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D’Amato A, Mariani MV, Prosperi S, Colombo L, De Prisco A, Lavalle C, Mancone M, Vizza CD, Severino P. Spontaneous Coronary Artery Dissection in Clinical Practice: Pathophysiology and Therapeutic Approaches. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:217. [PMID: 38399505 PMCID: PMC10889982 DOI: 10.3390/medicina60020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Spontaneous coronary artery dissection (SCAD) is a cause of myocardial infarction without obstructive coronary artery disease (MINOCA). It is determined by a coronary artery wall layers separation, which occurs regardless of traumatic or iatrogenic injuries. Even if it is often a missed diagnosis, its incidence is growing along with the improvement of intracoronary imaging techniques that allow for better detection. The main angiographical classification distinguishes three different forms, with slightly different prognoses at long-term follow up. SCAD is a recurrent condition, severely hampering the life quality of affected patients. The predominantly young age of patients with SCAD and the high prevalence of females among them have made the topic increasingly important, especially regarding therapeutic strategies. According to the data, the most recommended treatment is conservative, based on the use of antiplatelet agents and supportive anti-ischemic therapy. However, there are conflicting opinions concerning the need for dual antiplatelet therapy and its duration. In the case of invasive treatment, the choice between percutaneous coronary intervention and coronary artery bypass graft depends on the patient's clinical stability and the interested vessel. The purpose of the current review is to revise the pathophysiological mechanisms underlying SCAD and the current knowledge of its treatment.
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Affiliation(s)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 00161 Rome, Italy; (A.D.); (S.P.); (L.C.); (A.D.P.); (C.L.); (M.M.); (C.D.V.); (P.S.)
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Ilic I, Radunovic A, Timcic S, Odanovic N, Radoicic D, Dukuljev N, Krljanac G, Otasevic P, Apostolovic S. Drugs for spontaneous coronary dissection: a few untrusted options. Front Cardiovasc Med 2023; 10:1275725. [PMID: 38028484 PMCID: PMC10667692 DOI: 10.3389/fcvm.2023.1275725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome that is often overlooked, misdiagnosed, and maltreated. Medical treatment poses a significant challenge because of the lack of randomized studies to guide treatment. The initial clinical presentation should guide medical and interventional management. Fibrinolytic agents and anticoagulants should be avoided because they could favor hematoma propagation. In patients with SCAD, antiplatelet therapy should be prescribed especially dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel, whereas potent P2Y12 inhibitors, e.g., ticagrelor and prasugrel, should be avoided. If a stent was used, DAPT should be continued for 12 months. Aspirin only can be an option for patients without "high-risk" angiographic features-thrombus burden, critical stenosis, and decreased coronary flow. Beta-blocking (BB) agents should be used to prevent recurrence of SCAD. There is a general agreement that angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, mineralocorticoid antagonists, and loop diuretics should be used in patients with SCAD experiencing the symptoms of heart failure and a decrease in left ventricular ejection fraction below 50%. Although without firm evidence, statins can be used in SCAD due to their pleiotropic properties. The results of a randomized trial on the use of BB and statins are awaited. Aggregation of data from national registries might point out truly beneficial medications for patients with SCAD.
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Affiliation(s)
- Ivan Ilic
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anja Radunovic
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Stefan Timcic
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Natalija Odanovic
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Dragana Radoicic
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Natasa Dukuljev
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Gordana Krljanac
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Petar Otasevic
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetlana Apostolovic
- Cardiology Clinic, University Clinical Center Nis, Nis, Serbia
- School of Medicine, University of Nis, Nis, Serbia
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Cimmino G, Gallinoro E, di Serafino L, De Rosa G, Sugraliyev A, Golino P, Cirillo P. Uric acid plasma levels are associated with C-reactive protein concentrations and the extent of coronary artery lesions in patients with acute coronary syndromes. Intern Emerg Med 2023; 18:1751-1757. [PMID: 37466806 DOI: 10.1007/s11739-023-03360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
Many studies have pointed out that inflammation plays a pivotal role in pathophysiology of acute coronary syndromes (ACS) because several inflammatory molecules impair the endothelial functions in the coronary circulation and promote atherothrombotic events. Recently, many clinical/experimental evidences indicate that elevated plasma levels of uric acid (UA) might be considered a risk factor for developing ACS. It has been reported that elevated UA doses impair physiologic functions of endothelial cells, shifting them toward a pro atherothrombotic phenotype. In the present manuscript, we investigated the relationship between UA plasma levels, inflammatory burden, and extension of coronary atherosclerotic disease in patients with ACS. Patients with a clinical presentation of ACS (ST-elevated and non-ST-elevated myocardial infarction) admitted to the Vanvitelli Catheterization Laboratory at Monaldi Hospital in 2019, before the COVID-19 pandemia, were retrospectively analyzed. Biochemical profile, type of ACS presentation, as well as extension of coronary atherosclerosis were assessed. A total of 132 ACS patients were included in the analysis, and grouped into 3 tertiles according to the UA values (UA < 4.72 mg/dl, UA between 4.72 and 6.15 mg/dl, and UA > 6.15 mg/dl). Patients with UA plasma levels ≥ 6.15 mg/dL showed higher levels of C-reactive protein (mean of 5.1 mg/dL) as compared to patients with lower UA plasma levels. Moreover, the former group of patients showed higher levels of cardiac troponin and CPK, and presented more often with multivessel disease and complex coronary stenosis (type C of Ellis classification). Even though monocentric and with limited sample size, the present study shows that plasma levels of UA and hs-CRP are elevated in ACS patients and are associated with a more severe coronary disease, suggesting a potential role of UA in the pathophysiology of acute coronary events.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Gallinoro
