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Sheng C, Huang W, Liao M, Yang P. The Role of Gut Microbiota in Thromboangiitis Obliterans: Cohort and Mendelian Randomization Study. Biomedicines 2024; 12:1459. [PMID: 39062030 PMCID: PMC11274368 DOI: 10.3390/biomedicines12071459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/20/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND AND AIMS Thromboangiitis obliterans (TAO), also known as Buerger's disease, is a rare vasculitis. Observational epidemiology studies have suggested a relationship between the gut microbiota and TAO. However, due to confounding factors and reverse causality, the causal relationship remains unclear. Based on the assumption of their association, this study sought specific gut microbiota causally linked to TAO. METHODS The case-control study was conducted at the Xiangya Hospital of Central South University from November 2022 to January 2023 including twelve TAO patients and nine healthy controls. We conducted a Mendelian randomization (MR) study using summary statistics from a genome-wide association study (GWAS) of gut microbiota and TAO. Considering the scale and accessibility of the data, the MiBioGen consortium served as the exposure, whereas the FinnGen consortium GWAS study served as the outcome. Finally, we compared the results of the MR with those of the case-control studies. RESULTS The inverse variance weighted (IVW) (OR = 0.119, 95% CI: 0.021-0.688, p = 0.017) and maximum likelihood (ML) (OR = 0.121, 95% CI: 0.020-0.742, p = 0.022) estimates suggest that Ruminiclostridium 5 has a suggestive protective effect on TAO while the IVW (OR = 5.383, 95% CI: 1.128-25.693, p = 0.035) and ML (OR = 5.658, 95% CI: 1.142-28.021, p = 0.034) estimates suggest that Eubacterium (xylanophilum group) has a suggestive risk effect on TAO, and the ML (OR = 0.055, 95% CI: 0.004-0.755, p = 0.030) estimates suggest that Lachnospira has a suggestive protective effect on TAO. No significant heterogeneity of instrumental variables or horizontal pleiotropy was found. The results of the case-control study showed that the TAO had a lower relative abundance of Ruminiclostridium 5 (p = 0.015) and Lachnospira (p = 0.048), and a higher relative abundance of Eubacterium (xylanophilum group) (p = 0.029) than the healthy controls. These results were consistent with the MR analysis. CONCLUSIONS Our study demonstrates that Ruminiclostridium 5, Lachnospira, and Eubacterium (xylanophilum group) are causally related to TAO, suggesting their potential significance for the prevention and treatment of TAO.
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Affiliation(s)
- Chang Sheng
- Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Weihua Huang
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha 410078, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory, Pharmacogenetics Xiangya Hospital, Central South University, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410128, China
| | - Mingmei Liao
- National Health Commission Key Laboratory of Nanobiological Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Pu Yang
- Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
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Zahn C, Puga C, Malik A, Khanna D. Painful Raynaud's mimics. Best Pract Res Clin Rheumatol 2024:101948. [PMID: 38704280 DOI: 10.1016/j.berh.2024.101948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
Raynaud's syndrome is a common finding in many autoimmune conditions. Accurately diagnosing Raynaud's, and differentiating it from mimicking conditions, is imperative in rheumatologic diseases. Raynaud's syndrome and Raynaud's mimickers, especially painful Raynaud's mimickers, can prove a diagnostic challenge for the practicing rheumatologist. Painful Raynaud's mimickers can lead to increased patient stress and unnecessary medical work up; Healthcare providers need to be aware of Raynaud's mimickers when evaluating patient concerns of skin color changes and pain. The present narrative review aims to highlight Raynaud's syndrome, important painful mimickers that may be seen, diagnosis, and updated management recommendations.
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Affiliation(s)
- Carleigh Zahn
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, 300 North Ingalls Building - Rm 7C27, Ann Arbor, MI, 48109, USA.
| | - Cindy Puga
- Cedars Sinai Internal Medicine Residency, 8700 Beverly Blvd, Becker Bldg. B105 A, Los Angeles, CA, 90048, USA.
| | - Aroosa Malik
- Department of Internal Medicine, Division of Vascular Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, 300 North Ingalls Building - Rm 7C27, Ann Arbor, MI, 48109, USA.
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Bae M, Chung SW, Lee J, Kim E, Kang G, Jin M. Early Diagnosis and Intervention Are Needed for a Reasonable Prognosis of Thromboangiitis Obliterans. J Chest Surg 2023; 56:328-335. [PMID: 37248718 PMCID: PMC10480401 DOI: 10.5090/jcs.22.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 05/31/2023] Open
Abstract
Background Thromboangiitis obliterans (TAO) poses a higher risk of amputation than atherosclerosis obliterans. It is characterized by onset at a relatively young age. There are currently no clear treatment guidelines for TAO other than smoking cessation. In this study, we aimed to identify factors that could influence a favorable prognosis of TAO. Methods From January 2009 to December 2019, we retrospectively reviewed the initial symptoms, characteristics, treatments, and disease course of 37 patients (45 limbs) with TAO. Logistic regression analysis was performed to investigate factors affecting the course of symptoms that persisted or worsened despite treatment. Results Patients' mean age was 37.2±11.4 years, and all patients were men. The mortality rate was 0% during the follow-up period (76.9±51.1 months). All patients were smokers at the time of diagnosis, and 19 patients (51.4%) successfully quit smoking during treatment. When comparing the Rutherford categories before and after treatment, 23 limbs (51.1%) showed improvement, the category was maintained in 11 limbs (24.4%), and 11 limbs (24.4%) worsened. Symptom persistence or exacerbation despite treatment was associated with a higher initial Rutherford category (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.04-2.42; p=0.03) and a higher score of the involved below-knee artery at the time of diagnosis (OR, 2.26; 95% CI, 1.10-4.67; p=0.03). Conclusion The degree of disease progression at the time of diagnosis significantly affected patients' prognosis. Therefore, early diagnosis and intervention are important to improve the course of TAO.
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Affiliation(s)
- Miju Bae
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Woon Chung
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Jonggeun Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eunji Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gayeon Kang
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moran Jin
- Department of Thoracic and Cardiovascular Surgery, Mokpo Hankook Hospital, Mokpo, Korea
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Miyai-Murai Y, Okamoto-Shibayama K, Sato T, Kikuchi Y, Kokubu E, Potempa J, Ishihara K. Localization and pathogenic role of the cysteine protease dentipain in Treponema denticola. Mol Oral Microbiol 2023; 38:212-223. [PMID: 36641800 PMCID: PMC10175099 DOI: 10.1111/omi.12406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/14/2022] [Accepted: 01/05/2023] [Indexed: 01/16/2023]
Abstract
The Msp protein complex and the serine protease dentilisin are the best-characterized virulence factors in Treponema denticola, the major etiological agent of chronic periodontitis. In addition to these outer sheath factors, the cysteine protease dentipain contributes to pathogenicity, but its secretion, processing, cellular localization, and role in T. denticola virulence are not fully understood. In this study, we found that full-sized dentipain (74-kDa) and the 52-kDa truncated form of the enzyme are located, respectively, in the outer sheath derived from T. denticola dentilisin- and the Msp-deficient mutants. Furthermore, dentipain was barely detected in the wild-type strain. These results suggest that dentilisin and Msp, the major outer sheath proteins, are involved in the secretion and maturation of dentipain. Inactivation of the dentipain gene slowed the growth of T. denticola, and the effect was more profound in serum-free medium than in serum-containing medium. Several genes, including those encoding transporters and methyl-accepting chemotaxis proteins, were differentially expressed in the dentipain-deficient mutant. Furthermore, the mutant strain was more hydrophobic than the wild-type strain. Finally, the mutant showed less autoaggregation activity and adhesion to IgG in a serum-free medium than the wild-type strain. These findings suggest that dentipain contributes to the virulence of T. denticola by facilitating adhesion and acquisition of nutrients essential for colonization and proliferation in the gingival crevice under serum-rich conditions.
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Affiliation(s)
- Yuri Miyai-Murai
- Department of Crown and Bridge Prosthodontics, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Kazuko Okamoto-Shibayama
- Department of Microbiology, Tokyo Dental College, 2-1-14 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Toru Sato
- Department of Crown and Bridge Prosthodontics, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Yuichiro Kikuchi
- Department of Microbiology, Tokyo Dental College, 2-1-14 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Eitoyo Kokubu
- Department of Microbiology, Tokyo Dental College, 2-1-14 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Jan Potempa
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 30-387 Krakow, Poland and Department of Oral Immunity and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY 40202, USA
| | - Kazuyuki Ishihara
- Department of Microbiology, Tokyo Dental College, 2-1-14 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
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Modaghegh MHS, Kamyar MM, Shafiei A, Shariatmaghani SS, Saremi E, Sadeghipour Kermani F. A comprehensive review of the epidemiology and clinical features of 91 cases with Buerger's disease. Vascular 2023:17085381231175257. [PMID: 37172074 DOI: 10.1177/17085381231175257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Thromboangiitis Obliterans (TAO) is a disease of small and medium-sized arteries with an unclear natural course. This study aims to establish a national registry of the disease to gain a better understanding of its epidemiology and clinical course. METHOD This study was a cohort study of 242 patients with a high probability of TAO admitted to Mashhad University of Medical Sciences (MUMS) hospitals from 2000 to 2015. Of these, 91 patients with a confirmed diagnosis were included in the study (90 males and 1 female) with a mean age of 35 ± 7.8 years. RESULTS The most common symptom upon onset of the disease was paresthesia (29.7%), followed by cold sensitivity and paresthesia (93.4%) during the progression of the disease and Raynaud syndrome or vasospasm (93.9%) in the active phase. The right lower limb was the most commonly affected limb (46.2%), and presenting ischemic symptoms in 48.4%.Statistics indicated a positive correlation between the duration of Burger's disease and the number of affected limbs (p = 0.001). There was no effect of disease duration on the likelihood of amputations (p = 0.28). CONCLUSION Some patients may experience mild, subtle symptoms for years before the initial signs and symptoms appear, which can be severe and rapidly progress to the point of requiring amputation.We suggest that the diagnostic criteria for Buerger's disease should be revised in light of the presence of atherosclerosis and its associated risk factors, which present a challenge in terms of diagnosis and treatment. Clinical experience will be of great importance in this regard.
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Affiliation(s)
- Mohammad Hadi Saeed Modaghegh
- Professor of Vascular Surgery, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Mahdi Kamyar
- Assistant Professor of Vascular Surgery, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Shafiei
- Assistant Professor of Vascular Surgery, Qom University of Medical Sciences, Qom, Iran
| | - Somayeh Sadat Shariatmaghani
- Assistant Professor of Internal Medicine, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elena Saremi
- Vascular Surgeon, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sadeghipour Kermani
- Community and Preventive Medicine, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Science, Mashhad, Iran
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Sami A, Elimairi I, Ryan CA, Stanton C, Patangia D, Ross RP. Altered oral microbiome in Sudanese Toombak smokeless tobacco users carries a newly emerging risk of squamous cell carcinoma development and progression. Sci Rep 2023; 13:6645. [PMID: 37095112 PMCID: PMC10125980 DOI: 10.1038/s41598-023-32892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023] Open
Abstract
There are an estimated 6-10 million smokeless tobacco (Toombak) users in Sudan, the majority being males. Toombak is known to be a carcinogenic product that is likely to modify the oral microbiome spatiality into a high-risk potential for the development and progression of oral cancer, but previous studies are lacking in this field. Here, we endeavour for the first time the exploration of the oral microbiome in key mucosal areas of the oral cavity and assess the microbiome variations in premalignant and oral squamous cell carcinoma (OSCC) samples from both users and non-users of Toombak. 16S rRNA sequencing was performed on DNA obtained from pooled saliva, oral mucosa and supragingival plaque from 78 Sudanese users and non-users of Toombak, aged between 20 and 70 years. In 32 of the pooled saliva samples, the mycobiome (fungal) environment was analysed through ITS sequencing. Then, 46 formalin-fixed paraffin-embedded samples of premalignant and OSCC samples were collected, and their associated microbiomes sequenced. The oral Sudanese microbiome was found to be enriched in Streptococcaceae, but Staphylococcaceae were significantly more abundant amongst Toombak users. Genera enriched in the oral cavity of Toombak users included Corynebacterium_1 and Cardiobacterium while in non-users, Prevotella, Lactobacillus and Bifidobacterium were prominent. Aspergillus was the most abundant fungus in the mouths of Toombak users with a marked loss of Candida. The genus Corynebacterium_1 was abundant in the buccal, floor of the mouth and saliva microbiomes as well as in oral cancer samples from Toombak users indicating a possible role for this genus in the early stages of oral cancer development. An oral cancer microbiome that favours poor survival and metastasis in those who use Toombak also emerged that includes the genera Stenotrophomonas and Schlegelella. Those utilising Toombak carry an altered oral microbiome that may be an additional risk factor for this products carcinogenicity to the oral structures. These significant microbiome modulations are a newly emerging key driving factor in oral cancer development and progression in Toombak users while it is also shown that Toombak users carry an oral cancer microbiome that may increase the potential for a poorer prognosis.
