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Verovenko V, Tennstedt S, Kleinecke M, Kessler T, Schunkert H, Erdmann J, Ensminger S, Aherrahrou Z. Identification of a functional missense variant in the matrix metallopeptidase 10 (MMP10) gene in two families with premature myocardial infarction. Sci Rep 2024; 14:12212. [PMID: 38806571 PMCID: PMC11133425 DOI: 10.1038/s41598-024-62878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
A positive family history is a major independent risk factor for atherosclerosis, and genetic variation is an important aspect of cardiovascular disease research. We identified a heterozygous missense variant p.L245P in the MMP10 gene in two families with premature myocardial infarction using whole-exome sequencing. The aim of this study was to investigate the consequences of this variant using in-silico and functional in-vitro assays. Molecular dynamics simulations were used to analyze protein interactions, calculate free binding energy, and measure the volume of the substrate-binding cleft of MMP10-TIMP1 models. The p.L245P variant showed an altered protein surface, different intra- and intermolecular interactions of MMP10-TIMP1, a lower total free binding energy between MMP10-TIMP1, and a volume-minimized substrate-binding cleft of MMP10 compared to the wild-type. For the functional assays, human THP-1 cells were transfected with plasmids containing MMP10 cDNA carrying the p.L245P and wild-type variant and differentiated into macrophages. Macrophage adhesion and migration assays were then conducted, and pro-inflammatory chemokine levels were evaluated. The p.L245P variant led to macrophages that were more adherent, less migratory, and secreted higher levels of the pro-inflammatory chemokines CXCL1 and CXCL8 than wild-type macrophages. Thus, the p.L245P variant in MMP10 may influence the pathogenesis of atherosclerosis in families with premature myocardial infarction by altering protein - protein interactions, macrophage adhesion and migration, and expression of pro-inflammatory chemokines, which may increase plaque rupture. These results could contribute to the development of selective MMP10 inhibitors and reduce the risk of atherosclerosis in families with a history of premature myocardial infarction.
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Affiliation(s)
- Viktor Verovenko
- Institute for Cardiogenetics, University of Luebeck, Luebeck, Germany
- DZHK (German Research Centre for Cardiovascular Research) Partner Site Hamburg/Luebeck/Kiel, Luebeck, Germany
- University Heart Center, Luebeck, Germany
| | - Stephanie Tennstedt
- Institute for Cardiogenetics, University of Luebeck, Luebeck, Germany
- DZHK (German Research Centre for Cardiovascular Research) Partner Site Hamburg/Luebeck/Kiel, Luebeck, Germany
- University Heart Center, Luebeck, Germany
| | - Mariana Kleinecke
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, 0811, Australia
| | - Thorsten Kessler
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Luebeck, Luebeck, Germany
- DZHK (German Research Centre for Cardiovascular Research) Partner Site Hamburg/Luebeck/Kiel, Luebeck, Germany
- University Heart Center, Luebeck, Germany
| | - Stephan Ensminger
- University Heart Center, Luebeck, Germany
- Clinic for Cardiac and Thoracic Vascular Surgery, UKSH (University Hospital Schleswig-Holstein), Luebeck, Germany
| | - Zouhair Aherrahrou
- Institute for Cardiogenetics, University of Luebeck, Luebeck, Germany.
- DZHK (German Research Centre for Cardiovascular Research) Partner Site Hamburg/Luebeck/Kiel, Luebeck, Germany.
- University Heart Center, Luebeck, Germany.
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Zhang S, Wang J, Chen S, Zhang Y, He R, Wang X, Ding F, Hu W, Dai Y, Lu L, Zhang R, Ni J, Chen Q. Serum levels of lipoprotein-associated phospholipase A2 are associated with coronary atherosclerotic plaque progression in diabetic and non-diabetic patients. BMC Cardiovasc Disord 2024; 24:251. [PMID: 38745157 PMCID: PMC11092249 DOI: 10.1186/s12872-024-03931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Lp-PLA2 is linked to cardiovascular diseases and poor outcomes, especially in diabetes, as it functions as a pro-inflammatory and oxidative mediator. OBJECTIVES This research aimed to explore if there is a connection between the serum levels of Lp-PLA2 and the progression of coronary plaques (PP) in individuals with type 2 diabetes mellitus (T2DM) and those without the condition. MATERIALS AND METHODS Serum Lp-PLA2 levels were measured in 137 T2DM patients with PP and 137 T2DM patients with no PP, and in 205 non-diabetic patients with PP and 205 non-diabetic patients with no PP. These individuals met the criteria for eligibility and underwent quantitative coronary angiography at the outset and again after about one year of follow-up. The attributes and parameters of the participants at the outset were recorded. RESULTS Increased serum levels of Lp-PLA2 were closely associated with coronary artery PP, and also significantly correlated with change of MLD, change of diameter stenosis and change of cumulative coronary obstruction in both diabetic and non-diabetic groups, with higher correlation coefficients in diabetic patients as compared with non-diabetic patients. Moreover, multivariate logistic regression analysis showed that serum Lp-PLA2 level was an independent determinant of PP in both groups, with OR values more significant in diabetic patients than in non-diabetic patients. CONCLUSIONS Levels of serum Lp-PLA2 show a significant association with the progression of coronary atherosclerotic plaque in patients with T2DM and those without, especially among individuals with diabetes.
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Affiliation(s)
- Shudong Zhang
- Department of Cardiovascular Medicine, Wuxi branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi, China
| | - Jiangang Wang
- Health Management Medicine Center, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuai Chen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Zhang
- Department of Cardiovascular Medicine, Wuxi branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi, China
| | - Ruming He
- Department of Cardiovascular Medicine, Wuxi branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi, China
| | - Xiaoqun Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Ding
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbo Hu
- Eachy biopharma, Zhangjiagang, Jiangsu Province, China
| | - Yang Dai
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Lu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingwei Ni
- Department of Cardiovascular Medicine, Wuxi branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi, China.
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, China.
| | - Qiujing Chen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, China.
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Antonopoulos AS, Simantiris S. Preventative Imaging with Coronary Computed Tomography Angiography. Curr Cardiol Rep 2023; 25:1623-1632. [PMID: 37897677 DOI: 10.1007/s11886-023-01982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE OF REVIEW Coronary computed tomography angiography (CCTA) is the diagnostic modality of choice for patients with stable chest pain. In this review, we scrutinize the evidence on the use of CCTA for the screening of asymptomatic patients. RECENT FINDINGS Clinical evidence suggests that CCTA imaging enhances cardiovascular risk stratification and prompts the timely initiation of preventive treatment leading to reduced risk of major adverse coronary events. Visualization of coronary plaques by CCTA also helps patients to comply with preventive medications. The presence of non-obstructive plaques and total plaque burden are prognostic for cardiovascular events. High-risk plaque features and pericoronary fat attenuation index, enrich the prognostic output of CCTA on top of anatomical information by capturing information on plaque vulnerability and coronary inflammatory burden. Timely detection of atherosclerotic disease or coronary inflammation by CCTA can assist in the deployment of targeted preventive strategies and novel therapeutics to prevent cardiovascular disease.
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Affiliation(s)
- Alexios S Antonopoulos
- Biomedical Research Foundation of the Academy of Athens (BRFAA), 4 Soranou Efesiou Street, Athens, Greece.
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Spyridon Simantiris
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Lorenzatti D, Piña P, Csecs I, Schenone AL, Gongora CA, Garcia MJ, Blaha MJ, Budoff MJ, Williams MC, Dey D, Berman DS, Virani SS, Slipczuk L. Does Coronary Plaque Morphology Matter Beyond Plaque Burden? Curr Atheroscler Rep 2023; 25:167-180. [PMID: 36808390 DOI: 10.1007/s11883-023-01088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Imaging of adverse coronary plaque features by coronary computed tomography angiography (CCTA) has advanced greatly and at a fast pace. We aim to describe the evolution, present and future in plaque analysis, and its value in comparison to plaque burden. RECENT FINDINGS Recently, it has been demonstrated that in addition to plaque burden, quantitative and qualitative assessment of coronary plaque by CCTA can improve the prediction of future major adverse cardiovascular events in diverse coronary artery disease scenarios. The detection of high-risk non-obstructive coronary plaque can lead to higher use of preventive medical therapies such as statins and aspirin, help identify culprit plaque, and differentiate between myocardial infarction types. Even more, over traditional plaque burden, plaque analysis including pericoronary inflammation can potentially be useful tools for tracking disease progression and response to medical therapy. The identification of the higher risk phenotypes with plaque burden, plaque characteristics, or ideally both can allow the allocation of targeted therapies and potentially monitor response. Further observational data are now required to investigate these key issues in diverse populations, followed by rigorous randomized controlled trials.
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Affiliation(s)
- Daniel Lorenzatti
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pamela Piña
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiology Division, CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic
| | - Ibolya Csecs
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carlos A Gongora
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Michelle C Williams
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA.
- Clinical Cardiology, Advanced Cardiac Imaging, CV Atherosclerosis and Lipid Disorder Center, Montefiore Health System, NewYork, USA.
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Piña P, Lorenzatti D, Paula R, Daich J, Schenone AL, Gongora C, Garcia MJ, Blaha MJ, Budoff MJ, Berman DS, Virani SS, Slipczuk L. Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet? Am J Prev Cardiol 2022; 13:100451. [PMID: 36619296 PMCID: PMC9813535 DOI: 10.1016/j.ajpc.2022.100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/07/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Atherosclerotic cardiovascular disease risk (ASCVD) is an ongoing epidemic, and lipid abnormalities are its primordial cause. Most individuals suffering a first ASCVD event are previously asymptomatic and often do not receive preventative therapies. The cornerstone of primary prevention has been the identification of individuals at risk through risk calculators based on clinical and laboratory traditional risk factors plus risk enhancers. However, it is well accepted that a clinical risk calculator misclassifies a significant proportion of individuals leading to the prescription of a lipid-lowering medication with very little yield or a missed opportunity for lipid-lowering agents with a potentially preventable event. The development of coronary artery calcium scoring (CAC) and CT coronary angiography (CCTA) provide complementary tools to directly visualize coronary plaque and other risk-modifying imaging components that can potentially provide individualized lipid management. Understanding patient selection for CAC or potentially CCTA and the risk implications of the different parameters provided, such as CAC score, coronary stenosis, plaque characteristics and burden, epicardial adipose tissue, and pericoronary adipose tissue, have grown more complex as technologies evolve. These parameters directly affect the shared decision with patients to start or withhold lipid-lowering therapies, to adjust statin intensity or LDL cholesterol goals. Emerging lipid lowering studies with non-invasive imaging as a guide to patient selection and treatment efficacy, plus the evolution of lipid lowering therapies from statins to a diverse armament of newer high-cost agents have pushed these two fields forward with a complex interaction. This review will discuss existing risk estimators, and non-invasive imaging techniques for subclinical coronary atherosclerosis, traditionally studied using CAC and more recently CCTA with qualitative and quantitative measurements. We will also explore the current data, gaps of knowledge and future directions on the use of these techniques in the risk-stratification and guidance of lipid management.
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Affiliation(s)
- Pamela Piña
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Daniel Lorenzatti
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Rita Paula
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Jonathan Daich
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Carlos Gongora
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Baltimore, MD, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine. Baylor College of Medicine, and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- The Aga Khan University, Karachi, Pakistan
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center/Albert Einstein College of Medicine. Bronx, NY, USA
- Corresponding author.
