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Santos-Gomes J, Gandra I, Adão R, Perros F, Brás-Silva C. An Overview of Circulating Pulmonary Arterial Hypertension Biomarkers. Front Cardiovasc Med 2022; 9:924873. [PMID: 35911521 PMCID: PMC9333554 DOI: 10.3389/fcvm.2022.924873] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH), also known as Group 1 Pulmonary Hypertension (PH), is a PH subset characterized by pulmonary vascular remodeling and pulmonary arterial obstruction. PAH has an estimated incidence of 15-50 people per million in the United States and Europe, and is associated with high mortality and morbidity, with patients' survival time after diagnosis being only 2.8 years. According to current guidelines, right heart catheterization is the gold standard for diagnostic and prognostic evaluation of PAH patients. However, this technique is highly invasive, so it is not used in routine clinical practice or patient follow-up. Thereby, it is essential to find new non-invasive strategies for evaluating disease progression. Biomarkers can be an effective solution for determining PAH patient prognosis and response to therapy, and aiding in diagnostic efforts, so long as their detection is non-invasive, easy, and objective. This review aims to clarify and describe some of the potential new candidates as circulating biomarkers of PAH.
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Affiliation(s)
- Joana Santos-Gomes
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Gandra
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rui Adão
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Frédéric Perros
- Paris-Porto Pulmonary Hypertension Collaborative Laboratory (3PH), UMR_S 999, INSERM, Université Paris-Saclay, Paris, France
- Université Paris–Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Carmen Brás-Silva
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
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Abstract
Pulmonary arterial hypertension is characterized by obliteration and obstruction of the pulmonary arterioles that in turn results in high right ventricular afterload and right heart failure. The pathobiology of pulmonary arterial hypertension is complex, with contributions from multiple pathophysiologic processes that are regulated by a variety of molecular mechanisms. This nature likely explains the limited efficacy of our current therapies, which only target a small portion of the pathobiological mechanisms that underlie advanced disease. Here we review the pathobiology of pulmonary arterial hypertension, focusing on the systemic, cellular, and molecular mechanisms that underlie the disease.
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Affiliation(s)
- Sudarshan Rajagopal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Room 128A Hanes House, 330 Trent Drive, Durham, NC 27710, USA.
| | - Yen-Rei A Yu
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, 12605 E. 16th Avenue, Aurora, CO 80045, USA
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3
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Mamazhakypov A, Viswanathan G, Lawrie A, Schermuly RT, Rajagopal S. The role of chemokines and chemokine receptors in pulmonary arterial hypertension. Br J Pharmacol 2019; 178:72-89. [PMID: 31399998 DOI: 10.1111/bph.14826] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by progressive pulmonary artery remodelling leading to increased right ventricular pressure overload, which results in right heart failure and premature death. Inflammation plays a central role in the development of PAH, and the recruitment and function of immune cells are tightly regulated by chemotactic cytokines called chemokines. A number of studies have shown that the development and progression of PAH are associated with the dysregulated expression of several chemokines and chemokine receptors in the pulmonary vasculature. Moreover, some chemokines are differentially regulated in the pressure-overloaded right ventricle. Recent studies have tested the efficacy of pharmacological agents targeting several chemokines and chemokine receptors for their effects on the development of PAH, suggesting that these receptors could serve as useful therapeutic targets. In this review, we provide recent insights into the role of chemokines and chemokine receptors in PAH and RV remodelling and the opportunities and roadblocks in targeting them. LINKED ARTICLES: This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.1/issuetoc.
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Affiliation(s)
- Argen Mamazhakypov
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus Liebig University of Giessen, Giessen, Germany
| | - Gayathri Viswanathan
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Allan Lawrie
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ralph Theo Schermuly
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus Liebig University of Giessen, Giessen, Germany
| | - Sudarshan Rajagopal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Jonas K, Magoń W, Podolec P, Kopeć G. Triglyceride-to-High-Density Lipoprotein Cholesterol Ratio and Systemic Inflammation in Patients with Idiopathic Pulmonary Arterial Hypertension. Med Sci Monit 2019; 25:746-753. [PMID: 30683836 PMCID: PMC6359883 DOI: 10.12659/msm.912766] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Idiopathic pulmonary arterial hypertension (IPAH) patients are characterized by elevated triglyceride (TG)-to-HDL cholesterol (HDL-C) ratio, which has been proposed to be an important prognostic factor in this population. The mechanism of this phenomenon remains unknown. We therefore investigated the potential determinants of increased TG/HDL-C ratio in IPAH patients. Material/Methods We prospectively recruited consecutive clinically stable IPAH patients between January 2016 and February 2017. Patients with diabetes or using statins were excluded. Anthropometric measurements included body mass index (BMI) and skinfold thickness; body fat mass was calculated using age and sex-specific equations. We assessed lipid profile, homeostatic model assessment of insulin resistance (HOMA-IR), serum adipokine levels (adiponectin, resistin, leptin, and visfatin), and circulating cytokines (IL-1β, IL-6, MCP-1, and TNF-α). Results We assessed 47 IPAH patients: 9 of them had been diagnosed with diabetes and 10 were treated with statins; therefore, were excluded them from further analysis. Age, sex distribution, and BMI were similar irrespectively of TG/HDL-C ratio. Patients with increased TG/HDL-C ratio (>3) as compared to patients with TG/HDL-C ≤3 were characterized by higher levels of IL-1β, MCP-1, and IL-6. TG level was correlated with IL-1β (R=0.76, p<0.001), IL-6 (R=0.52, p=0.005), TNF-α (R=0.62, p<0.001), and MCP-1 (R=0.63, p<0.001). IL-1β was also inversely correlated with HDL-C (R=−0.44, p=0.02). We found no differences in concentration of fasting glucose, insulin, HOMA-IR, body fat content, or adipokine levels between patients with higher and lower TG/HDL-C ratios. Conclusions In IPAH patients, elevated TG/HDL-C ratio is a marker of systemic inflammation.
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Affiliation(s)
- Kamil Jonas
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Cracow, Cracow, Poland
| | - Wojciech Magoń
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Cracow, Cracow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Cracow, Cracow, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Cracow, Cracow, Poland
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Ichimura K, Matoba T, Koga JI, Nakano K, Funamoto D, Tsutsui H, Egashira K. Nanoparticle-Mediated Targeting of Pitavastatin to Small Pulmonary Arteries and Leukocytes by Intravenous Administration Attenuates the Progression of Monocrotaline-Induced Established Pulmonary Arterial Hypertension in Rats. Int Heart J 2018; 59:1432-1444. [PMID: 30369578 DOI: 10.1536/ihj.17-683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Statins are known to improve pulmonary arterial hypertension (PAH) by their anti-inflammatory and anti-proliferative effects in animal models. However, recent clinical studies have reported that clinically approved statin doses failed to improve clinical outcomes in patients with PAH. We therefore hypothesized that nanoparticle (NP) -mediated targeting of pitavastatin could attenuate the progression of established PAH.We induced PAH by subcutaneously injecting monocrotaline (MCT) in Sprague-Dawley rats. On day 14 after the MCT injection, animals that displayed established PAH on echocardiography were included. On day 17, they were randomly assigned to the following 5 groups: daily intravenous administration of (1) vehicle, (2) fluorescein-isothiocyanate-NP, (3) pitavastatin, (4) pitavastatin-NP, or (5) oral sildenafil. Intravenous NP was selectively delivered to small pulmonary arteries and circulating CD11b-positive leukocytes. On day 21, pitavastatin-NP attenuated the progression of PAH at lower doses than pitavastatin alone. This was associated with the inhibition of monocyte-mediated inflammation, proliferation, and remodeling of the pulmonary arteries. Interestingly, sildenafil attenuated the development of PAH, but had no effects on inflammation or remodeling of the pulmonary arteries. In separate experiments, only treatment with pitavastatin-NP reduced the mortality rate at day 35.NP-mediated targeting of pitavastatin to small pulmonary arteries and leukocytes attenuated the progression of established MCT-induced PAH and improved survival. Therapeutically, pitavastatin-NP was associated with anti-inflammatory and anti-proliferative effects on small pulmonary arteries, which was completely distinct from the vasodilatory effect of sildenafil. Pitavastatin-NP can be a novel therapeutic modality for PAH.
