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Katrukha IA, Katrukha AG. Myocardial Injury and the Release of Troponins I and T in the Blood of Patients. Clin Chem 2021; 67:124-130. [PMID: 33418589 DOI: 10.1093/clinchem/hvaa281] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiac troponin I (cTnI) and cTnT are the established biomarkers of cardiomyocyte damage and the recommended biomarkers for the diagnosis of acute myocardial infarction (MI). High-sensitivity immunochemical diagnostic systems are able to measure the cTn concentrations in the blood of a majority of healthy people. At the same time, the concentration of cTn may be increased not only after MI but also because of other pathologies that might affect myocardium. This effect reduces the clinical specificity of cTn for MI and may complicate the diagnosis. CONTENT This review summarizes the existing information regarding the causes and mechanisms that lead to the increase of cTn concentration in blood and the forms of cTn that are present in circulation after MI or other types of myocardial injury. SUMMARY Different etiologies of disease associated with increases of cTn above the 99th percentile and various mechanisms of troponin release from myocardium could result in the appearance of different forms of cTn in blood and provide the first clinical evidence of injury. Additional research is needed for the careful characterization of cTn forms that are present in the blood in different clinical settings. That knowledge may lead to the development of immunochemical systems that would differentiate certain forms of troponins and possibly certain types of cardiac disease.
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Affiliation(s)
- Ivan A Katrukha
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, School of Biology, MV Lomonosov Moscow State University, Moscow, Russia
| | - Alexey G Katrukha
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, School of Biology, MV Lomonosov Moscow State University, Moscow, Russia
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Domiati S, Mehanna M, Ragab H, Nakkash Chmaisse H, El Mallah A. Investigation of chronic efficacy and safety profile of two potential anti-inflammatory bipyrazole-based compounds in experimental animals. J Inflamm Res 2018; 11:143-153. [PMID: 29662323 PMCID: PMC5892962 DOI: 10.2147/jir.s157955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Although nonsteroidal anti-inflammatory drugs are widely used to treat a variety of disorders, their administration is associated with gastrointestinal side effects, acute kidney injury and liver enzymes’ elevation. Accordingly, researchers are encouraged to create novel agents with better safety profile. The aim of the current study was to evaluate the chronic efficacy and safety profile of two compounds previously proven to have acceptable acute anti-inflammatory and analgesic activities. Materials and methods Doses were determined through formalin-induced mice paw edema-based dose–response curves. Granuloma weight was used to assess the chronic effect of the investigated compounds as compared to the vehicle and diclofenac representing the positive and the negative controls, respectively. Mice kidneys, livers and stomachs were histologically examined. Moreover, troponin I, alanine aminotransferase, aspartate aminotransferase, serum creatinine and blood urea nitrogen levels were measured. Results The results highlight that the granulomas and exudates developed in mice after 7 days of treatment, with compound I and compound II were significantly lower than that of the negative control group. Moreover, compound I showed significantly better anti-inflammatory effect than diclofenac. Troponin level was undetected in all groups. Histopathological examination of the stomach revealed normal mucosa for both tested compounds and controls. Likewise, kidneys showed neither significant histologic alteration nor biomarkers increase as compared to the control over both 7- and 30-day treatment periods. Mice that received the tested compounds or diclofenac exhibited transient liver damage specifically; congestion, vacuolization, necrosis and inflammation after 7 days of treatment which decreased significantly after 30 days of treatment as emphasized by the Suzuki score and biomarker levels. Conclusion Since the tested compounds, specifically compound I, presented a satisfactory chronic safety profile as well as anti-inflammatory effect, it is worth conducting further molecular pharmacological, toxicological and bioavailability studies to elucidate the efficacy of these potential anti-inflammatory bipyrazole compounds.
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Affiliation(s)
- Souraya Domiati
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Mohammed Mehanna
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon.,Department of Industrial Pharmacy, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Hanan Ragab
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Hania Nakkash Chmaisse
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Ahmed El Mallah
- Department of Pharmacology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Manini AF, Nair AP, Vedanthan R, Vlahov D, Hoffman RS. Validation of the Prognostic Utility of the Electrocardiogram for Acute Drug Overdose. J Am Heart Assoc 2017; 6:e004320. [PMID: 28159815 PMCID: PMC5523748 DOI: 10.1161/jaha.116.004320] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND While it is certain that some emergency department patients with acute drug overdose suffer adverse cardiovascular events (ACVE), predicting ACVE is difficult. The prognostic utility of the ECG for heterogeneous drug overdose patients remains to be proven. This study was undertaken to validate previously derived features of the initial ECG associated with ACVE in this population. METHODS AND RESULTS We performed a prospective validation cohort study to evaluate adult emergency department patients with acute drug overdose at 2 urban university hospitals over 5 years in whom an emergency department admission ECG was performed. Exclusion criteria were alternate diagnoses, anaphylaxis, chronic drug toxicity, and missing outcome data. ACVE was defined as any of the following: circulatory shock, myocardial injury, ventricular dysrhythmia, or cardiac arrest. Blinded cardiologists interpreted ECGs for previously derived predictors of ACVE (ectopy, QT prolongation, nonsinus rhythm, ischemia/infarction), QT dispersion, and prominent R wave in lead AVR. Of 589 patients who met inclusion criteria (48% male, mean age 42), there were 95 ACVEs (39 shock, 64 myocardial injury, 26 dysrhythmia, 16 cardiac arrest). The most common drug exposures were as follows: benzodiazepines, opioids, and acetaminophen. Previously derived criteria were highly predictive of ACVE, with QT correction >500 ms as the highest risk feature (OR 11.2, CI 4.6-27). CONCLUSIONS This study confirms that early ECG evaluation is essential to assess the cardiovascular prognosis and medical clearance of emergency department patients with acute drug overdose. Furthermore, this study validates previously derived high-risk features of the admission ECG to risk stratify for ACVE in this patient population.
