1
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Tucker SM, Essajee SI, Warne CM, Dick GM, Heard MP, Crowe N, Goulopoulou S, Tune JD. Impaired balance between coronary blood flow and myocardial metabolism in postpartum swine. J Mol Cell Cardiol 2024; 194:96-104. [PMID: 38971217 DOI: 10.1016/j.yjmcc.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Abstract
Understanding of the mechanisms contributing to the increased maternal susceptibility for major adverse cardiovascular events in the postpartum period remains poor. Accordingly, this study tested the hypothesis that the balance between coronary blood flow and myocardial metabolism is compromised during the puerperium period (35-45 days post-delivery) in swine. Systemic and coronary hemodynamic responses were assessed in anesthetized, open-chest control (nonpregnant) and puerperium/postpartum swine at baseline and in response to intravenous infusion of dobutamine (1-30 μg/kg/min). Blood pressure and heart rate were lower in postpartum swine at baseline and in response to dobutamine (P < 0.05). Coronary blood flow and myocardial oxygen delivery were significantly diminished at baseline in postpartum swine (P < 0.001), which corresponded with ∼35% reduction in myocardial oxygen consumption (MVO2) (P < 0.001). Postpartum swine displayed enhanced retrograde coronary flow, larger cardiomyocyte area (P < 0.01) and marked capillary rarefaction (P < 0.01). The relationship between coronary blood flow and heart rate (P < 0.05) or MVO2 (P < 0.001) was significantly diminished in postpartum swine as dobutamine increased MVO2 up to ∼135% in both groups. This reduction in myocardial perfusion was associated with decreases in myocardial lactate uptake (P < 0.001), increases in coronary venous PCO2 (P < 0.01) and decreased coronary venous pH (P < 0.01). These findings suggest an impaired balance between coronary blood flow and myocardial metabolism could contribute to the increased incidence of maternal myocardial ischemia and premature death in the postpartum period.
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Affiliation(s)
- Selina M Tucker
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Salman I Essajee
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Cooper M Warne
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Gregory M Dick
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Michael P Heard
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Nicole Crowe
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Styliani Goulopoulou
- Lawrence D. Longo, MD Center for Perinatal Biology, Departments of Basic Sciences, Gynecology and Obstetrics Loma Linda University, Loma Linda, CA, United States of America
| | - Johnathan D Tune
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, United States of America.
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2
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Aziz F, Tripolt NJ, Pferschy PN, Scharnagl H, Abdellatif M, Oulhaj A, Benedikt M, Kolesnik E, von Lewinski D, Sourij H. Ketone body levels and its associations with cardiac markers following an acute myocardial infarction: a post hoc analysis of the EMMY trial. Cardiovasc Diabetol 2024; 23:145. [PMID: 38678253 PMCID: PMC11055693 DOI: 10.1186/s12933-024-02221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/30/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been suggested to exert cardioprotective effects in patients with heart failure, possibly by improving the metabolism of ketone bodies in the myocardium. METHODS This post hoc analysis of the EMMY trial investigated the changes in serum β-hydroxybutyrate (3-βOHB) levels after acute myocardial infarction (AMI) in response to 26-week of Empagliflozin therapy compared to the usual post-MI treatment. In addition, the association of baseline and repeated measurements of 3-βOHB with cardiac parameters and the interaction effects of Empagliflozin were investigated. Cardiac parameters included N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricle end-systolic volume (LVESV), left ventricle end-diastolic volume (LVEDV), and left ventricular filling pressure (E/é ratio). RESULTS The mean 3-βOHB levels increased from baseline (46.2 ± 3.0 vs. 51.7 ± 2.7) to 6 weeks (48.8 ± 2.2 vs. 42.0 ± 2.3) and 26 weeks (49.3 ± 2.2 vs. 35.8 ± 1.9) in the Empagliflozin group compared to a consistent decline in placebo over 26 weeks (pinteraction < 0.001). Baseline and longitudinal measurements of 3-βOHB were not significantly associated with NT-proBNP and E/é ratio. Baseline 3-βOHB value was negatively associated with LVEF (coefficient: - 0.464, 95%CI - 0.863;- 0.065, p = 0.023), while an increase in its levels over time was positively associated with LVEF (0.595, 0.156;1.035, 0.008). The baseline 3-βOHB was positively associated with LVESV (1.409, 0.186;2.632, 0.024) and LVEDV (0.640, - 1.170;- 2.449, 0.488), while an increase in its levels over time was negatively associated with these cardiac parameters (LVESV: - 2.099, - 3.443;- 0.755, 0.002; LVEDV: - 2.406, - 4.341;- 0.472, 0.015). Empagliflozin therapy appears to modify the association between 3-βOHB, LVEF (pinteraction = 0.090), LVESV (pinteraction = 0.134), and LVEDV (pinteraction = 0.168), particularly at 26 weeks; however, the results were not statistically significant. CONCLUSION This post hoc analysis showed that SGLT2i increased 3-βOHB levels after AMI compared to placebo. Higher baseline 3-βOHB levels were inversely associated with cardiac function at follow-up, whereas a sustained increase in 3-βOHB levels over time improved these markers. This highlights the importance of investigating ketone body metabolism in different post-MI phases. Although more pronounced effect of 3-βOHB on cardiac markers was observed in the SGLT2i group, further research is required to explore this interaction effect.