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Affiliation(s)
- Kenzo Ichimura
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Jun-Ichiro Koga
- Department of Cardiovascular Research, Development, and Translational Medicine, Center for Disruptive Cardiovascular Medicine, Kyushu University
| | - Kaku Nakano
- Department of Cardiovascular Research, Development, and Translational Medicine, Center for Disruptive Cardiovascular Medicine, Kyushu University
| | - Daiki Funamoto
- Department of Cardiovascular Research, Development, and Translational Medicine, Center for Disruptive Cardiovascular Medicine, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kensuke Egashira
- Department of Cardiovascular Research, Development, and Translational Medicine, Center for Disruptive Cardiovascular Medicine, Kyushu University
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Joshi AA, Davey R, Rao Y, Shen K, Benza RL, Raina A. Association between cytokines and functional, hemodynamic parameters, and clinical outcomes in pulmonary arterial hypertension. Pulm Circ 2018; 8:2045894018794051. [PMID: 30036135 PMCID: PMC6153541 DOI: 10.1177/2045894018794051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To assess the relationship of cytokines with functional and clinical outcomes in
pulmonary arterial hypertension (PAH). Endothelial dysfunction and vascular
inflammation are characteristic of PAH. We investigated whether markers of
angiogenesis and inflammation associated with functional, hemodynamic
parameters, and clinical outcomes in PAH. PAH patients (n = 206) were pooled
from two clinical trials: TRUST-1 and FREEDOM-C2. Baseline and post-treatment
cytokine levels were correlated to baseline clinical and hemodynamic parameters,
were assessed in clinical subgroups, and were associated with clinical outcomes.
In 206 patients (mean age = 48 years; 74% women) with WHO group-1 PAH, most
cytokine levels were higher in those with 6-min walking distance
(6MWD) < median (335 m) vs. those above median, including Ang-1 (11.9 ± 10.1
vs. 5.9 ± 6.0 ng/mL), Ang-2 (14.3 ± 11.8 vs. 12.2 ± 11.2 ng/mL), and MMP-9
(221 ± 262.3 vs. 119 ± 171 ng/mL). Baseline 6MWD inversely correlated with Ang-1
(r = −0.27, P < 0.0001), Ang-2 (r = −0.20,
P = 0.004), and MMP-9 (r = −0.27,
P < 0.0001). MMP-9 levels differed significantly by NYHA
functional class (P = 0.001) suggesting an association between
MMP-9 and subjective PAH severity. Mean Ang-2 levels were higher in those with
baseline right atrial pressure (RAP) > 15 mmHg compared to those with
RAP < 15 mmHg (23,841 vs. 11,020 pg/mL). Baseline RAP was associated with
change in MMP-9 levels (r = −0.53, P = 0.03). Finally, baseline
Ang-1, VEGF and MMP-9 levels were associated with risk of death and
hospitalization at 16-week follow-up. Inflammatory cytokines and vascular
angiogenesis markers are associated with baseline functional, hemodynamic
parameters in PAH, and predict death and hospitalization. Larger prospective
studies are needed to confirm the utility of cytokines in PAH.
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Affiliation(s)
- Aditya A Joshi
- 1 Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ryan Davey
- 2 Division of Cardiology, Western University, London, ON, Canada
| | - Youlan Rao
- 3 United Therapeutics Corporation, Research Triangle, NC, USA
| | - Kai Shen
- 3 United Therapeutics Corporation, Research Triangle, NC, USA
| | - Raymond L Benza
- 4 Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Amresh Raina
- 4 Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
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Misawa H, Ohashi W, Tomita K, Hattori K, Shimada Y, Hattori Y. Prostacyclin mimetics afford protection against lipopolysaccharide/d-galactosamine-induced acute liver injury in mice. Toxicol Appl Pharmacol 2017; 334:55-65. [DOI: 10.1016/j.taap.2017.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 02/06/2023]
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Clapp LH, Gurung R. The mechanistic basis of prostacyclin and its stable analogues in pulmonary arterial hypertension: Role of membrane versus nuclear receptors. Prostaglandins Other Lipid Mediat 2015; 120:56-71. [PMID: 25917921 DOI: 10.1016/j.prostaglandins.2015.04.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/13/2015] [Indexed: 12/22/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease of distal pulmonary arteries in which patients suffer from elevated pulmonary arterial pressure, extensive vascular remodelling and right ventricular failure. To date prostacyclin (PGI2) therapy remains the most efficacious treatment for PAH and is the only approved monotherapy to have a positive impact on long-term survival. A key thing to note is that improvement exceeds that predicted from vasodilator testing strongly suggesting that additional mechanisms contribute to the therapeutic benefit of prostacyclins in PAH. Given these agents have potent antiproliferative, anti-inflammatory and endothelial regenerating properties suggests therapeutic benefit might result from a slowing, stabilization or even some reversal of vascular remodelling in vivo. This review discusses evidence that the pharmacology of each prostacyclin (IP) receptor agonist so far developed is distinct, with non-IP receptor targets clearly contributing to the therapeutic and side effect profile of PGI2 (EP3), iloprost (EP1), treprostinil (EP2, DP1) along with a family of nuclear receptors known as peroxisome proliferator-activated receptors (PPARs), to which PGI2 and some analogues directly bind. These targets are functionally expressed to varying degrees in arteries, veins, platelets, fibroblasts and inflammatory cells and are likely to be involved in the biological actions of prostacylins. Recently, a highly selective IP agonist, selexipag has been developed for PAH. This agent should prove useful in distinguishing IP from other prostanoid receptors or PPAR binding effects in human tissue. It remains to be determined whether selectivity for the IP receptor gives rise to a superior or inferior clinical benefit in PAH.
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Affiliation(s)
- Lucie H Clapp
- Department of Medicine, UCL, Rayne Building, London WC1E 6JF, UK.
| | - Rijan Gurung
- Department of Medicine, UCL, Rayne Building, London WC1E 6JF, UK
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McCullagh BN, Costello CM, Li L, O’Connell C, Codd M, Lawrie A, Morton A, Kiely DG, Condliffe R, Elliot C, McLoughlin P, Gaine S. Elevated plasma CXCL12α is associated with a poorer prognosis in pulmonary arterial hypertension. PLoS One 2015; 10:e0123709. [PMID: 25856504 PMCID: PMC4391833 DOI: 10.1371/journal.pone.0123709] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/05/2015] [Indexed: 01/24/2023] Open
Abstract
RATIONALE Recent work in preclinical models suggests that signalling via the pro-angiogenic and pro-inflammatory cytokine, CXCL12 (SDF-1), plays an important pathogenic role in pulmonary hypertension (PH). The objective of this study was to establish whether circulating concentrations of CXCL12α were elevated in patients with PAH and related to mortality. METHODS Plasma samples were collected from patients with idiopathic pulmonary arterial hypertension (IPAH) and PAH associated with connective tissue diseases (CTD-PAH) attending two pulmonary hypertension referral centres (n = 95) and from age and gender matched healthy controls (n = 44). Patients were subsequently monitored throughout a period of five years. RESULTS CXCL12α concentrations were elevated in PAH groups compared to controls (P<0.05) and receiver-operating-characteristic analysis showed that plasma CXCL12α concentrations discriminated patients from healthy controls (AUC 0.80, 95% confidence interval 0.73-0.88). Kaplan Meier analysis indicated that elevated plasma CXCL12α concentration was associated with reduced survival (P<0.01). Multivariate Cox proportional hazards model showed that elevated CXCL12α independently predicted (P<0.05) earlier death in PAH with a hazard ratio (95% confidence interval) of 2.25 (1.01-5.00). In the largest subset by WHO functional class (Class 3, 65% of patients) elevated CXCL12α independently predicted (P<0.05) earlier death, hazard ratio 2.27 (1.05-4.89). CONCLUSIONS Our data show that elevated concentrations of circulating CXCL12α in PAH predicted poorer survival. Furthermore, elevated circulating CXCL12α was an independent risk factor for death that could potentially be included in a prognostic model and guide therapy.
