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Villegas CV, Gorman E, Liu FM, Winchell RJ. Acute kidney injury in the acute care surgery patient: What you need to know. J Trauma Acute Care Surg 2024:01586154-990000000-00800. [PMID: 39238092 DOI: 10.1097/ta.0000000000004401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
ABSTRACT Acute kidney injury is associated with poor outcomes in the trauma and emergency general surgery population, and recent consensus definitions have allowed for significant advances in defining the burden of disease. The current definitions rely on overall functional measures (i.e., serum creatinine and urine output), which can be confounded by a variety of clinical factors. Biomarkers are increasingly being investigated as more direct diagnostic assays for the diagnosis of acute kidney injury and may allow earlier detection and more timely therapeutic intervention. Etiologies fall into two general categories: disorders of renal perfusion and exposure to nephrotoxic agents. Therapy is largely supportive, and prevention offers the best chance to decrease clinical impact.
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Affiliation(s)
- Cassandra V Villegas
- From the Department of Surgery (C.V.V., E.G., R.J.W.), and Department of Nephrology (F.M.L.), Weill Cornell Medicine, New York, New York
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Verras C, Bezati S, Bistola V, Ventoulis I, Matsiras D, Tsiodras S, Parissis J, Polyzogopoulou E. Point-of-Care Serum Proenkephalin as an Early Predictor of Mortality in Patients Presenting to the Emergency Department with Septic Shock. Biomedicines 2024; 12:1004. [PMID: 38790966 PMCID: PMC11117930 DOI: 10.3390/biomedicines12051004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The aim of the present study is to investigate the prognostic utility of point-of-care (POC)-measured proenkephalin (PENK), a novel biomarker, in terms of predicting in-hospital mortality in patients presenting to the emergency department (ED) with septic shock. METHODS Bedside PENK was measured in consecutive patients presenting to the ED with septic shock according to the Sepsis-3 clinical criteria. The association of PENK with inflammatory and routine biomarkers, and its role as a predictor of in-hospital mortality, was examined. RESULTS Sixty-one patients with septic shock [53% females, median age 83 years (IQR 71-88)] were evaluated. Median (IQR) values of creatinine, plasma lactate, soluble urokinase plasminogen activator receptor (SuPAR), procalcitonin and PENK were 1.7 (1.0-2.9) mg/dL, 3.6 (2.1-6.8) mmol/L, 13.1 (10.0-21.4) ng/mL, 2.06 (0.84-3.49) ng/mL, and 205 (129-425) pmol/L, respectively. LogPENK significantly correlated with LogLactate (rho = 0.369, p = 0.004), LogCreatinine (rho = 0.537, p < 0.001), LogProcalcitonin (rho = 0.557, p < 0.001), and LogSuPAR (rho = 0.327, p = 0.011). During hospitalization, 39/61 (64%) patients died. In a multivariable logistic regression model, logPENK was an independent predictor of in-hospital mortality (OR 11.9, 95% CI: 1.7-84.6, p = 0.013). CONCLUSION POC PENK levels measured upon presentation to the ED strongly correlated with metabolic, renal and inflammatory biomarkers, and may serve as a predictor of in-hospital mortality in patients with septic shock.
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Affiliation(s)
- Christos Verras
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
| | - Sofia Bezati
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
| | - Vasiliki Bistola
- 2nd Cardiology Department, Attikon University Hospital, 12462 Athens, Greece;
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece;
| | - Dionysis Matsiras
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, 12462 Athens, Greece;
| | - John Parissis
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
| | - Effie Polyzogopoulou
- University Emergency Department, Attikon University Hospital, 12462 Athens, Greece; (S.B.); (D.M.); (J.P.); (E.P.)
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Lin LC, Chuan MH, Liu JH, Liao HW, Ng LL, Magnusson M, Jujic A, Pan HC, Wu VC, Forni LG. Proenkephalin as a biomarker correlates with acute kidney injury: a systematic review with meta-analysis and trial sequential analysis. Crit Care 2023; 27:481. [PMID: 38057904 PMCID: PMC10702091 DOI: 10.1186/s13054-023-04747-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Proenkephalin A 119-159 (PENK) is freely filtered in the glomerulus with plasma levels correlating with glomerular filtration rate. Therefore, PENK has been proposed as an early indicator of acute kidney injury (AKI) although its performance is dependent on the clinical setting. This meta-analysis aimed to investigate the correlation between PENK levels and the development of AKI. METHODS We conducted a comprehensive search on the PubMed, Embase, Cochrane databases, the website ClinicalTrials.gov and Cnki.net until June 26, 2023. Summary receiver operating characteristic (SROC) curves were used to amalgamate the overall test performance. Diagnostic odds ratio (DOR) was employed to compare the diagnostic accuracy of PENK with other biomarkers. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. RESULTS We incorporated 11 observational studies with 3969 patients with an incidence of AKI of 23.4% (929 out of 3969 patients) with the best optimal cutoff value of PENK for early detection of AKI being 57.3 pmol/L. The overall sensitivity and specificity of PENK in identifying AKI were 0.69 (95% CI 0.62-0.75) and 0.76 (95% CI 0.68-0.82), respectively. The combined positive likelihood ratio (LR) stood at 2.83 (95% CI 2.06-3.88), and the negative LR was 0.41 (95% CI 0.33-0.52). The SROC curve showcased pooled diagnostic accuracy of 0.77 (95% CI 0.73-0.81). Interestingly, patients with a history of hypertension or heart failure demonstrated a lower specificity of PENK in correlating the development of AKI. CONCLUSION Our results indicate that PENK possesses significant potential as a biomarker for the early detection of the development of AKI, using a cutoff point of 57.3 pmol/L for PENK.
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Affiliation(s)
- Li-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Hsiang Chuan
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jung-Hua Liu
- Department of Communication, National Chung Cheng University, Chiayi, Taiwan
| | - Hung-Wei Liao
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, UK
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Heng-Chih Pan
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, 222 Mai-Jin Road, Keelung, 204, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- NSARF (National Taiwan University Hospital Study Group of ARF), TAIPAI, (Taiwan Primary Aldosteronism Investigators), and CAKS (Taiwan Consortium for Acute Kidney Injury and Renal Diseases), Taipei, Taiwan
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital Foundation Trust, Guildford, UK.
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, UK.
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Gallo G, Lanza O, Savoia C. New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy. Int J Mol Sci 2023; 24:5089. [PMID: 36982164 PMCID: PMC10049666 DOI: 10.3390/ijms24065089] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Cardiorenal syndrome consists in the coexistence of acute or chronic dysfunction of heart and kidneys resulting in a cascade of feedback mechanisms and causing damage to both organs associated with high morbidity and mortality. In the last few years, different biomarkers have been investigated with the aim to achieve an early and accurate diagnosis of cardiorenal syndrome, to provide a prognostic role and to guide the development of targeted pharmacological and non-pharmacological therapies. In such a context, sodium-glucose cotransporter 2 (SGLT2) inhibitors, recommended as the first-line choice in the management of heart failure, might represent a promising strategy in the management of cardiorenal syndrome due to their efficacy in reducing both cardiac and renal outcomes. In this review, we will discuss the current knowledge on the pathophysiology of cardiorenal syndrome in adults, as well as the utility of biomarkers in cardiac and kidney dysfunction and potential insights into novel therapeutics.
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Affiliation(s)
| | | | - Carmine Savoia
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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Siranart N, Laohasurayotin K, Phanthong T, Sowalertrat W, Ariyachaipanich A, Chokesuwattanaskul R. Proenkephalin as a Novel Prognostic Marker in Heart Failure Patients: A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:ijms24054887. [PMID: 36902318 PMCID: PMC10003589 DOI: 10.3390/ijms24054887] [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: 12/23/2022] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Over the last several years, the use of biomarkers in the diagnosis of patients with heart failure (HF) has skyrocketed. Natriuretic peptides are currently the most widely used biomarker in the diagnosis and prognosis of individuals with HF. Proenkephalin (PENK) activates delta-opioid receptors in cardiac tissue, resulting in a decreased myocardial contractility and heart rate. However, the goal of this meta-analysis is to evaluate the association between the PENK level at the time of admission and prognosis in patients with HF, such as all-cause mortality, rehospitalization, and decreasing renal function. High PENK levels have been associated with a worsened prognosis in patients with HF.