- Cardiology Department, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | - Luigi di Serafino
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Gennaro De Rosa
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Akhmetzhan Sugraliyev
- Department of Internal Disease, Kazakh National Medical University, Almaty, Kazakhstan
| | - Paolo Golino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
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Cimmino G, Muscoli S, De Rosa S, Cesaro A, Perrone MA, Selvaggio S, Selvaggio G, Aimo A, Pedrinelli R, Mercuro G, Romeo F, Perrone Filardi P, Indolfi C, Coronelli M. Evolving concepts in the pathophysiology of atherosclerosis: from endothelial dysfunction to thrombus formation through multiple shades of inflammation. J Cardiovasc Med (Hagerstown) 2023; 24:e156-e167. [PMID: 37186566 DOI: 10.2459/jcm.0000000000001450] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Atherosclerosis is the anatomo-pathological substrate of most cardio, cerebro and vascular diseases such as acute and chronic coronary syndromes, stroke and peripheral artery diseases. The pathophysiology of atherosclerotic plaque and its complications are under continuous investigation. In the last 2 decades our understanding on the formation, progression and complication of the atherosclerotic lesion has greatly improved and the role of immunity and inflammation is now well documented and accepted. The conventional risk factors modulate endothelial function determining the switch to a proatherosclerotic phenotype. From this point, lipid accumulation with an imbalance from cholesterol influx and efflux, foam cells formation, T-cell activation, cytokines release and matrix-degrading enzymes production occur. Lesions with high inflammatory rate become vulnerable and prone to rupture. Once complicated, the intraplaque thrombogenic material, such as the tissue factor, is exposed to the flowing blood, thus inducing coagulation cascade activation, platelets aggregation and finally intravascular thrombus formation that leads to clinical manifestations of this disease. Nonconventional risk factors, such as gut microbiome, are emerging novel markers of atherosclerosis. Several data indicate that gut microbiota may play a causative role in formation, progression and complication of atherosclerotic lesions. The gut dysbiosis-related inflammation and gut microbiota-derived metabolites have been proposed as the main working hypothesis in contributing to disease formation and progression. The current evidence suggest that the conventional and nonconventional risk factors may modulate the degree of inflammation of the atherosclerotic lesion, thus influencing its final fate. Based on this hypothesis, targeting inflammation seems to be a promising approach to further improve our management of atherosclerotic-related diseases.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples
| | | | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples
- Division of Cardiology, A.O.R.N. 'Sant'Anna e San Sebastiano', Caserta
| | - Marco A Perrone
- Department of Cardiology and CardioLab, University of Rome Tor Vergata, Rome
| | | | | | - Alberto Aimo
- Fondazione Toscana Gabriele Monasterio
- Institute of Life Sciences, Scuola Superiore Sant'Anna
| | - Roberto Pedrinelli
- Critical Care Medicine-Cardiology Division, Department of Surgical, Medical and Molecular Pathology, University of Pisa, Pisa
| | - Giuseppe Mercuro
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi, Cagliari
| | | | - Pasquale Perrone Filardi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli 'Federico II', Napoli
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro
| | - Maurizio Coronelli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
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Cimmino G, Conte S, Palumbo D, Sperlongano S, Torella M, Della Corte A, Golino P. The Novel Role of Noncoding RNAs in Modulating Platelet Function: Implications in Activation and Aggregation. Int J Mol Sci 2023; 24:ijms24087650. [PMID: 37108819 PMCID: PMC10144470 DOI: 10.3390/ijms24087650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
It is currently believed that plaque complication, with the consequent superimposed thrombosis, is a key factor in the clinical occurrence of acute coronary syndromes (ACSs). Platelets are major players in this process. Despite the considerable progress made by the new antithrombotic strategies (P2Y12 receptor inhibitors, new oral anticoagulants, thrombin direct inhibitors, etc.) in terms of a reduction in major cardiovascular events, a significant number of patients with previous ACSs treated with these drugs continue to experience events, indicating that the mechanisms of platelet remain largely unknown. In the last decade, our knowledge of platelet pathophysiology has improved. It has been reported that, in response to physiological and pathological stimuli, platelet activation is accompanied by de novo protein synthesis, through a rapid and particularly well-regulated translation of resident mRNAs of megakaryocytic derivation. Although the platelets are anucleate, they indeed contain an important fraction of mRNAs that can be quickly used for protein synthesis following their activation. A better understanding of the pathophysiology of platelet activation and the interaction with the main cellular components of the vascular wall will open up new perspectives in the treatment of the majority of thrombotic disorders, such as ACSs, stroke, and peripheral artery diseases before and after the acute event. In the present review, we will discuss the novel role of noncoding RNAs in modulating platelet function, highlighting the possible implications in activation and aggregation.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, L. Bianchi Street, 80131 Naples, Italy
