1
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Pogran E, Burger AL, Zweiker D, Kaufmann CC, Muthspiel M, Rega-Kaun G, Wenkstetten-Holub A, Wojta J, Drexel H, Huber K. Lipid-Lowering Therapy after Acute Coronary Syndrome. J Clin Med 2024; 13:2043. [PMID: 38610808 PMCID: PMC11012397 DOI: 10.3390/jcm13072043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets remains a significant challenge in clinical practice. This review assesses the barriers to reaching LDL-C goals and explores the potential solutions to these issues. When aiming for the recommended LDL-C goal, strategies like "lower is better" and "strike early and strong" should be used. The evidence supports the safety and efficacy of intensive lipid-lowering therapy post-acute coronary syndrome (ACS), leading to improved long-term cardiovascular health and atherosclerotic plaque stabilization. Despite the availability of effective lipid-lowering therapies, such as high-intensity statins, ezetimibe, the combination of both, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a substantial proportion of patients do not meet their LDL-C targets. Contributing factors include systemic healthcare barriers, healthcare provider inertia, patient non-adherence, and statin intolerance. Statin intolerance, often rather statin reluctance, is a notable obstacle due to perceived or expected side effects, which can lead to discontinuation of therapy. In conclusion, while there are obstacles to achieving optimal LDL-C levels post-ACS, these can be overcome with a combination of patient-centric approaches, clinical vigilance, and the judicious use of available therapies. The safety and necessity of reaching lower LDL-C goals to improve outcomes in patients post-ACS are well-supported by current evidence.
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Affiliation(s)
- Edita Pogran
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - Achim Leo Burger
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - David Zweiker
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria
| | - Christoph Clemens Kaufmann
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - Marie Muthspiel
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - Gersina Rega-Kaun
- 5th Medical Department with Endocrinology, Rheumatology and Acute Geriatrics, Klinik Ottakring, 1160 Vienna, Austria; (G.R.-K.)
| | - Alfa Wenkstetten-Holub
- 5th Medical Department with Endocrinology, Rheumatology and Acute Geriatrics, Klinik Ottakring, 1160 Vienna, Austria; (G.R.-K.)
| | - Johann Wojta
- Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria;
- Core Facilities, Medical University of Vienna, 1090 Vienna, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, 6800 Feldkirch, Austria
| | - Kurt Huber
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, 1160 Vienna, Austria
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria;
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2
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Buntsma N, van der Pol E, Nieuwland R, Gąsecka A. Extracellular Vesicles in Coronary Artery Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1418:81-103. [PMID: 37603274 DOI: 10.1007/978-981-99-1443-2_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Despite recent progress in the diagnosis and treatment of CAD, evidence gaps remain, including pathogenesis, the most efficient diagnostic strategy, prognosis of individual patients, monitoring of therapy, and novel therapeutic strategies. These gaps could all be filled by developing novel, minimally invasive, blood-based biomarkers. Potentially, extracellular vesicles (EVs) could fill such gaps. EVs are lipid membrane particles released from cells into blood and other body fluids. Because the concentration, composition, and functions of EVs change during disease, and because all cell types involved in the development and progression of CAD release EVs, currently available guidelines potentially enable reliable and reproducible measurements of EVs in clinical trials, offering a wide range of opportunities. In this chapter, we provide an overview of the associations reported between EVs and CAD, including (1) the role of EVs in CAD pathogenesis, (2) EVs as biomarkers to diagnose CAD, predict prognosis, and monitor therapy in individual patients, and (3) EVs as new therapeutic targets and/or drug delivery vehicles. In addition, we summarize the challenges encountered in EV isolation and detection, and the lack of standardization, which has hampered real clinical applications of EVs. Since most conclusions are based on animal models and single-center studies, the knowledge and insights into the roles and opportunities of EVs as biomarkers in CAD are still changing, and therefore, the content of this chapter should be seen as a snapshot in time rather than a final and complete compendium of knowledge on EVs in CAD.
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Affiliation(s)
- Naomi Buntsma
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edwin van der Pol
- Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rienk Nieuwland
- Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Aleksandra Gąsecka
- Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
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3
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Pleiotropic Effects of PCSK9: Focus on Thrombosis and Haemostasis. Metabolites 2022; 12:metabo12030226. [PMID: 35323669 PMCID: PMC8950753 DOI: 10.3390/metabo12030226] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
The proprotein convertase subtilisin/keying 9 (PCSK9) is a serine protease that has gained importance in recent years as a drug target, mainly due to its effect on cholesterol metabolism in promoting the degradation of the low-density lipoprotein receptor (LDLR). However, this protease may also play an important role in lipid-independent reactions, including the process of thrombogenesis. Considering this, we reviewed the effects and implications of PCSK9 on platelet function and blood coagulation. PCSK9 knockout mice exhibited reduced platelet activity and developed less agonist-induced arterial thrombi compared to the respective control animals. This is in line with known research that elevated blood levels of PCSK9 are associated with an increased platelet reactivity and total number of circulating platelets in humans. Moreover, PCSK9 also has an effect on crucial factors of the coagulation cascade, such as increasing factor VIII plasma levels, since the degradation of this blood clotting factor is promoted by the LDLR. The aforementioned pleiotropic effects of the PCSK9 are important to take into account when evaluating the clinical benefit of PCSK9 inhibitors.
