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Zou ZY, He LX, Yao YT. The effects of tranexamic acid on platelets in patients undergoing cardiac surgery: a systematic review and meta-analysis. J Thromb Thrombolysis 2024; 57:235-247. [PMID: 37962715 DOI: 10.1007/s11239-023-02905-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/15/2023]
Abstract
This meta-analysis was designed to evaluate the effects of tranexamic acid (TXA) on platelets in patients undergoing cardiac surgery (CS). Relevant trials were identified by computerized searches of PUBMED, Cochrane Library, EMBASE, OVID, China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Data till Jun 4th, 2022, were searched using search terms "platelet", "Tranexamic acid", "cardiac surgery", "randomized controlled trial" database search was updated on Jan 1st 2023. Primary outcomes included platelet counts, function and platelet membrane proteins. Secondary outcome included postoperative bleeding. Search yielded 49 eligible trials, which were finally included in the current study. As compared to Control, TXA did not influence post-operative platelet counts in adult patients undergoing on- or off-pump CS, but significantly increased post-operative platelet counts in pediatric patients undergoing on-pump CS [(WMD = 16.72; 95% CI 6.33 to 27.10; P = 0.002)], significantly increased post-operative platelet counts in adults valvular surgery [(WMD = 14.24; 95% CI 1.36 to 27.12; P = 0.03). Additionally, TXA improved ADP-stimulated platelet aggression [(WMD = 1.88; 95% CI 0.93 to 2.83; P = 0.0001)] and improved CD63 expression on platelets [(WMD = 0.72; 95% CI 0.29 to 1.15; P = 0.001)]. The current study demonstrated that TXA administration did not affect post-operative platelet counts in adult patients undergoing either on- or off-pump CABG, but significantly increased post-operative platelet counts in pediatric patients undergoing on-pump CS and adults valvular surgery. Furthermore, TXA improved ADP-stimulated platelet aggression and improved CD63 expression on platelets. To further confirm this, more well designed and adequately powered randomized trials are needed.
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Affiliation(s)
- Zhi-Yao Zou
- Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, 650000, Kunming, Yunnan Province, China
| | - Li-Xian He
- Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, 650000, Kunming, Yunnan Province, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, 100037, Beijing, China.
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2
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Infante B, Conserva F, Pontrelli P, Leo S, Stasi A, Fiorentino M, Troise D, dello Strologo A, Alfieri C, Gesualdo L, Castellano G, Stallone G. Recent advances in molecular mechanisms of acute kidney injury in patients with diabetes mellitus. Front Endocrinol (Lausanne) 2023; 13:903970. [PMID: 36686462 PMCID: PMC9849571 DOI: 10.3389/fendo.2022.903970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
Several insults can lead to acute kidney injury (AKI) in native kidney and transplant patients, with diabetes critically contributing as pivotal risk factor. High glucose per se can disrupt several signaling pathways within the kidney that, if not restored, can favor the instauration of mechanisms of maladaptive repair, altering kidney homeostasis and proper function. Diabetic kidneys frequently show reduced oxygenation, vascular damage and enhanced inflammatory response, features that increase the kidney vulnerability to hypoxia. Importantly, epidemiologic data shows that previous episodes of AKI increase susceptibility to diabetic kidney disease (DKD), and that patients with DKD and history of AKI have a generally worse prognosis compared to DKD patients without AKI; it is therefore crucial to monitor diabetic patients for AKI. In the present review, we will describe the causes that contribute to increased susceptibility to AKI in diabetes, with focus on the molecular mechanisms that occur during hyperglycemia and how these mechanisms expose the different types of resident renal cells to be more vulnerable to maladaptive repair during AKI (contrast- and drug-induced AKI). Finally, we will review the list of the existing candidate biomarkers of diagnosis and prognosis of AKI in patients with diabetes.
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Affiliation(s)
- Barbara Infante
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Conserva
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Paola Pontrelli
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Serena Leo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandra Stasi
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Marco Fiorentino
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Dario Troise
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Carlo Alfieri
- Nephrology, Dialysis and Renal Transplant Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Castellano
- Nephrology, Dialysis and Renal Transplant Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Stallone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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3
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Kefalogianni R, Kamani F, Gaspar M, Aw TC, Donovan J, Laffan M, Pickering MC, Arachchillage DJ. Complement activation during cardiopulmonary bypass and association with clinical outcomes. EJHAEM 2022; 3:86-96. [PMID: 35846208 PMCID: PMC9175769 DOI: 10.1002/jha2.371] [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] [Received: 11/04/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/08/2022]
Abstract
In this prospective, single-centre observational study of 30 patients undergoing cardiopulmonary bypass (CPB), the effect of unfractionated heparin (UFH), CPB surgery and protamine sulphate on complement and on post-operative blood loss were assessed. Although C3 and C4 levels decreased significantly immediately following the administration of UFH, C3a, C5a, Bb fragment and SC5b-9 remained unchanged. During CPB, C3 and C4 continued to fall whilst both alternative and classical pathways activation markers, Bb, C3a, C5a and SC5b-9 increased significantly. Protamine sulphate had no effect on classical pathway components or activation markers but decreased alternative pathway activation marker Bb. Over the 12-24 h post-surgery, both classical and alternative pathway activation markers returned to baseline, whilst C3 and C4 levels increased significantly but not to baseline values. Total drain volume 24 h after the surgery showed a moderate inverse correlation with post-protamine C3 (r = -0.46, p = 0.01) and C4 (r = -0.57, p = 0.0009) levels, whilst a moderate positive correlation was observed with post-protamine C3a (r = 0.46, p = 0.009), C5a (r = 0.37, p = 0.04) and SC5b-9 (r = 0.56, p = 0.001) levels but not with Bb fragment (r = 0.25, p = 0.17). Thus, inhibition of complement activation may be a therapeutic intervention to reduce post-operative blood in patients undergoing CPB.
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Affiliation(s)
| | - Farah Kamani
- Department of HaematologyRoyal Brompton HospitalLondonUK
| | - Mihaela Gaspar
- Department of HaematologyRoyal Brompton HospitalLondonUK
| | - TC Aw
- Department of Anesthesia and Critical CareRoyal Brompton HospitalLondonUK
| | - Jackie Donovan
- Department of BiochemistryRoyal Brompton HospitalLondonUK
| | - Mike Laffan
- Centre for HaematologyDepartment of Immunology and InflammationImperial College LondonLondonUK
| | | | - Deepa J. Arachchillage
- Department of HaematologyRoyal Brompton HospitalLondonUK
- Centre for HaematologyDepartment of Immunology and InflammationImperial College LondonLondonUK
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4
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Xu H, Xie J, Yang J, Huang Z, Wang D, Pei F. Synergistic Effect of a Prolonged Combination Course of Tranexamic Acid and Dexamethasone Involving High Initial Doses in Total Knee Arthroplasty: A Randomized Controlled Trial. J Knee Surg 2021; 36:515-523. [PMID: 34794198 DOI: 10.1055/s-0041-1739197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The optimal regimes of tranexamic acid (TXA) and dexamethasone (DXM) in total knee arthroplasty (TKA) are still uncertain. The aim of this study was to assess the efficacy and safety of a prolonged course of intravenous TXA and DXM involving a high initial dose in TKA. Patients who underwent primary TKA at our center were randomized to receive one of four regimes: control (group A), prolonged course of TXA (B), prolonged course of DXM (C), or the combination of a prolonged course of TXA and DXM (D). The four groups were compared in primary outcomes (fibrinolytic and inflammatory markers, knee function, postoperative pain levels, and consumption of opioids) and secondary outcomes (blood loss, maximal drop in hemoglobin, coagulation, fasting blood glucose, and complications). A total of 162 patients were enrolled. On postoperative days 2 and 3, fibrinolytic markers were lower in groups B and D than in groups A and C; inflammatory markers were lower in groups C and D than in groups A and B. Inflammatory markers were lower in group B than in group A on postoperative day 3. Postoperative pain levels and oxycodone consumption were lower, and knee function was better in groups C and D. The four groups did not differ in any of the secondary outcomes. A prolonged course of intravenous TXA and DXM involving high initial doses can effectively inhibit postoperative fibrinolytic and inflammatory responses, reduce pain, and improve knee function after TKA.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
| | - Jinwei Xie
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
| | - Jingli Yang
- College of Earth and Environmental Sciences and School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Zeyu Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Duan Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
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5
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Vogel CW. The Role of Complement in Myocardial Infarction Reperfusion Injury: An Underappreciated Therapeutic Target. Front Cell Dev Biol 2020; 8:606407. [PMID: 33425913 PMCID: PMC7793727 DOI: 10.3389/fcell.2020.606407] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022] Open
Abstract
This article reviews the pathogenetic role of the complement system in myocardial infarction reperfusion injury. The complement activation pathways involved in myocardial tissue injury are identified, as are the complement-derived effector molecules. The results of past anti-complement therapies are reviewed; as the more recent therapeutic concept of complement depletion with humanized CVF described.
