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Rehberger Likozar A, Ugovšek S, Šebeštjen M. Effects of proprotein convertase subtilisin-kexin type 9 inhibitors on inflammatory and hemostatic parameters in post myocardial infarction patients. Eur J Pharmacol 2024; 963:176232. [PMID: 38070635 DOI: 10.1016/j.ejphar.2023.176232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
Despite progress in treatment, elevated levels of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) (Lp(a)), represent a significant part of the residual risk. Both are associated with inflammation and the coagulation fibrinolytic system. The purpose of our research was to evaluate the effect of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) on lipid parameters and indicators of inflammation, coagulation and fibrinolysis. We included 100 post myocardial infarction (MI) patients with insufficiently controlled LDL-C values despite the maximum dose of statin, and highly elevated Lp(a). Patients received alirocumab or evolocumab (150 mg sc or 140 mg sc every two weeks, respectively), or placebo for 6 months. In patients receiving PCSK9i, a significant decrease in total cholesterol (TC), LDL-C, triglycerides (TG) and Lp(a), and an increase in high density lipoprotein cholesterol (p < 0.001 for all) was found. Before treatment, the concentrations of TC, LDL-C and TG correlated with the concentrations of thrombin activatable fibrinolysis inhibitor (r = 0.41, p < 0.001; r = 0.353, p < 0.001; r = 0.311, p = 0.003, respectively), and plasminogen activator inhibitor-1 (r = 0.302, p = 0.007; r = 0.218, p = 0.049; r = 0.278; p = 0.013, respectively). The concentrations of TC and LDL-C correlated with overall fibrinolytic potential (r = -0.220, p = 0.034; r = -0.207, p = 0.047, respectively). The concentration of TG was related to the concentration of interleukin 6 (r = 0.290, p = 0.004) and interleukin 8 (r = 0.332, p = 0.001). No correlations between Lp(a) and inflammatory or hemostatic variables were found. No associations were found after treatment. Our results show that inflammatory cytokines and fibrinolytic parameters are related to LDL-C and not Lp(a) in post-MI patients before and with neither of them following PCSK9i treatment. The trial registration number: NCT04613167, Date of registration: November 3, 2020.
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Affiliation(s)
- Andreja Rehberger Likozar
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Sabina Ugovšek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Cardiology, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
| | - Miran Šebeštjen
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Cardiology, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia.
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Satoh T, Satoh K, Yaoita N, Kikuchi N, Omura J, Kurosawa R, Numano K, Al-Mamun E, Siddique MAH, Sunamura S, Nogi M, Suzuki K, Miyata S, Morser J, Shimokawa H. Activated TAFI Promotes the Development of Chronic Thromboembolic Pulmonary Hypertension: A Possible Novel Therapeutic Target. Circ Res 2017; 120:1246-1262. [PMID: 28289017 DOI: 10.1161/circresaha.117.310640] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/07/2017] [Accepted: 03/10/2017] [Indexed: 11/16/2022]
Abstract
RATIONALE Pulmonary hypertension is a fatal disease; however, its pathogenesis still remains to be elucidated. Thrombin-activatable fibrinolysis inhibitor (TAFI) is synthesized by the liver and inhibits fibrinolysis. Plasma TAFI levels are significantly increased in chronic thromboembolic pulmonary hypertension (CTEPH) patients. OBJECTIVE To determine the role of activated TAFI (TAFIa) in the development of CTEPH. METHODS AND RESULTS Immunostaining showed that TAFI and its binding partner thrombomodulin (TM) were highly expressed in the pulmonary arteries (PAs) and thrombus in patients with CTEPH. Moreover, plasma levels of TAFIa were increased 10-fold in CTEPH patients compared with controls. In mice, chronic hypoxia caused a 25-fold increase in plasma levels of TAFIa with increased plasma levels of thrombin and TM, which led to thrombus formation in PA, vascular remodeling, and pulmonary hypertension. Consistently, plasma clot lysis time was positively correlated with plasma TAFIa levels in mice. Additionally, overexpression of TAFIa caused organized thrombus with multiple obstruction of PA flow and reduced survival rate under hypoxia in mice. Bone marrow transplantation showed that circulating plasma TAFI from the liver, not in the bone marrow, was activated locally in PA endothelial cells through interactions with thrombin and TM. Mechanistic experiments demonstrated that TAFIa increased PA endothelial permeability, smooth muscle cell proliferation, and monocyte/macrophage activation. Importantly, TAFIa inhibitor and peroxisome proliferator-activated receptor-α agonists significantly reduced TAFIa and ameliorated animal models of pulmonary hypertension in mice and rats. CONCLUSIONS These results indicate that TAFIa could be a novel biomarker and realistic therapeutic target of CTEPH.
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Affiliation(s)
- Taijyu Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Kimio Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Nobuhiro Yaoita
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Nobuhiro Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Junichi Omura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Ryo Kurosawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Kazuhiko Numano
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Elias Al-Mamun
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Mohammad Abdul Hai Siddique
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Shinichiro Sunamura
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Masamichi Nogi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Kota Suzuki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - John Morser
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.)
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (T.S., K. Satoh, N.Y., N.K., J.O., R.K., K.N., E.A.-M., M.A.H.S., S.S., M.N., K. Suzuki, S.M., H.S.); and Department of Hematology, Stanford School of Medicine, CA (J.M.).
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