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Hirano R, Namazuda K. Pleiotropic effects of double filtration plasmapheresis. Ther Apher Dial 2024. [PMID: 39245561 DOI: 10.1111/1744-9987.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/01/2024] [Indexed: 09/10/2024]
Abstract
Double filtration plasmapheresis (DFPP) is a semi-selective blood purification modality derived from the plasma exchange modality. DFPP can be applied to a variety of refractory disorders including metabolic disorders, organ transplants, rheumatic disorders, neurological disorders, and dermatologic disorders. Familial hypercholesterolemia and lipoprotein (a) hyperlipoproteinemia are major chronic metabolic disorders. Lipoprotein apheresis (LA) is applied for those patients to remove low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) (Lp(a)). DFPP is used as one of the modalities in LA. In addition to removing LDL-C and Lp(a), DFPP has pleiotropic effects such as removal of lipid metabolism-related substances, C-reactive protein lowering effect, removal of adhesion molecules, removal of inflammatory cytokines, and anti-oxidative effect. This article summarizes the pleiotropic effects of DFPP based on recent clinical articles.
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Affiliation(s)
- Ryuichiro Hirano
- Blood Purification Business Division, Asahi Kasei Medical Co., Ltd., Tokyo, Japan
| | - Kenichiro Namazuda
- Blood Purification Business Division, Asahi Kasei Medical Co., Ltd., Tokyo, Japan
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2
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Rotella S, Gesualdo L, Fiorentino M. Heparin-Mediated Extracorporeal Low-Density Lipoprotein Precipitation Apheresis for Treating Peripheral Arterial Disease in Patients with Chronic Kidney Disease. J Clin Med 2024; 13:1121. [PMID: 38398435 PMCID: PMC10889472 DOI: 10.3390/jcm13041121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Patients with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD), have a high prevalence of cardiovascular disease and peripheral arterial disease (PAD). Medical treatment is mainly based on risk factor management, and the surgical approach remains the gold standard treatment in specific conditions. Heparin-mediated extracorporeal low-density lipoprotein precipitation (H.E.L.P.) apheresis is effective in reducing circulating lipoprotein, fibrinogen, inflammatory mediators and procoagulant factors, thereby reducing cardiovascular risk in patients with familial hypercholesterolemia and hypertriglyceridemia. These activities may be effective in reducing symptoms and ischemic vascular lesions even in patients with severe PAD. We reported the application of a treatment protocol with H.E.L.P. apheresis in an ESRD patient with severe PAD without clinical improvement after severe revascularization who was not suitable for further surgical approaches, despite normal LDL cholesterol and lipoprotein (a). The H.E.L.P. protocol was characterized by an intensive first phase with weekly treatments followed by a single session every 10-15 days for 6 months of treatment. The overall clinical condition, foot lesions and walking distance improved significantly after the first 2 months of treatment, and foot amputation was avoided. Here, we review the main pathogenetic mechanisms through which LDL apheresis improves microcirculation and clinical outcomes. Its wider application may represent an optimal therapeutic option for patients unresponsive to standard treatment.
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Affiliation(s)
| | | | - Marco Fiorentino
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRE-J), University of Bari Aldo Moro, 70121 Bari, Italy; (S.R.); (L.G.)
