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Duler L, Visser L, Nguyen N, Johnson LR, Stern JA, Li RHL. Platelet hyperresponsiveness and increased platelet-neutrophil aggregates in dogs with myxomatous mitral valve disease and pulmonary hypertension. J Vet Intern Med 2024; 38:2052-2063. [PMID: 38773707 PMCID: PMC11256165 DOI: 10.1111/jvim.17067] [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: 08/24/2023] [Accepted: 03/25/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) in dogs with myxomatous mitral valve disease (MMVD) is caused by increased pulmonary venous pressure. Thrombosis, vascular remodeling, and vasoconstriction mediated by platelets could exacerbate PH. HYPOTHESIS Dogs with PH will exhibit a hypercoagulable state, characterized by increased platelet activation, platelet-leukocyte, and platelet-neutrophil aggregate formation. ANIMALS Eleven dogs (≥3.5 kg) diagnosed with MMVD and PH and 10 dogs with MMVD lacking PH. METHODS Prospective cohort ex vivo study. All dogs underwent echocardiographic examination, CBC, 3-view thoracic radiographs, and heartworm antigen testing. Severity of PH and MMVD were assessed by echocardiography. Viscoelastic monitoring of coagulation was assessed using thromboelastography (TEG). Platelet activation and platelet-leukocyte/platelet-neutrophil interactions were assessed using flow cytometry. Plasma serotonin concentrations were measured by ELISA. RESULTS Unstimulated platelets from dogs with MMVD and PH expressed more surface P-selectin than MMVD controls (P = .03). Platelets from dogs with MMVD and PH had persistent activation in response to agonists. The number of platelet-leukocyte aggregates was higher in dogs with MMVD and PH compared with MMVD controls (P = .01). Ex vivo stimulation of whole blood resulted in higher numbers of platelet-neutrophil aggregates in dogs with MMVD and PH (P = .01). Assessment of hypercoagulability based on TEG or plasma serotonin concentrations did not differ between groups. CONCLUSION AND CLINICAL IMPORTANCE Platelet hyperresponsiveness and increased platelet-neutrophil interaction occur in dogs with MMVD and PH, suggesting that platelets play a role of in the pathogenesis of PH. Clinical benefits of antiplatelet drugs in dogs with MMVD and PH require further investigation.
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Affiliation(s)
- Laetitia Duler
- William R. Pritchard Veterinary Medicine Teaching Hospital, School of Veterinary Medicine, University of California DavisDavisCaliforniaUSA
| | - Lance Visser
- Department of Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Colorado State UniversityFort CollinsColoradoUSA
| | - Nghi Nguyen
- Department of Surgical and Radiological ScienceSchool of Veterinary Medicine, University of California DavisDavisCaliforniaUSA
| | - Lynelle R. Johnson
- Department of Medicine and EpidemiologySchool of Veterinary Medicine, University of California DavisDavisCaliforniaUSA
| | - Joshua A. Stern
- Department of Medicine and EpidemiologySchool of Veterinary Medicine, University of California DavisDavisCaliforniaUSA
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth CarolinaUSA
| | - Ronald H. L. Li
- Department of Surgical and Radiological ScienceSchool of Veterinary Medicine, University of California DavisDavisCaliforniaUSA
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2
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Zhang JJ, Mao-Mao, Shao MM, Wang MC. Therapeutic potential of natural flavonoids in pulmonary arterial hypertension: A review. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 128:155535. [PMID: 38537442 DOI: 10.1016/j.phymed.2024.155535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/06/2024] [Accepted: 03/12/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a fatal disease caused by pulmonary vascular remodeling, with a high incidence and mortality. At present, many clinical drugs for treating PAH mainly exert effects by relaxing the pulmonary artery, with limited therapeutic effects, so the search for viable therapeutic agents continues uninterrupted. In recent years, natural flavonoids have shown promising potential in the treatment of cardiovascular diseases. It is necessary to comprehensively elucidate the potential of natural flavonoids to combat PAH. PURPOSE To evaluate the potential of natural flavonoids to hinder or slow down the occurrence and development of PAH, and to identify promising drug discovery candidates. METHODS Literature was collected from PubMed, Science Direct, Web of science, CNKI databases and Google scholar. The search terms used included "pulmonary arterial hypertension", "pulmonary hypertension", "natural products", "natural flavonoids", "traditional chinese medicine", etc., and several combinations of these keywords. RESULTS The resources, structural characteristics, mechanisms, potential and prospect strategies of natural flavonoids for treating PAH were summarized. Natural flavonoids offer different solutions as possible treatments for PAH. These mechanisms may involve various pathways and molecular targets related to the pathogenesis of PAH, such as inflammation, oxidative stress, vascular remodeling, genetic, ion channels, cell proliferation and autophagy. In addition, prospect strategies of natural flavonoids for anti-PAH including structural modification and nanomaterial delivery systems have been explored. This review suggests that the potential of natural flavonoids as alternative therapeutic agents in the prevention and treatment of PAH holds promise for future research and clinical applications. CONCLUSION Despite displaying the enormous potential of flavonoids in PAH, some limitations need to be further explored. Firstly, using advanced drug discovery tools, including computer-aided design and high-throughput screening, to further investigate the safety, biological activity, and precise mechanism of action of flavonoids. Secondly, exploring the structural modifications of these compounds is expected to optimize their efficacy. Lastly, it is necessary to conduct well controlled clinical trials and a comprehensive evaluation of potential side effects to determine their effectiveness and safety.
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Affiliation(s)
- Jin-Jing Zhang
- Department of pharmacy, Affiliated Cixi Hospital, Wenzhou Medical University, China
| | - Mao-Mao
- Department of pharmacy, Affiliated Cixi Hospital, Wenzhou Medical University, China
| | - Min-Min Shao
- Department of pharmacy, Affiliated Cixi Hospital, Wenzhou Medical University, China
| | - Meng-Chuan Wang
- Department of pharmacy, Affiliated Cixi Hospital, Wenzhou Medical University, China.
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3
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Pope JE, Denton CP, Johnson SR, Fernandez-Codina A, Hudson M, Nevskaya T. State-of-the-art evidence in the treatment of systemic sclerosis. Nat Rev Rheumatol 2023; 19:212-226. [PMID: 36849541 PMCID: PMC9970138 DOI: 10.1038/s41584-023-00909-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 03/01/2023]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease with multi-organ involvement, fibrosis and vasculopathy. Treatment in SSc, including early diffuse cutaneous SSc (dcSSc) and the use of organ-specific therapies, has improved, as evident from randomized clinical trials. Treatments for early dcSSc include immunosuppressive agents such as mycophenolate mofetil, methotrexate, cyclophosphamide, rituximab and tocilizumab. Patients with rapidly progressive early dcSSc might be eligible for autologous haematopoietic stem cell transplantation, which can improve survival. Morbidity from interstitial lung disease and pulmonary arterial hypertension is improving with the use of proven therapies. Mycophenolate mofetil has surpassed cyclophosphamide as the initial treatment for SSc-interstitial lung disease. Nintedanib and possibly perfinidone can be considered in SSc pulmonary fibrosis. Pulmonary arterial hypertension is frequently treated with initial combination therapy (for example, with phosphodiesterase 5 inhibitors and endothelin receptor antagonists) and, if necessary, the addition of a prostacyclin analogue. Raynaud phenomenon and digital ulcers are treated with dihydropyridine calcium channel blockers (especially nifedipine), then phosphodiesterase 5 inhibitors or intravenous iloprost. Bosentan can reduce the development of new digital ulcers. Trial data for other manifestations are mostly lacking. Research is needed to develop targeted and highly effective treatments, best practices for organ-specific screening and early intervention, and sensitive outcome measurements.
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Affiliation(s)
- Janet E Pope
- Division of Rheumatology, St Joseph's Health Care, London, ON, Canada.
- Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
| | | | - Sindhu R Johnson
- Toronto Scleroderma Program, Toronto Western Hospital, Mount Sinai Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andreu Fernandez-Codina
- Division of Rheumatology, St Joseph's Health Care, London, ON, Canada
- General Internal Medicine, Windsor Regional Hospital, Windsor, ON, Canada
- Critical Care, Emergency and Systemic Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, QC, Canada
- Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Tatiana Nevskaya
- Division of Rheumatology, St Joseph's Health Care, London, ON, Canada
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4
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Demelo-Rodriguez P, Galeano-Valle F, Proietti M. Use of Oral Anticoagulant Drugs in Patients with Pulmonary Hypertension. Heart Fail Clin 2023; 19:97-106. [DOI: 10.1016/j.hfc.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43:3618-3731. [PMID: 36017548 DOI: 10.1093/eurheartj/ehac237] [Citation(s) in RCA: 1082] [Impact Index Per Article: 541.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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6
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Baptista de Barros Ribeiro Dourado LP, Santos M, Moreira-Gonçalves D. Nets, pulmonary arterial hypertension, and thrombo-inflammation. J Mol Med (Berl) 2022; 100:713-722. [PMID: 35441845 DOI: 10.1007/s00109-022-02197-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 12/28/2021] [Accepted: 03/31/2022] [Indexed: 02/07/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive and fatal vascular disease in which high blood pressure in the pulmonary artery and remodeling of the pulmonary vasculature ensues. This disorder is characterized by the presence of thrombotic lesions, resulting from chronic platelet, coagulation factors, and endothelium activation, which translate into platelet aggregation, vasoconstriction, and medial thickening. Neutrophil extracellular traps (NETs), a network of chromatin and cytoplasmatic enzymes (myeloperoxidase and neutrophil elastase) forming after neutrophil programmed cell death, were described in multiple cardiovascular diseases as thrombotic mediators, by creating a scaffold or by surface receptor interaction. In this review, we analyze the possible involvement of NETs in PAH, to enlighten future studies to explore this hypothesis. NETs may have a determining role in pulmonary hypertension through activation of platelets and endothelial cells. Simultaneously, NETosis may be induced by endothelial signaling and/or cell-cell interaction between platelets and primed neutrophils, creating a positive feedback loop. Confirming its role in the pathophysiology and prognosis of PAH may represent a new opportunity to explore new therapeutic options. KEY MESSAGES: Thrombosis and innate immunity are relevant axes in PAH. Patients with PAH display elevated levels of NETs. NETs could activate platelets/endothelium with proliferative and thrombotic effects. Activated platelets and endothelium could contribute to NETosis. NETs could open new therapy research avenues.