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia, 80138 Naples, Italy
| | - Stefano Conte
- Department of Translational Medical Sciences, Section of Lung Diseases, University of Campania Luigi Vanvitelli, L. Bianchi Street, 80131 Naples, Italy
| | - Domenico Palumbo
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, L. Bianchi Street, 80131 Naples, Italy
| | - Simona Sperlongano
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, L. Bianchi Street, 80131 Naples, Italy
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia, 80138 Naples, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, L. Bianchi Street, 80131 Naples, Italy
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, L. Bianchi Street, 80131 Naples, Italy
| | - Paolo Golino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, L. Bianchi Street, 80131 Naples, Italy
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Cimmino G, di Serafino L, Cirillo P. Pathophysiology and mechanisms of Acute Coronary Syndromes: athero-thrombosis, immune-inflammation and beyond. Expert Rev Cardiovasc Ther 2022; 20:351-362. [PMID: 35510629 DOI: 10.1080/14779072.2022.2074836] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The pathophysiology of atherosclerosis and its acute complications, such as the Acute Coronary Syndromes (ACS), is continuously under investigation. Immunity and inflammation seem to play a pivotal role in promoting formation and grow of atherosclerotic plaques. At the same time, plaque rupture followed by both platelets' activation and coagulation cascade induction lead to intracoronary thrombus formation. Although these phenomena might be considered responsible of about 90% of ACS, in up to 5-10% of acute syndromes a non-obstructive coronary artery disease (MINOCA) might be documented. This paper gives an overview on athero-thrombosis and immuno-inflammation processes involved in ACS pathophysiology also emphasizing the pathological mechanisms potentially involved in MINOCA. AREAS COVERED The relationship between immuno-inflammation and atherothrombosis is continuously updated by recent findings. At the same time, pathophysiology of MINOCA still remains a partially unexplored field, stimulating the research of potential links between these two aspects of ACS pathophysiology. EXPERT OPINION Pathophysyiology of ACS has been extensively investigated; however, several grey areas still remain. MINOCA represents one of these areas. At the same time, many aspects of immune-inflammation processes are still unknown. Thus, research should be continued to shed a brighter light on both these sides of "ACS" moon.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Zeeshan M, Yousaf S, Ahmed A, Bahadar H, Ali U, Jabeen S, Hussain HU, Mumtaz H, Hasan M. Co-relation of Monocyte Count in High vs. Low Thrombus Burden ST-Segment Elevated Myocardial Infarction (STEMI) Patients Undergoing Primary Percutaneous Coronary Intervention. Cureus 2022; 14:e24344. [PMID: 35607551 PMCID: PMC9123895 DOI: 10.7759/cureus.24344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
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Slevin M, Heidari N, Azamfirei L. Monomeric C-Reactive Protein: Current Perspectives for Utilization and Inclusion as a Prognostic Indicator and Therapeutic Target. Front Immunol 2022; 13:866379. [PMID: 35309334 PMCID: PMC8930844 DOI: 10.3389/fimmu.2022.866379] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 01/08/2023] Open
Abstract
Monomeric C-reactive protein (mCRP), once thought to be a figment of the imagination and whose biological activity was ascribed to its sodium azide preservative, has now pronounced itself as a critical molecule playing a direct role in mediating many of the acute and chronic aberrant pathological responses to inflammation. In this focused mini review, we describe the currently attributed pathobiological interactions of mCRP in disease, where its tissue and cellular distribution and deposition have recently been clearly characterized and linked to inflammation and other pathway-associated progression of neurological and cardiovascular complications and deleterious outcomes. and focus upon current opinions as to the diagnostic and prognostic potential of mCRP-plasma circulating protein and define the possible future therapeutics including ongoing research attempting to block CRP dissociation with small molecule inhibitors or prevention of cell surface binding directly using antibodies or modified orphan drug targeting directed towards CRP, inhibiting its cellular interactions and signaling activation. There is no doubt that understanding the full influence of the biological power of mCRP in disease development and outcome will be considered a critical parameter in future stratified treatment.
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Affiliation(s)
- Mark Slevin
- Department of Life Sciences, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
- The Regenerative Clinic, London, United Kingdom
- The School of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
- *Correspondence: Mark Slevin, ;
| | - Nima Heidari
- Department of Life Sciences, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
- The Regenerative Clinic, London, United Kingdom
| | - Leonard Azamfirei
- Department of Life Sciences, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
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Özbiçer S, Yüksel G, Urgun ÖD, Neşelioğlu S, Erel Ö. Thiols and disulfide levels are correlated with TIMI thrombus grade in non-ST elevation myocardial infarction patients. Biomark Med 2022; 16:233-240. [PMID: 35176898 DOI: 10.2217/bmm-2021-0659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We investigated the relationship between thrombolysis in myocardial infarction (TIMI) thrombus grade and thiol/disulfide levels. Materials & methods: 182 non-ST elevation myocardial infarction (NSTEMI) patients were divided into two groups; TIMI grade 0 patients who do not have any visible thrombus in their culprit vessels, and TIMI thrombus grade 1-5 patients. Results: Native and total thiol levels and disulfide to thiol ratio were higher in the low thrombus group. In addition, thrombus grade was positively correlated with disulfide to native and total thiol ratio and negatively with native and total thiol levels in NSTEMI patients. Conclusion: We can assert that thiol levels tend to decrease, and the disulfide to thiol ratio increase with increasing thrombus burden in NSTEMI patients.
