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Onnis C, Virmani R, Kawai K, Nardi V, Lerman A, Cademartiri F, Scicolone R, Boi A, Congiu T, Faa G, Libby P, Saba L. Coronary Artery Calcification: Current Concepts and Clinical Implications. Circulation 2024; 149:251-266. [PMID: 38227718 PMCID: PMC10794033 DOI: 10.1161/circulationaha.123.065657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Coronary artery calcification (CAC) accompanies the development of advanced atherosclerosis. Its role in atherosclerosis holds great interest because the presence and burden of coronary calcification provide direct evidence of the presence and extent of coronary artery disease; furthermore, CAC predicts future events independently of concomitant conventional cardiovascular risk factors and to a greater extent than any other noninvasive biomarker of this disease. Nevertheless, the relationship between CAC and the susceptibility of a plaque to provoke a thrombotic event remains incompletely understood. This review summarizes the current understanding and literature on CAC. It outlines the pathophysiology of CAC and reviews laboratory, histopathological, and genetic studies, as well as imaging findings, to characterize different types of calcification and to elucidate their implications. Some patterns of calcification such as microcalcification portend increased risk of rupture and cardiovascular events and may improve prognosis assessment noninvasively. However, contemporary computed tomography cannot assess early microcalcification. Limited spatial resolution and blooming artifacts may hinder estimation of degree of coronary artery stenosis. Technical advances such as photon counting detectors and combination with nuclear approaches (eg, NaF imaging) promise to improve the performance of cardiac computed tomography. These innovations may speed achieving the ultimate goal of providing noninvasively specific and clinically actionable information.
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Affiliation(s)
- Carlotta Onnis
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD
| | - Kenji Kawai
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD
| | - Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Roberta Scicolone
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
| | - Alberto Boi
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari Italy
| | - Terenzio Congiu
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Ospedale San Giovanni di Dio (Cagliari) 09100 ITALY
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Ospedale San Giovanni di Dio (Cagliari) 09100 ITALY
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, ITALY
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Sakaue T, Koyama T, Nakamura Y, Okamoto K, Kawashima T, Umeno T, Nakayama Y, Miyamoto S, Shikata F, Hamaguchi M, Aono J, Kurata M, Namiguchi K, Uchita S, Masumoto J, Yamaguchi O, Higashiyama S, Izutani H. Bioprosthetic Valve Deterioration: Accumulation of Circulating Proteins and Macrophages in the Valve Interstitium. JACC Basic Transl Sci 2023; 8:862-880. [PMID: 37547071 PMCID: PMC10401294 DOI: 10.1016/j.jacbts.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 08/08/2023]
Abstract
Histologic evaluations revealed excessive accumulations of macrophages and absence of fibroblastic interstitial cells in explanted bioprosthetic valves. Comprehensive gene and protein expression analysis and histology unveiled an accumulation of fibrinogen and plasminogen, an activator of infiltrated macrophages, from degenerated valve surfaces in the interstitial spaces. These pathologies were completely reproduced in a goat model replaced with an autologous pericardium-derived aortic valve. Further preclinical animal experiments using goats demonstrated that preventing infiltration of macrophages and circulating proteins by increasing collagen density and leaflet strength is an effective treatment option.
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Affiliation(s)
- Tomohisa Sakaue
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Cell Growth and Tumor Regulation, Proteo-Science Center, Toon, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Keitaro Okamoto
- Department of Cardiovascular Surgery, Oita University, Yufu, Japan
| | | | - Tadashi Umeno
- Department of Cardiovascular Surgery, Oita University, Yufu, Japan
| | - Yasuhide Nakayama
- Department of Cardiovascular Surgery, Oita University, Yufu, Japan
- Biotube, Tokyo, Japan
| | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Oita University, Yufu, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Mika Hamaguchi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun Aono
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Mie Kurata
- Department of Pathology, Division of Analytical Pathology, Ehime University Graduate School of Medicine, Toom, Japan
- Department of Pathology, Proteo-Science Center, Toon, Japan
| | - Kenji Namiguchi
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shunji Uchita
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Junya Masumoto
- Department of Pathology, Division of Analytical Pathology, Ehime University Graduate School of Medicine, Toom, Japan
- Department of Pathology, Proteo-Science Center, Toon, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shigeki Higashiyama
- Department of Cell Growth and Tumor Regulation, Proteo-Science Center, Toon, Japan
- Department of Biochemistry and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Japan
- Department of Molecular and Cellular Biology, Research Center, Osaka International Cancer Institute, Osaka, Japan
| | - Hironori Izutani
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan
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Kanaji Y, Ozcan I, Toya T, Gulati R, Young M, Kakuta T, Lerman LO, Lerman A. Circulating Progenitor Cells Are Associated With Bioprosthetic Aortic Valve Deterioration: A Preliminary Study. J Am Heart Assoc 2023; 12:e027364. [PMID: 36645093 PMCID: PMC9939063 DOI: 10.1161/jaha.122.027364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Mechanisms underlying bioprosthetic valve deterioration are multifactorial and incompletely elucidated. Reparative circulating progenitor cells, and conversely calcification-associated osteocalcin expressing circulating progenitor cells, have been linked to native aortic valve deterioration. However, their role in bioprosthetic valve deterioration remains elusive. This study sought to evaluate the contribution of different subpopulations of circulating progenitor cells in bioprosthetic valve deterioration. Methods and Results This single-center prospective study enrolled 121 patients who had peripheral blood mononuclear cells isolated before bioprosthetic aortic valve replacement and had an echocardiographic follow-up ≥2 years after the procedure. Using flow cytometry, fresh peripheral blood mononuclear cells were analyzed for the surface markers CD34, CD133, and osteocalcin. Bioprosthetic valve deterioration was evaluated by hemodynamic valve deterioration (HVD) using echocardiography, which was defined as an elevated mean transprosthetic gradient ≥30 mm Hg or at least moderate intraprosthetic regurgitation. Sixteen patients (13.2%) developed HVD during follow-up for a median of 5.9 years. Patients with HVD showed significantly lower levels of reparative CD34+CD133+ cells and higher levels of osteocalcin-positive cells than those without HVD (CD34+CD133+ cells: 125 [80, 210] versus 270 [130, 420], P=0.002; osteocalcin-positive cells: 3060 [523, 5528] versus 670 [180, 1930], P=0.005 respectively). Decreased level of CD34+CD133+ cells was a significant predictor of HVD (hazard ratio, 0.995 [95% CI, 0.990%-0.999%]). Conclusions Circulating levels of CD34+CD133+ cells and osteocalcin-positive cells were significantly associated with the subsequent occurrence of HVD in patients undergoing bioprosthetic aortic valve replacement. Circulating progenitor cells might play a vital role in the mechanism, risk stratification, and a potential therapeutic target for patients with bioprosthetic valve deterioration.
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Affiliation(s)
- Yoshihisa Kanaji
- Department of Cardiovascular MedicineRochesterMN,Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Ilke Ozcan
- Department of Cardiovascular MedicineRochesterMN
| | - Takumi Toya
- Department of Cardiovascular MedicineRochesterMN,Division of CardiologyNational Defense Medical CollegeTokorozawaJapan
| | - Rajiv Gulati
- Department of Cardiovascular MedicineRochesterMN
| | | | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo ClinicMayo ClinicRochesterMN
| | - Amir Lerman
- Department of Cardiovascular MedicineRochesterMN
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Xiang C, Zhu Y, Xu M, Zhang D. Fasudil Ameliorates Osteoporosis Following Myocardial Infarction by Regulating Cardiac Calcitonin Secretion. J Cardiovasc Transl Res 2022; 15:1352-1365. [PMID: 35551627 DOI: 10.1007/s12265-022-10271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/04/2022] [Indexed: 12/16/2022]
Abstract
We hypothesis that Rho kinase inhibitor fasudil ameliorates osteoporosis following myocardial infarction (MI) by regulating cardiac calcitonin secretion. A mice model of MI and cultured neonatal cardiomyocytes exposed to hypoxia and serum deprivation (H/SD), and fibroblasts exposed to TGF-β were used, respectively. Cardiac function in vivo was assessed with echocardiography. Osteoporosis in vivo was assessed with X-ray and micro-CT. In vivo and in vitro studies used histological and immunohistochemical techniques, along with western blots. In mice post-MI, fasudil ameliorates the microstructure and bone metabolism of the lumbar, improved cardiac function, and attenuated myocardial fibrosis. In vitro, fasudil or αCGRP could effectively inhibit the proliferation of primary fibroblasts treated with TGF-β. Moreover, fasudil ameliorates the cardiac calcitonin secretion induced by MI in vivo or by H/SD in vitro. Our findings suggest that fasudil improved MI-induced osteoporosis by promoting cardiac secreting calcitonin.
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Affiliation(s)
- Chengyu Xiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yeqian Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Maohua Xu
- Department of Emergency, Chun'an First People's Hospital, Zhejiang Provincial People's Hospital Chun'an Branch), Zhejiang Province, Hangzhou, China
| | - Dingguo Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Chan YH, Ngai MC, Chen Y, Wu MZ, Yu YJ, Zhen Z, Lai K, Chung HY, Lau CS, Tse HF, Yiu KH. Osteogenic Circulating Endothelial Progenitor Cells are Associated with Vascular Aging of the Large Arteries in Rheumatoid Arthritis. Clin Interv Aging 2022; 17:287-294. [PMID: 35321150 PMCID: PMC8937309 DOI: 10.2147/cia.s337118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Aim Rheumatoid arthritis is associated with both abnormal bone metabolism and accelerated vascular aging but a mechanistic link was lacking. This study aims to investigate the role of osteocalcin (OCN)-expressing circulating endothelial progenitor cells (EPCs) in vascular aging, as determined by arterial calcifications in rheumatoid arthritis. Methods We performed flow cytometry studies in 145 consecutive patients with rheumatoid arthritis to determine osteogenic circulating levels of OCN-positive (OCN+) CD34+KDR+ and OCN+CD34+ versus conventional early EPC CD34+CD133+KDR+. Total calcium load of the thoracic aorta (ascending plus descending) and the carotid arteries were assessed by non-contrast computed tomography (CT) and contrast CT angiography. Results Osteogenic EPCs OCN+CD34+KDR+ (P = 0.002) and OCN+CD34+ (P = 0.001), together with clinical parameters of age, history of hypertension, systolic blood pressure, serum levels of triglycerides, HbA1c and creatinine, use of leflunomide and brachial-ankle pulse-wave velocity (all P < 0.05), were associated with the clustered presence of aortic and carotid calcification. Multivariable analyses revealed that circulating OCN+CD34+KDR+ (B = 14.4 [95% CI 4.0 to 24.8], P = 0.007) and OCN+CD34+ (B = 9.6 [95% CI 4.9 to 14.3], P < 0.001) remained independently associated with increased aortic calcium load. OCN+CD34+ EPC (B = 0.8 [95% CI 0.1 to 1.5], P = 0.023), but not OCN+CD34+KDR+ EPC (B = 1.2 [95% CI −0.2 to 2.6], P = 0.09), was further independently associated with carotid calcium load. In comparison, conventional early EPC CD34+CD133+KDR+ had no significant association with aortic or carotid calcium load (P = 0.46 and 0.88, respectively). Conclusion Circulating level of osteogenic EPC is associated with increased vascular aging in terms of calcification of the large arteries in patients with rheumatoid arthritis. The findings may suggest a role of the bone-vascular axis underlying vascular aging in rheumatic diseases. Further research is needed to characterize the mechanistic links and basis of these observations.