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Affiliation(s)
- Brian N. McCullagh
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland
- Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Christine M. Costello
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland
| | - Lili Li
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland
| | - Caroline O’Connell
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland
- Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Mary Codd
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4, Ireland
| | - Allan Lawrie
- Department of Cardiovascular Sciences, University of Sheffield, Sheffield, United Kingdom
| | - Allison Morton
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Charles Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Paul McLoughlin
- School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland
- * E-mail:
| | - Sean Gaine
- Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Boulate D, Perros F, Dorfmuller P, Arthur-Ataam J, Guihaire J, Lamrani L, Decante B, Humbert M, Eddahibi S, Dartevelle P, Fadel E, Mercier O. Pulmonary microvascular lesions regress in reperfused chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 2015; 34:457-67. [DOI: 10.1016/j.healun.2014.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 05/08/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022] Open
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Circulating biomarkers in pulmonary arterial hypertension: Update and future direction. J Heart Lung Transplant 2015; 34:282-305. [DOI: 10.1016/j.healun.2014.12.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/29/2022] Open
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Different sizes of centrilobular ground-glass opacities in chest high-resolution computed tomography of patients with pulmonary veno-occlusive disease and patients with pulmonary capillary hemangiomatosis. Cardiovasc Pathol 2013; 22:287-93. [DOI: 10.1016/j.carpath.2012.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/07/2012] [Accepted: 12/05/2012] [Indexed: 11/21/2022] Open
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Circulating cytokines and growth factors in pediatric pulmonary hypertension. Mediators Inflamm 2012; 2012:143428. [PMID: 23316102 PMCID: PMC3536060 DOI: 10.1155/2012/143428] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 10/25/2012] [Accepted: 11/15/2012] [Indexed: 01/19/2023] Open
Abstract
Background. Management of pediatric pulmonary hypertension (PH) remains challenging. We have assessed a panel of circulating proteins in children with PH to investigate their value as predictive and/or prognostic biomarkers. From these determinations, we aim to develop a practical, noninvasive tool to aid in the management of pediatric PH. Methods. Twelve cytokines and growth factors putatively associated with lung or vascular disease were examined in plasma specimens from 70 children with PH using multiplex protein array technology. Associations between hemodynamics, adverse events, and protein markers were evaluated. Results. Epidermal growth factor (EGF) and IL-6 were associated with important hemodynamics. Of the twelve proteins, VEGF and IL-6 were significantly, univariately associated with the occurrence of an adverse event, with odds ratios (95% confidence intervals) of 0.56 (0.33–0.98) and 1.69 (1.03–2.77), respectively. When hemodynamic predictors were combined with protein markers, the ability to predict adverse outcomes within the following year significantly increased. Conclusions. Specific circulating proteins are associated with hemodynamic variables in pediatric PH. If confirmed in additional cohorts, measurement of these proteins could aid patient care and design of clinical trials by identifying patients at risk for adverse events. These findings also further support a role for inflammation in pediatric PH.
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14
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LeVarge BL, Channick RN. Inhaled treprostinil for the treatment of pulmonary arterial hypertension. Expert Rev Respir Med 2012; 6:255-65. [PMID: 22788940 DOI: 10.1586/ers.12.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treprostinil is a prostacyclin derivative approved for the treatment of pulmonary arterial hypertension by intravenous, subcutaneous and inhalational administration. Unlike its precursor epoprostenol, treprostinil is chemically stable at room temperature and neutral pH, and its plasma half-life is longer. In addition to promoting smooth muscle relaxation in the pulmonary vasculature, treprostinil has suppressive effects on platelet aggregation, smooth muscle proliferation and inflammation. A Phase III study, investigating the addition of inhaled treprostinil to oral bosentan or sildenafil, confirmed significant improvements in exercise capacity and quality of life. This review examines the pharmacodynamics, pharmacokinetics, clinical efficacy and safety of inhaled treprostinil for use in pulmonary arterial hypertension.
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Affiliation(s)
- Barbara L LeVarge
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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15
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Condliffe R, Pickworth JA, Hopkinson K, Walker SJ, Hameed AG, Suntharaligam J, Soon E, Treacy C, Pepke-Zaba J, Francis SE, Crossman DC, Newman CMH, Elliot CA, Morton AC, Morrell NW, Kiely DG, Lawrie A. Serum osteoprotegerin is increased and predicts survival in idiopathic pulmonary arterial hypertension. Pulm Circ 2012; 2:21-7. [PMID: 22558516 PMCID: PMC3342744 DOI: 10.4103/2045-8932.94819] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We previously reported that osteoprotegerin (OPG) is regulated by pathways associated with pulmonary arterial hypertension (PAH), and is present at elevated levels within pulmonary vascular lesions and sera from patients with idiopathic PAH (IPAH). Since OPG is a naturally secreted protein, we investigated the relationship between serum OPG and disease severity and outcome in patients with IPAH and animal models. OPG mRNA expression was measured in pulmonary artery smooth muscle cells (PASMC) from pulmonary arteries of patients with and without IPAH. Serum concentrations of OPG were measured in a retrospective and prospective group of patients. OPG levels were compared with phenotypic data and other putative PAH biomarkers. Prognostic significance was assessed and levels compared with healthy controls. Correlation of OPG and pulmonary vascular remodeling was also performed in rodent models of PAH. OPG mRNA was significantly increased 2-fold in PASMC isolated from explanted PAH lungs compared with control. Serum OPG concentrations were markedly elevated in IPAH compared with controls. In Cohort 1 OPG levels significantly correlated with mean right atrial pressure and cardiac index, while in Cohort 2 significant correlations existed between age-adjusted OPG levels and gas transfer. In both cohorts an OPG concentration above a ROC-derived threshold of 4728 pg/ml predicted poorer survival. In two rodent models, OPG correlated with the degree of pulmonary vascular remodeling. OPG levels are significantly elevated in patients with idiopathic PAH and are of prognostic significance. The role of OPG as a potential biomarker and therapeutic target merits further investigation.
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Affiliation(s)
- Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
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Price LC, Wort SJ, Perros F, Dorfmüller P, Huertas A, Montani D, Cohen-Kaminsky S, Humbert M. Inflammation in pulmonary arterial hypertension. Chest 2012; 141:210-221. [PMID: 22215829 DOI: 10.1378/chest.11-0793] [Citation(s) in RCA: 281] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling of the precapillary pulmonary arteries, with excessive proliferation of vascular cells. Although the exact pathophysiology remains unknown, there is increasing evidence to suggest an important role for inflammation. Firstly, pathologic specimens from patients with PAH reveal an accumulation of perivascular inflammatory cells, including macrophages, dendritic cells, T and B lymphocytes, and mast cells. Secondly, circulating levels of certain cytokines and chemokines are elevated, and these may correlate with a worse clinical outcome. Thirdly, certain inflammatory conditions such as connective tissue diseases are associated with an increased incidence of PAH. Finally, treatment of the underlying inflammatory condition may alleviate the associated PAH. Underlying pathologic mechanisms are likely to be "multihit" and complex. For instance, the inflammatory response may be regulated by bone morphogenetic protein receptor type 2 (BMPR II) status, and, in turn, BMPR II expression can be altered by certain cytokines. Although antiinflammatory therapies have been effective in certain connective-tissue-disease-associated PAH, this approach is untested in idiopathic PAH (iPAH). The potential benefit of antiinflammatory therapies in iPAH is of importance and requires further study.
