1
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Manukjan N, Chau S, Caiment F, van Herwijnen M, Smeets HJ, Fulton D, Ahmed Z, Blankesteijn WM, Foulquier S. Wnt7a Decreases Brain Endothelial Barrier Function Via β-Catenin Activation. Mol Neurobiol 2024; 61:4854-4867. [PMID: 38147228 PMCID: PMC11236883 DOI: 10.1007/s12035-023-03872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
The blood-brain barrier consists of tightly connected endothelial cells protecting the brain's microenvironment from the periphery. These endothelial cells are characterized by specific tight junction proteins such as Claudin-5 and Occludin, forming the endothelial barrier. Disrupting these cells might lead to blood-brain barrier dysfunction. The Wnt/β-catenin signaling pathway can regulate the expression of these tight junction proteins and subsequent barrier permeability. The aim of this study was to investigate the in vitro effects of Wnt7a mediated β-catenin signaling on endothelial barrier integrity. Mouse brain endothelial cells, bEnd.3, were treated with recombinant Wnt7a protein or XAV939, a selective inhibitor of Wnt/β-catenin mediated transcription to modulate the Wnt signaling pathway. The involvement of Wnt/HIF1α signaling was investigated by inhibiting Hif1α signaling with Hif1α siRNA. Wnt7a stimulation led to activation and nuclear translocation of β-catenin, which was inhibited by XAV939. Wnt7a stimulation decreased Claudin-5 expression mediated by β-catenin and decreased endothelial barrier formation. Wnt7a increased Hif1α and Vegfa expression mediated by β-catenin. However, Hif1α signaling pathway did not regulate tight junction proteins Claudin-5 and Occludin. Our data suggest that Wnt7a stimulation leads to a decrease in tight junction proteins mediated by the nuclear translocation of β-catenin, which hampers proper endothelial barrier formation. This process might be crucial in initiating endothelial cell proliferation and angiogenesis. Although HIF1α did not modulate the expression of tight junction proteins, it might play a role in brain angiogenesis and underlie pathogenic mechanisms in Wnt/HIF1α signaling in diseases such as cerebral small vessel disease.
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Affiliation(s)
- Narek Manukjan
- Department of Pharmacology and Toxicology, Maastricht University, 50 Universiteitssingel, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- CARIM-School for Cardiovascular Diseases, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
| | - Steven Chau
- Department of Pharmacology and Toxicology, Maastricht University, 50 Universiteitssingel, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Florian Caiment
- Department of Toxicogenomics, GROW - School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Marcel van Herwijnen
- Department of Toxicogenomics, GROW - School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Hubert J Smeets
- Department of Toxicogenomics, GROW - School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- MHeNs-School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Daniel Fulton
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
| | - Zubair Ahmed
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK.
- Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - W Matthijs Blankesteijn
- Department of Pharmacology and Toxicology, Maastricht University, 50 Universiteitssingel, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
- CARIM-School for Cardiovascular Diseases, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
| | - Sébastien Foulquier
- Department of Pharmacology and Toxicology, Maastricht University, 50 Universiteitssingel, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
- CARIM-School for Cardiovascular Diseases, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
- MHeNs-School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
- Department of Neurology, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands.
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2
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Gao Y, Li D, Lin J, Thomas AM, Miao J, Chen D, Li S, Chu C. Cerebral small vessel disease: Pathological mechanisms and potential therapeutic targets. Front Aging Neurosci 2022; 14:961661. [PMID: 36034144 PMCID: PMC9412755 DOI: 10.3389/fnagi.2022.961661] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Cerebral small vessel disease (CSVD) represents a diverse cluster of cerebrovascular diseases primarily affecting small arteries, capillaries, arterioles and venules. The diagnosis of CSVD relies on the identification of small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, and microbleeds using neuroimaging. CSVD is observed in 25% of strokes worldwide and is the most common pathology of cognitive decline and dementia in the elderly. Still, due to the poor understanding of pathophysiology in CSVD, there is not an effective preventative or therapeutic approach for CSVD. The most widely accepted approach to CSVD treatment is to mitigate vascular risk factors and adopt a healthier lifestyle. Thus, a deeper understanding of pathogenesis may foster more specific therapies. Here, we review the underlying mechanisms of pathological characteristics in CSVD development, with a focus on endothelial dysfunction, blood-brain barrier impairment and white matter change. We also describe inflammation in CSVD, whose role in contributing to CSVD pathology is gaining interest. Finally, we update the current treatments and preventative measures of CSVD, as well as discuss potential targets and novel strategies for CSVD treatment.
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Affiliation(s)
- Yue Gao
- Department of Neurointervention and Neurological Intensive Care, Dalian Municipal Central Hospital, Dalian, China
| | - Di Li
- Department of Neurointervention and Neurological Intensive Care, Dalian Municipal Central Hospital, Dalian, China
| | - Jianwen Lin
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
| | - Aline M. Thomas
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institution, Baltimore, MD, United States
| | - Jianyu Miao
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
| | - Dong Chen
- Department of Neurosurgery, Dalian Municipal Central Hospital, Dalian, China
| | - Shen Li
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chengyan Chu
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
- *Correspondence: Chengyan Chu,
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3
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Yang M, Houck KL, Dong X, Hernandez M, Wang Y, Nathan SS, Wu X, Afshar-Kharghan V, Fu X, Cruz MA, Zhang J, Nascimbene A, Dong JF. Hyperadhesive von Willebrand Factor Promotes Extracellular Vesicle-Induced Angiogenesis: Implication for LVAD-Induced Bleeding. JACC Basic Transl Sci 2022; 7:247-261. [PMID: 35411318 PMCID: PMC8993768 DOI: 10.1016/j.jacbts.2021.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022]
Abstract
VWF in patients on LVAD supports was hyperadhesive, activated platelets, and generated platelet-derived extracellular vesicles. Extracellular vesicles from LVAD patients and those from shear-activated platelets promoted aberrant angiogenesis in a VWF-dependent manner. The activated VWF exposed the A1 domain through the synergistic actions of oxidative stress and HSS generated in LVAD-driven circulation.