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Affiliation(s)
- Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Norbert J Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Peter N Pferschy
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Hubert Scharnagl
- Clinical Institute for Chemical and Medical Laboratory Analysis, Medical University of Graz, Graz, Austria
| | | | - Abderrahim Oulhaj
- Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University of Sciences and Technology, Abu Dhabi, United Arab Emirates
- Biotechnology Center, Khalifa University of Sciences and Technology, Abu Dhabi, United Arab Emirates
| | - Martin Benedikt
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Medical University of Graz, Graz, Austria.
- Working Group Myocardial Energetics and Metabolism, Medical University of Graz, Graz, Austria.
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
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3
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Cottrill KA, Chandler JD, Kobara S, Stephenson ST, Mohammad AF, Tidwell M, Mason C, Van Dresser M, Patrignani J, Kamaleswaran R, Fitzpatrick AM, Grunwell JR. Metabolomics identifies disturbances in arginine, phenylalanine, and glycine metabolism as differentiating features of exacerbating atopic asthma in children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100115. [PMID: 37609569 PMCID: PMC10443927 DOI: 10.1016/j.jacig.2023.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Asthma exacerbations are highly prevalent in children, but only a few studies have examined the biologic mechanisms underlying exacerbations in this population. Objective High-resolution metabolomics analyses were performed to understand the differences in metabolites in children with exacerbating asthma who were hospitalized in a pediatric intensive care unit for status asthmaticus. We hypothesized that compared with a similar population of stable outpatients with asthma, children with exacerbating asthma would have differing metabolite abundance patterns with distinct clustering profiles. Methods A total of 98 children aged 6 through 17 years with exacerbating asthma (n = 69) and stable asthma (n = 29) underwent clinical characterization procedures and submitted plasma samples for metabolomic analyses. High-confidence metabolites were retained and utilized for pathway enrichment analyses to identify the most relevant metabolic pathways that discriminated between groups. Results In all, 118 and 131 high-confidence metabolites were identified in positive and negative ionization mode, respectively. A total of 103 unique metabolites differed significantly between children with exacerbating asthma and children with stable asthma. In all, 8 significantly enriched pathways that were largely associated with alterations in arginine, phenylalanine, and glycine metabolism were identified. However, other metabolites and pathways of interest were also identified. Conclusion Metabolomic analyses identified multiple perturbed metabolites and pathways that discriminated children with exacerbating asthma who were hospitalized for status asthmaticus. These results highlight the complex biology of inflammation in children with exacerbating asthma and argue for additional studies of the metabolic determinants of asthma exacerbations in children because many of the identified metabolites of interest may be amenable to targeted interventions.