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Affiliation(s)
| | - Mário Santos
- Cardiology Department, Hospital Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.,Unit of Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal
| | - Daniel Moreira-Gonçalves
- CIAFEL, Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal.,ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
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7
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Siniarski A, Gąsecka A, Starczyński M, Banaszkiewicz M, Darocha S, Torbicki A, Kurzyna M, Filipiak KJ, Nessler J, Gajos G. Prostacyclin analogues decrease platelet aggregation but have no effect on thrombin generation, fibrin clot structure, and fibrinolysis in pulmonary arterial hypertension: PAPAYA coagulation. Platelets 2022; 33:1065-1074. [DOI: 10.1080/09537104.2022.2042234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Aleksander Siniarski
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Miłosz Starczyński
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Krzysztof J. Filipiak
- Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Grzegorz Gajos
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
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8
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Lastinger L, Ma'ayeh M, Cackovic M, Rood KM, Bradley EA, Daniels CJ. Medical management of pulmonary arterial hypertension in pregnancy: A single center experience. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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9
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Lu M, Blaine KP, Cullinane A, Hall C, Dulau-Florea A, Sun J, Chenwi HF, Graninger GM, Harper B, Thompson K, Krack J, Barnett CF, Brusca SB, Elinoff JM, Solomon MA. Pulmonary arterial hypertension patients display normal kinetics of clot formation using thrombelastography. Pulm Circ 2021; 11:20458940211022204. [PMID: 34249330 PMCID: PMC8237222 DOI: 10.1177/20458940211022204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/16/2021] [Indexed: 11/15/2022] Open
Abstract
Pulmonary arterial hypertension is characterized by endothelial dysfunction and
microthrombi formation. The role of anticoagulation remains controversial, with
studies demonstrating inconsistent effects on pulmonary arterial hypertension
mortality. Clinical anticoagulation practices are currently heterogeneous,
reflecting physician preference. This study uses thrombelastography and
hematology markers to evaluate whether clot formation and fibrinolysis are
abnormal in pulmonary arterial hypertension patients. Venous blood was collected
from healthy volunteers (n = 20) and patients with pulmonary
arterial hypertension (n = 20) on stable medical therapy for
thrombelastography analysis. Individual thrombelastography parameters and a
calculated coagulation index were used for comparison. In addition, hematologic
markers, including fibrinogen, factor VIII activity, von Willebrand factor
activity, von Willebrand factor antigen, and alpha2-antiplasmin, were measured
in pulmonary arterial hypertension patients and compared to healthy volunteers.
Between group differences were analyzed using t tests and linear mixed models,
accounting for repeated measures when applicable. Although the degree of
fibrinolysis (LY30) was significantly lower in pulmonary arterial hypertension
patients compared to healthy volunteers (0.3% ± 0.6 versus
1.3% ± 1.1, p = 0.04), all values were within the normal
reference range (0–8%). All other thrombelastography parameters were not
significantly different between pulmonary arterial hypertension patients and
healthy volunteers (p ≥ 0.15 for all). Similarly,
alpha2-antiplasmin activity levels were higher in pulmonary arterial
hypertension patients compared to healthy volunteers (103.7% ± 13.6
versus 82.6% ± 9.5, p < 0.0001), but
all individual values were within the normal range (75–132%). There were no
other significant differences in hematologic markers between pulmonary arterial
hypertension patients and healthy volunteers (p ≥ 0.07 for
all). Sub-group analysis comparing thrombelastography results in patients
treated with or without prostacyclin pathway targeted therapies were also
non-significant. In conclusion, treated pulmonary arterial hypertension patients
do not demonstrate abnormal clotting kinetics or fibrinolysis by
thrombelastography.
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Affiliation(s)
- Mengyun Lu
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kevin P Blaine
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.,Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Ann Cullinane
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Courtney Hall
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Alina Dulau-Florea
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Herman F Chenwi
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Grace M Graninger
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Bonnie Harper
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Keshia Thompson
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Janell Krack
- Pharmacy Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Christopher F Barnett
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Samuel B Brusca
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Jason M Elinoff
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Solomon
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.,Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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10
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Ennis D, Ahmad Z, Anderson MA, Johnson SR. Botulinum toxin in the management of primary and secondary Raynaud's phenomenon. Best Pract Res Clin Rheumatol 2021; 35:101684. [PMID: 33965340 DOI: 10.1016/j.berh.2021.101684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Raynaud's phenomenon (RP) is common in rheumatic diseases. In the setting of systemic sclerosis (SSc), it can be complicated by digital ischemia that includes ulceration and gangrene. Systemic adverse effects may preclude the use of oral or topical vasodilators for the treatment of RP and its complications. In this article, we review effectiveness/efficacy of botulinum toxin injection in primary and secondary RP. We discuss botulinum toxin formulations, dosage, sites of administration, and adverse effects. The evidence for botulinum toxin in the treatment of primary and SSc-associated RP is promising. Consistency across patient populations, treatment options (botulinum serotype, dose, and injection site), and outcome measures will be essential for further research.
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Affiliation(s)
- Daniel Ennis
- Mary Pack Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Zareen Ahmad
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Melanie A Anderson
- University Health Network Library and Information Services, Toronto, Ontario, Canada.
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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11
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Kurakula K, Smolders VFED, Tura-Ceide O, Jukema JW, Quax PHA, Goumans MJ. Endothelial Dysfunction in Pulmonary Hypertension: Cause or Consequence? Biomedicines 2021; 9:biomedicines9010057. [PMID: 33435311 PMCID: PMC7827874 DOI: 10.3390/biomedicines9010057] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, complex, and progressive disease that is characterized by the abnormal remodeling of the pulmonary arteries that leads to right ventricular failure and death. Although our understanding of the causes for abnormal vascular remodeling in PAH is limited, accumulating evidence indicates that endothelial cell (EC) dysfunction is one of the first triggers initiating this process. EC dysfunction leads to the activation of several cellular signalling pathways in the endothelium, resulting in the uncontrolled proliferation of ECs, pulmonary artery smooth muscle cells, and fibroblasts, and eventually leads to vascular remodelling and the occlusion of the pulmonary blood vessels. Other factors that are related to EC dysfunction in PAH are an increase in endothelial to mesenchymal transition, inflammation, apoptosis, and thrombus formation. In this review, we outline the latest advances on the role of EC dysfunction in PAH and other forms of pulmonary hypertension. We also elaborate on the molecular signals that orchestrate EC dysfunction in PAH. Understanding the role and mechanisms of EC dysfunction will unravel the therapeutic potential of targeting this process in PAH.
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Affiliation(s)
- Kondababu Kurakula
- Department of Cell and Chemical Biology, Laboratory for CardioVascular Cell Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Valérie F. E. D. Smolders
- Department of Surgery, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; (V.F.E.D.S.); (P.H.A.Q.)
| | - Olga Tura-Ceide
- Department of Pulmonary Medicine, Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institut (IDIBGI), 17190 Girona, Catalonia, Spain
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Paul H. A. Quax
- Department of Surgery, Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; (V.F.E.D.S.); (P.H.A.Q.)
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Laboratory for CardioVascular Cell Biology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
- Correspondence:
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12
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Ogawa A, Matsubara H. Increased levels of platelet-derived microparticles in pulmonary hypertension. Thromb Res 2020; 195:120-124. [PMID: 32683150 DOI: 10.1016/j.thromres.2020.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/22/2020] [Accepted: 07/10/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Thrombosis and coagulation abnormalities are thought to be involved in disease progression of pulmonary hypertension. Platelet-derived microparticles (PDMP) are released from platelets following stimulation and have recently been demonstrated to play an important role in pathogenesis of various diseases. This study aimed to evaluate PDMP levels in patients with pulmonary hypertension. MATERIALS AND METHODS Our cross-sectional study enrolled a total of 113 participants including 73 patients with pulmonary hypertension and 40 participants to serve as a control group. PDMP levels were measured using a PDMP ELISA kit, which detects glycoproteins CD42a and CD42b. Clinical parameters, including exercise capacity and hemodynamic parameters, were collected, and the relationship to PDMP levels were evaluated. RESULTS PDMP levels were significantly higher in patients than in participants in the control group (23.2 ± 39.4 U/mL and 7.8 ± 3.6 U/mL, respectively, P < 0.05). PDMP levels in patients with chronic thromboembolic pulmonary hypertension were correlated with right atrial pressure and cardiac index. PDMP levels were higher in male patients with idiopathic pulmonary arterial hypertension. Furthermore, patients administered a higher dose of epoprostenol had a tendency for lower PDMP levels. CONCLUSIONS The data suggest that PDMP levels are increased in patients with pulmonary hypertension. Further study is needed to understand the mechanism and impact of PDMP on disease progression.
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Affiliation(s)
- Aiko Ogawa
- Division of Molecular and Cellular Medicine, Department of Clinical Science, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama 701-1192, Japan.
| | - Hiromi Matsubara
- Division of Molecular and Cellular Medicine, Department of Clinical Science, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama 701-1192, Japan; Department of Cardiology, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama 701-1192, Japan
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13
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Hirani N, Brunner NW, Kapasi A, Chandy G, Rudski L, Paterson I, Langleben D, Mehta S, Mielniczuk L. Canadian Cardiovascular Society/Canadian Thoracic Society Position Statement on Pulmonary Hypertension. Can J Cardiol 2020; 36:977-992. [DOI: 10.1016/j.cjca.2019.11.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/15/2022] Open
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14
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Kuwabara Y, Tanaka-Ishikawa M, Abe K, Hirano M, Hirooka Y, Tsutsui H, Sunagawa K, Hirano K. Proteinase-activated receptor 1 antagonism ameliorates experimental pulmonary hypertension. Cardiovasc Res 2020; 115:1357-1368. [PMID: 30423156 DOI: 10.1093/cvr/cvy284] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/28/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022] Open
Abstract
AIMS Pulmonary hypertension (PH) is characterized by progressive increases in pulmonary vascular resistance (PVR). Thrombotic lesions are common pathological findings. The pulmonary artery has a unique property regarding the vasoconstrictive response to thrombin, which is mediated by proteinase-activated receptor 1 (PAR1). We aim to elucidate the role of PAR1 in the development and progression of PH. METHODS AND RESULTS A rat model of monocrotaline-induced PH and a mouse model of hypoxia (Hx)-induced PH were used to investigate the effects of atopaxar (a PAR1 antagonist) and PAR1 knockout on haemodynamic parameters, right ventricular hypertrophy (RVH), vascular remodelling and survival. In perfused lung preparations, the pressor response to PAR1 agonist was significantly augmented in monocrotaline-induced PH. Both the preventive and therapeutic administration of atopaxar significantly inhibited the increase in PVR and the development of RVH and prolonged survival. A real-time PCR revealed that the level of PAR1 mRNA in the pulmonary artery was significantly higher than that in any of the systemic arteries examined in control rats, and the level was significantly up-regulated in monocrotaline-induced PH. PAR1 gene knockout significantly attenuated the haemodynamic and histological findings in the mouse model of Hx-induced PH. CONCLUSION The specific expression of PAR1 in the pulmonary artery and its up-regulation were suggested to play a critical role in the development and progression of experimental PH in murine models. PAR1 is a potential therapeutic target for the treatment of PH.