Bleeding associated with left ventricular assist device (LVAD) implantation has been attributed to the loss of large von Willebrand factor (VWF) multimers to excessive cleavage by ADAMTS-13, but this mechanism is not fully supported by the current evidence. We analyzed VWF reactivity in longitudinal samples from LVAD patients and studied normal VWF and platelets exposed to high shear stress to show that VWF became hyperadhesive in LVAD patients to induce platelet microvesiculation. Platelet microvesicles activated endothelial cells, induced vascular permeability, and promoted angiogenesis in a VWF-dependent manner. Our findings suggest that LVAD-driven high shear stress primarily activates VWF, rather than inducing cleavage in the majority of patients.
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Key Words
- ADAMTS-13:Ag, ADAMTS-13 antigen
- AVS, aortic vascular segment
- EC, endothelial cell
- EV, extracellular vesicle
- EVFP, extracellular vesicle–free plasma
- GI, gastrointestinal
- GOF, gain of function
- GP, glycoprotein
- GPM, growth factor-poor medium
- GRM, growth factor-rich medium
- HSS, high shear stress
- LVAD, left ventricular assist device
- PS, phosphatidylserine
- SIPA, shear-induced platelet aggregation
- ULVWF, ultra-large von Willebrand factor
- VEGF, vascular endothelial growth factor
- VWF, von Willebrand factor
- VWF:Ag, von Willebrand factor antigen
- VWF:CB, von Willebrand factor binding to collagen
- VWF:pp, von Willebrand factor propeptide
- aVWS, acquired von Willebrand syndrome
- angiogenesis
- extracellular vesicles
- left ventricular assist devices
- pEV, extracellular vesicle from von Willebrand factor-activated platelets
- platelets
- shear stress
- von Willebrand factor
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Affiliation(s)
- Mengchen Yang
- Bloodworks Research Institute, Seattle, Washington, USA.,Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Katie L Houck
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Xinlong Dong
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Maria Hernandez
- Center for Advanced Heart Failure, University of Texas at Houston, Houston, Texas, USA
| | - Yi Wang
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Sriram S Nathan
- Center for Advanced Heart Failure, University of Texas at Houston, Houston, Texas, USA
| | - Xiaoping Wu
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vahid Afshar-Kharghan
- Division of Internal Medicine, Department of Pulmonary Medicine, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Xiaoyun Fu
- Bloodworks Research Institute, Seattle, Washington, USA
| | - Miguel A Cruz
- Cardiovascular Research Section, Department of Medicine, Baylor College of Medicine.,Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Angelo Nascimbene
- Center for Advanced Heart Failure, University of Texas at Houston, Houston, Texas, USA
| | - Jing-Fei Dong
- Bloodworks Research Institute, Seattle, Washington, USA.,Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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4
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Quick S, Moss J, Rajani RM, Williams A. A Vessel for Change: Endothelial Dysfunction in Cerebral Small Vessel Disease. Trends Neurosci 2020; 44:289-305. [PMID: 33308877 DOI: 10.1016/j.tins.2020.11.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/24/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
The blood vessels of the brain are lined with endothelial cells and it has been long known that these help to regulate blood flow to the brain. However, there is increasing evidence that these cells also interact with the surrounding brain tissue. These interactions change when the endothelial cells become dysfunctional and have an impact in diseases such as cerebral small vessel disease, the leading cause of vascular dementia. In this review, we focus on what endothelial dysfunction is, what causes it, how it leads to surrounding brain pathology, how researchers can investigate it with current models, and where this might lead in the future for dementia therapies.
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Affiliation(s)
- Sophie Quick
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK
| | - Jonathan Moss
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK
| | - Rikesh M Rajani
- UK Dementia Research Institute at UCL, University College London, London, UK
| | - Anna Williams
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK.
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5
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Li J, Lai H, Chen S, Kickler T, Lai S. Cocaine use modifies the association between antiretroviral therapy and endothelial dysfunction among adults with HIV infection. J Med Virol 2019; 91:1660-1667. [PMID: 31144332 DOI: 10.1002/jmv.25507] [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: 02/07/2019] [Revised: 05/03/2019] [Accepted: 05/12/2019] [Indexed: 11/05/2022]
Abstract
Cocaine is commonly used among HIV-infected people and may worsen HIV disease progression. In addition, existing evidence suggests a link between antiretroviral regimens and endothelial dysfunction. This study aimed to examine whether the associations of antiretroviral therapy (ART) regimens with endothelial dysfunction may be modified by cocaine use in adults with HIV infection. Between 2003 and 2014, 466 HIV-positive participants residing in Baltimore, Maryland, were enrolled in a study investigating comorbidities associated with HIV/ART. The associations between various risk factors and endothelial dysfunction indicators were examined by robust regression models fitted for the overall subjects and cocaine subgroups, separately. Duration of nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based therapy was negatively associated with plasma vWF:Ag levels in cocaine non-users (β = -.715, SE = .220, P < .05). However, cocaine users on longer-term NNRTI-based regimens had greater plasma endothelin-1 (ET-1) concentrations than their counterparts (β = .003, SE = .001, P < .05). In addition, current cigarette smoking was significantly positively associated with ET-1 concentrations in both cocaine non-users (β = .609, SE = .164, P < .05) and cocaine users (β = .331, SE = .086, P < .05). In conclusion, cocaine use modified the potential effects of NNRTI-based therapy on biomarkers of endothelial dysfunction. These findings suggested that reduction in cocaine use may improve endothelial function in HIV-infected cocaine users.
