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Cavalcante JS, Riciopo PM, Pereira AFM, Jeronimo BC, Angstmam DG, Pôssas FC, de Andrade Filho A, Cerni FA, Pucca MB, Ferreira Junior RS. Clinical complications in envenoming by Apis honeybee stings: insights into mechanisms, diagnosis, and pharmacological interventions. Front Immunol 2024; 15:1437413. [PMID: 39359723 PMCID: PMC11445026 DOI: 10.3389/fimmu.2024.1437413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/20/2024] [Indexed: 10/04/2024] Open
Abstract
Envenoming resulting from Apis honeybee stings pose a neglected public health concern, with clinical complications ranging from mild local reactions to severe systemic manifestations. This review explores the mechanisms underlying envenoming by honeybee sting, discusses diagnostic approaches, and reviews current pharmacological interventions. This section explores the diverse clinical presentations of honeybee envenoming, including allergic and non-allergic reactions, emphasizing the need for accurate diagnosis to guide appropriate medical management. Mechanistic insights into the honeybee venom's impact on physiological systems, including the immune and cardiovascular systems, are provided to enhance understanding of the complexities of honeybee sting envenoming. Additionally, the article evaluates emerging diagnostic technologies and therapeutic strategies, providing a critical analysis of their potential contributions to improved patient outcomes. This article aims to provide current knowledge for healthcare professionals to effectively manage honeybee sting envenoming, thereby improving patient care and treatment outcomes.
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Affiliation(s)
- Joeliton S Cavalcante
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Pedro Marques Riciopo
- Department of Bioprocess and Biotechnology, School of Agriculture, Agronomic Sciences School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Ana Flávia Marques Pereira
- Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Bruna Cristina Jeronimo
- Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Davi Gomes Angstmam
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Felipe Carvalhaes Pôssas
- Minas Gerais Toxicological Information and Assistance Center, João XXIII Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Adebal de Andrade Filho
- Minas Gerais Toxicological Information and Assistance Center, João XXIII Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Felipe A Cerni
- Graduate Program in Tropical Medicine of the State University of Amazonas, Manaus, Amazonas, Brazil
| | - Manuela B Pucca
- Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Rui Seabra Ferreira Junior
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Center for Translational Science and Development of Biopharmaceuticals FAPESP/CEVAP-UNESP, Botucatu, São Paulo, Brazil
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Thakur S, Sharma V, Kaur D, Purkait P. Angiotensin-Converting Enzyme (ACE) Insertion/Deletion (I/D) Polymorphism as a Conjoint Regulator of Coagulation, Fibrinolytic, and RAAS Pathway in Infertility and Associated Pregnancy Complications. J Renin Angiotensin Aldosterone Syst 2022; 2022:1695769. [PMID: 36532100 PMCID: PMC9726265 DOI: 10.1155/2022/1695769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 10/29/2023] Open
Abstract
Despite the increase in assisted reproductive technologies, the high rates of infertility and pregnancy complications are a major concern to infertility specialists worldwide. Infertility may be attributed to pregnancy complications like thrombophilia, preeclampsia and fibrin-induced recurrent pregnancy loss (RPL). Renin-angiotensin-aldosterone system (RAAS) directly or indirectly causes preeclampsia and thrombophilia through the fibrinolytic pathway that ultimately leads to RPL or infertility. The underlying mechanisms of this interaction are still unclear. The present comprehensive review is intended to demonstrate the role and interaction of RAAS and fibrinolytic pathways in pregnancy complications. How this interaction can induce pregnancy complications, and ultimately infertility, is also discussed in the light of current evidence. This study also presents common markers that link RAAS and fibrinolytic processes in developing thrombophilia, preeclampsia and RPL. The common link in these pathways is ACE gene I/D polymorphism. Apart from ACE, PAI-1, VIIa, XIIa, AT1R, AT1AA, and TF are common molecules that can delineate the underlying causes of pregnancy complications and infertility.