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Affiliation(s)
- Yap-Hang Chan
- Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Michael Cheong Ngai
- Division of Hematology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Yan Chen
- Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Yu-Juan Yu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Zhe Zhen
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Kevin Lai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Ho-Yin Chung
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Chak-Sing Lau
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Special Administrative Regions, People’s Republic of China
- Correspondence: Kai-Hang Yiu, Cardiology Division, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, 518053, Guangdong, People’s Republic of China, Tel +852 22553633, Fax +852 28186304, Email
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Wang Y, Jiang C, Shang Z, Qiu G, Yuan G, Xu K, Hou Q, He Y, Liu Y. AGEs/RAGE Promote Osteogenic Differentiation in Rat Bone Marrow-Derived Endothelial Progenitor Cells via MAPK Signaling. J Diabetes Res 2022; 2022:4067812. [PMID: 35155684 PMCID: PMC8825668 DOI: 10.1155/2022/4067812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022] Open
Abstract
Systemic vascular impairment is the most common complication of diabetes. Advanced glycation end products (AGEs) can exacerbate diabetes-related vascular damage by affecting the intima and media through a variety of mechanisms. In the study, we demonstrated that AGEs and their membrane receptor RAGE could induce the differentiation of EPCs into osteoblasts under certain circumstances, thereby promoting accelerated atherosclerosis. Differentiation into osteoblasts was confirmed by positive staining for DiI-acetylated fluorescently labeled low-density lipoprotein and FITC-conjugated Ulex europaeus agglutinin. During differentiation, expression of receptor for AGE (RAGE) was significantly upregulated. This upregulation was attenuated by transfection with RAGE-targeting small interfering (si)RNA. siRNA-mediated knockdown of RAGE expression significantly inhibited the upregulation of AGE-induced calcification-related proteins, such as runt-related transcription factor 2 (RUNX2) and osteoprotegerin (OPG). Additional experiments showed that AGE induction of EPCs significantly induced ERK, p38MAPK, and JNK activation. The AGE-induced upregulation of osteoblast proteins (RUNX2 and OPG) was suppressed by treatment with a p38MAPK inhibitor (SB203580) or JNK inhibitor (SP600125), but not by treatment with an ERK inhibitor (PD98059), which indicated that AGE-induced osteoblast differentiation from EPCs may be mediated by p38MAPK and JNK signaling, but not by ERK signaling. These data suggested that AGEs may bind to RAGE on the EPC membrane to trigger differentiation into osteoblasts. The underlying mechanism appears to involve the p38MAPK and JNK1/2 pathways, but not the ERK1/2 pathway.
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Affiliation(s)
- Yuping Wang
- Department of Vascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Department of Breast, Thyroid and Vascular Surgery, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
| | - Chunxia Jiang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Sichuan Luzhou 646000, China
| | - Zhongming Shang
- Department of Breast, Thyroid and Vascular Surgery, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
| | - Guochun Qiu
- Department of Breast, Thyroid and Vascular Surgery, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
| | - Gang Yuan
- Department of Intervention, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
| | - Kaiqiang Xu
- Department of Breast, Thyroid and Vascular Surgery, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
| | - Qingchun Hou
- Department of Pediatric Surgery & Vascular Surgery, Zigong Fourth People's Hospital, 643000 Zigong, China
| | - Yanzheng He
- Department of Vascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou 646000, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases) Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
- Department of General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Yong Liu
- Department of Vascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou 646000, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases) Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China
- Department of General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
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Stem Cells to the Rescue: Development and Application of Cell-Based Therapy for Microvascular Repair. Cells 2021; 10:cells10082144. [PMID: 34440914 PMCID: PMC8393633 DOI: 10.3390/cells10082144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022] Open
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Filippi A, Constantin A, Alexandru N, Voicu G, Constantinescu CA, Rebleanu D, Fenyo M, Simionescu D, Simionescu A, Manduteanu I, Georgescu A. Integrins α4β1 and αVβ3 are Reduced in Endothelial Progenitor Cells from Diabetic Dyslipidemic Mice and May Represent New Targets for Therapy in Aortic Valve Disease. Cell Transplant 2021; 29:963689720946277. [PMID: 32841051 PMCID: PMC7563030 DOI: 10.1177/0963689720946277] [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] [Indexed: 12/15/2022] Open
Abstract
Diabetes reduces the number and induces dysfunction in circulating endothelial progenitor cells (EPCs) by mechanisms that are still uncovered. This study aims to evaluate the number, viability, phenotype, and function of EPCs in dyslipidemic mice with early diabetes mellitus and EPC infiltration in the aortic valve in order to identify possible therapeutic targets in diabetes-associated cardiovascular disease. A streptozotocin-induced diabetic apolipoprotein E knock-out (ApoE-/-) mouse model was used to identify the early and progressive changes, at 4 or 7 days on atherogenic diet after the last streptozotocin or citrate buffer injection. Blood and aortic valves from diabetic or nondiabetic ApoE-/- animals were collected.EPCs were identified as CD34 and vascular endothelial growth factor receptor 2 positive monocytes, and the expression levels of α4β1, αVβ3, αVβ5, β1, αLβ2, α5 integrins, and C-X-C chemokine receptor type 4 chemokine receptor on EPC surface were assessed by flow cytometry. The number of CD34 positive cells in the aortic valve, previously found to be recruited progenitor cells, was measured by fluorescence microscopy. Our results show that aortic valves from mice fed 7 days with atherogenic diet presented a significantly higher number of CD34 positive cells compared with mice fed only 4 days with the same diet, and diabetes reversed this finding. We also show a reduction of circulatory EPC numbers in diabetic mice caused by cell senescence and lower mobilization. Dyslipidemia induced EPC death through apoptosis regardless of the presence of diabetes, as shown by the higher percent of propidium iodide positive cells and higher cleaved caspase-3 levels. EPCs from diabetic mice expressed α4β1 and αVβ3 integrins at a lower level, while the rest of the integrins tested were unaffected by diabetes or diet. In conclusion, reduced EPC number and expression of α4β1 and αVβ3 integrins on EPCs at 4 and 7 days after diabetes induction in atherosclerosis-prone mice have resulted in lower recruitment of EPCs in the aortic valve.
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Affiliation(s)
- Alexandru Filippi
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
| | - Alina Constantin
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
| | - Nicoleta Alexandru
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
| | - Geanina Voicu
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
| | - Cristina Ana Constantinescu
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
| | - Daniela Rebleanu
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
| | - Madalina Fenyo
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
| | | | - Agneta Simionescu
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania.,2545Clemson University, Clemson SC, USA
| | - Ileana Manduteanu
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
| | - Adriana Georgescu
- 199940Institute of Cellular Biology and Pathology "Nicolae Simionescu" of Romanian Academy, Bucharest, Romania
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Wang Y, Han D, Zhou T, Chen C, Cao H, Zhang JZ, Ma N, Liu C, Song M, Shi J, Jin X, Cao F, Dong N. DUSP26 induces aortic valve calcification by antagonizing MDM2-mediated ubiquitination of DPP4 in human valvular interstitial cells. Eur Heart J 2021; 42:2935-2951. [PMID: 34179958 DOI: 10.1093/eurheartj/ehab316] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/21/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS The morbidity and mortality rates of calcific aortic valve disease (CAVD) remain high while treatment options are limited. Here, we evaluated the role and therapeutic value of dual-specificity phosphatase 26 (DUSP26) in CAVD. METHODS AND RESULTS Microarray profiling of human calcific aortic valves and normal controls demonstrated that DUSP26 was significantly up-regulated in calcific aortic valves. ApoE-/- mice fed a normal diet or a high cholesterol diet (HCD) were infected with adeno-associated virus serotype 2 carrying DUSP26 short-hairpin RNA to examine the effects of DUSP26 silencing on aortic valve calcification. DUSP26 silencing ameliorated aortic valve calcification in HCD-treated ApoE-/- mice, as evidenced by reduced thickness and calcium deposition in the aortic valve leaflets, improved echocardiographic parameters (decreased peak transvalvular jet velocity and mean transvalvular pressure gradient, as well as increased aortic valve area), and decreased levels of osteogenic markers (Runx2, osterix, and osteocalcin) in the aortic valves. These results were confirmed in osteogenic medium-induced human valvular interstitial cells. Immunoprecipitation, liquid chromatography-tandem mass spectrometry, and functional assays revealed that dipeptidyl peptidase-4 (DPP4) interacted with DUSP26 to mediate the procalcific effects of DUSP26. High N6-methyladenosine levels up-regulated DUSP26 in CAVD; in turn, DUSP26 activated DPP4 by antagonizing mouse double minute 2-mediated ubiquitination and degradation of DPP4, thereby promoting CAVD progression. CONCLUSION DUSP26 promotes aortic valve calcification by inhibiting DPP4 degradation. Our findings identify a previously unrecognized mechanism of DPP4 up-regulation in CAVD, suggesting that DUSP26 silencing or inhibition is a viable therapeutic strategy to impede CAVD progression.
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Affiliation(s)
- Yongjun Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Dong Han
- National Clinical Research Center for Geriatric Diseases, 2nd Medical Center, Chinese PLA General Hospital, 28# Fuxing Road, Beijing 100853, China
| | - Tingwen Zhou
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Cheng Chen
- Institute of Geriatrics, National Clinical Research Center for Geriatrics Disease, Chinese PLA General Hospital, 28# Fuxing Road, Beijing 100853, China
| | - Hong Cao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Joe Z Zhang
- Stanford Cardiovascular Institute, Stanford School of Medicine, 265 Campus Drive, Stanford, CA 94305, USA
| | - Ning Ma
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), 96# Xingdao South Road, Haizhu District, Guangzhou, Guangdong 510320, China
| | - Chun Liu
- Stanford Cardiovascular Institute, Stanford School of Medicine, 265 Campus Drive, Stanford, CA 94305, USA
| | - Moshi Song
- Institute of Stem Cell and Regeneration, Chinese Academy of Sciences, 1# Beichen West Road, Beijing 100101, China
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, Hubei 430022, China
| | - Xin Jin
- Department of Urology, The Second Xiangya Hospital, Central South University, 139# Renmin middle road, Changsha, Hunan 410011, China
| | - Feng Cao
- National Clinical Research Center for Geriatric Diseases, 2nd Medical Center, Chinese PLA General Hospital, 28# Fuxing Road, Beijing 100853, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, Hubei 430022, China
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10
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Wang Y, Wang R, Liu Y, Bai L, Liu L, He L, Deng H, Li T, Xu S, Chen L, Wen K, Qi B. Associations between bone mineral density in different measurement locations and coronary artery disease: a cross-sectional study. Arch Osteoporos 2021; 16:100. [PMID: 34169345 DOI: 10.1007/s11657-021-00940-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/04/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The bone mineral density (BMD) loss is closely related to coronary heart disease (CAD). The BMD measured at different locations differ in BMD values, the risk to CAD, and the capability to identify CAD. An average BMD of the right and left femoral neck being below - 1.70 has the ability to indicate risk of CAD. PURPOSE Previous studies have reported that low bone mineral density (BMD) is closely related to coronary artery disease (CAD); however, it is not clear that the BMD loss at which location to what extent has the greatest effect in identifying risk of CAD. This study aimed to evaluate the ability of different measurement sites of BMD in identifying CAD and analyze the best measurement sites and the optimal cut-off of BMD for CAD. METHODS This was a cross-sectional study in which 180 of 817 participants were diagnosed with CAD. All participants in the study were measured by dual-energy X-ray absorptiometry (DEXA) for BMD at 8 locations, and following measurements were derived: the average BMD of lumbar spine (L1-L4), femoral neck (left and right), and total proximal femur (left and right). The association between BMD at different locations and CAD was analyzed using logistic regression. The receiver operating characteristic (ROC) curve was used to select the optimal measurement location and cut-off value of the BMD for identifying CAD. RESULTS There were significant differences in BMD at 3 different measurement locations. Higher BMD is a protective factor against CAD, which is more pronounced in the femoral neck and total proximal femur (ORs = 0.47 ~ 0.66, P < 0.001) than in the lumbar spine (ORs = 0.74 ~ 0.79, P < 0.001). The optimal site for predicting the risk of CAD by BMD is the femoral neck, with the AUC (area under the ROC curve) is 0.72 (95% CI: 0.67 ~ 0.76) and the cut-off is - 1.70. CONCLUSION The BMD below particular cut-off of the femoral neck rather than of the lumbar spine may have certain further research value for revealing the risk of CAD.
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Affiliation(s)
- Yaoling Wang
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Ruiyun Wang
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Yun Liu
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Lijuan Bai
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Lihua Liu
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Linfeng He
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Heng Deng
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Tao Li
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Sha Xu
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China
| | - Li Chen
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - Kai Wen
- School of Software & Microelectronics, Peking University, Beijing, China
| | - Benling Qi
- Department of Geriatrics, Union Hospital of Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430022, China.
