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Mou YG, Zhang T, Zhao YT. ST-segment elevations with bradycardia in inferior leads: Acute pulmonary embolism. J Electrocardiol 2024; 84:38-41. [PMID: 38484436 DOI: 10.1016/j.jelectrocard.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 06/16/2024]
Abstract
Electrocardiographic (ECG) abnormalities are seen in 70%-80% of patients with acute pulmonary embolism (PE). Rarely, acute PE presents with ST-segment elevation (STE) in leads II; III and aVF and V1-3 mimicking ST-segment elevation myocardial infarction (STEMI). Herein, we describe a case of acute PE presenting with STE in II; III and aVF and V1-3.
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Affiliation(s)
- Yan-Guang Mou
- Department of Cardiology, Weifang People's Hospital, Weifang, Shandong Province, China.
| | - Tian Zhang
- Department of Cardiology, Weifang People's Hospital, Weifang, Shandong Province, China
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2
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Schulman ES, Nishi H, Pelleg A. Degranulation of human mast cells: modulation by P2 receptors' agonists. Front Immunol 2023; 14:1216580. [PMID: 37868982 PMCID: PMC10585249 DOI: 10.3389/fimmu.2023.1216580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/04/2023] [Indexed: 10/24/2023] Open
Abstract
Since the late 1970s, there has been an alarming increase in the incidence of asthma and its morbidity and mortality. Acute obstruction and inflammation of allergic asthmatic airways are frequently caused by inhalation of exogenous substances such as allergens cross-linking IgE receptors expressed on the surface of the human lung mast cells (HLMC). The degree of constriction of human airways produced by identical amounts of inhaled allergens may vary from day to day and even hour to hour. Endogenous factors in the human mast cell (HMC)'s microenvironment during allergen exposure may markedly modulate the degranulation response. An increase in allergic responsiveness may significantly enhance bronchoconstriction and breathlessness. This review focuses on the role that the ubiquitous endogenous purine nucleotide, extracellular adenosine 5'-triphosphate (ATP), which is a component of the damage-associated molecular patterns, plays in mast cells' physiology. ATP activates P2 purinergic cell-surface receptors (P2R) to trigger signaling cascades resulting in heightened inflammatory responses. ATP is the most potent enhancer of IgE-mediated HLMC degranulation described to date. Current knowledge of ATP as it relates to targeted receptor(s) on HMC along with most recent studies exploring HMC post-receptor activation pathways are discussed. In addition, the reviewed studies may explain why brief, minimal exposures to allergens (e.g., dust, cat, mouse, and grass) can unpredictably lead to intense clinical reactions. Furthermore, potential therapeutic approaches targeting ATP-related enhancement of allergic reactions are presented.
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Affiliation(s)
- Edward S. Schulman
- Division of Pulmonary, Critical Care and Allergy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Haruhisa Nishi
- Department of Pharmacology, Jikei University School of Medicine, Tokyo, Japan
| | - Amir Pelleg
- Danmir Therapeutics, LLC, Haverford, PA, United States
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3
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Sun Y, Feng L, Huang X, Hu B, Yuan Y. Case report: An elderly woman with recurrent syncope after pacemaker implantation. Front Cardiovasc Med 2023; 10:1117244. [PMID: 36970349 PMCID: PMC10031013 DOI: 10.3389/fcvm.2023.1117244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023] Open
Abstract
Syncope caused by atrioventricular block may occur as a result of a cardiac vasodepressor reflex. This article reports on a case of recurrent syncope in an 80-year-old woman with high-grade atrioventricular block, documented by electrocardiographic monitoring after pacemaker implantation. Pacemaker testing revealed stable impedance and sensing but a clear increase in the ventricular capture threshold at outputs. This case is unusual because the patient's primary diagnosis was non-cardiac. However, a combination of high D-dimer, hypoxemia, and computerized tomography scan of the pulmonary artery confirmed the diagnosis of pulmonary embolism (PE). With 1 month of anticoagulant therapy, the ventricular capture threshold gradually dropped to the normal range and syncope resolved. This is the first report of an electrophysiological phenomenon detected by pacemaker testing in a patient with syncope arising from PE.