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Affiliation(s)
- Süleyman Özbiçer
- Department of Cardiology, University of Health Sciences Adana City Training & Research Hospital, Adana, Turkey
| | - Gülhan Yüksel
- Department of Cardiology, University of Health Sciences Adana City Training & Research Hospital, Adana, Turkey
| | - Örsan D Urgun
- Department of Cardiology, University of Health Sciences Adana City Training & Research Hospital, Adana, Turkey
| | - Salim Neşelioğlu
- Department of Clinical Biochemistry, Yıldırım Beyazıt University, Medicine Faculty, Ankara, Turkey
| | - Özcan Erel
- Department of Clinical Biochemistry, Yıldırım Beyazıt University, Medicine Faculty, Ankara, Turkey
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Cimmino G, Conte S, Morello M, Pellegrino G, Marra L, Morello A, Nicoletti G, De Rosa G, Golino P, Cirillo P. Vitamin D Inhibits IL-6 Pro-Atherothrombotic Effects in Human Endothelial Cells: A Potential Mechanism for Protection against COVID-19 Infection? J Cardiovasc Dev Dis 2022; 9:jcdd9010027. [PMID: 35050236 PMCID: PMC8781542 DOI: 10.3390/jcdd9010027] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Background: Thrombosis with cardiovascular involvement is a crucial complication in COVID-19 infection. COVID-19 infects the host by the angiotensin converting enzyme-2 receptor (ACE2r), which is expressed in endothelial cells too. Thus, COVID-related thrombotic events might be due to endothelial dysfunction. IL-6 is one of the main cytokines involved in the COVID-19 inflammatory storm. Some evidence indicates that Vitamin D (VitD) has a protective role in COVID-19 patients, but the molecular mechanisms involved are still debated. Thus, we investigated the effect of VitD on Tissue Factor and adhesion molecules (CAMs) in IL-6-stimulated endothelial cells (HUVEC). Moreover, we evaluated levels of the ACE2r gene and proteins. Finally, we studied the modulation of NF-kB and STAT3 pathways. Methods: HUVEC cultivated in VitD-enriched medium were stimulated with IL-6 (0.5 ng/mL). The TF gene (RT-PCR), protein (Western blot), surface expression (FACS) and procoagulant activity (FXa generation assay) were measured. Similarly, CAMs soluble values (ELISA) and ACE2r (RT-PCR and Western blot) levels were assessed. NF-kB and STAT3 modulation (Western blot) were also investigated. Results: VitD significantly reduced TF expression at both gene and protein levels as well as TF-procoagulant activity in IL-6-treated HUVEC. Similar effects were observed for CAMs and ACE2r expression. IL-6 modulates these effects by regulating NF-κB and STAT3 pathways. Conclusions: IL-6 induces endothelial dysfunction with TF and CAMs expression via upregulation of ACE2r. VitD prevented these IL-6 deleterious effects. Thus, it might be speculated that this is one of the hypothetical mechanism(s) by which VitD exerts its beneficial effects in COVID-19 infection.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.C.); (P.G.)
| | - Stefano Conte
- Department of Translational Medical Sciences, Section of Lung Disease, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Mariarosaria Morello
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (G.N.); (G.D.R.)
| | - Grazia Pellegrino
- Department of Woman, Child and General and Specialized Surgery, Section of Anesthesiology, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Laura Marra
- Department of Cell Biology and Biotherapy Research, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Naples, Italy;
| | - Andrea Morello
- Biochemical Unit, A. S. Re. M. (Azienda Sanitaria Regionale del Molise), Antonio Cardarelli Hospital, 86100 Campobasso, Italy;
| | - Giuseppe Nicoletti
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (G.N.); (G.D.R.)
| | - Gennaro De Rosa
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (G.N.); (G.D.R.)
| | - Paolo Golino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (G.C.); (P.G.)
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (G.N.); (G.D.R.)
- Correspondence: ; Tel./Fax: +39-081-746-2235
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Cirillo P, Conte S, Pellegrino G, Barra G, De Palma R, Sugraliyev A, Golino P, Cimmino G. Effects of colchicine on tissue factor in oxLDL-activated T-lymphocytes. J Thromb Thrombolysis 2021; 53:739-749. [PMID: 34671897 DOI: 10.1007/s11239-021-02585-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/17/2022]
Abstract
Several studies have shown that T-cells might be involved in pathophysiology of acute coronary syndromes (ACS). Tissue factor (TF) plays a key role in ACS. Many evidences have indicated that some statins reduce TF expression in several cell types. However, literature about rosuvastatin and TF and about statins effects on T-cells is still scanty. Colchicine is an anti-inflammatory drug recently proven to have beneficial effects in ACS via unknown mechanisms. This study investigates the effects of colchicine and rosuvastatin on TF expression in oxLDL-activated T-cells. T-cells, isolated from buffy coats of healthy volunteers, were stimulated with oxLDL (50 µg/dL). T-cells were pre-incubated with colchicine (10 µM) or rosuvastatin (5 µM) for 1 h and then stimulated with oxLDL (50 μg/mL). TF gene (RT-PCR), protein (western blot), surface expression (FACS) and procoagulant activity (FXa generation assay) were measured. NF-κB/IκB axis was examined by western blot analysis and translocation assay. Colchicine and rosuvastatin significantly reduced TF gene, and protein expression and procoagulant activity in oxLDL stimulated T-cells. This effect was associated with a significant reduction in TF surface expression as well as its procoagulant activity. These phenomena appear modulated by drug effects on the transcription factor NF-kB. Rosuvastatin and colchicine prevent TF expression in oxLDL-stimulated T-cells by modulating the NF-κB/IκB axis. Thus, we speculate that this might be another mechanism by which these drugs exert benefic cardiovascular effects.
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Affiliation(s)
- Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Stefano Conte
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Grazia Pellegrino
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giusi Barra
- Unit of Internal Medicine, Clinical Immunology and Translational Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Raffaele De Palma
- Unit of Internal Medicine, Clinical Immunology and Translational Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Akhmetzhan Sugraliyev
- Department of Internal Disease, Kazakh National Medical University, Almaty, Kazakhstan
| | - Paolo Golino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
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12
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Azharuddin M, Kapur P, Mishra R, Saleem S, Gupta AK, Adil M, Sharma M. Predictor for cardiovascular risk in patients with type-2 diabetes mellitus. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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OZTURK S, ERDOĞAN M, TURAN Y. Systemic immune-inflammation index and high-sensitivity cardiac troponin T in acute coronary syndromes. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.936506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Li X, Qiu Q, Tong Q, Wang Y, Yu H, Li F, Xie X, Zhang J. Value of galectin-3 in the diagnosis of acute coronary syndrome and the assessment of coronary artery lesions. Biomark Med 2021; 15:647-657. [PMID: 34039037 DOI: 10.2217/bmm-2020-0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate the value of galectin-3 in the diagnosis of acute coronary syndrome (ACS) and the assessment of coronary artery lesions. Methodology: This study recruited 157 patients with coronary artery disease where 102 and 55 of them were subsequently grouped as ACS and non-ACS, respectively. The severity of coronary artery lesions was evaluated by Gensini score and the number of vessels involved. Results: Receiver operator characteristics analyses of galectin-3 yielded an area under the curve of 0.679 in diagnosing ACS. The galectin-3 levels were correlated with Gensini score and the number of vessels involved. Conclusion: Our study demonstrated that galectin-3 is an effective auxiliary biomarker for the diagnosis of ACS and assessment of coronary artery lesions.