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Affiliation(s)
- Ji Li
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hong Lai
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shaoguang Chen
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Thomas Kickler
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shenghan Lai
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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6
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Fenton M, Simmonds J, Shah V, Brogan P, Klein N, Deanfield J, Burch M. Inflammatory Cytokines, Endothelial Function, and Chronic Allograft Vasculopathy in Children: An Investigation of the Donor and Recipient Vasculature After Heart Transplantation. Am J Transplant 2016; 16:1559-68. [PMID: 26614396 DOI: 10.1111/ajt.13643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/17/2015] [Accepted: 11/22/2015] [Indexed: 01/25/2023]
Abstract
Chronic allograft vasculopathy (CAV) limits the lifespan of pediatric heart transplant recipients. We investigated blood markers of inflammation, endothelial dysfunction, and damage to both the native and transplanted vasculature in children after heart transplantation. Serum samples were taken from pediatric heart transplant recipients for markers of inflammation and endothelial activation. The systemic vasculature was investigated using brachial artery flow-mediated dilatation and carotid artery intima-medial hyperplasia. CAV was investigated using intravascular ultrasound. Mean intima-media thickness (mIMT) > 0.5 mm was used to define significant CAV. Forty-eight children (25 male) aged 8-18 years were enrolled in the study. Patients were a median (interquartile range) 4.1 (2.2-8.7) years after transplant. Patients had increased levels of circulating IL6 (3.86 [2.84-4.95] vs. 1.66 [1.22-2.63] p < 0.0001), vascular cell adhesion molecule 1 (539 [451-621] vs. 402 [342-487] p < 0.001), intracellular adhesion molecule 1 305 (247-346) vs. 256 (224-294) p = 0.002 and thrombomodulin (7.1 [5.5-8.1] vs. 3.57 [3.03-4.71] p < 0.0001) and decreased levels of tumor necrosis factor-α, E selectin, and P selectin, compared with controls. The systemic vasculature was unaffected. Patients with severe CAV had raised serum von Willebrand factor and decreased serum thrombomodulin. Posttransplant thrombomodulin levels are elevated after transplant but significantly lower in those with mIMT > 0.5 mm. This suggests that subclinical inflammation is present and that natural anticoagulant/thrombomodulin activity is important after transplant.
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Affiliation(s)
- M Fenton
- Department of Cardiothoracic Transplant, Great Ormond Street Hospital, London, UK
| | - J Simmonds
- Department of Cardiothoracic Transplant, Great Ormond Street Hospital, London, UK
| | - V Shah
- UCL Institute of Child Health, Great Ormond Street Hospital, London, UK
| | - P Brogan
- UCL Institute of Child Health, Great Ormond Street Hospital, London, UK
| | - N Klein
- UCL Institute of Child Health, Great Ormond Street Hospital, London, UK
| | - J Deanfield
- UCL Institute of Cardiovascular Sciences, London, UK
| | - M Burch
- Department of Cardiothoracic Transplant, Great Ormond Street Hospital, London, UK
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7
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Colombo PC, Onat D, Harxhi A, Demmer RT, Hayashi Y, Jelic S, LeJemtel TH, Bucciarelli L, Kebschull M, Papapanou P, Uriel N, Schmidt AM, Sabbah HN, Jorde UP. Peripheral venous congestion causes inflammation, neurohormonal, and endothelial cell activation. Eur Heart J 2014; 35:448-54. [PMID: 24265434 PMCID: PMC3924182 DOI: 10.1093/eurheartj/eht456] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIMS Volume overload and venous congestion are typically viewed as a consequence of advanced and of acute heart failure (HF) and renal failure (RF) although it is possible that hypervolaemia itself might be a critical intermediate in the pathophysiology of these diseases. This study aimed at elucidating whether peripheral venous congestion is sufficient to promote changes in inflammatory, neurohormonal, and endothelial phenotype similar to those observed in HF and RF. METHODS To experimentally model peripheral venous congestion, we developed a new method (so-called venous stress test) and applied the methodology on 24 healthy subjects (14 men, age 35 ± 2 years). Venous arm pressure was increased to ∼30 mmHg above the baseline level by inflating a tourniquet cuff around the dominant arm (test arm). Blood and endothelial cells (ECs) were sampled from test and control arm (lacking an inflated cuff) before and after 75 min of venous congestion, using angiocatheters and endovascular wires. Magnetic beads coated with EC-specific antibodies were used for EC separation; amplified mRNA was analysed by Affymetrix HG-U133 Plus 2.0 Microarray. RESULTS Plasma interleukin-6 (IL-6), endothelin-1 (ET-1), angiotensin II (AII), vascular cell adhesion molecule-1 (VCAM-1), and chemokine (C-X-C motif) ligand 2 (CXCL2) were significantly increased in the congested arm. A total of 3437 mRNA probe sets were differentially expressed (P < 0.05) in venous ECs before vs. after testing, including ET-1, VCAM-1, and CXCL2. CONCLUSION Peripheral venous congestion causes release of inflammatory mediators, neurohormones, and activation of ECs. Overall, venous congestion mimicked, notable aspects of the phenotype typical of advanced and of acute HF and RF.