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3
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Watanabe Y, Tanaka A, Furuhashi K, Maruyama S. Current status of low-density lipoprotein apheresis treatment for patients with peripheral artery disease and chronic kidney disease in Japanese clinical database. Ther Apher Dial 2023; 27:1000-1009. [PMID: 37587685 DOI: 10.1111/1744-9987.14046] [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: 11/14/2022] [Accepted: 01/10/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Patients with peripheral arterial disease (PAD) have a poorer prognosis than those without PAD. PAD complications worsen the prognosis of patients with chronic kidney disease (CKD), especially those on maintenance dialysis. Although low-density lipoprotein apheresis (LDL-A) is expected to be effective in treating severe PAD, there are no large-scale reports on the prognosis of patients undergoing LDL-A. METHODS We obtained a clinical database from April 2008 to August 2021 and selected 924 238 patients with CKD. We selected patients with disease codes of lower limb arteriosclerosis obliterans, arteriosclerosis obliterans, and critical limb ischemia or foot ulcer. Patients who were prescribed antithrombotic medications were included. Patients who used steroids were excluded. Among these patients, those undergoing blood purification considered LDL-A were selected, and their current status was investigated. RESULTS We included 147 patients (113 males and 34 females). The mean patient age was 70 ± 10 years. Diabetes mellitus was present in 86%, ischemic heart disease in 34%, and stroke in 48%. Maintenance dialysis patients accounted for 86% of the patients. Statins were administered to 40% of the patients, and bypass surgery was performed in 2.7%. The median observation period was 812 days, and the mortality rate was 41%. CONCLUSION LDL-A was performed in a small population of patients with CKD with the most severe form of PAD. The prognosis for these patients is extremely poor. Therefore, strategies to improve prognosis are important.
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Affiliation(s)
- Yu Watanabe
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akihito Tanaka
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kazuhiro Furuhashi
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Imai E, Kaneko S, Hoshimoto A, Hisada R, Harano M, Anno E, Hagiwara S, Ozaki S, Torii H, Tsukamoto Y. Short term-efficacy and tolerability of Rheocarna, a novel direct hemoperfusion adsorptive column, for chronic limb-threatening ischemia in dialysis patients: A single-center case series. Ther Apher Dial 2023; 27:1010-1016. [PMID: 37605563 DOI: 10.1111/1744-9987.14049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/22/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION With population aging and lifestyle changes, the number of patients with chronic limb-threatening ischemia (CLTI) is increasing, and refractory or recurrent lesions are more common, especially in chronic dialysis patients. In March 2021, a new type of adsorptive cellulose bead column immobilized with dextran sulfate and L-tryptophan for direct hemoperfusion (DHP) was approved by Japan's medical insurance system as a treatment for CLTI. METHODS We retrospectively analyzed 17 cases of CLTI in dialysis patients treated with DHP using the novel column (Rheocarna) (DHP-R) at our hospital from May 2021 to October 2022. The short-term of efficacy of DHP-R was judged qualitatively by the foot care team every 2 weeks based on the assessment of skin color, warmth, ulcer epithelialization or shrinkage of the ulcer area, and foot pain. The final judgment of efficacy was made after the final DHP-R session. RESULTS The median age of patients was 66 years, the median dialysis duration was 10 years, 15 cases (88%) were male, and 15 cases (88%) had diabetes. The median total number of sessions was eight. In comparing the groups in which DHP-R was effective and ineffective, there was no significant difference in any factors including patient background data (i.e., age, diabetes, low-density lipoprotein cholesterol, hemoglobin, dialysis duration, etc.), type of anticoagulants, and presence of episodes of blood pressure drop or circuit clotting during session. Three cases with symptomatic hypotension during the session and two cases with circuit clotting that did not improve with increased heparin dose all resolved immediately after changing the anticoagulant from heparin to nafamostat mesylate (NM). CONCLUSION Identification of patients' characteristics in which DHP-R is favorable and some reliable index that allow a rapid decision to continue DHP-R are needed. In addition, validating whether the use of NM as anticoagulant affects the efficacy of DHP-R for CTLI treatment remains a challenge to resolve.