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Affiliation(s)
- Laura C Price
- Faculté de Médecine, Université Paris-Sud, Kremlin Bicêtre, France; Service de Pneumologie et Réanimation Respiratoire, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Antoine-Béclère, Assistance Publique, Hôpitaux de Paris, Clamart, France; INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France; Department of Pulmonary Hypertension, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, England
| | - S John Wort
- Department of Pulmonary Hypertension, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, England
| | - Frédéric Perros
- Faculté de Médecine, Université Paris-Sud, Kremlin Bicêtre, France; Service de Pneumologie et Réanimation Respiratoire, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Antoine-Béclère, Assistance Publique, Hôpitaux de Paris, Clamart, France; INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Peter Dorfmüller
- Faculté de Médecine, Université Paris-Sud, Kremlin Bicêtre, France; Service de Pneumologie et Réanimation Respiratoire, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Antoine-Béclère, Assistance Publique, Hôpitaux de Paris, Clamart, France; INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Alice Huertas
- Faculté de Médecine, Université Paris-Sud, Kremlin Bicêtre, France; Service de Pneumologie et Réanimation Respiratoire, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Antoine-Béclère, Assistance Publique, Hôpitaux de Paris, Clamart, France; INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - David Montani
- Faculté de Médecine, Université Paris-Sud, Kremlin Bicêtre, France; Service de Pneumologie et Réanimation Respiratoire, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Antoine-Béclère, Assistance Publique, Hôpitaux de Paris, Clamart, France; INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Sylvia Cohen-Kaminsky
- Faculté de Médecine, Université Paris-Sud, Kremlin Bicêtre, France; Service de Pneumologie et Réanimation Respiratoire, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Antoine-Béclère, Assistance Publique, Hôpitaux de Paris, Clamart, France; INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Marc Humbert
- Faculté de Médecine, Université Paris-Sud, Kremlin Bicêtre, France; Service de Pneumologie et Réanimation Respiratoire, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Antoine-Béclère, Assistance Publique, Hôpitaux de Paris, Clamart, France; INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
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17
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Saito Y, Nakamura K, Miyaji K, Akagi S, Mizoguchi H, Ogawa A, Fuke S, Fujio H, Kiyooka T, Nagase S, Kohno K, Morita H, Kusano KF, Matsubara H, Ohe T, Ito H. Acute Vasoreactivity Testing With Nicardipine in Patients With Pulmonary Arterial Hypertension. J Pharmacol Sci 2012; 120:206-12. [DOI: 10.1254/jphs.12114fp] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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18
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Kusano KF. Treatment for pulmonary hypertension including lung transplantation. Gen Thorac Cardiovasc Surg 2011; 59:538-46. [DOI: 10.1007/s11748-010-0747-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Indexed: 01/23/2023]
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19
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Perros F, Montani D, Dorfmüller P, Huertas A, Chaumais MC, Cohen-Kaminsky S, Humbert M. [Novel immunopathological approaches to pulmonary arterial hypertension]. Presse Med 2011; 40 Suppl 1:1S3-13. [PMID: 21536178 DOI: 10.1016/s0755-4982(11)70002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Inflammation is important for the initiation and the maintenance of vascular remodeling in the most commun animal models of pulmonary hypertension (PH), and its therapeutical targeting blocks PH development in these models. In human, pulmonary vascular lesions of PH are also the source of an intense chemokine production, linked to inflammatory cell recruitment. However, arteritis is uncommon in PH patients. Of note, current PH treatments have immunomodulatory properties. In addition, some studies have shown a correlation between levels of circulating inflammatory mediators and patients' survival. The study of autoimmunity in the pathophysiology of pulmonary arterial hypertension is becoming an area of intense investigation. New immunopathological approaches to PH should allow the development of innovative treatments for this very severe condition.
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Affiliation(s)
- Frédéric Perros
- Université Paris-Sud, Faculté de médecine, Le Kremlin-Bicêtre, France.
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20
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Larsen KO, Yndestad A, Sjaastad I, Løberg EM, Goverud IL, Halvorsen B, Jia J, Andreassen AK, Husberg C, Jonasson S, Lipp M, Christensen G, Aukrust P, Skjønsberg OH. Lack of CCR7 induces pulmonary hypertension involving perivascular leukocyte infiltration and inflammation. Am J Physiol Lung Cell Mol Physiol 2011; 301:L50-9. [PMID: 21498626 DOI: 10.1152/ajplung.00048.2010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The chemokine receptor CCR7 regulates lymphocyte trafficking, and CCR7 deficiency induces infiltration of T and B cells adjacent to vessels in mouse lungs. Perivascular infiltration of T and B cells has also been found in human pulmonary arterial hypertension, and downregulation of the CCR7 receptor in circulating leukocytes of such patients has been observed. To investigate whether changes in the CCR7 system contribute to the pathogenesis of pulmonary hypertension, we utilized mice deficient of the CCR7 receptor. The cardiopulmonary and inflammatory responses of CCR7 depletion were evaluated in CCR7-deficient and wild-type mice. Measurements of cytokines upregulated in the animal model were also performed in patients with pulmonary hypertension and controls and in vascular smooth muscle cells. We found that mice lacking CCR7 had increased right ventricular systolic pressure, reduced pulmonary artery acceleration time, increased right ventricular/tibial length ratio, Rho kinase-mediated pulmonary vasoconstriction, and increased muscularization of distal arteries, indicating pulmonary hypertension. These mice also showed increased perivascular infiltration of leukocytes, consisting mainly of T and B cells, and increased mRNA levels of the inflammatory cytokines interleukin-12 and CX3CL1 within pulmonary tissue. Increased serum levels of interleukin-12 and CX3CL1 were also observed in patients with pulmonary hypertension, particularly in those with pulmonary hypertension associated with connective tissue disorder. In smooth muscle cells, interleukin-12 induced secretion of the angiogenic cytokine interleukin-8. We conclude that these results suggest a role for CCR7 in the development of pulmonary arterial hypertension, at least in some subgroups, possibly via pulmonary infiltration of lymphocytes and secretion of interleukin-12 and CX3CL1.
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Affiliation(s)
- Karl-Otto Larsen
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway.
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21
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Ogawa A, Nakamura K, Mizoguchi H, Fujii N, Fujio H, Kusano KF, Ohe T, Ito H. Prednisolone ameliorates idiopathic pulmonary arterial hypertension. Am J Respir Crit Care Med 2011; 183:139-40. [PMID: 21193794 DOI: 10.1164/ajrccm.183.1.139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Miura R, Nakamura K, Miura D, Miura A, Kajiya M, Hisamatsu K, Nagase S, Morita H, Kusano KF, Matsubara H, Ohe T, Ito H. Cytokine reducing effect of azelnidipine in human peripheral blood mononuclear cells. Biol Pharm Bull 2010; 33:1148-51. [PMID: 20606305 DOI: 10.1248/bpb.33.1148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Numerous clinical trials have shown that calcium channel blocker (CCB) therapy improves the clinical outcome in patients with cardiovascular diseases. Since the progression of several types of cardiovascular diseases is closely associated with inflammation, alleviation of inflammation may be one potential mechanism of those beneficial effects of CCB therapy. We examined whether a new CCB (azelnidipine) could influence the inflammatory response of human peripheral blood mononuclear cells (PBMCs), which are recruited to inflammatory lesions and modulate inflammation. We investigated whether azelnidipine affected intracellular signaling and cytokine production by phytohemagglutinin (PHA)-stimulated human PBMCs in vitro. PBMCs were obtained from 10 healthy volunteers and stimulated with PHA. Then relative intracellular calcium ion concentration ([Ca(2+)](i)) was assessed by fluorescence microscopy, and the production of monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-alpha (TNF-alpha) were measured by enzyme-linked immunosorbent assay. Stimulation with PHA significantly raised [Ca(2+)](i) and enhanced the production of MCP-1 and TNF-alpha by human PBMCs. Azelnidipine significantly diminished the PHA-induced rise of [Ca(2+)](i), and the production of MCP-1 and TNF-alpha. These findings indicate that azelnidipine might have an anti-inflammatory influence on human PBMCs, although the mechanisms and the difference from other CCBs still remain unclear and further exploration should be required.