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Affiliation(s)
- Noppachai Siranart
- Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 13300, Thailand
- Division of Cardiology, Center of Excellence in Arrhythmia Research, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 13300, Thailand
| | - Khamik Laohasurayotin
- Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 13300, Thailand
| | - Tanattida Phanthong
- Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 13300, Thailand
| | - Walit Sowalertrat
- Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 13300, Thailand
| | - Aekarach Ariyachaipanich
- Division of Cardiology, Center of Excellence in Arrhythmia Research, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 13300, Thailand
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiology, Center of Excellence in Arrhythmia Research, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 13300, Thailand
- Correspondence: ; Tel.: +(66)-2256-4000
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Husain-Syed F, Reis T, Kashani K, Ronco C. Advances in laboratory detection of acute kidney injury. Pract Lab Med 2022; 31:e00283. [PMID: 35677313 PMCID: PMC9168173 DOI: 10.1016/j.plabm.2022.e00283] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/27/2022] [Accepted: 05/24/2022] [Indexed: 12/14/2022] Open
Abstract
Recent advances have improved our understanding of the epidemiology and pathophysiology of acute kidney injury (AKI). So far, the Kidney Disease: Improving Global Outcome guidelines define and stratify kidney injury based on increases in serum creatinine level and/or decreases in urine output. Although the term AKI acknowledges the existence of cellular injury, its diagnosis is still only defined by the reduced excretory function of the kidney. New biomarkers that aid a better understanding of the relationship between acute tubular injury and kidney dysfunction have been identified, reflecting the advances in molecular biology. The expression of some of these novel biomarkers precedes changes in conventional biomarkers or can increase their predictive power. Therefore, they might enhance the clinical accuracy of the definition of AKI. This review summarizes the limitations of the current AKI classification and a panel of candidate biomarkers for augmenting AKI classification and recognition of AKI subphenotypes. We expect that the integration of appropriately selected biomarkers in routine clinical practice can improve AKI care.
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Affiliation(s)
- Faeq Husain-Syed
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Thiago Reis
- Laboratory of Molecular Pharmacology, Faculty of Health Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
- Department of Nephrology and Kidney Transplantation, Clínica de Doenças Renais de Brasília, DF Star Hospital, Rede D'Or São Luiz, Brasília, Distrito Federal, Brazil
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Claudio Ronco
- Department of Medicine (DIMED), Università di Padova, Via Giustiniani, 2–35128, Padua, Italy
- International Renal Research Institute of Vicenza, Via Rodolfi, 37–36100, Vicenza, Italy
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Via Rodolfi, 37–36100, Vicenza, Italy
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Shemirani H, Sadeghi M, Dehkordi AD, Gheshlaghi F. Is high sensitive-troponin I a reliable biomarker for cardiac injury in methadone toxicity? A prospective cross-sectional study. BMC Pharmacol Toxicol 2022; 23:17. [PMID: 35321748 PMCID: PMC8940979 DOI: 10.1186/s40360-022-00558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/17/2022] [Indexed: 02/08/2023] Open
Abstract
Background Methadone is a synthetic opioid mostly used for detoxification therapy, as its use increases; the possibility for methadone-induced cardiotoxicity may rise. The aim of this study was to determine the association of high-sensitivity troponin I levels as a predictor of cardiac injury in methadone toxicity. Methods Sixty methadone toxicity patients included in this prospective cross-sectional study from October 2018–November 2020. High-sensitivity troponin I level and electrocardiogram were assessed in patients at admission. All patients underwent echocardiography at admission and 30 days later and compared this finding between two groups based on high-sensitivity troponin I results. Results Mean age of the patients was 34.5 ± 11.1 years (males: 67%). Twenty (20%) patients had positive high sensitive-troponin results. Long QT interval and inverted T in precordial leads were mostly observed in individuals with positive high-sensitivity troponin I (75% vs. 35%, P = 0.013 and 83% vs. 16%, P < 0.001, respectively). Patients with elevated troponin had reduced left ventricular ejection fraction in comparison to normal group during admission (43.1 ± 15.4% vs. 55%, P < 0.001) and this left ventricular ejection fraction remained abnormal after 30 days (43.7 ± 21.6%). Patients in positive high-sensitivity troponin I group had higher regional wall motion abnormality frequency both at admission and 30 days later compared to the other group (0 day: 42% vs. 0, P < 0.001, 30th days: 25% vs. 4%, P = 0.020). Conclusion Patients with simultaneous methadone toxicity and positive high-sensitivity troponin I had worse cardiac outcomes and this biomarker could be probably used for better implementation of therapeutic interventions and prognosis.
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Affiliation(s)
- Hasan Shemirani
- Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Farzad Gheshlaghi
- Department of Clinical Toxicology, Isfahan Clinical Toxicology Research Center, School Of Medicine, Isfahan University of Medical Sciences, Khoorshid Hospital, Ostandari Ave., Isfahan, Iran.
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Short SAP, Wilkinson K, Long DL, Judd S, Schulte J, Kissela BM, Howard G, Cushman M. Plasma Pro-Enkephalin A and Ischemic Stroke Risk: The Reasons for Geographic and Racial Differences in Stroke Cohort. J Stroke Cerebrovasc Dis 2022; 31:106237. [PMID: 34896817 PMCID: PMC8792292 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/05/2021] [Accepted: 11/20/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The opioid neuropeptide pro-enkephalin A (PENK-A) may be a circulating marker of cardiovascular risk, with prior findings relevant to heart failure, kidney disease, and vascular dementia. Despite these findings, the association of PENK-A with ischemic stroke is unknown, so we examined this association in a prospective cohort study and analyzed differences by race and sex. MATERIALS AND METHODS The REasons for Geographic and Racial Differences in Stroke study (REGARDS) is a prospective cohort study of 30,239 Black and White adults. Plasma PENK-A was measured in 473 participants that developed first-time ischemic stroke over 5.9 years and 899 randomly selected participants. Cox models adjusted for demographics and stroke risk factors were used to calculate hazard ratios (HRs) of stroke by baseline PENK-A. RESULTS PENK-A was higher with increasing age, female sex, White race, lower body mass index, and antihypertensive medication use. Each SD higher increment of PENK-A was associated with an adjusted HR of 1.20 (95% CI 1.01-1.42) for stroke, with minimal confounding by stroke risk factors. Spline plots suggested a U-shaped relationship, particularly in White men, with an adjusted HR 3.88 (95% CI 1.94-7.77) for the 95th versus 50th percentile of PENK-A in White men. CONCLUSIONS Higher baseline plasma PENK-A was independently associated with future stroke risk in REGARDS. This association was most apparent among White men. There was little confounding by established stroke risk factors, suggesting a possible causal role in stroke etiology. Further research is needed to understand the role of endogenous opioids in stroke pathogenesis.
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Affiliation(s)
- Samuel AP Short
- Larner College of Medicine, University of Vermont, Burlington, VT
| | - Katherine Wilkinson
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
| | - D Leann Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | | | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT,Address for Correspondence: Mary Cushman, MD MSc, University of Vermont, 360 South Park Drive, Colchester, VT 05446,
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9
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Lassus J, Tarvasmäki T, Tolppanen H. Biomarkers in cardiogenic shock. Adv Clin Chem 2022; 109:31-73. [DOI: 10.1016/bs.acc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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10
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Emmens JE, Ter Maaten JM, Brouwers FP, Kieneker LM, Damman K, Hartmann O, Schulte J, Bakker SJL, de Boer RA, Voors AA. Proenkephalin and the risk of new-onset heart failure: data from prevention of renal and vascular end-stage disease. Clin Cardiol 2021; 44:1662-1672. [PMID: 34716603 PMCID: PMC8715404 DOI: 10.1002/clc.23729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/13/2021] [Indexed: 12/26/2022] Open
Abstract
Background Enkephalins of the opioid system exert several cardiorenal effects. Proenkephalin (PENK), a stable surrogate, is associated with heart failure (HF) development after myocardial infarction and worse cardiorenal function and prognosis in patients with HF. The association between plasma PENK concentrations and new‐onset HF in the general population remains to be established. Hypothesis We hypothesized that plasma PENK concentrations are associated with new‐onset HF in the general population. Methods We included 6677 participants from the prevention of renal and vascular end‐stage disease study and investigated determinants of PENK concentrations and their association with new‐onset HF (both reduced [HFrEF] and preserved ejection fraction [HFpEF]). Results Median PENK concentrations were 52.7 (45.1–61.9) pmol/L. Higher PENK concentrations were associated with poorer renal function and higher NT‐proBNP concentrations. The main determinants of higher PENK concentrations were lower estimated glomerular filtration rate (eGFR), lower urinary creatinine excretion, and lower body mass index (all p < .001). After a median 8.3 (7.8–8.8) years follow‐up, 221 participants developed HF; 127 HFrEF and 94 HFpEF. PENK concentrations were higher in subjects who developed HF compared with those who did not, 56.2 (45.2–67.6) versus 52.7 (45.1–61.6) pmol/L, respectively (p = .003). In competing‐risk analyses, higher PENK concentrations were associated with higher risk of new‐onset HF (hazard ratio [HR] = 2.09[1.47–2.97], p < .001), including both HFrEF (HR = 2.31[1.48–3.61], p < .001) and HFpEF (HR = 1.74[1.02–2.96], p = .042). These associations were, however, lost after adjustment for eGFR. Conclusions In the general population, higher PENK concentrations were associated with lower eGFR and higher NT‐proBNP concentrations. Higher PENK concentrations were not independently associated with new‐onset HFrEF and HFpEF and mainly confounded by eGFR.