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Affiliation(s)
- Carl-Wilhelm Vogel
- University of Hawaii Cancer Center and Department of Pathology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
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Sauter RJ, Sauter M, Reis ES, Emschermann FN, Nording H, Ebenhöch S, Kraft P, Münzer P, Mauler M, Rheinlaender J, Madlung J, Edlich F, Schäffer TE, Meuth SG, Duerschmied D, Geisler T, Borst O, Gawaz M, Kleinschnitz C, Lambris JD, Langer HF. Functional Relevance of the Anaphylatoxin Receptor C3aR for Platelet Function and Arterial Thrombus Formation Marks an Intersection Point Between Innate Immunity and Thrombosis. Circulation 2019; 138:1720-1735. [PMID: 29802205 DOI: 10.1161/circulationaha.118.034600] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Platelets have distinct roles in the vascular system in that they are the major mediator of thrombosis, critical for restoration of tissue integrity, and players in vascular inflammatory conditions. In close spatiotemporal proximity, the complement system acts as the first line of defense against invading microorganisms and is a key mediator of inflammation. Whereas the fluid phase cross-talk between the complement and coagulation systems is well appreciated, the understanding of the pathophysiological implications of such interactions is still scant. METHODS We analyzed coexpression of the anaphylatoxin receptor C3aR with activated glycoprotein IIb/IIIa on platelets of 501 patients with coronary artery disease using flow cytometry; detected C3aR expression in human or murine specimen by polymerase chain reaction, immunofluorescence, Western blotting, or flow cytometry; and examined the importance of platelet C3aR by various in vitro platelet function tests, in vivo bleeding time, and intravital microscopy. The pathophysiological relevance of C3aR was scrutinized with the use of disease models of myocardial infarction and stroke. To approach underlying molecular mechanisms, we identified the platelet small GTPase Rap1b using nanoscale liquid chromatography coupled to tandem mass spectrometry. RESULTS We found a strong positive correlation of platelet complement C3aR expression with activated glycoprotein IIb/IIIa in patients with coronary artery disease and coexpression of C3aR with glycoprotein IIb/IIIa in thrombi obtained from patients with myocardial infarction. Our results demonstrate that the C3a/C3aR axis on platelets regulates distinct steps of thrombus formation such as platelet adhesion, spreading, and Ca2+ influx. Using C3aR-/- mice or C3-/- mice with reinjection of C3a, we uncovered that the complement activation fragment C3a regulates bleeding time after tail injury and thrombosis. Notably, C3aR-/- mice were less prone to experimental stroke and myocardial infarction. Furthermore, reconstitution of C3aR-/- mice with C3aR+/+ platelets and platelet depletion experiments demonstrated that the observed effects on thrombosis, myocardial infarction, and stroke were specifically caused by platelet C3aR. Mechanistically, C3aR-mediated signaling regulates the activation of Rap1b and thereby bleeding arrest after injury and in vivo thrombus formation. CONCLUSIONS Overall, our findings uncover a novel function of the anaphylatoxin C3a for platelet function and thrombus formation, highlighting a detrimental role of imbalanced complement activation in cardiovascular diseases.
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Affiliation(s)
- Reinhard J Sauter
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany.,Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Manuela Sauter
- Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Edimara S Reis
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia (E.S.R., J.D.L.)
| | - Frederic N Emschermann
- Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Henry Nording
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany.,Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Sonja Ebenhöch
- Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Peter Kraft
- Department of Neurology, University of Würzburg, Germany (P.K.)
| | - Patrick Münzer
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Maximilian Mauler
- Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine (M.M., D.D.), University of Freiburg, Germany
| | - Johannes Rheinlaender
- Institute of Applied Physics (J.R., T.E.S.), Eberhard Karls-University Tübingen, Germany
| | - Johannes Madlung
- Proteom Center, Interfaculty Institute for Cell Biology (J.M.), Eberhard Karls-University Tübingen, Germany
| | - Frank Edlich
- Institute of Biochemistry (F.E.), University of Freiburg, Germany.,Institute for Biochemistry and Molecular Biology, University of Freiburg, Germany (F.E.).,BIOSS, Centre for Biological Signaling Studies, University of Freiburg, Germany (F.E.)
| | - Tilman E Schäffer
- Institute of Applied Physics (J.R., T.E.S.), Eberhard Karls-University Tübingen, Germany
| | - Sven G Meuth
- Department of Neurology, University of Münster, Germany (S.G.M.)
| | - Daniel Duerschmied
- Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine (M.M., D.D.), University of Freiburg, Germany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Oliver Borst
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany
| | | | - John D Lambris
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia (E.S.R., J.D.L.)
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Clinic (R.J.S., H.N., P.M., T.G., O.B., M.G., H.F.L.), Eberhard Karls-University Tübingen, Germany.,Section for Cardioimmunology (R.J.S., M.S., F.N.E., H.N., S.E., H.F.L.), Eberhard Karls-University Tübingen, Germany
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Vishwakarma VK, Upadhyay PK, Gupta JK, Yadav HN. Pathophysiologic role of ischemia reperfusion injury: A review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jicc.2017.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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9
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Abstract
The importance of inflammation and inflammatory pathways in atherosclerotic disease and acute coronary syndromes (ACS) is well established. The success of statin therapy rests not only on potently reducing levels of low-density lipoprotein cholesterol, but also on the many beneficial, pleiotropic effects statin therapy has on various inflammatory mechanisms in atherosclerotic disease, from reducing endothelial dysfunction to attenuating levels of serum C-reactive protein. Due to the growing awareness of the importance of inflammation in ACS, investigators have attempted to develop novel therapies against known markers of inflammation for several decades. Targeted pathways have ranged from inhibiting C5 cleavage with a high-affinity monoclonal antibody against C5 to inhibiting the activation of the p38 mitogen-activated protein kinase signaling cascades. In each of these instances, despite promising early preclinical and mechanistic studies and phase 2 trials suggesting a potential benefit in reducing post-MI complications or restenosis, these novel therapies have failed to show benefits during large, phase 3 clinical outcomes trials. This review discusses several examples of novel anti-inflammatory therapies that failed to show significant improvement on clinical outcomes when tested in large, randomized trials and highlights potential explanations for why targeted therapies against known markers of inflammation in ACS have failed to launch.
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Key Words
- ACS, acute coronary syndromes
- CABG, coronary artery bypass graft
- CAD, coronary artery disease
- HDL-C, high-density lipoprotein cholesterol
- IL, interleukin
- LDL-C, low-density lipoprotein cholesterol
- Lp-PLA2, lipoprotein-associated phospholipase A2
- MAPK, mitogen-activated protein kinase
- MI, myocardial infarction
- NSTEMI, non–ST-segment myocardial infarction
- PCI, percutaneous coronary intervention
- PSGL, P-selectin glycoprotein ligand
- STEMI, ST-segment elevation myocardial infarction
- SVG, saphenous vein grafts
- TBR, tissue-to-background ratio
- acute coronary syndrome
- anti-inflammatory
- drug targets
- hsCRP, high-sensitivity C-reactive protein
- sPLA2, secretory phospholipase A2
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Chun N, Haddadin AS, Liu J, Hou Y, Wong KA, Lee D, Rushbrook JI, Gulaya K, Hines R, Hollis T, Nistal Nuno B, Mangi AA, Hashim S, Pekna M, Catalfamo A, Chin HY, Patel F, Rayala S, Shevde K, Heeger PS, Zhang M. Activation of complement factor B contributes to murine and human myocardial ischemia/reperfusion injury. PLoS One 2017; 12:e0179450. [PMID: 28662037 PMCID: PMC5491012 DOI: 10.1371/journal.pone.0179450] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/29/2017] [Indexed: 12/28/2022] Open
Abstract
The pathophysiology of myocardial injury that results from cardiac ischemia and reperfusion (I/R) is incompletely understood. Experimental evidence from murine models indicates that innate immune mechanisms including complement activation via the classical and lectin pathways are crucial. Whether factor B (fB), a component of the alternative complement pathway required for amplification of complement cascade activation, participates in the pathophysiology of myocardial I/R injury has not been addressed. We induced regional myocardial I/R injury by transient coronary ligation in WT C57BL/6 mice, a manipulation that resulted in marked myocardial necrosis associated with activation of fB protein and myocardial deposition of C3 activation products. In contrast, in fB-/- mice, the same procedure resulted in significantly reduced myocardial necrosis (% ventricular tissue necrotic; fB-/- mice, 20 ± 4%; WT mice, 45 ± 3%; P < 0.05) and diminished deposition of C3 activation products in the myocardial tissue (fB-/- mice, 0 ± 0%; WT mice, 31 ± 6%; P<0.05). Reconstitution of fB-/- mice with WT serum followed by cardiac I/R restored the myocardial necrosis and activated C3 deposition in the myocardium. In translational human studies we measured levels of activated fB (Bb) in intracoronary blood samples obtained during cardio-pulmonary bypass surgery before and after aortic cross clamping (AXCL), during which global heart ischemia was induced. Intracoronary Bb increased immediately after AXCL, and the levels were directly correlated with peripheral blood levels of cardiac troponin I, an established biomarker of myocardial necrosis (Spearman coefficient = 0.465, P < 0.01). Taken together, our results support the conclusion that circulating fB is a crucial pathophysiological amplifier of I/R-induced, complement-dependent myocardial necrosis and identify fB as a potential therapeutic target for prevention of human myocardial I/R injury.