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Affiliation(s)
- Sunil Thakur
- Origin LIFE Healthcare Solutions & Research Centre LLP, Chandigarh PIN-160036, India
| | - Vaishnavi Sharma
- Postgraduate Government College for Girls, Sector-42, Chandigarh, India
| | - Dipneet Kaur
- Origin LIFE Healthcare Solutions & Research Centre LLP, Chandigarh PIN-160036, India
| | - Pulakes Purkait
- Origin LIFE Healthcare Solutions & Research Centre LLP, Chandigarh PIN-160036, India
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Yee J, Song TJ, Yoon HY, Park J, Gwak HS. Genetic Factors of Renin–Angiotensin System Associated with Major Bleeding for Patients Treated with Direct Oral Anticoagulants. Pharmaceutics 2022; 14:pharmaceutics14020231. [PMID: 35213964 PMCID: PMC8877686 DOI: 10.3390/pharmaceutics14020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to identify the renin–angiotensin system (RAS)-related genetic factors associated with bleeding and develop the bleeding risk scoring system in patients receiving direct oral anticoagulants (DOACs). This study was a retrospective analysis of prospectively collected samples from June 2018 to May 2020. To investigate the associations between RAS-related genetic factors and major bleeding, we selected 16 single nucleotide polymorphisms (SNPs) from five genes (namely, AGT, REN, ACE, AGTR1, and AGTR2). Multivariable logistic regression analysis was employed to investigate the independent risk factors for bleeding and to develop a risk scoring system. A total of 172 patients were included in the analysis, including 33 major bleeding cases. Both old age (≥65 years) and moderate to severe renal impairment (CrCl < 50 mL/min) increased the risk of bleeding in the multivariable analysis. Among RAS-related polymorphisms, patients carrying TT genotype of rs5050 and A allele of rs4353 experienced a 3.6-fold (95% CI: 1.4–9.3) and 3.1-fold (95% CI: 1.1–9.3) increase in bleeding, respectively. The bleeding risk increased exponentially with a higher score; the risks were 0%, 2.8%, 16.9%, 32.7%, and 75% in patients with 0, 1, 2, 3, and 4 points, respectively. Although this study is limited to a retrospective study design, this is the first study to suggest RAS-related genetic markers and risk scoring systems, including both clinical and genetic factors, for major bleeding in patients receiving DOAC treatment.
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Affiliation(s)
- Jeong Yee
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea; (J.Y.); (H.-Y.Y.)
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Korea;
| | - Ha-Young Yoon
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea; (J.Y.); (H.-Y.Y.)
| | - Junbeom Park
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul 07985, Korea
- Correspondence: (J.P.); (H.-S.G.); Tel.: +82-2-2650-5826 (J.P.); +82-2-3277-4376 (H.-S.G.)
| | - Hye-Sun Gwak
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea; (J.Y.); (H.-Y.Y.)
- Correspondence: (J.P.); (H.-S.G.); Tel.: +82-2-2650-5826 (J.P.); +82-2-3277-4376 (H.-S.G.)
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Wang Z, Gao X, Miao H, Ma X, Ding R. Understanding COVID-19-associated coagulopathy: From PIC to SIC or DIC. JOURNAL OF INTENSIVE MEDICINE 2021; 1:35-41. [PMID: 36943814 PMCID: PMC7997848 DOI: 10.1016/j.jointm.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022]
Abstract
Coagulopathy, characterized by a high D-dimer level, is a common pathological occurrence in coronavirus disease 2019 (COVID-19) and is associated with poor prognosis. Severe cases with COVID-19 is associated with a significantly higher risk of deep vein thrombosis and acute pulmonary embolism. Pulmonary intravascular coagulopathy is the characteristic coagulopathy in COVID-19. Unlike sepsis-induced coagulopathy and disseminated intravascular coagulation, which are manifestations of systemic coagulopathy, pulmonary intravascular coagulopathy is a manifestation of a local coagulation disorder in the lung. The progression from pulmonary intravascular coagulopathy to sepsis-induced coagulopathy or disseminated intravascular coagulation in the context of COVID-19 may indicate that the patient's coagulation dysfunction has progressed from local to systemic. Exploring the associated coagulation disease will aid in the understanding of the pathophysiological mechanisms underlying severe COVID-19.
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Affiliation(s)
| | | | | | | | - Renyu Ding
- Corresponding author: Renyu Ding, Department of Critical Care Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, Liaoning 110001, China.
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Ozbaki-Yagan N, Liu X, Bodnar A, Ho J, Butterworth M. Aldosterone-induced microRNAs act as feedback regulators of mineralocorticoid receptor signaling in kidney epithelia. FASEB J 2020; 34:11714-11728. [PMID: 32652691 PMCID: PMC7725848 DOI: 10.1096/fj.201902254rr] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
The final steps in the Renin-Angiotensin-Aldosterone signaling System (RAAS) involve binding of the corticosteroid hormone, aldosterone to its mineralocorticoid receptor (MR). The bound MR interacts with response elements to induce or repress the transcription of aldosterone-regulated genes. A well characterized aldosterone-induced gene is the serum and glucocorticoid-induced kinase (SGK1), which acts downstream to increase sodium transport in distal kidney nephron epithelial cells. The role of microRNAs (miRs) induced by extended aldosterone stimulation in regulating MR and SGK1 has not been reported. In these studies, miRs predicted to bind to the 3'-UTR of mouse MR were profiled by qRT-PCR after aldosterone stimulation. The miR-466a/b/c/e family was upregulated in mouse kidney cortical collecting duct epithelial cells. A luciferase reporter assay confirmed miR-466 binding to both MR and SGK1 3'-UTRs. Inhibition of miR-466 increased MR and SGK1 mRNA and protein levels. Inhibiting miR-466b and preventing its upregulation after aldosterone stimulation increased amiloride-sensitive sodium transport and sensitivity to aldosterone stimulation. In vivo upregulation of miR-466 was confirmed in distal nephrons of mice on low Na+ diets. Repression of MR and SGK1 by aldosterone-induced miRs may represent a negative feedback loop that contributes to a form of aldosterone escape in vivo.