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11
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Ozcan I, Toya T, Corban MT, Ahmad A, Loeffler D, Morse D, Lerman LO, Kushwaha SS, Lerman A. Circulating Progenitor Cells Are Associated With Plaque Progression And Long-Term Outcomes In Heart Transplant Patients. Cardiovasc Res 2021; 118:1703-1712. [PMID: 34132771 DOI: 10.1093/cvr/cvab203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Circulating progenitor cells (CPCs) play a role in vascular repair and plaque stability, while osteocalcin (OC) expressing CPCs have been linked to unstable plaque and adverse cardiovascular outcomes. However, their role in cardiac allograft vasculopathy (CAV) has not been elucidated. This cohort study aimed to investigate the contribution of CPCs on CAV progression and cardiovascular events after heart transplantation. METHODS AND RESULTS A total of 80 heart transplant patients (mean age 55 ± 14 years, 72% male) undergoing annual intravascular ultrasound (IVUS) had fresh CPCs marked by CD34, CD133, and OC counted in peripheral blood using flow cytometry, on the same day as baseline IVUS. CAV progression was assessed by IVUS as the change (Δ) in plaque volume divided by segment length (PV/SL), adjusted for the time between IVUS measurements (median 3.0, interquartile range (IQR) [2.8, 3.1] years), and was defined as ΔPV/SL that is above the median ΔPV/SL of study population. Major adverse cardiac events (MACE) was defined as any incident of revascularization, myocardial infarction, heart failure admission, re-transplantation, stroke and death. Patients with higher CD34+CD133+ CPCs had a decreased risk of CAV progression (odds ratio 0.58, 95% confidence interval [CI] [0.37, 0.92], p = 0.01) and MACE (hazard ratio [HR] 0.79, 95% CI [0.66, 0.99], p = 0.05) during a median (IQR) follow up of 8.0 years (7.2, 8.3). Contrarily, higher OC+ cell counts were associated with an increased risk of MACE (HR 1.26, 95% CI [1.03, 1.57], p = 0.02). CONCLUSIONS Lower levels of CD34+CD133+ CPCs are associated with plaque progression and adverse long-term outcomes in patients who underwent allograft heart transplantation. In contrast, higher circulating OC+ levels are associated with adverse long term outcomes. Thus, CPCs might play a role in amelioration of transplant vasculopathy, while OC expression by these cells might play a role in progression. TRANSLATIONAL PERSPECTIVE The results of the current study suggest lower levels of circulating CD34+CD133+ cell levels are associated with cardiac allograft vasculopathy progression and future adverse cardiovascular events, while higher OC+ cell levels are associated with a greater risk of future cardiovascular events. Further studies confirming our findings might elucidate the role of circulating progenitor cells in the pathophysiology of CAV. Moreover, our findings might support the use of circulating progenitors as biomarkers, as well as the notion of cell therapy as potential treatment option for CAV, a disease with severe burden and limited treatment options.
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Affiliation(s)
- Ilke Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Takumi Toya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Michel T Corban
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell Loeffler
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - David Morse
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Sudhir S Kushwaha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Greenberg HZE, Zhao G, Shah AM, Zhang M. Role of oxidative stress in calcific aortic valve disease and its therapeutic implications. Cardiovasc Res 2021; 118:1433-1451. [PMID: 33881501 PMCID: PMC9074995 DOI: 10.1093/cvr/cvab142] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is the end result of active cellular processes that lead to the progressive fibrosis and calcification of aortic valve leaflets. In western populations, CAVD is a significant cause of cardiovascular morbidity and mortality, and in the absence of effective drugs, it will likely represent an increasing disease burden as populations age. As there are currently no pharmacological therapies available for preventing, treating, or slowing the development of CAVD, understanding the mechanisms underlying the initiation and progression of the disease is important for identifying novel therapeutic targets. Recent evidence has emerged of an important causative role for reactive oxygen species (ROS)-mediated oxidative stress in the pathophysiology of CAVD, inducing the differentiation of valve interstitial cells into myofibroblasts and then osteoblasts. In this review, we focus on the roles and sources of ROS driving CAVD and consider their potential as novel therapeutic targets for this debilitating condition.
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Affiliation(s)
- Harry Z E Greenberg
- King's College London British Heart Foundation Centre of Research Excellence, London, UK
| | - Guoan Zhao
- Department of Cardiology, the First Affiliated Hospital of Xinxiang Medical University, Heart Center of Xinxiang Medical University, Henan, China
| | - Ajay M Shah
- King's College London British Heart Foundation Centre of Research Excellence, London, UK
| | - Min Zhang
- King's College London British Heart Foundation Centre of Research Excellence, London, UK
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13
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Toya T, Ozcan I, Corban MT, Sara JD, Marietta EV, Ahmad A, Horwath IE, Loeffler DL, Murray JA, Lerman LO, Lerman A. Compositional change of gut microbiome and osteocalcin expressing endothelial progenitor cells in patients with coronary artery disease. PLoS One 2021; 16:e0249187. [PMID: 33765061 PMCID: PMC7993831 DOI: 10.1371/journal.pone.0249187] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/15/2021] [Indexed: 12/17/2022] Open
Abstract
Osteogenic endothelial progenitor cells (EPCs) contribute to impaired endothelial repair and promote coronary artery disease (CAD) and vascular calcification. Immature EPCs expressing osteocalcin (OCN) has been linked to unstable CAD; however, phenotypic regulation of OCN-expressing EPCs is not understood. We hypothesized that gut-microbiome derived pro-inflammatory substance, trimethylamine N-oxide (TMAO) might be associated with mobilization of OCN-expressing EPCs. This study aimed to investigate the association between dysbiosis, TMAO, and circulating mature and immature OCN-expressing EPCs levels in patients with and without CAD. We included 202 patients (CAD N = 88; no CAD N = 114) who underwent assessment of EPCs using flow cytometry and gut microbiome composition. Mature and immature EPCs co-staining for OCN were identified using cell surface markers as CD34+/CD133-/kinase insert domain receptor (KDR)+ and CD34-/CD133+/KDR+ cells, respectively. The number of observed operational taxonomy units (OTU), index of microbial richness, was used to identify patients with dysbiosis. The number of immature OCN-expressing EPCs were higher in patients with CAD or dysbiosis than patients without. TMAO levels were not associated with circulating levels of OCN-expressing EPCs. The relative abundance of Ruminococcus gnavus was moderately correlated with circulating levels of immature OCN-expressing EPCs, especially in diabetic patients. Gut dysbiosis was associated with increased levels of TMAO, immature OCN-expressing EPCs, and CAD. The relative abundance of Ruminococcus gnavus was correlated with immature OCN-expressing EPCs, suggesting that the harmful effects of immature OCN-expressing EPCs on CAD and potentially vascular calcification might be mediated by gut microbiome-derived systemic inflammation.
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Affiliation(s)
- Takumi Toya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
- Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ilke Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Michel T. Corban
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Jaskanwal D. Sara
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Eric V. Marietta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States of America
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Irina E. Horwath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States of America
| | - Darrell L. Loeffler
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Joseph A. Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States of America
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States of America
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
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14
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Human aortic valve interstitial cells obtained from patients with aortic valve stenosis are vascular endothelial growth factor receptor 2 positive and contribute to ectopic calcification. J Pharmacol Sci 2020; 145:213-221. [PMID: 33451756 DOI: 10.1016/j.jphs.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
Since aortic valve stenosis (AVS) is the most frequent and serious valvular heart disease in the elderly, and is accompanied by irreversible valve calcification, medicinal prevention of AVS is important. Although we recently demonstrated that human aortic valve interstitial cells (HAVICs) obtained from patients with AVS were highly sensitive to ectopic calcification stimulation, the cell types contributing to calcification are unknown. We aimed to immunocytochemically characterize HAVICs and identify their contribution to valve calcification. HAVICs were isolated from patients with AVS and cultured on non-coated dishes. Immunocytochemical features and HAVIC differentiation were analyzed in passage 1 (P1). The immunohistochemical features of the calcified aortic valve were analyzed. Most cultured P1 HAVICs were CD73-, CD90-, and CD105-positive, and CD45-and CD34-negative. HAVICs were vascular endothelial growth factor receptor 2 (VEGFR2)-positive; however, approximately half were α-smooth muscle actin (SMA)-positive, colonized, and easily differentiated into osteoblastic cells. Calcified aortic valve immunohistochemistry showed that all cells were positive for VEGFR2 and partly α-SMA. Further, VEGFR2-positive cells were more sensitive to tumor necrosis factor-α-induced ectopic calcification with or without α-SMA positivity. We conclude that HAVICs obtained from patients with AVS are VEGFR2-positive undifferentiated mesenchymal cells and may contribute to aortic valve ectopic calcification.
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15
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Chan YH, Ngai MC, Chen Y, Wu MZ, Yu YJ, Zhen Z, Lai K, Cheung T, Ho LM, Chung HY, Lau CS, Tse HF, Yiu KH. Cumulative Rheumatic Inflammation Modulates the Bone-Vascular Axis and Risk of Coronary Calcification. J Am Heart Assoc 2020; 8:e011540. [PMID: 31130038 PMCID: PMC6585350 DOI: 10.1161/jaha.118.011540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Rheumatic diseases are related to both abnormal bone turnover and atherogenesis, but a mechanistic link was missing. Methods and Results We investigated the effect of cumulative rheumatic inflammation (CRI) on risk of coronary calcification in a retrospective cohort of 145 rheumatoid arthritis patients. A time‐adjusted aggregate CRI score was derived by conglomerating all quarterly biomarker encounters of serum C‐reactive protein over 60 months immediately preceding computed tomography coronary angiography. Flow cytometry was performed to measure the osteocalcin‐positive (OCN+) CD34+KDR+ and OCN+CD34+ circulating endothelial progenitor cells (EPCs). Conventional early circulating EPCs CD34+CD133+KDR+ was determined. Coronary calcification was defined as any Agatston score >0. 50% of patients (n=72/145) had coronary calcification. CRI score was associated with presence of coronary calcification (P=0.004) (multivariable‐adjusted: highest versus lowest quartile: odds ratio=5.6 [95% CI 1.1–28.9], P=0.041). Receiver operating characteristics curve revealed divergent behavior of OCN‐expressing circulating EPCs (OCN+CD34+EPCs: area under the curve=0.60, P=0.034; OCN+CD34+KDR+EPCs: area under the curve=0.59, P=0.053, positive predictors) versus conventional early EPCs (CD34+CD133+KDR+: area under the curve=0.60, P=0.034, negative predictor) for coronary calcification, which persisted after multivariable adjustments (OCN+CD34+KDR+ [>75th percentile]: odds ratio=7.2 [95% CI 1.8–27.9], P=0.005; OCN+CD34+EPCs [>75th percentile]: odds ratio=6.0 [95% CI 1.5–23.3], P=0.010; CD34+CD133+KDR+ [>75th percentile: odds ratio=0.3 [95% CI 0.1–1.0], P=0.053). Intriguingly, the CRI score was associated with increased OCN+CD34+EPCs (highest versus lowest quartile: B=+25.6 [95% CI 0.8–50.5] [×103/mL peripheral blood], P=0.043), but reduced CD34+CD133+KDR+EPCs (highest versus lowest quartile: B=−16.2 [95% CI −31.5 to −0.9], P=0.038). Conclusions Preceding 60 months of CRI is associated with increased risk of coronary calcification and altered OCN expression in circulating EPCs.
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Affiliation(s)
- Yap-Hang Chan
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Michael Cheong Ngai
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Yan Chen
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China.,2 Cardiology Division Department of Medicine University of Hong Kong Shenzhen Hospital Shenzhen China
| | - Mei-Zhen Wu
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Yu-Juan Yu
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Zhe Zhen
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Kevin Lai
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Tommy Cheung
- 3 Division of Rheumatology Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Lai-Ming Ho
- 4 School of Public Health The University of Hong Kong Hong Kong
| | - Ho-Yin Chung
- 3 Division of Rheumatology Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Chak-Sing Lau
- 3 Division of Rheumatology Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China
| | - Hung-Fat Tse
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China.,2 Cardiology Division Department of Medicine University of Hong Kong Shenzhen Hospital Shenzhen China
| | - Kai-Hang Yiu
- 1 Cardiology Division Department of Medicine Queen Mary Hospital University of Hong Kong Hong Kong SAR China.,2 Cardiology Division Department of Medicine University of Hong Kong Shenzhen Hospital Shenzhen China
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16
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Fauvel C, Capoulade R, Durand E, Béziau DM, Schott JJ, Le Tourneau T, Eltchaninoff H. Durability of transcatheter aortic valve implantation: A translational review. Arch Cardiovasc Dis 2020; 113:209-221. [PMID: 32113816 DOI: 10.1016/j.acvd.2019.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 10/24/2022]
Abstract
Until recently, transcatheter aortic valve implantation was restricted to high-risk and inoperable patients. The updated 2017 European Society of Cardiology Guidelines has widened the indication to include intermediate-risk patients, based on two recently published trials (PARTNER 2 and SURTAVI). Moreover, two other recent trials (PARTNER 3 and EVOLUT LOW RISK) have demonstrated similar results with transcatheter aortic valve implantation in low-risk patients. Thus, extension of transcatheter aortic valve implantation to younger patients, who are currently treated by surgical aortic valve replacement, raises the crucial question of bioprosthesis durability. In this translational review, we propose to produce a state-of-the-art overview of the durability of transcatheter aortic valve implantation by integrating knowledge of the basic science of bioprosthesis degeneration (pathophysiology and biomarkers). After summarising the new definition of structural valve deterioration, we will present what is known about the pathophysiology of aortic stenosis and bioprosthesis degeneration. Next, we will consider how to identify a population at risk of early degeneration, and how basic science with the help of biomarkers could identify and predict structural valve deterioration. Finally, we will present data on the differences in durability of transcatheter aortic valve implantation compared with surgical aortic valve replacement.