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Affiliation(s)
- Nicholas Chun
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ala S. Haddadin
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Junying Liu
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Yunfang Hou
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Karen A. Wong
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Daniel Lee
- Department of Surgery, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Julie I. Rushbrook
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Karan Gulaya
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Roberta Hines
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Tamika Hollis
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Beatriz Nistal Nuno
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Abeel A. Mangi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Sabet Hashim
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Marcela Pekna
- Department of Medical Chemistry and Cell Biology, Göteborg University, Göteborg, Sweden
| | - Amy Catalfamo
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Hsiao-ying Chin
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Foramben Patel
- Department of Biomedical Sciences, Long Island University, Brookville, New York, United States of America
| | - Sravani Rayala
- Department of Biomedical Sciences, Long Island University, Brookville, New York, United States of America
| | - Ketan Shevde
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Peter S. Heeger
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ming Zhang
- Department of Anesthesiology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
- Department of Cell Biology, College of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
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11
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On the value of therapeutic interventions targeting the complement system in acute myocardial infarction. Transl Res 2017; 182:103-122. [PMID: 27810412 DOI: 10.1016/j.trsl.2016.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 01/12/2023]
Abstract
The complement system plays an important role in the inflammatory response subsequent to acute myocardial infarction (AMI). The aim of this study is to create a systematic overview of studies that have investigated therapeutic administration of complement inhibitors in both AMI animal models and human clinical trials. To enable extrapolation of observations from included animal studies toward post-AMI clinical trials, ex vivo studies on isolated hearts and proof-of-principle studies on inhibitor administration before experimental AMI induction were excluded. Positive therapeutic effects in AMI animal models have been described for cobra venom factor, soluble complement receptor 1, C1-esterase inhibitor (C1-inh), FUT-175, C1s-inhibitor, anti-C5, ADC-1004, clusterin, and glycosaminoglycans. Two types of complement inhibitors have been tested in clinical trials, being C1-inh and anti-C5. Pexelizumab (anti-C5) did not result in reproducible beneficial effects for AMI patients. Beneficial effects were reported in AMI patients for C1-inhibitor, albeit in small patient groups. In general, despite the absence of consistent positive effects in clinical trials thus far, the complement system remains a potentially interesting target for therapy in AMI patients. Based on the study designs of previous animal studies and clinical trials, we discuss several issues which require attention in the design of future studies: adjustment of clinical trial design to precise mechanism of action of administered inhibitor, optimizing the duration of therapy, and optimization of time point(s) on which therapeutic effects will be evaluated.
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Pischke SE, Gustavsen A, Orrem HL, Egge KH, Courivaud F, Fontenelle H, Despont A, Bongoni AK, Rieben R, Tønnessen TI, Nunn MA, Scott H, Skulstad H, Barratt-Due A, Mollnes TE. Complement factor 5 blockade reduces porcine myocardial infarction size and improves immediate cardiac function. Basic Res Cardiol 2017; 112:20. [PMID: 28258298 PMCID: PMC5336537 DOI: 10.1007/s00395-017-0610-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/28/2017] [Indexed: 12/31/2022]
Abstract
Inhibition of complement factor 5 (C5) reduced myocardial infarction in animal studies, while no benefit was found in clinical studies. Due to lack of cross-reactivity of clinically used C5 antibodies, different inhibitors were used in animal and clinical studies. Coversin (Ornithodoros moubata complement inhibitor, OmCI) blocks C5 cleavage and binds leukotriene B4 in humans and pigs. We hypothesized that inhibition of C5 before reperfusion will decrease infarct size and improve ventricular function in a porcine model of myocardial infarction. In pigs (Sus scrofa), the left anterior descending coronary artery was occluded (40 min) and reperfused (240 min). Coversin or placebo was infused 20 min after occlusion and throughout reperfusion in 16 blindly randomized pigs. Coversin significantly reduced myocardial infarction in the area at risk by 39% (p = 0.03, triphenyl tetrazolium chloride staining) and by 19% (p = 0.02) using magnetic resonance imaging. The methods correlated significantly (R = 0.92, p < 0.01). Tissue Doppler echocardiography showed increased systolic displacement (31%, p < 0.01) and increased systolic velocity (29%, p = 0.01) in coversin treated pigs. Interleukin-1β in myocardial microdialysis fluid was significantly reduced (31%, p < 0.05) and tissue E-selectin expression was significantly reduced (p = 0.01) in the non-infarcted area at risk by coversin treatment. Coversin ablated plasma C5 activation throughout the reperfusion period and decreased myocardial C5b-9 deposition, while neither plasma nor myocardial LTB4 were significantly reduced. Coversin substantially reduced the size of infarction, improved ventricular function, and attenuated interleukin-1β and E-selectin in this porcine model by inhibiting C5. We conclude that inhibition of C5 in myocardial infarction should be reconsidered.
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Affiliation(s)
- Soeren E Pischke
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway.
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway.
- Intervention Centre, Oslo University Hospital, Oslo, Norway.
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
| | - A Gustavsen
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
| | - H L Orrem
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - K H Egge
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
| | - F Courivaud
- Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - H Fontenelle
- Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - A Despont
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - A K Bongoni
- Immunology Research Centre, St. Vincent's Hospital, Melbourne, VIC, Australia
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - R Rieben
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - T I Tønnessen
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - M A Nunn
- Akari Therapeutics Plc, London, UK
| | - H Scott
- Department of Pathology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - H Skulstad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - A Barratt-Due
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - T E Mollnes
- Department of Immunology, Oslo University Hospital, Rikshospitalet, P.b. 4950 Nydalen, 0424, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
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Tranexamic acid decreases the magnitude of platelet dysfunction in aspirin-free patients undergoing cardiac surgery with cardiopulmonary bypass. Blood Coagul Fibrinolysis 2016; 27:855-861. [DOI: 10.1097/mbc.0000000000000485] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arlov Ø, Skjåk-Bræk G, Rokstad AM. Sulfated alginate microspheres associate with factor H and dampen the inflammatory cytokine response. Acta Biomater 2016; 42:180-188. [PMID: 27296843 DOI: 10.1016/j.actbio.2016.06.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/03/2016] [Accepted: 06/09/2016] [Indexed: 01/06/2023]
Abstract
UNLABELLED Alginate microspheres show promise for cell-encapsulation therapy but encounter challenges related to biocompatibility. In the present work we designed novel microbeads and microcapsules based on sulfated polyalternating MG alginate (SMG) and explored their inflammatory properties using a human whole blood model. SMG was either incorporated within the alginate microbeads or used as a secondary coat on poly-l-lysine (PLL)-containing microcapsules, resulting in reduction of the inflammatory cytokines (IL-1β, TNF, IL-6, IL-8, MIP-1α). The sulfated alginate microbeads exhibited a complement inert nature with no induction of terminal complement complex (TCC) above the values in freshly drawn blood and low surface accumulation of C3/C3b/iC3b. Conversely, SMG as a coating material lead to substantial TCC amounts and surface C3/C3b/iC3b. A common thread was an increased association of the complement inhibitor factor H to the alginate microbeads and microcapsules containing sulfated alginates. Factor H was also found to associate to non-sulfated alginate microbeads in lower amounts, indicating factor H binding as an inherent property of alginate. We conclude that the dampening effect on the cytokine response and increased factor H association points to sulfated alginate as a promising strategy for improving the biocompatibility of alginate microspheres. STATEMENT OF SIGNIFICANCE Alginate microspheres are candidate devices for cell encapsulation therapy. The concept is challenged by the inflammatory host response, and modification strategies for improved biocompatibility are urgently needed. One potential strategy is using sulfated alginates, acting as versatile heparin analogues with similar anti-inflammatory properties. We designed novel alginate microspheres using sulfated alginate with an alternating sequence mimicking glycosominoglycans. Evaluation in a physiologically relevant human whole blood model revealed a reduction of inflammatory cytokines by a sulfated alginate coating, and sulfated alginate microbeads were complement inert. These effects were correlated with a strong factor H association, which may represent the mechanistic explanation. This novel approach could improve the biocompatibility of alginate microspheres in vivo and present a new strategy toward clinical use.