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4
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Gao J, Liu JY, Lu PJ, Xiao JY, Gao MD, Li CP, Cui Z, Liu Y. Effects of Evolocumab Added to Moderate-Intensity Statin Therapy in Chinese Patients With Acute Coronary Syndrome: The EMSIACS Trial Study Protocol. Front Physiol 2021; 12:750872. [PMID: 34887772 PMCID: PMC8650150 DOI: 10.3389/fphys.2021.750872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Several studies have demonstrated that using a higher dose of statin can easily induce liver injury and myopathy. Low-density lipoprotein cholesterol (LDL-C) is a well-established modifiable risk factor for cardiovascular disease; however, the large majority of Chinese patients cannot meet the target level of LDL-C recommended by the Chinese expert consensus. Evolocumab has been demonstrated to reduce LDL-C by approximately 60% in many studies. Nevertheless, whether combined evolocumab and moderate-intensity statin is as effective in lowering LDL-C and decreasing incidence of MACE in Chinese patients presenting with the acute phase of acute coronary syndrome (ACS) remains unknown. Therefore, the "Evolocumab added to Moderate-Intensity Statin therapy on LDL-C lowering and cardiovascular adverse events in patients with Acute Coronary Syndrome" (EMSIACS) is conducted. Methods: The EMSIACS is a prospective, randomized, open-label, parallel-group, multicenter study involving analyzing the feasibility and efficacy of evolocumab added to moderate-intensity statin therapy on lowering LDL-C levels in adult Chinese patients hospitalized for acute phase ACS. The sample size calculation is based on the primary outcome, and 500 patients will be planned to recruit. Patients are randomized in evolocumab arm (evolocumab 140mg every 2weeks plus rosuvastatin 10mg/day or atorvastatin 20mg/day) and statin-only arm (rosuvastatin 10mg/day or atorvastatin 20mg/day). The primary outcome is the percentage change in LDL-C in weeks 4 and week 12 after treatment. The secondary outcome is the occurrence of MACE after 12weeks and 1year of treatment. Discussion: If the EMSIACS trial endpoints prove statistically significant, the evolocumab added to moderate-intensity statin therapy will have the potential to effectively lower subjects' LDL-C levels, especially for the Chinese patients with acute phase ACS. However, if the risk of MACE is not significantly different between the two groups, we may extend follow-up time for secondary outcome when the clinical trial is over. Clinical trial registration: The study is registered to ClinicalTrials.gov (NCT04100434), which retrospectively registered on November 24, 2020.
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Affiliation(s)
- Jing Gao
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China.,Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | - Jing-Yu Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Peng-Ju Lu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ming-Dong Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chang-Ping Li
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhuang Cui
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yin Liu
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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5
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Majka M, Kleibert M, Wojciechowska M. Impact of the Main Cardiovascular Risk Factors on Plasma Extracellular Vesicles and Their Influence on the Heart's Vulnerability to Ischemia-Reperfusion Injury. Cells 2021; 10:3331. [PMID: 34943838 PMCID: PMC8699798 DOI: 10.3390/cells10123331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022] Open
Abstract
The majority of cardiovascular deaths are associated with acute coronary syndrome, especially ST-elevation myocardial infarction. Therapeutic reperfusion alone can contribute up to 40 percent of total infarct size following coronary artery occlusion, which is called ischemia-reperfusion injury (IRI). Its size depends on many factors, including the main risk factors of cardiovascular mortality, such as age, sex, systolic blood pressure, smoking, and total cholesterol level as well as obesity, diabetes, and physical effort. Extracellular vesicles (EVs) are membrane-coated particles released by every type of cell, which can carry content that affects the functioning of other tissues. Their role is essential in the communication between healthy and dysfunctional cells. In this article, data on the variability of the content of EVs in patients with the most prevalent cardiovascular risk factors is presented, and their influence on IRI is discussed.
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Affiliation(s)
- Miłosz Majka
- Laboratory of Centre for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (M.M.); (M.K.)
| | - Marcin Kleibert
- Laboratory of Centre for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (M.M.); (M.K.)
| | - Małgorzata Wojciechowska
- Laboratory of Centre for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Banacha 1b, 02-097 Warsaw, Poland; (M.M.); (M.K.)
- Invasive Cardiology Unit, Independent Public Specialist Western Hospital John Paul II, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland
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6
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Pęczek P, Leśniewski M, Mazurek T, Szarpak L, Filipiak KJ, Gąsecka A. Antiplatelet Effects of PCSK9 Inhibitors in Primary Hypercholesterolemia. Life (Basel) 2021; 11:466. [PMID: 34071103 PMCID: PMC8224623 DOI: 10.3390/life11060466] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022] Open
Abstract
Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a novel group of hypolipidemic drugs that are recommended particularly for high-risk hypercholesterolemia patients, including those with primary hypercholesterolemia (PH), where lifelong exposure to high low-density lipoprotein (LDL) cholesterol levels results in an elevated risk of atherosclerosis at an early age. The onset and progression of atherosclerosis is significantly influenced by activated platelets. Oxidized LDL influences platelet activation by interacting with their surface receptors and remodeling the composition of their cell membrane. This results in platelet aggregation, endothelial cell activation, promotion of inflammation and oxidative stress, and acceleration of lipid accumulation in atherosclerotic plaques. PCSK9 inhibitors reduce platelet activation by both significantly lowering LDL levels and reducing the LDL receptor-mediated activation of platelets by PCSK9. They also work synergistically with other hypolipidemic and antithrombotic drugs, including statins, ezetimibe, acetylsalicylic acid, clopidogrel, and ticagrelor, which enhances their antiplatelet and LDL-lowering effects. In this review, we summarize the currently available evidence on platelet hyperreactivity in PH, the effects of PCSK9 inhibitors on platelets, and their synergism with other drugs used in PH therapy.
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Affiliation(s)
- Piotr Pęczek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 00-927 Warsaw, Poland; (P.P.); (M.L.); (T.M.); (K.J.F.)
| | - Mateusz Leśniewski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 00-927 Warsaw, Poland; (P.P.); (M.L.); (T.M.); (K.J.F.)
| | - Tomasz Mazurek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 00-927 Warsaw, Poland; (P.P.); (M.L.); (T.M.); (K.J.F.)
| | - Lukasz Szarpak
- Department of Research Outcomes, Maria Sklodowska-Curie Medical Academy in Warsaw, 03-411 Warsaw, Poland;
- Maria Sklodowska-Curie Bialystok Oncology Center, Department of Research Outcomes, 15-027 Bialystok, Poland
| | - Krzysztof J. Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 00-927 Warsaw, Poland; (P.P.); (M.L.); (T.M.); (K.J.F.)