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Affiliation(s)
- Charles Fauvel
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Romain Capoulade
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Eric Durand
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France; Normandie université, UNIROUEN, INSERM U1096, 76000 Rouen, France
| | - Delphine M Béziau
- Normandie Université, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, 76000 Rouen, France
| | - Jean-Jacques Schott
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Thierry Le Tourneau
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Hélène Eltchaninoff
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France; Normandie université, UNIROUEN, INSERM U1096, 76000 Rouen, France.
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17
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Kim JM, Lee WS, Kim J. Therapeutic strategy for atherosclerosis based on bone-vascular axis hypothesis. Pharmacol Ther 2020; 206:107436. [DOI: 10.1016/j.pharmthera.2019.107436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
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18
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Rogers MA, Aikawa E. Cardiovascular calcification: artificial intelligence and big data accelerate mechanistic discovery. Nat Rev Cardiol 2020; 16:261-274. [PMID: 30531869 DOI: 10.1038/s41569-018-0123-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cardiovascular calcification is a health disorder with increasing prevalence and high morbidity and mortality. The only available therapeutic options for calcific vascular and valvular heart disease are invasive transcatheter procedures or surgeries that do not fully address the wide spectrum of these conditions; therefore, an urgent need exists for medical options. Cardiovascular calcification is an active process, which provides a potential opportunity for effective therapeutic targeting. Numerous biological processes are involved in calcific disease, including matrix remodelling, transcriptional regulation, mitochondrial dysfunction, oxidative stress, calcium and phosphate signalling, endoplasmic reticulum stress, lipid and mineral metabolism, autophagy, inflammation, apoptosis, loss of mineralization inhibition, impaired mineral resorption, cellular senescence and extracellular vesicles that act as precursors of microcalcification. Advances in molecular imaging and big data technology, including in multiomics and network medicine, and the integration of these approaches are helping to provide a more comprehensive map of human disease. In this Review, we discuss ectopic calcification processes in the cardiovascular system, with an emphasis on emerging mechanistic knowledge obtained through patient data and advances in imaging methods, experimental models and multiomics-generated big data. We also highlight the potential and challenges of artificial intelligence, machine learning and deep learning to integrate imaging and mechanistic data for drug discovery.
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Affiliation(s)
- Maximillian A Rogers
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Center for Excellence in Vascular Biology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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19
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Comparison of Rapidly Proliferating, Multipotent Aortic Valve-Derived Stromal Cells and Valve Interstitial Cells in the Human Aortic Valve. Stem Cells Int 2019; 2019:7671638. [PMID: 31582988 PMCID: PMC6754971 DOI: 10.1155/2019/7671638] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/04/2019] [Indexed: 02/06/2023] Open
Abstract
Aortic valve calcification is a common clinical disease, caused by valve interstitial cells (VICs), which initiate the thickening and then calcification of valve leaflets. Classical valve-derived cells can be seen in different cell populations according to their different morphologies, but it is not clear whether different types of mesenchymal cells exist. In this study, culture conditions for mesenchymal stromal cells were used to selectively isolate valve-derived stromal cells (VDSCs). After subculturing, the morphology, proliferation, multidifferentiation, immunophenotype, and gene expression profiling in isolated VDSCs were compared with those in conventional cultured VICs. VDSCs isolated from human aortic valves were uniform spindle-shaped fibroblasts, had mutilineage differentiation abilities, and proliferated faster than VICs. Classic mesenchymal markers including cluster of differentiation 90 (CD90), CD44, and CD29 were positively expressed. In addition, the stem cell markers CD163, CD133, and CD106 were all expressed in VDSCs. RNA-sequencing identified 1595 differentially expressed genes between VDSCs and VICs of which 301 were upregulated and 1294 were downregulated. Valvular extracellular matrix genes of VDSCs such as collagen type 1, alpha 1 (COL1A1), COL1A2, and fibronectin 1 were abundantly expressed. In addition, runt-related transcription factor 2 and Ki-67 proteins were also markedly upregulated in VDSCs, whereas there was less expression of the focal adhesion genes integrin alpha and laminin alpha in VDSCs compared to VICs. In conclusion, novel rapidly proliferating VDSCs with fibroblast morphology, which were found to express mesenchymal and osteogenic markers, may contribute to aortic valve calcification.
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20
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Reconstruction of the pulmonary artery by a novel biodegradable conduit engineered with perinatal stem cell-derived vascular smooth muscle cells enables physiological vascular growth in a large animal model of congenital heart disease. Biomaterials 2019; 217:119284. [PMID: 31255979 PMCID: PMC6658806 DOI: 10.1016/j.biomaterials.2019.119284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022]
Abstract
Lack of growth potential of available grafts represents a bottleneck in the correction of congenital heart defects. Here we used a swine small intestinal submucosa (SIS) graft functionalized with mesenchymal stem cell (MSC)-derived vascular smooth muscle cells (VSMCs), for replacement of the pulmonary artery in piglets. MSCs were expanded from human umbilical cord blood or new-born swine peripheral blood, seeded onto decellularized SIS grafts and conditioned in a bioreactor to differentiate into VSMCs. Results indicate the equivalence of generating grafts engineered with human or swine MSC-derived VSMCs. Next, we conducted a randomized, controlled study in piglets (12–15 kg), which had the left pulmonary artery reconstructed with swine VSMC-engineered or acellular conduit grafts. Piglets recovered well from surgery, with no casualty and similar growth rate in either group. After 6 months, grafted arteries had larger circumference in the cellular group (28.3 ± 2.3 vs 18.3 ± 2.1 mm, P < 0.001), but without evidence of aneurism formation. Immunohistochemistry showed engineered grafts were composed of homogeneous endothelium covered by multi-layered muscular media, whereas the acellular grafts exhibited a patchy endothelial cell layer and a thinner muscular layer. Results show the feasibility and efficacy of pulmonary artery reconstruction using clinically available grafts engineered with allogeneic VSMCs in growing swine.
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21
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Raddatz MA, Madhur MS, Merryman WD. Adaptive immune cells in calcific aortic valve disease. Am J Physiol Heart Circ Physiol 2019; 317:H141-H155. [PMID: 31050556 DOI: 10.1152/ajpheart.00100.2019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Calcific aortic valve disease (CAVD) is highly prevalent and has no pharmaceutical treatment. Surgical replacement of the aortic valve has proved effective in advanced disease but is costly, time limited, and in many cases not optimal for elderly patients. This has driven an increasing interest in noninvasive therapies for patients with CAVD. Adaptive immune cell signaling in the aortic valve has shown potential as a target for such a therapy. Up to 15% of cells in the healthy aortic valve are hematopoietic in origin, and these cells, which include macrophages, T lymphocytes, and B lymphocytes, are increased further in calcified specimens. Additionally, cytokine signaling has been shown to play a causative role in aortic valve calcification both in vitro and in vivo. This review summarizes the physiological presence of hematopoietic cells in the valve, innate and adaptive immune cell infiltration in disease states, and the cytokine signaling pathways that play a significant role in CAVD pathophysiology and may prove to be pharmaceutical targets for this disease in the near future.
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Affiliation(s)
- Michael A Raddatz
- Department of Biomedical Engineering, Vanderbilt University , Nashville, Tennessee.,Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Meena S Madhur
- Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee.,Department of Molecular Physiology and Biophysics, Vanderbilt University , Nashville, Tennessee.,Division of Clinical Pharmacology, Vanderbilt University Medical Center , Nashville, Tennessee
| | - W David Merryman
- Department of Biomedical Engineering, Vanderbilt University , Nashville, Tennessee
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22
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Chan YH, Ngai MC, Chen Y, Wu MZ, Yu YJ, Zhen Z, Lai K, Cheung T, Ho LM, Chung HY, Lau CS, Lau CP, Tse HF, Yiu KH. Osteogenic circulating endothelial progenitor cells are linked to electrocardiographic conduction abnormalities in rheumatic patients. Ann Noninvasive Electrocardiol 2019; 24:e12651. [PMID: 31017736 DOI: 10.1111/anec.12651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Osteogenic circulating endothelial progenitor cells (EPC) play a pathogenic role in cardiovascular system degeneration through promulgating vasculature calcification, but its role in conduction disorders as part of the cardiovascular degenerative continuum remained unknown. AIM To investigate the role of osteocalcin (OCN)-expressing circulating EPCs in cardiac conduction disorders in the unique clinical sample of rheumatoid arthritis (RA) susceptible to both abnormal bone metabolism and cardiac conduction disorders. METHODS We performed flow cytometry studies in 134 consecutive asymptomatic patients with rheumatoid arthritis to derive osteogenic circulating OCN-positive (OCN+) CD34+KDR+ vs. CD34+CD133+KDR+ conventional EPC. Study endpoint was the prespecified combined endpoint of electrocardiographic conduction abnormalities. RESULTS Total prevalence of cardiac conduction abnormality was 9% (n = 12). All patients except one had normal sinus rhythm. One patient had atrial fibrillation. No patient had advanced atrioventricular (AV) block. Prevalence of first-degree heart block (>200 ms), widened QRS duration (>120 ms) and right bundle branch block were 6.7%, 2.1%, and 2.2% respectively. Circulating osteogenic OCN+ CD34+ KDR+ EPCs were significantly higher among patients with cardiac conduction abnormalities (p = 0.039). Elevated OCN+ CD34+ KDR+ EPCs> 75th percentile was associated with higher prevalence of cardiac conduction abnormalities (58.3% vs. 20.02%, p = 0.003). Adjusted for potential confounders, elevated OCN+ CD34+ KDR+ EPCs> 75th percentile remained independently associated with increased risk of cardiac conduction abnormalities (OR = 4.4 [95%CI 1.2-16.4], p = 0.028). No significant relation was found between conventional EPCs CD34+CD133+KDR+ and conduction abnormalities (p = 0.36). CONCLUSIONS Elevated osteogenic OCN+ CD34+ KDR+ EPCs are independently associated with the presence of electrocardiographic conduction abnormalities in patients with rheumatoid arthritis, unveiling a potential novel pathophysiological mechanism.
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Affiliation(s)
- Yap-Hang Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Michael Cheong Ngai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Yan Chen
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Yu-Juan Yu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Zhe Zhen
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Kevin Lai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Tommy Cheung
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ho-Yin Chung
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Chak-Sing Lau
- Division of Rheumatology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,Cardiology Division, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
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23
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Al-Hijji M, Narula N, Go JL, Khosla S, Enriquez-Sarano M, Loeffler D, Lennon R, Lerman LO, Lerman A. Circulating Osteogenic Progenitor Cells in Mild, Moderate, and Severe Aortic Valve Stenosis. Mayo Clin Proc 2019; 94:652-659. [PMID: 30947832 PMCID: PMC8170592 DOI: 10.1016/j.mayocp.2019.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/15/2018] [Accepted: 01/09/2019] [Indexed: 11/22/2022]
Abstract
The aim of this study was to characterize endothelial progenitor cells with osteoblastic phenotype (EPC-OCNs) and their role in individuals with varying degrees of aortic stenosis (AS). Peripheral blood mononuclear cells retrieved from blood samples of individuals with mild (n=40), moderate (n=35), or severe (n=103) AS from September 16, 2008, through March 30, 2015, were analyzed by flow cytometry for the EPC surface markers CD34, CD133, and kinase insert domain receptor (KDR) and the osteoblastic cell surface marker OCN. Levels of EPC-OCNs were correlated with AS severity and calcifications. Patients with severe AS had significantly elevated numbers of total circulating EPC-OCNs, including the EPC-OCN subtypes CD133+/OCN+, CD34+/CD133+/OCN+, and CD133+/KDR+/OCN+, compared with those with mild AS. Individuals with moderate AS also had significantly increased numbers of the circulating progenitor cell CD133+/OCN+ compared with patients with mild AS. There was a significant association between total circulating EPC-OCN levels and aortic valve (AV) calcification, AV mean gradient, and AV area measured by echocardiography. In summary, this study found the presence of circulating EPC-OCNs in patients with progressive AV stenosis. These findings might support the potential role for EPC-OCNs in the progression of AV stenosis and calcification.
