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Ivy D, Rosenzweig EB, Abman SH, Beghetti M, Bonnet D, Douwes JM, Manes A, Berger RMF. Embracing the challenges of neonatal and paediatric pulmonary hypertension. Eur Respir J 2024:2401345. [PMID: 39209483 DOI: 10.1183/13993003.01345-2024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
Paediatric pulmonary arterial hypertension (PAH) shares common features with adult disease, but is associated with several additional disorders and challenges that require unique approaches. This article discusses recent advances, ongoing challenges and distinct approaches for caring for infants and children with PAH, as presented by the paediatric task force of the 7th World Symposium on Pulmonary Hypertension. We provide updates on diagnosing, classifying, risk-stratifying and treating paediatric pulmonary hypertension (PH) and identify critical knowledge gaps. An updated risk stratification tool and treatment algorithm is provided, now also including strategies for patients with associated cardiopulmonary conditions. Treatment of paediatric PH continues to be hindered by the lack of randomised controlled clinical trials. The challenging management of children failing targeted PAH therapy is discussed, including balloon atrial septostomy, lung transplantation and pulmonary-to-systemic shunt (Potts). A novel strategy using a multimodal approach for the management of PAH associated with congenital heart diseases with borderline pulmonary vascular resistance is included. Advances in diagnosing neonatal PH, especially signs and interpretation of PH by echocardiography, are highlighted. A team approach to the rapidly changing physiology of neonatal PH is emphasised. Challenges in drug approval are discussed, particularly the challenges of designing accurate paediatric clinical trials with age-appropriate end-points and adequate enrolment.
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Affiliation(s)
- Dunbar Ivy
- Pediatric Cardiology, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO, USA
| | - Erika B Rosenzweig
- Department of Pediatrics, Maria Fareri Children's Hospital at WMC Health and New York Medical College of Touro University, Valhalla, NY, USA
| | - Steven H Abman
- Department of Pediatrics, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO, USA
| | - Maurice Beghetti
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paediatric Cardiology, Paris, France
| | - Johannes Menno Douwes
- Center for Congenital Heart Diseases, Paediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alessandra Manes
- Cardiology Unit IRCCS, S. Orsola University Hospital, Bologna, Italy
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Paediatric and Congenital Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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2
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Boxhammer E, Paar V, Kopp K, Gharibeh SX, Bovenkamp-Aberger E, Rezar R, Lichtenauer M, Hoppe UC, Mirna M. Insulin-like Growth Factor-Binding Protein 2 in Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Gender-Based Perspective. Int J Mol Sci 2024; 25:8220. [PMID: 39125788 PMCID: PMC11312253 DOI: 10.3390/ijms25158220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
Severe aortic valve stenosis (AS) and pulmonary hypertension (PH) are life-threatening cardiovascular conditions, necessitating early detection and intervention. Recent studies have explored the role of Insulin-like Growth Factor-Binding Protein 2 (IGF-BP2) in cardiovascular pathophysiology. Understanding its involvement may offer novel insights into disease mechanisms and therapeutic targets for these conditions. A total of 102 patients (46 female, 56 male) with severe AS undergoing a transcatheter aortic valve replacement (TAVR) in a single-center study were classified using echocardiography tests to determine systolic pulmonary artery pressure (sPAP) and the presence (sPAP ≥ 40 mmHg) or absence (sPAP < 40 mmHg) of PH. Additionally, serial laboratory determinations of IGF-BP2 before, and at 24 h, 96 h, and 3 months after intervention were conducted in all study participants. Considering the entire cohort, patients with PH had significant and continuously higher serum IGF-BP2 concentrations over time than patients without PH. After subdivision by sex, it could be demonstrated that the above-mentioned results were only verifiable in males, but not in females. In the male patients, baseline IGF-BP2 levels before the TAVR was an isolated risk factor for premature death after intervention and at 1, 3, and 5 years post-intervention. The same was valid for the combination of male and echocardiographically established PH patients. The predictive role of IGF-BP2 in severe AS and concurrent PH remains unknown. A more profound comprehension of IGF-BP2 mechanisms, particularly in males, could facilitate the earlier consideration of the TAVR as a more effective and successful treatment strategy.