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Affiliation(s)
- Johanna E Emmens
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank P Brouwers
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Lyanne M Kieneker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kevin Damman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Nilsson C, Christensson A, Nilsson PM, Melander O, Bennet L. Pro-Enkephalin and its association with renal function in Middle Eastern immigrants and native Swedes. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:573-578. [PMID: 34581639 DOI: 10.1080/00365513.2021.1979243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Iraqi-born immigrants residing in Sweden exhibit lower blood pressure as well as better renal function despite an overall worse metabolic risk profile in comparison with native Swedes. This may indicate the presence of cardiorenal protective mechanisms in the Middle Eastern population. Hence, the aim of this study was to investigate whether the association between renal function and Pro-Enkephalin (PENK), a biomarker predictive of both acute and chronic kidney dysfunction, differs across ethnicities. The MEDIM population-based study including a cohort of women and men, born in Iraq or Sweden, aged 30-75 years was conducted in Malmö, Sweden, from 2010 to 2012. The study included fasting blood samples, physical examinations and self-administrated questionnaires. Despite significantly better renal function assessed by creatinine-based eGFR in the Iraqi group, levels of PENK did not differ between the groups, (70.0 pmol/L, born in Iraq (n = 1263) vs 71.1, born in Sweden (n = 689), p = .4). However, the association between PENK and renal function was relatively weaker in the Iraqi born group, as supported by a significant interaction between PENK and country of birth (PInteraction= Country of birth x PENK = 0,010). This observational study suggests that the association between renal function and PENK was weaker in Middle Eastern immigrants. This is of interest as PENK may exhibit a direct effect on renal function, however further research is needed including studies on causality.
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Affiliation(s)
- Christopher Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Anders Christensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Louise Bennet
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Family Medicine, Lund University, Malmö, Sweden.,Clinical Research and Trial Center, Lund University Hospital, Sweden
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12
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Arfsten H, Goliasch G, Bartko PE, Prausmüller S, Spinka G, Cho A, Novak J, Mascherbauer J, Haslacher H, Strunk G, Hülsmann M, Pavo N. Neprilysin inhibition does not alter dynamic of proenkephalin-A 119-159 and pro-substance P in heart failure. ESC Heart Fail 2021; 8:2016-2024. [PMID: 33742565 PMCID: PMC8120349 DOI: 10.1002/ehf2.13278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/31/2021] [Accepted: 02/11/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS As NEP degrades many substrates, the specific therapeutic mechanism of NEP inhibition with angiotensin receptor neprilysin inhibitor (ARNi) in heart failure with reduced ejection fraction (HFrEF) is not entirely evident. The aim of this study was to investigate the response of two substrates of NEP-the tachykinin and enkephalin systems-to the initiation of ARNi therapy in HFrEF. METHODS AND RESULTS Between 2016 and 2018, 141 consecutive patients with stable HFrEF [74 with initiation of ARNi and 67 controls on continuous angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy] were prospectively enrolled. Plasma proenkephalin-A 119-159 (PENK) and pro-substance P (pro-SP) were serially determined. Proenkephalin-A 119-159 and pro-SP correlated strongly with each other (rs = 0.67, P < 0.001) and kidney function (rs = -0.66, P < 0.001 and rs = -0.54, P < 0.001) and modestly with NT-proBNP (rs = 0.32, P < 0.001 and rs = 0.24, P = 0.006, respectively). Concentrations of circulating PENK were slightly elevated after 1 and 2 year follow-up compared with baseline (BL) [BL median: 67.4 pmol/L (IQR: 57.3-89.8), 1 year: 83.5 pmol/L (IQR: 62.4-111.6), 2 years: 92.3 pmol/L (IQR: 63.1-101.9); BL vs. 1 year: P = 0.017 and BL vs. 2 years: P = 0.019] in the overall analysis, but lost significance at 2 year follow-up when assessed in paired subanalysis (P = 0.116). Plasma pro-SP levels remained comparable during the entire follow-up [BL median: 78.3 pmol/L (IQR: 67.9-90.6), 1 year: 75.9 pmol/L (IQR: 58.6-96.3), 2 years: 79.7 pmol/L (IQR: 59.9-105.3); P = ns for both timepoints]. Biomarker patterns of ARNi patients were independent from baseline therapy, that is, ACEi or ARB (P > 0.05 between groups). CONCLUSIONS Although enkephalins and SP are known substrates of NEP, NEP inhibition by ARNi does not clearly affect the circulating precursors PENK and pro-SP in HFrEF.
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Affiliation(s)
- Henrike Arfsten
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Suriya Prausmüller
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Anna Cho
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Johannes Novak
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Helmuth Haslacher
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Guido Strunk
- Complexity Research, Schönbrunner Straße 32, Vienna, 1050, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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13
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Budka J, Kowalski S, Chylinska M, Dzierzbicka K, Inkielewicz-Stepniak I. Opioid Growth Factor and its Derivatives as Potential Non-toxic Multifunctional Anticancer and Analgesic Compounds. Curr Med Chem 2021; 28:673-686. [PMID: 32129162 DOI: 10.2174/0929867327666200304122406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/02/2019] [Accepted: 10/14/2019] [Indexed: 11/22/2022]
Abstract
Despite significant research progress on the pathogenesis, molecular biology, diagnosis, treatment, and prevention of cancer, its morbidity and mortality are still high around the world. The emerging resistance of cancer cells to anticancer drugs remains still a significant problem in oncology today. Furthermore, an important challenge is the inability of anticancer drugs to selectively target tumor cells thus sparing healthy cells. One of the new potential options for efficient and safe therapy can be provided by opioid growth factor (OGF), chemically termed Met-enkephalin. It is an endogenous pentapeptide (Tyr-Gly-Gly-Phe-Met) with antitumor, analgesic, and immune-boosting properties. Clinical trials have demonstrated that OGF therapy alone, as well as in combination with standard chemotherapies, is a safe, non-toxic anticancer agent that reduces tumor size. In this paper, we review the structure-activity relationship of OGF and its analogues. We highlight also OGF derivatives with analgesic, immunomodulatory activity and the ability to penetrate the blood-brain barrier and may be used as safe agents enhancing chemotherapy efficacy and improving quality of life in cancer patients. The reviewed papers indicate that Met-enkephalin and its analogues are interesting candidates for the development of novel, non-toxic, and endowed with an analgesic activity anticancer drugs. More preclinical and clinical studies are needed to explore these opportunities.
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Affiliation(s)
- Justyna Budka
- Department of Medical Chemistry, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Szymon Kowalski
- Department of Medical Chemistry, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Monika Chylinska
- Department of Medical Chemistry, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Krystyna Dzierzbicka
- Department of Organic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Gdansk, Poland
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14
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Khalili P, Ayoobi F, Mohamadi M, Jamalizadeh A, La Vecchia C, Esmaeili-Nadimi A. Effect of opium consumption on cardiovascular diseases - a cross- sectional study based on data of Rafsanjan cohort study. BMC Cardiovasc Disord 2021; 21:2. [PMID: 33388044 PMCID: PMC7778811 DOI: 10.1186/s12872-020-01788-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/18/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There are differences of opinion about the beneficial or detrimental effects of opium consumption on cardiovascular diseases (CVDs). So, we aimed to study the association between opium use and CVDs. METHODS We used data obtained from the Rafsanjan Cohort Study (RCS), as a part of the prospective epidemiological research studies in IrAN (PERSIAN), with detailed, validated data on opium consumption and some other exposures. A total of 10,000 adults were enrolled in the study. Logistic regression models were used to assess the possible relationships of opium consumption with the prevalence of ischemic heart diseases (IHD) and myocardial infarction (MI). RESULTS In this study, 9990 participants in the baseline phase of the Rafsanjan adult cohort study were included according to their completed questionnaire. Among all participants, 870 and 296 individuals were found to suffer from IHD and MI, respectively. Opium consumption was found to be relatively high in the RCS participants, especially in men (men = 2150 and women = 228). Opium use was associated with a higher odds of IHD and MI, with the adjusted odds ratios (95% CI) of 1.51 (1.22-1.86) and 1.79 (1.31-2.45), respectively. Also, dose-response increases were observed with the highest odds ratios in the 4th quartile for MI and IHD (p-values for trend < 0.001). Increased odds were observed for the two main methods of opium consumption, i.e. oral and smoking, but oral administration had higher odds ratio. CONCLUSIONS Opium consumption is associated with the increased odds of both IHD and MI diseases.