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Affiliation(s)
- Alex F Manini
- Division of Medical Toxicology, Elmhurst Hospital Center, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajith P Nair
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - David Vlahov
- Office of the Dean, School of Nursing, University of California, San Francisco, CA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY
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Abstract
Drug overdose is now the leading cause of injury-related mortality in the USA, but the prognostic utility of cardiac biomarkers is unknown. We investigated whether serum cardiac troponin I (cTnI) was associated with overdose mortality. This prospective observational cohort studied adults with suspected acute drug overdose at two university hospital emergency departments (ED) over 3 years. The endpoint was in-hospital mortality, which was used to determine test characteristics of initial/peak cTnI. There were 437 overdoses analyzed, of whom there were 20 (4.6 %) deaths. Mean initial cTnI was significantly associated with mortality (1.2 vs. 0.06 ng/mL, p < 0.001), and the ROC curve revealed excellent cTnI prediction of mortality (AUC 0.87, CI 0.76-0.98). Test characteristics for initial cTnI (90 % specificity, 99 % negative predictive value) were better than peak cTnI (88.2 % specificity, 99.2 % negative predictive value), and initial cTnI was normal in only one death out of the entire cohort (1/437, CI 0.1-1.4 %). Initial cTnI results were highly associated with drug overdose mortality. Future research should focus on high-risk overdose features to optimize strategies for utilization of cTnI as part of the routine ED evaluation for acute drug overdose.
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Affiliation(s)
- Alex F Manini
- Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Box 1620, One Gustave Levy Place, New York, NY, 10029, USA.
- Elmhurst Hospital Center, New York, NY, 11373, USA.
| | - Barry Stimmel
- Cardiology Division, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, 10016, USA
- New York City Poison Control Center, Department of Health and Mental Hygiene, New York City, NY, 10016, USA
| | - David Vlahov
- School of Nursing, University of California, San Francisco, CA, 94143, USA
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Evaluation of cardioprotective activity of Lepidium sativum seed powder in albino rats treated with 5-fluorouracil. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2016. [DOI: 10.1016/j.bjbas.2016.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Gasparyan AY, Ayvazyan L, Yessirkepov M, Kitas GD. Colchicine as an anti-inflammatory and cardioprotective agent. Expert Opin Drug Metab Toxicol 2015; 11:1781-94. [PMID: 26239119 DOI: 10.1517/17425255.2015.1076391] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Colchicine has been successfully used for the treatment of neutrophilic disorders such as familial Mediterranean fever (FMF), Behçet disease (BD) and gout. There is a growing interest in its cardiovascular effects. AREAS COVERED A MEDLINE/PubMed search for English articles published from January 1972 to June 2015 was completed using the following terms: therapy, pharmacokinetics, efficiency, side effects, toxicity, heart, colchicine, inflammation, FMF, amyloidosis, BD, gout, cardiovascular disorders, pericarditis, arrhythmias, inflammation, neutrophils, platelets. EXPERT OPINION By targeting neutrophils, endothelial cells and platelets, inhibiting mitosis, vascular hyperplasia and fibrosis, colchicine improves outcomes of pericarditis, myocardial ischemia and coronary interventions. Studies in neutrophilic rheumatic diseases and cardiovascular disorders demonstrated that oral colchicine at doses of 0.5 - 2.5 mg/daily is useful for treating pericarditis, myocardial ischemia and coronary occlusion. In rheumatic and cardiovascular disorders, therapeutic doses of the drug reduce C-reactive protein to levels below 2 mg/L, prevent myocardial damage and preserve normal values of atrial and ventricular impulse generation. One of the drug's frequent side effects is diarrhea, which is treated by diet modification or temporary discontinuation of the therapy. Certain drugs (macrolides, statins), comorbidities and certain genetic factors increase risk of colchicine toxicity.