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Affiliation(s)
- Øystein Arlov
- Department of Biotechnology, Norwegian University of Science and Technology, Sem Sælands vei 6/8, 7034 Trondheim, Norway
| | - Gudmund Skjåk-Bræk
- Department of Biotechnology, Norwegian University of Science and Technology, Sem Sælands vei 6/8, 7034 Trondheim, Norway
| | - Anne Mari Rokstad
- Centre of Molecular Inflammation Research (CEMIR), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Prinsesse Kristinas gate 1, 7030 Trondheim, Norway; Liasion Committee between the Central Norway Regional Health authority (RHA) and the Norwegian University of Science and Technology (NTNU), Norway.
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Abramov D, Abu-Tailakh M, Frieger M, Ganiel A, Tuvbin D, Wolak A. Plasma Troponin Levels after Cardiac Surgery vs after Myocardial Infarction. Asian Cardiovasc Thorac Ann 2016; 14:530-5. [PMID: 17130336 DOI: 10.1177/021849230601400621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Raised plasma troponin, a diagnostic marker for myocardial infarction, usually occurs after cardiac surgery, leading to difficulties in diagnosing postoperative myocardial infarction. To ascertain whether the same processes influence troponin elevation in both conditions, a literature search was performed for plasma troponin elimination curves after myocardial infarction, myocardial infarction with reperfusion, and cardiac surgery. From 70 studies, 11 curves using the Stratus immunoassay kit were analyzed: 5 post-cardiac surgery (412 patients), 2 after myocardial infarction with reperfusion (169 patients), and 4 after myocardial infarction (640 patients). For each group, a new plot was formulated from the mean troponin level at each time interval. While the up-slope of the cardiac surgery curve was much steeper than that of myocardial infarction, resembling that of myocardial infarction with reperfusion, its down-slope was significantly more gentle than that of both other groups (−0.91 vs −5.31, t = 3.47, df = 8, p < 0.01). This suggests that postoperative troponin elevation involves enhanced cell permeability as seen after ischemia reperfusion rather than permanent cellular damage. The gentler down-slope may point to surgery-induced impaired troponin removal from the circulation. Due to the different mechanisms proposed, implications from post-myocardial infarction troponin levels may not be conferred on post-cardiac surgery patients.
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Affiliation(s)
- Dan Abramov
- Department of Cardiothoracic Surgery, Soroka Medical Center, Beer Sheva 84101, Israel.
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O'Donohoe TJ, Schrale RG, Ketheesan N. The role of anti-myosin antibodies in perpetuating cardiac damage following myocardial infarction. Int J Cardiol 2016; 209:226-33. [PMID: 26897075 DOI: 10.1016/j.ijcard.2016.02.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/21/2015] [Accepted: 02/02/2016] [Indexed: 12/17/2022]
Abstract
Recent improvements in the medical and surgical management of myocardial infarction mean that many patients are now surviving with greater impairment of cardiac function. Despite appropriate management, some of these patients subsequently develop pathological ventricular remodelling, which compounds their contractile dysfunction and can lead to congestive cardiac failure (CCF). The pathophysiological mechanism underpinning this process remains incompletely understood. One hypothesis suggests that a post-infarction autoimmune response, directed against constituents of cardiac myocytes, including cardiac myosin, may make an important contribution. Our review summarises the current literature related to the formation and clinical relevance of anti-myosin antibodies (AMAs) in patients with myocardial infarction. This discussion is supplemented with reference to a number of important animal studies, which provide evidence of the potential mechanisms underlying AMA formation and autoantibody mediated cardiac dysfunction.
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Affiliation(s)
- Tom J O'Donohoe
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland 4811, Australia; Department of Cardiology, The Townsville Hospital and Health Service, Townsville, Queensland 4811, Australia
| | - Ryan G Schrale
- Department of Cardiology, The Townsville Hospital and Health Service, Townsville, Queensland 4811, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia
| | - Natkunam Ketheesan
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland 4811, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4811, Australia.
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17
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Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review. Cardiovasc Psychiatry Neurol 2015; 2015:370612. [PMID: 26491558 PMCID: PMC4605208 DOI: 10.1155/2015/370612] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/15/2015] [Indexed: 12/20/2022] Open
Abstract
Modern day cardiac surgery evolved upon the advent of cardiopulmonary bypass machines (CPB) in the 1950s. Following this development, cardiac surgery in recent years has improved significantly. Despite such advances and the introduction of new technologies, neurological sequelae after cardiac surgery still exist. Ischaemic stroke, delirium, and cognitive impairment cause significant morbidity and mortality and unfortunately remain common complications. Postoperative cognitive decline (POCD) is believed to be associated with the presence of new ischaemic lesions originating from emboli entering the cerebral circulation during surgery. Cardiopulmonary bypass was thought to be the reason of POCD, but randomised controlled trials comparing with off-pump surgery show contradictory results. Attention has now turned to the growing evidence that perioperative risk factors, as well as patient-related risk factors, play an important role in early and late POCD. Clearly, identifying the mechanism of POCD is challenging. The purpose of this systematic review is to discuss the literature that has investigated patient and perioperative risk factors to better understand the magnitude of the risk factors associated with POCD after cardiac surgery.
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Seco M, Edelman JJB, Van Boxtel B, Forrest P, Byrom MJ, Wilson MK, Fraser J, Bannon PG, Vallely MP. Neurologic injury and protection in adult cardiac and aortic surgery. J Cardiothorac Vasc Anesth 2015; 29:185-95. [PMID: 25620144 DOI: 10.1053/j.jvca.2014.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - J James B Edelman
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Benjamin Van Boxtel
- Columbia University Medical Center-New York Presbyterian Hospital, New York, New York
| | - Paul Forrest
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael J Byrom
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael K Wilson
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael P Vallely
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
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19
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In Vitro Selection of Cancer Cell-Specific Molecular Recognition Elements from Amino Acid Libraries. J Immunol Res 2015; 2015:186586. [PMID: 26436100 PMCID: PMC4576012 DOI: 10.1155/2015/186586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/17/2015] [Accepted: 08/23/2015] [Indexed: 11/27/2022] Open
Abstract
Differential cell systematic evolution of ligands by exponential enrichment (SELEX) is an in vitro selection method for obtaining molecular recognition elements (MREs) that specifically bind to individual cell types with high affinity. MREs are selected from initial large libraries of different nucleic or amino acids. This review outlines the construction of peptide and antibody fragment libraries as well as their different host types. Common methods of selection are also reviewed. Additionally, examples of cancer cell MREs are discussed, as well as their potential applications.