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Henein MY, Vancheri S, Longo G, Vancheri F. The Role of Inflammation in Cardiovascular Disease. Int J Mol Sci 2022; 23:12906. [PMID: 36361701 PMCID: PMC9658900 DOI: 10.3390/ijms232112906] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 07/21/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory disease, in which the immune system has a prominent role in its development and progression. Inflammation-induced endothelial dysfunction results in an increased permeability to lipoproteins and their subendothelial accumulation, leukocyte recruitment, and platelets activation. Recruited monocytes differentiate into macrophages which develop pro- or anti-inflammatory properties according to their microenvironment. Atheroma progression or healing is determined by the balance between these functional phenotypes. Macrophages and smooth muscle cells secrete inflammatory cytokines including interleukins IL-1β, IL-12, and IL-6. Within the arterial wall, low-density lipoprotein cholesterol undergoes an oxidation. Additionally, triglyceride-rich lipoproteins and remnant lipoproteins exert pro-inflammatory effects. Macrophages catabolize the oxidized lipoproteins and coalesce into a lipid-rich necrotic core, encapsulated by a collagen fibrous cap, leading to the formation of fibro-atheroma. In the conditions of chronic inflammation, macrophages exert a catabolic effect on the fibrous cap, resulting in a thin-cap fibro-atheroma which makes the plaque vulnerable. However, their morphology may change over time, shifting from high-risk lesions to more stable calcified plaques. In addition to conventional cardiovascular risk factors, an exposure to acute and chronic psychological stress may increase the risk of cardiovascular disease through inflammation mediated by an increased sympathetic output which results in the release of inflammatory cytokines. Inflammation is also the link between ageing and cardiovascular disease through increased clones of leukocytes in peripheral blood. Anti-inflammatory interventions specifically blocking the cytokine pathways reduce the risk of myocardial infarction and stroke, although they increase the risk of infections.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK
- Molecular and Clinical Sciences Research Institute, St. George’s University, London UB8 3PH, UK
| | - Sergio Vancheri
- Interventional Neuroradiology Department, Besançon University Hospital, 25000 Besançon, France
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
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Willeit K, Santer P, Tschiderer L, Pechlaner R, Vermeer C, Willeit J, Kiechl S. Association of desphospho-uncarboxylated matrix gla protein with incident cardiovascular disease and all-cause mortality: Results from the prospective Bruneck Study. Atherosclerosis 2022; 353:20-27. [PMID: 35764030 DOI: 10.1016/j.atherosclerosis.2022.06.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/01/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Matrix Gla protein (MGP), a vitamin K-dependent protein, is a potent inhibitor of vascular calcification. Desphospho-uncarboxylated MGP (dp-ucMGP), a marker of vitamin K insufficiency, has been shown to predict cardiovascular disease (CVD) and all-cause mortality in high-risk populations. Whether the increased risk associated with dp-ucMGP also applies to the general, and especially, the elderly population has not yet been fully elucidated. METHODS AND RESULTS Plasma dp-ucMGP was measured in 684 individuals aged 50-89 years of the prospective population-based Bruneck Study (baseline evaluation in 2000). Baseline median dp-ucMGP was 478.4 (IQR 335.0-635.2) pmol/L. Over a median follow-up of 15.5 years, 163 CVD events occurred and 235 participants died. Age-/sex-adjusted hazard ratios (HRs) per 1-SD higher level of loge transformed dp-ucMGP were 1.30 (95%CI: 1.09-1.55; p=0.004) for incident CVD and 1.36 (95%CI: 1.17-1.57; p<0.001) for all-cause mortality. After multivariable adjustment, the associations remained significant with HRs of 1.23 (95%CI: 1.02-1.47, p=0.029) for CVD and 1.40 (95%CI: 1.20-1.64; p<0.001) for all-cause mortality. The associations remained virtually unchanged after additional adjustment for dietary quality as measured with the Alternative Healthy Eating Index. We found no association of dp-ucMGP with myocardial infarction and sudden cardiac deaths, but a strong association with other vascular deaths and non-vascular/non-cancer deaths. CONCLUSIONS This study shows a significant association of plasma dp-ucMGP with incident CVD and a significant and even stronger association with all-cause mortality. Clinical trials are needed to investigate whether vitamin K substitution results in improved health outcomes.
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Affiliation(s)
- Karin Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Santer
- Department of Laboratory Medicine, Hospital of Bruneck, Bruneck, Italy
| | - Lena Tschiderer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Cees Vermeer
- Cardiovascular Research Institute CARIM, Maastricht University, 6229 ER, Maastricht, the Netherlands
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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Laboratory Grown Biofilms of Bacteria Associated with Human Atherosclerotic Carotid Arteries Release Collagenases and Gelatinases during Iron-Induced Dispersion. Microbiol Spectr 2022; 10:e0100121. [PMID: 35543563 PMCID: PMC9241811 DOI: 10.1128/spectrum.01001-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The association of bacteria with arterial plaque lesions in patients with atherosclerosis has been widely reported. However, the role these bacteria play in the progression of atherosclerosis is still unclear. Previous work in our lab has demonstrated that bacteria exist in carotid artery plaques as biofilm deposits. Biofilms are communities of microorganisms enmeshed within a protective, self-produced extracellular matrix and have been shown to contribute to chronic infections in humans. Biofilm communities have the potential to impact surrounding tissues in an infection if they undergo a dispersion response, releasing bacteria into the surrounding environment by enzymatic degradation of the extracellular matrix. One concern relating to these enzymes is that they could cause collateral damage to host tissues. In this study, we present an in vitro multispecies biofilm culturing model used to investigate the potential role of bacterial biofilm dispersion in the progression of atherosclerosis. This work has demonstrated an increase in cell release from mixed-species biofilms formed by bacteria associated with human carotid arterial plaque deposits following treatment with iron or a combination of norepinephrine and transferrin. Greater extracellular lipase, protease, and collagenase/gelatinase activity was also associated with iron-treated biofilms. The results of this work suggest that bacteria in this model undergo iron-induced biofilm dispersion, as evidenced by the increased cell release and higher enzyme activity following treatment. This work demonstrates the potential for multispecies biofilm dispersion to contribute to arterial tissue degradation by bacteria and suggests that in atherosclerotic infections, biofilm dispersion may contribute to thrombogenesis, which can lead to heart attack or stroke. IMPORTANCE Atherosclerosis, or hardening of the arteries, is a leading cause of congestive heart failure, heart attack, and stroke in humans. Mounting evidence, in the literature and from our lab, points to the regular involvement of bacteria within arterial plaque deposits in patients with advanced atherosclerosis. Very little is known about the behavior of these bacteria and whether they may contribute to tissue damage in infected arteries. Tissue damage within the arterial plaque lesion can lead to rupture of the plaque contents into the bloodstream, where a clot may form, resulting in a potential heart attack or stroke. This study shows that plaque-associated bacteria, when cultured as mixed-species biofilms in the laboratory, can release degradative enzymes into their environment as the result of a dispersion response triggered by iron. These degradative enzymes can digest proteins and lipids which are associated with the tissues that separate the plaque lesion from the arterial lumen. Thus, this study demonstrates that if mixed species biofilms are induced to undergo dispersion in an infected atherosclerotic lesion when exposed to an elevated concentration of free iron, they have the potential to contribute to the weakening of arterial tissues, which may contribute to atherosclerotic plaque destabilization.
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Antonopoulos AS, Angelopoulos A, Tsioufis K, Antoniades C, Tousoulis D. Cardiovascular risk stratification by coronary computed tomography angiography imaging: current state-of-the-art. Eur J Prev Cardiol 2022; 29:608-624. [PMID: 33930129 DOI: 10.1093/eurjpc/zwab067] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022]
Abstract
Current cardiovascular risk stratification by use of clinical risk score systems or plasma biomarkers is good but less than satisfactory in identifying patients at residual risk for coronary events. Recent clinical evidence puts now further emphasis on the role of coronary anatomy assessment by coronary computed tomography angiography (CCTA) for the management of patients with stable ischaemic heart disease. Available computed tomography (CT) technology allows the quantification of plaque burden, identification of high-risk plaques, or the functional assessment of coronary lesions for ischaemia detection and revascularization for refractory angina symptoms. The current CT armamentum is also further enhanced by perivascular Fat Attenuation Index (FAI), a non-invasive metric of coronary inflammation, which allows for the first time the direct quantification of the residual vascular inflammatory burden. Machine learning and radiomic features' extraction and spectral CT for tissue characterization are also expected to maximize the diagnostic and prognostic yield of CCTA. The combination of anatomical, functional, and biological information on coronary circulation by CCTA offers a unique toolkit for the risk stratification of patients, and patient selection for targeted aggressive prevention strategies. We hereby provide a review of the current state-of-the art in the field and discuss how integrating the full capacities of CCTA into clinical care pathways opens new opportunities for the tailored management of coronary artery disease.
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Affiliation(s)
- Alexios S Antonopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
- RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Andreas Angelopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
| | - Charalambos Antoniades
- RDM Division of Cardiovascular Medicine, Oxford Academic CT Programme, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece
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Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Discoidin Domain-Containing Receptor 2 Is Present in Human Atherosclerotic Plaques and Involved in the Expression and Activity of MMP-2. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:1010496. [PMID: 34956435 PMCID: PMC8702333 DOI: 10.1155/2021/1010496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Abstract
Discoidin domain-containing receptor 2 (DDR2) has been suggested to be involved in atherosclerotic progression, but its pathological role remains unknown. Using immunochemical staining, we located and compared the expression of DDR2 in the atherosclerotic plaques of humans and various animal models. Then, siRNA was applied to knock down the expression of DDR2 in vascular smooth muscle cells (VSMCs), and the migration, proliferation, and collagen Ι-induced expression of matrix metalloproteinases (MMPs) were evaluated. We found that an abundance of DDR2 was present in the atherosclerotic plaques of humans and various animal models and was distributed around fatty and necrotic cores. After incubation of oxidized low-density lipoprotein (ox-LDL), DDR2 was upregulated in VSMCs in response to such a proatherosclerotic condition. Next, we found that decreased DDR2 expression in VSMCs inhibited the migration, proliferation, and collagen Ι-induced expression of matrix metalloproteinases (MMPs). Moreover, we found that DDR2 is strongly associated with the protein expression and activity of MMP-2, suggesting that DDR2 might play a role in the etiology of unstable plaques. Considering that DDR2 is present in the atherosclerotic plaques of humans and is associated with collagen Ι-induced secretion of MMP-2, the clinical role of DDR2 in cardiovascular disease should be elucidated in further experiments.
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12
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Li X, Yang Y, Wang Z, Jiang S, Meng Y, Song X, Zhao L, Zou L, Li M, Yu T. Targeting non-coding RNAs in unstable atherosclerotic plaques: Mechanism, regulation, possibilities, and limitations. Int J Biol Sci 2021; 17:3413-3427. [PMID: 34512156 PMCID: PMC8416736 DOI: 10.7150/ijbs.62506] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/23/2021] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVDs) caused by arteriosclerosis are the leading cause of death and disability worldwide. In the late stages of atherosclerosis, the atherosclerotic plaque gradually expands in the blood vessels, resulting in vascular stenosis. When the unstable plaque ruptures and falls off, it blocks the vessel causing vascular thrombosis, leading to strokes, myocardial infarctions, and a series of other serious diseases that endanger people's lives. Therefore, regulating plaque stability is the main means used to address the high mortality associated with CVDs. The progression of the atherosclerotic plaque is a complex integration of vascular cell apoptosis, lipid metabolism disorders, inflammatory cell infiltration, vascular smooth muscle cell migration, and neovascular infiltration. More recently, emerging evidence has demonstrated that non-coding RNAs (ncRNAs) play a significant role in regulating the pathophysiological process of atherosclerotic plaque formation by affecting the biological functions of the vasculature and its associated cells. The purpose of this paper is to comprehensively review the regulatory mechanisms involved in the susceptibility of atherosclerotic plaque rupture, discuss the limitations of current approaches to treat plaque instability, and highlight the potential clinical value of ncRNAs as novel diagnostic biomarkers and potential therapeutic strategies to improve plaque stability and reduce the risk of major cardiovascular events.