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Affiliation(s)
- Eri Imai
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Shuzo Kaneko
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Ainori Hoshimoto
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Rina Hisada
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Makiko Harano
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Emi Anno
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - So Hagiwara
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Shunsuke Ozaki
- Department of Cardiology, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Hiroko Torii
- Department of Plastic surgery, Itabashi-Chuo Medical Center, Tokyo, Japan
| | - Yusuke Tsukamoto
- Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan
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The Characteristics of Dialysis Membranes: Benefits of the AN69 Membrane in Hemodialysis Patients. J Clin Med 2023; 12:jcm12031123. [PMID: 36769771 PMCID: PMC9917867 DOI: 10.3390/jcm12031123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Patients undergoing hemodialysis (HD) experience serious cardiovascular complications, through malnutrition, inflammation, and atherosclerosis. Amputation for peripheral arterial disease (PAD) is more prevalent in patients undergoing HD than in the general population. In addition, revascularization procedures in dialysis patients are often associated with subsequent amputation and high mortality rates. To improve the prognosis of dialysis patients, malnutrition and inflammation must be properly treated, which necessitates a better understanding of the characteristics of dialysis membranes. Herein, the characteristics of several dialysis membranes were studied, with a special reference to the AN69 membrane, noting several similarities to low-density lipoprotein (LDL)-apheresis, which is also applicable for the treatment of PAD. Both systems (LDL-apheresis and AN69) have anti-inflammatory and anti-thrombogenic effects because they use a negatively charged surface for extracorporeal adsorptive filtration from the blood/plasma, and contact phase activation. The concomitant use of both these therapeutic systems may have additive therapeutic benefits in HD patients. Here, we reviewed the characteristics of dialysis membranes and benefits of the AN69 membrane in dialysis patients.
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Shimabukuro M, Ishii N, Ko T, Matsuzaki K, Kishi K. A Case of Refractory Heel Ulcer Complicated by Moderate Osteomyelitis and Cellulitis Successfully Treated with Rheocarna. World J Plast Surg 2023; 12:106-110. [PMID: 38226196 PMCID: PMC10788112 DOI: 10.61186/wjps.12.3.106] [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: 05/10/2023] [Accepted: 11/19/2023] [Indexed: 01/17/2024] Open
Abstract
Revascularization surgery was first considered for the treatment of ulcers in patients with critical limb ischemia (CLI). However, it may not be indicated for patients with severe infections or peripheral vascular occlusions. Although blood purification therapy is adjuvant therapy for such patients, it is not yet widely used due to insurance coverage. We report a case of a refractory heel ulcer with moderate osteomyelitis and cellulitis that was not amenable to revascularization. Treatment with the adsorptive blood purifier rheocarna® (Kaneka Corporation; Osaka, Japan) resulted in complete epithelialization of the ulcer and control of inflammation. Although this case required careful follow-up, we believe rheocarna might be a promising treatment option for patients with CLI who do not respond to revascularization. Rheocarna could improve peripheral blood flow and control inflammation by improving antibiotic drug delivery.
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Affiliation(s)
- Makoto Shimabukuro
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Takanori Ko
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Kyoichi Matsuzaki
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
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Ueda E, Toya Y, Wakui H, Kawai Y, Azushima K, Fujita T, Saigusa Y, Yamanaka T, Yabuki Y, Mikami T, Goda M, Sugano T, Tamura K. Low-density-lipoprotein apheresis-mediated endothelial activation therapy to severe-peripheral artery disease study: Rationale and study design. Ther Apher Dial 2020; 24:524-529. [PMID: 32524727 DOI: 10.1111/1744-9987.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
A novel approach is required for standard therapy-resistant peripheral arterial disease (PAD). This is a single-center, single-arm, interventional study (LDL Apheresis-Mediated Endothelial Activation Therapy to Severe-Peripheral Artery Disease study), which aims to evaluate the efficacy and safety of lipoprotein apheresis (LA) with a dextran sulfate cellulose column in PAD with controlled serum cholesterol levels. The study participants have standard therapy-resistant PAD with controlled serum cholesterol levels. A total of 35 patients undergo 10 sessions of LA therapy. The ankle-brachial index and vascular quality of life questionnaire are assessed before and after the treatment period as primary outcomes. Registration of patients began in November 2015 and is planned to be concluded in October 2020.
