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Matsui R, Fukazawa R, Fukunaga R, Motoji Y, Hashimoto Y, Watanabe M, Nagi-Miura N, Itoh Y. Candesartan Attenuates Vasculitis in a Mouse Model of Kawasaki Disease Induced by Candida albicans Water-Soluble Fraction. J NIPPON MED SCH 2024; 91:285-295. [PMID: 38972741 DOI: 10.1272/jnms.jnms.2024_91-307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND The standard treatment for Kawasaki disease is immunoglobulin therapy, but the high frequency of coronary sequelae in immunoglobulin-refractory cases indicates a need for further improvement in treatment. METHODS Kawasaki disease-like vasculitis was induced in 5-week-old DBA/2 mice by intraperitoneal administration of 0.5 mg Candida albicans water-soluble fraction (CAWS) daily for 5 days followed by daily administration of candesartan, an angiotensin receptor blocker. The vasculitis suppression effect was confirmed histologically and serologically in mice sacrificed at 28 days after the start of candesartan. RESULTS The area of inflammatory cell infiltration at the aortic root was 2.4±1.4% in the Control group, 18.1±1.9% in the CAWS group, and 7.1±2.3%, 5.8±1.4%, 7.6±2.4%, and 7.9±5.0% in the CAWS+candesartan 0.125-mg/kg, 0.25-mg/kg, 0.5-mg/kg, and 1.0-mg/kg groups, respectively (p=0.0200, p=0.0122, p=0.0122, and p=0.0200 vs. CAWS, respectively). The low-dose candesartan group also showed significantly reduced inflammatory cell infiltration. A similar trend was confirmed by immunostaining of macrophages and TGFβ receptors. Measurement of the inflammatory cytokines IL-1β, IL-6, and TNF-α confirmed the anti-vasculitis effect of candesartan. CONCLUSIONS Candesartan inhibited vasculitis even at clinical doses used in children, making it a strong future candidate as an additional treatment for immunoglobulin-refractory Kawasaki disease.
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Affiliation(s)
| | | | | | - Yusuke Motoji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | | | | | - Noriko Nagi-Miura
- Center for the Advancement of Pharmaceutical Education, Tokyo University of Pharmacy and Life Sciences
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Blanchard I, Vootukuru N, Bhattaru A, Patil S, Rojulpote C. PET Radiotracers in Atherosclerosis: A Review. Curr Probl Cardiol 2023; 48:101925. [PMID: 37392979 DOI: 10.1016/j.cpcardiol.2023.101925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Traditional atherosclerosis imaging modalities are limited to late stages of disease, prior to which patients are frequently asymptomatic. Positron emission tomography (PET) imaging allows for the visualization of metabolic processes underscoring disease progression via radioactive tracer, allowing earlier-stage disease to be identified. 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) uptake largely reflects the metabolic activity of macrophages, but is unspecific and limited in its utility. By detecting areas of microcalcification, 18F-Sodium Fluoride (18F-NaF) uptake also provides insight into atherosclerosis pathogenesis. Gallium-68 DOTA-0-Tyr3-Octreotate (68Ga-DOTATATE) PET has also shown potential in identifying vulnerable atherosclerotic plaques with high somatostatin receptor expression. Finally, 11-carbon (11C)-choline and 18F-fluoromethylcholine (FMCH) tracers may identify high-risk atherosclerotic plaques by detecting increased choline metabolism. Together, these radiotracers quantify disease burden, assess treatment efficacy, and stratify risk for adverse cardiac events.
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Affiliation(s)
| | - Nishita Vootukuru
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Abhijit Bhattaru
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ; Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Chaitanya Rojulpote
- Department of Radiology, University of Pennsylvania, Philadelphia, PA; Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA.
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3
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Napiórkowska-Baran K, Schmidt O, Szymczak B, Lubański J, Doligalska A, Bartuzi Z. Molecular Linkage between Immune System Disorders and Atherosclerosis. Curr Issues Mol Biol 2023; 45:8780-8815. [PMID: 37998729 PMCID: PMC10670175 DOI: 10.3390/cimb45110552] [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: 09/26/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
A strong relationship exists between immune dysfunction and cardiovascular disease. Immune dysregulation can promote the development of cardiovascular diseases as well as exacerbate their course. The disorders may occur due to the presence of primary immune defects (currently known as inborn errors of immunity) and the more common secondary immune deficiencies. Secondary immune deficiencies can be caused by certain chronic conditions (such as diabetes, chronic kidney disease, obesity, autoimmune diseases, or cancer), nutritional deficiencies (including both lack of nutrients and bioactive non-nutrient compounds), and medical treatments and addictive substances. This article unravels the molecular linkage between the aforementioned immune system disorders and atherosclerosis.
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Affiliation(s)
- Katarzyna Napiórkowska-Baran
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland;
| | - Oskar Schmidt
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (O.S.); (B.S.); (J.L.); (A.D.)
| | - Bartłomiej Szymczak
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (O.S.); (B.S.); (J.L.); (A.D.)
| | - Jakub Lubański
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (O.S.); (B.S.); (J.L.); (A.D.)
| | - Agata Doligalska
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (O.S.); (B.S.); (J.L.); (A.D.)
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland;
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4
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Tervaert JWC. For Your Eyes Only: 007 Tips for the Management of Cardiovascular Risk Factors in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. J Rheumatol 2023; 50:1097-1099. [PMID: 37061232 DOI: 10.3899/jrheum.2023-0219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- Jan Willem Cohen Tervaert
- J.W. Cohen Tervaert, MD, PhD, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, and Section Chief Rheumatology, Alberta Health Services, Zone, Edmonton, Alberta, Canada, and Maastricht University, Maastricht, the Netherlands.
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5
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Moiseev S, Bulanov N, Crnogorac M, Direskeneli H, Galesic K, Gazel U, Geetha D, Guillevin L, Hrušková Z, Little MA, O'Neill L, Makarov E, McAdoo SP, Mohammad AJ, Moran S, Novikov P, Pusey CD, Rahmattulla C, Satrapová V, Silva J, Suvorov A, Tesar V, Terrier B, Willeit P, Zhao MH, Kronbichler A, Jayne DRW. Traditional and Disease-Specific Risk Factors for Cardiovascular Events in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multinational Retrospective Study. J Rheumatol 2023; 50:1145-1151. [PMID: 36642436 DOI: 10.3899/jrheum.220851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the occurrence of cardiovascular events (CVEs) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, China, Turkey, Russia, the United Kingdom, and the USA. METHODS Patients with a definite diagnosis of AAV who were followed for ≥ 3 months and had sufficient documentation were included. Data on myocardial infarction (MI) and stroke were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS Over a median follow-up of 62.0 months (IQR 22.6-100.0), CVEs (mostly MIs) occurred in 245 (10.7%) of 2286 patients with AAV, with a higher frequency in China and the UK. On multivariate regression analysis, older age (55-64.9 yrs, HR 2.93, 95% CI 1.99-4.31), smoking (HR 1.98, 95% CI 1.48-2.64), Chinese origin (HR 4.24, 95% CI 3.07-5.85), and pulmonary (HR 1.50, 95% CI 1.09-2.06) and kidney (HR 3.02, 95% CI 2.08-4.37) involvement were independent variables associated with a higher occurrence of CVEs. CONCLUSION We showed that geographic region and both traditional and disease-specific (kidney involvement in particular) factors were independently associated with CVEs. Proper assessment and management of modifiable cardiovascular (CV) risk factors are essential for prevention of CV morbidity in patients with AAV.