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Affiliation(s)
| | - Joshua D. Chandler
- Department of Pediatrics, Emory University, Atlanta
- Children’s Healthcare of Atlanta
| | - Seibi Kobara
- Department of Biomedical Informatics, Emory University, Atlanta
| | | | | | | | | | | | | | - Rishikesan Kamaleswaran
- Department of Pediatrics, Emory University, Atlanta
- Department of Biomedical Informatics, Emory University, Atlanta
| | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta
- Children’s Healthcare of Atlanta
| | - Jocelyn R. Grunwell
- Department of Pediatrics, Emory University, Atlanta
- Children’s Healthcare of Atlanta
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4
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Wang Y, Sun X, Qiu J, Zhou A, Xu P, Liu Y, Wu H. A UHPLC-Q-TOF-MS-based serum and urine metabolomics approach reveals the mechanism of Gualou-Xiebai herb pair intervention against atherosclerosis process in ApoE -/- mice. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1215:123567. [PMID: 36529071 DOI: 10.1016/j.jchromb.2022.123567] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/05/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
Atherosclerosis (AS) is a metabolic disorder commonly correlated with a high-fat diet (HFD). There are many endogenous metabolic changes associated with AS development. Gualou-Xiebai (GLXB) is a traditional Chinese medicine herb pair that has been used to treat AS. However, the mechanism of GLXB herb pair on the process of AS is still essentially unknown. In this study, aortic histopathological examination and biochemical analyses were used to validate the anti-atherosclerotic effects of GLXB herb pair on ApoE-/- mice during the disease course of AS. The mechanism of GLXB herb pair were performed by metabolomics approach based on ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF-MS). As a result, GLXB herb pair has protective effects on AS lesion development and improves blood lipid levels in ApoE-/- mice. A total of 34, 39, and 49 metabolites were found to be profoundly altered in the 9-week, 14-week, and 19-week model groups compared with the corresponding control groups. Among them, 16, 18, and 18 metabolites showed a trend toward normal levels after pharmacological intervention. Metabolic pathway analysis found that GLXB herb pair mainly affects glycerophospholipid metabolism, pentose and glucuronate interconversions in 9 weeks; linoleic acid metabolism, cysteine and methionine metabolism, and arachidonic acid metabolism in 14 weeks; arachidonic acid metabolism and pentose and glucuronate interconversions in 19 weeks. The results demonstrated that GLXB herb pair mainly played a therapeutic role by regulating glycerophospholipid metabolism and pentose and glucuronate interconversions in the whole process of AS.
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Affiliation(s)
- Yuting Wang
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Xin Sun
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Jingwen Qiu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - An Zhou
- The Experimental Research Center, Anhui University of Chinese Medicine, Hefei 230038, China; Anhui Province Key Laboratory of Research & Development of Chinese Medicine, Hefei 230012, China.
| | - Pengbo Xu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Yarong Liu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; The Experimental Research Center, Anhui University of Chinese Medicine, Hefei 230038, China
| | - Hongfei Wu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; The Experimental Research Center, Anhui University of Chinese Medicine, Hefei 230038, China.
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5
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Licari C, Tenori L, Di Cesare F, Luchinat C, Giusti B, Kura A, De Cario R, Inzitari D, Piccardi B, Nesi M, Sarti C, Arba F, Palumbo V, Nencini P, Marcucci R, Gori AM, Sticchi E. Nuclear Magnetic Resonance-Based Metabolomics to Predict Early and Late Adverse Outcomes in Ischemic Stroke Treated with Intravenous Thrombolysis. J Proteome Res 2023; 22:16-25. [PMID: 36469426 PMCID: PMC9830637 DOI: 10.1021/acs.jproteome.2c00333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Metabolic perturbations and inflammatory mediators play a fundamental role in both early and late adverse post-acute ischemic stroke outcomes. Using data from the observational MAGIC (MArker bioloGici nell'Ictus Cerebrale) study, we evaluated the effect of 130 serum metabolic features, using a nuclear magnetic spectroscopy approach, on the following outcomes: hemorrhagic transformation at 24 h after stroke, non-response to intravenous thrombolytic treatment with the recombinant tissue plasminogen activator (rt-PA), and the 3 month functional outcome. Blood circulating metabolites, lipoproteins, and inflammatory markers were assessed at the baseline and 24 h after rt-PA treatment. Adjusting for the major determinants for unfavorable outcomes (i.e., age, sex, time onset-to-treatment, etc.), we found that acetone and 3-hydroxybutyrate were associated with symptomatic hemorrhagic transformation and with non-response to rt-PA; while 24 h after rt-PA, levels of triglycerides high-density lipoprotein (HDL) and triglycerides low-density lipoprotein (LDL) were associated with 3 month mortality. Cholesterol and phospholipids levels, mainly related to smaller and denser very low-density lipoprotein (VLDL) and LDL subfractions were associated with 3 month poor functional outcomes. We also reported associations between baseline 24 h relative variation (Δ) in VLDL subfractions and ΔC-reactive protein, Δinterleukin-10 levels with hemorrhagic transformation. All observed metabolic changes reflect a general condition of energy failure, oxidative stress, and systemic inflammation that characterize the development of adverse outcomes.