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Affiliation(s)
- Paolo C. Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA,Corresponding author. Tel: +1 2123052638, Fax: +1 2123057439,
| | - Duygu Onat
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Ante Harxhi
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Ryan T. Demmer
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, NY, USA
| | - Yacki Hayashi
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sanja Jelic
- Division of Pulmonary, Columbia University Medical Center, New York, NY, USA
| | - Thierry H. LeJemtel
- Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - Panos Papapanou
- Department of Periodontology, Columbia University Medical Center, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Ann Marie Schmidt
- Division of Endocrinology, Department of Medicine, New York University, New York, NY, USA
| | - Hani N. Sabbah
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Ulrich P. Jorde
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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8
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Kistorp C, Chong AY, Gustafsson F, Galatius S, Raymond I, Faber J, Lip GY, Hildebrandt P. Biomarkers of endothelial dysfunction are elevated and related to prognosis in chronic heart failure patients with diabetes but not in those without diabetes. Eur J Heart Fail 2014; 10:380-7. [DOI: 10.1016/j.ejheart.2008.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 12/30/2007] [Accepted: 02/19/2008] [Indexed: 12/25/2022] Open
Affiliation(s)
- Caroline Kistorp
- Department of Endocrinology; Herlev University Hospital; Copenhagen Denmark
| | - Aun Y. Chong
- Haemostasis Thrombosis and Vascular Biology Unit; University Department of Medicine, City Hospital; Birmingham United Kingdom
| | - Finn Gustafsson
- Department of Cardiology; State University Hospital (Rigshospitalet); Copenhagen Denmark
| | - Søren Galatius
- Department of Cardiology; Gentofte University Hospital; Denmark
| | - Ilan Raymond
- Department of Cardiology; Gentofte University Hospital; Denmark
| | - Jens Faber
- Department of Endocrinology; Herlev University Hospital; Copenhagen Denmark
| | - Gregory Y.H. Lip
- Haemostasis Thrombosis and Vascular Biology Unit; University Department of Medicine, City Hospital; Birmingham United Kingdom
| | - Per Hildebrandt
- Department of Medicine; Roskilde University Hospital; Denmark
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9
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Zhao JL, Yang YJ, Pei WD, Sun YH, Zhai M, Liu YX, Gao RL. Carvedilol reduces myocardial no-reflow by decreasing endothelin-1 via activation of the ATP-sensitive K+ channel. Perfusion 2008; 23:111-5. [PMID: 18840580 DOI: 10.1177/0267659108094628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It has been verified that carvedilol can attenuate myocardial no-reflow. However, the effects of carvedilol on adenosine triphosphate-sensitive K+ (KATP) channel and endothelin-1 (ET-1) are unknown. Forty mini-swines were randomized into 5 study groups: 8 control, 8 carvedilol pretreatment, 8 glibenclamide (KATP channel blocker)-treated, 8 carvedilol and glibenclamide-pre-treated and 8 sham-operated. An acute myocardial infarction(AMI) and reperfusion model was created with a three-hour occlusion of the left anterior descending coronary artery followed by one-hour reperfusion. Compared with the control group, carvedilol significantly decreased the area of no-reflow (myocardial contrast echocardiography: from 78.5±4.5% to 24.9±4.1%, pathological means: from 82.3±1.9% to 25.8±4.3% of ligation area, respectively; all p < 0.01) and reduced necrosis size from 98.5±1.3% to 74.4±4.7% of ligation area, p < 0.05). It also decreased plasma ET-1 and myocardial tissue ET-1. However, glibenclamide abrogated the protective effect of carvedilol. The beneficial effect of carvedilol on myocardial no-reflow could be due to its effect on ET-1 via the activation of the KATP channel.
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Affiliation(s)
- JL Zhao
- Department of Cardiology, Cardiovascular Institute and Fu-Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - YJ Yang
- Department of Cardiology, Cardiovascular Institute and Fu-Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - WD Pei
- Department of Cardiology, Cardiovascular Institute and Fu-Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - YH Sun
- Department of Cardiology, Cardiovascular Institute and Fu-Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - M Zhai
- Department of Cardiology, Cardiovascular Institute and Fu-Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - YX Liu
- Department of Cardiology, Cardiovascular Institute and Fu-Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - RL Gao
- Department of Cardiology, Cardiovascular Institute and Fu-Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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10
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Szapáry L, Horváth B, Márton Z, Fehér G, Tóth K, Komoly S. Effect of atorvastatin treatment on the hemorheological and hemostaseological parameters in chronic cerebrovascular patients. Orv Hetil 2008; 149:1117-23. [DOI: 10.1556/oh.2008.28267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cerebrovascularis betegekben gyakoriak a haemorrheologiai és haemostaseologiai paraméterek kóros eltérései. A statinok az ischaemiás stroke prevenciójában hatékonyan alkalmazható szerek, kedvező hatásuk hátterében a lipidszint csökkentése mellett egyéb tényezők is igazolhatók.
Célok:
Tanulmányukban a szerzők áttekintik az atorvastatin stroke-prevencióval, haemorrheologiai és haemostaseologiai hatásaival kapcsolatos irodalmi adatokat, hivatkozva egy korábbi vizsgálatuk eredményeire, mely kis dózisú atorvastatinkezelés rövid távú haemorrheologiai, valamint endothel-diszfunkcióra és a thrombocytaaggregációra gyakorolt effektusait vizsgálta.
Módszerek:
27 krónikus, hyperlipidaemiás agyérbetegnél (átlagéletkor: 61 ± 8 év) meghatározták a szérumlipidszinteket, a haemorrheologiai paramétereket (haematocrit, plazmafibrinogén-koncentráció, plazma- és teljesvér-viszkozitás, vörösvértest-aggregáció és -deformabilitás), a thrombocytaaggregációt kiinduláskor, majd 1 és 3 hónappal napi 10 mg atorvastatinkezelést követően. Az endothel-diszfunkciót jelző von Willebrand-faktor aktivitását a kezelés előtt, majd 1 hónap múlva mérték meg.
Eredmények:
A plazmakoleszterin-szint átlagos csökkenése 1, illetve 3 hónap múlva egyaránt 28% volt (
p
< 0,001), az LDL-koleszterin-szint 40%-kal, illetve 38%-kal (
p
< 0,001) csökkent a kiindulási értékhez képest. Az atorvastatinkezelés a teljesvér-viszkozitást a 3. hónap végére, míg a vvt-deformabilitást már az első hónap végére szignifikánsan csökkentette (
p
< 0,05). A kollagén indukálta thrombocytaaggregáció a kiindulási értékhez képest szignifikánsan csökkent (
p
< 0,001) változatlan antiaggregációs kezelés mellett. Szintén szignifikánsan javult a von Willebrand-faktor-aktivitás már 1 hónapos kezelést követően (
p
< 0,05).
Következtetések:
Mind az irodalmi, mind a szerzők saját eredményei az atorvastatin komplex, kedvező hatására utalnak. A lipidcsökkentő effektus mellett a kis dózisban és rövid ideig alkalmazott atorvastatin javítja a haemorrheologiai paramétereket, a thrombocytaaggregációt és az endothel-diszfunkciót.