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 00-927 Warsaw, Poland; (P.P.); (M.L.); (T.M.); (K.J.F.)
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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7
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Gąsecka A, Rogula S, Eyileten C, Postuła M, Jaguszewski MJ, Kochman J, Mazurek T, Nieuwland R, Filipiak KJ. Role of P2Y Receptors in Platelet Extracellular Vesicle Release. Int J Mol Sci 2020; 21:ijms21176065. [PMID: 32842470 PMCID: PMC7504123 DOI: 10.3390/ijms21176065] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022] Open
Abstract
Platelet extracellular vesicles (PEVs) are potential new biomarkers of platelet activation which may allow us to predict and/or diagnose developing coronary thrombosis before myocardial necrosis occurs. The P2Y1 and P2Y12 receptors play a key role in platelet activation and aggregation. Whereas the P2Y1 antagonists are at the preclinical stage, at present, the P2Y12 antagonists are the most effective treatment strategy to prevent stent thrombosis after percutaneous coronary intervention. Despite an increasing number of publications on PEVs, the mechanisms underlying their formation, including the role of purinergic receptors in this process, remain an active research field. Here, we outline the clinical relevance of PEVs in cardiovascular disease, summarize the role and downstream signalling of P2Y receptors in platelet activation, and discuss the available evidence regarding their role in PEV formation.
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Affiliation(s)
- Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland; (S.R.); (J.K.); (T.M.); (K.J.F.)
- Laboratory Experimental Clinical Chemistry, and Vesicle Observation Center, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
- Correspondence: ; Tel.:+48-22-599-19-51
| | - Sylwester Rogula
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland; (S.R.); (J.K.); (T.M.); (K.J.F.)
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02-097 Warsaw, Poland; (C.E.); (M.P.); (R.N.)
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02-097 Warsaw, Poland; (C.E.); (M.P.); (R.N.)
| | | | - Janusz Kochman
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland; (S.R.); (J.K.); (T.M.); (K.J.F.)
| | - Tomasz Mazurek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland; (S.R.); (J.K.); (T.M.); (K.J.F.)
| | - Rienk Nieuwland
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02-097 Warsaw, Poland; (C.E.); (M.P.); (R.N.)
| | - Krzysztof J. Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland; (S.R.); (J.K.); (T.M.); (K.J.F.)
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Chiva-Blanch G, Badimon L. Cross-Talk between Lipoproteins and Inflammation: The Role of Microvesicles. J Clin Med 2019; 8:E2059. [PMID: 31771128 PMCID: PMC6947387 DOI: 10.3390/jcm8122059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 12/21/2022] Open
Abstract
Atherothrombosis is the principal underlying cause of cardiovascular disease (CVD). Microvesicles (MV) are small blebs originated by an outward budding at the cell plasma membranes, which are released in normal conditions. However, MV release is increased in pathophysiologic conditions such as CVD. Low density lipoprotein (LDL) and MV contribute to atherothrombosis onset and progression by promoting inflammation and leukocyte recruitment to injured endothelium, as well as by increasing thrombosis and plaque vulnerability. Moreover, (oxidized)LDL induces MV release and vice-versa, perpetuating endothelium injury leading to CVD progression. Therefore, MV and lipoproteins exhibit common features, which should be considered in the interpretation of their respective roles in the pathophysiology of CVD. Understanding the pathways implicated in this process will aid in developing novel therapeutic approaches against atherothrombosis.
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Affiliation(s)
- Gemma Chiva-Blanch
- Cardiovascular Program ICCC, Institut de Recerca Hospital Santa Creu i Sant Pau—IIB Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain;
| | - Lina Badimon
- Cardiovascular Program ICCC, Institut de Recerca Hospital Santa Creu i Sant Pau—IIB Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain;
- CIBER Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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9
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Wan S, Huang C, Zhu X. Systematic review with a meta-analysis: clinical effects of statins on the reduction of portal hypertension and variceal haemorrhage in cirrhotic patients. BMJ Open 2019; 9:e030038. [PMID: 31315875 PMCID: PMC6661584 DOI: 10.1136/bmjopen-2019-030038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Statins may improve outcomes in patients with cirrhosis. We performed a systematic review and meta-analysis to evaluate the effect of statins on patients with cirrhosis and related complications, especially portal hypertension and variceal haemorrhage. METHODS Studies were searched in the PubMed, Embase and Cochrane library databases up to February 2019. The outcomes of interest were associations between statin use and improvement in portal hypertension (reduction >20% of baseline or <12 mm Hg) and the risk of variceal haemorrhage. The relative risk (RR) with a 95% CI was pooled and calculated using a random effects model. Subgroup analyses were performed based on the characteristics of the studies. RESULTS Eight studies (seven randomised controlled trials (RCTs) and one observational study) with 3195 patients were included. The pooled RR for reduction in portal hypertension was 1.91 (95% CI, 1.04 to 3.52; I2=63%) in six RCTs. On subgroup analysis of studies that used statin for 1 month, the RR was 2.01 (95% CI, 1.31 to 3.10; I2=0%); the pooled RR for studies that used statins for 3 months was 3.76 (95% CI, 0.36 to 39.77; I2=75%); the pooled RR for studies that used non-selective beta-blockers in the control group was 1.42 (95% CI, 0.82 to 2.45; I2=64%); the pooled RR for studies that used a drug that was not reported in the control group was 4.21 (95% CI, 1.52 to 11.70; I2=0%); the pooled RR for studies that used simvastatin was 2.20 (95% CI, 0.92 to 5.29; I2=69%); RR for study using atorvastatin was 1.82 (95% CI, 1.00 to 3.30). For the risk of a variceal haemorrhage, the RR based on an observational study was 0.47 (95% CI, 0.23 to 0.94); in two RCTs, the pooled RR was 0.88 (95% CI, 0.52 to 1.50; I2=0%). Overall, the summed RR was 0.64 (95% CI, 0.42 to 0.99; I2=6%). CONCLUSION Statins may improve hypertension and decrease the risk of variceal haemorrhage according to our assessment. However, further and larger RCTs are needed to confirm this conclusion.