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Affiliation(s)
- Amel Sami
- APC Microbiome Ireland, School of Microbiology, University College Cork, Cork, T12 YN60, Ireland
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Dentistry, National Ribat University, Nile street, 1111, Khartoum, Sudan
| | - Imad Elimairi
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Dentistry, National Ribat University, Nile street, 1111, Khartoum, Sudan
| | - C Anthony Ryan
- Department of Paediatrics and Child Health, University College Cork, Cork, T12 DFK4, Ireland
| | - Catherine Stanton
- APC Microbiome Ireland, School of Microbiology, University College Cork, Cork, T12 YN60, Ireland.
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, P61 C996, Ireland.
| | - Dhrati Patangia
- APC Microbiome Ireland, School of Microbiology, University College Cork, Cork, T12 YN60, Ireland
| | - R Paul Ross
- APC Microbiome Ireland, School of Microbiology, University College Cork, Cork, T12 YN60, Ireland
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Awara MA, Downing LM, Elnenaei MO. Psychiatric sequelae of thromboangiitis obliterans: a case report and review of the literature. J Med Case Rep 2023; 17:40. [PMID: 36717929 PMCID: PMC9885629 DOI: 10.1186/s13256-022-03694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/26/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Peripheral manifestations secondary to progressive vascular occlusions are characteristic of the rare condition termed thromboangiitis obliternas (TAO) or Buerger's disease. The central manifestations of this disease are however poorly characterized, particularly those of psychiatric nature, and their prevalence is largely unknown. Speculations have been made around the polymorphic nature and triggers of observed psychopathology in TAO; much however remains to be unraveled in this area. CASE PRESENTATION We present the case of a 33-year-old Caucasian male who developed first episode of psychosis at the age of 29 years. There was no history of previous mental illness either in the patient, or in any of his family members. He had been a long- term heavy smoker and was experiencing progressive lower limb claudication since the age of 22 years; however, all inflammatory, autoimmune and atherosclerotic markers were negative. His psychosis was characterized by retention of a warm affect, and despite some amelioration, was generally resistant to a fair trial of several anti-psychotic medications including Clozapine. CONCLUSION The pathophysiology of psychosis secondary to Buerger's is not yet well characterized which adds to the complexity of managing these cases. Recognizing that cerebral manifestations of this disease may evolve several years after the onset of peripheral thromboangiitic features is important for following the natural history and considering measures that may reduce the burden of illness.
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Affiliation(s)
- Mahmoud A. Awara
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, Medical
School, Halifax, Canada ,The College of Physicians and Surgeons of Nova Scotia, Halifax, Canada ,grid.452735.20000 0004 0496 9767The Royal College of Psychiatrists, London, UK
| | - Laura M. Downing
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, Medical
School, Halifax, Canada ,The College of Physicians and Surgeons of Nova Scotia, Halifax, Canada
| | - Manal O. Elnenaei
- The College of Physicians and Surgeons of Nova Scotia, Halifax, Canada ,grid.55602.340000 0004 1936 8200Department of Pathology and Laboratory Medicine, Dalhousie University, Medical School, Halifax, Canada ,grid.464675.20000 0001 2111 3563The Royal College of Pathologists, London, UK
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Carneiro FCF, Almeida BM, Cacione DG. Endovascular treatment for thromboangiitis obliterans (Buerger’s disease). THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023; 2023:CD014886. [PMCID: PMC9885982 DOI: 10.1002/14651858.cd014886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness and safety of endovascular treatment for thromboangiitis obliterans (Buerger’s disease).
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Affiliation(s)
| | | | - Beatriz M Almeida
- Division of Vascular and Endovascular Surgery, Department of SurgeryUNIFESP – Escola Paulista de MedicinaSão PauloBrazil
| | - Daniel G Cacione
- Division of Vascular and Endovascular Surgery, Department of SurgeryUNIFESP – Escola Paulista de MedicinaSão PauloBrazil
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Klomp T, Jahr H, Abdelbary MMH, Conrads G. Evaluation of hydrocortisone as a strain-dependent growth-regulator of Porphyromonasgingivalis. Anaerobe 2023; 80:102698. [PMID: 36681234 DOI: 10.1016/j.anaerobe.2023.102698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Porphyromonas gingivalis is an oral key pathogen and known to be very diverse in geno- and phenotypes. It is a fastidious bacterium with low O2-tolerance and 3-7 days of incubation are necessary. With growing interest in the field of microbial endocrinology we explored the potential growth-stimulating effect of hydrocortisone (HC, synonym cortisol) on P. gingivalis cultures. MATERIAL AND METHODS Six different P. gingivalis strains were pre-incubated in supplemented Brain-Heart-Infusion broth under appropriate conditions for 24 h, diluted and transferred into microplates. A newly developed and semi-automated spectrophotometric measurement in triplicate, applying a SpectraMax i3x microplate reader at an optical density of 600 nm, was conducted to test growth differences between test group (exposed to a supplement of either 1.25, 2.5, 5, 10, or 20 μg/ml of hydrocortisone) and control group over 48 h of anaerobic incubation (O2 ≤ 1%). Furthermore, strains were also incubated on HC-supplemented blood agar to test for a possible growth-stimulating effect on solid media. RESULTS HC significantly stimulated the lag-phase growth of four out of six P. gingivalis strains. Our data suggest a concentration-dependent growth stimulatory effect of HC between 2.5 and 5 μg/ml, while below 1.25 μg/ml and above 10 μg/ml HC either did not stimulate or inhibited growth. CONCLUSIONS HC could reduce the incubation time when isolating P. gingivalis from clinical samples and could boost low biomass cultivations especially during their lag-phase. The growth-modulating effect might be via modulation of virulence factors/quorum sensing gene expression or by reactive oxygen species(ROS)-capturing during early stages of bacterial growth. Further experiments are necessary to explain the mechanism behind our observations.
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Affiliation(s)
- Tim Klomp
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany; Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany
| | - Holger Jahr
- Department of Anatomy and Cell Biology, Uniklinik RWTH Aachen and Institute of Structural Mechanics and Lightweight Design, RWTH Aachen University, Aachen, Germany
| | - Mohamed M H Abdelbary
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany.
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10
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Bacterial Infections and Atherosclerosis – A Mini Review. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atherosclerosis is the most challenging subsets of coronary artery disease in humans, in which risk factors emerge from childhood, and its prevalence increases with age. Experimental research demonstrates that infections due to bacteria stimulate atherogenic events. Atherosclerosis has complex pathophysiology that is linked with several bacterial infections by damaging the inner arterial wall and heart muscles directly and indirectly by provoking a systemic pro-inflammation and acute-phase protein. Repeated bacterial infections trigger an inflammatory cascade that triggers immunological responses that negatively impact cardiovascular biomarkers includes triglycerides, high-density lipoprotein, C-reactive protein, heat shock proteins, cytokines, fibrinogen, and leukocyte count. Herein, we intended to share the role of bacterial infection in atherosclerosis and evaluate existing evidence of animal and human trials on the association between bacterial infections and atherosclerosis on update.
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Koga A, Ariyoshi W, Kobayashi K, Izumi M, Isobe A, Akifusa S, Nishihara T. The Association between Tannerella forsythia and the Onset of Fever in Older Nursing Home Residents: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084734. [PMID: 35457601 PMCID: PMC9025807 DOI: 10.3390/ijerph19084734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Background: Periodontal pathogens are related to the incidence of systemic diseases. This study aimed to examine whether periodontal pathogen burden is associated with the risk of fever onset in older adults. Methods: Older adults in nursing homes, aged ≥65 years, were enrolled. The study was set in Kitakyushu, Japan. The body temperatures of participants were ≥37.2 °C and were recorded for eight months. As periodontal pathogens, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia were qualified by a real-time polymerase chain reaction at the baseline. For statistical analysis, the number of bacterial counts was logarithmically conversed to 10 as a base. Results: Data from 56 participants with a median age of 88 (62−98) years were available for analysis. The logarithmic-conversed bacterial counts of T. forsythia, but not P. gingivalis or T. denticola, were associated with the onset of fever in older residents. The Kaplan−Meier method revealed that the group with <104 of T. forsythia had significantly less cumulative fever incidence than the group with ≥104 of T. forsythia. The group with ≥104 of T. forsythia was associated with an increased risk of fever onset (hazard ratio, 3.7; 98% confidence interval, 1.3−10.2; p = 0.012), which was adjusted for possible confounders. Conclusions: Bacterial burden of T. forsythia in the oral cavity was associated with the risk of the onset of fever in older nursing homes residents.
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Affiliation(s)
- Ayaka Koga
- Division of Infections and Molecular Biology, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (A.K.); (W.A.); (K.K.); (T.N.)
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (M.I.); (A.I.)
| | - Wataru Ariyoshi
- Division of Infections and Molecular Biology, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (A.K.); (W.A.); (K.K.); (T.N.)
| | - Kaoru Kobayashi
- Division of Infections and Molecular Biology, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (A.K.); (W.A.); (K.K.); (T.N.)
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (M.I.); (A.I.)
- ADTEC Co., Oita 879-0453, Japan
| | - Maya Izumi
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (M.I.); (A.I.)
| | - Ayaka Isobe
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (M.I.); (A.I.)
| | - Sumio Akifusa
- School of Oral Health Sciences, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (M.I.); (A.I.)
- Correspondence: ; Tel.: +81-93-285-3107
| | - Tatsuji Nishihara
- Division of Infections and Molecular Biology, Faculty of Dentistry, Kyushu Dental University, Fukuoka 803-8580, Japan; (A.K.); (W.A.); (K.K.); (T.N.)
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12
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Fazeli B, Masoudian M. SMOKING AND BUERGER’S DISEASE: FROM HYPOTHESES TO EVIDENCE SYNTHESIS. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2022. [DOI: 10.47316/cajmhe.2022.3.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Early after the definition of thromboangiitis obliterans (TAO), it was noticed that TAO patients are almost always tobacco smokers. Later on, the relationship between continued smoking and TAO prognosis was documented. Consequently, smoking came to be considered as the main cause of TAO. However, it is still unknown why, amongst millions of smokers, only a small number develop TAO. It also remains unknown why, of the TAO patients who continue smoking, only half of them show aggravation and undergo amputations. The aims of this review are to investigate evidence in support of or against the relationship between TAO and smoking, according to the TAO-related literature published from 1908 to January 2022, and to discover the possible role of smoking in TAO pathophysiology. Taken together, it appears that smoking predisposes TAO patients toward the potential harmful effects of the main aetiology and helps the main aetiology to develop vascular lesions. Therefore, smoking cessation would almost always be helpful for improving the prognosis of TAO patients and reducing disease manifestation. However, concluding that smoking is not the main aetiology of TAO would open a new door to finding the true main aetiology of TAO and to discovering the appropriate treatment and medical management of patients who fail to stop smoking.
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13
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Chung MH, Lee JS, Kang JS. Buerger’s Disease May be a Chronic Rickettsial Infection with Superimposed Thrombosis: Literature Review and Efficacy of Doxycycline in Three Patients. Infect Chemother 2022; 54:20-58. [PMID: 35384418 PMCID: PMC8987189 DOI: 10.3947/ic.2021.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/26/2022] [Indexed: 12/03/2022] Open
Abstract
Buerger’s disease (BD) is a chronic inflammatory vasculitis of unknown etiology. The infectious etiology of BD was proposed by Buerger in 1914. Furthermore, there are scattered reports insisting that BD may be related to rickettsial infection, first asserted by Goodman since 1916, followed by Giroud and other French investigators from the 1940s through the 1960s, Nicolau in the 1960s, Bartolo (1980s), and Fazeli (2010s). However, their causal relationship has hardly been accepted because rickettsial infections are known to be acute febrile, vector-borne illnesses, whereas BD is a chronic afebrile illness. In this article we review the relevant literature on the chronic nature of Rickettsia and Orientia infections and on the rickettsial etiology of BD. Excellent initial responses to doxycycline in three patients with BD are briefly described. Based on these findings, we hypothesize that BD patients acquired a rickettsial infection far before the onset of BD. Over years, the infected area expands to become a segment of the infected vessel. Subsequently, thrombus develops on the luminal surface of the infected endothelial cells, which produces the vascular obstructive manifestations of BD. Collectively, it is postulated that BD is a chronic infection with a member of the family Rickettsiaceae with superimposed thrombosis.