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Affiliation(s)
- Sergey Moiseev
- S. Moiseev, MD, Professor, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, and Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Bulanov
- N. Bulanov, MD, P. Novikov, MD, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Matija Crnogorac
- M. Crnogorac, MD, K. Galesic, MD, Professor, Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Haner Direskeneli
- H. Direskeneli, MD, Professor, U. Gazel, MD, Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Kresimir Galesic
- M. Crnogorac, MD, K. Galesic, MD, Professor, Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Ummugulsum Gazel
- H. Direskeneli, MD, Professor, U. Gazel, MD, Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Duvuru Geetha
- D. Geetha, MD, Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Loic Guillevin
- L. Guillevin, MD, Professor, B. Terrier, PhD, Professor, Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Zdenka Hrušková
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mark A Little
- M.A. Little, MD, Professor, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, and Irish Centre for Vascular Biology, Tallaght University Hospital, Dublin, Ireland
| | - Liam O'Neill
- L. O'Neill, MD, University Hospital Galway, Dublin, Ireland
| | - Egor Makarov
- E. Makarov, MD, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Stephen P McAdoo
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Aladdin J Mohammad
- A.J. Mohammad, MD, Department of Rheumatology, Clinical Sciences-Lund, Lund University, Lund, Sweden, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Sarah Moran
- S. Moran, MD, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Pavel Novikov
- N. Bulanov, MD, P. Novikov, MD, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Charles D Pusey
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Chinar Rahmattulla
- C. Rahmattulla, PhD, Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Veronika Satrapová
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Joana Silva
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Alexander Suvorov
- A. Suvorov, MD, Centre for Analysis of Complex Systems, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vladimír Tesar
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Benjamin Terrier
- L. Guillevin, MD, Professor, B. Terrier, PhD, Professor, Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Peter Willeit
- P. Willeit, PhD, Professor, Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, Austria, and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ming-Hui Zhao
- M.H. Zhao, MD, Professor, Renal Division, Peking University First Hospital, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Andreas Kronbichler
- A. Kronbichler, PhD, D.R.W. Jayne, MD, Professor, Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, and Department of Medicine, University of Cambridge, Cambridge, UK.
| | - David R W Jayne
- A. Kronbichler, PhD, D.R.W. Jayne, MD, Professor, Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, and Department of Medicine, University of Cambridge, Cambridge, UK
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6
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Garweg JG, Blum CA, Copt RP, Eandi CM, Hatz K, Prünte CF, Seelig E, Somfai GM. Brolucizumab in Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: Ophthalmology and Diabetology Treatment Aspects. Ophthalmol Ther 2023; 12:639-655. [PMID: 36633780 PMCID: PMC10011261 DOI: 10.1007/s40123-023-00647-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Anti-vascular endothelial growth factor (anti-VEGF) therapies have become the standard of care in the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), resulting in a remarkable decrease in disease-related vision loss. However, the need for regular injections places a significant burden on patients, caregivers, and the healthcare system and improvements in vision may not be maintained long term. As a result of its drying potency and duration of action, brolucizumab, an intravitreal anti-VEGF therapy approved for the treatment of nAMD and DME, could decrease injection frequency for patients and provide an efficacious treatment; however, balancing its benefits and risks can be challenging. There have been reports of intraocular inflammation (IOI) in patients treated with brolucizumab, which, if left untreated, may result in severe vision loss. Recent evidence, however, indicates that early recognition of IOI and prompt and aggressive systemic corticosteroid treatment in response to posterior segment involvement can lead to favorable outcomes in these relatively rare but severe cases. A series of consensus meetings were conducted in 2022 between Swiss medical retina experts and diabetologists, discussing the current data for brolucizumab and exploring various challenges to its use, including the associated risk of IOI. The outcome is a collation of practical insights and guidance for ophthalmologists on the use of brolucizumab in patients with nAMD and DME, including patient selection and assessment, treatment regimen and monitoring, and the recognition and management of adverse events.
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Affiliation(s)
- Justus G Garweg
- Berner Augenklinik, Zieglerstrasse 29 (Y), 3012, Bern, Switzerland. .,Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland. .,Swiss Eye Institute, Luzernerstrasse 1, 6343, Rotkreuz, Switzerland.
| | - Claudine A Blum
- University of Basel, Basel, Switzerland.,Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Chiara M Eandi
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital - Fondation Asile des Aveugles, Lausanne, Switzerland.,Department of Surgical Science, Eye Clinic, University of Torino, Turin, Italy
| | - Katja Hatz
- University of Basel, Basel, Switzerland.,Department of Ophthalmology, Vista Augenklinik, Binningen, Switzerland
| | - Christian F Prünte
- Department of Ophthalmology, University Clinic, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology (IOB), Basel, Switzerland
| | - Eleonora Seelig
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Gábor M Somfai
- Department of Ophthalmology, Stadtspital Zürich, 8063, Zurich, Switzerland.,Spross Research Institute, 8063, Zurich, Switzerland.,Department of Ophthalmology, Faculty of Medicine, Semmelweis University, 1085, Budapest, Hungary
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7
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Cardiac involvement and cardiovascular risk factors in pediatric primary systemic vasculitides. Clin Rheumatol 2023; 42:673-686. [PMID: 36369404 DOI: 10.1007/s10067-022-06434-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
Pediatric primary systemic vasculitides are a complex group of diseases. Vasculitis subgroups are mainly determined according to the size of the predominantly affected vessels. In patients with primary systemic vasculitis, the location of vascular involvement, the size of the vessels, the extent of vascular damage, and the underlying pathology determine the disease phenotype and severity. Cardiac involvement is rare in some pediatric vasculitis, such as IgA vasculitis and polyarteritis nodosa, while it is more common in some others like Kawasaki disease and Takayasu arteritis. On the other hand, chronic inflammation in the setting of systemic vasculitis forms a major cardiovascular risk factor. Accelerated atherosclerosis and the tendency to thrombosis are the main issues determining the cardiovascular risks in pediatric systemic vasculitis. Early diagnosis and treatment are essential in these patients to minimize morbidity and mortality. In this review, we aimed to raise physicians' awareness of cardiac involvement and cardiovascular risks in pediatric patients with primary systemic vasculitis.
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8
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An Updated Review of Cardiovascular Events in Giant Cell Arteritis. J Clin Med 2022; 11:jcm11041005. [PMID: 35207277 PMCID: PMC8878095 DOI: 10.3390/jcm11041005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Giant cell arteritis (GCA) is a systemic vasculitis with a direct and indirect increased risk of acute and chronic vascular events, affecting large and medium vessels, and responsible for most of the morbidity and mortality of this disease. We aimed in this review to provide an updated synthesis of knowledge regarding cardiovascular events observed in GCA. By definition, GCA patients are over 50 and often over 70 years old, and subsequently also present age-related cardiovascular risk factors. In addition, the systemic and vascular inflammation as well as glucocorticoids (GC) probably contribute to an accelerated atherosclerosis and to vascular changes leading to arterial stenoses and aortic dilations and/or dissections. GCA-related ischemic complications, especially ophthalmologic events, stroke or myocardial infarcts are mostly observed within the first months after the diagnosis, being mainly linked to the vasculitic process. Conversely, aortic complications, including dilations or dissections, generally occur several months or years after the diagnosis, mainly in patients with large-vessel vasculitis. In these patients, other factors such as atherosclerosis, GC-related endothelial damage and vascular wall remodeling/healing probably contribute to the vascular events. GCA management includes the detection and treatment of these previous and newly induced cardiovascular risk factors. Hence, the use of cardiovascular treatments (e.g., aspirin, anticoagulation, statins, anti-hypertensive treatments) should be evaluated individually. Aortic structural changes require regular morphologic evaluations, especially in patients with previous aortitis. The initial or secondary addition of immunosuppressants, especially tocilizumab, an anti-IL-6 receptor antibody, is discussed in patients with GCA-related cardiovascular complications and, more consensually, to limit GC-mediated comorbidities.
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Laustrup H, Voss A, Lund PE. Granulomatosis with polyangiitis and cardio vascular co-morbidity in Denmark. A registry-based study of 21 years of follow-up. J Transl Autoimmun 2021; 4:100136. [PMID: 34901815 PMCID: PMC8637641 DOI: 10.1016/j.jtauto.2021.100136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To describe the epidemiology of granulomatosis with polyangiitis (GPA) in Denmark. To investigate if cardiovascular (CV) related comorbidity and death were increased among Danish AAV patients registered with a diagnosis of granulomatosis with polyangiitis (GPA) in Denmark. To investigate if there was a temporal relation between diagnosis of GPA and CV disease and death. METHODS A population-based cohort study was performed using the Danish Civil Registration System, the Danish National Patient Registry and the Danish Cause of Death Register in the period January 1, 1995, to December 31, 2015. Patients registered twice or more with a diagnosis of GPA were included. Annual incidence rate (IR), point prevalence (PP) and standardized mortality rate (SMR) were calculated. The entire adult population in Denmark served as control population. CV morbidity and death caused by CV disease was registered. RESULTS We identified 1829 individuals with GPA. The median annual IR was 20.5/1,000,000 and PP increased from 64 to 277/1,000,000 in 2015. Overall SMR was 2.14. Among patients with GPA 171 had a hospital diagnosis of acute myocardial infarction (AMI). Compared to the control population, the hazard ratio (HR) of AMI was 2.47 (95% CI 1.24-4.94) during the first 3 months after the GPA diagnosis. From 3 months to one year declining to 1.41 (95%CI 0.80-2.49) and after 10 years the HR was still slightly increased to 1.64 (95%CI 1.20-2.23). The risk of a diagnosis of heart failure (HF) was markedly increased with a HR at 7.22 (95% CI 4.55-11.46) during the first 3 months after a GPA diagnosis, after three months up to one year 2.94 (95%CI 1.87-4.69), and 2.07 (95% CI 1.54-2.78) after 10 years. The total number of CV deaths in the GPA cohort was 307. During the first three months after a GPA diagnosis, the HR was increased to 9.51 (95%CI 7.12-12.70) declining to 2.51 (95% CI 1.77-3.58) after one year, but still increased to 1.56 (95% CI 1.23-1.98) after 10 years. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation. CONCLUSION In a population-based study on GPA, we found stable incidence, increasing prevalence and an overall increased SMR. The risk of CV comorbidity and of CV death among patients with a register diagnosis of GPA was increased.
