornithine ratio group had significantly higher incidence of all-cause death, cardiovascular death, and MACEs. CONCLUSION A low L-arginine/L-ornithine ratio may be associated with increased 10-year cardiac mortality.
Collapse
Affiliation(s)
- Yuki Ishinoda
- Department of Endocrinology, National Defense Medical College, Saitama, Japan
| | - Nobuyuki Masaki
- Department o f Intensive Care Medicine, National Defense Medical College, Saitama, Japan
| | - Yasuhiro Hitomi
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Akira Taruoka
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Akane Kawai
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Midori Iwashita
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Yusuke Yumita
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Kazuki Kagami
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Risako Yasuda
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Yasuo Ido
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Takumi Toya
- Department o f Intensive Care Medicine, National Defense Medical College, Saitama, Japan
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Yukinori Ikegami
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Takayuki Namba
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Koji Miyazaki
- Department of Comprehensive Internal Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Bonpei Takase
- Department o f Intensive Care Medicine, National Defense Medical College, Saitama, Japan
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| |
Collapse
|
3
|
Thonusin C, Nawara W, Khuanjing T, Prathumsup N, Arinno A, Ongnok B, Arunsak B, Sriwichaiin S, Chattipakorn SC, Chattipakorn N. Blood metabolomes as non-invasive biomarkers and targets of metabolic interventions for doxorubicin and trastuzumab-induced cardiotoxicity. Arch Toxicol 2023; 97:603-618. [PMID: 36357623 DOI: 10.1007/s00204-022-03412-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022]
Abstract
This study aimed to identify the alterations of blood metabolome levels and their association with cardiac dysfunction and cardiac injury following treatment with doxorubicin and trastuzumab. Eight-week-old male Wistar rats were divided into four groups (n = 6 per group) to receive intraperitoneal injection with either: (1) 1 mL of normal saline solution (NSS) at days 0, 4, 8, 15, 22, and 29 (control group for doxorubicin); (2) 3 mg/kg/day of doxorubicin at days 0, 4, 8, 15, 22, and 29 (doxorubicin group); (3) 1 mL of NSS at days 0-6 (control group for trastuzumab); or (4) 4 mg/kg/day of trastuzumab at days 0-6 (trastuzumab group). Four days after the last injected dose, cardiac function was determined. The rats were then euthanized to collect venous blood and the heart for the quantification of 107 serum and 100 cardiac metabolomes using mass spectrometry-based targeted metabolomics. We observed strong relationships between 72 cardiac versus 61 serum metabolomes in doxorubicin and trastuzumab groups. Moreover, significant correlations between cardiac function and the cardiac injury biomarker versus 28 and 58 serum metabolomes were revealed in doxorubicin and trastuzumab-treated rats, respectively. Interestingly, the patterns of both serum and cardiac metabolome alterations differed between doxorubicin and trastuzumab groups. Our findings emphasize the potential role of the constituents of the blood metabolome as non-invasive biomarkers to assess severity and prognosis of heart failure induced by doxorubicin and trastuzumab. These findings may contribute to the development of metabolic-targeted therapy specific for cardioprotection during different phases of cancer treatment.
Collapse
Affiliation(s)
- Chanisa Thonusin
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Wichwara Nawara
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Thawatchai Khuanjing
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nanthip Prathumsup
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Apiwan Arinno
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Benjamin Ongnok
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Busarin Arunsak
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Sirawit Sriwichaiin
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand.
| |
Collapse
|
4
|
Saheera S. Multifaceted role of cardiovascular biomarkers. Indian Heart J 2023; 75:91-97. [PMID: 36736458 PMCID: PMC10123438 DOI: 10.1016/j.ihj.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Cardiovascular diseases, a global health issue, claim the lives of many every year. Lifestyle changes and genetic predisposition are the key drivers for the development of CVDs. In many of the patients, the disease is detected at the end stage making heart transplantation the only treatment option. Hence every attempt should be made to identify the risk at an early stage and initiate preventive measures to improve the quality of their life. Biomarkers are one of the critical factors that aid in the early diagnosis of CVDs. More specific and highly sensitive biomarkers have been discovered lately and have been employed for prognosis and diagnosis of CVDs. The present review briefs about the various categories of cardiovascular biomarkers with emphasis on novel biomarkers and discusses the biomarkers employed for different purposes in CVDs. The biomarkers have also helped in identifying COVID-19 patients with increased risk for developing cardiovascular complications. Being non-invasive makes biomarkers advantageous over other methods for evaluating the pathophysiological status of CVDs.
Collapse
Affiliation(s)
- Sherin Saheera
- Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School, Worcester, MA, 01655, USA.
| |
Collapse
|
5
|
Sinha M, Zabini D, Guntur D, Nagaraj C, Enyedi P, Olschewski H, Kuebler WM, Olschewski A. Chloride channels in the lung: Challenges and perspectives for viral infections, pulmonary arterial hypertension, and cystic fibrosis. Pharmacol Ther 2022; 237:108249. [PMID: 35878810 DOI: 10.1016/j.pharmthera.2022.108249] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
Abstract
Fine control over chloride homeostasis in the lung is required to maintain membrane excitability, transepithelial transport as well as intra- and extracellular ion and water homeostasis. Over the last decades, a growing number of chloride channels and transporters have been identified in the cells of the pulmonary vasculature and the respiratory tract. The importance of these proteins is underpinned by the fact that impairment of their physiological function is associated with functional dysregulation, structural remodeling, or hereditary diseases of the lung. This paper reviews the field of chloride channels and transporters in the lung and discusses chloride channels in disease processes such as viral infections including SARS-CoV- 2, pulmonary arterial hypertension, cystic fibrosis and asthma. Although chloride channels have become a hot research topic in recent years, remarkably few of them have been targeted by pharmacological agents. As such, we complement the putative pathophysiological role of chloride channels here with a summary of their therapeutic potential.
Collapse
Affiliation(s)
- Madhushri Sinha
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Diana Zabini
- Department of Physiology, Neue Stiftingtalstrasse 6/V, 8010 Graz, Austria.
| | - Divya Guntur
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Chandran Nagaraj
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Peter Enyedi
- Department of Physiology, Semmelweis University, Tűzoltó utca 37-47, 1094 Budapest, Hungary.
| | - Horst Olschewski
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Andrea Olschewski
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| |
Collapse
|
6
|
Ferro F, Spelat R, Valente C, Contessotto P. Understanding How Heart Metabolic Derangement Shows Differential Stage Specificity for Heart Failure with Preserved and Reduced Ejection Fraction. Biomolecules 2022; 12:biom12070969. [PMID: 35883525 PMCID: PMC9312956 DOI: 10.3390/biom12070969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 12/12/2022] Open
Abstract
Heart failure (HF) is a clinical condition defined by structural and functional abnormalities in the heart that gradually result in reduced cardiac output (HFrEF) and/or increased cardiac pressures at rest and under stress (HFpEF). The presence of asymptomatic individuals hampers HF identification, resulting in delays in recognizing patients until heart dysfunction is manifested, thus increasing the chance of poor prognosis. Given the recent advances in metabolomics, in this review we dissect the main alterations occurring in the metabolic pathways behind the decrease in cardiac function caused by HF. Indeed, relevant preclinical and clinical research has been conducted on the metabolite connections and differences between HFpEF and HFrEF. Despite these promising results, it is crucial to note that, in addition to identifying single markers and reliable threshold levels within the healthy population, the introduction of composite panels would strongly help in the identification of those individuals with an increased HF risk. That said, additional research in the field is required to overcome the current drawbacks and shed light on the pathophysiological changes that lead to HF. Finally, greater collaborative data sharing, as well as standardization of procedures and approaches, would enhance this research field to fulfil its potential.
Collapse
Affiliation(s)
- Federico Ferro
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34125 Trieste, Italy
- Correspondence:
| | - Renza Spelat
- Neurobiology Sector, International School for Advanced Studies (SISSA), 34136 Trieste, Italy;
| | - Camilla Valente
- Department of Molecular Medicine, University of Padova, 35122 Padova, Italy; (C.V.); (P.C.)
| | - Paolo Contessotto
- Department of Molecular Medicine, University of Padova, 35122 Padova, Italy; (C.V.); (P.C.)
| |
Collapse
|
7
|
Onalo R, Cilliers A, Cooper P, Morris CR. Arginine Therapy and Cardiopulmonary Hemodynamics in Hospitalized Children with Sickle Cell Anemia: A Prospective, Double-blinded, Randomized Placebo-controlled Clinical Trial. Am J Respir Crit Care Med 2022; 206:70-80. [PMID: 35426778 PMCID: PMC9954326 DOI: 10.1164/rccm.202108-1930oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Acute changes in cardiopulmonary hemodynamics that include tricuspid regurgitant jet velocity (TRV) elevation measured by Doppler echocardiography are often encountered during sickle cell vasoocclusive pain and acute chest syndrome (ACS). Arginine and nitric oxide depletion develop in patients with these complications. Arginine administration may therefore improve nitric oxide bioavailability and potentiate pulmonary vasodilatation. Objectives: To evaluate effects of l-arginine supplementation on Doppler indices of cardiopulmonary hemodynamics in children with sickle cell anemia experiencing pain. Methods: This was a prospective, double-blinded, randomized placebo-controlled trial of oral arginine in children with sickle cell anemia age 5-17 years hospitalized with severe pain and/or ACS. Measurements and Main Results: Blood biomarkers and Doppler echocardiographic indices of cardiopulmonary hemodynamics were measured before and after supplementation. The mean change in TRV, pulmonary artery systolic pressure, mean pulmonary artery pressure, and other indices of cardiopulmonary hemodynamics were tested with paired Student's t test and correlated with markers of arginine bioavailability using Pearson correlation. Sixty-six children were randomized into arginine versus placebo groups. An elevated TRV ⩾ 2.5 m/s was seen in 40 (61%) patients. A Day 5 Doppler echocardiogram was performed in 47 patients who remained hospitalized. A greater reduction in median TRV occurred in the arginine group than placebo (22.2%, n = 22 vs. 3.8%, n = 25; p < 0.01). A larger percentage increase in global arginine bioavailability was associated with a lower TRV after 5 days of supplementation (r = -0.533; P = 0.001). Significant differences in multiple indices of cardiopulmonary hemodynamics and mean N-terminal pro B-type brain natriuretic peptide were also noted after arginine therapy. Conclusions: Oral arginine supplementation improves cardiopulmonary hemodynamics during sickle cell disease vasoocclusive pain and ACS.Clinical trial registered with Pan African Clinical Trial Registry https://pactr.samrc.ac.za/Search.aspx (PACTR201611001864290).