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Affiliation(s)
- Eiko Ueda
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Medicine, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiyuki Toya
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuki Kawai
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Medicine, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takayuki Fujita
- Graduate School of Medicine, Cardiovascular Research Institute, Yokohama City University, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yuichiro Yabuki
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Taro Mikami
- Department of Plastic Surgery, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Motohiko Goda
- Department of Cardiovascular Surgery, Yokohama City University, Yokohama, Japan
| | - Teruyasu Sugano
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Yasu T, Shimoyama M, Wada H, Iwakura T, Toyoda S, Kawabe A, Sugiyama T. Homozygous familial hypercholesterolemia with stenosis of the left anterior descending coronary artery successfully treated with weekly low-density lipoprotein apheresis for 16 years without percutaneous coronary intervention. Clin Case Rep 2019; 7:1608-1611. [PMID: 31428402 PMCID: PMC6693054 DOI: 10.1002/ccr3.2299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/08/2019] [Accepted: 06/16/2019] [Indexed: 12/03/2022] Open
Abstract
We successfully treated a patient with homozygous familial hypercholesterolemia (HoFH) with stable coronary arterial disease using optimal medical therapy and low-density lipoprotein (LDL) apheresis for 16 years without percutaneous coronary intervention or bypass surgery. Intensive LDL lowering using apheresis and medication protected the patient from coronary atherosclerotic progression even in HoFH.
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Affiliation(s)
- Takanori Yasu
- Department of Cardiovascular Medicine and NephrologyDokkyo Medical University Nikko Medical CenterNikkoJapan
| | - Masahiro Shimoyama
- Department of Cardiovascular Medicine and NephrologyDokkyo Medical University Nikko Medical CenterNikkoJapan
- Yuai ClinicSaitamaJapan
| | - Hiroshi Wada
- Department of First Integrated Medicine 1, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Tomohiro Iwakura
- Department of Cardiovascular SurgerySakakibara Heart InstituteTokyoJapan
| | - Shigeru Toyoda
- Department of Cardiovascular MedicineDokkyo Medical UniversityMibuJapan
| | - Atsuhiko Kawabe
- Department of Cardiovascular Medicine and NephrologyDokkyo Medical University Nikko Medical CenterNikkoJapan
| | - Takushi Sugiyama
- Department of Cardiovascular Medicine and NephrologyDokkyo Medical University Nikko Medical CenterNikkoJapan
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Makino H, Koezuka R, Tamanaha T, Ogura M, Matsuki K, Hosoda K, Harada-Shiba M. Familial Hypercholesterolemia and Lipoprotein Apheresis. J Atheroscler Thromb 2019; 26:679-687. [PMID: 31231083 PMCID: PMC6711846 DOI: 10.5551/jat.rv17033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Lipoprotein apheresis has been developed as the treatment for refractory familial hypercholesterolemia (FH) to remove low-density lipoprotein (LDL), which is the main pathogenic factor. Currently, three procedures are available in Japan, including the plasma exchange, double-membrane filtration, and selective LDL adsorption. Selective LDL adsorption, which was developed in Japan, has been one of the most common treatment methods in the world. Lipoprotein apheresis enabled the prevention of atherosclerosis progression even in homozygous FH (HoFH) patients. However, in our observational study, HoFH patients who started lipoprotein apheresis in adulthood had a poorer prognosis than those who started in childhood. Therefore, HoFH patients need to start lipoprotein apheresis as early as possible. Although the indication for lipoprotein apheresis in heterozygous FH (HeFH) patients has been decreasing with the advent of strong statins, our observational study showed that HeFH patients who discontinued lipoprotein apheresis had a poorer prognosis than patients who continued apheresis therapy. These results suggest that it is beneficial for very-high-risk HeFH patients to be treated by lipoprotein apheresis even if their LDL cholesterol is controlled well by lipid-lowering agents. Since launching a new class of lipid-lowering agents, proprotein convertase subtilisin/kexin type 9 (PCSK9) antibody and microsome triglyceride transfer protein inhibitors, the indication for lipoprotein apheresis in FH has been changing. However, despite the development of these drugs, lipoprotein apheresis is still an option with a high therapeutic effect for FH patients with severe atherosclerotic cardiovascular disease.