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Affiliation(s)
- Sizhe Wan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chenkai Huang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuan Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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10
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Rosinska J, Maciejewska J, Narożny R, Osztynowicz K, Raczak B, Michalak S, Watała C, Kozubski W, Łukasik M. Effect of acetylsalicylic acid intake on platelet derived microvesicles in healthy subjects. Platelets 2019; 31:206-214. [PMID: 30895834 DOI: 10.1080/09537104.2019.1588242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Platelet-derived microvesicles (pMVs) are released from platelets in physiological and pathological conditions and exhibit a wide range of prothrombotic, antithrombotic, proatherogenic, and pro-inflammatory properties. Antiplatelet agents, such as acetylsalicylic acid (ASA), are widely used for the prevention and treatment of vascular diseases, but their impact on pMV release remains poorly understood and contradictory mainly because of discrepancies in the methodology and lack of well-standardized MV assessment protocols. The present study investigated the effects of ASA not only on total pMV release but also on their phenotypes defined using the surface expression of pro-inflammatory (CD40L, CD62P, CD31) and procoagulant (PS, PAC-1) markers in healthy subjects. Fifty healthy volunteers were enrolled in the study and received a daily dose of 150 mg ASA for 3 consecutive days. Circulating pMVs were characterized and quantified before and after the intervention period using flow cytometry. Serum levels of thromboxane B2 (TXB2) and whole blood impedance platelet aggregation under arachidonic acid (AA) stimulation were also investigated to assess ASA compliance. In general, ASA did not effect pMV numbers in healthy subjects despite its effective inhibition of platelet aggregation Moreover, in premenopausal women, we noticed an increase in the number of pMVs. Further studies are needed to assess whether dose modification of ASA or combinations or changes in antiplatelet therapy would reduce pMV formation, especially in patients with cardiovascular risk factors.
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Affiliation(s)
- Justyna Rosinska
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Maciejewska
- Laboratory of Flow Cytometry and Vascular Biology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Robert Narożny
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krystyna Osztynowicz
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Beata Raczak
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Sławomir Michalak
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Cezary Watała
- Department of Haemostasis and Haemostatic Disorders, Medical University, Lodz, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Łukasik
- Laboratory of Flow Cytometry and Vascular Biology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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11
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Massunaga ND, França CN, Bianco HT, Ferreira CE, Kato JT, Póvoa RM, Figueiredo Neto AM, Izar MCO, Fonseca FAH. Circulating microparticles and central blood pressure according to antihypertensive strategy. Clinics (Sao Paulo) 2019; 74:e1234. [PMID: 31721907 PMCID: PMC6827330 DOI: 10.6061/clinics/2019/e1234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/18/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This prospective, randomized, open-label study aimed to compare the effects of antihypertensive treatment based on amlodipine or hydrochlorothiazide on the circulating microparticles and central blood pressure values of hypertensive patients. METHODS The effects of treatments on circulating microparticles were assessed during monotherapy and after the consecutive addition of valsartan and rosuvastatin followed by the withdrawal of rosuvastatin. Each treatment period lasted for 30 days. Central blood pressure and pulse wave velocity were measured at the end of each period. Endothelial, monocyte, and platelet circulating microparticles were determined by flow cytometry. Central blood pressure values and pulse wave velocity were recorded at the end of each treatment period. RESULTS No differences in brachial blood pressure were observed between the treatment groups throughout the study. Although similar central blood pressure values were observed during monotherapy, lower systolic and diastolic central blood pressure values and early and late blood pressure peaks were observed in the amlodipine arm after the addition of valsartan alone or combined with rosuvastatin. Hydrochlorothiazide-based therapy was associated with a lower number of endothelial microparticles throughout the study, whereas a higher number of platelet microparticles was observed after rosuvastatin withdrawal in the amlodipine arm. CONCLUSIONS Despite similar brachial blood pressure values between groups throughout the study, exposure to amlodipine was associated with lower central blood pressure values after combination with valsartan, indicating a beneficial interaction. Differences between circulating microparticles were modest and were mainly influenced by rosuvastatin withdrawal in the amlodipine arm.
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Affiliation(s)
- Nayara D. Massunaga
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Carolina N. França
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- Universidade Santo Amaro (UNISA), Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Henrique T. Bianco
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Carlos E.S. Ferreira
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Juliana T. Kato
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Rui M.S. Póvoa
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Antonio M. Figueiredo Neto
- Instituto Nacional de Ciencia e Tecnologia de Fluidos Complexos, Universidade Sao Paulo, Sao Paulo, SP, BR
| | - Maria Cristina O. Izar
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
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Abstract
Platelet-derived microvesicles (pMVs) are small, heterogeneous vesicles released from platelet membranes as a result of activation. These microvesicles possess a wide range of properties, including prothrombotic, proatherogenic, proinflammatory, immunomodulatory, and even anticoagulant activity. The elevated release of these microvesicles has been observed in various metabolic, inflammatory, thrombotic, and vascular diseases, including ischemic heart disease, stroke, hypertension, diabetes, and connective tissue disease. Modulation of both pMV generation and the expression of their surface molecules may have beneficial clinical implications and could become a novel therapeutic target. However, mechanisms by which pharmacological agents can modify pMV formation are elusive. The purpose of this review is to discuss the effects of drugs routinely used in primary and secondary prevention of vascular disease on the release of pMV and expression of their surface procoagulant and proinflammatory molecules.
