4G/5G polymorphism of the plasminogen activator inhibitor-1 gene and risk of restenosis after coronary artery stenting

Evaluation of carotid intima-media thickness measurements in patients with central serous chorioretinopathy

BACKGROUND

Central serous chorioretinopathy (CSC) is a systemic disease more than a disease localized to the eye, and there may be vascular involvement in its pathogenesis.

OBJECTIVE

This study aimed to evaluate the carotid intima-media thickness (IMT) of patients with CSC, to compare it with that of healthy individuals, and to explore whether there might be an association between CSC and subclinical carotid atherosclerotic disease.

MATERIALS AND METHODS

Adult patients with CSC (n = 30) and healthy individuals (n = 30) were included in this prospective study. All participants underwent complete ophthalmologic imaging and were then referred to the radiology department. Carotid IMT measurements were performed using ultrasound imaging. Measurements of the two groups were obtained and compared.

RESULTS

There was no statistically significant difference between patients with CSC and the control group with respect to age, gender, and smoking habits. The mean (±standard deviation, SD) carotid IMT values obtained by ultrasound measurements for the right and left sides in the patient group were 0.71 mm (± 0.19) and 0.71 mm (± 0.21), respectively. The mean (±SD) carotid IMT values for the right and left sides in the control group were 0.61 mm (± 0.15) and 0.60 mm (± 0.15), respectively. The mean carotid IMT values in the patient group were significantly higher than those in the control group for the right and left sides (p = 0.02 and p = 0.03, respectively).

CONCLUSION

Carotid IMT is increased in patients with CSC compared to healthy individuals. This outcome might reinforce the benefit of carotid artery screening following diagnosis of CSC by ophthalmologists for early detection of subclinical carotid atherosclerotic disease.

The Correlation of Central Serous Chorioretinopathy and Subsequent Cardiovascular Diseases of Different Types: A Population-Based Cohort Study

The aim of the present study was to survey the relationship between central serous chorioretinopathy (CSC) and several cardiovascular diseases (CVDs) with different severities using the National Health Insurance Research Database. A retrospective cohort study was conducted. Subjects with CSC were enrolled according to the relevant diagnostic codes, and an age- and gender-matched population was used as the control group with a 1:4 ratio. The main outcome being considered was the development of CVD after CSC exposure. Cox proportional hazard regression was applied to calculate the adjusted hazard ratio (aHR) of CSC and CVD of different types. A total of 2865 patients that were diagnosed with CSC were enrolled in the study group, while another 11,460 non-CSC subjects were selected as the control group. There were 171 events of CVD which occurred in the study group, while another 557 cases were found in the control group. No significant differences were observed among the CVD cases between the study and control group, whether they had an acute or chronic form, according to the aHR. In the subgroup analysis, there was a significantly higher risk of CVD development in the male population aged from 40 to 59 years (aHR: 1.351, confidence interval (CI): 1.063–1.716), which was mainly due to the higher risk of mild CVD (aHR: 1.391, CI: 1.062–1.822). On the contrary, there was no significant difference in CVD development in any of the age subgroups of the female population. In conclusion, the existence of CSC is correlated with a higher rate of chronic CVD occurrence in the middle-aged male population.

The Effect of PAI-1 4G/5G Polymorphism and Clinical Factors on Coronary Artery Occlusion in Myocardial Infarction

Objective. Data on the impact of PAI-1-675 4G/5G genotype for fibrinolysis during myocardial infarction are inconsistent. The aim of our study was to evaluate the association of clinical and genetic (PAI-1-675 4G/5G polymorphism) factors with coronary artery occlusion in patients with myocardial infarction. Materials and Methods. PAI-1-675 4G/5G detection was achieved by using Sanger sequencing in a sample of patients hospitalized for stent implantation due to myocardial infarction. We categorized the patients into two groups: patients with coronary artery occlusion and patients without coronary artery occlusion according to angiographic evaluation. Results. We identified n = 122 (32.4%) 4G/4G, n = 186 (49.5%) 4G/5G, and n = 68 (18.1%) 5G/5G PAI-1 genotype carriers. Univariate and multivariate analysis showed that only the 4G/5G genotype was associated with coronary artery occlusion (OR: 1.656 and 95% CI: 1.009–2.718, p = 0.046). Conclusions. Our results showed that carriers of PAI-1 4G/5G genotype with myocardial infarction have increased odds of coronary artery occlusion more than 1.6 times in comparison to the carriers of homozygous genotypes.