Collapse
Affiliation(s)
- Richard Onalo
- Cardiology Unit, Department of Paediatrics, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Antoinette Cilliers
- Division of Paediatric Cardiology, Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, and
| | - Peter Cooper
- Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia;,Children’s Healthcare of Atlanta, Atlanta, Georgia; and,Center for Clinical and Translational Research of Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia
| |
Collapse
|
8
|
Havlenova T, Skaroupkova P, Miklovic M, Behounek M, Chmel M, Jarkovska D, Sviglerova J, Stengl M, Kolar M, Novotny J, Benes J, Cervenka L, Petrak J, Melenovsky V. Right versus left ventricular remodeling in heart failure due to chronic volume overload. Sci Rep 2021; 11:17136. [PMID: 34429479 PMCID: PMC8384875 DOI: 10.1038/s41598-021-96618-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
Mechanisms of right ventricular (RV) dysfunction in heart failure (HF) are poorly understood. RV response to volume overload (VO), a common contributing factor to HF, is rarely studied. The goal was to identify interventricular differences in response to chronic VO. Rats underwent aorto-caval fistula (ACF)/sham operation to induce VO. After 24 weeks, RV and left ventricular (LV) functions, gene expression and proteomics were studied. ACF led to biventricular dilatation, systolic dysfunction and hypertrophy affecting relatively more RV. Increased RV afterload contributed to larger RV stroke work increment compared to LV. Both ACF ventricles displayed upregulation of genes of myocardial stress and metabolism. Most proteins reacted to VO in a similar direction in both ventricles, yet the expression changes were more pronounced in RV (pslope: < 0.001). The most upregulated were extracellular matrix (POSTN, NRAP, TGM2, CKAP4), cell adhesion (NCAM, NRAP, XIRP2) and cytoskeletal proteins (FHL1, CSRP3) and enzymes of carbohydrate (PKM) or norepinephrine (MAOA) metabolism. Downregulated were MYH6 and FAO enzymes. Therefore, when exposed to identical VO, both ventricles display similar upregulation of stress and metabolic markers. Relatively larger response of ACF RV compared to the LV may be caused by concomitant pulmonary hypertension. No evidence supports RV chamber-specific regulation of protein expression in response to VO.
Collapse
Affiliation(s)
- Tereza Havlenova
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Pathophysiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petra Skaroupkova
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic
| | - Matus Miklovic
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Pathophysiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Matej Behounek
- grid.4491.80000 0004 1937 116XBIOCEV, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Chmel
- grid.4491.80000 0004 1937 116XBIOCEV, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dagmar Jarkovska
- grid.4491.80000 0004 1937 116XFaculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Jitka Sviglerova
- grid.4491.80000 0004 1937 116XFaculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Milan Stengl
- grid.4491.80000 0004 1937 116XFaculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Michal Kolar
- grid.418827.00000 0004 0620 870XInstitute of Molecular Genetics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jiri Novotny
- grid.418827.00000 0004 0620 870XInstitute of Molecular Genetics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jan Benes
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic
| | - Ludek Cervenka
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Pathophysiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Petrak
- grid.4491.80000 0004 1937 116XBIOCEV, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vojtech Melenovsky
- grid.418930.70000 0001 2299 1368Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Videnska 1958/9, 140 21 Prague 4, Czech Republic
| |
Collapse
|
9
|
Cedars A, Manlhiot C, Ko JM, Bottiglieri T, Arning E, Weingarten A, Opotowsky A, Kutty S. Metabolomic Profiling of Adults with Congenital Heart Disease. Metabolites 2021; 11:metabo11080525. [PMID: 34436466 PMCID: PMC8398700 DOI: 10.3390/metabo11080525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 11/16/2022] Open
Abstract
Metabolomic analysis may provide an integrated assessment in genetically and pathologically heterogeneous populations. We used metabolomic analysis to gain mechanistic insight into the small and diverse population of adults with congenital heart disease (ACHD). Consecutive ACHD patients seen at a single institution were enrolled. Clinical variables and whole blood were collected at regular clinical visits. Stored plasma samples were analyzed for the concentrations of 674 metabolites and metabolic markers using mass spectrometry with internal standards. These samples were compared to 28 simultaneously assessed healthy non-ACHD controls. Principal component analysis and multivariable regression modeling were used to identify metabolites associated with clinical outcomes in ACHD. Plasma from ACHD and healthy control patients differed in the concentrations of multiple metabolites. Differences between control and ACHD were greater in number and in degree than those between ACHD anatomic groups. A metabolite cluster containing amino acids and metabolites of amino acids correlated with negative clinical outcomes across all anatomic groups. Metabolites in the arginine metabolic pathway, betaine, dehydroepiandrosterone, cystine, 1-methylhistidine, serotonin and bile acids were associated with specific clinical outcomes. Metabolic markers of disease may both be useful as biomarkers for disease activity and suggest etiologically related pathways as possible targets for disease-modifying intervention.
Collapse
Affiliation(s)
- Ari Cedars
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21218, USA; (C.M.); (J.-M.K.); (S.K.)
- Correspondence:
| | - Cedric Manlhiot
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21218, USA; (C.M.); (J.-M.K.); (S.K.)
| | - Jong-Mi Ko
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21218, USA; (C.M.); (J.-M.K.); (S.K.)
| | - Teodoro Bottiglieri
- Center of Metabolomics, Baylor Scott & White Research Institute, Dallas, TX 75204, USA; (T.B.); (E.A.)
| | - Erland Arning
- Center of Metabolomics, Baylor Scott & White Research Institute, Dallas, TX 75204, USA; (T.B.); (E.A.)
| | - Angela Weingarten
- Department of Medicine, Vanderbilt University, Nashville, TN 37235, USA;
| | - Alexander Opotowsky
- Department of Cardiology, Cincinnati Children’s Hospital, Cincinnati, OH 45229, USA;
| | - Shelby Kutty
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21218, USA; (C.M.); (J.-M.K.); (S.K.)
| |
Collapse
|
10
|
Pirlamarla P, Rame E, Hoopes C, Rajapreyar I. Pulmonary vasodilator use in continuous-flow left ventricular assist device management. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:522. [PMID: 33850919 PMCID: PMC8039680 DOI: 10.21037/atm-20-4710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pulmonary hypertension (PH) due to left heart disease is the most common etiology for PH. PH in patients with heart failure with reduced fraction (HFrEF) is associated with reduced functional capacity and increased mortality. PH-HFrEF can be isolated post-capillary or combined pre- and post-capillary PH. Chronic elevation of left-sided filling pressures may lead to reverse remodeling of the pulmonary vasculature with development of precapillary component of PH. Untreated PH in patients with HFrEF results in predominant right heart failure (RHF) with irreversible end-organ dysfunction. Management of PH-HFrEF includes diuretics, vasodilators like angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers or angiotensin-receptor blocker-neprilysin inhibitors, hydralazine and nitrates. There is no role for pulmonary vasodilator use in patients with PH-HFrEF due to increased mortality in clinical trials. In patients with end-stage HFrEF and fixed PH unresponsive to vasodilator challenge, implantation of continuous-flow left ventricular assist device (cfLVAD) results in marked improvement in pulmonary artery pressures within 6 months due to left ventricular (LV) mechanical unloading. The role of pulmonary vasodilators in management of precapillary component of PH after cfLVAD is not well-defined. The purpose of this review is to discuss the pharmacologic management of PH after cfLVAD implantation.
Collapse
Affiliation(s)
- Preethi Pirlamarla
- Advanced Heart Failure and Transplant Cardiology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Eduardo Rame
- Advanced Heart Failure and Transplant Cardiology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Charles Hoopes
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Indranee Rajapreyar
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama-Birmingham School of Medicine, Birmingham, AL, USA
| |
Collapse
|
11
|
Andersson C, Liu C, Cheng S, Wang TJ, Gerszten RE, Larson MG, Vasan RS. Metabolomic signatures of cardiac remodelling and heart failure risk in the community. ESC Heart Fail 2020; 7:3707-3715. [PMID: 32909388 PMCID: PMC7754777 DOI: 10.1002/ehf2.12923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 01/20/2023] Open
Abstract
Aims Heart failure (HF) is associated with several metabolic changes, but it is unknown whether distinct components of the circulating metabolome may be related to cardiac structure and function, and with incident HF in the community. Methods and results We assayed 217 circulating metabolites in 2336 Framingham Study participants (mean age 55 ± 10 years, 53% women) without HF at baseline. We used linear and Cox regression to relate concentrations of metabolites to left ventricular (LV) diastolic dimension, LV wall thickness, LV ejection fraction, left atrial dimension, LV ventricular mass, and aortic root size cross‐sectionally and to incident HF prospectively. Bonferroni‐adjusted P‐values <0.05 denoted statistical significance. Circulating concentrations of kynurenine [β = −0.12 cm per standard deviation (SD) increment in normalized residual of metabolite, P = 7.3 × 10−8] and aminoadipate (−0.11 cm per SD increment, P = 2.61 × 10−5) were associated with left ventricular diastolic dimension, phosphatidylcholine (carbon:double bound = 38:6) with left atrial dimension (0.10 cm per SD increment, P = 9.7 × 10−6), and cholesterol ester (carbon:double bound = 20:5) with left atrial dimension (0.10 cm per SD increment, P = 1.4 × 10−5) in multivariable‐adjusted models. During an average follow‐up of 15.8 (range 0.02–23.2) years, 113 participants (5%) were diagnosed with HF with reduced ejection fraction and 106 individuals (5%) with HF with preserved ejection fraction. In multivariable analyses, concentrations of phosphatidylcholine (hazard ratio 0.63, P = 1.3 × 10−5) and ornithine (hazard ratio 1.44, P = 0.00014) were associated with HF with reduced ejection fraction. Conclusions Several metabolites, including the vasoactive metabolite kynurenine, were related to cardiac structure and function in our sample. Additional research is warranted to confirm our observations and investigate if these metabolites can risk stratify ambulatory individuals.