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Affiliation(s)
- N. Ozbaki-Yagan
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - X. Liu
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - A.J. Bodnar
- Division of Nephrology in the Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - J. Ho
- Division of Nephrology in the Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - M.B. Butterworth
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA
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Ichikawa H, Shimada M, Narita M, Narita I, Kimura Y, Tanaka M, Osanai T, Okumura K, Tomita H. Rivaroxaban, a Direct Factor Xa Inhibitor, Ameliorates Hypertensive Renal Damage Through Inhibition of the Inflammatory Response Mediated by Protease-Activated Receptor Pathway. J Am Heart Assoc 2020; 8:e012195. [PMID: 30957622 PMCID: PMC6507187 DOI: 10.1161/jaha.119.012195] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background An enhanced renin‐angiotensin system causes hypertensive renal damage. Factor Xa not only functions in the coagulation cascade but also activates intracellular signaling through protease‐activated receptors (PAR). We investigated the effects of rivaroxaban, a factor Xa inhibitor, on hypertensive renal damage in hypertensive mice overexpressing renin (Ren‐TG). Methods and Results The 12‐ to 16‐week‐old Ren‐TG and wild‐type mice were orally administered with or without 6 or 12 mg/kg of rivaroxaban for 1 or 4 months. Plasma factor Xa was significantly increased in the Ren‐TG compared with the wild‐type mice and was reduced by 12 mg/kg of rivaroxaban (P<0.05). Urinary albumin excretion (UAE) was higher in the nontreated 8‐month‐old Ren‐TG than in the wild‐type mice (69.6±29 versus 20.1±8.2 μg/day; P<0.01). Treatment with 12 mg/kg of rivaroxaban for 4 months decreased the UAE to 38.1±13.2 μg/day (P<0.01). Moreover, rivaroxaban treatment attenuated histologic changes of glomerular hypertrophy, mesangial matrix expansion, effacement of the podocyte foot process, and thickened glomerular basement membrane in the Ren‐TG. The renal expression of PAR‐2 was increased in the Ren‐TG, but was inhibited with rivaroxaban treatment. In vitro study using the human podocytes showed that the expressions of PAR‐2 and inflammatory genes and nuclear factor–‐κB activation were induced by angiotensin II stimulation, but were inhibited by rivaroxaban. PAR‐2 knockdown by small interfering RNA also attenuated the PAR‐2‐related inflammatory gene expressions. Conclusions These findings indicate that rivaroxaban exerts protective effects against angiotensin II–induced renal damage, partly through inhibition of the PAR‐2 signaling‐mediated inflammatory response.
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Affiliation(s)
- Hiroaki Ichikawa
- 1 Department of Cardiology and Nephrology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Michiko Shimada
- 1 Department of Cardiology and Nephrology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Masato Narita
- 1 Department of Cardiology and Nephrology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Ikuyo Narita
- 1 Department of Cardiology and Nephrology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Yoshihiro Kimura
- 1 Department of Cardiology and Nephrology Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Makoto Tanaka
- 2 Department of Stroke and Cerebrovascular Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Tomohiro Osanai
- 3 Department of Nursing Science Hirosaki University Graduate School of Health Sciences Hirosaki Japan
| | - Ken Okumura
- 4 Division of Cardiology Saiseikai Kumamoto Hospital Kumamoto Japan
| | - Hirofumi Tomita
- 1 Department of Cardiology and Nephrology Hirosaki University Graduate School of Medicine Hirosaki Japan.,2 Department of Stroke and Cerebrovascular Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan
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Phytochemical profile and angiotensin I converting enzyme (ACE) inhibitory activity of Limonium michelsonii Lincz. J Nat Med 2017; 71:650-658. [PMID: 28550653 DOI: 10.1007/s11418-017-1095-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
Members of the genus Limonium are widely used as medicinal herbs due to their health-promoting effects, such as an ability to improve blood circulation by inhibiting angiotensin I converting enzyme (ACE). While the potential of L. michelsonii Lincz. (a medicinal plant endemic to Kazakhstan) to inhibit ACE has been demonstrated, the inhibitory activities of its secondary metabolites have not been explored. In this work, the principal phenolic compounds (1-20) among these metabolites were isolated to determine the components responsible for ACE inhibition. The natural abundances of the active constituents within the target plant were characterized by UPLC-Q-TOF/MS analysis. All of the isolated compounds except for gallates 10-12 were found to significantly inhibit ACE, with IC50 values of between 7.1 and 138.4 μM. Unexpectedly, the flavonol glycosides 16-20 were observed to be more potent than the corresponding aglycones 4 and 5. For example, quercetin (4) had IC50 = 30.3 μM, whereas its glycosides (16, 17) had IC50 = 10.2 and 14.5 μM, respectively. A similar trend was observed for myricetin (5) and its glycosides (18-20). In a kinetic study, the flavonols 3-5 and 16-20 and the dihydroflavonols 8 and 9 behaved as competitive inhibitors, whereas other flavones (1, 2, 13-15) and flavanones (6, 7) performed noncompetitive inhibition.