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Affiliation(s)
- Armen Yuri Gasparyan
- a 1 Dudley Group NHS Foundation Trust (Teaching Trust of University of Birmingham), Russells Hall Hospital, Departments of Rheumatology and Research & Development , DY1 2HQ, Dudley, UK +44 138 424 4842 ; +44 138 424 4808 ;
| | - Lilit Ayvazyan
- b 2 Yerevan State Medical University, Department of Medical Chemistry , Yerevan, Armenia
| | - Marlen Yessirkepov
- c 3 South Kazakhstan State Pharmaceutical Academy, Department of Biochemistry, Biology and Microbiology , Shymkent, Kazakhstan
| | - George D Kitas
- a 1 Dudley Group NHS Foundation Trust (Teaching Trust of University of Birmingham), Russells Hall Hospital, Departments of Rheumatology and Research & Development , DY1 2HQ, Dudley, UK +44 138 424 4842 ; +44 138 424 4808 ; .,d 4 University of Manchester, Arthritis Research UK Epidemiology Unit , Manchester, UK
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Manini AF, Hoffman RS, Stimmel B, Vlahov D. Clinical risk factors for in-hospital adverse cardiovascular events after acute drug overdose. Acad Emerg Med 2015; 22:499-507. [PMID: 25903997 PMCID: PMC4426077 DOI: 10.1111/acem.12658] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/11/2014] [Accepted: 01/12/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES It was recently demonstrated that adverse cardiovascular events (ACVE) complicate a high proportion of hospitalizations for patients with acute drug overdoses. The aim of this study was to derive independent clinical risk factors for ACVE in patients with acute drug overdoses. METHODS This prospective cohort study was conducted over 3 years at two urban university hospitals. Patients were adults with acute drug overdoses enrolled from the ED. In-hospital ACVE was defined as any of myocardial injury, shock, ventricular dysrhythmia, or cardiac arrest. RESULTS There were 1,562 patients meeting inclusion/exclusion criteria (mean age, 41.8 years; female, 46%; suicidal, 38%). ACVE occurred in 82 (5.7%) patients (myocardial injury, 61; shock, 37; dysrhythmia, 23; cardiac arrests, 22) and there were 18 (1.2%) deaths. On univariate analysis, ACVE risk increased with age, lower serum bicarbonate, prolonged QTc interval, prior cardiac disease, and altered mental status. In a multivariable model adjusting for these factors as well as patient sex and hospital site, independent predictors were: QTc > 500 msec (3.8% prevalence, odds ratio [OR] = 27.6), bicarbonate < 20 mEq/L (5.4% prevalence, OR = 4.4), and prior cardiac disease (7.1% prevalence, OR = 9.5). The derived prediction rule had 51.6% sensitivity, 93.7% specificity, and 97.1% negative predictive value, while presence of two or more risk factors had 90.9% positive predictive value. CONCLUSIONS The authors derived independent clinical risk factors for ACVE in patients with acute drug overdose, which should be validated in future studies as a prediction rule in distinct patient populations and clinical settings.
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Affiliation(s)
- Alex F Manini
- Division of Medical Toxicology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert S Hoffman
- Division of Medical Toxicology, Department of Emergency Medicine, New York University School of Medicine, New York, NY
| | - Barry Stimmel
- Cardiology Division, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David Vlahov
- Office of the Dean, School of Nursing, University of California, San Francisco, CA
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Christensen DL, Espino D, Infante-Ramírez R, Brage S, Terzic D, Goetze JP, Kjaergaard J. Normalization of elevated cardiac, kidney, and hemolysis plasma markers within 48 h in Mexican Tarahumara runners following a 78 km race at moderate altitude. Am J Hum Biol 2014; 26:836-43. [PMID: 25145663 PMCID: PMC4237147 DOI: 10.1002/ajhb.22607] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/08/2014] [Accepted: 08/07/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The aim of this study was to examine to what extent extreme endurance exercise results in changes of plasma markers associated with cardiac and renal damage, as well as hemolysis in male, Mexican Tarahumara runners. METHODS Ten Tarahumara runners (mean (sd) age of 38 (12) years) participated in a 78 km race in Chihuahua, Mexico at 2,400 m above sea level. Cardiac, kidney, and hematology plasma markers were measured pre-race and <5 min, 1 h, 3 h, 6 h, 24 h, and 48 h post-race. Anthropometry, blood pressure, pulse rate, electrocardiography, HbA1c, hemoglobin and VO2max (estimated from heart rate following step test) were assessed pre-race, while physical activity energy expenditure and intensity were estimated during the race, and oxygen partial pressure saturation (SpO2 ) <30 min post-race. RESULTS Estimated mean VO2max was 48 (9) mLO2 min(-1) kg(-1) and relative intensity during the race was 68 (11)%VO2 max. Mean SpO2 was 92 (3)% <30 min post-race. Plasma concentrations of especially total creatine kinase, creatine kinase-MB isoform, and haptoglobin changed significantly from pre-race values (P < 0.001) up to 24 h post-race, but had returned to pre-race values after 48 h. The plasma concentrations of mid-regional proatrial natiuretic peptide and copeptin returned to pre-race concentrations after 1 and 6 h, respectively. CONCLUSIONS Altered cardiac, renal, and hemolysis plasma markers were normalized after 48 h following 78 km of running, suggesting that the impact of exercise-induced cardiac and kidney damage as well as hemolysis in the Mexican Tarahumara is low.