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Affiliation(s)
- Hisashi Makino
- Department of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center
| | - Ryo Koezuka
- Department of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center
| | - Tamiko Tamanaha
- Department of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center
| | - Masatsune Ogura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
| | - Kota Matsuki
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
| | - Kiminori Hosoda
- Department of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center
| | - Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
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10
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Nakajima F, Morimoto S, Yurugi T, Amari Y, Kasuno Y, Fukui M, Furumatsu Y, Kitamura T. Increment of Cerebral Blood Flow by LDL-Apheresis in Dialysis Patients with Arteriosclerosis Obliterans: A Pilot Study. Int J Artif Organs 2018. [DOI: 10.1177/039139881203501103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fumitaka Nakajima
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka - Japan
| | - Satoshi Morimoto
- Second Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka - Japan
| | - Takatomi Yurugi
- Second Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka - Japan
| | - Yoshihumi Amari
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka - Japan
| | - Yuko Kasuno
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka - Japan
| | - Masayoshi Fukui
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka - Japan
| | - Yoshiyuki Furumatsu
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka - Japan
| | - Tetsuya Kitamura
- Department of Nephrology, Moriguchi Keijinkai Hospital, Moriguchi, Osaka - Japan
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12
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Akkoca M, Usanmaz SE, Koksoy C, Bengisun U, Demirel-Yilmaz E. Plasma nitric oxide level is correlated with microvascular functions in the peripheral arterial disease. Clin Hemorheol Microcirc 2017; 65:151-162. [PMID: 27983540 DOI: 10.3233/ch-16143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
At present there is no widely accepted biomarker for monitoring of vascular functions. The purpose of this prospective study was to investigate the association of some blood biomarkers with vascular reactivity in patients with peripheral arterial diseases (PAD). A prospective evaluation was made of 3 groups comprising a control group of healthy individuals, and patients with PAD caused by either atherosclerosis or Buerger's disease. Microvascular perfusion was examined using laser Doppler imaging of cutaneous erythrocyte flux after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP). The correlation of microvascular reactivity with endothelium-related biomarkers was assessed. ACh-induced and SNP-induced vasodilations were significantly diminished in the PAD groups. The plasma nitric oxide (NO) levels of PAD patients were significantly higher than those of the control group, but asymmetric dimethylarginine, total antioxidant capacity and hydrogen sulphide levels were similar. Plasma NO level was negatively correlated with ACh and SNP-stimulated microvascular flow increase, whereas a positive correlation was detected with blood glucose and glycated hemoglobin (HbA1c) levels in all groups. These results indicate that a high plasma level of NO in PAD patients is associated with diminished endothelium-dependent and independent flow increase in the microvascular bed. An excessive amount of NO-induced nitrosative stress in an inflammatory condition that might be a reason for vascular dysfunction should be taken into consideration in the diagnostic and therapeutic approaches to PAD.
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Affiliation(s)
- Muzaffer Akkoca
- Department of Peripheral Vascular Surgery, Ankara University, Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Suzan Emel Usanmaz
- Department of Medical Pharmacology, Ankara University, Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Cuneyt Koksoy
- Department of Peripheral Vascular Surgery, Ankara University, Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Ugur Bengisun
- Department of Peripheral Vascular Surgery, Ankara University, Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Emine Demirel-Yilmaz
- Department of Medical Pharmacology, Ankara University, Faculty of Medicine, Sihhiye, Ankara, Turkey
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Nagai K, Harada M, Yokota N, Okada D, Michiwaki H, Hirose D, Doi T, Minakuchi J, Tsuchida K. Evaluation of vascular quality of life questionnaire in dialysis patients with peripheral arterial disease treated by low-density lipoprotein apheresis. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0048-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Ohtake T, Mochida Y, Matsumi J, Tobita K, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Saito S, Kobayashi S. Beneficial Effect of Endovascular Therapy and Low-Density Lipoprotein Apheresis Combined Treatment in Hemodialysis Patients With Critical Limb Ischemia due to Below-Knee Arterial Lesions. Ther Apher Dial 2016; 20:661-667. [DOI: 10.1111/1744-9987.12450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/13/2016] [Accepted: 05/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Takayasu Ohtake