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Affiliation(s)
- Yukimitsu Kuwabara
- Department of Molecular Cardiology, Research Institute of Angiocardiology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan.,Department of Cardiovascular Medicine, Research Institute of Angiocardiology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Mariko Tanaka-Ishikawa
- Department of Cardiovascular Medicine, Research Institute of Angiocardiology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan.,Department of Anesthesiology and Critical Care, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Research Institute of Angiocardiology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Mayumi Hirano
- Department of Molecular Cardiology, Research Institute of Angiocardiology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Yoshitaka Hirooka
- Department of Advanced Cardiovascular Regulation and Therapeutics, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Research Institute of Angiocardiology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Kenji Sunagawa
- Department of Cardiovascular Medicine, Research Institute of Angiocardiology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Katsuya Hirano
- Department of Cardiovascular Physiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
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15
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New Insights into the Implication of Mitochondrial Dysfunction in Tissue, Peripheral Blood Mononuclear Cells, and Platelets during Lung Diseases. J Clin Med 2020; 9:jcm9051253. [PMID: 32357474 PMCID: PMC7287602 DOI: 10.3390/jcm9051253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
Lung diseases such as chronic obstructive pulmonary disease, asthma, pulmonary arterial hypertension, or idiopathic pulmonary fibrosis are major causes of morbidity and mortality. Complex, their physiopathology is multifactorial and includes lung mitochondrial dysfunction and enhanced reactive oxygen species (ROS) release, which deserves increased attention. Further, and importantly, circulating blood cells (peripheral blood mononuclear cells-(PBMCs) and platelets) likely participate in these systemic diseases. This review presents the data published so far and shows that circulating blood cells mitochondrial oxidative capacity are likely to be reduced in chronic obstructive pulmonary disease (COPD), but enhanced in asthma and pulmonary arterial hypertension in a context of increased oxidative stress. Besides such PBMCs or platelets bioenergetics modifications, mitochondrial DNA (mtDNA) changes have also been observed in patients. These new insights open exciting challenges to determine their role as biomarkers or potential guide to a new therapeutic approach in lung diseases.
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16
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Fan C, Wang J, Mao C, Li W, Liu K, Wang Z. The FGL2 prothrombinase contributes to the pathological process of experimental pulmonary hypertension. J Appl Physiol (1985) 2019; 127:1677-1687. [PMID: 31580221 DOI: 10.1152/japplphysiol.00396.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In situ thrombus formation is one of the major pathological features of pulmonary hypertension (PH). The mechanism of in situ thrombosis has not been clearly identified. Fibrinogen-like protein 2 (FGL2) prothrombinase is an immune coagulant that can cleave prothrombin to thrombin, which then converts fibrinogen into fibrin. This mechanism triggers in situ thrombus formation directly, bypassing both the intrinsic and extrinsic coagulation pathways. FGL2 prothrombinase is mainly expressed in endothelial cells and mediates multiple pathological processes. This implies that it may also play a role in PH. In this study, we examined the expression of FGL2 in idiopathic pulmonary arterial hypertension (IPAH) patients, and in monocrotaline-induced rat and hypoxia-induced mouse PH models. Fgl2−/− mice were used to evaluate the development of PH and explore associated pathological changes. These included in situ thrombosis, vascular remodeling, and endothelial apoptosis. Following these analyses, we examined possible signaling pathways downstream of FGL2 in PH. We show FGL2 is upregulated in pulmonary vascular endothelium in human IPAH and in two animal PH models. Genetic knockout of Fgl2 limited the development of PH, indicated by decreased in situ thrombus formation, less vascular remodeling, and reduced endothelial dysfunction. In addition, loss of FGL2 downregulated PAR1 (proteinase-activated receptor 1) expression and decreased the overactivation and consumption of platelets in hypoxia-induced PH. These results indicate FGL2 participate in the development of PH and loss of FGL2 could attenuate PH by reducing in situ thrombosis and suppressing PAR1 signaling. Thus we provide evidence that suggests FGL2 prothrombinase presents a potential therapeutic target for clinical treatment of PH. NEW & NOTEWORTHY This is the first study to demonstrate that fibrinogen-like protein 2 (FGL2) participates in the pathological progression of pulmonary hypertension (PH) in human idiopathic pulmonary arterial hypertension, a monocrotaline rat PH model, and a hypoxia mouse PH model. Genetic knockout of Fgl2 significantly limited the development of PH indicated by reduced in situ thrombosis, vascular remodeling, and endothelial dysfunction, and suppressed PAR1 (proteinase-activated receptor 1) signaling and overactivation of platelets on PH. These results suggest FGL2 presents a potential therapeutic target for clinical treatment of PH.
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Affiliation(s)
- Cheng Fan
- Department of Geriatrics, Institute of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jue Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoqin Mao
- Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhu Li
- Department of Geriatrics, Institute of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kun Liu
- Department of Cardiology, Institute of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaohui Wang
- Department of Geriatrics, Institute of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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Indications and potential pitfalls of anticoagulants in pulmonary hypertension: Would DOACs become a better option than VKAs? Blood Rev 2019; 37:100579. [DOI: 10.1016/j.blre.2019.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 01/23/2023]
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18
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Frey R, Becker C, Saleh S, Unger S, van der Mey D, Mück W. Clinical Pharmacokinetic and Pharmacodynamic Profile of Riociguat. Clin Pharmacokinet 2019; 57:647-661. [PMID: 29086344 PMCID: PMC5974002 DOI: 10.1007/s40262-017-0604-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Oral riociguat is a soluble guanylate cyclase (sGC) stimulator that targets the nitric oxide (NO)–sGC–cyclic guanosine monophosphate pathway with a dual mode of action: directly by stimulating sGC, and indirectly by increasing the sensitivity of sGC to NO. It is rapidly absorbed, displays almost complete bioavailability (94.3%), and can be taken with or without food and as crushed or whole tablets. Riociguat exposure shows pronounced interindividual (60%) and low intraindividual (30%) variability in patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH), and is therefore administered using an individual dose-adjustment scheme at treatment initiation. The half-life of riociguat is approximately 12 h in patients and approximately 7 h in healthy individuals. Riociguat and its metabolites are excreted via both renal (33–45%) and biliary routes (48–59%), and dose adjustment should be performed with particular care in patients with moderate hepatic impairment or mild to severe renal impairment (no data exist for patients with severe hepatic impairment). The pharmacodynamic effects of riociguat reflect the action of a vasodilatory agent, and the hemodynamic response to riociguat correlated with riociguat exposure in patients with PAH or CTEPH in phase III population pharmacokinetic/pharmacodynamic analyses. Riociguat has a low risk of clinically relevant drug interactions due to its clearance by multiple cytochrome P450 (CYP) enzymes and its lack of effect on major CYP isoforms and transporter proteins at therapeutic levels. Riociguat has been approved for the treatment of PAH and CTEPH that is inoperable or persistent/recurrent after surgical treatment.
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Affiliation(s)
- Reiner Frey
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany.
| | | | | | - Sigrun Unger
- Global Biostatistics, Bayer AG, Wuppertal, Germany
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19
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Khan MS, Usman MS, Siddiqi TJ, Khan SU, Murad MH, Mookadam F, Figueredo VM, Krasuski RA, Benza RL, Rich JD. Is Anticoagulation Beneficial in Pulmonary Arterial Hypertension? Circ Cardiovasc Qual Outcomes 2019; 11:e004757. [PMID: 30354550 DOI: 10.1161/circoutcomes.118.004757] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Data about anticoagulation in pulmonary arterial hypertension (PAH) patients are inconsistent. The objective of this study was to examine the impact of adjunctive oral anticoagulants in patients with PAH through meta-analysis, and to further assess whether response differs by PAH subtype. Methods and Results Cochrane CENTRAL, Medline, and Scopus databases were searched for randomized or nonrandomized studies that assessed the association between anticoagulation and outcomes in patients with PAH. Hazard ratios (HRs) for mortality were pooled using the random effects model. Subgroup analyses were performed for type of PAH and study design. Twelve nonrandomized studies, at moderate risk of bias, were included. These consisted of 2512 patients (1342 receiving anticoagulation and 1170 controls). Anticoagulation significantly reduced mortality in the overall PAH cohort (HR, 0.73 [0.57, 0.93]; P=0.001; I2=64%). On subgroup analysis, a significant mortality reduction was seen in idiopathic PAH patients (HR, 0.73 [0.56, 0.95]; P=0.02; I2=46%), whereas no significant difference was observed in connective tissue disease-related PAH (HR, 1.16 [0.58, 2.32]; P=0.67; I2=71%). Sensitivity analysis specific to scleroderma-associated PAH demonstrated a significant increase in mortality with anticoagulant use (HR, 1.58 [1.08, 2.31]; P=0.02; I2=9%). Conclusions This meta-analysis shows that use of anticoagulation may improve survival in idiopathic PAH patients, while increasing mortality when used in scleroderma-associated-PAH patients. Currently, no randomized clinical trials have been published, and until randomized data are available, anticoagulant use in PAH should be tailored to PAH subtype.
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Affiliation(s)
- Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (M.S.K.)
| | - Muhammad Shariq Usman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.U., T.J.S.)
| | - Tariq Jamal Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (M.S.U., T.J.S.)
| | - Safi U Khan
- Department of Internal Medicine, Robert Packer Hospital, Sayre, PA (S.U.K.)
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN (M.H.M.)
| | - Farouk Mookadam
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (F.M.)
| | - Vincent M Figueredo
- Department of Cardiovascular Medicine, Institute for Heart and Vascular Health, Einstein Medical Center Philadelphia, PA (V.M.F.)
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Health System, Durham, NC (R.A.K.)
| | - Raymond L Benza
- Department of Cardiovascular Medicine, Allegheny Health Network, Pittsburgh, PA (R.L.B.)
| | - Jonathan D Rich
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (J.D.R.)
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20
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Ando T, Yamasaki Y, Takakuwa Y, Iida H, Asari Y, Suzuki K, Uchida M, Kotoku N, Tanabe Y, Chosokabe M, Takahashi M, Suzuki K, Akashi YJ, Yamada H, Kawahata K. Concurrent onset of acute lupus myocarditis, pulmonary arterial hypertension and digital gangrene in a lupus patient: a possible role of vasculitis to the rare disorders. Mod Rheumatol Case Rep 2019; 4:21-27. [PMID: 33086967 DOI: 10.1080/24725625.2019.1650698] [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: 10/26/2022]
Abstract
Acute lupus myocarditis and pulmonary arterial hypertension (PAH) are rare complications associated with systemic lupus erythematosus (SLE). No previous reports have shown the coexistence of these disorders. Here we present a 41-year-old patient with SLE who concurrently developed severe acute lupus myocarditis and PAH with digital gangrene as an initial manifestation. Acute lupus myocarditis and PAH were successfully treated with prednisolone and intravenous cyclophosphamide pulse therapy (600-700 mg × 6) along with anticoagulant therapy. Catheter-directed thrombolysis was required for digital gangrene caused by vasculitis. Concurrent development of these rare disorders may represent a common mechanism such vasculitis as an underlining cause of SLE.