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Affiliation(s)
- Dirk L Christensen
- Unit of International Health, University of Copenhagen, Copenhagen, Denmark
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Herman E, Knapton A, Zhang J, Estis J, Todd J, Lipshultz S. The utility of serum biomarkers to detect myocardial alterations induced by Imatinib in rats. Pharmacol Res Perspect 2014; 2:e00015. [PMID: 25505575 PMCID: PMC4186398 DOI: 10.1002/prp2.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/10/2013] [Accepted: 10/15/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Imatinib (Imb) is a tyrosine kinase inhibitor with cardiotoxic activity (decreases in left ventricular function and congestive heart failure) in patients. Currently, clinical diagnosis of Imb cardiotoxicity relies primarily on evaluation of left ventricular function, Imb also induces cardiac lesions in rats. AIMS This study, in rats, sought to determine whether monitoring biochemical markers would be a sensitive means to detect Imb-induced changes in cardiomyocyte morphology. MATERIALS AND METHODS Groups of male Sprague-Dawley rats were dosed orally with 50, 100, 200 mg kg(-1) Imb or water daily for 28 days. Tissues and blood samples were collected 24 h after the last dosing. Cardiac biomarkers such as cardiac troponin I (cTnI), cardiac troponin T (cTnT), and fatty acid binding protein 3 (FABP3) were monitored by the Erenna, Elecsys, and Meso Scale immunoassay systems. RESULTS Imb caused microscopic myocardial lesions (myofibrillar loss, cytoplasmic vacuolization, and necrosis) at all doses as determined by unbiased histopathology analysis. The severity of the alterations was dose-related with mean lesion scores (based on a scale of 0-3) of 1.2 (50 mg kg(-1)), 2.1 (100 mg kg(-1)) and 2.9 (200 mg kg(-1)). However, the increases in cTnI, cTnT, and FABP3 levels were noted primarily in high-dose Imb treated animals. DISCUSSION AND CONCLUSION The occurrence of myocardial alterations in animals without consistent changes in cardiac troponin and FABP3 concentrations raises questions regarding the utility of these biomarkers as early indicators of Imb-induced cardiotoxicity. Due to limited numbers of animals the reasons for this discrepancy could not be determined.
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Affiliation(s)
- Eugene Herman
- Division of Drug Safety Research, Food and Drug Administration Silver Spring, Maryland
| | - Alan Knapton
- Division of Drug Safety Research, Food and Drug Administration Silver Spring, Maryland
| | - Jun Zhang
- Division of Drug Safety Research, Food and Drug Administration Silver Spring, Maryland
| | | | | | - Steven Lipshultz
- Department of Pediatrics, Mailman Center for Child Development, Leonard A. Miller School of Medicine, University of Miami Miami, Florida
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Jang DH, Spyres MB, Fox L, Manini AF. Toxin-Induced Cardiovascular Failure. Emerg Med Clin North Am 2014; 32:79-102. [DOI: 10.1016/j.emc.2013.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Herman EH, Knapton A, Liu Y, Lipshultz SE, Estis J, Todd J, Woodward RA, Cochran T, Zhang J, Poirier MC. The influence of age on serum concentrations of cardiac troponin I: results in rats, monkeys, and commercial sera. Toxicol Pathol 2013; 42:888-96. [PMID: 24129761 DOI: 10.1177/0192623313505154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac troponins serve as serum biomarkers of myocardial injury. The current study examined the influence of age on serum concentrations of cardiac troponin I (cTnI). An ultrasensitive immunoassay was used to monitor cTnI concentrations in Sprague-Dawley (SD) rats and Erythrocebus patas monkeys of different ages. The mean cTnI concentrations were highest in 10-day-old rats compared to 25-, 40-, and 80-day-old SD rats. Cardiomyocyte remodeling was apparent in hearts from 10-day-old SD rats as evident by hypercellularity, irregularly shaped nuclei, and moderate numbers of myocytes undergoing mitosis and apoptosis. The mean concentration of cTnI in 5 newborn monkeys was considerably higher than that of three 1-year-old monkeys. Evidence of cardiomyocyte remodeling was also observed in these newborn hearts (loss of myofibrils and cytoplasmic vacuolation). Commercial animal serum samples were also analyzed. The concentrations of cTnI detected in fetal equine and porcine serum were considerably higher than that found in adult equine and porcine serum samples Likewise, fetal bovine serum had higher cTnI concentrations (>2,400 pg/ml) than did adult caprine and laprine samples (2.5-2.7 pg/ml). The present study found age-related differences in cTnI concentrations, with higher levels occurring at younger ages. This effect was consistent across several animal species.
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Affiliation(s)
- Eugene H Herman
- Food and Drug Administration, Division of Drug Safety Research, Silver Spring, Maryland, USA
| | - Alan Knapton
- Food and Drug Administration, Division of Drug Safety Research, Silver Spring, Maryland, USA
| | - Yongmin Liu
- National Institutes of Health, National Cancer Institute, Carcinogen-DNA Interactions Section, Bethesda, Maryland, USA
| | - Steven E Lipshultz
- Department of Pediatrics, Leonard M. Miller School of Medicine, Mailman Center for Child Development, University of Miami, Miami, Florida, USA
| | - Joel Estis
- Singulex, Inc., Alameda, California, USA
| | - John Todd
- Singulex, Inc., Alameda, California, USA
| | - Ruth A Woodward
- Shared Animal Facility, NIH Animal Center, Dickerson, Maryland, USA
| | - Thomas Cochran
- Department of Pediatrics, Leonard M. Miller School of Medicine, Mailman Center for Child Development, University of Miami, Miami, Florida, USA
| | - Jun Zhang
- Food and Drug Administration, Division of Drug Safety Research, Silver Spring, Maryland, USA
| | - Miriam C Poirier
- National Institutes of Health, National Cancer Institute, Carcinogen-DNA Interactions Section, Bethesda, Maryland, USA
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ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2012; 60:2427-63. [PMID: 23154053 DOI: 10.1016/j.jacc.2012.08.969] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jia X, Hao Y, Guo X. Ultrafine carbon black disturbs heart rate variability in mice. Toxicol Lett 2012; 211:274-80. [PMID: 22537739 DOI: 10.1016/j.toxlet.2012.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 04/05/2012] [Accepted: 04/06/2012] [Indexed: 10/28/2022]
Abstract
Previous epidemiological and toxicological studies have reported the associations between ambient particulate matter (PM) exposure and changes in heart rate variability (HRV), a marker of cardiac autonomic nervous system (ANS) function. However, both the responsible components in PM and their mechanisms affecting HRV remain uncertain. We propose that carbon black (CB), one of the main components in PM, may affect HRV through mechanisms independent of cardio-pulmonary and systemic inflammation and/or injury. Male C57BL/6 mice were exposed by intra-tracheal instillation to ultrafine CB (once every two days for three times) at doses of 0, 0.05, 0.15 and 0.6 mg/kg. HRV indices, standard deviation of all normal R-R intervals (SDNN) and the square root of mean of sum of squares of differences between adjacent normal R-R intervals (RMSSD), showed significant decreases in 0.15 and 0.6 mg/kg CB exposed groups. Slight pulmonary inflammation and myocardial injury were only observed in 0.6 mg/kg CB exposed group. We conclude that CB can disturb cardiac ANS function in mice, indicated by the withdrawal of parasympathetic modulation, through mechanisms independent of apparent myocardial and pulmonary injury.