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Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
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Schlueter BC, Quanz K, Baldauf J, Petrovic A, Ruppert C, Guenther A, Gall H, Tello K, Grimminger F, Ghofrani HA, Weissmann N, Seeger W, Schermuly RT, Weiss A. The diverging roles of insulin-like growth factor binding proteins in pulmonary arterial hypertension. Vascul Pharmacol 2024; 155:107379. [PMID: 38762131 DOI: 10.1016/j.vph.2024.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/29/2023] [Accepted: 05/05/2024] [Indexed: 05/20/2024]
Abstract
Pulmonary hypertension (PH) is a progressive, severe and to date not curable disease of the pulmonary vasculature. Alterations of the insulin-like growth factor 1 (IGF-1) system are known to play a role in vascular pathologies and IGF-binding proteins (IGFBPs) are important regulators of the bioavailability and function of IGFs. In this study, we show that circulating plasma levels of IGFBP-1, IGFBP-2 and IGFBP-3 are increased in idiopathic pulmonary arterial hypertension (IPAH) patients compared to healthy individuals. These binding proteins inhibit the IGF-1 induced IGF-1 receptor (IGF1R) phosphorylation and exhibit diverging effects on the IGF-1 induced signaling pathways in human pulmonary arterial cells (i.e. healthy as well as IPAH-hPASMCs, and healthy hPAECs). Furthermore, IGFBPs are differentially expressed in an experimental mouse model of PH. In hypoxic mouse lungs, IGFBP-1 mRNA expression is decreased whereas the mRNA for IGFBP-2 is increased. In contrast to IGFBP-1, IGFBP-2 shows vaso-constrictive properties in the murine pulmonary vasculature. Our analyses show that IGFBP-1 and IGFBP-2 exhibit diverging effects on IGF-1 signaling and display a unique IGF1R-independent kinase activation pattern in human pulmonary arterial smooth muscle cells (hPASMCs), which represent a major contributor of PAH pathobiology. Furthermore, we could show that IGFBP-2, in contrast to IGFBP-1, induces epidermal growth factor receptor (EGFR) signaling, Stat-3 activation and expression of Stat-3 target genes. Based on our results, we conclude that the IGFBP family, especially IGFBP-1, IGFBP-2 and IGFBP-3, are deregulated in PAH, that they affect IGF signaling and thereby regulate the cellular phenotype in PH.
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MESH Headings
- Humans
- Animals
- Receptor, IGF Type 1/metabolism
- Receptor, IGF Type 1/genetics
- Signal Transduction
- Pulmonary Artery/metabolism
- Pulmonary Artery/pathology
- Pulmonary Artery/physiopathology
- Insulin-Like Growth Factor Binding Protein 3/metabolism
- Insulin-Like Growth Factor Binding Protein 3/genetics
- Insulin-Like Growth Factor Binding Protein 2/metabolism
- Insulin-Like Growth Factor Binding Protein 2/genetics
- Insulin-Like Growth Factor I/metabolism
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Cells, Cultured
- Male
- Insulin-Like Growth Factor Binding Protein 1/metabolism
- Insulin-Like Growth Factor Binding Protein 1/genetics
- Phosphorylation
- Disease Models, Animal
- STAT3 Transcription Factor/metabolism
- Case-Control Studies
- Mice, Inbred C57BL
- Familial Primary Pulmonary Hypertension/metabolism
- Familial Primary Pulmonary Hypertension/physiopathology
- Familial Primary Pulmonary Hypertension/pathology
- Familial Primary Pulmonary Hypertension/genetics
- Female
- ErbB Receptors/metabolism
- Middle Aged
- Vascular Remodeling
- Adult
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
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Affiliation(s)
- Beate Christiane Schlueter
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Karin Quanz
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Julia Baldauf
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Aleksandar Petrovic
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Clemens Ruppert
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Andreas Guenther
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; Agaplesion Lung Clinic Waldhof-Elgershausen, Greifenstein 35753, Germany
| | - Henning Gall
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Khodr Tello
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Friedrich Grimminger
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Hossein-Ardeschir Ghofrani
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Norbert Weissmann
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Werner Seeger
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; Max Planck Institute (MPI) for Heart and Lung Research, Parkstrasse 1, Bad Nauheim 61231, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Ralph Theo Schermuly
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Astrid Weiss
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany.