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Affiliation(s)
- Takayasu Ando
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshioki Yamasaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yukiko Takakuwa
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Harunobu Iida
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yusa Asari
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kanako Suzuki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Marina Uchida
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nozomi Kotoku
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Motohiro Chosokabe
- Division of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masahide Takahashi
- Division of Radiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Kengo Suzuki
- Division of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei-Yokohama Hospital, Yokohama, Japan
| | - Kimito Kawahata
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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21
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Nguyen QL, Wang Y, Helbling N, Simon MA, Shiva S. Alterations in platelet bioenergetics in Group 2 PH-HFpEF patients. PLoS One 2019; 14:e0220490. [PMID: 31365585 PMCID: PMC6668825 DOI: 10.1371/journal.pone.0220490] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/17/2019] [Indexed: 12/28/2022] Open
Abstract
Background Pulmonary hypertension (PH) is characterized by elevated pulmonary artery pressure but classified into subgroups based on disease etiology. It is established that systemic bioenergetic dysfunction contributes to the pathogenesis of pulmonary arterial hypertension classified as World Health Organization (WHO) Group 1. Consistent with this, we previously showed that platelets from Group 1 PH patients demonstrate increased glycolysis and enhanced maximal capacity for oxidative phosphorylation, which is due to increased fatty acid oxidation (FAO). However, it remains unclear whether identical mitochondrial alterations contribute to the pathology of other PH subgroups. The most prevalent subgroup of PH is WHO Group 2, which encompasses pulmonary venous hypertension secondary to left heart disease. Here, we hypothesized that platelets from Group 2 subjects show bioenergetic alteration compared to controls, and that these changes were similar to Group 1 PH patients. Method and results We isolated platelets from subjects with Group 2 PH and controls (n = 20) and measured platelet bioenergetics as well as hemodynamic parameters. We demonstrate that Group 2 PH platelets do not show a change in glycolytic rate but do demonstrate enhanced maximal capacity of respiration due at least partially to increased FAO. Moreover, this enhanced maximal capacity correlates negatively with right ventricular stroke work index and is not changed by administration of inhaled nitrite, a modulator of pulmonary hemodynamics. Conclusions These data demonstrate that Group 2 PH subjects have altered bioenergetic function though this alteration is not identical to that of Group 1 PH. The implications of this alteration for disease pathogenesis will be discussed.
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Affiliation(s)
- Quyen L. Nguyen
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Yinna Wang
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Nicole Helbling
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Marc A. Simon
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Sruti Shiva
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Pharmacology & Chemical Biology, Center for Metabolism & Mitochondrial Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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22
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Abstract
Pulmonary hypertension (PH) is divided into varied pathophysiological and etiologic groupings, as classified by the World Health Organization (WHO). Pulmonary arterial hypertension (PAH), which falls under WHO group 1 PH, is a progressive and potentially fatal disease characterized by a vasoconstrictive, proliferative, and thrombotic phenotype, which leads to increased pulmonary artery pressure, right heart failure, and death. Pathologically, in situ thromboses are found in the small distal pulmonary arteries. Dysregulation of coagulation, platelet function, and endothelial cells may contribute to a prothrombotic state. There is mixed evidence for the use of anticoagulation or antiplatelet therapy in PAH patients.
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23
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The role of platelets in the development and progression of pulmonary arterial hypertension. Adv Med Sci 2018; 63:312-316. [PMID: 29885631 DOI: 10.1016/j.advms.2018.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 12/19/2022]
Abstract
Pulmonary arterial hypertension is a multifactorial disease characterized by vasoconstriction, vascular remodeling, inflammation and thrombosis. Although an increasing number of research confirmed that pulmonary artery endothelial cells, pulmonary artery smooth muscle cells as well as platelets have a role in the pulmonary arterial hypertension pathogenesis, it is still unclear what integrates these factors. In this paper, we review the evidence that platelets through releasing a large variety of chemokines could actively impact the pulmonary arterial hypertension pathogenesis and development. A recent publication revealed that not only an excess of platelet derived cytokines, but also a deficiency may be associated with pulmonary arterial hypertension development and progression. Hence, a simple platelet blockade may not be a correct action to treat pulmonary arterial hypertension. Our review aims to analyse the interactions between the platelets and different types of cells involved in pulmonary arterial hypertension pathogenesis. This knowledge could help to find novel therapeutic options and improve prognosis in this devastating disease.
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Rol N, Kurakula KB, Happé C, Bogaard HJ, Goumans MJ. TGF-β and BMPR2 Signaling in PAH: Two Black Sheep in One Family. Int J Mol Sci 2018; 19:ijms19092585. [PMID: 30200294 PMCID: PMC6164161 DOI: 10.3390/ijms19092585] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 12/14/2022] Open
Abstract
Knowledge pertaining to the involvement of transforming growth factor β (TGF-β) and bone morphogenetic protein (BMP) signaling in pulmonary arterial hypertension (PAH) is continuously increasing. There is a growing understanding of the function of individual components involved in the pathway, but a clear synthesis of how these interact in PAH is currently lacking. Most of the focus has been on signaling downstream of BMPR2, but it is imperative to include the role of TGF-β signaling in PAH. This review gives a state of the art overview of disturbed signaling through the receptors of the TGF-β family with respect to vascular remodeling and cardiac effects as observed in PAH. Recent (pre)-clinical studies in which these two pathways were targeted will be discussed with an extended view on cardiovascular research fields outside of PAH, indicating novel future perspectives.
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Affiliation(s)
- Nina Rol
- Department of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, 1081HV Amsterdam, The Netherlands.
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, 1081HV Amsterdam, The Netherlands.
| | - Konda Babu Kurakula
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands.
| | - Chris Happé
- Department of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, 1081HV Amsterdam, The Netherlands.
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, 1081HV Amsterdam, The Netherlands.
| | - Harm Jan Bogaard
- Department of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, 1081HV Amsterdam, The Netherlands.
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands.
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25
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Vrigkou E, Tsangaris I, Bonovas S, Kopterides P, Kyriakou E, Konstantonis D, Pappas A, Anthi A, Gialeraki A, Orfanos SE, Armaganidis A, Tsantes A. Platelet and coagulation disorders in newly diagnosed patients with pulmonary arterial hypertension. Platelets 2018; 30:646-651. [PMID: 30047809 DOI: 10.1080/09537104.2018.1499890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There is a complex and not fully elucidated association between pulmonary arterial hypertension (PAH) and coagulation disorders. The goal of this study was to evaluate platelet function, coagulation and fibrinolysis in PAH patients at diagnosis, before PAH-specific treatment initiation. We enrolled 20 healthy controls and 30 PAH patients (20 with connective tissue disease (CTD-PAH) and 10 idiopathic (iPAH)). None of the participants was on any antiplatelet or anticoagulation therapy. Blood samples from PAH patients were collected during the initial right heart catheterization. All subjects were assessed with platelet function analyzer-100 (PFA-100), epinephrine (Epi) and ADP-induced light transmission aggregometry (LTA), thromboelastometry (ROTEM) and endogenous thrombin potential (ETP). Our results showed that Epi and ADP-LTA values were significantly lower in newly diagnosed PAH patients compared to controls. Disaggregation was present in 73% of patients, a characteristic not seen in healthy individuals. In ROTEM assay, CT and CFT measurements were significantly higher and a angle lower compared to controls. ETP testing revealed significantly reduced outcomes in AUC, Cmax and Tmax. When CTD-PAH and iPAH patient groups were compared, iPAH ADP-LTA values were significantly decreased compared to CTD-PAH. In conclusion, newly diagnosed PAH patients presented with decreased platelet aggregation, clot propagation and thrombin generation, along with delayed initiation of the coagulation process. These hemostatic deficits could indicate an "exhaustion" of the coagulation process that could be caused by endothelial dysfunction and chronic activation of the procoagulant pathways. Further studies are warranted to confirm these laboratory findings and assess their potential clinical significance.
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Affiliation(s)
- Eleni Vrigkou
- a Second Department of Critical Care Medicine , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Iraklis Tsangaris
- a Second Department of Critical Care Medicine , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Stefanos Bonovas
- b Humanitas University , Department of Biomedical Sciences , Milan , Italy.,c Humanitas Clinical and Research Center , Milan , Italy
| | - Petros Kopterides
- a Second Department of Critical Care Medicine , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Elias Kyriakou
- d Laboratory of Hematology & Blood Bank Unit , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Dimitrios Konstantonis
- a Second Department of Critical Care Medicine , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Athanasios Pappas
- a Second Department of Critical Care Medicine , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Anastasia Anthi
- a Second Department of Critical Care Medicine , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Argyri Gialeraki
- d Laboratory of Hematology & Blood Bank Unit , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Stylianos E Orfanos
- a Second Department of Critical Care Medicine , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Apostolos Armaganidis
- a Second Department of Critical Care Medicine , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Argyrios Tsantes
- d Laboratory of Hematology & Blood Bank Unit , University Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
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Kevane B, Allen S, Walsh K, Egan K, Maguire PB, Galligan MC, Kenny D, Savage R, Doran E, Lennon Á, Neary E, Ní Áinle F. Dual endothelin-1 receptor antagonism attenuates platelet-mediated derangements of blood coagulation in Eisenmenger syndrome. J Thromb Haemost 2018; 16:S1538-7836(22)02206-1. [PMID: 29802795 DOI: 10.1111/jth.14159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 01/07/2023]
Abstract
Essentials Eisenmenger syndrome is characterised by thrombotic and hemorrhagic risks of unclear aetiology. Calibrated automated thrombography was used to assess these coagulation derangements. Platelet activity supported abnormalities in procoagulant and anticoagulant pathway function. Endothelin-1 antagonism appeared to ameliorate these derangements. SUMMARY Aims The mechanisms underlying the competing thrombotic and hemorrhagic risks in Eisenmenger syndrome are poorly understood. We aimed to characterize derangements of blood coagulation and to assess the effect of dual endothelin-1 receptor antagonism in modulating hemostasis in this rare disorder. Methods In a 10-month recruitment period at a tertiary cardiology referral center, during which time there were over 14 000 outpatient consultations, consecutive subjects with Eisenmenger syndrome being considered for macitentan therapy (n = 9) and healthy volunteers (n = 9) were recruited. Plasma thrombin generation in platelet-rich and platelet-poor plasma was assessed by calibrated automated thrombography prior to and following therapy. Results Median peak plasma thrombin generation was higher in platelet-rich plasma obtained from Eisenmenger syndrome subjects relative to controls (median peak thrombin [25th-75th percentile]: 228.3 [206.5-258.6] nm vs. 169.9 [164.3-215.8] nm), suggesting a critical mechanistic role for platelets in supporting abnormal hypercoagulability in Eisenmenger syndrome. Abnormal enhanced sensitivity to the anticoagulant activity of activated protein C was also observed in platelet-rich plasma in Eisenmenger syndrome, suggesting that derangements of platelet activity may influence the activity of anticoagulant pathways in a manner that might promote bleeding in this disease state. Following 6 months of macitentan therapy, attenuations in the derangements in both procoagulant and anticoagulant pathways were observed. Conclusions Abnormal platelet activity contributes to derangements in procoagulant and anticoagulant pathways in Eisenmenger syndrome. Therapies targeting the underlying vascular pathology appear to ameliorate these derangements and may represent a novel strategy for the management of the competing prothrombotic and hemorrhagic tendencies in this disorder.