Collapse
Affiliation(s)
- Charlotte Andersson
- NHBLI and Boston University's Framingham Heart Study, Framingham, MA, USA.,Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.,Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Chunyu Liu
- NHBLI and Boston University's Framingham Heart Study, Framingham, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Susan Cheng
- NHBLI and Boston University's Framingham Heart Study, Framingham, MA, USA.,Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Broad Institute of MIT and Harvard Program in Metabolism, Cambridge, MA, USA
| | - Martin G Larson
- NHBLI and Boston University's Framingham Heart Study, Framingham, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ramachandran S Vasan
- NHBLI and Boston University's Framingham Heart Study, Framingham, MA, USA.,Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
12
|
Li C, Wang L, Li Y, Feng Z, Wang Q, Luo W. Common Variants in the ARG1 Gene Contribute to the Risk of Dilated Cardiomyopathy in the Han Chinese Population. Genet Test Mol Biomarkers 2020; 24:584-591. [PMID: 32721242 DOI: 10.1089/gtmb.2020.0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Arginase I, encoded by the ARG1 gene, is an enzyme that catalyzes the conversion of arginine to ornithine in the urea cycle; mutations in this gene has recently been reported to be associated with dilated cardiomyopathy (DCM) in Pakistan. The present study aimed to investigate the relationship between ARG1 gene mutations and DCM in the Han Chinese population. Methods: A total of 488 DCM cases and 924 matched-healthy controls were recruited. All subjects were genotyped for 12 tag single nucleotide polymorphisms (SNPs) within the ARG1 gene. Genetic association studies, including SNP and haplotype analyses, were performed. Further analyses were conducted to examine the correlations between the associated SNPs and specific clinical characteristics. Results: Only the rs2781666 and rs2781667 loci in the ARG1 gene were found to be significantly associated with DCM compared to the healthy controls. The risk of DCM at both of these loci for T allele carriers was ∼1.42-fold higher than that for carriers of the alternative alleles. There were significant differences in end-diastolic interventricular septal diameter, end-diastolic left ventricular posterior wall diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left ventricular ejection fraction among the genotype distributions of both SNPs. Furthermore, we found that the T alleles at the rs2781666 and rs2781667 loci were significantly associated with DCM in gender subgroups and the subgroup of patients <58 years of age. The haplotype T-T (rs2781666-rs2781667) also showed a significant association with DCM. Conclusion: Our results support the hypothesis that alleles and haplotypes of the ARG1 gene are significantly involved in the etiology of DCM in the Han Chinese population, but further research is necessary to elucidate the mechanism governing this association.
Collapse
Affiliation(s)
- Chaomin Li
- Department of Cardiovascular Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liping Wang
- Department of Cardiovascular Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yuanbo Li
- Department of Cardiovascular Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhang Feng
- Department of Cardiology, Xi'an Central Hospital, Xi'an, China
| | - Qiang Wang
- Department of Cardiovascular Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Wei Luo
- Department of Cardiovascular Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
13
|
Piersigilli F, Syed M, Lam TT, Dotta A, Massoud M, Vernocchi P, Quagliariello A, Putignani L, Auriti C, Salvatori G, Bagolan P, Bhandari V. An omic approach to congenital diaphragmatic hernia: a pilot study of genomic, microRNA, and metabolomic profiling. J Perinatol 2020; 40:952-961. [PMID: 32080334 DOI: 10.1038/s41372-020-0623-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The omic approach can help identify a signature that can be potentially used as biomarkers in babies with congenital diaphragmatic hernia (CDH). OBJECTIVES To find a specific microRNA (miR) and metabolic fingerprint of the tracheal aspirates (TA) of CDH patients. We conducted a genetic analysis from blood samples. METHODS TA samples collected in the first 48 h of life in patients with CDH, compared with age-matched controls. Metabolomics done by a mass spectroscopy-based assay. Genomics done using chromosomal microarray analysis. RESULTS CDH (n = 17) and 16 control neonates enrolled. miR-16, miR-17, miR-18, miR-19b, and miR-20a had an increased expression, while miR-19a had a twofold decreased expression in CDH patients, compared with age-matched control patients. Specific metabolites separated neonates with CDH from controls. A genetic mutation found in a small subset of patients. CONCLUSIONS Specific patterns of metabolites and miR expression can be discerned in TA samples in infants with CDH.
Collapse
Affiliation(s)
- Fiammetta Piersigilli
- Division of Perinatal Medicine, Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.,Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mansoor Syed
- Division of Perinatal Medicine, Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.,Section of Neonatal-Perinatal Medicine, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA, 19134, USA
| | - TuKiet T Lam
- Department of Molecular Biophysics & Biochemistry, Yale University, New Haven, CT, USA.,Keck MS & Proteomics Resource, WM Keck Foundation Biotechnology Resource Laboratory, New Haven, CT, USA
| | - Andrea Dotta
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michela Massoud
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pamela Vernocchi
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Quagliariello
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lorenza Putignani
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy.,Unit of Parasitology, Department of Laboratory and Immunological, Diagnostics Bambino Gesù Children's Hospital, Rome, Italy
| | - Cinzia Auriti
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Guglielmo Salvatori
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Division of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vineet Bhandari
- Division of Perinatal Medicine, Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA. .,Section of Neonatal-Perinatal Medicine, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA, 19134, USA. .,Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA.
| |
Collapse
|
14
|
Shao Z, Koh W, Ni Y, Li W, Agatisa-Boyle B, Merkurjev D, Tang WHW. RNA Sequence Analyses throughout the Course of Mouse Cardiac Laminopathy Identify Differentially Expressed Genes for Cell Cycle Control and Mitochondrial Function. Sci Rep 2020; 10:6632. [PMID: 32313136 PMCID: PMC7170950 DOI: 10.1038/s41598-020-63563-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/30/2020] [Indexed: 12/03/2022] Open
Abstract
Lamin A/C (LMNA) gene mutations are a known cause of familial dilated cardiomyopathy, but the precise mechanisms triggering disease progression remain unknown. We hypothesize that analysis of differentially expressed genes (DEGs) throughout the course of Lmna knockout (Lmna-/-)-induced cardiomyopathy may reveal novel Lmna-mediated alterations of signaling pathways leading to dilated cardiomyopathy. Although Lmna was the only DEG down-regulated at 1 week of age, we identified 730 and 1004 DEGs in Lmna-/- mice at 2 weeks and 1 month of age, respectively. At 2 weeks, Lmna-/- mice demonstrated both down- and up-regulation of the key genes involving cell cycle control, mitochondrial dysfunction, and oxidative phosphorylation, as well as down-regulated genes governing DNA damage repair and up-regulated genes involved in oxidative stress response, cell survival, and cardiac hypertrophy. At 1 month, the down-regulated genes included those involved in oxidative phosphorylation, mitochondrial dysfunction, nutrient metabolism, cardiac β-adrenergic signaling, action potential generation, and cell survival. We also found 96 overlapping DEGs at both ages involved in oxidative phosphorylation, mitochondrial function, and calcium signaling. Impaired oxidative phosphorylation was observed at early disease stage, even before the appearance of disease phenotypes, and worsened with disease progression, suggesting its importance in the pathogenesis and progression of LMNA cardiomyopathy. Reduction of oxidative stress might therefore prevent or delay the development from Lmna mutation to LMNA cardiomyopathy.
Collapse
Affiliation(s)
- Zhili Shao
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wonshill Koh
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ying Ni
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Li
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Brendan Agatisa-Boyle
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daria Merkurjev
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Wai Hong Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Kaufman Center for Heart Failure Treatment and Recovery, Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
15
|
Fernández AI, Yotti R, González-Mansilla A, Mombiela T, Gutiérrez-Ibanes E, Pérez del Villar C, Navas-Tejedor P, Chazo C, Martínez-Legazpi P, Fernández-Avilés F, Bermejo J. The Biological Bases of Group 2 Pulmonary Hypertension. Int J Mol Sci 2019; 20:ijms20235884. [PMID: 31771195 PMCID: PMC6928720 DOI: 10.3390/ijms20235884] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022] Open
Abstract
Pulmonary hypertension (PH) is a potentially fatal condition with a prevalence of around 1% in the world population and most commonly caused by left heart disease (PH-LHD). Usually, in PH-LHD, the increase of pulmonary pressure is only conditioned by the retrograde transmission of the left atrial pressure. However, in some cases, the long-term retrograde pressure overload may trigger complex and irreversible biomechanical and biological changes in the pulmonary vasculature. This latter clinical entity, designated as combined pre- and post-capillary PH, is associated with very poor outcomes. The underlying mechanisms of this progression are poorly understood, and most of the current knowledge comes from the field of Group 1-PAH. Treatment is also an unsolved issue in patients with PH-LHD. Targeting the molecular pathways that regulate pulmonary hemodynamics and vascular remodeling has provided excellent results in other forms of PH but has a neutral or detrimental result in patients with PH-LHD. Therefore, a deep and comprehensive biological characterization of PH-LHD is essential to improve the diagnostic and prognostic evaluation of patients and, eventually, identify new therapeutic targets. Ongoing research is aimed at identify candidate genes, variants, non-coding RNAs, and other biomarkers with potential diagnostic and therapeutic implications. In this review, we discuss the state-of-the-art cellular, molecular, genetic, and epigenetic mechanisms potentially involved in PH-LHD. Signaling and effective pathways are particularly emphasized, as well as the current knowledge on -omic biomarkers. Our final aim is to provide readers with the biological foundations on which to ground both clinical and pre-clinical research in the field of PH-LHD.