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Affiliation(s)
- Helle Laustrup
- Department of Rheumatology, Odense University Hospital, Denmark
| | - Anne Voss
- Department of Rheumatology, Odense University Hospital, Denmark
| | - Peter Enemark Lund
- Master of Science: Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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10
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Pulse wave velocity, carotid intima media thickness and flow-mediated dilation in Takayasu arteritis: a systematic review. ACTA ACUST UNITED AC 2021; 6:e79-e84. [PMID: 34027216 PMCID: PMC8117071 DOI: 10.5114/amsad.2021.105390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
Introduction Takayasu arteritis (TA) is a chronic vasculitis associated with an increased cardiovascular risk. The measurement of pulse wave velocity (PWV), carotid artery intima-media thickness (CIMT) and flow-mediated dilatation (FMD) are generally used for evaluating the cardiovascular risk. The application of these measurements to TA patients remains undetermined. Material and methods Clinical studies that reported the PWV, CIMT and FMD levels in TA patients, which were published prior to 2021, were summarized using PubMed. Results Fifteen studies were eligible. Overall, in TA patients, the PWV and CIMT levels were significantly higher and the FMD levels were significantly lower compared to controls. Part of the studies showed that the disease activity of TA was significantly associated with the PWV, CIMT or FMD levels. Conclusions The PWV, CIMT and FMD measurements could be useful for evaluating the cardiovascular risk in TA patients. Further studies to determine the proper use of these measurements are warranted.
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11
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Clifford AH, Cohen Tervaert JW. Cardiovascular events and the role of accelerated atherosclerosis in systemic vasculitis. Atherosclerosis 2021; 325:8-15. [PMID: 33873090 DOI: 10.1016/j.atherosclerosis.2021.03.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
The spectrum of inflammatory blood vessel diseases includes both atherosclerosis and the primary systemic vasculitides. Although the inciting triggers differ, significant overlap exists in the mechanisms that contribute to sustained inflammation and vascular damage in both entities. With improvement in therapeutics to control acute vasculitis leading to longer survival, cardiovascular morbidity and mortality has emerged as the leading cause of death for vasculitis patients. Cardiovascular events likely occur as a consequence of vasculitis, vascular damage from prior inflammation causing a sustained procoagulant state, and accelerated atherosclerosis. In this review, we discuss the latest evidence regarding risk of cardiovascular events in patients with major forms of primary systemic vasculitis, and review the mechanisms by which accelerated atherosclerosis may occur.
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Affiliation(s)
- Alison H Clifford
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada.
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12
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Nossent J, Raymond W, Keen H, Inderjeeth C, Preen D. Long-Term Risk of Comorbidity after IgA Vasculitis in Childhood: A Population-Based Cohort Study. Rheumatol Ther 2020; 7:927-935. [PMID: 33057924 PMCID: PMC7695788 DOI: 10.1007/s40744-020-00239-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Patients with IgA vasculitis (IgAV) may require aggressive treatment and are prone to disease relapses, and IgA deposition in tissues can persist. We investigated whether these factors predispose to long-term morbidity in children with IgAV. Methods Observational cohort study comparing rates for comorbidity development by Charlson comorbidity index (CCI) and rates for hospitalization, procedures, and emergency department (ED) visits over a 20-year period for IgAV patients < 20 years (n = 494) and matched hospital-based controls (n = 1385). Odds (OR) for events and rate ratios (RR) for event rates per 1000 person-years were derived from maximum likelihood estimates. Results Patient survival (99.1 vs. 99.7%, p = 0.6) and overall comorbidity accrual CCI (0.21 vs. 0.23, p = 0.7) were similar for IgAV patients and hospital-based controls after 20 years. IgAV patients did not develop other rheumatic diseases, but more often were diagnosed with peptic ulcer and end-stage renal failure. Hospitalization rates were three times higher for IgAV patients (RR 3.41 CI 3.04–3.82) in the first year following diagnosis, while ED attendance rates were higher in subsequent years (RR 1.29; 1.02–1.04; p < 0.01) for IgAV patients. Conclusions Childhood IgAV patients have good long-term prognosis despite the occurrence of end-stage renal failure and compared to hospital-based controls are at not at increased risk for other comorbidity or rheumatic disease. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00239-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Nossent
- Rheumatology Section, Medical School, University Western Australia, Perth, Australia. .,Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.
| | - Warren Raymond
- Rheumatology Section, Medical School, University Western Australia, Perth, Australia
| | - Helen Keen
- Rheumatology Section, Medical School, University Western Australia, Perth, Australia.,Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - Charles Inderjeeth
- Rheumatology Section, Medical School, University Western Australia, Perth, Australia.,Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
| | - David Preen
- School of Population and Global Health, University Western Australia, Perth, Australia
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13
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Chang LS, Kuo HC. The role of corticosteroids in the treatment of Kawasaki disease. Expert Rev Anti Infect Ther 2020; 18:155-164. [DOI: 10.1080/14787210.2020.1713752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ling-Sai Chang
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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14
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Pacholczak R, Bazan-Socha S, Iwaniec T, Zaręba L, Kielczewski S, Walocha JA, Musiał J, Dropiński J. Endothelial dysfunction in patients with eosinophilic granulomatosis with polyangiitis. Clin Rheumatol 2018; 38:417-424. [PMID: 30132147 DOI: 10.1007/s10067-018-4253-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/09/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of vasculitis associated with asthma and eosinophilia. Endothelial dysfunction has been well documented in other types of vasculitis but not in EGPA. Thirty patients (10 men and 20 women) diagnosed with EGPA and remaining in a remission, and 58 controls (24 men and 34 women) matched for age, sex, and body mass index, were enrolled in the study. We assessed each participants for typical risk factors of cardiovascular diseases and measured serum levels of vascular cell adhesion molecule-1 (VCAM-1), interleukin 6 (IL-6), and thrombomodulin. We also measured flow-mediated dilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the common carotid artery using ultrasonography. Patients with EGPA had 20% higher serum level of VCAM-1 (p < 0.001) and 41.9% of thrombomodulin (p < 0.001). They also had 38.8% lower relative increase of FMD (FMD%) (p < 0.001), indicating endothelial dysfunction. These differences remained significant also after adjustment for potential confounders. Laboratory and ultrasonographic parameters of endothelial injury were correlated to the markers of inflammation and impaired kidney function. Determinants of lower FMD% in a simple regression model were pack-years of smoking (β = - 0.3 [95% confidence interval (CI) - 0.5 to - 0.1]), serum level of IL-6 (β = - 0.36 [95% CI - 0.62 to - 0.1]), and thrombomodulin (β = - 0.34 [95% CI - 0.6 to - 0.08]). EGPA patients are characterized by inflammatory endothelial injury that is likely related to the pathogenesis of the disease. Proper immunosuppressive treatment is the best method to prevent atherosclerosis and future cardiovascular events, the patients may also benefit from additional preventive interventions.
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Affiliation(s)
- Renata Pacholczak
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Centre of Oncology, Maria Sklodowska-Curie Memorial Institute Cracow Branch, Cracow, Poland
| | - Stanisława Bazan-Socha
- Second Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Teresa Iwaniec
- Second Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Lech Zaręba
- Faculty of Mathematics and Natural Sciences, University of Rzeszow, Rzeszow, Poland
| | - Stan Kielczewski
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | | | - Jacek Musiał
- Second Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Jerzy Dropiński
- Second Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland.