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Hashim AS, Al-Obaidi MN, Al-Obaidi AD, Saleh SA, Hashim HT, Al Saeedi M, Ataallah B. "An unprecedented occurrence: a case report of pulmonary hypertension manifestation in Donohue syndrome". BMC Pediatr 2024; 24:327. [PMID: 38773407 PMCID: PMC11110280 DOI: 10.1186/s12887-024-04714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/20/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Donohue syndrome (DS), also referred to as leprechaunism, is a remarkably uncommon autosomal recessive disorder that primarily affects the endocrine system. Its incidence rate is exceedingly low, with only 1 case reported per 4 million live births. The syndrome is distinguished by a series of characteristic clinical features. CASE PRESENTATION We present a case of a twenty-month-old male with DS who experienced a range of dysmorphic and clinical features with the involvement of multiple systems. These features include skin hyperpigmentation, hypertrichosis, distinct facial features, abdominal distension, and microcephaly, with the involvement of the endocrine, renal, respiratory, and cardiac systems. CONCLUSION The primary features of DS involve severe insulin resistance and growth abnormalities, the association with pulmonary hypertension (PHTN) has not been reported before. This finding adds more complexity to the condition. To the best of the author's knowledge, this is the first report for a patient with DS who has PHTN. Further investigation is required since the mechanisms behind the development of PHTN in DS are not entirely understood. Shedding light on this association will contribute to better management strategies and outcomes for affected patients.
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Affiliation(s)
| | | | | | | | | | - Mina Al Saeedi
- College of Medicine, University of Al-Mustansiriyah, Baghdad, Iraq
| | - Basma Ataallah
- College of Medicine, University of Baghdad, Baghdad, Bab Al-Muaddam, Iraq
- Methodist Willbrook Hospital, Houston, USA
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5
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Wang C, Feng G, Zhao J, Xu Y, Li Y, Wang L, Wang M, Liu M, Wang Y, Mu H, Zhou C. Screening of novel biomarkers for acute kidney transplant rejection using DIA-MS based proteomics. Proteomics Clin Appl 2024; 18:e2300047. [PMID: 38215274 DOI: 10.1002/prca.202300047] [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: 04/27/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Kidney transplantation is the preferred treatment for patients with end-stage renal disease. However, acute rejection poses a threat to the graft long-term survival. The aim of this study was to identify novel biomarkers to detect acute kidney transplant rejection. METHODS The serum proteomic profiling of kidney transplant patients with T cell-mediated acute rejection (TCMR) and stable allograft function (STA) was analyzed using data-independent acquisition mass spectrometry (DIA-MS). The differentially expressed proteins (DEPs) of interest were further verified by enzyme-linked immunosorbent assay (ELISA). RESULTS A total of 131 DEPs were identified between STA and TCMR patients, 114 DEPs were identified between mild and severe TCMR patients. The verification results showed that remarkable higher concentrations of serum amyloid A protein 1 (SAA1) and insulin like growth factor binding protein 2 (IGFBP2), and lower fetuin-A (AHSG) concentration were found in TCMR patients when compared with STA patients. We also found higher SAA1 concentration in severe TCMR group when compared with mild TCMR group. The receiver operating characteristics (ROC) analysis further confirmed that combination of SAA1, AHSG, and IGFBP2 had excellent performance in the acute rejection diagnosis. CONCLUSIONS Our data demonstrated that serum SAA1, AHSG, and IGFBP2 could be effective biomarkers for diagnosing acute rejection after kidney transplantation. DIA-MS has great potential in biomarker screening of kidney transplantation.