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Affiliation(s)
- Parvin Khalili
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ayoobi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Maryam Mohamadi
- Pistachio Safety Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ahmad Jamalizadeh
- Health System Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University degli Study di Milano, Milan, Italy
| | - Ali Esmaeili-Nadimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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15
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Holm H, Nägga K, Nilsson ED, Ricci F, Melander O, Hansson O, Bachus E, Fedorowski A, Magnusson M. High circulating levels of midregional proenkephalin A predict vascular dementia: a population-based prospective study. Sci Rep 2020; 10:8027. [PMID: 32415209 PMCID: PMC7229155 DOI: 10.1038/s41598-020-64998-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
Midregional Pro-enkephalin A (MR-PENK A) and N-terminal Protachykinin A (NT-PTA) have been associated with vascular dementia. However, the longitudinal relationship between these biomarkers and incident dementia has not been fully investigated. In the population-based Malmö Preventive Project, circulating levels of MR-PENK A and NT-PTA were determined in a random sample of 5,323 study participants (mean age: 69 ± 6 years) who were followed-up over a period of 4.6 ± 1.6 years. The study sample included 369 patients (7%) who were diagnosed in the same period with dementia. We analyzed relationship of MR-PENK A and NT-PTA with the risk of developing dementia by using multivariable-adjusted Cox regression models adjusted for traditional risk factors. Increased plasma levels of MR-PENK A were associated with higher risk of incident vascular dementia whereas no associations were found with all-cause or Alzheimer dementia. The risk of vascular dementia was mainly conferred by the highest quartile of MR-PENK as compared with lower quartiles. Elevated levels of NT-PTA yielded significant association with all-cause dementia or dementia subtypes. Elevated plasma concentration of MR-PENK A independently predicts vascular dementia in the general population. MR-PENK A may be used as an additional tool for identifying vascular subtype in ambiguous dementia cases.
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Affiliation(s)
- H Holm
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden. .,Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
| | - K Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - E D Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Ricci
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden.,Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, G.d'Annunzio University, Chieti, Italy
| | - O Melander
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - O Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - E Bachus
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - A Fedorowski
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - M Magnusson
- Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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16
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Revuelta-López E, Núñez J, Gastelurrutia P, Cediel G, Januzzi JL, Ibrahim NE, Emdin M, VanKimmenade R, Pascual-Figal D, Núñez E, Gommans F, Lupón J, Bayés-Genís A. Neprilysin inhibition, endorphin dynamics, and early symptomatic improvement in heart failure: a pilot study. ESC Heart Fail 2020; 7:559-566. [PMID: 32045114 PMCID: PMC7160502 DOI: 10.1002/ehf2.12607] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Aim Sacubitril/valsartan is a first‐in‐class angiotensin receptor‐neprilysin inhibitor developed for the treatment of heart failure with reduced ejection fraction. Its benefits are achieved through the inhibition of neprilysin (NEP) and the specific blockade of the angiotensin receptor AT1. The many peptides metabolized by NEP suggest multifaceted potential consequences of its inhibition. We sought to evaluate the short‐term changes in serum endorphin (EP) values and their relation with patients' physical functioning after initiation of sacubitril/valsartan treatment. Methods and results A total of 105 patients with heart failure with reduced ejection fraction, who were candidates for sacubitril/valsartan treatment, were included in this prospective, observational, multicentre, and international study. In a first visit, and in agreement with current guidelines, treatment with angiotensin‐converting enzyme inhibitors or angiotensin receptor blocker was replaced by sacubitril/valsartan because of clinical indication by the responsible physician. By protocol, patients were reevaluated at 30 days after the start of sacubitril/valsartan. Serum levels of α‐ (α‐EP), γ‐Endorphin (γ‐EP), and soluble NEP (sNEP) were measured using enzyme‐linked immunoassays. New York Heart Association (NYHA) functional class was used as an indicator of patient's functional status. Baseline median levels of circulating α‐EP, γ‐EP, and sNEP were 582 (160–772), 101 (37–287), and 222 pg/mL (124–820), respectively. There was not a significant increase in α‐EP nor γ‐EP serum values after sacubitril/valsartan treatment (P value = 0.194 and 0.102, respectively). There were no significant differences in sNEP values between 30 days and baseline (P value = 0.103). Medians (IQR) of Δα‐EP, Δγ‐EP, and ΔsNEP between 30 days and baseline were 9.3 (−34 − 44), −3.0 (−46.0 − 18.9), and 0 units (−16.4 − 157.0), respectively. In a pre–post sacubitril/valsartan treatment comparison, there was a significant improvement in NYHA class, with 36 (34.3%) patients experiencing improvement by at least one NYHA class category. Δα‐EP and ΔsNEP showed to be significantly associated with NYHA class after 30 days of treatment (P = 0.014 and P < 0.001, respectively). Δα‐EP was linear and significantly associated with NYHA class improvement after 30 days of sacubitril/valsartan treatment. Conclusions These preliminary data suggest that beyond the haemodynamic benefits achieved with sacubitril/valsartan, the altered cleavage of endorphin peptides by NEP inhibition may participate in patients' symptoms improvement.
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Affiliation(s)
- Elena Revuelta-López
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Paloma Gastelurrutia
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Germán Cediel
- Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Roland VanKimmenade
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Domingo Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Frank Gommans
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Josep Lupón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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17
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Basirat M, Ziyaeifard M, Gorjipour F, Mehrabanian MJ, Attarzadeh SH, Nekoofard M, Mortazian M. Effect of Opium Addiction on Postoperative Arrhythmia Among Patients Undergoing CABG operation on Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2019; 34:444-450. [PMID: 31454198 PMCID: PMC6713381 DOI: 10.21470/1678-9741-2018-0392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. METHODS Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. RESULTS Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. CONCLUSION This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.
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Affiliation(s)
- Majid Basirat
- Islamic Azad University Sary Branch Sary Iran Sary Branch, Islamic Azad University, Sary, Iran
| | - Mohsen Ziyaeifard
- Iran University of Medical Sciences Rajaie Cardiovascular, Medical and Research Center Tehran Iran Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Gorjipour
- Iran University of Medical Sciences Rajaie Cardiovascular, Medical and Research Center Tehran Iran Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Mehrabanian
- Tehran University of Medical Sciences Tehran Heart Center Tehran Iran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hassan Attarzadeh
- Iran University of Medical Sciences Rajaie Cardiovascular, Medical and Research Center Tehran Iran Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Nekoofard
- Iran University of Medical Sciences Rajaie Cardiovascular, Medical and Research Center Tehran Iran Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Meysam Mortazian
- AJA University of Medical Sciences Tehran Iran AJA University of Medical Sciences, Tehran, Iran
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18
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Molvin J, Jujic A, Navarin S, Melander O, Zoccoli G, Hartmann O, Bergmann A, Struck J, Bachus E, Di Somma S, Magnusson M. Bioactive adrenomedullin, proenkephalin A and clinical outcomes in an acute heart failure setting. Open Heart 2019; 6:e001048. [PMID: 31354956 PMCID: PMC6615850 DOI: 10.1136/openhrt-2019-001048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/20/2019] [Accepted: 06/13/2019] [Indexed: 01/19/2023] Open
Abstract
Objectives In an acute heart failure (AHF) setting, proenkephalin A 119–159 (penKid) has emerged as a promising prognostic marker for predicting worsening renal function (WRF), while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion. We examined the diagnostic value of bio-ADM in congestion and penKid in WRF and investigated the prognostic value of bio-ADM and penKid regarding mortality, rehospitalisation and length of hospital stay in two separate European AHF cohorts. Methods Bio-ADM and penKid were measured in 530 subjects hospitalised for AHF in two cohorts: Swedish HeArt and bRain failure inVESTigation trial (HARVEST-Malmö) (n=322, 30.1% female; mean age 75.1+11.1 years; 12 months follow-up) and Italian GREAT Network Rome study (n=208, 54.8% female; mean age 78.5+9.9 years; no follow-up available). Results PenKid was associated with WRF (area under the curve (AUC) 0.65, p<0.001). In multivariable logistic regression analysis of the pooled cohort, penKid showed an independent association with WRF (adjusted OR (aOR) 1.74, p=0.004). Bio-ADM was associated with peripheral oedema (AUC 0.71, p<0.001), which proved to be independent after adjustment (aOR 2.30, p<0.001). PenKid was predictive of in-hospital mortality (OR 2.24, p<0.001). In HARVEST-Malmö, both penKid and bio-ADM were predictive of 1-year mortality (aOR 1.34, p=0.038 and aOR 1.39, p=0.030). Furthermore, bio-ADM was associated with rehospitalisation (aOR 1.25, p=0.007) and length of hospital stay (β=0.702, p=0.005). Conclusion In two different European AHF cohorts, bio-ADM and penKid perform as suitable biomarkers for early detection of congestion severity and WRF occurrence, respectively, and are associated with pertinent clinical outcomes.