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Affiliation(s)
- B Kevane
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- SPHERE Research Group, University College Dublin Conway Institute, Dublin, Ireland
- Department of Haematology, Rotunda Hospital, Dublin, Ireland
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Allen
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- SPHERE Research Group, University College Dublin Conway Institute, Dublin, Ireland
| | - K Walsh
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Egan
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- SPHERE Research Group, University College Dublin Conway Institute, Dublin, Ireland
| | - P B Maguire
- SPHERE Research Group, University College Dublin Conway Institute, Dublin, Ireland
- Department of Biomolecular and Biomedical Sciences, University College Dublin, Dublin, Ireland
| | - M C Galligan
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - D Kenny
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - R Savage
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - E Doran
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Á Lennon
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - E Neary
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
| | - F Ní Áinle
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- SPHERE Research Group, University College Dublin Conway Institute, Dublin, Ireland
- Department of Haematology, Rotunda Hospital, Dublin, Ireland
- Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland
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27
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New insights into the recognition, classification and management of systemic sclerosis-associated pulmonary hypertension. Curr Opin Rheumatol 2018; 29:561-567. [PMID: 28817465 DOI: 10.1097/bor.0000000000000440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Pulmonary hypertension is a common complication of systemic sclerosis (SSc), and remains a leading cause of morbidity and mortality. We will review recent developments in the recognition, classification and treatment of pulmonary hypertension in SSc. RECENT FINDINGS Advances in screening for pulmonary arterial hypertension (PAH) and use of exercise haemodynamics may help to identify pulmonary vascular disease earlier in SSc. Recent studies have led to changes in recommendations for adjunct therapy and selection of pulmonary vasodilators for the treatment of SSc-associated PAH. SUMMARY Recent advances in the diagnosis, classification and management of pulmonary hypertension in SSc have continued to improve our understanding of this challenging disease. Ongoing investigation in the pathogenesis of this disease will afford the opportunity to develop targeted therapies to improve outcomes for SSc patients with pulmonary hypertension.
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28
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Propensity Score Methods for Bias Reduction in Observational Studies of Treatment Effect. Rheum Dis Clin North Am 2018; 44:203-213. [DOI: 10.1016/j.rdc.2018.01.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Xu SZ, Yan Liang, Li XP, Li XM, Shuai ZW, Leng RX, Pan HF, Ye DQ. Features associated with pulmonary arterial hypertension in Chinese hospitalized systemic lupus erythematosus patients. Clin Rheumatol 2018. [PMID: 29520672 DOI: 10.1007/s10067-018-4056-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pulmonary arterial hypertension (PAH) is an increasingly recognized complication of systemic lupus erythematosus (SLE). This study aims to estimate the point prevalence of PAH and identify risk factors for PAH in a large cohort of hospitalized SLE patients. We have collected the medical records of patients hospitalized with SLE at the First Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital. Resting transthoracic echocardiography (TTE) was used to estimate pulmonary artery pressure (PAP) and PAH was defined as systolic PAP (PASP) > 30 mmHg. Patients with other connective tissue diseases, aPL syndrome, left heart disease, valvular heart disease, congenital heart disease, HIV, and portal hypertension were excluded because of diseases affecting the PAP. We assessed potential risk factors for PAH such as thrombogenic factors, SLE clinical manifestations, laboratory abnormalities and disease activity. Ninety-five were diagnosed with PAH of 1639 patients with SLE. The presence of high fibrinogen, serositis, and thrombocytopenia were significantly higher in patients with PAH than in those without PAH (all P < 0.05). Multivariate logistic regression found the associations between high fibrinogen (OR = 1.629), serositis (OR = 2.866), and thrombocytopenia (OR = 1.825) with PAH. The point prevalence of PAH was 5.8% in our cohort of patients with SLE. The significant association of high fibrinogen, serositis, and thrombocytopenia with PAH suggested that hypercoagulable state, organ damage, and hematological abnormality may all contribute to the development of PAH in SLE. This is important, as it is treatable.
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Affiliation(s)
- Shu-Zhen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Yan Liang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Xiang-Pei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui, 230001, China
| | - Xiao-Mei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, Hefei, Anhui, 230001, China
| | - Zong-Wen Shuai
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, China
| | - Rui-Xue Leng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China. .,Anhui Province Key Laboratory of Major Autoimmune Diseases, 81 Meishan Road, Hefei, Anhui, 230032, China.
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30
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Palazzini M, Manes A, Gotti E, Dardi F, Rinaldi A, Galiè N. Anticoagulant treatment in patients with pulmonary arterial hypertension associated with systemic sclerosis: More shadows than lights. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:39-42. [PMID: 35382126 PMCID: PMC8892881 DOI: 10.1177/2397198317751864] [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] [Accepted: 12/13/2017] [Indexed: 11/03/2023]
Abstract
Pulmonary arterial hypertension is a chronic and progressive disease characterized by elevated pulmonary artery pressure and pulmonary vascular resistance leading to heart failure and premature death. Pulmonary arterial hypertension is characterized by proliferative and obstructive lesions in the distal pulmonary arteries and some descriptions include also thrombotic lesions. Despite this, in an era when multiple effective pulmonary arterial hypertension therapies are available, the role of anticoagulation in the treatment of pulmonary arterial hypertension remains uncertain. In particular, anticoagulant treatment in pulmonary arterial hypertension associated with connective tissue disease seems to be associated with unfavorable risk to benefit ratio due to an increased rate of bleeding from the gastrointestinal tract. However, anticoagulation may be required in conditions with increased thrombophilia like in the presence of lupus anticoagulant phenomenon or in the presence of anticardiolipin antibodies.
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Affiliation(s)
- Massimiliano Palazzini
- Department of Experimental, Diagnostic and
Specialty Medicines (DIMES), University of Bologna, Bologna -
Italy
| | - Alessandra Manes
- Department of Experimental, Diagnostic and
Specialty Medicines (DIMES), University of Bologna, Bologna -
Italy
| | - Enrico Gotti
- Department of Experimental, Diagnostic and
Specialty Medicines (DIMES), University of Bologna, Bologna -
Italy
| | - Fabio Dardi
- Department of Experimental, Diagnostic and
Specialty Medicines (DIMES), University of Bologna, Bologna -
Italy
| | - Andrea Rinaldi
- Department of Experimental, Diagnostic and
Specialty Medicines (DIMES), University of Bologna, Bologna -
Italy
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and
Specialty Medicines (DIMES), University of Bologna, Bologna -
Italy
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31
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Nakamura H, Kato M, Nakaya T, Kono M, Tanimura S, Sato T, Fujieda Y, Oku K, Ohira H, Bohgaki T, Yasuda S, Tsujino I, Nishimura M, Atsumi T. Decreased haptoglobin levels inversely correlated with pulmonary artery pressure in patients with pulmonary arterial hypertension: A cross-sectional study. Medicine (Baltimore) 2017; 96:e8349. [PMID: 29069014 PMCID: PMC5671847 DOI: 10.1097/md.0000000000008349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We investigated the serum haptoglobin levels in patients with pulmonary arterial hypertension (PAH) based on the hypothesis that haptoglobin levels would reflect subclinical hemolysis due to microangiopathy in pulmonary arterioles.This cross-sectional study included 3 groups of patients attending Hokkaido University Hospital: PAH, chronic thromboembolic pulmonary hypertension (CTEPH), and connective tissue diseases (CTD) without PAH (CTD-non-PAH) group. Serum haptoglobin levels were measured by standardized turbidimetric immunoassay in all patients. Demographic data, laboratory results, right heart catheter, and echocardiographic findings were extracted from the medical records. Decreased haptoglobin levels were defined as below 19 mg/dL based on the 95th percentile of healthy controls.Thirty-five patients in PAH group including 11 with idiopathic PAH (IPAH) and 24 with CTD-associated PAH (CTD-PAH), 27 in CTEPH group, and 32 in CTD-non-PAH group were analyzed. Serum haptoglobin levels in PAH group (median 66 mg/dL) were significantly lower than those in CTEPH group (median 94 mg/dL, P = .03) and CTD-non-PAH group (median 79 mg/dL, P = .03). The prevalence of decreased haptoglobin levels was 26% in PAH group, 15% in CTEPH group, and 6% in CTD-non-PAH group. Serum haptoglobin levels had a significant negative correlation (r = -0.66, P < .001) with mean pulmonary artery pressure in PAH group, particularly in CTD-PAH subgroup (r = -0.74, P < .001), but no correlation in IPAH subgroup (r = -0.52, P = .13) and in CTEPH group (r = -0.17, P = .41). Follow-up cases of CTD-PAH showed lowering pulmonary artery pressure led to normalizing serum haptoglobin levels.Serum haptoglobin levels decreased in PAH patients and inversely correlated with pulmonary artery pressure in CTD-PAH patients, suggesting their potential as a surrogate marker for CTD-PAH.
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Affiliation(s)
- Hiroyuki Nakamura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Toshitaka Nakaya
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Michihiro Kono
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Shun Tanimura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Takahiro Sato
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yuichiro Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Hiroshi Ohira
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Toshiyuki Bohgaki
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Shinsuke Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masaharu Nishimura
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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32
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Rhodes CJ, Wharton J, Ghataorhe P, Watson G, Girerd B, Howard LS, Gibbs JSR, Condliffe R, Elliot CA, Kiely DG, Simonneau G, Montani D, Sitbon O, Gall H, Schermuly RT, Ghofrani HA, Lawrie A, Humbert M, Wilkins MR. Plasma proteome analysis in patients with pulmonary arterial hypertension: an observational cohort study. THE LANCET. RESPIRATORY MEDICINE 2017; 5:717-726. [PMID: 28624389 PMCID: PMC5573768 DOI: 10.1016/s2213-2600(17)30161-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/07/2017] [Accepted: 04/11/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Idiopathic and heritable pulmonary arterial hypertension form a rare but molecularly heterogeneous disease group. We aimed to measure and validate differences in plasma concentrations of proteins that are associated with survival in patients with idiopathic or heritable pulmonary arterial hypertension to improve risk stratification. METHODS In this observational cohort study, we enrolled patients with idiopathic or heritable pulmonary arterial hypertension from London (UK; cohorts 1 and 2), Giessen (Germany; cohort 3), and Paris (France; cohort 4). Blood samples were collected at routine clinical appointment visits, clinical data were collected within 30 days of blood sampling, and biochemical data were collected within 7 days of blood sampling. We used an aptamer-based assay of 1129 plasma proteins, and patient clinical details were concealed to the technicians. We identified a panel of prognostic proteins, confirmed with alternative targeted assays, which we evaluated against the established prognostic risk equation for pulmonary arterial hypertension derived from the REVEAL registry. All-cause mortality was the primary endpoint. FINDINGS 20 proteins differentiated survivors and non-survivors in 143 consecutive patients with idiopathic or heritable pulmonary arterial hypertension with 2 years' follow-up (cohort 1) and in a further 75 patients with 2·5 years' follow-up (cohort 2). Nine proteins were both prognostic independent of plasma NT-proBNP concentrations and confirmed by targeted assays. The functions of these proteins relate to myocardial stress, inflammation, pulmonary vascular cellular dysfunction and structural dysregulation, iron status, and coagulation. A cutoff-based score using the panel of nine proteins provided prognostic information independent of the REVEAL equation, improving the C statistic from area under the curve 0·83 (for REVEAL risk score, 95% CI 0·77-0·89; p<0·0001) to 0·91 (for panel and REVEAL 0·87-0·96; p<0·0001) and improving reclassification indices without detriment to calibration. Poor survival was preceded by an adverse change in panel score in paired samples from 43 incident patients with pulmonary arterial hypertension in cohort 3 (p=0·0133). The protein panel was validated in 93 patients with idiopathic or heritable pulmonary arterial hypertension in cohort 4, with 4·4 years' follow-up and improved risk estimates, providing complementary information to the clinical risk equation. INTERPRETATION A combination of nine circulating proteins identifies patients with pulmonary arterial hypertension with a high risk of mortality, independent of existing clinical assessments, and might have a use in clinical management and the evaluation of new therapies. FUNDING National Institute for Health Research, Wellcome Trust, British Heart Foundation, Assistance Publique-Hôpitaux de Paris, Inserm, Université Paris-Sud, and Agence Nationale de la Recherche.
