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Lim J, King J, Williams T, Boyle A. Unchanged cellular inflammatory response following recurrent ST-elevation myocardial infarction. Int J Cardiol 2024; 398:131656. [PMID: 38104725 DOI: 10.1016/j.ijcard.2023.131656] [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] [Received: 06/04/2023] [Revised: 11/14/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Recurrent ST-elevation myocardial infarctions (STEMIs) are associated with poorer prognosis. A diminished haematopoietic response has been proposed as the mechanism responsible for this, but has yet to be validated in human studies. We therefore aim to map out the leukocyte response, and its subtypes, following the first and second STEMI to identify if the inflammatory response is dampened after recurrent myocardial infarctions. METHODS Retrospective cohort study of patients presenting with recurrent STEMI undergoing percutaneous coronary intervention. Full blood counts were taken within 24 h of each admission, and daily thereafter. The primary outcome was whether there were any qualitative or quantitative difference in leukocyte cell response (and its subtypes) between first and second STEMI. RESULTS Thirty-one patients (mean age 59 years [SD 14.9], 26 males [83.9%]) with an average of 3.1 years between infarcts were included in the study. Overall, between first and second STEMI, similar mean leukocyte response (and its subtypes) was observed from admission to day three post PCI. Similarly, the peak leukocyte response (and its subtypes) was similar between the two STEMIs, even after adjusting for infarct size. CONCLUSIONS In recurrent STEMIs, there is no long-term memory effect on the cellular inflammatory response leading to diminished peripherally circulating leucocytes, and its subtypes.
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Affiliation(s)
- Joyce Lim
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - James King
- Department of Medicine, Flinders Medical Centre, Belford Park, SA, Australia
| | - Trent Williams
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia; Department of Cardiology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Andrew Boyle
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia; Department of Cardiology, John Hunter Hospital, New Lambton Heights, NSW, Australia.
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Serrier H, Rabier H, Fernandez V, Schott AM, Mewton N, Ovize M, Nighoghossian N, Duclos A, Colin C. Comparison of healthcare costs before and after a STEMI: A French national health data system-based cohort study. J Cardiol 2024; 83:44-48. [PMID: 37524298 DOI: 10.1016/j.jjcc.2023.07.010] [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] [Received: 11/30/2022] [Revised: 04/11/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Few studies have investigated real-world healthcare costs following a myocardial infarction (MI) and, to our knowledge, none after an ST-elevation MI (STEMI) specifically. Producing such data is important in order to help evaluate the economic burden of STEMI, but also to feed economic evaluation models and eventually show the economic interest of reducing STEMI incidence. The aim of this study was to estimate the healthcare cost in the year preceding and the year following a STEMI in France, in order to estimate the surplus in healthcare resource consumption after a STEMI. METHODS This study was conducted from the healthcare system perspective. The individual data from the HIBISCUS-STEMI cohort, which included patients with acute STEMI undergoing primary percutaneous coronary intervention, were matched with the French national health data system (Système National des Données de Santé, SNDS) using a probabilistic method. All expenses (in- and out-hospital) presented for reimbursement were taken into account to estimate a mean annual healthcare cost. RESULTS A total 258 patients from the HIBISCUS-STEMI cohort were included in this economic study. The total mean healthcare cost was estimated at €3516 before the STEMI, and at €9980 after the STEMI. Hospitalizations constituted the largest cost item, 27 % of the total cost before the STEMI and 41.8 % after the STEMI (Δ + 338.8 %). Follow-up and rehabilitative care represented the second largest cost item (25.9 % before and 18 % after the STEMI, Δ + 96.7 %). Treatments represented 19.4 % of the total cost before the STEMI and 17.2 % after (Δ + 150.8 %). CONCLUSIONS This study shows a significant surplus (threefold) of healthcare resource consumption in the year following a STEMI compared to the year preceding the STEMI.
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Affiliation(s)
- Hassan Serrier
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon cedex F-69424, Université Claude Bernard Lyon 1, INSERM U1290 Reshape, Lyon cedex F-69003, France.