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Affiliation(s)
- Xiaofeng Jia
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
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Bonura F, Di Lisi D, Novo S, D’Alessandro N. Timely Recognition of Cardiovascular Toxicity by Anticancer Agents: A Common Objective of the Pharmacologist, Oncologist and Cardiologist. Cardiovasc Toxicol 2011; 12:93-107. [DOI: 10.1007/s12012-011-9141-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Combined analyses of creatine kinase MB, cardiac troponin I and myoglobin in pericardial and cerebrospinal fluids to investigate myocardial and skeletal muscle injury in medicolegal autopsy cases. Leg Med (Tokyo) 2011; 13:226-32. [DOI: 10.1016/j.legalmed.2011.05.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 03/01/2011] [Accepted: 05/09/2011] [Indexed: 11/30/2022]
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Newby LK, Rodriguez I, Finkle J, Becker RC, Hicks KA, Hausner E, Chesler R, Harper C, Targum S, Berridge BR, Lewis E, Walker DB, Dollery C, Turner JR, Krucoff MW. Troponin measurements during drug development--considerations for monitoring and management of potential cardiotoxicity: an educational collaboration among the Cardiac Safety Research Consortium, the Duke Clinical Research Institute, and the US Food and Drug Administration. Am Heart J 2011; 162:64-73. [PMID: 21742091 DOI: 10.1016/j.ahj.2011.04.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 04/05/2011] [Indexed: 11/26/2022]
Abstract
Drug-induced cardiac toxicity is a recognized challenge in development and implementation of pharmacotherapy. Appropriate biomarkers are needed to detect these abnormalities early in development and to manage the risk of potentially cardiotoxic drugs or biologic agents. Circulating cardiac troponin (cTn) is the most widely used biomarker for detection of myocardial injury. Although most commonly used to detect myonecrosis in the setting of ischemia, cTns are also elevated with other acute and chronic disease processes, including heart failure, renal failure, sepsis, pulmonary embolic disease, and many others. High-sensitivity assays for both cTnI and cTnT are now available that achieve acceptable imprecision (coefficient of variation <10%) at the 99th percentile of a normal reference population. Even more sensitive assays are being developed that detect cTn in ranges that are near the level of normal cellular turnover (apoptosis). These properties of cTn and the continuing evolution of highly sensitive assays position cTn as a potentially uniquely informative marker for early detection of cardiac toxicity. This article summarizes collaborative discussions among key stakeholders in the Cardiac Safety Research Consortium about the use of cTn monitoring in drug development.
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Herman E, Knapton A, Rosen E, Zhang J, Estis J, Agee SJ, Lu QA, Todd JA, Lipshultz SE. Baseline Serum Cardiac Troponin I Concentrations in Sprague-Dawley, Spontaneous Hypertensive, Wistar, Wistar-Kyoto, and Fisher Rats as Determined with an Ultrasensitive Immunoassay. Toxicol Pathol 2011; 39:653-63. [DOI: 10.1177/0192623311406931] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cardiac troponins have proved to be reliable blood biomarkers for identifying a variety of myocardial alterations in humans and animals. Recently, an ultrasensitive cTnI assay (Erenna IA) has been used to demonstrate increases in baseline cTnI resulting from drug-induced myocardial injury in rats, dogs, and monkeys, as well as to document baseline cTnI ranges in Sprague-Dawley (SD) rats. The present study was initiated to use the Erenna cTnI assay to further document baseline cTnI concentrations in normal control animals from multiple strains, including SD, Spontaneous Hypertensive (SHR), Wistar, Wistar-Kyoto (WKY), and Fisher strains. Baseline cTnI concentrations were quantified in all rats tested, and males had higher mean cTnI concentrations than females of the same strain. SHR males had the highest mean cTnI concentrations and the largest cTnI variability. Interestingly, cTnI concentrations increased in castrated SHR compared with unaltered male SHR, whereas cTnI concentrations decreased in ovariectomized SHR compared with unaltered female SHR. These results show significant differences in cTnI concentrations between strains, sexes, and noncardiac surgical alterations in control animals, and identify these as potential contributing factors to cTnI baseline variability that should be taken into account when using ultrasensitive cTnI as a biomarker to assess preclinical cardiotoxicity.