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Affiliation(s)
- László Szapáry
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar Neurológiai Klinika Pécs Rét u. 2. 7623
| | - Beáta Horváth
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs
| | - Zsolt Márton
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs
| | - Gergely Fehér
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar Neurológiai Klinika Pécs Rét u. 2. 7623
| | - Kálmán Tóth
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs
| | - Sámuel Komoly
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar Neurológiai Klinika Pécs Rét u. 2. 7623
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11
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Dengler TJ, Gleissner CA, Klingenberg R, Sack FU, Schnabel PA, Katus HA. Biomarkers After Heart Transplantation: Nongenomic. Heart Fail Clin 2007; 3:69-81. [DOI: 10.1016/j.hfc.2007.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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12
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Silverborn M, Ambring A, Nilsson F, Friberg P, Jeppsson A. Vascular resistance and endothelial function in cyclosporine-treated lung transplant recipients. Transpl Int 2006; 19:974-81. [PMID: 17081226 DOI: 10.1111/j.1432-2277.2006.00372.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The majority of patients undergoing solid organ transplantation develop hypertension, to which vasoconstriction and impaired endothelial function have been suggested to contribute. We compared basal vascular resistance and nitric oxide-mediated endothelial-dependent and independent vasoreactivity between cyclosporine-treated lung transplant recipients and healthy subjects. Forearm blood flow was measured by venous occlusion plethysmography at rest and during acetylcholine, glyceryltrinitrate and N(G)-monomethyl-L-arginine acetate (L-NMMA) infusion in 11 lung transplant recipients 3-5 years after transplantation and in eight healthy subjects. Forearm vascular resistance (FVR) was calculated. Plasma levels of endothelin-1 (ET-1) and von Willebrand factor (vWf) were analysed. Basal vascular resistance was 40% lower in transplant recipients than in healthy subjects (P = 0.021). Endothelial-dependent and independent vasodilation did not differ. Plasma levels of ET-1 and vWf were higher in transplant recipients (P = 0.009 and P < 0.001 respectively). There was a significant correlation between ET-1 levels and FVR in healthy subjects (r = 0.83, P = 0.042), but not in transplant recipients (r = -0.14, P = 0.70). The findings oppose the theory of generalized vasoconstriction and impaired endothelial function in the pathogenesis of hypertension after transplantation. Increased plasma levels of ET-1 do not cause increased FVR in lung transplant recipients.
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Affiliation(s)
- Martin Silverborn
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Chamorro CI, Almenar L, Martínez-Dolz L, Reganon E, Sánchez-Lacuesta E, Villa P, Ten F, Andrés L, Martínez-Sales V, Salvador A. Usefulness of von Willebrand Factor in Cardiac Allograft Vasculopathy: Preliminary Experience. Transplant Proc 2006; 38:2566-8. [PMID: 17098004 DOI: 10.1016/j.transproceed.2006.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a disease that significantly limits the survival of transplant patients intravascular ultrasound (IVUS) is considered the method of choice for its diagnosis. von Willebrand factor (vWf) has been used as a marker of endothelial malfunction. We sought to evaluate the usefulness of vWf as a CAV marker. MATERIALS AND METHODS We prospectively analyzed 22 cardiac transplant subjects, on whom we performed a first study using coronary angiography and IVUS at 36 +/- 3 days and a second study at 598 +/- 49 days. During the follow-up period, five vWf serum controls were performed per patient. We analyzed the results with the repeated-measures ANOVA test and a ROC curve. RESULTS CAV was detected in 10 (45.5%) of the 22 patients. Although vWf levels tended to diminish progressively during evolution, this trend was not statistically significant (P = .3). However, differences were appreciated based on the presence versus absence of CAV (298 +/- 139 mg/dL versus 212 +/- 105 mg/dL, P = .02). The ROC curve showed a sensitivity of 40%, a specificity of 83%, and a negative predictive value of 82% with a cutoff point of 300 mg/dL. CONCLUSIONS Subjects with CAV showed significantly higher vWf serum concentrations, particularly during the preliminary phases of cardiac transplantation decreasing during its evolution. This marker could be useful for early screening of CAV.
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Affiliation(s)
- C I Chamorro
- Cardiac Failure and Transplant Unit, La Fe University Hospital, Valencia, Spain.
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14
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Wojnicz R, Nowak J, Szyguła-Jurkiewicz B, Wilczek K, Lekston A, Trzeciak P, Nowalany-Kozielska E, Zembala M, Wodniecki J, Poloński L. Adjunctive therapy with low-molecular-weight heparin in patients with chronic heart failure secondary to dilated cardiomyopathy: one-year follow-up results of the randomized trial. Am Heart J 2006; 152:713.e1-7. [PMID: 16996844 DOI: 10.1016/j.ahj.2006.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2006] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Defective endothelial function has been shown in dilated cardiomyopathy. Therefore, improvement in endothelial function after low-molecular-weight heparin (LMWH) therapy may be clinically beneficial. Consequently, the effect of adjunct enoxaparin, a LMWH, on standard treatment of dilated cardiomyopathy was investigated. METHODS This was a randomized, standard treatment-controlled, 2-center pilot trial of 102 patients (52 receiving adjunctive therapy with enoxaparin at a dosage of 1.5 mg/kg daily for 3 months and 50 receiving standard therapy with angiotensin-converting enzyme inhibitors, beta-blockers, and diuretics alone) with stable chronic heart failure secondary to dilated cardiomyopathy (New York Heart Association [NYHA] class II and III; left ventricular [LV] ejection fraction, < or = 40%). All patients underwent coronary angiography and endomyocardial biopsy and were clinically stable for at least 6 months before enrollment. The combined primary end point included mortality, urgent heart transplantation, and readmission to hospital due to heart failure progression. The secondary end point was to determine the severity of heart failure (serum level of N-terminal brain natriuretic peptide), cardiac function (LV ejection fraction by radionuclide ventriculography), LV diameters by echocardiography, exercise capacity (changes in NYHA class, changes in peak oxygen consumption), and changes in quality of life (Minnesota Living with Heart Failure questionnaire). The clinical outcome was assessed after 6 and 12 months of therapy. RESULTS Baseline characteristics were comparable in both groups. Five patients dropped out during 12 months of the study. Twelve patients achieved primary end point (8 in the control group and 4 in the LMWH group). The free survival rate was 94% for the LMWH group and 90% for the controls (not statistically significant). After the 12-month period, in the LMWH group, N-terminal brain natriuretic peptide level and LV diameters decreased significantly (P < .001 and P = .006, respectively), whereas LV systolic function increased (P < .001). Changes in exercise capacity and subjective improvement did not differentiate the groups (nonsignificant). Adverse reactions to the enoxaparin therapy were minor and transient. CONCLUSIONS In patients with chronic heart failure due to dilated cardiomyopathy, adjunct long-term enoxaparin therapy may offer additional clinical benefit without deleterious effects on major cardiac events.
