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Meidrops K, Groma V, Goldins NR, Apine L, Skuja S, Svirskis S, Gudra D, Fridmanis D, Stradins P. Understanding Bartonella-Associated Infective Endocarditis: Examining Heart Valve and Vegetation Appearance and the Role of Neutrophilic Leukocytes. Cells 2023; 13:43. [PMID: 38201247 PMCID: PMC10778237 DOI: 10.3390/cells13010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The endocardium and cardiac valves undergo severe impact during infective endocarditis (IE), and the formation of vegetation places IE patients at a heightened risk of embolic complications and mortality. The relevant literature indicates that 50% of IE cases exhibit structurally normal cardiac valves, with no preceding history of heart valve disease. Gram-positive cocci emerge as the predominant causative microorganisms in IE, while Gram-negative Bartonella spp., persisting in the endothelium, follow pathogenic pathways distinct from those of typical IE-causing agents. Employing clinical as well as advanced microbiological and molecular assays facilitated the identification of causative pathogens, and various morphological methods were applied to evaluate heart valve damage, shedding light on the role of neutrophilic leukocytes in host defense. In this research, the immunohistochemical analysis of neutrophilic leukocyte activation markers such as myeloperoxidase, neutrophil elastase, calprotectin, and histone H3, was performed. A distinct difference in the expression patterns of these markers was observed when comparing Bartonella spp.-caused and non-Bartonella spp.-caused IE. The markers exhibited significantly higher expression in non-Bartonella spp.-caused IE compared to Bartonella spp.-caused IE, and they were more prevalent in vegetation than in the valvular leaflets. Notably, the expression of these markers in all IE cases significantly differed from that in control samples. Furthermore, we advocated the use of 16S rRNA Next-Generation Sequencing on excised heart valves as an effective diagnostic tool for IE, particularly in cases where blood cultures yielded negative results. The compelling results achieved in this study regarding the enigmatic nature of Bartonella spp. IE's pathophysiology contribute significantly to our understanding of the peculiarities of inflammation and immune responses.
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Affiliation(s)
- Kristians Meidrops
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Valerija Groma
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
- Joint Laboratory of Electron Microscopy, Riga Stradins University, 9 Kronvalda Boulevard, LV-1010 Riga, Latvia
| | - Niks Ricards Goldins
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
| | - Lauma Apine
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
| | - Sandra Skuja
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
- Joint Laboratory of Electron Microscopy, Riga Stradins University, 9 Kronvalda Boulevard, LV-1010 Riga, Latvia
| | - Simons Svirskis
- Institute of Microbiology and Virology, Riga Stradins University, Ratsupites Str. 5, LV-1067 Riga, Latvia;
| | - Dita Gudra
- Latvian Biomedical Research and Study Centre, LV-1067 Riga, Latvia; (D.G.); (D.F.)
| | - Davids Fridmanis
- Latvian Biomedical Research and Study Centre, LV-1067 Riga, Latvia; (D.G.); (D.F.)
| | - Peteris Stradins
- Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia (L.A.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
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Pavasini R, Sinning C, Campo G, Tan TC. ObsErvatioNal prospective multicenter stuDy tO characterize the cLinical ANd DiagnoStiC feAtures of endocarditis in the contemPorary Era (ENDO-LANDSCAPE study): rationale and design. J Cardiovasc Med (Hagerstown) 2023; 24:354-360. [PMID: 37021952 DOI: 10.2459/jcm.0000000000001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Recent developments in the management of valvular heart disease and heart failure have resulted in a dramatic increase in percutaneous valve procedures and implanted devices. We hypothesize that this has impacted the epidemiology, diagnosis, and management of endocarditis. METHODS The obsErvatioNal prospective multicenter stuDy tO characterize the cLinical ANd DiagnoStiC feAtures of endocarditis in the contemPorary Era (ENDO-LANDSCAPE study) is an observational, multicenter, and international study aimed to examine the epidemiology of endocarditis in the contemporary era. The study will constitute of a retrospective arm for the determination of the sample size of the prospective arm, where cases of endocarditis between 2016 to 2022 at three tertiary referral institutions will be analyzed. The prospective arm will examine all consecutive patients referred for an echocardiography with a suspected or confirmed diagnosis of endocarditis, and their clinical course followed up over 12 months for adverse outcomes. The primary aim of the study will be to characterize the epidemiology of endocarditis, focusing on patients with prosthetic or implanted devices. The secondary aims would be: the appropriateness of the requests for first-line echocardiographic imaging in exclusion of endocarditis; the role of other imaging modalities in the diagnosis of endocarditis; and the impact of a specialized endocarditis team on outcomes. IMPLICATIONS The results of the ENDO-LANDSCAPE study will provide a contemporary update of the epidemiological trends in endocarditis. The data generated from this study would be useful in informing future clinical practice, potentially guiding future diagnostic and treatment algorithms in patients with endocarditis. CLINICALTRIALORG ID NCT05547607.
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Affiliation(s)
- Rita Pavasini
- UO Cardiologia, Azienda Ospedaliero Universitaria of Ferrara, Italy
| | - Christoph Sinning
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany
| | - Gianluca Campo
- UO Cardiologia, Azienda Ospedaliero Universitaria of Ferrara, Italy
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Western Sydney University
- Department of Cardiology, Westmead Hospital, Sydney University, Australia
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