Systematic testing of literature reported genetic variation associated with coronary restenosis: results of the GENDER Study

Background

Coronary restenosis after percutaneous coronary intervention still remains a significant problem, despite all medical advances. Unraveling the mechanisms leading to restenosis development remains challenging. Many studies have identified genetic markers associated with restenosis, but consistent replication of the reported markers is scarce. The aim of the current study was to analyze the joined effect of previously in literature reported candidate genes for restenosis in the GENetic DEterminants of Restenosis (GENDER) databank.

Methodology/Principal Findings

Candidate genes were selected using a MEDLINE search including the terms ‘genetic polymorphism’ and ‘coronary restenosis’. The final set included 36 genes. Subsequently, all single nucleotide polymorphisms (SNPs) in the genomic region of these genes were analyzed in GENDER using set-based analysis in PLINK. The GENDER databank contains genotypic data of 2,571,586 SNPs of 295 cases with restenosis and 571 matched controls. The set, including all 36 literature reported genes, was, indeed, significantly associated with restenosis, p = 0.024 in the GENDER study. Subsequent analyses of the individual genes demonstrated that the observed association of the complete set was determined by 6 of the 36 genes.

Conclusion

Despite overt inconsistencies in literature, with regard to individual candidate gene studies, this is the first study demonstrating that the joint effect of all these genes together, indeed, is associated with restenosis.

Plasminogen activator inhibitor-1 4G/5G gene polymorphism and coronary artery disease in the Chinese Han population: a meta-analysis

Background

The polymorphism of plasminogen activator inhibitor-1 (PAI-1) 4G/5G gene has been indicated to be correlated with coronary artery disease (CAD) susceptibility, but study results are still debatable.

Objective and Methods

The present meta-analysis was performed to investigate the association between PAI-1 4G/5G gene polymorphism and CAD in the Chinese Han population. A total of 879 CAD patients and 628 controls from eight separate studies were involved. The pooled odds ratio (OR) for the distribution of the 4G allele frequency of PAI-1 4G/5G gene and its corresponding 95% confidence interval (CI) was assessed by the random effect model.

Results

The distribution of the 4 G allele frequency was 0.61 for the CAD group and 0.51 for the control group. The association between PAI-1 4G/5G gene polymorphism and CAD in the Chinese Han population was significant under an allelic genetic model (OR = 1.70, 95% CI = 1.18 to 2.44, P = 0.004). The heterogeneity test was also significant (P<0.0001). Meta-regression was performed to explore the heterogeneity source. Among the confounding factors, the heterogeneity could be explained by the publication year (P = 0.017), study region (P = 0.014), control group sample size (P = 0.011), total sample size (P = 0.011), and ratio of the case to the control group sample size (RR) (P = 0.019). In a stratified analysis by the total sample size, significantly increased risk was only detected in subgroup 2 under an allelic genetic model (OR = 1.93, 95% CI = 1.09 to 3.35, P = 0.02).

Conclusions

In the Chinese Han population, PAI-1 4G/5G gene polymorphism was implied to be associated with increased CAD risk. Carriers of the 4G allele of the PAI-1 4G/5G gene might predispose to CAD.