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Affiliation(s)
- Xiaoxin Li
- Institute for translational medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, 266021, People's Republic of China
| | - Yanyan Yang
- Institute for translational medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, 266021, People's Republic of China
| | - Zhibin Wang
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Shaoyan Jiang
- Department of Cardiology, The Affiliated Cardiovascular Hospital of Qingdao University, No. 5 Zhiquan Road, Qingdao 266000, China
| | - Yuanyuan Meng
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Xiaoxia Song
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Liang Zhao
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Lu Zou
- Institute for translational medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, 266021, People's Republic of China
| | - Min Li
- Institute for translational medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, 266021, People's Republic of China
| | - Tao Yu
- Institute for translational medicine, The Affiliated Hospital of Qingdao University, No. 38 Dengzhou Road, 266021, People's Republic of China.,Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
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13
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Fedak A, Chrzan R, Chukwu O, Urbanik A. Ultrasound methods of imaging atherosclerotic plaque in carotid arteries: examinations using contrast agents. J Ultrason 2020; 20:e191-e200. [PMID: 33365156 PMCID: PMC7705485 DOI: 10.15557/jou.2020.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/11/2020] [Indexed: 11/22/2022] Open
Abstract
The primary technique for detecting the presence and monitoring the development of carotid atherosclerotic plaque is ultrasound. The development of ultrasound techniques has made it possible to precisely visualise not only blood flow, but also vessel walls, including atherosclerotic plaque. Contrast-enhanced ultrasound examination enables one to make an objective observation of atherosclerotic plaque neovascularisation, clearly indicating active inflammation, which is an inherent feature of vulnerable (unstable) plaque. Depending on the examination method used, it is possible to precisely visualise different components of the plaque and its behaviour during blood flow through the vessel lumen or through the neovessels of the plaque, and, consequently, determine the possible presence of inflammation, which is a defining feature of plaque stability. The full utilisation of physical phenomena that underlie contrast-enhanced ultrasound will bring further enormous progress of diagnostic and probably also therapeutic methods for carotid atherosclerosis. The selection of the right examination method significantly accelerates diagnosis and adequate classification of plaque, and makes it possible to monitor the progression of atherosclerosis. However, one needs to bear in mind that ultrasound remains a very subjective method. The success of contrast-enhanced ultrasound also depends on the skills and experience of the examiner. Current attempts at increasing the objectivity of contrast-enhanced ultrasound examination using artificial intelligence will make it possible in the future to make a definitive evaluation of atherosclerotic plaque stability. This will allow one to assess the risk of ischaemic stroke adequately.
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Affiliation(s)
- Andrzej Fedak
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Ositadima Chukwu
- Student Science Club, Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
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14
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Sterpetti AV. Inflammatory Cytokines and Atherosclerotic Plaque Progression. Therapeutic Implications. Curr Atheroscler Rep 2020; 22:75. [PMID: 33025148 PMCID: PMC7538409 DOI: 10.1007/s11883-020-00891-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF THE REVIEW Inflammatory cytokines play a major role in atherosclerotic plaque progression. This review summarizes the rationale for personalized anti-inflammatory therapy. RECENT FINDINGS Systemic inflammatory parameters may be used to follow the clinical outcome in primary and secondary prevention. Medical therapy, both in patients with stable cardiovascular disease, or with acute events, may be tailored taking into consideration the level and course of systemic inflammatory mediators. There is significant space for improvement in primary prevention and in the treatment of patients who have suffered from severe cardiovascular events, paying attention to not only blood pressure and cholesterol levels but also including inflammatory parameters in our clinical analysis. The potential exists to alter the course of atherosclerosis with anti-inflammatory drugs. With increased understanding of the specific mechanisms that regulate the relationship between inflammation and atherosclerosis, new, more effective and specific anti-inflammatory treatment may become available.
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Affiliation(s)
- Antonio V Sterpetti
- University of Rome Sapienza, Rome, Italy.
- AV Sterpetti- Policlinico Umberto I, Viale del Policlinico, 00167, Rome, Italy.
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15
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Vaisar T, Hu JH, Airhart N, Fox K, Heinecke J, Nicosia RF, Kohler T, Potter ZE, Simon GM, Dix MM, Cravatt BF, Gharib SA, Dichek DA. Parallel Murine and Human Plaque Proteomics Reveals Pathways of Plaque Rupture. Circ Res 2020; 127:997-1022. [PMID: 32762496 PMCID: PMC7508285 DOI: 10.1161/circresaha.120.317295] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
RATIONALE Plaque rupture is the proximate cause of most myocardial infarctions and many strokes. However, the molecular mechanisms that precipitate plaque rupture are unknown. OBJECTIVE By applying proteomic and bioinformatic approaches in mouse models of protease-induced plaque rupture and in ruptured human plaques, we aimed to illuminate biochemical pathways through which proteolysis causes plaque rupture and identify substrates that are cleaved in ruptured plaques. METHODS AND RESULTS We performed shotgun proteomics analyses of aortas of transgenic mice with macrophage-specific overexpression of urokinase (SR-uPA+/0 mice) and of SR-uPA+/0 bone marrow transplant recipients, and we used bioinformatic tools to evaluate protein abundance and functional category enrichment in these aortas. In parallel, we performed shotgun proteomics and bioinformatics studies on extracts of ruptured and stable areas of freshly harvested human carotid plaques. We also applied a separate protein-analysis method (protein topography and migration analysis platform) to attempt to identify substrates and proteolytic fragments in mouse and human plaque extracts. Approximately 10% of extracted aortic proteins were reproducibly altered in SR-uPA+/0 aortas. Proteases, inflammatory signaling molecules, as well as proteins involved with cell adhesion, the cytoskeleton, and apoptosis, were increased. ECM (Extracellular matrix) proteins, including basement-membrane proteins, were decreased. Approximately 40% of proteins were altered in ruptured versus stable areas of human carotid plaques, including many of the same functional categories that were altered in SR-uPA+/0 aortas. Collagens were minimally altered in SR-uPA+/0 aortas and ruptured human plaques; however, several basement-membrane proteins were reduced in both SR-uPA+/0 aortas and ruptured human plaques. Protein topography and migration analysis platform did not detect robust increases in proteolytic fragments of ECM proteins in either setting. CONCLUSIONS Parallel studies of SR-uPA+/0 mouse aortas and human plaques identify mechanisms that connect proteolysis with plaque rupture, including inflammation, basement-membrane protein loss, and apoptosis. Basement-membrane protein loss is a prominent feature of ruptured human plaques, suggesting a major role for basement-membrane proteins in maintaining plaque stability.
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Affiliation(s)
- Tomáš Vaisar
- Departments of Medicine (T.V., J.H.H., N.A., K.F., J.H., S.A.G., D.A.D.), University of Washington, Seattle
| | - Jie H Hu
- Departments of Medicine (T.V., J.H.H., N.A., K.F., J.H., S.A.G., D.A.D.), University of Washington, Seattle
| | - Nathan Airhart
- Departments of Medicine (T.V., J.H.H., N.A., K.F., J.H., S.A.G., D.A.D.), University of Washington, Seattle
| | - Kate Fox
- Departments of Medicine (T.V., J.H.H., N.A., K.F., J.H., S.A.G., D.A.D.), University of Washington, Seattle
| | - Jay Heinecke
- Departments of Medicine (T.V., J.H.H., N.A., K.F., J.H., S.A.G., D.A.D.), University of Washington, Seattle
| | - Roberto F Nicosia
- Departments of Pathology and Laboratory Medicine (D.A.D., R.F.N.), University of Washington, Seattle.,Departments of Pathology and Laboratory Medicine (R.F.N.), VA Puget Sound Health Care System, Seattle, WA
| | - Ted Kohler
- Departments of Surgery (T.K.), University of Washington, Seattle.,Departments of Surgery (T.K.), VA Puget Sound Health Care System, Seattle, WA
| | - Zachary E Potter
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA (Z.E.P., M.M.D., B.F.C.)
| | | | - Melissa M Dix
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA (Z.E.P., M.M.D., B.F.C.)
| | - Benjamin F Cravatt
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA (Z.E.P., M.M.D., B.F.C.)
| | - Sina A Gharib
- Departments of Medicine (T.V., J.H.H., N.A., K.F., J.H., S.A.G., D.A.D.), University of Washington, Seattle
| | - David A Dichek
- Departments of Medicine (T.V., J.H.H., N.A., K.F., J.H., S.A.G., D.A.D.), University of Washington, Seattle.,Departments of Pathology and Laboratory Medicine (D.A.D., R.F.N.), University of Washington, Seattle
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16
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Fedak A, Ciuk K, Urbanik A. Ultrasonography of vulnerable atherosclerotic plaque in the carotid arteries: B-mode imaging. J Ultrason 2020; 20:e135-e145. [PMID: 32609972 PMCID: PMC7418858 DOI: 10.15557/jou.2020.0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/30/2020] [Indexed: 11/22/2022] Open
Abstract
The most common type of stroke, i.e. ischemic stroke, is a great challenge for contemporary medicine as it poses both diagnostic and therapeutic difficulties. Atherosclerosis, which is rapidly beginning to affect more and more social groups, is the main cause of cerebrovascular accidents. Atherosclerosis is currently defined as a generalized, dynamic and heterogeneous inflammatory and immune process affecting arterial walls. Atherosclerotic plaque is the emanation of this disease. As the paradigm of the diagnosis of atherosclerosis has changed, it has become crucial to properly identify plaque instability within the carotid arteries by evaluating parameters and phenomena that signify a developing cascade of complications, eventually leading to stroke. Irrespective of the ultrasound technique employed, proper morphological evaluation of atherosclerotic plaque, involving observation of its echogenicity, i.e. subjective analysis of its structure, with the classification to Gray-Weale–Nicolaides types as well as assessment of the integrity of its surface, makes it possible to roughly evaluate plaque morphology and thereby its stability. This enables treatment planning and therapy monitoring. This evaluation should be a prelude to further diagnostic work-up, which involves non-invasive examinations that enable unambiguous assessment of plaque stability. These examinations include contrast-enhanced ultrasound to assess progression or recession of inflammation, which presents as plaque neovascularization, or shear wave elastography to objectively define tissue stiffness, and thereby its mineralization.
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Affiliation(s)
- Andrzej Fedak
- Department of Radiology, Jagiellonian University Medical College , Krakow , Poland
| | - Katarzyna Ciuk
- Students' Scientific Group at the Department of Radiology, Jagiellonian University Medical College , Krakow , Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College , Krakow , Poland
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17
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Optical coherence tomography versus intravascular ultrasound for culprit lesion assessment in patients with acute myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:145-152. [PMID: 32636898 PMCID: PMC7333203 DOI: 10.5114/aic.2020.96057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction In patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) the implanted stent may not fully cover the whole intravascular ultrasound (IVUS)-derived thin-cap fibroatheroma (TCFA) related to the culprit lesion (CL). Aim Whether this phenomenon is more pronounced when optical coherence tomography (OCT) assessment of the CL is performed is not known. Material and methods Thus, we aimed to assess CLs in 40 patients with AMI treated with PCI, using VH (virtual histology)-IVUS and OCT before and after intervention. The results were blinded to the operator and PCI was done under angiography guidance. Results Uncovered lipid-rich plaques were identified in the stent reference segments of 23 (57.5%) patients: in 13 (32.5%) of them in the distal reference segment and in 19 (47.5%) of them in the proximal reference segment. In 9 of them (22.5%) lipid plaques were found in both reference segments. In 36 (90%) patients OCT confirmed lipid plaques identified as VH-derived TCFA by VH-IVUS in the reference segments of the stented segment. However, OCT confirmed that only in 2 (5%) patients were uncovered lipid plaques true TCFA as defined by histology. Comparing IVUS and OCT qualitative characteristics of the stented segments OCT detected more thrombus protrusions and proximal and distal stent edge dissections compared to IVUS (92.5 vs. 55%, p = 0.001; 20% vs. 7.5%, p = 0.03 and 25% vs. 5%, p < 0.001, respectively). Conclusions Due to its superior resolution, OCT identifies TCFA more precisely. OCT more often shows remaining problems related to stent implantation than IVUS after angiographically guided PCI.