Collapse
Affiliation(s)
- Ana I. Fernández
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Enrique Gutiérrez-Ibanes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Candelas Pérez del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Paula Navas-Tejedor
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Christian Chazo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Pablo Martínez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.I.F.); (R.Y.); (A.G.-M.); (T.M.); (E.G.-I.); (C.P.d.V.); (P.N.-T.); (C.C.); (P.M.-L.); (F.F.-A.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Instituto de Salud Carlos III, 28026 Madrid, Spain
- Facultad de Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
- Correspondence: ; Tel.: +34-91-586-8279
| |
Collapse
|
16
|
Cheong HI, Farha S, Park MM, Thomas JD, Saygin D, Comhair SAA, Sharp J, Highland KB, Tang WHW, Erzurum SC. Endothelial Phenotype Evoked by Low Dose Carvedilol in Pulmonary Hypertension. Front Cardiovasc Med 2018; 5:180. [PMID: 30619887 PMCID: PMC6299019 DOI: 10.3389/fcvm.2018.00180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/30/2018] [Indexed: 01/06/2023] Open
Abstract
Background: The therapeutic benefits of β-blockers are well established in left heart failure. The Pulmonary Arterial Hypertension Treatment with Carvedilol for Heart Failure [PAHTCH] study showed safety and possible benefit of carvedilol in pulmonary arterial hypertension (PAH) associated right heart failure over 6 months. This study aims at evaluating the short-term cardiovascular effects and early mechanistic biomarkers of carvedilol therapy. Methods: Thirty patients with pulmonary hypertension (PH) received low dose carvedilol (3.125 mg twice daily) for 1 week prior to randomization to placebo, low-dose, or dose-escalating carvedilol therapy. Echocardiography was performed at baseline and 1 week. Exercise capacity was assessed by 6 min walk distance (6MWD). The L-arginine/nitric oxide pathway and other biological markers of endothelial function were measured. Results: All participants tolerated 1 week of carvedilol without adverse effects. After 1 week of carvedilol, 6MWD and heart rate at peak exercise did not vary (both p > 0.1). Heart rate at rest and 1 min post walk dropped significantly (both p < 0.05) with a trend for increase in heart rate recovery (p = 0.08). Right ventricular systolic pressure (RVSP) decreased by an average of 13 mmHg (p = 0.002). Patients who had a decrease in RVSP of more than 10 mm Hg were defined as responders (n = 17), and those with a lesser drop as non-responders (n = 13). Responders had a significant drop in pulmonary vascular resistance (PVR) after 1 week of carvedilol (p = 0.004). In addition, responders had a greater decrease in heart rate at rest and 1 min post walk compared to non-responders (both p < 0.05). Responders had higher plasma arginine and global bioavailability of arginine at baseline compared to non-responders (p = 0.03 and p = 0.05, respectively). After 1 week of carvedilol, responders had greater increase in urinary nitrate (p = 0.04). Responders treated with carvedilol had a sustained drop in RVSP and PVR after 6 months of carvedilol with no change in cardiac output. Conclusions: Low-dose carvedilol for 1 week can potentially identify a PH responder phenotype that may benefit from β-blockers that is associated with less endothelial dysfunction. Clinical Trial Registration:http://www.clinicaltrials.gov. identifier: NCT01586156.
Collapse
Affiliation(s)
- Hoi I Cheong
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Samar Farha
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Margaret M Park
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
| | - James D Thomas
- Heart and Vascular Institute, Northwestern University Hospital, Chicago, IL, United States
| | - Didem Saygin
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Suzy A A Comhair
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jacqueline Sharp
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | - W H Wilson Tang
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Serpil C Erzurum
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States
| |
Collapse
|
17
|
Carrara M, Babini G, Baselli G, Ristagno G, Pastorelli R, Brunelli L, Ferrario M. Blood pressure variability, heart functionality, and left ventricular tissue alterations in a protocol of severe hemorrhagic shock and resuscitation. J Appl Physiol (1985) 2018; 125:1011-1020. [PMID: 30001154 PMCID: PMC6230573 DOI: 10.1152/japplphysiol.00348.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Autonomic control of blood pressure (BP) and heart rate (HR) is crucial during bleeding and hemorrhagic shock (HS) to compensate for hypotension and hypoxia. Previous works have observed that at the point of hemodynamic decompensation a marked suppression of BP and HR variability occurs, leading to irreversible shock. We hypothesized that recovery of the autonomic control may be decisive for effective resuscitation, along with restoration of mean BP. We computed cardiovascular indexes of baroreflex sensitivity and BP and HR variability by analyzing hemodynamic recordings collected from five pigs during a protocol of severe hemorrhage and resuscitation; three pigs were sham-treated controls. Moreover, we assessed the effects of severe hemorrhage on heart functionality by integrating the hemodynamic findings with measures of plasma high-sensitivity cardiac troponin T and metabolite concentrations in left ventricular (LV) tissue. Resuscitation was performed with fluids and norepinephrine and then by reinfusion of shed blood. After first resuscitation, mean BP reached the target value, but cardiovascular indexes were not fully restored, hinting at a partial recovery of the autonomic mechanisms. Moreover, cardiac troponins were still elevated, suggesting a persistent myocardial sufferance. After blood reinfusion all the indexes returned to baseline. In the harvested heart, LV metabolic profile confirmed the acute stress condition sensed by the cardiomyocytes. Variability indexes and baroreflex trends can be valuable tools to evaluate the severity of HS, and they may represent a more useful end point for resuscitation in combination with standard measures such as mean values and biological measures. NEW & NOTEWORTHY Autonomic control of blood pressure was highly impaired during hemorrhagic shock, and it was not completely recovered after resuscitation despite global restoration of mean pressures. Moreover, a persistent myocardial sufferance emerged from measured cardiac troponin T and metabolite concentrations of left ventricular tissue. We highlight the importance of combining global mean values and biological markers with measures of variability and autonomic control for a better characterization of the effectiveness of the resuscitation strategy.
Collapse
Affiliation(s)
- Marta Carrara
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan , Italy
| | - Giovanni Babini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan , Milan , Italy
| | - Giuseppe Baselli
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan , Italy
| | | | | | - Laura Brunelli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Manuela Ferrario
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan , Italy
| |
Collapse
|
18
|
Deidda M, Noto A, Bassareo PP, Cadeddu Dessalvi C, Mercuro G. Metabolomic Approach to Redox and Nitrosative Reactions in Cardiovascular Diseases. Front Physiol 2018; 9:672. [PMID: 29997515 PMCID: PMC6031070 DOI: 10.3389/fphys.2018.00672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/15/2018] [Indexed: 11/16/2022] Open
Abstract
Metabolomics, also referred to as metabonomics, is one of the most recent innovative technologies in medicine. It offers a direct functional read-out of phenotypes by the detection, identification, and quantification of a large number of metabolites within a biological sample such as urine and blood. Metabolites (<1500 Da) represent the output of cellular metabolism, accounting for expression and activity of genes, transcripts, and proteins, and offering unique insights into small molecule regulation, which may uncover new biochemical patterns. Metabolomics research has considerable potential for translating the metabolic fingerprint into personalized therapeutic strategies. Within the field of interest, cardiovascular disease (CVD) is one of the most developed areas. However, CVD remains the leading cause of death worldwide with a marked increase in mortality rates over the past six decades. In this scenario, recent findings indicate the important role of redox and nitrosative (RN) reactions in CVD development and progression. RN reactions are generally involved in the homeostatic modulation of a wide number of cellular and organ functions. Conversely, the imbalance of these reactions may lead to a condition of allostasis that in turn can cause CVD. The aim of this review is to highlight how the use of metabolomics may be useful for the study of RN reactions related to CVD, providing a tool to understand the mechanisms underlying reactions that could lead to impaired ROS or RNS formation.
Collapse
Affiliation(s)
- Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Sardinia, Italy
| | - Antonio Noto
- Department of Medical Sciences and Public Health, University of Cagliari, Sardinia, Italy
| | - Pier P Bassareo
- Department of Medical Sciences and Public Health, University of Cagliari, Sardinia, Italy
| | | | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Sardinia, Italy
| |
Collapse
|
19
|
Wallace WD, Nouraie M, Chan SY, Risbano MG. Treatment of exercise pulmonary hypertension improves pulmonary vascular distensibility. Pulm Circ 2018; 8:2045894018787381. [PMID: 29916285 PMCID: PMC6047253 DOI: 10.1177/2045894018787381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Exercise pulmonary hypertension (ePH) is an underappreciated form of exertional limitation. Despite normal resting pulmonary artery pressures, patients with ePH demonstrate early pulmonary vascular changes with reduced pulmonary arterial compliance (PAC) and vascular distensibility (α). Recent data suggest that targeted vasodilator therapy may improve hemodynamics in ePH, but it is not well-known whether such medications alter pulmonary vascular distensibility. Thus, we sought to evaluate if vasodilator therapy improved α a marker of early pulmonary vascular disease in ePH. Ten patients performed supine exercise right heart catheterization (exRHC) with bicycle ergometer to peak exercise. Patients diagnosed with ePH were treated with pulmonary vasodilators. A repeat symptom-limited exercise RHC was performed at least six months after therapy. Patients with ePH had evidence of early pulmonary vascular disease, as baseline PAC and α were reduced. After pulmonary vasodilator therapy, a number of peak exercise hemodynamics statistically improved, including a decrease of total pulmonary resistance and pulmonary vascular resistance, while cardiac output increased. Importantly, vasodilator therapy partially reversed the pathogenic decreases of α at the time of repeat exRHC. Pulmonary vascular distensibility, α, a marker of early pulmonary vascular disease, improves in ePH after therapy with pulmonary vasodilators.
Collapse
Affiliation(s)
- William D Wallace
- 1 Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Mehdi Nouraie
- 2 Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,3 Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephen Y Chan
- 3 Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,4 Division of Cardiology, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael G Risbano
- 2 Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,3 Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
20
|
Abstract
Metabolomics is the study of small, organic molecules within biochemical pathways. With advancement of technology, nuclear magnetic resonance, gas chromatography, and mass spectrometry have allowed for the discovery and analysis of large databases of metabolites implicated in heart failure. Metabolomics also explores the patient and environment interactions and unlocks the link between environmental exposures and the development of cardiovascular disease. Although a relatively new field, metabolomics is poised to become a clinically impactful field that develops novel biomarkers and explores new therapeutic interventions in heart failure.