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Affiliation(s)
- Romuald Wojnicz
- 3rd Department of Cardiology, Silesian Center of Heart Disease, Silesian Medical University, Zabrze, Poland.
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15
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Wang YZ, Goetze JP, Videbaek R, Rehfeld JF, Kastrup J. Increased circulating endothelins are not of cardiopulmonary origin in heart failure patients. Scandinavian Journal of Clinical and Laboratory Investigation 2005; 65:341-7. [PMID: 16076689 DOI: 10.1080/00365510510025683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Plasma concentrations of endothelin-1 and big-endothelin are increased in heart failure patients. However, the precise contribution of endothelin secretion from the cardiopulmonary system remains unresolved. The aim of this study was to investigate whether the cardiopulmonary system contributes to the circulating endothelin-1 and big-endothelin concentrations in heart failure patients. MATERIAL AND METHODS Blood samples were obtained at right heart catheterization from different cardiovascular regions including the coronary sinus in chronic heart failure patients (n=12) and from age-matched control subjects (n=12). RESULTS The peripheral plasma concentrations of endothelin-1 were almost 3-fold higher in heart failure patients compared with the control subjects (1.25 pmol/l, 0.30-8.20 pmol/l (median, range) versus 0.46 pmol/l, 0.10-0.88 pmol/l, p<0.01). However, the endothelin-1 concentration was approximately 25% lower in plasma samples from the coronary sinus than in plasma from the inferior caval vein (p<0.05) in the heart failure patients. There were no differences in big-endothelin concentrations between any of the cardiovascular regions. CONCLUSIONS In heart failure patients, increased plasma concentrations of endothelin-1 and big-endothelin mainly reflect an increased secretion from the peripheral endothelium.
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Affiliation(s)
- Y Z Wang
- Medical Department B, Cardiac Catheterization Laboratory, the Heart Centre, and Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Denmark.
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16
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Tarnow I, Kristensen AT, Olsen LH, Pedersen HD. Assessment of changes in hemostatic markers in Cavalier King Charles Spaniels with myxomatous mitral valve disease. Am J Vet Res 2004; 65:1644-52. [PMID: 15631028 DOI: 10.2460/ajvr.2004.65.1644] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate markers of hemostasis and their relationship to the degree of mitral regurgitation (MR) and platelet function in Cavalier King Charles Spaniels (CKCSs) with myxomatous mitral valve disease. ANIMALS 76 clinically healthy CKCSs and 24 control dogs. PROCEDURE All dogs underwent echocardiographic examination; various hemostatic, hematologic, and biochemical variables were evaluated in blood. The CKCSs were allocated to 1 of 3 groups on the basis of MR severity. In 8 control dogs and 8 CKCSs, plasma von Willebrand factor (vWF) multimer analysis was performed. RESULTS Compared with control dogs, plasma fibrinogen concentration was higher in all CKCSs and related to left ventricular end diastolic diameter and left atrial-to-aortic root ratio among all CKCSs. The activated partial thromboplastin times and plasma D-dimer concentration were similar among the 4 groups. Plasma vWF concentration was lower in CKCSs with moderate to severe MR, compared with that of CKCSs with no MR and control dogs. There was a relationship between plasma vWF concentration and platelet function in CKCSs but not in control dogs. In 4 CKCSs with moderate to severe MR and low plasma vWF concentration, amounts of vWF high-molecular-weight multimers (HMWMs) were low. CONCLUSIONS AND CLINICAL RELEVANCE In CKCSs, MR appeared to be associated with a low plasma vWF concentration and likely a loss of vWF HMWMs (possibly through their destruction via shear stress to the blood). The importance of the changes in plasma fibrinogen concentration and the thromboembolic risk in dogs with MR remain to be investigated.