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Affiliation(s)
- Cristina Licari
- Magnetic
Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Firenze 50019, Italy
| | - Leonardo Tenori
- Magnetic
Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Firenze 50019, Italy,Department
of Chemistry “Ugo Schiff”, University of Florence, Via della Lastruccia 3-13, Sesto Fiorentino, Florence 50019, Italy
| | - Francesca Di Cesare
- Magnetic
Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Firenze 50019, Italy
| | - Claudio Luchinat
- Magnetic
Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Firenze 50019, Italy,Department
of Chemistry “Ugo Schiff”, University of Florence, Via della Lastruccia 3-13, Sesto Fiorentino, Florence 50019, Italy,CIRMMP, Via Luigi Sacconi
6, Sesto Fiorentino, Florence 50019, Italy
| | - Betti Giusti
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,Atherothrombotic
Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy,Excellence
Centre for Research, Transfer and High Education for the Development
of DE NOVO Therapies (DENOTHE), University
of Florence, Viale Pieraccini
6, Firenze 50139, Italy
| | - Ada Kura
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,Atherothrombotic
Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Rosina De Cario
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy
| | - Domenico Inzitari
- Stroke
Unit, Careggi University Hospital, Florence 50134, Italy,Institute
of Neuroscience, Italian National Research
Council (CNR), Via Madonna
del Piano, 10, Sesto Fiorentino, Florence 50019, Italy
| | | | - Mascia Nesi
- Stroke
Unit, Careggi University Hospital, Florence 50134, Italy
| | - Cristina Sarti
- NEUROFARBA
Department, Neuroscience Section, University
of Florence, Largo Brambilla
3, Florence 50134, Italy
| | - Francesco Arba
- Department
of Neurology, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Vanessa Palumbo
- Stroke
Unit, Careggi University Hospital, Florence 50134, Italy
| | | | - Rossella Marcucci
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,Atherothrombotic
Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy,Excellence
Centre for Research, Transfer and High Education for the Development
of DE NOVO Therapies (DENOTHE), University
of Florence, Viale Pieraccini
6, Firenze 50139, Italy
| | - Anna Maria Gori
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,Atherothrombotic
Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy,Excellence
Centre for Research, Transfer and High Education for the Development
of DE NOVO Therapies (DENOTHE), University
of Florence, Viale Pieraccini
6, Firenze 50139, Italy
| | - Elena Sticchi
- Department
of Experimental and Clinical Medicine, University
of Florence, Largo Brambilla
3, Florence 50134, Italy,
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6
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Viceconte N, Petrella G, Pelliccia F, Tanzilli G, Cicero DO. Unraveling Pathophysiology of Takotsubo Syndrome: The Emerging Role of the Oxidative Stress's Systemic Status. J Clin Med 2022; 11:jcm11247515. [PMID: 36556129 PMCID: PMC9781109 DOI: 10.3390/jcm11247515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Takotsubo Syndrome (TTS) is usually triggered by emotional or physical stressors, thus suggesting that an increased sympathetic activity, leading to myocardial perfusion abnormalities and ventricular dysfunction, plays a major pathogenetic role. However, it remains to be elucidated why severe emotional and physical stress might trigger TTS in certain individuals but not others. Clinical research has been focused mainly on mechanisms underlying the activation of the sympathetic nervous system and the occurrence of myocardial ischemia in TTS. However, scientific evidence shows that additional factors might play a pathophysiologic role in the condition's occurrence. In this regard, a significant contribution arrived from metabolomics studies that followed the systemic response to TTS. Specifically, preliminary data clearly show that there is an interplay between inflammation, genetics, and oxidative status which might explain susceptibility to the condition. This review aims to sum up the established pathogenetic factors underlying TTS and to appraise emerging mechanisms, with particular emphasis on oxidative status, which might better explain susceptibility to the condition.