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Affiliation(s)
| | - Nupoor Narula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jason L Go
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sundeep Khosla
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic, Rochester, MN
| | | | - Darrell Loeffler
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ryan Lennon
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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24
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Manno G, Bentivegna R, Morreale P, Nobile D, Santangelo A, Novo S, Novo G. Chronic inflammation: A key role in degeneration of bicuspid aortic valve. J Mol Cell Cardiol 2019; 130:59-64. [PMID: 30885747 DOI: 10.1016/j.yjmcc.2019.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Bicuspid aortic valve (BAV) is the most common congenital valvular heart defect resulting from abnormal aortic cusp formation during heart development, where two of the three normal and equal sized cusps fuse into a single large cusp resulting in a two cusps aortic valve. Over the past years, much interest has been given in understanding the pathogenesis of BAV and its complications. In this review, we focused on the role of inflammation, involved in the degeneration of BAV and the development of its complications. ROLE OF INFLAMMATION From a pathophysiological point of view, BAV may rapidly progress into aortic stenosis (AS) and is related to aortopathy. Several histopathologic studies have demonstrated that the development and progression of alterations in bicuspid aortic valve are related to an active process that includes: oxidative stress, shear stress, endothelial dysfunction, disorganized tissue architecture, inflammatory cells and cytokines. These factors are closely related one to each other, constituting the basis of the structural and functional alterations of the BAV. CONCLUSION Chronic inflammation plays a key role in the degeneration of BAV. Severe aortic stenosis in bicuspid aortic valves is associated with a more aggressive inflammatory process, increased inflammatory cells infiltration and neovascularization when compared to tricuspid AS. These findings might help to explain the more frequent onset and rapid progression of AS and the heavy aortic valve calcification seen in patients with BAV.
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Affiliation(s)
- G Manno
- Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (PROMISE) "G. D'Alessandro", Italy; Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy.
| | - R Bentivegna
- Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (PROMISE) "G. D'Alessandro", Italy; Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy
| | - P Morreale
- Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (PROMISE) "G. D'Alessandro", Italy; Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy
| | - D Nobile
- Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (PROMISE) "G. D'Alessandro", Italy; Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy
| | - A Santangelo
- Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (PROMISE) "G. D'Alessandro", Italy; Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy
| | - S Novo
- Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (PROMISE) "G. D'Alessandro", Italy; Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy
| | - G Novo
- Department of Excellence of Sciences for Health Promotion and Mothernal-Child Care, Internal Medicine and Specialities (PROMISE) "G. D'Alessandro", Italy; Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy.
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25
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Go JL, Prem K, Al-Hijji MA, Qin Q, Noble C, Young MD, Lerman LO, Lerman A. Experimental Metabolic Syndrome Model Associated with Mechanical and Structural Degenerative Changes of the Aortic Valve. Sci Rep 2018; 8:17835. [PMID: 30546028 PMCID: PMC6292876 DOI: 10.1038/s41598-018-36388-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/15/2018] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study was to test the hypothesis that an experimental high fat (HF) animal with metabolic syndrome results in structural degeneration of the aortic valve. Domestic pigs were divided (n = 12) and administered either a normal or HF diet. After 16-weeks, the HF diet group had increased weight (p ≤ 0.05), total cholesterol (p ≤ 0.05), and systolic and diastolic pressure (p ≤ 0.05). The aortic valve extracellular matrix showed loss of elastin fibers and increased collagen deposition in the HF diet group. Collagen was quantified with ELISA, which showed an increased concentration of collagen types 1 and 3 (p ≤ 0.05). In the HF diet group, the initial stages of microcalcification were observed. Uniaxial mechanical testing of aortic cusps revealed that the HF diet group expressed a decrease in ultimate tensile strength and elastic modulus compared to the control diet group (p ≤ 0.05). Western blot and immunohistochemistry indicated the presence of proteins: lipoprotein-associated phospholipase A2, osteopontin, and osteocalcin with an increased expression in the HF diet group. The current study demonstrates that experimental metabolic syndrome induced by a 16-week HF diet was associated with a statistically significant alteration to the physical architecture of the aortic valve.
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Affiliation(s)
- Jason L Go
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA
| | - Komal Prem
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA
| | - Mohammed A Al-Hijji
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA
| | - Qing Qin
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA
| | - Christopher Noble
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA
| | - Melissa D Young
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA
| | - Lilach O Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA.,Department of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA.
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26
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Jover E, Fagnano M, Angelini G, Madeddu P. Cell Sources for Tissue Engineering Strategies to Treat Calcific Valve Disease. Front Cardiovasc Med 2018; 5:155. [PMID: 30460245 PMCID: PMC6232262 DOI: 10.3389/fcvm.2018.00155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular calcification is an independent risk factor and an established predictor of adverse cardiovascular events. Despite concomitant factors leading to atherosclerosis and heart valve disease (VHD), the latter has been identified as an independent pathological entity. Calcific aortic valve stenosis is the most common form of VDH resulting of either congenital malformations or senile “degeneration.” About 2% of the population over 65 years is affected by aortic valve stenosis which represents a major cause of morbidity and mortality in the elderly. A multifactorial, complex and active heterotopic bone-like formation process, including extracellular matrix remodeling, osteogenesis and angiogenesis, drives heart valve “degeneration” and calcification, finally causing left ventricle outflow obstruction. Surgical heart valve replacement is the current therapeutic option for those patients diagnosed with severe VHD representing more than 20% of all cardiac surgeries nowadays. Tissue Engineering of Heart Valves (TEHV) is emerging as a valuable alternative for definitive treatment of VHD and promises to overcome either the chronic oral anticoagulation or the time-dependent deterioration and reintervention of current mechanical or biological prosthesis, respectively. Among the plethora of approaches and stablished techniques for TEHV, utilization of different cell sources may confer of additional properties, desirable and not, which need to be considered before moving from the bench to the bedside. This review aims to provide a critical appraisal of current knowledge about calcific VHD and to discuss the pros and cons of the main cell sources tested in studies addressing in vitro TEHV.
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Affiliation(s)
- Eva Jover
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Marco Fagnano
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni Angelini
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Paolo Madeddu
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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27
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Chen J, Zhang X, Wang Y, Ye Y, Huang Z. Differential ability of formononetin to stimulate proliferation of endothelial cells and breast cancer cells via a feedback loop involving MicroRNA-375, RASD1, and ERα. Mol Carcinog 2018; 57:817-830. [PMID: 29722068 DOI: 10.1002/mc.22531] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/24/2016] [Indexed: 01/12/2023]
Abstract
For postmenopausal cardiovascular disease, long-term estrogen therapy may increase the risk of breast cancer. To reduce this risk, estrogen may be replaced with the phytoestrogen formononetin, but how formononetin acts on vascular endothelial cells (ECs) and breast cancer cells is unclear. Here, we show that low concentrations of formononetin induced proliferation and inhibited apoptosis more strongly in cultured human umbilical vein endothelial cells (HUVECs) than in breast cancer cells expressing estrogen receptor α (ERα) (MCF-7, BT474) or not (MDA-MB-231), and that this differential stimulation was associated with miR-375 up-regulation in HUVECs. For the first time, we demonstrate the presence of a feedback loop involving miR-375, ras dexamethasone-induced 1 (RASD1), and ERα in normal HUVECs, and we show that formononetin stimulated this feedback loop in HUVECs but not in MCF-7 or BT474 cells. In all three cell lines, formononetin increased Akt phosphorylation and Bcl-2 expression. Inhibiting miR-375 blocked these changes and increased proliferation in HUVECs, but not in MCF-7 or BT474 cells. In ovariectomized rats, formononetin increased uterine weight and caused similar changes in levels of miR-375, RASD1, ERα, and Bcl-2 in aortic ECs as in cultured HUVECs. In mice bearing MCF-7 xenografts, tumor growth was stimulated by 17β-estradiol but not by formononetin. These results suggest selective action of formononetin in ECs (proliferation stimulation and apoptosis inhibition) relative to breast cancer cells, possibly via a feedback loop involving miR-375, RASD1, and ERα. This differential effect may explain why formononetin may not increase the risk of postmenopausal breast cancer.
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Affiliation(s)
- Jian Chen
- School of Basic Medical Sciences, Guilin Medical University, Guilin, China
| | - Xing Zhang
- School of Basic Medical Sciences, Guilin Medical University, Guilin, China
| | - Yong Wang
- School of Basic Medical Sciences, Guilin Medical University, Guilin, China
| | - Yu Ye
- Department of Emergency, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhaoquan Huang
- Department of Pathology, Guilin Medical University, Guilin, China
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28
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Carrabba M, Madeddu P. Current Strategies for the Manufacture of Small Size Tissue Engineering Vascular Grafts. Front Bioeng Biotechnol 2018; 6:41. [PMID: 29721495 PMCID: PMC5916236 DOI: 10.3389/fbioe.2018.00041] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/23/2018] [Indexed: 01/12/2023] Open
Abstract
Occlusive arterial disease, including coronary heart disease (CHD) and peripheral arterial disease (PAD), is the main cause of death, with an annual mortality incidence predicted to rise to 23.3 million worldwide by 2030. Current revascularization techniques consist of angioplasty, placement of a stent, or surgical bypass grafting. Autologous vessels, such as the saphenous vein and internal thoracic artery, represent the gold standard grafts for small-diameter vessels. However, they require invasive harvesting and are often unavailable. Synthetic vascular grafts represent an alternative to autologous vessels. These grafts have shown satisfactory long-term results for replacement of large- and medium-diameter arteries, such as the carotid or common femoral artery, but have poor patency rates when applied to small-diameter vessels, such as coronary arteries and arteries below the knee. Considering the limitations of current vascular bypass conduits, a tissue-engineered vascular graft (TEVG) with the ability to grow, remodel, and repair in vivo presents a potential solution for the future of vascular surgery. Here, we review the different methods that research groups have been investigating to create TEVGs in the last decades. We focus on the techniques employed in the manufacturing process of the grafts and categorize the approaches as scaffold-based (synthetic, natural, or hybrid) or self-assembled (cell-sheet, microtissue aggregation and bioprinting). Moreover, we highlight the attempts made so far to translate this new strategy from the bench to the bedside.
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Affiliation(s)
- Michele Carrabba
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Paolo Madeddu
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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29
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Gošev I, Zeljko M, Đurić Ž, Nikolić I, Gošev M, Ivčević S, Bešić D, Legčević Z, Paić F. Epigenome alterations in aortic valve stenosis and its related left ventricular hypertrophy. Clin Epigenetics 2017; 9:106. [PMID: 29026447 PMCID: PMC5627415 DOI: 10.1186/s13148-017-0406-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022] Open
Abstract
Aortic valve stenosis is the most common cardiac valve disease, and with current trends in the population demographics, its prevalence is likely to rise, thus posing a major health and economic burden facing the worldwide societies. Over the past decade, it has become more than clear that our traditional genetic views do not sufficiently explain the well-known link between AS, proatherogenic risk factors, flow-induced mechanical forces, and disease-prone environmental influences. Recent breakthroughs in the field of epigenetics offer us a new perspective on gene regulation, which has broadened our perspective on etiology of aortic stenosis and other aortic valve diseases. Since all known epigenetic marks are potentially reversible this perspective is especially exciting given the potential for development of successful and non-invasive therapeutic intervention and reprogramming of cells at the epigenetic level even in the early stages of disease progression. This review will examine the known relationships between four major epigenetic mechanisms: DNA methylation, posttranslational histone modification, ATP-dependent chromatin remodeling, and non-coding regulatory RNAs, and initiation and progression of AS. Numerous profiling and functional studies indicate that they could contribute to endothelial dysfunctions, disease-prone activation of monocyte-macrophage and circulatory osteoprogenitor cells and activation and osteogenic transdifferentiation of aortic valve interstitial cells, thus leading to valvular inflammation, fibrosis, and calcification, and to pressure overload-induced maladaptive myocardial remodeling and left ventricular hypertrophy. This is especcialy the case for small non-coding microRNAs but was also, although in a smaller scale, convincingly demonstrated for other members of cellular epigenome landscape. Equally important, and clinically most relevant, the reported data indicate that epigenetic marks, particularly certain microRNA signatures, could represent useful non-invasive biomarkers that reflect the disease progression and patients prognosis for recovery after the valve replacement surgery.