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Affiliation(s)
- Inge Tarnow
- Departments of Animal and Veterinary Basic Sciences, The Royal Veterinary and Agricultural University, 1870 Frederiksberg C, Denmark
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17
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Szapary L, Horvath B, Marton Z, Alexy T, Kesmarky G, Habon T, Szots M, Koltai K, Juricskay I, Czopf J, Toth K. Short-term effect of low-dose atorvastatin on haemorrheological parameters, platelet aggregation and endothelial function in patients with cerebrovascular disease and hyperlipidaemia. CNS Drugs 2004; 18:165-72. [PMID: 14871160 DOI: 10.2165/00023210-200418030-00003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION AND OBJECTIVE Haemorrheological parameters and endothelial function are known to be altered in vascular diseases, including stroke. Treatment with HMG-CoA reductase inhibitors ('statins') improves cerebrovascular (and cardiovascular) morbidity and mortality in patients with atherosclerosis; the beneficial effects may involve lipid-independent mechanisms. The aim of this study was to assess the short-term effect of low-dose atorvastatin on haemorrheological parameters, platelet aggregation and endothelial dysfunction in patients with chronic cerebrovascular disease and hyperlipidaemia. PATIENTS AND METHODS Twenty-seven patients (mean age 61 +/- 8 years) with chronic cerebrovascular disease and hyperlipidaemia were included in the study. Serum lipid levels, haemorrheological parameters (haematocrit, plasma fibrinogen levels, plasma and whole blood viscosity [WBV] and red blood cell [RBC] aggregation and deformability) and platelet aggregation were assessed at baseline and after 1 and 3 months of treatment with atorvastatin (Sortis) 10 mg/day. von Willebrand factor (vWF) activity (a measure of endothelial function) was measured at baseline and after 1 month of treatment. Adverse events were recorded at each visit. Physical examinations, haematological assessments and serum and urine chemistry assays were performed during the study. RESULTS Plasma total cholesterol levels were reduced by a mean of 27% compared with baseline after both 1 and 3 months of treatment (p < 0.001). Low density lipoprotein-cholesterol levels were reduced by a mean of 40% and 38% (p < 0.001), respectively, after 1 and 3 months of treatment, compared with baseline values. Triglyceride levels decreased by 20% at 1 month and by 10% after 3 months (p < 0.001). Atorvastatin significantly improved WBV after 3 months of treatment and RBC deformability after 1 month and 3 months of treatment (p < 0.05). Collagen-induced platelet aggregation was significantly decreased at 1 (p < 0.05) and 3 months (p < 0.001) compared with baseline values, despite unaltered antiplatelet therapy. vWF activity was also improved significantly (p < 0.05) after 1 month of treatment. CONCLUSIONS Our findings show that the beneficial effects of atorvastatin are complex. Besides lipid lowering, atorvastatin can improve haemorrheological parameters, platelet aggregation and endothelial dysfunction after short-term and low-dose therapy. Whether such early laboratory changes translate into clinical utility for secondary stroke prevention awaits the results of endpoint trials.
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Affiliation(s)
- Laszlo Szapary
- Department of Neurology, University of Pecs School of Medicine, Pecs, Hungary
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18
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Chong AY, Blann AD, Lip GYH. Assessment of endothelial damage and dysfunction: observations in relation to heart failure. QJM 2003; 96:253-67. [PMID: 12651970 DOI: 10.1093/qjmed/hcg037] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- A-Y Chong
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
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19
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Hashimoto M, Miyamoto Y, Matsuda Y, Akita H. New Methods to Evaluate Endothelial Function: Non-invasive Method of Evaluating Endothelial Function in Humans. J Pharmacol Sci 2003; 93:405-8. [PMID: 14737009 DOI: 10.1254/jphs.93.405] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Evidence has accumulated that impairment of vascular endothelial function is the initial step in the development of atherosclerosis. One important finding is impairment of the release of endothelium-dependent relaxing factor, which is now thought to be nitric oxide or its related substances, from endothelial cells. Flow-mediated dilatation has been known to be endothelium-dependent, and this can be detected during reactive hyperemia by high-resolution ultrasound in superficial arteries. Several coronary risk factors have been reported to be significantly related with decreased flow-mediated dilatation. We studied the association between the accumulation of coronary risk factors (hyperlipidemia, diabetes mellitus, hypertension, and current smoking habitus) and vascular endothelial function. The lower incidence of atherosclerosis in women before the menopause than that in men is an established epidemiological observation. Short-term estrogen therapy improves endothelial function in postmenopausal women. However, there are few reports on its long-term effects on endothelial function. Furthermore, we determined whether a reduced dosage of estrogen may maintain its beneficial effects. A similar improvement was also observed while women were on hormone replacement therapy even at the reduced dosage. Our results indicate that even at half the dose of estrogen, hormone replacement therapy may improve endothelial function in postmenopausal women.
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Affiliation(s)
- Masayoshi Hashimoto
- Department of General Internal Medicine, Kobe University School of Medicine, Japan.
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20
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Holm T, Aukrust P, Aagaard E, Ueland T, Haugstad TS, Kjekshus J, Simonsen S, Frøland SS, Gullestad L, Andreassen AK. Hypertension in relation to nitric oxide, asymmetric dimethylarginine, and inflammation: different patterns in heart transplant recipients and individuals with essential hypertension. Transplantation 2002; 74:1395-400. [PMID: 12451238 DOI: 10.1097/00007890-200211270-00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most heart transplant (HTx) recipients develop hypertension, characterized by increased peripheral vascular tone and endothelial dysfunction. Reduced levels of nitric oxide (NO) have been found in essential hypertension, and herein we investigated the possible role of altered concentrations of NO in posttransplant hypertension. METHODS Plasma levels of the NO-derived end products NO2(-) + NO3(-), the endogenous inhibitor of NO synthase asymmetric dimethylarginine (ADMA), and the inflammatory cytokine tumor necrosis factor (TNF)-alpha were examined in 65 stable hypertensive long-term (6 years [range 1-13]) survivors of HTx. HTx recipients were compared with 39 individuals with essential hypertension and 25 normotensive controls. RESULTS Hypertensive HTx recipients had raised NO2(-) + NO3(-) levels in plasma, positively correlated with 24-hour mean blood pressure (BP). In contrast, individuals with essential hypertension had decreased NO2(-) + NO3(-) concentration comparing controls, inversely correlated with 24-hour mean BP. Moreover, although TNF-alpha levels were significantly raised in HTx recipients compared with both healthy controls and individuals with essential hypertension, it was positively correlated to 24-hour BP and NO2(-) + NO3(-). Although only a slight increase was found in essential hypertension, no correlations were found in these nontransplant individuals. Finally, although asymmetric dimethylarginine (ADMA) tended to be raised in essential hypertension, this endogenous nitric oxide synthase (NOS) inhibitor was significantly decreased in HTx recipients compared with normotensive controls. CONCLUSION Our findings suggest that different mechanisms may be operating in the pathogenesis of posttransplant compared with essential hypertension, with persistent inflammation, raised NO2(-) + NO3(-), and decreased ADMA levels characterizing the former group.