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Affiliation(s)
- Eugene Herman
- Food and Drug Administration, Division of Applied Pharmacology Research, Silver Spring, Maryland, USA
| | - Alan Knapton
- Food and Drug Administration, Division of Applied Pharmacology Research, Silver Spring, Maryland, USA
| | - Elliot Rosen
- Food and Drug Administration, Division of Applied Pharmacology Research, Silver Spring, Maryland, USA
| | - Jun Zhang
- Food and Drug Administration, Division of Applied Pharmacology Research, Silver Spring, Maryland, USA
| | - Joel Estis
- Singulex, Inc., Alameda, California, USA
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21
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Rui D, Daojun C, Yongjian Y. Liver and heart toxicity due to 90-day oral exposure of ICR mice to N,N-dimethylformamide. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2011; 31:357-363. [PMID: 21787705 DOI: 10.1016/j.etap.2011.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 01/21/2011] [Accepted: 01/23/2011] [Indexed: 05/31/2023]
Abstract
N,N-dimethylformamide (DMF) is a colorless liquid with a faint amine odor, which is widely used in the world. DMF exposure may induce adverse effects on liver, but few studies showed damage to heart after exposure to DMF. In the present study, DMF was administered to ICR mice with the doses of 0.32, 0.63 and 1.26 g/kg of body weight by gavage for 90 days. The increase in the relative liver weight is accompanied with the presence of the centrilobular hepatocellular hypertrophy as well as increased serum levels of aspartate transaminase (AST) and alanine transaminase (ALT). An increase of malondialdehyde (MDA) level was shown in liver homogenate, while superoxide dismutase (SOD) and glutathione (GSH) activities decreased. Heart damage was also shown in mice exposed to DMF for 90 days, although pathological examination showed only slight inflammatory cell infiltration. Increased levels of serum lactate dehydrogenase (LDH), isoenzymes of creatine kinase (CK-MB) and cardiac troponin I (cTnI) were shown. Increased level of MDA was also shown in heart homogenate, in contrast with the decreased activity of SOD. These data suggested that the administration of DMF could induce liver and heart injuries and oxidative stress was involved in the toxic effects.
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Affiliation(s)
- Ding Rui
- School of Public Health, Anhui Medical University, China.
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22
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Schultze AE, Main BW, Hall DG, Hoffman WP, Lee HYC, Ackermann BL, Pritt ML, Smith HW. A comparison of mortality and cardiac biomarker response between three outbred stocks of Sprague Dawley rats treated with isoproterenol. Toxicol Pathol 2011; 39:576-88. [PMID: 21467541 DOI: 10.1177/0192623311402219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors compared the mortality and cardiac biomarker responses in three outbred stocks of Sprague Dawley rats (CD/IGS, Sasco, Harlan) treated with isoproterenol hydrochloride. Cardiac injury was confirmed by histologic evaluation, and increases in cardiac troponin I concentration in serum were measured by two methods. CD/IGS rats had a higher incidence and earlier mortality compared with Sasco or Harlan rats. Harlan rats had lower severity scores for cardiomyocyte degeneration/necrosis compared with the other stocks. Post-isoproterenol treatment cardiac troponin I concentrations were greater in CD/IGS and Sasco rats compared with Harlan rats. Concentrations of cardiac troponin T followed a similar pattern to that of cardiac troponin I in rats treated with isoproterenol. Myosin, light chain 3 concentrations increased in all rats treated with isoproterenol, but there was no difference between the three stocks in the magnitude or pattern of the dose response. Increases in fatty acid binding protein 3 concentrations were detected in only the highest dose group at the earliest timepoint postdose for all three stocks of rats. Results of these studies illustrate the need for investigators to recognize the potential differences in response between stocks of Sprague Dawley rats treated with cardiotoxicants or novel chemical entities.
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Affiliation(s)
- A Eric Schultze
- Department of Pathology, Lilly Research Laboratories, a Division of Eli Lilly and Company, Indianapolis, Indiana 46225, USA.
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23
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Shave R, Baggish A, George K, Wood M, Scharhag J, Whyte G, Gaze D, Thompson PD. Exercise-induced cardiac troponin elevation: evidence, mechanisms, and implications. J Am Coll Cardiol 2010; 56:169-76. [PMID: 20620736 DOI: 10.1016/j.jacc.2010.03.037] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 02/19/2010] [Accepted: 03/09/2010] [Indexed: 12/20/2022]
Abstract
Regular physical exercise is recommended for the primary prevention of cardiovascular disease. Although the high prevalence of physical inactivity remains a formidable public health issue, participation in exercise programs and recreational sporting events, such as marathons and triathlons, is on the rise. Although regular exercise training reduces cardiovascular disease risk, recent studies have documented elevations in cardiac troponin (cTn) consistent with cardiac damage after bouts of exercise in apparently healthy individuals. At present, the prevalence, mechanism(s), and clinical significance of exercise-induced cTn release remains incompletely understood. This paper will review the biochemistry, prevalence, potential mechanisms, and management of patients with exercise-induced cTn elevations.
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Affiliation(s)
- Rob Shave
- Brunel University, Uxbridge, Middlesex, United Kingdom.