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20
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Ubben JF, Lance MD, Buhre WF, Schreiber JU. Clinical Strategies to Prevent Pulmonary Complications in Cardiac Surgery: An Overview. J Cardiothorac Vasc Anesth 2015; 29:481-90. [DOI: 10.1053/j.jvca.2014.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Indexed: 11/11/2022]
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21
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Patzelt J, Mueller K, Breuning S, Karathanos A, Schleicher R, Seizer P, Gawaz M, Langer H, Geisler T. Expression of anaphylatoxin receptors on platelets in patients with coronary heart disease. Atherosclerosis 2015; 238:289-95. [DOI: 10.1016/j.atherosclerosis.2014.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/15/2014] [Accepted: 12/04/2014] [Indexed: 01/06/2023]
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22
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Schweizer D, Serno T, Goepferich A. Controlled release of therapeutic antibody formats. Eur J Pharm Biopharm 2014; 88:291-309. [DOI: 10.1016/j.ejpb.2014.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/30/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
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23
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Li X, Robertson CM, Yu X, Cheypesh A, Dinu IA, Li J. Early postoperative systemic inflammatory response is an important determinant for adverse 2-year neurodevelopment-associated outcomes after the Norwood procedure. J Thorac Cardiovasc Surg 2014; 148:202-6. [DOI: 10.1016/j.jtcvs.2013.07.079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/11/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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24
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Tsakiridis K, Mpakas A, Kesisis G, Arikas S, Argyriou M, Siminelakis S, Zarogoulidis P, Katsikogiannis N, Kougioumtzi I, Tsiouda T, Sarika E, Katamoutou I, Zarogoulidis K. Lung inflammatory response syndrome after cardiac-operations and treatment of lornoxicam. J Thorac Dis 2014; 6 Suppl 1:S78-98. [PMID: 24672703 DOI: 10.3978/j.issn.2072-1439.2013.12.07] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 12/04/2013] [Indexed: 12/19/2022]
Abstract
The majority of patients survive after extracorporeal circulation without any clinically apparent deleterious effects. However, disturbances exist in various degrees sometimes, which indicate the harmful effects of cardiopulmonary bypass (CPB) in the body. Several factors during extracorporeal circulation either mechanical dependent (exposure of blood to non-biological area) or mechanical independent (surgical wounds, ischemia and reperfusion, alteration in body temperature, release of endotoxins) have been shown to trigger the inflammatory reaction of the body. The complement activation, the release of cytokines, the leukocyte activation and accumulation as well as the production of several "mediators" such as oxygen free radicals, metabolites of arachidonic acid, platelet activating factors (PAF), nitric acid, and endothelin. The investigation continues today on the three metabolites of lornoxicam (the hydroxylated metabolite and two other metabolites of unknown chemical composition) to search for potential new pharmacological properties and activities.
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Affiliation(s)
- Kosmas Tsakiridis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Andreas Mpakas
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - George Kesisis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Stamatis Arikas
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Michael Argyriou
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Stavros Siminelakis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Theodora Tsiouda
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Eirini Sarika
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Ioanna Katamoutou
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Cardiothoracic Surgery Department, 2 Oncology Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 3 Cardiac Surgery Department, Evaggelismos General Hospital, Veikou 9-11, 11146 Athens, Greece ; 4 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Greece ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theiageneio" Anticancer Hospital, Thessaloniki, Greece
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Pągowska-Klimek I, Cedzyński M. Mannan-binding lectin in cardiovascular disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:616817. [PMID: 24877121 PMCID: PMC4022110 DOI: 10.1155/2014/616817] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/10/2014] [Indexed: 01/19/2023]
Abstract
Cardiovascular disease remains the leading cause of mortality and morbidity worldwide so research continues into underlying mechanisms. Since innate immunity and its potent component mannan-binding lectin have been proven to play an important role in the inflammatory response during infection and ischaemia-reperfusion injury, attention has been paid to its role in the development of cardiovascular complications as well. This review provides a general outline of the structure and genetic polymorphism of MBL and its role in inflammation/tissue injury with emphasis on associations with cardiovascular disease. MBL appears to be involved in the pathogenesis of atherosclerosis and, in consequence, coronary artery disease and also inflammation and tissue injury after myocardial infarction and heart transplantation. The relationship between MBL and disease is rather complex and depends on different genetic and environmental factors. That could be why the data obtained from animal and clinical studies are sometimes contradictory proving not for the first time that innate immunity is a "double-edge sword," sometimes beneficial and, at other times disastrous for the host.
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Affiliation(s)
- Izabela Pągowska-Klimek
- Department of Anesthesiology and Intensive Care, Polish Mother's Memorial Hospital Institute, Rzgowska 281/289, 93-338 Łódź, Poland
| | - Maciej Cedzyński
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Lodowa 106, 93-232 Łódź, Poland
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Tsakiridis K, Zarogoulidis P, Vretzkakis G, Mikroulis D, Mpakas A, Kesisis G, Arikas S, Kolettas A, Moschos G, Katsikogiannis N, Machairiotis N, Tsiouda T, Siminelakis S, Beleveslis T, Zarogoulidis K. Effect of lornoxicam in lung inflammatory response syndrome after operations for cardiac surgery with cardiopulmonary bypass. J Thorac Dis 2014; 6 Suppl 1:S7-S20. [PMID: 24672701 DOI: 10.3978/j.issn.2072-1439.2013.12.30] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/16/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The establishment of Extracorporeal Circulation (EC) significantly contributed to improvement of cardiac surgery, but this is accompanied by harmful side-effects. The most important of them is systemic inflammatory response syndrome. Many efforts have been undertaken to minimize this problem but unfortunately without satisfied solution to date. MATERIALS AND METHODS Lornoxicam is a non steroid anti-inflammatory drug which temporally inhibits the cycloxygenase. In this clinical trial we study the effect of lornoxicam in lung inflammatory response after operations for cardiac surgery with cardiopulmonary bypass. In our study we conclude 14 volunteers patients with ischemic coronary disease undergoing coronary artery bypass grafting with EC. In seven of them 16 mg lornoxicam was administered iv before the anesthesia induction and before the connection in heart-lung machine. In control group (7 patients) we administered the same amount of normal saline. RESULTS Both groups are equal regarding pro-operative and intra-operative parameters. The inflammatory markers were calculated by Elisa method. We measured the levels of cytokines (IL-6, IL-8, TNF-a), adhesion molecules (ICAM-1, e-Selectin, p-Selectin) and matrix metaloproteinase-3 (MMP-3) just after anesthesia induction, before and after cardiopulmonary bypass, just after the patients administration in ICU and after 8 and 24 hrs. In all patients we estimated the lung's inflammatory reaction with lung biopsy taken at the begging and at the end of the operation. We calculated hemodynamics parameters: Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Pulmonary Vascular Resistance Index (PVRI), Left Ventricular Stroke Work Index (LVSWI), Right Ventricular Stroke Work Index (RVSWI), and the Pulmonary arterial pressure, and respiratory parameters too: alveolo-arterial oxygen difference D (A-a), intrapulmonary shunt (Qs/Qt) and pulmonary Compliance. IL-6 levels of lornoxicam group were statistical significant lower at 1st postoperative day compared to them of control group (113±49 and 177±20 respectively, P=0.008). ICAM-1 levels were statistical significant lower at the patient admission in ICU, compared to them of control group (177±29 and 217±22 respectively, P=0.014), and the 1st postoperative day compared to them in control group (281±134 and 489±206 respectively, P=0.045). P-selectin levels were statistical significant lower, compared to them in control group in four measurements (97±23 and 119±7 respectively, P=0.030, 77±19 and 101±20 respectively, P=0.044, 86±4 and 105±13 respectively, P=0.06, 116±13 and 158±17 respectively, P=0.000). CONCLUSIONS Hemodynamics and respiratory parameters were improved compared to control group, but these differences was not statistical significant. Eosinofil adhesion and sequestration in intermediate tissue of lung parenchyma were significantly lower compared to control group. Also, alveolar edema was not noted in lornoxicam's group. Lornoxicam reduce the inflammatory response in patients undergone coronary artery bypass grafting with extracorporeal circulation. This calculated from levels reduction of IL-6, ICAM-1 και p-Selectin, and from lung pathologoanatomic examination (absence of alveolar edema, reduce in eosinofil adhesion and sequestration in intermediate tissues). Despite the favorable effect of lornoxicam on the hemodinamics and respiratory parameters these improvement did not seem to be statistical significant.