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Muacevic A, Adler JR, Alzarrad A, Joy T, Jarad H. Bradycardia as a Rare Sign of Pulmonary Embolism: A Case Report of Pulmonary Embolism Diagnosis in Cardiac Arrest Using Point-of-Care Ultrasound. Cureus 2022; 14:e32798. [PMID: 36694525 PMCID: PMC9859651 DOI: 10.7759/cureus.32798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
We describe a case of cardiac arrest with pulmonary embolism and deep venous thrombosis diagnosed by point-of-care ultrasound, which resulted in a favorable outcome. In this article, we have also delineated bradycardia as an atypical sign of pulmonary embolism and explained the potential mechanism behind it.
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Adenosine, Adenosine Receptors and Neurohumoral Syncope: From Molecular Basis to Personalized Treatment. Biomedicines 2022; 10:biomedicines10051127. [PMID: 35625864 PMCID: PMC9138351 DOI: 10.3390/biomedicines10051127] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Adenosine is a ubiquitous nucleoside that is implicated in the occurrence of clinical manifestations of neuro-humoral syncope (NHS). NHS is characterized by a drop in blood pressure due to vasodepression together with cardio inhibition. These manifestations are often preceded by prodromes such as headaches, abdominal pain, feeling of discomfort or sweating. There is evidence that adenosine is implicated in NHS. Adenosine acts via four subtypes of receptors, named A1 (A1R), A2A (A2AR), A2B (A2BR) and A3 (A3R) receptors, with all subtypes belonging to G protein membrane receptors. The main effects of adenosine on the cardiovascular system occurs via the modulation of potassium ion channels (IK Ado, K ATP), voltage-gate calcium channels and via cAMP production inhibition (A1R and A3R) or, conversely, through the increased production of cAMP (A2A/BR) in target cells. However, it turns out that adenosine, via the activation of A1R, leads to bradycardia, sinus arrest or atrioventricular block, while the activation of A2AR leads to vasodilation; these same manifestations are found during episodes of syncope. The use of adenosine receptor antagonists, such as theophylline or caffeine, should be useful in the treatment of some forms of NHS. The aim of this review was to summarize the main data regarding the link between the adenosinergic system and NHS and the possible consequences on NHS treatment by means of adenosine receptor antagonists.
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Li TT, Chen X. Missed Signs of Acute Pulmonary Embolism in Electrocardiogram Findings. JAMA Intern Med 2022; 182:573. [PMID: 35344002 DOI: 10.1001/jamainternmed.2022.0387] [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: 11/14/2022]
Affiliation(s)
- Ting-Ting Li
- Department of Cardiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Xiaohong Chen
- Department of Emergency, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
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Nishi H, Niyonsaba F, Pelleg A, Schulman ES. Enhancement of Mast Cell Degranulation Mediated by Purinergic Receptors' Activation and PI3K Type δ. THE JOURNAL OF IMMUNOLOGY 2021; 207:1001-1008. [PMID: 34330752 DOI: 10.4049/jimmunol.2001002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022]
Abstract
Mast cells express multiple metabotropic purinergic P2Y receptor (P2YR) subtypes. Few studies have evaluated their role in human mast cell (HMC) allergic response as quantified by degranulation induced by cross-linking the high-affinity IgE receptor (FcεRI). We have previously shown that extracellular nucleotides modify the FcεRI activation-dependent degranulation in HMCs derived from human lungs, but the mechanism of this action has not been fully delineated. This study was undertaken to determine the mechanism of activation of P2YRs on the degranulation of HMCs and elucidate the specific postreceptor pathways involved. Sensitized LAD2 cells, a human-derived mast cell line, were subjected to a weak allergic stimulation (WAS) using a low concentration of Ag in the absence and presence of P2YR agonists. Only the metabotropic purinergic P2Y11 receptor (P2Y11R) agonist, adenosine 5'-(3-thio)triphosphate (ATPγS), enhanced WAS-induced degranulation resulting in a net 7-fold increase in release (n = 4; p < 0.01). None of the P2YR agonists tested, including high concentrations of ATPγS (1000 μM), enhanced WAS-induced intracellular Ca2+ mobilization, an essential component of activated FcεRI-induced degranulation. Both a PI3K inhibitor and the relevant gene knockout decreased the ATPγS-induced enhancement. The effect of ATPγS was associated with enhanced phosphorylation of PI3K type δ and protein kinase B, but not the phosphoinositide-dependent kinase-1. The effects of ATPγS were dose dependently inhibited by NF157, a P2Y11R antagonist. To our knowledge, these data indicate for the first time that P2YR is linked to enhancement of allergic degranulation in HMC via the PI3K/protein kinase B pathway.