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Affiliation(s)
- Nicola Viceconte
- Department of Internal Medicine, Anesthesiologic and Cardiovascular Sciences, University Sapienza, 00161 Rome, Italy
| | - Greta Petrella
- Department of Chemical Science and Technology, University of Rome “Tor Vergata”, 00123 Rome, Italy
| | - Francesco Pelliccia
- Department of Internal Medicine, Anesthesiologic and Cardiovascular Sciences, University Sapienza, 00161 Rome, Italy
- Correspondence:
| | - Gaetano Tanzilli
- Department of Internal Medicine, Anesthesiologic and Cardiovascular Sciences, University Sapienza, 00161 Rome, Italy
| | - Daniel Oscar Cicero
- Department of Chemical Science and Technology, University of Rome “Tor Vergata”, 00123 Rome, Italy
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7
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A Pilot Study on the 1H-NMR Serum Metabolic Profile of Takotsubo Patients Reveals Systemic Response to Oxidative Stress. Antioxidants (Basel) 2021; 10:antiox10121982. [PMID: 34943085 PMCID: PMC8750825 DOI: 10.3390/antiox10121982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 01/07/2023] Open
Abstract
Takotsubo syndrome (TTS) presents as an acute coronary syndrome characterized by severe left ventricular (LV) dysfunction and non-obstructive coronary artery disease that typically shows spontaneous recovery within days or weeks. The mechanisms behind TTS are mainly related to beta-adrenergic overstimulation and acute endogenous catecholamine surge, both of which could increase oxidative status that may induce further deterioration of cardiac function. Although several studies reported evidence of inflammation and oxidative stress overload in myocardial tissue of TTS models, systemic biochemical evidence of augmented oxidant activity in patients with TTS is lacking. In this study, serum samples of ten TTS patients and ten controls have been analyzed using 1H-NMR spectroscopy. The results of this pilot study show a marked alteration in the systemic metabolic profile of TTS patients, mainly characterized by significant elevation of ketone bodies, 2-hydroxybutyrate, acetyl-L-carnitine, and glutamate levels, in contrast with a decrease of several amino acid levels. The overall metabolic fingerprint reflects a systemic response to oxidative stress caused by the stressor that triggered the syndrome’s onset.
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8
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de Koning MSLY, Westenbrink BD, Assa S, Garcia E, Connelly MA, van Veldhuisen DJ, Dullaart RPF, Lipsic E, van der Harst P. Association of Circulating Ketone Bodies With Functional Outcomes After ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2021; 78:1421-1432. [PMID: 34593124 DOI: 10.1016/j.jacc.2021.07.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Circulating ketone bodies (KBs) are increased in patients with heart failure (HF), corresponding with increased cardiac KB metabolism and HF severity. However, the role of circulating KBs in ischemia/reperfusion remains unknown. OBJECTIVES This study sought to investigate longitudinal changes of KBs and their associations with functional outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI). METHODS KBs were measured in 369 participants from a randomized trial on early metformin therapy after STEMI. Nonfasting plasma concentrations of KBs (β-hydroxybutyrate, acetoacetate, and acetone) were measured by nuclear magnetic resonance spectroscopy at presentation, at 24 hours, and after 4 months. Myocardial infarct size and left ventricular ejection fraction (LVEF) were determined by cardiac magnetic resonance imaging at 4 months. Associations of circulating KBs with infarct size and LVEF were determined using multivariable linear regression analyses. RESULTS Circulating KBs were high at presentation with STEMI (median total KBs: 520 μmol/L; interquartile range [IQR]: 315-997 μmol/L). At 24 hours after reperfusion, KBs were still high compared with levels at 4-month follow-up (206 μmol/L [IQR: 174-246] vs 166 μmol/L [IQR: 143-201], respectively; P < 0.001). Increased KB concentrations at 24 hours were independently associated with larger myocardial infarct size (total KBs, per 100 μmol/L: β = 1.56; 95% confidence interval: 0.29-2.83; P = 0.016) and lower LVEF (β = -1.78; 95% CI: (-3.17 to -0.39; P = 0.012). CONCLUSIONS Circulating KBs are increased in patients presenting with STEMI. Higher KBs at 24 hours are associated with functional outcomes after STEMI, which suggests a potential role for ketone metabolism in response to myocardial ischemia. (Metabolic Modulation With Metformin to Reduce Heart Failure After Acute Myocardial Infarction: Glycometabolic Intervention as Adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III): a Randomized Controlled Trial; NCT01217307).