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Affiliation(s)
- Xihong Li
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qing Qiu
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qingchao Tong
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanzhong Wang
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Haitao Yu
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fengying Li
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinyou Xie
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jun Zhang
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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15
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Colchicine inhibits the prothrombotic effects of oxLDL in human endothelial cells. Vascul Pharmacol 2020; 137:106822. [PMID: 33232770 DOI: 10.1016/j.vph.2020.106822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/26/2020] [Accepted: 11/18/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tissue Factor (TF) plays a pivotal role in coronary thrombosis. Oxidized low-density lipoproteins (oxLDL) are crucial in development of atherosclerosclerosis. Moreover, oxLDL are known to induce TF expression on several cell types including endothelial cells. The lectin-type oxidized LDL receptor 1 (LOX-1) represent the oxLDL receptor. Colchicine is an anti-mitotic drug recently proven to have beneficial effects in cardiovascular disease via unknown mechanisms. Thus, we aim at investigating colchicine effects on TF expression in oxLDL stimulated human vascular endothelial cells (HUVEC). Some molecular mechanism(s) potentially involved were investigated. METHODS HUVEC were pre-incubated with colchicine 10 μM for 1 h and then stimulated with oxLDL (50 μg/mL). TF gene (RT-PCR), protein (western blot), surface expression (FACS) and procoagulant activity (FXa generation assay) were measured. TF translocation to cell surface was investigated by immunofluorescence. NF-κB/IκB axis was examined by western blot analysis and translocation assay. Finally, LOX-1 expression was also investigated. RESULTS Colchicine significantly reduced TF gene and protein expression as well as its procoagulant activity in oxLDL-treated HUVEC. These effects seem to be related mainly to action of colchicine on microtubules that, in turn, modulate TF trafficking in the cytoplasm, NF-κB/IκB pathway and LOX-1 expression. CONCLUSIONS Data of the present study, although in vitro, indicate that one of the hypothetical mechanisms by which colchicine exert protective cardiovascular effects might be its ability to inhibit the pro-thrombotic activity of oxLDL.
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16
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Cimmino G, Morello A, Conte S, Pellegrino G, Marra L, Golino P, Cirillo P. Vitamin D inhibits Tissue Factor and CAMs expression in oxidized low-density lipoproteins-treated human endothelial cells by modulating NF-κB pathway. Eur J Pharmacol 2020; 885:173422. [PMID: 32755551 DOI: 10.1016/j.ejphar.2020.173422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Abstract
Epidemiologic studies have clearly demonstrated the correlation existing between Vitamin D (Vit. D) deficiency and increased risk of developing cardiovascular disease, suggesting that it might have a protective role in this clinical setting. Although many experimental studies have investigated the molecular mechanisms by which Vit. D might exert these effects, its potential role in protecting against athero-thrombosis is still partially unknown. We have investigated whether Vit. D might exert anti athero-thombotic effects by preventing expression of adhesion molecules (CAMs) and Tissue Factor (TF), molecules involved in atherothrombotic pathophysiology, in oxLDL stimulated endothelial cells (HUVEC). Moreover, we have investigated whether Vit. D effects might be due to the NF-kB modulation. HUVEC cultivated in medium enriched with Vit. D (10 nM) were stimulated with oxLDL (50 μg/ml). TF gene (RT-PCR), protein (Western blot), surface expression (FACS) and procoagulant activity (FXa generation assay) were measured. Similarly, CAMs gene (RT-PCR), surface expression (FACS) and soluble values (ELISA) were measured. NF-kB translocation was also investigated. Vit. D significantly reduced TF gene as well protein expression and procoagulant activity in oxLDL-treated HUVEC. Similar effects were observed for CAMs. These effects were associated with Vit. D modulation of NF-κB pathway. This study, although in vitro, indicate that Vit. D has protective effect on endothelial cells by inhibiting expression of TF and CAMs, proteins involved in atherothrombotic pathophysiology. Further studies will be necessary to translate these findings to a clinical scenario to better define the potential therapeutical role of Vit. D supplementation in the management of cardiovascular disease in patients with Vit. D deficiency.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Morello
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Naples, Italy
| | - Stefano Conte
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Grazia Pellegrino
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Naples, Italy
| | - Laura Marra
- SC Cell Biology and Biotherapy, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Paolo Golino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Naples, Italy.
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17
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Fan Z, Zhang Y, Xiao D, Ma J, Liu H, Shen L, Zhang M, He B. Long noncoding RNA UC.98 stabilizes atherosclerotic plaques by promoting the proliferation and adhesive capacity in murine aortic endothelial cells. Acta Biochim Biophys Sin (Shanghai) 2020; 52:141-149. [PMID: 31942916 DOI: 10.1093/abbs/gmz155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/01/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022] Open
Abstract
Pathological studies have shown that the vulnerability of plaques affects outcomes in patients with atherosclerosis (AS), a chronic inflammatory disease and common cause of morbidity and mortality worldwide. Although emerging technologies have enabled early diagnosis of AS with high-risk vulnerable plaques, more accurate and noninvasive diagnostic methods are urgently required. To this end, molecules involved in genetic or epigenetic regulation of the vulnerability of atherosclerotic plaques have been extensively studied. Here, we evaluated long noncoding RNA (lncRNA) variability by microarray assay in murine aortic endothelial cells (MAECs) bearing vulnerable plaques and identified the novel functional lncRNA UC.98, whose expression pattern was associated with the vulnerability of atherosclerotic plaques. Consistent with this, clinical statistics comparing the peripheral blood specimens from sets of patients with AS with or without vulnerable plaques confirmed the linear relationship between the expression pattern of UC.98 and plaque instability. Moreover, MTT assays and western blot analysis showed that silencing of intrinsic UC.98 in MAECs not only suppressed cell proliferation but also decreased the expressions of vascular cell adhesion molecule-1 and intercellular adhesion molecule-1, thereby inactivating the nuclear factor-κB pathway. In conclusion, our results highlighted the pivotal role of UC.98 in regulating the vulnerability of plaques during AS progression and suggested that UC.98 may be a biomarker of the early diagnosis and prognosis of AS with vulnerable plaques and a potential therapeutic target for slowing AS progression.