Collapse
|
21
|
Lundgren J, Sandqvist A, Hedeland M, Bondesson U, Wikström G, Rådegran G. Alterations in plasma L-arginine and methylarginines in heart failure and after heart transplantation. SCAND CARDIOVASC J 2018; 52:196-204. [PMID: 29648475 DOI: 10.1080/14017431.2018.1459823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Endothelial function, including the nitric oxide (NO)-pathway, has previously been extensively investigated in heart failure (HF). In contrast, studies are lacking on the NO pathway after heart transplantation (HT). We therefore investigated substances in the NO pathway prior to and after HT in relation to hemodynamic parameters. DESIGN 12 patients (median age 50.0 yrs, 2 females), heart transplanted between June 2012 and February 2014, evaluated at our hemodynamic lab, at rest, prior to HT, as well as four weeks and six months after HT were included. All patients had normal left ventricular function post-operatively and none had post-operative pulmonary hypertension or acute cellular rejection requiring therapy at the evaluations. Plasma concentrations of ADMA, SDMA, L-Arginine, L-Ornithine and L-Citrulline were analyzed at each evaluation. RESULTS In comparison to controls, the plasma L-Arginine concentration was low and ADMA high in HF patients, resulting in low L-Arginine/ADMA-ratio pre-HT. Already four weeks after HT L-Arginine was normalized whereas ADMA remained high. Consequently the L-Arginine/ADMA-ratio improved, but did not normalize. The biomarkers remained unchanged at the six-month evaluation and the L-Arginine/ADMA-ratio correlated inversely to pulmonary vascular resistance (PVR) six months post-HT. CONCLUSIONS Plasma L-Arginine concentrations normalize after HT. However, as ADMA is unchanged, the L-Arginine/ADMA-ratio remained low and correlated inversely to PVR. Together these findings suggest that (i) the L-Arginine/ADMA-ratio may be an indicator of pulmonary vascular tone after HT, and that (ii) NO-dependent endothelial function is partly restored after HT. Considering the good postoperative outcome, the biomarker levels may be considered "normal" after HT.
Collapse
Affiliation(s)
- Jakob Lundgren
- a Department of Clinical Sciences Lund, Cardiology , Lund University , Lund , Sweden.,b The Hemodynamic Lab, The Section for Heart Failure and Valvular Disease, The Heart and Lung Clinic , Skåne University Hospital , Lund , Sweden
| | - Anna Sandqvist
- c Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology , Umeå University , Umeå , Sweden
| | - Mikael Hedeland
- d Department of Chemistry, Environment and Feed Hygiene , National Veterinary Institute (SVA) , Uppsala , Sweden.,e Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry , Uppsala University , Uppsala , Sweden
| | - Ulf Bondesson
- d Department of Chemistry, Environment and Feed Hygiene , National Veterinary Institute (SVA) , Uppsala , Sweden.,e Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry , Uppsala University , Uppsala , Sweden
| | - Gerhard Wikström
- f Department of Medical Sciences, Cardiology , Uppsala University, Uppsala University Hospital , Uppsala , Sweden
| | - Göran Rådegran
- a Department of Clinical Sciences Lund, Cardiology , Lund University , Lund , Sweden.,b The Hemodynamic Lab, The Section for Heart Failure and Valvular Disease, The Heart and Lung Clinic , Skåne University Hospital , Lund , Sweden
| |
Collapse
|
22
|
Meneza SAEEL, Bahgat SM, Nasr AELS. Plasma Asymmetric Dimethylarginine Levels in Neonates with Bronchopulmonary Dysplasia Associated with Pulmonary Hypertension. OPEN JOURNAL OF PEDIATRICS 2018; 08:221-237. [DOI: 10.4236/ojped.2018.83024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
23
|
Sandqvist A, Schneede J, Kylhammar D, Henrohn D, Lundgren J, Hedeland M, Bondesson U, Rådegran G, Wikström G. Plasma L-arginine levels distinguish pulmonary arterial hypertension from left ventricular systolic dysfunction. Heart Vessels 2017; 33:255-263. [PMID: 28975394 PMCID: PMC5847178 DOI: 10.1007/s00380-017-1055-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening condition, characterized by an imbalance of vasoactive substances and remodeling of pulmonary vasculature. Nitric oxide, formed from L-arginine, is essential for homeostasis and smooth muscle cell relaxation in PAH. Our aim was to compare plasma concentrations of L-arginine, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) in PAH compared to left ventricular systolic dysfunction (LVSD) and healthy subjects. This was an observational, multicenter study comparing 21 patients with PAH to 14 patients with LVSD and 27 healthy subjects. Physical examinations were obtained and blood samples were collected. Plasma levels of ADMA, SDMA, L-arginine, L-ornithine, and L-citrulline were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Plasma levels of ADMA and SDMA were higher, whereas L-arginine and L-arginine/ADMA ratio were lower in PAH patients compared to healthy subjects (p < 0.001). Patients with PAH also had lower levels of L-arginine than patients with LVSD (p < 0.05). L-Arginine correlated to 6 min walking distance (6MWD) (r s = 0.58, p = 0.006) and L-arginine/ADMA correlated to WHO functional class (r s = -0.46, p = 0.043) in PAH. In conclusion, L-arginine levels were significantly lower in treatment naïve PAH patients compared to patients with LVSD. Furthermore, L-arginine correlated with 6MWD in PAH. L-arginine may provide useful information in differentiating PAH from LVSD.
Collapse
Affiliation(s)
- Anna Sandqvist
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, 901 87, Umeå, Sweden.
| | - Jörn Schneede
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, 901 87, Umeå, Sweden
| | - David Kylhammar
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden.,The Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Dan Henrohn
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Jakob Lundgren
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden.,The Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Mikael Hedeland
- Department of Chemistry, National Veterinary Institute (SVA), Uppsala, Sweden.,Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry, Uppsala University, Uppsala, Sweden
| | - Ulf Bondesson
- Department of Chemistry, National Veterinary Institute (SVA), Uppsala, Sweden.,Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry, Uppsala University, Uppsala, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden.,The Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Gerhard Wikström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
24
|
Malhotra R, Dhakal BP, Eisman AS, Pappagianopoulos PP, Dress A, Weiner RB, Baggish AL, Semigran MJ, Lewis GD. Pulmonary Vascular Distensibility Predicts Pulmonary Hypertension Severity, Exercise Capacity, and Survival in Heart Failure. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.003011. [PMID: 27301469 DOI: 10.1161/circheartfailure.115.003011] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 05/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pulmonary vascular (PV) distensibility, defined as the percent increase in pulmonary vessel diameter per mm Hg increase in pressure, permits the pulmonary vessels to increase in size to accommodate increased blood flow. We hypothesized that PV distensibility is abnormally low in patients with heart failure (HF) and serves as an important determinant of right ventricular performance and exercise capacity. METHODS AND RESULTS Patients with HF with preserved ejection fraction (n=48), HF with reduced ejection fraction (n=55), pulmonary arterial hypertension without left heart failure (n=18), and control subjects (n=30) underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring and first-pass radionuclide ventriculography. PV distensibility was derived from 1257 matched measurements (mean±SD, 8.3±2.8 per subject) of pulmonary arterial pressure, pulmonary arterial wedge pressure and cardiac output. PV distensibility was lowest in the pulmonary arterial hypertension group (0.40±0.24% per mm Hg) and intermediate in the HF with preserved ejection fraction and HF with reduced ejection fraction groups (0.92±0.39 and 0.84±0.33% per mm Hg, respectively) compared to the control group (1.39±0.32% per mm Hg, P<0.0001 for all three). PV distensibility was associated with change in right ventricular ejection fraction (RVEF, ρ=0.39, P<0.0001) with exercise and was an independent predictor of peak VO2. PV distensibility also predicted cardiovascular mortality independent of peak VO2 in HF patients (n=103; Cox hazard ratio, 0.30; 95% confidence interval, 0.10-0.93; P=0.036). In a subset of patients with HF with reduced ejection fraction (n=26), 12 weeks of treatment with the pulmonary vasodilator sildenafil or placebo led to a 24.6% increase in PV distensibility (P=0.015) in the sildenafil group only. CONCLUSIONS PV distensibility is reduced in patients with HF and pulmonary arterial hypertension and is closely related to RV systolic function during exercise, maximal exercise capacity, and survival. Furthermore, PV distensibility is modifiable with selective pulmonary vasodilator therapy and may represent an important target for therapy in selected HF patients with pulmonary hypertension. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00309790.
Collapse
Affiliation(s)
- Rajeev Malhotra
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bishnu P Dhakal
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aaron S Eisman
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Paul P Pappagianopoulos
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ashley Dress
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rory B Weiner
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aaron L Baggish
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marc J Semigran
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gregory D Lewis
- From the Cardiology Division (R.M., B.P.D., A.S.E., R.B.W., A.L.B., M.J.S., G.D.L.) and Pulmonary and Critical Care Unit (P.P.P., A.D., G.D.L.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
25
|
Kumar S, Sun X, Noonepalle SK, Lu Q, Zemskov E, Wang T, Aggarwal S, Gross C, Sharma S, Desai AA, Hou Y, Dasarathy S, Qu N, Reddy V, Lee SG, Cherian-Shaw M, Yuan JXJ, Catravas JD, Rafikov R, Garcia JGN, Black SM. Hyper-activation of pp60 Src limits nitric oxide signaling by increasing asymmetric dimethylarginine levels during acute lung injury. Free Radic Biol Med 2017; 102:217-228. [PMID: 27838434 PMCID: PMC5449193 DOI: 10.1016/j.freeradbiomed.2016.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 10/17/2016] [Accepted: 11/04/2016] [Indexed: 12/22/2022]
Abstract
The molecular mechanisms by which the endothelial barrier becomes compromised during lipopolysaccharide (LPS) mediated acute lung injury (ALI) are still unresolved. We have previously reported that the disruption of the endothelial barrier is due, at least in part, to the uncoupling of endothelial nitric oxide synthase (eNOS) and increased peroxynitrite-mediated nitration of RhoA. The purpose of this study was to elucidate the molecular mechanisms by which LPS induces eNOS uncoupling during ALI. Exposure of pulmonary endothelial cells (PAEC) to LPS increased pp60Src activity and this correlated with an increase in nitric oxide (NO) production, but also an increase in NOS derived superoxide, peroxynitrite formation and 3-nitrotyrosine (3-NT) levels. These effects could be simulated by the over-expression of a constitutively active pp60Src (Y527FSrc) mutant and attenuated by over-expression of dominant negative pp60Src mutant or reducing pp60Src expression. LPS induces both RhoA nitration and endothelial barrier disruption and these events were attenuated when pp60Src expression was reduced. Endothelial NOS uncoupling correlated with an increase in the levels of asymmetric dimethylarginine (ADMA) in both LPS exposed and Y527FSrc over-expressing PAEC. The effects in PAEC were also recapitulated when we transiently over-expressed Y527FSrc in the mouse lung. Finally, we found that the pp60-Src-mediated decrease in DDAH activity was mediated by the phosphorylation of DDAH II at Y207 and that a Y207F mutant DDAH II was resistant to pp60Src-mediated inhibition. We conclude that pp60Src can directly inhibit DDAH II and this is involved in the increased ADMA levels that enhance eNOS uncoupling during the development of ALI.