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Affiliation(s)
- Haruhisa Nishi
- Department of Pharmacology, Jikei University School of Medicine, Tokyo, Japan;
| | - François Niyonsaba
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan
| | - Amir Pelleg
- Danmir Therapeutics, LLC, Haverford, PA; and
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Pelleg A. Extracellular adenosine 5'-triphosphate in pulmonary disorders. Biochem Pharmacol 2020; 187:114319. [PMID: 33161021 DOI: 10.1016/j.bcp.2020.114319] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
Adenosine 5'-triphosphate (ATP) is found in every cell of the human body where it plays a critical role in cellular energetics and metabolism. ATP is released from cells under physiologic and pathophysiologic condition; extracellular ATP is rapidly degraded to adenosine 5'-diphosphate (ADP) and adenosine by ecto-enzymes (mainly, CD39 and CD73). Before its degradation, ATP acts as an autocrine and paracrine agent exerting its effects on targeted cells by activating cell surface receptors named P2 Purinergic receptors. The latter are expressed by different cell types in the lungs, the activation of which is involved in multiple pulmonary disorders. This succinct review summarizes the role of ATP in inflammation processes associated with these disorders including bronchoconstriction, cough, mechanical ventilation-induced lung injury and idiopathic pulmonary fibrosis. All of these disorders still constitute unmet clinical needs. Therefore, the various ATP-signaling pathways in pulmonary inflammation constitute attractive targets for novel drug-candidates that would improve the management of patients with multiple pulmonary diseases.
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Affiliation(s)
- Amir Pelleg
- Danmir Therapeutics, LLC, Haverford, PA, USA. http://www.danmirtherapeutics.com
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Zeng J, Ning Z, Wang Y, Xiong H. Implications of CD39 in immune-related diseases. Int Immunopharmacol 2020; 89:107055. [PMID: 33045579 DOI: 10.1016/j.intimp.2020.107055] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/10/2020] [Accepted: 09/26/2020] [Indexed: 02/07/2023]
Abstract
Extracellular adenosine triphosphate (eATP) mediates pro-inflammatory responses by recruiting and activating inflammatory cells. CD39 can hydrolyze eATP into adenosine monophosphate (AMP), while CD73 can convert AMP into the immunosuppressive nucleoside adenosine (ADO). CD39 is a rate-limiting enzyme in this cascade, which is regarded as an immunological switch shifting the ATP-mediated pro-inflammatory environment to the ADO- mediated anti-inflammatory status. The CD39 expression can be detected in a wide spectrum of immunocytes, which is under the influence of environmental and genetic factors. It is increasingly suggested that, CD39 participates in some pathophysiological processes, like inflammatory bowel disease (IBD), sepsis, multiple sclerosis (MS), allergic diseases, ischemia-reperfusion (I/R) injury, systemic lupus erythematosus (SLE), diabetes and cancer. Here, we focus on the current understanding of CD39 in immunity, and comprehensively illustrate the diverse CD39 functions within a variety of disorders.
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Affiliation(s)
- Jianrui Zeng
- Institute of Immunology and Molecular Medicine, Jining Medical University, Shandong 272067, China
| | - Zhaochen Ning
- Institute of Immunology and Molecular Medicine, Jining Medical University, Shandong 272067, China
| | - Yuzhong Wang
- Department of Neurology and Central Laboratory, Affiliated Hospital of Jining Medical University, Shandong 272000, China.
| | - Huabao Xiong
- Institute of Immunology and Molecular Medicine, Jining Medical University, Shandong 272067, China.
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Tribute to Prof. Geoffrey Burnstock: transition of purinergicsignaling to drug discovery. Purinergic Signal 2020; 17:3-8. [PMID: 32794053 DOI: 10.1007/s11302-020-09717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022] Open
Abstract
Geoffrey Burnstock made a chance observation early in his research career that did not fit the conventional scientific dogma-non-noradrenergic, non-cholinergic (NANC) nerves. Instead of rejecting these as an artifact, he followed their logical course to characterize the actions of extracellular ATP on nerves and muscles, eventually founding a large branch of pharmacology around purinergic signaling. The solid proof that validated his concept and dismissed many detractors was the cloning of seven ionotropic P2X receptors and eight metabotropic P2Y receptors, which are expressed in some combination in every tissue and organ. Given the broad importance of this signaling system in biology, medicinal chemists, inspired by Burnstock, began creating synthetic agonists and antagonists for these purinergic receptors. Various ligands have advanced to clinical trials, for disorders of the immune, nervous, cardiovascular, and other systems, and a few are already approved. Thus, medically important approaches have been derived from Burnstock's original pharmacological concepts and his constant guiding of the course of the field. The therapeutic potential of modulators of purinergic signaling is vast.