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Affiliation(s)
- Zixu Fan
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Ying Zhang
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Danrui Xiao
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Jianwei Ma
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Hua Liu
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Linghong Shen
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Min Zhang
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Ben He
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
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18
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YANG B, ZHENG C, YU H, ZHANG R, LI S, LEN M, CAI S. Comparison of Efficacy between Clopidogrel and Ticagrelor in Patients with Acute Coronary Syndrome after Interventional Treatment and Their Effects on IL-6. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:240-248. [PMID: 32461931 PMCID: PMC7231712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We aimed to compare the efficacy between clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and their effects on IL-6. METHODS A retrospective analysis and collection of 200 ACS patients diagnosed by the Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China in 2016 were performed. Patients were randomly divided into clopidogrel group and ticagrelor group. Data of left ventricular ejection fraction and ACS clinical classification before PCI, PCI treatment, IL-6, platelet aggregation status, maximum platelet aggregation rate (MPAR), P2Y12 response unit (PRU) and adverse reaction of patients were collected. After PCI, patients were followed up for 1 year to compare the ischemia after treatment between clopidogrel group and tigravilol group. RESULTS MPAR and PRU after PCI of clopidogrel group were significantly higher than those of ticagrelor group (P<0.05). The expression of IL-6 in two groups peaked at 1 day after PCI and then decreased. That of ticagrelor group was consistently lower than that of clopidogrel group (P<0.05). The incidence of ischemic events after treatment in clopidogrel group was significantly higher than that in ticagrelor group (P<0.001). CONCLUSION Compared with clopidogrel, tigerrilol had more significant inhibition of platelet aggregation after PCI in ACS patients, and tigerrilol had better effect after interventional treatment in ACS patients. In addition, compared with clopidogrel, tegrel can significantly inhibit the expression of IL-6 in patients with ACS and better alleviate the inflammatory response after PCI.
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Affiliation(s)
- Bin YANG
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunyan ZHENG
- Medical Consultation Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haichu YU
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rui ZHANG
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shan LI
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Min LEN
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shanglang CAI
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China,Corresponding Author:
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19
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Luke K, Purwanto B, Herawati L, Al-Farabi MJ, Oktaviono YH. Predictive Value of Hematologic Indices in the Diagnosis of Acute Coronary Syndrome. Open Access Maced J Med Sci 2019; 7:2428-2433. [PMID: 31666841 PMCID: PMC6814467 DOI: 10.3889/oamjms.2019.666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Distinguishing between Acute Coronary Syndrom (ACS) and SCAD (Stable Coronary Artery Disease) requires advanced laboratory instrument and electrocardiogram. However, their availabilities in primary care settings in developing countries are limited. Hematologic changes usually occur in the ACS patient and might be valuable to distinguish ACS from SCAD. AIM: This study compares the hematologic indices between ACS and SCAD patients and analyses its predictive value for ACS. MATERIAL AND METHODS: A total of 191 patients (79 ACS and 112 SCAD) were enrolled in this study based on the inclusion criteria. Patient’s characteristic, hematologic indices on admission, and the final diagnosis were obtained from medical records. Statistical analyses were done using SPSS 23.0. RESULTS: In this research MCHC value (33.40 vs. 32.80 g/dL; p < 0.05); WBC (11.16 vs. 7.40 x109/L; p < 0.001); NLR (6.29 vs. 2.18; p < 0.001); and PLR (173.88 vs 122.46; p < 0.001) were significantly higher in ACS compared to SCAD patients. While MPV (6.40 vs. 10.00 fL; p < 0.001) was significantly lower in ACS patients. ROC curve analysis showed MPV had the highest AUC (95%) for ACS diagnosis with an optimum cut-off point at ≤ 8.35 fL (sensitivity 93.6% and specificity 97.3%). CONCLUSION: There was a significant difference between hematologic indices between ACS and SCAD patients. MPV is the best indices to distinguish ACS.
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Affiliation(s)
- Kevin Luke
- Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Bambang Purwanto
- Department of Physiology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Lilik Herawati
- Department of Physiology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Makhyan Jibril Al-Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.,School of Management, Healthcare Entrepreneurship Division, University College London, Gower St, Bloomsbury, WC1E 6BT, London, UK
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
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20
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Biological profile of monocyte-derived macrophages in coronary heart disease patients: implications for plaque morphology. Sci Rep 2019; 9:8680. [PMID: 31213640 PMCID: PMC6581961 DOI: 10.1038/s41598-019-44847-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/24/2019] [Indexed: 02/06/2023] Open
Abstract
The prevalence of a macrophage phenotype in atherosclerotic plaque may drive its progression and/or instability. Macrophages from coronary plaques are not available, and monocyte-derived macrophages (MDMs) are usually considered as a surrogate. We compared the MDM profile obtained from coronary artery disease (CAD) patients and healthy subjects, and we evaluated the association between CAD MDM profile and in vivo coronary plaque characteristics assessed by optical coherence tomography (OCT). At morphological analysis, MDMs of CAD patients had a higher prevalence of round than spindle cells, whereas in healthy subjects the prevalence of the two morphotypes was similar. Compared to healthy subjects, MDMs of CAD patients had reduced efferocytosis, lower transglutaminase-2, CD206 and CD163 receptor levels, and higher tissue factor (TF) levels. At OCT, patients with a higher prevalence of round MDMs showed more frequently a lipid-rich plaque, a thin-cap fibroatheroma, a greater intra-plaque macrophage accumulation, and a ruptured plaque. The MDM efferocytosis correlated with minimal lumen area, and TF levels in MDMs correlated with the presence of ruptured plaque. MDMs obtained from CAD patients are characterized by a morpho-phenotypic heterogeneity with a prevalence of round cells, showing pro-inflammatory and pro-thrombotic properties. The MDM profile allows identifying CAD patients at high risk.