PAI-1 in tissue fibrosis

Fibrosis is defined as a fibroproliferative or abnormal fibroblast activation-related disease. Deregulation of wound healing leads to hyperactivation of fibroblasts and excessive accumulation of extracellular matrix (ECM) proteins in the wound area, the pathological manifestation of fibrosis. The accumulation of excessive levels of collagen in the ECM depends on two factors: an increased rate of collagen synthesis and or decreased rate of collagen degradation by cellular proteolytic activities. The urokinase/tissue type plasminogen activator (uPA/tPA) and plasmin play significant roles in the cellular proteolytic degradation of ECM proteins and the maintenance of tissue homeostasis. The activities of uPA/tPA/plasmin and plasmin-dependent MMPs rely mostly on the activity of a potent inhibitor of uPA/tPA, plasminogen activator inhibitor-1 (PAI-1). Under normal physiologic conditions, PAI-1 controls the activities of uPA/tPA/plasmin/MMP proteolytic activities and thus maintains the tissue homeostasis. During wound healing, elevated levels of PAI-1 inhibit uPA/tPA/plasmin and plasmin-dependent MMP activities, and, thus, help expedite wound healing. In contrast to this scenario, under pathologic conditions, excessive PAI-1 contributes to excessive accumulation of collagen and other ECM protein in the wound area, and thus preserves scarring. While the level of PAI-1 is significantly elevated in fibrotic tissues, lack of PAI-1 protects different organs from fibrosis in response to injury-related profibrotic signals. Thus, PAI-1 is implicated in the pathology of fibrosis in different organs including the heart, lung, kidney, liver, and skin. Paradoxically, PAI-1 deficiency promotes spontaneous cardiac-selective fibrosis. In this review, we discuss the significance of PAI-1 in the pathogenesis of fibrosis in multiple organs.

Non ST-segment elevation myocardial infarction in patient with essential thrombocythemia

A 68-year-old woman presented with acute chest pain and a greatly increased platelet count. Cardiac catheterization revealed subtotal occlusion and a thrombus-like filling defect in the right coronary artery. The patient was successfully treated with intravenous tirofiban. Essential thrombocythemia was diagnosed based on bone marrow findings, clinical presentation and laboratory analysis. The relationship between intracoronary thrombus and essential thrombocythemia is discussed.

Present status of outcome prediction of invasive coronary treatment by using genetic markers

A growing number of studies suggest that the outcome after invasive coronary treatment may be in part genetically determined. Here, we review the present status of outcome prediction of invasive coronary treatments by using genetic markers. Although some studies found an association between one or another genetic marker with one or another clinical endpoint, many other studies found no such relations; to date, none of the genetic markers that have been investigated in association studies are used in routine clinical practice to prospectively assess the prognosis following invasive coronary treatment or to decide upon therapeutic strategies. Many associations between genetic markers and certain clinical endpoints were initially reported in small studies but could not be confirmed in larger ones. Some of these discrepancies may be explained by publication bias. Some genetic variants may have true effects on clinical endpoints, which, albeit biologically interesting, do not bear much clinical relevance. On the other hand, many-if not most-studies that have been published to date are more or less grossly underpowered and very rarely report on the results of an a priori power analysis. Thus, there is still a need for further high-quality studies designed to investigate the specific contribution of genetic factors to the outcome after invasive coronary interventions.

Plasminogen activator inhibitor-1 4G/5G polymorphism and efficacy of reperfusion therapy in acute myocardial infarction