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15
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Erdbrügger U, Kielstein JT, Westman K, Ma JZ, Xin W, Bode-Böger SM, Segelmark M, Rasmussen N, De Groot K. Higher levels of SDMA and not ADMA are associated with poorer survival of trial patients with systemic ANCA-associated vasculitis. Eur J Rheumatol 2018; 5:153-159. [PMID: 30071927 DOI: 10.5152/eurjrheum.2018.17119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/30/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Endothelial dysfunction, increased cardiovascular events (CVE), and accelerated atherosclerosis have been described in patients with small vessel vasculitis and collagen vascular disease. Identifying predictors of cardiovascular risk will help to optimize short- and long-term care of patients with vasculitis. The present study investigates the predictive role of the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA) and its stereoisomer symmetric dimethylarginine (SDMA) for cardiovascular risk, all-cause mortality, and renal function in patients with anti-neutrophil-cytoplasmic antibodies-associated small vessel vasculitis (AASV) subjected to standardized treatment regimens in four European Vasculitis Study Group trials representing all stages of renal disease. METHODS Sera from 89 patients with AASV were available for measuring SDMA, ADMA, and arginine using liquid chromatography/mass spectrometry at the time of active disease and remission. Clinical data on disease activity, remission, relapse rate, and 5-year follow-up data for CVE and renal outcome were collected. RESULTS Symmetric dimethylarginine and ADMA levels were not predictive of CVE at 5 years of follow-up. The overall CVE rate was low in the present cohort of AASV (8%). However, SDMA, and not ADMA, levels were significantly associated with poorer survival (death/ESRD) independent of entry glomerular filtration rate. CONCLUSION This novel outcome in a well-defined group of patients with AASV might indicate a different mechanism of endothelial response in AASV as compared with atherosclerosis. This should be further explored in a larger cohort of AASV patients with a higher CVE rate and/or a longer follow-up. Moreover, these findings should be correlated to other markers of vascular damage.
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Affiliation(s)
- Uta Erdbrügger
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Virginia, USA
| | - Jan T Kielstein
- Department of Hypertension and Nephrology, Medical Clinic V, Klinikum Braunschweig, Braunschweig, Germany
| | | | - Jennie Z Ma
- Department of Biostatistics, University of Virginia Health System, Virginia, USA
| | - Wenjun Xin
- Department of Biostatistics, University of Virginia Health System, Virginia, USA
| | | | - Mȧrten Segelmark
- Division of Drug Research, Department of Medical Health Sciences, Linköping University, Linköping, Sweden
| | - Niels Rasmussen
- Department of Biochemistry and Immunology, Statens Seruminstitut, Copenhagen, Denmark
| | - Kirsten De Groot
- Department of Nephrology and Rheumatology, Medical Clinic III, Sana Klinikum, Offenbach, Germany
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16
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Banz Y, Stone JH. Why do temporal arteries go wrong? Principles and pearls from a clinician and a pathologist. Rheumatology (Oxford) 2018; 57:ii3-ii10. [PMID: 29982782 DOI: 10.1093/rheumatology/kex524] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
Early diagnosis and treatment of GCA is essential to prevent complications of the disease, including permanent vision loss. Temporal artery biopsy has been intrinsically linked with the diagnosis of GCA for several decades. A negative predictive value of > 90% has been reported for temporal artery biopsy; however, a negative result does not reliably indicate the absence of GCA because inflammation of the temporal artery is not always evident because of segmental involvement or other reasons. This is demonstrated by a case study of a patient hospitalized following acute vision loss to the right eye whose glucocorticoid treatment was suspended after temporal artery biopsy revealed no evidence of GCA. The patient subsequently lost sight in the left eye 6 weeks after stopping glucocorticoid therapy. The specificity of temporal artery biopsy for the diagnosis of GCA is variable and influenced by many factors, including length of biopsy specimens, vasculitis in vessels other than the temporal artery (ophthalmic, retinal and posterior ciliary vessels), unilateral versus bilateral biopsy, expertise of the surgeon, interpretation of histology, effects of treatment and confounding factors such as atherosclerosis or other non-GCA diseases that can affect the temporal artery. Considering the limitations of temporal artery biopsy, collaboration and education between the clinician, the pathologist and the patient, taking into account a thorough examination of patient history, recognizing signs and symptoms, and potentially involving newer imaging studies with trained technicians and physicians, are essential in confirming or eliminating diagnosis of GCA.
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Affiliation(s)
- Yara Banz
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - John H Stone
- Massachusetts General Hospital Rheumatology Unit, Harvard Medical School, Boston, MA, USA
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17
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Go E, Tarnawsky SP, Shelley WC, Banno K, Lin Y, Gil CH, Blue EK, Haneline LS, O’Neil KM, Yoder MC. Mycophenolic acid induces senescence of vascular precursor cells. PLoS One 2018. [PMID: 29538431 PMCID: PMC5851606 DOI: 10.1371/journal.pone.0193749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Endothelial dysfunction is central to the pathogenesis of many rheumatic diseases, typified by vascular inflammation and damage. Immunosuppressive drugs induce disease remission and lead to improved patient survival. However, there remains a higher incidence of cardiovascular disease in these patients even after adequate disease control. The purpose of this study was to determine the effect of mycophenolic acid (MPA), a commonly used immunosuppressive drug in rheumatology, on blood vessel or circulating endothelial colony forming cell number and function. METHODS We tested whether mycophenolic acid exerts an inhibitory effect on proliferation, clonogenic potential and vasculogenic function of endothelial colony forming cell. We also studied potential mechanisms involved in the observed effects. RESULTS Treatment with MPA decreased endothelial colony forming cell proliferation, clonogenic potential and vasculogenic function in a dose-dependent fashion. MPA increased senescence-associated β-galactosidase expression, p21 gene expression and p53 phosphorylation, indicative of activation of cellular senescence. Exogenous guanosine supplementation rescued diminished endothelial colony forming cell proliferation and indices of senescence, consistent with the known mechanism of action of MPA. CONCLUSION Our findings show that clinically relevant doses of MPA have potent anti-angiogenic and pro-senescent effects on vascular precursor cells in vitro, thus indicating that treatment with MPA can potentially affect vascular repair and regeneration. This warrants further studies in vivo to determine how MPA therapy contributes to vascular dysfunction and increased cardiovascular disease seen in patients with inflammatory rheumatic disease.
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Affiliation(s)
- Ellen Go
- Division of Pediatric Rheumatology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States of America
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Stefan P. Tarnawsky
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - W. Chris Shelley
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kimihiko Banno
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Yang Lin
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Chang-Hyun Gil
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Emily K. Blue
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Laura S. Haneline
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kathleen M. O’Neil
- Division of Pediatric Rheumatology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States of America
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Mervin C. Yoder
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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18
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González-Suárez I, Ríos-Blanco JJ, Arpa J. Accelerated atherosclerosis in ANCA-associated vasculitis. Acta Neurol Scand 2017; 136:688-693. [PMID: 28608454 DOI: 10.1111/ane.12787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Cardiovascular disease, including myocardial infarction and stroke, is a major cause of mortality in ANCA-associated vasculitis (AAV). Although AAV affects small vessels, an accelerated atherosclerosis not explained by traditional cardiovascular risk factors (CVRF) has been demonstrated. We aimed to investigate the association of atherosclerosis measured by carotid intima-media thickness (CIMT) and cerebral small vessel disease in AAV-patients. MATERIALS & METHODS Twenty-three AAV-patients in complete remission were recruited. Carotid ultrasonography (US), transcranial Doppler (TCD), brain magnetic resonance imaging (MRI), and SPECT after intravenous administration of tracer 99mTc-HMPAO (dose: 720MBq) were performed. RESULTS AAV-patients presented higher CIMT compared to normative population. Multivariate linear regression analysis demonstrated an association of higher CIMT with increased pulsatility index in middle cerebral artery (PI-MCA) (P=.011), higher lesion load on ARWMC scale (P=.011) and abnormal SPECT (P=.008). No association between higher CIMT and CVRF (diabetes or hypertension) was demonstrated. Increasing internal carotid artery pulsatility index (PI-ICA) was associated with decreasing mean flow velocity (MFV)-MCA (P=.038), increasing PI-MCA (P=.008) and increasing white matter lesions on MRI (P=.011). CONCLUSIONS Our study adds weight to the presence of increased atherosclerosis in AAV-patients. The association observed between CIMT and PI-ICA with small vessel cerebral disease, points the possible association of easy to use carotid US in predicting microvascular brain injury.