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24
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Pelander L, Ljungvall I, Häggström J. Myocardial cell damage in 24 dogs bitten by the common European viper (Vipera berus
). Vet Rec 2010; 166:687-90. [DOI: 10.1136/vr.b4817] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- L. Pelander
- Department of Clinical Sciences; University of Agricultural Sciences; 750 07 Uppsala Sweden
| | - I. Ljungvall
- Department of Clinical Sciences; University of Agricultural Sciences; 750 07 Uppsala Sweden
| | - J. Häggström
- Department of Clinical Sciences; University of Agricultural Sciences; 750 07 Uppsala Sweden
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25
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Witt KL, Malarkey DE, Hobbs CA, Davis JP, Kissling GE, Caspary W, Travlos G, Recio L. No increases in biomarkers of genetic damage or pathological changes in heart and brain tissues in male rats administered methylphenidate hydrochloride (Ritalin) for 28 days. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2010; 51:80-88. [PMID: 19634155 PMCID: PMC2807377 DOI: 10.1002/em.20515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Following a 2005 report of chromosomal damage in children with attention deficit/hyperactivity disorder (ADHD) who were treated with the commonly prescribed medication methylphenidate (MPH), numerous studies have been conducted to clarify the risk for MPH-induced genetic damage. Although most of these studies reported no changes in genetic damage endpoints associated with exposure to MPH, one recent study (Andreazza et al. [2007]: Prog Neuropsychopharmacol Biol Psychiatry 31:1282-1288) reported an increase in DNA damage detected by the Comet assay in blood and brain cells of Wistar rats treated by intraperitoneal injection with 1, 2, or 10 mg/kg MPH; no increases in micronucleated lymphocyte frequencies were observed in these rats. To clarify these findings, we treated adult male Wistar Han rats with 0, 2, 10, or 25 mg/kg MPH by gavage once daily for 28 consecutive days and measured micronucleated reticulocyte (MN-RET) frequencies in blood, and DNA damage in blood, brain, and liver cells 4 hr after final dosing. Flow cytometric evaluation of blood revealed no significant increases in MN-RET. Comet assay evaluations of blood leukocytes and cells of the liver, as well as of the striatum, hippocampus, and frontal cortex of the brain showed no increases in DNA damage in MPH-treated rats in any of the three treatment groups. Thus, the previously reported observations of DNA damage in blood and brain tissue of rats exposed to MPH for 28 days were not confirmed in this study. Additionally, no histopathological changes in brain or heart, or elevated serum biomarkers of cardiac injury were observed in these MPH-exposed rats.
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Affiliation(s)
- Kristine L Witt
- Biomolecular Screening Branch, NIEHS/NTP, National Institutes of Health, Research Triangle Park, North Carolina 27709, USA.
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26
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Cardiac troponin T for early detection of cardiotoxicity in breast cancer patients treated with epirubicin. Open Med (Wars) 2009. [DOI: 10.2478/s11536-008-0093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe aim of the study was to investigate the role of cTnT for the prediction of long term cardiac dysfunction after epirubicin-containing adjuvant chemotherapy for breast cancer. The study group comprised of 45 patients (all female; mean age 48 ±8 years), treated with epirubicin-containing adjuvant chemotherapy for stage 2 and stage 3 breast cancer. Patients received either 4 cycles of cyclophosphamide plus epirubicin (90 mg/m2) (n=23; stage 2 breast cancer) or 6 cycles of cyclophosphamide plus epirubicin (75 mg/m2) plus fluorouracil (n=18; stage 3 breast cancer). Venous blood samples were drawn, before and 72 hours after, every cycle of chemotherapy for the measurement of cTnT. Cardiac assessment was carried out at baseline and 1 year after chemotherapy by clinical evaluation, electrocardiography, radio-nuclide ventriculography (RNV) and transthoracic echocardiography. All patients remained free of clinical heart failure during the study period. In 26 patients (63%), cTnT was elevated after chemotherapy. Mean left ventricular ejection fraction, assessed by RNV at baseline and one year after chemotherapy, were 61±8% and 56±7% (p<0.0001). The sensitivity and specifity of cTnT for the detection of left ventricular systolic dysfunction at one year were 69% and 39% respectively. Echocardiographic examinations at baseline and one year after chemotherapy revealed a significant decrease in E/A ratio from 1.15±0.3 to 0.9±0.2 in cTnT positive patients, suggesting diastolic dysfunction. In conclusion, elevated serum cTnT levels after epirubicin-containing adjuvant chemotherapy for stage 2 and stage 3 breast cancer, predict future cardiac dysfunction with moderate sensitivity and poor specificity.