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Affiliation(s)
- Igor Gošev
- Department of Surgery, University of Rochester Medical center, Rochester, NY USA
| | - Martina Zeljko
- Department of Cardiology, Clinical Unit of Internal Medicine, Clinical Hospital Merkur, Zajćeva 19, 10 000 Zagreb, Croatia
| | - Željko Đurić
- Department of Cardiac Surgery, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia
| | - Ivana Nikolić
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Milorad Gošev
- School of Medicine, University of Josip Juraj Strossmayer, Trg Svetog trojstva 3, 31 000 Osijek, Croatia
| | - Sanja Ivčević
- Department of Physiology, School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
| | - Dino Bešić
- Laboratory for Epigenetics and Molecular Medicine, Department of Biology, School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
| | - Zoran Legčević
- Laboratory for Epigenetics and Molecular Medicine, Department of Biology, School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
| | - Frane Paić
- Laboratory for Epigenetics and Molecular Medicine, Department of Biology, School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
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30
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Choi B, Lee S, Kim SM, Lee EJ, Lee SR, Kim DH, Jang JY, Kang SW, Lee KU, Chang EJ, Song JK. Dipeptidyl Peptidase-4 Induces Aortic Valve Calcification by Inhibiting Insulin-Like Growth Factor-1 Signaling in Valvular Interstitial Cells. Circulation 2017; 135:1935-1950. [DOI: 10.1161/circulationaha.116.024270] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/31/2017] [Indexed: 01/08/2023]
Abstract
Background:
Calcification of the aortic valve leads to increased leaflet stiffness and consequently to the development of calcific aortic valve disease. However, the underlying molecular and cellular mechanisms of calcification remain unclear. Here, we identified that dipeptidyl peptidase-4 (DPP-4, also known as CD26) increases valvular calcification and promotes calcific aortic valve disease progression.
Methods:
We obtained the aortic valve tissues from humans and murine models (wild-type and endothelial nitric oxide synthase-deficient-mice) and cultured the valvular interstitial cells (VICs) and valvular endothelial cells from the cusps. We induced osteogenic differentiation in the primary cultured VICs and examined the effects of the DPP-4 inhibitor on the osteogenic changes in vitro and aortic valve calcification in endothelial nitric oxide synthase-deficient-mice. We also induced calcific aortic stenosis in male New Zealand rabbits (weight, 2.5–3.0 kg) by a cholesterol-enriched diet+vitamin D2 (25 000 IU, daily). Echocardiography was performed to assess the aortic valve area and the maximal and mean transaortic pressure gradients at baseline and 3-week intervals thereafter. After 12 weeks, we harvested the heart and evaluated the aortic valve tissue using immunohistochemistry.
Results:
We found that nitric oxide depletion in human valvular endothelial cells activates NF-κB in human VICs. Consequently, the NF-κB promotes DPP-4 expression, which then induces the osteogenic differentiation of VICs by limiting autocrine insulin-like growth factor-1 signaling. The inhibition of DPP-4 enzymatic activity blocked the osteogenic changes in VICs in vitro and reduced the aortic valve calcification in vivo in a mouse model. Sitagliptin administration in a rabbit calcific aortic valve disease model led to significant improvements in the rate of change in aortic valve area, transaortic peak velocity, and maximal and mean pressure gradients over 12 weeks. Immunohistochemistry staining confirmed the therapeutic effect of Sitagliptin in terms of reducing the calcium deposits in the rabbit aortic valve cusps. In rabbits receiving Sitagliptin, the plasma insulin-like growth factor-1 levels were significantly increased, in line with DPP-4 inhibition.
Conclusions:
DPP-4-dependent insulin-like growth factor-1 inhibition in VICs contributes to aortic valve calcification, suggesting that DPP-4 could serve as a potential therapeutic target to inhibit calcific aortic valve disease progression.
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Affiliation(s)
- Bongkun Choi
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sahmin Lee
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Min Kim
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Jin Lee
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ro Lee
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Hee Kim
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Yoon Jang
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Kang
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Up Lee
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Ju Chang
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- From Department of Biomedical Sciences (B.C., S.-M.K., E.- J.L., S.R.L., S.-W.K., E.-J.C.), Division of Cardiology (S.L., D.- H.K., J.Y.J., J.-K.S.), and Division of Endocrinology and Metabolism, Department of Internal Medicine (K.-U.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wu B, Wang Y, Xiao F, Butcher JT, Yutzey KE, Zhou B. Developmental Mechanisms of Aortic Valve Malformation and Disease. Annu Rev Physiol 2017; 79:21-41. [DOI: 10.1146/annurev-physiol-022516-034001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bingruo Wu
- Departments of Genetics, Pediatrics, and Medicine (Cardiology), Wilf Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York 10461;
| | - Yidong Wang
- Departments of Genetics, Pediatrics, and Medicine (Cardiology), Wilf Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York 10461;
| | - Feng Xiao
- Departments of Genetics, Pediatrics, and Medicine (Cardiology), Wilf Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York 10461;
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029 China
| | - Jonathan T. Butcher
- Department of Biomedical Engineering, Cornell University, Ithaca, New York 14853;
| | - Katherine E. Yutzey
- Division of Molecular Cardiovascular Biology, Cincinnati Children's Medical Center, Cincinnati, Ohio 45229;
| | - Bin Zhou
- Departments of Genetics, Pediatrics, and Medicine (Cardiology), Wilf Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York 10461;
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029 China
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A community-based study of the relationship between coronary artery disease and osteoporosis in Chinese postmenopausal women. Coron Artery Dis 2016; 27:59-64. [PMID: 26398152 DOI: 10.1097/mca.0000000000000306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Menopause is associated with an increased risk for osteoporosis (OP) and coronary artery disease (CAD). The goal of this study was to seek the possible relationship between CAD and OP in Chinese postmenopausal women. PATIENTS AND METHODS The total of 1825 participants with complete records were available for data analysis in this study. CAD was diagnosed if any one of the following was present: (i) history and/or treatment for angina and/or myocardial infarction; (ii) history of coronary artery revascularization procedures and/or coronary angiography with 50% or more stenosis in one or more of the major coronary arteries; and (iii) regional wall-motion abnormalities on rest echocardiography. OP was defined as T-score less than -2.5. Multiple regression models after controlling for confounding factors were performed to detect their relationships. RESULTS The multiple variable linear regression analyses failed to show a significant association between CAD and T-score. However, the multivariate logistic regression analyses after adjustment for relevant confounding factors detected significant associations between CAD and OP. CONCLUSION The present study provided data suggesting that CAD was independently and significantly associated with OP. The prevalence of OP was more frequent in Chinese postmenopausal women with CAD.
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Wu M, Zhang JD, Tang RN, Crowley SD, Liu H, Lv LL, Ma KL, Liu BC. Elevated PTH induces endothelial-to-chondrogenic transition in aortic endothelial cells. Am J Physiol Renal Physiol 2016; 312:F436-F444. [PMID: 27582099 DOI: 10.1152/ajprenal.00210.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/28/2016] [Indexed: 11/22/2022] Open
Abstract
Previous studies have shown that increased parathyroid hormone (PTH) attributable to secondary hyperparathyroidism in chronic kidney disease accelerates the arteriosclerotic fibrosis and calcification. Although the underlying mechanisms remain largely unknown, endothelial cells (ECs) have recently been demonstrated to participate in calcification in part by providing chondrogenic cells via the endothelial-to-mesenchymal transition (EndMT). Therefore, this study aimed to investigate whether elevated PTH could induce endothelial-to-chondrogenic transition in aortic ECs and to determine the possible underlying signaling pathway. We found that treatment of ECs with PTH significantly upregulated the expression of EndMT-related markers. Accordingly, ECs treated with PTH exhibited chondrogenic potential. In vivo, lineage-tracing model-subjected mice with endothelial-specific green fluorescent protein fluorescence to chronic PTH infusion showed a marked increase in the aortic expression of chondrocyte markers, and confocal microscopy revealed the endothelial origin of cells expressing chondrocyte markers in the aorta after PTH infusion. Furthermore, this in vitro study showed that PTH enhanced the nuclear localization of β-catenin in ECs, whereas β-catenin siRNA or DKK1, an inhibitor of β-catenin nuclear translocation, attenuated the upregulation of EndMT-associated and chondrogenic markers induced by PTH. In summary, our study demonstrated that elevated PTH could induce the transition of ECs to chondrogenic cells via EndMT, possibly mediated by the nuclear translocation of β-catenin.
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Affiliation(s)
- Min Wu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China; and
| | - Jian-Dong Zhang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China; and.,Division of Nephrology, Department of Medicine, Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina
| | - Ri-Ning Tang
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China; and
| | - Steven D Crowley
- Division of Nephrology, Department of Medicine, Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina
| | - Hong Liu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China; and
| | - Lin-Li Lv
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China; and
| | - Kun-Ling Ma
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China; and
| | - Bi-Cheng Liu
- Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China; and
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Wu CH, Lu YY, Chai CY, Su YF, Tsai TH, Tsai FJ, Lin CL. Increased risk of osteoporosis in patients with erectile dysfunction: A nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4024. [PMID: 27368024 PMCID: PMC4937938 DOI: 10.1097/md.0000000000004024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In this study, we aimed to investigate the risk of osteoporosis in patients with erectile dysfunction (ED) by analyzing data from the Taiwan National Health Insurance Research Database (NHIRD). From the Taiwan NHIRD, we analyzed data on 4460 patients aged ≥40 years diagnosed with ED between 1996 and 2010. In total, 17,480 age-matched patients without ED in a 1:4 ratio were randomly selected as the non-ED group. The relationship between ED and the risk of osteoporosis was estimated using Cox proportional hazard regression models. During the follow-up period, 264 patients with ED (5.92%) and 651 patients without ED (3.65%) developed osteoporosis. The overall incidence of osteoporosis was 3.04-fold higher in the ED group than in the non-ED group (9.74 vs 2.47 per 1000 person-years) after controlling for covariates. Compared with patients without ED, patients with psychogenic and organic ED were 3.19- and 3.03-fold more likely to develop osteoporosis. Our results indicate that patients with a history of ED, particularly younger men, had a high risk of osteoporosis. Patients with ED should be examined for bone mineral density, and men with osteoporosis should be evaluated for ED.
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Affiliation(s)
- Chieh-Hsin Wu
- Graduate Institute of Medicine, College of Medicine
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University
| | - Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital
- Cosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care & Management
- Graduate Institute of Medicine, College of Medicine
| | - Chee-Yin Chai
- Department of Pathology, Kaohsiung Medical University Hospital
- Graduate Institute of Medicine
- Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University
- Institute of Biomedical Sciences, National Sun Yat-Sen University
| | - Yu-Feng Su
- Department of Neurosurgery, Kaohsiung Medical University Hospital
| | - Tai-Hsin Tsai
- Department of Neurosurgery, Kaohsiung Medical University Hospital
| | - Feng-Ji Tsai
- Department of Neurosurgery, Kaohsiung Medical University Hospital
| | - Chih-Lung Lin
- Graduate Institute of Medicine
- Department of Neurosurgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Correspondence: Chih-Lung Lin, Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan (e-mail: )
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Shao J, Yu M, Jiang L, Wei F, Wu F, Liu Z, Liu X. Differences in calcification and osteogenic potential of herniated discs according to the severity of degeneration based on Pfirrmann grade: a cross-sectional study. BMC Musculoskelet Disord 2016; 17:191. [PMID: 27495942 PMCID: PMC4974757 DOI: 10.1186/s12891-016-1015-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/07/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Herniated discs may exhibit calcification, and calcified discs may complicate surgical treatment. However, the osteogenic potential and expression of osteogenic markers in degenerative discs of different degenerative grades are still unclear. Our purposes are to study the differences in calcification rate and osteogenic potential of herniated discs according to different degenerative grades. METHODS Fifty-eight lumbar intervertebral discs were removed from 41 patients. After grading according to the Pfirrmann scale, calcification was analyzed by micro computed tomography (μ-CT), and expression of osteogenic markers was analyzed by immunohistochemistry and real-time quantitative polymerase chain reaction (qPCR). Data from μ-CT scans were compared with the Kruskal-Wallis test. The Mann-Whitney test was applied to compare data between any two groups. Differences in osteogenic mRNA expression in different regions of the removed discs (posterior vs. anterior) were analyzed by paired t tests. Differences in the posterior portion of removed discs of different Pfirrmann grades were analyzed by one-way analysis of variance (ANOVA), and comparisons of data between discs of any two grades were completed with least significant difference (LSD) tests. RESULTS Significant differences in calcification according to μ-CT scanning were observed between discs of different degenerative grades. Nearly half of the discs of Pfirrmann grade V showed the highest degree of calcification compared to Pfirrman grade II discs. Bone morphogenetic protein (BMP)-2, Osterix, and Osteocalcin were detected histologically in discs of Pfirrmann grades III-V. Alkaline phosphatase (ALP) expression was observed in discs showing evidence of calcification. The qPCR analysis showed that BMP-2, Osterix, and Osteocalcin were expressed in most degenerated discs. We also observed greater expression of these osteogenic markers in the posterior portion of removed discs than in the anterior portion. CONCLUSIONS The osteogenic potential of degenerated intervertebral discs appears to increase with the severity of degeneration and to be greater in the tissue near the spinal canal than in tissue in the inner portion of the disc.