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Affiliation(s)
- John Molvin
- Department of Cardiology, Skånes universitetssjukhus Malmö, Malmoe, Sweden.,Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden
| | - Amra Jujic
- Department of Cardiology, Skånes universitetssjukhus Malmö, Malmoe, Sweden.,Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden
| | - Silvia Navarin
- Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza - University, Sant' Andrea Hospital, Roma, Italy.,GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - Olle Melander
- Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden.,Department of Internal Medicine, Skånes universitetssjukhus Malmö, Malmoe, Sweden
| | - Giada Zoccoli
- Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza - University, Sant' Andrea Hospital, Roma, Italy.,GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | | | | | | | - Erasmus Bachus
- Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden
| | - Salvatore Di Somma
- Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza - University, Sant' Andrea Hospital, Roma, Italy.,GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - Martin Magnusson
- Department of Cardiology, Skånes universitetssjukhus Malmö, Malmoe, Sweden.,Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden
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19
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Bayles RG, Tran J, Olivas A, Woodward WR, Fei SS, Gao L, Habecker BA. Sex differences in sympathetic gene expression and cardiac neurochemistry in Wistar Kyoto rats. PLoS One 2019; 14:e0218133. [PMID: 31194790 PMCID: PMC6564003 DOI: 10.1371/journal.pone.0218133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022] Open
Abstract
The stellate ganglia are the predominant source of sympathetic innervation to the heart. Remodeling of sympathetic nerves projecting to the heart has been observed in several cardiovascular diseases, and sympathetic dysfunction contributes to cardiac pathology. Wistar Kyoto rats are a common model for the study of cardiovascular diseases, but we lack a profile of the baseline transcriptomic and neurochemical characteristics of their cardiac sympathetic neurons. Most studies of cardiovascular disease have used male animals only, but in the future both male and female animals will be used for these types of studies; therefore, we sought to characterize the transcriptome of male and female stellate ganglia and to correlate that with catecholamine and acetylcholine content in the heart. We have generated a dataset of baseline RNA expression in male and female Wistar Kyoto rat stellate ganglia using RNA-seq, and have measured neurotransmitter levels in heart and stellate ganglia using HPLC and mass spectrometry. We identified numerous gene expression differences between male and female stellates, including genes encoding important developmental factors, receptors and neuropeptides. Female hearts had significantly higher neurotransmitter content than male hearts; however, no significant differences were detected in expression of the genes encoding neurotransmitter synthetic enzymes. Similarly, no statistically significant differences were identified between the sexes in cardiac tyrosine hydroxylase levels.
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Affiliation(s)
- Richard G. Bayles
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Joanne Tran
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Antoinette Olivas
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - William R. Woodward
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Suzanne S. Fei
- Bioinformatics & Biostatistics Core, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States of America
| | - Lina Gao
- Bioinformatics & Biostatistics Core, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, United States of America
| | - Beth A. Habecker
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, Oregon, United States of America
- * E-mail:
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Affiliation(s)
- Biykem Bozkurt
- The Mary and Gordon Cain Chair, W.A. "Tex" and Deborah Moncrief, Jr, Chair Professor of Medicine, Medical Care Line Executive, DeBakey VA Medical Center, Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX
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21
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Emmens JE, ter Maaten JM, Damman K, van Veldhuisen DJ, de Boer RA, Struck J, Bergmann A, Sama IE, Streng KW, Anker SD, Dickstein K, Lang CC, Metra M, Samani NJ, Ng LL, Voors AA. Proenkephalin, an Opioid System Surrogate, as a Novel Comprehensive Renal Marker in Heart Failure. Circ Heart Fail 2019; 12:e005544. [DOI: 10.1161/circheartfailure.118.005544] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Johanna E. Emmens
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (J.E.E., J.M.t.M., K. Damman, D.J.v.V., R.A.d.B., I.E.S., K.W.S., A.A.V.)
| | - Jozine M. ter Maaten
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (J.E.E., J.M.t.M., K. Damman, D.J.v.V., R.A.d.B., I.E.S., K.W.S., A.A.V.)
| | - Kevin Damman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (J.E.E., J.M.t.M., K. Damman, D.J.v.V., R.A.d.B., I.E.S., K.W.S., A.A.V.)
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (J.E.E., J.M.t.M., K. Damman, D.J.v.V., R.A.d.B., I.E.S., K.W.S., A.A.V.)
| | - Rudolf A. de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (J.E.E., J.M.t.M., K. Damman, D.J.v.V., R.A.d.B., I.E.S., K.W.S., A.A.V.)
| | | | | | - Iziah E. Sama
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (J.E.E., J.M.t.M., K. Damman, D.J.v.V., R.A.d.B., I.E.S., K.W.S., A.A.V.)
| | - Koen W. Streng
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (J.E.E., J.M.t.M., K. Damman, D.J.v.V., R.A.d.B., I.E.S., K.W.S., A.A.V.)
| | - Stefan D. Anker
- Division of Cardiology and Metabolism—Heart Failure, Cachexia and Sarcopenia, Department of Cardiology; Berlin-Brandenburg Center for Regenerative Therapies; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Berlin; Charité Universitätsmedizin Berlin, Germany (S.D.A.)
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Germany (S.D.A.)
| | - Kenneth Dickstein
- Department of Clinical Science, University of Bergen, Norway (K. Dickstein)
- Department of Cardiology, Stavanger University Hospital, Norway (K. Dickstein)
| | - Chim C. Lang
- School of Medicine Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, United Kingdom (C.C.L.)
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.M.)
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (N.J.S., L.L.N.)
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (N.J.S., L.L.N.)
| | - Leong L. Ng
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (N.J.S., L.L.N.)
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (N.J.S., L.L.N.)
| | - Adriaan A. Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (J.E.E., J.M.t.M., K. Damman, D.J.v.V., R.A.d.B., I.E.S., K.W.S., A.A.V.)
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Abstract
INTRODUCTION The term cardiorenal syndrome (CRS) describes the progressive pathology and interactions that develop upon heart and kidney failure. The definition of CRS is not firmly established and has evolved gradually during the last decade. The main clinical challenges associated with CRS are the lack of tools for early disease diagnosis and the inability to predict the development of cardiorenal pathophysiology. Currently several biomarkers have been proposed for improving CRS patient management. However, validation studies are needed to implement these initial findings to the clinical setting. Areas covered: In this review the database PubMed was used for a literature search on the definition and classification of CRS as well as biomarkers for CRS diagnosis and prognosis. Expert opinion: A universally acceptable classification system for CRS is not available. Thus, acquiring mechanistic insights relative to the pathophysiology of the disease is challenging. Reported biomarkers include well-established markers for heart/renal dysfunction and inflammation. Some proteins expressed in both organs have also been associated with CRS, yet their link to disease pathophysiology and organ cross-talk is missing. Establishing the link between deregulated molecular pathways and CRS phenotypes is required to define biological relevance of existing findings and ultimately biology-driven markers and targets.
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Affiliation(s)
- Eleni Petra
- a Biotechnology Division, Biomedical Research Foundation , Academy of Athens (BRFAA) , Athens , Greece
| | - Jerome Zoidakis
- a Biotechnology Division, Biomedical Research Foundation , Academy of Athens (BRFAA) , Athens , Greece
| | - Antonia Vlahou
- a Biotechnology Division, Biomedical Research Foundation , Academy of Athens (BRFAA) , Athens , Greece
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Teo SH, Endre ZH. Biomarkers in acute kidney injury (AKI). Best Pract Res Clin Anaesthesiol 2018; 31:331-344. [PMID: 29248140 DOI: 10.1016/j.bpa.2017.10.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/14/2022]
Abstract
Acute kidney injury is common in critically ill patients and portends a significant impact on mortality, progressive chronic kidney disease, and cardiovascular disease and mortality. Though most physicians alter therapy depending on changes in serum creatinine, this often represents delayed intervention. Various AKI biomarkers have been discovered and validated to improve timely detection, differentiation and stratification into risk groups for progressive renal decline, need for renal replacement therapy or death. This chapter will review AKI biomarkers validated over the past decade. We also describe the clinical performance of the biomarkers. We suggest that using AKI biomarkers to complement serum creatinine (or cystatin C) and urine output will better integrate patient care through earlier recognition and clinical outcome prediction after AKI.
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Affiliation(s)
- Su Hooi Teo
- Department of Nephrology, Singapore General Hospital, Singapore
| | - Zoltán Huba Endre
- Department of Nephrology, Prince of Wales Hospital, High Street, Randwick, Sydney, 2031, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Department of Medicine, University of Otago-Christchurch; Christchurch, New Zealand; School of Medicine, University of Queensland, Brisbane, Australia.
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Abstract
The World Health Organization suggests that the cardiovascular diseases (CVDs) are the major cause of mortality and account for two-thirds of the deaths all over the world. These diseases kill about 17 million people every year and 3 in every 10 deaths are due to these diseases. The past decade has seen considerable improvements in diagnosis as well as treatment of various heart diseases. Various new therapeutic targets are being identified through in-depth knowledge of the disease mechanisms which has favored the testing of new strategies leading to newer treatment options. Opioid peptides and G-protein-coupled opioid receptors (ORs) have been previously studied widely in terms of central nervous system actions in mitigating the pain and drug abuse. The OR agonism or antagonism induces cytoprotective states in the myocardium, rendering these receptors as an attractive target for protection of heart from the fatal heart diseases. The opioids can provide an extended window of protection of the heart from various diseases. Although the mechanisms may not be fully understood, they seem to play a crucial role in various CVDs such as hypertension, hyperlipidemia, ischemic heart disease myocardial ischemia, and congestive heart failure. Since these compounds are already being used in acute and chronic pain, soon these compounds might be approved for use as cardioprotective agents. The following review focuses on the new information acquired on the role of the ORs in various CVDs.