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Affiliation(s)
| | - J. J. Ríos-Blanco
- Internal Medicine Department; Hospital Universitario La Paz; Madrid Spain
| | - J. Arpa
- Neurology Department; Hospital Clínico San Carlos; Madrid Spain
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19
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Liozon E. Improving diagnosis and prognosis in giant cell arteritis: Still more issues than answers. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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20
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Mavrogeni S, Koutsogeorgopoulou L, Dimitroulas T, Markousis-Mavrogenis G, Kolovou G. Complementary role of cardiovascular imaging and laboratory indices in early detection of cardiovascular disease in systemic lupus erythematosus. Lupus 2017; 26:227-236. [DOI: 10.1177/0961203316671810] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background Cardiovascular disease (CVD) has been documented in >50% of systemic lupus erythematosus (SLE) patients, due to a complex interplay between traditional risk factors and SLE-related factors. Various processes, such as coronary artery disease, myocarditis, dilated cardiomyopathy, vasculitis, valvular heart disease, pulmonary hypertension and heart failure, account for CVD complications in SLE. Methods Electrocardiogram (ECG), echocardiography (echo), nuclear techniques, cardiac computed tomography (CT), cardiovascular magnetic resonance (CMR) and cardiac catheterization (CCa) can detect CVD in SLE at an early stage. ECG and echo are the cornerstones of CVD evaluation in SLE. The routine use of cardiac CT and nuclear techniques is limited by radiation exposure and use of iodinated contrast agents. Additionally, nuclear techniques are also limited by low spatial resolution that does not allow detection of sub-endocardial and sub-epicardial lesions. CCa gives definitive information about coronary artery anatomy and pulmonary artery pressure and offers the possibility of interventional therapy. However, it carries the risk of invasive instrumentation. Recently, CMR was proved of great value in the evaluation of cardiac function and the detection of myocardial inflammation, stress-rest perfusion defects and fibrosis. Results An algorithm for CVD evaluation in SLE includes clinical, laboratory, ECG and echo assessment as well as CMR evaluation in patients with inconclusive findings, persistent cardiac symptoms despite normal standard evaluation, new onset of life-threatening arrhythmia/heart failure and/or as a tool to select SLE patients for CCa. Conclusions A non-invasive approach including clinical, laboratory and imaging evaluation is key for early CVD detection in SLE.
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Affiliation(s)
- S Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece
| | - L Koutsogeorgopoulou
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - T Dimitroulas
- 4th Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - G Kolovou
- Onassis Cardiac Surgery Center, Athens, Greece
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21
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22
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Slot MC, Kroon AA, Damoiseaux JGMC, Theunissen R, Houben AJHM, de Leeuw PW, Tervaert JWC. CD4 +CD28 null T Cells are related to previous cytomegalovirus infection but not to accelerated atherosclerosis in ANCA-associated vasculitis. Rheumatol Int 2017; 37:791-798. [PMID: 28084533 PMCID: PMC5397454 DOI: 10.1007/s00296-016-3643-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Abstract
Previous studies have suggested an increased risk for cardiovascular events in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). We analyzed the presence of atherosclerotic damage in patients with AAV in relation to the presence of CD4+CD28null T cells and antibodies against cytomegalovirus (CMV) and human Heat-Shock Protein 60 (hHSP60). In this cross-sectional study, patients with inactive AAV were compared with healthy controls (HC). Carotid intima-media thickness (IMT) and aortic pulse-wave velocity (PWV) were measured. In addition, CD4+CD28null T cells, anti-CMV, and anti-hHSP60 levels were determined. Forty patients with AAV were included. Patients’ spouses were recruited as HC (N = 38). CD4+CD28null T cells are present in patients with AAV in a higher percentage (median 3.1, range 0.01–85) than in HC (0.28, 0–36, P < 0.0001). No significant difference in IMT (mm) between patients and controls was detected (mean 0.77 ± standard deviation 0.15 and 0.73 ± 0.11, respectively, P = 0.20). PWV standardized for MAP was increased in AAV patients (9.80 ± 2.50 m/s, compared to 8.72 ± 1.68 in HC, P = 0.04). There was a strong association between a previous CMV infection and the presence and percentage of CD4+CD28null T cells (0.33 vs 13.8, P < 0.001). There was no relationship between CD4+CD28null T cells and/or a previous CMV infection and IMT or PWV. There was no relation between anti-hHSP60 and CD4+CD28null T cells. Increased PWV values suggest atherosclerotic damage in patients with AAV. Plaque size, as determined by IMT, did not differ. CD4+CD28null T cells are increased in AAV and related to the previous CMV infection.
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Affiliation(s)
- Marjan C Slot
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands. .,Department of Internal Medicine, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Abraham A Kroon
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Jan G M C Damoiseaux
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Ruud Theunissen
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Alfons J H M Houben
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Jan Willem Cohen Tervaert
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
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23
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Approach to giant cell arteritis and recent evidence on its relation with cardiovascular risk. A review. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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24
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Wilde B, Mertens A, Arends SJ, Rouhl RP, Bijleveld R, Huitema J, Timmermans SA, Damoiseaux J, Witzke O, Duijvestijn AM, van Paassen P, van Oostenbrugge RJ, Cohen Tervaert JW. Endothelial progenitor cells are differentially impaired in ANCA-associated vasculitis compared to healthy controls. Arthritis Res Ther 2016; 18:147. [PMID: 27338585 PMCID: PMC4918016 DOI: 10.1186/s13075-016-1044-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/06/2016] [Indexed: 01/16/2023] Open
Abstract
Background Endothelial progenitor cells (EPC) are of major importance in vascular repair under healthy circumstances. Vascular injury in need of repair occurs frequently in ANCA-associated vasculitis (AAV). A specialized T cell subset enhancing EPC function and differentiation has recently been described. These angiogenic T cells (Tang) may have an important impact on the vascular repair process. Therefore, the aim of our study was to investigate EPC and Tang in AAV. Methods Fifty-three patients suffering from AAV and 29 healthy controls (HC) were enrolled in our study. Forty-four patients were in remission, nine patients were in active state of disease. Patients were either untreated or were under monotherapy with low-dose steroids (max. 5 mg/day) at the time of sampling. Circulating EPC and Tang were determined by flow cytometry (FACS). The functional capacity of EPC was assessed by established cell culture methods. Results Circulating EPC were significantly decreased in AAV as compared to HC. The capacity of EPC to differentiate and proliferate was differentially impaired in patients as compared to HC. The outgrowth of endothelial colony-forming cells (ECFC) was severely decreased in patients whereas colony-forming units-endothelial cell (CFU-EC) outgrowth was unaffected. ECFC and CFU-EC differentiation was strictly T cell-dependent. Patients with a relapsing disease course had an impaired ECFC outgrowth and expansion of Tang as compared to patients with a stable, nonrelapsing disease. Conclusions The differentiation process of EPC is impaired in AAV. This may favor insufficient vascular repair promoting a relapsing disease course. Finally, these factors may explain a higher cardiovascular morbidity as has been previously documented in AAV.
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Affiliation(s)
- B Wilde
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Nephrology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - A Mertens
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands
| | - S J Arends
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - R P Rouhl
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands
| | - R Bijleveld
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J Huitema
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - S A Timmermans
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - O Witzke
- Department of Nephrology, University Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Infectious Diseases, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - A M Duijvestijn
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - P van Paassen
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - R J van Oostenbrugge
- Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands
| | - J W Cohen Tervaert
- Immunology, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Hong J, Maron DJ, Shirai T, Weyand CM. Accelerated atherosclerosis in patients with chronic inflammatory rheumatologic conditions. ACTA ACUST UNITED AC 2015; 10:365-381. [PMID: 27042216 DOI: 10.2217/ijr.15.33] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Atherosclerosis is a complex inflammatory disease involving aberrant immune and tissue healing responses, which begins with endothelial dysfunction and ends with plaque development, instability and rupture. The increased risk for coronary artery disease in patients with rheumatologic diseases highlights how aberrancy in the innate and adaptive immune system may be central to development of both disease states and that atherosclerosis may be on a spectrum of immune-mediated conditions. Recognition of the tight association between chronic inflammatory disease and complications of atherosclerosis will impact the understanding of underlying pathogenic mechanisms and change diagnostic and therapeutic approaches in patients with rheumatologic syndromes as well as patients with coronary artery disease. In this review, we provide a summary of the role of the immune system in atherosclerosis, discuss the proposed mechanisms of accelerated atherosclerosis seen in association with rheumatologic diseases, evaluate the effect of immunosuppression on atherosclerosis and provide updates on available risk assessment tools, biomarkers and imaging modalities.
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Affiliation(s)
- Jison Hong
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - David J Maron
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Tsuyoshi Shirai
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Cornelia M Weyand
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
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Abstract
Autoimmune rheumatic diseases can affect the cardiac vasculature, valves, myocardium, pericardium, and conduction system, leading to a plethora of cardiovascular manifestations that can remain clinically silent or lead to substantial cardiovascular morbidity and mortality. Although the high risk of cardiovascular pathology in patients with autoimmune inflammatory rheumatological diseases is not owing to atherosclerosis alone, this particular condition contributes substantially to cardiovascular morbidity and mortality-the degree of coronary atherosclerosis observed in patients with rheumatic diseases can be as accelerated, diffuse, and extensive as in patients with diabetes mellitus. The high risk of atherosclerosis is not solely attributable to traditional cardiovascular risk factors: dysfunctional immune responses, a hallmark of patients with rheumatic disorders, are thought to cause chronic tissue-destructive inflammation. Prompt recognition of cardiovascular abnormalities is needed for timely and appropriate management, and aggressive control of traditional risk factors remains imperative in patients with rheumatic diseases. Moreover, therapies directed towards inflammatory process are crucial to reduce cardiovascular disease morbidity and mortality. In this Review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders, their underlying pathophysiology, and available management strategies, with particular emphasis on the vascular aspects of the emerging field of 'cardiorheumatology'.