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18
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Zhang F, Xie Y. Response by Zhang and Xie to Letter Regarding Article, "Spotty Calcium on Cervicocerebral Computed Tomography Angiography Associates With Increased Risk of Ischemic Stroke". Stroke 2019; 50:e232. [PMID: 31242824 DOI: 10.1161/strokeaha.119.026032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fan Zhang
- Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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19
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Abstract
The mechanisms that underlie superficial erosion, a cause of coronary thrombosis distinct from plaque rupture, have garnered recent interest. In an era of improved control of traditional risk factors, such as LDL (low-density lipoprotein), plaque erosion may assume greater clinical importance. Plaques complicated by erosion tend to be matrix-rich, lipid-poor, and usually lack prominent macrophage collections, unlike plaques that rupture, which characteristically have thin fibrous caps, large lipid pools, and abundant foam cells. Thrombi that complicate superficial erosion seem more platelet-rich than the fibrinous clots precipitated by plaque rupture. The pathogenesis of plaque rupture probably does not pertain to superficial erosion, a process heretofore little understood mechanistically. We review here data that support a substantial shift in the mechanisms of the thrombotic complications of atherosclerosis. We further consider pathophysiologic processes recently implicated in the mechanisms of erosion. Multiple processes likely predispose plaques to superficial erosion, including experiencing disturbed flow, basement membrane breakdown, endothelial cell death, and detachment potentiated by innate immune activation mediated through pattern-recognition receptors and endothelial-to-mesenchymal transition. Monocytes/macrophages predominate in the pathogenesis of plaque rupture and consequent thrombosis, but polymorphonuclear leukocytes likely promote endothelial damage during superficial erosion. The formation of neutrophil extracellular traps probably perpetuates and propagates intimal injury and potentiates thrombosis due to superficial erosion. These considerations have profound clinical implications. Acute coronary syndromes because of erosion may not require immediate invasive therapy. Understanding the biological bases of erosion points to novel therapies for acute coronary syndrome caused by erosion. Future research should probe further the mechanisms of superficial erosion, and develop point-of-care tests to distinguish acute coronary syndromes provoked by erosion versus rupture that may direct more precision management. Future clinical investigations should evaluate intervening on the targets that have emerged from experimental studies and the management strategies that they inform.
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Affiliation(s)
- Peter Libby
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Filippo Crea
- F. Policlinico Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Roma
| | - Ik-Kyung Jang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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20
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Mihanfar A, Nejabati HR, Fattahi A, Latifi Z, Pezeshkian M, Afrasiabi A, Safaie N, Jodati AR, Nouri M. The role of sphingosine 1 phosphate in coronary artery disease and ischemia reperfusion injury. J Cell Physiol 2018; 234:2083-2094. [PMID: 30341893 DOI: 10.1002/jcp.27353] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/17/2018] [Indexed: 12/15/2022]
Abstract
Coronary artery disease (CAD) is a common cause of morbidity and mortality worldwide. Atherosclerotic plaques, as a hallmark of CAD, cause chronic narrowing of coronary arteries over time and could also result in acute myocardial infarction (AMI). The standard treatments for ameliorating AMI are reperfusion strategies, which paradoxically result in ischemic reperfusion (I/R) injury. Sphingosine 1 phosphate (S1P), as a potent lysophospholipid, plays an important role in various organs, including immune and cardiovascular systems. In addition, high-density lipoprotein, as a negative predictor of atherosclerosis and CAD, is a major carrier of S1P in blood circulation. S1P mediates its effects through binding to specific G protein-coupled receptors, and its signaling contributes to a variety of responses, including cardiac inflammation, dysfunction, and I/R injury protection. In this review, we will focus on the role of S1P in CAD and I/R injury as a potential therapeutic target.
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Affiliation(s)
- Aynaz Mihanfar
- Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Reza Nejabati
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Latifi
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Pezeshkian
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Afrasiabi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Safaie
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Reza Jodati
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Nouri
- Stem Cell and Regenerative Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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Cocker MS, Spence JD, Hammond R, deKemp RA, Lum C, Wells G, Bernick J, Hill A, Nagpal S, Stotts G, Alturkustani M, Adeeko A, Yerofeyeva Y, Rayner K, Peterson J, Khan AR, Naidas AC, Garrard L, Yaffe MJ, Leung E, Prato FS, Tardif JC, Beanlands RSB. [18F]-Fluorodeoxyglucose PET/CT imaging as a marker of carotid plaque inflammation: Comparison to immunohistology and relationship to acuity of events. Int J Cardiol 2018; 271:378-386. [PMID: 30007487 DOI: 10.1016/j.ijcard.2018.05.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/02/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND [18F]-fluorodeoxyglucose (18FDG) uptake imaged with positron emission tomography (PET) and computed tomography (CT) may serve as a biomarker of plaque inflammation. This study evaluated the relationship between carotid plaque 18FDG uptake and a) intraplaque expression of macrophage and macrophage-like cellular CD68 immunohistology; b) intraplaque inflammatory burden using leukocyte-sensitive CD45 immunohistology; c) symptomatic patient presentation; d) time from last cerebrovascular event. METHODS 54 patients scheduled for carotid endarterectomy underwent 18FDG PET/CT imaging. Maximum 18FDG uptake (SUVmax) and tissue-to-blood ratio (TBRmax) was measured for carotid plaques. Quantitative immunohistological analysis of macrophage-like cell expression (CD68) and leukocyte content (CD45) was performed. RESULTS 18FDG uptake was related to CD68 macrophage expression (TBRmax: r = 0.51, p < 0.001), and total-plaque leukocyte CD45 expression (TBRmax: r = 0.632, p = 0.009, p < 0.001). 18FDG TBRmax uptake in carotid plaque associated with patient symptoms was greater than asymptomatic plaque (3.58 ± 1.01 vs. 3.13 ± 1.10, p = 0.008). 18FDG uptake differed between an acuity threshold of <90 days and >90 days (SUVmax:3.15 ± 0.87 vs. 2.52 ± 0.45, p = 0.015). CONCLUSIONS In this CAIN cohort, 18FDG uptake imaged with PET/CT serves a surrogate marker of intraplaque inflammatory macrophage, macrophage-like cell and leukocyte burden. 18FDG uptake is greater in plaque associated with patient symptoms and those with recent cerebrovascular events. Future studies are needed to relate 18FDG uptake and disease progression.
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Affiliation(s)
- Myra S Cocker
- Molecular Function and Imaging Program and the National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada.
| | - Robert Hammond
- Department of Pathology, Western University, London, Ontario, Canada.
| | - Robert A deKemp
- Molecular Function and Imaging Program and the National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Cheemun Lum
- Department of Radiology, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - George Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Jordan Bernick
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Andrew Hill
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Sudhir Nagpal
- Division of Vascular Surgery, Department of Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Grant Stotts
- Division of Neurology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
| | | | - Adebayo Adeeko
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Yulia Yerofeyeva
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Katey Rayner
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada.
| | - Joan Peterson
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Ali R Khan
- Department of Medical Biophysics, Robarts Research Institute, Western University, London, Ontario, Canada.
| | - Ann C Naidas
- Department of Pathology, Western University, London, Ontario, Canada.
| | - Linda Garrard
- Molecular Function and Imaging Program and the National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Martin J Yaffe
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Eugene Leung
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Frank S Prato
- Lawson Health Research Institute, London, Ontario, Canada.
| | - Jean-Claude Tardif
- Division of Cardiology, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada.
| | - Rob S B Beanlands
- Molecular Function and Imaging Program and the National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Radiology, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Nuclear Medicine, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
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23
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24
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Arterial inflammation measured by 18F-FDG-PET-CT to predict coronary events in older subjects. Atherosclerosis 2018; 268:49-54. [DOI: 10.1016/j.atherosclerosis.2017.11.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022]
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Nakamura D, Attizzani GF, Toma C, Sheth T, Wang W, Soud M, Aoun R, Tummala R, Leygerman M, Fares A, Mehanna E, Nishino S, Fung A, Costa MA, Bezerra HG. Failure Mechanisms and Neoatherosclerosis Patterns in Very Late Drug-Eluting and Bare-Metal Stent Thrombosis. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.003785. [PMID: 27582113 DOI: 10.1161/circinterventions.116.003785] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/25/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND There are few clinical studies on the pathophysiological mechanisms of very late stent thrombosis (VLST). We report optical coherence tomography findings in patients with VLST and compare the findings between bare-metal stents (BMS) and drug-eluting stents (DES). METHODS AND RESULTS We conducted a registry of stent thrombosis at 4 North American centers with optical coherence tomography imaging programs SAFE registry (The Study of Late Stent Failure Evaluated by OCT). Images were acquired in 61 patients (42 DES and 19 BMS) presenting with definite VLST. The median duration from implantation to VLST presentation was 51.4 months in the DES and 69.9 months in the BMS group (P=0.011). Uncovered and malapposed struts were observed in 70.5% (43/61) and 62.3% (38/61) of patients, respectively, whereas neoatherosclerosis was revealed in 49.2% (30/61). Stent underexpansion was observed in 42.4% of patients. Malapposed struts and stent underexpansion were more frequently demonstrated in DES than in BMS patients, whereas neoatherosclerosis was frequently observed in BMS (40.5% in DES and 68.4% in BMS; P=0.056). The percentage of frames with neoatherosclerosis was lower in DES than in BMS (15.56% [12.24-28.57] versus, 56.41% [40.74-70.00], respectively; P<0.001). Maximum consecutive lipid neointima length was shorter in DES than in BMS (2.4 [1.2-3.6] and 5.3 [3.0-7.0] mm; P=0.011). CONCLUSIONS Optical coherence tomography imaging demonstrated that VLST in DES and BMS had a wide variety of abnormal findings, such as neoatherosclerosis, uncovered strut, and malapposed strut. Neoatherosclerosis and lipid neointima were more frequently observed and had more longitudinal extension in BMS compared with DES.
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Affiliation(s)
- Daisuke Nakamura
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Guilherme F Attizzani
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
| | - Catalin Toma
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Tej Sheth
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Wei Wang
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Mohamad Soud
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Reem Aoun
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Ramyashree Tummala
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Milana Leygerman
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Anas Fares
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Emile Mehanna
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Setsu Nishino
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Anthony Fung
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Marco A Costa
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
| | - Hiram G Bezerra
- From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.)
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Kok AM, van der Lugt A, Verhagen HJM, van der Steen AFW, Wentzel JJ, Gijsen FJH. Model-based cap thickness and peak cap stress prediction for carotid MRI. J Biomech 2017; 60:175-180. [PMID: 28736079 PMCID: PMC5754323 DOI: 10.1016/j.jbiomech.2017.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/07/2017] [Accepted: 06/20/2017] [Indexed: 11/21/2022]
Abstract
A rupture-prone carotid plaque can potentially be identified by calculating the peak cap stress (PCS). For these calculations, plaque geometry from MRI is often used. Unfortunately, MRI is hampered by a low resolution, leading to an overestimation of cap thickness and an underestimation of PCS. We developed a model to reconstruct the cap based on plaque geometry to better predict cap thickness and PCS. We used histological stained plaques from 34 patients. These plaques were segmented and served as the ground truth. Sections of these plaques contained 93 necrotic cores with a cap thickness <0.62mm which were used to generate a geometry-based model. The histological data was used to simulate in vivo MRI images, which were manually delineated by three experienced MRI readers. Caps below the MRI resolution (n=31) were (digitally removed and) reconstructed according to the geometry-based model. Cap thickness and PCS were determined for the ground truth, readers, and reconstructed geometries. Cap thickness was 0.07mm for the ground truth, 0.23mm for the readers, and 0.12mm for the reconstructed geometries. The model predicts cap thickness significantly better than the readers. PCS was 464kPa for the ground truth, 262kPa for the readers and 384kPa for the reconstructed geometries. The model did not predict the PCS significantly better than the readers. The geometry-based model provided a significant improvement for cap thickness estimation and can potentially help in rupture-risk prediction, solely based on cap thickness. Estimation of PCS estimation did not improve, probably due to the complex shape of the plaques.