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Affiliation(s)
- Marie-Sophie L Y de Koning
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - B Daan Westenbrink
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Solmaz Assa
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erwin Garcia
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erik Lipsic
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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9
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Licari C, Tenori L, Giusti B, Sticchi E, Kura A, De Cario R, Inzitari D, Piccardi B, Nesi M, Sarti C, Arba F, Palumbo V, Nencini P, Marcucci R, Gori AM, Luchinat C, Saccenti E. Analysis of Metabolite and Lipid Association Networks Reveals Molecular Mechanisms Associated with 3-Month Mortality and Poor Functional Outcomes in Patients with Acute Ischemic Stroke after Thrombolytic Treatment with Recombinant Tissue Plasminogen Activator. J Proteome Res 2021; 20:4758-4770. [PMID: 34473513 PMCID: PMC8491161 DOI: 10.1021/acs.jproteome.1c00406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
![]()
Here, we present
an integrated multivariate, univariate, network
reconstruction and differential analysis of metabolite–metabolite
and metabolite–lipid association networks built from an array
of 18 serum metabolites and 110 lipids identified and quantified through
nuclear magnetic resonance spectroscopy in a cohort of 248 patients,
of which 22 died and 82 developed a poor functional outcome within
3 months from acute ischemic stroke (AIS) treated with intravenous
recombinant tissue plasminogen activator. We explored differences
in metabolite and lipid connectivity of patients who did not develop
a poor outcome and who survived the ischemic stroke from the related
opposite conditions. We report statistically significant differences
in the connectivity patterns of both low- and high-molecular-weight
metabolites, implying underlying variations in the metabolic pathway
involving leucine, glycine, glutamine, tyrosine, phenylalanine, citric,
lactic, and acetic acids, ketone bodies, and different lipids, thus
characterizing patients’ outcomes. Our results evidence the
promising and powerful role of the metabolite–metabolite and
metabolite–lipid association networks in investigating molecular
mechanisms underlying AIS patient’s outcome.
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Affiliation(s)
- Cristina Licari
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy
| | - Leonardo Tenori
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy.,Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (C.I.R.M.M.P.), Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy.,Department of Chemistry, University of Florence, Via della Lastruccia, 3, Sesto Fiorentino, Florence 50019, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.,Atherothrombotic Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy.,Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies (DENOTHE), University of Florence, Viale Pieraccini 6, Firenze 50139, Italy
| | - Elena Sticchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Ada Kura
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.,Atherothrombotic Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Rosina De Cario
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Domenico Inzitari
- Stroke Unit, Careggi University Hospital, Florence 50134, Italy.,Institute of Neuroscience, Italian National Research Council (CNR), Via Madonna del Piano, 10, Sesto Fiorentino, Florence 50019, Italy
| | | | - Mascia Nesi
- Stroke Unit, Careggi University Hospital, Florence 50134, Italy
| | - Cristina Sarti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Francesco Arba
- Department of Neurology, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Vanessa Palumbo
- Stroke Unit, Careggi University Hospital, Florence 50134, Italy
| | | | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.,Atherothrombotic Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy.,Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies (DENOTHE), University of Florence, Viale Pieraccini 6, Firenze 50139, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy.,Atherothrombotic Diseases Center, Careggi Hospital, Florence, Largo Brambilla 3, Florence 50134, Italy.,Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies (DENOTHE), University of Florence, Viale Pieraccini 6, Firenze 50139, Italy
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM), University of Florence, Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy.,Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (C.I.R.M.M.P.), Via Luigi Sacconi 6, Sesto Fiorentino, Florence 50019, Italy.,Department of Chemistry, University of Florence, Via della Lastruccia, 3, Sesto Fiorentino, Florence 50019, Italy
| | - Edoardo Saccenti
- Laboratory of Systems and Synthetic Biology, Wageningen University & Research, Stippeneng 4, Wageningen 6708 WE, the Netherlands
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10