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Affiliation(s)
| | - John Wharton
- Department of Medicine, Imperial College London, Hammersmith Campus, London, UK
| | - Pavandeep Ghataorhe
- Department of Medicine, Imperial College London, Hammersmith Campus, London, UK
| | - Geoffrey Watson
- Department of Medicine, Imperial College London, Hammersmith Campus, London, UK
| | - Barbara Girerd
- University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France,AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, London, UK,National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, London, UK,National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Charles A Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Gerald Simonneau
- University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France,AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - David Montani
- University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France,AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Olivier Sitbon
- University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France,AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Henning Gall
- University of Giessen and Marburg Lung Center, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Ralph T Schermuly
- University of Giessen and Marburg Lung Center, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - H Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Marc Humbert
- University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France,AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France,Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, Paris, France
| | - Martin R Wilkins
- Department of Medicine, Imperial College London, Hammersmith Campus, London, UK.
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33
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Jain A, Barrile R, van der Meer AD, Mammoto A, Mammoto T, De Ceunynck K, Aisiku O, Otieno MA, Louden CS, Hamilton GA, Flaumenhaft R, Ingber DE. Primary Human Lung Alveolus-on-a-chip Model of Intravascular Thrombosis for Assessment of Therapeutics. Clin Pharmacol Ther 2017; 103:332-340. [PMID: 28516446 DOI: 10.1002/cpt.742] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/26/2017] [Accepted: 05/08/2017] [Indexed: 12/26/2022]
Abstract
Pulmonary thrombosis is a significant cause of patient mortality; however, there are no effective in vitro models of thrombi formation in human lung microvessels that could also assess therapeutics and toxicology of antithrombotic drugs. Here, we show that a microfluidic lung alveolus-on-a-chip lined by human primary alveolar epithelium interfaced with endothelium and cultured under flowing whole blood can be used to perform quantitative analysis of organ-level contributions to inflammation-induced thrombosis. This microfluidic chip recapitulates in vivo responses, including platelet-endothelial dynamics and revealed that lipopolysaccharide (LPS) endotoxin indirectly stimulates intravascular thrombosis by activating the alveolar epithelium, rather than acting directly on endothelium. This model is also used to analyze inhibition of endothelial activation and thrombosis due to a protease activated receptor-1 (PAR-1) antagonist, demonstrating its ability to dissect complex responses and identify antithrombotic therapeutics. Thus, this methodology offers a new approach to study human pathophysiology of pulmonary thrombosis and advance drug development.
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Affiliation(s)
- A Jain
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA.,Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biomedical Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, Texas, USA
| | - R Barrile
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA.,Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - A D van der Meer
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - A Mammoto
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - T Mammoto
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - K De Ceunynck
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - O Aisiku
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - M A Otieno
- Janssen Pharmaceutical Research and Development, Pre-Clinical Development and Safety, Spring House, Pennsylvania, USA
| | - C S Louden
- Janssen Pharmaceutical Research and Development, Pre-Clinical Development and Safety, Spring House, Pennsylvania, USA
| | | | - R Flaumenhaft
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - D E Ingber
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts, USA.,Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts, USA
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34
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Roldan T, Rios JJ, Villamañan E, Waxman AB. Complications associated with the use of oral anticoagulation in patients with pulmonary arterial hypertension from two referral centers. Pulm Circ 2017; 7:692-701. [PMID: 28677986 PMCID: PMC5841891 DOI: 10.1177/2045893217721903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/15/2017] [Indexed: 01/25/2023] Open
Abstract
Anticoagulants are widely used in patients with pulmonary arterial hypertension (PAH) to prolong survival. However, there is a lack of robust evidence demonstrating the benefits of anticoagulants in PAH patients and very little is known about the complications of their use in this population. The objective of this study is to compare the safety of routine administration of oral anticoagulants between PAH patients who were and were not treated with oral anticoagulants. This observational, retrospective cohort study included consecutive patients with confirmed PAH from two centers: Brigham and Women's Hospital in Boston and Hospital Universitario La Paz in Madrid from January 2009 to August 2015. The study group comprised patients who received therapeutic anticoagulation; patients who had never received anticoagulants were placed in the control group. Of the 201 included patients, 60.2% were treated with oral anticoagulants and 39.8% were not treated. The hazard ratio for major bleeding was 2.7 (95% confidence interval [CI] = 1.1-6.8; P = 0.036). The incidence rate for the anticoagulation group was 4.7 per 100 patient-years (95% CI = 2.5-8.0). The most frequent major hemorrhage was gastrointestinal bleeding with 24 cases (72.7%). Prior bleeding, poor anticoagulation, HAS-BLED score ≥3, diabetes, and number of medications were factors that increased the risk of major bleeding in patients using anticoagulants. The harmful effects of anticoagulants could outweigh the benefits in PAH patients. Therefore, anticoagulants should be prescribed on a case-by-case basis and should not be systematically recommended.
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Affiliation(s)
- Tamara Roldan
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Pharmacy, Hospital Universitario La Paz, Madrid, Spain
| | - Juan J Rios
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Villamañan
- Department of Pharmacy, Hospital Universitario La Paz, Madrid, Spain
| | - Aaron B. Waxman
- Center for Pulmonary-Heart Diseases, Brigham and Women’s Hospital Heart and Vascular Center, Boston, MA, USA
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35
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Nguyen QL, Corey C, White P, Watson A, Gladwin MT, Simon MA, Shiva S. Platelets from pulmonary hypertension patients show increased mitochondrial reserve capacity. JCI Insight 2017; 2:e91415. [PMID: 28289721 DOI: 10.1172/jci.insight.91415] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Accumulating evidence suggests that altered cellular metabolism is systemic in pulmonary hypertension (PH) and central to disease pathogenesis. However, bioenergetic changes in PH patients and their association with disease severity remain unclear. Here, we hypothesize that alteration in bioenergetic function is present in platelets from PH patients and correlates with clinical parameters of PH. Platelets isolated from controls and PH patients (n = 28) were subjected to extracellular flux analysis to determine oxygen consumption and glycolytic rates. Platelets from PH patients showed greater glycolytic rates than controls. Surprisingly, this was accompanied by significant increases in the maximal capacity for oxygen consumption, leading to enhanced respiratory reserve capacity in PH platelets. This increased platelet reserve capacity correlated with mean pulmonary artery pressure, pulmonary vascular resistance, and right ventricular stroke work index in PH patients and was abolished by the inhibition of fatty acid oxidation (FAO). Consistent with a shift to FAO, PH platelets showed augmented enzymatic activity of carnitine palmitoyltransferase-1 and electron transport chain complex II. These data extend the observation of a metabolic alteration in PH from the pulmonary vascular axis to the hematologic compartment and suggest that measurement of platelet bioenergetics is potentially useful in assessment of disease progression and severity.
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Affiliation(s)
- Quyen L Nguyen
- Division of Pulmonary Allergy and Critical Care Medicine.,Vascular Medicine Institute
| | | | | | | | - Mark T Gladwin
- Division of Pulmonary Allergy and Critical Care Medicine.,Vascular Medicine Institute
| | - Marc A Simon
- Vascular Medicine Institute.,Division of Cardiology
| | - Sruti Shiva
- Vascular Medicine Institute.,Department of Pharmacology and Chemical Biology.,Center for Metabolism and Mitochondrial Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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36
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Preston IR, Roberts KE, Miller DP, Sen GP, Selej M, Benton WW, Hill NS, Farber HW. Effect of Warfarin Treatment on Survival of Patients With Pulmonary Arterial Hypertension (PAH) in the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL). Circulation 2015; 132:2403-11. [PMID: 26510696 PMCID: PMC4689180 DOI: 10.1161/circulationaha.115.018435] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 09/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long-term anticoagulation is recommended in idiopathic pulmonary arterial hypertension (IPAH). In contrast, limited data support anticoagulation in pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-PAH). We assessed the effect of warfarin anticoagulation on survival in IPAH and SSc-PAH patients enrolled in Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), a longitudinal registry of group I PAH. METHODS AND RESULTS Patients who initiated warfarin on study (n=187) were matched 1:1 with patients never on warfarin, by enrollment site, etiology, and diagnosis status. Descriptive analyses were conducted to compare warfarin users and nonusers by etiology. Survival analyses with and without risk adjustment were performed from the time of warfarin initiation or a corresponding quarterly update in matched pairs to avoid immortal time bias. Time-varying covariate models were used as sensitivity analyses. Mean warfarin treatment was 1 year; mean international normalized ratios were 1.9 (IPAH) and 2.0 (SSc-PAH). Two-thirds of patients initiating warfarin discontinued treatment before the last study assessment. There was no survival difference with warfarin in IPAH patients (adjusted hazard ratio, 1.37; P=0.21) or in SSc-PAH patients (adjusted hazard ratio, 1.60; P=0.15) in comparison with matched controls. However, SSc-PAH patients receiving warfarin within the previous year (hazard ratio, 1.57; P=0.031) or any time postbaseline (hazard ratio, 1.49; P=0.046) had increased mortality in comparison with warfarin-naïve patients. CONCLUSIONS No significant survival advantage was observed in IPAH patients who started warfarin. In SSc-PAH patients, long-term warfarin was associated with poorer survival than in patients not receiving warfarin, even after adjusting for confounders. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00370214.