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Affiliation(s)
- Annette M Kok
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Jolanda J Wentzel
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands
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27
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Ernst D, Weiberg D, Baerlecken NT, Schlumberger W, Daehnrich C, Schmidt RE, Bengel FM, Derlin T, Witte T. Anti-MYC-associated zinc finger protein antibodies are associated with inflammatory atherosclerotic lesions on 18 F-fluorodeoxyglucose positron emission tomography. Atherosclerosis 2017; 259:12-19. [DOI: 10.1016/j.atherosclerosis.2017.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 12/29/2022]
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28
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Su Y, Xu C, Li K, Wang B, Chen J, Liu L, Lin L, Dong Q, Du L. TGF-β1 and TIMP1 double directional rAAV targeted by UTMD in atherosclerotic vulnerable plaque. Exp Ther Med 2017; 13:1465-1469. [PMID: 28413493 PMCID: PMC5377323 DOI: 10.3892/etm.2017.4101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022] Open
Abstract
In the present study, we determined whether ultrasound-targeted microbubble destruction (UTMD) combined with dual targeting of transforming growth factor (TGF)-β1 and tissue inhibitors of metalloproteinase (TIMP) 1 recombinant adeno-associated virus (rAAV) can stabilize atherosclerotic vulnerable plaques. First, we used rabbit model to detect the TGF-β1/TIMP1 virus therapy result. H&E staining was used to evaluate the tissues. The protein levels of TGF-β1 and TIMP1 were detected in rabbit models. The THP-1 cells were induced into macrophages, and transfected with TGF-β1 and TIMP1 rAAV under optimized UTMD. The expression of TGF-β1 and TIMP1 was measured by RT-PCR and western blotting. We found that the apoptotic rates were induced when compared to the control group. The rAAV virus group showed a significant decrease in the p-ERT and p-AKT expression. These data support the hypothesis that TGF-β1 and TIMP1 are crucial in the regulation of atherosclerotic plaques.
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Affiliation(s)
- Yijin Su
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Changsong Xu
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Kunyu Li
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Bo Wang
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Jufang Chen
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Long Liu
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Lizhou Lin
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Qingqing Dong
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai 200080, P.R. China
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29
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Ma J, Luo Y, Sevag Packard RR, Ma T, Ding Y, Abiri P, Tai YC, Zhou Q, Shung KK, Li R, Hsiai T. Ultrasonic Transducer-Guided Electrochemical Impedance Spectroscopy to Assess Lipid-Laden Plaques. SENSORS AND ACTUATORS. B, CHEMICAL 2016; 235:154-161. [PMID: 27773967 PMCID: PMC5068578 DOI: 10.1016/j.snb.2016.04.179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Plaque rupture causes acute coronary syndromes and stroke. Intraplaque oxidized low density lipoprotein (oxLDL) is metabolically unstable and prone to induce rupture. We designed an intravascular ultrasound (IVUS)-guided electrochemical impedance spectroscopy (EIS) sensor to enhance the detection reproducibility of oxLDL-laden plaques. The flexible 2-point micro-electrode array for EIS was affixed to an inflatable balloon anchored onto a co-axial double layer catheter (outer diameter = 2 mm). The mechanically scanning-driven IVUS transducer (45 MHz) was deployed through the inner catheter (diameter = 1.3 mm) to the acoustic impedance matched-imaging window. Water filled the inner catheter to match acoustic impedance and air was pumped between the inner and outer catheters to inflate the balloon. The integrated EIS and IVUS sensor was deployed into the ex vivo aortas dissected from the fat-fed New Zealand White (NZW) rabbits (n=3 for fat-fed, n= 5 normal diet). IVUS imaging was able to guide the 2-point electrode to align with the plaque for EIS measurement upon balloon inflation. IVUS-guided EIS signal demonstrated reduced variability and increased reproducibility (p < 0.0001 for magnitude, p < 0.05 for phase at < 15 kHz) as compared to EIS sensor alone (p < 0.07 for impedance, p < 0.4 for phase at < 15 kHz). Thus, we enhanced topographic and EIS detection of oxLDL-laden plaques via a catheter-based integrated sensor design to enhance clinical assessment for unstable plaque.
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Affiliation(s)
- Jianguo Ma
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Yuan Luo
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - René R. Sevag Packard
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Teng Ma
- Department of Biomedical Engineering and Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Yichen Ding
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Parinaz Abiri
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Yu-Chong Tai
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Qifa Zhou
- Department of Biomedical Engineering and Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Kirk K. Shung
- Department of Biomedical Engineering and Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Rongsong Li
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Tzung Hsiai
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
- Corresponding Author: Tzung K. Hsiai, M.D., Ph.D., Department of Medicine (Cardiology) and Bioengineering, University of California, Los Angeles, 10833 Le Conte Ave., CHS17-054A, Los Angeles, CA 90095-1679, , Telephone: 310-268-3839
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Coronary Plaque Characterization Assessed by Optical Coherence Tomography and Plasma Trimethylamine-N-oxide Levels in Patients With Coronary Artery Disease. Am J Cardiol 2016; 118:1311-1315. [PMID: 27600460 DOI: 10.1016/j.amjcard.2016.07.071] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/22/2022]
Abstract
Optical coherence tomography (OCT) has been considered as the ideal tool for the evaluation of atherosclerotic plaques. Circulating trimethylamine-N-oxide (TMAO), which is a metabolite of the dietary lipid phosphatidylcholine, has recently been linked to elevated coronary artery disease (CAD) risk. The objective of the study was to investigate the relation between circulating TMAO level and coronary plaque vulnerability assessed by OCT in patients with CAD. A total of 26 patients with CAD were recruited to assess coronary plaque using OCT and measure plasma TMAO level. According to plaque rupture status, patients were divided into plaque rupture group (n = 12) and nonplaque rupture group (n = 14). Plasma TMAO level was significantly higher in patients with plaque rupture than in those with nonplaque rupture (8.6 ± 4.8 μmol/L vs 4.2 ± 2.4 μmol/L, p = 0.011). Moreover, positive correlations between plasma TMAO level and lipid arc (r = 0.43, p = 0.031), lipid volume index (r = 0.39, p = 0.048) were also observed. In conclusion, circulating TMAO level may reflect coronary plaque vulnerability and progression.
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31
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Gleissner CA, Erbel C, Linden F, Domschke G, Akhavanpoor M, Doesch AO, Buss SJ, Giannitsis E, Katus HA, Korosoglou G. Galectin-3 binding protein plasma levels are associated with long-term mortality in coronary artery disease independent of plaque morphology. Atherosclerosis 2016; 251:94-100. [DOI: 10.1016/j.atherosclerosis.2016.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/12/2016] [Accepted: 06/01/2016] [Indexed: 01/12/2023]
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32
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Kamaly N, Fredman G, Fojas JJR, Subramanian M, Choi W, Zepeda K, Vilos C, Yu M, Gadde S, Wu J, Milton J, Leitao RC, Fernandes LR, Hasan M, Gao H, Nguyen V, Harris J, Tabas I, Farokhzad OC. Targeted Interleukin-10 Nanotherapeutics Developed with a Microfluidic Chip Enhance Resolution of Inflammation in Advanced Atherosclerosis. ACS NANO 2016; 10:5280-92. [PMID: 27100066 PMCID: PMC5199136 DOI: 10.1021/acsnano.6b01114] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Inflammation is an essential protective biological response involving a coordinated cascade of signals between cytokines and immune signaling molecules that facilitate return to tissue homeostasis after acute injury or infection. However, inflammation is not effectively resolved in chronic inflammatory diseases such as atherosclerosis and can lead to tissue damage and exacerbation of the underlying condition. Therapeutics that dampen inflammation and enhance resolution are currently of considerable interest, in particular those that temper inflammation with minimal host collateral damage. Here we present the development and efficacy investigations of controlled-release polymeric nanoparticles incorporating the anti-inflammatory cytokine interleukin 10 (IL-10) for targeted delivery to atherosclerotic plaques. Nanoparticles were nanoengineered via self-assembly of biodegradable polyester polymers by nanoprecipitation using a rapid micromixer chip capable of producing nanoparticles with retained IL-10 bioactivity post-exposure to organic solvent. A systematic combinatorial approach was taken to screen nanoparticles, resulting in an optimal bioactive formulation from in vitro and ex vivo studies. The most potent nanoparticle termed Col-IV IL-10 NP22 significantly tempered acute inflammation in a self-limited peritonitis model and was shown to be more potent than native IL-10. Furthermore, the Col-IV IL-10 nanoparticles prevented vulnerable plaque formation by increasing fibrous cap thickness and decreasing necrotic cores in advanced lesions of high fat-fed LDLr(-/-) mice. These results demonstrate the efficacy and pro-resolving potential of this engineered nanoparticle for controlled delivery of the potent IL-10 cytokine for the treatment of atherosclerosis.
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Affiliation(s)
- Nazila Kamaly
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Gabrielle Fredman
- Departments of Medicine, Pathology and Cell Biology, and Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, United States
| | - Jhalique Jane R. Fojas
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Manikandan Subramanian
- Departments of Medicine, Pathology and Cell Biology, and Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, United States
| | - Won Choi
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
- Center for Convergence Bioceramic Materials, Convergence R&D Division, Korea Institute of Ceramic Engineering and Technology, 101, Soho-ro, Jinj-si, Gyeongsangnam-do 52851, Republic of Korea
| | - Katherine Zepeda
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Cristian Vilos
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
- Facultad de Medicina, Center for Integrative and Innovative Science, Universidad Andres Bello, Echaurren 183, Santiago 8370071, Chile
| | - Mikyung Yu
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Suresh Gadde
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Jun Wu
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Jaclyn Milton
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Renata Carvalho Leitao
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Livia Rosa Fernandes
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Moaraj Hasan
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Huayi Gao
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Vance Nguyen
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Jordan Harris
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
| | - Ira Tabas
- Departments of Medicine, Pathology and Cell Biology, and Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, United States
- Corresponding Authors: .
| | - Omid C. Farokhzad
- Laboratory of Nanomedicine and Biomaterials, Harvard Medical School, Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts 02115, United States
- King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Corresponding Authors: .
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Yang M, Yu Y, Walsh WR, Yang JL, Baker L, Lennox AF, Crowe PJ, Varcoe RL. A Microscopic and Biomarker Evaluation of Embolic Filter Debris Collected During Carotid Artery Stenting. J Endovasc Ther 2016; 23:275-84. [PMID: 26839124 DOI: 10.1177/1526602816628284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate and characterize debris retrieved from the cerebral embolic protection devices (EPDs) used during carotid artery stenting (CAS) and compare debris size, volume, tissue types, cellular composition, and protein biomarker expression in symptomatic and asymptomatic patients. METHODS Distal protection filters were retrieved from 22 consecutive patients (mean age 71.6 years, range 52-85; 16 men) undergoing elective CAS between July 2012 and February 2014 for >70% internal carotid artery stenosis (mean 85.4% ± 10.3%). Six patients were symptomatic. The debris within each EPD was visually characterized using stereomicroscopy and then processed for histology and immunohistochemistry. Biomarkers were immunohistochemically measured to evaluate plaque stability [matrix metalloproteinase-9 (MMP-9)], inflammation [glycoprotein CD68 and interleukin-6 (IL-6)], or phenotype [smooth muscle (SM)-actin and type IV collagen]. The immunohistochemical results were measured using semiquantitative grading criteria based on both staining intensity and distribution in the samples. RESULTS Macroscopic debris was visible in 5/22 EPDs; 3 of the 5 filters came from symptomatic patients. Microscopic debris was detected in all filters and ranged in size from 0.01 to 8.57 mm(2). Debris consisted of calcified, fibrous, and necrotic tissue, as well as fibrin and foam cells with no significant difference between the symptomatic and asymptomatic groups. There was no association between the degree or type of embolic material and stenosis severity, carotid tortuosity, calcium grade, soft plaque, or arch type. Symptomatic patients had a larger volume of debris (8.24 vs 0.58 mm(3), p<0.01), mean particle size (1.30 vs 0.32 mm(2), p<0.001), and expression of biomarkers IL-6 (2.17 vs 0.81, p<0.05), CD68 (2.00 vs 0.38, p<0.01), SM-actin (1.00 vs 0.25, p=0.055), type IV collagen (1.17 vs 0.25,p=0.082), and MMP-9 (1.00 vs 0.06, p<0.05). CONCLUSION Histological analysis revealed particulate embolization in all EPDs used during CAS. Symptomatic patients had a larger volume of embolic debris, mean particle size, and the biomarkers associated with inflammation, necrotic core, and diminished fibrous cap.