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Affiliation(s)
- Jia Shao
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd, Beijing, HaiDian District 100191 China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd, Beijing, HaiDian District 100191 China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd, Beijing, HaiDian District 100191 China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd, Beijing, HaiDian District 100191 China
| | - Fengliang Wu
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd, Beijing, HaiDian District 100191 China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd, Beijing, HaiDian District 100191 China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd, Beijing, HaiDian District 100191 China
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Dysregulation of ossification-related miRNAs in circulating osteogenic progenitor cells obtained from patients with aortic stenosis. Clin Sci (Lond) 2016; 130:1115-24. [PMID: 27129184 PMCID: PMC4876482 DOI: 10.1042/cs20160094] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/13/2016] [Indexed: 11/17/2022]
Abstract
CAVD (calcific aortic valve disease) is the defining feature of AS (aortic stenosis). The present study aimed to determine whether expression of ossification-related miRNAs is related to differentiation intro COPCs (circulating osteogenic progenitor cells) in patients with CAVD. The present study included 46 patients with AS and 46 controls. Twenty-nine patients underwent surgical AVR (aortic valve replacement) and 17 underwent TAVI (transcatheter aortic valve implantation). The number of COPCs was higher in the AS group than in the controls (P<0.01). Levels of miR-30c were higher in the AS group than in the controls (P<0.01), whereas levels of miR-106a, miR-148a, miR-204, miR-211, miR-31 and miR-424 were lower in the AS group than in the controls (P<0.01). The number of COPCs and levels of osteocalcin protein in COPCs were positively correlated with levels of miR-30a and negatively correlated with levels of the remaining miRNAs (all P<0.05). The degree of aortic valve calcification was weakly positively correlated with the number of COPCs and miR-30c levels. The number of COPCs and miR-30c levels were decreased after surgery, whereas levels of the remaining miRNAs were increased (all P<0.05). Changes in these levels were greater after AVR than after TAVI (all P<0.05). In vitro study using cultured peripheral blood mononuclear cells transfected with each ossification-related miRNA showed that these miRNAs controlled levels of osteocalcin protein. In conclusion, dysregulation of ossification-related miRNAs may be related to the differentiation into COPCs and may play a significant role in the pathogenesis of CAVD.
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Circulating Endothelial Progenitor Cells and Clinical Outcome in Patients with Aortic Stenosis. PLoS One 2016; 11:e0148766. [PMID: 26913741 PMCID: PMC4767873 DOI: 10.1371/journal.pone.0148766] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022] Open
Abstract
Background Aortic stenosis (AS) is the most common valvular disease. Endothelial progenitor cells (EPCs) have a role in the repair of endothelial surfaces after injury. Reduced numbers of EPCs are associated with endothelial dysfunction and adverse clinical events, suggesting that endothelial injury in the absence of sufficient repair by circulating EPCs promotes the progression of vascular and possibly valvular disorders. The aim of this study was to assess EPC number in patients with AS and to study the predictive value of their circulating levels on prognosis. Methods The number of EPCs was determined by flow cytometry in 241 patients with AS and a control group of 73 pts. Thirty-eight, 52 and 151 patients had mild, moderate and severe AS, respectively. We evaluated the association between baseline levels of EPCs and death from cardiovascular causes during follow up. Results EPC level was significantly higher in patients with AS compared to the control group (p = 0.017). Two hundred and three patients with moderate and severe AS were followed for a median of 20 months. One hundred and twenty patients underwent an intervention. Thirty four patients died during follow up, 20 patients died due to cardiac causes. Advanced age, the presence of coronary artery disease, AS severity index (combination of high NYHA class, smaller aortic valve area and elevated pulmonary artery pressure) and a low EPC number were predictors of cardiac death in the univariate analysis. Multivariate logistic regression model identified low EPCs number and AS severity index as associated with cardiac death during follow up (p = 0.026 and p = 0.037, respectively). Conclusions EPC number is increased in patients with AS. However, in patients with moderate or severe AS a relatively low number of EPCs is associated with cardiac death at follow up. These results may help to identify AS patients at increased cardiovascular risk.
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Challenges and opportunities for stem cell therapy in patients with chronic kidney disease. Kidney Int 2016; 89:767-78. [PMID: 26924058 DOI: 10.1016/j.kint.2015.11.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/10/2015] [Accepted: 11/18/2015] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) is a global health care burden affecting billions of individuals worldwide. The kidney has limited regenerative capacity from chronic insults, and for the most common causes of CKD, no effective treatment exists to prevent progression to end-stage kidney failure. Therefore, novel interventions, such as regenerative cell-based therapies, need to be developed for CKD. Given the risk of allosensitization, autologous transplantation of cells to boost regenerative potential is preferred. Therefore, verification of cell function and vitality in CKD patients is imperative. Two cell types have been most commonly applied in regenerative medicine. Endothelial progenitor cells contribute to neovasculogenesis primarily through paracrine angiogenic activity and partly by differentiation into mature endothelial cells in situ. Mesenchymal stem cells also exert paracrine effects, including proangiogenic, anti-inflammatory, and antifibrotic activity. However, in CKD, multiple factors may contribute to reduced cell function, including older age, coexisting cardiovascular disease, diabetes, chronic inflammatory states, and uremia, which may limit the effectiveness of an autologous cell-based therapy approach. This Review highlights current knowledge on stem and progenitor cell function and vitality, aspects of the uremic milieu that may serve as a barrier to therapy, and novel methods to improve stem cell function for potential transplantation.
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Savinov AY, Salehi M, Yadav MC, Radichev I, Millán JL, Savinova OV. Transgenic Overexpression of Tissue-Nonspecific Alkaline Phosphatase (TNAP) in Vascular Endothelium Results in Generalized Arterial Calcification. J Am Heart Assoc 2015; 4:e002499. [PMID: 26675253 PMCID: PMC4845279 DOI: 10.1161/jaha.115.002499] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/18/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ectopic vascular calcification is a common condition associated with aging, atherosclerosis, diabetes, and/or chronic kidney disease. Smooth muscle cells are the best characterized source of osteogenic progenitors in the vasculature; however, recent studies suggest that cells of endothelial origin can also promote calcification. To test this, we sought to increase the osteogenic potential of endothelial cells by overexpressing tissue-nonspecific alkaline phosphatase (TNAP), a key enzyme that regulates biomineralization, and to determine the pathophysiological effect of endothelial TNAP on vascular calcification and cardiovascular function. METHODS AND RESULTS We demonstrated previously that mice transgenic for ALPL (gene encoding human TNAP) develop severe arterial medial calcification and reduced viability when TNAP is overexpressed in smooth muscle cells. In this study, we expressed the ALPL transgene in endothelial cells following endothelial-specific Tie2-Cre recombination. Mice with endothelial TNAP overexpression survived well into adulthood and displayed generalized arterial calcification. Genes associated with osteochondrogenesis (Runx2, Bglap, Spp1, Opg, and Col2a1) were upregulated in the aortas of endothelial TNAP animals compared with controls. Lesions in coronary arteries of endothelial TNAP mice showed immunoreactivity to Runx2, osteocalcin, osteopontin, and collagen II as well as increased deposition of sialoproteins revealed by lectin staining. By 23 weeks of age, endothelial TNAP mice developed elevated blood pressure and compensatory left ventricular hypertrophy with preserved ejection fraction. CONCLUSIONS This study presented a novel genetic model demonstrating the osteogenic potential of TNAP-positive endothelial cells in promoting pathophysiological vascular calcification.
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Affiliation(s)
- Alexei Y. Savinov
- Children's Health Research CenterSanford ResearchSioux FallsSD
- Department of PediatricsSanford School of MedicineUniversity of South DakotaSioux FallsSD
| | - Maryam Salehi
- Children's Health Research CenterSanford ResearchSioux FallsSD
- Division of Basic Biomedical SciencesSanford School of MedicineUniversity of South DakotaVermillionSD
| | - Manisha C. Yadav
- Sanford Children's Health Research CenterSanford Burnham Prebys Medical Discovery InstituteLa JollaCA
| | - Ilian Radichev
- Children's Health Research CenterSanford ResearchSioux FallsSD
| | - José Luis Millán
- Sanford Children's Health Research CenterSanford Burnham Prebys Medical Discovery InstituteLa JollaCA
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Gunawardene P, Bermeo S, Vidal C, Al-Saedi A, Chung P, Boersma D, Phu S, Pokorski I, Suriyaarachchi P, Demontiero O, Duque G. Association Between Circulating Osteogenic Progenitor Cells and Disability and Frailty in Older Persons: The Nepean Osteoporosis and Frailty Study. J Gerontol A Biol Sci Med Sci 2015; 71:1124-30. [DOI: 10.1093/gerona/glv190] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/29/2015] [Indexed: 12/22/2022] Open
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Hutcheson JD, Goettsch C, Rogers MA, Aikawa E. Revisiting cardiovascular calcification: A multifaceted disease requiring a multidisciplinary approach. Semin Cell Dev Biol 2015; 46:68-77. [PMID: 26358815 DOI: 10.1016/j.semcdb.2015.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 12/24/2022]
Abstract
The presence of cardiovascular calcification significantly predicts patients' morbidity and mortality. Calcific mineral deposition within the soft cardiovascular tissues disrupts the normal biomechanical function of these tissues, leading to complications such as heart failure, myocardial infarction, and stroke. The realization that calcification results from active cellular processes offers hope that therapeutic intervention may prevent or reverse the disease. To this point, however, no clinically viable therapies have emerged. This may be due to the lack of certainty that remains in the mechanisms by which mineral is deposited in cardiovascular tissues. Gaining new insight into this process requires a multidisciplinary approach. The pathological changes in cell phenotype that lead to the physicochemical deposition of mineral and the resultant effects on tissue biomechanics must all be considered when designing strategies to treat cardiovascular calcification. In this review, we overview the current cardiovascular calcification paradigm and discuss emerging techniques that are providing new insight into the mechanisms of ectopic calcification.
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Affiliation(s)
- Joshua D Hutcheson
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
| | - Claudia Goettsch
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Maximillian A Rogers
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
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42
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Valvular endothelial cells: guardians or destroyers of aortic valve integrity? Atherosclerosis 2015; 242:396-8. [PMID: 26277631 DOI: 10.1016/j.atherosclerosis.2015.07.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 02/02/2023]
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Avolio E, Caputo M, Madeddu P. Stem cell therapy and tissue engineering for correction of congenital heart disease. Front Cell Dev Biol 2015; 3:39. [PMID: 26176009 PMCID: PMC4485350 DOI: 10.3389/fcell.2015.00039] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/10/2015] [Indexed: 01/08/2023] Open
Abstract
This review article reports on the new field of stem cell therapy and tissue engineering and its potential on the management of congenital heart disease. To date, stem cell therapy has mainly focused on treatment of ischemic heart disease and heart failure, with initial indication of safety and mild-to-moderate efficacy. Preclinical studies and initial clinical trials suggest that the approach could be uniquely suited for the correction of congenital defects of the heart. The basic concept is to create living material made by cellularized grafts that, once implanted into the heart, grows and remodels in parallel with the recipient organ. This would make a substantial improvement in current clinical management, which often requires repeated surgical corrections for failure of implanted grafts. Different types of stem cells have been considered and the identification of specific cardiac stem cells within the heterogeneous population of mesenchymal and stromal cells offers opportunities for de novo cardiomyogenesis. In addition, endothelial cells and vascular progenitors, including cells with pericyte characteristics, may be necessary to generate efficiently perfused grafts. The implementation of current surgical grafts by stem cell engineering could address the unmet clinical needs of patients with congenital heart defects.
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Affiliation(s)
- Elisa Avolio
- Division of Experimental Cardiovascular Medicine, School of Clinical Sciences, Bristol Heart Institute, University of Bristol Bristol, UK
| | - Massimo Caputo
- Congenital Heart Surgery, School of Clinical Sciences, Bristol Heart Institute, University of Bristol Bristol, UK
| | - Paolo Madeddu
- Division of Experimental Cardiovascular Medicine, School of Clinical Sciences, Bristol Heart Institute, University of Bristol Bristol, UK
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44
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Mathieu P, Bossé Y, Huggins GS, Della Corte A, Pibarot P, Michelena HI, Limongelli G, Boulanger MC, Evangelista A, Bédard E, Citro R, Body SC, Nemer M, Schoen FJ. The pathology and pathobiology of bicuspid aortic valve: State of the art and novel research perspectives. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2015; 1:195-206. [PMID: 27499904 PMCID: PMC4939890 DOI: 10.1002/cjp2.21] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/25/2015] [Indexed: 12/12/2022]
Abstract
Bicuspid aortic valve is the most prevalent cardiac valvular malformation. It is associated with a high rate of long‐term morbidity including development of calcific aortic valve disease, aortic regurgitation and concomitant thoracic aortic aneurysm and dissection. Recently, basic and translational studies have identified some key processes involved in the development of bicuspid aortic valve and its morbidity. The development of aortic valve disease and thoracic aortic aneurysm and dissection is the result of complex interactions between genotypes, environmental risk factors and specific haemodynamic conditions created by bicuspid aortic valve anatomy. Herein, we review the pathobiology of bicuspid aortic valve with a special emphasis on translational aspects of these basic findings. Important but unresolved problems in the pathology of bicuspid aortic valve and thoracic aortic aneurysm and dissection are discussed, along with the molecular processes involved.