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Affiliation(s)
- Ryuzea Miura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
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23
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Soon E, Holmes AM, Treacy CM, Doughty NJ, Southgate L, Machado RD, Trembath RC, Jennings S, Barker L, Nicklin P, Walker C, Budd DC, Pepke-Zaba J, Morrell NW. Elevated Levels of Inflammatory Cytokines Predict Survival in Idiopathic and Familial Pulmonary Arterial Hypertension. Circulation 2010; 122:920-7. [PMID: 20713898 DOI: 10.1161/circulationaha.109.933762] [Citation(s) in RCA: 537] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Inflammation is a feature of pulmonary arterial hypertension (PAH), and increased circulating levels of cytokines are reported in patients with PAH. However, to date, no information exists on the significance of elevated cytokines or their potential as biomarkers. We sought to determine the levels of a range of cytokines in PAH and to examine their impact on survival and relationship to hemodynamic indexes.
Methods and Results—
We measured levels of serum cytokines (tumor necrosis factor-α, interferon-γ and interleukin-1β, -2, -4, -5, -6, -8, -10, -12p70, and -13) using ELISAs in idiopathic and heritable PAH patients (n=60). Concurrent clinical data included hemodynamics, 6-minute walk distance, and survival time from sampling to death or transplantation. Healthy volunteers served as control subjects (n=21). PAH patients had significantly higher levels of interleukin-1β, -2, -4, -6, -8, -10, and -12p70 and tumor necrosis factor-α compared with healthy control subjects. Kaplan-Meier analysis showed that levels of interleukin-6, 8, 10, and 12p70 predicted survival in patients. For example, 5-year survival with interleukin-6 levels of >9 pg/mL was 30% compared with 63% for patients with levels ≤9 pg/mL (
P
=0.008). In this PAH cohort, cytokine levels were superior to traditional markers of prognosis such as 6-minute walk distance and hemodynamics.
Conclusions—
This study illustrates dysregulation of a broad range of inflammatory mediators in idiopathic and familial PAH and demonstrates that cytokine levels have a previously unrecognized impact on patient survival. They may prove to be useful biomarkers and provide insight into the contribution of inflammation in PAH.
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Affiliation(s)
- Elaine Soon
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Alan M. Holmes
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Carmen M. Treacy
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Natalie J. Doughty
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Laura Southgate
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Rajiv D. Machado
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Richard C. Trembath
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Simon Jennings
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Lucy Barker
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Paul Nicklin
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Christoph Walker
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - David C. Budd
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Joanna Pepke-Zaba
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
| | - Nicholas W. Morrell
- From the Department of Medicine, University of Cambridge, Cambridge, UK (E.S., N.W.M.); Pulmonary Vascular Diseases Unit, Papworth Hospital, Cambridge, UK (E.S., C.M.T., N.J.D., J.P.-Z., N.W.M.); Respiratory Disease Area, Novartis Institutes for Biomedical Research, West Sussex, UK (A.M.H., S.J., L.B., P.N., C.W., D.C.B.); and Department of Medical and Molecular Genetics, King’s College, London, UK (L.S., R.D.M., R.C.T.)
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24
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Li J, Li JJ, He JG, Nan JL, Guo YL, Xiong CM. Atorvastatin Decreases C-Reactive Protein-Induced Inflammatory Response in Pulmonary Artery Smooth Muscle Cells by Inhibiting Nuclear Factor-κB Pathway. Cardiovasc Ther 2010; 28:8-14. [PMID: 20074254 DOI: 10.1111/j.1755-5922.2009.00103.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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25
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Strassheim D, Riddle SR, Burke DL, Geraci MW, Stenmark KR. Prostacyclin inhibits IFN-gamma-stimulated cytokine expression by reduced recruitment of CBP/p300 to STAT1 in a SOCS-1-independent manner. THE JOURNAL OF IMMUNOLOGY 2009; 183:6981-8. [PMID: 19915063 DOI: 10.4049/jimmunol.0901045] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Increasing evidence indicates that pulmonary arterial hypertension is a vascular inflammatory disease. Prostacyclin (PGI(2)) is widely used to treat pulmonary arterial hypertension and is believed to benefit patients largely through vasodilatory effects. PGI(2) is also increasingly believed to have anti-inflammatory effects, including decreasing leukocyte cytokine production, yet few mechanistic details exist to explain how these effects are mediated at the transcriptional level. Because activated monocytes are critical sources of MCP-1 and other cytokines in cardiovascular inflammation, we examined the effects of iloprost on IFN-gamma- and IL-6-stimulated cytokine production in human monocytes. We found that iloprost inhibited IFN-gamma- and IL-6-induced MCP-1, IL-8, RANTES, and TNF-alpha production in monocytes, indicating wide-ranging anti-inflammatory action. We found that activation of STAT1 was critical for IFN-gamma-induced MCP-1 production and demonstrated that iloprost inhibited STAT1 activation by several actions as follows: 1) iloprost inhibited the phosphorylation of STAT1-S727 in the transactivation domain, thereby reducing recruitment of the histone acetylase and coactivator CBP/p300 to STAT1; 2) iloprost selectively inhibited activation of JAK2 but not JAK1, both responsible for activation of STAT1 via phosphorylation of STAT1-Y701, resulting in reduced nuclear recruitment and activation of STAT1; and 3) SOCS-1, which normally terminates IFN-gamma-signaling, was not involved in iloprost-mediated inhibition of STAT1, indicating divergence from the classical pathway for terminating IFN-gamma-signaling. We conclude that PGI(2) exerts anti-inflammatory action by inhibiting STAT1-induced cytokine production, in part by targeting the transactivation domain-induced recruitment of the histone acetylase CBP/p300.
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Affiliation(s)
- Derek Strassheim
- Pediatric Critical CareMedicine, University of Colorado Denver, Research Complex II, Room 6490, 12700 East 19th Avenue, Aurora, CO 80045, USA.
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26
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Kimura S, Egashira K, Chen L, Nakano K, Iwata E, Miyagawa M, Tsujimoto H, Hara K, Morishita R, Sueishi K, Tominaga R, Sunagawa K. Nanoparticle-Mediated Delivery of Nuclear Factor κB Decoy Into Lungs Ameliorates Monocrotaline-Induced Pulmonary Arterial Hypertension. Hypertension 2009; 53:877-83. [DOI: 10.1161/hypertensionaha.108.121418] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pulmonary arterial hypertension (PAH) is an intractable disease of the small pulmonary artery that involves multiple inflammatory factors. We hypothesized that a redox-sensitive transcription factor, nuclear factor κB (NF-κB), which regulates important inflammatory cytokines, plays a pivotal role in PAH. We investigated the activity of NF-κB in explanted lungs from patients with PAH and in a rat model of PAH. We also examined a nanotechnology-based therapeutic intervention in the rat model. Immunohistochemistry results indicated that the activity of NF-κB increased in small pulmonary arterial lesions and alveolar macrophages in lungs from patients with PAH compared with lungs from control patients. In a rat model of monocrotaline-induced PAH, single intratracheal instillation of polymeric nanoparticles (NPs) resulted in delivery of NPs into lungs for ≤14 days postinstillation. The NP-mediated NF-κB decoy delivery into lungs prevented monocrotaline-induced NF-κB activation. Blockade of NF-κB by NP-mediated delivery of the NF-κB decoy attenuated inflammation and proliferation and, thus, attenuated the development of PAH and pulmonary arterial remodeling induced by monocrotaline. Treatment with the NF-κB decoy NP 3 weeks after monocrotaline injection improved the survival rate as compared with vehicle administration. In conclusion, these data suggest that NF-κB plays a primary role in the pathogenesis of PAH and, thus, represent a new target for therapeutic intervention in PAH. This nanotechnology platform may be developed as a novel molecular approach for treatment of PAH in the future.