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Affiliation(s)
- Mark Yang
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, Sydney, Australia The University of Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Yan Yu
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - William R Walsh
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jia-Lin Yang
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, Australia Adult Cancer Program, Lowy Cancer Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Luke Baker
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Andrew F Lennox
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia The Vascular Institute, Prince of Wales, Sydney, Australia
| | - Philip J Crowe
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, Australia Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, Australia The Vascular Institute, Prince of Wales, Sydney, Australia
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Target lesion calcification and risk of adverse outcomes in patients with drug-eluting stents. Herz 2015; 40:1097-106. [DOI: 10.1007/s00059-015-4324-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/06/2015] [Accepted: 05/06/2015] [Indexed: 01/19/2023]
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The basics of intravascular optical coherence tomography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:74-83. [PMID: 26161097 PMCID: PMC4495121 DOI: 10.5114/pwki.2015.52278] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/12/2015] [Accepted: 05/09/2015] [Indexed: 12/23/2022] Open
Abstract
Optical coherence tomography (OCT) has opened new horizons for intravascular coronary imaging. It utilizes near-infrared light to provide a microscopic insight into the pathology of coronary arteries in vivo. Optical coherence tomography is also capable of identifying the chemical composition of atherosclerotic plaques and detecting traits of their vulnerability. At present it is the only tool to measure the thickness of the fibrous cap covering the lipid core of the atheroma, and thus it is an exceptional modality to detect plaques that are prone to rupture (thin fibrous cap atheromas). Moreover, it facilitates distinguishing between plaque rupture and plaque erosion as a cause of acute intracoronary thrombosis. Optical coherence tomography is applied to guide angioplasties of coronary lesions and to assess outcomes of percutaneous coronary interventions broadly. It identifies stent malapposition, dissections, and thrombosis with unprecedented precision. Furthermore, OCT helps to monitor vessel healing after stenting. It evaluates the coverage of stent struts by the neointima and detects in-stent neoatherosclerosis. With so much potential, new studies are warranted to determine OCT's clinical impact. The following review presents the technical background, basics of OCT image interpretation, and practical tips for adequate OCT imaging, and outlines its established and potential clinical application.
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Ramanan RV. Plaque rupture relationship to plaque composition in coronary arteries. A 320-slice CT angiographic analysis. APOLLO MEDICINE 2015. [DOI: 10.1016/j.apme.2015.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gleißner CA. The vulnerable vessel. Vascular disease in diabetes mellitus. Hamostaseologie 2015; 35:267-71. [PMID: 25990316 DOI: 10.5482/hamo-14-11-0059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/04/2015] [Indexed: 01/11/2023] Open
Abstract
Diabetes represents one of the most important risk factors for atherosclerosis, which is the leading cause of mortality worldwide. Recent imaging studies employing intravascular ultrasound or computed coronary angiography tomography clearly confirm that diabetes is associated with larger plaque burden and with more lesions displaying features of instability. Various molecular mechanisms promoting atherogenesis and plaque destabilization in diabetics have been described in the past. The current review specifically focuses on recent papers that have addressed the effects of diabetes and hyperglycemia (i) on myeloid cells, (ii) on oxidative stress, and (iii) on protein kinase C (PKC) activation. Thus, it has been demonstrated that hyperglycemia may promote myelopoiesis and differentiation of pro-inflammatory macrophages. Furthermore, novel studies emphasize the interplay between inflammation and oxidative stress at both the molecular and the genetic level. Finally, experimental studies shed light on the role of PKC-β in diabetes-associated atherosclerosis. Several of these recent studies suggest that atherogenesis and plaque destabilization in diabetic individuals may be mediated by diabetes-specific mechanisms. This may open the door for developing tailored anti-atherosclerotic therapies for diabetic patients.
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Affiliation(s)
- C A Gleißner
- Priv.-Doz. Dr. med. Christian A. Gleißner, Abteilung für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Tel. 062 21/56 86 11, Fax 062 21/56 55 15,
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van Thiel BS, van der Pluijm I, te Riet L, Essers J, Danser AHJ. The renin-angiotensin system and its involvement in vascular disease. Eur J Pharmacol 2015; 763:3-14. [PMID: 25987425 DOI: 10.1016/j.ejphar.2015.03.090] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/15/2015] [Accepted: 03/24/2015] [Indexed: 10/24/2022]
Abstract
The renin-angiotensin system (RAS) plays a critical role in the pathogenesis of many types of cardiovascular diseases including cardiomyopathy, valvular heart disease, aneurysms, stroke, coronary artery disease and vascular injury. Besides the classical regulatory effects on blood pressure and sodium homoeostasis, the RAS is involved in the regulation of contractility and remodelling of the vessel wall. Numerous studies have shown beneficial effect of inhibition of this system in the pathogenesis of cardiovascular diseases. However, dysregulation and overexpression of the RAS, through different molecular mechanisms, also induces, the initiation of vascular damage. The key effector peptide of the RAS, angiotensin II (Ang II) promotes cell proliferation, apoptosis, fibrosis, oxidative stress and inflammation, processes known to contribute to remodelling of the vasculature. In this review, we focus on the components that are under the influence of the RAS and contribute to the development and progression of vascular disease; extracellular matrix defects, atherosclerosis and ageing. Furthermore, the beneficial therapeutic effects of inhibition of the RAS on the vasculature are discussed, as well as the need for additive effects on top of RAS inhibition.
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Affiliation(s)
- Bibi S van Thiel
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Genetics, Erasmus MC, Rotterdam, The Netherlands; Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Ingrid van der Pluijm
- Department of Genetics, Erasmus MC, Rotterdam, The Netherlands; Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Luuk te Riet
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Jeroen Essers
- Department of Genetics, Erasmus MC, Rotterdam, The Netherlands; Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
| | - A H Jan Danser
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Thukkani AK, Jaffer FA. Molecular Imaging. Atherosclerosis 2015. [DOI: 10.1002/9781118828533.ch39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Blackham KA, Kim BS, Jung RS, Badve C, Manjila S, Sila CA, Bambakidis NC. In Vivo Characterization of Carotid Neointimal Hyperplasia by use of Optical Coherence Tomography: Before and After Cutting Balloon Angioplasty. J Neuroimaging 2015; 25:1044-6. [PMID: 25702776 DOI: 10.1111/jon.12223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/27/2014] [Indexed: 11/29/2022] Open
Abstract
Optical coherence tomography (OCT) is a modern intravascular imaging modality that has the capability to provide detailed, in vivo characterization of the arterial wall and atherosclerotic plaque. The current understanding of the appearance of atherosclerotic plaque via OCT is largely based on coronary arterial studies where OCT information has been employed to guide therapeutic management and permits the immediate evaluation of percutaneous intervention. The clinical success of OCT in the coronary arteries has laid the foundation for investigation of the carotid artery and thus, stroke risk assessment. We report the novel use of OCT for tissue characterization of severe stenosis subsequent to carotid artery stenting (CAS), both before and after treatment with cutting balloon angioplasty.
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Affiliation(s)
- Kristine A Blackham
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH.,Neurosurgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH
| | - Benny S Kim
- Interventional Neuroradiology, Lahey Clinic Medical Center, Burlington, MA
| | | | - Chaitra Badve
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH
| | - Sunil Manjila
- Neurosurgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH
| | - Cathy A Sila
- Neurology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH
| | - Nicholas C Bambakidis
- Neurosurgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH
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Fredman G, Kamaly N, Spolitu S, Milton J, Ghorpade D, Chiasson R, Kuriakose G, Perretti M, Farokzhad O, Tabas I. Targeted nanoparticles containing the proresolving peptide Ac2-26 protect against advanced atherosclerosis in hypercholesterolemic mice. Sci Transl Med 2015; 7:275ra20. [PMID: 25695999 PMCID: PMC4397585 DOI: 10.1126/scitranslmed.aaa1065] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic, nonresolving inflammation is a critical factor in the clinical progression of advanced atherosclerotic lesions. In the normal inflammatory response, resolution is mediated by several agonists, among which is the glucocorticoid-regulated protein called annexin A1. The proresolving actions of annexin A1, which are mediated through its receptor N-formyl peptide receptor 2 (FPR2/ALX), can be mimicked by an amino-terminal peptide encompassing amino acids 2-26 (Ac2-26). Collagen IV (Col IV)-targeted nanoparticles (NPs) containing Ac2-26 were evaluated for their therapeutic effect on chronic, advanced atherosclerosis in fat-fed Ldlr(-/-) mice. When administered to mice with preexisting lesions, Col IV-Ac2-26 NPs were targeted to lesions and led to a marked improvement in key advanced plaque properties, including an increase in the protective collagen layer overlying lesions (which was associated with a decrease in lesional collagenase activity), suppression of oxidative stress, and a decrease in plaque necrosis. In mice lacking FPR2/ALX in myeloid cells, these improvements were not seen. Thus, administration of a resolution-mediating peptide in a targeted NP activates its receptor on myeloid cells to stabilize advanced atherosclerotic lesions. These findings support the concept that defective inflammation resolution plays a role in advanced atherosclerosis, and suggest a new form of therapy.
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Affiliation(s)
- Gabrielle Fredman
- Departments of Medicine, Pathology & Cell Biology, and Physiology, Columbia University, New York, NY 10032, USA
| | - Nazila Kamaly
- Laboratory of Nanomedicine and Biomaterials, Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stefano Spolitu
- Departments of Medicine, Pathology & Cell Biology, and Physiology, Columbia University, New York, NY 10032, USA
| | - Jaclyn Milton
- Laboratory of Nanomedicine and Biomaterials, Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Devram Ghorpade
- Departments of Medicine, Pathology & Cell Biology, and Physiology, Columbia University, New York, NY 10032, USA
| | - Raymond Chiasson
- Laboratory of Nanomedicine and Biomaterials, Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - George Kuriakose
- Departments of Medicine, Pathology & Cell Biology, and Physiology, Columbia University, New York, NY 10032, USA
| | - Mauro Perretti
- The William Harvey Research Institute, Barts and The London School of Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - Omid Farokzhad
- Laboratory of Nanomedicine and Biomaterials, Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ira Tabas
- Departments of Medicine, Pathology & Cell Biology, and Physiology, Columbia University, New York, NY 10032, USA
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Yamak D, Panse P, Pavlicek W, Boltz T, Akay M. Non-calcified coronary atherosclerotic plaque characterization by dual energy computed tomography. IEEE J Biomed Health Inform 2015; 18:939-45. [PMID: 24808227 DOI: 10.1109/jbhi.2013.2295534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary heart disease (CHD) is the most prevalent cause of death worldwide. Atherosclerosis which is the condition of plaque buildup on the inside of the coronary artery wall is the main cause of CHD. Rupture of unstable atherosclerotic coronary plaque is known to be the cause of acute coronary syndrome. Vulnerability of atherosclerotic plaque has been related to a large lipid core covered by a fibrous cap. Non-invasive assessment of plaque characterization is necessary due to prognostic importance of early stage identification. The purpose of this study is to use the additional attenuation data provided by dual energy computed tomography (DECT) for plaque characterization. We propose to train supervised learners on pixel values recorded from DECT monochromatic X-ray and material basis pairs images, for more precise classification of fibrous and lipid plaques. The interaction of the pixel values from different image types is taken into consideration, as single pixel value might not be informative enough to separate fibrous from lipid. Organic phantom plaques scanned in a fabricated beating heart phantom were used as ground truth to train the learners. Our results show that support vector machines, artificial neural networks and random forests provide accurate results both on phantom and patient data.