| | - Hugo Rabier
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon cedex F-69424, Université Claude Bernard Lyon 1, INSERM U1290 Reshape, Lyon cedex F-69003, France
| | - Violaine Fernandez
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon cedex F-69424, Université Claude Bernard Lyon 1, INSERM U1290 Reshape, Lyon cedex F-69003, France
| | - Anne-Marie Schott
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon cedex F-69424, Université Claude Bernard Lyon 1, INSERM U1290 Reshape, Lyon cedex F-69003, France
| | - Nathan Mewton
- Hospices Civils de Lyon, Centre d'Investigation Clinique, Bron F-69500, Université Claude Bernard Lyon 1, INSERM U1060 CarMeN, Lyon cedex F-69003, France
| | - Michel Ovize
- Hospices Civils de Lyon, Centre d'Investigation Clinique, Bron F-69500, Université Claude Bernard Lyon 1, INSERM U1060 CarMeN, Lyon cedex F-69003, France
| | | | - Antoine Duclos
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon cedex F-69424, Université Claude Bernard Lyon 1, INSERM U1290 Reshape, Lyon cedex F-69003, France
| | - Cyrille Colin
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon cedex F-69424, Université Claude Bernard Lyon 1, INSERM U1290 Reshape, Lyon cedex F-69003, France
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Wang Y, Du W, Sun Y, Zhang J, Ma C, Jin X. CRTC1 is a potential target to delay aging-induced cognitive deficit by protecting the integrity of the blood-brain barrier via inhibiting inflammation. J Cereb Blood Flow Metab 2023; 43:1042-1059. [PMID: 37086081 PMCID: PMC10291461 DOI: 10.1177/0271678x231169133] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/09/2023] [Accepted: 03/24/2023] [Indexed: 04/23/2023]
Abstract
Aging can cause attenuation in the functioning of multiple organs, and blood-brain barrier (BBB) breakdown could promote the occurrence of disorders of the central nervous system during aging. Since inflammation is considered to be an important factor underlying BBB injury during aging, vascular endothelial cell senescence serves as a critical pathological basis for the destruction of BBB integrity. In the current review, we have first introduced the concepts related to aging-induced cognitive deficit and BBB integrity damage. Thereafter, we reviewed the potential relationship between disruption of BBB integrity and cognition deficit and the role of inflammation, vascular endothelial cell senescence, and BBB injury. We have also briefly introduced the function of CREB-regulated transcription co-activator 1 (CRTC1) in cognition and aging-induced CRTC1 changes as well as the critical roles of CRTC1/cyclooxygenase-2 (COX-2) in regulating inflammation, endothelial cell senescence, and BBB injury. Finally, the underlying mechanisms have been summarized and we propose that CRTC1 could be a promising target to delay aging-induced cognitive deficit by protecting the integrity of BBB through promoting inhibition of inflammation-mediated endothelial cell senescence.
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Affiliation(s)
- Yanping Wang
- Department of Neurology, the Second Hospital of Jiaxing City, Jiaxing, China
| | - Weihong Du
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research, Department of Histology and Embryology, School of Basic Medical Sciences, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yanyun Sun
- Institute of Neuroscience, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Junfang Zhang
- Department of Physiology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo, China
| | - Chaolin Ma
- School of Life Science and Institute of Life Science, Nanchang University, Nanchang, China
| | - Xinchun Jin
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research, Department of Histology and Embryology, School of Basic Medical Sciences, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Institute of Neuroscience, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Butyrate promotes post-stroke outcomes in aged mice via interleukin-22. Exp Neurol 2023; 363:114351. [PMID: 36804553 DOI: 10.1016/j.expneurol.2023.114351] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
Aging increases the risk of stroke, may exacerbate neuroinflammatory responses, reduce angiogenesis, and promote white matter damage post-stroke, all of which contribute to long-term functional recovery. Butyric acid, an important gut microbial metabolite, showed the highest correlation with the outcomes of ischemic stroke, and butyrate was selected as an effective treatment for aged stroke mice. Here, we tested the neurorestorative effect and potential therapeutic mechanisms of butyrate in aged mice with stroke. Aged male C57BL/6 J mice (17-19 months) were subjected to photothrombotic stroke. We performed butyrate supplementation in the drinking water for 3 weeks before surgery until 14 days after the stroke. At 14 days after ischemic stroke, white matter damage, leukocyte infiltration, and blood-brain barrier permeability were all decreased in the aged stroke mice that received the butyrate treatment, which also improved neurological outcomes by stimulating angiogenesis. Stroke reduces the level of interleukin-22 (IL-22) and butyrate treatment significantly enhanced IL-22 expression in the brain. To further validate the mechanisms of butyrate promoting neurological function after stroke, monoclonal antibodies were used to block IL-22 in aged stroke mice when butyrate treatment was provided. Blocking IL-22 in butyrate-treated aged stroke fails to improve functional outcomes and attenuated butyrate-induced angiogenesis, increased axon/white matter density and blood-brain barrier (BBB) integrity, but has no effect on inflammatory cells infiltration. In conclusion, butyrate improves outcomes in aged mice after stroke by promoting angiogenesis and BBB integrity and reducing leukocyte infiltration. To some extent, IL-22 may contribute to butyrate treatment induced vascular remodeling and increased BBB integrity responses in aged stroke mice.