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Affiliation(s)
- Kosmas Tsakiridis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Paul Zarogoulidis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Giorgos Vretzkakis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Dimitris Mikroulis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Andreas Mpakas
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Georgios Kesisis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Stamatis Arikas
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Alexandros Kolettas
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Giorgios Moschos
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Nikolaos Katsikogiannis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Nikolaos Machairiotis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Theodora Tsiouda
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Stavros Siminelakis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Thomas Beleveslis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
| | - Konstantinos Zarogoulidis
- 1 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 2 Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Anesthisiology Department, University of Larisa, Larisa, Greece ; 4 Cardiothoracic Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Oncology Department, 6 Anesthisology Department, 7 Cardiology Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 8 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Internal Medicine Department, "Thegeneio" Cancer Hospital, Thessaloniki, Greece ; 10 Cardiothoracic Surgery Department, University of Ioannina, Ioannina, Greece
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Hall R. Identification of Inflammatory Mediators and Their Modulation by Strategies for the Management of the Systemic Inflammatory Response During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:983-1033. [DOI: 10.1053/j.jvca.2012.09.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 12/21/2022]
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Di H, Zhang Y, Chen D. An anti-complementary polysaccharide from the roots of Bupleurum chinense. Int J Biol Macromol 2013; 58:179-85. [DOI: 10.1016/j.ijbiomac.2013.03.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 02/03/2013] [Accepted: 03/16/2013] [Indexed: 10/27/2022]
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Shimada M, Abe S, Takahashi T, Shiozaki K, Okuda M, Mizukami H, Klinman DM, Ozawa K, Okuda K. Prophylaxis and treatment of Alzheimer's disease by delivery of an adeno-associated virus encoding a monoclonal antibody targeting the amyloid Beta protein. PLoS One 2013; 8:e57606. [PMID: 23555563 PMCID: PMC3610755 DOI: 10.1371/journal.pone.0057606] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 01/23/2013] [Indexed: 02/03/2023] Open
Abstract
We previously reported on a monoclonal antibody (mAb) that targeted amyloid beta (Aß) protein. Repeated injection of that mAb reduced the accumulation of Aß protein in the brain of human Aß transgenic mice (Tg2576). In the present study, cDNA encoding the heavy and light chains of this mAb were subcloned into an adeno-associated virus type 1 (AAV) vector with a 2A/furin adapter. A single intramuscular injection of 3.0×1010 viral genome of these AAV vectors into C57BL/6 mice generated serum anti-Aß Ab levels up to 0.3 mg/ml. Anti-Aß Ab levels in excess of 0.1 mg/ml were maintained for up to 64 weeks. The effect of AAV administration on Aß levels in vivo was examined. A significant decrease in Aß levels in the brain of Tg2576 mice treated at 5 months (prophylactic) or 10 months (therapeutic) of age was observed. These results support the use of AAV vector encoding anti-Aß Ab for the prevention and treatment of Alzheimer's disease.
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Affiliation(s)
- Masaru Shimada
- Department of Molecular Biodefense Research, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shinya Abe
- Department of Molecular Biodefense Research, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Toru Takahashi
- Department of Molecular Biodefense Research, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kazumasa Shiozaki
- Department of Psychiatry, Yokohama City University, Yokohama, Kanagawa, Japan
| | | | - Hiroaki Mizukami
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical School, Tochigi-ken, Japan
| | - Dennis M. Klinman
- Laboratory of Experimental Immunology, Cancer and Inflammation Program, National Cancer Institute, National Institutes of Health, Frederick, Maryland, United States of America
| | - Keiya Ozawa
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical School, Tochigi-ken, Japan
| | - Kenji Okuda
- Department of Molecular Biodefense Research, Yokohama City University, Yokohama, Kanagawa, Japan
- * E-mail:
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Papadopoulos N, Bakhtiary F, Grün V, Weber CF, Strasser C, Moritz A. The effect of normovolemic modified ultrafiltration on inflammatory mediators, endotoxins, terminal complement complexes and clinical outcome in high-risk cardiac surgery patients. Perfusion 2013; 28:306-14. [DOI: 10.1177/0267659113478450] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The clinical benefit of normovolemic modified ultrafiltration (N-MUF) after cardiac surgery is still debated. As we have shown in a previous publication, there is a significant improvement in platelet function, so we were interested in whether ultrafiltration can reduce plasma levels of endotoxins, terminal complement complexes and cytokines after cardiopulmonary bypass (CPB) in adults with increased risk profiles. Methods: In this single-center, prospective, randomized trial, fifty high-risk patients (mean logistic EuroSCORE II: 17.5%) who underwent cardiac surgery were randomized. After CPB, Group 1 (n = 25) served as the control and in, Group 2 (n= 25), an N-MUF of 3000 ml was performed, using a BC140plus filter after weaning from CPB. Blood samples were taken after the induction of anesthesia, before CPB, before CPB weaning, 30 minutes after CPB and at 6, 24 and 48 hours postoperatively. Primary outcomes were plasma levels of lipopolysaccharide-binding protein (LBP), terminal complement complex (C5b9) and cytokines (IL-6, IL-10, IL-1beta, TNF-α). Secondary outcomes focused on differences in the clinical outcome. Results: A significant reduction in LBP concentration (preoperatively: 23.8±8.4 pg/ml, postoperatively: 14.2±12.9 pg/ml) and C5b9 (preoperatively: 4.18±2.6 pg/ml, postoperatively: 3.05±2.39 pg/ml) were detected 6 hours after N-MUF. In the N-MUF group, significantly lower concentrations of lactate could be detected in the early postoperative period. Furthermore, postoperative chest tube blood loss was significantly lower in the N-MUF group at 24 and 48 hours. Conclusions: N-MUF leads to a significant reduction of lipopolysaccharide-binding protein and terminal complement complex and was associated with reduced blood loss and postoperative lactate concentrations shortly after surgery.
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Affiliation(s)
- N Papadopoulos
- Department of Thoracic and Cardiovascular Surgery, J.-W. Goethe University Hospital, Frankfurt, Germany
| | - F Bakhtiary
- Department of Thoracic and Cardiovascular Surgery, University Hopital Leipzig, Leipzig, Germany
| | - V Grün
- Department of Thoracic and Cardiovascular Surgery, J.-W. Goethe University Hospital, Frankfurt, Germany
| | - CF Weber
- Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, J.-W. Goethe University Hospital, Frankfurt, Germany
| | - C Strasser
- Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, J.-W. Goethe University Hospital, Frankfurt, Germany
| | - A Moritz
- Department of Thoracic and Cardiovascular Surgery, J.-W. Goethe University Hospital, Frankfurt, Germany
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Pexelizumab fails to inhibit assembly of the terminal complement complex in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Insight from a substudy of the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Am Heart J 2012. [PMID: 23194495 DOI: 10.1016/j.ahj.2012.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pexelizumab fails to inhibit assembly of the terminal complement complex in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Insight from a substudy of the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Am Heart J 2012; 164:43-51. [PMID: 22795281 DOI: 10.1016/j.ahj.2012.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Reasons for pexelizumab lack of benefit in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention remain unclear. In a substudy of the APEX-AMI trial, we explored the hypothesis that early complement activation preceding drug administration explained the failure. METHODS A panel of terminal complement complex proteins and fragments and biomarkers of inflammation, apoptosis, and high-risk features were assessed in serum obtained before and 24 hours after administration of placebo or pexelizumab and primary percutaneous coronary intervention (n = 356) and in human umbilical vein endothelial cell cultures coincubated with serum (n = 45). RESULTS In the placebo group, C5a and sC5b-9 levels increased by 37% (7.9-14.2 ηg/mL, P = .007) and 96% (442-845 ηg/mL, P < .0001), respectively, during the first 24 hours. Pexelizumab prevented the increase in C5a (P = .01 vs placebo), but not that of sC5b-9 (502-1,157 ηg/mL, not significant vs placebo). Levels of C-reactive protein, interleukin (IL) 6, IL-1ß, Regulated on Activation, Normal T Cell Expressed and Secreted (RANTES) or Chemokine C-C motif ligand 5 (CCL5), and N-terminal probrain natriuretic peptide increased significantly in both groups; those of IL-10, IL-12, IL-1ra, and Interferon gamma-induced protein 10 (IP-10) or C-X-C motif chemokine 10 (CXCL10) decreased. Pexelizumab halved the increase in IL-6 (+92% vs 156%, P = .01) without effects on other markers, including C-reactive protein and N-terminal probrain natriuretic peptide. In cell culture, pexelizumab inhibited C5a, sC5b-9, and membrane-bound C5b-9 by 92%, 75%, and 78%, respectively (all P < .0001), without influencing cytokine levels and cell apoptosis. CONCLUSIONS The blockage of both C5a and terminal complement in cell culture, but of C5a only in vivo with minimal effects on inflammation and risk biomarkers, supports the hypothesis that late administration of pexelizumab after the ischemia/reperfusion insult precluded adequate myocardial protection, resulting in a negative trial.
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Gillani S, Cao J, Suzuki T, Hak DJ. The effect of ischemia reperfusion injury on skeletal muscle. Injury 2012; 43:670-5. [PMID: 21481870 DOI: 10.1016/j.injury.2011.03.008] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 02/24/2011] [Accepted: 03/07/2011] [Indexed: 02/02/2023]
Abstract
Ischemia reperfusion (IR) injury occurs when tissue is reperfused following a period of ischemia, and results from acute inflammation involving various mechanisms. IR injury can occur following a range of circumstances, ranging from a seemingly minor condition to major trauma. The intense inflammatory response has local as well as systemic effects because of the physiological, biochemical and immunological changes that occur during the ischemic and reperfusion periods. The sequellae of the cellular injury of IR may lead to the loss of organ or limb function, or even death. There are many factors which influence the outcome of these injuries, and it is important for clinicians to understand IR injury in order to minimize patient morbidity and mortality. In this paper, we review the pathophysiology, the effects of IR injury in skeletal muscle, and the associated clinical conditions; compartment syndrome, crush syndrome, and vascular injuries.