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Affiliation(s)
- Moon-Hyun Chung
- Division of Infectious Diseases, Department of Internal Medicine, Seogwipo Medical Center, Jeju, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine; Inha University, Incheon, Korea
| | - Jae-Seung Kang
- Department of Microbiology, Inha University, Incheon, Korea
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14
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The Antimicrobial Susceptibility of Porphyromonas gingivalis: Genetic Repertoire, Global Phenotype, and Review of the Literature. Antibiotics (Basel) 2021; 10:antibiotics10121438. [PMID: 34943650 PMCID: PMC8698109 DOI: 10.3390/antibiotics10121438] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
The in vitro antimicrobial susceptibility of 29 strains of the major periodontal pathogen Porphyromonas gingivalis and three P. gulae (as an ancestor) to nine antibiotics (amoxicillin, amoxicillin/clavulanate, clindamycin, metronidazole, moxifloxacin, doxycycline, azithromycin, imipenem, and cefoxitin) was evaluated by E-testing of minimal inhibitory concentration (MIC) according to international standards. The results were compared with 16 international studies reporting MICs from 1993 until recently. In addition, 77 currently available P. gingivalis genomes were screened for antimicrobial resistance genes. E-testing revealed a 100% sensitivity of P. gingivalis and P. gulae to all antibiotics. This was independent of the isolation year (1970 until 2021) or region, including rural areas in Indonesia and Africa. Regarding studies worldwide (675 strains), several method varieties regarding medium, McFarland inoculation standards (0.5-2) and incubation time (48-168 h) were used for MIC-testing. Overall, no resistances have been reported for amoxicillin + clavulanate, cefoxitin, and imipenem. Few strains showed intermediate susceptibility or resistance to amoxicillin and metronidazole, with the latter needing both confirmation and attention. The only antibiotics which might fail in the treatment of P. gingivalis-associated mixed anaerobic infections are clindamycin, macrolides, and tetracyclines, corresponding to the resistance genes erm(B), erm(F), and tet(Q) detected in our study here, as well as fluoroquinolones. Periodical antibiotic susceptibility testing is necessary to determine the efficacy of antimicrobial agents and to optimize antibiotic stewardship.
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15
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The Management of Ischemic Limb in Thromboangiitis Obliterans (Buerger’s Disease). Indian J Surg 2021. [DOI: 10.1007/s12262-021-02748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Iwai T, Matsui Y, Homma K, Takemura T, Fujiwara M, Aoyama N, Furukawa A, Sato H, Izumi Y. Pathological and immunological differences of arterial thrombi and wall caused by three different periodontal bacterial injections in rat models and proposals on the pathogeneses of vascular diseases. Clin Exp Dent Res 2021; 7:637-646. [PMID: 33463085 PMCID: PMC8543461 DOI: 10.1002/cre2.391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Periodontal bacteria that have been studied show a strong connection to various vascular diseases. Among the many kinds of periodontal bacteria, Porphyromonas gingivalis (Pg) is well examined in the general aspects and in a rat model. However, whether other periodontal bacteria work or react differently is not studied well. MATERIAL AND METHODS We chose Aggregatibacter actinomycetemcomitans (Aa) and Prevotella intermedia (Pi) as different types of periodontal bacteria. Low-density and high-density bacterial solutions were injected in the small artery of rats' groins using our rat model. Eighteen limbs of 9 SD male rats (500-650 g) were used. After 7 days, 14-18 days, and 28 days, the rats were sacrificed. A pathological and an immuno-histochemical study was conducted and reported on the low-density group with 12 limbs because the Pi group lacked a high-density study. Immuno-histochemical staining of live Pg was performed on three limbs of three rats at 1 h, 3 h, and 1 week after injection. RESULTS The appearances from the acute, at 7 days, to chronic phases, at 28 days, were observed. The differences of the species were certainly observed in the internal elastic lamina (IEL), and immuno-histochemical reactions. The inflammatory reactions, such as cellular distribution or intra-thrombus materials, were similar in all. One week later, we could not see any living bacteria in the specimen or immunological observation. CONCLUSIONS The three species were essentially the same, except for Aa's stronger disruption of IEL, and more CD3 (Pan T cell) in Pi and more CD79a (Pan B cell) in Pg. We propose a new concept of a possible mechanism of vascular diseases, in which the work of LPS (lipopolysaccharides) and a toll-like receptor (TLR) is emphasized.
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Affiliation(s)
- Takehisa Iwai
- Division of Vascular Surgery and Collagen Disease MedicineTsukuba Vascular CenterMoriyaJapan
| | - Yoshiki Matsui
- Division of Vascular Surgery and Collagen Disease MedicineTsukuba Vascular CenterMoriyaJapan
| | - Kaori Homma
- Division of Vascular Surgery and Collagen Disease MedicineTsukuba Vascular CenterMoriyaJapan
| | - Tamiko Takemura
- Section of PathologyJapanese Red‐Cross Medical CenterTokyoJapan
| | | | - Norio Aoyama
- Kanagawa Dental University HospitalYokosukaJapan
| | - Asuka Furukawa
- Department of Human PathologyTokyo Medical and Dental UniversityTokyoJapan
| | - Hiroki Sato
- Department of PeriodontologyTokyo Medical and Dental UniversityTokyoJapan
| | - Yuichi Izumi
- Department of PeriodontologyTokyo Medical and Dental UniversityTokyoJapan
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17
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Recent Updates and Advances in Winiwarter-Buerger Disease (Thromboangiitis Obliterans): Biomolecular Mechanisms, Diagnostics and Clinical Consequences. Diagnostics (Basel) 2021; 11:diagnostics11101736. [PMID: 34679434 PMCID: PMC8535045 DOI: 10.3390/diagnostics11101736] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 01/21/2023] Open
Abstract
Thromboangiitis obliterans (TAO) or Buerger’s disease is a segmental inflammatory, thrombotic occlusive peripheral vascular disease with unknown aetiology that usually involves the medium and small-sized vessels of young male smokers. Due to its unknown aetiology and similarities with atherosclerosis and vasculitis, TAO diagnosis is still challenging. We aimed to review the status of biomolecular and laboratory para-clinical markers in TAO compared to atherosclerosis and vasculitis. We reported that, although some biomarkers might be common in TAO, atherosclerosis, and vasculitis, each disease occurs through a different pathway and, to our knowledge, there is no specific and definitive marker for differentiating TAO from atherosclerosis or vasculitis. Our review highlighted that pro-inflammatory and cell-mediated immunity cytokines, IL-33, HMGB1, neopterin, MMPs, ICAM1, complement components, fibrinogen, oxidative stress, NO levels, eNOS polymorphism, adrenalin and noradrenalin, lead, cadmium, and homocysteine are common markers. Nitric oxide, MPV, TLRs, MDA, ox-LDL, sST2, antioxidant system, autoantibodies, and type of infection are differential markers, whereas platelet and leukocyte count, haemoglobin, lipid profile, CRP, ESR, FBS, creatinine, d-dimer, hypercoagulation activity, as well as protein C and S are controversial markers. Finally, our study proposed diagnostic panels for laboratory differential diagnosis to be considered at first and in more advanced stages.
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18
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Gupta PK, Dutta S, Kala S, Nekkanti M, Desai SC, Mahapatra SS, Dhar A, Raju R, M. R, Behera A, P. S, Raviraja N, Viswanathan P, Chandrashekar M, Thej C, K.V. P, Abraham J, Boggarapu H, Udaykumar K. Phase IV postmarketing surveillance study shows continued efficacy and safety of stempeucel® in patients with critical limb ischemia due to Buerger's disease. Stem Cells Transl Med 2021; 10:1602-1613. [PMID: 34519179 PMCID: PMC8641082 DOI: 10.1002/sctm.21-0197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 01/02/2023] Open
Abstract
Buerger's disease or thromboangiitis obliterans is a type of obstructive vascular diseases categorized as vasculitis and usually present in 95% of young smoker men. The main pathogenetic mechanism is interplay between immune system and inflammation. Earlier our phase II study has shown that Stempeucel is safe when injected at 2 million cells/kg body weight by virtue of its anti‐inflammatory, immunomodulatory, and angiogenetic properties. The present study was conducted to further assess the safety and efficacy of Stempeucel in critical limb ischemia due to Buerger's disease after obtaining approval from Indian FDA based on the data generated in the phase II study. This is an open label, multicenteric phase IV PMS study conducted across India with experienced vascular surgeons. Fifty patients of critical limb ischemia due to Buerger's disease with Rutherford III‐5 or III‐6 were included in the study and each individual received a dose of 2 million cells/kg body weight of Stempeucel in the calf muscles and around the ulcer. These patients were evaluated over 12 months from drug administration. The present study showed the continued long term efficacy over a period of 12 months follow up in these patients corroborating the result obtained in the previous phase II studies. There was significant improvement in rest pain, ankle systolic pressure, and ankle brachial pressure index with accelerated ulcer healing. In conclusion, the present study shows that the intramuscular administration of Stempeucel continues to be safe, tolerable, and effective alternative treatment in patients with Buerger's disease.
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Affiliation(s)
| | | | | | | | | | | | - Anita Dhar
- All India Institute of Medical SciencesNew DelhiIndia
| | | | | | - Arunanshu Behera
- Post‐Graduate Institute of Medical Education & ResearchChandigarhIndia
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19
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Fazeli B, Poredos P, Patel M, Klein-Weigel P, Catalano M, Stephen E, Al Salman MM, Altarazi L, Bashar AH, Chua B, Colgan MP, Cvjetko I, Desai S, Dimakakos EP, Erer D, Farkas K, Fowkes GR, Gerotziafas G, Hussein E, Ionac M, Iwai T, Karahan O, Kolossvary E, Kota A, Kozak M, Kroger K, Kumar PP, Liew A, Malecki R, Najafi MH, Olinic DM, Pandey SR, Pecsvarady Z, Ravari H, Samuel V, Schernthaner G, Selvaraj D, Sermsathanasawadi N, Sharebiani H, Stanek A, Szuba A, Taheri H, Wautrecht JC, Hakan Zor M. Milestones in thromboangiitis obliterans. A position paper of the VAS-European Independent Foundation in Angiology/Vascular Medicine. INT ANGIOL 2021; 40:395-408. [PMID: 34236154 DOI: 10.23736/s0392-9590.21.04712-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Unfortunately, even today Thromboangiitis Obliterans has disease features that remain misunderstood or underappreciated. The epidemiology, etiology and pathophysiology of the disease are still unclear. Biomarkers and disease activity markers are lacking, thus clinical assessment is difficult. We are still struggling to establish unique diagnostic, staging and treatment criteria. This is an academic-collaborative effort to describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the challenges of management of patients with TAO. METHODS A systematic search for relevant studies dating from 1900 to the end of 2020 was performed on the PubMed, SCOPUS, and Science Direct databases. RESULTS Given the intriguing nature of presentation of TAO, its management, to some extent is not only different in different regions of the world but also varies within the same region. Following this project, we discovered ambiguity, overlap and lack of clear-cut criteria for management of TAO. CONCLUSIONS AND RELEVANCE An international group of experts however came to one conclusion. They all agree that management of TAO is in need of a call for action for a renewed global look with multi-center studies, to update the geographical distribution of the disease and to establish a unique set of diagnostic criteria and a consensus-based guideline for best treatment based on current evidence.