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Affiliation(s)
- Hemangi Rawal
- Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
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25
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Kieneker LM, Hartmann O, Bergmann A, de Boer RA, Gansevoort RT, Joosten MM, Struck J, Bakker SJL. Proenkephalin and risk of developing chronic kidney disease: the Prevention of Renal and Vascular End-stage Disease study. Biomarkers 2018; 23:474-482. [DOI: 10.1080/1354750x.2018.1443514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lyanne M. Kieneker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Rudolf A. de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Ron T. Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Michel M. Joosten
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Stephan J. L. Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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26
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Quindry JC, Franklin BA. Cardioprotective Exercise and Pharmacologic Interventions as Complementary Antidotes to Cardiovascular Disease. Exerc Sport Sci Rev 2018; 46:5-17. [PMID: 28885265 DOI: 10.1249/jes.0000000000000134] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Exercise and pharmacologic therapies to prevent and treat cardiovascular disease have advanced largely through independent efforts. Understanding of first-line drug therapies, findings from preclinical animal studies, and the need for research initiatives related to complementary cardioprotective exercise-pharma interventions are reviewed from the premise that contemporary cardioprotective therapies must include adjunctive exercise and lifestyle interventions in addition to pharmacologic agents.
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Affiliation(s)
- John C Quindry
- Health and Human Performance, University of Montana, Missoula, MT
| | - Barry A Franklin
- Health and Human Performance, University of Montana, Missoula, MT
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27
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Beunders R, Struck J, Wu AH, Zarbock A, Di Somma S, Mehta RL, Koyner JL, Nadim MK, Maisel AS, Murray PT, Neath SX, Jaffe A, Pickkers P. Proenkephalin (PENK) as a Novel Biomarker for Kidney Function. ACTA ACUST UNITED AC 2017; 2:400-412. [DOI: 10.1373/jalm.2017.023598] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022]
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28
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Abstract
The opioid system is activated in heart failure, which may be cardioprotective but may also be counter-regulatory. Recently, systemic proenkephalin activation has been investigated in various conditions predicting mortality and kidney injury. In acute heart failure, proenkephalin independently predicts mortality and heart failure rehospitalization in addition to traditional risk markers. It also predicts worsening renal function, increasingly recognized as an important risk predictor for poor outcome in heart failure. This article explores the role of enkephalins and delta-opioid receptors in the heart, then reviews studies measuring proenkephalin levels in the circulation and their associations with prognosis.
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Affiliation(s)
- Daniel Chu Siong Chan
- Department of Cardiovascular Sciences, NIHR Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Thong Huy Cao
- Department of Cardiovascular Sciences, NIHR Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK; Department of General Internal Medicine, University of Medicine and Pharmacy, Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Leong Loke Ng
- Department of Cardiovascular Sciences, NIHR Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
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29
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Proenkephalin, Renal Dysfunction, and Prognosis in Patients With Acute Heart Failure: A GREAT Network Study. J Am Coll Cardiol 2017; 69:56-69. [PMID: 28057251 DOI: 10.1016/j.jacc.2016.10.038] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Proenkephalin A (PENK) and its receptors are widely distributed. Enkephalins are cardiodepressive and difficult to measure directly. PENK is a stable surrogate analyte of labile enkephalins that is correlated inversely with renal function. Cardiorenal syndrome is common in acute heart failure (HF) and portends poor prognosis. OBJECTIVES This study assessed the prognostic value of PENK in acute HF, by identifying levels that may be useful in clinical decisions, and evaluated its utility for predicting cardiorenal syndrome. METHODS This multicenter study measured PENK in 1,908 patients with acute HF (1,186 male; mean age 75.66 ± 11.74 years). The primary endpoint was 1-year all-cause mortality; secondary endpoints were in-hospital mortality, all-cause mortality or HF rehospitalization within 1 year, and in-hospital worsening renal function, defined as a rise in plasma creatinine ≥26.5 μmol/l or 50% higher than the admission value within 5 days of presentation. RESULTS During 1-year follow-up, 518 patients died. Measures of renal function were the major determinants of PENK levels. PENK independently predicted worsening renal function (odds ratio: 1.58; 95% confidence interval [CI]: 1.24 to 2.00; p < 0.0005) with a model receiver-operating characteristic area of 0.69. PENK was associated with the degree of worsening renal function. Multivariable Cox regression models showed that PENK level was an independent predictor of 1-year mortality (p < 0.0005) and 1-year death and/or HF (hazard ratio: 1.27; 95% CI: 1.10 to 1.45; p = 0.001). PENK levels independently predicted outcomes at 3 or 6 months and were independent predictors of in-hospital mortality, predominantly down-classifying risk in survivors when added to clinical scores; levels <133.3 pmol/l and >211.3 pmol/l detected low-risk and high-risk patients, respectively. CONCLUSIONS PENK levels reflect cardiorenal status in acute HF and are prognostic for worsening renal function and in-hospital mortality as well as mortality during follow-up.
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30
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Alleman RJ, Stewart LM, Tsang AM, Brown DA. Why Does Exercise "Trigger" Adaptive Protective Responses in the Heart? Dose Response 2015; 13:10.2203_dose-response.14-023.Alleman. [PMID: 26674259 PMCID: PMC4674163 DOI: 10.2203/dose-response.14-023.alleman] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Numerous epidemiological studies suggest that individuals who exercise have decreased cardiac morbidity and mortality. Pre-clinical studies in animal models also find clear cardioprotective phenotypes in animals that exercise, specifically characterized by lower myocardial infarction and arrhythmia. Despite the clear benefits, the underlying cellular and molecular mechanisms that are responsible for exercise preconditioning are not fully understood. In particular, the adaptive signaling events that occur during exercise to "trigger" cardioprotection represent emerging paradigms. In this review, we discuss recent studies that have identified several different factors that appear to initiate exercise preconditioning. We summarize the evidence for and against specific cellular factors in triggering exercise adaptations and identify areas for future study.
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Affiliation(s)
- Rick J Alleman
- Department of Physiology and East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville NC USA
| | - Luke M Stewart
- Department of Physiology and East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville NC USA
| | - Alvin M Tsang
- Department of Physiology and East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville NC USA
| | - David A Brown
- Department of Physiology and East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville NC USA
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31
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Miller LE, McGinnis GR, Peters BA, Ballmann CG, Nanayakkara G, Amin R, Quindry JC. Involvement of the δ-opioid receptor in exercise-induced cardioprotection. Exp Physiol 2015; 100:410-21. [DOI: 10.1113/expphysiol.2014.083436] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/26/2015] [Indexed: 01/08/2023]
Affiliation(s)
| | | | | | | | | | - Rajesh Amin
- Harrison School of Pharmacy; Auburn University; Auburn AL USA
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32
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Foster SR, Roura E, Molenaar P, Thomas WG. G protein-coupled receptors in cardiac biology: old and new receptors. Biophys Rev 2015; 7:77-89. [PMID: 28509979 DOI: 10.1007/s12551-014-0154-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/25/2014] [Indexed: 12/21/2022] Open
Abstract
G protein-coupled receptors (GPCRs) are seven-transmembrane-spanning proteins that mediate cellular and physiological responses. They are critical for cardiovascular function and are targeted for the treatment of hypertension and heart failure. Nevertheless, current therapies only target a small fraction of the cardiac GPCR repertoire, indicating that there are many opportunities to investigate unappreciated aspects of heart biology. Here, we offer an update on the contemporary view of GPCRs and the complexities of their signalling, and review the roles of the 'classical' GPCRs in cardiovascular physiology and disease. We then provide insights into other GPCRs that have been less extensively studied in the heart, including orphan, odorant and taste receptors. We contend that these novel cardiac GPCRs contribute to heart function in health and disease and thereby offer exciting opportunities to therapeutically modulate heart function.
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Affiliation(s)
- Simon R Foster
- School of Biomedical Sciences, University of Queensland, St Lucia Campus, 4072, Brisbane, Australia
| | - Eugeni Roura
- School of Biomedical Sciences, University of Queensland, St Lucia Campus, 4072, Brisbane, Australia.,Centre for Nutrition & Food Sciences, Queensland Alliance for Agriculture and Food Innovation, University of Queensland, St Lucia Campus, Brisbane, Australia
| | - Peter Molenaar
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, St Lucia Campus, Brisbane, Australia.,School of Medicine, University of Queensland, St Lucia Campus, Brisbane, Australia
| | - Walter G Thomas
- School of Biomedical Sciences, University of Queensland, St Lucia Campus, 4072, Brisbane, Australia.