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Affiliation(s)
- Syed Gillani
- Denver Health/Univeristy of Colorado, 777 Bannock Street, MC 0188 Denver, CO 80204, USA
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Abstract
Reperfusion of an organ following prolonged ischemia instigates the pro-inflammatory and pro-coagulant response of ischemia / reperfusion (IR) injury. IR injury is a wide-spread pathology, observed in many clinically relevant situations, including myocardial infarction, stroke, organ transplantation, sepsis and shock, and cardiovascular surgery on cardiopulmonary bypass. Activation of the classical, alternative, and lectin complement pathways and the generation of the anaphylatoxins C3a and C5a lead to recruitment of polymorphonuclear leukocytes, generation of radical oxygen species, up-regulation of adhesion molecules on the endothelium and platelets, and induction of cytokine release. Generalized or pathway-specific complement inhibition using protein-based drugs or low-molecular-weight inhibitors has been shown to significantly reduce tissue injury and improve outcome in numerous in-vitro, ex-vivo, and in-vivo models. Despite the obvious benefits in experimental research, only few complement inhibitors, including C1-esterase inhibitor, anti-C5 antibody, and soluble complement receptor 1, have made it into clinical trials of IR injury. The results are mixed, and the next objectives should be to combine knowledge and experience obtained in the past from animal models and channel future work to translate this into clinical trials in surgical and interventional reperfusion therapy as well as organ transplantation.
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Affiliation(s)
- Yara Banz
- Institute of Pathology, University of Bern, Switzerland
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36
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Dang S, Hong T, Ding BS, Zhang W. A humanized single-chain variable fragment antibody against beta3 integrin in Escherichia coli. Hybridoma (Larchmt) 2012; 30:543-8. [PMID: 22149280 DOI: 10.1089/hyb.2011.0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with HIV-1 immune-related thrombocytopenia (HIV-1-ITP) have a unique antibody (Ab) against platelet GPIIIa49-66, which is capable of inducing oxidative platelet fragmentation in the absence of complement activation. By screening a human phage antibody library with the GPIIIa49-66 peptide as bait, we have developed several humanized phage Abs, which act similarly to the parental Ab. However, the presence of a stop codon in the heavy chain of the obtained phage clones limits their expression in soluble recombinant form. To circumvent this problem, we mutated the stop codon inside clone 11 that exhibits the highest binding activity to platelet GPIIIa49-66, resulting in a soluble scFv format (named A11) in Escherichia coli Rosseta. In in vitro binding assay, A11 exhibited similar binding specificity to parental Ab at various concentrations. Moreover, A11 is able to induce oxidative platelet fragmentation by preferentially binding to activated versus resting platelets. These findings provide a proof-of-principle for the development of a novel approach to inhibit arterial thrombosis by generating a selective scFv for the lysis of platelet-rich thrombi.
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Affiliation(s)
- Suying Dang
- Department of Medical Genetics, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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37
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Kortekaas KA, van der Pol P, Lindeman JH, Baan CC, van Kooten C, Klautz RJ. No prominent role for terminal complement activation in the early myocardial reperfusion phase following cardiac surgery. Eur J Cardiothorac Surg 2012; 41:e117-25. [DOI: 10.1093/ejcts/ezs088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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38
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Pediatric cardiopulmonary bypass and the inflammatory response: years of investigation, only incremental progress. Pediatr Crit Care Med 2011; 12:594-6. [PMID: 21897161 DOI: 10.1097/pcc.0b013e3181fe3b48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Abstract
The complement system is an important part of innate immunity; however, as with other parts of the immune system, the complement system can become pathologically activated and create or worsen disease. Anticomplement reagents have been studied for several years, but only recently have they emerged as a viable therapeutic tool. Here, we describe the role of the complement system in a wide array of diseases, as well as the use of anticomplement therapy as treatment for these diseases in animal models and in human clinical trials. Specifically, we will discuss the role of anticomplement therapy in paroxysmal nocturnal hemoglobinuria, glomerulonephritis, and heart disease, including coronary artery disease, myocardial infarction, and coronary revascularization procedures such as percutaneous coronary angioplasty and coronary artery bypass graft surgery.
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40
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Effects of C5 complement inhibitor pexelizumab on outcome in high-risk coronary artery bypass grafting: Combined results from the PRIMO-CABG I and II trials. J Thorac Cardiovasc Surg 2011; 142:89-98. [DOI: 10.1016/j.jtcvs.2010.08.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 07/26/2010] [Accepted: 08/05/2010] [Indexed: 11/20/2022]
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41
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Weber CF, Jámbor C, Strasser C, Moritz A, Papadopoulos N, Zacharowski K, Meininger D. Normovolemic modified ultrafiltration is associated with better preserved platelet function and less postoperative blood loss in patients undergoing complex cardiac surgery: A randomized and controlled study. J Thorac Cardiovasc Surg 2011; 141:1298-304. [DOI: 10.1016/j.jtcvs.2010.09.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/30/2010] [Accepted: 09/12/2010] [Indexed: 10/18/2022]
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42
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Bergseth G, Lambris JD, Mollnes TE, Lappegård KT. Artificial surface-induced inflammation relies on complement factor 5: proof from a deficient person. Ann Thorac Surg 2011; 91:527-33. [PMID: 21256307 DOI: 10.1016/j.athoracsur.2010.10.084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/27/2010] [Accepted: 10/28/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exposing blood to artificial surfaces results in an inflammatory response, including complement activation and cytokine release. The aim of this investigation was to study complement-dependency and independency in artificial surface-induced inflammation in human whole blood from a patient with a genetic deficiency of complement factor 5 (C5). METHODS Whole blood from a C5-deficient patient, C5 protein reconstituted blood, and blood from a control subject was used. The complement inhibitor compstatin (C3 inhibitor) and a C5a receptor antagonist were used to block complement. Blood was circulated in closed loops of polyvinyl chloride tubing. Leukocyte CD11b expression and release of granule enzymes (myeloperoxidase, elastase, lactoferrin), cytokines (interleukins, chemokines, and growth factors; n = 27) as well as complement activation were measured after incubation. RESULTS In C5-deficient blood, there was no formation of the terminal complement complex, as opposed to reconstituted or control blood. Release of granule enzymes was partly dependent on C3, revealed by a compstatin-dependent effect in C5-deficient blood, and partly C5a-dependent as evident from the reconstitution and control blood. The chemokines interleukin-8 and monocyte chemoattractant protein-1 were also highly complement dependent, the effect being C5a-mediated, whereas platelet-derived and vascular endothelial growth factors were partly complement dependent. Interferon-γ increased in a complement-independent manner, whereas the rest of the cytokines did not respond to the surface. Leukocyte expression of CD11b was only marginally increased in deficient blood exposed to the surface, whereas reconstitution induced a considerable, C5a-dependent increase, comparable with that of the control. CONCLUSIONS The polyvinyl chloride surface induced a defined inflammatory response, which largely depended on C5.
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Affiliation(s)
- Grethe Bergseth
- Research Laboratory and Division of Internal Medicine, Nordland Hospital, Bodø, Norway.
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43
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Tranexamic acid partially improves platelet function in patients treated with dual antiplatelet therapy. Eur J Anaesthesiol 2011; 28:57-62. [DOI: 10.1097/eja.0b013e32834050ab] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Dissolution of arterial platelet thrombi in vivo with a bifunctional platelet GPIIIa49-66 ligand which specifically targets the platelet thrombus. Blood 2010; 116:2336-44. [PMID: 20525921 DOI: 10.1182/blood-2010-01-264358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Patients with HIV-1 immune-related thrombocytopenia have a unique antibody (Ab) against integrin GPIIIa49-66 capable of inducing oxidative platelet fragmentation via Ab activation of platelet nicotinamide adenine dinucleotide phosphate oxidase and 12-lipoxygenase releasing reactive oxygen species. Using a phage display single-chain antibody (scFv) library, we developed a novel human monoclonal scFv Ab against GPIIIa49-66 (named A11) capable of inducing fragmentation of activated platelets. In this study, we investigated the in vivo use of A11. We show that A11 does not induce significant thrombocytopenia or inhibit platelet function. A11 can prevent the cessation of carotid artery flow produced by induced artery injury and dissolve the induced thrombus 2 hours after cessation of blood flow. In addition, A11 can prevent, as well as ameliorate, murine middle cerebral artery stroke, without thrombocytopenia or brain hemorrhage. To further optimize the antithrombotic activity of A11, we produced a bifunctional A11-plasminogen first kringle agent (SLK), which homes to newly deposited fibrin strands within and surrounding the platelet thrombus, reducing effects on nonactivated circulating platelets. Indeed, SLK is able to completely reopen occluded carotid vessels 4 hours after cessation of blood flow, whereas A11 had no effect at 4 hours. Thus, a new antithrombotic agent was developed for platelet thrombus clearance.