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Liu YP, Gu YM, Thijs L, Knapen MHJ, Salvi E, Citterio L, Petit T, Carpini SD, Zhang Z, Jacobs L, Jin Y, Barlassina C, Manunta P, Kuznetsova T, Verhamme P, Struijker-Boudier HA, Cusi D, Vermeer C, Staessen JA. Inactive matrix Gla protein is causally related to adverse health outcomes: a Mendelian randomization study in a Flemish population. Hypertension 2015; 65:463-70. [PMID: 25421980 DOI: 10.1161/hypertensionaha.114.04494] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Matrix Gla-protein is a vitamin K-dependent protein that strongly inhibits arterial calcification. Vitamin K deficiency leads to production of inactive nonphosphorylated and uncarboxylated matrix Gla protein (dp-ucMGP). The risk associated with dp-ucMGP in the population is unknown. In a Flemish population study, we measured circulating dp-ucMGP at baseline (1996-2011), genotyped MGP, recorded adverse health outcomes until December 31, 2012, and assessed the multivariable-adjusted associations of adverse health outcomes with dp-ucMGP. We applied a Mendelian randomization analysis using MGP genotypes as instrumental variables. Among 2318 participants, baseline dp-ucMGP averaged 3.61 μg/L. Over 14.1 years (median), 197 deaths occurred, 58 from cancer and 70 from cardiovascular disease; 85 participants experienced a coronary event. The risk of death and non-cancer mortality curvilinearly increased (P≤0.008) by 15.0% (95% confidence interval, 6.9-25.3) and by 21.5% (11.1-32.9) for a doubling of the nadir (1.43 and 0.97 μg/L, respectively). With higher dp-ucMGP, cardiovascular mortality log-linearly increased (hazard ratio for dp-ucMGP doubling, 1.14 [1.01-1.28]; P=0.027), but coronary events log-linearly decreased (0.93 [0.88-0.99]; P=0.021). dp-ucMGP levels were associated (P≤0.001) with MGP variants rs2098435, rs4236, and rs2430692. For non-cancer mortality and coronary events (P≤0.022), but not for total and cardiovascular mortality (P≥0.13), the Mendelian randomization analysis suggested causality. Higher dp-ucMGP predicts total, non-cancer and cardiovascular mortality, but lower coronary risk. For non-cancer mortality and coronary events, these associations are likely causal.
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Affiliation(s)
- Yan-Ping Liu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Yu-Mei Gu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Lutgarde Thijs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Marjo H J Knapen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Erika Salvi
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Lorena Citterio
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Thibault Petit
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Simona Delli Carpini
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Zhenyu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Lotte Jacobs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Yu Jin
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Cristina Barlassina
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Paolo Manunta
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Tatiana Kuznetsova
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Peter Verhamme
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Harry A Struijker-Boudier
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Daniele Cusi
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Cees Vermeer
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy
| | - Jan A Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology (Y.-P.L., Y.-M.G., L.T., T.P., Z.-Y.Z., L.J., Y.J., T.K., J.A.S.) and the Centre for Molecular and Vascular Biology (P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; VitaK (M.H.J.K., C.V.) and Department of Pharmacology (H.A.S.), Maastricht University, Maastricht, The Netherlands; Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy (E.S., C.B., D.C.); and Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute (L.C., S.D.C.) and School of Nephrology, University Vita-Salute San Raffaele (P.M.), Milan, Italy.
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Emami H, Singh P, MacNabb M, Vucic E, Lavender Z, Rudd JHF, Fayad ZA, Lehrer-Graiwer J, Korsgren M, Figueroa AL, Fredrickson J, Rubin B, Hoffmann U, Truong QA, Min JK, Baruch A, Nasir K, Nahrendorf M, Tawakol A. Splenic metabolic activity predicts risk of future cardiovascular events: demonstration of a cardiosplenic axis in humans. JACC Cardiovasc Imaging 2015; 8:121-30. [PMID: 25577441 DOI: 10.1016/j.jcmg.2014.10.009] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/24/2014] [Accepted: 10/07/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study sought to determine whether splenic activation after acute coronary syndrome (ACS) is linked to leukocyte proinflammatory remodeling and whether splenic activity independently predicts the risk of cardiovascular disease (CVD) events. BACKGROUND Pre-clinical data suggest the existence of a cardiosplenic axis, wherein activation of hematopoietic tissues (notably in the spleen) results in liberation of proinflammatory leukocytes and accelerated atherosclerotic inflammation. However, it is presently unknown whether a cardiosplenic axis exists in humans and whether splenic activation relates to CVD risk. METHODS (18)F-fluorodeoxyglucose ((18)FDG)-positron emission tomography (PET) imaging was performed in 508 individuals across 2 studies. In the first study, we performed FDG-PET imaging in 22 patients with recent ACS and 22 control subjects. FDG uptake was measured in spleen and arterial wall, whereas proinflammatory gene expression of circulating leukocytes was assessed by quantitative real-time polymerase chain reaction. In a second study, we examined the relationship between splenic tissue FDG uptake with subsequent CVD events during follow-up (median 4 years) in 464 patients who previously had undergone FDG-PET imaging. RESULTS Splenic activity increased after ACS and was significantly associated with multiple indices of inflammation: 1) up-regulated gene expression of proinflammatory leukocytes; 2) increased C-reactive protein; and 3) increased arterial wall inflammation (FDG uptake). Moreover, in the second study, splenic activity (greater than or equal to the median) was associated with an increased risk of CVD events (hazard ratio [HR]: 3.3; 95% confidence interval [CI]: 1.5 to 7.3; p = 0.003), which remained significant after adjustment for CVD risk factors (HR: 2.26; 95% CI: 1.01 to 5.06; p = 0.04) and for arterial FDG uptake (HR: 2.68; 95% CI: 1.5 to 7.4; p = 0.02). CONCLUSIONS Our findings demonstrate increased splenic metabolic activity after ACS and its association with proinflammatory remodeling of circulating leukocytes. Moreover, we observed that metabolic activity of the spleen independently predicted risk of subsequent CVD events. Collectively, these findings provide evidence of a cardiosplenic axis in humans similar to that shown in pre-clinical studies.
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Affiliation(s)
- Hamed Emami
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Parmanand Singh
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Megan MacNabb
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Esad Vucic
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zachary Lavender
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Amparo L Figueroa
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Barry Rubin
- Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Quynh A Truong
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - James K Min
- Departments of Radiology and Medicine, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, New York
| | | | | | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ahmed Tawakol
- Cardiac MR PET CT Program, Division of Cardiac Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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Abstract
Danhong injection (DHI), a certificated Chinese medical product made from radix salviae miltiorrhizae and flos carthami, is prescribed to patients with coronary heart disease in China. To investigate if DHI can inhibit atherosclerosis, apolipoprotein E-deficient (Apoe⁻/⁻) or low-density lipoprotein receptor-deficient (Ldlr⁻/⁻) mice on high-fat diet were divided into 2 groups and received daily intraperitoneal injection of saline and DHI, respectively, for 16 or 20 weeks. After the treatment, mouse aortas were collected to determine lesions, expression of adenosine triphosphate-binding cassette transporter A1 and tumor necrosis factor-α (TNF-α), and macrophage accumulation. Additionally, serum lipid profiles and expression of hepatic HMG-CoA reductase messenger RNA and low-density lipoprotein receptor protein were determined. We observed that DHI inhibited lesions in both Apoe⁻/⁻ and Ldlr⁻/⁻ mice. Associated with the decreased lesions, the aortic adenosine triphosphate-binding cassette transporter A1 expression was increased, whereas the macrophage accumulation was decreased in male Apoe⁻/⁻ mice and both male and female Ldlr⁻/⁻ mice. Although DHI reduced HMG-CoA reductase messenger RNA expression in both female Apoe⁻/⁻ and Ldlr⁻/⁻ mice, it decreased low-density lipoprotein cholesterol levels only in female Apoe⁻/⁻ mice. In addition to attenuation of lipopolysaccharide-induced expression of TNF-α, IL-1β, IL-6 in macrophages, and human C-reactive protein in hepatocytes, respectively, at the transcriptional level in vitro, DHI also reduced TNF-α protein expression in aortic root of both Apoe⁻/⁻ and Ldlr⁻/⁻ mice, suggesting the importance of the anti-inflammatory properties of DHI in the inhibition of lesion development. Taken together, our study demonstrates that DHI inhibits atherosclerosis in both Apoe⁻/⁻ and Ldlr⁻/⁻ mice with various mechanisms, including anti-inflammation. The inhibition of atherosclerosis can be attributed to the cardioprotective properties of DHI.
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Sovershaev TA, Egorina EM, Unruh D, Bogdanov VY, Hansen JB, Sovershaev MA. BMP-7 induces TF expression in human monocytes by increasing F3 transcriptional activity. Thromb Res 2014; 135:398-403. [PMID: 25533127 DOI: 10.1016/j.thromres.2014.11.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/10/2014] [Accepted: 11/30/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Bone morphogenetic protein (BMP)-7, a major regulator of bone metabolism, inhibits ectopic calcification in atherosclerotic plaques. We have recently reported that BMP-7 is also a potent inducer of tissue factor (TF) in human mononuclear cells (MNCs). While nuclear factor kappa beta (NF-kB) and activation protein-1 (AP-1) are the transcription factors essential for inducible expression of human TF gene (F3), the mechanisms responsible for TF induction by BMP-7 are not known. OBJECTIVE To elucidate the molecular mechanisms governing BMP-7-triggered TF expression in human MNCs. METHODS Human blood monocytes were stimulated with BMP-7 and western blotting, qRT-PCR, and flow cytometry studies were carried out to assess F3 expression; promoter studies were also performed using a panel of reporter constructs. Procoagulant TF activity was measured using a validated FXa generation assay. The significance of NF-kB transcriptional activity was verified via pharmacological inhibition. RESULTS BMP-7 increased TF protein levels, procoagulant activity, surface presentation, and TF mRNA expression. This increase was accompanied by activation of NF-kB as evidenced by reduced IkB-α levels and elevated transcriptional activity of an NF-kB-sensitive reporter in transfected MNCs. Although treatment with BMP-7 also led to a strong phosphorylation of c-Jun, activation of AP-1 alone was not sufficient to induce TF expression: JSH-23, a potent and specific NF-kB inhibitor, completely blocked BMP-7-induced TF expression. CONCLUSIONS We report that BMP-7-dependent activation of TF in human MNCs is mediated via increased activity of NF-kB, leading to enhanced F3 transcription in human MNCs.
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Affiliation(s)
- T A Sovershaev
- K.G. Jebsen Thrombosis and Expertise Centre (TREC), Tromsø, Norway; Hematological Research Group, Department of Clinical Medicine, the Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway; Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
| | - E M Egorina
- Section for Clinical Pharmacology, University Hospital of North Norway, N-9038, Tromsø, Norway
| | - D Unruh
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - V Y Bogdanov
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - J B Hansen
- K.G. Jebsen Thrombosis and Expertise Centre (TREC), Tromsø, Norway; Hematological Research Group, Department of Clinical Medicine, the Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, N-9038, Tromsø, Norway
| | - M A Sovershaev
- Hematological Research Group, Department of Clinical Medicine, the Faculty of Health Sciences, University of Tromsø, N-9037, Tromsø, Norway; Section for Medical Biochemistry, Department of Laboratory Medicine, University Hospital of Northern Norway, N-9038, Tromsø, Norway
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Ramsey SA, Vengrenyuk Y, Menon P, Podolsky I, Feig JE, Aderem A, Fisher EA, Gold ES. Epigenome-guided analysis of the transcriptome of plaque macrophages during atherosclerosis regression reveals activation of the Wnt signaling pathway. PLoS Genet 2014; 10:e1004828. [PMID: 25474352 PMCID: PMC4256277 DOI: 10.1371/journal.pgen.1004828] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 10/15/2014] [Indexed: 11/19/2022] Open
Abstract
We report the first systems biology investigation of regulators controlling arterial plaque macrophage transcriptional changes in response to lipid lowering in vivo in two distinct mouse models of atherosclerosis regression. Transcriptome measurements from plaque macrophages from the Reversa mouse were integrated with measurements from an aortic transplant-based mouse model of plaque regression. Functional relevance of the genes detected as differentially expressed in plaque macrophages in response to lipid lowering in vivo was assessed through analysis of gene functional annotations, overlap with in vitro foam cell studies, and overlap of associated eQTLs with human atherosclerosis/CAD risk SNPs. To identify transcription factors that control plaque macrophage responses to lipid lowering in vivo, we used an integrative strategy – leveraging macrophage epigenomic measurements – to detect enrichment of transcription factor binding sites upstream of genes that are differentially expressed in plaque macrophages during regression. The integrated analysis uncovered eight transcription factor binding site elements that were statistically overrepresented within the 5′ regulatory regions of genes that were upregulated in plaque macrophages in the Reversa model under maximal regression conditions and within the 5′ regulatory regions of genes that were upregulated in the aortic transplant model during regression. Of these, the TCF/LEF binding site was present in promoters of upregulated genes related to cell motility, suggesting that the canonical Wnt signaling pathway may be activated in plaque macrophages during regression. We validated this network-based prediction by demonstrating that β-catenin expression is higher in regressing (vs. control group) plaques in both regression models, and we further demonstrated that stimulation of canonical Wnt signaling increases macrophage migration in vitro. These results suggest involvement of canonical Wnt signaling in macrophage emigration from the plaque during lipid lowering-induced regression, and they illustrate the discovery potential of an epigenome-guided, systems approach to understanding atherosclerosis regression. Atherosclerosis, a progressive accumulation of lipid-rich plaque within arteries, is an inflammatory disease in which the response of macrophages (a key cell type of the innate immune system) to plasma lipoproteins plays a central role. In humans, the goal of significantly reducing already-established plaque through drug treatments, including statins, remains elusive. In mice, atherosclerosis can be reversed by experimental manipulations that lower circulating lipid levels. A common feature of many regression models is that macrophages transition to a less inflammatory state and emigrate from the plaque. While the molecular regulators that control these responses are largely unknown, we hypothesized that by integrating global measurements of macrophage gene expression in regressing plaques with measurements of the macrophage chromatin landscape, we could identify key molecules that control macrophage responses to the lowering of circulating lipid levels. Our systems biology analysis of plaque macrophages yielded a network in which the Wnt signaling pathway emerged as a candidate upstream regulator. Wnt signaling is known to affect both inflammation and the ability of macrophages to migrate from one location to another, and our targeted validation studies provide evidence that Wnt signaling is increased in plaque macrophages during regression. Our findings both demonstrate the power of a systems approach to uncover candidate regulators of regression and to identify a potential new therapeutic target.