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Jensen GS, Lenninger M, Ero MP, Benson KF. Consumption of nattokinase is associated with reduced blood pressure and von Willebrand factor, a cardiovascular risk marker: results from a randomized, double-blind, placebo-controlled, multicenter North American clinical trial. Integr Blood Press Control 2016; 9:95-104. [PMID: 27785095 PMCID: PMC5066864 DOI: 10.2147/ibpc.s99553] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The objective of this study is to evaluate the effects of consumption of nattokinase on hypertension in a North American hypertensive population with associated genetic, dietary, and lifestyle factors. This is in extension of, and contrast to, previous studies on Asian populations. MATERIALS AND METHODS A randomized, double-blind, placebo-controlled, parallel-arm clinical study was performed to evaluate nattokinase (NSK-SD), a fermented soy extract nattō from which vitamin K2 has been removed. Based on the results from previous studies on Asian populations, 79 subjects were enrolled upon screening for elevated blood pressure (BP; systolic BP ≥130 or diastolic BP ≥90 mmHg) who consumed placebo or 100 mg nattokinase/d for the 8-week study duration. Blood collections were performed at baseline and 8 weeks for testing plasma renin activity, von Willebrand factor (vWF), and platelet factor-4. Seventy-four people completed the study with good compliance. RESULTS Consumption of nattokinase was associated with a reduction in both systolic and diastolic BP. The reduction in systolic BP was seen for both sexes but was more robust in males consuming nattokinase. The average reduction in diastolic BP in the nattokinase group from 87 mmHg to 84 mmHg was statistically significant when compared to that in the group consuming placebo, where the average diastolic BP remained constant at 87 mmHg (P<0.05), and reached a high level of significance for males consuming nattokinase, where the average diastolic BP dropped from 86 mmHg to 81 mmHg (P<0.006). A decrease in vWF was seen in the female population consuming nattokinase (P<0.1). In the subpopulation with low plasma renin activity levels at baseline (<0.29 ng/mL/h), an increase was seen for 66% of the people after 8-week consumption of nattokinase (P<0.1), in contrast to only 8% in the placebo group. CONCLUSION The data suggest that nattokinase consumption in a North American population is associated with beneficial changes to BP in a hypertensive population, indicating sex-specific mechanisms of action of nattokinase's effect on vWF and hypertension.
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de Carvalho SS, Simões e Silva AC, Sabino ADP, Evangelista FCG, Gomes KB, Dusse LMS, Rios DRA. Influence of ACE I/D Polymorphism on Circulating Levels of Plasminogen Activator Inhibitor 1, D-Dimer, Ultrasensitive C-Reactive Protein and Transforming Growth Factor β1 in Patients Undergoing Hemodialysis. PLoS One 2016; 11:e0150613. [PMID: 27022914 PMCID: PMC4811575 DOI: 10.1371/journal.pone.0150613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/16/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is substantial evidence that chronic renal and cardiovascular diseases are associated with coagulation disorders, endothelial dysfunction, inflammation and fibrosis. Angiotensin-Converting Enzyme Insertion/Deletion polymorphism (ACE I/D polymorphism) has also be linked to cardiovascular diseases. Therefore, this study aimed to compare plasma levels of ultrassensible C-reactive protein (usCRP), PAI-1, D-dimer and TGF-β1 in patients undergoing HD with different ACE I/D polymorphisms. METHODS The study was performed in 138 patients at ESRD under hemodialysis therapy for more than six months. The patients were divided into three groups according to the genotype. Genomic DNA was extracted from blood cells (leukocytes). ACE I/D polymorphism was investigated by single polymerase chain reaction (PCR). Plasma levels of D-dimer, PAI-1 and TGF-β1 were measured by enzyme-linked immunosorbent assay (ELISA), and the determination of plasma levels of usCRP was performed by immunonephelometry. Data were analyzed by the software SigmaStat 2.03. RESULTS Clinical characteristics were similar in patients with these three ACE I/D polymorphisms, except for interdialytic weight gain. I allele could be associated with higher interdialytic weight gain (P = 0.017). Patients genotyped as DD and as ID had significantly higher levels of PAI-1 than those with II genotype. Other laboratory parameters did not significantly differ among the three subgroups (P = 0.033). Despite not reaching statistical significance, plasma levels of usCRP were higher in patients carrying the D allele. CONCLUSION ACE I/D polymorphisms could be associated with changes in the regulation of sodium, fibrinolytic system, and possibly, inflammation. Our data showed that high levels of PAI-1 are detected when D allele is present, whereas greater interdialytic gain is associated with the presence of I allele. However, further studies with different experimental designs are necessary to elucidate the mechanisms involved in these associations.