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45
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Nussmeier NA, Miao Y, Roach GW, Wolman RL, Mora-Mangano C, Fox M, Szekely A, Tommasino C, Schwann NM, Mangano DT. Predictive value of the National Institutes of Health Stroke Scale and the Mini-Mental State Examination for neurologic outcome after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2010; 139:901-12. [DOI: 10.1016/j.jtcvs.2009.07.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 06/02/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
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46
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Chao YK, Wu YC, Yang KJ, Chiang LL, Liu HP, Lin PJ, Chu Y. Pulmonary perfusion with L-arginine ameliorates post-cardiopulmonary bypass lung injury in a rabbit model. J Surg Res 2009; 167:e77-83. [PMID: 20189593 DOI: 10.1016/j.jss.2009.10.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 10/12/2009] [Accepted: 10/30/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-cardiopulmonary bypass (CPB) lung injury is the combination of whole body inflammatory response and local ischemia-reperfusion (IR) injury. We investigated the benefit of pulmonary perfusion with L-arginine in protection against post-CPB lung injury. METHODS New Zealand white rabbits (n = 50, weight, 2.5-2.8 kg) were divided into five groups (n = 10 each): sham (sham sternotomy), CPB (CPB without pulmonary perfusion), perfusion (CPB with pulmonary perfusion), L-arginine (CPB with perfusion + L-arginine), and L-NAME (CPB with perfusion + L-NAME). The duration of CPB was 60 min followed by 2 h of reperfusion. Pulmonary perfusion was performed every 20 min through the pulmonary artery during CPB. Checking parameters included: (1) pulmonary vascular resistance, (2) pulmonary artery endothelium relaxation (organ chamber study), and (3) IR marker (myeloperoxidase) and inflammatory markers (TNF-α, IL-B, NF-κB). RESULTS CPB induced pulmonary artery endothelium dysfunction manifested by increased pulmonary vascular resistance and impaired pulmonary artery relaxation. Pulmonary perfusion could significantly reverse the phenomenon (P < 0.01) while provision of NO precursor-L-arginine with pulmonary perfusion together further possessed significant relaxation ability for pulmonary arterial endothelium compared with perfusion alone (P < 0.05). Accordingly, lung parenchyma myeloperoxidase activity and inflammatory cytokine level were also markedly increased after CPB (P < 0.05). Pulmonary perfusion could partially decrease the response, whereas additional L-arginine further attenuated inflammatory cytokine release (P < 0.05). CONCLUSIONS Pulmonary perfusion during CPB partially ameliorates CPB-induced lung injury. Pulmonary perfusion with L-arginine could further attenuate lung injury by restoring endothelial function and decreasing inflammatory response.
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Affiliation(s)
- Yin Kai Chao
- Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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47
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Abstract
Advances in extracorporeal membrane oxygenation (ECMO) management have helped to reduce complications compared with its inception but they remain high. The principal causes of mortality and morbidity are bleeding and thrombosis. The nonbiologic surface of an extracorporeal circuit provokes a massive inflammatory response leading to consumption and activation of procoagulant and anticoagulant components. The vast differences in neonatal and adult anticoagulation and transfusion requirements demands tremendous clinical knowledge to provide the best care. Increased use of thrombelastogram will complement other methods currently being used to improved care. Methods to recognize the level of thrombin formation at the bedside could help reduce neurologic complications. ECMO requires a multidisciplinary team approach to achieve the best outcomes.
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Affiliation(s)
- William C Oliver
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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48
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Aljassim O, Karlsson M, Wiklund L, Jeppsson A, Olsson P, Berglin E. Inflammatory response and platelet activation after off-pump coronary artery bypass surgery. SCAND CARDIOVASC J 2009; 40:43-8. [PMID: 16448997 DOI: 10.1080/14017430500381307] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cardiac surgery induces a systemic inflammatory activation and alterations in the hemostatic cascade. The responses contribute to postoperative complications but may also have protective effects. We investigated the relationship between inflammation, hemostasis and bleeding after off-pump coronary artery bypass surgery (OPCAB). METHODS Ten OPCAB patients were included in a prospective descriptive study. Selected markers of inflammation (IL-6, IL-8, PMN-elastase, C3a, and SC5b-9), and hemostasis (platelet count, ss-thromboglobulin, anti-thrombin, D-dimer and fibrinogen) were measured before and immediately after surgery. Postoperative bleeding was registered. RESULTS Inflammatory variables did not alter significantly during surgery while ss-thromboglobulin concentrations increased and anti-thrombin and fibrinogen decreased. There were significant postoperative correlations between PMN-elastase and ss-thromboglobulin (r=0.82, p=0.004), between PMN-elastase and fibrinogen (r=0.69, p=0.03) and between C3a and ss-thromboglobulin (r=0.71, p=0.02). In addition, there were significant inverse correlations between postoperative bleeding and pre- and postoperative fibrinogen levels (r=-0.76, p=0.011 and r=-0.84, p=0.002 respectively), between bleeding and postoperative ss-thromboglobulin levels (r=-0.66, p=0.04) and between bleeding and postoperative PMN-elastase (r=-0.75, p=0.01). CONCLUSIONS The results give further evidence for an association between the inflammatory response and hemostasis after cardiac surgery.
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Affiliation(s)
- Obaid Aljassim
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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49
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de Vries DK, Lindeman JHN, Tsikas D, de Heer E, Roos A, de Fijter JW, Baranski AG, van Pelt J, Schaapherder AFM. Early renal ischemia-reperfusion injury in humans is dominated by IL-6 release from the allograft. Am J Transplant 2009; 9:1574-84. [PMID: 19459788 DOI: 10.1111/j.1600-6143.2009.02675.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The pathophysiology of ischemia/reperfusion (I/R) injury is complex, and current knowledge of I/R injury in humans is incomplete. In the present study, human living-donor kidney transplantation was used as a highly reproducible model to systematically study various processes potentially involved in early I/R injury. Unique, direct measurements of arteriovenous concentration differences over the kidney revealed massive release of interleukin (IL)-6 in the first 30 minutes of graft reperfusion and a modest release of IL-8. Among the assessed markers of oxidative and nitrosative stress, only 15(S)-8-iso-PGF(2alpha) was released. When assessing cell activation, release of prothrombin factor 1 + 2 indicated thrombocyte activation, whereas there was no release of markers for endothelial activation or neutrophil activation. Common complement activation complex sC5b-9 was not released into the bloodstream, but was released into urine rapidly after reperfusion. To investigate whether IL-6 plays a modulating role in I/R injury, a mouse experiment of renal I/R injury was performed. Neutralizing anti-IL-6 antibody treatment considerably worsened kidney function. In conclusion, this study shows that renal I/R in humans is dominated by local IL-6 release. Neutralization of IL-6 in mice resulted in a significant aggravation of renal I/R injury.
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Affiliation(s)
- D K de Vries
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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50
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Murata K, Baldwin WM. Mechanisms of complement activation, C4d deposition, and their contribution to the pathogenesis of antibody-mediated rejection. Transplant Rev (Orlando) 2009; 23:139-50. [PMID: 19362461 PMCID: PMC2797368 DOI: 10.1016/j.trre.2009.02.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Complement split products have emerged as useful markers of antibody-mediated rejection in solid organ transplants. One split product, C4d, is now widely accepted as a marker for antibody-mediated rejection in renal and cardiac allografts. This review summarizes the rationale for the use of C4d as a marker of antibody-mediated rejection, along with the clinical evidence supporting its use in the clinical diagnosis of antibody-mediated rejection. Antibody-independent mechanisms by which C4d can be activated by the classical and lectin pathways of complement activation are also identified. Finally, mechanisms by which complement activation stimulates effector cells (neutrophils, monocytes, macrophages, platelets, and B and T lymphocytes) as well as target cells (endothelial cells) are discussed in relation to antibody-mediated allograft rejection.
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Affiliation(s)
- Kazunori Murata
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - William M Baldwin
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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