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Affiliation(s)
- Ioana R Preston
- From Tufts University School of Medicine, Boston, MA (I.R.P., K.E.R., N.S.H.); ICON Clinical Research, San Francisco, CA (D.P.M., G.P.S.); Actelion Pharmaceuticals US Inc., South San Francisco, CA (M.S., W.W.B.); and Boston University School of Medicine, Boston, MA (H.W.F.)
| | - Kari E Roberts
- From Tufts University School of Medicine, Boston, MA (I.R.P., K.E.R., N.S.H.); ICON Clinical Research, San Francisco, CA (D.P.M., G.P.S.); Actelion Pharmaceuticals US Inc., South San Francisco, CA (M.S., W.W.B.); and Boston University School of Medicine, Boston, MA (H.W.F.)
| | - Dave P Miller
- From Tufts University School of Medicine, Boston, MA (I.R.P., K.E.R., N.S.H.); ICON Clinical Research, San Francisco, CA (D.P.M., G.P.S.); Actelion Pharmaceuticals US Inc., South San Francisco, CA (M.S., W.W.B.); and Boston University School of Medicine, Boston, MA (H.W.F.)
| | - Ginny P Sen
- From Tufts University School of Medicine, Boston, MA (I.R.P., K.E.R., N.S.H.); ICON Clinical Research, San Francisco, CA (D.P.M., G.P.S.); Actelion Pharmaceuticals US Inc., South San Francisco, CA (M.S., W.W.B.); and Boston University School of Medicine, Boston, MA (H.W.F.)
| | - Mona Selej
- From Tufts University School of Medicine, Boston, MA (I.R.P., K.E.R., N.S.H.); ICON Clinical Research, San Francisco, CA (D.P.M., G.P.S.); Actelion Pharmaceuticals US Inc., South San Francisco, CA (M.S., W.W.B.); and Boston University School of Medicine, Boston, MA (H.W.F.)
| | - Wade W Benton
- From Tufts University School of Medicine, Boston, MA (I.R.P., K.E.R., N.S.H.); ICON Clinical Research, San Francisco, CA (D.P.M., G.P.S.); Actelion Pharmaceuticals US Inc., South San Francisco, CA (M.S., W.W.B.); and Boston University School of Medicine, Boston, MA (H.W.F.)
| | - Nicholas S Hill
- From Tufts University School of Medicine, Boston, MA (I.R.P., K.E.R., N.S.H.); ICON Clinical Research, San Francisco, CA (D.P.M., G.P.S.); Actelion Pharmaceuticals US Inc., South San Francisco, CA (M.S., W.W.B.); and Boston University School of Medicine, Boston, MA (H.W.F.)
| | - Harrison W Farber
- From Tufts University School of Medicine, Boston, MA (I.R.P., K.E.R., N.S.H.); ICON Clinical Research, San Francisco, CA (D.P.M., G.P.S.); Actelion Pharmaceuticals US Inc., South San Francisco, CA (M.S., W.W.B.); and Boston University School of Medicine, Boston, MA (H.W.F.).
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37
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Anticoagulation in patients with pulmonary arterial hypertension: An update on current knowledge. J Heart Lung Transplant 2015; 35:151-64. [PMID: 26527532 DOI: 10.1016/j.healun.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/05/2015] [Accepted: 10/01/2015] [Indexed: 11/23/2022] Open
Abstract
Pulmonary hypertension is a severe clinical condition characterized by molecular and anatomic changes in pulmonary circulation. It is associated with increased pulmonary vascular resistance, which leads to right-sided heart failure if left untreated and, ultimately, death. Treatment of patients with pulmonary arterial hypertension (PAH) involves a complex strategy that takes into consideration disease severity, general and supportive measures, and combination drug regimens. Abnormalities of blood coagulation factors, anti-thrombotic factors, and the fibrinolytic system may contribute to a prothrombotic state in patients with idiopathic PAH. These physiologic changes, in concert with the presence of non-specific risk factors for venous thromboembolism such as heart failure and immobility, are thought to be the basis for oral anticoagulation in PAH. Several observational studies provide helpful information in favor of anticoagulation use in idiopathic PAH but not in other pulmonary hypertension etiologies. Guideline recommendations are based on the lack of prospective comparative trials in this regard. For that reason, large differences exist in the use of anticoagulants in different countries and centers. More studies should be carried out to clarify the risks and the potential benefits of anticoagulant use in a heterogeneous population of patients who are already at considerable life risk.
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38
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Kodur S, Ahmad W, Heittarachi M, Reeves G, Attia J, Barker D, Collins N. Influence of Age on Outcome in Patients with Pulmonary Arterial Hypertension. Heart Lung Circ 2015; 24:719-23. [PMID: 25790775 DOI: 10.1016/j.hlc.2015.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 11/03/2014] [Accepted: 01/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The development of effective orally administered medical therapy for pulmonary arterial hypertension (PAH) has made a significant impact on outcome in patients with PAH. Identification of patient groups likely to derive optimal benefit is important, given cost and potential side effects; the clinical effectiveness of these therapies in older patients with PAH is unclear as the presence of co-morbidity may limit benefits of therapy. AIMS We evaluated the epidemiology of PAH in a contemporary cohort to assess the influence of age on long-term outcome using PAH-specific therapies. RESULTS A total of 119 patients (88% female; mean age 65±12 years) were reviewed, comprising 52% with underlying connective tissue disease. Bosentan was the PAH specific agent most frequently used. The baseline 6MWT distance in the entire cohort was 304m with age associated with a significant decline in 6MWT. CONCLUSIONS In a large cohort of patients treated with PAH-specific therapies, patients less than 55 years of age showed improvement in 6MWT with older patients demonstrating stabilisation or decline.
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Affiliation(s)
- Sreekanth Kodur
- Cardiovascular Unit, John Hunter Hospital, New Lambton, NSW, 2305
| | - Waheed Ahmad
- Cardiovascular Unit, John Hunter Hospital, New Lambton, NSW, 2305
| | | | - Glenn Reeves
- Hunter Area Pathology Service, John Hunter Hospital, New Lambton, NSW, 2305
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308
| | - Nicholas Collins
- Cardiovascular Unit, John Hunter Hospital, New Lambton, NSW, 2305
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39
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Kang BJ, Lee SD, Oh YM, Lee JS. Improved survival of Korean patients with idiopathic pulmonary arterial hypertension after the introduction of targeted therapies. Heart Lung 2014; 43:561-8. [PMID: 25151431 DOI: 10.1016/j.hrtlng.2014.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/19/2014] [Accepted: 07/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We compared the survival of patients with idiopathic pulmonary arterial hypertension (IPAH), receiving conventional and targeted therapies. BACKGROUND IPAH is an incurable disease with high mortality. To manage IPAH, several targeted therapies have been used in Korea. METHODS We performed a retrospective study of 71 patients diagnosed with IPAH in a tertiary hospital between January 1994 and February 2013. Patients were classified into "conventional therapy group" (treated with conventional therapies and/or beraprost) and "targeted therapy group" (treated with targeted therapies other than beraprost). RESULTS The median age of the patients was 33 years and 50 patients were female. The survival rate at 1, 3, 5, and 10 years was 80.1% 62.0%, 51.5%, and 26.8%, respectively. The survival rate in the targeted therapy group was greater than in the conventional therapy group (p-value = 0.026). CONCLUSIONS We believe targeted therapies would improve survival benefits in IPAH patients.
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Affiliation(s)
- Byung Ju Kang
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Center for Pulmonary Hypertension and Venous Thromboembolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Center for Pulmonary Hypertension and Venous Thromboembolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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40
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Oral Anticoagulation for Pulmonary Arterial Hypertension: Systematic Review and Meta-analysis. Can J Cardiol 2014; 30:879-87. [DOI: 10.1016/j.cjca.2014.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/30/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022] Open
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41
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Affiliation(s)
- Zhongjie Sun
- From the Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
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42
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Said K. Anticoagulation in pulmonary arterial hypertension: Contemporary data from COMPERA registry. Glob Cardiol Sci Pract 2014; 2014:48-52. [PMID: 25405178 PMCID: PMC4220434 DOI: 10.5339/gcsp.2014.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/02/2014] [Indexed: 01/13/2023] Open
Abstract
The use of anticoagulant therapy in patients with pulmonary arterial hypertension (PAH) has been controversial for decades. Recommendations for anticoagulation in these patients are often derived from small, retrospective, and single centre studies without any placebo-controlled randomized study. Furthermore, uncertainties exist regarding a number of issues such as patient selection, risk stratification for bleeding, the intensity of anticoagulation, appropriateness of anticoagulation in different types of PAH, and the potential use of new oral anticoagulants. Recently, the database of the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) has been analyzed to assess the effect of anticoagulation on the long-term outcome of patients with various forms of PAH. This analysis is the largest to date to assess anticoagulant therapy in PAH patients in a prospective design with long observation period. The results of COMPERA lend support to current recommendations for the use of anticoagulant therapy in patients with idiopathic PAH, but not in other forms of PAH. Also, the study confirmed the previously reported concern that anticoagulant therapy may be harmful in patients with scleroderma-associated PAH.
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43
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Tauil KMW, Gaio E, Melo-Silva CA, Carvalho RS, Amado VM. Pulmonary arterial hypertension and sepsis: prothrombotic profile and inflammation can changes pulmonary mechanics? Med Hypotheses 2014; 83:290-1. [PMID: 24957506 DOI: 10.1016/j.mehy.2014.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022]
Abstract
Pulmonary arterial hypertension (PAH) is associated to cellular and structural alterations of lung vasculature. Endothelial dysfunction promotes vasoconstriction, smooth muscle hypertrophy, intimal proliferation, angioproliferative plexiform lesions, and in situ thrombosis increasing pulmonary vascular resistance and arterial stiffness. Indeed, an inflammatory component has been defined in PAH on the last years. Sepsis is a systemic complex syndrome, of infectious origin. The presence of inflammation is well established in this condition and it is also considered a risk factor for acute lung injury. Thrombotic events play important role in sepsis pathophysiology. The association between PAH and sepsis potentiate the metabolic oxygen consumption/offer imbalance, with very high mortality risk. Furthermore, it is possible that the association of these two conditions should intensify thrombotic events on pulmonary microcirculation, reducing area of pulmonary vascular bed available for blood flow. For the other side, an inflammation synergism observed on these two conditions should increase the respiratory system impedance.