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Affiliation(s)
- Bahare Fazeli
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pavel Poredos
- Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia -
| | - Malay Patel
- Vascular Surgery Department, Apollo CVHF Hospital, Ahmedabad, India
| | - Peter Klein-Weigel
- Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Mariella Catalano
- Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
| | - Edwin Stephen
- Vascular Surgery Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mussaad M Al Salman
- Division of Vascular Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Louay Altarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Abul H Bashar
- National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh
| | - Benjamin Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ivan Cvjetko
- James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Sanjay Desai
- Department of Vascular Surgery, University Hospital Mekur, Zagreb, Croatia
| | - Evangelos P Dimakakos
- Department of vascular and endovascular surgery, Ramaiah Medical College Hospital, Bangalore, India
| | - Dilek Erer
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katalin Farkas
- Gazi university, Faculty of Medicine, Department of cardiovascular surgery, Ankara, Turkey
| | | | | | - Emad Hussein
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Mihai Ionac
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
| | - Takehisa Iwai
- Vascular surgery department, Ain Shams University, Cairo, Egypt
| | - Oguz Karahan
- Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, Timisoara, Romania
| | - Endre Kolossvary
- Gazi university, Faculty of Medicine, Department of cardiovascular surgery, Ankara, Turkey
| | - Albert Kota
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Matija Kozak
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Turkey
| | - Knut Kroger
- Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prabhu P Kumar
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Aaron Liew
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Rafal Malecki
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Mohammad H Najafi
- Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Dan M Olinic
- Department of Angiology, Systemic hypertension and diabetology
| | | | | | - Hasan Ravari
- Department of Cardiology, Tehran Medical Unit, Azad University, Tehran, Iran
| | - Vimalin Samuel
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | - Gerit Schernthaner
- Medical Clinic No 1, University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dheepak Selvaraj
- Department of Surgery, Division of Vascular Surgery, Periodontology, Tokyo Medical and Dental University, Japan
| | | | - Hiva Sharebiani
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Agata Stanek
- Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
| | - Andrzej Szuba
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Hossein Taheri
- Vascular Surgery Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jean Claude Wautrecht
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Mustafa Hakan Zor
- Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
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20
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Analysis of Interaction Between Porphyromonas gingivalis and Endothelial Cells In Vitro. Methods Mol Biol 2021. [PMID: 32815143 DOI: 10.1007/978-1-0716-0939-2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Chronic periodontitis is the most common periodontitis observed in adults. Recently, its association with systemic diseases such as ischemic heart-brain disease and diabetes has been pointed out. Porphyromonas gingivalis, a major causative bacterium of chronic periodontitis, has properties of adhering to blood vessels and inducing inflammation, and those properties are involved in the induction of vascular inflammation and promotion of atherosclerosis. Therefore, analysis of the interaction of P. gingivalis with vascular endothelial cells will contribute to an understanding of the link between periodontitis and vascular lesions.
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21
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Abstract
Buerger’s disease or Thromboangiitis Obliterans (TAO) is a nonatherosclerotic segmental vascular disease which affects small and medium arteries and veins in the upper and lower extremities. Based on pathological findings, TAO can be considered as a distinct form of vasculitis that is most prevalent in young male smokers. There is no definitive cure for this disease as therapeutic modalities are limited in number and efficacy. Surgical bypass has limited utility and 24% of patients will ultimately require amputation. Recently, studies have shown that therapeutic angiogenesis and immunomodulatory approaches through the delivery of stem cells to target tissues are potential options for ischemic lesion treatment. In this review, we summarize the current knowledge of TAO treatment and provide an overview of stem cell-based treatment modalities.
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22
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Almoosawy SA, McGowan M, Hijazi K, Patey R, Bachoo P, Cherukara G. The oral health status of patients with peripheral vascular disorders: A systematic review. Vascular 2020; 29:556-566. [PMID: 33045941 PMCID: PMC8366191 DOI: 10.1177/1708538120963914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Periodontal disease and tooth loss were found to be associated with several peripheral vascular disorders. Nonetheless, an evaluation of the literature on the broader domains of oral health in individuals with peripheral vascular disorders is lacking. This systematic review aims to collate the current evidence on the oral health status of individuals with peripheral vascular disorders. Methods Five electronic databases were searched for studies assessing oral health parameters in individuals with peripheral vascular disorders. Outcome measures considered were periodontal health, dentition status, caries indices, oral prostheses, oral pathologies and oral hygiene behaviours. The Newcastle-Ottawa scale was used to appraise the quality of the studies. Results From 3025 records identified, 24 studies involving 1232 participants with peripheral vascular disorders were included in this review. In nine studies, periodontitis was significantly more prevalent in peripheral vascular disorders compared to non-peripheral vascular disorders participants. A further six studies reported individuals with peripheral vascular disorders also had significantly fewer teeth and increased rates of edentulism. Only one study reported a higher incidence of dental caries in peripheral vascular disorders participants. Other aspects of oral health such as oral prosthesis, oral pathology and oral hygiene behaviours were seldom assessed. Conclusions The scarcity of studies reporting on broader domains limited our ability to arrive at a conclusion regarding the oral health status of individuals with peripheral vascular disorders. Future studies ought to assess these domains in individuals with peripheral vascular disorders and controls to gain a more complete understanding of oral health and its potential association with peripheral vascular disorders.
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Affiliation(s)
| | - Mhairi McGowan
- Institute of Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Karolin Hijazi
- Institute of Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Rona Patey
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Paul Bachoo
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - George Cherukara
- Institute of Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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23
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Matsushita K, Yamada-Furukawa M, Kurosawa M, Shikama Y. Periodontal Disease and Periodontal Disease-Related Bacteria Involved in the Pathogenesis of Alzheimer's Disease. J Inflamm Res 2020; 13:275-283. [PMID: 32636667 PMCID: PMC7335281 DOI: 10.2147/jir.s255309] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common cause of dementia, and it exhibits pathological properties such as deposition of extracellular amyloid β (Aβ) and abnormally phosphorylated Tau in nerve cells and a decrease of synapses. Conventionally, drugs targeting Aβ and its related molecules have been developed on the basis of the amyloid cascade hypothesis, but sufficient effects on the disease have not been obtained in past clinical trials. On the other hand, it has been pointed out that chronic inflammation and microbial infection in the brain may be involved in the pathogenesis of AD. Recently, attention has been focused on the relationship between the periodontopathic bacterium Porphylomonas gingivalis and AD. P. gingivalis and its toxins have been detected in autopsy brain tissues from patients with AD. In addition, pathological conditions of AD are formed or exacerbated in mice infected with P. gingivalis. Compounds that target the toxins of P. gingivalis ameliorate the pathogenesis of AD triggered by P. gingivalis infection. These findings indicate that the pathological condition of AD may be regulated by controlling the bacteria in the oral cavity and the body. In the current aging society, the importance of oral and periodontal care for preventing the onset of AD will increase.
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Affiliation(s)
- Kenji Matsushita
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Masae Yamada-Furukawa
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Mie Kurosawa
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Yosuke Shikama
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
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24
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Chang Y, Woo HG, Lee JS, Song TJ. Better oral hygiene is associated with lower risk of stroke. J Periodontol 2020; 92:87-94. [PMID: 32432793 DOI: 10.1002/jper.20-0053] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/22/2020] [Accepted: 03/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Periodontal disease or poor oral hygiene may lead to local infection, inflammation, and systemic inflammatory reactions, which are important mediators of development of stroke. We aimed to investigate the association of oral hygiene with risk of stroke in a nationwide population-based cohort. METHODS From Korean National Health Insurance System-Health Screening Cohort, 206,602 participants without missing data regarding demographic information, medical history, or blood/urine examination results were included. The presence of periodontal disease and indicators of oral hygiene, such as number of tooth brushings, dental visit history, dental scaling, and number of teeth loss and dental caries were evaluated. Occurrence of stroke including cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage was defined as newly registration of International Classification of Diseases-10 codes from I60 to I64 accompanying brain CT and/or MR examination at that time of diagnosis. RESULTS The 7337 (3.6%) cases of stroke including 5795 (79.0%) cases of cerebral infarction, 1568 (21.4%) cases of cerebral hemorrhage, and 621 (8.5%) cases of subarachnoid hemorrhage occurred during a median 10.4 years follow-up. In multivariable analysis, frequent tooth brushing (≥3 times per day) was negatively associated with risk of stroke occurrence (hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.73-0.84). Number of dental caries (≥4) was positively related to stroke occurrence (HR: 1.28, 95% CI: 1.13-1.44). CONCLUSIONS Regular oral hygiene behavior was negatively, and infrequent oral hygiene care was positively associated with risk of occurrence for stroke, respectively. Brushing one's teeth three or more times daily may be associated with lower risk of stroke.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Cacione DG, Macedo CR, do Carmo Novaes F, Baptista-Silva JC. Pharmacological treatment for Buerger's disease. Cochrane Database Syst Rev 2020; 5:CD011033. [PMID: 32364620 PMCID: PMC7197514 DOI: 10.1002/14651858.cd011033.pub4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic, segmental inflammatory pathology that most commonly affects the small and medium sized arteries, veins, and nerves in the upper and lower extremities. The aetiology is unknown, but involves hereditary susceptibility, tobacco exposure, immune and coagulation responses. In many cases, there is no possibility of revascularisation to improve the condition. Pharmacological treatment is an option for patients with severe complications, such as ischaemic ulcers or rest pain.This is an update of the review first published in 2016. OBJECTIVES To assess the effectiveness of any pharmacological agent (intravenous or oral) compared with placebo or any other pharmacological agent in patients with Buerger's disease. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, AMED, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 15 October 2019. The review authors searched LILACS, ISRCTN, Australian New Zealand Clinical Trials Registry, EU Clinical Trials Register, clincialtrials.gov and the OpenGrey Database to 5 January 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) involving pharmacological agents used in the treatment of Buerger's disease. DATA COLLECTION AND ANALYSIS Two review authors, independently assessed the studies, extracted data and performed data analysis. MAIN RESULTS No new studies were identified for this update. Five randomised controlled trials (total 602 participants) compared prostacyclin analogue with placebo, aspirin, or a prostaglandin analogue, and folic acid with placebo. No studies assessed other pharmacological agents such as cilostazol, clopidogrel and pentoxifylline or compared oral versus intravenous prostanoid. Compared with aspirin, intravenous prostacyclin analogue iloprost improved ulcer healing (risk ratio (RR) 2.65; 95% confidence interval (CI) 1.15 to 6.11; 98 participants; 1 study; moderate-certainty evidence), and helped to eradicate rest pain after 28 days (RR 2.28; 95% CI 1.48 to 3.52; 133 participants; 1 study; moderate-certainty evidence), although amputation rates were similar six months after treatment (RR 0.32; 95% CI 0.09 to 1.15; 95 participants; 1 study; moderate-certainty evidence). When comparing prostacyclin (iloprost and clinprost) with prostaglandin (alprostadil) analogues, ulcer healing was similar (RR 1.13; 95% CI 0.76 to 1.69; 89 participants; 2 studies; I² = 0%; very low-certainty evidence), as was the eradication of rest pain after 28 days (RR 1.57; 95% CI 0.72 to 3.44; 38 participants; 1 study; low-certainty evidence), while amputation rates were not measured. Compared with placebo, the effects of oral prostacyclin analogue iloprost were similar for: healing ischaemic ulcers (iloprost 200 mcg: RR 1.11; 95% CI 0.54 to 2.29; 133 participants; 1 study; moderate-certainty evidence, and iloprost 400 mcg: RR 0.90; 95% CI 0.42 to 1.93; 135 participants; 1 study; moderate-certainty evidence), eradication of rest pain after eight weeks (iloprost 200 mcg: RR 1.14; 95% CI 0.79 to 1.63; 207 participants; 1 study; moderate-certainty evidence, and iloprost 400 mcg: RR 1.11; 95% CI 0.77 to 1.59; 201 participants; 1 study; moderate-certainty evidence), and amputation rates after six months (iloprost 200 mcg: RR 0.54; 95% CI 0.19 to 1.56; 209 participants; 1 study, and iloprost 400 mcg: RR 0.42; 95% CI 0.13 to 1.31; 213 participants; 1 study). When comparing folic acid with placebo in patients with Buerger's disease and hyperhomocysteinaemia, pain scores were similar, there were no new cases of amputation in either group, and ulcer healing was not assessed (very low-certainty evidence). Treatment side effects such as headaches, flushing or nausea were not associated with treatment interruptions or more serious consequences. Outcomes such as amputation-free survival, walking distance or pain-free walking distance, and ankle brachial index were not assessed by any study. Overall, the certainty of the evidence was very low to moderate, with few studies, small numbers of participants, variation in severity of disease of participants between studies and missing information (for example regarding baseline tobacco exposure). AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that intravenous iloprost (prostacyclin analogue) is more effective than aspirin for eradicating rest pain and healing ischaemic ulcers in Buerger's disease, but oral iloprost is not more effective than placebo. Very low and low-certainty evidence suggests there is no clear difference between prostacyclin (iloprost and clinprost) and the prostaglandin analogue alprostadil for healing ulcers and relieving pain respectively in severe Buerger's disease. Very low-certainty evidence suggests there is no clear difference in pain scores and amputation rates between folic acid and placebo, in people with Buerger's disease and hyperhomocysteinaemia. Further well designed RCTs assessing the effectiveness of pharmacological agents (intravenous or oral) in people with Buerger's disease are needed.