Collapse
Affiliation(s)
- Sanjiv Kumar
- Vascular Biology Center and the Center for Biotechnology & Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Xutong Sun
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | | | - Qing Lu
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Evgeny Zemskov
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Ting Wang
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Saurabh Aggarwal
- Department of Anesthesiology, The University of Alabama, Birmingham, AL, United States
| | - Christine Gross
- Vascular Biology Center and the Center for Biotechnology & Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Shruti Sharma
- Center for Biotechnology & Genomic Medicine, Old Dominion University, Norfolk, VA, United States
| | - Ankit A Desai
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Yali Hou
- Vascular Biology Center and the Center for Biotechnology & Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Sridevi Dasarathy
- Vascular Biology Center and the Center for Biotechnology & Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Ning Qu
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Vijay Reddy
- Vascular Biology Center and the Center for Biotechnology & Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Sung Gon Lee
- Vascular Biology Center and the Center for Biotechnology & Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Mary Cherian-Shaw
- Vascular Biology Center and the Center for Biotechnology & Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Jason X-J Yuan
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | - John D Catravas
- Center for Biotechnology & Genomic Medicine, Old Dominion University, Norfolk, VA, United States
| | - Ruslan Rafikov
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Joe G N Garcia
- Department of Medicine, The University of Arizona, Tucson, AZ, United States
| | - Stephen M Black
- Department of Medicine, The University of Arizona, Tucson, AZ, United States.
| |
Collapse
|
26
|
Lewis GD, Ngo D, Hemnes AR, Farrell L, Domos C, Pappagianopoulos PP, Dhakal BP, Souza A, Shi X, Pugh ME, Beloiartsev A, Sinha S, Clish CB, Gerszten RE. Metabolic Profiling of Right Ventricular-Pulmonary Vascular Function Reveals Circulating Biomarkers of Pulmonary Hypertension. J Am Coll Cardiol 2016; 67:174-189. [PMID: 26791065 DOI: 10.1016/j.jacc.2015.10.072] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/06/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pulmonary hypertension and associated right ventricular (RV) dysfunction are important determinants of morbidity and mortality, which are optimally characterized by invasive hemodynamic measurements. OBJECTIVES This study sought to determine whether metabolite profiling could identify plasma signatures of right ventricular-pulmonary vascular (RV-PV) dysfunction. METHODS We measured plasma concentrations of 105 metabolites using targeted mass spectrometry in 71 individuals (discovery cohort) who underwent comprehensive physiological assessment with right-sided heart catheterization and radionuclide ventriculography at rest and during exercise. Our findings were validated in a second cohort undergoing invasive hemodynamic evaluations (n = 71), as well as in an independent cohort with or without known pulmonary arterial (PA) hypertension (n = 30). RESULTS In the discovery cohort, 21 metabolites were associated with 2 or more hemodynamic indicators of RV-PV function (i.e., resting right atrial pressure, mean PA pressure, pulmonary vascular resistance [PVR], and PVR and PA pressure-flow response [ΔPQ] during exercise). We identified novel associations of RV-PV dysfunction with circulating indoleamine 2,3-dioxygenase (IDO)-dependent tryptophan metabolites (TMs), tricarboxylic acid intermediates, and purine metabolites and confirmed previously described associations with arginine-nitric oxide metabolic pathway constituents. IDO-TM levels were inversely related to RV ejection fraction and were particularly well correlated with exercise PVR and ΔPQ. Multisite sampling demonstrated transpulmonary release of IDO-TMs. IDO-TMs also identified RV-PV dysfunction in a validation cohort with known risk factors for pulmonary hypertension and in patients with established PA hypertension. CONCLUSIONS Metabolic profiling identified reproducible signatures of RV-PV dysfunction, highlighting both new biomarkers and pathways for further functional characterization.
Collapse
Affiliation(s)
- Gregory D Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
| | - Debby Ngo
- Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna R Hemnes
- Vanderbilt University Pulmonary Unit, Nashville, Tennessee
| | - Laurie Farrell
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carly Domos
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul P Pappagianopoulos
- Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bishnu P Dhakal
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amanda Souza
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Xu Shi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Arkadi Beloiartsev
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sumita Sinha
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Robert E Gerszten
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
27
|
Calvo E, García-Álvarez A, Vázquez J. The Quest for Metabolic Biomarkers of Pulmonary Hypertension. J Am Coll Cardiol 2016; 67:190-192. [PMID: 26791066 DOI: 10.1016/j.jacc.2015.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Enrique Calvo
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Ana García-Álvarez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Jesús Vázquez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
| |
Collapse
|
28
|
Ward WO, Kodavanti UP. Left ventricular gene expression profile of healthy and cardiovascular compromised rat models used in air pollution studies. Inhal Toxicol 2015; 27 Suppl 1:63-79. [DOI: 10.3109/08958378.2014.954171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- William O. Ward
- Biostatistics Core, Research Cores Unit, National Health and Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA and
| | - Urmila P. Kodavanti
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| |
Collapse
|
29
|
|
30
|
Kennedy DJ, Shrestha K, Sheehey B, Li XS, Guggilam A, Wu Y, Finucan M, Gabi A, Medert CM, Westfall K, Borowski A, Fedorova O, Bagrov AY, Tang WHW. Elevated Plasma Marinobufagenin, An Endogenous Cardiotonic Steroid, Is Associated With Right Ventricular Dysfunction and Nitrative Stress in Heart Failure. Circ Heart Fail 2015; 8:1068-76. [PMID: 26276886 DOI: 10.1161/circheartfailure.114.001976] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 08/05/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Plasma levels of cardiotonic steroids are elevated in volume-expanded states, such as chronic kidney disease, but the role of these natriuretic hormones in subjects with heart failure (HF) is unclear. We sought to determine the prognostic role of the cardiotonic steroids marinobufagenin (MBG) in HF, particularly in relation to long-term outcomes. METHODS AND RESULTS We first measured plasma MBG levels and performed comprehensive clinical, laboratory, and echocardiographic assessment in 245 patients with HF. All-cause mortality, cardiac transplantation, and HF hospitalization were tracked for 5 years. In our study cohort, median (interquartile range) MBG was 583 (383-812) pM. Higher MBG was associated with higher myeloperoxidase (r=0.42, P<0.0001), B-type natriuretic peptide (r=0.25, P=0.001), and asymmetrical dimethylarginine (r=0.32, P<0.001). Elevated levels of MBG were associated with measures of worse right ventricular function (RV s', r=-0.39, P<0.0001) and predicted increased risk of adverse clinical outcomes (MBG≥574 pmol/L: hazard ratio 1.58 [1.10-2.31], P=0.014) even after adjustment for age, sex, diabetes mellitus, and ischemic pathogenesis. In mice, a left anterior descending coronary artery ligation model of HF lead to increases in MBG, whereas infusion of MBG into mice for 4 weeks lead to significant increases in myeloperoxidase, asymmetrical dimethylarginine, and cardiac fibrosis. CONCLUSIONS In the setting of HF, elevated plasma levels of MBG are associated with right ventricular dysfunction and predict worse long-term clinical outcomes in multivariable models adjusting for established clinical and biochemical risk factors. Infusion of MBG seems to directly contribute to increased nitrative stress and cardiac fibrosis.
Collapse
Affiliation(s)
- David J Kennedy
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Kevin Shrestha
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Brendan Sheehey
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Xinmin S Li
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Anuradha Guggilam
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Yuping Wu
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Michael Finucan
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Alaa Gabi
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Charles M Medert
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Kristen Westfall
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Allen Borowski
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Olga Fedorova
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - Alexei Y Bagrov
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.)
| | - W H Wilson Tang
- From the Department of Cellular and Molecular Medicine (D.J.K., K.S., B.S., X.S.L., A.G., Y.W., M.F., A.G., C.M.M., K.W., A.B., W.H.W.T.), Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute (W.H.W.T.), Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (D.J.K.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH; and Laboratory of Cardiovascular Science, Hypertension Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD (O.F., A.Y.B.).
| |
Collapse
|
31
|
Nitric Oxide Bioavailability in Obstructive Sleep Apnea: Interplay of Asymmetric Dimethylarginine and Free Radicals. SLEEP DISORDERS 2015; 2015:387801. [PMID: 26064689 PMCID: PMC4438195 DOI: 10.1155/2015/387801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/15/2015] [Accepted: 04/17/2015] [Indexed: 01/13/2023]
Abstract
Obstructive sleep apnea (OSA) occurs in 2% of middle-aged women and 4% of middle-aged men and is considered an independent risk factor for cerebrovascular and cardiovascular diseases. Nitric oxide (NO) is an important endothelium derived vasodilating substance that plays a critical role in maintaining vascular homeostasis. Low levels of NO are associated with impaired endothelial function. Asymmetric dimethylarginine (ADMA), an analogue of L-arginine, is a naturally occurring product of metabolism found in the human circulation. Elevated levels of ADMA inhibit NO synthesis while oxidative stress decreases its bioavailability, so impairing endothelial function and promoting atherosclerosis. Several clinical trials report increased oxidative stress and ADMA levels in patients with OSA. This review discusses the role of oxidative stress and increased ADMA levels in cardiovascular disease resulting from OSA.