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21
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Cimmino G, Cirillo P. Tissue factor: newer concepts in thrombosis and its role beyond thrombosis and hemostasis. Cardiovasc Diagn Ther 2018; 8:581-593. [PMID: 30498683 DOI: 10.21037/cdt.2018.10.14] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For many years, the attention on tissue factor (TF) in human pathophysiology has been limited to its role as initiator of extrinsic coagulation pathway. Moreover, it was described as a glycoprotein located in several tissue including vascular wall and atherosclerotic plaque. However, in the last two decades, the discovery that TF circulates in the blood as cell-associated protein, microparticles (MPs) bound and as soluble form, is changing this old vessel-wall TF dogma. Moreover, it has been reported that TF is expressed by different cell types, even T lymphocytes and platelets, and different pathological conditions, such as acute and chronic inflammatory status, and cancer, may enhance its expression and activity. Thus, recent advances in the biology of TF have clearly indicated that beyond its known effects on blood coagulation, it is a "true surface receptor" involved in many intracellular signaling, cell-survival, gene and protein expression, proliferation, angiogenesis and tumor metastasis. Finally, therapeutic modulation of TF expression and/or activity has been tested with controversial results. This report, starting from the old point of view about TF as initiator of extrinsic coagulation pathway, briefly illustrates the more recent concepts about TF and thrombosis and finally gives an overview about its role beyond thrombosis and haemostasis focusing on the different intracellular mechanisms triggered by its activation and potentially involved in atherosclerosis.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Science, Division of Cardiology, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Plinio Cirillo
- Department of Advance Biomedical Science, Division of Cardiology, University of Naples "Federico II", Naples, Italy
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22
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Ciccarelli G, D'Elia S, De Paulis M, Golino P, Cimmino G. Lipid Target in Very High-Risk Cardiovascular Patients: Lesson from PCSK9 Monoclonal Antibodies. Diseases 2018; 6:diseases6010022. [PMID: 29562587 PMCID: PMC5871968 DOI: 10.3390/diseases6010022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
The role of low-density lipoproteins (LDLs) as a major risk factor for cardiovascular disease has been demonstrated by several epidemiological studies. The molecular basis for LDLs in atherosclerotic plaque formation and progression is not completely unraveled yet. Pharmacological modulation of plasma LDL-C concentrations and randomized clinical trials addressing the impact of lipid-lowering interventions on cardiovascular outcome have clearly shown that reducing plasma LDL-C concentrations results in a significant decrease in major cardiovascular events. For many years, statins have represented the most powerful pharmacological agents available to lower plasma LDL-C concentrations. In clinical trials, it has been shown that the greater the reduction in plasma LDL-C concentrations, the lower the rate of major cardiovascular events, especially in high-risk patients, because of multiple risk factors and recurrent events. However, in a substantial number of patients, the recommended LDL target is difficult to achieve because of different factors: genetic background (familial hypercholesterolemia), side effects (statin intolerance), or high baseline plasma LDL-C concentrations. In the last decade, our understanding of the molecular mechanisms involved in LDL metabolism has progressed significantly and the key role of proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged. This protein is an enzyme able to bind the LDL receptors (LDL-R) on hepatocytes, favoring their degradation. Blocking PCSK9 represents an intriguing new therapeutic approach to decrease plasma LDL-C concentrations, which in recent studies has been demonstrated to also result in a significant reduction in major cardiovascular events.
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Affiliation(s)
- Giovanni Ciccarelli
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Saverio D'Elia
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Michele De Paulis
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Paolo Golino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
| | - Giovanni Cimmino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
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23
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Wang Z, Liu N, Ren L, Lei L, Ye H, Peng J. Association of Monocyte Count on Admission with the Angiographic Thrombus Burden in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Arq Bras Cardiol 2018. [PMID: 29538502 PMCID: PMC5941955 DOI: 10.5935/abc.20180034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The intracoronary high-thrombus burden during the primary percutaneous
coronary intervention in patients with ST-elevation myocardial infarction
(STEMI) can lead to poor outcomes. Monocytes have been described to play an
important role in thrombotic disorders. Objectives This study aimed to investigate the relationship between admission monocyte
count and angiographic intracoronary thrombus burden in patients receiving
primary percutaneous coronary intervention (PPCI). Methods A total of 273 patients with acute STEMI who underwent PPCI were enrolled.
The patients were divided into two groups according to the thrombolysis in
myocardial infarction (TIMI) thrombus grade: low-thrombus burden group with
a grade of 0-2 and high-thrombus burden group with a grade of 3-4. The
monocyte count and other laboratory parameters were measured on admission
before PPCI. P-value < 0.05 was considered significant. Results There were 95 patients (34.8%) in the high-thrombus burden group, and 178
patients (65.2%) in the low-thrombus burden group. Patients with
high-thrombus burden had significantly higher admission monocyte count (0.61
± 0.29×109/L vs. 0.53 ±
0.24×109/L, p = 0.021). In multivariate analysis,
monocyte count was the independent predictor of angiographic high-thrombus
burden (odds ratio 3.107, 95% confidence interval [CI]
1.199-7.052, p = 0.020). For the prediction of angiographic high-thrombus
burden, admission monocyte count at a cut-off value of
0.48×109/L yielded 0.59 ROC-AUC (71.9% sensitivity,
46.9% specificity). Conclusions Monocyte count on admission was an independent clinical predictor of
high-thrombus burden in patients with STEMI undergoing PPCI. Our findings
suggest that admission monocyte count may be available for early risk
stratification of high-thrombus burden in acute STEMI patients and might
allow the optimization of antithrombotic therapy to improve the outcomes of
PPCI.