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Affiliation(s)
- Torbjørn Holm
- Department of Cardiology, University of Oslo, Oslo, Norway
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21
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Krum H, Denver R, Tzanidis A, Martin P. Diagnostic and therapeutic potential of the endothelin system in patients with chronic heart failure. Heart Fail Rev 2001; 6:341-52. [PMID: 11447309 DOI: 10.1023/a:1011416611765] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There is now considerable evidence to support a role for the endothelin (ET) system in the pathogenesis and progression of chronic heart failure (CHF). As such, the potential exists for this system to be useful in both diagnosis (by measurement of peptide levels in plasma and other body fluids) and treatment (by pharmacological blockade) of this condition. Plasma levels of endothelin-1 (ET-1) are elevated in CHF and the magnitude of elevation correlates with disease severity. ET-1 levels in plasma predict subsequent mortality in patients with CHF. ET-1 may also contribute to symptoms associated with CHF, such as exercise intolerance. In the diagnosis of CHF, plasma levels of ET-1 appear to be a less powerful discriminator between patients with mild disease and control subjects with normal ventricular function on multivariate analyses, compared to brain natriuretic peptide (BNP), or its N-terminal fragment. ET-1 concentrations are also elevated in the saliva of patients with CHF and may represent an alternative approach to assessment of the status of the ET system in these patients. Specific ET receptor antagonists (both mixed and ET(A)-selective) have been developed. Studies with these agents in animal models of CHF have demonstrated beneficial effects via both haemodynamic and non-haemodynamic pathways. A number of short-term clinical studies have been performed demonstrating improvements in haemodynamic parameters without neurohormonal activation. Long-term clinical studies with ET receptor antagonists are currently underway to definitively test the impact of blockade of this system on mortality and major cardiovascular endpoints. Endothelin converting enzyme (ECE) inhibitors represent an alternative strategy of ET blockade, and early data from animal models suggest these agents may be of clinical utility, either alone or, more likely, in combination with other zinc metallopeptidases.
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Affiliation(s)
- H Krum
- Clinical Pharmacology Unit, Dept of Epidemiology & Preventive Medicine/Department of Medicine, Monash University/Alfred Hospital, Prahran, Victoria, Australia.
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22
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Serneri GG, Cecioni I, Vanni S, Paniccia R, Bandinelli B, Vetere A, Janming X, Bertolozzi I, Boddi M, Lisi GF, Sani G, Modesti PA. Selective upregulation of cardiac endothelin system in patients with ischemic but not idiopathic dilated cardiomyopathy: endothelin-1 system in the human failing heart. Circ Res 2000; 86:377-85. [PMID: 10700441 DOI: 10.1161/01.res.86.4.377] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Only scarce information is available on the activity and modifications of the cardiac endothelin (ET)-1 system in heart failure due to ischemic (ICM) or idiopathic dilated (DCM) cardiomyopathy. The activity of the ET-1 system was investigated by measuring cardiac ET-1 and big ET-1 formation and quantifying cardiac mRNA for prepro-ET-1 (ppET-1), ET-converting enzyme-1, and ET(A) and ET(B) receptors both in myocardium and in isolated myocytes using Northern blot, reverse transcription-polymerase chain reaction, and in situ hybridization in 22 patients with DCM and 20 with ICM who underwent cardiac transplantation and in 7 potential heart transplant donors (nonfailing hearts). Notwithstanding a similar increase of plasma ET-1 in the 2 groups, cardiac ET formation, mRNA levels for ppET-1, and ET(A) and ET(B) receptors were higher on both the myocardium and isolated myocytes from ICM than on those from DCM hearts (P<0.001 for all). ppET-1 and ET-converting enzyme-1 mRNAs were expressed on myocytes and endothelial and interstitial cells in ICM, whereas in DCM and nonfailing hearts they were mainly expressed on nonmyocyte cells. In both ICM and DCM, the ET(A) mRNA signal was expressed on both myocytes and nonmyocyte cells, whereas ET(B) mRNA was almost exclusively localized on nonmyocyte cells. ET(A)- and ET(B)-specific receptor binding was increased on both myocytes and cardiac membranes, showing a positive correlation with left ventricular ejection fraction in ICM (r=0.78 and 0.70) but not in DCM patients. The present results show that human ventricular myocytes express all of the components of the ET-1 system, which is selectively upregulated in ICM patients and appears to be functionally important in the maintenance of cardiac function.
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Affiliation(s)
- G G Serneri
- Clinica Medica Generale e Cardiologia, University of Florence, Italy
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23
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Stefanec T. Endothelial apoptosis: could it have a role in the pathogenesis and treatment of disease? Chest 2000; 117:841-54. [PMID: 10713015 DOI: 10.1378/chest.117.3.841] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Endothelial apoptosis can be found in a number of diseases. This review summarizes the current knowledge about the causes and consequences of endothelial apoptosis, and analyzes its possible role in the pathogenesis and treatment of several diseases. Novel forms of therapy based on the proposed pathophysiologic mechanisms are discussed.
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Affiliation(s)
- T Stefanec
- Section of Critical Care Medicine, Saint Vincent Hospital and Medical Center, New York, NY, USA.
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24
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Abstract
The endothelium is a functional barrier between vessel wall and blood stream. Assuming the total human vascular and capillary system occupies a surface area of more than 1,000 m2 which is covered by 1,013 endothelial cells, the complex role of the endothelium for hemostasis and immunological and metabolic processes becomes obvious. Dysfunction of the endothelium is a critical factor in the pathogenesis of vascular diseases and thrombus formation. This paper provides a brief review of physiological endothelial functions and summarizes measurable changes in products released from endothelial cells under pathological conditions which were associated with endothelial dysfunction.
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Affiliation(s)
- M M Müller
- Institute of Laboratory Diagnostics, Kaiser-Franz-Josef-Hospital, Vienna, Austria.
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