Plasminogen activator inhibitor-1 (PAI-1) plays a central role in the modulation of intravascular thrombosis and thrombolysis. The level of transcription and the plasma level of PAI-1 are in part determined by the 4G/5G polymorphism in the promoter region of the gene. In this study we investigate the effect of 4G/5G polymorphism on the efficacy of reperfusion therapy in acute myocardial infarction (AMI). Two hundred and ninety-three patients were enrolled in two randomized trials comparing stenting plus abciximab with thrombolysis (alteplase alone or alteplase plus abciximab) in AMI. Patients were genotyped for the PAI-1 4G/5G polymorphism with a TaqMan assay. Technetium-99m sestamibi was injected before and 1-2 weeks after reperfusion treatment. Scintigrams were used to calculate the initial perfusion defect, the final infarct size and the salvage index representing the proportion of the initial defect salvaged by reperfusion. An 18-month clinical follow-up was carried out after reperfusion treatment. The distribution of genotypes was as follows: 4G4G in 28.0%, 4G5G in 49.5% and 5G5G in 22.5% of the patients. No significant differences between the three genotypes were detected for the final infarct size (%) of the left ventricle [median (interquartile range); 13.5 (5.0--27.0) for 4G4G patients, 12.0 (5.2--24.6) for 4G5G patients and 16 (7.1--31.2) for 5G5G patients; P=0.36], the salvage index [0.49 (0.25--0.75) in 4G4G patients, 0.47 (0.18--0.73) in 4G5G patients and 0.46 (0.22--0.62) in 5G5G patients; P=0.58] and the mortality 18 months after treatment (8.5% for 4G4G patients, 7.6% for 4G5G patients and 6.1% for 5G5G patients; P=0.85). There was no association in any of the two treatment groups (stenting and thrombolysis) between the 4G/5G genotype and myocardial salvage. The PAI-1 4G/5G polymorphism has no impact on the amount of myocardial salvage achieved by reperfusion with stenting or thrombolysis in patients with AMI.

Lack of Plasminogen Activator Inhibitor-1 Enhances the Preventive Effect of DX-9065a, a Selective Factor Xa Inhibitor, on Venous Thrombus and Acute Pulmonary Embolism in Mice

We have studied the physiological effects of DX-9065a, a selective factor Xa (FXa) inhibitor, and heparin in experimental venous thrombus and acute pulmonary embolism. Moreover, the effects of these compounds were also evaluated under the condition of plasminogen activator inhibitor-1 (PAI-1) deficiency. A thrombus was induced in the murine femoral vein. The compounds prolonged the time to occlusion in a dose-dependent manner. Pulmonary embolism was induced by continuous induction of venous thrombi in the left jugular vein. The mortality of mice increased time-dependently. Histological evidence of thromboembolism in the lung was obtained in all mice. Treatment with DX-9065a, but not heparin, reduced the mortality at 6 h after initiation of venous thrombi. In separate experiments, pulmonary thromboembolism was induced in PAI-1 knockout mice. The mortality in PAI-1 knockout mice was reduced compared with that of wild-type mice. Moreover, when DX- 9065a was administered to PAI-1 knockout mice with pulmonary thromboembolism, mice survived well without marked bleeding. These findings indicate that the dual inhibition of coagulation FXa and PAI-1 could be beneficial in the treatment of acute pulmonary embolism.

Genetics of thrombophilia: impact on atherogenesis

PURPOSE OF REVIEW

The goal of this review is to present an update on basic and epidemiological findings associating variants in prothrombotic genes with atherogenesis and atherothrombotic disease.

RECENT FINDINGS

The relation between atherosclerosis and thrombosis has long been recognized but only recently has it been understood that certain hemostatic factors affect not only thrombus formation, but also have a direct atherogenic role. Atherosclerosis is a complex disorder that results from the interaction of multiple genetic and environmental factors. Numerous polymorphisms and mutations in genes related to the hemostatic system and to vascular redox determinants that modulate nitric oxide bioavailability have been identified in the past decade; their role in atherogenesis and the risk of cardiovascular disease, however, remain uncertain. We will discuss the functional implications and association with disease risk of polymorphisms in coagulation factors (fibrinogen, prothrombin, and factor V); fibrinolytic factors (plasminogen activator inhibitor 1 and lipoprotein(a)); platelet surface receptors; and vascular redox determinants (methylenetetrahydrofolate reductase, endothelial nitric oxide synthase, and the antioxidant enzymes cellular glutathione peroxidase and paraoxonase).

SUMMARY

Overall, these genetic variants have a modest effect on risk when considered individually but gain potency when acting synergistically with other genetic or environmental risk factors. We conclude that a better characterization of these interactions, in addition to the identification of potential novel genetic determinants, constitute key issues in the future understanding of the pathogenesis of atherothrombosis.