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Doukas P, Hartmann O, Frankort J, Arlt B, Krabbe H, Jacobs MJ, Greiner A, Frese JP, Gombert A. Postoperative bioactive adrenomedullin is associated with the onset of ARDS and adverse outcomes in patients undergoing open thoracoabdominal aortic surgery. Sci Rep 2024; 14:12795. [PMID: 38834580 PMCID: PMC11150250 DOI: 10.1038/s41598-024-63412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
Cytokine-mediated systemic inflammation after open thoracoabdominal aortic aneurysm (TAAA) repairs plays a pivotal role in disrupting circulatory homeostasis, potentially leading to organ dysfunction. The bioactive form of adrenomedullin (bio-ADM) is a peptide hormone with immunomodulatory and vasomotor effects, making it a potential diagnostic agent in these cases. This retrospective, bicentric study, conducted between January 2019 and December 2022, recruited 36 elective open TAAA repair patients in two German centres. Serum and plasma samples were collected at multiple time points to measure bio-ADM levels. The primary objective was to evaluate the association of bio-ADM levels with the onset of acute respiratory distress syndrome (ARDS), with secondary endpoints focusing on mortality and SIRS-related morbidity. Results showed a significant association between postoperative bio-ADM levels (12-48 h after surgery) and the onset of ARDS (p < .001), prolonged ventilation (p = .015 at 12h after surgery), atrial fibrillation (p < .001), and mortality (p = .05 at 24h). The biomarker was also strongly associated with sepsis (p = .01 at 12 h) and multi-organ dysfunction syndrome (MODS) (p = .02 at 24 h after surgery). The study underscores the potential utility of bio-ADM as a diagnostic tool for identifying patients at risk of postoperative complications following open TAAA repairs.
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Affiliation(s)
- Panagiotis Doukas
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074, Aachen, Germany.
| | | | - Jelle Frankort
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074, Aachen, Germany
| | - Birte Arlt
- SphingoTec GmbH, Hennigsdorf, Berlin, Germany
| | - Hanif Krabbe
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074, Aachen, Germany
| | - Michael Johan Jacobs
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074, Aachen, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Paul Frese
- Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Gombert
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, RWTH University Hospital Aachen, 52074, Aachen, Germany
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Kasahara T, Tanaka M, Zhao Y, Kamiyoshi A, Sakurai T, Ichikawa-Shindo Y, Kawate H, Matsuda Y, Zhang Y, Guo Q, Li P, Hoshiyama K, Li J, Onishi N, Hayashi M, Sanjo H, Ishida K, Tanaka S, Kawamata M, Shindo T. Receptor activity-modifying proteins of adrenomedullin (RAMP2/3): Roles in the pathogenesis of ARDS. Peptides 2024; 171:171118. [PMID: 38012983 DOI: 10.1016/j.peptides.2023.171118] [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: 09/22/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition characterized by widespread inflammation and pulmonary edema. Adrenomedullin (AM), a bioactive peptide with various functions, is expected to be applied in treating ARDS. Its functions are regulated primarily by two receptor activity-modifying proteins, RAMP2 and RAMP3, which bind to the AM receptor calcitonin receptor-like receptor (CLR). However, the roles of RAMP2 and RAMP3 in ARDS remain unclear. We generated a mouse model of ARDS via intratracheal administration of lipopolysaccharide (LPS), and analyzed the pathophysiological significance of RAMP2 and RAMP3. RAMP2 expression declined with LPS administration, whereas RAMP3 expression increased at low doses and decreased at high doses of LPS. After LPS administration, drug-inducible vascular endothelial cell-specific RAMP2 knockout mice (DI-E-RAMP2-/-) showed reduced survival, increased lung weight, and had more apoptotic cells in the lungs. DI-E-RAMP2-/- mice exhibited reduced expression of Epac1 (which regulates vascular endothelial cell barrier function), while RAMP3 was upregulated in compensation. In contrast, after LPS administration, RAMP3-/- mice showed no significant changes in survival, lung weight, or lung pathology, although they exhibited significant downregulation of iNOS, TNF-α, and NLRP3 during the later stages of inflammation. Based on transcriptomic analysis, RAMP2 contributed more to the circulation-regulating effects of AM, whereas RAMP3 contributed more to its inflammation-regulating effects. These findings indicate that, while both RAMP2 and RAMP3 participate in ARDS pathogenesis, their functions differ distinctly. Further elucidation of the pathophysiological significance and functional differences between RAMP2 and RAMP3 is critical for the future therapeutic application of AM in ARDS.
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Affiliation(s)
- Tomoki Kasahara
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan; Department of Anesthesiology, Shinshu University School of Medicine, Japan
| | - Megumu Tanaka
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Yunlu Zhao
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Akiko Kamiyoshi
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan; Department of Life Innovation, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Japan
| | - Takayuki Sakurai
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan; Department of Life Innovation, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Japan
| | - Yuka Ichikawa-Shindo
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Hisaka Kawate
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Yorishige Matsuda
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan; Department of Ophthalmology, Shinshu University School of Medicine, Japan
| | - Yan Zhang
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Qianqian Guo
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Peixuan Li
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Ken Hoshiyama
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan; Department of Ophthalmology, Shinshu University School of Medicine, Japan
| | - Jiake Li
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Naho Onishi
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Marina Hayashi
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan
| | - Hideki Sanjo
- Department of Molecular and Cellular Immunology, Shinshu University School of Medicine, Japan
| | - Kumiko Ishida
- Department of Anesthesiology, Shinshu University School of Medicine, Japan
| | - Satoshi Tanaka
- Department of Anesthesiology, Shinshu University School of Medicine, Japan
| | - Mikito Kawamata
- Department of Anesthesiology, Shinshu University School of Medicine, Japan
| | - Takayuki Shindo
- Department of Cardiovascular Research, Shinshu University School of Medicine, Japan; Department of Life Innovation, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Japan.
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Pietraszko P, Zorawski M, Bielecka E, Sielatycki P, Zbroch E. Mid-Regional Proadrenomedullin in COVID-19-May It Act as a Predictor of Prolonged Cardiovascular Complications? Int J Mol Sci 2023; 24:16821. [PMID: 38069140 PMCID: PMC10705931 DOI: 10.3390/ijms242316821] [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: 09/28/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
The rising prevalence of cardiovascular disease (CVD) and the impact of the SARS-CoV-2 pandemic have both led to increased mortality rates, affecting public health and the global economy. Therefore, it is essential to find accessible, non-invasive prognostic markers capable of identifying patients at high risk. One encouraging avenue of exploration is the potential of mid-regional proadrenomedullin (MR-proADM) as a biomarker in various health conditions, especially in the context of CVD and COVID-19. MR-proADM presents the ability to predict mortality, heart failure, and adverse outcomes in CVD, offering promise for improved risk assessment and treatment strategies. On the other hand, an elevated MR-proADM level is associated with disease severity and cytokine storms in patients with COVID-19, making it a predictive indicator for intensive care unit admissions and mortality rates. Moreover, MR-proADM may have relevance in long COVID, aiding in the risk assessment, triage, and monitoring of individuals at increased risk of developing prolonged cardiac issues. Our review explores the potential of MR-proADM as a predictor of enduring cardiovascular complications following COVID-19 infection.
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Affiliation(s)
| | | | | | | | - Edyta Zbroch
- Department of Internal Medicine and Hypertension, Medical University of Bialystok, 15-089 Bialystok, Poland; (P.P.); (M.Z.); (E.B.); (P.S.)
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