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MESH Headings
- Animals
- Cells, Cultured
- Epigenesis, Genetic/drug effects
- Epigenesis, Genetic/physiology
- Female
- Gene Expression Profiling
- Genome/drug effects
- Hypolipidemic Agents/pharmacology
- Hypolipidemic Agents/therapeutic use
- Macrophages/drug effects
- Macrophages/metabolism
- Macrophages/pathology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Microarray Analysis
- Plaque, Atherosclerotic/drug therapy
- Plaque, Atherosclerotic/genetics
- Plaque, Atherosclerotic/metabolism
- Plaque, Atherosclerotic/pathology
- Receptors, LDL/genetics
- Remission Induction
- Transcriptome/drug effects
- Wnt Signaling Pathway/drug effects
- Wnt Signaling Pathway/genetics
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Affiliation(s)
- Stephen A. Ramsey
- Department of Biomedical Sciences and School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon, United States of America
| | - Yuliya Vengrenyuk
- Division of Cardiology, School of Medicine, New York University, New York, New York, United States of America
| | - Prashanthi Menon
- Division of Cardiology, School of Medicine, New York University, New York, New York, United States of America
| | - Irina Podolsky
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Jonathan E. Feig
- Division of Cardiology, School of Medicine, New York University, New York, New York, United States of America
| | - Alan Aderem
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Edward A. Fisher
- Division of Cardiology, School of Medicine, New York University, New York, New York, United States of America
- * E-mail: (EAF); (ESG)
| | - Elizabeth S. Gold
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- * E-mail: (EAF); (ESG)
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Brezinski ME. Practical Challenges of Current Video Rate OCT Elastography: Accounting for Dynamic and Static Tissue Properties. JOURNAL OF LASERS, OPTICS & PHOTONICS 2014; 1:112. [PMID: 29286052 PMCID: PMC5743221 DOI: 10.4172/2469-410x.1000112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Optical coherence tomography (OCT) elastography (OCTE) has the potential to be an important diagnostic tool for pathologies including coronary artery disease, osteoarthritis, malignancies, and even dental caries. Many groups have performed OCTE, including our own, using a wide range of approaches. However, we will demonstrate current OCTE approaches are not scalable to real-time, in vivo imaging. As will be discussed, among the most important reasons is current designs focus on the system and not the target. Specifically, tissue dynamic responses are not accounted, with examples being the tissue strain response time, preload variability, and conditioning variability. Tissue dynamic responses, and to a lesser degree static tissue properties, prevent accurate video rate modulus assessments for current embodiments. Accounting for them is the focus of this paper. A top-down approach will be presented to overcome these challenges to real time in vivo tissue characterization. Discussed first is an example clinical scenario where OTCE would be of substantial relevance, the prevention of acute myocardial infarction or heart attacks. Then the principles behind OCTE are examined. Next, constrains on in vivo application of current OCTE are evaluated, focusing on dynamic tissue responses. An example is the tissue strain response, where it takes about 20 msec after a stress is applied to reach plateau. This response delay is not an issue at slow acquisition rates, as most current OCTE approaches are preformed, but it is for video rate OCTE. Since at video rate each frame is only 30 msec, for essentially all current approaches this means the strain for a given stress is changing constantly during the B-scan. Therefore the modulus can't be accurately assessed. This serious issue is an even greater problem for pulsed techniques as it means the strain/modulus for a given stress (at a location) is unpredictably changing over a B-scan. The paper concludes by introducing a novel video rate approach to overcome these challenges.
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Affiliation(s)
- Mark E Brezinski
- Center for Optics and Modern Physics, Brigham and Women’s Hospital, 75 Francis Street, Boston, M.A. 02115, USA
- Harvard Medical School, 25 Shattuck Street, Boston, M.A. 02115, USA
- Department of Electrical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, M.A. 02139, USA
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Galon MZ, Wang Z, Bezerra HG, Lemos PA, Schnell A, Wilson DL, Rollins AM, Costa MA, Attizzani GF. Differences determined by optical coherence tomography volumetric analysis in non-culprit lesion morphology and inflammation in ST-segment elevation myocardial infarction and stable angina pectoris patients. Catheter Cardiovasc Interv 2014; 85:E108-15. [PMID: 25178981 DOI: 10.1002/ccd.25660] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/29/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND While the current methodology for determining fibrous cap (FC) thickness of lipid plaques is based on manual measurements of arbitrary points, which could lead to high variability and decreased accuracy, it ignores the three-dimensional (3-D) morphology of coronary artery disease. OBJECTIVE To compare, utilizing optical coherence tomography (OCT) assessments, volumetric quantification of FC, and macrophage detection using both visual assessment and automated image processing algorithms in non-culprit lesions of STEMI and stable angina pectoris (SAP) patients. METHODS Lipid plaques were selected from 67 consecutive patients (1 artery/patient). FC was manually delineated by a computer-aided method and automatically classified into three thickness categories: FC < 65 μm (i.e., thin-cap fibroatheroma [TCFA]), 65-150 μm, and >150 μm. Minimum thickness, absolute categorical surface area, and fractional luminal area of FC were analyzed. Automated detection and quantification of macrophage was performed within the segmented FC. RESULTS A total of 5,503 cross-sections were analyzed. STEMI patients when compared with SAP patients had more absolute categorical surface area for TCFA (0.43 ± 0.45 mm(2) vs. 0.15 ± 0.25 mm(2) ; P = 0.011), thinner minimum FC thickness (31.63 ± 17.09 µm vs. 47.27 ± 26.56 µm, P = 0.012), greater fractional luminal area for TCFA (1.65 ± 1.56% vs. 0.74 ± 1.2%, P = 0.046), and greater macrophage index (0.0217 ± 0.0081% vs. 0.0153 ± 0.0045%, respectively, P < 0.01). CONCLUSION The novel OCT-based 3-D quantification of the FC and macrophage demonstrated thinner FC thickness and larger areas of TCFA coupled with more inflammation in non-culprit sites of STEMI compared with SAP.
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Marsch E, Theelen TL, Demandt JAF, Jeurissen M, van Gink M, Verjans R, Janssen A, Cleutjens JP, Meex SJR, Donners MM, Haenen GR, Schalkwijk CG, Dubois LJ, Lambin P, Mallat Z, Gijbels MJ, Heemskerk JWM, Fisher EA, Biessen EAL, Janssen BJ, Daemen MJAP, Sluimer JC. Reversal of hypoxia in murine atherosclerosis prevents necrotic core expansion by enhancing efferocytosis. Arterioscler Thromb Vasc Biol 2014; 34:2545-53. [PMID: 25256233 DOI: 10.1161/atvbaha.114.304023] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Advanced murine and human plaques are hypoxic, but it remains unclear whether plaque hypoxia is causally related to atherogenesis. Here, we test the hypothesis that reversal of hypoxia in atherosclerotic plaques by breathing hyperoxic carbogen gas will prevent atherosclerosis. APPROACH AND RESULTS Low-density lipoprotein receptor-deficient mice (LDLR(-/-)) were fed a Western-type diet, exposed to carbogen (95% O2, 5% CO2) or air, and the effect on plaque hypoxia, size, and phenotype was studied. First, the hypoxic marker pimonidazole was detected in murine LDLR(-/-) plaque macrophages from plaque initiation onwards. Second, the efficacy of breathing carbogen (90 minutes, single exposure) was studied. Compared with air, carbogen increased arterial blood pO2 5-fold in LDLR(-/-) mice and reduced plaque hypoxia in advanced plaques of the aortic root (-32%) and arch (-84%). Finally, the effect of repeated carbogen exposure on progression of atherosclerosis was studied in LDLR(-/-) mice fed a Western-type diet for an initial 4 weeks, followed by 4 weeks of diet and carbogen or air (both 90 min/d). Carbogen reduced plaque hypoxia (-40%), necrotic core size (-37%), and TUNEL(+) (terminal uridine nick-end labeling positive) apoptotic cell content (-50%) and increased efferocytosis of apoptotic cells by cluster of differentiation 107b(+) (CD107b, MAC3) macrophages (+36%) in advanced plaques of the aortic root. Plaque size, plasma cholesterol, hematopoiesis, and systemic inflammation were unchanged. In vitro, hypoxia hampered efferocytosis by bone marrow-derived macrophages, which was dependent on the receptor Mer tyrosine kinase. CONCLUSIONS Carbogen restored murine plaque oxygenation and prevented necrotic core expansion by enhancing efferocytosis, likely via Mer tyrosine kinase. Thus, plaque hypoxia is causally related to necrotic core expansion.
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Affiliation(s)
- Elke Marsch
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Thomas L Theelen
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Jasper A F Demandt
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Mike Jeurissen
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Mathijs van Gink
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Robin Verjans
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Anique Janssen
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Jack P Cleutjens
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Steven J R Meex
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Marjo M Donners
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Guido R Haenen
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Casper G Schalkwijk
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Ludwig J Dubois
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Philippe Lambin
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Ziad Mallat
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Marion J Gijbels
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Johan W M Heemskerk
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Edward A Fisher
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Erik A L Biessen
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Ben J Janssen
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Mat J A P Daemen
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.)
| | - Judith C Sluimer
- From the Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM) (E.M., T.L.T., J.A.F.D., M.J., M.v.G., R.V., A.J., J.P.C., M.M.D., M.J.G., E.A.L.B., J.C.S.), Department of Clinical Chemistry (S.J.R.M.), Department of Toxicology (G.R.H.), Department of Internal Medicine, CARIM (C.G.S.), Department of Radiation Oncology (Maastro Lab), GROW (L.J.D., P.L.), Department of Molecular Genetics, CARIM (M.J.G.), Department of Biochemistry, CARIM (J.W.M.H.), Department of Pharmacology, CARIM (B.J.J.), Maastricht University Medical Centre, Maastricht, The Netherlands; Paris Centre de Recherche Cardiovasculaire (PARCC) Inserm-UMR 970, Paris, France (Z.M.); Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Z.M.); Department of Medical Biochemistry (M.J.G.) and Department of Pathology (M.J.A.P.D.), AMC, Amsterdam, The Netherlands; and Department of Medicine (Cardiology), New York University School of Medicine, New York (E.A.F.).
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