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Affiliation(s)
- Sara Santos de Carvalho
- Campus Centro Oeste Dona Lindu, Universidade Federal de São João del-Rei, Divinópolis/MG – Brazil
| | - Ana Cristina Simões e Silva
- Department of Pediatrics, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine – Universidade Federal de Minas Gerais, Belo Horizonte/MG – Brazil
| | - Adriano de Paula Sabino
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Universidade Federal de Minas Gerais, Belo Horizonte/MG – Brazil
| | | | - Karina Braga Gomes
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Universidade Federal de Minas Gerais, Belo Horizonte/MG – Brazil
| | - Luci Maria SantAna Dusse
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Universidade Federal de Minas Gerais, Belo Horizonte/MG – Brazil
| | - Danyelle Romana Alves Rios
- Campus Centro Oeste Dona Lindu, Universidade Federal de São João del-Rei, Divinópolis/MG – Brazil
- * E-mail:
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Ozolina A, Strike E, Nikitina-Zake L, Jaunalksne I, Krumina A, Lacis R, Bjertnaes LJ, Vanags I. Polymorphisms on PAI-1 and ACE genes in association with fibrinolytic bleeding after on-pump cardiac surgery. BMC Anesthesiol 2015; 15:122. [PMID: 26340801 PMCID: PMC4560913 DOI: 10.1186/s12871-015-0101-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 08/26/2015] [Indexed: 12/11/2022] Open
Abstract
Background Carriers of plasminogen activator inhibitor -1 (PAI-1) -675 genotype 5G/5G may be associated with lower preoperative PAI-1 plasma levels and higher blood loss after heart surgery using cardiopulmonary bypass (CPB). We speculate if polymorphisms of PAI-1 -844 A/G and angiotensin converting enzyme (ACE) intron 16 I/D also might promote fibrinolysis and increase postoperative bleeding. Methods We assessed PAI-1 -844 A/G, and ACE intron 16 I/D polymorphisms by polymerase chain reaction technique and direct sequencing of genomic DNA from 83 open heart surgery patients that we have presented earlier. As primary outcome, accumulated chest tube drainage (CTD) at 4 and 24 h were analyzed for association with genetic polymorphisms. As secondary outcome, differences in plasma levels of PAI-1, t-PA/PAI-1 complex and D-dimer were determined for each polymorphism. SPSS® was used for statistical evaluation. Results The lowest preoperative PAI-1 plasma levels were associated with PAI-1 -844 genotype G/G, and higher CTD, as compared with genotype A/A at 4 and 24 h after surgery. Correspondingly, 4 h after the surgery CTD was higher in carriers of ACE intron 16 genotype I/I, as compared with genotype D/D. PAI-1 plasma levels and t-PA/PAI-1 complex reached nadir in carriers of ACE intron 16 genotype I/I, in whom we also noticed the highest D-dimer levels immediately after surgery. Notably, carriers of PAI-1 -844 genotype G/G displayed higher D-dimer levels at 24 h after surgery as compared with those of genotype A/G. Conclusions Increased postoperative blood loss secondary to enhanced fibrinolysis was associated with carriers of PAI-1 -844 G/G and ACE Intron 16 I/I, suggesting that these genotypes might predict increased postoperative blood loss after cardiac surgery using CPB. Electronic supplementary material The online version of this article (doi:10.1186/s12871-015-0101-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agnese Ozolina
- Department of Cardiac surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, Latvia. .,Riga Stradins University, Dzirciema Street 16, Riga, Latvia.