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33
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Treskatsch S, Feldheiser A, Shaqura M, Dehe L, Habazettl H, Röpke TK, Shakibaei M, Schäfer M, Spies CD, Mousa SA. Cellular localization and adaptive changes of the cardiac delta opioid receptor system in an experimental model of heart failure in rats. Heart Vessels 2015; 31:241-50. [PMID: 25552382 DOI: 10.1007/s00380-014-0620-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/19/2014] [Indexed: 01/30/2023]
Abstract
The role of the cardiac opioid system in congestive heart failure (CHF) is not fully understood. Therefore, this project investigated the cellular localization of delta opioid receptors (DOR) in left ventricle (LV) myocardium and adaptive changes in DOR and its endogenous ligand, the precursor peptide proenkephalin (PENK), during CHF. Following IRB approval, DOR localization was determined by radioligand binding using [H(3)]Naltrindole and by double immunofluorescence confocal analysis in the LV of male Wistar rats. Additionally, 28 days following an infrarenal aortocaval fistula (ACF) the extent of CHF and adaptions in left ventricular DOR and PENK expression were examined by hemodynamic measurements, RT-PCR, and Western blot. DOR specific membrane binding sites were identified in LV myocardium. DOR were colocalized with L-type Ca(2+)-channels (Cav1.2) as well as with intracellular ryanodine receptors (RyR) of the sarcoplasmatic reticulum. Following ACF severe congestive heart failure developed in all rats and was accompanied by up-regulation of DOR and PENK on mRNA as well as receptor proteins representing consecutive adaptations. These findings might suggest that the cardiac delta opioid system possesses the ability to play a regulatory role in the cardiomyocyte calcium homeostasis, especially in response to heart failure.
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Affiliation(s)
- Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Aarne Feldheiser
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Mohammed Shaqura
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Lukas Dehe
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Helmut Habazettl
- Institute of Physiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Torsten K Röpke
- Department of Cardiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Mehdi Shakibaei
- Institute of Anatomy, Ludwig-Maximilians-Universität München, Pettenkoferstraße 11, 80336, Munich, Germany.
| | - Michael Schäfer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Claudia D Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Shaaban A Mousa
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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34
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van den Brink OWV, Cochrane AD, Rosenfeldt FL, Penny DJ, Pepe S. Increased myocardial methionine-enkephalin with reduced arterial oxygenation in congenital heart disease. J Paediatr Child Health 2014; 50:E63-7. [PMID: 20626583 DOI: 10.1111/j.1440-1754.2010.01794.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardiac opioid peptides have been identified to exert important adaptive metabolic signalling for cardioprotection against ischaemia or hypoxia-related injury. AIMS To determine myocardial methionine-enkephalin content in children with hypoxemic congenital heart defects and to correlate myocardial content of methionine-enkephalin with the extent of arterial oxygen desaturation. METHODS Children (n= 20, median age of 16 months), undergoing cardiac surgical repair (tetralogy of Fallot, 17/20), were included in this study. Arterial oxygen saturation was measured on admission. Myocardial samples obtained during surgery were assayed via radioimmunochemistry for methionine-enkephalin content. RESULTS Greater methionine-enkephalin content was measured in the right ventricles of the patients suffering from recent cyanotic spells compared with those with no recent spells (cyanotic spells: 2418 ± 844 pg/g wet weight tissue, n= 6; no spells: 1175 ± 189 pg/g wet weight tissue, n= 14, P= 0.04). An inverse correlation was evident between the arterial oxygen saturation and myocardial methionine-enkephalin content. CONCLUSION Myocardial methionine-enkephalin levels increase with the severity of hypoxic stress in congenital cardiac disease and may play an important adaptive role in countering adrenergic over-activity and related excess demand on myocardial metabolic capacity.
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Affiliation(s)
- Olivier W V van den Brink
- Department of Cardiothoracic Surgery, Alfred Hospital, Department of Surgery, Monash University, Murdoch Children's Research Institute, Critical Care and Neurosciences, Heart Research, Victorian Paediatric Cardiac Surgery Unit, Department of Cardiology, Royal Children's Hospital and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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35
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Gao JB, Tang WD, Wang X, Shen J. Prognostic value of neuropeptide proenkephalin A in patients with severe traumatic brain injury. Peptides 2014; 58:42-6. [PMID: 24937655 DOI: 10.1016/j.peptides.2014.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
High plasma proenkephalin A levels have been associated with poor clinical outcome of aneurysmal subarachnoid hemorrhage. This prospective observatory study was designed to investigate the relationship between plasma proenkephalin A levels and 1-week mortality, 6-month mortality and 6-month unfavorable outcome (defined as Glasgow Outcome Scale score of 1-3) in patients with severe traumatic brain injury. This study recruited 128 patients and 128 sex- and age-matched healthy controls. Plasma proenkephalin A levels, as measured by chemoluminescence sandwich immunoassay, were statistically significantly higher in patients than in healthy controls (239.1±93.0 pmol/L vs.81.3±22.1 pmol/L; P<0.001) and were correlated with Glasgow Coma Scale scores (r=-0.540, P<0.001). It was identified as an independent prognostic predictor of 1-week mortality [odds ratio (OR), 1.214; 95% confidence interval (CI), 1.103-1.425; P<0.001], 6-month mortality (OR, 1.162; 95% CI, 1.101-1.372; P<0.001) and 6-month unfavorable outcome (OR, 1.116; 95% CI, 1.097-1.281; P<0.001). Moreover, it had high predictive value for 1-week mortality [area under curve (AUC), 0.852; 95% CI, 0.778-0.908], 6-month mortality (AUC, 0.841; 95% CI, 0.766-0.899) and 6-month unfavorable outcome (AUC, 0.830; 95% CI, 0.754-0.891). Furthermore, its predictive value was similar to Glasgow Coma Scale score's (all P>0.05). Yet, a combined logistic-regression model did not show that it statistically significantly improved the predictive value of Glasgow Coma Scale score (all P>0.05). Thus, it was proposed that enhanced plasma proenkephalin A could be a useful, complementary tool to predict short- or long-term clinical outcome after severe traumatic brain injury.
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Affiliation(s)
- Jian-Bo Gao
- Department of Emergency Medicine, Fuyang People's Hospital, 2-4 Guihua Road, Fuyang 311400, Zhejiang Province, China.
| | - Wei-Dong Tang
- Department of Critical Care Medicine, Fuyang People's Hospital, 2-4 Guihua Road, Fuyang 311400, Zhejiang Province, China
| | - Xiao Wang
- Department of Emergency Medicine, Fuyang People's Hospital, 2-4 Guihua Road, Fuyang 311400, Zhejiang Province, China
| | - Jia Shen
- Department of Neurosurgery, Fuyang People's Hospital, 2-4 Guihua Road, Fuyang 311400, Zhejiang Province, China
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Ng LL, Sandhu JK, Narayan H, Quinn PA, Squire IB, Davies JE, Bergmann A, Maisel A, Jones DJL. Proenkephalin and prognosis after acute myocardial infarction. J Am Coll Cardiol 2013; 63:280-9. [PMID: 24140658 DOI: 10.1016/j.jacc.2013.09.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/08/2013] [Accepted: 09/10/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The goal of this research was to assess the prognostic value of proenkephalin (PENK) levels in acute myocardial infarction (AMI) by using N-terminal pro-B-type natriuretic peptide and Global Registry of Acute Coronary Events (GRACE) scores as comparators and to identify levels that might be valuable in clinical decision making. BACKGROUND PENK is a stable analyte of labile enkephalins. Few biomarkers predict recurrent AMI. METHODS We measured PENK in 1,141 patients (820 male subjects; mean age 66.2 ± 12.8 years) with AMI. Endpoints were major adverse events (composite of death, myocardial infarction [MI], and heart failure [HF] hospitalization) and recurrent MI at 2 years. GRACE scoring was used for comparisons with PENK for the death and/or MI endpoint at 6 months. RESULTS During follow-up, 139 patients died, and there were 112 HF hospitalizations and 149 recurrent AMIs. PENK levels were highest on admission and were related to estimated glomerular filtration rate, left ventricular wall motion index, sex, blood pressure, and age. Multivariable Cox regression models found that the PENK level was a predictor of major adverse events (hazard ratio [HR]: 1.52 [95% confidence interval (CI): 1.19 to 1.94]), death and/or AMI (HR: 1.76 [95% CI: 1.34 to 2.30]), and death and/or HF (HR: 1.67 [95% CI: 1.24 to 2.25]) (all comparisons p < 0.001), as well as recurrent AMI (HR: 1.43 [95% CI: 1.07 to 1.91]; p < 0.01). PENK levels were independent predictors of 6-month death and/or MI compared with GRACE scores. PENK-adjusted GRACE scores reclassified patients significantly (overall category-free net reclassification improvement [>0] of 21.9 [95% CI: 4.5 to 39.4]; p < 0.014). PENK levels <48.3 pmol/l and >91 pmol/l detected low- and high-risk patients, respectively. CONCLUSIONS PENK levels reflect cardiorenal status post-AMI and are prognostic for death, recurrent AMI, or HF. Cutoff values define low- and high-risk groups and improve risk prediction of GRACE scores.