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Affiliation(s)
- Justyna Rosińska
- Department of Neurology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355, Poznan, Poland.
| | - Maria Łukasik
- Department of Neurology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355, Poznan, Poland
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13
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Fonseca FAH, Izar MC, Maugeri IML, Berwanger O, Damiani LP, Pinto IM, Szarf G, França CN, Bianco HT, Moreira FT, Caixeta A, Alves CMR, Soriano Lopes A, Klassen A, Tavares MFM, Fonseca HA, Carvalho ACC. Effects of four antiplatelet/statin combined strategies on immune and inflammatory responses in patients with acute myocardial infarction undergoing pharmacoinvasive strategy: Design and rationale of the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction (BATTLE-AMI) study: study protocol for a randomized controlled trial. Trials 2017; 18:601. [PMID: 29258572 PMCID: PMC5735810 DOI: 10.1186/s13063-017-2361-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Early reperfusion of the occluded coronary artery during acute myocardial infarction is considered crucial for reduction of infarcted mass and recovery of ventricular function. Effective microcirculation and the balance between protective and harmful lymphocytes may have roles in reperfusion injury and may affect final ventricular remodeling. Methods/design BATTLE-AMI is an open-label, randomized trial comparing the effects of four therapeutic strategies (rosuvastatin/ticagrelor, rosuvastatin/clopidogrel, simvastatin plus ezetimibe/ticagrelor, or simvastatin plus ezetimibe/clopidogrel) on infarcted mass and left ventricular ejection fraction (LVEF) (blinded endpoints) in patients with ST-segment elevation myocardial infarction submitted to fibrinolytic therapy before coronary angiogram (pharmacoinvasive strategy). All patients (n = 300, 75 per arm) will be followed up for six months. The effects of treatment on subsets of B and T lymphocytes will be determined by flow-cytometry/ELISPOT and will be correlated with the infarcted mass, LVEF, and microcirculation perfusion obtained by cardiac magnetic resonance imaging. The primary hypothesis is that the combined rosuvastatin/ticagrelor therapy will be superior to other therapies (particularly for the comparison with simvastatin plus ezetimibe/clopidogrel) for the achievement of better LVEF at 30 days (primary endpoint) and smaller infarcted mass (secondary endpoint) at 30 days and six months. The trial will also evaluate the improvement in the immune/inflammatory responses mediated by B and T lymphocytes. Omics field (metabolomics and proteomics) will help to understand these responses by molecular events. Discussion BATTLE-AMI is aimed to (1) evaluate the role of subsets of lymphocytes on microcirculation improvement and (2) show how the choice of statin/antiplatelet therapy may affect cardiac remodeling after acute myocardial infarction with ST elevation. Trial registration ClinicalTrials.gov, NCT02428374. Registered on 28 September 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2361-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francisco A H Fonseca
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil.
| | - Maria Cristina Izar
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Ieda M L Maugeri
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Otavio Berwanger
- Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147, São Paulo, Brazil
| | - Lucas P Damiani
- Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147, São Paulo, Brazil
| | - Ibraim M Pinto
- Instituto Dante Pazzanese de Cardiologia, Avenida Dante Pazzanese 500, São Paulo, Brazil
| | - Gilberto Szarf
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Carolina N França
- Universidade Santo Amaro, Rua Professor Enéas de Siqueira 340, São Paulo, Brazil
| | - Henrique T Bianco
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Flavio T Moreira
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Adriano Caixeta
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Claudia M R Alves
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Aline Soriano Lopes
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Aline Klassen
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Marina F M Tavares
- Universidade de São Paulo, Avenida Professor Lineu Prestes, 748, São Paulo, Brazil
| | - Henrique A Fonseca
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Antonio C C Carvalho
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
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Bittencourt CRDO, Izar MCDO, França CN, Schwerz VL, Póvoa RMDS, Fonseca FAH. Effects of Chronic Exercise on Endothelial Progenitor Cells and Microparticles in Professional Runners. Arq Bras Cardiol 2017; 108:212-216. [PMID: 28443964 PMCID: PMC5389870 DOI: 10.5935/abc.20170022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/10/2016] [Indexed: 12/14/2022] Open
Abstract
Background The effects of chronic exposure to exercise training on vascular biomarkers
have been poorly explored. Objective Our study aimed to compare the amounts of endothelial progenitor cells
(EPCs), and endothelial (EMP) and platelet (PMP) microparticles between
professional runners and healthy controls. Methods Twenty-five half-marathon runners and 24 age- and gender-matched healthy
controls were included in the study. EPCs (CD34+/KDR+, CD133+/KDR+, and
CD34+/CD133+), EMP (CD51+) and PMP (CD42+/CD31+) were quantified by
flow-cytometry. All blood samples were obtained after 12 h of fasting and
the athletes were encouraged to perform their routine exercises on the day
before. Results As compared with controls, the CD34+/KDR+ EPCs (p=0.038) and CD133+/KDR+ EPCs
(p=0.018) were increased, whereas CD34+/CD133+ EPCs were not different
(p=0.51) in athletes. In addition, there was no difference in MPs levels
between the groups. Conclusion Chronic exposure to exercise in professional runners was associated with
higher percentage of EPCs. Taking into account the similar number of MPs in
athletes and controls, the study suggests a favorable effect of exercise on
these vascular biomarkers.