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Affiliation(s)
- Daniel G Cacione
- Division of Vascular and Endovascular Surgery, Department of Surgery, UNIFESP - Escola Paulista de Medicina, São Paulo, Brazil
| | - Cristiane R Macedo
- Brazilian Cochrane Centre, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | | | - Jose Cc Baptista-Silva
- Evidence Based Medicine, Cochrane Brazil, Universidade Federal de São Paulo, São Paulo, Brazil
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26
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Mohamad Yusoff F, Kajikawa M, Takaeko Y, Kishimoto S, Hashimoto H, Maruhashi T, Kihara Y, Nakashima A, Higashi Y. Long-Term Clinical Outcomes of Autologous Bone Marrow Mononuclear Cell Implantation in Patients With Severe Thromboangiitis Obliterans. Circ J 2020; 84:650-655. [PMID: 32132348 DOI: 10.1253/circj.cj-19-1041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with severe Buerger disease, also known as thromboangiitis obliterans (TAO), are at risk of major limb amputation. It has been shown that autologous bone marrow mononuclear cell (BM-MNC) implantation improves the condition of critical limb ischemia in TAO patients. This study was conducted to further clarify the long-term (>10 years) results of autologous BM-MNC implantation in patients with TAO.Methods and Results:An observational study was conducted of the long-term results of BM-MNC implantation in 47 lower limbs of 27 patients with TAO. The mean (±SD) follow-up period was 12.0±8.6 years. There was no major amputation event up to 10 years of follow-up in patients treated with BM-MNC implantation. The overall amputation-free survival rates were significantly higher in patients who underwent BM-MNC implantation than in internal controls and historical controls. There was no significant difference in amputation-free survival rates between the historical and internal controls. There was also no significant difference in overall survival between patients who underwent BM-MNC implantation and the historical controls. CONCLUSIONS BM-MNC transplantation successfully prevented major limb amputation over a period of >10 years in patients with severe TAO who had no other therapeutic options.
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Affiliation(s)
- Farina Mohamad Yusoff
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
| | - Yuji Takaeko
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Shinji Kishimoto
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Haruki Hashimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Tatsuya Maruhashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Ayumu Nakashima
- Department of Stem Cell Biology and Medicine, Hiroshima University Graduate School of Biomedical Sciences
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University.,Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences
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27
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Fazeli B, Mirhosseini A, Hashemi Z, Taheri H. Detection of Rickettsia Endosymbiont Bemisia Tabaci in the Amputated Limbs of Three Buerger's Disease Patients. Int Med Case Rep J 2020; 13:33-40. [PMID: 32110116 PMCID: PMC7035904 DOI: 10.2147/imcrj.s225839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 02/04/2020] [Indexed: 11/23/2022] Open
Abstract
Until recently, the aetiology of Buerger’s disease (BD) has been unknown. Although there is a close relationship between BD and smoking, it cannot explain the low prevalence of BD among smokers or the disease’s geographical distribution. Infectious pathogens, such as Rickettsial infection, have also been suggested as the trigger of BD development, but this theory has neither been proven nor ruled out. The aim of this study was to evaluate the footprint of Rickettsial infection in tissue specimens obtained from amputees with Buerger’s disease. Forty-nine tissue biopsies were obtained from three below-the-knee amputees who also had a diagnosis of BD according to Olin’s criteria (between 14–21 biopsies for each patient). After extraction of DNA from the tissue samples, the existence of 16srRNA was evaluated using a PCR test. The sequence of PCR products was evaluated using Geneious 11.1.2 software and NCBI blast. The 16srRNA was found in 3 to 7 samples from each patient. The sequence of the PCR products had a 98% homology with Rickettsia Tabaci. The sequences of the three patients were aligned, and no difference was found in the sequence of 16srRNA amongst the patients. Rickettsia Tabaci is a pathogen that infects tobacco leaves. Thus, BD might be an infectious disease for which smoking could be the route of pathogen entry into the bloodstreams of the sufferers. However, further studies are highly recommended to confirm this hypothesis.
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Affiliation(s)
- Bahare Fazeli
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Vascular Independent Research and Education, European Foundation, Milan, Italy
| | - Ali Mirhosseini
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Hashemi
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Isobe M, Amano K, Arimura Y, Ishizu A, Ito S, Kaname S, Kobayashi S, Komagata Y, Komuro I, Komori K, Takahashi K, Tanemoto K, Hasegawa H, Harigai M, Fujimoto S, Miyazaki T, Miyata T, Yamada H, Yoshida A, Wada T, Inoue Y, Uchida HA, Ota H, Okazaki T, Onimaru M, Kawakami T, Kinouchi R, Kurata A, Kosuge H, Sada KE, Shigematsu K, Suematsu E, Sueyoshi E, Sugihara T, Sugiyama H, Takeno M, Tamura N, Tsutsumino M, Dobashi H, Nakaoka Y, Nagasaka K, Maejima Y, Yoshifuji H, Watanabe Y, Ozaki S, Kimura T, Shigematsu H, Yamauchi-Takihara K, Murohara T, Momomura SI. JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version. Circ J 2020; 84:299-359. [PMID: 31956163 DOI: 10.1253/circj.cj-19-0773] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine.,Internal Medicine, Kichijoji Asahi Hospital
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | | | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
| | | | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hideki Ota
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine
| | - Takahiro Okazaki
- Vice-Director, Shizuoka Medical Center, National Hospital Organization
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University
| | - Reiko Kinouchi
- Medicine and Engineering Combined Research Institute, Asahikawa Medical University.,Department of Ophthalmology, Asahikawa Medical University
| | - Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University
| | | | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Eiichi Suematsu
- Division of Internal Medicine and Rheumatology, National Hospital Organization, Kyushu Medical Center
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
| | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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29
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Iwai T, Matsui Y, Homma K, Takemura T, Fujiwara M, Aoyama N, Sato H, Izumi Y. Oral-bacterial-induced arterial and venous thrombus in rats: Pathological and immunological studies. Clin Exp Dent Res 2019; 5:497-504. [PMID: 31687183 PMCID: PMC6820577 DOI: 10.1002/cre2.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 11/06/2022] Open
Abstract
Objectives Our study investigated the pathological outcome of experimental thrombi that incorporate oral bacteria. Material and methods A small artery and vein in the rats' groins were injected with a solution containing periodontal bacteria Porphyromonas gingivalis and followed up for 28 days. In all, 18 limbs of nine male rats (500-650 g) were used for the arterial study, and eight limbs of four rats were used for the veins. Two densities of the bacterial solution and two arterial thicknesses sizes were used in the arterial study. Both proximal and distal arteries and veins were ligated loosely using a monofilament nylon suture before bacterial suspensions or control solutions were injected into the ligated vessels. Results After 7, 14-18, and 28 days, the rats were sacrificed. Pathology and immunohistochemistry were performed. All specimens exhibited thrombus formation and an acute inflammation reaction with granulocytes at 7 days and then settled down to chronic fibrous change with plasma cells or macrophages at 28 days in the arterial thrombus. CD3 (Pan T-cells), CD79a (Pan B cells in the rats), and IgG were observed in the process of the healing of the arterial thrombus. Venous changes showed relatively clear recanalization that appeared at 7 days, which is slightly different from the artery. Granulocytes were present from 7 to 28 days. Conclusions Periodontal bacteria act as an inflammatory core in the vessels, but not as an infectious agent, in our experiments, because of their low ability to invade tissues.
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Affiliation(s)
- Takehisa Iwai
- Division of Vascular Surgery and Collagen Disease Medicine Tsukuba Vascular Center Ibaraki Japan
| | - Yoshiki Matsui
- Division of Vascular Surgery and Collagen Disease Medicine Tsukuba Vascular Center Ibaraki Japan
| | - Kaori Homma
- Division of Vascular Surgery and Collagen Disease Medicine Tsukuba Vascular Center Ibaraki Japan
| | - Tamiko Takemura
- Section of Pathology Japanese Red-Cross Medical Center Tokyo Japan
| | | | - Norio Aoyama
- Department of Periodontology Kanagawa Dental University Kanagawa Japan
| | - Hiroki Sato
- Department of Periodontology Tokyo Medical and Dental University Tokyo Japan
| | - Yuichi Izumi
- Department of Periodontology Tokyo Medical and Dental University Tokyo Japan
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30
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Kiss-Szemán AJ, Harmat V, Menyhárd DK. Achieving Functionality Through Modular Build-up: Structure and Size Selection of Serine Oligopeptidases. Curr Protein Pept Sci 2019; 20:1089-1101. [PMID: 31553292 DOI: 10.2174/1389203720666190925103339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/13/2019] [Accepted: 04/12/2019] [Indexed: 01/13/2023]
Abstract
Enzymes of the prolyl oligopeptidase family (S9 family) recognize their substrates not only by the specificity motif to be cleaved but also by size - they hydrolyze oligopeptides smaller than 30 amino acids. They belong to the serine-protease family, but differ from classical serine-proteases in size (80 kDa), structure (two domains) and regulation system (size selection of substrates). This group of enzymes is an important target for drug design as they are linked to amnesia, schizophrenia, type 2 diabetes, trypanosomiasis, periodontitis and cell growth. By comparing the structure of various members of the family we show that the most important features contributing to selectivity and efficiency are: (i) whether the interactions weaving the two domains together play a role in stabilizing the catalytic triad and thus their absence may provide for its deactivation: these oligopeptidases can screen their substrates by opening up, and (ii) whether the interaction-prone β-edge of the hydrolase domain is accessible and thus can guide a multimerization process that creates shielded entrance or intricate inner channels for the size-based selection of substrates. These cornerstones can be used to estimate the multimeric state and selection strategy of yet undetermined structures.
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Affiliation(s)
- Anna J Kiss-Szemán
- Laboratory of Structural Chemistry and Biology, Institute of Chemistry, Eotvos Lorand University, Budapest, Hungary
| | - Veronika Harmat
- Laboratory of Structural Chemistry and Biology, Institute of Chemistry, Eotvos Lorand University, Budapest, Hungary.,MTA-ELTE Protein Modelling Research Group, Eötvös Loránd University, Budapest, Hungary
| | - Dóra K Menyhárd
- MTA-ELTE Protein Modelling Research Group, Eotvos Lorand University, Budapest, Hungary
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31
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Associations Between Elevated Plasma Total Homocysteine Level and Risk of Thromboangiitis Obliterans in a Chinese Population: A Matched Case-Control Study. Ann Vasc Surg 2019; 62:335-341. [PMID: 31472234 DOI: 10.1016/j.avsg.2019.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/07/2019] [Accepted: 06/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Elevated plasma total homocysteine level is a risk factor for various vascular diseases; however, an association with risk of thromboangiitis obliterans (TAO) has not been defined. This study aims to assess whether elevated plasma total homocysteine level is associated with risk of TAO. METHODS We performed a matched case-control study including 64 patients with TAO and 256 controls. Multivariate logistic regression models were used to estimate the association between elevated plasma homocysteine level and the risk of TAO. Interaction and stratified analyses were conducted according to age, sex, smoking, alcohol consumption, and histories of chronic diseases. RESULTS Patients with TAO versus controls had a higher mean plasma total homocysteine level (21.2 ± 12.8 μmol/L vs. 14.1 ± 4.9 μmol/L; P < 0.01). The risk of TAO was 3.68-fold increased in participants with plasma total homocysteine level >15 μmol/L (95% confidence interval [95% CI], 1.2-11.7). A 1 μmol/L increase in plasma total homocysteine level was associated with 20% higher risk of TAO (odds ratio, 1.2; 95% CI, 1.1-1.3). CONCLUSIONS Our findings suggest that the risk of TAO was significantly associated with elevated plasma total homocysteine level independently of other factors analyzed, including smoking. Studies on the use of homocysteine-lowering therapy to prevent TAO would allow testing causality of the latter association.