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Pelleg A, Xu F, Zhuang J, Undem B, Burnstock G. DT-0111: a novel drug-candidate for the treatment of COPD and chronic cough. Ther Adv Respir Dis 2020; 13:1753466619877960. [PMID: 31558105 PMCID: PMC6767719 DOI: 10.1177/1753466619877960] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Extracellular adenosine 5′-triphosphate (ATP) plays important mechanistic
roles in pulmonary disorders in general and chronic obstructive pulmonary
disease (COPD) and cough in particular. The effects of ATP in the lungs are
mediated to a large extent by P2X2/3 receptors (P2X2/3R) localized on vagal
sensory nerve terminals (both C and Aδ fibers). The activation of these
receptors by ATP triggers a pulmonary-pulmonary central reflex, which
results in bronchoconstriction and cough, and is also proinflammatory due to
the release of neuropeptides from these nerve terminals via
the axon reflex. These actions of ATP in the lungs constitute a strong
rationale for the development of a new class of drugs targeting P2X2/3R.
DT-0111 is a novel, small, water-soluble molecule that acts as an antagonist
at P2X2/3R sites. Methods: Experiments using receptor-binding functional assays, rat nodose ganglionic
cells, perfused innervated guinea pig lung preparation ex
vivo, and anesthetized and conscious guinea pigs in
vivo were performed. Results: DT-0111 acted as a selective and effective antagonist at P2X2/3R, that is, it
did not activate or block P2YR; markedly inhibited the activation by ATP of
nodose pulmonary vagal afferents in vitro; and, given as an
aerosol, inhibited aerosolized ATP-induced bronchoconstriction and cough
in vivo. Conclusions: These results indicate that DT-0111 is an attractive drug-candidate for the
treatment of COPD and chronic cough, both of which still constitute major
unmet clinical needs. The reviews of this paper are available via the supplementary
material section.
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Affiliation(s)
- Amir Pelleg
- Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA 19102, USA.,Danmir Therapeutics, LLC, Haverford, PA, USA
| | - Fadi Xu
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Jianguo Zhuang
- Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Bradley Undem
- Johns Hopkins University Asthma Center, Baltimore, MD, USA
| | - Geoffrey Burnstock
- Department of Pharmacology and Therapeutics, The University of Melbourne, Parkville, Victoria, Australia.,Autonomic Neuroscience Institute, Royal Free and University College Medical School, London, UK
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Matthews GDK, Grace AA. Unmasking Adenosine: The Purinergic Signalling Molecule Critical to Arrhythmia Pathophysiology and Management. Arrhythm Electrophysiol Rev 2020; 8:240-248. [PMID: 32685154 PMCID: PMC7358948 DOI: 10.15420/aer.2019.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Adenosine was identified in 1929 and immediately recognised as having a potential role in therapy for arrhythmia because of its negative chronotropic and dromotropic effects. Adenosine entered mainstream use in the 1980s as a highly effective agent for the termination of supraventricular tachycardia (SVT) involving the atrioventricular node, as well as for its ability to unmask the underlying rhythm in other SVTs. Adenosine has subsequently been found to have applications in interventional electrophysiology. While considered a safe agent because of its short half-life, adenosine may provoke arrhythmias in the form of AF, bradyarrhythmia and ventricular tachyarrhythmia. Adenosine is also associated with bronchospasm, although this may reflect irritant-induced dyspnoea rather than true obstruction. Adenosine is linked to numerous pathologies relevant to arrhythmia predisposition, including heart failure, obesity, ischaemia and the ageing process itself. This article examines 90 years of experience with adenosine in the light of new European Society of Cardiology guidelines for the management of SVT.
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Affiliation(s)
- Gareth DK Matthews
- Cambridge University NHS Foundation Trust, Cambridge, UK; Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Andrew A Grace
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Department of Biochemistry, University of Cambridge, Cambridge, UK
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