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27
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28
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Varga A, Schober KE, Walker WL, Lakritz J, Michael Rings D. Validation of a commercially available immunoassay for the measurement of bovine cardiac troponin I. J Vet Intern Med 2009; 23:359-65. [PMID: 19192157 DOI: 10.1111/j.1939-1676.2009.0256.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Commercially available cardiac troponin I (cTnI) assays developed for use in humans have not yet been validated for use in cattle. HYPOTHESES The ADVIA Centaur TnI-Ultra immunoassay can be used for the detection of bovine cTnI. In healthy cattle, serum cTnI is undetectable or is present only in trace amounts. METHODS Purified bovine cTnI and cTnI-free bovine serum were used for the evaluation of assay performance including intra- and inter-assay precision, sensitivity, interference, linearity, and recovery. Effects of storage at 23, 4, -20, and -80 degrees C for 2 days, and at -20 and -80 degrees C for 7 and 14 days and repeated freeze-thaw cycles on recovery of cTnI were analyzed. Serum cTnI concentrations in 30 healthy dairy cows were determined. RESULTS Intra- and inter-assay precisions (mean +/- SD) were 4.48 +/- 2.26 and 13.36 +/- 6.59%, respectively. The assay demonstrated linearity at 0.5, 2, 15, and 30 ng/mL cTnI. Mean recovery was 100.81, 85.26, 87.72, and 114.42%, respectively. Skeletal muscle homogenate added to serum of known cTnI concentration did not alter the concentration of the analyte (P > .05). Concentration of cTnI significantly decreased when samples were stored at 4 and 23 degrees C for 2 days (P < .05). Repeated freeze-thaw cycles and storage at -20 degrees C for 7 days had no significant influence on cTnI concentration (P > .05). Serum cTnI concentration in healthy cattle was <or=0.03 ng/mL. CONCLUSION AND CLINICAL IMPORTANCE ADVIA Centaur can be used reliably for the detection of serum cTnI concentration in cattle.
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Affiliation(s)
- A Varga
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
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29
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Gaze DC. Cardiac troponin in cerebral injury: understanding your laboratory reports. Biomark Med 2008; 2:433-5. [PMID: 20477418 DOI: 10.2217/17520363.2.5.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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30
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Schultze AE, Konrad RJ, Credille KM, Lu QA, Todd J. Ultrasensitive Cross-species Measurement of Cardiac Troponin-I Using the Erenna Immunoassay System. Toxicol Pathol 2008; 36:777-82. [DOI: 10.1177/0192623308322016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Serum cardiac troponin-I (cTnI) has been validated as a biomarker for cardiotoxicity in numerous animal models; however, owing to sensitivity issues cTnI concentrations in healthy, resting animals used in toxicology studies have not been established. Serum from healthy and isoproterenol hydrochloride (iso)-treated rats, dogs, and monkeys were assayed using the Erenna system. The Erenna cTnI assay provided sensitivity < 1 ng/L across human, rat, dog, and monkey cTnI. Linear responses ( R2= 0.99) were observed for all species. Precision studies yielded interassay CVs of curve fit quantification from 2% to 4% between 1.6 and 5000 ng/L, and 23% at 0.78 ng/L. Strong correlation ( R2= 0.99) was obtained between Erenna and Beckman Access cTnI. Concentrations of cTnI in healthy animals ranged from 1 to 9 ng/L. In longitudinal studies of iso-treated animals, the concentrations of cTnI in the control vehicle-treated groups were 10–20 ng/L for rats (N = 10) and predose values of 2–3 ng/L for dogs (N = 3). Measured with the Erenna assay system, cTnI was quantifiable at all time intervals tested in all animals treated with iso. The Erenna system provides sensitive measurement of cTnI in rats, dogs, and monkeys, makes it possible to determine small changes from normal concentrations, and provides cTnI values from small volumes of serum.
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Affiliation(s)
- A. Eric Schultze
- Department of Pathology, Lilly Research Laboratories, A Division of Eli Lilly and Company, Greenfield, Indiana, USA
| | - Robert J. Konrad
- Laboratory for Experimental Medicine, Lilly Research Laboratories, A Division of Eli Lilly and Company, Greenfield, Indiana, USA
| | - Kelly M. Credille
- Department of Pathology, Lilly Research Laboratories, A Division of Eli Lilly and Company, Greenfield, Indiana, USA
| | | | - John Todd
- Singulex, Inc., Alameda, California, USA
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31
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Collinson PO, Gaze DC. Biomarkers of cardiovascular damage. Med Princ Pract 2007; 16:247-61. [PMID: 17541289 DOI: 10.1159/000102146] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 02/17/2007] [Indexed: 01/12/2023] Open
Abstract
Acute coronary syndromes (ACS) are due to the rupture or erosion of atheromatous plaques. This produces, depending on plaque size, vascular anatomy and degree of collateral circulation, progressive tissue ischaemia which may progress to cardiomyocyte necrosis. This may then result in cardiac remodelling. Serum biomarkers are available which can be used for diagnosis of all of these stages. Markers to detect myocardial ischaemia at the pre-infarction stage are potentially the most interesting but also the most challenging. An ischaemia marker offers the opportunity to intervene to prevent progression to infarction. The problems with potential ischaemia markers are specificity and the reference diagnostic standard against which they can be judged. To date, only one, ischaemia-modified albumin(R), has reached the point where clinical studies can be performed. The measurement of the cardiac troponins, cardiac troponin T and cardiac troponin I, have become recognised as the diagnostic reference standard for myocardial necrosis. The sensitive nature of these tests has also revealed that myocardial necrosis is also found in a range of other clinical situations, highlighting the need to use all clinical information for diagnosis of acute myocardial infarction. The measurement of B-type natriuretic peptides can be shown to be diagnostic and prognostic in both ACS and detecting the sequelae of post-infarction myocardial insufficiency. The role of the B-type natriuretic peptides in detection of cardiac failure, both acute and chronic, is well defined but remains the subject of further studies, in ACS.
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Affiliation(s)
- Paul O Collinson
- Departments of Chemical Pathology, Cardiac Research and Cardiology, St George's Hospital and Medical School, London, UK.
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