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Zhang T, Kan L, Jin C, Shi W. Adverse childhood experiences and their impacts on subsequent depression and cognitive impairment in Chinese adults: A nationwide multi-center study. J Affect Disord 2023; 323:884-892. [PMID: 36566934 DOI: 10.1016/j.jad.2022.12.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACES) are prevalent and have long-lasting effects. This study explored how ACE exposure is associated with subsequent depression and cognitive impairment and whether sociodemographic characteristics modify that association. METHOD This study used data on 14,484 participants of the 2015 China Health and Retirement Longitudinal Study (CHARLS) and 2014 CHARLS life history survey. Depression was assessed using the 10-item Center for Epidemiologic Studies Depression scale. Cognitive performance was evaluated via three composite measures: episodic memory, mental intactness, and global cognition. Twelve ACE indicators were measured using a validated questionnaire. Multiple regression models and stratified analyses explored the relationship between ACES and subsequent depression and cognitive impairment, as well as potential modifiers. RESULTS Compared with individuals without ACES, those who experienced four or more ACES had a higher risk of subsequent depression (adjusted odds ratio, aOR = 2.65, 95 % confidence intervals [CIs]: 2.21 to 3.16), poorer mental intactness (β = -0.317 [-0.508 to -0.125]), and worse global cognition (-0.437 [-0.693 to -0.181]). Trend analyses showed a dose-response association between accumulated ACES and subsequent depression and cognitive impairment. No modifications of those associations by age, sex, educational level, or family's financial status during childhood were observed. LIMITATIONS Self-reported measures could favour recall bias. CONCLUSION Our study suggests that ACES increase the risk of subsequent depression and cognitive impairment in Chinese adults regardless of sociodemographic characteristics. These findings provide important implications for mitigating the adverse effects of early-life stress and promoting health in adulthood.
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Affiliation(s)
- Tiantian Zhang
- School of Social Development and Public Policy, Fudan University, Shanghai, China; Fudan University Center for Population and Development Policy Studies, Fudan University, Shanghai, China; Fudan Institute on Ageing, Fudan University, Shanghai, China
| | - Lena Kan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Changbo Jin
- Tongji University School of Medicine, Shanghai, China.
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Wang J, Zhang F, Gao M, Wang Y, Song X, Li Y, Dang Y, Qi X. The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2023. [DOI: 10.15212/cvia.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: Coronary no-reflow phenomenon (NRP), a common adverse complication in patients with ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI), is associated with poor patient prognosis. In this study, the correlation between the systemic immune-inflammation index (SII) and NRP in older patients with STEMI was studied, to provide a basis for early identification of high-risk patients and improve their prognosis.
Materials and methods: Between January 2017 and June 2020, 578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study. Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation. Clinical data and the examination indexes of the two groups were collected. Logistic regression was used to analyze the independent predictors of NRP, and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.
Results: Multivariate logistic analysis indicated that hypertension (OR=2.048, 95% CI:1.252–3.352, P=0.004), lymphocyte count (OR=0.571, 95% CI:0.368–0.885, P=0.012), platelet count (OR=1.009, 95% CI:1.005–1.013, P<0.001), hemoglobin (OR=1.015, 95% CI:1.003–1.028, P=0.018), multivessel disease (OR=2.237, 95% CI:1.407–3.558, P=0.001), and SII≥1814 (OR=3.799, 95% CI:2.190–6.593, P<0.001) were independent predictors of NRP after primary PCI in older patients with STEMI. Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP (AUC=0.738; 95% CI:0.686–0.790), with the best cut-off value of 1814, a sensitivity of 52.85% and a specificity of 85.71%.
Conclusion: For older patients with STEMI undergoing primary PCI, SII is a valid predictor of NRP.
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Affiliation(s)
- Jiaqi Wang
- Hebei North University, Zhangjiakou, Hebei Province, China
| | - Feifei Zhang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Man Gao
- Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Yudan Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Xuelian Song
- Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Yingxiao Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Xiaoyong Qi
- Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
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Tuohy MC, Hillman EMC, Marshall R, Agalliu D. The age-dependent immune response to ischemic stroke. Curr Opin Neurobiol 2023; 78:102670. [PMID: 36586305 PMCID: PMC9845177 DOI: 10.1016/j.conb.2022.102670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
Stroke is a devastating cause of global morbidity and mortality. Ischemic brain injury triggers a profound local and systemic immune response that participates in stroke pathophysiology. In turn, this immune response has emerged as a potential therapeutic target. In order to maximize its therapeutic potential, it is critical to understand how the immune response to ischemic brain injury is affected by age - the strongest non-modifiable risk factor for stroke. The development of multi-omics and single-cell technologies has provided a more comprehensive characterization of transcriptional and cellular changes that occur during aging. In this review, we summarize recent advances in our understanding of how age-related immune alterations shape differential stroke outcomes in older versus younger organisms, highlighting studies in both experimental mouse models and patient cohorts. Wherever possible, we emphasize outstanding questions that present important avenues for future investigation with therapeutic value for the aging population.
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Affiliation(s)
- Mary Claire Tuohy
- Doctoral Program in Neurobiology and Behavior, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Zuckerman Mind Brain Behavior Institute and Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Elizabeth M C Hillman
- Zuckerman Mind Brain Behavior Institute and Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA. https://twitter.com/HillmanLab
| | - Randolph Marshall
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Dritan Agalliu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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