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Affiliation(s)
- Zuoyan Wang
- Beijing Shijitan Hospital - Capital Medical University
| | - Na Liu
- Beijing Shijitan Hospital - Capital Medical University
| | - Lihui Ren
- Beijing Shijitan Hospital - Capital Medical University
| | - Licheng Lei
- Beijing Shijitan Hospital - Capital Medical University
| | - Huiming Ye
- Beijing Shijitan Hospital - Capital Medical University
| | - Jianjun Peng
- Beijing Shijitan Hospital - Capital Medical University
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24
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Hamilton JA, Hasturk H, Kantarci A, Serhan CN, Van Dyke T. Atherosclerosis, Periodontal Disease, and Treatment with Resolvins. Curr Atheroscler Rep 2017; 19:57. [PMID: 29110146 DOI: 10.1007/s11883-017-0696-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW This review aims to discuss the existing evidence on the link between atherosclerosis and periodontitis by particularly presenting new findings that link the pathology and therapy of these diseases. Acute vascular ischemic events that can lead to stroke or myocardial infarction are initiated by inflammatory processes leading to rupture or erosion of plaques susceptible to thrombosis ("high risk" or "vulnerable"). These are highly inflamed plaques residing in the media and adventitia that may not be detected by angiography measurments of luminal narrowing. Statistically significant excess risk for atherosclerotic cardiovascular disease has been reported in persons with periodontitis independent of established risk factors. We hypothesized that the systemic pathologic links also represent potential therapeutic links. RECENT FINDINGS We recently demonstrated that periodontal inflammation promotes atherosclerotic plaque inflammation and destabilization. As discrete pathological regions, these plaques with a high susceptibility to rupture can be imaged and differentiated from lower risk plaques. In cholesterol-fed rabbits with periodontal disease, circulating inflammatory mediators were also significantly elevated thereby contributing to "vulnerable blood," a systemic characteristic of high risk for cardiovascular events. New studies show that certain lipid mediators, including lipoxins and resolvins, are potent in preventing and possibly treating a number of inflammation-associated diseases, including periodontitis and vascular inflammation. The concept of the vulnerable patient and the pro-resolving approach open new terrain for discovery of paradigm-changing therapies for the prevention and treatment of two of the most common diseases of man. Importantly, lipoxins and resolvins are natural receptor agonists that do not exhibit the same pro-atherogenic side effects attributed to anti-inflammatory medications (e.g., NSAIDs) but rather coordinate resolution of inflammation and a return to homeostasis.
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Affiliation(s)
- James A Hamilton
- Department of Physiology and Biophysics, Boston University School of Medicine, 700 Albany Street, W302, Boston, MA, 02118-2526, USA.
| | - Hatice Hasturk
- Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA, 02142, USA
| | - Alpdogan Kantarci
- Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA, 02142, USA
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Thomas Van Dyke
- Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA, 02142, USA
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Cimmino G, Ciuffreda LP, Ciccarelli G, Calabrò P, Ferraiolo FAV, Rivellino A, De Palma R, Golino P, Rossi F, Cirillo P, Berrino L. Upregulation of TH/IL-17 Pathway-Related Genes in Human Coronary Endothelial Cells Stimulated with Serum of Patients with Acute Coronary Syndromes. Front Cardiovasc Med 2017; 4:1. [PMID: 28224128 PMCID: PMC5293806 DOI: 10.3389/fcvm.2017.00001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022] Open
Abstract
Background Inflammation plays an essential role in the development and complications of atherosclerosis plaques, including acute coronary syndromes (ACS). Indeed, previous reports have shown that within the coronary circulation of ACS patients, several soluble mediators are released. Moreover, it has been demonstrated that endothelial dysfunction might play an important role in atherosclerosis as well as ACS pathophysiology. However, the mechanisms by which these soluble mediators might affect endothelial functions are still largely unknown. We have evaluated whether soluble mediators contained in serum from coronary circulation of ACS patients might promote changes of gene profile in human coronary endothelial cells (HCAECs). Methods HCAECs were stimulated in vitro for 12 h with serum obtained from the coronary sinus (CS) and the aorta (Ao) of ACS patients; stable angina (SA) patients served as controls. Gene expression profiles of stimulated cells were evaluated by microarray and real-time PCR. Results HCAECs stimulated with serum from CS of ACS patients showed a significant change (upregulation and downregulation) in gene expression profile as compared with cells stimulated with serum from CS of SA patients. Moreover, ad hoc sub analysis indicated the upregulation of Th-17/IL-17 pathway-related genes. Conclusion This study demonstrates that, in ACS patients, the chemical mediators released in the coronary circulation might be able to perturb coronary endothelial cells (ECs) modifying their gene profile. These modified ECs, through downregulation of protective gene and, mainly, through upregulation of gene able to modulate the Th-17/IL-17 pathway, might play a key role in progression of coronary atherosclerosis and in developing future acute events.
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Affiliation(s)
- Giovanni Cimmino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Loreta Pia Ciuffreda
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Giovanni Ciccarelli
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | | | - Alessia Rivellino
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Raffaele De Palma
- Department of Clinical and Experimental Medicine, Section of Immunology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Paolo Golino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples, "Federico II" , Naples , Italy
| | - Liberato Berrino
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli" , Naples , Italy
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