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Affiliation(s)
- Ce Wang
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Gang Feng
- Department of Kidney Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Jie Zhao
- Department of Kidney Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Yang Xu
- Department of Kidney Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Yang Li
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Lin Wang
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Meng Wang
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Miao Liu
- The First Central Clinical School, Tianjin Medical University, Tianjin, China
| | - Yilin Wang
- The First Central Clinical School, Tianjin Medical University, Tianjin, China
| | - Hong Mu
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Chunlei Zhou
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
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6
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Wang W, Ye J, Xu L, Mo DG, Chen C, Li T, Yao HC. The effects of IGF-1 and IGFBP-2 treatments on the atherosclerosis in the aorta and the coronary arteries of the high cholesterol diet-fed rabbits. Int Immunopharmacol 2024; 127:111409. [PMID: 38118312 DOI: 10.1016/j.intimp.2023.111409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/22/2023]
Abstract
Several studies have demonstrated suppression of aortic atherosclerosis by insulin like growth factor-1 (IGF-1) in hypercholesterolemic rabbits. Though a recent study has reported that IGF-1 exerts anti-atherogenic effects in coronary arteries, the mechanisms of IGF-1 in coronary arteries need to be further verified. Studies about insulin like growth factor binding protein-2 (IGFBP-2) in atherosclerosis are rarely. The objective of this study is to examine the effects of IGF-1 and IGFBP-2 on the atherosclerosis development in the aorta and coronary arteries of the high-cholesterol diet (HCD)-fed rabbits. New Zealand white rabbits were fed either normal chow (n = 5) or a diet containing 1.0 % cholesterol (n = 18) for 12 weeks. Cholesterol-fed rabbits were given IGF-1 or IGFBP-2 or saline intravenously (each n = 6) for 10 weeks. The results revealed that IGF-1 decreased total cholesterol (TC) and low-density lipoprotein (LDL) levels (p < 0.05), whereas IGFBP-2 did not. IGF-1 significantly attenuated atherosclerotic lesions and reduced accumulated macrophages within the coronary artery plaques, whereas IGFBP-2 deteriorated these changes. Moreover, IGF-1 reduced serum platelet-activating factor acetylhydrolase levels, C reactive protein (CRP), and inhibited the protein expression levels of tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6). IGFBP-2 elevated serum 8-hydroxy-2'-deoxyguanosine levels, CRP, and promoted the protein expression levels of TNF-α and IL-6. In conclusion, IGF-1 can substantially suppress plaque formation in coronary arteries with a marked inhibition of macrophage accumulation likely via its anti-inflammatory properties, whereas IGFBP-2 plays an opposite effect on atherosclerosis. The present study highlighted a theoretical basis for pharmacological treatment of atherosclerosis.
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Affiliation(s)
- Wei Wang
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong 252000, China
| | - Jing Ye
- Department of Pathology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, China
| | - Li Xu
- Stem Cell and Regenerative Medicine Laboratory, Liaocheng People's Hospital, Liaocheng 252000, PR China
| | - De-Gang Mo
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong 252000, China
| | - Chen Chen
- Department of Urology, Liaocheng People's Hospital, Liaocheng 252000, PR China
| | - Tai Li
- Department of Nursing, Liaocheng Vocational & Technical College, Liaocheng 252000, China
| | - Heng-Chen Yao
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong 252000, China; Department of Cardiology, Liaocheng People's Hospital, Shandong University, Jinan, Shandong 250012, China.
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7
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Wang W, Yu K, Zhao SY, Mo DG, Liu JH, Han LJ, Li T, Yao HC. The impact of circulating IGF-1 and IGFBP-2 on cardiovascular prognosis in patients with acute coronary syndrome. Front Cardiovasc Med 2023; 10:1126093. [PMID: 36970368 PMCID: PMC10036580 DOI: 10.3389/fcvm.2023.1126093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundWhile insulin-like growth factor 1 (IGF-1) exerts a cardioprotective effect in the setting of atherosclerosis, insulin-like growth factor binding protein 2 (IGFBP-2) is involved in metabolic syndrome. Although IGF-1 and IGFBP-2 are known to be predictors for mortality in patients with heart failure, their use in clinic as prognostic biomarkers for acute coronary syndrome (ACS) requires investigation. We evaluated the relationship between IGF-1 and IGFBP-2 levels at admission and the risk of major adverse cardiovascular events (MACEs) in patients with ACS.MethodsA total of 277 ACS patients and 42 healthy controls were included in this prospective cohort study. Plasma samples were obtained and analyzed at admission. Patients were followed for MACEs after hospitalization.ResultsAmong patients who suffered acute myocardial infarction, plasma levels of IGF-1 and IGFBP-2 were lower and higher, respectively, as compared to healthy controls (both p < 0.05). The mean follow-up period was 5.22 (1.0–6.0) months and MACEs incidence was 22.4% (62 of 277 patients). Kaplan–Meier survival analysis revealed that patients with low IGFBP-2 levels had a greater event-free survival rate than patients with high IGFBP-2 levels (p < 0.001). Multivariate Cox proportional hazards analysis revealed IGFBP-2, but not IGF-1, to be a positive predictor of MACEs (hazard ratio 2.412, 95% CI 1.360–4.277; p = 0.003).ConclusionOur findings suggest that high IGFBP-2 levels are associated with the development of MACEs following ACS. Moreover, IGFBP-2 is likely an independent predictive marker of clinical outcomes in ACS.