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Lindsay RT, Dieckmann S, Krzyzanska D, Manetta-Jones D, West JA, Castro C, Griffin JL, Murray AJ. β-hydroxybutyrate accumulates in the rat heart during low-flow ischaemia with implications for functional recovery. eLife 2021; 10:e71270. [PMID: 34491199 PMCID: PMC8423437 DOI: 10.7554/elife.71270] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022] Open
Abstract
Extrahepatic tissues which oxidise ketone bodies also have the capacity to accumulate them under particular conditions. We hypothesised that acetyl-coenzyme A (acetyl-CoA) accumulation and altered redox status during low-flow ischaemia would support ketone body production in the heart. Combining a Langendorff heart model of low-flow ischaemia/reperfusion with liquid chromatography coupled tandem mass spectrometry (LC-MS/MS), we show that β-hydroxybutyrate (β-OHB) accumulated in the ischaemic heart to 23.9 nmol/gww and was secreted into the coronary effluent. Sodium oxamate, a lactate dehydrogenase (LDH) inhibitor, increased ischaemic β-OHB levels 5.3-fold and slowed contractile recovery. Inhibition of β-hydroxy-β-methylglutaryl (HMG)-CoA synthase (HMGCS2) with hymeglusin lowered ischaemic β-OHB accumulation by 40%, despite increased flux through succinyl-CoA-3-oxaloacid CoA transferase (SCOT), resulting in greater contractile recovery. Hymeglusin also protected cardiac mitochondrial respiratory capacity during ischaemia/reperfusion. In conclusion, net ketone generation occurs in the heart under conditions of low-flow ischaemia. The process is driven by flux through both HMGCS2 and SCOT, and impacts on cardiac functional recovery from ischaemia/reperfusion.
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Affiliation(s)
- Ross T Lindsay
- Department of Physiology, Development and Neuroscience, University of CambridgeLondonUnited Kingdom
- Department of Biochemistry and Cambridge Systems Biology Centre, University of CambridgeLondonUnited Kingdom
| | - Sophie Dieckmann
- Department of Physiology, Development and Neuroscience, University of CambridgeLondonUnited Kingdom
| | - Dominika Krzyzanska
- Department of Physiology, Development and Neuroscience, University of CambridgeLondonUnited Kingdom
| | - Dominic Manetta-Jones
- Department of Physiology, Development and Neuroscience, University of CambridgeLondonUnited Kingdom
| | - James A West
- Department of Biochemistry and Cambridge Systems Biology Centre, University of CambridgeLondonUnited Kingdom
| | - Cecilia Castro
- Department of Biochemistry and Cambridge Systems Biology Centre, University of CambridgeLondonUnited Kingdom
| | - Julian L Griffin
- Department of Biochemistry and Cambridge Systems Biology Centre, University of CambridgeLondonUnited Kingdom
- Section of Biomolecular Medicine, Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College LondonLondonUnited Kingdom
| | - Andrew J Murray
- Department of Physiology, Development and Neuroscience, University of CambridgeLondonUnited Kingdom
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11
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Deidda M, Noto A, Cadeddu Dessalvi C, Andreini D, Andreotti F, Ferrannini E, Latini R, Maggioni AP, Magnoni M, Maseri A, Mercuro G. Metabolomic correlates of coronary atherosclerosis, cardiovascular risk, both or neither. Results of the 2 × 2 phenotypic CAPIRE study. Int J Cardiol 2021; 336:14-21. [PMID: 34022320 DOI: 10.1016/j.ijcard.2021.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Traditional cardiovascular risk factors (RFs) and coronary artery disease (CAD) do not always run parallel. We investigated functional-metabolic correlations of CAD, RFs, or neither in the CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation) 2 × 2 phenotypic observational study. METHODS Two hundred and fortyone subjects were included based on RF burden, presence/absence of CAD (assessed by computed tomography angiography), age and sex. Participants displayed one of four phenotypes: CAD with ≥3 RFs, no-CAD with ≥3 RFs, CAD with ≤1 RF and no-CAD with ≤1 RF. Metabolites were identified by gas chromatography-mass spectrometry and pathways by metabolite set enrichment analysis. RESULTS Characteristic patterns and specific pathways emerged for each phenotypic group: amino sugars for CAD/high-RF; urea cycle for no-CAD/high-RF; glutathione for CAD/low-RF; glycine and serine for no-CAD/low-RF. Presence of CAD correlated with ammonia recycling; absence of CAD with the transfer of acetyl groups into mitochondria; high-risk profile with alanine metabolism (all p < 0.05). The comparative case-control analyses showed a statistically significant difference for the two pathways of phenylalanine, tyrosine and tryptophan biosynthesis and phenylalanine metabolism in the CAD/Low-RF vs NoCAD/Low-RF comparison. CONCLUSIONS The present 2 × 2 observational study identified specific metabolic pathways for each of the four phenotypes, providing novel functional insights, particularly on CAD with low RF profiles and on the absence of CAD despite high-risk factor profiles.