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Ramirez GA, Maugeri N, Sabbadini MG, Rovere-Querini P, Manfredi AA. Intravascular immunity as a key to systemic vasculitis: a work in progress, gaining momentum. Clin Exp Immunol 2014; 175:150-66. [PMID: 24128276 DOI: 10.1111/cei.12223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 01/06/2023] Open
Abstract
Vascular inflammation contributes to the defence against invading microbes and to the repair of injured tissues. In most cases it resolves before becoming apparent. Vasculitis comprises heterogeneous clinical entities that are characterized by the persistence of vascular inflammation after it has served its homeostatic function. Most underlying mechanisms have so far remained elusive. Intravascular immunity refers to the surveillance of the vasculature by leucocytes that sense microbial or sterile threats to vessel integrity and initiate protective responses that entail most events that determine the clinical manifestations of vasculitis, such as end-organ ischaemia, neutrophil extracellular traps generation and thrombosis, leucocyte extravasation and degranulation. Understanding how the resolution of vascular inflammation goes awry in patients with systemic vasculitis will facilitate the identification of novel pharmacological targets and bring us a step closer in each patient to the selection of more effective and less toxic treatments.
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Affiliation(s)
- G A Ramirez
- Istituto Scientifico San Raffaele and Università Vita Salute San Raffaele, Milano, Italy
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Boynosky NA, Stokking L. Atherosclerosis associated with vasculopathic lesions in a golden retriever with hypercholesterolemia. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2014; 55:484-488. [PMID: 24790237 PMCID: PMC3992312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 2-year-old neutered male golden retriever dog presented for lameness secondary to ulcerations of multiple digital paw pads was diagnosed with vasculitis and hypercholesterolemia. Despite treatment, ischemic necrosis progressed to include all distal extremities and the dog eventually expired due to myocardial infarction secondary to severe atherosclerosis. The rapid demise and the dermatologic lesions may have been secondary to cholesterol embolism syndrome which has never before been reported in a dog.
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Stagi S, Losi S, Chiarelli F, de Martino M, Falcini F. Kawasaki disease in a girl with Turner syndrome: a remarkable association. Ital J Pediatr 2014; 40:24. [PMID: 24580845 PMCID: PMC3944673 DOI: 10.1186/1824-7288-40-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/20/2014] [Indexed: 11/10/2022] Open
Abstract
We describe a girl with Turner syndrome, a genetic disorder of the X chromosome in a phenotypic female at increased risk of autoimmune and immunological diseases, who developed Kawasaki disease at the age of four years. Given the possible relationship between these two disorders, we recommend suspecting Kawasaki disease in patients with Turner syndrome who present with persistent fever of unknown origin and who are not responsive to antibiotic therapy. Attention should be given to this phenomenon, as patients with Turner syndrome are themselves at higher risk of cardiovascular defects. Further studies are needed to better clarify this issue.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
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Tanaka N, Kusunoki N, Kusunoki Y, Hasunuma T, Kawai S. Resistin is associated with the inflammation process in patients with systemic autoimmune diseases undergoing glucocorticoid therapy: comparison with leptin and adiponectin. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0623-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Nahoko Tanaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Natsuko Kusunoki
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Yoshie Kusunoki
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Tomoko Hasunuma
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
- Research Center for Clinical Pharmacology, Kitasato University,
Tokyo, Japan
| | - Shinichi Kawai
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
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Aller MA, Heras NDL, Nava MP, Regadera J, Arias J, Lahera V. Splanchnic-aortic inflammatory axis in experimental portal hypertension. World J Gastroenterol 2013; 19:7992-7999. [PMID: 24307792 PMCID: PMC3848146 DOI: 10.3748/wjg.v19.i44.7992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/22/2013] [Indexed: 02/06/2023] Open
Abstract
Splanchnic and systemic low-grade inflammation has been proposed to be a consequence of long-term prehepatic portal hypertension. This experimental model causes minimal alternations in the liver, thus making a more selective study possible for the pathological changes characteristic of prehepatic portal hypertension. Low-grade splanchnic inflammation after long-term triple partial portal vein ligation could be associated with liver steatosis and portal hypertensive intestinal vasculopathy. In fact, we have previously shown that prehepatic portal hypertension in the rat induces liver steatosis and changes in lipid and carbohydrate metabolism similar to those produced in chronic inflammatory conditions described in metabolic syndrome in humans. Dysbiosis and bacterial translocation in this experimental model suggest the existence of a portal hypertensive intestinal microbiome implicated in both the splanchnic and systemic alterations related to prehepatic portal hypertension. Among the systemic impairments, aortopathy characterized by oxidative stress, increased levels of proinflammatory cytokines and profibrogenic mediators stand out. In this experimental model of long-term triple portal vein ligated-rats, the abdominal aortic proinflammatory response could be attributed to oxidative stress. Thus, the increased aortic reduced-nicotinamide-adenine dinucleotide phosphate [NAD(P)H] oxidase activity could be associated with reactive oxygen species production and promote aortic inflammation. Also, oxidative stress mediated by NAD(P)H oxidase has been associated with risk factors for inflammation and atherosclerosis. The splanchnic and systemic pathology that is produced in the long term after triple partial portal vein ligation in the rat reinforces the validity of this experimental model to study the chronic low-grade inflammatory response induced by prehepatic portal hypertension.
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Cardiovascular disease in autoimmune rheumatic diseases. Autoimmun Rev 2013; 12:1004-15. [PMID: 23541482 DOI: 10.1016/j.autrev.2013.03.013] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 03/07/2013] [Indexed: 12/18/2022]
Abstract
Various autoimmune rheumatic diseases (ARDs), including rheumatoid arthritis, spondyloarthritis, vasculitis and systemic lupus erythematosus, are associated with premature atherosclerosis. However, premature atherosclerosis has not been uniformly observed in systemic sclerosis. Furthermore, although experimental models of atherosclerosis support the role of antiphospholipid antibodies in atherosclerosis, there is no clear evidence of premature atherosclerosis in antiphospholipid syndrome (APA). Ischemic events in APA are more likely to be caused by pro-thrombotic state than by enhanced atherosclerosis. Cardiovascular disease (CVD) in ARDs is caused by traditional and non-traditional risk factors. Besides other factors, inflammation and immunologic abnormalities, the quantity and quality of lipoproteins, hypertension, insulin resistance/hyperglycemia, obesity and underweight, presence of platelets bearing complement protein C4d, reduced number and function of endothelial progenitor cells, apoptosis of endothelial cells, epigenetic mechanisms, renal disease, periodontal disease, depression, hyperuricemia, hypothyroidism, sleep apnea and vitamin D deficiency may contribute to the premature CVD. Although most research has focused on systemic inflammation, vascular inflammation may play a crucial role in the premature CVD in ARDs. It may be involved in the development and destabilization of both atherosclerotic lesions and of aortic aneurysms (a known complication of ARDs). Inflammation in subintimal vascular and perivascular layers appears to frequently occur in CVD, with a higher frequency in ARD than in non-ARD patients. It is possible that this inflammation is caused by infections and/or autoimmunity, which might have consequences for treatment. Importantly, drugs targeting immunologic factors participating in the subintimal inflammation (e.g., T- and B-cells) might have a protective effect on CVD. Interestingly, vasa vasorum and cardiovascular adipose tissue may play an important role in atherogenesis. Inflammation and complement depositions in the vessel wall are likely to contribute to vascular stiffness. Based on biopsy findings, also inflammation in the myocardium and small vessels may contribute to premature CVD in ARDs (cardiac ischemia and heart failure). There is an enormous need for an improved CVD prevention in ARDs. Studies examining the effect of DMARDs/biologics on vascular inflammation and CV risk are warranted.