Collapse
|
32
|
Verbrugge FH, Dupont M, Bertrand PB, Nijst P, Grieten L, Dens J, Verhaert D, Janssens S, Tang WHW, Mullens W. Pulmonary vascular response to exercise in symptomatic heart failure with reduced ejection fraction and pulmonary hypertension. Eur J Heart Fail 2014; 17:320-8. [DOI: 10.1002/ejhf.217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/09/2014] [Accepted: 10/24/2014] [Indexed: 11/05/2022] Open
Affiliation(s)
- Frederik H. Verbrugge
- Department of Cardiology; Ziekenhuis Oost-Limburg; Schiepse Bos 6 3600 Genk Belgium
- Doctoral school for Medicine and Life Sciences; Hasselt University; Diepenbeek Belgium
| | - Matthias Dupont
- Department of Cardiology; Ziekenhuis Oost-Limburg; Schiepse Bos 6 3600 Genk Belgium
| | - Philippe B. Bertrand
- Department of Cardiology; Ziekenhuis Oost-Limburg; Schiepse Bos 6 3600 Genk Belgium
- Doctoral school for Medicine and Life Sciences; Hasselt University; Diepenbeek Belgium
| | - Petra Nijst
- Department of Cardiology; Ziekenhuis Oost-Limburg; Schiepse Bos 6 3600 Genk Belgium
- Doctoral school for Medicine and Life Sciences; Hasselt University; Diepenbeek Belgium
| | - Lars Grieten
- Department of Cardiology; Ziekenhuis Oost-Limburg; Schiepse Bos 6 3600 Genk Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences; Hasselt University; Diepenbeek Belgium
| | - Joseph Dens
- Department of Cardiology; Ziekenhuis Oost-Limburg; Schiepse Bos 6 3600 Genk Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences; Hasselt University; Diepenbeek Belgium
| | - David Verhaert
- Department of Cardiology; Ziekenhuis Oost-Limburg; Schiepse Bos 6 3600 Genk Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases; University Hospital Gasthuisberg; KU Leuven Leuven, Belgium
| | - W. H. Wilson Tang
- Department of Cardiovascular Medicine; Heart and Vascular Institute, Cleveland Clinic; Cleveland OH USA
| | - Wilfried Mullens
- Department of Cardiology; Ziekenhuis Oost-Limburg; Schiepse Bos 6 3600 Genk Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences; Hasselt University; Diepenbeek Belgium
| |
Collapse
|
33
|
Tang WHW, Wang Z, Shrestha K, Borowski AG, Wu Y, Troughton RW, Klein AL, Hazen SL. Intestinal microbiota-dependent phosphatidylcholine metabolites, diastolic dysfunction, and adverse clinical outcomes in chronic systolic heart failure. J Card Fail 2014; 21:91-6. [PMID: 25459686 DOI: 10.1016/j.cardfail.2014.11.006] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/03/2014] [Accepted: 11/11/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Trimethylamine-N-oxide (TMAO) has been linked to increased cardiovascular risk. We aimed to determine the prognostic value of TMAO and its dietary precursors, choline and betaine, in heart failure (HF). METHODS AND RESULTS In 112 patients with chronic systolic HF with comprehensive echocardiographic evaluation, we measured plasma TMAO, choline, and betaine by mass spectrometry. Median (interquartile range) TMAO levels, choline, and betaine levels were 5.8 (3.6-12.1) μmol/L, 10.9 (8.4-14.0) μmol/L, and 43.8 (37.1-53.0) μmol/L, respectively, and were correlated with each other (all P < .0001 for both). TMAO levels were significantly higher in patients with diabetes mellitus (9.4 [4.9-13.2] vs 4.8 [3.4-9.8] μmol/L; P = .005) and in subjects with New York Heart Association functional class III or greater (7.0 [4.7-14.8] vs 4.7 [3.4-11.3] μmol/L; P = .02). Elevated TMAO, choline, and betaine levels were each associated with higher plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and more advanced left ventricular diastolic dysfunction, but not systolic dysfunction or inflammatory and endothelial biomarkers. Higher choline (hazard ratio [HR] 1.64, 95% CI 1.22-2.20; P = .001), betaine (HR 1.51, 95% CI 1.10-2.08; P = .01), and TMAO (HR 1.48, 95% CI 1.10-1.96; P = .01) predicted increased risk for 5-year adverse clinical events (death/transplantation). Only higher TMAO levels predicted incident adverse clinical events independently from age, estimated glomerular filtration rate, mitral E/septal Ea, and NT-proBNP levels (HR 1.46, 95% CI 1.03-2.14; P = .03). CONCLUSION Elevated plasma TMAO, choline, and betaine levels are each associated with more advanced left ventricular diastolic dysfunction and portend poorer long-term adverse clinical outcomes in chronic systolic HF. However, only higher plasma TMAO was associated with poor prognosis after adjustment for cardiorenal indices.
Collapse
Affiliation(s)
- W H Wilson Tang
- Center for Cardiovascular Diagnostics and Prevention, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Zeneng Wang
- Center for Cardiovascular Diagnostics and Prevention, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, Ohio
| | - Kevin Shrestha
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allen G Borowski
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, Ohio
| | - Richard W Troughton
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
| | - Allan L Klein
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stanley L Hazen
- Center for Cardiovascular Diagnostics and Prevention, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
34
|
Toya T, Hakuno D, Shiraishi Y, Kujiraoka T, Adachi T. Arginase inhibition augments nitric oxide production and facilitates left ventricular systolic function in doxorubicin-induced cardiomyopathy in mice. Physiol Rep 2014; 2:2/9/e12130. [PMID: 25263201 PMCID: PMC4270236 DOI: 10.14814/phy2.12130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A metabolizing enzyme arginase can decrease nitric oxide (NO) production by competing with NO synthase for arginine as a substrate, but its pathophysiological role in heart failure remains unknown. We aimed to investigate the effect of pharmacological inhibition of arginase on left ventricular function in doxorubicin‐induced cardiomyopathy in mice. Doxorubicin administration for 5 weeks significantly increased protein expression levels or activity of arginase in the lungs and liver, and caused moderate increase in arginase 2 expression in the aorta. In the lungs, accumulated interstitial cells strongly expressed both arginase 1 and arginase 2 by doxorubicin administration. Echocardiography revealed that administration of a potent, reversible arginase inhibitor N‐omega‐hydroxy‐nor‐l‐arginine completely reversed doxorubicin‐induced decrease in the ejection fraction, in parallel with expression levels of BNP mRNA, without affecting apoptosis, hypertrophy, fibrosis, or macrophage infiltration in the left ventricle. Arginase inhibition reversibly lowered systolic blood pressure, and importantly, it recovered doxorubicin‐induced decline in NO concentration in the serum, lungs, and aorta. Furthermore, arginase inhibition stimulated NO secretion from aortic endothelial cells and peritoneal macrophages in vitro. In conclusion, pharmacological inhibition of arginase augmented NO concentration in the serum, lungs, and aorta, promoted NO‐mediated decrease in afterload for left ventricle, and facilitated left ventricular systolic function in doxorubicin‐induced cardiomyopathy in mice. e12130 This figure shows that administration of an arginase inhibitor nor‐ NOHA facilitates LV systolic function in murine Dox‐induced cardiomyopathy.
Collapse
Affiliation(s)
- Takumi Toya
- Division of Cardiology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Daihiko Hakuno
- Division of Cardiology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yasunaga Shiraishi
- Division of Cardiology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takehiko Kujiraoka
- Division of Cardiology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takeshi Adachi
- Division of Cardiology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| |
Collapse
|
35
|
Lewis GD. The emerging role of metabolomics in the development of biomarkers for pulmonary hypertension and other cardiovascular diseases (2013 Grover Conference series). Pulm Circ 2014; 4:417-23. [PMID: 25621155 PMCID: PMC4278601 DOI: 10.1086/677369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/30/2014] [Indexed: 12/17/2022] Open
Abstract
The functional and prognostic significance of pulmonary hypertension (PH) is well established, yet our understanding of circulating peptides and metabolites that might mark or contribute to various forms of PH remains limited. Metabolites are the end result of all the regulatory complexity present in a cell, tissue, or organism and therefore serve as the most proximal reporters of the body's response to a disease process or drug therapy. This review presents the rationale, methodology, and preliminary findings from studies that apply comprehensive metabolite profiling to gain knowledge of new circulating markers of PH.
Collapse
Affiliation(s)
- Gregory D Lewis
- Cardiology Division and Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
36
|
Augustine MS, Rogers LK. Measurement of arginine metabolites: regulators of nitric oxide metabolism. CURRENT PROTOCOLS IN TOXICOLOGY 2013; 58:Unit 17.16.. [PMID: 24510541 DOI: 10.1002/0471140856.tx1716s58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Arginine is the substrate for nitric oxide synthases (NOS), and arginine availability regulates the production of nitric oxide. Through the activity of methyltransferases, arginine can be methylated to form monomethylarginine (NMMA), asymmetrical dimethylarginine (ADMA), and symmetrical dimethylarginine (SDMA). NMMA and ADMA directly inhibit NOS, whereas SDMA inhibits the cellular import of arginine through the cationic amino acid transporter. Increased levels of methylarginine compounds have been associated with many diseases including atherosclerosis, renal failure, pulmonary hypertension, and preeclampsia. Previous HPLC methods to measure these molecules rely on derivatization with ortho-phthalaldehyde, which is unstable and requires immediate pre- or post-column reactions. We have identified a new fluorometric agent that is stable for at least 1 week and provides chromatographic properties that facilitate separation of these chemically similar compounds by reverse phase chromatography.
Collapse
Affiliation(s)
- Molly S Augustine
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | | |
Collapse
|
37
|
Aggarwal S, Gross CM, Sharma S, Fineman JR, Black SM. Reactive oxygen species in pulmonary vascular remodeling. Compr Physiol 2013; 3:1011-34. [PMID: 23897679 DOI: 10.1002/cphy.c120024] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The pathogenesis of pulmonary hypertension is a complex multifactorial process that involves the remodeling of pulmonary arteries. This remodeling process encompasses concentric medial thickening of small arterioles, neomuscularization of previously nonmuscular capillary-like vessels, and structural wall changes in larger pulmonary arteries. The pulmonary arterial muscularization is characterized by vascular smooth muscle cell hyperplasia and hypertrophy. In addition, in uncontrolled pulmonary hypertension, the clonal expansion of apoptosis-resistant endothelial cells leads to the formation of plexiform lesions. Based upon a large number of studies in animal models, the three major stimuli that drive the vascular remodeling process are inflammation, shear stress, and hypoxia. Although, the precise mechanisms by which these stimuli impair pulmonary vascular function and structure are unknown, reactive oxygen species (ROS)-mediated oxidative damage appears to play an important role. ROS are highly reactive due to their unpaired valence shell electron. Oxidative damage occurs when the production of ROS exceeds the quenching capacity of the antioxidant mechanisms of the cell. ROS can be produced from complexes in the cell membrane (nicotinamide adenine dinucleotide phosphate-oxidase), cellular organelles (peroxisomes and mitochondria), and in the cytoplasm (xanthine oxidase). Furthermore, low levels of tetrahydrobiopterin (BH4) and L-arginine the rate limiting cofactor and substrate for endothelial nitric oxide synthase (eNOS), can cause the uncoupling of eNOS, resulting in decreased NO production and increased ROS production. This review will focus on the ROS generation systems, scavenger antioxidants, and oxidative stress associated alterations in vascular remodeling in pulmonary hypertension.