| | - Eva Strike
- Department of Cardiac surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, Latvia. .,Riga Stradins University, Dzirciema Street 16, Riga, Latvia.
| | - Liene Nikitina-Zake
- Latvian Biomedical Research and Study Center, Ratsupites Street 1, Riga, Latvia.
| | - Inta Jaunalksne
- Clinical Immunology Centre, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, Latvia.
| | - Angelika Krumina
- Department of Infectology and Dermatology, Riga Stradins University, Dzirciema Street 16, Riga, Latvia.
| | - Romans Lacis
- Department of Cardiac surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, Latvia. .,Riga Stradins University, Dzirciema Street 16, Riga, Latvia.
| | - Lars J Bjertnaes
- Anesthesia and Critical Care Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway.
| | - Indulis Vanags
- Riga Stradins University, Dzirciema Street 16, Riga, Latvia.
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Kramkowski K, Leszczynska A, Buczko W. Pharmacological modulation of fibrinolytic response - In vivo and in vitro studies. Pharmacol Rep 2015; 67:695-703. [PMID: 26321270 DOI: 10.1016/j.pharep.2015.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
Fibrinolysis is an action of converting plasminogen by its activators, like tissue- or urokinase-type plasminogen activators (t-PA, u-PA), to plasmin, which in turn cleaves fibrin, thereby causing clot dissolution and restoration of blood flow. Endothelial cells release t-PA, prostacyclin (PGI2) and nitric oxide (NO), the potent factors playing a crucial role in regulation of the fibrinolytic system. Since blood platelets can release not only prothrombotic, but also antifibrinolytic factors, like plasminogen activator inhibitor type-1 (PAI-1), they are involved in fibrynolysis regulation. Therefore agents enhancing fibrinolysis can be preferred pharmacologicals in many cardiovascular diseases. This review describes mechanisms by which major cardiovascular drugs (renin-angiotensin-aldosterone system inhibitors, statins, adrenergic receptors and calcium channel blockers, aspirin and 1-methylnicotinamide) influence fibrinolysis. The presented data indicate, that the influence of these drugs on endothelium-blood platelets interactions via NO/PGI2 pathway is fundamental for its antithrombotic and profibrinolytic action. We also described new approaches for intravital confocal real-time imaging as a tool useful to investigate mechanisms of thrombus formation and the effects of drugs affecting haemostasis and mechanisms of their action in the circulation.
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Affiliation(s)
- Karol Kramkowski
- Department of Biopharmacy, Medical University of Białystok, Białystok, Poland.
| | | | - Wlodzimierz Buczko
- Department of Pharmacodynamics, Medical University of Białystok, Białystok, Poland; Higher Vocational School, Suwałki, Poland
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Marqueti RDC, Hashimoto NY, Durigan JLQ, Batista e Silva LL, Almeida JAD, Silva MDGD, Oliveira EMD, Araújo HSSD. Nandrolone increases angiotensin-I converting enzyme activity in rats tendons. REV BRAS MED ESPORTE 2015. [DOI: 10.1590/1517-869220152103143667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: The renin-angiotensin system (RAS) has been associated with several biological processes of the human body, regulating, among others blood pressure and water and electrolytes balance. Moreover, RAS also regulates connective tissue growth. Recently, studies have shown that the use of nandrolone modifies the angiotensin-I converting enzyme (ACE) activity and increases collagen deposition in the heart. OBJECTIVE: The aim of study was to evaluate the Angiotensin-I converting enzyme (ACE) activity in the superficial flexor tendon (SFT) and in serum after load exercise in combination with anabolic androgenic steroid (AAS) administration after training session and six weeks of detraining. METHODS: Forty-eight Wistar rats were used into two groups (G1 and G2) subdivided into four subgroups: Sedentary (S); trained (T); AAS-treated (Deca-Durabolin(r), 5mg/kg, twice a week) sedentary rats (AAS) and AAS-treated and trained animals (AAST). Trained groups performed jumps in water: four series of 10 jumps each, followed by a 30 sec interval between the series, for seven weeks. RESULTS: Training increased ACE activity in the SFT compared to the control group (p <0.05). Both AAS and AAST groups presented higher ACE activity levels (p < 0.05). The AAST increased the ACE activity only compared to the trained animals. Only the AAST group presented significant higher levels of ACE in the serum. In the G2 group, all experimental groups presented decreased ACE activity in the serum and in the tendon, as compared to the control group. CONCLUSION: This study indicates that AAS administration and its combination with exercise increased ACE activity of tendons. AAS abuse could compromise tendon adaptation causing maladaptive remodeling.