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Affiliation(s)
- Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Noto
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy
| | - Felicita Andreotti
- Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Roberto Latini
- Mario Negri Institute of Pharmacological Research, IRCCS, Milan, Italy
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Marco Magnoni
- IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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12
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Vignoli A, Tenori L, Giusti B, Takis PG, Valente S, Carrabba N, Balzi D, Barchielli A, Marchionni N, Gensini GF, Marcucci R, Luchinat C, Gori AM. NMR-based metabolomics identifies patients at high risk of death within two years after acute myocardial infarction in the AMI-Florence II cohort. BMC Med 2019; 17:3. [PMID: 30616610 PMCID: PMC6323789 DOI: 10.1186/s12916-018-1240-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 12/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Risk stratification and management of acute myocardial infarction patients continue to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The aim of this study was to investigate the metabolomic fingerprint of acute myocardial infarction using nuclear magnetic resonance spectroscopy on patient serum samples and to evaluate the possible role of metabolomics in the prognostic stratification of acute myocardial infarction patients. METHODS In total, 978 acute myocardial infarction patients were enrolled in this study; of these, 146 died and 832 survived during 2 years of follow-up after the acute myocardial infarction. Serum samples were analyzed via high-resolution 1H-nuclear magnetic resonance spectroscopy and the spectra were used to characterize the metabolic fingerprint of patients. Multivariate statistics were used to create a prognostic model for the prediction of death within 2 years after the cardiovascular event. RESULTS In the training set, metabolomics showed significant differential clustering of the two outcomes cohorts. A prognostic risk model predicted death with 76.9% sensitivity, 79.5% specificity, and 78.2% accuracy, and an area under the receiver operating characteristics curve of 0.859. These results were reproduced in the validation set, obtaining 72.6% sensitivity, 72.6% specificity, and 72.6% accuracy. Cox models were used to compare the known prognostic factors (for example, Global Registry of Acute Coronary Events score, age, sex, Killip class) with the metabolomic random forest risk score. In the univariate analysis, many prognostic factors were statistically associated with the outcomes; among them, the random forest score calculated from the nuclear magnetic resonance data showed a statistically relevant hazard ratio of 6.45 (p = 2.16×10-16). Moreover, in the multivariate regression only age, dyslipidemia, previous cerebrovascular disease, Killip class, and random forest score remained statistically significant, demonstrating their independence from the other variables. CONCLUSIONS For the first time, metabolomic profiling technologies were used to discriminate between patients with different outcomes after an acute myocardial infarction. These technologies seem to be a valid and accurate addition to standard stratification based on clinical and biohumoral parameters.
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Affiliation(s)
- Alessia Vignoli
- Magnetic Resonance Center (CERM), University of Florence, Sesto Fiorentino, Italy.,Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine - C.I.R.M.M.P, Sesto Fiorentino, Italy
| | - Leonardo Tenori
- Magnetic Resonance Center (CERM), University of Florence, Sesto Fiorentino, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. .,Careggi Hospital, Florence, Italy.
| | | | | | | | | | | | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Careggi Hospital, Florence, Italy
| | | | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Careggi Hospital, Florence, Italy
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM), University of Florence, Sesto Fiorentino, Italy.,Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine - C.I.R.M.M.P, Sesto Fiorentino, Italy.,Department of Chemistry, University of Florence, Sesto Fiorentino, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Careggi Hospital, Florence, Italy
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