Collapse
Affiliation(s)
- Saurabh Aggarwal
- Pulmonary Disease Program, Vascular Biology Center, Georgia Health Sciences University, Augusta, Georgia, USA
| | | | | | | | | |
Collapse
|
38
|
Tang WHW, Shrestha K, Wang Z, Troughton RW, Klein AL, Hazen SL. Diminished global arginine bioavailability as a metabolic defect in chronic systolic heart failure. J Card Fail 2013; 19:87-93. [PMID: 23384633 DOI: 10.1016/j.cardfail.2013.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 11/25/2012] [Accepted: 01/02/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Systemic alterations in arginine bioavailability occur in heart failure (HF) patients with more advanced myocardial dysfunction and poorer clinical outcomes, and they improve with beta-blocker therapy. METHODS AND RESULTS We measured fasting plasma levels of L-arginine and related biogenic amine metabolites in 138 stable symptomatic HF patients with left ventricular ejection fraction ≤35% and comprehensive echocardiographic evaluation. Long-term adverse clinical outcomes (death and cardiac transplantation) were followed for 5 years. Lower global arginine bioavailability ratio (GABR; ratio of L-arginine to L-ornithine + L-citrulline) was associated with higher plasma natriuretic peptide levels, more advanced left ventricular diastolic dysfunction, and more severe right ventricular systolic dysfunction (all P < .001). Patients taking beta-blockers had significantly higher GABR than those not taking beta-blockers (0.86 [interquartile range (IQR) 0.68-1.17] vs 0.61 [0.44-0.89]; P < .001). Subjects with higher GABR experienced fewer long-term adverse clinical events (hazard ratio 0.61 [95% confidence interval 0.43-0.84]; P = .002). In an independent beta-blocker naïve patient cohort, GABR increased following long-term (6 month) beta-blocker therapy (0.89 [IQR 0.52-1.07] to 0.97 [0.81-1.20]; P = .019). CONCLUSIONS In patients with chronic systolic heart failure, diminished global L-arginine bioavailability is associated with more advanced myocardial dysfunction and poorer long-term adverse clinical outcomes. GABR levels improved with beta-blocker therapy.
Collapse
Affiliation(s)
- W H Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Dupont M, Tang WHW. Right ventricular afterload and the role of nitric oxide metabolism in left-sided heart failure. J Card Fail 2013; 19:712-21. [PMID: 24125109 DOI: 10.1016/j.cardfail.2013.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/29/2013] [Accepted: 08/08/2013] [Indexed: 12/17/2022]
Abstract
Awareness has grown in recent years that right ventricular (RV) function is equally important as left ventricular (LV) function in the setting of left-sided heart disease. RV dysfunction can be the consequence of an increased afterload imposed by the failing LV. The concept of "afterload" is physically most correctly described by vascular input impedance. However, for clinical purposes, afterload is most often modeled to consist of 3 components; pulmonary vascular resistance (PVR), pulmonary arterial compliance (PAC), and characteristic impedance. Whereas PVR is historically most described, PAC (which represents the distensibility of the vasculature) has rapidly gained recognition for its prognostic ability in both pulmonary arterial hypertension and left-sided heart disease. Owing to the specific anatomy of the pulmonary circulation, PVR and PAC have an inverse hyperbolic relationship, which position can be shifted by varying wedge pressures. Knowledge of the afterload components helps one to understand how elevated left-sided filling pressures increase pulsatile load on the RV. An increase in resistive load (known as "reactive" or "out-of-proportion" pulmonary hypertension) ultimately complements the increase in pulsatile load. Perturbations in nitric oxide metabolism are thought to be crucial in this evolution and have therefore been sought as a major therapeutic target.
Collapse
Affiliation(s)
- Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | |
Collapse
|
40
|
Vicente D, Montó F, Oliver E, Buendía F, Rueda J, Agüero J, Almenar L, Barettino D, D'Ocon P. Myocardial and lymphocytic expression of eNOS and nNOS before and after heart transplantation: Relationship to clinical status. Life Sci 2013; 93:108-15. [DOI: 10.1016/j.lfs.2013.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/16/2013] [Accepted: 05/29/2013] [Indexed: 12/26/2022]
|
41
|
Schuster A, Thakur A, Wang Z, Borowski AG, Thomas JD, Tang WHW. Increased exhaled nitric oxide levels after exercise in patients with chronic systolic heart failure with pulmonary venous hypertension. J Card Fail 2013; 18:799-803. [PMID: 23040116 DOI: 10.1016/j.cardfail.2012.08.356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/13/2012] [Accepted: 08/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (eNO) is recognized as a marker of pulmonary endothelial function. Oxidative stress is associated with systemic endothelial nitric oxide production, but its correlation with eNO in heart failure (HF) patients has not been described. Previous studies have reported increased eNO levels after exercise in symptomatic HF patients but decreased levels with pulmonary arterial hypertension. Our objective was to prospectively examine the potential myocardial and functional determinants of exercise-induced rise of eNO in HF. METHODS AND RESULTS Thirty-four consecutive ambulatory patients with chronic systolic HF (left ventricular ejection fraction [LVEF] ≤45%) underwent symptom-limited cardiopulmonary stress testing and echocardiography. eNO was determined immediately after exercise. Systemic endothelial dysfunction was assessed by asymmetric dimethylarginine (ADMA) and the L-arginine/ADMA ratio. In our study cohort (mean age 53 ± 13 years, 76% male, median LVEF 31%, interquartile range [IQR] 25%-40%), the mean eNO was 23 ± 9 ppb. eNO levels were higher in patients with diastolic dysfunction stages 2 or 3 than stage 1 or normal diastology (26.1 ± 9 vs 19.5 ± 7 ppb; P = .013). eNO had a positive correlation with estimated systolic pulmonary artery pressure (r = 0.57; P = .0009) and indexed left atrium volume (r = 0.43; P = .014), but it did not correlate with cardiopulmonary exercise test parameters, ADMA, or symptom score. CONCLUSIONS In contrast to earlier reports, the increase in postexercise eNO observed in stable chronic systolic HF patients may be attributed to the presence of underlying pulmonary venous hypertension probably secondary to advanced diastolic dysfunction.
Collapse
Affiliation(s)
- Andres Schuster
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | | | | | | | | | | |
Collapse
|
42
|
Asymmetric dimethylarginine predicts clinical outcomes in ischemic chronic heart failure. Atherosclerosis 2012; 225:504-10. [DOI: 10.1016/j.atherosclerosis.2012.09.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 09/10/2012] [Accepted: 09/26/2012] [Indexed: 11/23/2022]
|
43
|
Abstract
Metabolomics is the systematic study of the unique chemical fingerprints of small molecules or metabolite profiles that are related to a variety of cellular metabolic processes in a cell, organ, or organism. Although messenger RNA gene expression data and proteomic analyses do not tell the whole story of what might be happening in a cell, metabolic profiling provides direct and indirect physiologic insights that can potentially be detectable in a wide range of biospecimens. Although not specific to cardiac conditions, translating metabolomics to cardiovascular biomarkers has followed the traditional path of biomarker discovery from identification and confirmation to clinical validation and bedside testing. With technological advances in metabolomic tools (such as nuclear magnetic resonance spectroscopy and mass spectrometry) and more sophisticated bioinformatics and analytical techniques, the ability to measure low-molecular-weight metabolites in biospecimens provides a unique insight into established and novel metabolic pathways. Systemic metabolomics may provide physiologic understanding of cardiovascular disease states beyond traditional profiling and may involve descriptions of metabolic responses of an individual or population to therapeutic interventions or environmental exposures.
Collapse
Affiliation(s)
- Todd Senn
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | |
Collapse
|
44
|
Dimitroulas T, Sandoo A, Kitas GD. Asymmetric dimethylarginine as a surrogate marker of endothelial dysfunction and cardiovascular risk in patients with systemic rheumatic diseases. Int J Mol Sci 2012. [PMID: 23202900 PMCID: PMC3497274 DOI: 10.3390/ijms131012315] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The last few decades have witnessed an increased life expectancy of patients suffering with systemic rheumatic diseases, mainly due to improved management, advanced therapies and preventative measures. However, autoimmune disorders are associated with significantly enhanced cardiovascular morbidity and mortality not fully explained by traditional cardiovascular disease (CVD) risk factors. It has been suggested that interactions between high-grade systemic inflammation and the vasculature lead to endothelial dysfunction and atherosclerosis, which may account for the excess risk for CVD events in this population. Diminished nitric oxide synthesis—due to down regulation of endothelial nitric oxide synthase—appears to play a prominent role in the imbalance between vasoactive factors, the consequent impairment of the endothelial hemostasis and the early development of atherosclerosis. Asymmetric dimethylarginine (ADMA) is one of the most potent endogenous inhibitors of the three isoforms of nitric oxide synthase and it is a newly discovered risk factor in the setting of diseases associated with endothelial dysfunction and adverse cardiovascular events. In the context of systemic inflammatory disorders there is increasing evidence that ADMA contributes to the vascular changes and to endothelial cell abnormalities, as several studies have revealed derangement of nitric oxide/ADMA pathway in different disease subsets. In this article we discuss the role of endothelial dysfunction in patients with rheumatic diseases, with a specific focus on the nitric oxide/ADMA system and we provide an overview on the literature pertaining to ADMA as a surrogate marker of subclinical vascular disease.
Collapse
Affiliation(s)
- Theodoros Dimitroulas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
- Author to whom correspondence should be addressed; E-Mail: or ; Tel.: +44-1384-244842; Fax: +44-1283-244272
| | - Aamer Sandoo
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
| | - George D. Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester M15 6SZ, UK
| |
Collapse
|
45
|
Shao Z, Hazen SL, Tang WW. Reply. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
46
|
Billecke SS, D'Alecy LG, Marcovitz PA. Potential Treatment Influences and Mechanisms Related to Asymmetric Dimethylarginine Control in Heart Failure. J Am Coll Cardiol 2012; 60:948-9; author reply 949. [DOI: 10.1016/j.jacc.2012.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 04/18/2012] [Accepted: 04/23/2012] [Indexed: 10/27/2022]
|