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Affiliation(s)
- Satoshi Kimura
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Kensuke Egashira
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Ling Chen
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Kaku Nakano
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Eiko Iwata
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Miho Miyagawa
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Hiroyuki Tsujimoto
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Kaori Hara
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Ryuichi Morishita
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Katsuo Sueishi
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Ryuji Tominaga
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
| | - Kenji Sunagawa
- From the Departments of Surgery (S.K., R.T.), Cardiovascular Medicine (K.E., L.C., K.N., E.I., M.M., K. Sunagawa), and Pathology (K. Sueishi), Graduate School of Medical Science, Kyushu University, Fukuoka; Hosokawa Powder Technology Research Institute (H.T., K.H.), Osaka; and Division of Clinical Gene Therapy (R.M.), Osaka University Medical School, Osaka, Japan
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Relationship between circulating levels of monocyte chemoattractant protein-1 and systolic dysfunction in patients with hypertrophic cardiomyopathy. Cardiovasc Pathol 2009; 18:317-22. [PMID: 19211266 DOI: 10.1016/j.carpath.2008.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 10/29/2008] [Accepted: 12/03/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Progression of hypertrophic cardiomyopathy (HCM) to left ventricular dilatation and systolic dysfunction sometimes occurs. However, the mechanism of the transition from hypertrophy to dysfunction has not been elucidated. It has been reported that circulating levels of monocyte chemoattractant protein-1 (MCP-1), which is a major factor promoting the accumulation of macrophages, are increased in patients with congestive heart failure. We measured circulating levels of MCP-1 in patients with HCM and examined whether MCP-1 was expressed in the myocardium of HCM patients. We also examined whether circulating levels of MCP-1 were correlated with left ventricular dysfunction. METHODS Circulating levels of MCP-1 were measured by an enzyme immunoassay in 26 patients with HCM (60+/-2 years old) and 20 control subjects (57+/-2 years old). Cardiac function was evaluated by two-dimensional echocardiography and cardiac catheterization. RESULTS HCM patients had significantly elevated levels of MCP-1 (HCM: 309+/-30 vs. control: 178+/-8 pg/ml, P<.001). MCP-1 levels in patients with systolic dysfunction were significantly higher than those in patients without systolic dysfunction (P<.05) and were also significantly higher than those in patients with outflow obstruction (P<.05). Immunohistochemical analysis revealed that MCP-1 was expressed in endomyocardial biopsy samples obtained from HCM patients with systolic dysfunction. Furthermore, MCP-1 levels were inversely correlated with fractional shortening (r=-.401, P<.05) and correlated with left ventricular end-diastolic pressure (r=-.579, P<.01). CONCLUSION These results show that MCP-1 is associated with, and might be involved in the pathogenesis of, left ventricular systolic dysfunction in patients with HCM.
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Nakamura K, Shimizu J, Kataoka N, Hashimoto K, Ikeda T, Fujio H, Ohta-Ogo K, Ogawa A, Miura A, Mohri S, Nagase S, Morita H, Kusano KF, Date H, Matsubara H, Mochizuki S, Hashimoto K, Kajiya F, Ohe T. Altered nano/micro-order elasticity of pulmonary artery smooth muscle cells of patients with idiopathic pulmonary arterial hypertension. Int J Cardiol 2008; 140:102-7. [PMID: 19073348 DOI: 10.1016/j.ijcard.2008.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Revised: 08/12/2008] [Accepted: 11/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Idiopathic pulmonary arterial hypertension (IPAH) is a disease characterized by progressively increased resistance of pulmonary arteries. In this study, we evaluated the mechanical property of single pulmonary artery smooth muscles cells (PASMC) from patients with IPAH and tested whether the PASMC showed abnormal response to a vasodilator by use of an atomic force microscope (AFM). METHODS PASMC were isolated and cultured from explanted lungs of 7 patients with IPAH (IPAH-PASMC). Normal vascular specimens from 3 patients with bronchogenic carcinoma were used as normal controls (normal PASMC). The nano/micro-order elasticity of five to ten living PASMC in each sample was measured by parabolic force curves of cantilever deflection/indentation obtained by using an AFM. The elasticity measurements were performed under control conditions and under condition of nitric oxide (NO) treatment (190 and 380 nmol/L). RESULTS There was no significant difference between nano/micro-order elasticity of normal PASMC and that of IPAH-PASMC under the control conditions. In normal PASMC, NO (190 and 380 nmol/L) significantly reduced (i.e., softened) the nano/micro-order elasticity. However, NO did not reduce elasticity in IPAH-PASMC, indicating higher vasodilator-resistive nano/micro-order rigidity in IPAH-PASMC. CONCLUSION Nano/micro-order elasticity change in PASMC in response to vasodilation induced by NO is reduced in patients with IPAH.
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Affiliation(s)
- Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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Steiner MK, Syrkina OL, Kolliputi N, Mark EJ, Hales CA, Waxman AB. Interleukin-6 overexpression induces pulmonary hypertension. Circ Res 2008; 104:236-44, 28p following 244. [PMID: 19074475 DOI: 10.1161/circresaha.108.182014] [Citation(s) in RCA: 467] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Inflammatory cytokine interleukin (IL)-6 is elevated in the serum and lungs of patients with pulmonary artery hypertension (PAH). Several animal models of PAH cite the potential role of inflammatory mediators. We investigated role of IL-6 in the pathogenesis of pulmonary vascular disease. Indices of pulmonary vascular remodeling were measured in lung-specific IL-6-overexpressing transgenic mice (Tg(+)) and compared to wild-type (Tg(-)) controls in both normoxic and chronic hypoxic conditions. The Tg(+) mice exhibited elevated right ventricular systolic pressures and right ventricular hypertrophy with corresponding pulmonary vasculopathic changes, all of which were exacerbated by chronic hypoxia. IL-6 overexpression increased muscularization of the proximal arterial tree, and hypoxia enhanced this effect. It also reproduced the muscularization and proliferative arteriopathy seen in the distal arteriolar vessels of PAH patients. The latter was characterized by the formation of occlusive neointimal angioproliferative lesions that worsened with hypoxia and were composed of endothelial cells and T-lymphocytes. IL-6-induced arteriopathic changes were accompanied by activation of proangiogenic factor, vascular endothelial growth factor, the proproliferative kinase extracellular signal-regulated kinase, proproliferative transcription factors c-MYC and MAX, and the antiapoptotic proteins survivin and Bcl-2 and downregulation of the growth inhibitor transforming growth factor-beta and proapoptotic kinases JNK and p38. These findings suggest that IL-6 promotes the development and progression of pulmonary vascular remodeling and PAH through proproliferative antiapoptotic mechanisms.
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Affiliation(s)
- M Kathryn Steiner
- Division of Pulmonary Critical Care Medicine, University of Massachusetts Memorial Medical Center, Worcester, MA 01655, USA.