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Yasuhiro Mochida
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Junya Matsumi
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kunihiro Ishioka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Machiko Oka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kyoko Maesato
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Hidekazu Moriya
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Sumi Hidaka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Shuzo Kobayashi
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
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15
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Oxidative DNA Damage Mediated by Intranuclear MMP Activity Is Associated with Neuronal Apoptosis in Ischemic Stroke. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:6927328. [PMID: 26925194 PMCID: PMC4748094 DOI: 10.1155/2016/6927328] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 12/26/2015] [Accepted: 12/31/2015] [Indexed: 11/18/2022]
Abstract
Evidence of the pathological roles of matrix metalloproteinases (MMPs) in various neurological disorders has made them attractive therapeutic targets. MMPs disrupt the blood-brain barrier and cause neuronal death and neuroinflammation in acute cerebral ischemia and are critical for angiogenesis during recovery. However, some challenges have to be overcome before MMPs can be further validated as drug targets in stroke injury. Identifying in vivo substrates of MMPs should greatly improve our understanding of the mechanisms of ischemic injury and is critical for providing more precise drug targets. Recent works have uncovered nontraditional roles for MMPs in the cytosol and nucleus. These have shed light on intracellular targets and biological actions of MMPs, adding additional layers of complexity for therapeutic MMP inhibition. In this review, we discussed the recent advances made in understanding nuclear location of MMPs, their regulation of intranuclear sorting, and their intranuclear proteolytic activity and substrates. In particular, we highlighted the roles of intranuclear MMPs in oxidative DNA damage, neuronal apoptosis, and neuroinflammation at an early stage of stroke insult. These novel data point to new putative MMP-mediated intranuclear actions in stroke-induced pathological processes and may lead to novel approaches to treatment of stroke and other neurological diseases.
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Single whole blood dextran sulfate adsorption favorably affects systemic oxidative balance in lipoprotein apheresis patients. ATHEROSCLEROSIS SUPP 2013; 14:157-60. [DOI: 10.1016/j.atherosclerosissup.2012.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tamura K, Tsurumi-Ikeya Y, Wakui H, Maeda A, Ohsawa M, Azushima K, Kanaoka T, Uneda K, Haku S, Azuma K, Mitsuhashi H, Tamura N, Toya Y, Tokita Y, Kokuho T, Umemura S. Therapeutic Potential of Low-Density Lipoprotein Apheresis in the Management of Peripheral Artery Disease in Patients With Chronic Kidney Disease. Ther Apher Dial 2012; 17:185-92. [DOI: 10.1111/j.1744-9987.2012.01149.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Allian-Sauer MU, Falko JM. Role of apheresis in the management of familial hypercholesterolemia and elevated Lp(a) levels. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/clp.11.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Schettler V, Völker K, Schulz EG, Wieland E. Impact of Lipid Apheresis on Egr-1, c-Jun, c-Fos, and Hsp70 Gene Expression in White Blood Cells. Ther Apher Dial 2010; 15:105-12. [DOI: 10.1111/j.1744-9987.2010.00861.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tsurumi-Ikeya Y, Tamura K, Azuma K, Mitsuhashi H, Wakui H, Nakazawa I, Sugano T, Mochida Y, Ebina T, Hirawa N, Toya Y, Uchino K, Umemura S. Sustained Inhibition of Oxidized Low-Density Lipoprotein Is Involved in the Long-Term Therapeutic Effects of Apheresis in Dialysis Patients. Arterioscler Thromb Vasc Biol 2010; 30:1058-65. [DOI: 10.1161/atvbaha.109.200212] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yuko Tsurumi-Ikeya
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koichi Azuma
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Mitsuhashi
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ichiro Nakazawa
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Teruyasu Sugano
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuyuki Mochida
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Toshiaki Ebina
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhito Hirawa
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshiyuki Toya
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuaki Uchino
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoshi Umemura
- From Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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