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Jansen F, Nickenig G, Werner N. Extracellular Vesicles in Cardiovascular Disease: Potential Applications in Diagnosis, Prognosis, and Epidemiology. Circ Res 2017; 120:1649-1657. [PMID: 28495995 DOI: 10.1161/circresaha.117.310752] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Extracellular vesicles originate from diverse subcellular compartments and are released in the extracellular space. By transferring their cargoes into target cells and tissues, they now emerge as novel regulators of intercellular communication between adjacent and remote cells. Because vesicle composition and biological content are specific signatures of cellular activation and injury, their potential as diagnostic and prognostic biomarkers has raised significant interest in cardiovascular diseases. Characterization of circulating vesicles- or nonvesicles-bound nucleic acids represents a valuable tool for diagnosing and monitoring cardiovascular diseases, recently referred to as a liquid biopsy. Circulating extracellular vesicles offer a noninvasive and almost continuous access to circulating information on the disease state in epidemiological investigations. Finally, genetic engineering and cell-specific application of extracellular vesicles could display a novel therapeutic option for the treatment of cardiovascular diseases. In this review, we summarize the current knowledge about extracellular vesicles as diagnostic and prognostic biomarkers, as well as their potential applications for longitudinal epidemiological studies in cardiovascular diseases.
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Affiliation(s)
- Felix Jansen
- From the Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Georg Nickenig
- From the Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Nikos Werner
- From the Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany.
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16
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Vozel D, Uršič B, Krek JL, Štukelj R, Kralj-Iglič V. Applicability of extracellular vesicles in clinical studies. Eur J Clin Invest 2017; 47:305-313. [PMID: 28156006 DOI: 10.1111/eci.12733] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/29/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Extracellular vesicles (EVs) are submicron cellular fragments that mediate intercellular communication. EVs have in the last decade attracted major interest as biomarkers or platforms for biomarkers of health and disease. To better understand the reasons why despite great expectations and considerable effort, EV-based methods have not yet been introduced into clinical practice, we present a systematic analysis of published results of clinical studies. MATERIALS AND METHODS Clinical studies on populations of body fluid samples, published from 2010 to including 2015, applying centrifugation of fluid human samples with centrifuge accelerations up to about 25 000 g and flow cytometry for detection of EVs were analysed with respect to statistical significance (p), statistical power (P), clinical significance (CS), defined as the difference between the means divided by the sum of standard deviations, and size of the populations (Nmin ), defined as the number of samples in the smaller group. RESULTS Final analysis included 65 publications with 716 comparisons reporting 308 (43%) statistically significant differences (P < 0·05), 242 (34%) had statistical power P > 0·8 and 88 (12%) had clinical importance CS > 1·96. None of comparison with CS > 1·96 included populations in which the smaller group consisted of 50 or more samples. CONCLUSIONS To fulfil claimed expectations for EV-based methods as promising diagnostic tools, more evidence on EV-based mechanisms of diseases should be gathered. Also, the methods of EV harvesting and assessment should be improved to yield better repeatability and thus allow clinical studies with larger number of samples.
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Affiliation(s)
- Domen Vozel
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Bojana Uršič
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Judita Lea Krek
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Roman Štukelj
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Veronika Kralj-Iglič
- Laboratory of Clinical Biophysics, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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Circulating endothelial microparticles and miR-92a in acute myocardial infarction. Biosci Rep 2017; 37:BSR20170047. [PMID: 28213360 PMCID: PMC5469331 DOI: 10.1042/bsr20170047] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 02/03/2023] Open
Abstract
Microparticles (MPs) and miRNAs have been shown to play important roles in coronary artery disease (CAD) by monitoring endothelial dysfunction. The present study aims to investigate the diagnostic value of endothelial MPs (EMPs) and miRNAs (miR-92a or miR-23a) as biomarkers in distinguishing patients with acute myocardial infarction (AMI) from those with CAD. Plasma samples from 37 patients with AMI, 42 patients with stable CAD (SCAD), and 35 healthy adults were collected for investigation in the present study. The numbers of CD31+/CD42b- MPs, CD31+/CD42b+ MPs, and CD31-/CD42b- MPs were measured by flow cytometry and the levels of miR-92a and miR-23a were analyzed using reverse transcription-quantitative PCR. Moreover, cardiac troponin I (cTnI) expression was detected by ELISA to serve as a routine diagnostic parameter. The number of CD31+/CD42b- was higher in AMI group than those in SCAD and healthy groups. Besides, the expression of miR-92a was higher in AMI group compared with two other groups. Furthermore, evidence showed that there was a positive correlation between the levels of CD31+/CD42b- MPs and miR-92a Finally, the receiver operating characteristic (ROC) curve revealed that the area value under the curve of CD31+/CD42b- MPs, miR-92a and cTnI was 0.893, 0.888, and 0.912 respectively. CD31+/CD42b- MPs and miR-92a might have great potential to provide diagnostic value for AMI and could probably regulate the endothelial dysfunction in AMI patients.
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Koganti S, Eleftheriou D, Brogan PA, Kotecha T, Hong Y, Rakhit RD. Microparticles and their role in coronary artery disease. Int J Cardiol 2017; 230:339-345. [DOI: 10.1016/j.ijcard.2016.12.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/04/2016] [Accepted: 12/17/2016] [Indexed: 12/16/2022]
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Abstract
Membrane vesicles released in the extracellular space are composed of a lipid bilayer enclosing soluble cytosolic material and nuclear components. Extracellular vesicles include apoptotic bodies, exosomes, and microvesicles (also known previously as microparticles). Originating from different subcellular compartments, the role of extracellular vesicles as regulators of transfer of biological information, acting locally and remotely, is now acknowledged. Circulating vesicles released from platelets, erythrocytes, leukocytes, and endothelial cells contain potential valuable biological information for biomarker discovery in primary and secondary prevention of coronary artery disease. Extracellular vesicles also accumulate in human atherosclerotic plaques, where they affect major biological pathways, including inflammation, proliferation, thrombosis, calcification, and vasoactive responses. Extracellular vesicles also recapitulate the beneficial effect of stem cells to treat cardiac consequences of acute myocardial infarction, and now emerge as an attractive alternative to cell therapy, opening new avenues to vectorize biological information to target tissues. Although interest in microvesicles in the cardiovascular field emerged about 2 decades ago, that for extracellular vesicles, in particular exosomes, started to unfold a decade ago, opening new research and therapeutic avenues. This Review summarizes current knowledge on the role of extracellular vesicles in coronary artery disease, and their emerging potential as biomarkers and therapeutic agents.