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Jeon YJ, Kim JH, Lee BE, Rah H, Shin JE, Kang H, Choi DH, Yoon TK, Lee WS, Shim SH, Kim NK. Association between Polymorphisms in the Renin-Angiotensin System Genes and Prevalence of Spontaneously Aborted Fetuses. Am J Reprod Immunol 2013; 70:238-45. [DOI: 10.1111/aji.12110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 02/06/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Young Joo Jeon
- Institute for Clinical Research; CHA Bundang Medical Center; CHA University; Seongnam South Korea
- Department of Biomedical Science; College of Life Science; CHA University; Seongnam South Korea
| | - Ji Hyang Kim
- Department of Obstetrics and Gynecology; CHA Bundang Medical Center; CHA University; Seongnam South Korea
| | - Bo Eun Lee
- Institute for Clinical Research; CHA Bundang Medical Center; CHA University; Seongnam South Korea
- Department of Biomedical Science; College of Life Science; CHA University; Seongnam South Korea
| | - HyungChul Rah
- Institute for Clinical Research; CHA Bundang Medical Center; CHA University; Seongnam South Korea
- Department of Biomedical Science; College of Life Science; CHA University; Seongnam South Korea
| | - Ji Eun Shin
- Department of Obstetrics and Gynecology; CHA Bundang Medical Center; CHA University; Seongnam South Korea
| | - Hojeong Kang
- Department of Obstetrics and Gynecology; CHA Bundang Medical Center; CHA University; Seongnam South Korea
| | - Dong Hee Choi
- Department of Obstetrics and Gynecology; CHA Bundang Medical Center; CHA University; Seongnam South Korea
| | - Tae Ki Yoon
- Fertility Center of CHA Gangnam Medical Center; CHA University; Seoul South Korea
| | - Woo Sik Lee
- Fertility Center of CHA Gangnam Medical Center; CHA University; Seoul South Korea
| | - Sung Han Shim
- Fertility Center of CHA Gangnam Medical Center; CHA University; Seoul South Korea
| | - Nam Keun Kim
- Institute for Clinical Research; CHA Bundang Medical Center; CHA University; Seongnam South Korea
- Department of Biomedical Science; College of Life Science; CHA University; Seongnam South Korea
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14
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Dab H, Hachani R, Hodroj W, Sakly M, Bricca G, Kacem K. Differential control of MMP and t-PA/PAI-1 expressions by sympathetic and renin–angiotensin systems in rat left ventricle. Auton Neurosci 2009; 150:27-32. [DOI: 10.1016/j.autneu.2009.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 03/04/2009] [Accepted: 04/01/2009] [Indexed: 12/31/2022]
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15
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Sechi LA, Novello M, Colussi G, Di Fabio A, Chiuch A, Nadalini E, Casanova-Borca A, Uzzau A, Catena C. Relationship of plasma renin with a prothrombotic state in hypertension: relevance for organ damage. Am J Hypertens 2008; 21:1347-53. [PMID: 18948960 DOI: 10.1038/ajh.2008.293] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Components of the renin-angiotensin-aldosterone system (RAAS) and a prothrombotic state are predictors of cardiovascular events in hypertensive patients. A relationship between the RAAS and the coagulation/fibrinolytic systems has been demonstrated, but its clinical relevance in hypertension is unclear. We investigated the relationships of the RAAS and the hemostatic system with hypertensive organ damage. METHODS Plasma components of the RAAS and parameters that directly assess the activation of coagulation and fibrinolysis were measured in 247 essential hypertensive patients in whom the extent of organ damage had been characterized at the cardiac, renal, and vascular level. RESULTS Positive association with increasing plasma renin activity (PRA) was demonstrated for plasma fibrinogen, D-dimer, and plasminogen activator inhibitor-1 (PAI-1) levels. PRA was directly correlated with plasma aldosterone, fibrinogen, d-dimer, and PAI-1. The relationship of PRA with fibrinogen and PAI-1 remained significant after correction for age, gender, duration of hypertension, and smoking status. Plasma aldosterone levels were directly correlated with fibrinogen, D-dimer, and PAI-1, whereas plasma angiotensin-converting enzyme was not related with any of the coagulation parameters. Elevated PRA, aldosterone, fibrinogen, D-dimer, prothrombin fragment 1+2, and PAI-1 levels were associated with clinical and/or instrumental evidence of hypertension-related cardiac and renal damage. Both fibrinogen and PAI-1 were independent predictors of the presence of organ damage and their inclusion in a multivariate model eliminated PRA and aldosterone as independent predictors. CONCLUSIONS A strong and independent association exists between renin, aldosterone, and markers of a prothrombotic state in essential hypertension. This relationship might contribute to the development of hypertensive organ damage.