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32
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Mousazadeh B, Sharebiani H, Taheri H, Valizedeh N, Fazeli B. Unexpected inflammation in the sympathetic ganglia in thromboangiitis obliterans: more likely sterile or infectious induced inflammation? Clin Mol Allergy 2019; 17:10. [PMID: 31316304 PMCID: PMC6612411 DOI: 10.1186/s12948-019-0114-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 06/22/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction The aim of this study was to determine if the inflammation of the sympathetic ganglia (SG) in thromboangiitis obliterans (TAO) is induced by an infectious pathogen inside or if it is a reactive sterile inflammation. Methods For the purpose of this study, the gene expression of high-mobility group box 1 (HMGB1), toll-like receptor 4 (TLR4), toll-like receptor 9 (TLR9), and the receptor for advanced glycation end-products (RAGE) were evaluated on the complementary DNA (cDNA) of the SG tissues of 24 TAO patients and two controls with hyperhidrosis by real-time polymerase chain reaction (PCR) and analysed by the Pfaffl method. Results The gene expression of HMGB1 and TLR9 increased by about 25- and 2-fold changes in the SG of the TAO patients, respectively. However, there was no change in the gene expression of TLR4 or RAGE. Conclusion It appears that the inflammation in the SG of TAO patients is more likely a sterile inflammation, and its trigger may be mitochondrial DNA (mtDNA). Cadmium in cigarettes could be responsible for the induction of mtDNA release to the cell cytoplasm. In addition, the high expression of HMGB1 may play a role in the pathogenesis of TAO and may be responsible for both clinical manifestation of the disease and the imaging findings. Moreover, HMGB1 may be a target for treatment protocols for TAO. Further studies are highly recommended.
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Affiliation(s)
- Behzad Mousazadeh
- 1Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hiva Sharebiani
- 1Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Narges Valizedeh
- 1Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahare Fazeli
- 1Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Vascular Independent Research and Education, European Foundation, Milan, Italy
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33
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Cacione DG, do Carmo Novaes F, Moreno DH. Stem cell therapy for treatment of thromboangiitis obliterans (Buerger's disease). Cochrane Database Syst Rev 2018; 10:CD012794. [PMID: 30378681 PMCID: PMC6516882 DOI: 10.1002/14651858.cd012794.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Thromboangiitis obliterans, also known as Buerger's disease, is a non-atherosclerotic, segmental inflammatory pathology that most commonly affects the small- and medium-sized arteries, veins, and nerves in the upper and lower extremities. The etiology is unknown, but involves hereditary susceptibility, tobacco exposure, immune and coagulation responses. In many cases, there is no possibility of revascularization to improve the condition. Stem cell therapy is an option for patients with severe complications, such as ischemic ulcers or rest pain. OBJECTIVES To assess the effectiveness and safety of stem cell therapy in individuals with thromboangiitis obliterans (Buerger's disease). SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 17 October 2017. The review authors searched the European grey literature OpenGrey Database, screened reference lists of relevant studies and contacted study authors. SELECTION CRITERIA Randomized controlled trials (RCTs) or quasi-RCTs of stem cell therapy in thromboangiitis obliterans (Buerger's disease). DATA COLLECTION AND ANALYSIS The review authors (DC, DM, FN) independently assessed the studies, extracted data and performed data analysis. MAIN RESULTS We only included one RCT (18 participants with thromboangiitis obliterans) comparing the implantation of stem cell derived from bone marrow with placebo and standard wound dressing care in this review. We identified no studies that compared stem cell therapy (bone marrow source) versus stem cell therapy (umbilical cord source), stem cell therapy (any source) versus pharmacological treatment and stem cell therapy (any source) versus sympathectomy. Ulcer healing was assessed in the form of ulcer size. The mean ulcer area decreased more in the stem cell implantation group: from 5.04 cm2 (standard deviation (SD) 0.70) to 1.48 cm2 (SD 0.56) compared with the control group: mean ulcer size area decreased from 4.68 cm2 (SD 0.62) to 3.59 cm2 (SD 0.14); mean difference (MD) -2.11 cm2, 95% confidence interval (CI) -2.49 to -1.73; 1 study, 18 participants; very low-quality evidence. Pain-free walking distance showed more of an improvement in the stem cell implantation group: from mean of 38.33 meters (SD 17.68) to 284.44 meters (SD 212.12) compared with the control group: mean walking distance increased from 35.66 meters (SD 19.79) to 78.22 meters (SD 35.35); MD 206.22 meters, 95% CI 65.73 to 346.71; 1 study; 18 participants; very low-quality evidence.Outcomes such as rate of amputation, pain, amputation-free survival and adverse effects were not assessed.The quality of evidence was classified as very low, with only one study, small numbers of participants, high risk of bias in many domains and missing information regarding tobacco exposure status. AUTHORS' CONCLUSIONS Very low-quality evidence suggests there may be an effect of the use of bone marrow-derived stem cells in the healing of ulcers and improvement in the pain-free walking distance in patients with Buerger's disease. High-quality trials assessing the effectiveness of stem cell therapy for treatment of patients with thromboangiitis obliterans (Buerger's disease) are needed.
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Affiliation(s)
- Daniel G Cacione
- UNIFESP – Escola Paulista de MedicinaDivision of Vascular and Endovascular Surgery, Department of SurgeryRua Borges Lagoa, 564 cj 124Vila ClementinoSão PauloBrazil04038000
| | | | - Daniel H Moreno
- UNIFESP – Escola Paulista de MedicinaDivision of Vascular and Endovascular Surgery, Department of SurgeryRua Borges Lagoa, 564 cj 124Vila ClementinoSão PauloBrazil04038000
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Mohareri M, Mirhosseini A, Mehraban S, Fazeli B. Thromboangiitis obliterans episode: autoimmune flare-up or reinfection? Vasc Health Risk Manag 2018; 14:247-251. [PMID: 30319267 PMCID: PMC6168068 DOI: 10.2147/vhrm.s172047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The possible role of infectious pathogens in the development of thromboangiitis obliterans (TAO) was considered soon after the disease was first described. However, it is not yet known whether infectious pathogens induce thrombotic vasculitis or if they cause a type of autoimmune disease. To investigate whether TAO relapses are more likely due to reinfection or autoimmune flare, the serum levels of toll-like receptor (sTLR) 4, sTLR2, C-reactive protein (CRP), and neopterin were evaluated in TAO patients during both the acute and quiescent phases of the disease as well as in a gender-, age-, and smoking habit-matched control group. METHODS Following a cross-sectional study design, 28 patients in the acute phase of TAO and 23 patients in the quiescent phase participated in this study. In addition, 31 matched controls were enrolled. RESULTS Toll-like receptor (TLR) 4 was significantly higher in patients in the acute phase of the disease than in patients in the quiescent phase (P=0.012). Also, TLR4 was significantly higher in the patients with CRP >7 µm/mL than in the patients with lower CRP (P=0.031). Notably, TLR4 in the patients in the quiescent phase of TAO was significantly lower than in the controls (P=0.006). No significant difference in the level of TLR2 was found among the groups (P>0.05). Neopterin was significantly higher in the acute phase of TAO in comparison to the quiescent phase (P=0.003) and the controls (P=0.005). CONCLUSION These findings indicate that the trigger of TAO might be Gram-negative bacteria, which can be hidden or immunologically suppressed in the quiescent phase of TAO, leading to a lower level of TLR4 accompanying the normal level of neopterin. However, relapses might develop according to toxic or hypoxic cell injuries. Hence, TLR4 shedding will increase, and therefore, sTLR4 could become closer to the level demonstrated in the controls.
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Affiliation(s)
- Mehran Mohareri
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,
| | - Ali Mirhosseini
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,
| | - Saeedeh Mehraban
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,
| | - Bahare Fazeli
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,
- Vascular Independent Research and Education, European Foundation, Milan, Italy,
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Aoyama N, Suzuki JI, Thanakun S, Izumi Y, Minabe M, Isobe M. Elevated concentrations of specific periodontopathic pathogens associated with severe periodontitis in Japanese patients with cardiovascular disease and concomitant obesity. J Oral Biosci 2018. [DOI: 10.1016/j.job.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Takeuchi T, Hashizume-Takizawa T, Kobayashi R. Oral immunization with Porphyromonas gingivalis outer membrane protein and CpG oligodeoxynucleotides attenuates P. gingivalis-accelerated atherosclerosis and inflammation. J Oral Biosci 2017. [DOI: 10.1016/j.job.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cacione DG, Moreno DH. Stem cell therapy for treatment of thromboangiitis obliterans (Buerger's disease). Hippokratia 2017. [DOI: 10.1002/14651858.cd012794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Daniel G Cacione
- UNIFESP - Escola Paulista de Medicina; Division of Vascular and Endovascular Surgery, Department of Surgery; Rua Borges Lagoa, 564 cj 124 Vila Clementino São Paulo Brazil 04038000
| | - Daniel H Moreno
- UNIFESP - Escola Paulista de Medicina; Division of Vascular and Endovascular Surgery, Department of Surgery; Rua Borges Lagoa, 564 cj 124 Vila Clementino São Paulo Brazil 04038000
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Igari K, Kudo T, Toyofuku T, Inoue Y. Endothelial dysfunction in patients with Buerger disease. Vasc Health Risk Manag 2017; 13:317-323. [PMID: 28860792 PMCID: PMC5574590 DOI: 10.2147/vhrm.s139892] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We evaluated the endothelial function of patients with Buerger disease using peripheral arterial tonometry test, and examined the factors that are significantly correlated with the endothelial dysfunction in these patients. We performed the peripheral arterial tonometry test in 22 patients with Buerger disease. We recorded the patients' characteristics, including ankle brachial pressure index and reactive hyperemia index, which reflect the endothelial dysfunction. We divided the patients with Buerger disease into the conservative treatment and lumbar sympathectomy group. While the reactive hyperemia index was not significantly different between these two groups, the ankle brachial pressure index was significantly different (1.12 versus 0.83, P=0.003). Furthermore, the reactive hyperemia index was significantly correlated with the ankle brachial pressure index value in the patients in the lumbar sympathectomy group (ρ=0.848, P=0.005). Given that patients with Buerger disease show impairment of the sympathetic nervous system, we should consider the after-effects of such an impaired system on the condition of these patients. The patients treated with lumbar sympathectomy might be more appropriate to evaluate their endothelial function by a peripheral arterial tonometry test.
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Affiliation(s)
- Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Toyofuku
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Sun XL, Law BYK, de Seabra Rodrigues Dias IR, Mok SWF, He YZ, Wong VKW. Pathogenesis of thromboangiitis obliterans: Gene polymorphism and immunoregulation of human vascular endothelial cells. Atherosclerosis 2017; 265:258-265. [PMID: 28864202 DOI: 10.1016/j.atherosclerosis.2017.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/24/2017] [Accepted: 08/17/2017] [Indexed: 01/19/2023]
Abstract
Thromboangiitis obliterans (TAO) is a nonatherosclerotic, segmental, inflammatory vasculitis, which commonly affects the small- and medium-sized arteries of the upper and lower extremities. Despite its discovery more than a century ago, little progress has been made in its treatment. Unless the pathogenesis is elucidated, therapeutic approaches will be limited. The purpose of this review article is to collate current knowledge of mechanisms for the pathogenesis of thromboangiitis obliterans and to propose potential mechanisms from a genetic and immunoreactive point of view for its inception. Therefore, we discuss the possibility that the pathogenesis of this disease is due to a type of gene polymorphism, which leads to an immunological inflammatory vasculitis associated with tobacco abuse, highly linked to T cells, human vascular endothelial cells (HVECs), and the TLR-MyD88-NFκB pathway, distinct from arteriosclerosis obliterans and other vasculitides.
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Affiliation(s)
- Xiao-Lei Sun
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China; Department of Vascular and Thyroid Surgery of the Affiliated Hospital of Southwest Medical University, Sichuan Province, China
| | - Betty Yuen-Kwan Law
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | | | - Simon Wing Fai Mok
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Yan-Zheng He
- Department of Vascular and Thyroid Surgery of the Affiliated Hospital of Southwest Medical University, Sichuan Province, China.
| | - Vincent Kam-Wai Wong
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China.
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Igari K, Inoue Y, Iwai T. An Experimental Model of Peripheral Vascular Disease Involving the Intravenous Injection of Oral Bacteria. Ann Vasc Dis 2016; 9:267-271. [PMID: 28018496 DOI: 10.3400/avd.oa.16-00092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to observe the direct effects of oral bacteria, such as Porphyromonas gingivalis (Pg) and Treponema denticola (Td), on the peripheral vasculature. Materials and Methods: Beagles were directly injected (at various doses) with Pg or Td. Each leg vein was exposed, ligated at proximal and distal sites, and then injected with bacteria diluted with sterile saline. The collected vascular tissue was examined microscopically, and samples of the vascular tissue and blood were cultured and then subjected to the polymerase chain reaction (PCR) in order to detect the bacterial deoxyribonucleic acid (DNA). Results: No genes of the injected bacteria were detected in the Td-inoculated blood or vascular tissue samples collected 2 weeks after the injection. The Pg gene was also not detected in the blood samples collected 4 weeks after the injection although it was detected in the vascular tissue using PCR. Microscopic examinations showed that the inflammatory reactions in the perivascular tissue increased in a bacterial dose-dependent manner, as expected. Conclusion: We observed the direct effects of oral bacteria on vascular tissue. Further studies are needed to investigate the correlations between oral bacteria and systemic diseases. (This article is a translation of Jpn J Phlebol 2015; 26: 41-6.).