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30
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Okawada M, Kobayashi H, Tei E, Okazaki T, Lane GJ, Yamataka A. Serum monocyte chemotactic protein-1 levels in congenital diaphragmatic hernia. Pediatr Surg Int 2007; 23:487-91. [PMID: 17206432 DOI: 10.1007/s00383-006-1858-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To measure serum monocyte chemotactic protein-1 (MCP-1) in patients with congenital diaphragmatic hernia (CDH) and investigate its relationship to the development of persistent pulmonary hypertension (PPH). Serum MCP-1 was measured in 13 neonates with high risk for CDH at the time of diagnosis and postoperatively, and in five age-matched controls using an ELISA system. The 13 CDH subjects were divided into four groups according to the presence of PPH and outcome. Group I (severe-pre group): subjects with severe PPH who died prior to surgery (n = 5); Group II (mild-pre group): subjects with mild PPH controlled by medications (n = 8); Group IIa (severe-post group): subjects who subsequently developed severe PPH postoperatively and died (n = 3); and Group IIb (mild-post group): subjects who continued to have mild PPH controlled by medications. We also examined nitrofen-induced hypoplastic lungs from five rat fetuses with CDH and five control lung specimens for MCP-1 using immunohistochemistry. Mean serum MCP-1 in Group I was (1038.0 +/- 95.8 pg/ml), which was significantly higher than Group II (444.9 +/- 39.7 pg/ml) (P < 0.0001) and controls (147.3 +/- 11.3 pg/ml) (P < 0.0001). Postoperatively, Group IIa was significantly higher than Group IIb from 24 to 120 h postoperatively (P < 0.001). In Group IIb serum MCP-1 did not rise at all between 24 and 120 h postoperatively. Hypoplastic fetal rat CDH lungs had strong expression of MCP-1 compared with control lungs. Up-regulated expression and high circulating levels of MCP-1 in CDH patients with PPH suggest that MCP-1 may play a role in the development of PPH in CDH.
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Affiliation(s)
- Manabu Okawada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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31
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Hagen M, Fagan K, Steudel W, Carr M, Lane K, Rodman DM, West J. Interaction of interleukin-6 and the BMP pathway in pulmonary smooth muscle. Am J Physiol Lung Cell Mol Physiol 2007; 292:L1473-9. [PMID: 17322283 DOI: 10.1152/ajplung.00197.2006] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The majority of familial pulmonary arterial hypertension (PAH) cases are caused by mutations in the type 2 bone morphogenetic protein receptor (BMPR2). However, less than one-half of BMPR2 mutation carriers develop PAH, suggesting that the most important function of BMPR2 mutation is to cause susceptibility to a "second hit." There is substantial evidence from the literature implicating dysregulated inflammation, in particular the cytokine IL-6, in the development of PAH. We thus hypothesized that the BMP pathway regulates IL-6 in pulmonary tissues and conversely that IL-6 regulates the BMP pathway. We tested this in vivo using transgenic mice expressing an inducible dominant negative BMPR2 in smooth muscle, using mice injected with an IL-6-expressing virus, and in vitro using small interfering RNA (siRNA) to BMPR2 in human pulmonary artery smooth muscle cells (PA SMC). Consistent with our hypothesis, we found upregulation of IL-6 in both the transgenic mice and in cultured PA SMC with siRNA to BMPR2; this could be abolished with p38(MAPK) inhibitors. We also found that IL-6 in vivo caused a twofold increase in expression of the BMP signaling target Id1 and caused increased BMP activity in a luciferase-reporter assay in PA SMC. Thus we have shown both in vitro and in vivo a complete negative feedback loop between IL-6 and BMP, suggesting that an important consequence of BMPR2 mutations may be poor regulation of cytokines and thus vulnerability to an inflammatory second hit.
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MESH Headings
- Animals
- Bone Morphogenetic Protein Receptors, Type II/genetics
- Bone Morphogenetic Protein Receptors, Type II/metabolism
- Cells, Cultured
- Chemokine CCL2/genetics
- Chemokine CCL2/metabolism
- Humans
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/physiopathology
- Inhibitor of Differentiation Protein 1/genetics
- Interleukin-6/genetics
- Interleukin-6/metabolism
- Mice
- Mice, Transgenic
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/immunology
- Muscle, Smooth, Vascular/metabolism
- Pulmonary Artery/cytology
- Pulmonary Artery/immunology
- Pulmonary Artery/metabolism
- RNA, Small Interfering
- Signal Transduction/immunology
- Transcription, Genetic/physiology
- Transforming Growth Factor beta/genetics
- Transforming Growth Factor beta/metabolism
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Affiliation(s)
- Moira Hagen
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA
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Kobayashi H, Tamatani T, Tamura T, Kusafuka J, Koga H, Yamataka A, Lane GJ, Miyahara K, Sueyoshi N, Miyano T. The role of monocyte chemoattractant protein-1 in biliary atresia. J Pediatr Surg 2006; 41:1967-72. [PMID: 17161183 DOI: 10.1016/j.jpedsurg.2006.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to explain the role of monocyte chemoattractant protein-1 (MCP-1) in biliary atresia (BA). METHODS Concentrations of serum MCP-1 and collagen type IV were measured in 38 patients with BA by using commercially available kits. MCP-1 was also assessed in liver biopsy specimens by using immunohistochemistry. Subjects were classified into groups. Group 1 comprised BA patients with normal liver function (n = 13), group II comprised BA patients with moderate liver dysfunction (n = 18), group III comprised BA patients older than 20 years awaiting liver transplantation (n = 7), and the control group comprised age-matched patients without evidence of liver disease (n = 23). RESULTS Serum MCP-1 levels were significantly increased in group II compared with group I (P < .0001) and the control group (P < .0001). Serum MCP-1 levels in group III were lower than in the control group (P < .0001). There was a significant linear correlation between serum MCP-1 levels and type IV collagen levels in group II. Group II subjects with portal hypertension (PH) had higher MCP-1 levels than those without PH (P = .0009). Biopsy specimens showed MCP-1 was expressed mainly on biliary epithelial cells, vascular endothelial cells, and hepatocytes in group II. CONCLUSIONS These findings suggest that MCP-1 probably plays a significant role in the development of progressive liver fibrosis in BA.
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Affiliation(s)
- Hiroyuki Kobayashi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan.
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Itoh T, Nagaya N, Ishibashi-Ueda H, Kyotani S, Oya H, Sakamaki F, Kimura H, Nakanishi N. Increased plasma monocyte chemoattractant protein-1 level in idiopathic pulmonary arterial hypertension. Respirology 2006; 11:158-63. [PMID: 16548900 DOI: 10.1111/j.1440-1843.2006.00821.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Monocyte chemoattractant protein-1 (MCP-1), a pro-inflammatory chemokine, has potent chemoattractant activity for monocytes/macrophages. We sought to investigate the clinical significance of MCP-1 in idiopathic pulmonary arterial hypertension (IPAH). METHODS This study included 28 patients with IPAH, seven patients with pulmonary arterial hypertension (PAH) related to collagen vascular disease, and 13 healthy subjects. Plasma MCP-1 levels were measured together with serum IL-6 and tumour necrosis factor-alpha (TNF-alpha) levels. RESULTS Circulating levels of MCP-1, IL-6 and TNF-alpha were significantly higher in patients with IPAH than in healthy controls, although they were lower than in patients with PAH related to collagen vascular disease. Plasma MCP-1 did not significantly correlate with any haemodynamic variables. However, plasma MCP-1 levels correlated negatively with the disease duration (time from symptom onset). CONCLUSIONS Plasma MCP-1 levels were elevated in patients with IPAH, and this elevation was particularly marked in the early stage of disease. Taking into account the chemoattractant activity of MCP-1, these results imply a contribution of MCP-1 to the development of pulmonary hypertension.