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Jung C, Lichtenauer M, Wernly B, Franz M, Goebel B, Rafnsson A, Figulla HR, Pernow J. Effect of endothelin-1 and endothelin receptor blockade on the release of microparticles. Eur J Clin Invest 2016; 46:707-13. [PMID: 27322814 DOI: 10.1111/eci.12652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/18/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Increased levels of endothelial cell microparticles (EMP) are known to reflect endothelial dysfunction (ED). In diabetes mellitus type 2 (T2DM), the expression of endothelin (ET)-1 is increased. As treatment with an ET-1 antagonist significantly inhibited atherosclerosis in animal models, we sought to investigate whether treatment with ET-1 antagonists affects EMP levels in vitro and in vivo in patients with T2DM. MATERIALS AND METHODS In vitro study: Human umbilical vein endothelial cells (HUVEC) were stimulated with ET-1 alone and ET-1 in combination with a dual ET-A and ET-B endothelin receptor blocker. In vivo study: Patients with T2DM were randomized to treatment with the ET receptor antagonist bosentan or placebo. After 4 weeks, the patients were re-examined and blood samples were obtained. EMP counts in supernatants and plasma samples were determined using flow cytometry. RESULTS In vitro study: In supernatants of ET-1-stimulated HUVECs, the increased release of EMP was reduced significantly by co-incubation with an ET-1 receptor antagonist (e.g. CD31+/CD42b-EMP decreased from 37·1% ± 2·8 to 31·5% ± 2·8 SEM, P = 0·0078). In vivo study: No changes in EMP levels in blood samples of patients with T2DM were found after 4 weeks of bosentan treatment (n = 36, P = ns). CONCLUSIONS Our in vitro results suggest that ET-1 stimulates the release of EMP from HUVECs via a receptor-dependent mechanism. Co-incubation with an endothelin receptor blocker abolished ET-1-dependent EMP release. However, treatment with bosentan for 4 weeks failed to alter EMP levels in patients with T2DM. Other factors seem to have influenced EMP release in patients with T2DM independent of ET-1 receptor-mediated mechanisms.
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Affiliation(s)
- Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Marcus Franz
- Universitätsherzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - Bjoern Goebel
- Universitätsherzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - Arnar Rafnsson
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hans-Reiner Figulla
- Universitätsherzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - John Pernow
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Chiva-Blanch G, Suades R, Padró T, Vilahur G, Peña E, Ybarra J, Pou JM, Badimon L. El ácido acetilsalicílico reduce la liberación de micropartículas eritrocitarias, monocitarias y de células del músculo liso vascular en pacientes diabéticos. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.12.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Chiva-Blanch G, Suades R, Padró T, Vilahur G, Peña E, Ybarra J, Pou JM, Badimon L. Microparticle Shedding by Erythrocytes, Monocytes and Vascular Smooth Muscular Cells Is Reduced by Aspirin in Diabetic Patients. ACTA ACUST UNITED AC 2016; 69:672-80. [PMID: 27103451 DOI: 10.1016/j.rec.2015.12.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/22/2015] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Diabetes mellitus is associated with an enhanced risk for cardiovascular disease and its prevalence is increasing. Diabetes induces metabolic stress on blood and vascular cells, promoting platelet activation and vascular dysfunction. The level of vascular cell activation can be measured by the number and phenotype of microparticles found in the circulation. The aim of this study was to investigate the effect of a platelet-inhibitory dose of aspirin on the number and type of microparticles shed to the circulation. METHODS Forty-three diabetic patients were enrolled in the study and received a daily dose of 100mg of aspirin for 10 days to cover the average platelet life-span in the circulation. Before and after the intervention period, circulating microparticles were characterized and quantified by flow cytometry. RESULTS Type 1 diabetic patients had about twice the number of tissue factor-positive circulating microparticles (derived both from platelets and monocytes) and endothelial-derived E-selectin positive microparticles than type 2 diabetic patients. Aspirin therapy significantly inhibited platelets since cyclooxygenase 1 derived thromboxane generation levels were reduced by 99%. Microparticles derived from erythrocytes, activated monocytes, and smooth muscle cells were significantly reduced after 10 days of aspirin administration. CONCLUSIONS These results indicate that: a) vascular and blood cells in type 1 diabetic patients are exposed to more sustained stress shown by their specific microparticle origin and levels; b) aspirin therapy inhibits vascular wall cell activation and microparticle shedding, and c) the effects of aspirin are similar in type 1 and 2 diabetes.
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Affiliation(s)
| | - Rosa Suades
- Institut Català de Ciències Cardiovasculars (ICCC), Barcelona, Spain
| | - Teresa Padró
- Institut Català de Ciències Cardiovasculars (ICCC), Barcelona, Spain
| | - Gemma Vilahur
- Institut Català de Ciències Cardiovasculars (ICCC), Barcelona, Spain
| | - Esther Peña
- Institut Català de Ciències Cardiovasculars (ICCC), Barcelona, Spain
| | | | - Jose M Pou
- Servicio de Endocrinología, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lina Badimon
- Institut Català de Ciències Cardiovasculars (ICCC), Barcelona, Spain.