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Affiliation(s)
| | - Eduardo Gaio
- Laboratory of Respiratory Physiology, Universidade de Brasília, Brasília - DF, Brazil
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44
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Ezedunukwe IR, Enuh H, Nfonoyim J, Enuh CU. Anticoagulation therapy versus placebo for pulmonary hypertension. Cochrane Database Syst Rev 2014; 2014:CD010695. [PMID: 24887213 PMCID: PMC6885066 DOI: 10.1002/14651858.cd010695.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Elevation of pulmonary pressure is no longer a rare disease, given its multifactorial etiology. However data on the actual incidence of this condition are still limited, and controversies regarding its management are ongoing. Use of anticoagulation in the management of pulmonary hypertension is based on the presence of in situ thrombosis in the patient with pulmonary arterial hypertension (PAH) and on retrospective evidence of clinical benefit. Current practice is dependent mostly on expert opinion and individualised experience. The real benefit of its use in different types of pulmonary hypertension is still debatable, and the therapeutic target of the international normalised ratio (INR) among treated patients remains inconclusive. Adverse outcomes associated with anticoagulants are significant and can include fatal haemorrhage. Justification for the use of this intervention requires critical evaluation of randomised controlled trials. OBJECTIVES 1. To evaluate the effectiveness of, and potential adverse events associated with, anticoagulation in the management of pulmonary hypertension (PH).2. To evaluate the effective therapeutic INR in pulmonary hypertensive patients receiving anticoagulants (North American centres 1.5 to 2.5, European centres 2.0 to 3.0). SEARCH METHODS We identified trials through searches of the following databases.Cochrane Airways Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library; MEDLINE (Ovid); EMBASE (Ovid); CINAHL (EBSCOhost); Clinical trials.gov and the World Health Organization (WHO) trials portal. The trial search date was 28 March 2014. SELECTION CRITERIA We planned to include only randomised controlled trials. Participants with PH with co-morbidities including medical conditions requiring long-term anticoagulation were to be included. We also planned to include trials comparing any anticoagulant with placebo. DATA COLLECTION AND ANALYSIS Review authors (IE and HE) independently appraised all identified citations to establish their relevance for inclusion in the review. IE and HE independently screened the titles and abstracts of all identified potential studies for inclusion. MAIN RESULTS No eligible trials were identified for inclusion in this review. AUTHORS' CONCLUSIONS No eligible studies were identified for inclusion in this review. Although our review of available non-randomised studies shows beneficial effect, this finding should be interpreted with caution since there are likely to be biases associated with their design and our methods were not designed to identify, appraise and summarise evidence from them. So that better decisions can be made regarding the effectiveness of this intervention, well-designed randomised controlled trials are needed.
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Affiliation(s)
| | - Hilary Enuh
- Richmond University Medical CenterDepartment of Internal MedicineStaten IslandUSA
| | - Jay Nfonoyim
- Richmond University Medical CenterDepartment of Pulmonary Critical Care355 Bard AvenueStaten IslandUSA1030
| | - Collins U Enuh
- University of Abuja Teaching HospitalDepartment of AnaesthesiologyGwagwalda FCTAbujaNigeria234
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45
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Lannan KL, Phipps RP, White RJ. Thrombosis, platelets, microparticles and PAH: more than a clot. Drug Discov Today 2014; 19:1230-5. [PMID: 24747560 DOI: 10.1016/j.drudis.2014.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/02/2014] [Indexed: 12/19/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease that involves pathological remodeling, vasoconstriction and thrombosis. Alterations in hemostasis, coagulation and platelet activation are consistently observed in PAH patients. Microparticles derived from platelets, inflammatory cells and the endothelium are an increasingly well-recognized signal in a variety of cardiovascular diseases, including PAH. This review will focus on the roles of coagulation, thrombosis, platelet activation and microparticles in the pathology and progression of PAH.
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Affiliation(s)
- Katie L Lannan
- Department of Microbiology and Immunology, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Richard P Phipps
- Department of Microbiology and Immunology, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Pathology and Laboratory Medicine, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Environmental Medicine, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - R James White
- Aab Cardiovascular Research Institute and Division of Pulmonary and Critical Care Medicine, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA.
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46
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Bauer EM, Chanthaphavong RS, Sodhi CP, Hackam DJ, Billiar TR, Bauer PM. Genetic deletion of toll-like receptor 4 on platelets attenuates experimental pulmonary hypertension. Circ Res 2014; 114:1596-600. [PMID: 24637196 DOI: 10.1161/circresaha.114.303662] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
RATIONALE Recent studies demonstrate a role for toll-like receptor 4 (TLR4) in the pathogenesis of pulmonary hypertension (PH); however, the cell types involved in mediating the effects of TLR4 remain unknown. OBJECTIVES The objective of this study was to determine the contribution of TLR4 expressed on nonparenchymal cells to the pathogenesis of PH. METHODS AND RESULTS TLR4 bone marrow chimeric mice revealed an equal contribution of TLR4 on nonparenchymal and parenchymal cells in the pathogenesis of PH as determined by measuring right ventricular (RV) systolic pressure and RV hypertrophy. However, the deletion of TLR4 from myeloid lineage cells had no effect on the development of PH because we found no difference in RV systolic pressure or RV hypertrophy in wild-type versus LysM-TLR4(-/-) mice. To explore the potential role of platelet TLR4 in the pathogenesis of PH, platelet-specific TLR4(-/-) mice were generated (PF4-TLR4(-/-) mice). TLR4(-/-) platelets from either global TLR4(-/-) or PF4-TLR4(-/-) mice were functional but failed to respond to lipopolysaccharide, demonstrating a lack of TLR4. PF4-TLR4(-/-) mice demonstrated significant protection from hypoxia-induced PH, including attenuated increases in RV systolic pressure and RV hypertrophy, decreased platelet activation, and less pulmonary vascular remodeling. The deletion of TLR4 from platelets attenuated serotonin release after chronic hypoxia, and lipopolysaccharide-stimulated platelets released serotonin and promoted pulmonary artery smooth muscle cell proliferation in a serotonin-dependent manner. CONCLUSIONS Our data demonstrate that TLR4 on platelets contributes to the pathogenesis of PH and further highlights the role of platelets in PH.
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Affiliation(s)
- Eileen M Bauer
- From the Department of Surgery (E.M.B., R.S.C., C.P.S., D.J.H., T.R.B., P.M.B.), University of Pittsburgh Cancer Institute (E.M.B.), Division of Pediatric Surgery, Children's Hospital Pittsburgh (C.P.S., D.J.H.), Department of Pharmacology and Chemical Biology (P.M.B.), and Vascular Medicine Institute (P.M.B.), University of Pittsburgh School of Medicine, PA
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47
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Nikpour M, Stevens W, Proudman SM, Buchbinder R, Prior D, Zochling J, Williams T, Gabbay E, Nandurkar H. Should patients with systemic sclerosis-related pulmonary arterial hypertension be anticoagulated? Intern Med J 2014; 43:599-603. [PMID: 23668273 DOI: 10.1111/imj.12111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/03/2013] [Indexed: 11/29/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a major cause of mortality in scleroderma and despite 'advanced' therapies confers a median survival of less than 5 years. Anticoagulation in systemic sclerosis-related PAH (SSc-PAH) is currently one of the most contentious issues in the management of patients with connective tissue disease. While some studies have shown a survival benefit with warfarin therapy in this disease, others have not. Accordingly, a state of clinical equipoise exists in relation to anticoagulation in SSc-PAH. With an over fivefold reduction in mortality demonstrated in some observational studies, the issue of anticoagulation in SSc-PAH demands resolution through a well-designed randomised controlled trial.
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Affiliation(s)
- M Nikpour
- Department of Medicine, St Vincent's Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia.
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48
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Olsson KM, Delcroix M, Ghofrani HA, Tiede H, Huscher D, Speich R, Grünig E, Staehler G, Rosenkranz S, Halank M, Held M, Lange TJ, Behr J, Klose H, Claussen M, Ewert R, Opitz CF, Vizza CD, Scelsi L, Vonk-Noordegraaf A, Kaemmerer H, Gibbs JSR, Coghlan G, Pepke-Zaba J, Schulz U, Gorenflo M, Pittrow D, Hoeper MM. Anticoagulation and Survival in Pulmonary Arterial Hypertension. Circulation 2014; 129:57-65. [DOI: 10.1161/circulationaha.113.004526] [Citation(s) in RCA: 264] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
For almost 30 years, anticoagulation has been recommended for patients with idiopathic pulmonary arterial hypertension (IPAH). Supporting evidence, however, is limited, and it is unclear whether this recommendation is still justified in the modern management era and whether it should be extended to patients with other forms of pulmonary arterial hypertension (PAH).
Methods and Results—
We analyzed data from Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA), an ongoing European pulmonary hypertension registry. Survival rates of patients with IPAH and other forms of PAH were compared by the use of anticoagulation. The sample consisted of 1283 consecutively enrolled patients with newly diagnosed PAH. Anticoagulation was used in 66% of 800 patients with IPAH and in 43% of 483 patients with other forms of PAH. In patients with IPAH, there was a significantly better 3-year survival (
P
=0.006) in patients on anticoagulation compared with patients who never received anticoagulation, albeit the patients in the anticoagulation group had more severe disease at baseline. The survival difference at 3 years remained statistically significant (
P
=0.017) in a matched-pair analysis of n=336 IPAH patients. The beneficial effect of anticoagulation on survival of IPAH patients was confirmed by Cox multivariable regression analysis (hazard ratio, 0.79; 95% confidence interval, 0.66–0.94). In contrast, the use of anticoagulants was not associated with a survival benefit in patients with other forms of PAH.
Conclusions—
The present data suggest that the use of anticoagulation is associated with a survival benefit in patients with IPAH, supporting current treatment recommendations. The evidence remains inconclusive for other forms of PAH.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01347216.
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Affiliation(s)
- Karen M. Olsson
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Marion Delcroix
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - H. Ardeschir Ghofrani
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Henning Tiede
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Doerte Huscher
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Rudolf Speich
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Ekkehard Grünig
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Gerd Staehler
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Stephan Rosenkranz
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Michael Halank
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Matthias Held
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Tobias J. Lange
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Juergen Behr
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Hans Klose
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Martin Claussen
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Ralf Ewert
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Christian F. Opitz
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - C. Dario Vizza
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Laura Scelsi
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Anton Vonk-Noordegraaf
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Harald Kaemmerer
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - J. Simon R. Gibbs
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Gerry Coghlan
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Joanna Pepke-Zaba
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Uwe Schulz
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Matthias Gorenflo
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - David Pittrow
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
| | - Marius M. Hoeper
- From the Department of Respiratory Medicine and German Center of Lung Research (DZL), Hannover Medical School, Hannover, Germany (K.M.O., M.M.H.); Department of Pneumology, University Hospitals of Leuven, Leuven, Belgium (M.D.); University of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Hannover, Germany (H.A.G., H.T.); Department of Rheumatology and Clinical Immunology, Charité University Hospital, and Epidemiology unit, German Rheumatism Research Centre, Berlin,
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Prasad M, Wilson ME, McGoon MD. 69-year-old woman with ascites, hypoxia, and weight loss. Mayo Clin Proc 2013; 88:1475-9. [PMID: 24290122 DOI: 10.1016/j.mayocp.2013.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/01/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Megha Prasad
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
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Hosokawa S, Haraguchi G, Sasaki A, Arai H, Muto S, Itai A, Doi S, Mizutani S, Isobe M. Pathophysiological roles of nuclear factor kappaB (NF-kB) in pulmonary arterial hypertension: effects of synthetic selective NF-kB inhibitor IMD-0354. Cardiovasc Res 2013; 99:35-43. [DOI: 10.1093/cvr/cvt105] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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