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Pomaro DR, Ihara SSM, Pinto LESA, Ueda I, Casarini DE, Ebihara F, Santos AO, Izar MCO, Fonseca FAH. High glucose levels abolish antiatherosclerotic benefits of ACE inhibition in alloxan-induced diabetes in rabbits. J Cardiovasc Pharmacol 2005; 45:295-300. [PMID: 15772516 DOI: 10.1097/01.fjc.0000155384.64350.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renin-angiotensin system activation is recognized to play an important role in atherosclerosis. This study aimed to verify the antiatherosclerotic effects of ACE inhibition on an experimental model of diabetes and hypercholesterolemia. Diabetes was induced in New Zealand male rabbits with a single dose of alloxan (100 mg/kg, i.v.), and, according to plasma glucose levels obtained after 1 week, the animals were divided into 2 groups (> or =250 mg/dL or <250 mg/dL). Each group was randomly assigned to receive or not quinapril (30 mg/d) added to a 0.5% cholesterol-enriched diet. Animals with high glucose levels at 1 week and that remained high after 12 weeks presented higher triglyceride levels (P < 0.02 versus basal). Those initially hyperglycemic but presenting <250 mg/dL glucose at the end of study formed an additional group. Plasma ACE activity was lower in quinapril-treated animals (P < 0.01 versus untreated groups). However, aorta intima/media ratio and intima area were lower only in the subgroups of quinapril-treated animals with low glucose levels (P < 0.05). Our results support the hypothesis that high plasma glucose may abolish the antiatherosclerotic effect of ACE inhibitors.
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Affiliation(s)
- Daniel R Pomaro
- Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
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17
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von Känel R, Dimsdale JE. Hemostatic Alterations in Patients With Obstructive Sleep Apnea and the Implications for Cardiovascular Disease *. Chest 2003; 124:1956-67. [PMID: 14605073 DOI: 10.1378/chest.124.5.1956] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Patients with obstructive sleep apnea (OSA) are at increased risk for coronary artery and cerebrovascular diseases. Numerous studies suggest that a hypercoagulable state is prospectively related to atherothrombotic events. This review explores whether changes in hemostasis may constitute one biological link between OSA and vascular disease. DESIGN Ten studies on hemostatic variables in OSA were located by electronic library search and descriptively reviewed. Work on hemostatic function with physiologic conditions similar to those found in OSA (hypoxemia and hyperactivity of the sympathetic nervous system) was considered to discuss potential molecular mechanisms of procoagulant disturbances in OSA. MEASUREMENTS AND RESULTS The reviewed data suggest that, as compared to non-OSA control subjects, patients with OSA have elevated plasma fibrinogen levels, exaggerated platelet activity, and reduced fibrinolytic capacity. Although not consistently shown, severity of OSA (ie, apnea-hypopnea index) and plasma epinephrine were independent predictors of platelet activity, and average minimal oxygen saturation was an independent predictor of fibrinogen. In some studies, treatment with continuous positive airway pressure decreased platelet activity, plasma fibrinogen levels, and activity of clotting factor VII. CONCLUSIONS There is some evidence for a hypercoagulable state in OSA, which might help explain the increased prevalence of vascular diseases in this population. To further confirm such a notion, future studies need to be performed on sufficiently large samples to be able to control for confounders of hemostatic activity. Prospective studies are needed to examine the association between hemostasis molecules and strong vascular end points.
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Affiliation(s)
- Roland von Känel
- Institute for Behavioral Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland.
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Jamerson KA. The first hypertension trial comparing the effects of two fixed-dose combination therapy regimens on cardiovascular events: Avoiding Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH). J Clin Hypertens (Greenwich) 2003; 5:29-35. [PMID: 12941995 PMCID: PMC8099324 DOI: 10.1111/j.1524-6175.2003.02676.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Current recommendations for the treatment of hypertension clarify the need to achieve lower blood pressure levels in the general population (<140/90 mm Hg) and in specific high-risk patient groups such as patients with diabetes or chronic renal disease (<130/80 mm Hg). Further, it is evident that to reach appropriate blood pressure control, most patients with high blood pressure will require two or more antihypertensive agents. There is scarce clinical trial outcome evidence to guide clinicians in the selection of optimal combinations of antihypertensive classes for high-risk hypertensive patients. A new clinical trial, Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH), is the first large clinical trial to directly compare cardiovascular mortality and morbidity rates for two fixed-dose combination therapies. Results from ACCOMPLISH should provide much-needed guidance for selecting optimal combination therapy for high-risk hypertensive patients.
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Affiliation(s)
- Kenneth A Jamerson
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
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Affiliation(s)
- G Y H Lip
- University Department of Medicine, City Hospital, Birmingham B18 7QH, UK
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