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Cardiovascular disease due to accelerated atherosclerosis in systemic vasculitides. Best Pract Res Clin Rheumatol 2013; 27:33-44. [DOI: 10.1016/j.berh.2012.12.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 12/22/2012] [Accepted: 12/27/2012] [Indexed: 02/08/2023]
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Jacobi B, Schulte AC, Partovi S, Michel S, Karimi S, Lyo JK, Daikeler T, Aschwanden M, Staub D, Zipp L, Rasmus M, Huegli RW, Bongartz G, Bilecen D. Alterations of skeletal muscle microcirculation detected by blood oxygenation level-dependent MRI in a patient with granulomatosis with polyangiitis. Rheumatology (Oxford) 2012; 52:579-81. [DOI: 10.1093/rheumatology/kes176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fujieda M, Karasawa R, Takasugi H, Yamamoto M, Kataoka K, Yudoh K, Kato T, Ozaki S, Wakiguchi H. A novel anti-peroxiredoxin autoantibody in patients with Kawasaki disease. Microbiol Immunol 2012; 56:56-61. [PMID: 22003971 DOI: 10.1111/j.1348-0421.2011.00393.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Antibodies to the anti-oxidative peroxiredoxin (Prx) enzymes occur in both systemic autoimmune disease and vasculitis in adulthood. Because increased oxidative stress induces vasculitis in Kawasaki disease (KD), autoimmunity to Prxs in patients with KD was investigated. The presence of antibodies to Prx 1, 2 and 4 was analyzed by ELISA and Western blot. Of 30 patients with KD, 13 (43.3%) possessed antibodies to Prx 2, whereas these antibodies were present in only 1 of 10 patients (10.0%) with sepsis (4 with purulent meningitis and 6 with septicemia). In contrast, antibodies to Prx 1 and 4 were not detected in either group. There was no significant correlation among the titers of the three antibodies. Clinical parameters were compared between anti-Prx 2-positive and -negative patients. The presence of anti-Prx 2 antibodies correlated with a longer period of fever and poor response to high-dose γ-globulin therapy in patients with KD. Anti-Prx 2-positive patients had significantly greater excretion of urinary 8-isoprostaglandin than did anti-Prx 2-negative patients. These results provide the first evidence for an antibody to Prx 2 in patients with KD. They also suggest that this antibody might serve as a marker of disease severity and be involved in the pathophysiology of vasculitis in some patients with KD.
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Affiliation(s)
- Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan.
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de Las Heras N, Aller MA, Martín-Fernández B, Miana M, Ballesteros S, Regadera J, Cachofeiro V, Arias J, Lahera V. A wound-like inflammatory aortic response in chronic portal hypertensive rats. Mol Immunol 2012; 51:177-87. [PMID: 22463791 DOI: 10.1016/j.molimm.2012.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 02/24/2012] [Accepted: 03/03/2012] [Indexed: 02/07/2023]
Abstract
Long-term prehepatic portal hypertension in the rat produces a low-grade splanchnic inflammation with liver steatosis and dyslipidemia. It has been suggested that in this experimental model these inflammatory alterations could represent a risk factor of vascular disease. Therefore, our aim was to investigate whether long-term prehepatic portal hypertension (PH) induces vascular pathology, fundamentally inflammatory aortopathy. Male Wistar sham-operated (SO) rats and rats with triple partial portal vein ligation in the very long-term (22 months) of postoperative evolution were used. Serum lipid profile, pro- and anti- inflammatory cytokines and ACTH and corticosterone were assayed by spectrophotometric and ELISA techniques. Aorta mRNA expression of oxidative and nitrosative stress enzymes, NFκB e IκB, immune-related cytokine production and vascular fibrosis parameters, were evaluated by real time RT-PCR. In addition, aortic p22phox subunit immunostaining, morphometry and vascular fibrosis in aorta were analyzed. PH rats have increased serum cholesterol, triglyceride, low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL), while high-density lipoproteins (HDL) were lower than in SO rats. Serum ACTH and corticosterone decreased in PH rats. Also, serum TNF-α, IL-1β and IL-6 were significantly higher in PH-rats. Portal hypertensive-rats showed aortic oxidative stress with increased mRNA expressions of NAD(P)H oxidase p22phox, XDh, SOD and eNOS; higher aortic levels of pro-inflammatory cytokines, including TNF-α, IL-1β and IL-6; remodeling markers, like collagen I, CTGF and MMP-9; and finally, higher protein production of p22phox and collagen and extracellular matrix density were significantly higher in rats with PH. The results from the current study suggest that very long-term prehepatic portal hypertension in rats induces an abdominal aortic inflammatory and fibrotic response. Therefore, it could be considered that portal hypertension aggravates aortic inflammaging and one of its more severe complications, which is remodeling by a wound healing reaction.
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Affiliation(s)
- Natalia de Las Heras
- Department of Physiology, School of Medicine, Universidad Complutense, Plaza de Ramón y Cajal s.n., 28040 Madrid, Spain
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Tanaka N, Kusunoki N, Kusunoki Y, Hasunuma T, Kawai S. Resistin is associated with the inflammation process in patients with systemic autoimmune diseases undergoing glucocorticoid therapy: comparison with leptin and adiponectin. Mod Rheumatol 2012; 23:8-18. [PMID: 22434063 DOI: 10.1007/s10165-012-0623-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 02/14/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We investigated the role of adipokines in patients with systemic autoimmune diseases who received glucocorticoid therapy. METHODS Fifty-two patients with systemic autoimmune diseases who had started glucocorticoid therapy were prospectively enrolled. One hundred forty healthy persons were also studied as controls. Serum levels of 3 adipokines [resistin, leptin, and high molecular weight (HMW)-adiponectin] were measured with enzyme-linked immunosorbent assay kits before and at weekly intervals for 4 weeks during glucocorticoid therapy. The effects of lipopolysaccharide and dexamethasone on adipokine expression in human peripheral blood mononuclear cells (PBMCs) were also examined. RESULTS The serum resistin level was significantly higher in patients than in controls before glucocorticoid therapy, and it decreased after glucocorticoid therapy. Consistent with these results, dexamethasone inhibited lipopolysaccharide-induced upregulation of resistin expression in PBMCs in vitro. Serum leptin and HMW-adiponectin levels were lower in the patients than in the controls at baseline, and both adipokine levels were increased after glucocorticoid therapy. There was a significant correlation between serum resistin and high-sensitivity C-reactive protein. However, there was no association between serum adipokines and intima-media thickness. CONCLUSION Resistin may be associated with the inflammatory process but not atherosclerosis in patients with systemic autoimmune diseases.
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Affiliation(s)
- Nahoko Tanaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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Gräni C, Langenegger T, Fäh A, Kurz D, Zbinden R, Ramsay D. Perimyocarditis and myocardial infarction: A rare manifestation of Churg-Strauss syndrome. Exp Clin Cardiol 2012; 17:245-247. [PMID: 23592945 PMCID: PMC3627284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present article reports a case involving a 58-year-old man without cardiovascular risk factors who was admitted to hospital with acute coronary syndrome. Coronary angiography revealed high-grade arteriosclerotic stenosis of the mid-left anterior descending coronary artery and 80% proximal intermediate branch stenosis, which were treated using three drug-eluting stents. Churg-Strauss syndrome was diagnosed based on the patient's history of asthma, sinusitis, eosinophilia, nasal polyps, transient radiological pulmonary infiltrations and transient paresthesia over the left tibia, and eosinophilic pericardial effusion and eosinophilic infiltrations revealed in a myocardial biopsy. Treatment with prednisone was initiated, followed by treatment with cyclophosphamide. Eosinophil levels returned to normal after nine days of treatment. There is evidence that Churg-Strauss syndrome may promote arteriosclerosis.