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Affiliation(s)
- Leong L Ng
- Department of Cardiovascular Sciences and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester, United Kingdom.
| | - Jatinderpal K Sandhu
- Department of Cardiovascular Sciences and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
| | - Hafid Narayan
- Department of Cardiovascular Sciences and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
| | - Paulene A Quinn
- Department of Cardiovascular Sciences and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
| | - Iain B Squire
- Department of Cardiovascular Sciences and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
| | - Joan E Davies
- Department of Cardiovascular Sciences and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
| | - Andreas Bergmann
- Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, University of Leicester, Leicester, United Kingdom
| | - Alan Maisel
- San Diego VA Medical Center, San Diego, California
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Najafipour H, Joukar S. Combination of opium smoking and hypercholesterolemia augments susceptibility for lethal cardiac arrhythmia and atherogenesis in rabbit. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2012; 34:154-159. [PMID: 22522425 DOI: 10.1016/j.etap.2012.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/02/2012] [Accepted: 03/18/2012] [Indexed: 05/31/2023]
Abstract
Opium consumption is increasing in some eastern societies, where it is grown. We investigated the effect of opium smoking on plasma atherogenic index and incidence of lethal cardiac arrhythmia, i.e. ventricular tachycardia (VT) and ventricular fibrillation (VF) in rabbits. Animals were divided into two-, normo- and hyper-cholesterolemic main groups fed with normal or high cholesterol diet prior and during short-term and long-term exposure to opium smoke. Then, isoproterenol (3mg/kg, i.p.) was injected to induce cardiac ischemia and animals were followed for 3h for counting of lethal arrhythmia incidence. Long-term opium smoking significantly increased the plasma atherogenic index. In ischemic hearts, opium smoking along with hypercholesterolemia significantly enhanced the incidence of fatal arrhythmia. This vulnerability was not mediated by changes in QT interval. These data suggest that opium smoking, especially in hypercholesterolemic conditions, can be a predisposing factor for atherogenesis and lethal arrhythmia.
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Affiliation(s)
- Hamid Najafipour
- Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran; Department of Physiology and Pharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Siyavash Joukar
- Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran; Department of Physiology and Pharmacology, Kerman University of Medical Sciences, Kerman, Iran.
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Wojciechowski P, Szereda-Przestaszewska M, Lipkowski AW. Delta opioid receptors contribute to the cardiorespiratory effects of biphalin in anesthetized rats. Pharmacol Rep 2011; 63:1235-42. [PMID: 22180367 DOI: 10.1016/s1734-1140(11)70644-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 06/08/2011] [Indexed: 10/25/2022]
Abstract
Biphalin expresses almost equal affinity for μ- and δ-opioid receptors. The aim of this study was to delineate a possible role of δ-opioid receptors in the cardio-respiratory effects of systemic injection of biphalin in anesthetized, spontaneously breathing rats. In control animals, an intravenous bolus of biphalin (0.3 μmol/kg) evoked apnea, followed by a decreased breathing rate and increased tidal volume, hypotension and bradycardia. Blockade of δ-opioid receptors with naltrindole (4.2 μmol/kg) significantly reduced the duration of apnea, slowdown of respiration, immediate post-challenge hypotension and bradycardia induced by biphalin administration. These results indicate that the activation of δ-opioid receptors adds to the depressive response produced by biphalin.
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Affiliation(s)
- Piotr Wojciechowski
- Laboratory of Respiratory Reflexes, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawińskiego 5, PL 02-106 Warszawa, Poland
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Safaii N, Kazemi B. Effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery. Gen Thorac Cardiovasc Surg 2010; 58:62-7. [PMID: 20155341 DOI: 10.1007/s11748-009-0529-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 08/04/2009] [Indexed: 12/17/2022]
Abstract
PURPOSE Data regarding the effect of opium use on short-term outcome in patients undergoing coronary artery bypass surgery are limited. We sought to assess the morbidity and in-hospital mortality of current and past users compared the data with those from nonusers of opium after coronary artery bypass grafting (CABG). METHODS This is a descriptive analytical review of prospectively collected data on 782 consecutive male patients who underwent isolated CABG between January 2005 and December 2007. Of these, 708 (90.5%) were nonusers, 56 (7.1%) were current users, and 18 (2.3%) were former opium users of more than 4 weeks. The effect of opium usage on clinical, admission, and outcome variables were analyzed. RESULTS Current opium users were younger (P = 0.004) and more likely to be cigarette smokers (P = 0.0004). Other demographic characteristics, major coronary risk factors, rates of postoperative complications, intensive care unit readmission, postoperative length of stay, and in-hospital mortality did not differ among the three groups. Current opium users needed less analgesic postoperatively (P = 0.0001), were significantly less compliant with medical and dietary recommendations after discharge (P < 0.0001), and were more likely to be rehospitalized with cardiovascular causes within 6 months after CABG surgery; these differences were much more pronounced for nonusers versus current users of opium (P < 0.0001). CONCLUSION Continued use of opium is a significant predictor of rehospitalization with a cardiac cause within 6 months of CABG surgery. This may be partly due to the low compliance of these patients with treatment recommendations.
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Affiliation(s)
- Nasser Safaii
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, 5166615573, Iran
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Abstract
BACKGROUND The effects of opium consumption on coronary artery disease are still unknown. METHODS A cross-sectional study was conducted on 2405 patients admitted to the Angiographic Ward at Tehran Heart Center from 7 May 2005 to 13 August 2005. RESULTS After adjusting for conventional cardiovascular risk factors, opium consumption was a significant risk factor for coronary artery disease (P=0.01 and odds ratio=1.8). Moreover, the amount of opium consumption was associated significantly with the severity of coronary atherosclerosis, as measured by clinical vessel score (r=0.2, P=0.002). CONCLUSIONS To our knowledge, this is the first time that the adverse effects of opium consumption on coronary arteries was defined.
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Ebrahimi F, Tavakoli S, Hajrasouliha AR, Sadeghipour H, Dehghani M, Ahmadi SH, Dehpour AR. Involvement of endogenous opioid peptides and nitric oxide in the blunted chronotropic and inotropic responses to beta-adrenergic stimulation in cirrhotic rats. Fundam Clin Pharmacol 2007; 20:461-71. [PMID: 16968416 DOI: 10.1111/j.1472-8206.2006.00431.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
It is well known that chronotropic and inotropic responses to beta-adrenergic stimulation are impaired in cirrhosis, but the exact reason is not clear. Considering the inhibitory effect of endogenous opioid peptides and nitric oxide (NO) on beta-adrenergic pathway, we examined their roles in hyporesponsiveness of isolated atria and papillary muscles to isoproterenol stimulation in cirrhotic rats. Cirrhosis was induced by chronic bile duct ligation. Four weeks after ligation or sham operation, the responses of the isolated atria and papillary muscles to isoproterenol stimulation were evaluated in the absence and presence of naltrexone HCl (10(-6) m), N(omega)-nitro-L-arginine methyl ester (L-NAME, 10(-4) m), and naltrexone plus L-NAME in the organ bath. Considering the role of inducible NOS (iNOS) in hemodynamic abnormalities of cirrhotic rats, the chronotropic and inotropic responses of cirrhotic rats to isoproterenol stimulation were also assessed in the presence of aminoguanidine (a selective inhibitor of iNOS, 3 x 10(-4) m). Sham operation had no significant effect on basal atrial beating rate, contractile force, and maximal time derivatives for the development and the dissipation of papillary muscle tension. The basal atrial beating rate of cirrhotic rats did not show any significant difference compared with the sham-operated ones; however, the basal contractile parameters were significantly decreased in cirrhosis. Although the maximum effects of isoproterenol on chronotropic and inotropic responses were significantly reduced in cirrhotic rats, there was no difference in half-maximal effective concentrations of isoproterenol in these concentration-response curves. The basal abnormalities and the attenuated chronotropic and inotropic responses to isoproterenol were completely corrected by the administration of naltrexone, L-NAME and aminoguanidine. Concurrent administration of naltrexone and L-NAME also restored to normal the basal abnormalities and the blunted responses to isoproterenol in cirrhotic rats, and did not show any antagonistic effect. Based on these findings, both the endogenous opioid peptides and NO may be involved in the attenuated chronotropic and inotropic responses to beta-adrenergic stimulation in cirrhosis. It seems that the iNOS activity results in NO-induced hyporesponsiveness to beta-adrenergic stimulation in cirrhosis.
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Affiliation(s)
- Farzad Ebrahimi
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, PO Box 13145-784, Tehran, Iran
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