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Affiliation(s)
- Kimihiro Igari
- Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehisa Iwai
- Tsukuba Vascular Center, Buerger Disease Research Institute, Moriya, Ibaraki, Japan
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Yang WW, Guo B, Jia WY, Jia Y. Porphyromonas gingivalis-derived outer membrane vesicles promote calcification of vascular smooth muscle cells through ERK1/2-RUNX2. FEBS Open Bio 2016; 6:1310-1319. [PMID: 28255538 PMCID: PMC5324769 DOI: 10.1002/2211-5463.12151] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/19/2016] [Accepted: 10/31/2016] [Indexed: 12/31/2022] Open
Abstract
The outer membrane vesicle (OMV) derived from Porphyromonas gingivalis plays an essential role in causing inflammation which, in turn, plays an important part in the pathogenesis of cardiovascular diseases such as atherosclerosis and thromboembolism. However, the contribution of oral bacteria to vascular calcification is yet to be determined. Here, we evaluated the effect of OMV on vascular smooth muscle cell (VSMC) calcification both in vitro and ex vivo. We established a reproducible P. gingivalis OMV-induced differentiation and calcification model of VSMCs in vitro. The results indicate that OMV promotes VSMC calcification in a concentration-dependent manner, modulating the expression of bone markers and SMC markers both on genes and proteins that are important for osteoblastic differentiation and mineralization of VSMCs. We also showed that the key osteogenic transcription factor, runt-related transcription factor 2 (Runx2), which is affected by upstream extracellular-regulated kinase (ERK) signaling, is a key regulator of OMV-induced VSMC differentiation and calcification. Taken together, our research demonstrates that Runx2 is a crucial component of OMV-induced calcification of VSMCs, and ERK signaling plays a vital role in mediating Runx2 up-regulation and VSMC calcification.
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Affiliation(s)
- Wen Wei Yang
- Department of StomatologyAviation General Hospital of China Medical UniversityBeijingChina
| | - Bin Guo
- Department of StomatologyAviation General Hospital of China Medical UniversityBeijingChina
- Department of StomatologyThe General Hospital of Chinese People's LiberationBeijingChina
| | - Wen Yuan Jia
- Department of PeriodonticsWest China College of StomatologySichuan UniversityChengduChina
| | - Yue Jia
- Department of StomatologyAviation General Hospital of China Medical UniversityBeijingChina
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Zheng JF, Chen YM, Chen DY, Lin CH, Chen HH. The Incidence and Prevalence of Thromboangiitis Obliterans in Taiwan: A Nationwide, Population-based Analysis of Data Collected from 2002 to 2011. Clinics (Sao Paulo) 2016; 71:399-403. [PMID: 27464297 PMCID: PMC4946527 DOI: 10.6061/clinics/2016(07)08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/10/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the incidence and prevalence of thromboangiitis obliterans in Taiwan in the period spanning from 2002 to 2011. METHODS We identified all incident and prevalent cases with a diagnosis of thromboangiitis obliterans (International Classification of Diseases, Ninth Revision code 443.1) in the period spanning from 2002 to 2011 using Taiwan's National Health Insurance Research Database. We calculated the age- and sex-specific incidence and prevalence rates of thromboangiitis obliterans during the study period. RESULTS From 2002 to 2011, 158 patients were diagnosed with thromboangiitis obliterans; of these, 76% were men. Most (63%) of the patients were <50 years old when they were first diagnosed. After reaching 20 years of age, the incidence rate increased with age and peaked among those aged ≥60 years. The average incidence rate of thromboangiitis obliterans during the 2002-2011 period was 0.068 per 105 years. The incidence of thromboangiitis obliterans decreased with time, from 0.10 per 105 years in 2002 to 0.04 per 105 years in 2011. The prevalence increased from 0.26 × 10-5 in 2002 to 0.65 × 10-5 in 2011. CONCLUSION This is the first epidemiologic study of thromboangiitis obliterans using claims data from a general population in Taiwan. This nationwide, population-based study found that the incidence and prevalence of thromboangiitis obliterans in Taiwan in the 2002-2011 period were lower than those in other countries before 2000. This study also revealed a trend of decreasing incidence with simultaneous increasing prevalence of thromboangiitis obliterans in Taiwan from 2002 to 2011.
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Affiliation(s)
- Jie-Fu Zheng
- Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology
| | - Yi-Ming Chen
- Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology
- Department of Medical Research
- Department of Medical Education, Taichung, Taiwan
- National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Der-Yuan Chen
- Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology
- Department of Medical Research
- Department of Medical Education, Taichung, Taiwan
- National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Ching-Heng Lin
- National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Hsin-Hua Chen
- Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology
- Department of Medical Research
- Department of Medical Education, Taichung, Taiwan
- National Yang-Ming University, School of Medicine, Taipei, Taiwan
- National Chung-Hsing University, Institute of Biomedical Science and Rong Hsing Taichung Veterans General Hospital, Taichung, Taiwan
- Chung-Shan Medical University, School of Medicine, Taichung, Taiwan
- National Yang-Ming University, Institute of Public Health and Community Medicine Research Center, Taiwan
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Abstract
BACKGROUND Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic, segmental inflammatory pathology that most commonly affects the small and medium sized arteries, veins, and nerves in the upper and lower extremities. The etiology is unknown, but involves hereditary susceptibility, tobacco exposure, immune and coagulation responses. In many cases, there is no possibility of revascularization to improve the condition. Pharmacological treatment is an option for patients with severe complications, such as ischaemic ulcers or rest pain. OBJECTIVES To assess the effectiveness of any pharmacological agent (intravenous or oral) compared with placebo or any other pharmacological agent in patients with Buerger's disease. SEARCH METHODS The Cochrane Vascular Trials Search Co-ordinator searched their Specialised Register (last searched in April 2015) and the Cochrane Register of Studies (Issue 3, 2015). The review authors searched trial registers and the European grey literature; screened reference lists of relevant studies, and contacted study authors and major pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) involving pharmacological agents used in the treatment of Buerger's disease. DATA COLLECTION AND ANALYSIS Two review authors, independently assessed the studies, extracted data and performed data analysis. MAIN RESULTS Five randomised controlled trials (total 602 participants) compared prostacyclin analogue with placebo, aspirin, or a prostaglandin analogue, and folic acid with placebo. No studies assessed other pharmacological agents such as cilostazol, clopidogrel and pentoxifylline or compared oral versus intravenous prostanoid.Compared with aspirin, intravenous prostacyclin analogue iloprost improved ulcer healing (risk ratio (RR) 2.65; 95% confidence interval (CI) 1.15 to 6.11; 98 participants; one study; moderate quality evidence), and helped to eradicate rest pain after 28 days (RR 2.28; 95% CI 1.48 to 3.52; 133 participants; one study; moderate quality evidence), although amputation rates were similar six months after treatment (RR 0.32; 95% CI 0.09 to 1.15; 95 participants; one study; moderate quality evidence). When comparing prostacyclin (iloprost and clinprost) with prostaglandin (alprostadil) analogues, ulcer healing was similar (RR 1.13; 95% CI 0.76 to 1.69; 89 participants; two studies; I² = 0%; very low quality evidence), as was the eradication of rest pain after 28 days (RR 1.57; 95% CI 0.72 to 3.44; 38 participants; one study; low quality evidence), while amputation rates were not measured. Compared with placebo, the effects of oral prostacyclin analogue iloprost were similar for: healing ischaemic ulcers (iloprost 200 mcg: RR 1.11; 95% CI 0.54 to 2.29; 133 participants; one study; moderate quality evidence, and iloprost 400 mcg: RR 0.90; 95% CI 0.42 to 1.93; 135 participants; one study; moderate quality evidence), eradication of rest pain after eight weeks (iloprost 200 mcg: RR 1.14; 95% CI 0.79 to 1.63; 207 participants; one study; moderate quality evidence, and iloprost 400 mcg: RR 1.11; 95% CI 0.77 to 1.59; 201 participants; one study; moderate quality evidence), and amputation rates after six months (iloprost 200 mcg: RR 0.54; 95% CI 0.19 to 1.56; 209 participants; one study, and iloprost 400 mcg: RR 0.42; 95% CI 0.13 to 1.31; 213 participants; one study). When comparing folic acid with placebo in patients with Buerger's disease and hyperhomocysteinaemia, pain scores were similar, there were no new cases of amputation in either group, and ulcer healing was not assessed (very low quality evidence).Treatment side effects such as headaches, flushing or nausea were not associated with treatment interruptions or more serious consequences. Outcomes such as amputation-free survival, walking distance or pain-free walking distance, and ankle brachial index were not assessed by any study.Overall, the quality of the evidence was very low to moderate, with few studies, small numbers of participants, variation in severity of disease of participants between studies and missing information regarding for example baseline tobacco exposure. AUTHORS' CONCLUSIONS Moderate quality evidence suggests that intravenous iloprost (prostacyclin analogue) is more effective than aspirin for eradicating rest pain and healing ischaemic ulcers in Buerger's disease, but oral iloprost is not more effective than placebo. Verylow and low quality evidence suggests there is no difference between prostacyclin (iloprost and clinprost) and the prostaglandin analogue alprostadil for healing ulcers and relieving pain respectively in severe Buerger's disease. Very-low quality evidence suggests there is no difference in pain scores and amputation rates between folic acid and placebo, in people with Buerger's disease and hyperhomocysteinaemia. High quality trials assessing the effectiveness of pharmacological agents (intravenous or oral) in people with Buerger's disease are needed.
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Affiliation(s)
- Daniel G Cacione
- UNIFESP – Escola Paulista de MedicinaDepartment of SurgeryRua Borges Lagoa, 564 cj 124Vila ClementinoSão PauloBrazil04038000
| | - Cristiane R Macedo
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeBrazilian Cochrane CentreRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Jose CC Baptista‐Silva
- Universidade Federal de São PauloEvidence Based Medicine, Cochrane BrazilRua Borges Lagoa, 564, cj 124São PauloSão PauloBrazil04038‐000
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Nemoto TK, Ohara-Nemoto Y, Bezerra GA, Shimoyama Y, Kimura S. A Porphyromonas gingivalis Periplasmic Novel Exopeptidase, Acylpeptidyl Oligopeptidase, Releases N-Acylated Di- and Tripeptides from Oligopeptides. J Biol Chem 2016; 291:5913-5925. [PMID: 26733202 PMCID: PMC4786725 DOI: 10.1074/jbc.m115.687566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/06/2015] [Indexed: 01/01/2023] Open
Abstract
Exopeptidases, including dipeptidyl- and tripeptidylpeptidase, are crucial for the growth of Porphyromonas gingivalis, a periodontopathic asaccharolytic bacterium that incorporates amino acids mainly as di- and tripeptides. In this study, we identified a novel exopeptidase, designated acylpeptidyl oligopeptidase (AOP), composed of 759 amino acid residues with active Ser(615) and encoded by PGN_1349 in P. gingivalis ATCC 33277. AOP is currently listed as an unassigned S9 family peptidase or prolyl oligopeptidase. Recombinant AOP did not hydrolyze a Pro-Xaa bond. In addition, although sequence similarities to human and archaea-type acylaminoacyl peptidase sequences were observed, its enzymatic properties were apparently distinct from those, because AOP scarcely released an N-acyl-amino acid as compared with di- and tripeptides, especially with N-terminal modification. The kcat/Km value against benzyloxycarbonyl-Val-Lys-Met-4-methycoumaryl-7-amide, the most potent substrate, was 123.3 ± 17.3 μm(-1) s(-1), optimal pH was 7-8.5, and the activity was decreased with increased NaCl concentrations. AOP existed predominantly in the periplasmic fraction as a monomer, whereas equilibrium between monomers and oligomers was observed with a recombinant molecule, suggesting a tendency of oligomerization mediated by the N-terminal region (Met(16)-Glu(101)). Three-dimensional modeling revealed the three domain structures (residues Met(16)-Ala(126), which has no similar homologue with known structure; residues Leu(127)-Met(495) (β-propeller domain); and residues Ala(496)-Phe(736) (α/β-hydrolase domain)) and further indicated the hydrophobic S1 site of AOP in accord with its hydrophobic P1 preference. AOP orthologues are widely distributed in bacteria, archaea, and eukaryotes, suggesting its importance for processing of nutritional and/or bioactive oligopeptides.