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Affiliation(s)
| | | | - Anja Fäh
- Department of Cardiology, Zuger Kantonsspital, Baar, Zürich, Switzerland
| | - David Kurz
- Department of Cardiology, Triemlispital, Zürich, Switzerland
| | - Rainer Zbinden
- Department of Cardiology, Triemlispital, Zürich, Switzerland
| | - David Ramsay
- Department of Cardiology, Zuger Kantonsspital, Baar, Zürich, Switzerland
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Lambert M, Hatron PY. Artérite du sujet jeune : éléments d’orientation du diagnostic étiologique. Presse Med 2011; 40:707-12. [DOI: 10.1016/j.lpm.2011.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022] Open
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Karasawa R, Kurokawa MS, Yudoh K, Masuko K, Ozaki S, Kato T. Peroxiredoxin 2 is a novel autoantigen for anti-endothelial cell antibodies in systemic vasculitis. Clin Exp Immunol 2011; 161:459-70. [PMID: 20646000 DOI: 10.1111/j.1365-2249.2010.04218.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Anti-endothelial cell antibodies (AECA) have been frequently detected in systemic vasculitis, which affects blood vessels of various sizes. To understand the pathogenic roles of AECA in systemic vasculitis, we attempted to identify target antigens for AECA comprehensively by a proteomic approach. Proteins extracted from human umbilical vein endothelial cells (HUVEC) were separated by two-dimensional electrophoresis, and Western blotting was subsequently conducted using sera from patients with systemic vasculitis. As a result, 53 autoantigenic protein spots for AECA were detected, nine of which were identified by mass spectrometry. One of the identified proteins was peroxiredoxin 2 (Prx2), an anti-oxidant enzyme. Frequency of anti-Prx2 autoantibodies, measured by enzyme-linked immunosorbent assay (ELISA), was significantly higher in systemic vasculitis (60%) compared to those in collagen diseases without clinical vasculitis (7%, P < 0·01) and healthy individuals (0%, P < 0·01). Further, the titres changed in parallel with the disease activity during time-courses. The presence of anti-Prx2 autoantibodies correlated significantly with elevation of serum d-dimers and thrombin-antithrombin complex (P < 0·05). Immunocytochemical analysis revealed that live endothelial cells expressed Prx2 on their surface. Interestingly, stimulation of HUVEC with rabbit anti-Prx2 antibodies increased secretion of interleukin (IL)-6, IL-1β, IL-1ra, growth regulated oncogene (GRO)-α, granulocyte colony-stimulating factor (G-CSF), granulocyte macrophage colony-stimulating factor (GM-CSF), IL-8 and monocyte chemoattractant protein (MCP)-1 more than twofold compared to that of with rabbit immunoglobulin (Ig)G. Taken together, our data suggest that anti-Prx2 autoantibodies would be a useful marker for systemic vasculitis and would be involved in the inflammatory processes of systemic vasculitis.
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Affiliation(s)
- R Karasawa
- Department of Frontier Medicine, Institute of Medical Science, St Marianna University Graduate School of Medicine, Miyamae-ku, Kawasaki, Japan
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Soltész P, Kerekes G, Dér H, Szücs G, Szántó S, Kiss E, Bodolay E, Zeher M, Timár O, Szodoray P, Szegedi G, Szekanecz Z. Comparative assessment of vascular function in autoimmune rheumatic diseases: considerations of prevention and treatment. Autoimmun Rev 2011; 10:416-25. [PMID: 21281743 DOI: 10.1016/j.autrev.2011.01.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 01/08/2011] [Indexed: 12/31/2022]
Abstract
Numerous autoimmune-inflammatory rheumatic diseases have been associated with accelerated atherosclerosis or other types of vasculopathy leading to increased cardio- and cerebrovascular disease risk. Traditional risk factors, as well as the role of systemic inflammation including cytokines, chemokines, proteases, autoantibodies, adhesion receptors and others have been implicated in the development of these vascular pathologies. The characteristics of vasculopathies may significantly differ depending on the underlying disease. While classical accelerated atherosclerosis has been associated with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or spondyloarthropathies (SpA), obliterative vasculopathy may rather be characteristic for systemic sclerosis (SSc) or mixed connective tissue disease (MCTD). Antiphospholipid antibodies have been implicated in vasculopathies underlying SLE, antiphospholipid syndrome (APS), RA and MCTD. There is also heterogeneity with respect to inflammatory risk factors. Cytokines, such as tumor necrosis factor-α (TNF-α) or interleukin 6 (IL-6) and immune complexes are primarily involved in arthritides, such as RA, SpA, as well as in SLE. On the other hand, autoantibodies including anti-oxLDL anti-cardiolipin and anti-β2GPI are rather involved in SLE- and APS-associated vasculopathies. Regarding the non-invasive assessment of vascular function, endothelial dysfunction, overt atherosclerosis and vascular stiffness may be indicated by brachial artery flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and aortic pulse-wave velocity (PWV), respectively. These abnormalities have been described in most inflammatory rheumatic diseases. While ccIMT and stiffness are relatively stable, FMD may be influenced by many confounding factors. In addition to traditional vasculoprotection, immunosuppressive agents including corticosteroids, traditional and biologic DMARDs may have significant vascular and metabolic effects. The official EULAR recommendations on the assessment and management of cardiovascular disease in arthritides have just been published, and similar recommendations in connective tissue diseases are to be developed soon.
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Affiliation(s)
- Pál Soltész
- University of Debrecen Medical and Health Sciences Center, Institute of Medicine, Third Department of Medicine, Angiology and Intensive Care Unit, Debrecen, Hungary
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Bartoloni E, Shoenfeld Y, Gerli R. Inflammatory and autoimmune mechanisms in the induction of atherosclerotic damage in systemic rheumatic diseases: Two faces of the same coin. Arthritis Care Res (Hoboken) 2011; 63:178-83. [DOI: 10.1002/acr.20322] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Vasculitis is pathologically identified as specific cellular inflammation, vessel destruction, and tissue necrosis. Current classifications of vasculitis such as the Chapel Hill Classification (CHCC) and American College of Rheumatology (ACR) guidelines are not sufficiently adequate for clinicians to diagnose vasculitis. The biomarkers that are currently in clinical use such as PR3-ANCA and MPO-ANCA, only help in diagnosing small vessel vasculitis and their sensitivity and specificity are not sufficient. However, recent developments related to the pathogenesis and etiopathogenesis of vasculitis have the potential to contribute to new and improved biomarkers. The determination of diverse roles of ANCA and synergistic effects of infection, genetic, environmental factors and drugs on pathogenesis is quite important. The demonstration of a new autoantibody directed to hLAMP-2 and the resemblance to some microbial structures, in addition to the determination of the possible roles of hepatitis B and C on vasculitis are important findings. These hints may lead to new biomarker developments, providing a better method to diagnose vasculitis. The evidence on T cell immunity as circulatory and lesional will likely contribute to the development of new drugs for vasculitis.
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Affiliation(s)
- Gülfidan Aras
- Yedikule Education and Research Hospital of Chest Diseases, Turkey.
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Weyand CM, Goronzy JJ. Polymyalgia rheumatica and giant cell arteritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00152-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Wada K, Kamisaki Y. Molecular dissection of Porphyromonas gingivalis-related arteriosclerosis: a novel mechanism of vascular disease. Periodontol 2000 2010; 54:222-34. [PMID: 20712642 DOI: 10.1111/j.1600-0757.2009.00336.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Interleukin (IL)-17 (also known as IL-17A) is produced by activated T cells. It is a marker cytokine of the T(H₁₇) lineage. IL-17 production is induced in infections, autoimmune diseases and other inflammatory events. IL-17 is involved in host defense, but also inflammatory tissue destruction. Vascular disease, mostly in the chronic form of atherosclerosis, is a leading cause of death. While normal vessels harbor only few leukocytes, large numbers of both innate and adaptive immune cells accumulate during vascular inflammation, both in chronic forms such as atherosclerosis and in acute vasculitis. IL-17 has a role in chronic vascular inflammation of atherosclerosis and possibly hypertensive vascular changes. In acute inflammation, IL-17 is elevated and may be causally involved in the autoimmune vasculitides including vasculitis in systemic lupus erythematodes. Blood vessels are important targets in alloimmune graft rejection and a number of studies provide data on a role of IL-17 in this context. This brief review summarizes the currently available evidence for and putative mechanisms of action of IL-17 in mouse models of and human vascular disease.
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Affiliation(s)
- Sibylle von Vietinghoff
- Division of Inflammation Biology, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
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Arranz L, De Castro NM, Baeza I, Maté I, Viveros MP, De la Fuente M. Environmental Enrichment Improves Age-Related Immune System Impairment: Long-Term Exposure Since Adulthood Increases Life Span in Mice. Rejuvenation Res 2010; 13:415-28. [DOI: 10.1089/rej.2009.0989] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lorena Arranz
- Department of Physiology (Animal Physiology II), Faculty of Biological Sciences, Madrid Complutense University, Madrid, Spain
| | - Nuria M. De Castro
- Department of Physiology (Animal Physiology II), Faculty of Biological Sciences, Madrid Complutense University, Madrid, Spain
| | - Isabel Baeza
- Department of Physiology (Animal Physiology II), Faculty of Biological Sciences, Madrid Complutense University, Madrid, Spain
| | - Ianire Maté
- Department of Physiology (Animal Physiology II), Faculty of Biological Sciences, Madrid Complutense University, Madrid, Spain
| | - Maria Paz Viveros
- Department of Physiology (Animal Physiology II), Faculty of Biological Sciences, Madrid Complutense University, Madrid, Spain
| | - Mónica De la Fuente
- Department of Physiology (Animal Physiology II), Faculty of Biological Sciences, Madrid Complutense University, Madrid, Spain
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