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Affiliation(s)
- Wei Wang
- Department of Cardiology, Liaocheng People's Hospital, Shandong University, Jinan, China
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Kang Yu
- Department of Laboratory Medicine, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Shou-Yong Zhao
- Department of Laboratory Medicine, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - De-Gang Mo
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Jia-Hui Liu
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Li-Jinn Han
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Tai Li
- Department of Nursing, Liaocheng Vocational & Technical College, Liaocheng, China
| | - Heng-Chen Yao
- Department of Cardiology, Liaocheng People's Hospital, Shandong University, Jinan, China
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
- Correspondence: Heng-Chen Yao
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8
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Kletzer J, Hecht S, Ramsauer S, Scharinger B, Kaufmann R, Kammler J, Kellermair J, Akbari K, Blessberger H, Steinwender C, Hergan K, Hoppe UC, Lichtenauer M, Boxhammer E. A Story of PA/BSA and Biomarkers to Diagnose Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis-The Rise of IGF-BP2 and GDF-15. J Cardiovasc Dev Dis 2023; 10:22. [PMID: 36661917 PMCID: PMC9864369 DOI: 10.3390/jcdd10010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
(1) Background: Currently, echocardiography is the primary non-invasive diagnostic method used to screen patients with severe aortic valve stenosis (AS) for pulmonary hypertension (PH) by estimating systolic pulmonary artery pressure (sPAP). Other radiological methods have been a focus of research in the past couple of years, as it was shown that by determining the pulmonary artery (PA) diameter, prognostic statements concerning overall mortality could be made in these patients. This study compared established and novel cardiovascular biomarkers with the PA/BSA value to detect PH in patients with severe AS. (2) Methods: The study cohort comprised 188 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR), who were then divided into two groups based on PA/BSA values obtained through CT-angiography. The presence of PH was defined as a PA/BSA ≥ 16.6 mm/m2 (n = 81), and absence as a PA/BSA < 16.6 mm/m2 (n = 107). Blood samples were taken before TAVR to assess cardiovascular biomarkers used in this study, namely brain natriuretic peptide (BNP), cardiac troponin I (cTnI), high-sensitive troponin (hsTN), soluble suppression of tumorigenesis-2 (sST2), growth/differentiation factor 15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), insulin-like growth factor binding protein 2 (IGF-BP2), and soluble urokinase-type plasminogen activator receptor (suPAR). (3) Results: Patients with a PA/BSA ≥ 16.6 mm/m2 showed significantly higher levels of BNP (p = <0.001), GDF-15 (p = 0.040), and H-FABP (p = 0.007). The other investigated cardiovascular biomarkers did not significantly differ between the two groups. To predict a PA/BSA ≥ 16.6 mm/m2, cut-off values for the biomarkers were calculated. Here, GDF-15 (p = 0.029; cut-off 1172.0 pg/mL) and BNP (p < 0.001; cut-off 2194.0 pg/mL) showed significant results. Consequently, analyses of combined biomarkers were performed, which yielded IGF-BP2 + BNP (AUC = 0.721; 95%CI = 0.585−0.857; p = 0.004) as the best result of the two-way analyses and GDF-15 + IGF-BP2 + BNP (AUC = 0.727; 95%CI = 0.590−0.864; p = 0.004) as the best result of the three-way analyses. No significant difference regarding the 1-year survival between patients with PA/BSA < 16.6 mm/m2 and patients with PA/BSA ≥ 16.6 mm/m2 was found (log-rank test: p = 0.452). (4) Conclusions: Although PA/BSA aims to reduce the bias of the PA value caused by different body compositions and sizes, it is still a controversial parameter for diagnosing PH. Combining the parameter with different cardiovascular biomarkers did not lead to a significant increase in the diagnostic precision for detecting PH in patients with severe AS.
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Affiliation(s)
- Joseph Kletzer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Susanne Ramsauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Bernhard Scharinger
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Reinhard Kaufmann
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Jürgen Kammler
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Jörg Kellermair
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Kaveh Akbari
- Department of Radiology, Johannes Kepler University Hospital Linz, 4020 Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
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