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Affiliation(s)
- Patrick Mathieu
- Laboratoire d'Études Moléculaires des Valvulopathies (LEMV), Groupe de Recherche en Valvulopathies (GRV), Department of Surgery Quebec Heart and Lung Institute/Research Center, Laval University Quebec Canada
| | - Yohan Bossé
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Gordon S Huggins
- Molecular Cardiology Research Institute Center for Translational Genomics, Tufts Medical Center Boston Massachussetts USA
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Cardiac Surgery Second University of Naples 80131 Naples Italy
| | - Philippe Pibarot
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Hector I Michelena
- Division of Cardiovascular Diseases, Mayo Clinic Rochester Minnesota USA
| | - Giuseppe Limongelli
- Department of Cardiology and Cardiothoracic and Respiratory Sciences, Cardiologia SUN, Monaldi Hospital, AO Colli Naples Italy
| | - Marie-Chloé Boulanger
- Laboratoire d'Études Moléculaires des Valvulopathies (LEMV), Groupe de Recherche en Valvulopathies (GRV), Department of Surgery Quebec Heart and Lung Institute/Research Center, Laval University Quebec Canada
| | - Arturo Evangelista
- Department of Cardiology Hospital Universitary Vall d'Hebron Barcelona Spain
| | - Elisabeth Bédard
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine Center for Perioperative Genomics, Brigham and Women's Hospital Boston Massachusetts USA
| | - Mona Nemer
- Laboratory for Cardiac Development and Differentiation University of Ottawa Ontario Canada
| | - Frederick J Schoen
- Department of Pathology Brigham and Women's Hospital, Harvard Medical School USA
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45
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Novel association of elastofibroma with aortic stenosis: report of a case report interfering with a thoracotomy procedure and a reassessment of typical patient demographics and tumor location. J Thorac Oncol 2015; 10:e18-20. [PMID: 25789839 DOI: 10.1097/jto.0000000000000452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bowler MA, Merryman WD. In vitro models of aortic valve calcification: solidifying a system. Cardiovasc Pathol 2015; 24:1-10. [PMID: 25249188 PMCID: PMC4268061 DOI: 10.1016/j.carpath.2014.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/21/2014] [Accepted: 08/07/2014] [Indexed: 12/21/2022] Open
Abstract
Calcific aortic valve disease (CAVD) affects 25% of people over 65, and the late-stage stenotic state can only be treated with total valve replacement, requiring 85,000 surgeries annually in the US alone (University of Maryland Medical Center, 2013, http://umm.edu/programs/services/heart-center-programs/cardiothoracic-surgery/valve-surgery/facts). As CAVD is an age-related disease, many of the affected patients are unable to undergo the open-chest surgery that is its only current cure. This challenge motivates the elucidation of the mechanisms involved in calcification, with the eventual goal of alternative preventative and therapeutic strategies. There is no sufficient animal model of CAVD, so we turn to potential in vitro models. In general, in vitro models have the advantages of shortened experiment time and better control over multiple variables compared to in vivo models. As with all models, the hypothesis being tested dictates the most important characteristics of the in vivo physiology to recapitulate. Here, we collate the relevant pieces of designing and evaluating aortic valve calcification so that investigators can more effectively draw significant conclusions from their results.
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Affiliation(s)
- Meghan A Bowler
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212
| | - W David Merryman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212.
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Soriano S, Carmona A, Triviño F, Rodriguez M, Alvarez-Benito M, Martín-Malo A, Alvarez-Lara MA, Ramírez R, Aljama P, Carracedo J. Endothelial damage and vascular calcification in patients with chronic kidney disease. Am J Physiol Renal Physiol 2014; 307:F1302-11. [PMID: 25339701 DOI: 10.1152/ajprenal.00114.2014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vascular calcification (VC) is a frequent complication of chronic kidney disease (CKD) and is a predictor of cardiovascular morbidity and mortality. In the present study, we investigated the potential involvement of endothelial microparticles (MPs) and endothelial progenitor cells (EPCs) in the generation of VC in CKD patients. The number of circulating EMPs is greater in patients with VC than without VC (307 ± 167 vs. 99 ± 75 EMPs/μl, P < 0.001). The percentage of EPCs is significantly lower in patient with VC than in patients without VC (0.14 ± 0.11% vs. 0.25 ± 0.18%, P = 0.002). The number of EPCs expressing osteocalcin (OCN) was higher in VC patients (349 ± 63 cells/100,000) than in non-VC patients (139 ± 75 cells/100,000, P < 0.01). In vitro, MPs obtained from CKD patients were able to induce OCN expression in EPCs from healthy donors; the increase in OCN expression was more accentuated if MPs were obtained from CKD patients with VC. MPs from CKD patients also induced OCN expression in vascular smooth muscle cells and fibroblasts. In CKD patients, the rise in endothelial MPs associated with a decrease in the number of EPCs, suggesting an imbalance in the processes of endothelial damage and repair in CKD patients, mainly those with VC. Our results suggest that EPCs, through OCN expression, may directly participate in the process of VC.
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Affiliation(s)
- Sagrario Soriano
- Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; Nephrology Unit, Reina Sofía University Hospital, Córdoba, Spain; RETICs Red Renal (Instituto de Salud Carlos III), Madrid, Spain; and
| | - Andrés Carmona
- Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; Nephrology Unit, Reina Sofía University Hospital, Córdoba, Spain; RETICs Red Renal (Instituto de Salud Carlos III), Madrid, Spain; and
| | | | - Mariano Rodriguez
- Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; Nephrology Unit, Reina Sofía University Hospital, Córdoba, Spain; RETICs Red Renal (Instituto de Salud Carlos III), Madrid, Spain; and
| | | | - Alejandro Martín-Malo
- Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; Nephrology Unit, Reina Sofía University Hospital, Córdoba, Spain; RETICs Red Renal (Instituto de Salud Carlos III), Madrid, Spain; and
| | - Maria-Antonia Alvarez-Lara
- Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; Nephrology Unit, Reina Sofía University Hospital, Córdoba, Spain; RETICs Red Renal (Instituto de Salud Carlos III), Madrid, Spain; and
| | - Rafael Ramírez
- Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; RETICs Red Renal (Instituto de Salud Carlos III), Madrid, Spain; and Biologia de Sistemas Department Módulo II-Planta B, Alcala de Henares University, Madrid, Spain
| | - Pedro Aljama
- Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; Nephrology Unit, Reina Sofía University Hospital, Córdoba, Spain; RETICs Red Renal (Instituto de Salud Carlos III), Madrid, Spain; and
| | - Julia Carracedo
- Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain; Nephrology Unit, Reina Sofía University Hospital, Córdoba, Spain; RETICs Red Renal (Instituto de Salud Carlos III), Madrid, Spain; and
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48
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Abstract
During every heartbeat, cardiac valves open and close coordinately to control the unidirectional flow of blood. In this dynamically challenging environment, resident valve cells actively maintain homeostasis, but the signalling between cells and their microenvironment is complex. When homeostasis is disrupted and the valve opening obstructed, haemodynamic profiles can be altered and lead to impaired cardiac function. Currently, late stages of cardiac valve diseases are treated surgically, because no drug therapies exist to reverse or halt disease progression. Consequently, investigators have sought to understand the molecular and cellular mechanisms of valvular diseases using in vitro cell culture systems and biomaterial scaffolds that can mimic the extracellular microenvironment. In this Review, we describe how signals in the extracellular matrix regulate valve cell function. We propose that the cellular context is a critical factor when studying the molecular basis of valvular diseases in vitro, and one should consider how the surrounding matrix might influence cell signalling and functional outcomes in the valve. Investigators need to build a systems-level understanding of the complex signalling network involved in valve regulation, to facilitate drug target identification and promote in situ or ex vivo heart valve regeneration.
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Imazu M, Takahama H, Asanuma H, Funada A, Sugano Y, Ohara T, Hasegawa T, Asakura M, Kanzaki H, Anzai T, Kitakaze M. Pathophysiological impact of serum fibroblast growth factor 23 in patients with nonischemic cardiac disease and early chronic kidney disease. Am J Physiol Heart Circ Physiol 2014; 307:H1504-11. [PMID: 25217649 DOI: 10.1152/ajpheart.00331.2014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Although the important role of fibroblast growth factor (FGF)23 on cardiac remodeling has been suggested in advanced chronic kidney disease (CKD), little is known about serum (s)FGF23 levels in patients with heart failure (HF) due to nonischemic cardiac disease (NICD) and early CKD. The present study aimed to investigate sFGF23 levels in NICD patients and identify the responsible factors for the elevation of sFGF23 levels. We prospectively measured sFGF23 levels in consecutive hospitalized NICD patients with early CKD (estimated glomerular filtration rate ≥ 40 ml·min(-1)·1.73 m(-2)) and analyzed the data of both echocardiography and right heart catheterization. Of the 156 NICD patients (estimated glomerular filtration rate range: 41-128 ml·min(-1)·1.73 m(-2)), the most severe HF symptom (New York Heart Association class III-IV, 53% vs. 33%, P = 0.015) was found in the above median sFGF23 (39.1 pg/ml) group compared with the below median sFGF23 group. sFGF23 levels were higher in patients with HF hospitalization history compared with those without HF [median: 46.8 (interquartile range: 38.8-62.7) vs. 34.7 (interquartile range: 29.6-42.4) pg/ml, P < 0.0001]. In the multivariate analysis, HF hospitalization was independently related to elevated sFGF23 levels (P = 0.022). Both systolic dysfunction and high plasma aldosterone concentration were identified as predictors of high sFGF23 levels (P < 0.05). Among the neurohormonal parameters, elevated sFGF23 levels were the only factor to predict a declining left ventricular ejection fraction (P = 0.001). These findings suggest that the progression of HF per se contributes to the elevation of sFGF23 levels even in the early stages of CKD, which leads to further myocardial dysfunction, potentially creating a vicious cycle.
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Affiliation(s)
- Miki Imazu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroshi Asanuma
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; and
| | - Akira Funada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takahiro Ohara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masanori Asakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masafumi Kitakaze
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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50
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Prasad M, Reriani M, Khosla S, Gössl M, Lennon R, Gulati R, Prasad A, Lerman LO, Lerman A. Coronary microvascular endothelial dysfunction is an independent predictor of development of osteoporosis in postmenopausal women. Vasc Health Risk Manag 2014; 10:533-8. [PMID: 25210458 PMCID: PMC4155804 DOI: 10.2147/vhrm.s63580] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A growing body of evidence links coronary artery atherosclerosis and calcification to osteoporosis in women. The endothelium plays a critical role in maintaining vascular integrity and may play a role in bone metabolism. We aimed to determine whether early coronary atherosclerosis, as detected by coronary microvascular endothelial dysfunction (CMED), predicts the development of osteoporosis in postmenopausal women. METHODS Coronary vascular reactivity was evaluated in 194 postmenopausal women greater than 50 years of age and with non-obstructive coronary arteries by administration of intracoronary acetylcholine during diagnostic angiography. CMED was defined as ≤50% increase in coronary blood flow from baseline in response to maximal dose. After a median follow-up of 7.0±0.3 years, patients were assessed by a questionnaire for development of osteoporosis. RESULTS The average age of the cohort was 60.9±7.4 years. Women with CMED were twice as likely to develop osteoporosis compared with women without endothelial dysfunction after adjustment for potential confounders (relative risk, 2.4; 95% confidence interval [CI], 1.1, 5.6, P=0.02). Epicardial endothelial dysfunction was not associated with development of osteoporosis. DISCUSSION Early coronary atherosclerosis with endothelial dysfunction is an independent marker for increased risk of developing osteoporosis in postmenopausal women greater than 50 years of age without obstructive coronary artery disease. The current study supports a link between coronary atherosclerosis and osteoporosis.
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Affiliation(s)
- Megha Prasad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Martin Reriani
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sundeep Khosla
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Mario Gössl
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ryan Lennon
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Abhiram Prasad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Lilach O Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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