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Altabas V, Altabas K, Kirigin L. Endothelial progenitor cells (EPCs) in ageing and age-related diseases: How currently available treatment modalities affect EPC biology, atherosclerosis, and cardiovascular outcomes. Mech Ageing Dev 2016; 159:49-62. [PMID: 26919825 DOI: 10.1016/j.mad.2016.02.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/25/2016] [Accepted: 02/22/2016] [Indexed: 12/15/2022]
Abstract
Endothelial progenitor cells (EPCs) are mononuclear cells that circulate in the blood and are derived from different tissues, expressing cell surface markers that are similar to mature endothelial cells. The discovery of EPCs has lead to new insights in vascular repair and atherosclerosis and also a new theory for ageing. EPCs from the bone marrow and some other organs aid in vascular repair by migrating to distant vessels where they differentiate into mature endothelial cells and replace old and injured endothelial cells. The ability of EPCs to repair vascular damage depends on their number and functionality. Currently marketed drugs used in a variety of diseases can modulate these characteristics. In this review, the effect of currently available treatment options for cardiovascular and metabolic disorders on EPC biology will be discussed. The various EPC-based therapies that will be discussed include lipid-lowering agents, antihypertensive agents, antidiabetic drugs, phosphodiesteraze inhibitors, hormones, as well as EPC capturing stents.
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Affiliation(s)
- Velimir Altabas
- Department of Internal Medicine, University Clinical Hospital "Sestre milosrdnice", Zagreb, Croatia.
| | - Karmela Altabas
- Department of Internal Medicine, University Clinical Hospital "Sestre milosrdnice", Zagreb, Croatia.
| | - Lora Kirigin
- Department of Internal Medicine, University Clinical Hospital "Sestre milosrdnice", Zagreb, Croatia.
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Tempo JA, Englyst NA, Holloway JA, Smith DC. Platelet Microvesicles (Microparticles) in Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:222-8. [DOI: 10.1053/j.jvca.2015.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Indexed: 11/11/2022]
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25
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Almquist T, Mobarrez F, Jacobson SH, Wallén H, Hjemdahl P. Effects of lipid-lowering treatment on circulating microparticles in patients with diabetes mellitus and chronic kidney disease. Nephrol Dial Transplant 2015; 31:944-52. [PMID: 26394646 DOI: 10.1093/ndt/gfv337] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/11/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Elevated levels of circulating microparticles (MPs) may contribute to the high cardiovascular risk in diabetes mellitus (DM) and chronic kidney disease (CKD). Therefore, we investigated the effects of lipid-lowering treatment (LLT) with simvastatin alone (S) or with ezetimibe (S+E) on MPs in DM patients with or without CKD. METHODS After a placebo run-in period, 18 DM patients with an estimated glomerular filtration rate (eGFR) of 15-59 mL/min (CKD stages 3-4) (DM-CKD) and 21 DM patients with eGFR >75 mL/min (DM-only) were treated with S and S+E in a randomized, double-blind, crossover study. MPs from platelets, monocytes and endothelial cells (PMPs, MMPs and EMPs), and their expression of phosphatidylserine (PS), P-selectin, CD40 ligand (CD40L) and tissue factor (TF) were measured by flow cytometry. RESULTS At baseline, all types of MPs, except TF-positive MMPs, were elevated in DM-CKD compared with DM-only patients. All MPs, regardless of origin and phenotype, were inversely correlated with eGFR. S reduced the expression of P-selectin, TF and CD40L on PMPs and of TF on MMPs in both patient groups. S+E had no further effect. S also reduced total PS-positive procoagulant MPs, PMPs and MMPs in DM-CKD but not in DM-only patients. CONCLUSIONS DM patients with CKD stages 3-4 had elevated PMPs, EMPs and MMPs compared with DM patients with normal GFR. Simvastatin reduced procoagulant MPs, MMPs and PMPs in DM-CKD patients, suggesting a beneficial reduction of hypercoagulability in this high-risk patient group. Differences between DM-CKD and DM-only patients were counteracted by LLT.
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Affiliation(s)
- Tora Almquist
- Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Stockholm, Sweden Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Fariborz Mobarrez
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden Department of Medicine Solna, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Stefan H Jacobson
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Håkan Wallén
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Stockholm, Sweden
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Extracellular vesicles as new pharmacological targets to treat atherosclerosis. Eur J Pharmacol 2015; 763:90-103. [PMID: 26142082 DOI: 10.1016/j.ejphar.2015.06.047] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/13/2015] [Accepted: 06/25/2015] [Indexed: 01/09/2023]
Abstract
Extracellular vesicles released by most cell types, include apoptotic bodies (ABs), microvesicles (MVs) and exosomes. They play a crucial role in physiology and pathology, contributing to "cell-to-cell" communication by modifying the phenotype and the function of target cells. Thus, extracellular vesicles participate in the key processes of atherosclerosis from endothelial dysfunction, vascular wall inflammation to vascular remodeling. The purpose of this review is to summarize recent findings on extracellular vesicle formation, structure, release and clearance. We focus on the deleterious and beneficial effects of extracellular vesicles in the development of atherosclerosis. The potential role of extracellular vesicles as biomarkers and pharmacological targets, their innate therapeutic capacity, or their use for novel drug delivery devices in atherosclerotic cardiovascular diseases will also be discussed.
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França CN, Izar MCDO, Amaral JBD, Tegani DM, Fonseca FAH. Microparticles as potential biomarkers of cardiovascular disease. Arq Bras Cardiol 2015; 104:169-74. [PMID: 25626759 PMCID: PMC4375661 DOI: 10.5935/abc.20140210] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/21/2014] [Indexed: 12/26/2022] Open
Abstract
Primary prevention of cardiovascular disease is a choice of great relevance because
of its impact on health. Some biomarkers, such as microparticles derived from
different cell populations, have been considered useful in the assessment of
cardiovascular disease. Microparticles are released by the membrane structures of
different cell types upon activation or apoptosis, and are present in the plasma of
healthy individuals (in levels considered physiological) and in patients with
different pathologies. Many studies have suggested an association between
microparticles and different pathological conditions, mainly the relationship with
the development of cardiovascular diseases. Moreover, the effects of different
lipid-lowering therapies have been described in regard to measurement of
microparticles. The studies are still controversial regarding the levels of
microparticles that can be considered pathological. In addition, the methodologies
used still vary, suggesting the need for standardization of the different protocols
applied, aiming at using microparticles as biomarkers in clinical practice.
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