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Affiliation(s)
- Takefumi Itoh
- Department of Regenerative Medicine and Tissue Engineering, National Cardiovascular Center Research Institute, Osaka, Japan
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34
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Ogawa A, Nakamura K, Matsubara H, Fujio H, Ikeda T, Kobayashi K, Miyazaki I, Asanuma M, Miyaji K, Miura D, Kusano KF, Date H, Ohe T. Prednisolone inhibits proliferation of cultured pulmonary artery smooth muscle cells of patients with idiopathic pulmonary arterial hypertension. Circulation 2005; 112:1806-12. [PMID: 16157769 DOI: 10.1161/circulationaha.105.536169] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Idiopathic pulmonary arterial hypertension (IPAH) is associated with proliferation of smooth muscle cells (SMCs) in small pulmonary arteries. There is no therapy that specifically inhibits SMC proliferation. Recent studies reported that prednisolone (PSL) inhibits the postangioplasty proliferation of SMCs in atherosclerotic arteries. In this study, we tested the hypothesis that PSL has antiproliferative effects on pulmonary artery SMCs of patients with IPAH. METHODS AND RESULTS Pulmonary artery SMCs were harvested from the pulmonary arteries of 6 patients with IPAH who underwent lung transplantation. Control SMCs were obtained from 5 patients with bronchogenic carcinoma who underwent lung lobectomy. After incubation in the presence of platelet-derived growth factor (PDGF), PSL was added at different concentrations and cell proliferation was assessed by 3H-thymidine incorporation. PSL (2x10(-4) and 2x10(-3) mol/L) significantly inhibited PDGF-stimulated proliferation (P<0.05) of SMCs from patients with IPAH but did not affect cell viability of SMCs, as confirmed by trypan blue staining. In cell cycle analysis using a microscope-based multiparameter laser scanning cytometer, PSL inhibited the progression of SMCs from G(0)/G1 to the S phase. This inhibition was associated with increased p27 expression level. PSL (2x10(-4) mol/L) also inhibited PDGF-induced SMC migration. CONCLUSIONS Our results indicate that PSL has an antiproliferative effect on cultured SMCs of pulmonary arteries from patients with IPAH and suggest that PSL may be potentially useful therapeutically in patients with IPAH.
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Affiliation(s)
- Aiko Ogawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan.
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35
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Sasayama S, Kunieda T, Tomoike H, Matsuzaki M, Shirato K, Kuriyama T, Izumi T, Origasa H, Giersbergen PLV, Dingemanse J, Tanaka S. Effects of the endothelin receptor antagonist bosentan on hemodynamics, symptoms and functional capacity in Japanese patients with severe pulmonary hypertension. Circ J 2005; 69:131-7. [PMID: 15671601 DOI: 10.1253/circj.69.131] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Endothelin (ET)-1 has a pathogenic role in pulmonary arterial hypertension (PAH). Recent clinical studies carried out in Western populations showed that blockade of the ET receptors by bosentan improves pulmonary hemodynamics and exercise capacity. In the present study, the efficacy of bosentan was assessed in Japanese patients with PAH. METHOD AND RESULTS Because the pharmacokinetics of bosentan and its metabolites are similar in Japanese and Caucasian subjects, the same dose of bosentan, 125 mg twice daily, was administered in the Japanese open-label clinical trial. In 18 patients, mean pulmonary arterial pressure decreased from 52.4+/-13.8 to 46.8+/-13.8 mmHg (p=0.003) and cardiac index increased from 2.20+/-0.74 to 2.61 +/-0.72 L.min(-1).m(-2) (p=0.002). The 6-min walking distance increased from 410+/-89.5 to 494+/-86.0 m (p<0.0001). The dyspnea index (Borg scale) decreased from 3.2+/-2.4 to 2.2+/-1.7 (p=0.02). The specific activity scale (SAS) gradually increased throughout the study period from 2.9+/-0.8 to 4.6+/-1.9 METs (p=0.0005). WHO Class improved in 10 patients. CONCLUSION Bosentan was well tolerated and improved the hemodynamics, symptoms, exercise capacity, and quality of life of Japanese patients with PAH. Thus, bosentan can be a valuable therapeutic option in Japanese patients.
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Durongpisitkul K, Laoprasitiporn D, Layangool T, Sittiwankul R, Panamonta M, Mokrapong P. Comparison of the acute pulmonary vasodilating effect of beraprost sodium and nitric oxide in congenital heart disease. Circ J 2005; 69:61-4. [PMID: 15635204 DOI: 10.1253/circj.69.61] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Congenital heart disease patients who have pulmonary hypertension (PH) require an evaluation for pulmonary vascular reactivity before surgical repair. In the present study the acute pulmonary vasodilating effects of 100% oxygen (O2), beraprost sodium (BPS) and 40 ppm inhaled nitric oxide (iNO) during cardiac catheterization were compared. METHODS AND RESULTS There were 90 patients who underwent cardiac catheterization for evaluation of PH (mean age, 16.5+/-16 years). The baseline mean pulmonary artery (mPA) pressure was 69.6+/-14.8 mmHg and the pulmonary arteriolar resistance (Rpa) was 13.8+/-8.3 Wood unit m2. Change in pulmonary vascular reactivity was defined as a decrease in mPA or Rpa>20% from baseline. The response to 100%O2, iNO and BPS during cardiac catheterization was 84%, 72.7% and 64%, respectively. Pair comparisons among each hemodynamic parameter showed no difference between the acute vasodilating effect of BPS and iNO. In some patients BPS showed a stronger effect than iNO in lowering Rpa. CONCLUSIONS BPS has a similar pulmonary vasodilating effect to iNO and can be used as an acute pulmonary vasodilating agent during cardiac catheterization with potential benefits over iNO.
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Affiliation(s)
- Kritvikrom Durongpisitkul
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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37
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Kusano KF, Nakamura K, Kusano H, Nishii N, Banba K, Ikeda T, Hashimoto K, Yamamoto M, Fujio H, Miura A, Ohta K, Morita H, Saito H, Emori T, Nakamura Y, Kusano I, Ohe T. Significance of the level of monocyte chemoattractant protein-1 in human atherosclerosis. Circ J 2005; 68:671-6. [PMID: 15226634 DOI: 10.1253/circj.68.671] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Monocyte chemoattractant protein-1 (MCP-1), a potent chemoattractant for monocytes, plays an important role in the earliest events of atherogenesis. However, direct evidence of the effects of MCP-1 on atherosclerosis in chronic hemodialysis (HD) patients has not been reported. METHODS AND RESULTS The serum MCP-1 concentrations and the intimal - medial thickness (IMT) in the carotid arteries were measured in 42 non-diabetic chronic HD patients and 20 age-matched controls. The expression of MCP-1 was examined immunohistochemically in radial arterial tissues obtained from the HD patients. IMT and the serum concentration of MCP-1 in the HD patients were both significantly greater than in controls. Multiple regression analysis revealed that the serum concentration of MCP-1 was an independent factor influencing IMT. Tissue immunostaining showed that MCP-1 is expressed in both endothelial and smooth muscle cells and that its level of expression correlates with the serum concentration of MCP-1. CONCLUSIONS An increase in MCP-1 may be an important factor in the progression of atherosclerosis in non-diabetic HD patients.
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Affiliation(s)
- Kengo Fukushima Kusano
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
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Ogawa A, Matsubara H, Fujio H, Miyaji K, Nakamura K, Morita H, Saito H, Kusano KF, Emori T, Date H, Ohe T. Risk of Alveolar Hemorrhage in Patients With Primary Pulmonary Hypertension-Anticoagulation and Epoprostenol Therapy-. Circ J 2005; 69:216-20. [PMID: 15671616 DOI: 10.1253/circj.69.216] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anticoagulation therapy and continuous intravenous infusion of epoprostenol are the standard treatment for primary pulmonary hypertension (PPH). Because epoprostenol has an antiplatelet effect, concomitant use of an anticoagulant could increase the likelihood of hemorrhagic complications. METHODS AND RESULTS In the present study, 31 consecutive patients with PPH (10 men, 21 women, mean +/- SD age, 28.5+/-10.1 years) treated with anticoagulation and epoprostenol between April 1999 and December 2003 were retrospectively evaluated. Clinical and hematological data at the time of the bleeding episode were retrieved from the medical records. Nine patients (22.6%) experienced 11 bleeding episodes: 9 episodes (81.8%) were alveolar hemorrhage and 2 patients were in severe respiratory distress. The mean dose of epoprostenol at the time of the first bleeding episode was 89.0 +/-40.5 ng.kg(-1).min(-1) (range, 28.1-164.0). More of the patients who did not have a bleeding episode remain alive than did patients with bleeding episodes (59% vs 33%) nor did they require lung transplantation. CONCLUSIONS A considerable number of patients with PPH who received combined anticoagulant and high-dose epoprostenol therapy developed alveolar hemorrhage, which can be fatal.
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Affiliation(s)
- Aiko Ogawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry, Japan.
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