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Affiliation(s)
- Takayuki K Nemoto
- From the Department of Oral Molecular Biology, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Yuko Ohara-Nemoto
- From the Department of Oral Molecular Biology, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Gustavo Arruda Bezerra
- the Department of Structural and Computational Biology, Max F. Perutz Laboratories, University of Vienna, Campus Vienna Biocenter 5, 1030 Vienna, Austria, and.
| | - Yu Shimoyama
- the Division of Molecular Microbiology, Iwate Medical University, Iwate 028-3694, Japan
| | - Shigenobu Kimura
- the Division of Molecular Microbiology, Iwate Medical University, Iwate 028-3694, Japan
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Abstract
BACKGROUND Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic, segmental inflammatory pathology that most commonly affects the small and medium sized arteries, veins, and nerves in the upper and lower extremities. The etiology is unknown, but involves hereditary susceptibility, tobacco exposure, immune and coagulation responses. In many cases, there is no possibility of revascularization to improve the condition. Pharmacological treatment is an option for patients with severe complications, such as ischaemic ulcers or rest pain. OBJECTIVES To assess the effectiveness of any pharmacological agent (intravenous or oral) compared with placebo or any other pharmacological agent in patients with Buerger's disease. SEARCH METHODS The Cochrane Vascular Trials Search Co-ordinator searched their Specialised Register (last searched in April 2015) and the Cochrane Register of Studies (Issue 3, 2015). The review authors searched trial registers and the European grey literature; screened reference lists of relevant studies, and contacted study authors and major pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) involving pharmacological agents used in the treatment of Buerger's disease. DATA COLLECTION AND ANALYSIS Two review authors, independently assessed the studies, extracted data and performed data analysis. MAIN RESULTS Five randomised controlled trials (total 602 participants) compared prostacyclin analogue with placebo, aspirin, or a prostaglandin analogue, and folic acid with placebo. No studies assessed other pharmacological agents such as cilostazol, clopidogrel and pentoxifylline or compared oral versus intravenous prostanoid.Compared with aspirin, intravenous prostacyclin analogue iloprost improved ulcer healing (risk ratio (RR) 2.65; 95% confidence interval (CI) 1.15 to 6.11; 98 participants; one study; moderate quality evidence), and helped to eradicate rest pain after 28 days (RR 2.28; 95% CI 1.48 to 3.52; 133 participants; one study; moderate quality evidence), although amputation rates were similar six months after treatment (RR 0.32; 95% CI 0.09 to 1.15; 95 participants; one study; moderate quality evidence). When comparing prostacyclin (iloprost and clinprost) with prostaglandin (alprostadil) analogues, ulcer healing was similar (RR 1.13; 95% CI 0.76 to 1.69; 89 participants; two studies; I² = 0%; very low quality evidence), as was the eradication of rest pain after 28 days (RR 1.57; 95% CI 0.72 to 3.44; 38 participants; one study; low quality evidence), while amputation rates were not measured. Compared with placebo, the effects of oral prostacyclin analogue iloprost were similar for: healing ischaemic ulcers (iloprost 200 mcg: RR 1.11; 95% CI 0.54 to 2.29; 133 participants; one study; moderate quality evidence, and iloprost 400 mcg: RR 0.90; 95% CI 0.42 to 1.93; 135 participants; one study; moderate quality evidence), eradication of rest pain after eight weeks (iloprost 200 mcg: RR 1.14; 95% CI 0.79 to 1.63; 207 participants; one study; moderate quality evidence, and iloprost 400 mcg: RR 1.11; 95% CI 0.77 to 1.59; 201 participants; one study; moderate quality evidence), and amputation rates after six months (iloprost 200 mcg: RR 0.54; 95% CI 0.19 to 1.56; 209 participants; one study, and iloprost 400 mcg: RR 0.42; 95% CI 0.13 to 1.31; 213 participants; one study). When comparing folic acid with placebo in patients with Buerger's disease and hyperhomocysteinaemia, pain scores were similar, there were no new cases of amputation in either group, and ulcer healing was not assessed (very low quality evidence).Treatment side effects such as headaches, flushing or nausea were not associated with treatment interruptions or more serious consequences. Outcomes such as amputation-free survival, walking distance or pain-free walking distance, and ankle brachial index were not assessed by any study.Overall, the quality of the evidence was very low to moderate, with few studies, small numbers of participants, variation in severity of disease of participants between studies and missing information regarding for example baseline tobacco exposure. AUTHORS' CONCLUSIONS Moderate quality evidence suggests that intravenous iloprost (prostacyclin analogue) is more effective than aspirin for eradicating rest pain and healing ischaemic ulcers in Buerger's disease, but oral iloprost is not more effective than placebo. Verylow and low quality evidence suggests there is no difference between prostacyclin (iloprost and clinprost) and the prostaglandin analogue alprostadil for healing ulcers and relieving pain respectively in severe Buerger's disease. Very-low quality evidence suggests there is no difference in pain scores and amputation rates between folic acid and placebo, in people with Buerger's disease and hyperhomocysteinaemia. High quality trials assessing the effectiveness of pharmacological agents (intravenous or oral) in people with Buerger's disease are needed.
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Affiliation(s)
- Daniel G Cacione
- Department of Surgery, UNIFESP - Escola Paulista de Medicina, Rua Borges Lagoa, 564 cj 124, Vila Clementino, São Paulo, Brazil, 04038000
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Nemoto TK, Ohara-Nemoto Y. Exopeptidases and gingipains in Porphyromonas gingivalis as prerequisites for its amino acid metabolism. JAPANESE DENTAL SCIENCE REVIEW 2016; 52:22-29. [PMID: 28408952 PMCID: PMC5382784 DOI: 10.1016/j.jdsr.2015.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 01/22/2023] Open
Abstract
Porphyromonas gingivalis, an asaccharolytic bacterium, utilizes amino acids as energy and carbon sources. Since amino acids are incorporated into the bacterial cells mainly as di- and tri-peptides, exopeptidases including dipeptidyl-peptidase (DPP) and tripeptidyl-peptidase are considered to be prerequisite components for their metabolism. We recently discovered DPP11, DPP5, and acylpeptidyl oligopeptidase in addition to previously reported DPP4, DPP7, and prolyl tripeptidyl peptidase A. DPP11 is a novel enzyme specific for acidic P1 residues (Asp and Glu) and distributed ubiquitously in eubacteria, while DPP5 is preferential for the hydrophobic P1 residue and the first entity identified in prokaryotes. Recently, acylpeptidyl oligopeptidase with a preference for hydrophobic P1 residues was found to release N-terminally blocked di- and tri-peptides. Furthermore, we also demonstrated that gingipains R and K contribute to P1-basic dipeptide production. These observations implicate that most, if not all, combinations of di- and tri-peptides are produced from extracellular oligopeptides even with an N-terminal modification. Here, we review P. gingivalis exopeptidases mainly in regard to their enzymatic characteristics. These exopeptidases with various substrate specificities benefit P. gingivalis for obtaining energy and carbon sources from the nutritionally limited subgingival environment.
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Affiliation(s)
- Takayuki K. Nemoto
- Department of Oral Molecular Biology, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Igari K, Inoue Y, Iwai T. The Epidemiologic and Clinical Findings of Patients with Buerger Disease. Ann Vasc Surg 2015; 30:263-9. [PMID: 26370744 DOI: 10.1016/j.avsg.2015.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/26/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Buerger disease is a nonatherosclerotic peripheral arterial disease, which is mostly observed in young male smokers. Buerger disease is characterized by the observation of peripheral arterial occlusion by angiography. The condition may be caused by microembolization in the small-sized arteries of the distal extremities. Buerger disease is diagnosed based on the Shionoya's clinical diagnostic criteria, which include: (1) a history of smoking, (2) onset before the age of 50 years, (3) the presence of infrapopliteal arterial occlusions, (4) either upper limb involvement or phlebitis migrans, and (5) the absence of atherosclerotic risk factors other than smoking. Several studies have reported that oral bacterial infections (periodontitis) could activate the onset of Buerger disease. In this study, we report the epidemiologic and clinical manifestations of patients with Buerger disease. METHODS Fifty-eight patients who were surgically treated between July 1989 and June 2014 at Tokyo Medical and Dental University Hospital were enrolled in this study. All of the patients clinically diagnosed with Buerger disease based on Shionoya's clinical diagnostic criteria. Fifty-five male and 3 female patients were treated. The mean age of the patients was 48 years (range, 21-73 years). RESULTS All of the patients were either smokers or had a history of smoking. The mean Brinkman index score was 780 (range, 150-1,640). Their mean age at the onset of Buerger disease was 38 years (range, 21-50). The arterial lesions extended to the femoral arteries in 25% of cases, to the iliac arteries in 8% and to the abdominal aorta and/or visceral arteries in 6% of cases. Upper limb involvement, including cyanosis, paleness, and gangrene, was obvious in 84% of patients, and phlebitis migrans was recognized in 34%. The lower extremities symptoms involved intermittent claudication in 23% of the patients, rest pain in 13% of the patients, and ulceration or gangrene in 64% of the patients. Fifteen patients had undergone surgical arterial reconstruction, 4 patients had received endovascular therapy, 33 patients had undergone lumbar sympathectomy and 8 patients had undergone thoracic sympathectomy. Twenty percent of the patients needed minor limb amputations, and 4% required major limb amputations. In the patients who were examined for their oral conditions, periodontitis corresponding to grades B (moderate periodontitis), C (severe periodontitis), and D (edentulous patients) was revealed in 31%, 56%, and 13% of the patients, respectively. CONCLUSIONS More than half of the Buerger disease patients in this study were suffering from severe periodontitis. It is possible that not only the cessation of smoking, but also the improvement of periodontal care could improve the clinical symptoms related to Buerger disease.
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Affiliation(s)
- Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yoshinori Inoue
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehisa Iwai
- Department of Vascular Surgery, Tsukuba Vascular Center, Buerger Disease Research Institute, Ibaraki, Japan
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Liew NC, Lee L, Nor Hanipah Z, Gee T, Jabar MF. Pathogenesis and Management of Buerger's Disease. INT J LOW EXTR WOUND 2015; 14:231-5. [PMID: 26264874 DOI: 10.1177/1534734615599654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Buerger's disease or thromboangiitis obliterans causes pain, ulceration, or gangrene in the lower or upper extremity. It is associated with chronic cigarette smoking and is believed to be an immune mediated vasculitis. The pathogenesis is still unknown but recent postulate of its association with odontal bacteria has generated much renewed interest. Despite its recognition more than a century ago, little progress has been made in its treatment. Until the pathogenesis is elucidated, abstinence from cigarette is the only effective therapy.
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Affiliation(s)
| | - Limi Lee
- Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | | | - Tikfu Gee
- Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Fazeli B, Rezaee SA. A review on thromboangiitis obliterans pathophysiology: thrombosis and angiitis, which is to blame? Vascular 2015; 19:141-53. [PMID: 21652666 DOI: 10.1258/vasc.2010.ra0045] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A century has passed since thromboangiitis obliterans (TAO), or Buerger's disease, was first described, but the etiology remains unclear. It is still uncertain as to whether thrombosis or vascular inflammation is the first event. TAO is an episodic inflammatory and thrombotic-occlusive vascular disease of unknown origin. The involvement of the distal vessels and nerves within the neuro-vascular bundles occurs almost always in legs and occasionally in arms. The cumulative data demonstrate that at the cellular and molecular levels, at least four main components of inflammatory reactions, including endothelial cells, platelets, leukocytes and sensory neurons, might be involved in TAO pathogenesis. The interactions among these cells in an altered microenvironment of small- and medium-sized vessels may also orchestrate the onset of TAO events. In this review, the factors that may promote thrombosis and angiitis are reconsidered at three levels: (1) host characteristics such as male gender and genetic background; (2) probable triggers including cigarette smoking and infectious agents; and (3) environmental factors such as chronic anxiety and mental stress as a consequence of low socioeconomic status. At each level, the interactions among vascular endothelium, platelets, leukocytes and sensory neurons are discussed.
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Affiliation(s)
- Bahare Fazeli
- Immunology Department, Avicenna (Bu-Ali) Research Institute, Bu-Ali Sq., Ferdosi Sq., Mashhad, Khorasan Razavi, PC 91967-73117
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